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Objective: To demonstrate sexual dimorphism in serum leptin levels not only during puberty, but also in childhood in Japan. Design: Cross-sectional study. Setting: Hamamatsu-Hokuen study in Japan. Subjects: Body weight and height were measured in normal-weight Japanese children and adolescents (143 boys, 178 girls), and 161 boys and 129 girls whose percentage of overweight for the standard (%Wt) was more than+25%. Serum leptin levels were compared with %Wt. Subjects were divided into group 1 (6–10 y of age) and group 2 (11–15 y of age) according to their age. Results: In overweight subjects, leptin was more highly correlated with %Wt in boys of group 2 (r=0.67, P

Purpose Weight bias internalization (WBI) is associated with negative health consequences such as eating disorders and psychosocial problems in children. To date, it is unknown to what extent WBI considerably raises the risk of negative outcomes. Methods Analyses are based on cross-sectional data of 1,061 children (9–13 years, M = 11, SD = 0.9; 52.1% female) who filled in the WBI scale (WBIS-C). First, ROC analyses were run to identify critical cut-off values of WBI (WBIS-C score) that identify those who are at higher risk for psychosocial problems or eating disorder symptoms (as reported by parents). Second, it was examined whether WBI is more sensitive than the relative weight status in that respect. Third, to confirm that the cut-off value is also accompanied by higher psychological strain, high- and low-risk groups were compared in terms of their self-reported depressive symptoms, anxious symptoms, body dissatisfaction, and self-esteem. Results WBIS-C scores ≥ 1.55 were associated with a higher risk of disturbed eating behavior; for psychosocial problems, no cut-off score reached adequate sensitivity and specificity. Compared to relative weight status, WBI was better suited to detect disturbed eating behavior. Children with a WBIS-C score ≥ 1.55 also reported higher scores for both depressive and anxious symptoms, higher body dissatisfaction, and lower self-esteem. Conclusion The WBIS-C is suitable for identifying risk groups, and even low levels of WBI are accompanied by adverse mental health. Therefore, WBI is, beyond weight status, an important risk factor that should be considered in prevention and intervention. Level of evidence Level III, cross-sectional analyses based on data taken from a well-designed, prospective cohort study.

Background Postprandial hypoglycemia after bariatric surgery is an exigent disorder, often impacting the quality of life. Distinguishing clinically relevant hypoglycemic episodes from symptoms of other origin can be challenging. Diagnosis is demanding and often requires an extensive testing such as prolonged glucose tolerance or mixed-meal test. Therefore, we investigated whether baseline parameters of patients after gastric bypass with suspected hypoglycemia can predict the diagnosis. Methods We analyzed data from 35 patients after gastric bypass with suspected postprandial hypoglycemia and performed a standardized mixed-meal test. Hypoglycemia was defined by the appearance of typical symptoms, low plasma glucose, and relief of symptoms following glucose administration. Parameters that differed in patients with and without hypoglycemia during MMT were identified and evaluated for predictive precision using receiver operating characteristic (ROC) areas under the curve (AUC). Results Out of 35 patients, 19 (54%) developed symptomatic hypoglycemia as a result of exaggerated insulin and C-peptide release in response to the mixed-meal. Hypoglycemic patients exhibited lower glycosylated hemoglobin A1c (HbA1c) and higher absolute and relative weight loss from pre-surgery to study date. HbA1c and absolute weight loss alone could achieve acceptable AUCs in ROC analyses (0.76 and 0.72, respectively) but a combined score of absolute weight loss divided by HbA1c (0.78) achieved the best AUC. Conclusions HbA1c and weight loss differed in patients with and without symptomatic hypoglycemia during mixed-meal test. These baseline parameters could be used for screening of postprandial hypoglycemia in patients after gastric bypass and may facilitate the selection of patients requiring further evaluation. Graphical abstract

Background: An international physical activity (PA) questionnaire is beneficial to make cross-country comparisons among children and adolescents. This study assesses the validity of the PA questions in the World Health Organization Health Behavior in School-Aged Children (WHO HBSC) survey in Japanese children and adolescents. Methods: Participants were fifth- to sixth-grade Japanese primary school students (67 students aged 10.8 [0.5] y) and first- to third-grade junior high school students (108 students aged 13.0 [0.7] y). The Japanese version of the PA questions in the WHO HBSC (WHO HBSC-J) was used. To assess the validity of the PA questions, the authors used a partial correlation adjusted for sex, age, and relative weight between the answers to the survey questions and objectively measured moderate to vigorous PA (MVPA) by an accelerometer. Results: A significant positive correlation was found between accelerometer-measured MVPA and the number of reported days with at least 60 minutes/day of MVPA in primary school students (r = .39, P = .002) and junior high school students (r = .32, P Conclusion: The HBSC-J has moderate validity for evaluating MVPA in Japanese primary school and junior high school students.

OBJECTIVE: There is a growing call to identify specific outcome predictors in real-world eating disorder (ED) treatment settings. Studies have implicated several ED treatment outcome predictors [rapid response (RR), weight suppression, illness duration, ED diagnosis, and psychiatric comorbidity] in inpatient settings or randomized controlled trials of individual outpatient therapy. However, research has not yet examined outcome predictors in intensive outpatient programs (IOP). The current study aimed to replicate findings from randomized controlled research trials and inpatient samples, identifying treatment outcome predictors in a transdiagnostic ED IOP sample. METHOD: The current sample comprised 210 consecutive unique IOP patient admissions who received evidence-based ED treatment, M(SD)(Duration) = 15.82 (13.38) weeks. Weekly patient measures of ED symptoms and global functioning were obtained from patients’ medical charts. RESULTS: In relative weight analysis, RR was the only significant predictor of ED symptoms post treatment, uniquely accounting for 45.6% of the predicted variance in ED symptoms. In contrast, baseline ED pathology was the strongest unique predictor of end-of-treatment global functioning, accounting for 15.89% of predicted variance. Baseline factors did not differentiate patients who made RR from those who did not. CONCLUSIONS: Consistent with findings in more controlled treatment settings, RR remains a robust predictor of outcome for patients receiving IOP-level treatment for EDs. Future work should evaluate factors that mediate and moderate RR, incorporating these findings into ED treatment design and implementation. LEVEL OF EVIDENCE: Level IV, uncontrolled intervention.

International audience; In contrast to short-term cognitive outcomes, long-term cognitive outcomes (over 5 years) has been scarcely assessed so far. Yet, predicting long-term outcomes at any time point of the epilepsy, from initial diagnosis, to medically intractability is very important for therapeutic decision-making, patient information, and orientation. Assessing long-term cognitive outcomes in patients with epilepsy would ideally require longitudinal studies and a comparison with a healthy controls group. This issue has been addressed extensively, but with controversial results. However, there is a general consensus about the fact that cognitive outcome is not the same in all groups of patients with epilepsy. Possible prognostic factors include age at onset, duration of epilepsy, syndrome and etiology, seizure outcome and therapeutics. The multiplicity of factors makes it very difficult to assess their relative weight in individuals. Although long-term cognitive outcome studies are scarce, this issue has been specifically studied in newly diagnosed epilepsies and in focal drug-resistant epilepsies. In the first clinical setting, i.e. newly diagnosed epilepsy, it appears that cognitive deficits are already present at epilepsy onset in a significant proportion of patients but seem to remain stable over time. In focal drug-resistant epilepsies, cognitive deficits (mainly verbal memory) were generally shown to remain stable provided that seizures were controlled either by medication or by surgery. Beyond the possible correlation between seizure and cognitive outcome, no causal link however has been demonstrated between these two important outcomes.

Objective: To advance the development of an ideal and sustainable framework agreement for the public procurement of vaccines in Spain, and to agree on the desirable award criteria and their relative weight. Methods: A multidisciplinary committee of seven health-care professionals and managers developed a partial multi-criteria decision analysis to determine the award criteria that should be considered and their specific weights for the public procurement of routine vaccines and seasonal influenza vaccines, considering their legal viability. A re-test of the results was carried out. The current situation was analyzed through 118 tender specifications and compared to the ideal framework. Results: Price is the prevailing award criterion for the public procurement of both routine (weighting of 60% versus 40% for all other criteria) and influenza (36% versus 64%) vaccines. Ideally, 22 criteria should be considered for routine vaccines, grouped and weighted into five domains: efficacy (weighting of 29%), economic aspects (27%), vaccine characteristics (22%), presentation form and packaging (13%), and others (9%). Per criteria set, price was the most important criterion (22%), followed by effectiveness (9%), and composition/formulation (7%). Regarding influenza vaccines, 20 criteria were selected, grouped, and weighted: efficacy (29%), economic aspects (25%), vaccine characteristics (20%), presentation form and packaging (16%), and others (11%). Per criteria set, price was also the most relevant criterion (19%), followed by composition/formulation (8%), and effectiveness (8%). Conclusions: Contrary to the current approach, technical award criteria should prevail over economic criteria in an ideal and sustainable framework agreement for the public procurement of vaccines.

(1) Background: school travel is an important part of a child’s daily activities. A comfortable walking environment can encourage children to walk to school. The existing methods of evaluating walking environments are not specific to children’s walks to school. (2) Methods: this study proposes a method of evaluating walking comfort in children traveling to school at street scale. Related indexes were selected that reflect children’s school travel behavior and their needs in street environments based on walking environment audit tools. Factor analysis was then used to calculate the relative weight of each index. (3) Results: the new evaluation method was tested in the neighborhoods around the First Central Primary School in Hedong District, Tianjin, China. The walking comfort for children’s school travel was evaluated in eight indexes: effective street width, street flatness, street cleanliness, interface diversity, buffer, shade coverage, green looking ratio, and sound decibels. Different classes and types of streets were found to have various vulnerabilities. (4) Conclusions: this evaluation method can accurately locate the weak spots in streets to improve the local policymakers’ perception of street environments, which can greatly facilitate the implementation of precise measures to promote children walking to school.

International audience; Consonants and vowels have been considered to fulfill different functions in language processing, vowels being more important for prosodic and syntactic processes and consonants for lexically related processes (Nespor et al., 2003). This C-bias hypothesis in lexical processing is supported by studies with adults and infants in many languages such as English, French, Spanish, although a few studies, on Danish and Mandarin, suggest the existence of cross-linguistic variation. The present study explores whether a C-bias exists in a tone language with a complex tone system, Cantonese, by comparing the relative weight given to consonants, vowels, and also tones during word learning. To do so, looking behaviors of Cantonese-learning 20-and 30-month-olds (24 children per age/condition, 6 groups) were recorded by an eyetracker while they watched animated cartoons in Cantonese to learn pairs of novel words. The words differed minimally by either a consonant (e.g., /toe6/ vs. /koe6/), a vowel (e.g., /k h im3/ vs. /k h ɛm3/), or a tone (e.g., T2 vs. T5). Analyses on proportional looking times revealed significant learning in 30-month-olds only, and at that age, only for the vowel contrasts. Growth curve analyses revealed better performance for the vowel condition compared to the other two conditions. The present findings establish a V-bias in Cantoneselearning 30-month-olds, adding new evidence from that tone language that the C-bias in lexical processing is not language-general. Implications for theoretical discussions on the origins of this phonological bias, and the impact of tones in early language acquisition, are discussed.

PURPOSE: Boys represent a small proportion of samples in randomized clinical trials (RCT) investigating evidence-based treatment for adolescents with anorexia nervosa (AN). Consequently, knowledge of potential gender differences in clinical characteristics and treatment response in adolescents is considerably limited. METHODS: Secondary analyses of aggregated data from two RCTs were used to characterize baseline and end-of-treatment clinical features in male and female adolescents with AN (n = 228, 10.53% male). Mixed analyses of variance were used to investigate potential gender differences in treatment response relative to weight outcomes (%median BMI) and eating disorder cognitions (Eating Disorder Examination Global scores; EDE). RESULTS: There were no significant gender differences in prior inpatient care, illness duration, psychiatric comorbidity, or psychotropic medication use at baseline. Nor were there significant gender differences in binge eating, purging, or driven exercise at baseline or end-of-treatment. Girls reported elevated weight and shape concern compared to boys at baseline but overall reduction in EDE Global scores over the course of treatment did not differ according to gender. Boys gained more relative weight during treatment than girls, but this difference was statistically non-significant. CONCLUSION: Overall findings do not suggest significant differences in treatment outcome relative to weight or ED cognitions, by gender. Current evidence suggests that, with the exception of shape and weight concerns, boys present with cognitive and behavioral symptoms as severe as their female counterparts which underscores the need for increased accuracy in assessment of these disorders in boys and young men. LEVEL OF EVIDENCE: Level 1, secondary data analysis of randomized controlled trials

Spain is considered the healthiest nation in the world, due to lifepromoting aspects such as good diet, care facilities and a favourable family environment. However, although increased life expectancy is an indicator of development, it may have a negative impact on the other two variables of health service efficiency, namely health expenditure per capita and its relative weight in Gross Domestic Product.

BACKGROUND: Neoadjuvant treatment followed by esophagectomy is standard practice in locally advanced esophageal cancer. However, not all patients who started neoadjuvant treatment will undergo esophageal resection. The purpose of our study was to investigate the group of patients, scheduled for neoadjuvant treatment followed by esophagectomy, who never made it to esophageal resection. METHODS: We retrospectively analyzed patients treated between 2002 and 2015 for locally advanced esophageal cancer, who did not undergo esophagectomy after neoadjuvant treatment. Subanalysis was performed according to time period (2002-2010 versus 2011-2015) and histology (adenocarcinoma versus squamous cell carcinoma). RESULTS: In 114 of 679 patients (16.8%), surgery was not performed after neoadjuvant treatment. Reasons for cancelation were disease progression (50 patients, 43.9%), poor general condition (26 patients, 22.8%), irresectability (14 patients, 12.3%), patients' own decision (15 patients, 13.2%), and death during neoadjuvant treatment (9 patients, 7.9%). In the second time period, there were less irresectable tumors (17.7% versus 5.8%; p = 0.044). Median overall survival was not different over time (9.2 versus 12.5 months; p = 0.937). Irresectability (p = 0.032), patients' refusal (p = 0.012), and poor general condition (p = 0.002) were more frequent as reasons for cancelation in squamous cell carcinoma patients. Median overall survival was, respectively, 12.5 and 9.9 months for adenocarcinoma and squamous cell carcinoma patients (p = 0.441). The majority of patients refusing surgery had a clinical complete response (73.3%). They had a median overall survival of 33.2 months. CONCLUSIONS: One in six patients starting neoadjuvant treatment for locally advanced esophageal cancer never made it to esophagectomy, more than half of them for oncological reasons, but also 1.3% because of death during treatment. Over time, irresectability as reason decreased. As a result, the relative weight of medical inoperability increased, indicating the importance of upfront testing of medical operability. Cancelation of surgery was significantly more common in patients with a squamous cell carcinoma, and this histology seems to represent a more complex oncological and functional entity. Refusal of esophagectomy based on clinical complete response showed a significant survival benefit compared to those who did not undergo esophagectomy because of other reasons. ispartof: World J Surg Oncol vol:17 issue:89 pages:1-9 ispartof: location:England status: Published online

Background The association between the weight of school bag and Low Back Pain (LBP) amongst students remains under intense debate worldwide. This study aimed to estimate the prevalence of LBP amongst public high school students (14 to 19 years) in Kuwait and to investigate the association between LBP and the weight of school bags. Methods An analytical cross-sectional study using multistage cluster random sampling with probability proportional to size was conducted on a total of 950 public high school students from all governorates. Data on LBP were collected through face-to-face interviews using a structured questionnaire. A 0–10 Numeric Pain Rating Scale was used to rate the intensity of LBP. The students’ height and weight in addition to the weight of their school bags were measured using appropriate weight and height scales. Logistic regression was used to investigate the association between the weight of school bags and LBP while adjusting for potential confounders. Results The estimated lifetime, 6-month, and 1-month prevalence of LBP were 70.3% (95% CI: 67.30–73.21%), 49.1% (95% CI: 45.83–52.28%), and 30.8% (95% CI: 27.81–33.78%) respectively, with significantly higher prevalence amongst females compared to males (p

Introduction: Patients with obsessive-compulsive disorder (OCD) showed impaired spatial working memory (SWM). We evaluated whether patients and healthy controls (HCs) differed in spatial store capacity, and whether they differed in the relative weight of spatial store capacity and/or executive strategy in SWM. Methods: Thirty inpatients with OCD and 31 age- and education-matched HCs underwent the CANTAB SWM, SRM (a measure of spatial store). The severity of OC symptoms was assessed using the Y-BOCS. Statistical significance: alpha = 0.05. Results: Patients showed poorer performance than HCs in all neuropsychological outcomes. Both poorer SRM and SWM strategy were significantly associated with poorer SWM in the entire sample. No significant interaction between SRM and Group was found, while a significant interaction between SWM strategy and Group emerged; in patients the magnitude of this association was approximately twofold larger than in HCs. OC symptom severity did not correlate with neuropsychological performance. Conclusions: Patients with OCD had poorer spatial store capacity than HCs. However, the weight of poorer executive strategy in SWM was greater in patients than HCs, whereas the weight of spatial store was similar. We provided a direct evidence that an impairment in the executive component might be the crucial factor influencing the poorer SWM of these patients.

BACKGROUND CONTEXT Vertebral fragility fractures (VFFs), mostly due to osteoporosis, are very common and are associated with significant morbidity and mortality. There is a lack of consensus on the appropriate management of patients with or suspected of having a VFF. PURPOSE This work aimed at developing a comprehensive clinical care pathway (CCP) for VFF. STUDY DESIGN/SETTING The RAND/UCLA Appropriateness Method was used to develop patient-specific recommendations for the various components of the CCP. The study included two individual rating rounds and two plenary discussion sessions. METHODS A multispecialty expert panel (orthopedic and neurosurgeons, interventional [neuro]radiologists and pain specialists) assessed the importance of 20 signs and symptoms for the suspicion of VFF, the relevance of 5 diagnostic procedures, the appropriateness of vertebral augmentation versus nonsurgical management for 576 clinical scenarios, and the adequacy of 6 aspects of follow-up care. RESULTS The panel identified 10 signs and symptoms believed to be relatively specific for VFF. In patients suspected of VFF, advanced imaging was considered highly desirable, with MRI being the preferred diagnostic modality. Vertebral augmentation was considered appropriate in patients with positive findings on advanced imaging and in whom symptoms had worsened and in patients with 2 to 4 unfavorable conditions (eg, progression of height loss and severe impact on functioning), dependent on their relative weight. Time since fracture was considered less relevant for treatment choice. Follow-up should include evaluation of bone mineral density and treatment of osteoporosis. CONCLUSIONS Using the RAND/UCLA Appropriateness Method, a multispecialty expert panel established a comprehensive CCP for the management of VFF. The CCP may be helpful to support decision-making in daily clinical practice and to improve quality of care.

Objectives The aim of this study was to analyze the effects of intermittent fasting (IF) on the performance of rats subjected to resistance training ladder climbs (RTLCs). Methods Thirty-two Wistar rats (80-d-old) were placed into one of the following four groups (n = 8/group): control (C), which were fed a standard diet with no exercise; intermittent fasting (IF) rats underwent IF for 16 h/d, fed a standard diet for a period of 8 h/d with no exercise; trained control (TC) were fed a standard diet and submitted to RTLC; and trained intermittent fasting (TIF) underwent IF for 16 h/d, fed a standard diet for a period of 8 h/d, and submitted to RTLC. Training groups completed 6-wk of RTLC (3 × /wk). The maximal load test (MLT) was applied on two occasions: before the first RTLC session and at the end of week 6 of physical training. Its purpose was to compare changes in performance over time. Both blood collection and total extraction of the organs were performed at the end of the experimental period. Results Food intake was higher in the TC group than in either the IF or TIF groups. TC supported a higher load (g) during the final MLT compared with the C, IF, and TIF groups, respectively. TC (initial MLT: 371.4 ± 31.1; final MLT: 593.9 ± 33.5) and TIF (initial MLT: 402.3 ± 31.8; final MLT: 495.4 ± 83.3) presented higher values when the pre- and post-RTLC moments were compared. The relative weight of the stomach was higher in TIF than in C and TC rats. There was no difference in aspartate transaminase and alanine transaminase enzyme activities or in creatinine and total cholesterol levels. Conclusions IF negatively affected RTLC performance. IF plus RTLC increased the relative weight of the stomach as well as reduced food intake, without an increase in body weight, suggesting this combination may have promoted dilation of this organ, due, hypothetically, to the scarcity of food for several hours and the energy expenditure generated by physical training.

Objective:The aim of this study was an assessment of the effects of urbanisation level, family size and parental education on body mass index (BMI) and mid-upper arm circumference (MUAC) among Polish schoolchildren in cross-sectional surveys conducted between 1966 and 2012.Design:The analysis involved schoolchildren measured in four Polish Anthropological Surveys (1966, 1978, 1988 and 2012). Socio-economic factors involved: urbanisation level (city, town and village), family size (one child, two children, three children, four or more children), and father’s and mother’s education (lower and higher education).Setting:Regions in Poland – cities: Warsaw, Lodz and Wroclaw; towns: Bystrzyca Klodzka, Pinczow, Siemiatycze, Wolsztyn and their rural surroundings.Participants:A total sample consisted of 63 757 children (31 774 boys and 31 983 girls) aged 7–18 years.Results:Between 1966 and 1988, both BMI and MUAC had significantly higher values in children from cities, in families with one child and with higher parental education (P < 0·05). However, MUAC revealed significant differences between particular socio-economic groups more frequently than BMI. In 2012, urbanisation level and parental education ceased to show a differentiating effect on both indicators, while family size remained a significant social factor for both measures (BMI: P < 0·05; MUAC: P < 0·01).Conclusions:Since MUAC reflected socio-economic differences more frequently than BMI, it could be a more sensitive and reliable anthropometric measure revealing the effects of socio-economic factors on children’s nutritional status.

The theory of evolution is one of the greatest scientific achievements in the intellectual history of humankind, yet it is still contentious within certain social groups. Despite being as robust and evidence-based as any other notable scientific theory, some people show a strong reluctance to accept it. In this study, we used the Measure of Acceptance of the Theory of Evolution (MATE) and Knowledge of Evolution Exam (KEE) questionnaires with university students from four academic degree programs (Chemistry, English, History, and Biology) of ten universities from Spain to measure, respectively, acceptance and knowledge of evolutionary theory among third-year undergraduate students (nMATE = 978; nKEE = 981). Results show that acceptance of evolution is relatively high (87.2%), whereas knowledge of the theory is moderate (5.4 out of 10) although there are differences across degrees (Biology>Chemistry>History>English), and even among various universities (ranging from 4.71 to 5.81). Statistical analysis reveals that knowledge of evolutionary theory among Biology students is partially explained by the relative weight of evolutionary themes within the curriculum, suggesting that an increase in the number of hours dedicated to this topic could have a direct influence on students’ knowledge of it. We also found that religion may have a significant— although relatively small—negative influence on evolutionary theory acceptance. The moderate knowledge of evolution in our undergraduate students, together with the potential problem of acceptance in certain groups, suggests the need for a revision of the evolutionary concepts in the teaching curricula of our students since primary school., This work was supported by Xunta de Galicia (ED431C 2016-037), FONDOS FEDER (“unha maneira de facer Europa”), and Spain’s Ministerio de Economía, Industria y Competitividad, Agencia Estatal de Investigación (CGL2016-75904-C2-1-P), Dr. Emilio Rolán Alvarez.

Purpose Glaucoma leads as the first cause of irreversible blindness. The number of patients will greatly increase in upcoming years and changes will have to be accomplished to cope with those numbers. As such, data are important to understand the effect of new policies introduced in glaucoma management. Only few countries have described their glaucoma surgical profile and, in Europe, only the United Kingdom described the last 15 years. The aim of this study is to assess the glaucoma surgical profile and its changes in mainland Portugal from 2000 to 2015. Methods Retrospective database analysis of inpatient and surgical outpatients' episodes of all public hospitals in mainland Portugal was performed. The annual absolute numbers of ophthalmic procedures, as well as their surgical rate (per 100,000 inhabitants) were calculated. Results Glaucoma patients undergoing glaucoma procedures were 67±14 years old and 50% were female. During the study period there was an increase in the number and surgical rate of glaucoma procedures. Trabeculectomy showed a stable surgical rate (7 per 100,000 inhabitants) despite a reduction in terms of relative weight among glaucoma procedures. At the same time, the surgical rate of glaucoma drainage devices and cyclophotoablation increased, while remaining stable for cyclocryoablation. Conclusions In Portugal, trabeculectomy had a stable surgical rate throughout the study period, being the most performed glaucoma surgical procedure. Other surgeries, like glaucoma drainage devices and cyclophotoablation are gaining ground among glaucoma specialists. Our results match what has been published by other countries worldwide and can be used to achieve a better health planning.

BackgroundAround the age of 6 months, difficulties in settling to sleep and frequent night awakenings are generally occurring in 20 to 30% of infants. According to the transactional model parental factors can play a significant role in influencing infant sleep development. The purpose of the current study was to explore the combined effect of infants’ factors (temperament and sleep onset problems), and parental factors (parental mental health in terms of post-partum affective disorders, consistent bedtime routines and fathers’ involvement at bedtime), on infant bedtime difficulties (e.g. fussing, crying or protesting), including both maternal and paternal perspectives.MethodsSixty Italian intact two-parent families of infants (34 boys and 26 girls) ageing from 8 to 12 months (M = 10.73, SD = 2.54) were enrolled in the study. The parents filled out self-report questionnaires to measure the aforementioned variables. To investigate which infant and parental factors predicted infants’ bedtime difficulties, two multiple linear regressions (MR), one for fathers and one for mothers, and relative weight analyses (RWA) were conducted.ResultsWith regard to infants’ bedtime difficulties reported by fathers (R2 = .35) they were explained by infant involvement in constant bedtime routines (β = −.35,p = .030) and paternal involvement at bedtime (β = −.45,p = .007). Instead infants’ bedtime difficulties reported by mothers (R2 = .32) were explained by minutes the child taken to fall asleep (β = .24,p = .04), infant involvement in constant bedtime routines (β = −.31,p = .01) and bedtime paternal involvement (β = −.27,p = .05).ConclusionsThe main results of this study emphasized the protective role of consistent bedtime routines and bedtime paternal involvement in reducing infants’ bedtime difficulties perceived both from mothers and fathers. Future research could help to raise awareness and improve understanding of the familial influences on children’s sleep, providing recommendations for educating families, school professionals, healthcare providers, and the general public on risk and protective factors that could play a meaningful role in infants and children’s developing sleep patterns.

Our paper explores the value-laden and epistemic resources that scientists working in epigenetics and developmental programming of health and disease (DOHaD) mobilise to produce scientific representations of pregnancy and parenthood, which in turn imagine norms, values, and responsibilities for the protection of future generations. In order to do so, we first describe the place of questions regarding the relative weight of paternal and maternal influences on the health of the offspring in the discursive formalisation of this research in scientific publications. This enables us to identify the mutual constitution of 'prototypes' (i.e. experimental designs, settings, techniques) and 'stereotypes' (i.e. social meanings, beliefs, norms and values) of parental roles in DOHaD and epigenetic biomedical sciences, by means of a specific gendered figuration of paternal influences: the 'father-as-sperm'. Second, and drawing from a set of interviews (N = 15), we describe a tension between this dominant, objectifying molecular discourse and the perspective of individual scientists. The situated perspective of individual researchers provides in fact evidence for a conflictual (moral and epistemic) economy of gendered engagements with parental figurations in DOHaD and epigenetic research, and consequently suggests a more fine-grained, as well as conflictual web of socio-political positioning of this 'knowledge' in its societal circulation.

Cautious optimism is appropriate for a near future (five years) time frame for a number of drugs acting on the different pathophysiological components of Alzheimer's disease (amyloid deposition, tau hyperphosphorylation, neuroinflammation, vascular changes, to name the most important known so far). Since the relative weight of these components will be different between individuals and will even change over time for each individual, a 'one drug fit for all' approach is no longer defensible. Precision medicine using biomarkers in the diagnosis and treatment of Alzheimer's disease is the new strategy.

Background: The Children’s Eating Behaviour Questionnaire (CEBQ) is used with parents to determine the characteristics of eating behaviour of their children and, consequently, children’s propensity to become obese. It has been successfully used mainly in Western countries, but not in Saudi Arabia. In this pilot study, we explored the use of the Saudi version of the CEBQ for preschool children aged 2–6 years in Saudi Arabia, and assessed the associations between eating behaviours and children’s age, gender and relative weight and parental weight. Methods: Parents of 200 Saudi preschool children in Riyadh completed the Saudi version of the CEBQ. Factor analyses on all CEBQ items were performed and differences between genders and age groups were examined. Correlations between children’s BMI z-scores and eating behaviours were analysed using linear regression. Results: The factor analysis revealed an eight-factor solution similar to the theoretical factor structure, with good internal reliability and acceptable correlations between subscales. Boys scored higher than girls on food responsiveness, no difference between age groups was found. Positive associations between BMI z-scores and ‘food approach’ subscales, food responsiveness, enjoyment of food and emotional overeating were found, while ‘food avoidant’ subscales, satiety responsiveness and slowness in eating had inverse relationships with BMI z-scores. Maternal BMI had a positive association with BMI z-scores and food responsiveness. Conclusion: The CEBQ is a valid psychometric tool that can be reliably used to assess eating behaviour characteristics in Saudi preschool children.

Narrative psychology emphasizes the role of culture in shaping identities. Less attention has been paid to how individuals resist culture. Specifically, two aspects have remained understudied: the diverse forms of doing narrative resistance and the navigation between different types of master narratives involved in the process. The present study aimed to fill these gaps by examining the personal stories of former residents of Yamit, an Israeli region in the Sinai Peninsula that was evacuated following the peace agreement between Israel and Egypt. Holistic narrative analysis of the personal stories revealed three strategies of resisting the episodic master narrative of Yamit established in Israeli society - explicit debate, implicit debate, and neutralization - which differ in the relative weight of my/our story and the story about us. To remain within the Israeli consensus, resistance to the episodic master narrative was intertwined with appropriation of the Zionist foundational master narrative. The study demonstrates that narrative resistance can take diverse forms and simultaneously involve compliance with and resistance to different types of master narratives. Investigating these two findings offers a nuanced understanding of counter-narratives as multifaceted, illuminating the complex relationships between personal stories and culture.

Purpose The purpose of this study was to prospectively investigate the association between retinopathy of prematurity (ROP) and ocular growth in premature infants during the earliest weeks of life. Methods Premature infants in the national ROP screening program were recruited and examined at 1- or 2-week intervals between 30 and 38 weeks of postmenstrual age. One hundred infants with gestational age (GA) between 24 and 35 weeks (30.04 + 2.13), and birth weight (BW) between 550 and 2060 g (1251.45 + 317.19) were included in the study. At each examination, the presence, stage, and zone of ROP were recorded along with axial length (AL), central corneal thickness (CCT), and weight gain. Biometric parameters were measured by A-scan biometry. Study variables included GA, BW, AL, CCT, weight gain, relative weight (RW), and dif_AL, dif_CCT, and dif_weight, which are the differences between two consecutive recordings of the same infant. Multiple regression analysis models were used to determine the association between the study variables and ROP. Results dif_AL, dif_CCT, and RW were the most appropriate variables to detect the optimal threshold points that discriminate ROP: weekly increase of AL < 0.095 mm, weekly reduction of CCT < 0.5 μm, or weekly weight gain < 7% is associated with ROP development. Conclusions ROP is associated with delayed ocular development, as eyes of premature infants with ROP have shorter axial lengths and thicker corneas than eyes of premature infants without ROP. The association of AL, CCT, and weight gain with ROP could be of value for future development of predictive models for ROP.

Chronic lymphocytic leukemia patients with differential somatic hypermutation status of the immunoglobulin heavy variable genes, namely mutated or unmutated, display fundamental clinicobiological differences. Considering this, we assessed prognosis separately within mutated and unmutated chronic lymphocytic leukemia in 3015 patients, hypothesizing that the relative significance of relevant indicators may differ between these two categories. Within Binet-A mutated chronic lymphocytic leukemia patients, besides TP53 abnormalities, trisomy 12 and stereotyped subset #2 membership were equivalently associated with the shortest time-to-first-treatment and a treatment probability at 5- and 10-years after diagnosis of 40% and 55%, respectively; the remaining cases exhibited 5-year and 10-year treatment probability of 12% and 25%, respectively. Within Binet-A unmutated chronic lymphocytic leukemia patients, besides TP53 abnormalities, del(11q) and/or SF3B1 mutations were associated with the shortest time-to-first-trearment (5- and 10-year treatment probability: 78% and 98%, respectively); in the remaining cases, males had a significantly worse prognosis than females. In conclusion, the relative weight of indicators that can accurately risk stratify early-stage chronic lymphocytic leukemia patients differs depending on the somatic hypermutation status of the immunoglobulin heavy variable genes of each patient. This finding highlights the fact that compartmentalized approaches based on immunogenetic features are necessary to refine and tailor prognostication in chronic lymphocytic leukemia.

Here we evaluated hospitalisation rates and associated risk factors of human immunodeficiency virus (HIV)-infected individuals who were followed up in an Italian reference hospital from 1998 to 2016. Incidence rates (IR) of hospitalisations were calculated for five study periods from 1998 to 2016. The random-effects Poisson regression model was used to assess risk factors for hospitalisation including demographic and clinical characteristics. To consider that more events may occur for the same subject, multiple failure-time data analysis was also performed for selected causes using the Cox proportional hazards model. We evaluated 2031 patients. During 13 173 person-years (py) of follow-up, 3356 hospital admissions were carried out for 756 patients (IR: 255 per 1000 py). IR decreased significantly over the study period, from 634 in 1998–2000 to 126 per 1000 py in 2013–2016. Major declines were detected for AIDS-defining events, non-HIV/AIDS-related infections and neurological diseases. Older age, female sex, longer HIV duration and HCV coinfection were associated with a higher hospitalisation risk, whereas higher CD4 nadir and antiretroviral therapy were associated with a reduced risk. Influence of advanced HIV disease markers declined over time. Hospitalisation rates decreased during the study period in most causes. The relative weight of hospitalisations for non-AIDS-related tumours, cardiovascular, respiratory and kidney diseases increased during the study period, whereas those for AIDS-defining events declined.

Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index >= 25kg/m(2)). Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (>= 90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption. Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar. Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.

The study presents results of toxicological analysis performed on seized material in Neapolitan area in the period from 2013 to 2018. A constancy in THC and heroin percentages is evidenced (%THC ~10% and ~11.5% for marijuana and hashish; heroine: 20–24%), with mean values exceeding the European data. Data on cocaine revealed a constant increment of active principle percentage over the studied period (from 40% in 2013 to ~65% in 2018), with peak of 70% in 2017; also, number of samples exceeding the mean value increased over years. Active principles contents resulted higher than the ones reported in other Italian area ever the same period; marijuana was prevalent on hashish, confirming an Italian trend different from other European countries. A map of the Campania region evidenced two main “storage” districts, one corresponding to the city center and the second located in the northern part. If compared with literature data on the presence of local mafia, these areas are perfectly superimposable to those with the highest risk of homicides, thus confirming the degree of radicalization of local organizations and the relative weight of proceeds from drugs sale. Moreover, such radicalization within the territory seems to be the main reason of the absence of new psychoactive substances among the seized material.

Most epidemiologic studies of circulating phospholipid fatty acids (PLFAs) and disease risk have used the relative concentration (percentage of total) of each fatty acid as the measure of exposure. Using relative concentrations, the total of all fatty acids is summed to 100% and thus the values of individual fatty acid are not independent. This has led to debate, along with the suggestion to use absolute concentrations of fatty acids. We aimed to examine the relationship between relative (weight percentage) and absolute (mg/L) concentrations of individual circulating PLFAs.Relative and absolute concentrations of 41 circulating PLFAs were measured by gas chromatography in samples from 3 diverse populations. Correlations between the relative and absolute concentrations for each fatty acid were used to measure agreement. Unadjusted correlations and correlations adjusting absolute PLFA concentrations for total cholesterol were calculated.Unadjusted correlations between relative and absolute concentrations, as well as correlations adjusting absolute PLFA concentrations for total cholesterol, were high for most PLFAs in all 3 studies. Across the 3 studies, 28 of the 41 analyzed PLFAs had unadjusted correlations0.6 and 39 had adjusted correlations0.6.Choice of relative vs absolute concentration may not affect interpretation of results for most circulating PLFAs in studies of association between individual PLFAs and disease outcomes, especially if a covariate reflecting total lipids, such as total circulating cholesterol, is included in the model. However, for fatty acids, such as 16:0 (palmitic acid), with low correlation between the 2 metrics, using relative vs absolute concentration may lead to different inferences regarding their association with the outcome. Because both concentrations could be obtained simultaneously from the same laboratory assay, use of both metrics is warranted to better understand PLFA-disease relationships.

We asked whether previous observations of group interactions modulate subsequent social attention episodes. Participants first completed a learning phase with two conditions. In the ‘leader’ condition one of three identities turned her gaze first, followed by the two other faces. In the ‘follower’ condition, one of the identities turned her gaze after the two other faces had first shifted their gaze. Thus, participants observed that some individuals were consistently ‘leaders’ and others ‘followers’ of others’ attention. In the test phase, the faces of ‘leaders’ and ‘followers’ were presented in a gaze cueing paradigm. Remarkably, the ‘followers’ did not elicit gaze cueing. Our data demonstrate that individuals who do not guide group attention in exploring the environment are ineffective social attention directors in later encounters. Thus, the role played in previous group social attention interactions modulates the relative weight assigned to others’ gaze: we ignore the gaze of group followers.

Purpose Comprehensive assessment of stuttering requires consideration of a wide range of behaviors that impact outcomes, and the Overall Assessment of the Speaker’s Experience of Stuttering (OASES) is an assessment tool that accomplishes such. The purpose of this study was to determine how the individual components of the test contribute to the OASES’ impact score. Method Data collected at a university speech-language and hearing clinic from 29 adults were used for a relative weight analysis (RWA). RWA was utilized to determine the relative contributions of the OASES’ subtests to the OASES’ impact score. Confidence intervals for the individual relative weights were calculated for each OASES subtest and significance tests based on bootstrapping with 10,000 replications. Results Differences were present in contributions of the OASES’ subtests to the OASES’ overall impact score, where the following explained a significant amount of variance in the OASES’ impact score: Speaker’s Reactions; Daily Communication; and Quality of Life. However, contribution of the subtest, “General Information”, was not significant. Conclusion Through examination of relative contributions to the impact of stuttering using the OASES, this project has identified differences in contributors to the overall impact of the disorder of stuttering. This information is beneficial to researchers and clinicians alike in that it gives specific guidance into what determines increased impact in adults who stutter (AWS). Future works should pursue clarification of these differences with an end goal of identifying and overcoming barriers to positive outcomes while also identifying and nurturing facilitators to optimal management.

Globally, methods of controlling blood pressure in hypertension patients remain inefficient. The difficulty of prescribing appropriate drugs specific to a patient's clinical features serves as one of the most important factors. Characterizing the critical drug-related features, just like that of the antibacterial spectrum (where each item is sensitive to the targeted drug's effectiveness or a specified indication), may help a doctor easily prescribe appropriate drugs by matching a patient's attributes with drug-related features, and effectiveness of the selected drugs would also be ascertained. In this study, we aimed to apply data mining methods to obtain the clinical characteristics spectrum or important clinical features of five frequently used drugs (Irbesartan, Metoprolol, Felodipine, Amlodipine, and Levamlodipine) for hypertension control by comparing successful and unsuccessful cases. Spectrum analysis based on a statistical method and five algorithms based on machine learning were used to extract the critical clinical features. A visualized relative weight matrix was then achieved by combining the results from the characteristic spectrum and machine learning-based methods. Our results indicated that the five targeted antihypertension agents had different importance orders of the 15 relative clinical features. Clinical analysis showed that the extracted important clinical attributes of the five drugs were both reasonable and meaningful in the selection of hypertension treatment. Therefore, our study provided a data-driven reference for the personalization of clinical antihypertensive drugs.

The purpose of this study was to investigate the effect of fatigue on selected lower extremity muscles synergy during running using non-negative matrix factorization algorithm method. Sixteen male recreational runners participated in this study. The surface electromyographic activity of rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus, gastrocnemius medialis (GM), soleus (SO) and tibialis anterior (TA) were recorded on treadmill at 3.3 m s−1 before and after the fatigue protocol. Synergy pattern and relative muscle weight were calculated by non-negative matrix factorization (NNMF) algorithm method. The results showed that using the VAF method, five muscle synergies were extracted from the emg data during running. After the fatigue, the number of muscular synergies did not show a change, but relative weight of the muscles changed. Fatigue did not have any effect on the structure of muscular synergy, but changed the relative weight of muscles. These changes could be the strategy of the central nervous system to maintain optimal function of the motor system.

The oft-applied assumption in the use of Quality Adjusted Life Years (QALYs) in economic evaluation, that all QALYs are valued equally, has been questioned from the outset. The literature has focused on differential values of a QALY based on equity considerations such as the characteristics of the beneficiaries of the QALYs. However, a key characteristic which may affect the value of a QALY is the type of QALY itself. QALY gains can be generated purely by gains in survival, purely by improvements in quality of life, or by changes in both. Using a discrete choice experiment and a new methodological approach to the derivation of relative weights, we undertake the first direct and systematic exploration of the relative weight accorded different QALY types and do so in the presence of equity considerations; age and severity. Results provide new evidence against the normative starting point that all QALYs are valued equally.

Purpose Research suggests resilience is a complex multifactorial construct, which may improve health outcomes in cancer, but significant controversy exists regarding its definition and measurement. This study aimed to determine the components of resilience and their relative weight, as measured by the Connor-Davidson Resilience Scale in cancer patients. Methods As part of a larger study, a questionnaire including the Connor-Davidson Resilience Scale was distributed to 228 cancer patients. Principal component analysis was performed to identify the components of resilience measured by the Connor-Davidson Resilience Scale. Results Principal component analysis yielded six factors: (1) personal strength and problem-based coping, (2) spirituality/fate, (3) social support, (4) adaptability and flexibility, (5) giving best efforts and (6) self-determination, explaining 64.27% of the variance. Conclusion The Connor-Davidson Resilience Scale accounts for approximately two-thirds of variance in resilience in cancer patients, but 36% of the total variance remains unexplained, suggesting there are still unexplored determinants of resilience in cancer. Identification of these determinants may improve measurement of resilience in cancer through refinement of existing resilience measures or development of cancer-specific measures. Given the associations found within this study, interventions targeted towards improving coping strategies in at-risk individuals, and ensuring they have adequate social and spiritual support may improve resilience, although additional research is required to verify this.

The paper studied the problem of finding the optimal methodology for determining the safety and critical load conditions for the body trained and untrained people in the process of training the force pool. It was found that for trained individuals who have a sufficient level of adaptation to the power load, the use of “standard” modes of operation in the course of employment by fitness power safely. However, the problematic issue is that to the untrained troops, it is almost impossible to determine the safe load parameters using conventional techniques, which are mainly used in cyclic sports. Thus, the solution to this problem lies in the fact that using the integral method for estimating the value of power loads and a computer program for determining the relative weight of the index weights, safety and critical load parameters were calculated for untrained persons. At the same time, studied the biochemical parameters of blood (testosterone, cortisol, and lactate dehydrogenase activity) fixed after exercise, compared with the state of rest, confirmed our calculations clearly enough.

Background/objectives To elicit and compare preferences in terms of the attributes of home enteral nutrition (HEN) among patients and physicians, using a discrete choice experiment (DCE). Subjects/methods A DCE comprising eight choice scenarios, with six HEN attributes (tolerability, adaptation to comorbidities, nutrition and calories, handling, connections and information; two levels each) was designed. The Relative Importance (RI) for patients and physicians of each attribute was estimated. Sociodemographic and clinical variables, as well as additional questions (n = 8) were compiled to analyze possible explanatory variables and other preferences. Results A total of 148 HEN patients (71 needing caregivers to answer on their behalf) and 114 physicians completed the DCE. The most important attributes for patients were adaptation to comorbidities (33% RI), tolerability (33% RI), and nutrition and calories (26% RI). Significantly, younger patients had stronger preferences for tolerability whereas elderly ones (≥75 years) were more concerned about handling. In comparison, physicians gave a higher RI to tolerability, and nutrition and calories compared to patients (p = 0.002). Overall, a higher percentage of physicians answered that HEN characteristics such as easy-handling bags (85.1 vs. 64.9%; p = 0.001), container material (69.3 vs. 57.1%; p = 0.003) or reusable containers (79.8 vs. 70.3%; p = 0.01) were “important” or “very important” compared to patients. Conclusions Our findings showed that although patients and physicians have a similar perception about the relevance of different HEN attributes, the relative weight given to each one varies between them. Therefore, both points of view should be considered when choosing a HEN product in order to improve patients’ satisfaction and clinical outcomes.

Are consumers interested in aspects of pig production and do they take these into account in their buying decisions when such information is available? Samples of consumers in Germany and Poland selected the two – for them – most important out of a list of ten production characteristics, relating to animal welfare, health and safety, and environmental issues. In a subsequent choice experiment, the relative weight these characteristics had in consumers' choices was estimated. Relative importance of production characteristics varied between consumer segments, with the production interested segment being bigger in Germany than in Poland. With the exception of one animal welfare related criterion in Germany, those production characteristics that consumers perceive as most important relate to health and safety aspects rather than to animal welfare and environmental impact.

The purpose of this study is to analyze the alignment of supply and demand for antenatal care (ANC) in Mexico based on the definition of access provided by Donabedian: the "degree of adjustment" between resources and needs. Alignment was studied in the teenage and adult population of Mexico that lacked conventional social security between 2008 and 2015, a period of expanding financial resources for health and public health insurance coverage. Spatial econometric methods were used to analyze data from the Ministry of Health on the supply and demand for ANC in 2,314 municipalities (94% of all municipalities in Mexico). During this period, the relative weight of ANC demand among adolescents increased 37% while the production of antenatal consultations for adolescent and adult women remained unchanged. Bivariate spatial analyses of correlation between supply and demand for ANC services yielded a minimal spatial correlation, or lack of territorial correspondence, between supply and demand among women in both age groups. Spatial econometric analysis confirmed a non-significant association between supply and demand for ANC services. Our findings suggest the existence of misalignment between supply and demand for these services. This requires a reassessment of the management and delivery of ANC services at the local level in order to increase effective coverage and improve the overall performance of the health system.

Introduction Physical activity (PA) is strongly endorsed for managing chronic conditions, and a vital sign tool (indicator of general physical condition) could alert providers of inadequate PA to prompt counseling or referral. This systematic review examined the use, definitions, psychometric properties, and outcomes of brief PA instruments as vital sign measures, with attention primarily to studies focused on arthritis. Methods Electronic databases were searched for English-language literature from 1985 through 2016 using the terms PA, exercise, vital sign, exercise referral scheme, and exercise counseling. Of the 838 articles identified for title and abstract review, 9 articles qualified for full text review and data extraction. Results Five brief PA measures were identified: Exercise Vital Sign (EVS), Physical Activity Vital Sign (PAVS), Speedy Nutrition and Physical Activity Assessment (SNAP), General Practice Physical Activity Questionnaire (GPPAQ), and Stanford Brief Activity Survey (SBAS). Studies focusing on arthritis were not found. Over 1.5 years of using EVS in a large hospital system, improvements occurred in relative weight loss among overweight patients and reduction in glycosylated hemoglobin among diabetic patients. On PAVS, moderate physical activity of 5 or more days per week versus fewer than 5 days per week was associated with a lower body mass index (-2.90 kg/m2). Compared with accelerometer-defined physical activity, EVS was weakly correlated (r = 0.27), had low sensitivity (27%-59%), and high specificity (74%-89%); SNAP showed weak agreement (κ = 0.12); GPPAQ had moderate sensitivity (46%) and specificity (50%), and SBAS was weakly correlated (r = 0.10-0.28), had poor to moderate sensitivity (18%-67%), and had moderate specificity (58%-79%). Conclusion Few studies have examined a brief physical activity tool as a vital sign measure. Initial investigations suggest the promise of these simple and quick assessment tools, and research is needed to test the effects of their use on chronic disease outcomes.

Three deterministic Kermack-McKendrick-type models for studying the transmission dynamics of an infection in a two-sex closed population are analyzed here. In each model it is assumed that infection can be transmitted through heterosexual contacts, and that there is a higher probability of transmission from one sex to the other than vice versa. The study is focused on understanding whether and how this bias in transmission reflects in sex differences in final attack ratios (i.e. the fraction of individuals of each sex that eventually gets infected). In the first model, where the other two transmission modes are not considered, the attack ratios (fractions of the population of each sex that will eventually be infected) can be obtained as solutions of a system of two nonlinear equations, that has a unique solution if the net reproduction number exceeds unity. It is also shown that the ratio of attack ratios depends solely on the ratio of gender-specific susceptibilities and on the basic reproductive number of the epidemic $ \mathcal{R}_0 $, and that the gender-specific final attack-ratio is biased in the same direction as the gender-specific susceptibilities. The second model allows also for infection transmission through direct, non-sexual, contacts. In this case too, an analytical expression is derived from which the attack ratios can be obtained. The qualitative results are similar to those obtained for the previous model, but another important parameter for determining the value of the ratio between the attack ratios in the two sexes is obtained, the relative weight of direct vs. heterosexual transmission (namely, ρ ). Quantitatively, the ratio of final attack ratios generally will not exceed 1.5, if non-sexual transmission accounts for most transmission events ( ρ ≥ 0.6) and the ratio of gender-specific susceptibilities is not too large (say, 5 at most). The third model considers vector-borne, instead of direct transmission. In this case, we were not able to find an analytical expression for the final attack ratios, but used instead numerical simulations. The results on final attack ratios are actually quite similar to those obtained with the second model. It is interesting to note that transient patterns can differ from final attack ratios, as new cases will tend to occur more often in the more susceptible sex, while later depletion of susceptibles may bias the ratio in the opposite direction. The analysis of these simple models, despite their lack of realism, can help in providing insight into, and assessment of, the potential role of gender-specific transmission in infections with multiple modes of transmission, such as Zika virus (ZIKV), by gauging what can be expected to be seen from epidemiological reports of new cases, disease incidence and seroprevalence surveys.

Different types of food wastes, e.g., meats, bones, cereals, fruits, and vegetables, were collected from hotels in Hong Kong, mixed in different ratio, and processed into feed pellets (food wastes (FWs) A, B, and C) for feeding trials in aquaculture species. Grass carp fed with cereal-dominant feed (FW A) showed the best growth (in terms of specific growth rate, relative weight gain, and protein efficiency ratio), among all food waste feeds. However, the growth rates of food waste groups especially the meat product-contained feeds (FW B and FW C) were lower than the commercial feed, Jinfeng(®) 613 formulation (control). The results indicated that grass carp utilized plant proteins better than animal proteins and preferred carbohydrate as a major energy source than lipid. The high-lipid content in feed containing meat products was also a possible reason for hindering growth and resulted high body lipid. It is suggested that lipid should be removed in the preparation of food waste feed or further investigations by implementing supplements, e.g., enzymes in feed to enhance lipid or protein utilization by fish. This utilization of food waste could be an effective and practical way to deal with these wastes in this densely populated city.

PURPOSE Cortical auditory evoked potentials may serve as an early indicator of developmental problems in the auditory cortex. The aim of the study was to determine the effect on neonatal cortical auditory processing of clinical conditions occurring in early prematurity. METHODS Sixty-seven preterm infants born at 29 weeks mean gestational age (range, 23-34 weeks) were recorded at a mean postconception age of 35 weeks, before discharge from the third level neonatal intensive care unit. The average of 330 responses to standard 1000 Hz pure tones delivered in an oddball paradigm was recorded at frontal location. Data of 45 of 67 recruited premature infants were available for analysis. Mean amplitudes calculated from the data points of 30 milliseconds centered on P1 and N2 peaks in the waveforms of each subject were measured. The effect of perinatal clinical factors on cortical auditory evoked responses was evaluated. RESULTS The amplitude of P1 component was significantly lower in infants with bronco-pulmonary dysplasia (P = 0.004) and retinopathy of prematurity (P = 0.03). The multivariate analysis, done to evaluate the relative weight of gestational age and bronco-pulmonary dysplasia and/or retinopathy of prematurity on cortical auditory evoked potentials components, showed an effect of clinical factors on P1 (P = 0.005) and of gestational age on N2 (P = 0.02). CONCLUSIONS Cortical auditory processing seems to be influenced by clinical conditions complicating extremely preterm birth.

Background: Several studies have reported on associations of size at birth and early growth with general and central obesity; however, few have examined the potential effects of birth weight and postnatal growth on separate abdominal fat compartments. We investigated the effects of size at birth, linear growth and relative weight gain from birth to adulthood on visceral (VFT) and subcutaneous abdominal (SAFT) fat thicknesses at age 30 years. Methods: A total of 2663 participants from the 1982 Pelotas (Brazil) birth cohort study had complete information on ultrasound measures of abdominal fat at age 30 years, and anthropometric measurements for at least five visits (0/2/4/23/30 years). We estimated weight and height Z-score changes, conditional relative weight gain and conditional height at several ages. Results: In both men and women, VFT and SAFT showed positive associations with conditional relative weight gain during all age periods beyond 2 years and birth, respectively (all P⩽0.01). Women born with intrauterine growth restriction (IUGR) had greater VFT than other women (difference=0.15 s.d., 95% CI: 0.01–0.29), and they showed a stronger positive influence of infant weight gain 0–2 years on VFT (IUGR: β=0.17 s.d., 95% CI: 0.05–0.29; non-IUGR: β=0.01 s.d., 95% CI: −0.04 to 0.06; Pinteraction=0.02). Stunting at 2 years was associated with lower SAFT but not VFT, and it modified the influence of weight gain 2–4 years on SAFT in both sexes (both Pinteraction

Objectives: Non-small cell lung carcinoma (NSCLC) with N1 involvement is associated with 5-year survival rates ranging from 7% to 55%. Numerous factors have been independently reported to explain this heterogeneous prognosis, but their relative weight on long-term survival is unknown. Methods: Patients who underwent surgical resection for NSCLC in two French centers from 1993 to 2010 were prospectively recorded and retrospectively reviewed. The overall survival (OS) of patients undergoing first-line surgery for pN1 disease was analyzed according to the type of extension, number of metastatic LN, number and anatomic location of metastatic stations. Results: The study group included 450 patients (male 80.2%, mean age 63.3 � 9.9 years, 5-year overall survival 46%). The number of metastatic station was 1 in 340 (75.6%, single-station disease) and � 2 in 110 patients (24.4%, multi-station disease). The number of metastatic stations was correlated with the number of metastatic LN (p < .001), and associated with adverse OS (p ¼ .0014). The presence of intralobar metastatic LN (station 12e13e14) was associated with a mechanism of direct extension (p < .001), but did not impact OS (p ¼ .71). The location of metastatic stations was of prognostic significance only in case of multi-station disease, with hilar (station 10) involvement being associated with adverse OS (p ¼ .005). The 110 patients with multi-station pN1 disease and the 134 patients operated on for single-station pN0N2 (skip-N2) disease during the study period yield comparable outcome (p ¼ .52). Conclusions: In patients with resected pN1 NSCLC, the number of metastatic stations and their location in case of multi-station disease have a prognostic value. 2014 Published by Elsevier Ltd.

Learning a second language (L2) can be crucial in the present globalized society. However, reaching the level of L1 performance of native speakers is still a challenge for many. Distinct factors could account for the persistent gap observed between natives' and non-natives' syntactic abilities: L1-L2 differences, AoA, proficiency, L2 immersion duration, L2 training duration. Although different theoretical approaches described the role of these several factors, not all studies using on-line measures have investigated them comprehensively and consistently. The present work reviews available ERP studies on L2 syntactic analysis in order to establish the relative weight of each factor on the time course of L2 processing. Logistic regression analyses were performed on the presence or absence of ERP effects reported in response to L2 syntactic violations, including all the influential factors as categorical independent variables. The results showed that immersion duration has an influence on the ERP correlates linked to early mechanisms of syntactic processing, while the global proficiency level has an impact on the ERP correlates related to late, language-monitoring activity.

Soluble ST2 is involved in multiple pathogenic pathways, including cardiac strain, inflammation, and myocardial necrosis with remodeling. The relative weight of ST2 and the point at which its prognostic value in heart failure (HF) is affected by different degrees of myocardial strain, inflammation, necrosis, and remodeling is unknown.We examined whether soluble ST2 levels improves HF risk stratification relative to other biomarkers representative of multiple pathogenic pathways-N-terminal pro-B-type natriuretic peptide (NT-proBNP; strain), high-sensitivity C-reactive protein (hsCRP; inflammation), and galectin-3 and high-sensitivity troponin T (hsTnT; necrosis and remodeling)-in 1,015 patients with mean left ventricular ejection fraction (LVEF) 33.5%. Mean follow-up was 4.2 ± 2.1 years. The correlation with soluble ST2 was highest with NT-proBNP (r = 0.32; P.001) and lowest with galectin-3 (r = 0.15; P.001). ST2 levels increased with increasing concentrations of the other biomarkers (P.001 in all cases). During follow-up, 467 patients died. Soluble ST2 remained an independent prognosticator of risk at every tertile of each biomarker. This was observed even after adjusting for clinical parameters.Soluble ST2 may be regarded as a 3-in-1 prognosis biomarker in HF. ST2 provides valuable long-term risk stratification information in HF beyond that reported by other biomarkers of stretch, inflammation, necrosis, and remodeling.

Objectives To test the hypothesis that greater weight fluctuation between 2 and 6 years is associated with an increase in weight measures (such as body mass index [BMI]) and cardiometabolic risk in young adulthood. Study design Weight fluctuation (determined by BMI SD scores) was measured at least 3 times between the ages of 2 and 6 years in 166 girls and 116 boys from the Terneuzen Birth Cohort. Cardiometabolic risk factors in young adulthood include components of the metabolic syndrome and weight. The extent of weight fluctuation was determined by assessing each individual's SE (or variation) around each individual's linear regression slope (or weight slope). The obtained variation scores were subsequently related to adult BMI, other weight measures, and cardiometabolic risk factors. Results In girls, greater weight fluctuation between 2 and 6 years was statistically significantly related to greater adult weight measures (1.08; 95% CI 1.01-1.15) and nonsignificantly with the metabolic syndrome. For boys weight fluctuation was not associated with adult weight (1.04; 95% CI 0.97-1.11), but weight slope was statistically significantly associated with adult overweight. Conclusions The results suggest that weight fluctuations during early childhood are predictive for adult overweight in girls. For boys weight slope instead of weight fluctuation is predictive for adult overweight.

A dietary survey of 939 Swiss adults, randomly selected from the population of Geneva and its surrounding communities, was performed according to the history method. A factor analysis, using average weekly intakes for 33 food variables, reveals three principal components of the diet: satiating capacity, healthfulness and culinary complexity. These characteristics, together with the energy content of the diet, were analysed for differences according to sex, age, relative weight index, birthplace, marital status and occupation. All of these sociodemographic variables influence some dimension of dietary habits. Alcohol consumption is positively associated with satiating, protein rich diets, but energy intake from foods does not significatively differ between various groups of abstainers and drinkers. Although the energy contribution of alcoholic beverages is globally additive, we suggest that cultural and societal norms may modulate the relationship of alcohol and diet