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Statistical Methods for Rates and Proportions. New York:
... = substantial", and "0.81-1 = almost perfect" as proposed by Landis and Koch (1977). Another option suggested by Fleiss et al. (2003) involves a description of models with Kappa values > 0.75 as excellent, 0.40-0.75 fair to good, and < 0.40 as poor. ...
... The results indicate that up-sampling significantly improved the model performance to an accuracy of 0.78 (CI: 0.64, 0.89). A Kappa value of 0.72 indicated that this model performed substantially well according to criteria by Landis and Koch (1977) and excellent according to the criteria proposed by Fleiss et al. (2003). ...
... The Kappa statistic was 0.69, which is substantial according to criteria by Landis and Koch (1977) and fair to good according to Fleiss et al. (2003). Sensitivity, specificity, positive predictive, and negative predictive values were all ≥0.8 except for the outcomes diarrhea and bloody diarrhea, where there were lower values in some performance measures (Table 2). ...
The ever decreasing cost and increase in throughput of next generation sequencing (NGS) techniques have resulted in a rapid increase in availability of NGS data. Such data have the potential for rapid, reproducible and highly discriminative characterization of pathogens. This provides an opportunity in microbial risk assessment to account for variations in survivability and virulence among strains. A major challenge towards such attempts remains the highly dimensional nature of genomic data versus the number of isolates. Machine learning-based (ML) predictive risk modelling provides a solution to this “curse of dimensionality” while accounting for individual effects that are dependent on interactions with other genetic and environmental factors. This pilot study explores the potential of ML in the prediction of health endpoints resulting from shigatoxigenic E. coli (STEC) infection. Accessory genes in amino acid sequences were used as model input to predict and differentiate health outcomes in STEC infections including diarrhea, bloody diarrhea, hemolytic uremic syndrome and their combinations. Outcomes severity was also distinguished by hospitalization. A matrix of percent similarity between accessory genes and the E. coli genomes was generated and subsequently used as input for ML. The performances of ML algorithms random forest, support vector machine (radial and linear kernel), gradient boosting, and logit boost were compared. Logit boost was the best model showing an outcome prediction accuracy of 0.75 (95% CI: 0.60, 0.86), an excellent or substantial performance (Kappa = 0.72). Important genetic predictors of riskier STEC clinical outcomes included proteins involved in initial attachment to the host cell, persistence of plasmids or genomic islands, conjugative plasmid transfer and formation of sex pili, regulation of locus of enterocyte effacement expression, post-translational acetylation of proteins, facilitation of the rearrangement or deletion of sections within the pathogenic islands and transport macromolecules across the cell envelope. We propose further studies are proposed on the proteins with undefined or unclear functionality. One protein family in particular predicted HUS outcome. Toxin-antitoxin systems are potential stress adaptation markers which may mediate environmental persistence of strains in diverse sources. We foresee the application of ML approach to the set-up of real-time online analysis of whole genome sequence data to estimate the human health risk at the population or strain level. The ML approach is envisaged to support the prediction of more specific STEC clinical endpoints type by inputting isolate sequence data.
... Cronbach α was used to verify internal consistency by measuring the degree of interrelationship between the instrument items and reflecting their strength (homogeneity). 17 Appropriate values were between 0.70 and 0.95. 18 Construct validity analysis was performed using Pearson correlation coefficient (r), which verified the correlation between the question and domains and the scores of the VSQ-Br with the other instruments used in this study. ...
... Diagram of confirmatory factor analysis (AMOS software) of the Vulvovaginal Symptoms Questionnaire-Brazilian Portuguese. Q1… Q21 = questions; e = errors.ALEM ET AL[ICC2.1]) and 95% confidence interval: weak (ICC < 0.4), moderate (0.40 < ICC > 0.7), and strong (ICC > 0.7).17 ...
Objective:
The aims of this study were to perform a cross-cultural adaptation of the Vulvovaginal Symptoms Questionnaire (VSQ) into Brazilian Portuguese (VSQ-Br) and evaluate its measurement properties (structural validity, construct validity, internal consistency, and reliability).
Methods:
Cross-cultural adaptation was conducted through the translation, synthesis, and back-translation of the VSQ-Br. Subsequently, 314 women completed the Pelvic Floor Impact Questionnaire, Pelvic Floor Disorders Inventory, Medical Outcomes Study 36-Item Short-Form Health Survey, and VSQ-Br. Seven to 10 days later, participants completed the VSQ-Br for the second time. Data were submitted for confirmatory factor analysis. Cronbach α was used to verify internal consistency, and construct validity was assessed using Pearson correlation coefficient (r). Reliability was calculated using the intraclass correlation coefficient.
Results:
Confirmatory factor analysis showed that the questions were grouped into four domains (symptoms, emotions, life impact, and sexual impact). The model showed good fit (>0.95). The Cronbach α in this study was 0.85, reflecting adequate internal consistency. Adequate reliability was confirmed, with an intraclass correlation coefficient total score of 0.80. The VSQ-Br had a weak correlation with the pelvic domain of the Pelvic Floor Disorders Inventory, the pelvic organ prolapse domain of the Pelvic Floor Impact Questionnaire, and pain, vitality, and the social aspect domains of the Medical Outcomes Study 36-Item Short-Form Health Survey.
Conclusions:
The VSQ-Br was validated and had acceptable measurement properties for assessing vulvovaginal symptoms in Brazilian women.
... This was done separately for the answers regarding model, manufacturer and decade. The results were analyzed with the MantelHaenszel method (Fleiss, 1981). First, this determined whether overall the odds differed between items with and without correct item-specific verbal semantic knowledge (i.e., was the overall odds ratio greater than 1). ...
... Given that the initial analyses did no show much difference between developmental and acquired prosopagnosia, we combined these two groups together. We then used the Mantel-Haenszel method to test whether the odds ratios for the moreexpert group differed from those for the less-expert group (Fleiss, 1981). ...
Whether face and object recognition are dissociated in prosopagnosia continues to be debated: a recent review highlighted deficiencies in prior studies regarding the evidence for such a dissociation. Our goal was to study cohorts with acquired and developmental prosopagnosia with a complementary battery of tests of object recognition that address prior limitations, as well as evaluating for residual effects of object expertise. We studied 15 subjects with acquired and 12 subjects with developmental prosopagnosia on three tests: the Old/New Tests, the Cambridge Bicycle Memory Test, and the Expertise-adjusted Test of Car Recognition. Most subjects with developmental prosopagnosia were normal on the Old/New Tests: for acquired prosopagnosia, subjects with occipitotemporal lesions often showed impairments while those with anterior temporal lesions did not. Ten subjects showed a putative classical dissociation between the Cambridge Face and Bicycle Memory Tests, seven of whom had normal reaction times. Both developmental and acquired groups showed reduced car recognition on the expertise-adjusted test, though residual effects of expertise were still evident. Two subjects with developmental prosopagnosia met criteria for normal object recognition across all tests. We conclude that strong evidence for intact object recognition can be found in a few subjects but the majority show deficits, particularly those with the acquired form. Both acquired and developmental forms show residual but reduced object expertise effects.
... We used the following formula to calculate the sample size [29]. ...
Background
Fear of childbirth (FOC) can influence both maternal and child health. Research on FOC in China is scarce, especially on rural women. This study aimed to assess pre- and postpartum FOC and its predictors among Chinese rural women.
Methods
This was a prospective correlation study. A total of 569 women completed the prenatal questionnaire in the third trimester, and 477 of them completed the postpartum questionnaire within three days after childbirth. Maternal socio-demographic information, clinical information, childbirth self-efficacy and prenatal and postpartum FOC were investigated. FOC was evaluated using the Wijma Childbirth Expectancy/ Experience Questionnaire (WDEQ). Descriptive, bivariate, multivariate linear regression analysis, univariate and multivariate logistic regression analyses were performed.
Results
The mean pre- and postpartum FOC scores were 64.5 (standard deviation: 25.1) and 64.3 (standard deviation: 23.9), respectively, with 20.8% of women reporting severe fear before childbirth and 18.2% after childbirth. Multivariate linear regression analysis revealed predictors for higher levels of prenatal FOC including higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy (p < 0.05) and the predictors for higher levels of postpartum FOC included unemployed status, lower childbirth self-efficacy, and higher prenatal FOC (p < 0.05). Multivariate logistic regression showed that higher childbirth self-efficacy reduced the likelihood of severe prenatal FOC (OR: 0.99, p < 0.001), while severe prenatal FOC increased the likelihood of severe postpartum FOC (OR: 3.57, p < 0.001).
Conclusion
The rural women have high levels of FOC before and after childbirth, with approximately 20% experiencing severe FOC during both periods. Higher education level, nullipara, higher monthly household income, lower family support, and lower childbirth self-efficacy are predictors of heightened prenatal FOC. Unemployed status, lower childbirth self-efficacy, and higher prenatal FOC are predictors of heightened postpartum FOC. Notably, enhancing childbirth self-efficacy emerges as crucial in mitigating severe prenatal FOC, while severe prenatal FOC significantly increases the likelihood of severe postpartum FOC. The development of targeted intervention strategies for the above factors can help reduce women’s FOC level and improve their overall pregnancy and childbirth experience.
... Participation rates of the LLUH BREATHE cohort were computed as proportions and confidence intervals were computed using Fleiss's Quadratic method with a continuity correction 11 . Under the intent-to-treat principle, participants were defined as those employee smokers, and/or their covered spouse who smoked, that chose the wholeness health plan at the time it was offered. ...
Introduction:
Systematic analyses of workplace smoking cessation programs indicate that efficacy can be enhanced by using incentives. There is variation in the type of incentives used and their effect on participation and efficacy. The aim of our study was to examine whether lowering employee health plan costs (employee contributions, co-pays) encourage employee smokers to participate in workplace smoking cessation.
Methods:
We conducted a 2014–2015 prospective cohort study of 415 employee smokers of Loma Linda University Health (LLUH). The employees were offered participation in a workplace smoking cessation program (LLUH BREATHE Initiative) with the incentive of enrollment in an employer-provided health plan that had a 50% lower employee monthly contribution and co-payment relative to the employer-provided health plan for non-participants. Participation rates and variables associated with participation were analyzed.
Results:
In the LLUH BREATHE cohort, we found a very high rate of participation (72.7%; 95% CI: 69–77%) in workplace smoking cessation that was encouraged by a lower out-of-pocket health plan cost for the participating employee and/or spouse. Participation did, however, vary by gender and spouse, whereby female employee households with a qualifying smoker were more than two times more likely (employee: OR=2.89; 95% CI: 1.59–5.24) or spouse (spouse: OR=2.71; 95% CI: 1.47–5.00) to participate in smoking cessation than male employee households. The point prevalence, at four months, of abstinence from smoking among the participants was 48% (95% CI: 42–54%).
Conclusions:
Our findings indicate that a workplace smoking cessation program that uses a novel reward-based incentive of lower out-of-pocket health plan costs results in a participation rate that is much higher than US norms.
... A definição Pileggi-Castro et al. 5 kappa para as variáveis categóricas. Adotou-se como adequado um resultado a partir de 0,61, o que representa uma concordância substancial para o kappa 13 , e de satisfatória a boa para o CCI 14 . ...
O objetivo foi validar uma definição de identificação de casos de near miss neonatal precoce utilizando dados dos sistemas de informação em saúde (SIS). Estudo de validação concorrente entre três definições para identificação de casos de near miss neonatal precoce, realizado em hospital universitário com nascidos vivos ocorridos em 2012. Foram aplicadas três definições a esta coorte de nascidos vivos com utilização dos critérios peso ao nascer, idade gestacional, Índice de Apgar no 5º minuto de vida, internação em Unidade de Terapia Intensiva neonatal, ventilação mecânica e más-formações congênitas com diferentes combinações, considerando as proposições de dois artigos brasileiros publicados (definição Silva et al.; definição Pillegi-Castro et al.) e uma terceira (definição SIS) com dados disponíveis em Sistemas de Informação em Saúde. Foram considerados casos os sobreviventes às condições de risco até o 7º dia de vida. Para a validação concorrente, adotaram-se como referência os óbitos neonatais precoces. Dos 2.097 nascidos vivos estudados, 33 foram a óbito no período neonatal precoce, e o número de casos de near miss neonatal precoce variou segundo a definição adotada: 153 (definição Silva), 194 (definição Pileggi-Castro) e 304 (definição SIS). A sensibilidade e especificidade foi, respectivamente, 97% e 92,6% na definição Silva, 90,9% e 90,6% na definição Pileggi-Castro e 93,9% e 85,3% na definição SIS. Os resultados mostram que a definição SIS apresenta sensibilidade e especificidade próxima às outras definições e sugere que é possível monitorar o near miss neonatal precoce com uso apenas de dados disponíveis nos sistemas oficiais de informações em saúde.
To enhance patient outcomes, we previously developed “Hibilog”, an app that allows patients to report symptoms electronically. The paper-based Symptom Illustration Scale (SIS) was adapted using stickers and emojis to evaluate patient-reported outcomes (PROs). This study aimed to validate SIS within an electronic PRO monitoring environment for metastatic breast cancer patients undergoing chemotherapy.
The patients used the Electronic Patient-Reported Outcomes Monitoring (ePROM) “Hibilog” application to answer a questionnaire consisting of 18 items selected from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE), focusing on symptoms related to breast cancer treatment, along with the corresponding SIS questionnaire. Symptom monitoring began upon registration and continued every two weeks until the completion of the study. The primary outcome was the criterion-related validity of the SIS against PRO-CTCA using the ePROM. The secondary endpoints included the response rate, response time, and missing rates for each item.
Patients (n = 75) were registered between September 2019 and March 2020. For criterion validity, the Spearman rank correlation coefficients between the PRO-CTCAE and SIS items showed high correlations (rs ≥ 0.41) for all 18 items. The κ correlation coefficient indicated a high correlation (κ > 0.41) in 11 of the 18 items (61.1%), unlike the correlation with continuous variables. In terms of response and missing rates, the SIS in ePROM demonstrated similarly high performance as our results. Additionally, the average response time was 3.0 min (SD 4.2) for SIS, with a substantially shorter response time.
We conclude that SIS is a useful tool in an ePROM environment for patients with MBC undergoing chemotherapy. The clinical utility of SIS in an ePRO environment needs to be validated to develop a more accurate scale for capturing patient symptoms.
BACKGROUND
The National Institutes of Health Stroke Scale is used globally to rate neurological deficits in patients with acute stroke. Originally designed for research use, the scale uses idiosyncratic scoring rules and requires thorough training for proper use. Currently available training and certification systems are timeworn and limited in the range of demonstrated neurological findings. We aimed to develop a new training and certification method to address the limitations of the prior system.
METHODS
We describe a new animated system that uses state-of-the-art digital motion capture, avatar rendering, and digital animation that enables illustration of all possible scale item responses within a training module. For certification, we created 20 unique case vignettes, which can be viewed from many angles allowing better scoring scenario presentation. Training to use the scale via telemedicine was added. Alpha and beta testing was completed to enhance iterative development. From a penultimate version, we measured interrater agreement among 42 pilot users who each viewed 6 cases. After further improvement, we finalized the application and confirmed interrater agreement in a second sample of 365 consecutive, unselected users viewing 3 cases. Clinometric analysis methods followed our prior studies of the scale.
RESULTS
Users agreed the new, animated training module is more engaging and informative than legacy training videos. We compared the new system to the legacy live-video certification system for clinometric reliability. In the confirmatory sample, the intraclass correlation coefficient was 0.979 (97.5% CI, 0.919–0.99). Kappa scores ranged from 0.25 to 0.90 across all 15 scale items. These results are comparable to previous studies.
CONCLUSIONS
A new, animated training and certification system showed equivalent clinometric properties to legacy systems, providing a reliable method for National Institutes of Health Stroke Scale training and certification. The new system allows modification and reconfiguration if needed to maintain user interest and case novelty.
Background
Trial informativeness describes the likelihood of a clinical trial to have a meaningful impact on clinical practice, research, or policy decisions. A dedicated scientific review process for protocols at the post-funding stage is not common, yet is an opportunity to enhance trial informativeness. The Bill and Melinda Gates Foundation (BMGF), one of the largest funders of clinical trials, created a group called Design, Analyze, Communicate (DAC). DAC’s first completion of an expert scientific review of a grantee’s trial protocol was in 2020. We categorized and quantified areas of scientific review feedback provided for 52 clinical trial protocols submitted to DAC over a 3-year period. Most trials planned to study treatment interventions and included at least one trial site in a low- and middle-income country. Feedback themes offer insight into areas of trial design weakness.
Methods
We conducted a retrospective analysis of protocol review feedback provided by DAC to grantees. Reviews were completed by BMGF between 2020 and 2022. A qualitative content analysis was conducted by developing a codebook of clinical trial methodology topics and subtopics and systematically coding free-text review feedback. Manual text classification of individual feedback statements enabled quantification and frequency analysis of review feedback.
Results
A total of 1537 individual recommendations were made across all 52 protocols. The median number of recommendations per protocol was 28 (range: 13 to 52), covering a wide range of issues related to clinical trial design, implementation, analysis, and impact. Nearly half of all recommendations (47%) were characterized by the review team as high priority. The areas with the highest frequency of recommendations were statistics and data analysis, trial procedures, and intervention/dose.
Conclusions
This study provides a taxonomy of scientific review feedback topic areas that can be used to categorize clinical trial design topics. The high number of recommendations per protocol review across several distinct topic areas highlights the need for a scientific review to enhance trial informativeness. This review must take place prior to trial initiation and review teams should include statistical and trial design expertise with additional expertise tailored to the trial/intervention type and phase.
The study of electoral pledges has become an increasingly influential approach to parties’ programmatic commitments and their consequences. Researchers identify specific policies to which parties commit themselves in their electoral campaigns and examine whether these policies have subsequently been enacted. This approach relies on largely standardized methods and definitions, a central aim being the comparability of the results obtained in different contexts. Our article highlights methodological challenges related to the identification of pledges. Specifically, we are concerned with the narrow understanding of the concept of electoral pledge that is applied in several case studies, whereby a pledge is defined as a clear commitment to an action or an outcome whose occurrence can be verified. This operationalization appears to minimize discretion with respect to the contents of the pledges that parties have made, on one hand, and whether parties have carried out their pledges, on the other. However, this narrow understanding of electoral pledges is not as straightforward and simple as it appears. Building on the linguistic underdeterminacy thesis and using examples from a real coding process, we highlight several ways in which even this narrow operationalization leaves room for interpretation on behalf of researchers. Specifically, coders may attach differing weights to parts of a statement, concepts may have non-obvious meanings, and some words may mean different things to different audiences. We conclude that from the point of view of transparency, the field would benefit from observing the linguistic nature of electoral pledges in greater detail.
This article continues the work of Rojas-de-Gracia et al. (2019) in which they question the appropriateness of relying on a single partner, male or female, to identify the decision-maker in tourism decisions. That study concluded that there is no general consensus among the members of the couple. As a solution, they proposed including the child as an impartial observer. This research tests that suggestion and shows that children’s perceptions differ from those of their parents, considering tourism decisions mostly autonomous and mainly dominated by the mother, contrary to parents’ perceptions of joint decision making. The practical implications of this finding are discussed.
The species Leishmania infantum and L. chagasi are considered causal agents of visceral leishmaniasis, a relevant disease due to its zoonosis and severity in humans. Canines are the main reservoirs, hence the need to implement precise diagnoses to identify the Leishmania species involved. The aim of the study was to perform a molecular diagnosis of leishmaniasis (conventional PCR and Sanger sequencing) in 29 tissue samples from canines clinically suspected of leishmaniasis, previously diagnosed by non-molecular methods. The presence of the parasite could be identified by PCR in 9/29 samples (L. infantum, n=4; L. chagasi, n=4; L. braziliensis, n=1), evidencing a predominance of L. infantum and L. chagasi in canines with cutaneous and mucocutaneous leishmaniasis. The PCR allowed to clarify previously negative diagnoses; however, limitations were found, such as the absence of Leishmania DNA in some samples and the inability to obtain additional samples due to inaccessibility to patients. Despite these limitations, the study highlights the importance of molecular diagnosis to identify the species causing leishmaniasis.
Serious adverse drug reactions (sADRs) have a serious impact on the progress being made in providing antiretroviral therapy. The presence of HIV/AIDS and its complications associated with sADRs, has a negative effect on the quality of life (QoL) of people living with HIV/AIDS (PLWHA). This was a descriptive retrospective cohort study of 400 adult HIV patients in which the QoL of PLWHA with sADRs was compared to patients that did not experience ADR who had been on antiretroviral therapy (ART) was followed up for 48 months using the WHOQOL-HIV BREF to measure QoL. Out of 400 patients, 373 (93.25%) respondents completed the study with an overall mean age was 40.8 years (SD ± 8.64). One hundred and ninety-nine patients (53.4%) reported to have experiencing sADR. The response consistently showed significantly higher mean scores in the QoL of patients who had no ADRs in the psychological, social and environments state of health domains compared to those who had ADRs with mean scores (P = 0.000, 0.037 and 0.028), respectively. This study revealed significantly higher scores in patients who had no ADRs compared to those who had ADRs. Low QoL due to serious ADR may add additional burden to HIV disease and complications, and the related discrimination often faced by PLWHA. This study would help clinicians pay serious attention to identifying and promptly managing ADR.
Purpose
This study aimed to assess the association between migraine headache and glaucoma among the adult population living in Armenia.
Methods
This case–control study recruited 145 cases with glaucoma and 250 controls without glaucoma and other ocular disorders except refractive error from Optomed Canada Diagnostic Eye Center in Armenia. A structured questionnaire contained questions on socio-demographics, family history of glaucoma and stroke, ocular health, smoking, migraine, and obstructive sleep apnea. The Migraine Screening Questionnaire assessed possible migraine and the Berlin Questionnaire measured obstructive sleep apnea.
Results
The mean ages of cases and controls were 63.3 (SD = 12.3) and 39.5 (SD = 13.5), respectively. Females comprised 62.8% of cases and 69.1% of controls. A total of 17.8% of cases and 19.0% of controls had possible migraine. In the adjusted analysis older age (OR 1.17; 95% CI 1.12; 1.23), average/lower than average socio-economic status (OR 5.27; 95% CI 1.30; 21.3), and family history of glaucoma (OR 4.25; 95% CI 1.51; 11.9) were associated with high-tension glaucoma.
Conclusion
Timely case detection of glaucoma among those with average/low socio-economic status and those with family history of glaucoma could prevent further progression of the disease. Further studies to explore the relationship between migraine headache and specific types of glaucoma may be worthwhile.
We developed a new tool to assess the severity of osteoporotic vertebral fracture using radiographs of the spine. Our technique can be used in patient care by helping to stratify patients with osteoporotic vertebral fractures into appropriate treatment pathways. It can also be used for research purposes.
The aim of our study was to propose a semi-quantitative (SQ) grading scheme for osteoporotic vertebral fracture (OVF) on anteroposterior (AP) radiographs.
On AP radiographs, the vertebrae are divided into right and left halves, which are graded (A) vertical rectangle, (B) square, (C) traverse rectangle, and (D) trapezoid; whole vertebrae are graded (E) transverse band or (F) bow-tie. Type A and B were compared with normal and Genant SQ grade 1 OVF, Type C and D with grade 2 OVF, and Type E and F with grade 3 OVF. Spine AP radiographs and lateral radiographs of 50 females were assessed by AP radiographs SQ grading. After training, an experienced board-certified radiologist and a radiology trainee assessed the 50 AP radiographs.
The height-to-width ratio of the half vertebrae varied 1.32–1.48. On lateral radiographs, 84 vertebrae of the 50 patients had OVFs (38 grade 1, 24 grade 2, and 22 grade 3). On AP radiographs, the radiologist correctly assigned 84.2%, 91.7%, and 77.2% and the trainee correctly assigned 68.4%, 79.2%, and 81.8% of grade 1, 2, and 3 OVFs, respectively. Compared with lateral radiographs, the radiologist had a weighted Kappa of 0.944 including normal vertebrae and 0.883 not including normal vertebrae, while the corresponding Kappa values for the trainee were 0.891 and 0.830, respectively.
We propose a new semi-quantitative grading system for vertebral fracture severity assessment on AP spine radiographs.
Objetivo: Determinar relaciones, entre el estado de nutrición y variables biológicas (VB) y socioeconómicas (VSE) de niños pobres. Material y Métodos: Durante 1998 y 1999 se encuestaron 14957 menores de doce años adscritos al Instituto Colombiano de Bienestar Familiar en Santander, Colombia, y con datos de corte transversal se realizó un estudio analítico. A través de regresiones lineales múltiples (RLM), se establecieron once modelos causales y su grado de explicación sobre los indicadores Peso/Talla (p/t) y Talla/Edad (t/e). Resultados: La variación en p/t es explicada por la escolaridad del responsable del menor, el número de menores de siete años con quien convive y el sexo (modelo G) (R2 = 0,0040). La variación en t/e es explicada por la escolaridad del responsable del menor, el número de menores de siete años con quien convive, el tamaño de la familia, el número de miembros que trabajan y aportan, la edad, el sexo y el estrato socioeconómico (modelo K) (R2 = 0,0600). Conclusiones: los modelos de RLM, permiten explicaciones que incorporan la interacción entre las variables. Existe menos variación en el indicador t/e con respecto al indicador p/t al explorar por grupos de edad. Son necesarios nuevos indicadores para clasificar correctamente la población pobre. El comportamiento de la variable tipo de tenencia de la vivienda causa confusión. La disminución de la vigencia y desaparición de relaciones entre estado de nutrición y VSE hacen difícil comprender los complejos causales para desnutrición u obesidad.
Background
An elegant bedside provocation test has been shown to aid the diagnosis of long‐QT syndrome (LQTS) in a retrospective cohort by evaluation of QT intervals and T‐wave morphology changes resulting from the brief tachycardia provoked by standing. We aimed to prospectively determine the potential diagnostic value of the standing test for LQTS.
Methods and Results
In adults suspected for LQTS who had a standing test, the QT interval was assessed manually and automated. In addition, T‐wave morphology changes were determined. A total of 167 controls and 131 genetically confirmed patients with LQTS were included. A prolonged heart rate–corrected QT interval (QTc) (men ≥430 ms, women ≥450 ms) at baseline before standing yielded a sensitivity of 61% (95% CI, 47–74) in men and 54% (95% CI, 42–66) in women, with a specificity of 90% (95% CI, 80–96) and 89% (95% CI, 81–95), respectively. In both men and women, QTc≥460 ms after standing increased sensitivity (89% [95% CI, 83–94]) but decreased specificity (49% [95% CI, 41–57]). Sensitivity further increased ( P <0.01) when a prolonged baseline QTc was accompanied by a QTc≥460 ms after standing in both men (93% [95% CI, 84–98]) and women (90% [95% CI, 81–96]). However, the area under the curve did not improve. T‐wave abnormalities after standing did not further increase the sensitivity or the area under the curve significantly.
Conclusions
Despite earlier retrospective studies, a baseline ECG and the standing test in a prospective evaluation displayed a different diagnostic profile for congenital LQTS but no unequivocal synergism or advantage. This suggests that there is markedly reduced penetrance and incomplete expression in genetically confirmed LQTS with retention of repolarization reserve in response to the brief tachycardia provoked by standing.
Objective
We hypothesize that cut screws will deform in a manner that increases the core and outer diameters of the screw hole compared to uncut controls, and effects will be more pronounced in titanium screws.Materials and methodsWe used biomechanical polyurethane foam blocks to simulate cortical bone. We organized four groups of stainless steel and titanium cut and uncut screws. Blocks were fitted with a jig to ensure perpendicular screw insertion. We imaged the blocks using digital mammography and measured them using PACS software. Power analysis determined a power of 0.95 and an alpha error of 0.05.ResultsHighly statistically significant differences in core diameter were found after cutting stainless steel and titanium screws. Cutting stainless steel screws increased core diameter by 0.30 mm (95% CI, 0.16 to 0.45; p < .001). Titanium screws’ core diameter increased by 0.45 mm (95% CI, 0.30 to 0.61; p < .001). No significant differences were found in the outer diameters of stainless steel and titanium screws after cutting.Conclusion
Titanium and stainless steel screw tracts demonstrated screw core diameter and screw thread pattern deformation after cutting. Titanium screws demonstrated more significant effects.
Resumo Introdução: A doença renal crônica (DRC) é um problema de saúde pública mundial. No Brasil, as taxas de incidência e prevalência da DRC dialítica aumentam progressivamente, mas o processo de transição apresenta-se como desafio para pacientes e cuidadores no enfrentamento da doença. Urgência dialítica, ausência de acesso planejado ou conhecimento prévio do tratamento é uma realidade para a maioria. Diretrizes recomendam que opções de tratamento devam incluir a preferência consciente de um paciente totalmente informado. No entanto, informação educacional pré-diálise é exceção, acarretando grande número de diálises iniciais não planejadas. O estudo original “Empowering Patients on Choices for Renal Replacement Therapy” (EPOCH-RRT) teve por objetivo identificar as prioridades do paciente e as lacunas na tomada de decisões compartilhadas sobre a diálise, utilizando entrevistas estruturadas, com questões sobre dados demográficos, história clínica e percepção dos pacientes sobre sua saúde. O objetivo desta pesquisa foi realizar a tradução, adaptação transcultural e validação dos questionários utilizados no Estudo EPOCH-RRT para o contexto brasileiro. Método: Trata-se de estudo metodológico que consistiu na tradução inicial, síntese das traduções, retro tradução, revisão por um comitê de especialistas, pré-teste e avaliação das propriedades psicométricas do instrumento. Todos os preceitos éticos foram seguidos. Resultados: Os questionários foram traduzidos, adaptados e validados para o contexto brasileiro. Adicionalmente, foi aplicado em 84 pacientes renais crônicos em hemodiálise, diálise peritoneal e ambulatoriais. Discussão: Há carência de enfoque educativo-terapêutico dirigido aos pacientes com DRC, e o questionário EPOCH-RRT pode ser uma ferramenta para serviços de diálise brasileiros mudarem esse paradigma.
The Büyük Menderes watershed is the largest drainage watershed in Western Anatolia with an area of approximately 26,000 km². In the study area, almost 863 landslides occurred, extending over 222 km² with a mean landslide area of 0.21 km². In this study, landslide susceptibility assessments were carried out using artificial neural network method, which is one of the data-driven methods. In this study, that will contribute to the mitigation or control of the landslides caused by the reasons controlling the spatial and temporal distribution of landslides created in the GIS and MATLAB environment by using scientific and technological approaches within the framework. Since derivative activation function is also used in back-propagation artificial neural networks, its derivative is easily calculated in order not to slow down the calculation. Levenberg–Marquardt back-propagation (LM), resilient back propagation back-propagation (trainrp), scaled conjugate gradient back-propagation (trainscg), conjugate gradient with Powell/Beale restarts back-propagation (traincgb), and Fletcher-Powell conjugate gradient back-propagation (traincgf) algorithms are used, which constantly interrogate the link between the input parameter and the result output, and at least one cell’s output is given as an input to any other cell. Geology, digital elevation model, slope, topographic wetness index, roughness index, plan, profile curvatures, and proximity to active faults and rivers were used as landslide conditioning factors. In susceptibility assessments, landslides were separated by 70% analysis, 15% test, and 15% validation datasets by random selection method. The performances of the landslide susceptibility maps were assessed by the area under the ROC curve (AUC), accuracy (ACC), precision, recall, F1 score, Kappa test error histogram, and confusion matrix, respectively. The area under the receiver operating characteristic curves, analysis, testing, validation, landslides, and study areas were found between 0.873 and 0.911. The susceptibility map had a high prediction rate in which high and very high susceptible zones corresponded to 26% of the study area including 82% of the recorded landslides.
PurposeBrainstem radionecrosis is an important issue during the irradiation of tumors of the posterior fossa. The aim of the present study is to analyze postsurgical geometrical variations of tumor bed (TB) and brainstem (BS) and their impact on dosimetry.Methods
Retrospective collection of data from pediatric patients treated at a single institution. Availability of presurgical magnetic resonance imaging (MRI) was verified; availability of at least two postsurgical MRIs was considered a further inclusion criterion. The following metrics were analyzed: total volume, Dice similarity coefficient (DSC), and Haudsdorff distances (HD).ResultsFourteen patients were available for the quantification of major postsurgical geometrical variations of TB. DSC, HD max, and HD average values were 0.47 (range: 0.08;0.76), 11.3 mm (7.7;24.5), and 2.6 mm (0.7;6.7) between the first and the second postoperative MRI, respectively. Postsurgical geometrical variations of the BS were also observed. Coverage to the TB was reduced in one patient (D95: −2.9 Gy), while D2 to the BS was increased for the majority of patients. Overall, predictive factors for significant geometrical changes were presurgical gross tumor volume (GTV) > 33 mL, hydrocephaly at diagnosis, Luschka foramen involvement, and younger age (≤ 8 years).Conclusion
Major volume changes were observed in this cohort, with some dosimetric impact. The use of a recent co-registration MRI is advised. The 2–3 mm HD average observed should be considered in the planning target volume/planning organ at risk volume (PTV/PRV) margin and/or robust optimization planning. Results from wider efforts are needed to verify our findings.
Background
There is a strong need for improvements in motion robust T1-weighted abdominal imaging sequences in children to enable high-quality, free-breathing imaging.Objective
To compare imaging time and quality of a radial stack-of-stars, free-breathing T1-weighted gradient echo acquisition (volumetric interpolated breath-hold examination [VIBE]) three-dimensional (3-D) Dixon sequence in sedated pediatric patients undergoing abdominal magnetic resonance imaging (MRI) against conventional Cartesian T1-weighed sequences.Materials and methodsThis study was approved by the institutional review board with informed consent obtained from all subjects. Study subjects included 31 pediatric patients (19 male, 12 female; median age: 5 years; interquartile range: 5 years) undergoing abdominal MRI at 3 tesla with a free-breathing T1-weighted radial stack-of-stars 3-D VIBE Dixon prototype sequence, StarVIBE Dixon (radial technique), between October 2018 and June 2019 with previous abdominal MR imaging using conventional Cartesian T1-weighed imaging (traditional technique). MRI component times were recorded as well as the total number of non-contrast T1-weighted sequences. Two radiologists independently rated images for quality using a scale from 1 to 5 according to the following metrics: overall image quality, hepatic edge sharpness, hepatic vessel clarity and respiratory motion robustness. Scores were compared between the groups.ResultsMean T1-weighted imaging times for all subjects were 3.63 min for radial exams and 8.01 min for traditional exams (P<0.001), and total non-contrast imaging time was 32.7 min vs. 43.9 min (P=0.002). Adjusted mean total MRI time for all subjects was 60.2 min for radial exams and 65.7 min for traditional exams (P=0.387). The mean number of non-contrast T1-weighted sequences performed in radial MRI exams was 1.0 compared to 1.9 (range: 0–6) in traditional exams (P<0.001). StarVIBE Dixon outperformed Cartesian methods in all quality metrics. The mean overall image quality (scale 1–5) was 3.95 for radial exams and 3.31 for traditional exams (P<0.001).Conclusion
Radial stack-of-stars 3-D VIBE Dixon during free-breathing abdominal MRI in pediatric patients offers improved image quality compared to Cartesian T1-weighted imaging techniques with decreased T1-weighted and total non-contrast imaging time. This has important implications for children undergoing sedation for imaging.
Background:
Crohn's disease (CD) and ulcerative colitis, two forms of inflammatory bowel disease (IBD), are chronic and relapsing conditions of the gastrointestinal tract both characterized by long lasting chronic inflammation and increased risk of dysplasia and colorectal cancer (CRC). The aim of our study was to evaluate the interobserver agreement about IBD-associated dysplasia among pathologists belonging to the Italian Group for Inflammatory Bowel Diseases (IG-IBD P).
Methods:
The present multicenter survey was performed using telepathology, supported by an open source E-learning platform. Biopsy specimens from 30 colonoscopies and from 20 patients were included. The glass slides of any case, including clinical and endoscopic data, were digitalized and uploaded on the E-learning platform. All the digital slides were grouped in 54 diagnostic "blocks". Blinded histopathological evaluation on all the digital slides was performed by 20 gastrointestinal pathologists. Closed-ended questions about (1) the occurrence of IBD; (2) the classification of IBD (as UC or CD); (3) the presence of active versus quiescent disease; (4) the presence of dysplasia; (5) the possible association of dysplasia with the sites of disease (dysplasia-associated lesion or mass-DALM vs adenoma-like mass-ALM); (6) the grading of dysplasia according to the ECCO guidelines (negative, indefinite, low grade, high grade categories) and (7) the presence of associated serrated features, were proposed in each case. Inter-observer agreement was evaluated by mean agreement percentage and kappa statistic, when suitable.
Results:
The diagnosis of IBD was confirmed in 19 of 20 patients, 17 of 19 being classified as UC, 2 as CD. The mean interobserver agreement percentages about (1) the evidence of IBD, (2) the presence of either UC or CD and (3) the activity grading resulted to be 80%, 69% and 86%, respectively. Dysplasia was detected in 8/20 patients, with moderate agreement between pathologists (mean 72%, k 0.48). Particularly, low grade dysplasia was found in 13 biopsies (combined k 0.38), whereas high grade dysplasia in 8 (combined k 0.47). When the endoscopic and histopathological data were combined, features consistent with DALM were found in 6 of 20 patients with low grade dysplasia and those consistent with ALM in 2 patients with low grade dysplasia in a single biopsy (mean agreement: 86%). An associated serrated pattern was discovered in 4 patients (7 biopsies).
Conclusions:
Our study showed moderate interobserver agreement about the histopathological detection and classification of IBD-associated dysplasia. Further efforts should be undertaken to integrate the histopathological data with both the ancillary tests and molecular investigations.
Background
The use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD).
Methods
Santé publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use.
Results
Two-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps.
Conclusion
Our results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.
Background:
The aim of this study was to investigate the differences in objectively measured physical activity and in self-reported physical activity between overweight and normal-weight children.
Methods:
Data from a prospective cohort study including children, presenting at the participating general practices in the south-west of the Netherlands, were used. Children (aged 4-15 years) were categorized as normal-weight or overweight using age- and sex specific cut-off points. They wore an ActiGraph accelerometer for one week to register physical activity, and filled out a diary for one week about physical activity.
Results:
A total of 57 children were included in this study. Overweight children spent significantly less percentage time per day in sedentary behavior (β - 1.68 (95%CI -3.129, - 0.07)). There were no significant differences in percentage time per day spent in moderate to vigorous physical activity (β 0.33 (- 0.11, 0.78)). No significant differences were found between children of normal-weight and overweight in self-reported measures of physical activity.
Conclusions:
Overweight children are not less physically active than normal-weight children, which may be associated with the risen awareness towards overweight/obesity and with implemented interventions for children with overweight/obesity.
The rapid development of artificial intelligence brings with it the increasing likelihood of ubiquitous interaction between humans and robots. A significant contribution to studying human–robot interactions (HRI) comes from experimental studies, whereby humans and robots interact in controlled conditions and researchers observe and measure the reactions of humans (and robots). The use of experiments to understand human interactions has long been a central source of information in the field of experimental social psychology. These studies have yielded numerous major insights into the causes and outcomes of interaction. The methodology of experiments, however, including the demands made upon human participants to behave in predictable ways and the impact of experimenters’ expectancies upon results, has been a focus of much critical analysis. We examined a sample of 100 high impact HRI studies for evidence of potentially contaminating experimental artefacts and/or authors’ awareness of such factors. In our conclusions we highlight several methodological issues that appeared frequently in our sample, which may impede generalisations from laboratory experiments to real-world settings. Ultimately, we suggest that researchers may need to reformulate the methodologies used to study the unique features of HRI, and offer a number of recommendations for researchers designing HRI experiments.
Background:
There are limited treatment options that clinicians can provide to children presenting to emergency departments with vomiting secondary to acute gastroenteritis. Based on evidence of effectiveness and safety, clinicians now routinely administer ondansetron in the emergency department to promote oral rehydration therapy success. However, clinicians are also increasingly providing multiple doses of ondansetron for home use, creating unquantified cost and health system resource use implications without any evidence to support this expanding practice.
Methods/design:
DOSE-AGE is a randomized, placebo-controlled, double-blinded, six-center, pragmatic clinical trial being conducted in six Canadian pediatric emergency departments (EDs). In September 2019 the study began recruiting children aged 6 months to 18 years with a minimum of three episodes of vomiting in the 24 h preceding enrollment, <72 h of gastroenteritis symptoms and who were administered a dose of ondansetron during their ED visit. We are recruiting 1030 children (1:1 allocation via an internet-based, third-party, randomization service) to receive a 48-h supply (i.e., six doses) of ondansetron oral solution or placebo, administered on an as-needed basis. All participants, caregivers and outcome assessors will be blinded to group assignment. Outcome data will be collected by surveys administered to caregivers 24, 48 and 168 h following enrollment. The primary outcome is the development of moderate-to-severe gastroenteritis in the 7 days following the ED visit as measured by a validated clinical score (the Modified Vesikari Scale). Secondary outcomes include duration and frequency of vomiting and diarrhea, proportions of children experiencing unscheduled health care visits and intravenous rehydration, caregiver satisfaction with treatment and safety. A preplanned economic evaluation will be conducted alongside the trial.
Discussion:
Definitive data are lacking to guide the clinical use of post-ED visit multidose ondansetron in children with acute gastroenteritis. Usage is increasing, despite the absence of supportive evidence. The incumbent additional costs associated with use, and potential side effects such as diarrhea and repeat visits, create an urgent need to evaluate the effect and safety of multiple doses of ondansetron in children focusing on post-emergency department visit and patient-centered outcomes.
Trial registration:
ClinicalTrials.gov: NCT03851835. Registered on 22 February 2019.
Background:
The use of combined antibiotic therapy has become an option for infections caused by multidrug-resistant (MDR) bacteria. The time-kill (TK) assay is considered the gold standard method for the evaluation of in vitro synergy, but it is a time-consuming and expensive method. The purpose of this study was to evaluate two methods for testing in vitro antimicrobial combinations: the disk diffusion method through disk approximation (DA) and the agar gradient diffusion method via the MIC:MIC ratio. The TK assay was included as the gold standard. MDR Gram-negative clinical isolates (n = 62; 28 Pseudomonas aeruginosa, 20 Acinetobacter baumannii, and 14 Serratia marcescens) were submitted to TK, DA, and MIC:MIC ratio synergy methods.
Results:
Overall, the agreement between the DA and TK assays ranged from 20 to 93%. The isolates of A. baumannii showed variable results of synergism according to TK, and the calculated agreement was statistically significant in this species against fosfomycin with meropenem including colistin-resistant isolates. The MIC:MIC ratiometric agreed from 35 to 71% with TK assays. The kappa test showed good agreement for the combination of colistin with amikacin (K = 0.58; P = 0.04) among the colistin-resistant A. baumannii isolates.
Conclusions:
The DA and MIC:MIC ratiometric methods are easier to perform and might be a more viable tool for clinical microbiology laboratories.
Background:
End stage kidney disease and hemodialysis dependence are associated with impairments in health-related quality of life (HRQOL), which may be related to vascular access (VA). Few HRQOL measures are VA-specific and none differentiate HRQOL impact by VA type. We developed a VA-targeted HRQOL measure to distinguish the impact of fistulas, grafts and catheters.
Methods:
We created an initial item pool based on literature review and then conducted focus groups at 4 US sites with 37 adults and interviews with nine dialysis clinicians about VA's impact on HRQOL. We then drafted the Hemodialysis Access-Related Quality of Life (HARQ) measure and cognitively tested it with 17 hemodialysis patients. Focus group and cognitive interview participants were diverse in age, gender, years on dialysis, and VA.
Results:
We identified six domains for the HARQ: symptoms, physical functioning, emotional impacts, social and role functioning, sleep, and care-related burdens. Cognitive interviews indicated that items were easily understood and supported content validity. Attributing HRQOL impact to VA as opposed to other hemodialysis burden was challenging for some items. Some items were dropped that were considered redundant by patients, limitations while dressing was added, and reference to VA-specific impact was included for each item. The average Flesch-Kincaid reading grade level for the revised 47-item HARQ was 5.3.
Conclusions:
The HARQ features VA-specific content not addressed in other HRQOL measures, making it ideal for comparisons of different VA types and new VA technologies. The psychometric properties of the HARQ will be evaluated in future research.
Background
Poor oral health has an impact on food choices and intake of important nutrients among older population. The use of oral health-related quality of life instruments along with the clinical dental indicators can help to assess the oral problems that lead to nutritional problems in this group. This study aims to determine the association between oral health-related quality of life (OHRQoL) and nutritional status among a group of older adults in Kuala Pilah district, Malaysia.
Methods
A cross-sectional study was carried out on 446 older adults aged 50 years and above from 20 randomly selected villages. Respondents were interviewed to collect information on their demographic characteristics and oral health perception, followed by physical examination to measure height, weight and body mass index (BMI) of respondents. The validated Malay version of General Oral Health Assessment Index (GOHAI) was used to measure OHRQoL.
Results
About one-third (35.8%) of the respondents had normal BMI. Majority of the respondents were overweight (40.4%) and obese (19.9%), while only a small proportion was underweight (3.9%). Mean GOHAI score was 53.3 (SD = 4.7), indicating low perception of oral health. About 81.6% respondents had moderate to low perception of oral health. Logistic regression analysis showed a statistically significant association between the GOHAI and BMI scores (OR = 2.3; p < 0.01).
Conclusions
Oral health-related quality of life was significantly associated with nutritional condition of respondents. Older adults with poor perception of their oral health were more likely to have unsatisfactory BMI compared to those who perceived their oral health to be good.
Background:
Leptospirosis is still endemic in Malaysia and has been prevalent in Selangor where cases have been underreported. Primarily, this was due to lack of awareness in the urban community in this region. This study determined the knowledge, attitude and preventive practice (KAP) of leptospirosis, and identified the significant predictors influencing KAP among urban community in Hulu Langat, Selangor.
Methods:
This cross-sectional study was conducted from 2015 to 2017 using validated questionnaire. Sampling methods included multistage cluster sampling, followed by simple random sampling to obtain 315 respondents. Descriptive analysis was performed to determine the KAP while χ2 and the subsequent logistic regression analysis were carried out to identify associations and predictors between variables.
Results:
Respondents were mainly Malaysian Bumiputra with a mean (Standard Deviation (SD)) age of 32.5 (13.0) years. Of 315 respondents, 80.3% (n = 253) had poor knowledge, 87.0% (n = 274) had good attitude, and 81.3% (n = 256) showed unacceptable practice towards leptospirosis and its prevention. Regression analysis identified age as the sole predictor influencing good knowledge (AOR 2.388; 95% CI = 1.298, 4.396; p = 0.005). Education level (AOR 2.197; 95% CI = 1.109, 4.352; p = 0.024) was also noted as the significant predictor influencing the overall practice.
Conclusions:
The urban community in Selangor showed a positive attitude in waste management despite having little knowledge regarding the disease itself. The study also discovered inadequacy in preventive practice, hence marking the importance of the proper integration of knowledge and attitude into forming an acceptable practice to reduce transmission of Leptospira among urban population in Malaysia.
The presence and abundance of vertebrates influences the circulation of zoonotic diseases. White-tailed deer (Odocoileus virginianus) are widely distributed in North America and deer densities are frequently high in unhunted areas, including most major metropolitan regions. This study investigated the seroprevalence for Toxoplasma gondii from live-captured and culled deer sampled in two suburban forest preserves around Chicago, Illinois, from 1995 to 1999. Seroprevalence for T. gondii was 55.9% (n = 443) and was significantly higher at the northern study site, Des Plaines. Seroprevalence for T. gondii varied by year and month. Multivariate logistic regression (LR) screened main effect variables (age, sex, site, year, and month) by backward stepwise elimination. The final LR model for T. gondii contained all main effect variables. This study provides baseline data for future T. gondii suburban deer studies and information to public health and wildlife officials regarding the prevalence a parasitic pathogen present in two public forest preserves in Chicago, Illinois.
Purpose
The purpose of this study was to compare the reliability and accuracy of existing computed tomography (CT) methods for measuring the distal tibiofibular syndesmosis in uninjured, paired cadaveric specimens and in simulated malreduction models. It was hypothesized that a repeatable set of measurements exists to accurately and quantitatively describe the typical forms of syndesmotic malreduction using contralateral ankle comparison.
Methods
Twelve cadaveric lower-leg specimen pairs were imaged with CT to generate models for this study. Thirty-five measurements were performed on each native model. Next, four distinct fibular malreductions were produced via digital simulation and all measurements were repeated for each state: (1) 2-mm lateral translation; (2) 2-mm posterior translation; (3) 7-degree external rotation; (4) the previous three states combined. The modified standardized response mean (mSRM) was calculated for each measurement. To assess rater reliability and side-to-side agreements of the native state measurements, intraclass correlation coefficients (ICC) and Pearson correlation coefficients (PCC) were calculated, respectively.
Results
The most responsive measurements for detecting isolated malreduction were the Leporjärvi clear space for lateral translation, the Nault anterior tibiofibular distance for posterior translation, and the Nault talar dome angle for external rotation of the fibula. These measurements demonstrated fair to excellent inter-rater ICCs (0.64–0.76) and variable side-to-side PCCs (0.14–0.47).
Conclusions
The most reliable method to assess the syndesmosis on CT was to compare side-to-side differences using three distinct measurements, one for each type of fibular malreduction, allowing assessment of the magnitude and directionality of syndesmosis malreduction. Reliable evaluation is essential for assessing subtle syndesmosis injuries, malreduction and surgical planning.
Linear enamel hypoplasias are developmental defects ranging in appearance from microscopic to macroscopic furrows in enamel that encircle the tooth crown. Environmental stressors, including lack of food and infectious diseases during early periods of development, are known to induce hypoplasias in human and nonhuman primates. Social correlates of hypoplasias have not been extensively studied, however. Here, we examined the relationship between matriline dominance rank and linear enamel hypoplasia prevalence (i.e., absence or presence) and count (the total number of hypoplasias observed) in free-ranging rhesus monkeys (Macacca mulatta) in Cayo Santiago, Puerto Rico. We sampled 86 female offspring from low-, mid-, and high-ranking matrilines. Our results show that although hypoplasia prevalence and count were numerically higher in the combined group of low-and mid-ranking matrilines than in high-ranking matrilines, this effect was not statistically significant. There was, however, a significant negative relationship between age and hypoplasia prevalence, as well as between age and mean number of enamel defects, likely due to the attrition and abrasion of enamel that wear away shallow defects as individuals age. Future studies would benefit from using large sample sizes and collecting detailed behavioral data to determine if and when social status mediates enamel defect formation.
Actor gender and partner gender effects on conversational strategies were investigated among young adult friends during assigned negotiation and self-disclosure tasks. The sample comprised 146 same- or mixed-gender friendship pairs (age range = 17–23) of U.S. undergraduates from diverse ethnic-racial backgrounds (52% White, 19% Latinx, 17% Asian, 18% other). Pairs of same-gender friends or mixed-gender friends were assigned a negotiation task and a self-disclosure task while their conversations were video-recorded. Dyadic analyses were conducted using hierarchical linear modeling to assess actor gender and partner gender effects on conversational strategies. During the negotiation task, women were more likely than men were to use affiliative strategies (requests, indirect suggestions, justifications); in contrast, men were more likely to use self-emphasizing strategies (direct suggestions). In the self-disclosure task, women were more likely than men to express self-disclosing statements and to provide reflective listening responses to friends’ disclosures (e.g., elaborations, backchannel interjections) especially in same-gender pairs. In contrast, men were more likely to use distancing responses (e.g., negative comments). Most effect sizes were small. Finally, participants’ ratings of conflict in the friendship were related to the likelihood of some speech strategies in both tasks. Findings highlight the contexts of gender-related variations in language use among young adult friends.
This research investigates consistency of emotion detection in email negotiations. Conveying and detecting emotions in negotiation is important because emotions can function strategically. Therefore, this research systematically explores in four separate studies how consistently individuals detect discrete emotions in text-based (email) negotiations. Study 1 compared the ratings from two coders using a high quantity of thought units (n = 1317) and a negative bargaining zone negotiation scenario. In studies 2 and 3, three different negotiation scenarios were explored, first on a thought unit level and then on a message unit level using a hierarchical emotion coding scheme. In all three studies, coders’ perceptions were also compared with the text analysis program LIWC. Study 4 compared coding from seven of the actual negotiators with that of an independent coder and a computerized text program. All four studies found low emotion recognition consistency across 14 different coders with only one negotiation scenario in study 3 showing a moderate level of consistency. Comparisons of computerized coding with human coders did not show improved agreement. High amounts of contrary coding by independent coders were also found. Our research makes an important contribution to the literature by challenging the common assumption that emotions can be reliably detected in email negotiation. Factors that might influence more consistent emotion recognition and conveyance as well as implications for practice and future research are discussed.
BACKGROUNDS:
Reports of increasing incidence rates of delirium in critically ill children are reason for concern. We evaluated the measurement properties of the pediatric delirium component (PD-scale) of the Sophia Observation Withdrawal Symptoms scale Pediatric Delirium scale (SOS-PD scale).
METHODS:
In a multicenter prospective observational study in four Dutch pediatric ICUs (PICUs), patients aged ≥ 3 months and admitted for ≥ 48 h were assessed with the PD-scale thrice daily. Criterion validity was assessed: if the PD-scale score was ≥ 4, a child psychiatrist clinically assessed the presence or absence of PD according to the Diagnostic and statistical manual of mental disorders (DSM)-IV. In addition, the child psychiatrist assessed a randomly selected group to establish the false-negative rate. The construct validity was assessed by calculating the Pearson coefficient (rp) for correlation between the PD-scale and Cornell Assessment Pediatric Delirium (CAP-D) scores. Interrater reliability was determined by comparing paired nurse-researcher PD-scale assessments and calculating the intraclass correlation coefficient (ICC).
RESULTS:
Four hundred eighty-five patients with a median age of 27.0 months (IQR 8-102) were included, of whom 48 patients were diagnosed with delirium by the child psychiatrist. The PD-scale had overall sensitivity of 92.3% and specificity of 96.5% compared to the psychiatrist diagnosis for a cutoff score ≥4 points. The rp between the PD-scale and the CAP-D was 0.89 (CI 95%, 0.82-0.93; p < 0.001). The ICC of 75 paired nurse-researcher observations was 0.99 (95% CI, 0.98-0.99).
CONCLUSIONS:
The PD-scale has good reliability and validity for early screening of PD in critically ill children. It can be validly and reliably used by nurses to this aim.
Purpose
Long-term disease-free survival patterns following surgical, radiation, and endocrine therapy treatments for ductal carcinoma in situ (DCIS) are not well characterized in general US practice.
Methods
We identified 1252 women diagnosed with DCIS in Vermont during 1994–2012 using data from the Vermont Breast Cancer Surveillance System, a statewide registry of breast imaging and pathology records. Poisson regression and Cox regression with time-varying hazards were used to evaluate disease-free survival among self-selected treatment groups.
Results
With 7.8 years median follow-up, 192 cases experienced a second breast cancer diagnosis. For women treated with breast-conserving surgery (BCS) alone, the annual rate of second events decreased from 3.1% (95% CI 2.2–4.2%) during follow-up years 1–5 to 1.7% (95% CI 0.7–3.5%) after 10 years. In contrast, the annual rate of second events among women treated with BCS plus adjuvant radiation therapy increased from 1.8% (95% CI 1.1–2.6%) during years 1–5 to 2.8% (95% CI 1.6–4.7%) after 10 years (P < 0.05 for difference in trend compared to BCS alone). Annual rates of second events also increased over time among women treated with BCS plus adjuvant radiation and endocrine therapy (P = 0.01 for difference in trend compared to BCS alone). The rate of contralateral events increased after 10 years for all groups with adjuvant treatments. The rate of second events did not vary over time among women who underwent ipsilateral mastectomy (P = 0.62).
Conclusions
Long-term risk of a second event after DCIS varies over time in a manner dependent on initial treatment.
Background
Colorectal peritoneal metastases (PM) are often diagnosed in an advanced disease stage. Cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) improve survival of patients with colorectal PM, although most benefit is seen in patients with limited peritoneal disease. Advanced imaging techniques might improve the detection of PM, potentially leading to earlier diagnosis and improved cytoreduction. This prospective clinical trial compared three advanced techniques with conventional white-light imaging for the detection of colorectal PM: narrow-band imaging (NBI), near-infrared indocyanine green fluorescent imaging (NIR-ICG), and spray-dye chromoendoscopy (SDCE).
Methods
Patients with colorectal PM were prospectively included. Prior to cytoreduction and HIPEC, all abdominal regions were inspected with white-light imaging, NBI, NIR-ICG, and SDCE during exploratory laparoscopy. Primary endpoints were sensitivity and specificity for the detection of PM, using pathological examination of biopsied lesions as the reference standard. The safety of all techniques was assessed.
Results
Between May 2016 and March 2018, four different techniques were analyzed in 28 patients, resulting in 169 biopsies. Sensitivity for the detection of PM significantly increased from 80.0% with white light to 96.0% with NBI (p = 0.008), without loss of specificity (74.8% vs. 73.1%, respectively, p = 0.804). The use of NIR-ICG and SDCE was discontinued after 10 patients had undergone treatment because the lesions were not fluorescent using NIR-ICG, and because SDCE did not visualize the whole peritoneum. No adverse events relating to the imaging techniques occurred.
Conclusion
NBI substantially increased the detection of PM. This method is safe and could improve the detection of metastatic lesions and help optimize cytoreduction in patients with colorectal PM.
In several areas of research, data collection in the usual sense may not be feasible or may not be required. Data—not the ones directly needed to study the underlying phenomenon—may be available in documents, artifacts, public pronouncements, images, newspaper reports or television serials and the like. Messages bearing on the research questions as are covertly contained in such data have to be deciphered, coded and then subjected to some form of analysis to draw relevant conclusions. This exercise is known as Content Analysis and has a great appeal to social scientists. Usually, more than one coder or referee or rater will be coding the data into some categories and agreement among the raters will be examined by using simple statistical tools. Once sufficient agreement among raters has been established, we proceed to test for relevant research hypotheses using statistical techniques appropriate to categorical data. The present chapter discusses several measures of concordance among raters applicable to different situations and provides their standard errors, so that observed values of the measures can be tested for their significance or otherwise. Several illustrations have been provided to facilitate application of techniques used in Content Analysis.
Objective
To evaluate the influence of weight-bearing (WB) load in standard axial ankle syndesmotic measurements using cone beam CT (CBCT) examination of asymptomatic uninjured ankles.
Materials and methods
In this IRB approved, prospective study, patients with previous unilateral ankle fractures were recruited. We simultaneously scanned the injured ankles and asymptomatic contralateral ankles of 27 patients in both WB and NWB modes. For this study, only asymptomatic contralateral ankles with normal plain radiographs were included. Twelve standardized syndesmosis measurements at two axial planes (10 mm above the tibial plafond and 5 mm below the talar dome) were obtained by two expert readers using a custom CBCT viewer with the capability for geometric measurements between user-identified anatomical landmarks. Inter-reader reliability between two readers was obtained using the intra-class correlation coefficient (ICC). We compared the WB and NWB measurements using paired t test.
Results
Significant agreement was observed between two readers for both WB and NWB measurements (p <0.05). ICC values for WB and NWB measurements had a range of 50–95 and 31–71 respectively. Mean values of the medial clear space on WB images (1.75, 95% confidence interval [95% CI]: 1.6, 1.9) were significantly lower than on NWB images (2.05, 95% CI: 1.8, 2.2) measurements (p <0.001). There was no significant difference between the remaining WB and NWB measurements.
Conclusion
Measurements obtained from WB images are reliable. Except for the medial clear space, no significant difference in syndesmotic measurements were observed during the WB mode of CBCT acquisition, implying that the tibio-fibular relationship remains unchanged when the physiological axial weight-bearing load is applied.
Background
Capsule endoscopy can be used to identify the early stage of small bowel Crohn’s disease (CD). We evaluated significant small bowel capsule endoscopy (SBCE) findings that can lead to early diagnosis of CD.
Methods
We retrospectively accumulated clinical and SBCE data of 108 patients (63 with and 45 without CD). Types of small bowel mucosal injuries, including erosion, ulceration, and cobblestone appearance, and the alignment of diminutive lesions were compared between patients with and without CD. Inter- and intra-observer agreement in the determination of lesions was assessed in 25 pairs of SBCE from the two groups.
Results
Under SBCE, cobblestone appearance (33% vs. 2%, p < 0.0001), longitudinal ulcers (78% vs. 20%, p < 0.0001), and irregular ulcers (84% vs. 60%, p < 0.01) were more frequently found in patients with CD. Linear erosion (90% vs. 38%, p < 0.0001) and irregular erosion (89% vs. 64%, p < 0.005) were also more frequent in patients with CD. Furthermore, circumferential (75% vs. 9%, p < 0.0001) and longitudinal (56% vs. 7%, p < 0.0001) alignment of diminutive lesions, mainly observed in the 1st tertile of the small bowel, was more frequent in patients with CD. Good intra-observer agreement was found for ulcers, cobblestone appearance, and lesion alignment. However, inter-observer agreement of SBCE findings differed among observers.
Conclusions
Circumferential or longitudinal alignment of diminutive lesions, especially in the upper small bowel, may be a diagnostic clue for CD under SBCE, while inter-observer variations should be cautiously considered when using SBCE.
Little is known about the long-term impact of vertebral fractures on physical activity. There is also uncertainty over the clinical significance of mild vertebral fracture. We showed that women with moderate/severe but not mild vertebral fracture do less walking duration and housework than those without fracture after 5.4 years of follow-up.
Introduction
Little is known about the long-term impact of vertebral fractures on physical activities. There is also uncertainty over the clinical significance of mild fracture. Therefore, the aim of this study was to evaluate the prospective association between vertebral fracture and future physical activity.
Methods
This is a 5-year prospective study of a mixed community and secondary care cohort of women aged > 50 from the UK. Vertebral fractures were identified at baseline on radiographs or DXA-based Vertebral Fracture Assessment by a Quantitative Morphometric approach and defined as moderate/severe (≥ 25% height decrease) or mild (20–24.9% height decrease). Physical activity data were collected 5.4 years later by self-completion questionnaires. Multivariable logistic regression was used to determine the association between presence of fracture and various physical activities while adjusting for potential confounders.
Results
Two hundred eighty-six women without, 58 with mild, and 69 with moderate/severe fracture were recruited. Those with mild and moderate/severe fracture were older than women without fracture and had more concomitant diseases at baseline. At 5.4 years follow-up, women with moderate/severe fracture self-reported shorter walking duration compared to those without fracture, even after adjusting for potential confounders (OR 2.96, 95%CI 1.11–7.88, P = 0.030). No independent association was seen between the presence of mild fractures and reduced physical activity at follow-up.
Conclusion
This is the first study of older women from the UK that explored the prospective association between vertebral fracture and physical activity duration. Moderate/severe fractures were associated with reduced walking duration. Mild fractures had no impact on future physical ability.
Background:
Pay for Performance (P4P) has increasingly being adopted in different countries as a provider payment mechanism to improve health system performance. Evaluations of pay for performance (P4P) schemes across several countries show significant variation in effectiveness, which may be explained by differences in design. There is however no reliable framework to structure the reporting of the design or a typology to help analyse and interpret results of P4P schemes. This paper reports the development of a reporting framework and a typology of P4P schemes.
Methods:
P4P design features were identified from literature and then explored using relevant theories from behavioural and economic science. These design features were then combined with the help of multidimensional tables to produce a reporting framework and a typology which was tested using 74 P4P studies. The inter-rater reliability of the typology was assessed using Fleiss' Kappa.
Results:
A Healthcare Incentive Scheme Reporting Framework (HISReF) was developed consisting of nine design features. This was collapsed into a typology consisting of 4 items/design features. There was good inter-rater reliability on all the four items on the typology (kappa > 0.7).
Conclusion:
The HISReF provides an important first step towards establishing a common language in which intervention designers can clearly specify the content of P4P designs. Our typology may be used to aid evidence synthesis and interpretation of results of P4P schemes.
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