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The advisory board to the Ontario Ministry of Health considered adopting the new three-variable international risk scoring tool (IRST) to guide prophylaxis against respiratory syncytial virus hospitalization (RSVH) in moderate-to-late preterm infants born 32–35 weeks' gestational age (wGA). Canada currently uses a nationally validated, seven-variable RST, to predict RSVH in 33–35 wGA infants. We explored the potential implications of switching from the Canadian to the IRST. Predictive accuracy (area under the receiver operating characteristic curve [AUROC]) of the two RSTs and correlations (Spearman rank) and number needed to treat (NNT) between cut-off scores for low-, moderate- and high-risk subjects were assessed. The RSTs contain many of the same risk factors (birth proximity to the RSV season, smoking, siblings, daycare), with the Canadian RST also including sex, small for GA and familial eczema. Predictive accuracy was similar (AUROC, IRST: 0.773 [sensitivity: 68.9%; specificity: 73.0%] vs Canadian: 0.762 [68.2%; 71.9%]). Significant correlations between cut-off scores (p <.001) and risk categories (p <.001) were apparent, although the correlation coefficients were weak for both (scores: 0.217; categories: 0.055). While the proportion of high-risk infants was similar (IRST: 0.7% vs Canadian: 0.6%), the NNT was lower for the Canadian RST (7.5 vs 14.3), and more infants were assigned moderate risk by the IRST (19.9% vs 9.8%). The IRST can be considered simpler (fewer risk factors) than the Canadian RST and its adoption may reduce the number of RSVHs among moderate-to-late preterm infants; however, the cost-effective implications for RSV prophylaxis warrant further investigation. [ABSTRACT FROM AUTHOR]

Since early May 2011 a large food-borne outbreak caused by E. coli O104:H4 affected Germany then spread over 13 European countries, U.S.A. and Canada. The outbreak strain was found to possess an unusual combination of enteroaggregative E. coli pathotype with StxII. In this report we described the molecular investigation of epidemic clone in Poland during the international outbreak. We confirmed three cases of E. coli O104:H4 infections. The molecular characteristics of the Polish E. coli O104:H4 isolates including virulence profile, antimicrobial resistance, PFGE and plasmids profiles were corresponded with Germany outbreak strains.

Childhood adversities have significantly negative consequences on physical and mental health. The Childhood Experience of Care and Abuse Questionnaire, Version 3 (CECA.Q3) interview, as an extended version of the CECA.Q, is widely used in the assessment of childhood adversities. Although its reliability and validity have been demonstrated, the application of CECA.Q3 is limited due to its intensive and lengthy interview. This article aimed to develop and validate a brief form of the CECA.Q3 (CECA.Q3-BF) among a population of mood disorders. Data analyzed were from a clinical sample of 210 patients with mood disorders. Data were randomly split into training and testing datasets. The training data set was used for scale reduction by applying principal component factor analysis, while the testing one was used for cross-validation to examine whether the CECA.Q3-BF could have a good yield of accuracy. The optimal cutoff points of the CECA.Q3 were also tested. Overall, four out of eight subscales had items reduction without compromising their accuracy of measurements for childhood adversities. They are Antipathy (reduced by four items), Neglect (reduced by five items), Psychological Abuse (reduced by 15 items), and Role Reversal (reduced by 11 items). The CECA.Q3-BF removed 35 items (35/100, 35%) from the full CECA.Q3. The accuracy of CECA.Q3-BF was validated in the testing dataset. The CECA.Q3-BF offers a brief but good accuracy of measure for childhood adversities. Future studies are warranted to further validate this brief form. The CECA.Q3-BF is expected to improve the application of CECA.Q3 in clinical and epidemiological surveys, as it significantly reduces the length of the interview and therefore has better compliance. [ABSTRACT FROM AUTHOR]

The "Measured Annual Nutrient loads from AGricultural Environments" (MANAGE) database was developed to be a readily accessible, easily queried database of site characteristic and field-scale nutrient export data. The original version of MANAGE, which drew heavily from an early 1980s compilation of nutrient export data, created an electronic database with nutrient load data and corresponding site characteristics from 40 studies on agricultural (cultivated and pasture/range) land uses. In the current update, N and P load data from 15 additional studies of agricultural runoff were included along with N and P concentration data for all 55 studies. The database now contains 1677 watershed years of data for various agricultural land uses (703 for pasture/rangeland; 333 for corn; 291 for various crop rotations; 177 for wheat/oats; and 4-33 yr for barley, citrus, vegetables, sorghum, soybeans, cotton, fallow, and peanuts). Across all land uses, annual runoff loads averaged 14.2 kg ha(-1) for total N and 2.2 kg ha(-1) for total P. On average, these losses represented 10 to 25% of applied fertilizer N and 4 to 9% of applied fertilizer P. Although such statistics produce interesting generalities across a wide range of land use, management, and climatic conditions, regional crop-specific analyses should be conducted to guide regulatory and programmatic decisions. With this update, MANAGE contains data from a vast majority of published peer-reviewed N and P export studies on homogeneous agricultural land uses in the USA under natural rainfall-runoff conditions and thus provides necessary data for modeling and decision-making related to agricultural runoff. The current version can be downloaded at http://www.ars.usda.gov/spa/manage-nutrient.

Purpose: Distress is an important issue facing adolescent and young adults (AYA) with cancer due to their stage of development. Metrics are necessary to help improve psychosocial outcomes in this population. This study determined cut-points for the newly developed Cancer Distress Scales (CDS)-AYA. Methods: The CDS-AYA is a new patient-reported outcomes measure that comprises five independently functioning scales, including the following: Impact of Cancer (12 items), Physical (12 items), Emotional (11 items), Cognitive (8 items), and Cancer Worry (5 items). Canadian AYA with cancer 15–39 years of age completed the CDS-AYA and the Hospital Anxiety and Depression Scale (HADS), as part of the CDS-AYA field test. Only patients who had completed responses to the CDS-AYA and HADS were included in these analyses. Receiver operating characteristic (ROC) curve analysis was used to generate cut-points for five CDS-AYA scales based on distress defined by the HADS anxiety and HADS depression scale. Results: In total 453 of 515 respondents had complete data for the CDS-AYA and HADS were included in analyses. Area under the curve (AUC) in the ROC analyses ranged from 0.75 to 0.85. The CDS-AYA Emotional scale had the greatest AUC. The cutoff value for the Emotional scale was 27 based on the HADS anxiety scores (78.3% and 78.9%). Conclusions: The five CDS-AYA scales had fair to good accuracy when classifying the none/low and moderate/severe distress categories based on HADS anxiety and depression scales. For screening purposes, it is recommended that the Emotional scale or Impact of Cancer scale be utilized. [ABSTRACT FROM AUTHOR]

Background: Conventional MRI is limited in quantitative evaluation of ankylosing spondylitis (AS) activity states. A comparison of the effectiveness of the whole-lesion apparent diffusion coefficient (ADC) histogram analysis with the Spondyloarthritis Research Consortium of Canada (SPARCC) MRI index in evaluating the disease activity of AS might aid in this assessment.Purpose: To compare the effectiveness of the whole-lesion ADC histogram analysis with the SPARCC MRI index in evaluating the disease activity states of AS.Study Type: Prospective.Population: A total of 57 AS patients and 27 healthy matched volunteers were included.Field Strength/sequence: 3.0T MR including a diffusion-weighted imaging (DWI) sequence (b = 0, 1000 s/mm2 ).Statistical Tests: One-way analysis of variance (ANOVA) and Scheffe's post-hoc was used to compare the parameters among different groups. A receiver operating characteristic (ROC) analysis and the Spearman rank correlation were performed to test the diagnostic performance of all parameters in distinguishing different disease activity states and determining the correlations between them.Assessment: AS disease activity states was evaluated according to the Ankylosing Spondylitis Disease Activity Score (ASDAS). Initial DWI images and corresponding ADC maps were imported into our in-house software. Regions of interest (ROIs) were drawn in all slices and the relevant parameters were derived simultaneously. The SPARCC MRI index scores were counted artificially based on T2 -PDW-SPAIR images.Results: The ADCmean , ADC percentiles, and SPARCC MRI index of the active group were significantly higher than the inactive and control groups (all P < 0.001). The 90th percentile could differentiate the inactive from the control group and the low disease activity group from the inactive group (P = 0.011 and 0.006, respectively). The 50th percentile of the high disease activity group was significantly higher than the low group (P = 0.004), while the SPARCC MRI index of the very high disease activity group was higher than the high group (P < 0.001).Data Conclusion: The whole-volume ADC histogram analysis was superior to the SPARCC MRI index in assessing AS activity states.Level Of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:114-126. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD) are two distinct conditions characterized by similar symptoms including leg pain and walking limitations due to claudication. Differentiation between both origins can be difficult and characteristics such as symptom manifestations, time to relief in rest position and pain localization should be considered when determining diagnosis and the treatment plan. The objectives of this study were to compare changes in walking time to symptom change during treadmill tests and self-reported outcomes measures related to claudication, kinesophobia and global health between individuals with LSS, PAD and non-specific low back pain (nLBP). Method: Fifty-five patients (23 with LSS, 14 with PAD and 18 with nLBP) were recruited from May 2018 to March 2020 to complete a treadmill walking test involving two 5-min walking tasks (Upright and Forward Leaning Trunk (FLT) Walking tasks). The speed was set at 1.9 km/h (1.2 mph), and each task was followed by a 5-min rest period. Walking time to symptom change and Total walking time were recorded during each walking task. Patients were asked to complete four questionnaires related to the impact of claudication, walking impairment, kinesiophobia and global health. One-way ANOVAs were performed to compare walking time difference from the Upright to the FLT walking tasks and to compare questionnaires results between groups. Results: One-way ANOVAs showed a significant difference between groups regarding difference in Walking time to symptom change between both tasks (F = 4.12, p = 0.022). The LSS group improved its Walking time to symptom change from the Upright to the FLT walking tasks more than the PAD (p = 0.34) and the nLBP group (p = 0.12). The nLBP group was less impacted by claudication and less impaired during walking compared to the LSS and PAD groups (ps < 0.001). The nLBP group also had less kinesiophobia than the LSS one (p < 0.001), but was similar to the PAD group. The global health rating was not statistically different between groups (p = 0.118). Conclusion: The test was able to distinguish neurogenic from vascular or nLBP related claudication. However, further studies are needed to validate this new treadmill walking test. Trial registration: clinicaltrials.gov (NCT04058171), Registered August 15, 2019 –Registered during recruitment [ABSTRACT FROM AUTHOR]

Background: Persisting atopic dermatitis (AD) is known to be associated with more serious allergic diseases at later ages; however, making an accurate diagnosis during infancy is challenging. We assessed the diagnostic performance of questionnaire-based AD measures with criteria-based in-person clinical assessments at age 1 year and evaluated the ability of these diagnostic methods to predict asthma, allergic rhinitis and food allergies at age 5 years.Methods: Data relate to 3014 children participating in the Canadian Healthy Infant Longitudinal Development (CHILD) Study who were directly observed in a clinical assessment by an experienced healthcare professional using the UK Working Party criteria. The majority (2221; 73.7%) of these children also provided multiple other methods of AD ascertainment: a parent reporting a characteristic rash on a questionnaire, a parent reporting the diagnosis provided by an external physician and a combination of these two reports.Results: Relative to the direct clinical assessment, the area under the Receiver Operating Characteristic curve for a parental report of a characteristic rash, reported physician diagnosis and a combination of both were, respectively, 0.60, 0.69 and 0.70. The strongest predictor of asthma at 5 years was AD determined by criteria-based in-person clinical assessment followed by the combination of parental and physician report.Conclusions: These findings suggest that questionnaire data cannot accurately substitute for assessment by experienced healthcare professionals using validated criteria for diagnosis of atopic dermatitis. Combining the parental report with diagnosis by a family physician might sometimes be appropriate (eg to avoid costs of a clinical assessment). [ABSTRACT FROM AUTHOR]

Despite calls in the literature, little is known about how dimensions of a social and task nature relate to each other in school and out-of-school learning environments. This study explored whether interpersonal and task dimensions of the youth sport environment, as perceived by young people, are related, and, if so, how they are related. We used data from 310 adolescent sport participants from eastern Canada (M age = 14.69 ± 1.60 years; 54.8% girls). Participants completed comprehensive assessments of interpersonal dimensions of the sport environment and the characteristics of learning activities they do in practices. We used canonical correlation analysis to examine the multivariate shared relationship between the variable sets. The relationship was largely captured by the first three functions in the canonical model. The first two functions revealed areas of intersection between perceptions of interpersonal and practice-based activity factors in the form of supports and challenges for the learning and development process in sport. Accounting for the participants' age, the third function displayed characteristics consistent with recent descriptions of complex environments in youth sport. The findings suggest that adolescents' perceptions of interpersonal- and task-related features of sport are interdependent, and highlight the relevance of including variables assessing both factors in studies that attempt to characterize and understand learning environments in sport and other achievement domains. Findings also afford new insights into whether dimensions of a social and task nature are complementary, and inadequacies in one dimension can be attenuated by strengths in another or not. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the wound healing outcomes of patients with a plantar diabetic foot ulcer (DFU) treated with an interdisciplinary team approach, and to identify associated variables. A retrospective observational cohort study of 140 adult patients, with a plantar DFU, treated between 2012 and 2018 at a wound care clinic of a University affiliated hospital was conducted. Predictive and explicative analyses were conducted with logistic multivariate methods and with a Receiver Operating Characteristics curve. The best predictor of wound healing at 3 months was a 41.8% wound size reduction at 4 weeks (AUC: 0.86; sensitivity: 83.1%; specificity: 67.2%, positive predictive value: 72.8%; negative predictive value: 78.9%; positive and negative likelihood ratios: 2.53 and 0.25, respectively). Main baseline variables independently associated with this predictor were: a monophasic Doppler waveform (OR 7.52, 95% CI [2.64–21.39]), cigarette smoking (OR 4.7, 95% CI [1.44–15.29]), and male gender (OR 3.58, 95% CI [1.30–9.87]). The health care provider should be cautious and intensify its management of DFUs particularly with patients of male gender; smoking, having a monophasic waveform with a hand‐held Doppler, and not achieving a minimal 41.8% wound area reduction at 4 weeks of treatment. [ABSTRACT FROM AUTHOR]

Background: Removal of immobilization is a critical phase of distal radius fracture (DRF) rehabilitation, typically occurring by 2 months post injury. This study examined the extent to which pain at rest (PAR), movement evoked pain (MEP), or the ratio between those (MEPR) assessed at 2-months after DRF predicts the occurrence of chronic pain or disability at 6- and 12-months after the injury. Methods: This secondary analysis of a prospective cohort study was done at the Hand and Upper Limb Centre (HULC), London, Ontario, Canada. A total of 229 patients with DRF (159 (69.4%) women) were included. Scores for the pain and function subscales of the Patient-Rated Wrist Evaluation (PRWE) were extracted for 2, 6 and 12 months after DRF. Logistic as well as nonlinear quartile regression examined whether PAR and MEP predicted the severity of chronic pain and disability at 6- and 12-months after DRF. Receiver Operating Characteristics Curve were plotted, where area under the curve (AUC) examined the accuracy of the PAR and MEP scores in classifying those who experienced chronic pain and disability. Results: Scores of ≥3 (AUC of 0.77) for PAR or ≥ 6 (AUC of 0.78) for MEP at 2 months after DRF predicted moderate to severe wrist pain at 6-months, whereas scores of ≥7 (AUC of 0.79) for MEP at 2-months predicted ongoing wrist disability at 6-months after the injury. The MEPR of 2 ≤ or ≥ 8 at 2-months was associated with adverse pain at 6-months and functional outcomes at 6- and 12-months (R-square = 0.7 and 0.04 respectively), but prediction accuracy was very poor (AUC ≤ 0.50). Conclusion: Chronic wrist-related pain at 6-months can be predicted by either elevated PAR ≥ 3/10) or MEP (≥ 6/10) reported at 2-months after the injury, while disability experienced at 6-months after DRF is best predicted by MEP (≥7/10) reported at 2-months. The ratio of these two pain indicators increases assessment complexity and reduces classification accuracy. [ABSTRACT FROM AUTHOR]

Background: The aims of this study were to develop a prediction model for identification of individuals with diabetes based on clinical and perceived periodontal measurements; and to evaluate its added value when combined with standard diabetes screening tools.Methods: The study was carried out among 250 adults attending primary care clinics in Riyadh (Saudi Arabia). The study adopted a case-control approach, where diabetes status was first ascertained, and the Finnish Diabetes Risk Score (FINDRISC), Canadian Diabetes Risk questionnaire (CANRISK), and periodontal examinations were carried out afterward.Results: A periodontal prediction model (PPM) including three periodontal indicators (missing teeth, percentage of sites with pocket probing depth ≥6 mm, and mean pocket probing depth) had an area under the curve (AUC) of 0.694 (95% Confidence Interval: 0.612-0.776) and classified correctly 62.4% of participants. The FINDRISC and CANRISK tools had AUCs of 0.766 (95% CI: 0.690-0.843) and 0.821 (95% CI: 0.763-0.879), respectively. The addition of the PPM significantly improved the AUC of FINDRISC (P = 0.048) but not of CANRISK (P = 0.144), with 26.8% and 9.8% of participants correctly reclassified, respectively. Finally, decision curve analysis showed that adding the PPM to both tools would result in net benefits among patients with probability scores lower than 70%.Conclusions: This study showed that periodontal measurements could play a role in identifying individuals with diabetes, and that addition of clinical periodontal measurements improved the performance of FINDRISC and CANRISK. [ABSTRACT FROM AUTHOR]

Individual socioeconomic status is known to correlate with multimorbidity, but the role of neighbourhood-level socioeconomic deprivation is uncertain. Participants from five cities (n=16,313) from the Canadian Longitudinal Study on Aging were mapped by postal code and their local area socioeconomic deprivation scores were calculated using the Vancouver Area Neighbourhood Deprivation Index. Logistic regression models were used to estimate deprivation-associated odds of multimorbidity, controlling for age, sex, obesity, alcohol consumption, and tobacco use, and validated using a Bayesian machine learning technique. Significant associations with neighbourhood deprivation were observed, underscoring the importance of a person's local socioeconomic environment in multimorbidity risk, net of key covariates. The implications of the results are discussed in terms of community and health care organization and intervention programs targeting multimorbidity. [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) can create significant financial burden, with cost of living rising consistently with increasing age and disability. We aimed to determine the prevalence and predictors of financial strain among a large sample of older Canadians with MS. A binomial logistic regression, which estimates the probability of an event happening (financial strain—yes/no), was performed. Participants were 64.6 (SD ± 6.2) years old and reported living with MS symptoms 32.8 (SD ± 9.4) years. In total, 22% of participants experienced financial strain. Predictors of financial strain (from greatest to least) were not having private health insurance, job loss due to MS, having moderate to high stress, greater physical impact of MS, not having home adaptations, not having social support, and living alone. These findings point to insufficiencies in Canada's health and social systems when it comes to the provision of universal care to those living with disabling neurological chronic illness. [ABSTRACT FROM AUTHOR]

The Brief Screener for Substance and Behavioral Addictions (SSBAs) was developed to assess a common addiction construct across four substances (alcohol, tobacco, cannabis, and cocaine), and six behaviors (gambling, shopping, videogaming, eating, sexual activity, and working) using a lay epidemiology perspective. This paper extends our previous work by examining the predictive utility of the SSBA to identify self-attributed addiction problems. Participants (N = 6,000) were recruited in Canada using quota sampling methods. Receiver Operating Characteristics (ROCs) analyses were conducted, and thresholds established for each target behavior's subscale to predict self-attributed problems with these substances and behaviors. For each substance and behavior, regression models compared overall classification accuracy and model fit when lay epidemiologic indicators assessed using the SSBA were compared with validated screening measures to predict selfattributed problems. ROC analyses indicted moderate to high diagnostic accuracy (Area under the curves (AUCs) 0.73–0.94) across SSBA subscales. Thresholds for identifying self-attributed problems were 3 for six of the subscales (alcohol, tobacco, cannabis, cocaine, shopping, and gaming), and 2 for the remaining four behaviors (gambling, eating, sexual activity, and working). Compared to other instruments assessing addiction problems, models using the SSBA provided equivalent or better model fit, and overall had higher classification accuracy in the prediction of self-attributed problems. The SSBA is a viable screening tool for problematic engagement across ten potentially addictive behaviors. Where longer screening tools are not appropriate, the SSBA may be used to identify individuals who would benefit from further assessment. [ABSTRACT FROM AUTHOR]

Presents the results of a comparative study of pockmark sediments and associated features appearing on both sides of the North Atlantic, on the Scotian Shelf off Nova Scotia and in the northern North Sea. Formation in seabed material consisting of soft silty clay; Seismic, sonar and lithologic characteristics of the sediments; Gas efflux through the seafloor.

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Parents with intellectual disability, like all parents, need support with childrearing. Early identification of parental intellectual disability may be key to the planning and delivery of appropriately adapted, inclusive family supports and services. The purpose of this study was to investigate the performance of a brief screener for parental intellectual disability. A total of 185 parents, including 91 parents in receipt of specialist intellectual disability services and 94 parents utilizing generic family support services, completed an interview/survey which incorporated candidate screening questions. The results of logistic regression and ROC curve analysis showed that a simple four-item screener performed well (accuracy 90.44%, sensitivity 92.31%, specificity 90.43%, AUC.96). The potential benefits of screening have to be weighed up against the risks of potential misuse. We therefore suggest that screening be introduced in the context of continuing professional education and initiatives to build system's capacity to support parents with intellectual disability and their families. [ABSTRACT FROM AUTHOR]

Background: Individuals with cystic fibrosis (CF) diagnosed as adults represent a rare but growing subset of the CF population. Limited studies have described their lung function trajectories.Research Question: What is the overall trajectory of lung function and clinical characteristics associated with lung function decline in people who receive a diagnosis of CF as adults?Study Design and Methods: The Canadian CF Patient Registry (CCFR) was used to identify patients with CF who were ≥ 18 years of age at diagnosis and received a diagnosis between 2000 and 2017. Linear mixed-effects models were used to quantify the change in lung function over age and to examine clinical characteristics associated with lung function decline.Results: Lung function was stable in early adulthood, with a decline in middle adulthood (age 30-50 years) and a greater decline after 50 years of age. Individuals who receive a diagnosis at older ages (> 50 years: slope, -0.71%/y; 41-50 years: -0.68%/y; 31-40 years: -0.29%/y; 18-30 years: -0.28%/y) and those demonstrating pulmonary symptoms (slope, -0.41%/y) compared with no pulmonary symptoms at baseline were associated with faster rate of lung function decline.Interpretation: The lung function of who receive a diagnosis of CF as adults in the CCFR declines slowly compared with estimates from the overall adult CF population. Individuals with adult-diagnosed CF who are older and demonstrate pulmonary symptoms at diagnosis experience a faster rate of lung function decline and should be monitored more closely. [ABSTRACT FROM AUTHOR]

In medical diagnostic testing problems, the covariate adjusted receiver operating characteristic (ROC) curves have been discussed recently for achieving the best separation between disease and control. Due to various restrictions such as cost, the availability of patients, and ethical issues quite frequently only limited information is available. As a result, we are unlikely to have a large enough overall sample size to support reliable direct estimations of ROCs for all the underlying covariates of interest. For example, some genetic factors are less commonly observable compared with others. To get an accurate covariate adjusted ROC estimation, novel statistical methods are needed to effectively utilize the limited information. Therefore, it is desirable to use indirect estimates that borrow strength by employing values of the variables of interest from neighbouring covariates. In this paper we discuss two semiparametric exponential tilting models, where the density functions from different covariate levels share a common baseline density, and the parameters in the exponential tilting component reflect the difference among the covariates. With the proposed models, the estimated covariate adjusted ROC is much smoother and more efficient than the nonparametric counterpart without borrowing information from neighbouring covariates. A simulation study and a real data application are reported. The Canadian Journal of Statistics 40: 569-587; 2012 © 2012 Statistical Society of Canada [ABSTRACT FROM AUTHOR]

Human listening tests were conducted to investigate if participants could distinguish between samples of target echoes and clutter obtained from a broadband active sonar experiment. For each echo, the listeners assigned a rating based on how confident they were that it was a target echo or clutter. The measure of performance was the area under the binormal receiver-operating-characteristic (ROC) curve, Az. The mean performance was Az = 0.95 ± 0.04 when signals were presented with their full available acoustic bandwidth of approximately 0-2 kHz. It was Az = 0.77 ± 0.08 when the bandwidth was reduced to 0.5-2 kHz. The error bounds are stated as 95% confidence intervals. These results show that the listeners could definitely hear differences, but their performance was significantly degraded when the low-frequency signal information was removed. The performance of an automatic aural classifier was compared against this human-performance baseline. Results of statistical tests showed that it outperformed 2 of 13 listeners and 5 of 9 human listeners in the full-bandwidth and reduced-bandwidth tests, respectively, and performed similarly to the other listeners. Given its performance, the automatic aural classifier may prove beneficial to Navy sonar systems. [ABSTRACT FROM AUTHOR]

Context.: Pain is one of the most common symptoms reported by patients living with Multiple Sclerosis (MS). Risk factors associated with pain may include individual's cognitive thinking process, emotional and behavioural response to pain and amount of social support. There is a lack of research on the influence on the amount of social support and its association to pain outcomes. Objective.: The primary objective of this study was to determine the association between amount and of social support and its association with odds of pain among individuals with MS. Methods.: The Survey on Living with Neurological Conditions in Canada (SLNCC) 2011-2012 linked to the Canadian Community Health Survey (CCHS) 2010-2011 was used to carry out a logistic regression model for this analysis (N = 78,623). Main outcome measures.: The factors that were assessed were psychological factors, problems with sleeping, self-perceived general health, self-perceived level of stress, number of years living with MS, as well as social factors. The outcome variable was pain. Results.: The amount of social support was found to be significant in that individuals who had 3 or fewer types of social support were 3.02 times more likely (95% CI 1.06 to 8.59) to report being in pain as opposed to individuals who had 4 types of support. The results indicate the importance of self efficacy in overcoming symptoms of MS and the need for more home care services. [ABSTRACT FROM AUTHOR]

Importance: Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Outcomes and Measures: Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. Results: The ScanCourse had an AUC of.702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Conclusions and Relevance: Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. What This Article Adds: Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: To adapt the Canadian Diabetes Risk Assessment Questionnaire for the Chinese population and to evaluate its psychometric properties. Design and Sample: A cross‐sectional study was conducted with a convenience sample of 194 individuals aged 35–74 years from October 2014 to April 2015. Methods: The Canadian Diabetes Risk Assessment Questionnaire was adapted and translated for the Chinese population. Test–retest reliability was conducted to measure stability. Criterion and convergent validity of the adapted questionnaire were assessed using 2‐hr 75 g oral glucose tolerance tests and the Finnish Diabetes Risk Scores, respectively. Sensitivity and specificity were evaluated to establish its predictive validity. Results: The test–retest reliability was 0.988. Adequate validity of the adapted questionnaire was demonstrated by positive correlations found between the scores and 2‐hr 75 g oral glucose tolerance tests (r = .343, p < .001) and with the Finnish Diabetes Risk Scores (r = .738, p < .001). The area under receiver operating characteristic curve was 0.705 (95% CI .632, .778), demonstrating moderate diagnostic value at a cutoff score of 30. The sensitivity was 73%, with a positive predictive value of 57% and negative predictive value of 78%. Conclusions: Our results provided evidence supporting the translation consistency, content validity, convergent validity, criterion validity, sensitivity, and specificity of the translated Canadian Diabetes Risk Assessment Questionnaire with minor modifications. This paper provides clinical, practical, and methodological information on how to adapt a diabetes risk calculator between cultures for public health nurses. [ABSTRACT FROM AUTHOR]

Background: The incidence of oropharyngeal cancer has risen over the past 2 decades. This rise has been attributed to human papillomavirus (HPV), but information on temporal trends in incidence of HPV-associated cancers across Canada is limited.Methods: We collected social, clinical and demographic characteristics and p16 protein status (p16-positive or p16-negative, using this immunohistochemistry variable as a surrogate marker of HPV status) for 3643 patients with oropharyngeal cancer diagnosed between 2000 and 2012 at comprehensive cancer centres in British Columbia (6 centres), Edmonton, Calgary, Toronto and Halifax. We used receiver operating characteristic curves and multiple imputation to estimate the p16 status for missing values. We chose a best-imputation probability cut point on the basis of accuracy in samples with known p16 status and through an independent relation between p16 status and overall survival. We used logistic and Cox proportional hazard regression.Results: We found no temporal changes in p16-positive status initially, but there was significant selection bias, with p16 testing significantly more likely to be performed in males, lifetime never-smokers, patients with tonsillar or base-of-tongue tumours and those with nodal involvement (p < 0.05 for each variable). We used the following variables associated with p16-positive status for multiple imputation: male sex, tonsillar or base-of-tongue tumours, smaller tumours, nodal involvement, less smoking and lower alcohol consumption (p < 0.05 for each variable). Using sensitivity analyses, we showed that different imputation probability cut points for p16-positive status each identified a rise from 2000 to 2012, with the best-probability cut point identifying an increase from 47.3% in 2000 to 73.7% in 2012 (p < 0.001).Interpretation: Across multiple centres in Canada, there was a steady rise in the proportion of oropharyngeal cancers attributable to HPV from 2000 to 2012. [ABSTRACT FROM AUTHOR]

Objective. The aim was to evaluate diffusion-weighted imaging (DWI) as a tool for measuring treatment response in adolescents with enthesitis-related arthropathy (ERA). Methods. Twenty-two adolescents with ERA underwent routine MRI and DWI before and after TNF inhibitor therapy. Each patient's images were visually scored by two radiologists using the Spondyloarthritis Research Consortium of Canada system, and sacroiliac joint apparent diffusion coefficient (ADC) and normalized ADC (nADC) were measured for each patient. Therapeutic clinical response was defined as an improvement of ≽ 30% physician global assessment and radiological response defined as ≽2.5-point reduction in Spondyloarthritis Research Consortium of Canada score. We compared ADC and nADC changes in responders and non-responders using the Mann-Whitney-Wilcoxon test. Results. For both radiological and clinical definitions of response, reductions in ADC and nADC after treatment were greater in responders than in non-responders (for radiological response: ADC: P<0.01; nADC: P = 0.055; for clinical response: ADC: P = 0.33; nADC: P = 0.089). ADC and nADC could predict radiological response with a high level of sensitivity and specificity and were moderately sensitive and specific predictors of clinical response (the area under the receiver operating characteristic curves were as follows: ADC: 0.97, nADC: 0.82 for radiological response; and ADC: 0.67, nADC: 0.78 for clinical response). Conclusion. DWI measurements reflect the response to TNF inhibitor treatment in ERA patients with sacroiliitis as defined using radiological criteria and may also reflect clinical response. DWI is more objective than visual scoring and has the potential to be automated. ADC/nADC could be used as biomarkers of sacroiliitis in the clinic and in clinical trials. [ABSTRACT FROM AUTHOR]

Background: An international group of experts recommended reclassifying non-invasive follicular variant of papillary thyroid cancers (FVPTC) as 'non-invasive follicular thyroid neoplasm with papillary-like nuclear features' (NIFTP) in April 2016. The purpose of this study was to establish preoperative clinical, laboratory, ultrasonographic, and cytological variables, which can differentiate NIFTP from FVPTC. Methods: We conducted a retrospective chart review of consecutive patients from a single institution evaluated between January 2012 and December 2017. 203 adult patients underwent lobectomy or total thyroidectomy for a FVPTC during that period. Each patient's medical chart was reviewed and information on pre-operative variables was recorded. An expert pathologist reviewed all surgical specimens and reclassified a subset of FVPTC as NIFTP according to the specific criteria. Results: Overall, 44 patients were included in the NIFTP group and 159 in the non-NIFTP group. Mean age was 50.1 years in the NIFTP group and 50.7 in the non-NIFTP group. Most patients were female (86.4% (38/44) in the NIFTP group vs 79.8% (127/159) in the non-NIFTP group). More patients underwent lobectomy in the NIFTP group (50% (22/44) vs 16.4% (26/159) in the non-NIFTP group, p = < 0.0001). Less patients received radioactive iodine in the NIFTP group (31.8% (14/44) vs 52.2% (83/159) in the non-NIFTP group, p = 0.0177). Preoperative thyroglobulin levels were lower in NIFTP patients (Median 25.55 mcg/L +/− 67.8 vs 76.06 mcg/L +/− 119.8 in Non-NIFTP, p = 0.0104). NIFTP nodules were smaller (Mean size 22.97 mm +/− 12.3 vs 25.88 mm +/− 11.2 for non-NIFTP, p = 0.0448) and more often solid than non-NIFTP (93.2% (41/44) vs 74.8% (119/159) for non-NIFTP, p = 0.0067). 2017 ACR TIRADS nodule category of 1–4 on ultrasound had a negative predictive value and a sensitivity of 100% for NIFTP. ROC Curve Analysis demonstrated that a preoperative thyroglobulin level of 31.3 mcg/L had a sensitivity of 75% and a specificity of 62.5% to differentiate NIFTP from non-NIFTP cancers. Conclusion: Lower preoperative thyroglobulin levels, smaller nodule size, solid texture and 2017 ACR TIRADS Category of 1–4 are more strongly associated with NIFTP than FVPTC and can favour less invasive surgical options such as lobectomy. [ABSTRACT FROM AUTHOR]

From a public health perspective, gambling shares many of the same characteristics as alcohol. Notably, excessive gambling is associated with many physical and emotional health harms, including depression, suicidal ideation, substance use and addiction and greater utilization of health care resources. Gambling also demonstrates a similar 'dose-response' relationship as alcohol—the more one gambles, the greater the likelihood of harm. Using the same collaborative, evidence-informed approach that produced Canada's Low-Risk Alcohol Drinking and Lower Risk Cannabis Use Guidelines, a research team is leading the development of the first national Low-Risk Gambling Guidelines (LRGGs) that will include quantitative thresholds for safe gambling. This paper describes the research methodology and the decision-making process for the project. The guidelines will be derived through secondary analyses of several large population datasets from Canada and other countries, including both cross-sectional and longitudinal data on over 50 000 adults. A scientific committee will pool the results and put forward recommendations for LRGGs to a nationally representative, multi-agency advisory committee for endorsement. To our knowledge, this is the first systematic attempt to generate a workable set of LRGGs from population data. Once validated, the guidelines inform public health policy and prevention initiatives and will be disseminated to addiction professionals, policy makers, regulators, communication experts and the gambling industry. The availability of the LRGGs will help the general public make well-informed decisions about their gambling activities and reduce the harms associated with gambling. [ABSTRACT FROM AUTHOR]

This document is a corrigendum for an article titled "Second malignant neoplasms within 5 years from first primary diagnosis in pediatric oncology patients in Canada: a population-based retrospective cohort study." The corrigendum addresses an error in the legend for Figures 5 to 7, stating that the hazard ratio has been suppressed because less than 5 patients have the characteristic. The authors apologize for the error and clarify that it does not affect the scientific conclusions of the article. [Extracted from the article]

Rationale: Owing to resource limitations, the testing of patients for obstructive sleep apnea (OSA) is often delayed. There is a need to accurately triage and expedite testing in those with a high pretest probability of OSA. Acoustic pharyngometry is a simple, noninvasive technique used to assess the upper airway cross-sectional area (UA-XSA), which is known to be reduced in those with OSA.Objectives: To determine the discriminative ability and predictive value of UA-XSA measurements by acoustic pharyngometry for OSA.Methods: We conducted a cross-sectional study with a clinical cohort of consecutive adults with suspected OSA who had undergone both polysomnography and acoustic pharyngometry. OSA was defined as an apnea-hypopnea index greater than or equal to 5. Multivariable logistic regression analyses and receiver operating characteristic curves were used.Measurements and Main Results: The cohort included 576 subjects, 87% of whom had OSA and 64% of whom were men. The subjects' median body mass index (BMI) was 30.3 kg/m2, and their median age was 57 years. The median UA-XSA at FRC when sitting was significantly smaller in those with OSA compared with those without OSA (3.3 cm2 [interquartile range, 2.7-3.8] vs. 3.7 cm2 [interquartile range, of 2.9-4.2]). When the analysis was controlled for age, sex, BMI, and comorbidities, the odds of OSA increased for every 1-cm2 decrease in the mean UA-XSA FRC when sitting (odds ratio, 1.62; 95% confidence interval, 1.23-2.13). The mean UA-XSA provided fair discrimination for OSA (area under the curve, 0.60). A cutoff value of 3.75 cm2, the point with the best sum of sensitivity and specificity, had sensitivity of 73% and specificity of 46%. The magnitude of the incremental discriminative value of UA-XSA over clinical variables (age, sex, BMI, and comorbidities) was small and nonsignificant (P = 0.5).Conclusions: The mean UA-XSA at FRC when sitting or supine provided no further significant advantage over clinical variables for the discernment of OSA. [ABSTRACT FROM AUTHOR]

It has been recognised that medication names that look or sound similar are a cause of medication errors. This study builds statistical classifiers for identifying medication incidents due to look-alike sound-alike mix-ups. A total of 227 patient safety incident advisories related to medication were obtained from the Canadian Patient Safety Institute’s Global Patient Safety Alerts system. Eight feature selection strategies based on frequent terms, frequent drug terms and constituent terms were performed. Statistical text classifiers based on logistic regression, support vector machines with linear, polynomial, radial-basis and sigmoid kernels and decision tree were trained and tested. The models developed achieved an average accuracy of above 0.8 across all the model settings. The receiver operating characteristic curves indicated the classifiers performed reasonably well. The results obtained in this study suggest that statistical text classification can be a feasible method for identifying medication incidents due to look-alike sound-alike mix-ups based on a database of advisories from Global Patient Safety Alerts. [ABSTRACT FROM AUTHOR]

Background: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient's risk of developing specific postoperative outcomes. Methods: Patient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection. Preoperative information for 107 patients was entered into the risk calculator and compared to observed postoperative outcomes. Statistical analysis of the risk calculator was completed for the entire study population, for stratification by procedure, and by utilization of microvascular reconstruction. Accuracy was assessed using the ratio of predicted to observed outcomes, Receiver Operating Characteristics (ROC), Brier score, and the Wilcoxon signed--ranked test. Results: The risk calculator accurately predicted the incidences for 11 of 12 outcomes for patients that did not undergo free flap reconstruction (NFF group), but was less accurate for patients that underwent free flap reconstruction (FF group). Length of stay (LOS) analysis showed similar results, with predicted and observed LOS statistically different in the overall population and FF group analyses (p = 0.001 for both), but not for the NFF group analysis (p = 0.764). All outcomes in the NFF group, when analyzed for calibration, met the threshold value (Brier scores < 0.09). Risk predictions for 8 of 12, and 10 of 12 outcomes were adequately calibrated in the FF group and the overall study population, respectively. Analyses by procedure were excellent, with the risk calculator showing adequate calibration for 7 of 8 procedural categories and adequate discrimination for all calculable categories (6 of 6). Conclusion: The NSQIP-RC demonstrated efficacy for predicting postoperative complications in head and neck oncology surgeries that do not require microvascular reconstruction. The predictive value of the metric can be improved by inclusion of several factors important for risk stratification in head and neck oncology. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to provide reference data and evaluate the psychometric properties for the finite verb morphology composite (FVMC) measure in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method: Participants included 377 children between age 4 and age 9, including 300 children with typical language and 77 children with language impairment (LI). Narrative samples were collected using a story generation task. FVMC scores were computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for FVMC were further evaluated. Results: Children's performance on FVMC increased significantly between age 4 and age 9 in the typical language and LI groups. Moreover, the correlation coefficients for the split-half reliability and concurrent criterion validity of FVMC were medium to large (rs ≥ .429, ps < .001) at each age level. The diagnostic accuracy of FVMC was good or acceptable from age 4 to age 7, but it dropped to a poor level at age 8 and age 9. Conclusion: With the empirical evidence, FVMC is appropriate for identifying children with LI between age 4 and age 7. The reference data of FVMC could also be used for monitoring treatment progress. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article was to provide the reference data and evaluate psychometric properties for the percent grammatical utterances (PGU; Eisenberg & Guo, 2013) in children between 4 and 9 years of age from the database of the Edmonton Narrative Norms Instrument (ENNI; Schneider, Dubé, & Hayward, 2005). Method: Participants were 377 children who were between 4 and 9 years of age, including 300 children with typical language (TL) and 77 children with language impairment (LI). Narrative samples were collected using the ENNI protocol (i.e., a story generation task). PGU was computed from the samples. Split-half reliability, concurrent criterion validity, and diagnostic accuracy for PGU were further evaluated. Results: PGU increased significantly in children between 4 and 9 years of age in both the TL and LI groups. In addition, the correlation coefficients for the split-half reliability and concurrent criterion validity of PGU were all large (rs ≥ .557, ps < .001). The diagnostic accuracy of PGU was also good or acceptable from ages 4 to 9 years. Conclusions: With the attested psychometric properties, PGU computed from the ENNI could be used as an assessment tool for identifying children with LI between 4 and 9 years of age. The reference data of PGU could also be used for monitoring treatment progress. [ABSTRACT FROM AUTHOR]

Background: Clinical practice and literature has supported the existence of a phenotypic sub-type of depression in men. While a number of self-report rating scales have been developed in order to empirically test the male depression construct, psychometric validation of these scales is limited. Aim: To confirm the psychometric properties of the multidimensional Male Depression Risk Scale (MDRS-22) and to develop clinical cut-off scores for the MDRS-22. Method: Data were obtained from an online sample of 1000 Canadian men (median age (M) = 49.63, standard deviation (SD) = 14.60). Confirmatory factor analysis (CFA) was used to replicate the established six-factor model of the MDRS-22. Results: Psychometric values of the MDRS subscales were comparable to the widely used Patient Health Questionnaire-9. CFA model fit indices indicated adequate model fit for the six-factor MDRS-22 model. ROC curve analysis indicated the MDRS-22 was effective for identifying those with a recent (previous four-weeks) suicide attempt (area under curve (AUC) values = 0.837). The MDRS-22 cut-off identified proportionally more (84.62%) cases of recent suicide attempt relative to the PHQ-9 moderate range (53.85%). Conclusion: The MDRS-22 is the first male-sensitive depression scale to be psychometrically validated using CFA techniques in independent and cross-nation samples. Additional studies should identify differential item functioning and evaluate cross-cultural effects. [ABSTRACT FROM AUTHOR]

Objectives: An obstetric comorbidity index has been developed recently with superior performance characteristics relative to general comorbidity measures in an obstetric population. This study aimed to externally validate this index and to examine the impact of including hospitalisation/delivery records only when estimating comorbidity prevalence and discriminative performance of the obstetric comorbidity index.Design: Validation study.Setting: Alberta, Canada.Population: Pregnant women who delivered a live or stillborn infant in hospital (n = 5995).Methods: Administrative databases were linked to create a population-based cohort. Comorbid conditions were identified from diagnoses for the delivery hospitalisation, all hospitalisations and all healthcare contacts (i.e. hospitalisations, emergency room visits and physician visits) that occurred during pregnancy and 3 months pre-conception. Logistic regression was used to test the discriminative performance of the comorbidity index.Main Outcome Measures: Maternal end-organ damage and extended length of stay for delivery.Results: Although prevalence estimates for comorbid conditions were consistently lower in delivery records and hospitalisation data than in data for all healthcare contacts, the discriminative performance of the comorbidity index was constant for maternal end-organ damage [all healthcare contacts area under the receiver operating characteristic curve (AUC) = 0.70; hospitalisation data AUC = 0.67; delivery data AUC = 0.65] and extended length of stay for delivery (all healthcare contacts AUC = 0.60; hospitalisation data AUC = 0.58; delivery data AUC = 0.58).Conclusions: The obstetric comorbidity index shows similar performance characteristics in an external population and is a valid measure of comorbidity in an obstetric population. Furthermore, the discriminative performance of the comorbidity index was similar for comorbidities ascertained at the time of delivery, in hospitalisation data or through all healthcare contacts. [ABSTRACT FROM AUTHOR]

Context Checklists are commonly used in the assessment of procedural competence. However, on most checklists, high scores are often unable to rule out incompetence as the commission of a few serious procedural errors typically results in only a minimal reduction in performance score. We hypothesised that checklists constructed based on procedural errors may be better at identifying incompetence. Objectives This study sought to compare the efficacy of an error-focused checklist and a conventionally constructed checklist in identifying procedural incompetence. Methods We constructed a 15-item error-focused checklist for lumbar puncture ( LP) based on input from 13 experts in four Canadian academic centres, using a modified Delphi approach, over three rounds of survey. Ratings of 18 video-recorded performances of LP on simulators using the error-focused tool were compared with ratings obtained using a published conventional 21-item checklist. Competence/incompetence decisions were based on global assessment. Diagnostic accuracy was estimated using the area under the curve ( AUC) in receiver operating characteristic analyses. Results The accuracy of the conventional checklist in identifying incompetence was low ( AUC 0.11, 95% confidence interval [ CI] 0.00-0.28) in comparison with that of the error-focused checklist ( AUC 0.85, 95% CI 0.67-1.00). The internal consistency of the error-focused checklist was lower than that of the conventional checklist (α = 0.35 and α = 0.79, respectively). The inter-rater reliability of both tools was high (conventional checklist: intraclass correlation coefficient [ ICC] 0.99, 95% CI 0.98-1.00; error-focused checklist: ICC 0.92, 95% CI 0.68-0.98). Conclusions Despite higher internal consistency and inter-rater reliability, the conventional checklist was less accurate at identifying procedural incompetence. For assessments in which it is important to identify procedural incompetence, we recommend the use of an error-focused checklist. [ABSTRACT FROM AUTHOR]

Comprehensive risk assessment can benefit from combining static and dynamic scales. The purpose of this study was to validate the Risk Matrix 2000, examine incremental validity of the STABLE-2007 and develop structured rules for combining the two scales. In a routine sample of Canadian sex offenders (n = 710), the Risk Matrix 2000/Sex, /Violence and /Combined scales significantly predicted the six recidivism outcomes: sexual, any sexual (including sexually motivated breaches), non-sexual violent, violent, any crime (excluding breaches) and any recidivism (including breaches). Area under the receiver operating characteristic curve (AUC) values were moderate to large. The STABLE-2007 generally added incremental predictive validity to the Risk Matrix 2000. Structured rules and recidivism estimates are provided for combining the two scales. The current study illustrates that predictive accuracy can be improved by combining static and dynamic risk scales in a structured manner. [ABSTRACT FROM AUTHOR]

Aim To determine if differences exist between paediatric intensive care nurses and allied health professionals in empathy, secondary trauma, burnout, pain exposure and pain ratings of self and others. Early and late career differences were also examined. Background Nurses are routinely exposed to patient pain expression. This work context may make them vulnerable to adverse outcomes such as desensitization to patient pain or a compromise in personal well-being. Design Cross-sectional study. Methods Data were collected from a convenience sample of paediatric intensive care nurses ( n = 27) and allied health professionals ( n = 24), from September 2014-June 2015, at a Canadian health centre. Both groups completed one demographic and three behavioural scales. Participants underwent fMRI while rating the pain of infant and adult patients in a series of video clips. Data were analyzed using parametric and non-parametric methods. fMRI results are reported in a second paper. Results Nurses were significantly more likely to be exposed to pain at work than allied health professionals and scored significantly higher on dimensions of empathy, secondary trauma and burnout. Nurses scored their own pain and the pain of infant and adult patients, higher than allied health participants. Less experienced nurses had higher secondary trauma and burnout scores than more experienced nurses. Conclusions Paediatric intensive care work demands, such as patient pain exposure, may be associated with nurse's higher report of empathy and pain in self and others, but also with higher levels of secondary trauma and burnout, when compared with allied health professionals. [ABSTRACT FROM AUTHOR]

Background: Compared to very low gestational age (<32 weeks, VLGA) cohorts, very low birth weight (<1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes.Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared.Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (<1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and <32 weeks, AUC 0.60-0.62).Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking. [ABSTRACT FROM AUTHOR]

The objective of this study was to define the optimal algorithm to identify patients with dyslipidemia using electronic medical records (EMRs). EMRs of patients attending primary care clinics in St. John's, Newfoundland and Labrador (NL), Canada during 2009-2010, were studied to determine the best algorithm for identification of dyslipidemia. Six algorithms containing three components, dyslipidemia ICD coding, lipid lowering medication use, and abnormal laboratory lipid levels, were tested against a gold standard, defined as the existence of any of the three criteria. Linear discriminate analysis, and bootstrapping were performed following sensitivity/specificity testing and receiver's operating curve analysis. Two validating datasets, NL records of 2011-2014, and Canada-wide records of 2010-2012, were used to replicate the results. Relative to the gold standard, combining laboratory data together with lipid lowering medication consumption yielded the highest sensitivity (99.6%), NPV (98.1%), Kappa agreement (0.98), and area under the curve (AUC, 0.998). The linear discriminant analysis for this combination resulted in an error rate of 0.15 and an Eigenvalue of 1.99, and the bootstrapping led to AUC: 0.998, 95% confidence interval: 0.997-0.999, Kappa: 0.99. This algorithm in the first validating dataset yielded a sensitivity of 97%, Negative Predictive Value (NPV) = 83%, Kappa = 0.88, and AUC = 0.98. These figures for the second validating data set were 98%, 93%, 0.95, and 0.99, respectively. Combining laboratory data with lipid lowering medication consumption within the EMR is the best algorithm for detecting dyslipidemia. These results can generate standardized information systems for dyslipidemia and other chronic disease investigations using EMRs. [ABSTRACT FROM AUTHOR]

Purpose: Identify patient subgroups with different functional outcomes after SCI and study the association between functional status and initial ISNCSCI components. Methods: Using CART, we performed an observational cohort study on data from 675 patients enrolled in the Rick-Hansen Registry(RHSCIR) between 2014 and 2019. The outcome was the Spinal Cord Independence Measure (SCIM) and predictors included AIS, NLI, UEMS, LEMS, pinprick(PPSS), and light touch(LTSS) scores. A temporal validation was performed on data from 62 patients treated between 2020 and 2021 in one of the RHSCIR participating centers. Results: The final CART resulted in four subgroups with increasing totSCIM according to PPSS, LEMS, and UEMS: 1)PPSS < 27(totSCIM = 28.4 ± 16.3); 2)PPSS ≥ 27, LEMS < 1.5, UEMS < 45(totSCIM = 39.5 ± 19.0); 3)PPSS ≥ 27, LEMS < 1.5, UEMS ≥ 45(totSCIM = 57.4 ± 13.8); 4)PPSS ≥ 27, LEMS ≥ 1.5(totSCIM = 66.3 ± 21.7). The validation model performed similarly to the original model. The adjusted R-squared and F-test were respectively 0.556 and 62.2(P-value <0.001) in the development cohort and, 0.520 and 31.9(P-value <0.001) in the validation cohort. Conclusion: Acknowledging the presence of four characteristic subgroups of patients with distinct phenotypes of functional recovery based on PPSS, LEMS, and UEMS could be used by clinicians early after tSCI to plan rehabilitation and establish realistic goals. An improved sensory function could be key for potentiating motor gains, as a PPSS ≥ 27 was a predictor of a good function. IMPLICATIONS FOR REHABILITATION: After a traumatic Spinal Cord Injury (SCI), early neurological examination using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is recommended to determine initial injury severity and prognosis. This study identified three initial ISNCSCI components defining four subgroups of SCI patients with different expectations in functional outcomes, namely the initial pinprick sensory score, the Lower Extremity Motor Score, and the Upper Extremity Motor Score. Clinicians could use these subgroups early after tSCI to plan rehabilitation and set realistic therapeutic goals regarding functional outcomes. In clinical practice, careful and accurate assessment of pinprick sensation early after the SCI is crucial when predicting function or stratifying patients based on the expected function. [ABSTRACT FROM AUTHOR]

Objectives: Sequential Organ Failure Assessment score is the basis of the Sepsis-3 criteria and requires arterial blood gas analysis to assess respiratory function. Peripheral oxygen saturation is a noninvasive alternative but is not included in neither Sequential Organ Failure Assessment score nor Sepsis-3. We aimed to assess the association between worst peripheral oxygen saturation during onset of suspected infection and mortality.Design: Cohort study of hospital admissions from a main cohort and emergency department visits from four external validation cohorts between year 2011 and 2018. Data were collected from electronic health records and prospectively by study investigators.Setting: Eight academic and community hospitals in Sweden and Canada.Patients: Adult patients with suspected infection episodes.Interventions: None.Measurements and Main Results: The main cohort included 19,396 episodes (median age, 67.0 [53.0-77.0]; 9,007 [46.4%] women; 1,044 [5.4%] died). The validation cohorts included 10,586 episodes (range of median age, 61.0-76.0; women 42.1-50.2%; mortality 2.3-13.3%). Peripheral oxygen saturation levels 96-95% were not significantly associated with increased mortality in the main or pooled validation cohorts. At peripheral oxygen saturation 94%, the adjusted odds ratio of death was 1.56 (95% CI, 1.10-2.23) in the main cohort and 1.36 (95% CI, 1.00-1.85) in the pooled validation cohorts and increased gradually below this level. Respiratory assessment using peripheral oxygen saturation 94-91% and less than 91% to generate 1 and 2 Sequential Organ Failure Assessment points, respectively, improved the discrimination of the Sequential Organ Failure Assessment score from area under the receiver operating characteristics 0.75 (95% CI, 0.74-0.77) to 0.78 (95% CI, 0.77-0.80; p < 0.001). Peripheral oxygen saturation/Fio2 ratio had slightly better predictive performance compared with peripheral oxygen saturation alone, but the clinical impact was minor.Conclusions: These findings provide evidence for assessing respiratory function with peripheral oxygen saturation in the Sequential Organ Failure Assessment score and the Sepsis-3 criteria. Our data support using peripheral oxygen saturation thresholds 94% and 90% to get 1 and 2 Sequential Organ Failure Assessment respiratory points, respectively. This has important implications primarily for emergency practice, rapid response teams, surveillance, research, and resource-limited settings. [ABSTRACT FROM AUTHOR]

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Purpose: To examine the predictive validity of the Language Use Inventory (LUI), a parent report of language use by children 18-47 months old (O'Neill, 2009). Method: 348 children whose parents had completed the LUI were reassessed at 5-6 years old with standardized, norm-referenced language measures and parent report of developmental history. The relationship between scores on the LUI and later measures was examined through correlation, binary classification, and receiver operating characteristic curve analysis. Results: For children aged 24-47 months at the time of LUI completion, LUI scores correlated significantly with language measure scores. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were also calculated for 4 cutoff scores on the LUI, including -1.64 SD, a score that maximized sensitivity to 81 % and specificity to 93%. For children aged 18-23 months at the time of LUI completion, specificity and NPV were high, but sensitivity and PPV were lower than desirable. Conclusions: The results provide initial support for the LUI's predictive validity, particularly for children 24-47 months, and suggest the LUI can serve as an indicator of later language outcomes in referred populations. The results compare favorably to findings for other early child-language measures. [ABSTRACT FROM AUTHOR]

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS ( r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8-17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4-6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0-7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3-19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented. [ABSTRACT FROM AUTHOR]

Background: Childhood acquired brain injuries can disrupt communication functions needed for success in school, work and social interaction. Cognitive-communication difficulties may not be apparent until adolescence, when academic, environmental and social-emotional demands increase. Objective: The Functional Assessment of Verbal Reasoning and Executive Strategies for Students (S-FAVRES) is a new activity-level measure of cognitive-communication skills in complex, contextual and integrative tasks that simulate real world communication challenges. It is hypothesized that S-FAVRES performance would differentiate adolescents with and without acquired brain injury (ABI) on scores for Accuracy, Rationale, Reasoning Subskills and Time. Methods: S-FAVRES was administered to 182 typically-developing (TD) and 57 adolescents with mild-to-severe ABI aged 12–19. Group differences, internal consistency, sensitivity, specificity, reliability and contributing factors to performance (age, gender, brain injury) were examined statistically. Results: Those with ABI attained statistically lower Accuracy, Rationale and Reasoning sub-skills scores than their TD peers. Time scores were not significantly different. Performance trends were consistent across tasks, administrations, gender and age groups. Inter-rater reliability for scoring was acceptable. Conclusion: The S-FAVRES provides a reliable, functional and quantifiable measure of subtle cognitive-communication difficulties in adolescents that can assist speech-language pathologists in planning treatment and integration to school and real world communication. [ABSTRACT FROM AUTHOR]

This study explored the role of age at release on the risk of reoffending using a sample of sex offenders. It examined whether the risk of reoffending, assessed using actuarial tools, should be adjusted according to the offender's age at the time of release. The sample comprised 553 offenders, all of whom were consecutive admissions to a Canadian federal penitentiary. Scores on the Static-99 as well as age at release were included in successive nested prediction models using Cox-regression. Receiver operating characteristic (ROC) curves and Allison's R2 were computed to assess the predictive accuracy of the models and the strength of the association between the covariate measures of general and violent/sexual reoffending. Results showed that overall predictive accuracy observed across models was fair at best. Generally, age of onset and age at release improved the prediction accuracy over and above the scores on the Static-99. In fact, by itself, age at release showed a predictive accuracy comparable to that of the actuarial tool. The results suggest that risk assessors should adjust the risk of reoffending based on the offender's age at release. The implications of this study are discussed in light of the age-crime curve literature and the risk management of sex offenders in the community. [ABSTRACT FROM AUTHOR]

Purpose: To test whether T2 mapping of the sacro-iliac joints (SIJs) might help identifying patients with spondyloarthritis.Method: This study included 20 biologic-naive patients with axial spondyloarthritis (10 females; mean age: 38 ± 9years; range, 19-47) and 27 controls (16 males; mean age = 39 ± 13years; range = 28-71) who prospectively underwent SIJs MRI at 1.5 T, including a multislice multiecho spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and SPondyloArthritis Research Consortium of Canada (SPARCC) MRI index. T2 maps obtained from multiecho sequences were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using BASDAI questionnaire. Bland-Altman method, ROC curve analysis, Chi square, Mann-Whitney U, Pearson's and Spearman's correlation coefficient were used for data analysis.Results: According to ASAS criteria, MRI was positive for sacroiliitis in 5/20 patients (25 %). Inter-observer reproducibility of T2 values was 87 % (coefficient of repeatability = 7.0; bias = 0.49; p < .001). Mean T2 values of patients (58.5 ± 4.4 ms, range: 52.6-68.2 ms) were significantly higher (p < .001) than those of controls (44.1 ± 6.6 ms, range: 33.6-67.2 ms). A T2 value of 52.51 ms yielded 100 % sensitivity and 91.7 % specificity to differentiate patients from controls. No statistically significant association/correlation was found between T2 values and BASDAI (r=-.026, p = .827), disease duration (r = .024, p = .871), SPARCC (r=-.004, p = .981), ASAS criteria (p = .476), HLA-B27-positivity (p = .139), age (r=-.2.53, p = .891), and gender (p = .404).Conclusions: T2 relaxation times of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful to early identify patients with spondyloarthritis. [ABSTRACT FROM AUTHOR]

Background. The attainment of walking is a focus of physical therapy intervention in children with cerebral palsy (CP) and may affect their independence in mobility and participation in daily activities. However, knowledge of determinants of independent walking to guide physical therapists' decision making is lacking. Objective. The aim of this study was to identify child factors (postural control, reciprocal lower limb movement, functional strength, and motivation) and family factors (family support to child and support to family) that predict independent walking 1 year later in young children with CP at Gross Motor Function Classification System (GMFCS) levels II and III. Design. A secondary data analysis of an observational cohort study was performed. Methods. Participants were 80 children with CP, 2 through 6 years of age. Child factors were measured 1 year prior to the walking outcome. Parent-reported items representing family factors were collected 7 months after study onset. The predictive model was analyzed using backward stepwise logistic regression. Results. A measure of functional strength and dynamic postural control in a sit-to-stand activity was the only significant predictor of taking ≥3 steps independently. The positive likelihood ratio for predicting a "walker " was 3.26, and the negative likelihood ratio was 0.74. The model correctly identified a walker or "nonwalker " 75% of the time. Limitations. Prediction of walking ability was limited by the lack of specificity of child and family characteristics not prospectively selected and measurement of postural control, reciprocal lower limb movement, and functional strength 1 year prior to the walking outcome. Conclusions. The ability to transfer from sitting to standing and from standing to sitting predicted independent walking in young children with CP. Prospective longitudinal studies are recommended to determine indicators of readiness for independent walking. [ABSTRACT FROM AUTHOR]