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Background/objectives: Few studies have investigated the effects of bariatric surgery on vitamin status in the long term. We examined changes in vitamin status up to 5 years after Roux-en-Y gastric bypass surgery.Subjects/methods: Using a retrospectively maintained database of patients undergoing weight loss surgery, we identified all patients operated with Roux-en-Y gastric bypass at our tertiary care hospital during July 2004-May 2008. Data on vitamin concentrations and patient-reported intake of dietary supplements were collected up to July 2012. Linear mixed models were used to estimate changes in vitamin concentrations during follow-up, adjusting for age and sex. All patients were recommended daily oral multivitamin, calcium/vitamin D and iron supplements and 3-monthly intramuscular B-12 after surgery.Results: Out of the 443 patients operated with gastric bypass, we included 441 (99.5%) patients with one or more measurements of vitamin concentrations (75.1% women; mean age 41.5 years, mean body mass index 46.1 kg/m(2) at baseline). At 5 years after surgery, the patients' estimated mean vitamin concentrations were either significantly higher (vitamin B-6, folic acid, vitamin B-12, vitamin C and vitamin A) or not significantly different (thiamine, 25-hydroxyvitamin D and lipid-adjusted vitamin E) compared with before surgery. Use of multivitamin, calcium/vitamin D and vitamin B-12 supplements was reported by 1-9% of patients before surgery, 79-84% of patients at 1 year and 52-83% of patients 5 years after surgery.Conclusions: In patients who underwent gastric bypass surgery, estimated vitamin concentrations were either significantly increased or unchanged up to 5 years after surgery. [ABSTRACT FROM AUTHOR]

Accurate treatment response assessment using serial CT scans is essential in oncological clinical trials. However, oncologists' assessment following the Response Evaluation Criteria in Solid Tumors (RECIST) guideline is subjective, time-consuming, and sometimes fallible. Advanced liver cancer often presents multifocal hepatic lesions on CT imaging, making accurate characterization more challenging than with other malignancies. In this work, we developed a tumor volume guided comprehensive objective response evaluation based on deep learning (RECORD) for liver cancer. RECORD performs liver tumor segmentation, followed by sum of the volume (SOV)-based treatment response classification and new lesion assessment. Then, it can provide treatment evaluations of response, stability, and progression, and calculates progression-free survival (PFS) and response time. The RECORD pipeline was developed with both CNN and ViT backbones. Its performance was evaluated in three longitudinal cohorts involving 60 multi-national centers, 206 patients, 891 CT scans, using internal five-fold cross-validation and external validations. RECORD with the most effective backbone achieved an average AUC-response of 0.981, AUC-stable of 0.929, and AUC-progression of 0.969 for SOV-based disease status classification, F1-score of 0.887 for new lesion identification, and accuracy of 0.889 for final treatment outcome assessments across all cohorts. RECORD's PFS and response time predictions strongly correlated with clinician's assessments (P < 0.001). Moreover, RECORD can better stratify high-risk versus low-risk patients for overall survival compared to the human-assessed RECIST results. In conclusion, RECORD demonstrates efficiency and objectivity in analyzing liver lesions for treatment response evaluation. Further research should extend the pipeline to other metastatic organ sites., Competing Interests: Competing interests Z.S.Y., Y.J.X., JieZ., JinZ., X.L.X., and G.K. are filing a patent for the deep learning model in this study. All other authors declare they have no competing interests., (© 2024. The Author(s).)

The occurrence and regularity of macrofungal fruitbody formation are influenced by meteorological conditions; however, there is a scarcity of data about the use of machine-learning techniques to estimate their occurrence based on meteorological indicators. Therefore, we employed an artificial neural network (ANN) to forecast fruitbody occurrence in mycorrhizal species of Russula and Amanita, utilizing meteorological factors and validating the accuracy of the forecast of fruitbody formation. Fungal data were collected from two locations in Western Hungary between 2015 and 2020. The ANN was the commonly used algorithm for classification problems: feed-forward multilayer perceptrons with a backpropagation algorithm to estimate the binary (Yes/No) classification of fruitbody appearance in natural and undisturbed forests. The verification indices resulted in two outcomes: however, development is most often studied by genus level, we established a more successful, new model per species. Furthermore, the algorithm is able to successfully estimate fruitbody formations with medium to high accuracy (60–80%). Therefore, this work was the first to reliably utilise the ANN approach of estimating fruitbody occurrence based on meteorological parameters of mycorrhizal specified with an extended vegetation period. These findings can assist in field mycological investigations that utilize sporocarp occurrences to ascertain species abundance. [ABSTRACT FROM AUTHOR]

Aim: Sedentary behavior poses a serious health risk. Students in particular are highly affected by prolonged, uninterrupted periods of sitting due to routines in everyday university life, such as attending lectures, self-study periods in the library, etc. Whereas university students are mostly young and therefore appear to be healthy, evidence-based consequences of prolonged sitting may come to pass in prospective times. Therefore, primary prevention must be initiated to shield university students from the occurrence of non-communicable diseases (NCDs). Consequently, the study aims to evaluate a messenger-based intervention designed to reduce sedentary time among university students. Subjects and Methods: The effectiveness of the intervention was assessed in a randomized controlled trial with a convenience sample of thirty-four German university students. ActivPal devices (Pal Technologies Ltd., Glasgow) were applied to measure sedentary behavior objectively before and after a 3-week intervention of messages to interrupt sedentary time. An additional evaluation of the messages was carried out. Results: Sedentary behavior decreased by about one hour in the intervention group. Explorative analysis shows a statistically significant, negative correlation between sedentary time at baseline and the change of sedentary behavior over time in the intervention group (r = −.81) indicating effectiveness of the intervention for the participants with the highest sedentary times at baseline. Additionally, the messages were considered appropriate by the participants. Conclusion: A reduction of sedentary time of one hour per day in the intervention group is practically significant. The current investigation had similar findings with prior studies where promising results for the reduction of sedentary behavior were observed through mobile-based interventions. The detected effects of the intervention in this pilot study demonstrate an opportunity for further research in this field. [ABSTRACT FROM AUTHOR]

In health sciences, technical contributions may be undervalued and excluded in the author byline. In this paper, I demonstrate how authorship is a historical construct which perpetuates systemic injustices including technical undervaluation. I make use of Pierre Bourdieu's conceptual work to demonstrate how the power dynamics at play in academia make it very challenging to change the habitual state or "habitus". To counter this, I argue that we must reconceive technical contributions to not be a priori less important based on its nature when assigning roles and opportunities leading to authorship. I make this argument based on two premises. First, science has evolved due to major information and biotechnological innovation; this requires 'technicians' to acquire and exercise a commensurate high degree of both technical and intellectual expertise which in turn increases the value of their contribution. I will illustrate this by providing a brief historical view of work statisticians, computer programmers/data scientists and laboratory technicians. Second, excluding or undervaluing this type of work is contrary to norms of responsibility, fairness and trustworthiness of the individual researchers and of teams in science. Although such norms are continuously tested because of power dynamics, their importance is central to ethical authorship practice and research integrity. While it may be argued that detailed disclosure of contributions (known as contributorship) increases accountability by clearly identifying who did what in the publication, I contend that this may unintentionally legitimize undervaluation of technical roles and may decrease integrity of science. Finally, this paper offers recommendations to promote ethical inclusion of technical contributors. [ABSTRACT FROM AUTHOR]

Installing signs is known to be effective in encouraging people to use stairs instead of escalators. However, it has been reported that the effectiveness of such signs is diminished as the number of stairs increases, and no effect was reported at 44 steps. Thus, this study examined whether stair use could be promoted even with 80 or 105 steps by presenting specific numerical values for the health benefits of using stairs. At two universities with parallel escalators and stairs (105 and 80 steps, respectively), we installed signs stating, "Going up one flight of stairs increases your life span by 4 seconds." A one-week baseline period was followed by a one-week intervention using signs displayed to passersby. Follow-up data were also collected for one week immediately after removing the signs. Measurements were collected Monday through Friday from 7:30 to 9:15 a.m. The number of passersby was recorded by categorizing them into four attributes: male and female students, and male and female faculty/staff. A total of 25,065 observations (963 stair users vs. 24,102 escalator users) at University A and 25,677 observations (1020 stair users vs. 24,657 escalator users) at University B were recorded. Sign installation promoted stair use at University A (odds ratio [OR], 1.513; 95% confidence interval [CI], 1.307–1.752) and University B (OR, 1.221; 95% CI, 1.046–1.425). However, there was no effect of the sign installation on the population with attributes that had a high percentage of stair use prior to this study, implying that there is a ceiling effect on the effectiveness of such signs. The implication of the findings is that it is effective to provide detailed information to passersby on the health benefits of stair use for stairs with 80 or 105 steps. [ABSTRACT FROM AUTHOR]

Exercise addiction is characterized by morbid pattern of behavior which may have negative psychological consequences, seriously compromising the lives of those affected. The Exercise Addiction Inventory (EAI) is one of the most used psychometric instruments for assessing the risk of exercise addiction and has been translated into a number of languages. However, it has never been psychometrically validated in Italian. Therefore, the purpose of the present study was to test the psychometric properties of the EAI among Italian-speaking exercisers. The back-translation process was utilized to develop an Italian version of the EAI. A cross-sectional online survey was used to recruit a sample of 331 Italian regular exercisers (Mage = 30.64 years, SD = 12.10). The participants completed the Italian EAI, alongside a battery of other self-report psychometric scales used to assess some aspects of the concurrent validity of the EAI. The one-factor structure of the EAI was confirmed, which also showed good internal consistency and a satisfactory construct validity in the Italian version. No gender differences were found for the risk of exercise addiction. The data obtained in this study provide some evidence suggesting that Italian Exercise Addiction Inventory (EAI) is a valid and reliable self-report scale that can be used to assess the risk of exercise addiction among Italian-speaking individuals. The scale showed some psychometrically robust features, and is a quick and easy-to-use scale that can be used in different cultures and countries, including Italy. [ABSTRACT FROM AUTHOR]

Objectives: To construct a radiomic model of low-dose CT (LDCT) to predict the differentiation grade of invasive non-mucinous pulmonary adenocarcinoma (IPA) and compare its diagnostic performance with quantitative-semantic model and radiologists. Methods: A total of 682 pulmonary nodules were divided into the primary cohort (181 grade 1; 254 grade 2; 64 grade 3) and validation cohort (69 grade 1; 99 grade 2; 15 grade 3) according to scanners. The radiomic and quantitative-semantic models were built using ordinal logistic regression. The diagnostic performance of the models and radiologists was assessed by the area under the curve (AUC) of the receiver operating characteristic curve and accuracy. Results: The radiomic model demonstrated excellent diagnostic performance in the validation cohort (AUC, 0.900 (95%CI: 0.847–0.939) for Grade 1 vs. Grade 2/Grade 3; AUC, 0.929 (95%CI: 0.882–0.962) for Grade 1/Grade 2 vs. Grade 3; accuracy, 0.803 (95%CI: 0.737–0.857)). No significant difference in diagnostic performance was found between the radiomic model and radiological expert (AUC, 0.840 (95%CI: 0.779–0.890) for Grade 1 vs. Grade 2/Grade 3, p = 0.130; AUC, 0.852 (95%CI: 0.793–0.900) for Grade 1/Grade 2 vs. Grade 3, p = 0.170; accuracy, 0.743 (95%CI: 0.673–0.804), p = 0.079), but the radiomic model outperformed the quantitative-semantic model and inexperienced radiologists (all p < 0.05). Conclusions: The radiomic model of LDCT can be used to predict the differentiation grade of IPA in lung cancer screening, and its diagnostic performance is comparable to that of radiological expert. Key Points: • Early identifying the novel differentiation grade of invasive non-mucinous pulmonary adenocarcinoma may provide guidance for further surveillance, surgical strategy, or more adjuvant treatment. • The diagnostic performance of the radiomic model is comparable to that of a radiological expert and superior to that of the quantitative-semantic model and inexperienced radiologists. • The radiomic model of low-dose CT can be used to predict the differentiation grade of invasive non-mucinous pulmonary adenocarcinoma in lung cancer screening. [ABSTRACT FROM AUTHOR]

Background: Lung ultrasound is a non-invasive tool available at the bedside for the assessment of critically ill patients. The objective of this study was to evaluate the usefulness of lung ultrasound in assessing the severity of SARS-CoV-2 infection in critically-ill patients in a low-income setting. Methods: We conducted a 12-month observational study in a university hospital intensive care unit (ICU) in Mali, on patients admitted for COVID-19 as diagnosed by a positive polymerase chain reaction for SARS-CoV-2 and/or typical lung computed tomography scan findings. Results: The inclusion criteria was met by 156 patients with a median age of 59 years. Almost all patients (96%) had respiratory failure at admission and many needed respiratory support (121/156, 78%). The feasibility of lung ultrasound was very good, with 1802/1872 (96%) quadrants assessed. The reproducibility was good with an intra-class correlation coefficient of elementary patterns of 0.74 (95% CI 0.65, 0.82) and a coefficient of repeatability of lung ultrasound score < 3 for an overall score of 24. Confluent B lines were the most common lesions found in patients (155/156). The overall mean ultrasound score was 23 ± 5.4, and was significantly correlated with oxygen saturation (Pearson correlation coefficient of − 0.38, p < 0.001). More than half of the patients died (86/156, 55.1%). The factors associated with mortality, as shown by multivariable analysis, were: the patients' age; number of organ failures; therapeutic anticoagulation, and lung ultrasound score. Conclusion: Lung ultrasound was feasible and contributed to characterize lung injury in critically-ill COVID-19 patients in a low income setting. Lung ultrasound score was associated with oxygenation impairment and mortality. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to investigate the association between intake of seafood and plant-derived n-3 polyunsaturated fatty acids (PUFA) and development of total atherosclerotic cardiovascular disease (ASCVD) and acute major ischemic events. Methods: A total of 53,909 men and women were enrolled between 1993 and 1997 into the Danish Diet, Cancer and Health cohort and followed through nationwide Danish registries for development of total ASCVD defined as a first registration of myocardial infarction, peripheral artery disease, or ischemic stroke due to large artery atherosclerosis or small-vessel occlusion. At recruitment, the intake of the major marine n-3 PUFA, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) and the plant-derived n-3 PUFA, alpha-linolenic acid (ALA), was assessed using a validated food frequency questionnaire. Statistical analyses were conducted using sex-stratified multivariable Cox proportional hazard regression models. Results: During a median of 13.5 years of follow-up, 3958 participants developed ASCVD including 3270 patients with an acute major ischemic event. In multivariable analyses including adjustment for established risk factors, we found no associations for intake of ALA, but indications of inverse associations between intake of EPA, DHA and EPA + DHA and the rate of total ASCVD and acute major ischemic events. Conclusions: A high intake of marine n-3 PUFA was associated with a lower risk of total ASCVD and acute major ischemic events, whereas no association could be demonstrated for the plant-derived ALA. [ABSTRACT FROM AUTHOR]

Purpose: The Covid-19 restriction exposed most athletes to insufficient training stimuli leading to detraining. This study investigated whether a home-based exercise training program could preserve body composition and exercise performance in young high-level kayak athletes during Covid-19 restriction. Methods: Seventeen healthy young high-level kayak athletes (10 males and 7 females), aged 14.7 ± 1 yrs, participated in this study. A 7-week home-based training program was followed during Covid-19 restriction. Baseline measurements were assessed 4 weeks before Covid-19 pandemic and ended on 4 May 2020. Body composition, flexibility, isometric muscle trunk strength (Biodex), anaerobic power (30-s all-out trial), and aerobic capacity (4-min maximal test) were evaluated. Personal daily loads and wellness details were collected with AthleteMonitoring.com software. Results: Home-based exercise training program was effective to improve flexibility (9.20 ± 2.85%) and lean body mass (3.96 ± 0.89%), to maintain muscle strength, anaerobic power, body mass, and body fat percentage but insufficient to maintain aerobic capacity (− 8.96 ± 2.49%). Conclusion: The findings of the present study potentially highlight the importance of the implementation of such a program to minimize the detraining effect on young athletes during periods of movement restriction caused by pandemics. [ABSTRACT FROM AUTHOR]

Background: Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. Methods: A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test–retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. Results: The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test–retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. Conclusion: PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to describe magnetic resonance imaging findings in patients planned for lumbar spinal stenosis surgery. Further, to describe possible associations between MRI findings and patient characteristics with patient reported disability or pain. Methods: The NORDSTEN spinal stenosis trial included 437 patients planned for surgical decompression of LSS. The following MRI findings were evaluated before surgery: morphological (Schizas) and quantitative (cross-sectional area) grade of stenosis, disk degeneration (Pfirrmann), facet joint tropism and fatty infiltration of the multifidus muscle. Patients were dichotomized into a moderate or severe category for each radiological parameter classification. A multivariable linear regression analysis was performed to investigate the association between MRI findings and preoperative scores for Oswestry Disability Index, Zurich Claudication Questionnaire and Numeric rating scale for back and leg pain. The following patient characteristics were included in the analysis: gender, age, smoking and weight. Results: The percentage of patients with severe scores was as follows: Schizas (C + D) 71.3%, cross-sectional area (< 75 mm2) 86.8%, Pfirrmann (4 + 5) 58.1%, tropism (≥ 15°) 11.9%, degeneration of multifidus muscle (2–4) 83.7%. Regression coefficients indicated minimal changes in severity of symptoms when comparing the groups with moderate and severe MRI findings. Only gender had a significant and clinically relevant association with ODI score. Conclusion: In this cross-sectional study, the majority of the patients had MRI findings classified as severe LSS changes, but the findings had no clinically relevant association with patient reported disability and pain at baseline. Patient characteristics have a larger impact on disability and pain than radiological findings. Trial registration: www.ClinicalTrials.gov identifier: NCT02007083, registered December 2013. [ABSTRACT FROM AUTHOR]

Purpose: To critically analyse the literature on the antenatal corticosteroids (ACS)-to-birth interval from a causal point of view and to present a solution to the problem of bias caused by post hoc analysis. Methods: Due to the post hoc nature of the ACS-to-birth interval, a randomised controlled trial (RCT) of ACS versus placebo is not able to examine the importance of the interval. When an RCT is not feasible, for whatsoever reason, a target trial can be set up and an attempt can be made to answer the causal question of interest using observational data. An attempt was made to set up a target trial which could enable to examine the causal effect of the ACS-to-birth interval on neonatal outcomes. An analysis of current literature on the ACS-to-birth interval was done. Results: The majority of studies aimed to examine the causal effect of the interval, but their study design only permitted to find associations between the interval and neonatal outcomes. Barriers for setting up a target trial are highlighted. Conclusion: Evidence on the superiority of any ACS-to-birth interval is lacking and the question can only be addressed causally and become clinically relevant if baseline randomisation to ACS-to-birth intervals is made possible. [ABSTRACT FROM AUTHOR]

Summary: We estimated and characterized the imminent fracture risk (1–2 years) of high-risk fracture patients through a multinational (UK, Spain, Denmark) cohort study. Older individuals with newly diagnosed osteoporosis and individuals who had a fracture while on treatment with a bisphosphonate were at a high risk of imminent fracture. Purpose: To characterize and estimate 1- to 2-year fracture risk in high-risk fracture patients. Methods: Multi-cohort study in (database/study period) UK (CPRD/1995–2017), Spain (SIDIAP/2006–2016) and Denmark (DHR/1995–2016) including individuals ≥ 50 years old in NDO (newly diagnosed osteoporosis), OFx (incident osteoporotic fracture), BP (incident oral bisphosphonates use) or FWOT (fracture while on treatment with bisphosphonates). Outcomes (ICD-10/READ): hip, clinical spine, non-hip, non-spine and hip/humerus/distal forearm fracture. Follow-up: from cohort entry until death, migration/transfer or end of the study. Statistics: baseline characteristics and incidence rate (IR per 1000 persons). Results (1-year IR): NDO included 69,899 (UK), 37,901 (Spain) and 158,191 (Denmark) individuals. Spanish-IR was lowest for hip (4.7), clinical spine (2.5) and major osteoporotic fracture (MOF) (17.3) and highest in Denmark (74.2, 26.0 and 120.1, respectively). OFx included 83,514 (UK), 51,044 (Spain) and 509,551 (Denmark) individuals. IR in Denmark was highest for hip (24.1) and MOF (47.2), in Spain was highest for the clinical spine (9.4) and lowest for hip (9.5) and in the UK was lowest for the clinical spine (2.8) and MOF (20.7). BP included 148,507 (UK), 52,037 (Spain) and 204,010 (Denmark) individuals. Spanish-IR was lowest for hip (5.0) and MOF (21.1) and highest in Denmark (20.3 and 48.6, respectively). FWOT included 28,930 (UK), 1,865 (Spain) and 31,882 (Denmark) individuals. Clinical spine-IR was highest for Spain (12.0). Hip-IR was lowest for Spain (7.6) and highest for Denmark (33.6). Comparing young subjects, those who have FWOT started with an increased fracture rate. Conclusion: OFx and FWOT individuals experience higher re-fracture incidence rates than those with osteoporosis with or without treatment. [ABSTRACT FROM AUTHOR]

Background: Uncertainty remains about the optimum step count per day for health promotion. Objective: We aimed to investigate the association between step count per day and all-cause mortality risk. Methods: PubMed, Scopus, and ISI Web of Science were searched to January 2021 to find prospective cohort studies of the association between device-based step count per day and all-cause mortality risk in the general population. Two reviewers extracted data in duplicate and rated the certainty of evidence using the GRADE approach. Study-specific hazard ratios (HRs) were pooled using a random-effects model. Results: Seven prospective cohort studies with 175,370 person-years and 2310 cases of all-cause mortality were included. The HR for each 1000 steps per day was 0.88 (95% CI 0.83–0.93; I2 = 79%, n = 7) in the overall analysis, 0.87 (95% CI 0.78–0.97; I2 = 59%, n = 3) in adults older than 70 years, and 0.92 (95% CI 0.89–0.95; I2 = 37%, n = 2) in studies controlled for step intensity. Dose–response meta-analysis indicated a strong inverse association, wherein the risk decreased linearly from 2700 to17,000 steps per day. The HR for 10,000 steps per day was 0.44 (95% CI 0.31–0.63). The certainty of evidence was rated strong due to upgrades for large effect size and dose–response gradient. Conclusions: Even a modest increase in steps per day may be associated with a lower risk of death. These results can be used to develop simple, efficient and easy-to-understand public health messages. [ABSTRACT FROM AUTHOR]

Recent replication crisis has led to a number of ad hoc suggestions to decrease the chance of making false positive findings. Among them, Johnson (Proceedings of the National Academy of Sciences, 110, 19313–19317, 2013) and Benjamin et al. (Nature Human Behaviour, 2, 6–10 2018) recommend using the significance level of α = 0.005 (0.5%) as opposed to the conventional 0.05 (5%) level. Even though their suggestion is easy to implement, it is unclear whether or not the commonly used statistical tests are robust and/or powerful at such a small significance level. Therefore, the main aim of our study is to investigate the robustness and power curve behaviors of independent (unpaired) two-sample tests for metric and ordinal data at nominal significance levels of α = 0.005 and α = 0.05. Through an extensive simulation study, it is found that the permutation versions of the Welch t-test and the Brunner-Munzel test are particularly robust and powerful while the commonly used two-sample tests which utilize t-distribution tend to be either liberal or conservative, and have peculiar power curve behaviors under skewed distributions with variance heterogeneity. [ABSTRACT FROM AUTHOR]

Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15–2.77), lower psychological resilience (OR 0.84; 95% CI 0.71–0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80–8.02), recent financial hardship (OR 2.16; 95% CI 1.48–3.14), and recent transactional sex (OR 3.87; 95% CI 2.43–6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between exercise addiction level and performance enhancement in elite athletes. Seventy-four athletes participated in the study. The participants were asked to present their best official competition ranks in order for the years 2014, 2015, 2016, 2017 and 2018. "Exercise Addiction Scale" was used for data collection. t test, ANOVA and post hoc statistics were used to analyse the research data. The study found that the mean exercise addiction score of the participants was (55.67 ± 20.83). Although addiction levels of the athletes with the lowest performance enhancement were significantly higher compared to other participants, no significant difference was found between gender and exercise addiction (p > 0.05). Consequently, in the study, it was related that the athletes with high levels of exercise addiction displayed poor performance in all branches of track and field. Addiction may stand out among the factors that have a negative impact on athlete performance. [ABSTRACT FROM AUTHOR]

Objective: To identify a diagnostic indicator of lumbar spondylolysis visible in plain X-ray films.Methods: One hundred and seventy-two patients with low back pain who received X-ray and computerized tomography (CT) examinations were identified and studied. They were divided into three groups: the spondylosis without spondylolisthesis (SWS) group, comprising 67 patients with bilateral pars interarticularis defects at L5 and without spondylolisthesis, the isthmic spondylolisthesis (IS) group, comprising 74 patients with L5/S1 spondylolisthesis and bilateral L5 pars interarticularis defects, and the control group, comprising 31 patients with low back pain but without spondylolysis. The sagittal diameters of the vertebral arch (SDVAs) of L4 and L5 were measured in lateral X-ray image, and the differences in SDVA between L4 and L5 (DSL4-5) in each case were calculated and analyzed.Results: There were no significant differences in demographic characteristics among the three groups. In the SWS and IS groups, the SDVA of L5 was significantly longer than the SDVA of L4 (p < 0.001), whereas no significant difference found in the control group (p > 0.05). DSL4-5, in which the SDVA of L4 was subtracted from the SDVA of L5, significantly differed among the three groups (p < 0.001), and the normal threshold was provisionally determined to be 1.55 mm.Conclusions: In bilateral L5 spondylolysis, the SDVA of L5 is wider than the SDVA of L4, and this difference is greater in isthmic spondylolisthesis. This sign in lateral X-rays may provide a simple and convenient aid for the diagnosis of spondylolysis. [ABSTRACT FROM AUTHOR]

The Social Communication Questionnaire (SCQ) is a 40-item instrument designed to screen children at risk for Autism Spectrum Disorder (ASD). Both Lifetime and Current forms of the scale are available. Although these forms are manageable for many respondents, their use may result in substantial respondent and administrative burden, particularly among individuals who have difficulty reading, have physical illness, and/or are asked to take multiple questionnaires. The objective of this research was to examine the potential of two stopping rules for computer-based testing (namely, curtailment and stochastic curtailment) to shorten the SCQ without compromising its screening properties. A retrospective analysis was conducted using data from the National Database for Autism Research (NDAR); responses regarding 1236 at-risk individuals from the SCQ Lifetime and 709 at-risk individuals from the SCQ Current were analyzed. In post-hoc simulation, curtailment reduced mean test lengths by 29% to 44% compared to the full-length Lifetime form, and by 25% to 39% compared to the full-length Current form, while providing the same screening result as the corresponding full-length form in 100% of cases. Stochastic curtailment made further reductions in test length, but was not always concordant with the full-length form's screening result. These findings suggest that curtailment has potential to improve the efficiency of the SCQ in computer-based administrations and should be tested prospectively. [ABSTRACT FROM AUTHOR]

A considerable number of adopted animals are returned to animal shelters post-adoption which can be stressful for both the animal and the owner. In this retrospective analysis of 23,932 animal records from a US shelter, we identified animal characteristics associated with the likelihood of return, key return reasons, and outcomes post-return for dogs and cats. Binary logistic regression models were used to describe the likelihood of return, return reason and outcome based on intake age, intake type, sex, breed and return frequency. Behavioral issues and incompatibility with existing pets were the most common return reasons. Age and breed group (dogs only) predicted the likelihood of return, return reason and post-adoption return outcome. Adult dogs had the greatest odds of post-adoption return (OR 3.40, 95% CI 2.88–4.01) and post-return euthanasia (OR 3.94, 95% CI 2.04–7.59). Toy and terrier breeds were 65% and 35% less likely to be returned compared with herding breeds. Pit bull-type breeds were more likely to be returned multiple times (X2 = 18.11, p = 0.01) and euthanized post-return (OR 2.60, 95% CI 1.47–4.61). Our findings highlight the importance of animal behavior in the retention of newly adopted animals and provide useful direction for allocation of resources and future adoption counselling and post-adoption support services. [ABSTRACT FROM AUTHOR]

There is a plethora of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) serological tests based either on nucleocapsid phosphoprotein (N), S1-subunit of spike glycoprotein (S1) or receptor binding domain (RBD). Although these single-antigen based tests demonstrate high clinical performance, there is growing evidence regarding their limitations in epidemiological serosurveys. To address this, we developed a Luminex-based multiplex immunoassay that detects total antibodies (IgG/IgM/IgA) against the N, S1 and RBD antigens and used it to compare antibody responses in 1225 blood donors across Greece. Seroprevalence based on single-antigen readouts was strongly influenced by both the antigen type and cut-off value and ranged widely [0.8% (95% CI 0.4–1.5%)–7.5% (95% CI 6.0–8.9%)]. A multi-antigen approach requiring partial agreement between RBD and N or S1 readouts (RBD&N|S1 rule) was less affected by cut-off selection, resulting in robust seroprevalence estimation [0.6% (95% CI 0.3–1.1%)–1.2% (95% CI 0.7–2.0%)] and accurate identification of seroconverted individuals. [ABSTRACT FROM AUTHOR]

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) and tumor necrosis factor inhibitors (TNFi) are the most common therapies used in AS, however, the associated long-term cardiovascular risk is unclear. We performed a systematic review and meta-analysis on the association of therapies used for ankylosing spondylitis (AS) such as NSAIDs and TNFi on cardiovascular events (CVE) in AS. Methods: A comprehensive search was performed from database inception to May 29, 2020 to include controlled studies of AS treated with NSAIDs, oral small molecules, or biologics reporting CVE. Study-specific risk ratios (RR) were pooled using a random effects model. Results: Nine non-randomized studies from 1570 studies screened fulfilled inclusion criteria. Among NSAID users as a whole versus no NSAIDs, no increased risk of CVE (composite outcome) was observed; however, the risk of cerebrovascular accident was significantly lower (RR 0.58, 95% CI 0.37–0.93, I2 = 66%). Cox-2 inhibitor use was associated with reduced risk of all CVE (RR 0.48, 95% CI 0.33–0.70, I2 = 0%). Non-selective NSAIDs were not associated with any increased/decreased risk of any CVE. Meta-analysis of three studies of MI did not show a significant association with TNFi (RR 0.88, 95% CI 0.57–1.35, I2 = 76%). Conclusions: In this meta-analysis of non-randomized studies, NSAID users as a whole and users of non-selective NSAIDs did not seem to have a higher risk of any CVE. Limited data suggest a lower risk of composite CVE outcome with Cox-2 inhibitors, unlike the increased risk reported in the general population. No significant association between TNFi and MI was observed. The certainty in evidence was very low due to all studies being observational. More studies are needed to study the association between TNFi use and CVE in general to evaluate a possible protective role in AS. [ABSTRACT FROM AUTHOR]

Summary: Effects on bone material properties of two-year antiosteoporotic treatment were assessed using in vivo impact microindentation (IMI) in patients with low bone mineral density (BMD) values. Antiresorptive treatment, in contrast to vitamin D ± calcium treatment alone, induced BMD-independent increases in bone material strength index, measured by IMI, the magnitude of which depended on pretreatment values. Introduction: Bone material strength index (BMSi), measured by IMI in vivo, is reduced in patients with fragility fractures, but there is no information about changes in values during long-term therapy. In the present study, we assessed changes in BMSi in patients receiving antiosteoporotic treatments for periods longer than 12 months. Methods: We included treatment-naive patients with low bone mass who had a BMSi measurement with OsteoProbe® at presentation and consented to a repeat measurement after treatment. Results: We studied 54 patients (34 women), median age 58 years, of whom 30 were treated with bisphosphonates or denosumab (treatment group) and 24 with vitamin D ± calcium alone (control group). There were no differences in clinical characteristics between the two groups with the exception of a higher number of previous fragility fractures in the treatment group. Baseline hip BMD and BMSi values were lower in the treatment group. After 23.1 ± 6.6 months, BMSi increased significantly in the treatment group (82.4 ± 4.3 vs 79.3 ± 4.1; p < 0.001), but did not change in the control group (81.5 ± 5.2 vs 82.2 ± 4.1; p = 0.35). Changes in BMSi with antiresorptives were inversely related with baseline values (r = − 0.43; p = 0.02) but not with changes in BMD. Two patients in the control group with large decreases in BMSi values sustained incident fractures. Conclusion: In patients at increased fracture risk, antiresorptive treatments induced BMD-independent increases in BMSi values, the magnitude of which depended on pretreatment values. [ABSTRACT FROM AUTHOR]

Summary: PTH levels might be associated with bone material strength as measured by impact microindentation. Resistance to microfracture is decreased in hypoparathyroidism and appears to be associated with more severe disease and to improve with PTH replacement. Introduction: PTH is a key regulator of bone structure and remodeling. When PTH is absent in hypoparathyroidism (HypoPT), bone mass is increased and remodeling is decreased. In addition to bone structure and remodeling, bone material properties contribute to fracture resistance. Yet little is known about the relationship between PTH and bone material properties. Impact microindentation provides a clinical assessment of microfracture resistance, measured as the bone material strength index (BMSi). Methods: Case-control cross-sectional study of PTH levels and in vivo BMSi measurement by impact microindentation at the anterior tibia in HypoPT patients (n = 17) and in controls matched for age, sex, and menopausal status (n = 17), with follow-up in a subgroup of HypoPT patients (n = 5) after recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] treatment. Results: BMSi was positively associated with PTH levels in controls (r = 0.58, p = 0.02) and was 11% lower (p = 0.01) in HypoPT patients as compared with controls. In HypoPT, lower BMSi was associated with a trend toward greater supplemental calcium doses (p = 0.07). BMSi increased after rhPTH(1-84) treatment in the HypoPT patients who underwent repeat microindentation. Conclusions: PTH levels might be associated with bone material strength, although other factors might be contributory. In HypoPT, resistance to microfracture is decreased and may be associated with greater supplemental calcium doses and might increase with PTH replacement. It remains to be determined whether changes in bone remodeling and microarchitecture contribute to the effects of PTH on microfracture resistance. [ABSTRACT FROM AUTHOR]

Summary: Less is known about the impact of non-hip non-vertebral fractures (NHNV) on early death. This study demonstrated increased risk of dying following hip and NHNV fractures which was further increased by a subsequent fracture. This highlights the importance of early intervention to prevent both initial and subsequent fractures and improve survival. Introduction: Osteoporotic fractures are a major health concern. Limited evidence exists on their impact on mortality in ageing populations. This study examined the contribution of initial fracture type and subsequent fracture on mortality in a Norwegian population that has one of the highest rates of fractures. Methods: The Tromsø Study is a prospective population-based cohort in Norway. Women and men aged 50+ years were followed from 1994 to 2010. All incident hip and non-hip non-vertebral (NHNV) fractures were registered. NHNV fractures were classified as either proximal or distal. Information on self-reported co-morbidities, lifestyle factors, general health and education level was collected. Multivariable Cox models were used to quantify mortality risk with incident and subsequent fractures analysed as time-dependent variables. Results: Of 5214 women and 4620 men, 1549 (30%) and 504 (11%) sustained a fracture, followed by 589 (38%) and 254 (51%) deaths over 10,523 and 2821 person-years, respectively. There were 403 (26%) subsequent fractures in women and 68 (13%) in men. Hip fracture was associated with a two-fold increase in mortality risk (HR 2.05, 95% CI 1.73–2.42 in women and 2.49, 95% CI 2.00–3.11 in men). Proximal NHNV fractures were associated with 49% and 81% increased mortality risk in women and men (HR 1.49, 95% CI 1.21–1.84 and 1.81, 95% CI 1.37–2.41), respectively. Distal NHNV fractures were not associated with mortality. Subsequent fracture was associated with 89% and 77% increased mortality risk in women and men (HR 1.89, 95% CI 1.52–2.35 and 1.77, 95% CI 1.16–2.71), respectively. Conclusion: Hip, proximal NHNV and subsequent fractures were significantly associated with increased mortality risk in the elderly, highlighting the importance of early intervention. [ABSTRACT FROM AUTHOR]

Purpose: Describe the motivation for floorball participation, injury prevention expectations, injury risk perceptions and prevalence of health problems in youth floorball players at the start of the season.Methods: This cross-sectional survey is part of a larger Sport Without Injury ProgrammE (SWIPE) project and provides baseline data before a cluster randomised controlled trial of an injury prevention program (Knee Control). A baseline survey (online and paper based) was collected from 47 teams with 471 youth floorball players from two provinces of Sweden before the start of the 2017 season.Results: The mean age for 140 females and 331 males was 13.7 (± 1.5) and 13.3 (± 1.0) years, respectively. The two most significant motivators for floorball participation were being part of the team (82% females, 75% males) and friends (65% females, 70% males). Fractures (84% females, 90% males), eye injuries (90% females, 83% males) and concussion (82% females, 83% males) were perceived as the most severe injuries. 93% of players believed that sports injuries can be prevented, while 74% believed it is unlikely that they will sustain an injury. Existing health problems at the beginning of the season were prevalent in 33% of players, with 65% being injuries and 35% illnesses. 17% of existing injuries at the start of the season caused time-loss from play and 17% required medical attention.Conclusion: Social aspects were the greatest motivators for floorball participation in youths, suggesting that these factors are important to retain sports participants. The high number of health problems in youth is a concern; as such more effort, resources and priority should be given to sports safety programs. Many players believed that sports injuries can be prevented, possibly providing a fertile ground for implementation of such programs.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to elucidate the specific regional cerebral blood flow (rCBF) alterations for idiopathic normal pressure hydrocephalus (iNPH) by comparing the proportional rCBF and gray matter change from those of a normal database at the same point of SPECT and MRI examinations.Methods: Thirty subjects with iNPH underwent both CBF SPECT and MRI. After normalization, voxel-wise two-sample t tests between patients and 11 normal controls were conducted to compare the regional alteration in the gray matter density and rCBF.Results: The rCBF reduction and the gray matter decrease were seen in almost similar regions surrounding Sylvian fissure, the left parietotemporal region and frontal lobes, whereas we did not find rCBF increase at the top of the high convexity, where the increase of the gray matter density was the highest (p < 0.05).Conclusion: Our study showed regional associations and dissociations between the relative gray matter density and rCBF in patients with iNPH. [ABSTRACT FROM AUTHOR]

Purpose: To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery.Method: A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations between HRQL, social support, and comorbid disorders.Results: The overall 15D scores for the total sample improved significantly from 2 weeks to 3 months post surgery, with only a gradual change observed from 3 to 12 months. Thirty percent (n = 92) of the total sample reported a lower 15D total score at 12 months compared to preoperative status, of whom 78% (n = 71) had a negative minimum important differences (MID), indicating a worse HRQL status. When adjusted for age and marital status, women had statistically significant lower 15D total scores compared to men at 3, 6, and 12 months post surgery. Compared to pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of HRQL for women, and in 6 out of 15 dimensions for men at 12 months post surgery. Both men and women associated back/neck problems, depression, and persistent pain intensity with lower HRQL; for women, not living with a partner/spouse was associated with lower HRQL up to 12 months.Conclusion: Women experienced decreased HRQL and a slower first-year recovery following cardiac surgery compared to men. This study demonstrates a need for follow-up and support to help women manage their symptoms and improve their function within the first year after cardiac surgery. This was particularly pronounced for those women living alone. [ABSTRACT FROM AUTHOR]

Summary: We evaluated the relationship between bone material strength index (BMSi) and fragility fractures, including vertebral fractures. Our data showed that BMSi is low in all fracture patients with low bone mass, independently of whether patients sustained a vertebral or a non-vertebral fracture. Introduction: Impact microindentation (IMI) is a new technique for the measurement of tissue level properties of cortical bone in vivo. Previous studies showed an association between BMSi and non-vertebral fractures, but an association with vertebral fractures is still being debated. The objective of this paper was to evaluate the relationship between BMSi and different types of fragility fractures, including vertebral fractures. Methods: In this cross-sectional study, we measured BMSi in patients of both sexes with different types of fragility fractures and low bone mass with the IMI method using the Osteoprobe®. Vertebral fractures were diagnosed and graded on lateral spine radiographs. Results: A total of 132 patients were included in the study, of whom 101 patients (65 women) had sustained a low energy fracture and 31 (mean age 57.7 ± 9.9 years) had no history or radiological evidence for a fracture. Of the fracture patients, 53 (mean age 62.8 ± 8.3 years) had only non-vertebral fractures (VF−/Fx+), 34 (mean age 62.8 ± 9.9 years) had vertebral and non-vertebral fractures (VF+/Fx+), and 14 (mean age 64.7 ± 9.3 years) had only vertebral fractures (VF+/Fx−). BMSi values, adjusted for age and BMD, were similar for all three groups of fracture patients (78.9 ± 0.7, 78.3 ± 0.9, and 78.4 ± 1.4, respectively; p = 0.866). BMSi values were not associated with number or severity of vertebral fractures. Conclusion: Our data demonstrate that BMSi is low in fracture patients with low bone mass, irrespective of whether they sustained a vertebral fracture or a non-vertebral fracture. [ABSTRACT FROM AUTHOR]

Purpose of Review: In this paper, we review the epidemiology, diagnosis, and pathogenesis of fractures and renal osteodystrophy. Recent Findings: The role of bone quality in the pathogenesis of fracture susceptibility in chronic kidney disease (CKD) is beginning to be elucidated. Bone quality refers to bone material properties, such as cortical and trabecular microarchitecture, mineralization, turnover, microdamage, and collagen content and structure. Recent data has added to our understanding of the effects of CKD on alterations to bone quality, emerging data on the role of abnormal collagen structure on bone strength, the potential of non-invasive methods to inform our knowledge of bone quality, and how we can use these methods to inform strategies that protect against bone loss and fractures. However, more prospective data is required. Summary: CKD is associated with abnormal bone quality and strength which results in high fracture incidence. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic sleeve gastrectomy (LSG) has become more popular in recent years. The aim of this study was to determine the vitamin and mineral status in patients up to 5 years after LSG and to explore changes that occurred from pre-operatively to 1, 2 and 5 years after surgery. Methods: Data reviewed included age, sex, weight and body mass index (BMI), micronutrient supplements consumed and blood levels of 25 hydroxyvitamin D (25 (OH) D), PTH (parathyroid hormone), ferritin, haemoglobin, folate and vitamin B12, prior to and post-LSG. Data was collated from medical records of morbidly obese patients who had undergone LSG surgery. Results: There were a maximum of 336 patients with pre-operative and 1 year after surgery values, n = 272 for 2 years and n = 116 for 5 years after surgery. At 5 years, only 54 % (58/107) of patients reported taking daily multivitamin supplements. Whilst most patients had values within the reference range for haemoglobin, vitamin B12, folate and vitamin D 5 years after LSG, 36 % (34/94) of the patients had serum ferritin below reference value. Conclusion: This study has highlighted a low micronutrient supplementation adherence. Ferritin levels decreased over time even with multivitamin supplementation. To improve micronutrient guidelines prior to and after LSG, more research, including controlled supplementation studies, are necessary. [ABSTRACT FROM AUTHOR]

Tissue-level mechanical properties characterize mechanical behavior independently of microscopic porosity. Specifically, quasi-static nanoindentation provides measurements of modulus (stiffness) and hardness (resistance to yielding) of tissue at the length scale of the lamella, while dynamic nanoindentation assesses time-dependent behavior in the form of storage modulus (stiffness), loss modulus (dampening), and loss factor (ratio of the two). While these properties are useful in establishing how a gene, signaling pathway, or disease of interest affects bone tissue, they generally do not vary with aging after skeletal maturation or with osteoporosis. Heterogeneity in tissue-level mechanical properties or in compositional properties may contribute to fracture risk, but a consensus on whether the contribution is negative or positive has not emerged. In vivo indentation of bone tissue is now possible, and the mechanical resistance to microindentation has the potential for improving fracture risk assessment, though determinants are currently unknown. [ABSTRACT FROM AUTHOR]

Few research-developed early intervention models have been deployed to and tested in real world preschool programs. In this study, teaching staff implemented a social communication modularized intervention, JASPER, in their daily program. Sixty-six preschool children with autism in twelve classrooms (12 teachers) were randomized to receive immediate JASPER training (IT) or were waitlisted (WL) for 3 months with a 1-month follow up. Measures of core deficits (initiations of joint engagement, joint attention gestures and language, play skills) and standardized cognitive measures were improved for IT over WL children. IT teachers achieved and maintained high fidelity. Teachers can implement evidence-based interventions with significant improvements in core deficits of their children with ASD. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the leading causes of blindness worldwide. There is no cure for glaucoma but detection at its earliest stage and subsequent treatment can aid patients to prevent blindness. Currently, optic disc and retinal imaging facilitates glaucoma detection but this method requires manual post-imaging modifications that are time-consuming and subjective to image assessment by human observers. Therefore, it is necessary to automate this process. In this work, we have first proposed a novel computer aided approach for automatic glaucoma detection based on Regional Image Features Model (RIFM) which can automatically perform classification between normal and glaucoma images on the basis of regional information. Different from all the existing methods, our approach can extract both geometric (e.g. morphometric properties) and non-geometric based properties (e.g. pixel appearance/intensity values, texture) from images and significantly increase the classification performance. Our proposed approach consists of three new major contributions including automatic localisation of optic disc, automatic segmentation of disc, and classification between normal and glaucoma based on geometric and non-geometric properties of different regions of an image. We have compared our method with existing approaches and tested it on both fundus and Scanning laser ophthalmoscopy (SLO) images. The experimental results show that our proposed approach outperforms the state-of-the-art approaches using either geometric or non-geometric properties. The overall glaucoma classification accuracy for fundus images is 94.4 % and accuracy of detection of suspicion of glaucoma in SLO images is 93.9 %. [ABSTRACT FROM AUTHOR]

Tests of goodness of fit of sparse multinomial models with non-canonical links is proposed by using approximations to the first three moments of the conditional distribution of a modified Pearson Chi-square statistic. The modified Pearson statistic is obtained using a supplementary estimating equation approach. Approximations to the first three conditional moments of the modified Pearson statistic are derived. A simulation study is conducted to compare, in terms of empirical size and power, the usual Pearson Chi-square statistic, the standardized modified Pearson Chi-square statistic using the first two conditional moments, a method using Edgeworth approximation of the p-values based on the first three conditional moments and a score test statistic. There does not seems to be any qualitative difference in size of the four methods. However, the standardized modified Pearson Chi-square statistic and the Edgeworth approximation method of obtaining p-values using the first three conditional moments show power advantages compared to the usual Pearson Chi-square statistic, and the score test statistic. In some situations, for example, for small nominal level, the standardized modified Pearson Chi-square statistic shows some power advantage over the method using Edgeworth approximation of the p-values using the first three conditional moments. Also, the former is easier to use and so is preferable. Two data sets are analyzed and a discussion is given. [ABSTRACT FROM AUTHOR]

Summary: Reference point indentation is a novel method to assess bone material strength index (BMSi) in vivo. We found that BMSi at the mid-tibia was weakly associated with spine and hip areal bone mineral density but not with prevalent fracture in a population-based cohort of 211 older women. Introduction: Reference point indentation is a novel method to assess BMSi in vivo. Lower BMSi has been observed in patients with prior fracture than in controls, but no association between BMSi and areal bone mineral density (aBMD) has been found. Population-based association studies and prospective studies with BMSi and fractures are lacking. We hypothesized that BMSi would be associated with prevalent fractures in older Swedish women. The aim was to investigate the associations between BMSi, aBMD, and prevalent fracture in older women. Methods: Two hundred eleven women, mean age 78.3 ± 1.1 years, were included in this cross-sectional, population-based study. BMSi was assessed using the OsteoProbe device at the mid-tibia. Areal BMD of the hip, spine, and non-dominant radius was measured using dual-energy X-ray absorptiometry (DXA). Fracture history was retrieved using questionnaires, and vertebral fractures were identified using vertebral fracture assessment (VFA) by DXA. Results: One hundred ninety-eight previous fractures in 109 subjects were reported. A total of 106 women had a vertebral fracture, of which 58 women had moderate or severe fractures. An inverse correlation between BMSi and weight ( r = −0.14, p = 0.04) was seen, and BMSi differed according to operator (ANOVA p < 0.01). Adjusting for weight and operator in a linear regression model, we found that BMSi was positively associated with aBMD of the total hip ( β = 0.14, p = 0.04), non-dominant radius ( β = 0.17, p = 0.02), and lumbar spine (L1-L4) ( β = 0.14, p < 0.05). Using logistic regression, we could not find any association in crude or adjusted BMSi (for age, weight, height, walking speed, calcium intake, smoking, bisphosphonate and glucocorticoid use, and operator) with prevalent fractures. Conclusion: We conclude that BMSi is associated with aBMD but not with prevalent fracture in a population-based cohort of 211 older women. [ABSTRACT FROM AUTHOR]

We have assembled and assessed the statistical procedure which is capable to objectively explore influence of the Danube's major tributaries (the Rivers Tisa, Sava, and Velika Morava) to its eco-chemical status. Procedure contains several tests for measurement of central tendencies: one-way analysis of variance (ANOVA), repeated measures ANOVA, and nonparametric Kruskal-Wallis and Mann-Whitney tests. Various nuisance factors, (outliers, departures from normality, seasonality, and heteroscedasticity) which are present in large data bases, affect the objectivity of central tendency tests; therefore, it was important not only to estimate their robustness, but also to apply proper procedures for detection of the nuisance factors (Grubbs', generalized ESD-extreme Studentized deviate, Kolmogorov-Smirnov, Shapiro-Wilk, turning point, Wald-Wolfowitz runs, Kendall rank, and Levene's tests) and to mitigate their influence (outlier exclusion, Box-Cox, and logarithmic transformations). The analysis of selected eco-chemical parameters: biological oxygen demand-5, chemical oxygen demand, UV extinction at 254 nm, dissolved oxygen, oxygen saturation, total dissolved solids, electrical conductivity, suspended matter, total phosphorus, phosphates, nitrates, ammonia, pH, total alkalinity, m-2p alkalinity, CO, and temperature, was performed for 15 years period. The Tisa was the most polluted tributary, but its pollution load was not substantial enough to exceed the Danube self-purification potential. The City of Belgrade was also identified as serious pollution source. Assessment of assembled statistical procedure, which was based on the real environmental data, indicates that proposed tests are sufficiently robust to the observed level of nuisance factors with the exception of pronounced seasonality. [ABSTRACT FROM AUTHOR]

Earlier autism diagnosis, the importance of early intervention, and development of specific interventions for young children have contributed to the emergence of similar, empirically supported, autism interventions that represent the merging of applied behavioral and developmental sciences. 'Naturalistic Developmental Behavioral Interventions (NDBI)' are implemented in natural settings, involve shared control between child and therapist, utilize natural contingencies, and use a variety of behavioral strategies to teach developmentally appropriate and prerequisite skills. We describe the development of NDBIs, their theoretical bases, empirical support, requisite characteristics, common features, and suggest future research needs. We wish to bring parsimony to a field that includes interventions with different names but common features thus improving understanding and choice-making among families, service providers and referring agencies. [ABSTRACT FROM AUTHOR]