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This paper considers linear panel data models with a grouped pattern of heterogeneity when the latent group membership structure and/or the values of slope coefficients change at a break point. We propose a least squares approach to jointly estimate the break point, group membership structure, and coefficients. The proposed estimators are consistent, and the asymptotic distribution of the coefficient estimators is identical to that under known break point and group structure even when the cross-sectional sample size is much larger than the length of time series. Monte Carlo simulations and an empirical example illustrate the use of the approach and associated inference.

Background The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). Methods A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. Results We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7–10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1–4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15–96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15–96.93). Conclusion Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.

Objective With this cross-sectional study, we aimed to evaluate factors associated with moderate and high risk of periodontal disease (PD) progression in the Saudi population. Methods We reviewed 281 patients’ clinical charts from predoctoral periodontal clinics at the dental teaching hospital in the College of Dentistry (COD) at Imam Abdulrahman Bin Faisal University (IAU) in Dammam, Saudi Arabia. After obtaining ethical approval, we determined the Periodontal Risk Assessment (PRA) of the included patients based on the modified criteria developed by Lang and Tonetti (2003) . We used logistic regression on stratified data and divided the results into two categories (low-moderate and high risk) to assess the effect modifier for potential risk factors. We used SPSS version 22 for data analysis, and considered a P-value ≤ 0.05 to be statistically significant. Results Out of the 281 patients, 104 (37.0%) were male and 177 (63.0%) were female, with a mean age of 39.9 ± 14.0 years; 78.1% were Saudi nationals, 77% were married, and 44.6% were in the age group of 30 to 49. The PRA revealed 86 (30.5%) to represent high risk, 108 (38.3%) denoted moderate risk, and 88 (31.2%) signaled low risk for periodontitis. Logistic regression analysis showed that males were three times more likely to have high PRA (OR = 3.24) and to be married (OR = 2.77), as well as to be active smokers (OR = 8.87). The highest predictive factors of high PRA were 8 or more pockets ≥ 5 mm (OR = 29.0), those with active diabetes mellitus (DM; OR = 10.2), and those with 8 or more missing teeth (OR = 9.15). Conclusion Saudi males who are married and have residual periodontal pockets, are actively diabetic, and with missing teeth are at high risk of PD. Further research is needed with a larger sample size comparing the general population with and without PD.

Objective: This study aims to evaluate the effects of a symptom management intervention (SMI) based on symptom management group sessions combined with a mobile health (mHealth) application (app) on the knowledge of symptom management, the certainty of symptom self-management, symptom severity, symptom distress, medication adherence, social support, and quality of life among persons living with HIV (PLWH) in China. Methods: A parallel randomized controlled trial with 61 PLWH was conducted in Shanghai, China. The participants in the control group (n = 30) downloaded the Symptom Management (SM) app according to their needs and preferences, and received routine follow-ups. The participants in the intervention group (n = 31) were guided to download and use the SM app, and received four tailored weekly group sessions at routine follow-ups. Each group session lasted for approximately 2 h and targeted one of the major modules of the SM app. All the outcomes were assessed at baseline and post-intervention. The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024821). Results: The symptom management knowledge and certainty of symptom self-management were significantly improved after the intervention (all P 0.05). Conclusion: The SMI could improve PLWH’s symptom management knowledge and certainty of symptom self-management. Multi-center studies with larger sample sizes and longer follow-ups are needed to further understand the effects of SM app on ameliorating symptom severity and symptom distress. More innovative strategies are also needed to promote and maintain the sustainability of the SM app.

Background: The Fragility Index (FI) and Reverse Fragility Index are powerful tools to supplement the P value in evaluation of randomized clinical trial (RCT) outcomes. These metrics are defined as the number of patients needed to change the significance level of an outcome. The purpose of this study was to calculate these metrics for published RCTs in total joint arthroplasty (TJA). Methods: We performed a systematic review of RCTs in TJA over the last decade. For each study, we calculated the FI (for statistically significant outcomes) or Reverse Fragility Index (for nonstatistically significant outcomes) for all dichotomous, categorical outcomes. We also used the Pearson correlation coefficient to evaluate publication-level variables. Results: We included 104 studies with 473 outcomes; 92 were significant, and 381 were nonstatistically significant. The median FI was 6 overall and 4 and 7 for significant and nonsignificant outcomes, respectively. There was a positive correlation between FI and sample size (R = 0.14, P = .002) and between FI and P values (R = 0.197, P = .000012). Conclusions: This study is the largest evaluation of FI in orthopedics literature to date. We found a median FI that was comparable to or higher than FIs calculated in other orthopedic subspecialties. Although the mean and median FIs were greater than the 2 recommended by the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines to demonstrate strong evidence, a large percentage of studies have an FI < 2. This suggests that the TJA literature is on par or slightly better than other subspecialties, but improvements must be made. Level of Evidence: Level I; Systematic Review.

Background/purpose Oral health care provision in long-term care settings is often limited by specific behaviors exhibited by residents, which may be interpreted as a refusal of care. Such behaviors can be attributed to oral tactile hypersensitivity (TH), which is characterized by aberrations in the perception of oral stimuli. TH is also associated with a decline in ingestion and swallowing function. The purpose of this study was to examine the effectiveness of a technique for mitigating TH (TMH) among institutionalized older persons. Materials and methods In this study, 18 institutionalized older persons (Mean age, 90.6 ± 4.5 years; 92.9% females) with TH were randomized to a control group or an intervention group. Pre- and post-intervention assessments were conducted for seven participants in each group. Routine oral care was provided by the facility's staff in both groups. TMH in the intervention group was performed by a dental hygienist over a 3-month period. Results In the intervention group, the number of areas with TH was significantly reduced (P = 0.027). No significant change was observed in the control group. Conclusion The results of this study suggest that TMH can effectively mitigate TH. Our findings provide clinicians with an additional treatment option for hypersensitivity in older patients. Additional long-term studies with larger sample sizes are required to confirm the effectiveness of this technique.

Objective To translate, culturally adapt, and evaluate the psychometric properties of Adolescent Barriers Questionnaire for use in Brazilian adolescents with cancer aged 12 to 18 years, based on the original American Adolescent Barriers Questionnaire which was designed to measure the extent to which adolescents with cancer have concerns about reporting pain and using analgesics. Methods The study analyzed the psychometric properties reliability (internal consistency and test-retest) and validity (known groups and convergent) of Adolescent Barriers Questionnaire in adolescents between 12 and 18 years of age with a diagnosis of cancer who were using or who had used analgesic medication (opioid or not) in a pediatric public health institution. It was estimated 64 adolescents as sample size and the research was conclude with 48. Results Results of pre-test suggest good understanding (content validity index > 0.9). The internal consistency value Cronbach's α was 88%. The convergent validity values ranged between -0.400 and -0.450. Analysis of known groups showed that the instrument discriminated groups of patients with solid vs. hematologic tumors. The intraclass correlation coefficient obtained after retest was 0.863. Conclusion After the process of translations, validations and analysis of psychometric properties, the Brazilian Portuguese version of Adolescent Barriers Questionnaire could be considered culturally adapted, valid, and reliable for the Brazilian adolescent population with cancer aged 12 to 18 years and it can be useful in practical clinic, offering the health professionals the opportunity to understand which barriers the adolescent with cancer can encounter and offer, thus, all the support to overcome them.

In a recent review published in this journal, Coutts et al. (2019) compared nine different ways to estimate the maximum depositional age (MDA) of siliclastic rocks by means of detrital geochronology. Their results show that among these methods three are positively and six negatively biased. This paper investigates the cause of these biases and proposes a solution to it. A simple toy example shows that it is theoretically impossible for the reviewed methods to find the correct depositional age in even a best case scenario: the MDA estimates drift to ever smaller values with increasing sample size. The issue can be solved using a maximum likelihood model that was originally developed for fission track thermochronology by Galbraith and Laslett (1993). This approach parameterises the MDA estimation problem with a binary mixture of discrete and continuous distributions. The ‘Maximum Likelihood Age’ (MLA) algorithm converges to a unique MDA value, unlike the ad hoc methods reviewed by Coutts et al. (2019). It successfully recovers the depositional age for the toy example, and produces sensible results for realistic distributions. This is illustrated with an application to a published dataset of 13 sandstone samples that were analysed by both LA-ICPMS and CA-TIMS U–Pb geochronology. The ad hoc algorithms produce unrealistic MDA estimates that are systematically younger for the LA-ICPMS data than for the CA-TIMS data. The MLA algorithm does not suffer from this negative bias. The MLA method is a purely statistical approach to MDA estimation. Like the ad hoc methods, it does not readily accommodate geological complications such as post-depositional Pb-loss, or analytical issues causing erroneously young outliers. The best approach in such complex cases is to re-analyse the youngest grains using more accurate dating techniques. The results of the MLA method are best visualised on radial plots. Both the model and the plots have applications outside detrital geochronology, for example to determine volcanic eruption ages.

Aim In order to improve the understanding of dental fluorosis prevalence in Saudi Arabia and have a good idea of the quality of the studies that have been conducted, a systematic review was conducted to evaluate the prevalence of dental fluorosis among people who live in Saudi Arabia. Methods Online databases EMBASE and MEDLINE and the Cochrane Library were searched, without any restriction regarding age. In addition, there were no study design filters applied to the search engine. Study selection and data extraction were conducted in duplicate. Studies were included if they were conducted in Saudi Arabia on any population (adults and children) and collected dental fluorosis data. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the studies. A narrative synthesis was conducted. Results Seven cross-sectional studies were identified. Areas of weakness in study design/conduct were low response rates, and identification and handling of confounding factors. Statistical pooling of data was not appropriate due to substantial heterogeneity, due in part to variation in sample size, variation of water fluoridation concentration, index used, targeted population and age group. Seven studies present dental fluorosis at any level. The proportion of dental fluorosis prevalence at any level ranged from 0.00 to 0.91. Six studies explored the prevalence of dental fluorosis of aesthetic-only level of concern. The proportion of dental fluorosis in this category ranged from 0.07 to 0.76. Conclusion The proportion of dental fluorosis at any level ranged from 0.00 to 0.91 and fluorosis at aesthetics level ranged from 0.07 to 0.76. However, current data does not provide a complete assessment of dental fluorosis across Saudi Arabia. Existing studies are limited in terms of the population covered. The included studies had methodological flaws.

Objectives Therapeutic drug monitoring (TDM) is one of the tools that aim to improve and ensure the best therapeutic effects while avoiding drug toxicity. This study aimed to identify the clinical utilization and application of TDM at a major teaching hospital in Jeddah. Methods A cross sectional survey of the clinical utilization and application of TDM at King Abdulaziz University Teaching Hospital across nurses in medical, surgical, pediatric, and intensive care units. The sample size (n = 130) represented 30% of the nursing population. The collection of questionnaires started on the 31st of January 2019 and was completed by the 10th of March 2019. Results The indication to use TDM was well-known to respondents. However, only 64% of respondents reported collection and measuring of the correct drug levels at a precise sampling time with no specific protocols being followed for each drug. Moreover, only 53% reported that the drug levels were being re-measured and adequately monitored for the right indication and proper sampling time. Regarding the presence of clinical pharmacists, 70% of the respondents indicated that no clinical pharmacist worked in their department. Conclusion Results demonstrate that appropriate sampling time was not used for the majority of monitored drugs. In the absence of a TDM request form, this finding probably indicates the lack of national or local TDM guidelines. In conclusion, TDM services, which include standardized forms, references, and an active clinical pharmacist will likely improve the application of TDM.

Background/objectives There is limited availability of well-designed comparative studies using propensity score matching with a sufficient sample size to compare laparoscopic liver resection (LLR) vs. open liver resection (OLR) for hepatocellular carcinoma (HCC). We aimed to compare the feasibility and safety of LLR and OLR in patients with HCC. Methods We enrolled 168 patients who underwent elective LLR (n = 58) or OLR (n = 110) for HCC in two tertiary medical centers between November 2009 and December 2018. Patients who underwent LLR were propensity score-matched to patients who underwent OLR in a 1:1 ratio. Perioperative and postoperative outcomes and disease-free and overall survival rates were prospectively evaluated. Results Among the 116 patients analyzed, 58 each belonged to the LLR and OLR groups. We performed 85 segmentectomies or sectionectomies, 19 left-lateral-sectionectomies, 9 left-hemihepatectomies, and 3 right-hemihepatectomies. There was no significant difference in age, sex, Child-Pugh class, original liver disease, preoperative alpha-fetoprotein, tumor size, tumor location, overall morbidity, and operative time. There was a significant difference in the length of postoperative hospital stay between the two groups (LLR vs OLR; 8 vs 10 days, p = 0.003). The 1-, 3-, and 5-year overall survival rates in the LLR and OLR groups were 96.6%, 92.8%, and 73.3% and 93.1%, 88.8%, and 76.1%, respectively (p = 0.642). The 1-, 3-, and 5-year disease-free survival rates in the LLR and OLR groups were 84.4%, 64.0%, and 60.2% and 93.1%, 67.4%, and 63.9%, respectively (p = 0.391). Conclusion LLR for HCC can be performed safely with acceptable short-term and long-term outcomes compared with OLR.

Integrated Energy System (IES) is able to collaborate various energy systems and boost energy supply efficiency. To further facilitate the energy scheduling in IES, load forecasting model of the system is required to describe the conditions continuously on a future time span. While the IES is a service model with frequent in-and-out users which are always dynamically changed, thus the dataset for some new users is always not enough sufficient to build the predicting model. Most of present researches focus on model refinement and accuracy boosting but rarely consider such data lack problem in IES. To tackle this issue, an integrated load forecasting model based on Bidirectional Generative Adversarial Networks (BiGAN) data augmentation and transfer learning techniques is proposed in this paper. Ten different types of data-driven models including the proposed model have been compared on two cases, resident and commercial users, in order to carry out the ablation and contrast experiment. Accuracy with the presented model is 2.08% and 1.50% higher than the original model averagely on resident and commercial users respectively, proving the effectiveness of the new model. And impact of sample size is analyzed and disclosed the effect patterns of the two modules. Result shows that the two modules can flexibly couple with different predictive models and boost their efficiency on both resident and commercial cases on data missing problem. And load forecasting becomes feasible for users with fewer samples or even zero samples when adopting the proposed framework.

Background Pelvic lipomatosis (PL) is a rare condition characterized by diffuse pelvic overgrowth of nonmalignant but infiltrative adipose tissue in perivesical and perirectal space. Objective To share our robotic experience and difficulties encountered and suggested techniques to overcome them successfully. It is the first series from India. Design, setting, and participants A prospective observational study was conducted. All consecutive patients diagnosed with PL between 2016 and 2019 underwent robotic-assisted wide bladder fat extirpation and bilateral ureteral reimplantation (extravesical refluxing type) with double J stenting and were evaluated prospectively. Outcome measurements and statistical analysis Demographics, serum creatinine level, radiographic features, postoperative complications, and patient-reported outcomes were evaluated. Continuous variables are presented as median and range, as the sample size is very small. Results and limitations We encountered a total of five patients with PL. The median console time was 126 (range 120–130) min, with a median estimated blood loss of 120 (range 100–150) ml. Postoperative complications were Clavien-Dindo grade I in three cases, and the median hospital stay was 2 d. Distal ureteric margins showed subepithelial edema with submucosal fibrosis, and bladder fat biopsies were reported as adipose tissue with hemorrhage. At initial 3-mo and annual follow-ups, all patients had normal serum creatinine and there was no evidence of disease recurrence. Limitations of our study are the very small sample size (a low incidence of PL) and short follow-up time period (the question of how long the surgical effect will be sustained due to abnormal proliferation of fat cells remains unanswered). Conclusions Robotic management of wide bladder fat extirpation and bilateral ureteral reimplantation with double J stenting has a good success rate and good outcome in PL. Patient summary Pelvic lipomatosis is a very rare condition. Robotic management in treating the condition has good outcome for the patient. Here, we have discussed the difficulties encountered in treating the condition and the techniques used to overcome them., Take Home Message • Robotic management of pelvic lipomatosis causing bilateral hydroureteronephrosis has good surgical outcome. • Imaging cannot always reliably detect this condition. • The choice of surgical technique purely depends on the surgeon’s comfort, leaving logistic issues aside.

Objective This study aimed to consider the estimated time to multi-resistant tuberculosis culture conversion, and associated factors, in order to enhance evidence utilization in eastern Africa. Methods We systematically identified available articles on multidrug-resistant tuberculosis culture conversion using PubMed, Scopus, Cochrane Library, Web of Science core collection, and Science Direct databases. A random-effects model was employed using the R 3.6.1 version and Stata/se 14 software. Results Nine articles with a sample size of 2458 multidrug-resistant tuberculosis patients were included. The two-month culture conversion rate was 75.4%, with a median time of 61.2 days (interquartile range: 48.6-73.8). In the included studies, favorable treatment outcomes of MDR-TB patients were seen in 75% of the cases, while unfavorable treatment outcomes were seen in 18% (10% deaths, 7% defaulted, and 1% treatment failure) of the cases. The independent factor for delayed sputum culture conversion was body mass index below 18.5 kg/m2 (HR = 3.1, 95% CI: 2.0, 6.7). Conclusion The median time to sputum culture conversion was 61.2 days, which is a reasonably short time. Body mass index was the identified associated factor leading to delayed culture conversion. Therefore, there is a need for awareness of how to improve the nutritional status of multidrug-resistant tuberculosis patients through appropriate nutritional supports.

This paper presents the Bayesian inference of the 3-component Kumaraswamy mixture distribution. The paper formulates the 3-component model, provides Bayesian estimates and their respective posterior risks assuming non-informative prior under type-I censoring. Since the Bayes estimates are not in closed form, the paper provides a comparative analysis of the estimates and their respective risks derived under quadrature method and importance sampling using different loss functions, assuming different sample sizes, test termination times and mixture probabilities. Finally, the proposed 3 component mixture model is then applied to the real life data to assess its validity. The convergence of the estimates under importance sampling is rapidly observed as compared to quadrature methods.

Purpose: The aim of this study is to assess the diagnostic value of magnetic resonance imaging (MRI), alone or combined with positron emission tomography (PET), for evaluation of mediastinal disease in lymphoma in comparison with PET/computed tomography (CT). Material and methods: Eighteen prospective studies with sample size ranging between 17 and 140 patients were included in this analysis. MRI, regardless of the sequence obtained, where used for the evaluation of lymphoma. Histopathology results and clinical or imaging follow-up were used as the reference standard. Studies were excluded if the sample size was less than 15 cases or if less than 15 lymph nodes assessment were presented. Papers not reporting sufficient data were also excluded. Results: As compared to PET/CT, MRI proved to be an alternative to use in evaluation of mediastinal disease of lymphoma. MRI has high sensitivity and specificity for nodal and extranodal involvement in lymphoma and the agreement between MRI with the standard technique was high. The ALARA principle reinforces these findings because it is a radiation-free technique and its use is preferred in young population at risk of being subjected to several studies. Conclusion: MRI seems to be a promising and free-radiation alternative due to its high sensitivity and specificity, as well as its high level of agreement with the standard reference. This suggests that MRI could play a significant role in lymphoma study. Resumen: Objetivo: El objetivo de este estudio es evaluar el valor diagnóstico de la resonancia magnética (RM), sola o combinada con la tomografía por emisión de positrones (PET), para la valoración de la afectación mediastínica en el linfoma en comparación con la tomografía computarizada (TC)/PET. Material y métodos: Se incluyeron en el análisis 18 estudios prospectivos con un tamaño de muestra que oscilaba entre los 17 y los 140 pacientes. Se utilizó la resonancia magnética, independientemente de la secuencia obtenida para la evaluación del linfoma. Los resultados de histopatología y el seguimiento clínico o de imagen se utilizaron como estándar de referencia. Se excluyeron los estudios si el tamaño de la muestra era inferior a 15 casos, o si se presentaron evaluaciones de menos de 15 ganglios linfáticos. Los artículos que no proporcionaban datos suficientes también fueron excluidos. Resultados: En comparación con PET/TC, la RM demostró ser una alternativa útil en la evaluación de la afectación mediastínica del linfoma. La RM tiene una alta sensibilidad y especificidad para detectar afectación nodal y extranodal en el linfoma y la concordancia entre la RMy la técnica estándar fue alta. El principio ALARA refuerza estos hallazgos porque es una técnica libre de radiación y su uso se prefiere en la población joven en peligro de ser sometida a varios estudios. Conclusión: La RM parece ser una alternativa prometedora y libre de radiación debido a su alta sensibilidad y especificidad, así como a su alto nivel de concordancia con la referencia estándar. Esto sugiere que la RM podría desempeñar un papel importante en el estudio del linfoma.

Purpose: The blunt abdominal trauma (BAT) is a common emergency and is significantly associated with morbidity and mortality. Our study was conducted to achieve the goal that a new scoring system could be used for the BAT patients. Methods: The statistical population of this study was 1000 patients with BAT referred to emergency department of Imam Hossein Hospital, Tehran, Iran. Sampling was carried out in a convenience non-random manner and continued to reach the required sample size. All the patients with BAT due to road traffic accidents, falls, and other direct blunt traumas such as punctures and kickbacks were included in the study. Exclusion criteria were after 3 months of pregnancy, under the age of 18, warfarin taking, no reliable medical history providing and penetrating trauma. The study questionnaire was based on BAT scoring system. The data were analyzed by SPSS V20 software. The receiver operating characteristic curve was used to analyze the effectiveness of the new scoring system in predicting the BAT patients’ outcome. Results: The mean age of the patients (n = 1000) was (35.79 ± 13.09) years. The mean score of patients was (6.29 ± 5.80). Based on this scoring system, the patients were divided into three categories. The first group was patients at low risk with score of less than 8, the second group was patients at moderate risk with score of 8–12 and the third group was patients at high risk with score of 12–24. The score of 661 (66.1%) patients were low, 109 (10.9%) were moderate and 230 (23%) had a high score. The association between hip fracture and abdominal tenderness with abdominal injury was significant (p

This chapter discusses the methodology for doing inferences on means of a normally distributed population where the variance is unknown. It describes some of the assumptions necessary for ensuring the validity of these inference procedures and provides an example for which a violation has occurred and a possible alternative inference procedure for that situation. Two major assumptions are needed to assure correctness for statistical inferences: (1) randomness of the sample observations and (2) the distribution of the variables being studied. The sample size requirements for an estimation problem are examined and the degrees of freedom of the test statistic are discussed. An alternate approximation for the confidence interval is also explained. The solution is to add two successes and two failures and then use the standard formula to calculate the confidence interval. This adjustment results in much better performance of the confidence interval, even with relative small samples.

A new method is developed for performing sufficient dimension reduction when probabilistic graphical models are being used to estimate parameters. The procedure enriches the domain of application of dimension reduction techniques to settings where (i) p the number of variables in the model is much larger than the available sample size n, (ii) p is much larger than the number of slices H the model uses and (iii) D the number of projection vectors can be larger than the number of slices H. The methodology is developed for the case of the sliced inverse regression model, but extensions to other dimension reduction techniques such as sliced average variance estimation or other methods are straightforward.

The problem of environmental pollution in today's world is not just a problem for the country or a specific territory. This research was conducted with the aim of investigating the environmental behavior of Iranian citizens. The present study was carried out using meta-analysis method on the performed studies (1998–2018) on pro-environmental behavior Papers related to the subject were gathered with the keywords for environmental behavior and environmental support behavior through searching on Magiran, SID, Scopus, Medline (PubMed) and Science-direct databases. Heterogeneity of studies was obtained using the I2 index, and data were analyzed in the comprehensive meta-analysis software. In 21 papers submitted to the meta-analysis process, 10 papers in the score range 20–100 (A) and 11 papers in the score range 1–5 (B), the total number of samples entered into the study was 3670 in the age range of 15–87 year scores (A), 4413 in the age range of 10–70 year scores (B). The overall mean and standard deviation of the environmental behavior (A) based on a meta-analysis of 50.4 ± 3.1 (44.56%–2.5%: 95% confidence limit) and in the score range 1–5 (B), 3.4 ± 0.18 (3.05%–5.7%, 95% confidence limit), were obtained. The effect of sample size and the publication issue of studies based on meta-regression in order to investigate the effect of heterogeneity in studies. The mean increases in each interval from 1 to 5, with an increase in sample size; in both intervals with an increase in the publication issue, the mean scores increase (P < 0.05). According to Mata-analysis results, the environmental behavior of Iranian citizens in both study intervals, is about average the global mean index of environmental performance., Environmental support behavior, Iran, Meta-analysis, Systematic review, Pro-environmental behavior.

There might be an association between Internet addiction (IA) and loneliness; however, inconsistent evidence suggests that the severity of this association remains unclear. This study was conducted to assess the association between IA and loneliness. A systematic literature search was conducted in four online databases, including PubMed (MESH terms), Web of Science, Scopus, and Embase. Observational studies measuring the association between IA and loneliness were screened and included in this review. A meta-analysis was conducted using the Stata software. Twenty-six articles with a total sample size of 16496 subjects were included in the analysis. A moderate positive association (r = 0.15 (95% CI: 0.13, 0.16)) was found between IA and loneliness. The individuals with IA had significantly higher scores of loneliness. According to this meta-analysis, we need more attention to the early symptoms of loneliness in individuals with IA. Longitudinal studies are needed to determine the temporality of this association considering adjustment for time varying confounders.

Cognitive performance can be predicted from an individual’s functional brain connectivity with modest accuracy using machine learning approaches. As yet, however, predictive models have arguably yielded limited insight into the neurobiological processes supporting cognition. To do so, feature selection and feature weight estimation need to be reliable to ensure that important connections and circuits with high predictive utility can be reliably identified. We comprehensively investigate feature weight test-retest reliability for various predictive models of cognitive performance built from resting-state functional connectivity networks in healthy young adults (n=400). Despite achieving modest prediction accuracies (r=0.2-0.4), we find that feature weight reliability is generally poor for all predictive models (ICC

Summary Background An optimised standard experimental setup across different hospitals is urgently needed to ensure consistency in nucleic acid test results for SARS-CoV-2 detection. A standard comparison across different nucleic acid tests and their optimal experimental setups is not present. We assessed the performance of three common nucleic acid tests, namely digital PCR (dPCR), quantitative PCR (qPCR), and loop-mediated isothermal amplification (LAMP), to detect SARS-CoV-2 in clinical settings. Methods In this systematic review and meta-analysis we compared sensitivity and specificity of qPCR, dPCR, and LAMP and their performances when different experimental setups (namely specimen type used, use of RNA extraction, primer–probe sets, and RNA extraction methods) are applied. We searched PubMed, BioRxiv, MedRxiv, SciFinder, and ScienceDirect for studies and preprints published between Feb 29 and Dec 15, 2020. Included dPCR, qPCR, and LAMP studies using any type of human specimens should report the number of true-positive, true-negative, false-positive, and false-negative cases with Emergency Use Authorization (EUA)-approved PCR assays as the comparator. Studies with a sample size of less than ten, descriptive studies, case studies, reviews, and duplicated studies were excluded. Pooled sensitivity and specificity were computed from the true and false positive and negative cases using Reitsma's bivariate random-effects and bivariate latent class models. Test performance reported in area under the curve (AUC) of the three nucleic acid tests was further compared by pooling studies with similar experimental setups (eg, tests that used RNA extracted pharyngeal swabs but with either the open reading frame 1ab or the N primer). Heterogeneity was assessed and reported in I2 and τ2. Findings Our search identified 1277 studies of which we included 66 studies (11 dPCR, 32 qPCR, and 23 LAMP) with 15 017 clinical samples in total in our systematic review and 52 studies in our meta-analysis. dPCR had the highest pooled diagnostic sensitivity (94·1%, 95% CI 88·9–96·6, by Reitsma's model and 95·8%, 54·9–100·0, by latent class model), followed by qPCR (92·7%, 88·3–95·6, and 93·4%, 60·9–99·9) and LAMP (83·3%, 76·9–88·2, and 86·2%, 20·7–99·9), using EUA-approved PCR kits as the reference standard. LAMP was the most specific with a pooled estimate of 96·3% (93·8–97·8) by Reitsma's model and 94·3% (49·1–100·0) by latent class model, followed by qPCR (92·9%, 87·2–96·2, and 93·1%, 47·1–100·0) and dPCR (78·5%, 57·4–90·8, and 73·8%, 0·9–100·0). The overall heterogeneity was I2 0·5% (τ2 2·79) for dPCR studies, 0% (4·60) for qPCR studies, and 0% (3·96) for LAMP studies. AUCs of the three nucleic acid tests were the highest and differed the least between tests (ie, AUC>0·98 for all tests) when performed with RNA extracted pharyngeal swabs using SARS-CoV-2 open reading frame 1ab primer. Interpretation All three nucleic acid tests consistently perform better with pharyngeal swabs using SARS-CoV-2 open reading frame 1ab primer with RNA extraction. dPCR was shown to be the most sensitive, followed by qPCR and LAMP. However, their accuracy does not differ significantly. Instead, accuracy depends on specific experimental conditions, implying that more efforts should be directed to optimising the experimental setups for the nucleic acid tests. Hence, our results could be a reference for optimising and establishing a standard nucleic acid test protocol that is applicable in laboratories worldwide. Funding University Grants Committee and The Chinese University of Hong Kong.

Objective: Accumulating evidence has been reported regarding the effect of dietary antioxidants on clinical variables in IBD patients, however, findings are controversial. This systematic review and meta-analysis aimed to investigate effect of dietary antioxidants on clinical variables in patients with IBD or its subtypes. Methods: We searched PubMed, Scopus, and ISI Web of Science from inception to January 2021 using relevant keywords. Data were pooled by using the random-effect model. All statistical analyses were done using STATA version 14. Results: Our meta-analysis was exclusively done on studies about the effect of curcumin on IBD patients, because limited studies were done on other antioxidants. Curcumin administration resulted in significant increment of clinical remission in patients with IBD (SMD: 0.86%, 95% CI: 0.16, 1.56, p = 0.016), significant remission in clinical symptoms (SMD: −0.96 score, 95% CI: −1.34, −0.57, p

Objectives: Tobacco use and exposure to second-hand smoke (SHS) in the home setting are major health hazards for adolescents. The objectives of this study were to estimate tobacco use and exposure to SHS among high school students in Ernakulam district of Kerala, India, and to investigate associated factors. Study design: Cross-sectional study. Methods: A school-based cross-sectional study was carried out in 25 randomly selected high schools from 210 schools in the Ernakulam educational district of Kerala, India. The minimum calculated sample size for ever-use of tobacco and SHS exposure was determined to be 2500, with 95% confidence interval (CI) and 10% relative precision. Data were collected using a semi-structured, pre-tested questionnaire from 2585 high school students. Data analyses were performed using SPSS version 20. Results: The ever-use of tobacco was reported to be 3.9% (95% CI 3.16 to 4.54) and the mean age of the participants was 13.97 ± 0.77 years. One-fifth of participants had tried a tobacco product before the age of 10 years. SHS exposure at home was reported by one in every 5 respondents (20.3%). Male gender (adjusted odds ratio [aOR] 8.79; 95% CI 3.16, 24.53), presence of a family member who smokes within the home (aOR 4.28; 95% CI 2.58, 7.12), lack of awareness about the harmful effects of SHS exposure (aOR 2.47; 95% CI 1.41, 5.18) and having seen an advertisement or promotion at point of sale (aOR 2.16; 95% CI 1.29, 3.60) were found to be independent predictors for tobacco use.Participants with respiratory infections were three times more likely to have experienced SHS exposure at home (aOR 2.87; 95% CI 2.21, 3.74), there was an 86% protective effect of SHS exposure for participants with a father in a professional occupation compared with unskilled profession (aOR 0.14; 95% CI 0.02, 0.67; p

Development of non-pharmacological interventions to improve disrupted rest-activity patterns and disturbed behavior in people with dementia is an important research goal. Here we report a proof-of-concept study which evaluates the effect and applicability of a dynamic light intervention to improve rest-activity patterns in cognitively impaired, institutionalized, older adults. The study was a randomized, open-label, proof-of-concept trial of limited sample size conducted at a nursing home for older adults in a non-metropolitan area in Denmark. Participants were 24 older nursing home residents with cognitive deficiencies. Equipment for delivery of a specialized dynamic light intervention was installed in the private apartments (within the nursing home) of the residents in the experimental group (N = 12). Study duration was four weeks. The control group (N = 12) was exposed to conventional lighting. We measured activity and rest using actigraphy, functional disability, behavioral disturbances, and time in bed We performed regression analyses to examine differences between the intervention groups. Participants in the experimental group partially improved on one of three diurnal rhythm variables, but otherwise no differences were observed between the two intervention groups. The improvement was found for the intradaily variability during the first part of the intervention period indicating a more stable and less fragmented 24-h rest-activity rhythm. However, availability of staff assistance in response to impaired physical mobility of the residents seemed to be a stronger determinant of activity level and pattern. The examined intervention showed promising results but did not consistently alter circadian rest-activity patterns in older nursing home residents given the current sample size. Future studies in the field need to consider real-life applicability of the experimental intervention and the interaction and importance of other important zeitgebers than light., Highlights • Circadian rest-activity disturbances are frequent in nursing home residents. • Dynamic lighting might stabilize certain aspects of circadian disruption. • Future interventions should include zeitgebers other than light.

OBJECTIVE: Although instrumental learning deficits are, among other deficits, assumed to contribute to attention-deficit/hyperactivity disorder (ADHD), no comprehensive systematic review of instrumental learning deficits in ADHD exists. This review examines differences between ADHD and typically developing (TD) children in basic instrumental learning and the effects of reinforcement form, magnitude, schedule, and complexity, as well as effects of medication, on instrumental learning in children with ADHD. METHOD: A systematic search of PubMed, PsyINFO, CINAHL, EMBASE+EMBASE CLASSIC, ERIC, and Web of Science was conducted for articles up to March 16, 2020. Experimental studies comparing instrumental learning between groups (ADHD versus TD) or a manipulation of reinforcement/medication within an ADHD sample were included. Quality of studies was assessed with an adapted version of the Hombrados and Waddington criteria to assess risk of bias in (quasi-) experimental studies. RESULTS: A total of 19 studies from among 3,384 non-duplicate screened articles were included. No difference in basic instrumental learning was found between children with ADHD and TD children, nor effects of form or magnitude of reinforcement. Results regarding reinforcement schedule and reversal learning were mixed, but children with ADHD seemed to show deficits in conditional discrimination learning compared to TD children. Methylphenidate improved instrumental learning in children with ADHD. Quality assessment showed poor quality of studies with respect to sample sizes and outcome and missing data reporting. CONCLUSION: The review identified very few and highly heterogenous studies, with inconsistent findings. No clear deficit was found in instrumental learning under laboratory conditions. Children with ADHD do show deficits in complex forms of learning, that is, conditional discrimination learning. Clearly more research is needed, using more similar task designs and manipulations. ispartof: Journal Of The American Academy Of Child And Adolescent Psychiatry vol:60 issue:11 pages:1367-1381 ispartof: location:United States status: published

Several analytical techniques have shown use for the identification of historical synthetic organic pigments (SOPs) in samples. However, as the techniques differ—for example, in the extent of sample intervention, modes of detection, and limits of detection—so do they differ in results and insights into the colorants and colorant derivatives in a sample. Liquid chromatography (LC) is infrequently applied to the task of SOP identification, despite its ability to differentiate similar molecules, detect at low concentrations, and separate of complex samples and its established usage for organic dyes. This research compared results obtained with micro-Raman spectroscopy and pyrolysis gas chromatography with results from ultra-high performance (UP)LC coupled with photodiode array detection (UPLC-PDA), and high resolution mass spectrometry (UPLC-HRMS) to judge the quantity and quality of SOP information obtained by each technique. In this study, 67 historical samples were analyzed from historical samples and sample books (1918–1950), consisting of 10 oil paint tubes, 45 oil-bound paint-outs, and 13 gum-bound pigment washes using sample sizes less than a milligram. As few studies have used LC for SOP identification, special attention is also paid to issues around sample preparation and interpretation of results from UPLC-PDA and UPLC-PDA-HRMS results. Finally, archival sources and other contemporary documents are used to contextualize and evaluate the plausibility of the analytical results. The results indicate that specific combinations of analytical techniques are required for confident SOP identifications. While Raman results were accurate and independent of sample solubility, they relied heavily on database completeness and were not sensitive to mixtures or differences in relative amounts of SOPs. UPLC-PDA was an effective complement for these shortcomings, except for a few samples that were insoluble. The use of HRMS was critical for the elucidation of unknown SOPs.

Background Refractive errors are the most common vision problem and prove to be a significant health issue. There are several methods for correction of refractive errors including spectacles, contact lenses and refractive surgery. Nowadays, the reliance on contact lenses and glasses is decreased by means of refractive eye surgery. Our study aimed to determine the awareness of refractive surgery among undergraduate medical students and their preferred method of refractive error correction. Method This was a cross-sectional study that was conducted among a sample size of 374 medical students at King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia in June–August 2020. Data were collected through a questionnaire which consisted of 20 questions to assess the demographics, awareness about refractive surgery and preferred method of correction. The data were entered using Microsoft Excel 2016 and analyzed by SPSS version 21. Results Our results showed that 177 of participants had refractive errors. Most participants complained of myopia (66.7%) and the most preferred correction method was spectacles (45.8%). Among users of spectacles, 53.7% found the spectacles comfortable due to ease of use. Majority of the students (92.1%) were aware of refractive surgery and 73% of them were willing to undergo refractive surgery. Many obtained their information regarding these procedures from family and friends (55.1%). The remaining refused to undergo surgery and the primary reason was fear of the complications of the procedure (14.1%). Conclusion Though corrective refractive surgery is a commonly performed procedure, extensive knowledge regarding this correction method and its complications is poor among medical students. The results showed that the majority have heard of refractive surgery, however, fear of undergoing surgery was still present. We suggest that refractive error correction surgery be taught by physicians during Ophthalmology rotations so that knowledge may be gained from more reliable sources., Highlights - Though corrective refractive surgery is a commonly performed procedure, proper knowledge regarding this correction method is poor among medical students. - Spectacles were the most common correction method used, followed by both spectacles and contact lenses. - The results of our study demonstrate that most students are aware of refractive surgery but there is still a moderate willingness to undergo refractive surgery mostly due to fear of complications. - Most of the participants reported that family and friends were their main source of knowledge. - We recommend refractive surgical correction methods be introduced by physicians in Ophthalmology rotations during medical school and provide students with more information about the safety and efficacy of these surgeries.

Introduction: A panoramic radiography is a test, which allows the evaluation of the maxillo-mandibular anatomy. The objective of this study was to use panoramic radiography to evaluate the state of the mandibular basilar cortical of normal tooth and edentulous female subjects over 40 years of age by the mandibular cortical index. Research methods and materials: This was a cross-sectional study of female subjects aged 40 years and over. A sample size of 360 radiographs of 180 totally edentulous and 180 normal tooth subjects were considered for this study. The mandibular basilar cortical bone was assessed by the mandibular cortical index using the classification described by Klemetti: C1 (normal cortex), C2 (slightly or moderately eroded cortex), C3 (severely eroded cortical layer). Statistical data collection and analysis were conducted with Jamovi. The results for qualitative variables were expressed in percentages and those of quantitative variables in means ± standard deviation. The significance level was set at p ≤ 0.05. Results: The average age for normal tooth subjects was 55 ± 11 years. Subjects with C1 CMI represented 27.8% of the population studied, 55.3%, and 16.9% for C2 and C3 indices respectively. The association between MCI and dental status revealed a significant statistical difference p

Introduction Nonadherence and poor health care behaviors contribute to worsening of heart failure symptoms, in many cases leading to increased morbidity and mortality. Aim To assess the efficacy of nurse-led cardiac rehabilitation on health care behaviours in adults with chronic heart failure. Method. An experimental design was conducted in India from January to December of 2019. A sample size of 200 adults with heart failure from a tertiary cardiac care center was enrolled. Participants were allocated into an intervention group (n = 100) and a control group (n = 100). A nurse-led cardiac rehabilitation program using a virtual educational video and reminder telephone calls was given to the intervention group for six months. A modified heart failure adherence and health care behaviours scale was used. Results 78% of the adults in the intervention group and 79% of the adults in the control group were males. 43% of the adults in the intervention group and 32% of the adults in the control group had ≥2 years of chronic heart failure. 42.27% of the participants in the intervention group and 35.05% of the adults in the control group indicated that medical follow-ups were essential. 21.65% of the adults in the intervention group and 13.40% of the adults in the control group expressed no difficulty adhering to the sodium restriction in the posttest2. The participants in the intervention group had higher health care behaviours compared to control group, p Conclusion/Implication Cardiac nurses need to adopt cardiac rehabilitation in continuity of care for improving health care behaviours for adults with chronic heart failure.

Human activity recognition (HAR) attempts to classify performed activities from data retrieved from different sensors attached to the body. Most publications pertaining to HAR based on deep neural networks (DNNs) report the development of a suitable architecture to improve recognition accuracy by increasing the parameters of the architecture. Our work follows a different approach by attempting to optimise DNN-based HAR by reducing the dimensions of acceleration data, by finding a suitable sample size for processing by the DNN and by reducing the parameters of the proposed architecture. The experiments rely on employing two previously presented DNN-based HAR architectures as the baselines and starting points to create our candidate architectures. The variations in the dimensions of acceleration data, i.e., {xy, yz, xz, x, y, z}, and the sample size, i.e. {4, 6, 8} s duration, to these candidate architectures are experimented to produce the winner architecture which takes the shortest sample size and the minimal dimensions of acceleration data while preserving the recognition precision. The results indicate that despite the number of parameters is approximately half of the baseline architecture with two dimensions of acceleration data and shorter sample size (i.e., using a sample of 4 s duration instead of 8 s and only the xy axes of acceleration data), the resulting DNN-based HAR classifiers can produce comparable or better recognition precision than the baseline classifiers. The experimental results were obtained using three different popular datasets: the WISDM, the UCI HAR, and the Real World 2016. The proposed classifiers with optimised settings are useful as they require less processing time and reduce power consumption, both in terms of retrieving acceleration data from the sensor and the CPU processing time. Furthermore, they reduce the memory requirements for parameter storing and are suitable for incorporation in a wearable device., Human activity recognition; Deep neural network; Wearable device.

Purpose: Transcranial magnetic stimulation (TMS) provides an indication of changes occurring in the corticospinal pathway. This study aimed to determine the between-day (trials 1 week apart) and within-day (trials 1 h apart) reliability of TMS and peripheral nerve stimulation.\ud \ud Methods: 22 male participants (age 23 ± 4 years; height 1.80 ± 0.07 m; body mass 75.1 ± 11.7 kg; body mass index 23.1 ± 2.5 kg.m 2) completed 2 familiarisation sessions and 3 experimental trials (trial 2 and 3 split by 1 h). The interpolated twitch technique was used to determine TMS-assessed voluntary activations (VA-TMS) superimposed on submaximal and maximal leg extension performed on a custom-built dynamometer. Reliability was assessed using equivalence tests, systematic error, 95% limits of agreement, intraclass correlation coefficient (ICC) and coefficient of variation (CV).\ud \ud Results: VA-TMS was equivalent between-day (94.1 ± 4.4% versus 93.7 ± 4.9%, P < 0.01) and within-day (93.7 ± 4.9% versus 93.7 ± 4.8%, P < 0.01). Systematic error (95% limits of agreement) for VA-TMS was 0.5% (5.1%, 4.2%) for between-day and 0.0% 2 (5.3%, 5.4%) for within-day. ICC and CV values demonstrated high reliability between-day (ICC = 0.93, CV = 2.5%) and within-day (ICC = 0.92, CV = 2.9%).\ud \ud Conclusion: Results indicate that TMS can reliably estimate the output of the motor cortex to the knee extensors, both between-day and within-day. The findings have been used to estimate sample sizes for this technique for future research.

Research on smartphone use among college students is extensive. Although numerous studies have examined the relationships between mobile phone use and academic achievements, many such studies have yielded mixed findings. Hence, the overarching goal of this meta-analysis was to comprehensively synthesize existing research to investigate the effects of smartphone addiction on learning. The authors included 44 studies (45 effects) in the analysis yielding a sample size of N ​= ​147,943 college students from 16 countries. The results show that smartphone addiction negatively impacts students' learning and overall academic performance (Q (43) ​= ​711.87, p ​

Background Bhutan lacks a medical school and all medical students are trained in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic led to the closure of medical schools in these countries in March–April 2020, the medical students were repatriated to Bhutan. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and their attitude towards participation in government's health response to COVID-19. Methods This was a cross-sectional study among medical students who had returned to the country. The survey was conducted through an online questionnaire while the students were in facility quarantine. The sample size calculated was 129 and convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Knowledge was considered “good” if the cumulative score was ≥80%, “satisfactory” if ≥60–79% and “poor” if, COVID-19; Medical education; Medical school; Online learning; Social media; Pandemic

Background In clinical setting, to answer a research question, very often more than one outcome variables are used which are statistically correlated. Univariate analysis approach, which is commonly used in such context, violates the assumption of independence for correlated variables, while multivariate approach could give more robust and precise clinical decision by accounting this correlation. This paper is a demonstration of the change in statistical decision in multivariate approach compared to univariate approach in analysing medical data with multiple correlated outcome variables. Method ology: The data used in this paper was the ACCORD trial data and the variables were Systolic blood pressure (SBP) and Diastolic blood pressure (DBP) which are correlated. The condition of bivariate normality was checked after removing the outliers. We compared the differences in means of SBP and DBP separately between the groups at different follow up time points by univariate approach using unpaired ‘t' test and thereafter together by bivariate approach using Hotelling ‘T2'. Further the role of varied levels of correlation between SBP and DBP coupled with the variations in sample size in changing the statistical inference has been investigated. Robustness of these results were demonstrated through 1000 samples of simulated data from Accord trial data. Results The statistical decision regarding difference in means of either SBP or DBP between the two groups at baseline, 12th, 36th and 84th month in both univariate and bivariate approaches were similar. At baseline and 84th month the hypotheses were accepted and at 12th and 36th month the hypotheses were rejected with both the approaches. However at 60th and 72nd month the univariate and multivariate approach results contradicted each other which reflect the significance of correlation in modifying the inference. The analysis results further indicated that varied levels of correlation and sample size too modify the inference in bivariate approach and contradict univariate results. Conclusion Studies with multiple correlated outcomes, the multivariate approach which accounts this statistical correlation has potential to change statistical decisions and provide more precise results. Hence multivariate approach is recommended in such situations.

Background Depression and fatigue are common consequences of breast cancer that lead to dysfunction and reduced quality of life of patients. The aim of the present study was to determine the effect of exercise program on depression and fatigue in breast cancer women undergoing chemotherapy. Methods This randomized controlled trial study was performed on 60 breast cancer women undergoing chemotherapy in Kermanshah hospitals from 2017-2018. Participants were selected using convenience sampling and were randomly divided into intervention and control groups. Data collection tools included demographic information form and standard Beck depression inventory (BDI-II) and fatigue severity scale (FSS). The intervention group performed the 20-30-minute indoor exercise program 3 sessions a week for 6 weeks. Questionnaires were completed before, immediately, and one month after the intervention by both groups and data analysis was carried out using SPSS ver.22. Results There was no statistically significant difference between the two groups in terms of the mean fatigue intensity and depression scores before the intervention; however, the mean fatigue intensity scores were significantly decreased in the intervention group as compared to the control group immediately and one month after the intervention (P = 0.001). There was no statistically significant difference between the two groups in terms of mean depression score immediately and one month after the intervention (p > 0.05). Conclusion Considering that indoor exercises reduced fatigue in breast cancer women undergoing chemotherapy, patients are recommended to perform exercise interventions as a non-pharmacological, safe, easy, and non-invasive solution to improve their physiological capacities and functional abilities as well as Quality of life. On the other hand, since exercise program had no effect on depression among breast cancer women in the present study, longer studies with larger sample size are recommended., Depression, Fatigue, Breast cancer, Exercise, Randomized controlled trial.

Background and Objectives Missing outcome data are a common occurrence for most clinical research trials. The ’complete case analysis’ is a widely adopted method to tackle with missing observations. However, it reduced the sample size of the study and thus have an impact on statistical power. Hence every effort should be made to reduce the amount of missing data. The objective of this work is to provide the application of different analytical tools to handle missing data imputation techniques through illustration. Methods We used Imputation techniques such as EM algorithm, MCMC, Regression, and Predictive Mean matching methods and compared the results on hepatitis C virus-induced hepatocellular carcinoma (HCV-HCC) data. The statistical models by Generalized Estimating Equations, Time-dependent Cox Regression, and Joint Modeling were applied to obtain the statistical inference on imputed data. The missing data handling technique compatible with Principle Component Analysis (PCA) was found suitable to work with high dimensional data. Results Joint modelling provides a slightly lower standard error than other analytical methods each imputation. Accordingly, to our methodology, Joint Modeling analysis with the EM algorithm imputation method has appeared to be the most appropriate method with HCV-HCC data. However, Generalized Estimating Equations and Time-dependent Cox Regression methods were relatively easy to run. Conclusion The multiple imputation methods are efficient to provide inference with missing data. It is technically robust than any ad hoc approach to working with missing data.

BackgroundSARS-CoV-2 antibody tests are used for population surveillance and might have a future role in individual risk assessment. Lateral flow immunoassays (LFIAs) can deliver results rapidly and at scale, but have widely varying accuracy.MethodsIn a laboratory setting, we performed head-to-head comparisons of four LFIAs: the Rapid Test Consortium’s AbC-19™Rapid Test, OrientGene COVID IgG/IgM Rapid Test Cassette, SureScreen COVID-19 Rapid Test Cassette, and Biomerica COVID-19 IgG/IgM Rapid Test. We analysed blood samples from 2,847 key workers and 1,995 pre-pandemic blood donors with all four devices.FindingsWe observed a clear trade-off between sensitivity and specificity: the IgG band of the SureScreen device and the AbC-19™device had higher specificities but OrientGene and Biomerica higher sensitivities. Based on analysis of pre-pandemic samples, SureScreen IgG band had the highest specificity (98.9%, 95% confidence interval 98.3 to 99.3%), which translated to the highest positive predictive value across any pre-test probability: for example, 95.1% (95%CI 92.6, 96.8%) at 20% pre-test probability. All four devices showed higher sensitivity at higher antibody concentrations (“spectrum effects”), but the extent of this varied by device.InterpretationThe estimates of sensitivity and specificity can be used to adjust for test error rates when using these devices to estimate the prevalence of antibody. If tests were used to determine whether an individual has SARS-CoV-2 antibodies, in an example scenario in which 20% of individuals have antibodies we estimate around 5% of positive results on the most specific device would be false positives.FundingPublic Health England.Research in contextEvidence before this studyWe searched for evidence on the accuracy of the four devices compared in this study: OrientGene COVID IgG/IgM Rapid Test Cassette, SureScreen COVID-19™ Rapid Test Cassette, Biomerica COVID-19 IgG/IgM Rapid Test and the UK Rapid Test Consortium’s AbC-19™ Rapid Test. We searched Ovid MEDLINE (In-Process & Other Non-Indexed Citations and Daily), PubMed, MedRxiv/BioRxiv and Google Scholar from January 2020 to 16thJanuary 2021. Search terms included device names AND ((SARS-CoV-2) OR (covid)). Of 303 records assessed, data were extracted from 24 studies: 18 reporting on the accuracy of the OrientGene device, 7 SureScreen, 2 AbC-19™ and 1 Biomerica. Only three studies compared the accuracy of two or more of the four devices. With the exception of our previous report on the accuracy of the AbC-19™ device, which the current manuscript builds upon, sample size ranged from 7 to 684. For details, see Supplementary Materials.The largest study compared OrientGene, SureScreen and Biomerica. SureScreen was estimated to have the highest specificity (99.8%, 95% CI 98.9 to 100%) and OrientGene the highest sensitivity (92.6%), but with uncertainty about the latter result due to small sample sizes. The other two comparative studies were small (n = 65, n = 67) and therefore provide very uncertain results.We previously observed spectrum effects for the AbC-19™ device, such that sensitivity is upwardly biased if estimated only from PCR-confirmed cases. The vast majority of previous studies estimated sensitivity in this way.Added value of this studyWe performed a large scale (n = 4,842), head-to-head laboratory-based evaluation and comparison of four lateral flow devices, which were selected for evaluation by the UK Department of Health and Social Care’s New Tests Advisory Group, on the basis of a survey of test and performance data available. We evaluated the performance of diagnosis based on both IgG and IgM bands, and the IgG band alone. We found a clear trade-off between sensitivity and specificity across devices, with the SureScreen and AbC-19™ devices being more specific and OrientGene and Biomerica more sensitive. Based on analysis of 1,995 pre-pandemic blood samples, we are 99% confident that SureScreen (IgG band reading) has the highest specificity of the four devices (98.9%, 95% CI 98.3, 99.3%).We found evidence that all four devices have reduced sensitivity at lower antibody indices, i.e. spectrum effects. However, the extent of this varies by device and appears to be less for other devices than for AbC-19.Our estimates of sensitivity and specificity are likely to be higher than would be observed in real use of these devices, as they were based on majority readings of three trained laboratory personnel.Implications of all the available evidenceWhen used in epidemiological studies of antibody prevalence, the estimates of sensitivity and specificity provided in this study can be used to adjust for test errors. Increased precision in error rates will translate to increased precision in seroprevalence estimates. If lateral flow devices were used for individual risk assessment, devices with maximum specificity would be preferable. However, if, for an example, 20% of the tested population had antibodies, we estimate that around 1 in 20 positive results on the most specific device would be incorrect.

Evidence for Action (E4A), a signature program of the Robert Wood Johnson Foundation, funds investigator-initiated research on the impacts of social programs and policies on population health and health inequities. Across thousands of letters of intent and full proposals E4A has received since 2015, one of the most common methodological challenges faced by applicants is selecting realistic effect sizes to inform calculations of power, sample size, and minimum detectable effect (MDE). E4A prioritizes health studies that are both (1) adequately powered to detect effect sizes that may reasonably be expected for the given intervention and (2) likely to achieve intervention effects sizes that, if demonstrated, correspond to actionable evidence for population health stakeholders. However, little guidance exists to inform the selection of effect sizes for population health research proposals. We draw on examples of five rigorously evaluated population health interventions. These examples illustrate considerations for selecting realistic and actionable effect sizes as inputs to calculations of power, sample size and MDE for research proposals to study population health interventions. We show that plausible effects sizes for population health interventions may be smaller than commonly cited guidelines suggest. Effect sizes achieved with population health interventions depend on the characteristics of the intervention, the target population, and the outcomes studied. Population health impact depends on the proportion of the population receiving the intervention. When adequately powered, even studies of interventions with small effect sizes can offer valuable evidence to inform population health if such interventions can be implemented broadly. Demonstrating the effectiveness of such interventions, however, requires large sample sizes., Highlights • Effect sizes achievable with population health interventions are likely small. • Effect sizes depend on intervention characteristics, mechanisms of effect, target population, and outcome measures. • Small individual-level effects can translate to large population health effects. • Adequate power will usually require large sample sizes. • Power calculations can use the smallest effect size that would justify intervention adoption.

Introduction Reminiscence therapy has been shown to improve mental health and quality of life in dementia; however, reminiscence therapy is often delivered by therapists instead of being technology-enabled. This study evaluated the preliminary efficacy of Memory Matters (MM), an iPad reminiscence game on mood, social interaction, quality of life, and behavioral and psychological symptoms of dementia. Methods This pilot study used an experimental design where participants were randomized on a 2:2:1 ratio to three arms: individual MM (one-on-one with an interventionist), group MM (2–3 participants per session), or waitlist control. MM was delivered for 30 minutes a session, twice a week for six weeks, followed by six-week self-play. Outcomes were assessed at the baseline, six weeks, and 12 weeks by data collectors blinded to group allocation. Data were analyzed using intention-to-treat analysis and analysis of covariance. Results The sample (n = 80) was 82.1 ± 7.8 years in age with 58% female, 15.3 ± 3.3 years of education. Mood did not differ, except for apathetic mood between group MM and control arm at 12 weeks (P = .051). Social interaction improved for individual MM compared with group MM (t = 2.38, P = .017) and control (t = 2.84, P = .005) at six weeks, but not 12 weeks. Other outcomes did not differ. Discussion MM improved social interaction and possibly mood. Future studies are needed to evaluate the efficacy of MM with a sufficient sample size.

Objective: To analyze the effect of height catch-up at school age on the bone mass of adolescents of a Brazilian birth cohort. Methods: A cohort study using data obtained from the three moments (birth, 7/9 years and 18/19 years of age) of the Cohorts-RPS study. Height catch-up was defined based on the difference between the schoolchild's z-score and birth z-score. The adolescents’ bone mineral mass was analyzed using the z-score index for the lumbar spine measured by dual emission X-ray absorptiometry. A theoretical model was developed for the proposed analysis using directed acyclic graphs paired through the nearest-neighbor matching propensity score using the STATA software, version 14.0. The level of significance was set at 5%. Results: Of the 297 studied children, 24.5% achieved height catch-up. The bone mass below the expected for age was observed in 5.39% of the subjects. The mean lumbar spine z-score was −0.34 (±1.01). After the adjustment, no effect was observed between height catch-up at school age and bone mass in adolescents (Coeff = 0.598; 95% CI −0.117 to 1.313; p = 0.101). Conclusion: Even using the directed acyclic graphs and the causal inference method by adjusting the propensity score, the height catch-up did not seem to affect bone mass in adolescents, a result perhaps related to the sample size. Resumo: Objetivo: Analisar o efeito do catch-up de estatura na idade escolar na massa óssea em adolescentes em uma coorte brasileira de nascimento. Métodos: Estudo de coorte, utilizando dados dos três momentos (nascimento, aos 7/9 anos e 18/19 anos) da pesquisa Coortes-RPS. Catch-up de estatura foi definida a partir da diferença entre o Z-score do escolar e Z-score do nascimento. Para a análise da massa óssea em adolescentes foi utilizado o índice Z-score da coluna lombar medido pela densitometria por dupla emissão de raio X. Para análise proposta, foi construído modelo teórico usando os gráficos acíclicos direcionados e pareado por escore de propensão do tipo vizinho mais próximo utilizando o software STATA versão 14.0. O nível de significância adotado foi de 5%. Resultados: Das 297 crianças, 24,58% realizaram o catch-up estatural. Massa óssea abaixo do esperado para a idade foi de 5,39%. O Z-score médio da coluna lombar foi -0,34 (± 1,01). Após ajuste, não foi observado efeito entre catch-up de estatura na idade escolar e massa óssea no adolescente (Coef = 0,598; IC 95% -0,117 – 1,313; p = 0,101). Conclusão: Mesmo com os gráficos acíclicos direcionados e o método de inferência causal por ajuste do escore de propensão, o catch-up de estatura parece não afetar a massa óssea em adolescentes, resultado talvez relacionado ao tamanho da amostra. Keywords: Growth, Height, Bone density, Cohort studies, Propensity scores, Palavras-chave: Crescimento, Estatura, Densidade óssea, Estudos de coortes, Pontuação de propensão

The testing for stationarity of energy imports, in order to infer whether policies to reduce resource dependence are likely to have long term impact, is limited in the literature. A recently introduced residual augmented least squares procedure is used to examine the stationarity of crude oil imports per capita in 32 countries. The results provide evidence for nonstationarity in oil imports per capita of 10 countries (or 31% of the total sample size). In order to provide corroborating evidence, we employ recent panel unit root tests, which provide for the possibility of cross-sectional dependence among the members of a panel. The empirical findings provide support in favour of stationarity of imports per capita in the series. The policy implications of the results are discussed. Keywords: Crude oil imports, Energy dependence, Unit root test, Time series, Panel data

As next-generation sequencing (NGS) technology has become widely used to identify genetic causal variants for various diseases and traits, a number of packages for checking NGS data quality have sprung up in public domains. In addition to the quality of sequencing data, sample quality issues, such as gender mismatch, abnormal inbreeding coefficient, cryptic relatedness, and population outliers, can also have fundamental impact on downstream analysis. However, there is a lack of tools specialized in identifying problematic samples from NGS data, often due to the limitation of sample size and variant counts. We developed SeqSQC, a Bioconductor package, to automate and accelerate sample cleaning in NGS data of any scale. SeqSQC is designed for efficient data storage and access, and equipped with interactive plots for intuitive data visualization to expedite the identification of problematic samples. SeqSQC is available at http://bioconductor.org/packages/SeqSQC. Keywords: Next-generation sequencing, Quality assessment, 1000 Genomes Project, Whole-exome sequencing, Bioconductor package

Objectives: Exposome-wide association studies (EWAS) are a systematic and unbiased way to investigate multiple environmental factors associated with phenotype. We applied EWAS to study semen quality and queried the sample size requirements to detect modest associations in a reproductive cohort. Study design and setting: We conducted 1) a multivariate EWAS of 128 endocrine disrupting chemicals (EDCs) from 15 chemical classes measured in urine/serum relative to 7 semen quality endpoints in a prospective cohort study comprising 473 men and 2) estimated the sample size requirements for EWAS etiologic investigations. Results: None of the EDCs were associated with semen quality endpoints after adjusting for multiple tests. However, several EDCs (e.g., polychlorinated biphenyl congeners 99, 105, 114, and 167) were associated with raw p

Background: “Evidence Mapping” is an emerging tool that is increasingly being used to systematically identify, review, organize, quantify, and summarize the literature. It can be used as an effective method for identifying well-studied topic areas relevant to a broad research question along with any important literature gaps. However, because the procedure can be significantly resource-intensive, approaches that can increase the speed and reproducibility of evidence mapping are in great demand. Methods: We propose an alternative process called “rapid Evidence Mapping” (rEM) to map the scientific evidence in a time-efficient manner, while still utilizing rigorous, transparent and explicit methodological approaches. To illustrate its application, we have conducted a proof-of-concept case study on the topic of low-calorie sweeteners (LCS) with respect to human dietary exposures and health outcomes. During this process, we developed and made publicly available our study protocol, established a PECO (Participants, Exposure, Comparator, and Outcomes) statement, searched the literature, screened titles and abstracts to identify potentially relevant studies, and applied semi-automated machine learning approaches to tag and categorize the included articles. We created various visualizations including bubble plots and frequency tables to map the evidence and research gaps according to comparison type, population baseline health status, outcome group, and study sample size. We compared our results with a traditional evidence mapping of the same topic published in 2016 (Wang et al., 2016). Results: We conducted an rEM of LCS, for which we identified 8122 records from a PubMed search (January 1, 1946–May 1, 2014) and then utilized machine learning (SWIFT-Active Screener) to prioritize relevant records. After screening 2267 (28%) of the total set of titles and abstracts to achieve 95% estimated recall, we ultimately included 297 relevant studies. Overall, our findings corroborated those of Wang et al. (2016) and identified that most studies were acute or short-term in healthy individuals, and studied the outcomes of appetite, energy sensing and body weight. We also identified a lack of studies assessing appetite and dietary intake related outcomes in people with diabetes. The rEM approach required approximately 100 person-hours conducted over 7 calendar months. Conclusion: Rapid Evidence Mapping is an expeditious approach based on rigorous methodology that can be used to quickly summarize the available body of evidence relevant to a research question, identify gaps in the literature to inform future research, and contextualize the design of a systematic review within the broader scientific literature, significantly reducing human effort while yielding results comparable to those from traditional methods. The potential time savings of this approach in comparison to the traditional evidence mapping process make it a potentially powerful tool for rapidly translating knowledge to inform science-based decision-making. Keywords: Rapid evidence mapping, Evidence map, Systematic review, Evidence-based methodology, Low calorie sweeteners, Artificial sweeteners

Purpose: To compare the efficacy and safety of recombinant human bone morphogenetic protein (rhBMP) and iliac crest autograft in the fusion treatment of lumbar spondylolisthesis. Methods: The studies using randomized controlled trials to compare the rhBMP with iliac crest autograft in the treatment of lumbar spondylolisthesis were retrieved from Embase, Pubmed, ProQuest dissertations & theses (PQDT), China national knowledge infrastructure (CNKI), Chinese Biomedical Database, Wanfang Data, Cochrane Library (from March 1998 to March 2018). Postoperative fusion rate, clinical success rate, postoperative intervertebral height, complications, operation time, blood loss and duration of hospitalization were chosen as the outcome indicators. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.3 was used for data-analysis. Results: Eleven articles were included in the meta-analysis. The results showed that, comparing the efficacy of rhBMP with iliac crest autograft, statistical significance was found in the 24-month fusion rate post operation [95% CI (1.38, 24.70), p ＝0.02] and operation time [95% CI (-14.22, -2.08), p ＝0.008]. There is not sufficient evidence for statistical differences in the remaining indicators. Conclusion: The current literature shows rhBMP is a safe and effective grafting material in the treatment of lumbar spondylolisthesis. Further evidence is dependent on the emergence of more randomized controlled trials with higher quality and larger sample sizes in the future. Key words: Spondylolysis; Bone morphogenetic proteins; Ilium; Autografts; Meta-analysis

The measurement of insects is an important component of many entomological applications, including forensic evidence, where larvae size is used as a proxy for developmental stage, and hence time since colonization/death. Current methods for measuring insects are confounded by varying preservation techniques, biased and non-standardized measurements, and often a lack of sample size given practical constraints. Towards enhanced accuracy and precision in measuring live insects to help avoid these variables, and that allows for different measurements to be analyzed, we developed a non-invasive, digital method using widely available free analytical software to measure live blow fly larvae. Using crime scene photographic equipment currently standard in investigation protocols, we measured the live length of 282 Phormia regina larvae. Repeated measurements of maggots, for all instars, were performed for several orientations and images. Most accurate measurements were obtained when maggots were oriented in their natural full extension. Killed specimens resulted in greater length measurements (Mean 1.79 ± 1.11 mm) when compared to live length. Herein, we report a technically simple, fast, and accurate measurement technique adapted for field and lab-based measurements, as well as, a simple linear equation for conversion of live length to standard killed length measurements. We propose this method be utilized for the standardization of forensic entomological evidence collection and development model creation. Keywords: Forensic entomology, Digital image measurement, Morphometric, Insect size, Phormia regina, Forensic photography

Background World Health Organization defined stillbirth as birth of fetus at 28 weeks or above gestation with a birth weight of ≥1000 g or body length of ≥35 cm. Majority of stillbirths occur in low and middle income nations. Efforts made in Ethiopia to improve maternal and child health are showing encouraging results, even though the magnitude didn't reach the expected level. Identification of determinants of stillbirth is quite substantial to apply further meaningful actions. Objective To assess the determinants of stillbirth in hospitals of North Shoa Zone, Oromia region, Central Ethiopia. Method Institution based unmatched Case control study was conducted from March 01 to May 30/2019 among 342 women who gave birth in Fitche, Kuyu, Gundomeskel, and Muketurihospitals. Sample size was calculated by using Epi-info version 7.1.1 software package. Statistical Package for Social Sciences version 25 was used to analyze the data. Descriptive statistics, bivariate and multivariate logistic regression analysis were conducted. Variables having P-value ≤ 0.05 in multivariable logistic regression were considered as statistically significant. Result Type of labor (AOR = 3.79, 95%CI = 1.53, 9.38), duration of labor (AOR = 3.59, 95% CI = 1.53, 8.33), mal-presentation (AOR = 3.45, 95%CI = 1.99, 9.8), preeclampsia/eclampsia (AOR = 4.58, 95%CI = 1.45, 14.48) and birth defect (AOR = 3.05, 95%CI = 1.31, 7.1) were found to be the determinants of stillbirth. Conclusion and recommendation Causes of still birth in more than two third of the cases were identified. Type of labor, duration of labor, mal presentation, preeclampsia/eclampsia were identified as determinants of stillbirth from mothers’ side while birth defect was found to be determinant of stillbirth from fetal side. Heath care providers, policy makers, and other stakeholders, should focus on identified factors to combat problems associated with still birth., Determinants, Stillbirth, Hospitals, North Shoa