Sensitivity and specificity of information criteria

Association of the Clínica Universidad de Navarra-Body Adiposity Estimator With Type 2 Diabetes: A Retrospective Cohort Study

Objectives: Clínica Universidad de Navarra-Body Adiposity Estimator (CUN-BAE) is considered to be a more accurate indicator of body fat estimation. We aimed to investigate the association of CUN-BAE with the risk of type 2 diabetes mellitus (T2DM) and to compare the strength of the association between CUN-BAE, body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and T2DM. Methods: The data were obtained from the annual health checkup database of residents in Xinzheng, China. From January 2011 to December 2021, 80,555 subjects aged ≥45 years met the inclusion criteria. Cox proportional hazard regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for CUN-BAE, BMI, WC, and WHtR in T2DM. Results: During a mean follow-up of 6.26 years, T2DM occurred in 12,967 subjects. The multivariable-adjusted HRs (95% CIs) of T2DM (highest vs. reference group) were 1.994 (1.811-2.196) for CUN-BAE, 1.751 (1.665-1.842) for WC, 1.715 (1.631-1.804) for WHtR, and 1.510 (1.436-1.588) for BMI, respectively. In addition, the risk of T2DM increased with baseline CUN-BAE (HR: 1.374; 95% CI: 1.328, 1.421), WC (HR: 1.236; 95% CI: 1.215, 1.256), WHtR (HR: 1.228; 95% CI: 1.208, 1.248), and BMI (HR: 1.175; 95% CI: 1.156, 1.195). Conclusion: Compared to BMI, WC or WHtR, CUN-BAE may more adequately reflect the adverse effects of adiposity on the risk of T2DM.

Self-Reported Pain Treatment Practices Among U.S. and Canadian Adults: Findings From a Population Survey

Background and Objectives

Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fill this gap, we evaluated self-reported pain treatment types among community-dwelling adults in the United States and Canada. We also assessed how treatment types correlate with individuals' pain levels, sociodemographic characteristics, and country of residence, and identified unique clusters of adults in terms of treatment combinations.

Research Design and Methods

We used the 2020 "Recovery and Resilience" United States-Canada general online survey with 2 041 U.S. and 2 072 Canadian community-dwelling adults. Respondents selected up to 10 pain treatment options including medication, physical therapy, exercise, etc., and an open-ended item was available for self-report of any additional treatments. Data were analyzed using descriptive, regression-based, and latent class analyses.

Results

Over-the-counter (OTC) medication was reported most frequently (by 55% of respondents, 95% CI 53%-56%), followed by "just living with pain" (41%, 95% CI 40%-43%) and exercise (40%, 95% CI 38%-41%). The modal response (29%) to the open-ended item was cannabis use. Pain was the most salient correlate, predicting a greater frequency of all pain treatments. Country differences were generally small; a notable exception was alcohol use, which was reported twice as often among U.S. versus Canadian adults. Individuals were grouped into 5 distinct clusters: 2 groups relied predominantly on medication (prescription or OTC), another favored exercise and other self-care approaches, one included adults "just living with" pain, and the cluster with the highest pain levels employed all modalities heavily.

Discussion and Implications

Our findings provide new insights into recent pain treatment strategies among North American adults and identify population subgroups with potentially unmet need for more adaptive and effective pain management.

The relationship between age and sex partner counts during the mpox outbreak in the UK, 2022

BACKGROUND

Understanding the dynamics of an infectious disease outbreak linked to sexual activity requires valid expectations of likely counts of unique sex partners during the infectious period. Typically, age is the key demographic trait linked to expected partner count, with many transmission models removing adults from the sexually active pool abruptly at a pre-specified age threshold. Modelling the rate of decline in partner counts with age would benefit from a better description of empirical evidence.

METHODS

During the 2022 mpox epidemic in the UK, we asked individuals about their partner counts in the preceding three weeks, which is about the same as usual infectious period for persons with active mpox. We used negative binomial regression (all responses) and Weibull regression (non-zero responses) to analyse the relationship between age and partner counts, adjusted for other demographic data (such as education level and occupation), sub-dividing by three types of respondent: men who have sex with men (MSM), men who have sex with women, and women who have sex with men.

RESULTS

Most respondents had zero or one recent partner, all distributions were skewed. There was a relatively linear declining relationship between age and partner counts for heterosexual partnership groups, but a peak in partner counts and concurrency for MSMs in middle age years (age 35-54), especially for MSM who seemed to be in a highly sexually active subgroup.

CONCLUSION

Useful data were collected that can be used to describe sex partner counts during the British mpox epidemic and that show distinctive partner count relationships with age, dependent on partnership type.

Importance of the Number and Location of Lymph Node Metastasis in Oropharyngeal Cancer

BACKGROUND/AIM

The 8th edition of the American Joint Committee on Cancer staging system classifies oropharyngeal cancer (OPC) by the expression of p16. The discrepancy observed in this system between pathological and clinical N-stages in p16-positive OPC has provoked controversy. Therefore, this study investigated prognostic factors not included in the new staging system for p16-positive OPC patients.

PATIENTS AND METHODS

Patients with non-metastatic OPC receiving radiotherapy were reviewed. Clinical lymph node statuses were reassessed based on contrast-enhanced computed tomography and fluorodeoxyglucose positron emission tomography. Overall survival (OS) and cause-specific survival (CSS) were analyzed using multivariate analyses to adjust baseline imbalances.

RESULTS

In total, 166 OPC patients were reviewed. Among them, 81 patients with p16-positive were analyzed. Three or more lymph node metastases (LNM) were observed in 21 p16-positive OPCs. Retropharyngeal lymph node metastasis (Rp) was found in 12. Three-year OS, CSS, and progression-free survival rates in p16-positive patients were 76, 88, and 81%, respectively. In multivariate analyses of p16-positive OPC, LNM ≥3 was a prognostic factor of OS (hazard ratio=9.30, p<0.001) and CSS (hazard ratio=17.80, p=0.005). Rp was associated with poor CSS (hazard ratio=8.73, p=0.03). In N0-1 p16-positive patients, LNM ≥3 trended to be associated with poor OS (hazard ratio=3.93, p=0.06). CSS in patients with Rp was unfavorable (hazard ratio=70.16, p=0.05).

CONCLUSION

LNM ≥3 and Rp may be predictive of OS and CCS in p16-positive OPC. These are also possibly used to subcategorize p16-positive cN0-1 OPC. Further validation of lymph node staging is needed to refine the clinical staging system.

Longitudinal health behaviour patterns among adults aged ≥50 years in China and their associations with trajectories of depressive symptoms

OBJECTIVES

Against the background of the growing recognition of the need for a holistic perspective on health behaviour, we aim to identify longitudinal patterns of multiple health behaviours, and to assess associations of such patterns with depressive symptoms among older people in China.

METHODS

Using three waves of China Health and Retirement Longitudinal Study data (n = 8439), we performed latent class growth analyses (LCGAs) to identify longitudinal patterns of multiple health behaviours. Random-effects models were estimated to assess associations between health behaviour patterns and depressive symptoms.

RESULTS

The best fitting LCGA model had seven classes: (1) connected active non-smokers (average posterior probability: 21.8%), (2) isolated active non-smokers (24.7%), (3) isolated inactive non-smokers (17.0%), (4) isolated active smokers (14.5%), (5) connected active smokers (12.2%), (6) increasingly connected and active non-smokers (5.4%), and (7) moderately connected inactive smokers (4.4%). Depressive symptoms were highest in the four classes with lower probabilities of social participation across waves. No evidence was found of change over time in depressive symptomatology gaps between people with different health behaviour trajectories.

CONCLUSION

Health behaviour patterns characterized by consistently low social participation were associated with raised depressive symptomatology, suggesting that focusing on social participation may benefit later-life mental health promotion strategies.

Retrospective evaluation of factors associated with emergency frequency and survival in equids presenting for emergency care (2019-2020): 3071 cases

OBJECTIVE

To determine factors associated with frequency and outcome of equid emergencies in private practice.

DESIGN

Retrospective study from February 2019 to January 2020.

SETTING

Private practice large animal hospital.

ANIMALS

A total of 3071 equids of various breeds and ages presenting for emergency care.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Variables included for analysis of daily emergency frequency included day of the week, month, and daily climate data. A Poisson regression model found the maximum temperature (P = 0.05), average barometric pressure (P = 0.005), and decreases in barometric pressure (P = 0.05) were associated with an increasing daily number of emergencies. Overall survival for all emergencies was 89% (2748/3071). Variables included for analysis of nonsurvival for emergencies included signalment, body system, clinical examination findings, laboratory data, and experience of the veterinarian. A logistic regression model for primary emergencies (nonreferral) found that increasing age, increasing heart rate, and decreased gastrointestinal sounds were associated with an increase in nonsurvival. Body system and experience of the veterinarian affected nonsurvival. A logistic regression model for all emergencies (primary and referral) found that absent gastrointestinal sounds and an increasing PCV were associated with increased nonsurvival.

CONCLUSIONS

The number of daily emergencies in this practice was affected by the month of the year and day of the week. Additionally, hotter days, increased barometric pressure, or drops in barometric pressure are likely to be associated with a higher emergency caseload. Nonsurvival of primary equid emergencies in private practice increases with age, higher heart rates, and decreased gastrointestinal sounds.

Likelihood-ratio test statistic for the finite-sample case in nonlinear ordinary differential equation models

Likelihood ratios are frequently utilized as basis for statistical tests, for model selection criteria and for assessing parameter and prediction uncertainties, e.g. using the profile likelihood. However, translating these likelihood ratios into p-values or confidence intervals requires the exact form of the test statistic's distribution. The lack of knowledge about this distribution for nonlinear ordinary differential equation (ODE) models requires an approximation which assumes the so-called asymptotic setting, i.e. a sufficiently large amount of data. Since the amount of data from quantitative molecular biology is typically limited in applications, this finite-sample case regularly occurs for mechanistic models of dynamical systems, e.g. biochemical reaction networks or infectious disease models. Thus, it is unclear whether the standard approach of using statistical thresholds derived for the asymptotic large-sample setting in realistic applications results in valid conclusions. In this study, empirical likelihood ratios for parameters from 19 published nonlinear ODE benchmark models are investigated using a resampling approach for the original data designs. Their distributions are compared to the asymptotic approximation and statistical thresholds are checked for conservativeness. It turns out, that corrections of the likelihood ratios in such finite-sample applications are required in order to avoid anti-conservative results.

Patterns of life stress and the development of ruminative brooding in adolescence: A person-centered approach

Research links life stressors, including acute, chronic, and early life stress, to the development of ruminative brooding. However, singular forms of life stress rarely occur in isolation, as adolescents typically encounter stressors that vary on important dimensions (e.g., types, timings, quantities) across development. The current study employs latent profile analysis (LPA) to identify natural clusters of life stress that, over time, may be differently associated with ruminative brooding. Evaluations of episodic, chronic, and early life stress were conducted with community-recruited mid-adolescents (N = 241, Mage = 15.90 years, 53% female) and their parents using the UCLA Life Stress Interview and lifetime adversity portions of the Youth Life Stress Interview. Analyses identified four distinct patterns: low stress, high peer stress, moderate home / family stress, and multifaceted / high school stress. Adolescents in the high peer stress and moderate home / family stress profiles were at highest risk for developing a brooding style over time. Despite high overall levels of stress, teens in the multifaceted / high school stress profile were at not at elevated risk for developing a brooding style. Findings demonstrate the utility of person-centered approaches to identify patterns of stress exposure that heighten risk for brooding over time.

Sexual lives of reproductive-aged people with disabilities in Central Sidama National Regional State, Ethiopia: a mixed-methods study

BACKGROUND

Sexuality is an important part of human life; people with disabilities have the same sexual desires as people without disabilities. However, the status of the sexual lives of reproductive-aged people with disabilities is unfolded in Ethiopia. Therefore, this study was aimed to assess sexual lives and its associated factors among reproductive-aged people with disabilities in central Sidama National Regional State, Ethiopia.

METHODS

A mixed-methods study was conducted among randomly selected 685 reproductive-age people with disabilities and fifteen (15) in-depth interviews among individuals who have sexual practice experience from June 20 to July 15, 2022. The quantitative data were collected through face-to-face interviewing techniques using a structured and semi-structured questionnaire. A multilevel logistic regression analysis model was employed to analyze the data. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to report the measures of associations. The qualitative data were managed and analyzed using the phenomenological research analysis approach.

RESULTS

In this study, 59.9% (95% CI: 56.1, 63.5) of the people with disabilities have practiced sexual intercourse. Of these, 30.8% (95% CI: 27.4, 34.4) were males and 29.1% (95% CI: 25.7, 32.6) were females with disabilities. Being female (AOR = 2.81; 95% CI: 1.70, 4.62), having an occupation (AOR = 7.55; 95% CI: 4.03, 14.1), having a disability and being in a wheelchair (AOR = 0.27; 95% CI: 0.09, 0.82), having a good self-perception (AOR = 0.46; 95% CI: 0.28, 0.77), and having a rich economic status (AOR = 2.05; 95% CI: 1.08, 3.89) were factors associated with the sexual practice. The qualitative findings revealed that having sexuality information (training) is the facilitator, and community discrimination and low economic income are the barriers to sexual practice.

CONCLUSION

Sexual practice among people with disabilities is low in the Dale and Wonsho districts and Yirgalem city administration. Socio-demographic and economic factors and sexuality training are the associated factors. Therefore, creating job opportunities and economic empowerment, providing sexuality training, and creating community awareness are crucial to improving the sexual practice of reproductive-age people with disabilities.

A time-series analysis of short-term ambient ozone exposure and hospitalizations from acute myocardial infarction in Henan, China

Epidemiological studies in recent years have identified an association between exposure to air pollutants and acute myocardial infarction (AMI); however, the association between short-term ozone (O3) exposure and AMI hospitalization remains unclear, particularly in developing countries. Therefore, this study collected information on 24,489 AMI patients, including daily air pollutant and meteorological data in Henan, China, between 2016 and 2021. A distributed lagged nonlinear model combined with a Poisson regression model was used to estimate the nonlinear lagged effect of O3 on AMI hospitalizations. We also quantified the effects of O3 on the number of AMI hospitalizations, hospitalization days, and hospitalization costs. The results showed that single- and dual-pollution models of O3 at lag0, lag1, and lag (01-07) were risk factors for AMI hospitalizations, with the most significant effect at lag03 (RR = 1.132, 95% CI:1.083-1.182). Further studies showed that males, younger people (15-64 years), warm seasons, and long sunshine duration were more susceptible to O3. Hospitalizations attributable to O3 during the study period accounted for 11.66% of the total hospitalizations, corresponding to 2856 patients, 33,492 hospital days, and 90 million RMB. Maintaining O3 at 10-130 µg/m3 can prevent hundreds of AMI hospitalizations and save millions of RMB per year in Henan, China. In conclusion, we found that short-term exposure to O3 was significantly associated with an increased risk of hospitalization for AMI in Henan, China, and that further reductions in ambient O3 levels may have substantial health and economic benefits for patients and local healthcare facilities.

Incidental vertebral fracture prediction using neuronal network-based automatic spine segmentation and volumetric bone mineral density extraction from routine clinical CT scans

Objectives

To investigate vertebral osteoporotic fracture (VF) prediction by automatically extracted trabecular volumetric bone mineral density (vBMD) from routine CT, and to compare the model with fracture prevalence-based prediction models.

Methods

This single-center retrospective study included patients who underwent two thoraco-abdominal CT scans during clinical routine with an average inter-scan interval of 21.7 ± 13.1 months (range 5-52 months). Automatic spine segmentation and vBMD extraction was performed by a convolutional neural network framework (anduin.bonescreen.de). Mean vBMD was calculated for levels T5-8, T9-12, and L1-5. VFs were identified by an expert in spine imaging. Odds ratios (ORs) for prevalent and incident VFs were calculated for vBMD (per standard deviation decrease) at each level, for baseline VF prevalence (yes/no), and for baseline VF count (n) using logistic regression models, adjusted for age and sex. Models were compared using Akaike's and Bayesian information criteria (AIC & BIC).

Results

420 patients (mean age, 63 years ± 9, 276 males) were included in this study. 40 (25 female) had prevalent and 24 (13 female) had incident VFs. Individuals with lower vBMD at any spine level had higher odds for VFs (L1-5, prevalent VF: OR,95%-CI,p: 2.2, 1.4-3.5,p=0.001; incident VF: 3.5, 1.8-6.9,p<0.001). In contrast, VF status (2.15, 0.72-6.43,p=0.170) and count (1.38, 0.89-2.12,p=0.147) performed worse in incident VF prediction. Information criteria revealed best fit for vBMD-based models (AIC vBMD=165.2; VF status=181.0; count=180.7).

Conclusions

VF prediction based on automatically extracted vBMD from routine clinical MDCT outperforms prediction models based on VF status and count. These findings underline the importance of opportunistic quantitative osteoporosis screening in clinical routine MDCT data.

Effect of Microdoses of Incisional Antibiotics on the Rate of Surgical Site Infections in Skin Cancer Surgery: A Randomized Clinical Trial

Importance

Surgical site infections (SSIs) represent a costly and preventable complication of cutaneous surgery. However, there is a paucity of randomized clinical trials investigating antibiotic prophylaxis for reducing SSIs in skin cancer surgery, and evidence-based guidelines are lacking. Incisional antibiotics have been shown to reduce the rate of SSIs before Mohs micrographic surgery, but this represents a small subset of skin cancer surgery.

Objective

To determine whether microdosed incisional antibiotics reduce the rate of SSIs before skin cancer surgery.

Design, Setting, and Participants

In this double-blind, controlled, parallel-design randomized clinical trial, adult patients presenting to a high-volume skin cancer treatment center in Auckland, New Zealand, for any form of skin cancer surgery over 6 months from February to July 2019 were included. Patient presentations were randomized to one of 3 treatment arms. Data were analyzed from October 2021 to February 2022.

Interventions

Patients received an incision site injection of buffered local anesthetic alone (control), buffered local anesthetic with microdosed flucloxacillin (500 µg/mL), or buffered local anesthetic with microdosed clindamycin (500 µg/mL).

Main Outcomes and Measures

The primary end point was the rate of postoperative SSI (calculated as number of lesions with SSI per total number of lesions in the group), defined as a standardized postoperative wound infection score of 5 or more.

Results

A total of 681 patients (721 total presentations; 1133 total lesions) returned for postoperative assessments and were analyzed. Of these, 413 (60.6%) were male, and the mean (SD) age was 70.4 (14.8) years. Based on treatment received, the proportion of lesions exhibiting a postoperative wound infection score of 5 or greater was 5.7% (22 of 388) in the control arm, 5.3% (17 of 323) in the flucloxacillin arm, and 2.1% (9 of 422) in the clindamycin arm (P = .01 for clindamycin vs control). Findings were similar after adjusting for baseline differences among arms. Compared with lesions in the control arm (31 of 388 [8.0%]), significantly fewer lesions in the clindamycin arm (9 of 422 [2.1%]; P < .001) and flucloxacillin (13 of 323 [4.0%]; P = .03) arms required postoperative systemic antibiotics.

Conclusions and Relevance

This study evaluated the use of incisional antibiotics for SSI prophylaxis in general skin cancer surgery and compared the efficacy of flucloxacillin vs clindamycin relative to control in cutaneous surgery. The significant reduction in SSI with locally applied microdosed incisional clindamycin provides robust evidence to inform treatment guidelines in this area, which are currently lacking.

Trial Registration

anzctr.org.au Identifier: ACTRN12616000364471.

Estimating the willingness-to-pay to avoid the consequences of foodborne illnesses: a discrete choice experiment

Lost productivity is one of the largest costs associated with foodborne illness (FBI); however, the methods used to estimate lost productivity are often criticised for overestimating the actual burden of illness. A discrete choice experiment (DCE) was undertaken to elicit preferences to avoid six possible FBIs and estimate whether ability to work, availability of paid sick leave and health-related quality of life affect willingness-to-pay (WTP) to avoid FBI. Respondents (N = 1918) each completed 20 DCE tasks covering two different FBIs [gastrointestinal illness, flu-like illness, irritable bowel syndrome (IBS), Guillain-Barre syndrome (GBS), reactive arthritis (ReA), or haemolytic uraemic syndrome (HUS)]. Attributes included: ability to work, availability of sick leave, treatment costs and illness duration. Choices were modelled using mixed logit regression and WTP was estimated. The WTP to avoid a severe illness was higher than a mild illness. For chronic conditions, the marginal WTP to avoid a chronic illness for one year, ranged from $531 for mild ReA ($1412 for severe ReA) to $1025 for mild HUS ($2195 for severe HUS). There was a substantial increase in the marginal WTP to avoid all the chronic conditions when the ability to work was reduced and paid sick leave was not available, ranging from $6289 for mild IBS to $11,352 for severe ReA. Including factors that reflect productivity and compensation to workers influenced the WTP to avoid a range of FBIs for both acute and chronic conditions. These results have implications for estimating the burden and cost of FBI.

Statistical analysis of high-dimensional biomedical data: a gentle introduction to analytical goals, common approaches and challenges

BACKGROUND

In high-dimensional data (HDD) settings, the number of variables associated with each observation is very large. Prominent examples of HDD in biomedical research include omics data with a large number of variables such as many measurements across the genome, proteome, or metabolome, as well as electronic health records data that have large numbers of variables recorded for each patient. The statistical analysis of such data requires knowledge and experience, sometimes of complex methods adapted to the respective research questions.

METHODS

Advances in statistical methodology and machine learning methods offer new opportunities for innovative analyses of HDD, but at the same time require a deeper understanding of some fundamental statistical concepts. Topic group TG9 "High-dimensional data" of the STRATOS (STRengthening Analytical Thinking for Observational Studies) initiative provides guidance for the analysis of observational studies, addressing particular statistical challenges and opportunities for the analysis of studies involving HDD. In this overview, we discuss key aspects of HDD analysis to provide a gentle introduction for non-statisticians and for classically trained statisticians with little experience specific to HDD.

RESULTS

The paper is organized with respect to subtopics that are most relevant for the analysis of HDD, in particular initial data analysis, exploratory data analysis, multiple testing, and prediction. For each subtopic, main analytical goals in HDD settings are outlined. For each of these goals, basic explanations for some commonly used analysis methods are provided. Situations are identified where traditional statistical methods cannot, or should not, be used in the HDD setting, or where adequate analytic tools are still lacking. Many key references are provided.

CONCLUSIONS

This review aims to provide a solid statistical foundation for researchers, including statisticians and non-statisticians, who are new to research with HDD or simply want to better evaluate and understand the results of HDD analyses.

The impact of China's zero markup drug policy on drug costs for managing Parkinson's disease and its complications: an interrupted time series analysis

Background

In April 2009, the Chinese government launched Zero Markup Drug Policy (ZMDP) to adjust medical institutions' revenue and expenditure structures.

Objective

This study evaluated the impact of implementing ZMDP (as an intervention) on the drug costs for managing Parkinson's disease (PD) and its complications from the healthcare providers' perspective.

Methods

The drug costs for managing PD and its complications per outpatient visit or inpatient stay were estimated using electronic health data from a tertiary hospital in China from January 2016 to August 2018. An interrupted time series analysis was conducted to evaluate the immediate change following the intervention (step change, β₁) and the change in slope, comparing post-intervention with the pre-intervention period (trend change, β₂). Subgroup analyses were conducted in outpatients within the strata of age, patients with or without health insurance, and whether drugs were listed in the national Essential Medicine List (EML).

Results

Overall, 18,158 outpatient visits and 366 inpatient stays were included. Outpatient (β₁ = -201.7, 95%CI: -285.4, -117.9) and inpatient (β₁ = -372.1, 95% CI: -643.6, -100.6) drug costs for managing PD significantly decreased when implementing ZMDP. However, for outpatients without health insurance, the trend change in drug costs for managing PD (β₂ = 16.8, 95% CI: 8.0, 25.6) or PD complications (β₂ = 12.6, 95% CI: 5.5, 19.7) significantly increased. Trend changes in outpatient drug costs for managing PD differed when stratifying drugs listed in EML (β₂ = -1.4, 95% CI: -2.6, -0.2) or not (β₂ = 6.3, 95%CI: 2.0, 10.7). Trend changes of outpatient drug costs for managing PD complications significantly increased in drugs listed in EML (β₂ = 14.7, 95% CI 9.2, 20.3), patients without health insurance (β₂ = 12.6, 95% CI 5.5, 19.7), and age under 65 (β₂ = 24.3, 95% CI 17.3, 31.4).

Conclusions

Drug costs for managing PD and its complications significantly decreased when implementing ZMDP. However, the trend in drug costs increased significantly in several subgroups, which may offset the decrease at the implementation.

Ready-to-Eat Innovative Legumes Snack: The Influence of Nutritional Ingredients and Labelling Claims in Italian Consumers' Choice and Willingness-to-Pay

The global offer of legume-based snacks has sharply increased in recent years. However, to date, few studies have focused on the relationship between product supply and demand concerning the importance of attributes of such innovative foods. In this research, we identified the key internal and external determinants that affect legumes snack (LS) price and choice by Italian industries and consumers, respectively. In parallel, we investigated their preferences and perceptions towards these foods. We used the hedonic price model (HPM) and the discrete choice experiment (DCE) approach for these purposes, respectively. HPM revealed that the monetary value of LS was determined to greater significance by the: (i) size of the package; (ii) presence of rice, presence of lentils; (iii) presence of the nutritional information; and (iv) the discount shops as site of purchase. DCE revealed that the: (i) origin certification, (ii) recyclability of the package, and (iii) use of extra virgin olive oil of LS provided Italian consumers a high utility, for which they were willing to pay an average price premium of EUR 3.85, 3.64, and 1.87, respectively. On the contrary, the sunflower oil induced a decrease in their function utility. As such, this paper contributes to define potent market-segmentation strategies and to deliver effective private and public nutrition interventions for healthy eating.

Physical exercise practice was positively associated with better dietary practices of aged people during COVID-19 social distance: A cross-sectional study

BACKGROUND & AIMS

COVID-19 is a respiratory syndrome caused by SARS-CoV-2. In the absence of effective treatment and vaccines, social distance (SD) is essential to reduce the spread of the virus. However, SD generates several behavioral changes, especially in psychological (i.e., emotions and depressive symptoms) and lifestyle-related parameters (i.e., diet, physical activity, and sleep), and the aged people could be more susceptible to COVID-19 SD-related effects (i.e., loneliness, stress, fear, concerns about life, etc.). As such, we aimed to explore the relationship between lifestyle- (physical exercise practice and sleep quality) and psychological-related factors with the dietary practices derived from the Brazilian National Food Guide of older adult during the COVID-19 SD.

METHODS

A web-based survey was conducted in São Paulo, Brazil. Data were collected between August and December 2020 (a period of social isolation due to the COVID-19 pandemic). The questions were extracted from validated questionnaires to verify dietary practices (score of adhesion to the food guide for the Brazilian population), sleep quality (by Pittsburgh questionnaire), emotional food-related dimensions (by Three-factor Eating Questionnaire), and depression symptoms (by Beck's questionnaire).

RESULTS

Results were from 229 aged people (mean age 66.5 ± 6.02 years old; mean BMI 27.5 ± 4.32 kg/m²; mean sleep duration 8.23 ± 1.41 h; Pittsburg sleep quality score 6.55 ± 4.83; dietary practice score 42.5 ± 6.47). In the adjusted-linear regression model, we verified that physical exercise practice at home (β = 2.179; 95% CI: 0.599 to 3.758; p = 0.007) during COVID-19 SD was positively associated with better dietary practices in aged people. In contrast, emotional eating was negatively associated with dietary practices (β = -0.051; 95% CI: -0.092 to - 0.009; p = 0.015).

CONCLUSION

We conclude that in aged people, physical exercise practice at home during COVID-19 SD was positively associated with better dietary practices, while emotional eating was negatively associated.

Measurement Invariant but Non-Normal Treatment Responses in Guided Internet Psychotherapies for Depressive and Generalized Anxiety Disorders

Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.

Cost-effectiveness analysis of sorafenib, lenvatinib, atezolizumab plus bevacizumab and sintilimab plus bevacizumab for the treatment of advanced hepatocellular carcinoma in China

BACKGROUND AND OBJECTIVE

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related death worldwide, especially in China. According to the 2021 Chinese Society of Clinical Oncology guidelines, sorafenib, lenvatinib, atezolizumab combined with bevacizumab, and sintilimab combined with bevacizumab are recommended as first-line treatment options for advanced HCC. This study provides a cost-effectiveness analysis of these treatments from the patient perspective.

METHODS

A partitioned survival model was established using the TreeAge 2019 software to evaluate the cost-effectiveness. The model includes three states, namely progression-free survival, progressive disease, and death. Clinical data were derived from three randomized controlled studies involving patients with advanced HCC who received the following treatment: sorafenib and lenvatinib (NCT01761266); atezolizumab in combination with bevacizumab (NCT03434379); and sintilimab in combination with bevacizumab (NCT03794440). Cost and clinical preference data were obtained from the literature and interviews with clinicians.

RESULTS

All compared with sorafenib therapy, lenvatinib had an incremental cost-effectiveness ratio (ICER) of US$188,625.25 per quality-adjusted life year (QALY) gained; sintilimab plus bevacizumab had an ICER of US$75,150.32 per QALY gained; and atezolizumab plus bevacizumab had an ICER of US$144,513.71 per QALY gained. The probabilistic sensitivity analysis indicated that treatment with sorafenib achieved a 100% probability of cost-effectiveness at a threshold of US$36,600/QALY. One-way sensitivity analysis revealed that the results were most sensitive to the medical insurance reimbursement ratio and drug prices.

CONCLUSIONS

In this economic evaluation, therapy with lenvatinib, sintilimab plus bevacizumab, and atezolizumab plus bevacizumab generated incremental QALYs compared with sorafenib; however, these regimens were not cost-effective at a willingness-to-pay threshold of US$36,600 per QALY. Therefore, some patients may achieve preferred economic outcomes from these three therapies by tailoring the regimen based on individual patient factors.

Patterns of coparenting and young children's social-emotional adjustment in low-income families

This study identified coparenting patterns using data collected across 2007-2010 from low-income couples (N = 2915; 26.90% non-Hispanic White; 9.41% non-Hispanic Black; 34.24% Hispanic, 29.27% other or mixed race) with young children (M = 3.65 years; SD = 1.31 years; 48% girls) and examined relations with children's social-emotional adjustment. Latent profile analysis revealed four coparenting patterns: mutual high-quality (43.4%), moderate-quality, mothers less positive (31.8%), moderate-quality, fathers less positive (15.9%), and low-quality, mothers less positive (8.9%). When parents' perspectives on coparenting were positive and congruent, children fared best. Children also fared well when coparenting quality was moderate, and mothers were less positive than fathers. When coparenting quality was moderate and fathers were less positive than mothers, children showed the poorest adjustment.

Should we adjust health expenditure for age structure on health systems efficiency? A worldwide analysis

INTRODUCTION

Healthcare expenditure, a common input used in health systems efficiency analyses is affected by population age structure. However, while age structure is usually considered to adjust health system outputs, health expenditure and other inputs are seldom adjusted. We propose methods for adjusting Health Expenditure per Capita (HEpC) for population age structure on health system efficiency analyses and assess the goodness-of-fit, correlation, reliability and disagreement of different approaches.

METHODS

We performed a worldwide (188 countries) cross-sectional study of efficiency in 2015, using a stochastic frontier analysis. As single outputs, healthy life expectancy (HALE) at birth and at 65 years-old were considered in different models. We developed five models using as inputs: (1) HEpC (unadjusted); (2) age-adjusted HEpC; (3) HEpC and the proportion of 0-14, 15-64 and 65 + years-old; (4) HEpC and 5-year age-groups; and (5) HEpC ageing index. Akaike and Bayesian information criteria, Spearman's rank correlation, intraclass correlation coefficient and information-based measure of disagreement were computed.

RESULTS

Models 1 and 2 showed the highest correlation (0.981 and 0.986 for HALE at birth and HALE at 65 years-old, respectively) and reliability (0.986 and 0.988) and the lowest disagreement (0.011 and 0.014). Model 2, with age-adjusted HEpC, presented the lowest information criteria values.

CONCLUSIONS

Despite different models showing good correlation and reliability and low disagreement, there was important variability when age structure is considered that cannot be disregarded. The age-adjusted HE model provided the best goodness-of-fit and was the closest option to the current standard.

Patient preferences for attributes of injected or infused preventive migraine medications: Findings from a discrete choice experiment

OBJECTIVE

To assess preferences among adults with migraine for differentiating attributes of injected or infused preventive treatment options and evaluate their importance in determining a treatment choice.

BACKGROUND

Adults with migraine and health-care providers consider many factors when making treatment decisions. Injected or infused preventive migraine treatment options differ in several attributes, including mode of administration and dosing frequency, which may be preferentially selected or avoided by patients. Understanding a patient's preference is important for clinicians as they advise on various treatment options.

METHODS

A total of 604 US adults diagnosed with migraine participated in an online survey that captured information on demographics, migraine history, and treatment preferences. A discrete choice experiment (DCE) was used to evaluate participants' preferences for specific attributes of injected/infused preventive migraine therapies. The DCE data were utilized to estimate attribute importance (expressed as a percentage) and identify subgroups that had different distributions of preferences.

RESULTS

In the overall migraine population, mode of administration (28.8%), durability of effectiveness (27.0%), and speed of onset (25.5%) had the highest relative importance, whereas administration setting (9.9%) and dosing frequency (8.8%) had the lowest. Four distinct subgroups were identified: Group 1 (n = 128) preferred self-injection administration and durability of effectiveness; Group 2 (n = 189) expressed aversion to cranial injections; Group 3 (n = 158) prioritized rapid speed of onset; and Group 4 (n = 129) favored health-care provider administration and durability of effectiveness.

CONCLUSIONS

Speed of onset, durability of effectiveness, and mode of administration are key moderators of treatment preference among US adults with migraine. Certain segments of the migraine population prioritize specific treatment attributes over others, with intravenous infusion not considered a barrier in three of four identified segments. Clinicians can best help their patients find the right medication if they understand which medication attributes are most and least important to them.

Plant-based diets and the risk of pancreatic cancer: a large prospective multicenter study

BACKGROUND

Plant-based diets have been recommended for improving health outcomes, including cancer. However, previous studies on plant-based diets and the risk of pancreatic cancer are scarce and fail to consider plant food quality.

OBJECTIVES

We sought to examine the potential associations of 3 plant-based diet indices (PDIs) with the risk of pancreatic cancer in a US population.

METHODS

A population-based cohort of 101,748 US adults was identified from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. The overall PDI, healthful PDI (hPDI), and unhealthful PDI (uPDI) were constructed to qualify adherence to overall, healthy, and less healthy plant-based diets, respectively, with higher scores indicating better adherence. Multivariable Cox regression was used to compute hazard ratios (HRs) for pancreatic cancer incidence. Subgroup analysis was conducted to identify the potential effect modifiers.

RESULTS

Over a mean follow-up of 8.86 years, 421 pancreatic cancer cases occurred. Participants in the highest compared with the lowest quartiles of overall PDI had a lower risk of pancreatic cancer [HR_{quartile 4 versus 1}: 0.74; 95% confidence interval (CI): 0.57, 0.96; P_trend = 0.023]. A stronger inverse association was observed for hPDI (HR_{quartile 4 versus 1}: 0.56; 95% CI: 0.42, 0.75; P_trend < 0.001). Conversely, uPDI was positively associated with the risk of pancreatic cancer (HR_{quartile 4 versus 1}: 1.38; 95% CI: 1.02, 1.85; P_trend = 0.012). Subgroup analyses revealed a stronger positive association for uPDI in participants with BMI <25 (HR_{quartile 4 versus 1}: 3.22; 95% CI: 1.56, 6.65) than in those with BMI ≥25 (HR_{quartile 4 versus 1}: 1.08; 95% CI: 0.78, 1.51) (P_interaction = 0.001).

CONCLUSIONS

In this US population, adherence to a healthy plant-based diet confers a lower risk of pancreatic cancer, whereas adherence to a less healthy plant-based diet confers a higher risk. These findings highlight the importance of considering plant food quality in preventing pancreatic cancer.

Ultrasonography Measurement of Renal Dimension and Its Correlation with Age, Body Indices, and eGFR in Type 1 Diabetes Mellitus Patients: Real World Data in Taiwan

BACKGROUND

Assessment of renal size is clinically significant for the screening, diagnosis, and follow-up of renal diseases as the basis of clinical decisions. However, the relationship of renal dimension with age, body indices, and the estimated glomerular filtration rate (eGFR) has rarely been reported in the Chinese type 1 diabetes mellitus (T1DM) population.

METHODS

A total of 220 T1DM patients were retrospectively analyzed from the Chang Gung Research Database in Taiwan. Demographic data, laboratory data, and ultrasonographic images from January 2001 to November 2018 were extracted.

RESULTS

Eighty-five participants (38.6%) were male. The mean age was 34.2 years. The median eGFR was 60.0 mL/min/1.73 m². The mean ultrasonographic left and right renal lengths (LL and RL) with S.D. were 10.9 ± 1.5 cm and 11.0 ± 1.1 cm, respectively. Renal lengths were longer with increasing body height and body weight but shorter with increasing age in patients with T1DM. In trajectory analysis, a linear mixed model revealed no significant trend in the changes in eGFR during the follow-up period. Moreover, renal length did not play a significant role in predicting KDIGO CKD stage 5 in the cohort.

CONCLUSIONS

Renal length and its comparison to the reference ranges demonstrated very limited advantages in predicting renal function decline in T1DM patients.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Combination of transcriptional biomarkers and clinical parameters for early prediction of sepsis indued acute respiratory distress syndrome

Objective

As a common yet intractable complication of severe sepsis, acute respiratory distress syndrome (ARDS) is closely associated with poor clinical outcomes and elevated medical expenses. The aim of the current study is to generate a model combining transcriptional biomarkers and clinical parameters to alarm the development of ARDS in septic patients.

Methods

Gene expression profile (GSE66890) was downloaded from the Gene Expression Omnibus database and clinical data were extracted. Differentially expressed genes (DEGs) from whole blood leukocytes were identified between patients with sepsis alone and septic patients who develop ARDS. ARDS prediction model was constructed using backward stepwise regression and Akaike Information Criterion (AIC). Meanwhile, a nomogram based on this model was established, with subsequent internal validation.

Results

A total of 57 severe septic patients were enrolled in this study, and 28 (49.1%) developed ARDS. Based on the differential expression analysis, six DEGs (BPI, OLFM4, LCN2, CD24, MMP8 and MME) were screened. According to the outcome prediction model, six valuable risk factors (direct lung injury, shock, tumor, BPI, MME and MMP8) were incorporated into a nomogram, which was used to predict the onset of ARDS in septic patients. The calibration curves of the nomogram showed good consistency between the probabilities and observed values. The decision curve analysis also revealed the potential clinical usefulness of the nomogram. The area under the receiver operating characteristic (AUROC) for the prediction of ARDS occurrence in septic patients by the nomogram was 0.86 (95% CI = 0.767-0.952). A sensitivity analysis showed that the AUROC for the prediction of ARDS development in septic patients without direct lung injury was 0.967 (95% CI = 0.896-1.0).

Conclusions

The nomogram based on transcriptional biomarkers and clinical parameters showed a good performance for the prediction of ARDS occurrence in septic patients.

Individual- and community-level determinants of maternal health service utilization in southern Ethiopia: A multilevel analysis

BACKGROUND

Maternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia.

OBJECTIVES

This study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia.

DESIGN

A community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region.

METHODS

Data were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization.

RESULTS

Utilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73).

CONCLUSION

Maternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.

Political donations and the gender gap during COVID-19

What effect has the COVID-19 pandemic had on the political donations gender gap in Canada? Drawing on data from two national surveys conducted in May and August 2020, as well as Elections Canada data from 2019 and 2020, we find an overall decline in contributions to political parties and a reduced but still significant gender gap, with women less likely to donate to political parties than men.

Novel theory of mind task demonstrates representation of minds in mental state inference

Theory of mind (ToM), the ability to represent the mental states of oneself and others, is argued to be central to human social experience, and impairments in this ability are thought to underlie several psychiatric and developmental conditions. To examine the accuracy of mental state inferences, a novel ToM task was developed, requiring inferences to be made about the mental states of 'Targets', prior participants who took part in a videoed mock interview. Participants also made estimates of the Targets' personality traits. These inferences were compared to ground-truth data, provided by the Targets, of their true traits and mental states. Results from 55 adult participants demonstrated that trait inferences were used to derive mental state inferences, and that the accuracy of trait estimates predicted the accuracy of mental state inferences. Moreover, the size and direction of the association between trait accuracy and mental state accuracy varied according to the trait-mental state combination. The accuracy of trait inferences was predicted by the accuracy of participants' understanding of trait covariation at the population level. Findings are in accordance with the Mind-space theory, that representation of the Target mind is used in the inference of their mental states.

Using developmental regression to reorganize the clinical importance of autistic atypicalities

Early regression (ER) is often reported in autistic children with a prototypical phenotype and has been proposed as a possible pathognomonic sign present in most autistic children. Despite the uncertainties attached to its definition and report, using ER to anchor the autism phenotype could help identify the signs that best contribute to an autism diagnosis. We extracted retrospective data from 1547 autistic children between the ages of 6 and 18 years from the Simons Simplex collection. Logistic regression identified the atypicalities associated with a history of ER. Stepwise variable selection using logistic regression analysis followed by a bootstrap procedure of 1000 iterations identified the cluster of atypicalities best associated with ER. Linear and logistic regressions measured the association between combinations of atypicalities within the identified cluster and adaptative behaviors, diagnostic areas of severity, and other categories. Seven atypicalities significantly increased the likelihood of having experienced ER (OR = 1.73-2.13). Four ("hand leading-ever", "pronominal reversal-ever", "never shakes head at age 4-5" and "stereotypic use of objects or interest in parts of objects-ever"), when grouped together, best characterized the phenotype of verbal autistic children with ER. This clustering of signs was associated with certain persistent language difficulties, higher summary scores on a diagnostic scale for autism, and greater odds of receiving an "autistic disorder" diagnosis instead of another pervasive developmental disorder (PDD) diagnosis. These results raise questions about using language as a clinical specifier, defining cross-sectional signs independent of their relationship with an early developmental trajectory, and relying on polythetic criteria or equivalent weighted autistic atypicalities.

Latent structure of cognitive tests is invariant in men and women with schizophrenia

Studies comparing the cognitive functioning of men and women with schizophrenia have produced conflicting results which could arise from sex-based differences in the latent structure of cognitive abilities. The current study used multigroup confirmatory factor analysis to examine invariance in latent structure of cognitive abilities to between men and women with schizophrenia. Confirmatory factor analysis of an initial neurocognitive assessment (men n = 612, women n = 201) and cross-validation using second assessment (men n = 549, women n = 198) demonstrated that a bifactor seven-factor model fit the data best for both men and women. Invariance analyses further indicated this model was invariant across men and women at both assessments. Group comparisons indicated women had significantly higher scores for Semantic Memory, Verbal Memory, and General Cognitive factors, whereas men exhibited better performance on the Vigilance factor. Results indicate that cognition in SZ is characterized by both a general cognitive factor and specific domains for both men and women. Invariance analysis provides evidence that cognitive differences between men and women do not result from sex-based differences in the latent structure of cognitive abilities. Current results also indicate small but statistically significant neurocognitive differences between men and women with schizophrenia.

Alcohol, Marijuana and Other Illicit Drugs Use Throughout Adolescence: Co-occurring Courses and Preadolescent Risk-Factors

This study examined developmental patterns of co-occurrent alcohol, marijuana, and other illicit drugs use during adolescence and the associated preadolescent risk factors in a longitudinal sample of 926 boys from low-socioeconomic, urban neighborhoods. Latent growth mixture modeling revealed six developmental patterns: non-/low-alcohol and non-illicit drug users (61% sample) and five polysubstance user-groups varying in severity based on onset, frequency and type of substances used. In comparisons with non-/low-users, several preadolescent risk factors were associated with increasing severity of polysubstance use. Higher sensation-seeking and lower anxiety were associated with all user-groups. Low self-esteem and family-related risk factors differentiated all user-groups from later-onset users. Higher impulsivity and school problems characterized early-onset and frequent polysubstance users. Impulsive sensation-seekers with lower anxiety and self-esteem cumulated a larger number and higher severity of risk factors and were at risk of early-onset frequent polysubstance use, emphasising the importance of indicated prevention for these high-risk boys.

Dosing time optimization of antihypertensive medications by including the circadian rhythm in pharmacokinetic-pharmacodynamic models

Blood pressure (BP) follows a circadian variation, increasing during active hours, showing a small postprandial valley and a deeper decrease during sleep. Nighttime reduction of 10–20% relative to daytime BP is defined as a dipper pattern, and a reduction of less than 10%, as a non-dipper pattern. Despite this BP variability, hypertension’s diagnostic criteria and therapeutic objectives are usually based on BP average values. Indeed, studies have shown that chrono-pharmacological optimization significantly reduces long-term cardiovascular risk if a BP dipper pattern is maintained. Changes in the effect of antihypertensive medications can be explained by circadian variations in their pharmacokinetics (PK) and pharmacodynamics (PD). Nevertheless, BP circadian variation has been scarcely included in PK-PD models of antihypertensive medications to date. In this work, we developed PK-PD models that include circadian rhythm to find the optimal dosing time (Ta) of first-line antihypertensive medications for dipper and non-dipper patterns. The parameters of the PK-PD models were estimated using global optimization, and models were selected according to the lowest corrected Akaike information criterion value. Simultaneously, sensitivity and identifiability analysis were performed to determine the relevance of the parameters and establish those that can be estimated. Subsequently, Ta parameters were optimized to maximize the effect on BP average, BP peaks, and sleep-time dip. As a result, all selected models included at least one circadian PK component, and circadian parameters had the highest sensitivity. Furthermore, Ta with which BP>130/80 mmHg and a dip of 10–20% are achieved were proposed when possible. We show that the optimal Ta depends on the therapeutic objective, the medication, and the BP profile. Therefore, our results suggest making chrono-pharmacological recommendations in a personalized way.

The Role of Pornography Use in Intimate Partner Violence in Different-Sex Couples: A Prospective Longitudinal Study

Pornography use and intimate partner violence (IPV) are both prevalent in romantic relationships. However, information is lacking about whether pornography use predicts IPV. This study examined the relation between frequency of pornography use (FPU) and IPV across a span of 4 months in a sample of 132 different-sex couple dyads. At least one partner in each couple was attending a Canadian university. Participants (N = 264) completed online measures of pornography use, IPV, and social desirability at baseline and at a 4-month follow-up. Two longitudinal actor-partner interdependence models using a structural equation framework to conduct path analyses demonstrated that (a) higher FPU among men at baseline predicted increases in IPV perpetration and victimization from baseline to 4-month follow-up for both men and women and (b) women's baseline FPU did not predict change in IPV over time for themselves or their partners. These findings suggest that frequent pornography use among male partners in different-sex romantic relationships may represent an under-recognized risk factor for IPV, and further research is needed to identify latent factors that may be contributing to this relation. Although women's baseline FPU did not predict changes in IPV over time, this may be because women used pornography less frequently than men.

Variation in Benzodiazepine and Antipsychotic Prescribing Among Hospice Agencies

BACKGROUND

Benzodiazepines and antipsychotics are routinely prescribed for symptom management in hospice. There is minimal evidence to guide prescribing in this population, and little is known about how prescribing varies across hospice agencies.

OBJECTIVE

Examine patient- and hospice agency-level characteristics associated with incident prescribing of benzodiazepines and antipsychotics in hospice.

DESIGN

Retrospective cohort study of a 20% sample of Medicare beneficiaries newly enrolled in hospice.

PARTICIPANTS

Medicare hospice beneficiaries ≥ 65 years old between 2014 and 2016, restricted to those without benzodiazepine (N = 169,688) or antipsychotic (N = 190,441) prescription fills in the 6 months before hospice enrollment.

MAIN MEASURES

The primary outcome was incident (i.e., new) prescribing of a benzodiazepine or antipsychotic. A series of multilevel Cox regression models with random intercepts for hospice agency were fit to examine the association of incident benzodiazepine and antipsychotic prescribing with patient and hospice agency characteristics.

KEY RESULTS

A total of 91,728 (54.1%) and 58,175 (30.5%) hospice beneficiaries were newly prescribed an incident benzodiazepine or antipsychotic. The prescribing rate of the hospice agency was the strongest predictor of incident prescribing: Compared to patients in bottom-quartile benzodiazepine-prescribing agencies, those in top-quartile agencies were 10.7 times more likely to be prescribed an incident benzodiazepine (adjusted hazard ratio [AHR] 10.7, 95% CI 10.1-11.3). For incident antipsychotic prescribing, patients in top-quartile agencies were 51.7 times more likely to receive an antipsychotic (AHR 51.7, 95% CI 44.3-60.4) compared to those in the bottom quartile. Results remained consistent accounting for comfort kit prescribing.

CONCLUSIONS

The pattern of benzodiazepine or antipsychotic prescribing of a hospice agency strongly predicts whether a hospice enrollee is prescribed these medications, exceeding every other patient-level factor. While the appropriate level of prescribing in hospice is unclear, this variation may reflect a strong local prescribing culture across individual hospice agencies.

Identification and Validation of a Novel Necroptosis-Related Long Noncoding RNA Prognostic Signature for Lung Adenocarcinoma

Background

Several cancers, including lung adenocarcinoma (LUAD), are caused by genes related to necroptosis. However, it is still unknown how necroptosis-related long noncoding RNAs (lncRNAs) may be involved in LUAD. In order to predict the prognosis of LUAD patients and personalize immunotherapy, this study set out to construct a necroptosis-related lncRNA prognostic signature (NLPS).

Methods

The Cancer Genome Atlas (TCGA) database was used to download the LUAD transcriptome data and the associated clinical data. lncRNAs associated with necroptosis were screened using coexpression analysis. An NLPS was built using univariate and least absolute shrinkage and selection operator (LASSO) Cox regression analyses. The Gene Expression Omnibus (GEO) database's GSE30219 was used to validate the NLPS. The prognostic value of the risk score was assessed using Kaplan-Meier survival, receiver operating characteristic (ROC) Cox regression, multivariate Cox regression, and nomogram analyses. Then, we looked into the differences between the low- and high-risk groups in the tumor immune microenvironment, immunotherapy response, and half-maximal inhibitory concentration (IC50).

Results

The 14 lncRNAs in a novel NLPS were created. With further validation in the GSE30219 dataset, the risk score according to the NLPS was an independent prognostic indicator for LUAD patients. Patients with better overall survival (OS) in the low-risk group, who were characterized by increased immune cell infiltration, tumor mutational burden (TMB), and immunophenoscore (IPS), may have hot tumors and higher immunotherapy response rates. In addition, the risk score was also closely linked to sensitivity to various anticancer medications.

Conclusions

We constructed a novel NLPS that could predict OS and sensitivity to immunotherapy in LUAD patients.

Bayesian Network Analysis for Prediction of Unplanned Hospital Readmissions of Cancer Patients with Breakthrough Cancer Pain and Complex Care Needs

Background: Unplanned hospital readmissions (HRAs) are very common in cancer patients. These events can potentially impair the patients’ health-related quality of life and increase cancer care costs. In this study, data-driven prediction models were developed for identifying patients at a higher risk for HRA. Methods: A large dataset on cancer pain and additional data from clinical registries were used for conducting a Bayesian network analysis. A cohort of gastrointestinal cancer patients was selected. Logical and clinical relationships were a priori established to define and associate the considered variables including cancer type, body mass index (BMI), bone metastasis, serum albumin, nutritional support, breakthrough cancer pain (BTcP), and radiotherapy. Results: The best model (Bayesian Information Criterion) demonstrated that, in the investigated setting, unplanned HRAs are directly related to nutritional support (p = 0.05) and radiotherapy. On the contrary, BTcP did not significantly affect HRAs. Nevertheless, the correlation between variables showed that when BMI ≥ 25 kg/m², the spontaneous BTcP is more predictive for HRAs. Conclusions: Whilst not without limitations, a Bayesian model, combined with a careful selection of clinical variables, can represent a valid strategy for predicting unexpected HRA events in cancer patients. These findings could be useful for calibrating care interventions and implementing processes of resource allocation.

Prognostic value of m6A regulators and the nomogram construction in glioma patients

Although N6-methyladenosine (m6A) has been implicated in various biological functions in human cancers, its role in predicting the prognosis of glioma remains unclear. In this study, the transcriptome expression profiles and the clinical data of 961 patients were derived from the Chinese Glioma Genome Atlas (CGGA). We comprehensively evaluated the association between the expression of m6A regulators and the prognosis of glioma and established a 3-gene (YTHDF2, FTO, and ALKBH5) risk signature using least absolute shrinkage and selection operator (LASSO) analysis. Patients with a high-risk signature had significantly adverse prognoses. Gene set enrichment analysis (GSEA) analysis revealed that the G2M checkpoint, MTORC1 signaling, epithelial mesenchymal transition, and PI3K-AKT-mTOR signaling were significantly enriched in the high-risk group. Univariate and multivariate Cox regression analyses confirmed the independent prognostic value of this risk signature. We then constructed a nomogram for individualized prediction of overall survival (OS) by integrating clinicopathological features (age, World Health Organization [WHO] grade), treatment information (radiotherapy, temozolomide therapy), and m6A risk signature. The calibration curves showed excellent agreement between the predicted and actual probabilities for the 1-, 3-, and 5-year OS, with a C-index of 0.780 in the training cohort and 0.717 in the validation cohort. Altogether, our study elucidated the important role of m6A regulators in glioma prognosis, which is valuable for the selection of therapeutic methods and clinical management of patients with glioma.

Meta-Analysis Addressing the Implications of Model Uncertainty in Understanding the Persistence of Indicators and Pathogens in Natural Surface Waters

This study evaluates the impact persistence model selection has on the prediction of persistence values of interest and the identification of influential water quality and environmental factors for microorganisms in natural surface waters. Five persistence models representing first-order decay and nonlinear decay profiles were fit to a comprehensive database of 629 data sets for fecal indicator bacteria (FIB), bacteriophages, bacteria, viruses, and protozoa mined from the literature. Initial periods of minimal decay and decay rates tapering off over time were often observed, and a two-parameter model, based on the logistic probability distribution, provided the best fit to the data most frequently. First-order decay kinetics provided the best fit to less than 20% of the analyzed data. Using the best fitting models in this analysis, T90 and T99 metrics were calculated for each data set and used as the dependent variable in a variety of exploratory factor analyses. Random forest methods identified temperature and predation as some of the most important water quality factors influencing persistence, and the protozoa target type differed the most from FIB. This analysis further confirmed the interactions between temperature and predation and suggests that pH and turbidity be more frequently documented in persistence studies to further elucidate their impact on target persistence. The findings from this analysis and the calculated persistence metrics can be used to better inform quantitative microbial risk assessments and may lead to improved predictions of human health risks and water management decisions.

Focus on Self-Presentation on Social Media across Sociodemographic Variables, Lifestyles, and Personalities: A Cross-Sectional Study

Upward social comparison and aspects of self-presentation on social media such as feedback-seeking and strategic self-presentation may represent risk factors for experiencing negative mental health effects of social media use. The aim of this exploratory study was to assess how adolescents differ in upward social comparison and aspects of self-presentation on social media and whether these differences are linked to sociodemographic variables, lifestyle, or personality. The study was based on cross-sectional data from the "LifeOnSoMe" study performed in Bergen, Norway, including 2023 senior high school pupils (response rate 54%, mean age 17.4, 44% boys). Nine potentially relevant items were assessed using factor analysis, and latent class analysis was used to identify latent classes with distinct patterns of responses across seven retained items. The retained items converged into one factor, called "focus on self-presentation". We identified three groups of adolescents with a low, intermediate, and high focus on self-presentation. Associations between identified latent classes and covariates were assessed using regression analyses. Being a girl, higher extraversion, lower emotional stability, more frequent alcohol consumption, and having tried tobacco were associated with membership in the high-focus group. These results suggest some characteristics that are associated with a higher focus on self-presentation and that could inform targeted interventions.

A predictive model for first-trimester pregnancy inception after IVF-ET based on multimodal ultrasound evaluation of endometrial receptivity

Background

In-vitro fertilization-embryo transfer (IVF-ET) is a commonly used assisted reproductive technology. Its success depends on many factors, including endometrial receptivity. Endometrial receptivity can be evaluated by ultrasound, endometrial biopsy, and magnetic resonance imaging. Compared with the latter two methods, ultrasound has the advantages of wide availability, non-invasiveness, and low cost. Three-dimensional (3D) ultrasound imaging examines endometrial thickness, morphology, and blood vessels, which are associated with the success of embryo implantation. However, there are no reports of endometrial receptivity assessment by 3D ultrasound. Therefore, we aimed to evaluate endometrial receptivity using 3D ultrasound and construct a predictive model for first-trimester pregnancy inception following IVF-ET.

Methods

We performed a prospective observational study on infertile women who underwent IVF-ET between December 2019 and February 2021. These women had 3D ultrasound evaluations, measuring endometrial thickness, volume, pattern, morphology, peristalsis, uterine artery blood flow index, sub-endometrial blood flow index, and distribution pattern. We recorded the occurrence of first-trimester pregnancies in these women. Using Akaike information criterion (AIC) and backward stepwise regression, a first-trimester pregnancy prediction model was constructed based on the minimum AIC value and validated internally and externally.

Results

111 women were enrolled, with 103 included in the analysis. Univariate and multiple logistic regression analyses showed that endometrial thickness and vascularization flow index (VFI) were independent factors associated with the occurrence of a pregnancy. The final prediction model corresponding to the minimum AIC value (65.166) was Y = − 6.131–0.182endometrial thickness + 0.542endometrial volume + 4.374VFI + 0.132age. In the test set, modeling cohort, and external validation cohort, the model showed satisfactory differentiation, with C index of 0.841 (95%CI 0.699–0.817), 0.727 (95%CI 0.619–0.815), and 0.745 (95%CI 0.671–0.840), respectively. The Hosmer–Lemeshow goodness of fit tests reported P = 0.865, 0.139, and 0.070, respectively, indicating a high agreement with the actual IVF-ET outcome. This model reached the highest diagnostic efficiency (sensitivity 88.9%, specificity 75%, Youden index 0.639) at a diagnostic cut-off value of ≥ 0.360.

Conclusions

The predictive model based on endometrial receptivity evaluations by 3D ultrasound had high diagnostic efficiency and could be a simple and effective tool to predict first-trimester pregnancy inception after IVF-ET.

Understanding Homeostatic Regulation: The Role of Relationships and Conditions in Feedback Loop Reasoning

Understanding homeostasis is a goal of biology education curricula, as homeostasis is a core feature of living systems. Identifying and understanding the underlying molecular feedback mechanisms appear to be challenging for students. Understanding the properties and mechanisms of such complex homeostatic systems requires feedback loop reasoning, which is a part of systems thinking. Novices seem to struggle to 1) consider more than one initiating condition in cause-effect relationships and 2) track cause and effect across a sequence of processes. In this cross-sectional study, we analyzed how these factors impede feedback loop reasoning. High school and undergraduate students analyzed the organizational, behavioral, and modeling-related features of a homeostatic system (blood calcium regulation). Using multidimensional item response theory, we were able to confirm the three-dimensional structure of the theoretical systems-thinking model and to identify the factors causing item difficulty. As hypothesized, indirect relationships and derived inverse conditions are challenging factors for participants in the context of homeostasis across dimensions. Hence, we recommend paying special attention to these factors when teaching homeostasis as part of systems thinking. We assume that allowing students to reason from different initiating conditions in a learning setting may improve their systems-thinking skills.

Latent class analysis of racial microaggressions and institution-specific racial discrimination at a U.S. minority-serving university: Implications for mental health and coping

Research has demonstrated that ethnoracially minoritized college students face negative mental health outcomes associated with racism. However, little is known about the intersections between microaggressions and institution-specific racial discrimination, their relationship with psychological distress, and the role of coping in this relationship. An ethnoracially diverse sample of 915 young adults attending an urban minority-serving institution (MSI) completed self-report measures on sociodemographics, microaggressions and institution-specific racial discrimination, coping, anxiety and depression, and perceived stress. Latent class analysis (LCA) determined the number and nature of classes for both forms of racism. Hierarchical linear regressions assessed the association between the LCA classes and anxiety/depression and examined the moderating role of coping in said association. The LCA revealed two classes: "exoticization and environmental microaggressions" (EM), whose members reported experiencing these two types of microaggressions, and "institution-specific racial discrimination and microaggressions" (IRM), whose members reported both institution-specific racial discrimination and microaggressions in multiple domains. Belonging to the IRM group was associated with depression but not anxiety after adjusting for perceived stress. Black students and those reporting lower family income were more likely to belong to the IRM group. Coping moderated the relation between IRM group membership and depression, which was weaker for those who reported active coping in response to racism. College students from MSIs who experience both institution-specific racial discrimination and microaggressions may be at greater risk for depression than those who experience exoticization and environmental microaggressions alone. Active coping may ameliorate depression risk. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of the COVID-19 pandemic on the conduct of clinical trials: a quantitative analysis

BACKGROUND

Globally, healthcare has shouldered much of the socioeconomic brunt of the COVID-19 pandemic leading to numerous clinical trials suspended or discontinued.

OBJECTIVE

To estimate the COVID-19 impact on the number of clinical trials worldwide.

METHODS

Data deposited by 219 countries in the ClinicalTrials.gov database (2007-2020) were interrogated using targeted queries. A time series model was fitted to the data for studies ongoing, initiated, or ended between 2007 Quarter (Q) 1 and 2019 Q4 to predict the expected trials number in 2020 in the COVID-19 absence. The predicted values were compared with the actual 2020 data to quantify the pandemic impact.

RESULTS

The ongoing registered trials number grew from 2007 Q1 (33,739) to 2019 Q4 (80,319). By contrast, there were markedly fewer ongoing trials in all four quarters of 2020 compared with forecasted values (1.6%-2.8% decrease). When excluding COVID-19-related studies, this disparity grew further (3.4%-5.8% decrease), to a peak of almost 5,000 fewer ongoing trials than estimated for 2020 Q2. The initiated non-COVID-19 trials number was higher than predicted in 2020 Q4 (9.9%).

CONCLUSIONS

This pandemic has impacted clinical trials. Provided that current trends persist, clinical trial activities may soon recover to at least pre-COVID-19 levels.

Tramadol Use in Pediatric Surgery: Trends After the Food and Drug Administration Black-Box Warning

INTRODUCTION

The U.S. Food and Drug Administration (FDA) issued a black-box warning in 2017 contraindicating tramadol in children <12 y. Longitudinal trends and factors associated with perioperative tramadol use in children remain unclear.

METHODS

A retrospective, multi-institutional cohort study utilizing the Pediatric Health Information System database was performed for children 2-18 y who underwent one of ten common surgeries from 1/2009-2/2020. Temporal trends correlated with the FDA tramadol contraindication were evaluated. Hierarchical multivariable logistic regression analysis identified factors associated with tramadol use.

RESULTS

Of 477,153 children undergoing surgery, 5857(1.2%) received tramadol during hospitalization. Tramadol use occurred in 942 (16.1%) children after the black-box warning, 390 of whom were <12 y. For children <12 y, annual tramadol use peaked at 1.87% (2016) and decreased to 0.66% (2019). Female sex (odds ratio OR 1.32; 95% confidence interval CI:1.24,1.40), age ≥12 y (OR 2.79; 95%CI: 2.62,2.97), and Midwest location (OR 4.07; 95% CI:1.64,10.11) increased likelihood of receiving tramadol. Tramadol use was more likely after cholecystectomy (OR 1.17; 95% CI:1.04,1.32) and in children with gastrointestinal (OR 2.39; 95% CI: 2.19,2.60), metabolic (OR 1.39; 95% CI:1.26,1.53) or transplant-related (OR 1.82; 95% CI: 1.57,2.10) comorbidities. Children of Hispanic/Latino ethnicity and those with public insurance had decreased likelihood of receiving tramadol. Adjusting for patient and hospital characteristics, children <12 y were less likely to receive tramadol following the black-box warning (OR 0.65; 95% CI: 0.59,0.70).

CONCLUSIONS

Despite the FDA contraindication, tramadol prescribing continues among children <12 y undergoing surgery, with use varying by patient and institutional factors. Interventions are required to reduce perioperative tramadol use in children.

Psychosocial Interventions for Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis by the CADDRA Guidelines Work GROUP

Multiple psychosocial interventions to treat ADHD symptoms have been developed and empirically tested. However, no clear recommendations exist regarding the utilization of these interventions for treating core ADHD symptoms across different populations. The objective of this systematic review and meta-analysis by the CADDRA Guidelines work Group was to generate such recommendations, using recent evidence. Randomized controlled trials (RCT) and meta-analyses (MA) from 2010 to 13 February 2020 were searched in PubMed, PsycINFO, EMBASE, EBM Reviews and CINAHL. Studies of populations with significant levels of comorbidities were excluded. Thirty-one studies were included in the qualitative synthesis (22 RCT, 9 MA) and 24 studies (19 RCT, 5 MA) were included in the quantitative synthesis. Using three-level meta-analyses to pool results of multiple observations from each RCT, as well as four-level meta-analyses to pool results from multiples outcomes and multiple studies of each MA, we generated recommendations using the GRADE approach for: Cognitive Behavioral Therapy; Physical Exercise and Mind–Body intervention; Caregiver intervention; School-based and Executive intervention; and other interventions for core ADHD symptoms across Preschooler, Child, Adolescent and Adult populations. The evidence supports a recommendation for Cognitive Behavioral Therapy for adults and Caregiver intervention for Children, but not for preschoolers. There were not enough data to provide recommendations for the other types of psychosocial interventions. Our results are in line with previous meta-analytic assessments; however, they provide a more in-depth assessment of the effect of psychosocial intervention on core ADHD symptoms.

Better prediction of stroke in atrial fibrillation with incorporation of cancer in CHA2DS2VASC score: CCHA2DS2VASC score

Introduction

Atrial fibrillation (AF) is associated with an increased risk of stroke. Despite evidence linking cancer and thrombosis, cancer is not part of the CHA₂DS₂VASc score.

Hypothesis

Cancer is an independent risk factor for thromboembolic stroke in patients with AF.

Method

The SEER database was utilized to identify patients with lung, colon, breast, and prostate cancers with AF and no prior diagnosis of stroke and. compared to controls within the dataset. The primary endpoint was rates of stroke per 100 person-years. Cox regression modeling and a nested model comparing CHA₂DS₂VASc score (Model 1) with a complete model including cancer diagnosis (Model 2) were performed. Models were compared using Akaike Information Criterion (AIC) and Net Reclassification Index (NRI). A propensity-matched cohort with equivalent CHA₂DS₂VASc scores determining stroke-free survival was also performed.

Results

A total of 101,185 patients were included in the analysis, with 48,242 in the Cancer and 52,943 in the Non-cancer Group. Stroke rate per 100 person-years was significantly higher in the Cancer Group. The CHA₂DS₂VASc model (Model 1) was compared against a model including cancer (Model 2) showing improved predictability as assessed by both NRI and AIC. Cox regression analysis calculated a hazard ratio of 1.085 for Cancer, which was comparable to age >75, female sex, and diabetes. Propensity matched Kaplan-Meier curve demonstrated a decreased probability of stroke-free survival in the Cancer Group.

Conclusion

Cancers increase the risk of stroke in patients with AF. Consideration should be given to the addition of cancer to the clinical scoring system.

PCDM and PCDM4MP: New Pairwise Correlation-Based Data Mining Tools for Parallel Processing of Large Tabular Datasets

The paper describes PCDM and PCDM4MP as new tools and commands capable of exploring large datasets. They select variables based on identifying the absolute values of Pearson’s pairwise correlation coefficients between a chosen response variable and any other existing in the dataset. In addition, for each pair, they also report the corresponding significance and the number of non-null intersecting observations, and all this reporting is performed in a record-oriented manner (both source and output). Optionally, using threshold values for these three as parameters of PCDM, any user can select the most correlated variables based on high magnitude, significance, and support criteria. The syntax is simple, and the tools show the exploration progress in real-time. In addition, PCDM4MP can trigger different instances of Stata, each using a distinct class of variables belonging to the same dataset and resulting after simple name filtering (first letter). Moreover, this multi-processing (MP) version overcomes the parallelization limitations of the existing parallel module, and this is accomplished by using vertical instead of horizontal partitions of large flat datasets, dynamic generation of the task pattern, tasks, and logs, all within a single execution of this second command, and the existing qsub module to automatically and continuously allocate the tasks to logical processors and thereby emulating with fewer resources a cluster environment. In addition, any user can perform further selections based on the results printed in the console. The paper contains examples of using these tools for large datasets such as the one belonging to the World Values Survey and based on a simple variable naming practice. This article includes many recorded simulations and presents performance results. They depend on different resources and hardware configurations used, including cloud vs. on-premises, large vs. small amounts of RAM and processing cores, and in-memory vs. traditional storage.

The Heritability of Upper Airway Dimensions Using MRI Scans in Twins

Introduction: Obstructive sleep apnea (OSA) is a common disorder characterized by the repetitive collapse of the upper airways during sleep, most likely in the oropharyngeal region. Anatomical factors significantly contribute to the disease development; however, the heritability of the upper airway dimensions, which lead to the collapsibility of the upper airways, is less known. In the current study, we aimed to quantify the impact of heritable and environmental factors on the upper airway dimensions in twins using magnetic resonance imaging (MRI). Methods: We completed head and neck MRI imaging on 110 (66 monozygotic and 44 dizygotic, age median and Q1–Q3: 53 (44–63.75) years) adult twins from the Hungarian Twin Registry. We completed cephalometric, soft tissue and fatty tissue space measurements on T1- and T2-weighted images in sagittal, coronal and axial planes. For the analysis of the genetic and environmental, the determination of the measured parameters was performed with an ACE twin statistical model. Results: We found a strong genetic determination in the anteroposterior diameter of the tongue and the thickness of the submental fatty tissue of the neck. Other parameters of the tongue, soft palate and uvula have shown moderate heritability, while we found strong environmental determination in the thickness of the parapharyngeal fatty tissue, the thickness of the pharyngeal wall, and the smallest diameter of the posterior upper airways. Conclusion: Our twin study can help better understand the genetic and environmental background of anatomical structures involved in the development of sleep apnea.