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Objective The disease process in rheumatoid arthritis (RA) starts years before the clinical diagnosis is made, and elevated levels of disease-specific autoantibodies can be detected during this period. Early responses to known or novel autoantigens likely drive the eventual production of pathogenic autoimmunity. Importantly, the presence of disease-specific autoantibodies can identify individuals who are at high risk of developing RA but who do not currently have arthritis. The goal of the current study was to characterize plasmablasts from individuals at risk of developing RA. Methods We investigated antibody-secreting plasmablasts derived from a well-characterized cohort of individuals who were at risk of developing RA, based on RA-related serum autoantibody positivity, as compared to patients with early (<1 year) seropositive RA as well as healthy control subjects. The plasmablast antibody repertoires of at-risk subjects were analyzed using DNA barcode-based methods with paired heavy- and light-chain gene sequencing. Cells were single-cell sorted, the cell- and plate-specific DNA barcodes were sequentially added, and next-generation sequencing was performed. Results Total plasmablast levels were similar in the antibody-positive (1%) and control (0.4-1.6%) groups. However, increased frequencies of IgA+ versus IgG+ plasmablasts were observed in the antibody-positive group (39% IgA+ and 37% IgG+) as compared to other groups (1-9% IgA+ and 71-87% IgG+). Paired antibody sequences from antibody-positive subjects revealed cross-isotype clonal families and similar sequence characteristics in the IgA and IgG plasmablast repertoires. Antibody-positive individuals also demonstrated elevated serum levels of IgA isotype anti-cyclic citrullinated peptide 3 antibodies. Conclusion The IgA plasmablast dominance in these antibody-positive individuals suggests that a subset of RA-related autoantibodies may arise from mucosal immune responses and may be involved in early disease pathogenesis in individuals who are at risk of developing RA. [ABSTRACT FROM AUTHOR]

Objective To determine the effect of alendronate (ALN) and teriparatide on trabecular bone score (TBS) in patients with glucocorticoid-induced osteoporosis. Methods Patients with chronic glucocorticoid therapy-induced osteoporosis (median 7.5 mg/day prednisone equivalent for ≥90 days) were randomized to receive oral ALN 10 mg/day (n = 214) or subcutaneous teriparatide 20 μg/day (n = 214) for 36 months; 118 patients in the ALN group and 123 patients in the teriparatide group completed treatment. Dual x-ray absorptiometry (DXA) results for 53 patients receiving ALN and 56 patients receiving teriparatide who had DXA scans with adequate resolution to perform TBS analysis and completed 36 months of therapy were blindly analyzed for TBS at baseline and 3, 6, 12, 18, 24, and 36 months. Results In teriparatide-treated patients, TBS was significantly increased at 18 months compared to baseline, and by 36 months had increased 3.7% ( P < 0.05). In ALN-treated patients, there was not a significant change in TBS compared to baseline at any time point. Changes in lumbar spine bone mineral density (BMD) measured by DXA in the subgroup with TBS data were similar to BMD results in the overall study population. At 36 months, increases in lumbar spine BMD were 5.5% and 10.3% in patients treated with ALN and teriparatide, respectively. Conclusion In patients with glucocorticoid-induced osteoporosis, both ALN and teriparatide increased lumbar spine BMD. However, trabecular bone score significantly increased with teriparatide but did not significantly change with ALN. The pathogenesis of glucocorticoid-induced osteoporosis is predominantly reduced bone formation. TBS may represent a sensitive measure to discriminate treatment effects of an anabolic versus an antiresorptive drug in glucocorticoid-induced osteoporosis. [ABSTRACT FROM AUTHOR]

Integrating the perspectives of psychological contract and sex differences, this study examines how organizational decision to reduce labour costs influences employees' perceived psychological contract breach and their commitment to their organizations. Using two experiments, we found three-way interaction effects among the decision to reduce labour costs, employee sex, and the managerial control over the decision. The decision of labour costs reduction leads to stronger feelings of psychological contract breach for females when the decision is in low than in high levels of managerial control, but the same decision leads to stronger psychological contract breach for males when the decision is in high than in low levels of managerial control. Furthermore, the indirect effect of labour costs reduction on employees' organizational commitment through psychological contract breach is also contingent upon the interaction between employee sex and managerial control. Our findings expand the literature of psychological contract and shed light on timely practical issues of management's decisions regarding labour costs reduction. Practitioner points Labour costs reductions in economic downturns lead to different responses from employees, and managers are advised to plan their actions bearing in mind such differences., Management in crisis or difficulties calls for more delicate considerations of employees' psychological feelings towards the organization., Nuanced empirical evidence informs us about the different needs and responses of a diverse group of employees and how their responses contradict. [ABSTRACT FROM AUTHOR]

Drawing on conservation of resources ( COR) theory, this study examines conditions under which psychological contract breach relates to employees' use of work-role innovation as a means to acquire or conserve resources. Specifically, we used the organizational embeddedness dimensions of links, person-organization ( P- O) fit, and sacrifices ( Mitchell et al., , Academy of Management Journal, 44, 1102) to capture the kinds of resources that are likely to determine whether breach relates to more (resource acquisition) or less (resource conservation) innovation. We expected breach to relate to more innovation among employees with more links, better P- O fit, or fewer sacrifices. Using survey data from 90 university professionals and alumni in Australia, we found that links, P- O fit, and sacrifices moderated the breach-innovation relationship as hypothesized. Specifically, breach was related to more innovation after 6 months among employees with more links, better P- O fit, or fewer perceived sacrifices, as compared to those with fewer links, lower P- O fit, or greater perceived sacrifices. Implications of these findings for theory and practice are discussed. Practitioner points To promote constructive employee responses to resource loss, organizations should find ways to increase employees' instrumental social and psychological resources., Employees' social resources (links) can be increased through social events, mentoring programmes, or the use of role models during on-the-job socialization., Building employees' psychological resources ( P- O fit) starts with recruitment and selection. Realistic information about the organization's values should be provided to job candidates, so they can make informed choices about their compatibility with this value system., Binding employees to the organization with material and psychological job benefits (e.g., bonuses and interesting projects) might not encourage constructive employee responses to resource loss. [ABSTRACT FROM AUTHOR]

Objectives: The rate of recombinant tissue plasminogen activator (rtPA) use for stroke is low among the Chinese-Taiwanese. The study objective was to determine if less restrictive exclusion criteria for rtPA would increase eligibility and the rate of treatment. Methods: This retrospective before-and-after study was conducted from 2006 to 2009. The authors compared stroke patients treated under the old rtPA exclusion criteria (January 2006 to December 2008) with those treated with less restrictive rtPA exclusion criteria (January to December 2009). Rates of eligibility and treatment and reasons for exclusion from rtPA between the two phases were assessed. Results: Of 461 eligible patients during the study period, 333 were evaluated by the old criteria and 128 were evaluated by the less restrictive criteria. Minor or improving stroke was the primary exclusion reason in both groups (194/333, 58% vs. 70/128, 55%). Eligibility for rtPA was increased in the less restrictive criteria (35/127, 27%, 95% confidence interval [CI] = 20% to 36%) compared to the old criteria (40/333, 12%, 95% CI = 8.7% to 16%; p = 0.0001). Fewer patients were excluded due to old age in the less restrictive criteria (0/128, 0%) compared to the old criteria (37/333, 11%; p = 0.0001). The rate of consent refusal increased in the less restrictive criteria (27/128, 21%, 95% CI = 14% to 29%) compared to the old criteria (23/333, 6.9%, 95% CI = 4.4% to 10%; p < 0.0001). Rate of rtPA treatment was unchanged between the less restrictive criteria (8/128, 6.3%, 95% CI = 2.7% to 12%) and the old criteria (17/333, 5.1%, 95% CI = 3% to 8%; p = 0.63). Conclusions: Increasing eligibility for rtPA does not increase the rate of treatment, possibly due to the high symptomatic intracerebral hemorrhage rate among Chinese-Taiwanese, which is a major concern among emergency physicians (EPs), neurologists, and patients. Dealing with perceived safety issues of rtPA is crucial before the rate of treatment can be increased. [ABSTRACT FROM AUTHOR]

Objectives: This study examined selected effects of the proper use of nonparametric inferential statistical methods for analysis of nonnormally distributed data, as exemplified by emergency department length of stay (ED LOS). The hypothesis was that parametric methods have been used inappropriately for evaluation of ED LOS in most recent studies in leading emergency medicine (EM) journals. To illustrate why such a methodologic flaw should be avoided, a demonstration, using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), is presented. The demonstration shows how inappropriate analysis of ED LOS increases the probability of type II errors. Methods: Five major EM journals were reviewed, January 1, 2004, through December 31, 2007, and all studies with ED LOS as one of the reported outcomes were reviewed. The authors determined whether ED LOS was analyzed correctly by ascertaining whether nonparametric tests were used when indicated. An illustrative analysis of ED LOS was constructed using 2006 NHAMCS data, to demonstrate how inferential testing for statistical significance can deliver differing conclusions, depending on whether nonparametric methods are used when indicated. Results: Forty-nine articles were identified that studied ED LOS; 80% did not perform a test of normality on the ED LOS data. Data were not normally distributed in all 10 of the studies that did perform such tests. Overall, 43% failed to use appropriate nonparametric methods. Analysis of NHAMCS data confirmed that failure to use nonparametric bivariate tests results in type II statistical error and in multivariate models with less explanatory power (a smaller R 2 value). Conclusions: ED LOS, a key ED operational metric, is frequently analyzed incorrectly in the EM literature. Applying parametric statistical tests to such nonnormally distributed data reduces power and increases the probability of a type II error, which is the failure to find true associations. Appropriate use of nonparametric statistics should be a core component of statistical literacy because such use increases the validity of ED research and quality improvement projects. ACADEMIC EMERGENCY MEDICINE 2010; 17:1113-1121 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2010; 17:940–950 © 2010 by the Society for Academic Emergency Medicine Objectives: The objectives of this study were to determine concordance of emergency department (ED) management of acute myocardial infarction (AMI) with guideline recommendations and to identify ED and patient characteristics predictive of higher guideline concordance. Methods: The authors conducted a chart review study of ED AMI care as part of the National Emergency Department Safety Study (NEDSS). Using a primary hospital discharge diagnosis of AMI (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM], codes 410.XX), a random sample of ED visits for AMI in 58 urban EDs across 20 U.S. states between 2003 and 2006 were identified. Concordance with American College of Cardiology/American Heart Association (ACC/AHA) guideline recommendations was evaluated using five individual quality measures and a composite concordance score. Concordance scores were calculated as the percentage of eligible patients who received guidelines-recommended care. These percentage scores were rescaled from 0 to 100, with 100 indicating perfect concordance. Results: The cohort consisted of 3,819 subjects; their median age was 65 years, and 62% were men. The mean (± standard deviation [SD]) ED composite concordance score was 61 ± 8), with a broad range of values (42 to 84). Except for aspirin use (mean concordance, 82), ED concordance scores were low (beta-blocker use, 56; timely electrocardiogram [ECG], 41; timely fibrinolytic therapy, 26; timely ED disposition for primary percutaneous coronary intervention [PCI] candidates, 43). In multivariable analyses, older age (beta-coefficient per 10-year increase, −1.5; 95% confidence interval [CI] = −2.4 to −0.5) and southern EDs (beta-coefficient, −5.2; 95% CI = −9.6 to −0.9) were associated with lower guideline concordance, whereas ST-segment elevation on initial ED ECG was associated with higher guideline concordance (beta-coefficient, 3.6; 95% CI = 1.5 to 5.7). Conclusions: Overall ED concordance with guideline-recommended processes of care was low to moderate. Emergency physicians should continue to work with other stakeholders in AMI care, such as emergency medical services (EMS) and cardiologists, to develop strategies to improve care processes. [ABSTRACT FROM AUTHOR]

This article examines the consistency, interpretation and application of Bayes factors constructed from standard test statistics. Primary conclusions are that Bayes factors based on multinomial and normal test statistics are consistent for suitable choices of the hyperparameters used to specify alternative hypotheses, and that such constructions can be extended to obtain consistent Bayes factors based on likelihood ratio statistics. A connection between Bayes factors based on likelihood ratio statistics and the Bayesian information criterion is exposed, as is a connection between Bayes factors based on F statistics and parametric Bayes factors based on normal-inverse gamma models. Similarly, Bayes factors based on chi-squared statistics for multinomial data are shown to provide accurate approximations to Bayes factors based on multinomial/Dirichlet models. An illustration of how the simple form of these Bayes factors can be exploited to generate easily interpretable summaries of the experimental ‘weight of evidence’ is provided. [ABSTRACT FROM AUTHOR]

This paper is concerned with giving general conditions for the validity of an approximation to a distribution function by means of the weighted sum of a set of Chi-squared distribution functions. The conditions are very similar to those of [3]. The approximation is illustrated by an example of its use. [ABSTRACT FROM AUTHOR]

It is recommended that infants from the age of 12 months should be weaned from bottles. However, an overwhelming proportion of young children were still using bottle after the recommended age of bottle-weaning. This cross-sectional study examined the association between utensils for milk drinking and food group consumption, growth and socio-demographic characteristics among young children. Data from the Survey of Infant and Young Child Feeding in Hong Kong were analyzed for 649 children aged 18-48 months old. Dietary outcomes were obtained via 3-day dietary records, while utensils for milk drinking and socio-demographic characteristics were collected from a self-developed questionnaire. Length/height and weight of the children were measured by the nurses. Results showed that daily consumption of formula milk was significantly greater among bottle users or bottle plus cup users than non-bottle users ( p < 0.05). Exclusive bottle users had significantly lower intakes of meat and meat alternatives than bottle plus cup users for the 18 to 24-month group ( p = 0.001) and lower intakes of fruits than non-bottle users in the 48-month group ( p = 0.015). BMI z-score was significantly higher for exclusive bottle users than non-bottle users, even after adjusting for socio-economic factors and child's age ( p = 0.006). The results showed that the milk drinking utensil was associated with the amount of formula milk and food group consumption as well as BMI z-score. There is a need to actively discourage prolonged bottle use in order to help young children develop good dietary habits. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]

Nipple pain and damage are commonly experienced by breastfeeding women and are associated with negative breastfeeding outcomes. Health care providers often recommend the application of lanolin to treat painful/damaged nipples, yet no randomized controlled trial has evaluated the effectiveness of lanolin on nipple pain and breastfeeding outcomes. The purpose of this study was to evaluate the effect of lanolin on nipple pain among breastfeeding women with damaged nipples. A randomized, single-blind, controlled trial was conducted at a tertiary care hospital in Hamilton, Ontario, Canada. Breastfeeding women ( N = 186) identified as having nipple pain/damage were randomized to apply lanolin (intervention group; n = 93) or to receive usual postpartum care (control group; n = 93). The primary outcome was nipple pain at 4 days post-randomization measured by the Numeric Rating Scale. Additional outcomes included nipple pain measured by the Short Form McGill Pain Questionnaire, breastfeeding duration/exclusivity, breastfeeding self-efficacy, and maternal satisfaction with lanolin treatment versus usual care. The results revealed no significant group differences in mean pain scores at 4 days post-randomization. Women in both groups experienced clinically relevant decreases in nipple pain by 7 days post-randomization. Significantly, more women in the lanolin group reported that they were satisfied with treatment compared with those receiving usual care. No significant group differences were found for other secondary outcomes. While more women were satisfied using lanolin, its application to sore/damaged nipples was ineffective for reducing nipple pain or improving breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Common mental disorders, such as depression and anxiety, affect approximately 16% of pregnant women in low- and middle-income countries. Food insecurity (FI) has been shown to be associated with depressive symptoms. It has also been suggested that the association between FI and depressive symptoms is moderated by social support (SS); however, there is limited evidence of these associations among pregnant women living in low-income and middle-income countries. We studied the association between FI and depressive symptoms severity and assessed whether such an association varied among Ugandan pregnant women with low vs. high SS. Cross-sectional data were collected among 403 pregnant women in northern Uganda. SS was assessed using an eight-item version of the Duke-UNC functional SS scale. FI and depressive symptoms were assessed by, respectively, the individually focused FI scale and the Center for Epidemiologic Studies-Depression scale. Women were categorized into two SS groups, based on scoring < or ≥ to the median SS value. Multivariate linear regression models indicated an independent association between FI and depressive symptoms severity. The association between FI and depressive symptoms severity was moderated by SS i.e. was stronger among women in the low SS category (adjusted beta (95%CI): 0.91 (0.55; 1.27)) than for women belonging to the high SS group (0.53 (0.28; 0.78)) (adjusted p value for interaction = 0.026). There is need for longitudinal or interventional studies among pregnant women living in northern Uganda or similar contexts to examine the temporal sequence of the associations among food insecurity, depressive symptoms severity and social support. © 2016 John Wiley & Sons Ltd [ABSTRACT FROM AUTHOR]