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Background: Although artificial intelligence (AI) has potential in the field of screening of breast cancer, there are still issues. It is vital to make sure AI does not overlook cancer or cause needless recalls. The aim of this work was to investigate the effectiveness of indulging AI in combination with one radiologist in the routine double reading of mammography for breast cancer screening. The study prospectively analyzed 32,822 screening mammograms. Reading was performed in a blind-paired style by (i) two radiologists and (ii) one radiologist paired with AI. A heatmap and abnormality scoring percentage were provided by AI for abnormalities detected on mammograms. Negative mammograms and benign-looking lesions that were not biopsied were confirmed by a 2-year follow-up. Results: Double reading by the radiologist and AI detected 1324 cancers (6.4%); on the other side, reading by two radiologists revealed 1293 cancers (6.2%) and presented a relative proportion of 1·02 (p < 0·0001). At the recall stage, suspicion and biopsy recommendation were more presented by the AI plus one radiologist combination than by the two radiologists. The interpretation of the mammogram by AI plus only one radiologist showed a sensitivity of 94.03%, a specificity of 99.75%, a positive predictive value of 96.571%, a negative predictive value of 99.567%, and an accuracy of 99.369% (from 99.252 to 99.472%). The positive likelihood ratio was 387.260, negative likelihood ratio was 0.060, and AUC "area under the curve" was 0.969 (0.967–0.971). Conclusions: AI could be used as an initial reader for the evaluation of screening mammography in routine workflow. Implementation of AI enhanced the opportunity to reduce false negative cases and supported the decision to recall or biopsy. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy is the most common bariatric procedure and its long-term complications include inadequate weight loss, weight regain, and de novo GERD, often requiring revisional surgery. Revisions, notably re-sleeve and conversion to Roux-en-Y gastric bypass (RYGB), are frequently performed, but safety data is limited. Herein, we used the MBSAQIP database to compare 30 day outcomes of primary sleeve gastrectomy (SG) with re-sleeve (RS) and SG to RYGB conversion. Methods: Patients who underwent primary SG, RS, and SG to RYGB conversion within the MBSAQIP data registry from January 1, 2020 to December 31, 2022 were included in this study. Using Propensity Score Matching analysis, the cohorts were matched for 23 preoperative characteristics. We then compared 30 day postoperative outcomes and bariatric-specific complications between primary SG and RS (analysis 1) and between RS and SG to RYGB conversion (analysis 2). Results: A total of 302,961 were included. The matched cohorts in analysis 1 (n = 1630) and analysis 2 (n = 1633) had similar pre-operative characteristics. Propensity-matched outcomes in analysis 1 showed that patients in the RS group had significantly higher staple line leak (1.3% vs. 0.1%, p < 0.001) when compared to primary SG. Similarly, longer operative times (90.16 ± 51.90 min vs. 68.32 ± 37.54 min, p < 0.001) and higher rates of readmissions (5.5% vs. 2.1%, p < 0.001), reoperations (2.3% vs. 0.6%, p < 0.001), interventions (2.5% vs. 0.4%, p < 0.001) were found in those who underwent RS. In analysis 2, RS showed higher leak rates (1.3% vs. 0.5%, p = 0.015) when compared to conversion from SG to RYGB. Conclusion: The RS group has a higher risk of staple line leaks compared to primary SG and conversion from SG to RYGB. In our study, there was a 2.6-fold increase in staple line leak after re-sleeve compared to RYGB conversion and a 13-fold increase compared to primary SG. [ABSTRACT FROM AUTHOR]

Background: Surveys have found concerningly high levels of agreement that the United States will experience civil war soon. This study assesses variation in expectation of and perceived need for civil war with respondent sociopolitical characteristics, beliefs, firearm ownership, and willingness to engage in political violence. Methods: Findings are from Wave 2 of a nationally representative annual longitudinal survey of members of the Ipsos KnowledgePanel, conducted May 18–June 8, 2023. All respondents to 2022's Wave 1 who remained in KnowledgePanel were invited to participate. Outcomes are expressed as weighted proportions and adjusted prevalence differences, with p-values adjusted for the false discovery rate and reported as q-values. Results: The completion rate was 84.2%; there were 9385 respondents. After weighting, half the sample was female (50.7%, 95% CI 49.4%, 52.1%); the weighted mean (± standard deviation) age was 48.5 (25.9) years. Approximately 1 respondent in 20 (5.7%, 95% CI 5.1%, 6.4%) agreed strongly or very strongly that "in the next few years, there will be civil war in the United States." About 1 in 25 (3.8%, 95% CI 3.2%, 4.4%), and nearly 40% (38.4%, 95% CI 32.3%, 44.5%) of those who strongly or very strongly agreed that civil war was coming, also agreed strongly or very strongly that "the United States needs a civil war to set things right." Expectation of and perceived need for civil war were higher among subsets of respondents who in Wave 1 were more willing than others to commit political violence, including MAGA Republicans, persons in strong agreement with racist beliefs or statements of the potential need for violence to effect social change, persons who strongly approved of specified extreme right-wing political organizations and movements, firearm owners who purchased firearms in 2020 or later, and firearm owners who carried firearms in public all or nearly all the time. Conclusions: In 2023, the expectation that civil war was likely and the belief that it was needed were uncommon but were higher among subsets of the population that had previously been associated with greater willingness to commit political violence. These findings can help guide prevention efforts. [ABSTRACT FROM AUTHOR]

Deep learning has enabled breakthroughs in automated diagnosis from medical imaging, with many successful applications in ophthalmology. However, standard medical image classification approaches only assess disease presence at the time of acquisition, neglecting the common clinical setting of longitudinal imaging. For slow, progressive eye diseases like age-related macular degeneration (AMD) and primary open-angle glaucoma (POAG), patients undergo repeated imaging over time to track disease progression and forecasting the future risk of developing a disease is critical to properly plan treatment. Our proposed Longitudinal Transformer for Survival Analysis (LTSA) enables dynamic disease prognosis from longitudinal medical imaging, modeling the time to disease from sequences of fundus photography images captured over long, irregular time periods. Using longitudinal imaging data from the Age-Related Eye Disease Study (AREDS) and Ocular Hypertension Treatment Study (OHTS), LTSA significantly outperformed a single-image baseline in 19/20 head-to-head comparisons on late AMD prognosis and 18/20 comparisons on POAG prognosis. A temporal attention analysis also suggested that, while the most recent image is typically the most influential, prior imaging still provides additional prognostic value. [ABSTRACT FROM AUTHOR]

Background: Systemic sclerosis (SSc) is an autoimmune disease that results in micro-vasculopathy, leading to organ dysfunction. Sirtuins are known for their role in cellular processes such as the cell cycle, aging, and inflammation, Sirtuins also play an important role in regulating fibrotic responses, inhibiting collagen production and myofibroblast differentiation, implying that its dysregulation is involved in the pathogenesis of systemic sclerosis. The aim of this study was to determine the circulating Sirtuin3 and Sirtuin7 levels in patients suffering from systemic sclerosis with a focus on how they might be associated with the different clinical features and subsets of the disease. Methods: This prospective cross-sectional case–control study included 56 participants 41 SSc patients and 15 healthy controls. Demographics, clinical, and laboratory data were analyzed. Quantitative determination of human Sirtuin3 and Sirtuin7 concentrations was done. Results: Among systemic sclerosis patients, the age of SSc patients was 42.27 ± 10.46 years. The mean serum levels of Sirtuin3 and Sirtuin7 were significantly lower in SSc patients than in healthy controls (p < 0.001). SIRT3 and SIRT7 levels among SSc patients showed a statistically significant positive correlation (p < 0.001). SIRT7 level was insignificantly decreased in dcSSc (14.16 ± 5.93) than in lcSSc (20.01 ± 8.34). Regarding the SIRT3 level, there was an insignificant difference between dcSSc and lcSSc. Modified Rodnan's skin score correlated negatively with Sirtuin3 and Sirtuin7 levels. In systemic sclerosis patients with interstitial lung disease (56.1%), there was an insignificant difference in SIRT3 and SIRT7 levels (0.12 ± 0.01and 21.23 ± 8.23) compared with systemic sclerosis patients without interstitial lung disease (0.10 ± 0.01 and 17.47 ± 8.57), with p = 0.408 and 0.258, respectively. The receiver operating characteristic curve for SSc prediction with Sirtuin3 has an accuracy of 83.0%, sensitivity of 85.4%, and specificity of 80.0% and p < 0.001. Regarding Sirtuin7, it has an accuracy of 89.5%, sensitivity of 85.4%, and specificity of 93.3% and p < 0.001. Conclusion: Sirtuin3 and Sirtuin7 levels were found to have a significant positive correlation in SSc patients. Sirtuin3 and Sirtuin7 levels are both good diagnostic biomarkers for detecting and diagnosing SSc, with Sirtuin7 being more accurate, specific, and predictive of the disease than Sirtuin3. Sirtuin7 is thought to be a new biomarker for SSc disease. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes mellitus (T2DM) is a common co-morbidity in patients who receive esophagectomy and has unfavorable effects on glucose and lipid metabolism in patients. This study examines how weight and glycolipid metabolism change in patients with T2DM following esophagectomy. Methods: This retrospective, one-center, observational analysis with a propensity score matching analysis (PSM) included 114 patients who underwent esophageal surgery in the Department of Cardiothoracic Surgery, the 900th Hospital of Joint Logistic Support Force from 2017 to 2020, which were separated into T2DM group and Non-T2DM group. Weight, body mass index (BMI), fasting plasma glucose (FPG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) were measured and analyzed before and after the operation. Results: Two groups showed similar reductions in weight and BMI after surgery. In the T2DM group, weight decreased from 63.10(10.31) before surgery to 55.10(11.60) kg at 6 months (P < 0.001) with BMI decreasing from 22.67 (2.90) to 19.77 (3.48); While in the Non-T2DM group, weight decreased from 61.42 (8.46) to 53.19 (9.26) kg at 6 months after surgery with BMI decline from 22.49 (2.77) before operation to 19.45 (3.08) at 6 months after surgery. Fasting plasma glucose levels showed a significant decrease (P = 0.035) in the T2DM group at a six-month point of 7.00 (2.21) mmol/L compared to preoperative levels of 7.67 (2.32) mmol/L. HDL levels increased significantly in the Non-T2DM group at six months postoperatively at 1.52 (0.05) with P < 0.001 compared to preoperative levels of 1.22(0.04) mmol/L. TG, LDL, and TC levels decreased significantly in both groups from the preoperative to the 6-month point. Conclusions: Esophagectomy induces weight loss in T2DM and Non-T2DM groups, improves long-term glucose metabolism in the T2DM group, and enhances lipid metabolism in both groups. Further research is needed to understand their mechanisms. [ABSTRACT FROM AUTHOR]

The purpose of this study is to illustrate how matching approaches based on different balancing scores lead to variations in the treatment effect estimators. We introduced a case study evaluating the effect of anti-thrombotic agents on the severe progression of patients with intracerebral hemorrhage. We extracted subpopulations based on propensity and prognostic scores and then estimated the relative risk between the treatment groups. Furthermore, to illustrate the situation where the treatment effect estimates varied depending on employed balancing scores, we conducted a simulation experiment. In the case study, the matching using different balancing scores extracted subpopulations with different characteristics. Then, the estimated relative risk (95% confidence interval) was 1.27 (0.98–1.94) among the propensity score matched cohort, whereas it was 0.91 (0.76–1.08) among the prognostic score matched cohort. In the simulation experiments, the results indicated that the matching schemes based on different balancing scores created distinct matched cohorts, leading to varying estimates under treatment effect heterogeneity. Moreover, the variability of the estimated effect becomes substantial when there are covariates strongly related to the dependent variable of the nuisance functions. The difference in the selected subpopulation via matching based on different balancing scores is a thoughtful factor that can result in different estimates when there is effect heterogeneity. In practice, we recommend assessing the characteristics of the matched subpopulation and employing the balancing score that can estimate the treatment effect among the target population of interest in each study. Plain Language Summary: This study aimed to understand why different methods of matching patients in a study can lead to different estimates of how well a treatment works. We used a real example of a study where the treatment's effectiveness varied for different patients and compared how different methods of matching patients affected the results. We also did a series of experiments to see how the different methods affected estimates of treatment effect when the effectiveness varied among patients. Our study found that the different matching methods extracted the different patients. The difference in the matched patients led to very different results, especially when the treatment's effectiveness was not the same for all patients. Therefore, it is important to check the characteristics of patients after matching and consider whether the treatment's effectiveness is not the same for all patients. [ABSTRACT FROM AUTHOR]

Introduction: There is growing evidence that the use of robotic-assisted surgery (RAS) in colorectal cancer resections is associated with improved short-term outcomes when compared to laparoscopic surgery (LS) or open surgery (OS), possibly through a reduced systemic inflammatory response (SIR). Serum C-reactive protein (CRP) is a sensitive SIR biomarker and its utility in the early identification of post-operative complications has been validated in a variety of surgical procedures. There remains a paucity of studies characterising post-operative SIR in RAS. Methods: Retrospective study of a prospectively collected database of consecutive patients undergoing OS, LS and RAS for left-sided and rectal cancer in a single high-volume unit. Patient and disease characteristics, post-operative CRP levels, and clinical outcomes were reviewed, and their relationships explored within binary logistic regression and propensity scores matched models. Results: A total of 1031 patients were included (483 OS, 376 LS, and 172 RAS). RAS and LS were associated with lower CRP levels across the first 4 post-operative days (p < 0.001) as well as reduced complications and length of stay compared to OS in unadjusted analyses. In binary logistic regression models, RAS was independently associated with lower CRP levels at Day 3 post-operatively (OR 0.35, 95% CI 0.21–0.59, p < 0.001) and a reduction in the rate of all complications (OR 0.39, 95% CI 0.26–0.56, p < 0.001) and major complications (OR 0.5, 95% CI 0.26–0.95, p = 0.036). Within a propensity scores matched model comparing LS versus RAS specifically, RAS was associated with lower post-operative CRP levels in the first two post-operative days, a lower proportion of patients with a CRP ≥ 150 mg/L at Day 3 (20.9% versus 30.5%, p = 0.036) and a lower rate of all complications (34.7% versus 46.7%, p = 0.033). Conclusions: The present observational study shows that an RAS approach was associated with lower postoperative SIR, and a better postoperative complications profile. [ABSTRACT FROM AUTHOR]

Type 1 diabetes (T1D) is a chronic condition characterized by glucose fluctuations. Laboratory studies suggest that cognition is reduced when glucose is very low (hypoglycemia) and very high (hyperglycemia). Until recently, technological limitations prevented researchers from understanding how naturally-occurring glucose fluctuations impact cognitive fluctuations. This study leveraged advances in continuous glucose monitoring (CGM) and cognitive ecological momentary assessment (EMA) to characterize dynamic, within-person associations between glucose and cognition in naturalistic environments. Using CGM and EMA, we obtained intensive longitudinal measurements of glucose and cognition (processing speed, sustained attention) in 200 adults with T1D. First, we used hierarchical Bayesian modeling to estimate dynamic, within-person associations between glucose and cognition. Consistent with laboratory studies, we hypothesized that cognitive performance would be reduced at low and high glucose, reflecting cognitive vulnerability to glucose fluctuations. Second, we used data-driven lasso regression to identify clinical characteristics that predicted individual differences in cognitive vulnerability to glucose fluctuations. Large glucose fluctuations were associated with slower and less accurate processing speed, although slight glucose elevations (relative to person-level means) were associated with faster processing speed. Glucose fluctuations were not related to sustained attention. Seven clinical characteristics predicted individual differences in cognitive vulnerability to glucose fluctuations: age, time in hypoglycemia, lifetime severe hypoglycemic events, microvascular complications, glucose variability, fatigue, and neck circumference. Results establish the impact of glucose on processing speed in naturalistic environments, suggest that minimizing glucose fluctuations is important for optimizing processing speed, and identify several clinical characteristics that may exacerbate cognitive vulnerability to glucose fluctuations. [ABSTRACT FROM AUTHOR]

Assessment of study success using conditional power (CP), the predictive power of success (PPoS) and probability of success (PoS) is becoming increasingly common for resource optimization and adaption of trials in clinical investigation. Determination of these measures is often a non-trivial mathematical task. Further, the terminologies used across the literature are not consistent, and there is no consolidated presentation on this. We have made a structured presentation on these measures for both trial success and clinical success: first, we have summarized the expressions of CP, PPoS and PoS in a general setting and subsequently, expressions for these measures are obtained for continuous, binary, and time-to-event endpoints in single-arm and two-arm trial settings. Many of these expressions are previously published; however, some of the expressions are very new including the expressions for testing median of time-to-event endpoint in a single-arm trial. We have also shown that 1 / (no. of events) consistently underestimates the variance of log(median) and alternative expression for variance was derived. Examples are given along with the comparison of CP and PPoS. Expressions presented in this paper are implemented in LongCART package in R and in R shiny app https://ppos.shinyapps.io/public/. [ABSTRACT FROM AUTHOR]

Background: Research on sensory processing, particularly its association with language disorders, has been increasing in recent years, aiming to understand the correlation between language and sensory processing. This study aimed to determine sensory profiles among children aged 36 and 120 months with language disorders (autism spectrum disorders (ASD), attention deficit hyperactivity disorders (ADHD), specific language impairment (SLI), and intellectual disability (ID)) and correlate their language ages with their sensory profile responses. Results: The study involved 120 children with language disorders (ASD, ADHD, SLI, and ID), and 30 typically developing children. All children were subjected to assessment by the Sensory Profile and the Preschool Language Scale Fourth Edition (PLS-4) Arabic edition. Based on their sensory profile, children with language disorders are distinguished from typically developing peers. The former has a higher prevalence of sensory modulation disorders as well as atypical emotional and behavioral responses to sensory inputs compared to typically developing children. Children with ASD have the highest atypical sensory responses, followed by those with SLI, ADHD, and ID. A negative correlation was found between some sensory profile scores and receptive language scores. Expressive language was related to oral processing in some subtypes of language disorders. Conclusions: The study indicates that detailed sensory processing assessment in children reveals different faces for different types of language disorders. [ABSTRACT FROM AUTHOR]

Longitudinal processes often unfold concurrently where the growth patterns of two or more longitudinal outcomes are associated. Additionally, if the study under investigation is long, the growth curves may exhibit nonconstant change with respect to time. Multiple existing studies have developed multivariate growth models with nonlinear functional forms to explore joint development where two longitudinal records are correlated over time. However, the relationship between multiple longitudinal outcomes may also be unidirectional. Accordingly, it is of interest to estimate regression coefficients of such unidirectional paths. One statistical tool for such analyses is longitudinal mediation models. In this study, we develop two models to evaluate mediational processes where the linear–linear piecewise functional form is utilized to capture the change patterns. We define the mediational process as either the baseline covariate or the change in covariate influencing the change in the mediator, which, in turn, affects the change in the outcome. We present the proposed models through simulation studies and real-world data analyses. Our simulation studies demonstrate that the proposed mediational models can provide unbiased and accurate point estimates with target coverage probabilities with a 95% confidence interval. The empirical analyses demonstrate that the proposed models can estimate covariates' direct and indirect effects on the change in the outcome. We also provide the corresponding code for the proposed models. [ABSTRACT FROM AUTHOR]

Introduction: Children aged two to five years old are influenced by the behaviors of their guardians and Early Care Education (ECE) teachers. This study aims to determine the relationship between adults' and children's health behaviors in home and ECE settings. This study is novel in examining this correlation between multiple environments. Method: Surveys were conducted across 32 ECE centers. Guardians and teachers reported on their and their children's health behaviors within the home and ECE. Matched child-adult responses (n = 1,140) were analyzed from a representative sample of 32 ECE centers throughout Georgia. Frequency of consumption of fruits, vegetables, and water, as well as frequency of physical activity were measured. Spearman rho correlations were analyzed using SPSS software, with p < 0.05 indicating significance. Results: Spearman rho correlations indicated significant positive correlations between guardian and child behavior (rho = 0.49 to 0.70, p < 0.001) for all data. Teacher and child correlations were inconsistently significant across categories (rho = -0.11 to 0.17, p < 0.001). Discussion: The influence of guardian behavior modeling on child health outcomes is critical for improving ECE programming and child obesity outcomes. This research can be used to inform future health interventions for young children. Significance: Children's behaviors are influenced by the behaviors of guardians in their life. Childhood obesity rates are increasing in the United States, and increased physical activity and improved dietary practices are key methods to prevent obesity. This study assessed the degree to which children's health behaviors model those of their guardians and teachers. Children's health behavior practices were significantly correlated with the practices of their guardians but not with teachers, indicating home-based health promotions can have positive impacts on both adults and children. [ABSTRACT FROM AUTHOR]

Objective and Background: We assessed current understandings in interpretation of Bayesian and traditional statistical results within the clinical researcher (non-statistician) community. Methods: Within a 22-question survey, including demographics and experience and comfort levels with Bayesian analyses, we included questions on how to interpret both Bayesian and traditional statistical outputs. We also assessed whether Bayesian or traditional interpretations are considered more useful. Results: Among the 323 respondent clinicians, 42.4% and 36.5% chose the correct interpretations of the posterior probability and 95% credible interval, respectively. Only 11.5% of respondents interpreted the p-value correctly and 23.5% interpreted the 95% confidence interval correctly. Conclusions: Based on these survey results, we conclude that most of these clinicians face uncertainty when attempting to interpret results from both Bayesian and traditional statistical outputs. When presented with accurate interpretations, clinicians generally conclude that Bayesian results are more useful than conventional ones. We believe there is a need for education of clinicians in statistical interpretation in ways that are customized to this audience. [ABSTRACT FROM AUTHOR]

This paper aims to solve the arterial input function (AIF) determination in dynamic contrast-enhanced MRI (DCE-MRI), an important linear ill-posed inverse problem, using the maximum entropy technique (MET) and regularization functionals. In addition, estimating the pharmacokinetic parameters from a DCE-MR image investigations is an urgent need to obtain the precise information about the AIF–the concentration of the contrast agent on the left ventricular blood pool measured over time. For this reason, the main idea is to show how to find a unique solution of linear system of equations generally in the form of y = A x + b , named an ill-conditioned linear system of equations after discretization of the integral equations, which appear in different tomographic image restoration and reconstruction issues. Here, a new algorithm is described to estimate an appropriate probability distribution function for AIF according to the MET and regularization functionals for the contrast agent concentration when applying Bayesian estimation approach to estimate two different pharmacokinetic parameters. Moreover, by using the proposed approach when analyzing simulated and real datasets of the breast tumors according to pharmacokinetic factors, it indicates that using Bayesian inference—that infer the uncertainties of the computed solutions, and specific knowledge of the noise and errors—combined with the regularization functional of the maximum entropy problem, improved the convergence behavior and led to more consistent morphological and functional statistics and results. Finally, in comparison to the proposed exponential distribution based on MET and Newton's method, or Weibull distribution via the MET and teaching–learning-based optimization (MET/TLBO) in the previous studies, the family of Gamma and Erlang distributions estimated by the new algorithm are more appropriate and robust AIFs. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate if overweight and obesity in the offspring is reduced by a low-intensity antenatal primary care intervention with focus on diet and physical activity for pregnant women with obesity, comparing children to mothers receiving the intervention with children to mothers who did not. Methods: This study is a follow-up of children 2.5 years of age after their mothers' participation in a non-randomised controlled intervention intending to limit gestational weight gain. All study participants received standard antenatal care. The intervention group received lifestyle support via motivational talks with midwife and support from dietician. Data on child weight were collected by medical records, letter and phone. Results: There was no significant difference between the groups 2.5 years after intervention (International Obesity Task Force ISO-BMI 25 (child BMI corresponding to adult BMI of 25): 20% vs. 21%; ISO-BMI 30: 4.6% vs. 1.3%). The mother's BMI at the beginning of pregnancy significantly influenced child BMI at 2.5 years (r = 0.13, p = 0.014, r2 = 0.017). For each unit of increase in maternal BMI at enrollment, the probability of child ISO-BMI ≥ 25 increased by 7.5% (p = 0.021) and of ≥ 30, by 12.9% (p = 0.017). Conclusion: The frequency of overweight and obesity of the children at 2.5 years of age was significantly correlated to the mother's BMI, but not correlated to the mothers' participation in the antenatal lifestyle intervention. Thus, it seems important to address obesity and lifestyle issues before and between pregnancies. Trial registration The study has been registered at ClinicalTrials.gov, Identifier: NCT03147079. [ABSTRACT FROM AUTHOR]

Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4–22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype. [ABSTRACT FROM AUTHOR]

This article discusses the variability and randomness of p values, the most widely used currency of evidence in nutritional and health studies. One implication of this, the importance of always testing interaction terms when subgroups are examined and presented separately is also discussed. [ABSTRACT FROM AUTHOR]

Medical insurance claims are becoming increasingly common data sources to answer a variety of questions in biomedical research. Although comprehensive in terms of longitudinal characterization of disease development and progression for a potentially large number of patients, population-based inference using these datasets require thoughtful modifications to sample selection and analytic strategies relative to other types of studies. Along with complex selection bias and missing data issues, claims-based studies are purely observational, which limits effective understanding and characterization of the treatment differences between groups being compared. All these issues contribute to a crisis in reproducibility and replication of comparative findings using medical claims. This paper offers practical guidance to the analytical process, demonstrates methods for estimating causal treatment effects with propensity score methods for several types of outcomes common to such studies, such as binary, count, time to event and longitudinally varying measures, and also aims to increase transparency and reproducibility of reporting of results from these investigations. We provide an online version of the paper with readily implementable code for the entire analysis pipeline to serve as a guided tutorial for practitioners. The online version can be accessed at https://rydaro.github.io/. The analytic pipeline is illustrated using a sub-cohort of patients with advanced prostate cancer from the large Clinformatics TM Data Mart Database (OptumInsight, Eden Prairie, Minnesota), consisting of 73 million distinct private payer insures from 2001 to 2016. [ABSTRACT FROM AUTHOR]

As the use of electronic health records (EHR) to estimate treatment effects has become widespread, concern about bias introduced by error in EHR-derived covariates has also grown. While methods exist to address measurement error in individual covariates, little prior research has investigated the implications of using propensity scores for confounder control when the propensity scores are constructed from a combination of accurate and error-prone covariates. We reviewed approaches to account for error in propensity scores and used simulation studies to compare their performance. These comparisons were conducted across a range of scenarios featuring variation in outcome type, validation sample size, main sample size, strength of confounding, and structure of the error in the mismeasured covariate. We then applied these approaches to a real-world EHR-based comparative effectiveness study of alternative treatments for metastatic bladder cancer. This head-to-head comparison of measurement error correction methods in the context of a propensity score-adjusted analysis demonstrated that multiple imputation for propensity scores performs best when the outcome is continuous and regression calibration-based methods perform best when the outcome is binary. [ABSTRACT FROM AUTHOR]

Greater understanding can increase our knowledge and intervention effectiveness for activity participation problems of children with disabilities. We examined participation difficulties of children with autism spectrum disorders (ASD) and intellectual disabilities (ID) in the 2011 Survey of Pathway to Diagnosis and Services. We utilized propensity score matching with inverse probability of treatment weight with questions from parents of 1783 children aged 6–17 years. Friendship was the most difficult area for all children. Children with both ASD and ID experienced the most difficulty in all areas, followed by ASD alone. Reported levels of home life, friendships, classroom and leisure difficulties were moderately correlated for all children. Children who were previously diagnosed, but have no current diagnosis experienced substantial difficulties. [ABSTRACT FROM AUTHOR]

Hidden Markov models (HMM) presents an attractive analytical framework for capturing the state-switching process for auto-correlated data. These models have been extended to longitudinal data setting where simultaneous multiple processes are observed by including subject specific random effects. However, application of HMMs for intensive longitudinal data, where each subject gets measured intensively over relatively short period of time, has not been widely studied. In this paper, we extend the mixed hidden Markov model and allow subject heterogeneity with respect to the mean and within subject variance by including subject random effects in both perspectives. We focus on the application of this model to intensive longitudinal studies in psychological and behavioral research where individual's latent states and state-switching process are of interest. Models are estimated using forward–backward algorithm via Bayesian sampling approach. Advantages over regular HMM and mixed HMM that only accounts for the subjects' mean heterogeneity are illustrated through a series of simulation studies. Finally, models are applied to an adolescent mood study data set and results show that the proposed mixed location scale HMM achieves better model fit and more interpretative mood state identification in terms of state specific covariate effects compared to regular HMM and mixed HMM. [ABSTRACT FROM AUTHOR]

Purpose: Workers' compensation schemes usually recompense workers below their regular wage. This may cause financial stress, which has previously been associated with poorer health and work outcomes after injury. We sought to determine the level of financial stress experienced by injured workers and the influence of post-injury income source on financial stress. Methods: Analysis of a cross-sectional national survey of 4532 adults who had been injured at work and had at least one day of workers' compensation paid. Financial stress at time of survey was measured on a scale of 1–10 and subsequently dichotomised at the top quartile for further analysis. The effect of current main income source on financial stress, adjusted for demographic and psychosocial confounders, was assessed using logistic regression. Results: Sixty-nine percent of workers whose main income was social assistance or insurance and 54% whose main income was workers' compensation were experiencing financial stress. Relative to wages or salaries, workers with a main income from social assistance or insurance (odds ratio: 3.33, 95% CI 2.22–5.00) and workers' compensation (1.71, 1.31–2.24) had higher odds of financial stress. Workers with a main income of an aged pension or superannuation had lower odds of financial stress (0.52, 0.28–0.97). Conclusion: Injured workers receiving workers' compensation or social assistance benefits are vulnerable to increased financial stress. Given the potential negative consequences of financial stress on health, particularly mental health, this study suggests the need for careful consideration of income replacement benefits in the design of workers' compensation schemes. [ABSTRACT FROM AUTHOR]

Objectives and background: The effect of headache on cognitive performance is controversial, due to conflicting results obtained from studies in clinical or population settings. We aimed to understand if migraine and other headaches modify the rates of decline on different cognitive measures, during a 5-year interval. Design and method: A cohort of community dwelling adults (> 50 years) with migraine (MH), non-migraine headaches (NMH) and controls without headache (WoH), was assessed by a comprehensive neuropsychological battery with tests of memory, language and executive functions, repeated 5 years apart. Change in performance between baseline and reevaluation was compared between groups, and controlled for age, gender, literacy and depressive symptoms. Results: A total of 275 participants (78.5% WoH, 12.7% MH, 8.7% NMH) were reevaluated (average age 70.40 + 8.34 years, 64% females). Cognitive decline or dementia occurred in 11.4%, with a similar proportion among the three groups. Although MH participants had significantly more subjective cognitive complaints (p = 0.030, 95%CI:]-3.929,-0.014[), both MH and NMH subjects showed an age-associated decline identical to controls. Furthermore, migraine features (disease and attack duration, frequency and aura) were unrelated with cognitive performance. Conclusion: Migraine and non-migraine headache are not associated with increasing risk of dementia or cognitive decline at an older age although subjects with migraine have more cognitive complaints. Longer longitudinal studies are necessary to understand if this pattern persists for more than 5 years. [ABSTRACT FROM AUTHOR]

Panel count data commonly arise in epidemiological, social science, and medical studies, in which subjects have repeated measurements on the recurrent events of interest at different observation times. Since the subjects are not under continuous monitoring, the exact times of those recurrent events are not observed but the counts of such events within the adjacent observation times are known. A Bayesian semiparametric approach is proposed for analyzing panel count data under the proportional mean model. Specifically, a nonhomogeneous Poisson process is assumed to model the panel count response over time, and the baseline mean function is approximated by monotone I-splines of Ramsay (Stat Sci 3:425-461, 1988). Our approach allows to estimate the regression parameters and the baseline mean function jointly. The proposed Gibbs sampler is computationally efficient and easy to implement because all of the full conditional distributions either have closed form or are log-concave. Extensive simulations are conducted to evaluate the proposed method and to compare with two other bench methods. The proposed approach is also illustrated by an application to a famous bladder tumor data set (Byar, in: Pavone-Macaluso M, Smith PH, Edsmyn F (eds) Bladder tumors and other topics in urological oncology. Plenum, New York, 1980). [ABSTRACT FROM AUTHOR]

Background: Emerging evidence showed promising effects of vitamin D on headaches characteristics. Thus, it seems there is still a need for more researches to clarify the mechanisms by which this vitamin exerts anti-migraine effects. Methods: The present study was conducted as a 16-week randomized double-blind placebo-controlled trial on 80 episodic migraine patients allocated in 2 parallel groups each consisted of 40 patients who received vitamin D 2000 IU/d or placebo. At baseline and after the intervention completion, headache diaries and migraine disability assessment questionnaire (MIDAS) were used to assess migraine related variables in patients. Also, interictal serum concentration of calcitonin gene-related peptide (CGRP) (as the dominant mediator of migraine pain pathogenesis) was evaluated using ELISA method. Results: The mean (SD) of age in the vitamin D and placebo groups was 37 (8) and 38 (12) years, respectively. ANCOVA test adjusted for baseline values, and confounders showed vitamin D supplementation resulted in a significant improvement in MIDAS score after 12 weeks in the intervention group (21.49 (16.22–26.77)) compared to placebo (31.16 (25.51–36.82) P value: 0.016). Moreover, after controlling for baseline levels, and other variables using ANCOVA, CGRP level was appeared to be significantly lower following vitamin D supplementation (153.26 (133.03–173.49) ng/L) than the patients in the placebo arm (188.35 (167.15–209.54) ng/L) (P value = 0.022). Conclusion: According to the current findings, vitamin D supplementation in episodic migraineurs, particularly in those with migraine with aura, may potentially improve migraine headache characteristics and disability probably through attenuating CGRP levels. Therefore, these results could provide a new insight into anti-nociceptive effects of vitamin D; however, more studies are required to confirm our findings. Trial registration: The trial is registered in the Iranian registry of clinical trials (IRCT) at 11 July 2018, with IRCT code: IRCT20151128025267N6. [ABSTRACT FROM AUTHOR]

Function-based hypothesis testing in two-sample location-scale models has been addressed for uncensored data using the empirical characteristic function. A test of adequacy in censored two-sample location-scale models is lacking, however. A plug-in empirical likelihood approach is used to introduce a test statistic, which, asymptotically, is not distribution free. Hence for practical situations bootstrap is necessary for performing the test. A multiplier bootstrap and a model appropriate resampling procedure are given to approximate critical values from the null asymptotic distribution. Although minimum distance estimators of the location and scale are deployed for the plug-in, any consistent estimators can be used. Numerical studies are carried out that validate the proposed testing method, and real example illustrations are given. [ABSTRACT FROM AUTHOR]

The cumulative incidence function (CIF) displays key information in the competing risks setting, which is common in medical research. In this article, we introduce two new methods to compute non-parametric confidence intervals for the CIF. First, we introduce non-parametric profile-likelihood confidence intervals. The method builds on constrained non-parametric maximum likelihood estimation (NPMLE), for which we derive closed-form formulas. This method can be seen as an extension of that of Thomas and Grunkemeier (J Am Stat Assoc 70:865-871, 1975) to the competing risks setting, when the CIF is of interest instead of the survival function. Second, we build on constrained NPMLE to introduce constrained bootstrap confidence intervals. This extends an interesting approach introduced by Barber and Jennison (Biometrics 52:430-436, 1999) to the competing risks setting. A simulation study illustrates how these methods can perform as compared to benchmarks implemented in popular software. The results suggest that more accurate confidence intervals than usual Wald-type ones can be obtained in the case of small to moderate sample sizes and few observed events. An application to melanoma data is provided for illustration purpose. [ABSTRACT FROM AUTHOR]

We propose a two-stage outcome-dependent sampling design and inference procedure for studies that concern interval-censored failure time outcomes. This design enhances the study efficiency by allowing the selection probabilities of the second-stage sample, for which the expensive exposure variable is ascertained, to depend on the first-stage observed interval-censored failure time outcomes. In particular, the second-stage sample is enriched by selectively including subjects who are known or observed to experience the failure at an early or late time. We develop a sieve semiparametric maximum pseudo likelihood procedure that makes use of all available data from the proposed two-stage design. The resulting regression parameter estimator is shown to be consistent and asymptotically normal, and a consistent estimator for its asymptotic variance is derived. Simulation results demonstrate that the proposed design and inference procedure performs well in practical situations and is more efficient than the existing designs and methods. An application to a phase 3 HIV vaccine trial is provided. [ABSTRACT FROM AUTHOR]

Purpose: To correlate the presence of calcifications in alveolar echinococcosis (AE) hepatic lesions to the metabolic activity in 18 fluorodeoxyglucose positron emission tomography combined with computed tomography (FDG-PET/CT). Methods: Our institutional review board approved this study. 61 patients (29 women, 32 men, aged from 15 to 86 years) were included in the study. Images of FDG-PET/CT were interpreted by two independent nuclear medicine physicians. AE hepatic lesions were classified as AE lesions with or without hypermetabolic activity. The presence of calcifications was assessed on unenhanced CT scans by two independent radiologists blinded with regard to the metabolic activity of the AE hepatic lesions. Every single calcification the size of which was < 3 mm and non-measurable calcifications which were forming areas with a powdery appearance were considered as microcalcifications. All other types of calcifications were reported as macrocalcifications. Statistical analysis was performed and p value < 0.05 was considered as statistically significant. Results: Microcalcifications and macrocalcifications were present at CT in 95% (58/61) AE hepatic lesions and 43% (26/61) AE hepatic lesions, respectively. Hypermetabolic activity was present at FDG-PET/CT in 93% (57/61) AE hepatic lesions. 98% (56/57) of the AE hepatic lesions presenting with hypermetabolic activity at FDG-PET/CT showed microcalcifications at CT (p = 0.01) when only 40% (23/57) showed macrocalcifications at CT (p = 0.3). 100% (23/23) of the AE hepatic lesions with hypermetabolic activity at FDG-PET/CT and macrocalcifications at CT showed also microcalcifications at CT. Conclusions: Hypermetabolic activity of AE hepatic lesions at FDG-PET/CT is strongly correlated to the presence of microcalcifications at CT, independently of the presence of macrocalcifications. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the eating behaviors and social cognitive factors that affect fruit and vegetable consumption. Strategies to change, pros & cons, enjoyment, family support, and peer influence were measured in children ages 8–10 years both pre- and post- Zest Quest® program (pre: n = 82; post: n = 80). Children for a comparison group were selected from comparable elementary schools and pre- and post- measures were evaluated (pre: n = 92; post: n = 87). Chi-squared analyses were conducted on individual measures and Spearman correlations & linear regression were used for composite variables with fruit and vegetable consumption as the dependent variable. Results from the study demonstrated significant moderate correlations for fruit change strategies pre- (rs = 0.39) and post-intervention (rs = 0.33) and vegetable change strategies pre-intervention (rs = 0.42) in the Zest Quest® group. Peer influence (rs = 0.33) and enjoyment (rs = 0.38) showed significant moderate correlations with fruit intake in the comparison group. The regression analysis showed pros (β = 0.24, p value 0.05) and cons (β = 0.14, p value 0.05) to be significant predictors for fruit intake post-intervention in the Zest Quest® group. Prior to the intervention, strategies to change (β = 0.10, p value 0.02) was a significant predictor for fruit intake and cons (β = 0.15, p value = 0.03) for vegetable intake in this group. Family support and peer influence were not significant in the regression models, but demonstrated significance in the crude model. Eating behaviors and social cognitive factors may have an effect on fruit and vegetable consumption, but these measures are difficult to capture. Future research should continue exploring the impact of family support and peer influence on fruit and vegetable intake. [ABSTRACT FROM AUTHOR]

Propensity score-based methods have been widely developed to adjust for confounders in observational studies to estimate causal treatment effect for binary treatments. We generalize these causal inference methods to the multi-level treatment case. We review the generalized causal inference framework and several propensity score estimation methods. We conduct a comprehensive simulation study to evaluate the performance of multinomial logistic regression, generalized boosted models, random forest and data adaptive matching score for estimating propensity scores based on inverse probability of treatment weighting. From our findings, multinomial logistic regression is susceptible to yielding extreme weights while a mis-specified model is assumed, which results in poor performance of the inverse probability weighted estimator. On the other hand, machine-learned propensity scores tend to have less biased and more stable performance, and the data adaptive matching score tends to perform the best overall. The above-mentioned propensity score based methods are applied to the Taobao dataset to evaluate the causal effect of reputation on sales. [ABSTRACT FROM AUTHOR]

This paper concerns full-scale wave measurements of individual wave heights and crest heights at one location with water depth 190 m in the northern North Sea from 2004 up to date. The surface elevation was recorded by a Saab WaveRadar REX from one location in the northern North Sea. The measured individual wave heights and crest heights have been compared to well-known theoretical distributions. For wave heights, the Rayleigh distribution is found to form a conservative upper bound, whilst the Forristall distribution is considered to show a good accuracy, though somewhat conservative in the most severe sea states. For crest heights, the Rayleigh distribution is found to be nonconservative, whilst the Forristall distributions for long- and short-crested sea both provide reasonable descriptions. Based on the present study, the Forristall distributions for individual wave height and crest heights in long-crested seas are considered to provide the most appropriate descriptions of these measured wave data. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effects of the single-energy metal artifact reduction (SEMAR) algorithm on image quality of cerebral CT and CT angiography (CTA) for patients who underwent intracranial aneurysm coiling.Methods: Twenty patients underwent cerebral CT and CTA using a 320-detector row CT after intracranial aneurysm coiling. Images with and without application of the SEMAR algorithm (SEMAR CT and standard CT images, respectively) were reconstructed for each patient. The images were qualitatively assessed by two independent radiologists in a blinded manner for the depiction of anatomical structures around the coil, delineation of the arteries around the coil, and the depiction of the status of coiled aneurysms. Artifact strength was quantitatively assessed by measuring the standard deviation of attenuation values around the coil.Results: The strength of artifacts measured in SEMAR CT images was significantly lower than that in standard CT images (25.7 ± 10.2 H.U. vs. 80.4 ± 67.2 H.U., p < 0.01, Student’s paired t test). SEMAR CT images were significantly improved compared with standard CT images in the depiction of anatomical structures around the coil (p < 0.01, the sign test), delineation of the arteries around the coil (p < 0.01), and the depiction of the status of coiled aneurysms (p < 0.01).Conclusion: The SEMAR algorithm significantly reduces metal artifacts from intracranial aneurysm coiling and improves visualization of anatomical structures and arteries around the coil, and depiction of the status of coiled aneurysms on post-interventional cerebral CT. [ABSTRACT FROM AUTHOR]

Aim: To test the correlation among dental caries, dental fluorosis, and the percentage of municipalities with optimal fluoridated water among Brazilian 12-year-old schoolchildren.Subjects and methods: An ecological study was performed using primary data from the latest Brazilian Oral Health Survey. The units of analysis were the 26 states plus the Federal District of Brazil (n = 7328 schoolchildren). Dental caries was diagnosed according to the DMFT criteria and dental fluorosis according to Dean’s Index. Descriptive and analytical statistics (p < 0.05) were performed. Google My Maps® was used to display data by state.Results: Mean DMFT ranged from 1.06 to 4.81 between states, whereas the prevalence rates of dental caries and dental fluorosis ranged from 37.3 to 78.2% and from 0 to 45.8% between states, respectively. In Brazil, 60.25% of the municipalities have an optimal fluoridated water supply. The percentage of municipalities with an optimal fluoridated water supply in each state ranged from 0 to 97.4%. Dental fluorosis was negatively correlated with mean DMFT (r = − 0.645; p < 0.001) and with dental caries (r = − 0.678; p < 0.001). The percentage of municipalities with optimal fluoridated water was negatively correlated with dental caries (r = − 0.678; p < 0.001) and positively correlated with dental fluorosis (r = 0.668; p < 0.001).Conclusion: Lower prevalence of dental caries was found with the increasing percentage of municipalities with optimal fluoridated water and with the increasing prevalence of dental fluorosis. [ABSTRACT FROM AUTHOR]

Background: Smoking is a major risk factor for death-related diseases. Not all healthcare professionals are following evidence-based guidelines for smoking cessation counseling in primary care settings. The WHO, Framework Convention on Tobacco Control (FCTC), and United States Public Health Service (USPHS) guidelines recommend that all healthcare professionals, including students in healthcare training programs, receive education in the management of tobacco use and dependence.Objective: To evaluate the effect of training programs for primary healthcare physicians on the knowledge, attitude, and practice of smoking cessation counseling.Methods: This was a pre-post intervention study. The study included 74 primary care physicians working in primary healthcare centers affiliated with the Ministry of Health and Suez Canal University Hospitals in Port Said City. The study was conducted between June 2015 and March 2016 using a structured questionnaire and observation checklist to assess counseling of patients willing to quit smoking.Results: There were highly statistically significant improvements in the physicians’ median scores of knowledge (30%-80%), attitude (65% -100%), and practice (20%-70%) (p < 0.001) pre-post intervention. The most frequent correct knowledge was consequences of smoking (73%-87.3%) (p < 0.001) pre-post intervention. The most favorable attitude was the importance of smoking cessation (70.3%-100%) (p < 0.001) pre-post intervention. The best observed correct practice was asking about smoking (70.3%-100%) (p < 0.001) pre-post intervention.Conclusion: Knowledge, attitude, and practice skills regarding smoking cessation counseling among primary healthcare physicians were markedly improved after implementation of the education program. [ABSTRACT FROM AUTHOR]

Based on four observations of a stellar aggregate which are fairly widely separated in time, the possibility of estimating the total number of irregularly variable stars in it is demonstrated. The inverse problem of recovering the luminosity function of the stellar aggregate from the averaged brightnesses of its members is formulated. The problem of finding the brightness distribution function is examined under the assumption that the variabilities of the stars are a stationary random process. Detailed photometric data on the stars in two “pictures” of the aggregate which are fairly widely separated in time are used as initial information. [ABSTRACT FROM AUTHOR]

The topic of this article is hypothesis testing when the populations from which the data are drawn are known only with a given probability distribution. Some important areas of application for which such a situation arises is reviewed briefly. The specific cases herein considered are testing a one-sided hypothesis involving two populations. An illustrative small data set, involving six observations, is used to demonstrate relevant approaches and calculations for such testing. Both a frequentist approach and a Bayesian approach are developed. In both of these approaches, use is made of all possible data configurations along with their corresponding probabilities. Various measures of goodness are developed for each of the two approaches. A simulation approach is developed for larger data sets. [ABSTRACT FROM AUTHOR]

Diversity of the workforce in healthcare facilities, representative of the general population’s ethnic/racial composition, is an important health priority. Nevertheless, this diversity may generate tensions. The objective of the study was to assess tensions and coping strategies among ethnic minority and majority healthcare workers. A questionnaire was delivered to 60 healthcare workers employed in emergency departments in two hospitals, where Jewish majority and Arab minority workers care for a mixed Jewish and Arab population. Internal consistency reliability was assessed and the survey data were statistically analyzed. Several differences were found between Arab and Jewish healthcare workers. The questionnaire may be used to examine tensions in other healthcare systems, characterized by ethnic/racial diversity in the workforce. By exploring ethnic/racial tensions, health organizations should be able to manage them better and reduce their frequency. [ABSTRACT FROM AUTHOR]

In response to a dearth of research on injuries among children of immigrants, this study examined child injury rates by immigrant generation. We used generalized estimating equations and nationally representative data to estimate injury risk for school-aged children of immigrants of different generations compared to children of native, US-born parents. After controlling for multiple other factors including socioeconomic status, citizenship, and children’s general health, both 1st and 2nd generation school-aged children had significantly lower odds of having injuries compared to children of natives. Additional analyses also found lower odds of injuries among 1st and 2nd generation children relative to children of natives that persisted in both lower- and higher-income families. The findings suggest that 1st and 2nd generation immigrant families possess factors that protect children from injury independent of socioeconomic status. Policy and program development would benefit from a clearer understanding of these protective factors. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the knowledge, comfort and attitudes of physiotherapy students towards human sexuality. An observational, cross-sectional study was conducted in four universities. Physiotherapy students (n = 248) enrolled in an undergraduate degree program were invited to participate and 203 (82%) were included. Students were enrolled in the first (29%), second (22%), third (33%) and fourth (16%) years of the undergraduate degree program. The instrument used was the Scale of Knowledge, Comfort and Attitudes of Physiotherapy Students towards Human Sexuality. Results indicated that students enrolled in the first year of the program reported less knowledge then students in the third (p ≤ 0.001) and fourth years (p ≤ 0.001). Students enrolled in the second year reported less knowledge than the students in the third (p = 0.007) and fourth years (p = 0.002). Students enrolled in the fourth year of the program reported more discomfort compared with students enrolled in the first year (p = 0.049). Additionally, female students showed more discomfort, especially when issues are related to male patients. These findings highlight the importance of a change in the physiotherapy curriculum to better prepare future physiotherapists in delivering holistic treatment. [ABSTRACT FROM AUTHOR]

Background: Propensity score methods are techniques commonly employed in observational research to account for confounding when estimating the effects of treatments and exposures. These methods have been increasingly employed in the acute care surgery literature in an attempt to infer causality; however, the adequacy of reporting and the appropriateness of statistical analyses when using propensity score matching remain unclear.Objectives: The goal of this systematic review is to assess the adequacy of reporting of propensity score methods, with an emphasis on propensity score matching (to assess balance and the use of appropriate statistical tests), in acute care surgery (ACS) studies and to provide suggestions for improvement for junior investigators.Methods: We searched three databases, and other relevant literature (from January 2005 to June 2015) to identify observational studies within the ACS literature using propensity score methods (PROSPERO No: CRD42016036432). Two reviewers extracted data and assessed the quality of the studies retrieved by reviewing the adequacy of both overall reporting and of the propensity score matching methods used.Results: A total of 49/71 (69%) of studies adequately reported propensity score methods overall. Matching was the most common propensity score method used in 46/71 (65%) studies, with 36/46 (78%) studies reporting matching methods adequately. Only 19/46 (41%) of matching studies reported the balance of baseline characteristics between treated and untreated subjects while 6/46 (13%) used correct statistical methods to assess balance. There were 35/46 (76%) of matching studies that explicitly used statistical methods appropriate for the analysis of matched data when estimating the treatment effect and its statistical significance.Conclusion: We have proposed reporting guidelines for the use of propensity score methods in the acute care surgery literature. This is to help investigators improve the adequacy of reporting and statistical analyses when using observational data to estimate effects of treatments and exposures. [ABSTRACT FROM AUTHOR]

Background: It has been suggested that pacing is a thermoregulatory behaviour. We investigated the effect of competition on pacing, performance and thermophysiological strain during exercise in the heat and the psychological factors mediating competition effects.Method: Eighteen males (maximum oxygen uptake [VO2max] 3.69 [0.44] L min−1) undertook a preliminary 20-km cool (wet-bulb globe temperature [WBGT] 12 °C) cycling time trial (TT) and three experimental 20-km trials (balanced order): (i) cool TT (CoolSolo); (ii) hot (WBGT 26 °C) TT (HotSolo); (iii) hot head-to-head competition (HotH2H). During TTs, an avatar of the participant’s performance was visible. During HotH2H, participants believed they were competing against another participant, but the competitor’s avatar replicated their own preliminary (cool) TT.Results: TTs (min:sec [SD]) slowed with increased ambient temperature [CoolSolo 35:31 (2:11) versus HotSolo 36:10 (2:26); p = 0.011]. This effect was negated by competition; performances were not different between HotH2H [35:17 (1:52)] and CoolSolo (p = 0.160) and were quicker in HotH2H versus HotSolo (p = 0.001). End-exercise rectal temperature, mean body temperature and physiological strain index were (p < 0.05) higher in HotH2H than either solo condition. Despite faster performance and greater thermophysiological strain, rating of perceived exertion (RPE), thermal comfort and sensation, and perceptual strain index were not different between HotH2H and HotSolo. The difference in end-exercise rectal temperature between HotH2H and HotSolo was related to pre-exercise anticipatory heart rate response (r = 0.608, p = 0.010) and participants’ propensity for deliberate risk-taking (B = 0.12, p < 0.001), whereas self-reported resilience predicted change in performance times between HotH2H versus HotSolo (B = − 9.40, p = 0.010).Conclusion: Competition changes the relationship between perceived and actual thermophysiological state, altering behavioural thermoregulation and increasing thermophysiological strain; this could increase heat-illness risk. Psychophysiological and psychological measures may identify susceptible individuals. [ABSTRACT FROM AUTHOR]

Background: Reducing the energetic cost of running seems the most feasible path to a sub-2-hour marathon. Footwear mass, cushioning, and bending stiffness each affect the energetic cost of running. Recently, prototype running shoes were developed that combine a new highly compliant and resilient midsole material with a stiff embedded plate.Objective: The aim of this study was to determine if, and to what extent, these newly developed running shoes reduce the energetic cost of running compared with established marathon racing shoes.Methods: 18 high-caliber athletes ran six 5-min trials (three shoes × two replicates) in prototype shoes (NP), and two established marathon shoes (NS and AB) during three separate sessions: 14, 16, and 18 km/h. We measured submaximal oxygen uptake and carbon dioxide production during minutes 3-5 and averaged energetic cost (W/kg) for the two trials in each shoe model.Results: Compared with the established racing shoes, the new shoes reduced the energetic cost of running in all 18 subjects tested. Averaged across all three velocities, the energetic cost for running in the NP shoes (16.45 ± 0.89 W/kg; mean ± SD) was 4.16 and 4.01% lower than in the NS and AB shoes, when shoe mass was matched (17.16 ± 0.92 and 17.14 ± 0.97 W/kg, respectively, both p < 0.001). The observed percent changes were independent of running velocity (14-18 km/h).Conclusion: The prototype shoes lowered the energetic cost of running by 4% on average. We predict that with these shoes, top athletes could run substantially faster and achieve the first sub-2-hour marathon. [ABSTRACT FROM AUTHOR]

Background: Patients recently discharged from the hospital are vulnerable and are at high risk for readmission. Home-delivered meals may be beneficial in improving their health and facilitating independent living in the community. The purpose of this study was to identify the association between home-delivered meals and use of hospital services.Methods: This study includes 120 clients recently discharged from an inpatient hospital stay or from an emergency department (ED) visit who received meal services from Meals On Wheels, Inc., of Tarrant County. Healthcare utilization data was extracted from the Dallas-Fort Worth Hospital Council Foundation, a regional all claims database used by over 90% of hospitals in Dallas-Fort Worth area. Signed tests and generalized linear models (GLM) were performed.Results: A total of 16,959 meals were delivered from March 2013 through March 2014. Each client received an average of 6.19 meals per week. The average number of ED visits decreased from 5.03 before receipt of meals to 1.45 after receipt of meals, z = -5.23, p <.001. The average number of hospitalizations decreased from 1.33 to.83, z = -7.29, p <.001. The average length of stay per hospitalization decreased from 5.47 days to 2.34 days, z = -5.84, p <.001. Clients who received more meals were less likely to experience ED visits and hospitalizations after controlling for demographic characteristics and levels of physical functioning.Conclusion: The findings of this study indicate that home-delivered meals services may contribute to a reduction in hospital based care services among frail and vulnerable adults. Additional studies should consider the short and long-term effects of home-delivered meals services on healthcare utilization and the potential to decrease healthcare costs. [ABSTRACT FROM AUTHOR]

Solitude during adolescence is a potentially double edged sword. Involuntary (non-self-determined solitude) is associated with loneliness, which is known to predict many forms of psychological ill-being. In contrast, freely chosen (self-determined solitude) is associated with healthy developmental outcomes. It is possible that cultural attitudes towards solitude could influence the way adolescents think about and engage in solitude. The present study examined whether South African adolescents from individualist and collectivist cultures differ in their motivations for solitude, using the Motivation for Solitude Scale (MSS-SF). Respondents included 426 adolescents from collectivist and 266 from individualist cultures, between 14 and 18 years of age (mean age = 15.7). For valid cross-cultural comparisons, measurement equivalence was established using invariance and differential item functioning analysis. Results for the measurement invariance analysis (MI) marginally failed to support scalar invariance. Given criticism that MI is overly restrictive, Rasch analysis was used to test for uniform DIF, which supported invariance. Next, Bayesian analysis was used to investigate group differences. There was no difference between the cultural groups for non-self-determined solitude, but, adolescents from individualist cultures were less likely to engage in self-determined solitude. Results support the cross-cultural application of the MSS-SF, and point to a possible cultural bias against self-determined solitude in individualist cultures, despite its potential benefits. [ABSTRACT FROM AUTHOR]

Purpose: The aims of this study were to (i) examine gender differences in physical inactivity in countries with different levels of Human Development Index (HDI); and (ii) assess whether small changes in the prevalence of inactivity in women could achieve the World Health Organization's (WHO) global inactivity target. Methods: Data on inactivity were extracted for 142 countries for the year 2010 from the WHO Data Repository. Data for HDI were obtained for the year 2010 from the United Nations Development Program. Absolute and relative gender differences were calculated for countries according to four HDI categories. The potential effects of increasing women's activity levels on achievement of the WHO physical inactivity target were computed. Results: Overall inactivity prevalence was higher in women (27%) than in men (20%). Women were more inactive than men in all except eight countries. Absolute gender differences [median 7.5% (range −10.1 to 33.2)] did not vary by HDI category, but there was a small negative correlation between relative gender difference in inactivity and HDI (rho −0.19; p = 0.02), which was mostly influenced by three outlier countries with low HDI. A decrease in inactivity levels of 4.8% points among women across the world would achieve the WHO target of reducing global levels of inactivity by 10%. Conclusion: Gender differences in the prevalence of physical inactivity were highly variable, both within and across categories of HDI. Interventions which result in small changes in inactivity prevalence in women would achieve the 2025 WHO global target for inactivity, without any change to the prevalence in men. [ABSTRACT FROM AUTHOR]

Background: Increased muscle mitochondrial mass is characteristic of elite professional endurance athletes (PAs), whereas increased blood lactate levels (lactatemia) at the same absolute submaximal exercise intensities and decreased mitochondrial oxidative capacity are characteristics of individuals with low aerobic power. In contrast to PAs, patients with metabolic syndrome (MtS) are characterized by a decreased capacity to oxidize lipids and by early transition from fat to carbohydrate oxidation (FATox/CHOox), as well as elevated blood lactate concentration [La] as exercise power output (PO) increases, a condition termed 'metabolic inflexibility'. Objective: The aim of this study was to assess metabolic flexibility across populations with different metabolic characteristics. Methods: We used indirect calorimetry and [La] measurements to study the metabolic responses to exercise in PAs, moderately active individuals (MAs), and MtS individuals. Results: FATox was significantly higher in PAs than MAs and patients with MtS ( p < 0.01), while [La] was significantly lower in PAs compared with MAs and patients with MtS. FATox and [La] were inversely correlated in all three groups (PA: r = −0.97, p < 0.01; MA: r = −0.98, p < 0.01; MtS: r = −0.92, p < 0.01). The correlation between FATox and [La] for all data points corresponding to all populations studied was r = −0.76 ( p < 0.01). Conclusions: Blood lactate accumulation is negatively correlated with FATox and positively correlated with CHOox during exercise across populations with widely ranging metabolic capabilities. Because both lactate and fatty acids are mitochondrial substrates, we believe that measurements of [La] and FATox rate during exercise provide an indirect method to assess metabolic flexibility and oxidative capacity across individuals of widely different metabolic capabilities. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the sensitivity and responsiveness to change for the Brazilian version of the Child Perceptions Questionnaire (CPQ8–10) after dental caries treatment.Subject and methods: Thirty children aged 8 to 10 years old with untreated dental caries were randomly selected from public schools. They responded to the CPQ8–10 before and 1 month after finishing treatment for dental caries. Sensitivity was assessed by determining distribution changes using paired t-tests and Wilcoxon signed-rank tests. Responsiveness to change was evaluated by effect size (ES) and standardized response mean (SRM). Minimally important differences (MIDs) were also evaluated.Results: Mean/median pre-treatment values for the total CPQ8–10 score and subscales were significantly higher than the post-treatment values (p < 0.05). ES was large (effect size ≥ 0.8) for the total CPQ8–10 score and oral symptoms (OS), functional limitations (FL) and emotional wellbeing (EW) subscales and moderate (effect size 0.3–0.7) for the social wellbeing (SW) subscale. SRM values were moderate (0.3–0.7) for the total CPQ8–10 score and FL, EW and SW subscales and high (≥ 0.8) for the OS subscale. MID values for the total CPQ8–10 score and all subscales were lower than the mean score change.Conclusion: The Brazilian version of the CPQ8–10 is sensitive and responsive enough to detect changes brought about by dental caries treatment. [ABSTRACT FROM AUTHOR]