Child involvement, alliance, and therapist flexibility: process variables in cognitive-behavioural therapy for anxiety disorders in childhood.

PubMed

Hudson, Jennifer L; Kendall, Philip C; Chu, Brian C; Gosch, Elizabeth; Martin, Erin; Taylor, Alan; Knight, Ashleigh

2014-01-01

This study examined the relations between treatment process variables and child anxiety outcomes. Independent raters watched/listened to taped therapy sessions of 151 anxiety-disordered (6-14 yr-old; M = 10.71) children (43% boys) and assessed process variables (child alliance, therapist alliance, child involvement, therapist flexibility and therapist functionality) within a manual-based cognitive-behavioural treatment. Latent growth modelling examined three latent variables (intercept, slope, and quadratic) for each process variable. Child age, gender, family income and ethnicity were examined as potential antecedents. Outcome was analyzed using factorially derived clinician, mother, father, child and teacher scores from questionnaire and structured diagnostic interviews at pretreatment, posttreatment and 12-month follow-up. Latent growth models demonstrated a concave quadratic curve for child involvement and therapist flexibility over time. A predominantly linear, downward slope was observed for alliance, and functional flexibility remained consistent over time. Increased alliance, child involvement and therapist flexibility showed some albeit inconsistent, associations with positive treatment outcome. Findings support the notion that maintaining the initial high level of alliance or involvement is important for clinical improvement. There is some support that progressively increasing alliance/involvement also positively impacts on treatment outcome. These findings were not consistent across outcome measurement points or reporters. Copyright © 2013 Elsevier Ltd. All rights reserved.

Heart rate variability measured early in patients with evolving acute coronary syndrome and 1-year outcomes of rehospitalization and mortality.

PubMed

Harris, Patricia R E; Stein, Phyllis K; Fung, Gordon L; Drew, Barbara J

2014-01-01

This study sought to examine the prognostic value of heart rate variability (HRV) measurement initiated immediately after emergency department presentation for patients with acute coronary syndrome (ACS). Altered HRV has been associated with adverse outcomes in heart disease, but the value of HRV measured during the earliest phases of ACS related to risk of 1-year rehospitalization and death has not been established. Twenty-four-hour Holter recordings of 279 patients with ACS were initiated within 45 minutes of emergency department arrival; recordings with ≥18 hours of sinus rhythm were selected for HRV analysis (number [N] =193). Time domain, frequency domain, and nonlinear HRV were examined. Survival analysis was performed. During the 1-year follow-up, 94 patients were event-free, 82 were readmitted, and 17 died. HRV was altered in relation to outcomes. Predictors of rehospitalization included increased normalized high frequency power, decreased normalized low frequency power, and decreased low/high frequency ratio. Normalized high frequency >42 ms(2) predicted rehospitalization while controlling for clinical variables (hazard ratio [HR] =2.3; 95% confidence interval [CI] =1.4-3.8, P=0.001). Variables significantly associated with death included natural logs of total power and ultra low frequency power. A model with ultra low frequency power <8 ms(2) (HR =3.8; 95% CI =1.5-10.1; P=0.007) and troponin >0.3 ng/mL (HR =4.0; 95% CI =1.3-12.1; P=0.016) revealed that each contributed independently in predicting mortality. Nonlinear HRV variables were significant predictors of both outcomes. HRV measured close to the ACS onset may assist in risk stratification. HRV cut-points may provide additional, incremental prognostic information to established assessment guidelines, and may be worthy of additional study.

Postvention in the U.S. Military: Survey of Survivors of Suicide Loss from 2010-2014

DTIC Science & Technology

2018-02-01

cause of death and psychological well-being decrease or become non-significant when satisfaction with postvention providers and services is added to...variable (here, cause of death) and the outcome (here, psychological outcome variables) is reduced when the mediator (here, postvention satisfaction) is...expressed high satisfaction when they perceived that the first responder went “above and beyond” the expected duties, for example by following up

Teaching a Machine to Feel Postoperative Pain: Combining High-Dimensional Clinical Data with Machine Learning Algorithms to Forecast Acute Postoperative Pain

PubMed Central

Tighe, Patrick J.; Harle, Christopher A.; Hurley, Robert W.; Aytug, Haldun; Boezaart, Andre P.; Fillingim, Roger B.

2015-01-01

Background Given their ability to process highly dimensional datasets with hundreds of variables, machine learning algorithms may offer one solution to the vexing challenge of predicting postoperative pain. Methods Here, we report on the application of machine learning algorithms to predict postoperative pain outcomes in a retrospective cohort of 8071 surgical patients using 796 clinical variables. Five algorithms were compared in terms of their ability to forecast moderate to severe postoperative pain: Least Absolute Shrinkage and Selection Operator (LASSO), gradient-boosted decision tree, support vector machine, neural network, and k-nearest neighbor, with logistic regression included for baseline comparison. Results In forecasting moderate to severe postoperative pain for postoperative day (POD) 1, the LASSO algorithm, using all 796 variables, had the highest accuracy with an area under the receiver-operating curve (ROC) of 0.704. Next, the gradient-boosted decision tree had an ROC of 0.665 and the k-nearest neighbor algorithm had an ROC of 0.643. For POD 3, the LASSO algorithm, using all variables, again had the highest accuracy, with an ROC of 0.727. Logistic regression had a lower ROC of 0.5 for predicting pain outcomes on POD 1 and 3. Conclusions Machine learning algorithms, when combined with complex and heterogeneous data from electronic medical record systems, can forecast acute postoperative pain outcomes with accuracies similar to methods that rely only on variables specifically collected for pain outcome prediction. PMID:26031220

What Makes a Difference during the Last Two Years of High School: An Overview of Studies Based on High School and Beyond Data.

ERIC Educational Resources Information Center

Marsh, Herbert W.

Variables that influence growth and change in educational outcomes in the last 2 years of high school were studied using data from the High School and Beyond (HSB) study. The HSB study provided a database of thousands of variables for about 30 students from each of 1,000 randomly selected high schools in the United States in their sophomore and…

Motor Experts Care about Consistency and Are Reluctant to Change Motor Outcome.

PubMed

Kast, Volker; Leukel, Christian

2016-01-01

Thousands of hours of physical practice substantially change the way movements are performed. The mechanisms underlying altered behavior in highly-trained individuals are so far little understood. We studied experts (handballers) and untrained individuals (novices) in visuomotor adaptation of free throws, where subjects had to adapt their throwing direction to a visual displacement induced by prismatic glasses. Before visual displacement, experts expressed lower variability of motor errors than novices. Experts adapted and de-adapted slower, and also forgot the adaptation slower than novices. The variability during baseline was correlated with the learning rate during adaptation. Subjects adapted faster when variability was higher. Our results indicate that experts produced higher consistency of motor outcome. They were still susceptible to the sensory feedback informing about motor error, but made smaller adjustments than novices. The findings of our study relate to previous investigations emphasizing the importance of action exploration, expressed in terms of outcome variability, to facilitate learning.

Variability in Second Language Learning: The Roles of Individual Differences, Learning Conditions, and Linguistic Complexity

ERIC Educational Resources Information Center

Tagarelli, Kaitlyn M.; Ruiz, Simón; Vega, José Luis Moreno; Rebuschat, Patrick

2016-01-01

Second language learning outcomes are highly variable, due to a variety of factors, including individual differences, exposure conditions, and linguistic complexity. However, exactly how these factors interact to influence language learning is unknown. This article examines the relationship between these three variables in language learners.…

Closed treatment of unilateral mandibular condyle fractures in adults: a systematic review.

PubMed

Rozeboom, A V J; Dubois, L; Bos, R R M; Spijker, R; de Lange, J

2017-04-01

Of all mandibular fractures, 25-35% are condylar. Many studies have focused on whether to treat such fractures via open or closed modalities. A uniform protocol for closed treatment is lacking, but such a protocol could ensure good clinical practice. The aims of this systematic review were to provide an overview of the published studies exclusively pertaining to closed treatment and to summarize the existing modalities for closed treatment and their clinical outcomes. Sixteen studies were selected for detailed analysis. The treatments given were highly variable, ranging from doing nothing to applying maxillomandibular fixation with stainless steel wires. The results of the different studies and the treatment modalities used were difficult to interpret; however no clear differences in the outcome measures were seen between the treatment modalities applied. Complications encountered after closed treatment included malocclusion, limited mouth opening, reduced range of motion, and persistent pain. Due to the heterogeneity between groups, high loss-to-follow-up, poor descriptions of the treatments given, and variability in outcome measurement methods, no clear associations between adverse outcomes and the treatments applied could be determined. This review suggests that due to the high level of methodological variability in the relevant studies published to date, there are currently no uniform standards for the closed treatment of condylar fractures that can be expected to yield good clinical results. The establishment of such standards could potentially improve treatment outcomes. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

University of North Carolina Caries Risk Assessment Study: comparisons of high risk prediction, any risk prediction, and any risk etiologic models.

PubMed

Beck, J D; Weintraub, J A; Disney, J A; Graves, R C; Stamm, J W; Kaste, L M; Bohannan, H M

1992-12-01

The purpose of this analysis is to compare three different statistical models for predicting children likely to be at risk of developing dental caries over a 3-yr period. Data are based on 4117 children who participated in the University of North Carolina Caries Risk Assessment Study, a longitudinal study conducted in the Aiken, South Carolina, and Portland, Maine areas. The three models differed with respect to either the types of variables included or the definition of disease outcome. The two "Prediction" models included both risk factor variables thought to cause dental caries and indicator variables that are associated with dental caries, but are not thought to be causal for the disease. The "Etiologic" model included only etiologic factors as variables. A dichotomous outcome measure--none or any 3-yr increment, was used in the "Any Risk Etiologic model" and the "Any Risk Prediction Model". Another outcome, based on a gradient measure of disease, was used in the "High Risk Prediction Model". The variables that are significant in these models vary across grades and sites, but are more consistent among the Etiologic model than the Predictor models. However, among the three sets of models, the Any Risk Prediction Models have the highest sensitivity and positive predictive values, whereas the High Risk Prediction Models have the highest specificity and negative predictive values. Considerations in determining model preference are discussed.

African-American adolescent females' predictors of having sex.

PubMed

Dancy, Barbara L; Crittenden, Kathleen S; Freels, Sally

2006-12-01

African-American adolescent females are at high risk for HIV infection, acquired primarily as a result of heterosexual intercourse. Multiple regression analyses was used to describe the correlates of the outcome variable, ever having had sex, for low-income African-American adolescent females in a cross-sectional study of 322 (N = 322) mother/daughter pairs. The results revealed that while the daughters' age was positively associated with the outcome variable, the daughters' perceptions of strictness of curfew and maternal monitoring, and the daughters'self-efficacy to refuse sex and their intention to refuse sex were negatively associated with the outcome variable. Mothers tended to report significantly more maternal monitoring and stricter curfews than what their daughters perceived them to be. The daughters'intention to refuse sex mediated the effects of age and self-efficacy to refuse sex on the outcome variable. These results suggest that health-care providers should promote clearer communication between mothers and daughters in order to reduce divergent perceptions and to help mothers facilitate their daughters' self-efficacy and their intention to refuse sex.

Dynamics of melanoma tumor therapy with vesicular stomatitis virus: explaining the variability in outcomes using mathematical modeling.

PubMed

Rommelfanger, D M; Offord, C P; Dev, J; Bajzer, Z; Vile, R G; Dingli, D

2012-05-01

Tumor selective, replication competent viruses are being tested for cancer gene therapy. This approach introduces a new therapeutic paradigm due to potential replication of the therapeutic agent and induction of a tumor-specific immune response. However, the experimental outcomes are quite variable, even when studies utilize highly inbred strains of mice and the same cell line and virus. Recognizing that virotherapy is an exercise in population dynamics, we utilize mathematical modeling to understand the variable outcomes observed when B16ova malignant melanoma tumors are treated with vesicular stomatitis virus in syngeneic, fully immunocompetent mice. We show how variability in the initial tumor size and the actual amount of virus delivered to the tumor have critical roles on the outcome of therapy. Virotherapy works best when tumors are small, and a robust innate immune response can lead to superior tumor control. Strategies that reduce tumor burden without suppressing the immune response and methods that maximize the amount of virus delivered to the tumor should optimize tumor control in this model system.

Determinants of safety outcomes and performance: A systematic literature review of research in four high-risk industries.

PubMed

Cornelissen, Pieter A; Van Hoof, Joris J; De Jong, Menno D T

2017-09-01

In spite of increasing governmental and organizational efforts, organizations still struggle to improve the safety of their employees as evidenced by the yearly 2.3 million work-related deaths worldwide. Occupational safety research is scattered and inaccessible, especially for practitioners. Through systematically reviewing the safety literature, this study aims to provide a comprehensive overview of behavioral and circumstantial factors that endanger or support employee safety. A broad search on occupational safety literature using four online bibliographical databases yielded 27.527 articles. Through a systematic reviewing process 176 online articles were identified that met the inclusion criteria (e.g., original peer-reviewed research; conducted in selected high-risk industries; published between 1980-2016). Variables and the nature of their interrelationships (i.e., positive, negative, or nonsignificant) were extracted, and then grouped and classified through a process of bottom-up coding. The results indicate that safety outcomes and performance prevail as dependent research areas, dependent on variables related to management & colleagues, work(place) characteristics & circumstances, employee demographics, climate & culture, and external factors. Consensus was found for five variables related to safety outcomes and seven variables related to performance, while there is debate about 31 other relationships. Last, 21 variables related to safety outcomes and performance appear understudied. The majority of safety research has focused on addressing negative safety outcomes and performance through variables related to others within the organization, the work(place) itself, employee demographics, and-to a lesser extent-climate & culture and external factors. This systematic literature review provides both scientists and safety practitioners an overview of the (under)studied behavioral and circumstantial factors related to occupational safety behavior. Scientists could use this overview to study gaps, and validate or falsify relationships. Safety practitioners could use the insights to evaluate organizational safety policies, and to further development of safety interventions. Copyright © 2017 National Safety Council and Elsevier Ltd. All rights reserved.

Does additional cone beam computed tomography decrease the risk of inferior alveolar nerve injury in high-risk cases undergoing third molar surgery?Does CBCT decrease the risk of IAN injury?

PubMed

Korkmaz, Y T; Kayıpmaz, S; Senel, F C; Atasoy, K T; Gumrukcu, Z

2017-05-01

The objectives of this study were to evaluate the efficacy of additional cone beam computed tomography (CBCT) imaging on decreasing the risk of inferior alveolar nerve (IAN) injury during third molar removal in patients at high risk and to assess the surgical outcomes. The study sample included patients considered at high risk for IAN injury based on panoramic radiography (PAN) evaluation. The primary predictor was the type of imaging method (PAN only or with additional CBCT). The other variables were demographic and anatomical/radiographic factors. The primary outcome variable was IAN injury. The secondary outcome variables were the preoperative surgical plan and surgical results including IAN exposure and duration of surgery. The sample comprised 122 patients (139 teeth) aged 18-48 years. Postoperative temporary IAN injury was present in three (4.2%) cases in the CBCT group and 11 (16.4%) in the PAN group at 7 days after surgery. However, none of the patients had a permanent IAN injury at the 6-month follow-up. Additional CBCT imaging was not superior to PAN in reducing IAN injury after third molar surgery during long-term follow-up. Nonetheless, CBCT may decrease the prevalence of temporary IAN injury and improve the surgical outcomes in high-risk patients. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Need for Cognitive Closure Modulates How Perceptual Decisions Are Affected by Task Difficulty and Outcome Relevance.

PubMed

Viola, Vanda; Tosoni, Annalisa; Brizi, Ambra; Salvato, Ilaria; Kruglanski, Arie W; Galati, Gaspare; Mannetti, Lucia

2015-01-01

The aim of this study was to assess the extent to which Need for Cognitive Closure (NCC), an individual-level epistemic motivation, can explain inter-individual variability in the cognitive effort invested on a perceptual decision making task (the random motion task). High levels of NCC are manifested in a preference for clarity, order and structure and a desire for firm and stable knowledge. The study evaluated how NCC moderates the impact of two variables known to increase the amount of cognitive effort invested on a task, namely task ambiguity (i.e., the difficulty of the perceptual discrimination) and outcome relevance (i.e., the monetary gain associated with a correct discrimination). Based on previous work and current design, we assumed that reaction times (RTs) on our motion discrimination task represent a valid index of effort investment. Task ambiguity was associated with increased cognitive effort in participants with low or medium NCC but, interestingly, it did not affect the RTs of participants with high NCC. A different pattern of association was observed for outcome relevance; high outcome relevance increased cognitive effort in participants with moderate or high NCC, but did not affect the performance of low NCC participants. In summary, the performance of individuals with low NCC was affected by task difficulty but not by outcome relevance, whereas individuals with high NCC were influenced by outcome relevance but not by task difficulty; only participants with medium NCC were affected by both task difficulty and outcome relevance. These results suggest that perceptual decision making is influenced by the interaction between context and NCC.

Glycaemic variability in patients with severe sepsis or septic shock admitted to an Intensive Care Unit.

PubMed

Silveira, L M; Basile-Filho, A; Nicolini, E A; Dessotte, C A M; Aguiar, G C S; Stabile, A M

2017-08-01

Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis. To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock. Retrospective and exploratory study that involved collection of patients' sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions. Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions. Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Young adult educational and vocational outcomes of children diagnosed with ADHD.

PubMed

Kuriyan, Aparajita B; Pelham, William E; Molina, Brooke S G; Waschbusch, Daniel A; Gnagy, Elizabeth M; Sibley, Margaret H; Babinski, Dara E; Walther, Christine; Cheong, Jeewon; Yu, Jihnhee; Kent, Kristine M

2013-01-01

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment.

Astronaut Preflight Cardiovascular Variables Associated with Vascular Compliance are Highly Correlated with Post-Flight Eye Outcome Measures in the Visual Impairment Intracranial Pressure (VIIP) Syndrome Following Long Duration Spaceflight

NASA Technical Reports Server (NTRS)

Otto, Christian; Ploutz-Snyder, R.

2015-01-01

The detection of the first VIIP case occurred in 2005, and adequate eye outcome measures were available for 31 (67.4%) of the 46 long duration US crewmembers who had flown on the ISS since its first crewed mission in 2000. Therefore, this analysis is limited to a subgroup (22 males and 9 females). A "cardiovascular profile" for each astronaut was compiled by examining twelve individual parameters; eleven of these were preflight variables: systolic blood pressure, pulse pressure, body mass index, percentage body fat, LDL, HDL, triglycerides, use of anti-lipid medication, fasting serum glucose, and maximal oxygen uptake in ml/kg. Each of these variables was averaged across three preflight annual physical exams. Astronaut age prior to the long duration mission, and inflight salt intake was also included in the analysis. The group of cardiovascular variables for each crew member was compared with seven VIIP eye outcome variables collected during the immediate post-flight period: anterior-posterior axial length of the globe measured by ultrasound and optical biometry; optic nerve sheath diameter, optic nerve diameter, and optic nerve to sheath ratio- each measured by ultrasound and magnetic resonance imaging (MRI), intraocular pressure (IOP), change in manifest refraction, mean retinal nerve fiber layer (RNFL) on optical coherence tomography (OCT), and RNFL of the inferior and superior retinal quadrants. Since most of the VIIP eye outcome measures were added sequentially beginning in 2005, as knowledge of the syndrome improved, data were unavailable for 22.0% of the outcome measurements. To address the missing data, we employed multivariate multiple imputation techniques with predictive mean matching methods to accumulate 200 separate imputed datasets for analysis. We were able to impute data for the 22.0% of missing VIIP eye outcomes. We then applied Rubin's rules for collapsing the statistical results across our 200 multiply imputed data sets to assess the canonical correlation between the eye outcomes and the twelve astronaut cardiovascular variables available for all 31 subjects. Results: A highly significant canonical correlation was observed among the canonical solutions (p<.00001), with an average best canonical correlation of.97. The results suggest a strong association between astronauts' measures of cardiovascular health and the seven eye outcomes of the VIIP syndrome used in this analysis. Furthermore, the "joint test" revealed a significant difference in cardiovascular profile between male and female astronauts (Prob > F = 0.00001). Overall, female astronauts demonstrated a significantly healthier cardiovascular status. Individually, the female astronauts had significantly healthier profiles on seven of twelve cardiovascular variables than the men (p values ranging from <0.0001 to <0.05). Male astronauts did not demonstrate significantly healthier values on any of the twelve cardiovascular variables measured

Temperament as a Predictor of Symptomotology and Adaptive Functioning in Adolescents with High-Functioning Autism

PubMed Central

Schwartz, Caley B.; Henderson, Heather A.; Inge, Anne P.; Zahka, Nicole E.; Coman, Drew C.; Kojkowski, Nicole M.; Hileman, Camilla M.; Mundy, Peter C.

2009-01-01

Variation in temperament is characteristic of all people but is rarely studied as a predictor of individual differences among individuals with autism. Relative to a matched comparison sample, adolescents with High-Functioning Autism (HFA) reported lower levels of Surgency and higher levels of Negative Affect. Variability in temperament predicted symptomotology, social skills, and social-emotional outcomes differently for individuals with HFA than for the comparison sample. This study is unique in that temperament was measured by self-report, while all outcome measures were reported by parents. The broader implications of this study suggest that by identifying individual variability in constructs, such as temperament, that may influence adaptive functioning, interventions may be developed to target these constructs and increase the likelihood that individuals with HFA will achieve more adaptive life outcomes. PMID:19165586

Predicting high-risk preterm birth using artificial neural networks.

PubMed

Catley, Christina; Frize, Monique; Walker, C Robin; Petriu, Dorina C

2006-07-01

A reengineered approach to the early prediction of preterm birth is presented as a complimentary technique to the current procedure of using costly and invasive clinical testing on high-risk maternal populations. Artificial neural networks (ANNs) are employed as a screening tool for preterm birth on a heterogeneous maternal population; risk estimations use obstetrical variables available to physicians before 23 weeks gestation. The objective was to assess if ANNs have a potential use in obstetrical outcome estimations in low-risk maternal populations. The back-propagation feedforward ANN was trained and tested on cases with eight input variables describing the patient's obstetrical history; the output variables were: 1) preterm birth; 2) high-risk preterm birth; and 3) a refined high-risk preterm birth outcome excluding all cases where resuscitation was delivered in the form of free flow oxygen. Artificial training sets were created to increase the distribution of the underrepresented class to 20%. Training on the refined high-risk preterm birth model increased the network's sensitivity to 54.8%, compared to just over 20% for the nonartificially distributed preterm birth model.

Relating Psychosocial Variables in High School to Alcohol Use Trajectories During the Transition to Young Adulthood

DTIC Science & Technology

2000-05-01

of Abnormal Child Psychology, 26: 453-466. Jessor, R. 1986. Adolescent Problem Drinking: Psychosocial Aspects and Developmental Outcomes. In R...UNCLASSIFIED UNLIMITED The Pennsylvania State University The Graduate School Department of Psychology RELATING PSYCHOSOCIAL VARIABLES IN HIGH...20000509 098 May 2000 UNCLASSIFIE D DTIC QUALITY INSPECTED 8 Ill ABSTRACT This study examined the relationships between psychosocial indicators

Estimating the Effects of Pre-College Education on College Performance

DTIC Science & Technology

2013-05-10

background information from many variables into a single measure of the expected likelihood of a person receiving treatment. This leads into a discussion of...but do not directly effect outcome variables like academic order of merit, graduation rates, or academic grades. Our model had to not only include the...both indicator variables for whether the individual’s parents ever served in any of the armed forces. High School Quality Measure is a variable

Young Adult Educational and Vocational Outcomes of Children Diagnosed with ADHD

PubMed Central

Kuriyan, Aparajita B.; Pelham, William E.; Molina, Brooke S. G.; Waschbusch, Daniel A.; Gnagy, Elizabeth M.; Sibley, Margaret H.; Babinski, Dara E.; Walther, Christine; Cheong, JeeWon; Yu, Jihnhee; Kent, Kristine M.

2012-01-01

Decreased success at work and educational attainment by adulthood are of concern for children with ADHD given their widely documented academic difficulties; however there are few studies that have examined this empirically and even fewer that have studied predictors and individual variability of these outcomes. The current study compares young adults with and without a childhood diagnosis of ADHD on educational and occupational outcomes and the predictors of these outcomes. Participants were from the Pittsburgh ADHD Longitudinal Study (PALS), a prospective study with yearly data collection. Significant group differences were found for nearly all variables such that educational and occupational attainment was lower for adults with compared to adults without histories of childhood ADHD. Despite the mean difference, educational functioning was wide-ranging. High school academic achievement significantly predicted enrollment in post-high school education and academic and disciplinary problems mediated the relationship between childhood ADHD and post-high school education. Interestingly, ADHD diagnosis and disciplinary problems negatively predicted occupational status while enrollment in post-high school education was a positive predictor. Job loss was positively predicted by a higher rate of academic problems and diagnosis of ADHD. This study supports the need for interventions that target the child and adolescent predictors of later educational and occupational outcomes in addition to continuing treatment of ADHD in young adulthood targeting developmentally appropriate milestones, such as completing post-high school education and gaining and maintaining stable employment. PMID:22752720

Eight Weeks of Strength and Power Training Improves Club Head Speed in Collegiate Golfers.

PubMed

Oranchuk, Dustin J; Mannerberg, Jason M; Robinson, Tracey L; Nelson, Megan C

2018-02-14

Club head speed (CHS) is a major determinant of drive distance, a key component of golf performance. The purpose of this study was to determine the indirect effects of an eight-week strength and power program on CHS. Twelve (6 male, 6 female) NCAA Division II golfers (20.3±1.5 years) randomly assigned to an intervention or control group, underwent either a periodized strength and power program consisting of high-load barbell movements or a bodyweight and rotational movement focused resistance training program. Outcomes were CHS, countermovement jump (CMJ) height, and 1RM back squat (BS), power clean (PC), and deadlift (DL). Dependent t-tests were utilized to assess differences in outcome variables pre-to-post for each group, independent t-tests were utilized to assess differences between groups, and Pearson correlations were utilized to assess associations between CHS and outcome variables. On average, the intervention group experienced improvements in all outcome variables except peak CHS (p=0.60); the control group displayed no changes in any outcome variable except a decrease in average CHS (p=0.028). Compared to the control group, the intervention group experienced greater improvements in average CHS, BS, PC, and average and peak CMJ height (p<0.05). Additionally, CHS had large associations with PC (r=0.70, p=0.012), BS (r=0.64, p=0.025), DL (r=0.54, p=0.068) and CMJ (r=0.73, p=0.007). These results suggest improving muscular strength and power by increasing PC, BS, and CMJ is associated with increased CHS in collegiate golfers. Integrating a high-load, barbell-focused strength and power program may be beneficial for improving CHS and indirectly, golf performance.

VR Employment Outcomes of Individuals with Autism Spectrum Disorders: A Decade in the Making

ERIC Educational Resources Information Center

Alverson, Charlotte Y.; Yamamoto, Scott H.

2018-01-01

This study utilized hierarchical linear modeling analysis of a 10-year extant dataset from Rehabilitation Services Administration to investigate significant predictors of employment outcomes for vocational rehabilitation (VR) clients with autism. Predictor variables were gender, ethnicity, attained education level, IEP status in high school,…

Social gradients in periodontal diseases among adolescents.

PubMed

López, Rodrigo; Fernández, Olaya; Baelum, Vibeke

2006-06-01

To investigate the association between socioeconomic position and periodontal diseases among adolescents. Data were obtained from 9203 Chilean high school students. Clinical examinations included direct recordings of clinical attachment level and the necrotizing ulcerative gingival lesions. Students answered a questionnaire on various dimensions of socioeconomic position. Seven periodontal outcomes were analyzed. Logistic regression analyses were used to identify socioeconomic variables associated with the periodontal outcomes. The occurrence of all periodontal outcomes investigated followed social gradients, and paternal income and parental education were the most influential variables. The study demonstrates the existence of significant social gradients in periodontal diseases already among adolescents. This is worrying, and indicates a new potential for further insight into the mechanisms of periodontal disease causation.

Psychological Predictors of Outcomes with Lumbar Spinal Fusion: A Systematic Literature Review.

PubMed

Wilhelm, Mark; Reiman, Michael; Goode, Adam; Richardson, William; Brown, Christopher; Vaughn, Daniel; Cook, Chad

2017-04-01

To review the predictive/risk psychological factors at baseline that are associated with a favourable (or non-favourable) outcome following lumbar spinal fusion (LSF). A computer-assisted literature search of PubMed, CINAHL complete and EMBASE for studies published between January 1, 1990 and October 1, 2014 with controlled vocabulary and key words related to LSF, degenerative lumbar spine diagnoses and appropriate terms for predictive variables. Each study was required to be a retrospective or prospective design that involved LSF (all forms). Quality assessment was conducted with the Quality In Prognosis Studies tool. A study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO# CRD42014008728). The majority of the eight accepted studies were observational, prospective cohorts (n = 6). High levels of baseline depression and lower SF-36 Mental Component Scores (MCS) lower quality of life were associated with non-favourable outcomes. Two studies were rated as high quality, five were moderate and one study had low quality. At present, there are a number of psychological variables that are associated with a poorer outcome with LSF. Higher levels of depression and lower scores on the SF-36 MCS are the most commonly implicated. However, based on the results of the studies using single arm designs there is not enough evidence to determine which psychological variables are influential in predicting outcomes for LSF. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Predictors of contemporary coronary artery bypass grafting outcomes.

PubMed

Weisel, Richard D; Nussmeier, Nancy; Newman, Mark F; Pearl, Ronald G; Wechsler, Andrew S; Ambrosio, Giuseppe; Pitt, Bertram; Clare, Robert M; Pieper, Karen S; Mongero, Linda; Reece, Tammy L; Yau, Terrence M; Fremes, Stephen; Menasché, Philippe; Lira, Armando; Harrington, Robert A; Ferguson, T Bruce

2014-12-01

The study objective was to identify the predictors of outcomes in a contemporary cohort of patients from the Reduction in cardiovascular Events by acaDesine in patients undergoing CABG (RED-CABG) trial. Despite the increasing risk profile of patients who undergo coronary artery bypass grafting, morbidity and mortality have remained low, and identification of the current predictors of adverse outcomes may permit new treatments to further improve outcomes. The RED-CABG trial was a multicenter, randomized, double-blind, placebo-controlled study that determined that acadesine did not reduce adverse events in moderately high-risk patients undergoing nonemergency coronary artery bypass grafting. The primary efficacy end point was a composite of all-cause death, nonfatal stroke, or the need for mechanical support for severe left ventricular dysfunction through postoperative day 28. Logistic regression modeling with stepwise variable selection identified which prespecified baseline characteristics were associated with the primary outcome. A second logistic model included intraoperative variables as potential covariates. The 4 independent preoperative risk factors predictive of the composite end point were (1) a history of heart failure (odds ratio, 2.9); (2) increasing age (odds ratio, 1.033 per decade); (3) a history of peripheral vascular disease (odds ratio, 1.6); and (4) receiving aspirin before coronary artery bypass grafting (odds ratio, 0.5), which was protective. The duration of the cardiopulmonary bypass (odds ratio, 1.8) was the only intraoperative variable that contributed to adverse outcomes. Patients who had heart failure and preserved systolic function had a similar high risk of adverse outcomes as those with low ejection fractions, and new approaches may mitigate this risk. Recognition of patients with excessive atherosclerotic burden may permit perioperative interventions to improve their outcomes. The contemporary risks of coronary artery bypass grafting have changed, and their identification may permit new methods to improve outcomes. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Quantitative EEG Metrics Differ Between Outcome Groups and Change Over the First 72 h in Comatose Cardiac Arrest Patients.

PubMed

Wiley, Sara Leingang; Razavi, Babak; Krishnamohan, Prashanth; Mlynash, Michael; Eyngorn, Irina; Meador, Kimford J; Hirsch, Karen G

2018-02-01

Forty to sixty-six percent of patients resuscitated from cardiac arrest remain comatose, and historic outcome predictors are unreliable. Quantitative spectral analysis of continuous electroencephalography (cEEG) may differ between patients with good and poor outcomes. Consecutive patients with post-cardiac arrest hypoxic-ischemic coma undergoing cEEG were enrolled. Spectral analysis was conducted on artifact-free contiguous 5-min cEEG epochs from each hour. Whole band (1-30 Hz), delta (δ, 1-4 Hz), theta (θ, 4-8 Hz), alpha (α, 8-13 Hz), beta (β, 13-30 Hz), α/δ power ratio, percent suppression, and variability were calculated and correlated with outcome. Graphical patterns of quantitative EEG (qEEG) were described and categorized as correlating with outcome. Clinical outcome was dichotomized, with good neurologic outcome being consciousness recovery. Ten subjects with a mean age = 50 yrs (range = 18-65) were analyzed. There were significant differences in total power (3.50 [3.30-4.06] vs. 0.68 [0.52-1.02], p = 0.01), alpha power (1.39 [0.66-1.79] vs 0.27 [0.17-0.48], p < 0.05), delta power (2.78 [2.21-3.01] vs 0.55 [0.38-0.83], p = 0.01), percent suppression (0.66 [0.02-2.42] vs 73.4 [48.0-97.5], p = 0.01), and multiple measures of variability between good and poor outcome patients (all values median [IQR], good vs. poor). qEEG patterns with high or increasing power or large power variability were associated with good outcome (n = 6). Patterns with consistently low or decreasing power or minimal power variability were associated with poor outcome (n = 4). These preliminary results suggest qEEG metrics correlate with outcome. In some patients, qEEG patterns change over the first three days post-arrest.

Mediators and treatment matching in behavior therapy, cognitive therapy and cognitive behavior therapy for chronic insomnia.

PubMed

Harvey, Allison G; Dong, Lu; Bélanger, Lynda; Morin, Charles M

2017-10-01

To examine the mediators and the potential of treatment matching to improve outcome for cognitive behavior therapy (CBT) for insomnia. Participants were 188 adults (117 women; Mage = 47.4 years, SD = 12.6) meeting the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; text rev.; DSM-IV-TR; American Psychiatric Association [APA], 2000) diagnostic criteria for chronic insomnia (Mduration: 14.5 years, SD: 12.8). Participants were randomized to behavior therapy (BT; n = 63), cognitive therapy (CT; n = 65), or CBT (n = 60). The outcome measure was the Insomnia Severity Index (ISI). Hypothesized BT mediators were sleep-incompatible behaviors, bedtime variability (BTv), risetime variability (RTv) and time in bed (TIB). Hypothesized CT mediators were worry, unhelpful beliefs, and monitoring for sleep-related threat. The behavioral processes mediated outcome for BT but not CT. The cognitive processes mediated outcome in both BT and CT. The subgroup scoring high on both behavioral and cognitive processes had a marginally significant better outcome if they received CBT relative to BT or CT. The subgroup scoring relatively high on behavioral but low on cognitive processes and received BT or CBT did not differ from those who received CT. The subgroup scoring relatively high on cognitive but low on behavioral processes and received CT or CBT did not differ from those who received BT. The behavioral mediators were specific to BT relative to CT. The cognitive mediators were significant for both BT and CT outcomes. Patients exhibiting high levels of both behavioral and cognitive processes achieve better outcome if they receive CBT relative to BT or CT alone. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Assessing factors related to waist circumference and obesity: application of a latent variable model.

PubMed

Dalvand, Sahar; Koohpayehzadeh, Jalil; Karimlou, Masoud; Asgari, Fereshteh; Rafei, Ali; Seifi, Behjat; Niksima, Seyed Hassan; Bakhshi, Enayatollah

2015-01-01

Because the use of BMI (Body Mass Index) alone as a measure of adiposity has been criticized, in the present study our aim was to fit a latent variable model to simultaneously examine the factors that affect waist circumference (continuous outcome) and obesity (binary outcome) among Iranian adults. Data included 18,990 Iranian individuals aged 20-65 years that are derived from the third National Survey of Noncommunicable Diseases Risk Factors in Iran. Using latent variable model, we estimated the relation of two correlated responses (waist circumference and obesity) with independent variables including age, gender, PR (Place of Residence), PA (physical activity), smoking status, SBP (Systolic Blood Pressure), DBP (Diastolic Blood Pressure), CHOL (cholesterol), FBG (Fasting Blood Glucose), diabetes, and FHD (family history of diabetes). All variables were related to both obesity and waist circumference (WC). Older age, female sex, being an urban resident, physical inactivity, nonsmoking, hypertension, hypercholesterolemia, hyperglycemia, diabetes, and having family history of diabetes were significant risk factors that increased WC and obesity. Findings from this study of Iranian adult settings offer more insights into factors associated with high WC and high prevalence of obesity in this population.

Factors Affecting Outcomes in Cochlear Implant Recipients Implanted With a Perimodiolar Electrode Array Located in Scala Tympani.

PubMed

Holden, Laura K; Firszt, Jill B; Reeder, Ruth M; Uchanski, Rosalie M; Dwyer, Noël Y; Holden, Timothy A

2016-12-01

To identify primary biographic and audiologic factors contributing to cochlear implant (CI) performance variability in quiet and noise by controlling electrode array type and electrode position within the cochlea. Although CI outcomes have improved over time, considerable outcome variability still exists. Biographic, audiologic, and device-related factors have been shown to influence performance. Examining CI recipients with consistent array type and electrode position may allow focused investigation into outcome variability resulting from biographic and audiologic factors. Thirty-nine adults (40 ears) implanted for at least 6 months with a perimodiolar electrode array known (via computed tomography [CT] imaging) to be in scala tympani participated. Test materials, administered CI only, included monosyllabic words, sentences in quiet and noise, and spectral ripple discrimination. In quiet, scores were high with mean word and sentence scores of 76 and 87%, respectively; however, sentence scores decreased by an average of 35 percentage points when noise was added. A principal components (PC) analysis of biographic and audiologic factors found three distinct factors, PC1 Age, PC2 Duration, and PC3 Pre-op Hearing. PC1 Age was the only factor that correlated, albeit modestly, with speech recognition in quiet and noise. Spectral ripple discrimination strongly correlated with speech measures. For these recipients with consistent electrode position, PC1 Age was related to speech recognition performance. Consistent electrode position may have contributed to high speech understanding in quiet. Inter-subject variability in noise may have been influenced by auditory/cognitive processing, known to decline with age, and mechanisms that underlie spectral resolution ability.

T-wave alternans and dispersion of the QT interval as risk stratification markers in patients susceptible to sustained ventricular arrhythmias

NASA Technical Reports Server (NTRS)

Armoundas, A. A.; Osaka, M.; Mela, T.; Rosenbaum, D. S.; Ruskin, J. N.; Garan, H.; Cohen, R. J.

1998-01-01

T-wave alternans and QT dispersion were compared as predictors of the outcome of electrophysiologic study and arrhythmia-free survival in patients undergoing electrophysiologic evaluation. T-wave alternans was a highly significant predictor of these 2 outcome variables, whereas QT dispersion was not.

Association of Various Components of Media Literacy and Adolescent Smoking

ERIC Educational Resources Information Center

Primack, Brian A.; Hobbs, Renee

2009-01-01

Objective: To determine which specific aspects of media literacy were most strongly associated with smoking outcomes. Methods: Students at a public high school responded to cross-sectional survey items measuring smoking outcomes, components of media literacy, and other variables. Results: Of the 1211 participants, 19% were current smokers (N =…

High glucose variability is associated with poor neurodevelopmental outcomes in neonatal hypoxic ischemic encephalopathy.

PubMed

Al Shafouri, N; Narvey, M; Srinivasan, G; Vallance, J; Hansen, G

2015-01-01

In neonatal hypoxic ischemic encephalopathy (HIE), hypo- and hyperglycemia have been associated with poor outcomes. However, glucose variability has not been reported in this population. To examine the association between serum glucose variability within the first 24 hours and two-year neurodevelopmental outcomes in neonates cooled for HIE. In this retrospective cohort study, glucose, clinical and demographic data were documented from 23 term newborns treated with whole body therapeutic hypothermia. Severe neurodevelopmental outcomes from planned two-year assessments were defined as the presence of any one of the following: Gross Motor Function Classification System levels 3 to 5, Bayley III Motor Standard Score <70, Bayley III Language Score <70 and Bayley III Cognitive Standard Score <70. The neurodevelopmental outcomes from 8 of 23 patients were considered severe, and this group demonstrated a significant increase of mean absolute glucose (MAG) change (-0.28 to -0.03, 95% CI, p = 0.032). There were no significant differences between outcome groups with regards to number of patients with hyperglycemic means, one or multiple hypo- or hyperglycemic measurement(s). There were also no differences between both groups with mean glucose, although mean glucose standard deviation was approaching significance. Poor neurodevelopmental outcomes in whole body cooled HIE neonates are significantly associated with MAG changes. This information may be relevant for prognostication and potential management strategies.

Meningitis With a Negative Cerebrospinal Fluid Gram Stain in Adults: Risk Classification for an Adverse Clinical Outcome

PubMed Central

Khoury, Nabil T.; Hossain, Md Monir; Wootton, Susan H.; Salazar, Lucrecia; Hasbun, Rodrigo

2012-01-01

Objective To derive and validate a risk score for an adverse clinical outcome in adults with meningitis and a negative cerebrospinal fluid (CSF) Gram stain. Patients and Methods We conducted a retrospective study of 567 adults from Houston, Texas, with meningitis evaluated between January 1, 2005, and January 1, 2010. The patients were divided into derivation (N=292) and validation (N=275) cohorts. An adverse clinical outcome was defined as a Glasgow Outcome Scale score of 4 or less. Results Of the 567 patients, 62 (11%) had an adverse clinical outcome. A predictive model was created using 3 baseline variables that were independently associated with an adverse clinical outcome (P<.05): age greater than 60 years, abnormal findings on neurologic examination (altered mental status, focal neurologic deficits, or seizures), and CSF glucose level of less than 2.4975 mmol/L (to convert CSF glucose to mmol/L, multiply by 0.05551). The model classified patients into 2 categories of risk for an adverse clinical outcome—derivation sample: low risk, 0.6% and high risk, 32.8%; P<.001; and validation sample: low risk, 0.5% and high risk, 21.1%; P<.001. Conclusion Adults with meningitis and a negative CSF Gram stain can be accurately stratified for the risk of an adverse clinical outcome using clinical variables available at presentation. PMID:23218086

Exploring heterogeneity in clinical trials with latent class analysis

PubMed Central

Abarda, Abdallah; Contractor, Ateka A.; Wang, Juan; Dayton, C. Mitchell

2018-01-01

Case-mix is common in clinical trials and treatment effect can vary across different subgroups. Conventionally, a subgroup analysis is performed by dividing the overall study population by one or two grouping variables. It is usually impossible to explore complex high-order intersections among confounding variables. Latent class analysis (LCA) provides a framework to identify latent classes by observed manifest variables. Distal clinical outcomes and treatment effect can be different across these classes. This paper provides a step-by-step tutorial on how to perform LCA with R. A simulated dataset is generated to illustrate the process. In the example, the classify-analyze approach is employed to explore the differential treatment effects on distal outcomes across latent classes. PMID:29955579

Paternal influences on pregnancy complications and birth outcomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cleghorn de Rohrmoser, D.C.

1992-01-01

The purpose of this study was to investigate the relationship of selected characteristics of the paternal work environment and occupational history to the incidence of complications in pregnancy, complications in labor and anomalies in birth outcomes. The literature suggested that male exposure to teratogenic hazards in the form of radiation and chemical compounds, primarily in the form of solvents, has been implicated in reproductive disorders and malformed offspring in animals. Similarly, some recent research suggests that the exposure of male workers to such hazards on their job may have consequences for their spouses and children. Based on these experimental researchmore » studies and analyses of persons working in high risk occupations, a broader study of the potential contribution of paternal work environment variables to the success of pregnancy and birth outcomes seemed warranted. Based upon the literature review, a model was proposed for predicting complications in pregnancy, complications in labor and birth outcome (normal birth, low birth weight, congenital malformations and fetal death). From the 1980 National Natality Survey and the 1980 National Fetal Mortality Survey, four sub-samples of married couples, with both husband and wife employed, were selected on the basis of one of the four birth outcomes. The model called for controlling a range of maternal intrinsic and extrinsic health and behavioral variables known to be related to birth outcomes. Multiple logistic regression procedures were used to analyze the effects of father's exposure to radiation and solvents on the job, to complications in pregnancy and labor, and to birth outcome, while controlling for maternal variables. The results indicated that none of the paternal variables were predictors of complications in labor. Further, there was no clear pattern of results, though father's degree of exposure to solvents, and exposures to radiation did reach significance in some analyses.« less

A Strategy for Assessing the Impact of Time-Varying Family Risk Factors on High School Dropout

ERIC Educational Resources Information Center

Randolph, Karen A.; Fraser, Mark W.; Orthner, Dennis K.

2006-01-01

Human behavior is dynamic, influenced by changing situations over time. Yet the impact of the dynamic nature of important explanatory variables on outcomes has only recently begun to be estimated in developmental models. Using a risk factor perspective, this article demonstrates the potential benefits of regressing time-varying outcome measures on…

Colorism and Educational Outcomes of Asian Americans: Evidence from the National Longitudinal Study of Adolescent Health

ERIC Educational Resources Information Center

Ryabov, Igor

2016-01-01

Using a nationally representative longitudinal data set, the current study examines the link between colorism and educational attainment of Asian American young adults. Three levels of educational attainment are used as outcomes: high school diploma, some college and a Bachelor's degree or higher. Independent variables include skin tone, ethnic…

The Impact of Managerial Coaching on Learning Outcomes within the Team Context: An Analysis

ERIC Educational Resources Information Center

Hagen, Marcia; Aguilar, Mariya Gavrilova

2012-01-01

This study investigates the relationship between coaching expertise, project difficulty, and team empowerment on team learning outcomes within the context of a high-performance work team. Variables were tested using multiple regression analysis. The data were analyzed for two groups--team leaders and team members--using t-tests, factor analysis,…

Risk adjustment for comparing hospital quality with surgery: how many variables are needed?

PubMed

Dimick, Justin B; Osborne, Nicholas H; Hall, Bruce L; Ko, Clifford Y; Birkmeyer, John D

2010-04-01

The American College of Surgeons' National Surgical Quality Improvement Program (ACS NSQIP) will soon be reporting procedure-specific outcomes, and hopes to reduce the burden of data collection by collecting fewer variables. We sought to determine whether these changes threaten the robustness of the risk adjustment of hospital quality comparisons. We used prospective, clinical data from the ACS NSQIP from 2005 to 2007 (184 hospitals, 74,887 patients). For the 5 general surgery operations in the procedure-specific NSQIP, we compared the ability of the full model (21 variables), an intermediate model (12 variables), and a limited model (5 variables) to predict patient outcomes and to risk-adjust hospital outcomes. The intermediate and limited models were comparable with the full model in all analyses. In the assessment of patient risk, the limited and full models had very similar discrimination at the patient level (C-indices for all 5 procedures combined of 0.93 versus 0.91 for mortality and 0.78 versus 0.76 for morbidity) and showed good calibration across strata of patient risk. In assessing hospital-specific outcomes, results from the limited and full-risk models were highly correlated for both mortality (range 0.94 to 0.99 across the 5 operations) and morbidity (range 0.96 to 0.99). Procedure-specific hospital quality measures can be adequately risk-adjusted with a limited number of variables. In the context of the ACS NSQIP, moving to a more limited model will dramatically reduce the burden of data collection for participating hospitals. Published by Elsevier Inc.

A comparison of two microscale laboratory reporting methods in a secondary chemistry classroom

NASA Astrophysics Data System (ADS)

Martinez, Lance Michael

This study attempted to determine if there was a difference between the laboratory achievement of students who used a modified reporting method and those who used traditional laboratory reporting. The study also determined the relationships between laboratory performance scores and the independent variables score on the Group Assessment of Logical Thinking (GALT) test, chronological age in months, gender, and ethnicity for each of the treatment groups. The study was conducted using 113 high school students who were enrolled in first-year general chemistry classes at Pueblo South High School in Colorado. The research design used was the quasi-experimental Nonequivalent Control Group Design. The statistical treatment consisted of the Multiple Regression Analysis and the Analysis of Covariance. Based on the GALT, students in the two groups were generally in the concrete and transitional stages of the Piagetian cognitive levels. The findings of the study revealed that the traditional and the modified methods of laboratory reporting did not have any effect on the laboratory performance outcome of the subjects. However, the students who used the traditional method of reporting showed a higher laboratory performance score when evaluation was conducted using the New Standards rubric recommended by the state. Multiple Regression Analysis revealed that there was a significant relationship between the criterion variable student laboratory performance outcome of individuals who employed traditional laboratory reporting methods and the composite set of predictor variables. On the contrary, there was no significant relationship between the criterion variable student laboratory performance outcome of individuals who employed modified laboratory reporting methods and the composite set of predictor variables.

Cigarette Smoking Outcomes at Four Years of Follow-Up, Psychosocial Factors, and Reactions to Group Intervention.

ERIC Educational Resources Information Center

Benfari, Robert C.; Eaker, Elaine

1984-01-01

Studied male smokers (N=182) at high risk of coronary heart disease to determine variables that discriminated between successful and nonsuccessful quitters. Analysis revealed that baseline level of smoking, life events, personal security, and selected group process variables were predictive of success or failure in the intervention program.…

Clinical Outcome Reporting in Youth ACL Literature Is Widely Variable

PubMed Central

Brusalis, Christopher M.; Lakomkin, Nikita; Suryavanshi, Joash R.; Cruz, Aristides I.; Green, Daniel W.; Jones, Kristofer J.; Fabricant, Peter D.

2017-01-01

Background: Advances in anterior cruciate ligament (ACL) reconstruction procedures in pediatric and adolescent patients have resulted in an increase in recent clinical studies on this topic. However, the consistency with which outcome measures are reported in this demographic is unknown. Purpose: To document outcome reporting patterns of youth ACL reconstruction studies in high-impact journals. Study Design: Systematic review; Level of evidence, 4. Methods: All articles published in 5 high-impact orthopaedic journals from 2010 to 2016 were reviewed to identify those reporting clinical outcomes of young patients who underwent ACL reconstruction. Studies that were nonclinical, reported on patients older than 18 years, or included fewer than 10 patients were excluded. Outcome measures used in all included studies were recorded. Results: Seventeen studies encompassing 772 subjects (mean age, 14.3 years; range, 6.3-18.0 years) were analyzed. Eight studies (47%) reported on Tanner stage of subjects, while 1 study reported skeletal age. Ten studies (59%) clearly documented the presence or absence of surgical complications. Range of motion was reported in 65% of studies. Leg-length discrepancy and angular deformity were each reported in 76% of studies, with 12% quantifying results through radiographic measurements. Ligament testing was variably defined by inclusion of instrumented testing (65%), Lachman test (53%), and pivot-shift test (53%). Fourteen studies (82%) explicitly reported on the rate of ACL rerupture, while 71% reported on the rate of revision surgery. Rate of return to preinjury activity was reported in 8 studies (47%), of which 2 defined criteria for return to sport and 3 defined the level of competitive sport. Patient-reported outcome measures (PROMs) were used variably. For the 3 most commonly reported PROMs (Lysholm, International Knee Documentation Committee, and Tegner), 24% of studies reported all 3 PROMs, 35% of studies reported 2 PROMs, and 6% of studies reported 1 PROM in isolation. A pediatric-specific PROM was reported in 1 of the 17 studies. Conclusion: Studies on pediatric ACL reconstruction published in high-impact journals unreliably defined subjects’ skeletal maturity, inconsistently reported on objective outcome measures, and used disparate adult-validated PROMs to assess subjective outcomes. These findings highlight the need for standardized, pediatric-specific outcome measures to be applied in future studies evaluating ACL reconstruction in children and adolescents. PMID:28840156

Greater temperature variability is not associated with a worse neurological outcome after cardiac arrest.

PubMed

Nobile, Leda; Lamanna, Irene; Fontana, Vito; Donadello, Katia; Dell'anna, Antonio Maria; Creteur, Jacques; Vincent, Jean-Louis; Pappalardo, Federico; Taccone, Fabio Silvio

2015-11-01

Spontaneous alterations in temperature homeostasis after cardiac arrest (CA) are associated with worse outcome. However, it remains unclear the prognostic role of temperature variability (TV) during cooling procedures. We hypothesized that low TV during targeted temperature management (TTM) would be associated with a favourable neurological outcome after CA. We reviewed data from all comatose patients after in-hospital or out-of-hospital CA admitted to our Department of Intensive Care between December 2006 and January 2014 who underwent TTM (32-34°C) and survived at least 24h. We collected demographic data, CA characteristics, intensive care unit (ICU) survival and neurological outcome at three months (favourable neurological outcome was defined as cerebral performance category 1-2). TV was expressed using the standard deviation (SD) of all temperature measurements during hypothermia; high TV was defined as an SD >1°C. Of the 301 patients admitted over the study period, 72 patients were excluded and a total of 229 patients were studied; 88 had a favourable neurological outcome. The median temperature on ICU admission was 35.8 [34.9-36.9]°C and the median time to hypothermia (body temperature <34°C), was 4 [3-7] h. Median TV was 0.9 [0.6-1.0]°C and 57 patients (25%) had high TV. In multivariable logistic regression, witnessed CA, ventricular fibrillation/tachycardia and previous neurological disease were independent risk factors for high TV. Younger age, bystander cardiopulmonary resuscitation, shorter time to return of spontaneous circulation, cardiac origin of arrest, shockable rhythm and longer time to target temperature were independent predictors of favourable neurological outcome, but TV was not. Among comatose survivors treated with TTM after CA, 25% of patients had high TV; however, this was not associated with a worse neurologic outcome. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Homework compliance counts in cognitive-behavioral therapy.

PubMed

Lebeau, Richard T; Davies, Carolyn D; Culver, Najwa C; Craske, Michelle G

2013-01-01

Prior research has demonstrated that there is some association between treatment engagement and treatment outcome in behavioral therapy for anxiety disorders. However, many of these investigations have been limited by weak measurement of treatment engagement variables, failure to control for potentially important baseline variables, and failure to consider various treatment engagement variables simultaneously. The purpose of the present study is to examine the relationship between two treatment engagement variables (treatment expectancy and homework compliance) and the extent to which they predict improvement from cognitive-behavioral therapy (CBT) for anxiety disorders. 84 adults with a DSM-IV-defined principal anxiety disorder took part in up to 12 sessions of CBT or acceptance and commitment therapy. Pre- and post-treatment disorder severity was assessed using clinical severity ratings from a semi-structured diagnostic interview. Participants made ratings of treatment expectancy after the first session. Homework compliance was assessed each session by the treating clinician. Contrary to hypotheses, treatment expectancy and homework compliance were poorly correlated. Regression analyses revealed that homework compliance, but not treatment expectancy, predicted a significant portion of the variance in treatment outcome (10%). The present research suggests that although treatment expectation and homework compliance likely represent unique constructs of treatment engagement, homework compliance may be the more important treatment engagement variable for outcomes. The present research suggests that improvement of homework compliance has the potential to be a highly practical and effective way to improve clinical outcomes in CBT targeting anxiety disorders.

Liver Transplantation for Fulminant Hepatic Failure

PubMed Central

Farmer, Douglas G.; Anselmo, Dean M.; Ghobrial, R. Mark; Yersiz, Hasan; McDiarmid, Suzanne V.; Cao, Carlos; Weaver, Michael; Figueroa, Jesus; Khan, Khurram; Vargas, Jorge; Saab, Sammy; Han, Steven; Durazo, Francisco; Goldstein, Leonard; Holt, Curtis; Busuttil, Ronald W.

2003-01-01

Objective To analyze outcomes after liver transplantation (LT) in patients with fulminant hepatic failure (FHF) with emphasis on pretransplant variables that can potentially help predict posttransplant outcome. Summary Background Data FHF is a formidable clinical problem associated with a high mortality rate. While LT is the treatment of choice for irreversible FHF, few investigations have examined pretransplant variables that can potentially predict outcome after LT. Methods A retrospective review was undertaken of all patients undergoing LT for FHF at a single transplant center. The median follow-up was 41 months. Thirty-five variables were analyzed by univariate and multivariate analysis to determine their impact on patient and graft survival. Results Two hundred four patients (60% female, median age 20.2 years) required urgent LT for FHF. Before LT, the majority of patients were comatose (76%), on hemodialysis (16%), and ICU-bound. The 1- and 5-year survival rates were 73% and 67% (patient) and 63% and 57% (graft). The primary cause of patient death was sepsis, and the primary cause of graft failure was primary graft nonfunction. Univariate analysis of pre-LT variables revealed that 19 variables predicted survival. From these results, multivariate analysis determined that the serum creatinine was the single most important prognosticator of patient survival. Conclusions This study, representing one of the largest published series on LT for FHF, demonstrates a long-term survival of nearly 70% and develops a clinically applicable and readily measurable set of pretransplant factors that determine posttransplant outcome. PMID:12724633

Multidisciplinary treatment in children with problematic severe asthma: A prospective evaluation.

PubMed

Verkleij, Marieke; Beelen, Anita; van Ewijk, Bart E; Geenen, Rinie

2017-05-01

For children with problematic severe asthma, achieving adequate control of asthma is difficult. The aim of this prospective observational study was to evaluate the effects of intensive multidisciplinary inpatient treatment on multiple outcome variables in children with problematic severe asthma. Participants were 89 children with problematic severe asthma (mean age 13.6 ± 2.5 years) treated in tertiary care clinics at high altitude (Switzerland) or sea level (Netherlands) and their parents (85 mothers, 55 fathers). The primary outcome variable was the Childhood Asthma Control Test (C-ACT). Other outcome variables were forced expiratory volume in 1 sec (FEV 1 ), fractional concentration of exhaled nitric oxide (FeNO), quality of life [PAQLQ(S)], children's coping (UCL-A), parents' report of behavioral problems (CBCL), and parenting stress (PSI/NOSI). Evaluations were taken pre-treatment, post-treatment, and 3-6 months follow-up. Median [P25;P75] treatment duration 74 [56;80] days; Median follow-up interval 131 [103;177] days. The percentages of children showing controlled asthma (C-ACT) were 18% (pre-treatment), 69% (post-treatment), and 44% (follow-up). The vast majority of the children (80%) showed an improvement on C-ACT with 4% showing a deterioration. On C-ACT, FeNO, quality of life, and behavioral problems, improvements at post-treatment were highly significant. Improvements generally remained at a functional level at follow-up. Children's coping and parenting stress in parents did not change. The improvement in asthma control and other outcome variables suggests that multidisciplinary inpatient treatment is an effective approach for a heterogeneous group of children with asthma that remained uncontrolled in secondary care. Pediatr Pulmonol. 2017;52:588-597. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.

PubMed

Baugh, Nancy; Harris, David E; Aboueissa, AbouEl-Makarim; Sarton, Cheryl; Lichter, Erika

2016-01-01

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

Use of social adaptability index to explain self-care and diabetes outcomes.

PubMed

Campbell, Jennifer A; Walker, Rebekah J; Smalls, Brittany L; Egede, Leonard E

2017-06-20

To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes. Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes. Separate models were run for each self-care behavior and outcome. Two models were run for each dependent variable to compare associations with the SAI and components of the index. The SAI has a significant association with the mental component of quality of life (0.23, p < 0.01). In adjusted analyses, the SAI score did not have a significant association with any of the self-care behaviors. Individual components from the index had significant associations between self-care and multiple SAI indicator variables. Significant associations also exist between outcomes and the individual SAI indicators for education and employment. In this population, the SAI has low explanatory power and few significant associations with diabetes self-care/outcomes. While the use of a composite index to predict outcomes within a diabetes population would have high utility, particularly for clinical settings, this SAI lacks statistical and clinical significance in a representative diabetes population. Based on these results, the index does not provide a good model fit and masks the relationship of individual components to diabetes self-care and outcomes. These findings suggest that five items alone are not adequate to explain or predict outcomes for patients with type 2 diabetes.

A Partial Least-Squares Analysis of Health-Related Quality-of-Life Outcomes After Aneurysmal Subarachnoid Hemorrhage.

PubMed

Young, Julia M; Morgan, Benjamin R; Mišić, Bratislav; Schweizer, Tom A; Ibrahim, George M; Macdonald, R Loch

2015-12-01

Individuals who have aneurysmal subarachnoid hemorrhages (SAHs) experience decreased health-related qualities of life (HRQoLs) that persist after the primary insult. To identify clinical variables that concurrently associate with HRQoL outcomes by using a partial least-squares approach, which has the distinct advantage of explaining multidimensional variance where predictor variables may be highly collinear. Data collected from the CONSCIOUS-1 trial was used to extract 29 clinical variables including SAH presentation, hospital procedures, and demographic information in addition to 5 HRQoL outcome variables for 256 individuals. A partial least-squares analysis was performed by calculating a heterogeneous correlation matrix and applying singular value decomposition to determine components that best represent the correlations between the 2 sets of variables. Bootstrapping was used to estimate statistical significance. The first 2 components accounting for 81.6% and 7.8% of the total variance revealed significant associations between clinical predictors and HRQoL outcomes. The first component identified associations between disability in self-care with longer durations of critical care stay, invasive intracranial monitoring, ventricular drain time, poorer clinical grade on presentation, greater amounts of cerebral spinal fluid drainage, and a history of hypertension. The second component identified associations between disability due to pain and discomfort as well as anxiety and depression with greater body mass index, abnormal heart rate, longer durations of deep sedation and critical care, and higher World Federation of Neurosurgical Societies and Hijdra scores. By applying a data-driven, multivariate approach, we identified robust associations between SAH clinical presentations and HRQoL outcomes. EQ-VAS, EuroQoL visual analog scaleHRQoL, health-related quality of lifeICU, intensive care unitIVH, intraventricular hemorrhagePLS, partial least squaresSAH, subarachnoid hemorrhageSVD, singular value decompositionWFNS, World Federation of Neurosurgical Societies.

Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults - a prospective cohort study

PubMed Central

2011-01-01

Background Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults. Methods The study group consisted of young adults 20-24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately. Results There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women. Conclusions High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility. PMID:21281471

Mobile phone use and stress, sleep disturbances, and symptoms of depression among young adults--a prospective cohort study.

PubMed

Thomée, Sara; Härenstam, Annika; Hagberg, Mats

2011-01-31

Because of the quick development and widespread use of mobile phones, and their vast effect on communication and interactions, it is important to study possible negative health effects of mobile phone exposure. The overall aim of this study was to investigate whether there are associations between psychosocial aspects of mobile phone use and mental health symptoms in a prospective cohort of young adults. The study group consisted of young adults 20-24 years old (n = 4156), who responded to a questionnaire at baseline and 1-year follow-up. Mobile phone exposure variables included frequency of use, but also more qualitative variables: demands on availability, perceived stressfulness of accessibility, being awakened at night by the mobile phone, and personal overuse of the mobile phone. Mental health outcomes included current stress, sleep disorders, and symptoms of depression. Prevalence ratios (PRs) were calculated for cross-sectional and prospective associations between exposure variables and mental health outcomes for men and women separately. There were cross-sectional associations between high compared to low mobile phone use and stress, sleep disturbances, and symptoms of depression for the men and women. When excluding respondents reporting mental health symptoms at baseline, high mobile phone use was associated with sleep disturbances and symptoms of depression for the men and symptoms of depression for the women at 1-year follow-up. All qualitative variables had cross-sectional associations with mental health outcomes. In prospective analysis, overuse was associated with stress and sleep disturbances for women, and high accessibility stress was associated with stress, sleep disturbances, and symptoms of depression for both men and women. High frequency of mobile phone use at baseline was a risk factor for mental health outcomes at 1-year follow-up among the young adults. The risk for reporting mental health symptoms at follow-up was greatest among those who had perceived accessibility via mobile phones to be stressful. Public health prevention strategies focusing on attitudes could include information and advice, helping young adults to set limits for their own and others' accessibility.

Outcomes assessment in rotator cuff pathology: what are we measuring?

PubMed

Makhni, Eric C; Steinhaus, Michael E; Morrow, Zachary S; Jobin, Charles M; Verma, Nikhil N; Cole, Brian J; Bach, Bernard R

2015-12-01

Assessments used to measure outcomes associated with rotator cuff pathology and after repair are varied. This lack of standardization leads to difficulty drawing comparisons across studies. We hypothesize that this variability in patient-reported outcome measures and objective metrics used in rotator cuff studies persists even in high-impact, peer reviewed journals. All studies assessing rotator cuff tear and repair outcomes in 6 orthopedic journals with a high impact factor from January 2010 to December 2014 were reviewed. Cadaveric and animal studies and those without outcomes were excluded. Outcome measures included range of motion (forward elevation, abduction, external rotation, and internal rotation), strength (in the same 4 planes), tendon integrity imaging, patient satisfaction, and functional assessment scores. Of the 156 included studies, 63% documented range of motion measurements, with 18% reporting range of motion in all 4 planes. Only 38% of studies reported quantitative strength measurements. In 65% of studies, tendon integrity was documented with imaging (38% magnetic resonance imaging/magnetic resonance anrhrogram, 31% ultrasound, and 8% computed tomography arthrogram). Finally, functional score reporting varied significantly, with the 5 most frequently reported scores ranging from 16% to 61% in studies, and 15 of the least reported outcomes were each reported in ≤6% of studies. Significant variability exists in outcomes reporting after rotator cuff tear and repair, making comparisons between clinical studies difficult. Creating a uniformly accepted, validated outcomes tool that assesses pain, function, patient satisfaction, and anatomic integrity would enable consistent outcomes assessment after operative and nonoperative management and allow comparisons across the literature. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Can aircraft noise less than or equal 115 to dBA adversely affect reproductive outcome in USAF women?

NASA Astrophysics Data System (ADS)

Brubaker, P. A.

1985-06-01

It has been suggested, mainly through animal studies, that exposure to high noise levels may be associated with lower birth weight, reduced gestational length and other adverse reproductive outcomes. Few studies have been done on humans to show this association. The Air Force employs pregnant women in areas where there is a high potential for exposure to high noise levels. This study proposes a method to determine if there is an association between high frequency noise levels or = 115 dBA and adverse reproductive outcomes through a review of records and self-administered questionnaires in a case-comparison design. Prevelance rates will be calculated and a multiple logistic regression analysis computed for the independent variables that can affect reproduction.

High interpatient variability of treosulfan exposure is associated with early toxicity in paediatric HSCT: a prospective multicentre study.

PubMed

van der Stoep, M Y Eileen C; Bertaina, Alice; Ten Brink, Marloes H; Bredius, Robbert G; Smiers, Frans J; Wanders, Dominique C M; Moes, Dirk Jan A R; Locatelli, Franco; Guchelaar, Henk-Jan; Zwaveling, Juliëtte; Lankester, Arjan C

2017-12-01

Treosulfan-based conditioning is increasingly employed in paediatric haematopoietic stem cell transplantation (HSCT). Data on treosulfan pharmacokinetics in children are scarce, and the relationship between treosulfan exposure, toxicity and clinical outcome is unresolved. In this multicentre prospective observational study, we studied treosulfan pharmacokinetics and the drug's relationship with regimen-related toxicity and early clinical outcome in 77 paediatric patients. Treosulfan dose was 30 g/m 2 , administered over 3 consecutive days in infants <1 year old (n = 12) and 42 g/m 2 in children ≥1 year old (n = 65). Mean day 1 treosulfan exposure was 1744 ± 795 mg*h/l (10 g/m 2 ) and 1561 ± 511 mg*h/l (14 g/m 2 ), with an inter-individual variability of 56 and 33% in the respective groups. High treosulfan exposure (>1650 mg*h/l) was associated with an increased risk of mucosal [Odds ratio (OR) 4·40; 95% confidence interval (CI) 1·19-16·28, P = 0·026] and skin toxicity (OR 4·51; 95% CI 1·07-18·93, P = 0·040). No correlation was found between treosulfan exposure and the early clinical outcome parameters: engraftment, acute graft-versus-host disease and donor chimerism. Our study provides the first evidence in a large cohort of paediatric patients of high variability in treosulfan pharmacokinetics and an association between treosulfan exposure and early toxicity. Ongoing studies will reveal whether treosulfan exposure is related to long-term disease-specific outcome and late treatment-related toxicity. © 2017 John Wiley & Sons Ltd.

Medicine and democracy: The importance of institutional quality in the relationship between health expenditure and health outcomes in the MENA region.

PubMed

Bousmah, Marwân-Al-Qays; Ventelou, Bruno; Abu-Zaineh, Mohammad

2016-08-01

Evidence suggests that the effect of health expenditure on health outcomes is highly context-specific and may be driven by other factors. We construct a panel dataset of 18 countries from the Middle East and North Africa region for the period 1995-2012. Panel data models are used to estimate the macro-level determinants of health outcomes. The core finding of the paper is that increasing health expenditure leads to health outcomes improvements only to the extent that the quality of institutions within a country is sufficiently high. The sensitivity of the results is assessed using various measures of health outcomes as well as institutional variables. Overall, it appears that increasing health care expenditure in the MENA region is a necessary but not sufficient condition for health outcomes improvements. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Predictors of Poor School Readiness in Children Without Developmental Delay at Age 2

PubMed Central

Dudovitz, Rebecca N.; Coker, Tumaini R.; Barnert, Elizabeth S.; Biely, Christopher; Li, Ning; Szilagyi, Peter G.; Larson, Kandyce; Halfon, Neal; Zimmerman, Frederick J.; Chung, Paul J.

2016-01-01

BACKGROUND AND OBJECTIVES: Current recommendations emphasize developmental screening and surveillance to identify developmental delays (DDs) for referral to early intervention (EI) services. Many young children without DDs, however, are at high risk for poor developmental and behavioral outcomes by school entry but are ineligible for EI. We developed models for 2-year-olds without DD that predict, at kindergarten entry, poor academic performance and high problem behaviors. METHODS: Data from the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), were used for this study. The analytic sample excluded children likely eligible for EI because of DDs or very low birth weight. Dependent variables included low academic scores and high problem behaviors at the kindergarten wave. Regression models were developed by using candidate predictors feasibly obtainable during typical 2-year well-child visits. Models were cross-validated internally on randomly selected subsamples. RESULTS: Approximately 24% of all 2-year-old children were ineligible for EI at 2 years of age but still had poor academic or behavioral outcomes at school entry. Prediction models each contain 9 variables, almost entirely parental, social, or economic. Four variables were associated with both academic and behavioral risk: parental education below bachelor’s degree, little/no shared reading at home, food insecurity, and fair/poor parental health. Areas under the receiver-operating characteristic curve were 0.76 for academic risk and 0.71 for behavioral risk. Adding the mental scale score from the Bayley Short Form–Research Edition did not improve areas under the receiver-operating characteristic curve for either model. CONCLUSIONS: Among children ineligible for EI services, a small set of clinically available variables at age 2 years predicted academic and behavioral outcomes at school entry. PMID:27432845

Developing from child to adult: Risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy.

PubMed

Geerlings, R P J; Aldenkamp, A P; Gottmer-Welschen, L M C; de With, P H N; Zinger, S; van Staa, A L; de Louw, A J A

2015-10-01

Childhood-onset epilepsy during the years of transition to adulthood may affect normal social, physical, and mental development, frequently leading to psychosocial and health-related problems in the long term. This study aimed to describe the main characteristics of patients in transition and to identify risk factors for poor psychosocial outcome in adolescents and young adults with epilepsy. Patients with epilepsy, 15-25years of age, who visited the Kempenhaeghe Epilepsy Transition Clinic from March 2012 to December 2014 were included (n=138). Predefined risk scores for medical, educational/occupational status, and independence/separation/identity were obtained, along with individual risk profile scores for poor psychosocial outcome. Multivariate linear regression analysis and discriminant analysis were used to identify variables associated with an increased risk of poor long-term psychosocial outcome. Demographic, epilepsy-related, and psychosocial variables associated with a high risk of poor long-term outcome were lower intelligence, higher seizure frequency, ongoing seizures, and an unsupportive and unstable family environment. Using the aforementioned factors in combination, we were able to correctly classify the majority (55.1%) of the patients regarding their risk of poor psychosocial outcome. Our analysis may allow early identification of patients at high risk of prevention, preferably at pretransition age. The combination of a chronic refractory epilepsy and an unstable family environment constitutes a higher risk of transition problems and poor outcome in adulthood. As a consequence, early interventions should be put into place to protect youth at risk of poor transition outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

Cerebral autoregulation in the preterm newborn using near-infrared spectroscopy: a comparison of time-domain and frequency-domain analyses

NASA Astrophysics Data System (ADS)

Eriksen, Vibeke R.; Hahn, Gitte H.; Greisen, Gorm

2015-03-01

The aim was to compare two conventional methods used to describe cerebral autoregulation (CA): frequency-domain analysis and time-domain analysis. We measured cerebral oxygenation (as a surrogate for cerebral blood flow) and mean arterial blood pressure (MAP) in 60 preterm infants. In the frequency domain, outcome variables were coherence and gain, whereas the cerebral oximetry index (COx) and the regression coefficient were the outcome variables in the time domain. Correlation between coherence and COx was poor. The disagreement between the two methods was due to the MAP and cerebral oxygenation signals being in counterphase in three cases. High gain and high coherence may arise spuriously when cerebral oxygenation decreases as MAP increases; hence, time-domain analysis appears to be a more robust-and simpler-method to describe CA.

Outcome Prediction in Mathematical Models of Immune Response to Infection.

PubMed

Mai, Manuel; Wang, Kun; Huber, Greg; Kirby, Michael; Shattuck, Mark D; O'Hern, Corey S

2015-01-01

Clinicians need to predict patient outcomes with high accuracy as early as possible after disease inception. In this manuscript, we show that patient-to-patient variability sets a fundamental limit on outcome prediction accuracy for a general class of mathematical models for the immune response to infection. However, accuracy can be increased at the expense of delayed prognosis. We investigate several systems of ordinary differential equations (ODEs) that model the host immune response to a pathogen load. Advantages of systems of ODEs for investigating the immune response to infection include the ability to collect data on large numbers of 'virtual patients', each with a given set of model parameters, and obtain many time points during the course of the infection. We implement patient-to-patient variability v in the ODE models by randomly selecting the model parameters from distributions with coefficients of variation v that are centered on physiological values. We use logistic regression with one-versus-all classification to predict the discrete steady-state outcomes of the system. We find that the prediction algorithm achieves near 100% accuracy for v = 0, and the accuracy decreases with increasing v for all ODE models studied. The fact that multiple steady-state outcomes can be obtained for a given initial condition, i.e. the basins of attraction overlap in the space of initial conditions, limits the prediction accuracy for v > 0. Increasing the elapsed time of the variables used to train and test the classifier, increases the prediction accuracy, while adding explicit external noise to the ODE models decreases the prediction accuracy. Our results quantify the competition between early prognosis and high prediction accuracy that is frequently encountered by clinicians.

Bilingualism: A Pearl to Overcome Certain Perils of Cochlear Implants

PubMed Central

Humphries, Tom; Kushalnagar, Poorna; Mathur, Gaurav; Napoli, Donna Jo; Padden, Carol; Rathmann, Christian; Smith, Scott

2014-01-01

Cochlear implants (CI) have demonstrated success in improving young deaf children’s speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children’s language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes. PMID:25419095

Admission glycemic variability correlates with in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome undergoing percutaneous coronary intervention

PubMed Central

Su, Gong; Zhang, Tao; Yang, Hongxia; Dai, Wenlong; Tian, Lei; Tao, Hong; Wang, Tao; Mi, Shuhua

2018-01-01

Objective The aim of this study is to evaluate the effects of admission glycemic variability (AGV) on in-hospital outcomes in diabetic patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI). Methods We studied 759 diabetic patients with NSTE-ACS undergoing PCI. AGV was accessed based on the mean amplitude of glycemic excursions (MAGEs) in the first 24 hours after admission. Primary outcome was a composite of in-hospital events, all-cause mortality, new-onset myocardial infarction, acute heart failure, and stroke. Secondary outcomes were each of these considered separately. Predictive effects of AGV on the in-hospital outcomes in patients were analyzed. Results Patients with high MAGE levels had significantly higher incidence of total outcomes (9.9% vs. 4.8%, p=0.009) and all-cause mortality (2.3% vs. 0.4%, p=0.023) than those with low MAGE levels during hospitalization. Multivariable analysis revealed that AGV was significantly associated with incidence of in-hospital outcomes (Odds ratio=2.024, 95% CI 1.105-3.704, p=0.022) but hemoglobin A1c (HbA1c) was not. In the receiver-operating characteristic curve analysis for MAGE and HbA1c in predicting in-hospital outcomes, the area under the curve for MAGE (0.608, p=0.012) was superior to that for HbA1c (0.556, p=0.193). Conclusion High AGV levels may be closely correlated with increased in-hospital poor outcomes in diabetic patients with NSTE-ACS following PCI. PMID:29848920

Age at disease onset and peak ammonium level rather than interventional variables predict the neurological outcome in urea cycle disorders.

PubMed

Posset, Roland; Garcia-Cazorla, Angeles; Valayannopoulos, Vassili; Teles, Elisa Leão; Dionisi-Vici, Carlo; Brassier, Anaïs; Burlina, Alberto B; Burgard, Peter; Cortès-Saladelafont, Elisenda; Dobbelaere, Dries; Couce, Maria L; Sykut-Cegielska, Jolanta; Häberle, Johannes; Lund, Allan M; Chakrapani, Anupam; Schiff, Manuel; Walter, John H; Zeman, Jiri; Vara, Roshni; Kölker, Stefan

2016-09-01

Patients with urea cycle disorders (UCDs) have an increased risk of neurological disease manifestation. Determining the effect of diagnostic and therapeutic interventions on the neurological outcome. Evaluation of baseline, regular follow-up and emergency visits of 456 UCD patients prospectively followed between 2011 and 2015 by the E-IMD patient registry. About two-thirds of UCD patients remained asymptomatic until age 12 days [i.e. the median age at diagnosis of patients identified by newborn screening (NBS)] suggesting a potential benefit of NBS. In fact, NBS lowered the age at diagnosis in patients with late onset of symptoms (>28 days), and a trend towards improved long-term neurological outcome was found for patients with argininosuccinate synthetase and lyase deficiency as well as argininemia identified by NBS. Three to 17 different drug combinations were used for maintenance therapy, but superiority of any single drug or specific drug combination above other combinations was not demonstrated. Importantly, non-interventional variables of disease severity, such as age at disease onset and peak ammonium level of the initial hyperammonemic crisis (cut-off level: 500 μmol/L) best predicted the neurological outcome. Promising results of NBS for late onset UCD patients are reported and should be re-evaluated in a larger and more advanced age group. However, non-interventional variables affect the neurological outcome of UCD patients. Available evidence-based guideline recommendations are currently heterogeneously implemented into practice, leading to a high variability of drug combinations that hamper our understanding of optimised long-term and emergency treatment.

National Efforts to Bring Reform to Scale in High-Poverty Schools: Outcomes and Implications

ERIC Educational Resources Information Center

Borman, Geoffrey D.

2005-01-01

Education in the United States is a decentralized system composed of highly variable practices, programs, and school contexts. The primary technology of education, teaching, is highly complex and is typically designed and implemented by teachers who have traditionally enjoyed a great deal of autonomy and independence from regular inspection. The…

Presence Relates to Distinct Outcomes in Two Virtual Environments Employing Different Learning Modalities

PubMed Central

Persky, Susan; Kaphingst, Kimberly A.; McCall, Cade; Lachance, Christina; Beall, Andrew C.; Blascovich, Jim

2009-01-01

Presence in virtual learning environments (VLEs) has been associated with a number of outcome factors related to a user’s ability and motivation to learn. The extant but relatively small body of research suggests that a high level of presence is related to better performance on learning outcomes in VLEs. Different configurations of form and content variables such as those associated with active (self-driven, interactive activities) versus didactic (reading or lecture) learning may, however, influence how presence operates and on what content it operates. We compared the influence of presence between two types of immersive VLEs (i.e., active versus didactic techniques) on comprehension and engagement-related outcomes. The findings revealed that the active VLE promoted greater presence. Although we found no relationship between presence and learning comprehension outcomes for either virtual environment, presence was related to information engagement variables in the didactic immersive VLE but not the active environment. Results demonstrate that presence is not uniformly elicited or effective across immersive VLEs. Educational delivery mode and environment complexity may influence the impact of presence on engagement. PMID:19366319

Presence relates to distinct outcomes in two virtual environments employing different learning modalities.

PubMed

Persky, Susan; Kaphingst, Kimberly A; McCall, Cade; Lachance, Christina; Beall, Andrew C; Blascovich, Jim

2009-06-01

Presence in virtual learning environments (VLEs) has been associated with a number of outcome factors related to a user's ability and motivation to learn. The extant but relatively small body of research suggests that a high level of presence is related to better performance on learning outcomes in VLEs. Different configurations of form and content variables such as those associated with active (self-driven, interactive activities) versus didactic (reading or lecture) learning may, however, influence how presence operates and on what content it operates. We compared the influence of presence between two types of immersive VLEs (i.e., active versus didactic techniques) on comprehension and engagement-related outcomes. The findings revealed that the active VLE promoted greater presence. Although we found no relationship between presence and learning comprehension outcomes for either virtual environment, presence was related to information engagement variables in the didactic immersive VLE but not the active environment. Results demonstrate that presence is not uniformly elicited or effective across immersive VLEs. Educational delivery mode and environment complexity may influence the impact of presence on engagement.

Visit-to-visit cholesterol variability correlates with coronary atheroma progression and clinical outcomes.

PubMed

Clark, Donald; Nicholls, Stephen J; St John, Julie; Elshazly, Mohamed B; Kapadia, Samir R; Tuzcu, E Murat; Nissen, Steven E; Puri, Rishi

2018-04-21

Utilizing serial intravascular ultrasonography (IVUS), we aimed to exam the association of intra-individual lipid variability, coronary atheroma progression, and clinical outcomes. We performed a post hoc patient-level analysis of nine clinical trials involving 4976 patients with coronary artery disease who underwent serial coronary IVUS in the setting of a range of medical therapies. We assessed the associations between progression in percent atheroma volume (ΔPAV), clinical outcomes, and visit-to-visit lipid variability including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, total cholesterol (TC)/HDL-C, and apolipoprotein B (ApoB). Variability of lipid parameters was measured using intra-individual standard deviation over 3, 6, 12, 18, and 24 months. Atherogenic lipoprotein variability significantly associated with ΔPAV [odds ratio (95% confidence interval; P-value), LDL-C: 1.09 (1.02, 1.17, P = 0.01); non-HDL-C: 1.10 (1.02, 1.18, P = 0.01); TC/HDL-C: 1.14 (1.06, 1.24, P = 0.001); ApoB: 1.13 (1.03, 1.24, P = 0.01)]. Survival curves revealed significant stepwise relationships between cumulative major adverse cardiovascular events and increasing quartiles of atherogenic lipoprotein variability at 24-months follow-up (log-rank P < 0.01 for all lipoproteins except HDL-C). Stronger associations were noted between achieved lipoprotein levels and ΔPAV [LDL-C: 1.27 (1.17, 1.39; P < 0.001); non-HDL-C: 1.32 (1.21, 1.45; P < 0.001); TC/HDL-C: 1.31 (1.19, 1.45; P < 0.001); ApoB: 1.20 (1.07, 1.35; P = 0.003)]. Greater visit-to-visit variability in atherogenic lipoprotein levels significantly associates with coronary atheroma progression and clinical outcomes, although the association between achieved atherogenic lipoproteins and atheroma progression appears stronger. These data highlight the importance of achieving low and consistent atherogenic lipoprotein levels to promote plaque regression and improve clinical outcomes.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010

PubMed Central

Sarton, Cheryl; Lichter, Erika

2016-01-01

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000–2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes. PMID:27747104

Early Adolescent Relationship Predictors of Emerging Adult Outcomes: Youth with and without Type 1 Diabetes

PubMed Central

Helgeson, Vicki S.; Palladino, Dianne K.; Reynolds, Kerry A.; Becker, Dorothy; Escobar, Oscar; Siminerio, Linda

2013-01-01

Background Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. Purpose To examine whether adolescents’ relationships with parents and friends predict health and risk behaviors during emerging adulthood. Method Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. Results Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. Conclusions Adolescent parent relationships remain an important influence on emerging adults’ lives. PMID:24178509

Employment outcome and predictors of competitive employment at 2-year follow-up of a vocational rehabilitation programme for individuals with schizophrenia in a high-income welfare society.

PubMed

Evensen, Stig; Ueland, Torill; Lystad, June Ullevoldsæter; Bull, Helen; Klungsøyr, Ole; Martinsen, Egil W; Falkum, Erik

2017-04-01

Employment is an important part of recovery for individuals with schizophrenia. The employment rate for this group is as low as 10% in Norway, and major system related barriers to employment are evident. This study reports the competitive employment outcome at 2-year follow-up of a vocational rehabilitation study augmented with cognitive remediation (CR) or elements from cognitive behaviour therapy (CBT) for individuals with schizophrenia spectrum disorders. It also investigates if global functioning, self-esteem, and depression at baseline predicts employment outcome, and if change in these variables during the intervention period is associated with employment outcome. One hundred and forty-eight participants with schizophrenia spectrum disorders in six Norwegian counties received 10 months vocational rehabilitation augmented with either CBT (n = 84) or CR (n = 64). Both competitive and sheltered workplaces were used. Participants were assessed at baseline, at the end of the intervention period, and at 2-year follow-up. At 2-year follow-up, 21.2% had obtained competitive employment. A further 25.3% had work placements in competitive workplaces. Significant improvements were found in global functioning, self-esteem, and depression during the intervention period, but no significant differences between the two intervention groups. High baseline global functioning and self-esteem, as well as positive change in these variables during the intervention period, were significantly associated with higher competitive employment outcome at 2-year follow-up. The results add to existing evidence that competitive employment is attainable for individuals with schizophrenia. High global functioning and self-esteem were strongly associated with competitive employment outcome.

Short-term stability of sleep and heart rate variability in good sleepers and patients with insomnia: for some measures, one night is enough.

PubMed

Israel, Benjamin; Buysse, Daniel J; Krafty, Robert T; Begley, Amy; Miewald, Jean; Hall, Martica

2012-09-01

Quantify the short-term stability of multiple indices of sleep and nocturnal physiology in good sleeper controls and primary insomnia patients. Intra-class correlation coefficients (ICC) were used to quantify the short-term stability of study outcomes. Sleep laboratory. Fifty-four adults with primary insomnia (PI) and 22 good sleeper controls (GSC). Visually scored sleep outcomes included indices of sleep duration, continuity, and architecture. Quantitative EEG outcomes included power in the delta, theta, alpha, sigma, and beta bands during NREM sleep. Power spectral analysis was used to estimate high-frequency heart rate variability (HRV) and the ratio of low- to high-frequency HRV power during NREM and REM sleep. With the exception of percent stage 3+4 sleep; visually scored sleep outcomes did not exhibit short-term stability across study nights. Most QEEG outcomes demonstrated short-term stability in both groups. Although power in the beta band was stable in the PI group (ICC = 0.75), it tended to be less stable in GSCs (ICC = 0.55). Both measures of cardiac autonomic tone exhibited short-term stability in GSCs and PIs during NREM and REM sleep. Most QEEG bandwidths and HRV during sleep show high short-term stability in good sleepers and patients with insomnia alike. One night of data is, thus, sufficient to derive reliable estimates of these outcomes in studies focused on group differences or correlates of QEEG and/or HRV. In contrast, one night of data is unlikely to generate reliable estimates of PSG-assessed sleep duration, continuity or architecture, with the exception of slow wave sleep.

Monitoring of Intracranial Pressure in Meningitis.

PubMed

Depreitere, Bart; Bruyninckx, Dominike; Güiza, Fabian

2016-01-01

The literature on intracranial pressure (ICP) monitoring in meningitis is limited to case reports and a handful of descriptive series. The aim of this study is to investigate relationships among ICP, cerebral perfusion pressure (CPP), and outcome in meningitis and to identify whether ICP affected clinical decisions. Between 1999 and 2011, a total of 17 patients with meningitis underwent ICP monitoring at the University Hospitals Leuven. Charts were reviewed for clinical history, ICP/CPP data, imaging findings, and Glasgow Outcome Scale score. Univariate correlations were computed for outcome and ICP/CPP variables, computed tomography characteristics, and Corticosteroid Randomization After Significant Head Injury outcome model variables. Treatment decisions were assessed regarding whether or not they were based on ICP. At drain placement, Glasgow Coma Scale scores showed a median of 8 (range 3-12). Six of 17 patients had either one or two nonreactive pupils. Significant correlations with outcome were found for the highest documented ICP value (r = -0.70), the number of episodes when CPP <50 mmHg (r =-0.50), the lowest documented CPP value (r = 0.61), and pupil reactivity (r = 0.57). Treatment was influenced by ICP in all patients. The results support the notion that in meningitis high ICP and low CPP represent secondary insults. The poor condition of the patients illustrates that the level of suspicion for increased ICP in meningitis may not be high enough.

Between-centre variability in transfer function analysis, a widely used method for linear quantification of the dynamic pressure–flow relation: The CARNet study

PubMed Central

Meel-van den Abeelen, Aisha S.S.; Simpson, David M.; Wang, Lotte J.Y.; Slump, Cornelis H.; Zhang, Rong; Tarumi, Takashi; Rickards, Caroline A.; Payne, Stephen; Mitsis, Georgios D.; Kostoglou, Kyriaki; Marmarelis, Vasilis; Shin, Dae; Tzeng, Yu-Chieh; Ainslie, Philip N.; Gommer, Erik; Müller, Martin; Dorado, Alexander C.; Smielewski, Peter; Yelicich, Bernardo; Puppo, Corina; Liu, Xiuyun; Czosnyka, Marek; Wang, Cheng-Yen; Novak, Vera; Panerai, Ronney B.; Claassen, Jurgen A.H.R.

2014-01-01

Transfer function analysis (TFA) is a frequently used method to assess dynamic cerebral autoregulation (CA) using spontaneous oscillations in blood pressure (BP) and cerebral blood flow velocity (CBFV). However, controversies and variations exist in how research groups utilise TFA, causing high variability in interpretation. The objective of this study was to evaluate between-centre variability in TFA outcome metrics. 15 centres analysed the same 70 BP and CBFV datasets from healthy subjects (n = 50 rest; n = 20 during hypercapnia); 10 additional datasets were computer-generated. Each centre used their in-house TFA methods; however, certain parameters were specified to reduce a priori between-centre variability. Hypercapnia was used to assess discriminatory performance and synthetic data to evaluate effects of parameter settings. Results were analysed using the Mann–Whitney test and logistic regression. A large non-homogeneous variation was found in TFA outcome metrics between the centres. Logistic regression demonstrated that 11 centres were able to distinguish between normal and impaired CA with an AUC > 0.85. Further analysis identified TFA settings that are associated with large variation in outcome measures. These results indicate the need for standardisation of TFA settings in order to reduce between-centre variability and to allow accurate comparison between studies. Suggestions on optimal signal processing methods are proposed. PMID:24725709

Temperature variability during targeted temperature management is not associated with neurological outcomes following cardiac arrest.

PubMed

Nayeri, Arash; Bhatia, Nirmanmoh; Holmes, Benjamin; Borges, Nyal; Armstrong, William; Xu, Meng; Farber-Eger, Eric; Wells, Quinn S; McPherson, John A

2017-06-01

Recent studies on comatose survivors of cardiac arrest undergoing targeted temperature management (TTM) have shown similar outcomes at multiple target temperatures. However, details regarding core temperature variability during TTM and its prognostic implications remain largely unknown. We sought to assess the association between core temperature variability and neurological outcomes in patients undergoing TTM following cardiac arrest. We analyzed a prospectively collected cohort of 242 patients treated with TTM following cardiac arrest at a tertiary care hospital between 2007 and 2014. Core temperature variability was defined as the statistical variance (i.e. standard deviation squared) amongst all core temperature recordings during the maintenance phase of TTM. Poor neurological outcome at hospital discharge, defined as a Cerebral Performance Category (CPC) score>2, was the primary outcome. Death prior to hospital discharge was assessed as the secondary outcome. Multivariable logistic regression was used to examine the association between temperature variability and neurological outcome or death at hospital discharge. A poor neurological outcome was observed in 147 (61%) patients and 136 (56%) patients died prior to hospital discharge. In multivariable logistic regression, increased core temperature variability was not associated with increased odds of poor neurological outcomes (OR 0.38, 95% CI 0.11-1.38, p=0.142) or death (OR 0.43, 95% CI 0.12-1.53, p=0.193) at hospital discharge. In this study, individual core temperature variability during TTM was not associated with poor neurological outcomes or death at hospital discharge. Copyright © 2017 Elsevier Inc. All rights reserved.

Instrumental Variable Analysis with a Nonlinear Exposure–Outcome Relationship

PubMed Central

Davies, Neil M.; Thompson, Simon G.

2014-01-01

Background: Instrumental variable methods can estimate the causal effect of an exposure on an outcome using observational data. Many instrumental variable methods assume that the exposure–outcome relation is linear, but in practice this assumption is often in doubt, or perhaps the shape of the relation is a target for investigation. We investigate this issue in the context of Mendelian randomization, the use of genetic variants as instrumental variables. Methods: Using simulations, we demonstrate the performance of a simple linear instrumental variable method when the true shape of the exposure–outcome relation is not linear. We also present a novel method for estimating the effect of the exposure on the outcome within strata of the exposure distribution. This enables the estimation of localized average causal effects within quantile groups of the exposure or as a continuous function of the exposure using a sliding window approach. Results: Our simulations suggest that linear instrumental variable estimates approximate a population-averaged causal effect. This is the average difference in the outcome if the exposure for every individual in the population is increased by a fixed amount. Estimates of localized average causal effects reveal the shape of the exposure–outcome relation for a variety of models. These methods are used to investigate the relations between body mass index and a range of cardiovascular risk factors. Conclusions: Nonlinear exposure–outcome relations should not be a barrier to instrumental variable analyses. When the exposure–outcome relation is not linear, either a population-averaged causal effect or the shape of the exposure–outcome relation can be estimated. PMID:25166881

Predictors of outcome and methodological issues in children with acute lymphoblastic leukaemia in El Salvador.

PubMed

Bonilla, Miguel; Gupta, Sumit; Vasquez, Roberto; Fuentes, Soad L; deReyes, Gladis; Ribeiro, Raul; Sung, Lillian

2010-12-01

Most children with cancer live in low-income countries (LICs) where risk factors in paediatric acute lymphoblastic leukaemia (ALL) developed in high-income countries may not apply. We describe predictors of survival for children in El Salvador with ALL. We included patients <16 years diagnosed with ALL between January 2001 and July 2007 treated with the El Salvador-Guatemala-Honduras II protocol. Demographic, disease-related, socioeconomic and nutritional variables were examined as potential predictors of event-free survival (EFS) and overall survival (OS). 260/443 patients (58.7%) were classified as standard risk. Standard- and high-risk 5-year EFS were 56.3 ± 4.5% and 48.6 ± 5.5%; 5-year OS were 77.7 ± 3.8% and 61.9 ± 5.8%, respectively. Among standard-risk children, socioeconomic variables such as higher monthly income (hazard ratio [HR] per $100 = 0.84 [95% confidence interval (CI) 0.70-0.99; P=0.04]) and parental secondary education (HR = 0.49, 95% CI 0.29-0.84; P = 0.01) were associated with better EFS. Among high-risk children, higher initial white blood cell (HR per 10×10(9)/L = 1.03, 95% CI 1.02-1.05; P<0.001) predicted worse EFS; socioeconomic variables were not predictive. The difference in EFS and OS appeared related to overestimating OS secondary to poor follow-up after abandonment/relapse. Socioeconomic variables predicted worse EFS in standard-risk children while disease-related variables were predictive in high-risk patients. Further studies should delineate pathways through which socioeconomic status affects EFS in order to design effective interventions. EFS should be the primary outcome in LIC studies. Copyright © 2010 Elsevier Ltd. All rights reserved.

Femoral Access PCI in a Default Radial Center Identifies High-Risk Patients With Poor Outcomes.

PubMed

Uddin, Muezz; Bundhoo, Shantu; Mitra, Rito; Ossei-Gerning, Nicholas; Morris, Keith; Anderson, Richard; Kinnaird, Tim

2015-10-01

Increasingly the trans-radial route (TRR) is preferred over the trans-femoral route (TFR) for PCI. However, even in high volume default TRR centers a cohort of patients undergo TFR PCI. We examined the demographics, procedural characteristics, and outcomes of patients undergoing PCI via the TF. The patient demographics, procedural data, and outcomes of 5,379 consecutive patients undergoing PCI at a default radial center between 2009 and 2012 were examined. Major bleeding (MB) was classified by ACUITY and BARC definitions. A total of 559 (10.4%) patients underwent PCI via the TFR and 4,820 patients via the TRR (89.6%). Baseline variables associated with TFR were shock, previous CABG, chronic total occlusion intervention, rotablation/laser use, female sex, and renal failure. Sixty-five patients of the TFR cohort (11.6%) experienced MB with 27 (41.5%) being access site related. MB was significantly more frequent than in the radial cohort. The variables independently associated with MB in the TFR cohort were renal failure, acute presentation, shock, and age. In the TFR, patients with MB mortality was high at 30 days (17.2% vs 2.6% for no MB, P < 0.0001) and at 1 year (37.6% vs 5.0%, P < 0.0001). Shock and MB were highly predictive of 30 day and 12 month mortality. In a default radial PCI center 10% of patients undergo PCI via the femoral artery. These patients have high baseline bleeding risk and undergo complex interventions. As a result the incidence of major bleeding, transfusion and death are high. Alternative strategies are required to optimize outcomes in this select group. © 2015, Wiley Periodicals, Inc.

Functional variability of habitats within the Sacramento-San Joaquin Delta: Restoration implications

USGS Publications Warehouse

Lucas, L.V.; Cloern, J.E.; Thompson, J.K.; Monsen, N.E.

2002-01-01

We have now entered an era of large-scale attempts to restore ecological functions and biological communities in impaired ecosystems. Our knowledge base of complex ecosystems and interrelated functions is limited, so the outcomes of specific restoration actions are highly uncertain. One approach for exploring that uncertainty and anticipating the range of possible restoration outcomes is comparative study of existing habitats similar to future habitats slated for construction. Here we compare two examples of one habitat type targeted for restoration in the Sacramento-San Joaquin River Delta. We compare one critical ecological function provided by these shallow tidal habitats - production and distribution of phytoplankton biomass as the food supply to pelagic consumers. We measured spatial and short-term temporal variability of phytoplankton biomass and growth rate and quantified the hydrodynamic and biological processes governing that variability. Results show that the production and distribution of phytoplankton biomass can be highly variable within and between nearby habitats of the same type, due to variations in phytoplankton sources, sinks, and transport. Therefore, superficially similar, geographically proximate habitats can function very differently, and that functional variability introduces large uncertainties into the restoration process. Comparative study of existing habitats is one way ecosystem science can elucidate and potentially minimize restoration uncertainties, by identifying processes shaping habitat functionality, including those that can be controlled in the restoration design.

The distribution of outcomes research papers across clinical journals.

PubMed

Goldsack, Jennifer; McLaughlin, Chris; Bristol, Mirar N; Loeb, Alex; Bergey, Meredith; Sonnad, Seema S

2011-06-01

This study examines the distribution of health outcomes research (HOR) studies in the clinical literature by clinical areas and journal impact factor. The authors reviewed 535 journals and divided the sample into higher and lower impact journals across four clinical area. Mann-Whitney and Kruskal-Wallis tests were used to examine differences across four categories of outcomes research articles published, specifically the incidence of articles in higher versus lower impact journals and differences across clinical areas. All high-impact journals published more safety and quality articles than process assessment, quality of life, or cost analysis studies. The number of each type of outcomes research study published was highly variable across all clinical areas. Only arthritis and outcomes research journals showed statistically significant differences between higher versus lower impact journals. Authors may benefit from considering these differences in their clinical specialty area when deciding where to submit HOR studies.

Role of Body Mass Index and Gestational Weight Gain in Breastfeeding Outcomes

PubMed Central

Schaefer, Eric W.; Beiler, Jessica S.; Paul, Ian M.

2012-01-01

Abstract Objective This study determined whether high maternal prepregnancy body mass index (BMI) and/or excess gestational weight gain (GWG) is associated with reduced breastfeeding duration and earlier formula supplementation. Study Design A prospective longitudinal cohort of postpartum women (n=718), who were a subset of a larger randomized trial, was followed for 6 months postdelivery. We evaluated the relationship between BMI or BMI/GWG groups and timing of breastfeeding cessation and introduction of formula using Kaplan–Meier curves and log-rank tests. Then, we used multivariable Cox proportional hazards models to evaluate the relationship between BMI and BMI/GWG on these breastfeeding outcomes after controlling for potential confounding variables. Results The expected relationships between high BMI and high BMI/GWG and poor breastfeeding outcomes were observed in Kaplan–Meier curves. However, after adjusting for relevant maternal and infant covariates in the Cox models, the differences became nonsignificant. Prepregnancy BMI category was not statistically associated with breastfeeding duration (p=0.06) or timing of formula introduction (p=0.15). Similarly, BMI and GWG in combination were not associated with duration (p=0.33) or timing of formula introduction (p=0.18). Mothers' intended breastfeeding duration and rating of the importance of breastfeeding remained the only significant modifiable predictors of breastfeeding outcomes in the final models. Conclusions Maternal BMI and GWG were not significantly associated with breastfeeding outcomes after adjusting for confounding variables. Mothers' plans for breastfeeding duration and the importance mothers assign to breastfeeding remain the optimal intervention points for lengthening breastfeeding duration and reducing formula supplementation. PMID:23215909

[Predicting the outcome in severe injuries: an analysis of 2069 patients from the trauma register of the German Society of Traumatology (DGU)].

PubMed

Rixen, D; Raum, M; Bouillon, B; Schlosser, L E; Neugebauer, E

2001-03-01

On hospital admission numerous variables are documented from multiple trauma patients. The value of these variables to predict outcome are discussed controversially. The aim was the ability to initially determine the probability of death of multiple trauma patients. Thus, a multivariate probability model was developed based on data obtained from the trauma registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU). On hospital admission the DGU trauma registry collects more than 30 variables prospectively. In the first step of analysis those variables were selected, that were assumed to be clinical predictors for outcome from literature. In a second step a univariate analysis of these variables was performed. For all primary variables with univariate significance in outcome prediction a multivariate logistic regression was performed in the third step and a multivariate prognostic model was developed. 2069 patients from 20 hospitals were prospectively included in the trauma registry from 01.01.1993-31.12.1997 (age 39 +/- 19 years; 70.0% males; ISS 22 +/- 13; 18.6% lethality). From more than 30 initially documented variables, the age, the GCS, the ISS, the base excess (BE) and the prothrombin time were the most important prognostic factors to predict the probability of death (P(death)). The following prognostic model was developed: P(death) = 1/1 + e(-[k + beta 1(age) + beta 2(GCS) + beta 3(ISS) + beta 4(BE) + beta 5(prothrombin time)]) where: k = -0.1551, beta 1 = 0.0438 with p < 0.0001, beta 2 = -0.2067 with p < 0.0001, beta 3 = 0.0252 with p = 0.0071, beta 4 = -0.0840 with p < 0.0001 and beta 5 = -0.0359 with p < 0.0001. Each of the five variables contributed significantly to the multifactorial model. These data show that the age, GCS, ISS, base excess and prothrombin time are potentially important predictors to initially identify multiple trauma patients with a high risk of lethality. With the base excess and prothrombin time value, as only variables of this multifactorial model that can be therapeutically influenced, it might be possible to better guide early and aggressive therapy.

Using social cognitive theory to explain discretionary, "leisure-time" physical exercise among high school students.

PubMed

Winters, Eric R; Petosa, Rick L; Charlton, Thomas E

2003-06-01

To examine whether knowledge of high school students' actions of self-regulation, and perceptions of self-efficacy to overcome exercise barriers, social situation, and outcome expectation will predict non-school related moderate and vigorous physical exercise. High school students enrolled in introductory Physical Education courses completed questionnaires that targeted selected Social Cognitive Theory variables. They also self-reported their typical "leisure-time" exercise participation using a standardized questionnaire. Bivariate correlation statistic and hierarchical regression were conducted on reports of moderate and vigorous exercise frequency. Each predictor variable was significantly associated with measures of moderate and vigorous exercise frequency. All predictor variables were significant in the final regression model used to explain vigorous exercise. After controlling for the effects of gender, the psychosocial variables explained 29% of variance in vigorous exercise frequency. Three of four predictor variables were significant in the final regression equation used to explain moderate exercise. The final regression equation accounted for 11% of variance in moderate exercise frequency. Professionals who attempt to increase the prevalence of physical exercise through educational methods should focus on the psychosocial variables utilized in this study.

Body Dissatisfaction Among Sexual Minority Men: Psychological and Sexual Health Outcomes.

PubMed

Blashill, Aaron J; Tomassilli, Julia; Biello, Katie; O'Cleirigh, Conall; Safren, Steven A; Mayer, Kenneth H

2016-07-01

Body dissatisfaction is common among sexual minority (i.e., gay and bisexual) men; however, few studies have investigated the relationship between body dissatisfaction and psychosexual health variables among this population. The data that do exist are exclusively cross-sectional, casting uncertainty regarding temporal associations. Thus, the aims of the current study were to assess the prospective relationship between body dissatisfaction and psychological and sexual health outcomes. Participants were 131 gay and bisexual men who completed a battery of self-report measures across two time points (baseline and 3-month follow-up), including assessment of body dissatisfaction, depressive symptoms, and sexual health variables (sexual self-efficacy and sexual anxiety). Generalized linear modeling was employed to assess the prospective relationship between body dissatisfaction and outcomes variables, accounting for non-normal distributions. Body dissatisfaction significantly predicted elevated depressive symptoms (B = .21, p = .01), lower sexual self-efficacy (B = -.22, p = .04), and elevated sexual anxiety (B = .05, p = .03). Elevated body dissatisfaction is prospectively associated with negative psychological and sexual health outcomes. Given the high prevalence of body image concerns in sexual minority men, depression and/or HIV/STI prevention programs may benefit from routinely assessing for body dissatisfaction among this population, and addressing those who report concerns.

Incidence and Outcomes of Dating Violence Victimization Among High School Youth: The Role of Gender and Sexual Orientation.

PubMed

Edwards, Katie M

2018-05-01

The purpose of this study was to examine rates of dating violence (DV) victimization and DV victimization outcomes as a function of sex and sexual orientation. Participants were 25,122 high school students who participated in the 2013 New Hampshire Youth Risk Behavior Survey study. Heterosexual youth, especially heterosexual male youth, were less likely to report experiencing physical and sexual DV victimization than lesbian, gay, bisexual, and questioning (LGBQ) girls and boys. Among LGBQ girls and boys, there was little variability in rates of DV victimization with the exception of questioning boys being significantly more likely to experience physical and sexual DV victimization than several other LGBQ sub-groups. Furthermore, LGBQ DV victims reported worse outcomes than heterosexual DV victims on measures of depression, binge drinking, and poor academic performance. At the sub-group level, bisexual and questioning female victims were most at risk for depression; bisexual and questioning male victims were most at risk for binge drinking; bisexual male victims were most at risk for poor academic performance. The findings underscore the importance of better understanding variability in DV incidence and outcomes within the LGBQ population and using this information to inform clinical intervention and prevention efforts.

The effects and interactions of student, teacher, and setting variables on reading outcomes for kindergartners receiving supplemental reading intervention.

PubMed

Hagan-Burke, Shanna; Coyne, Michael D; Kwok, Oi-Man; Simmons, Deborah C; Kim, Minjung; Simmons, Leslie E; Skidmore, Susan T; Hernandez, Caitlin L; McSparran Ruby, Maureen

2013-01-01

This exploratory study examined the influences of student, teacher, and setting characteristics on kindergarteners' early reading outcomes and investigated whether those relations were moderated by type of intervention. Participants included 206 kindergarteners identified as at risk for reading difficulties and randomly assigned to one of two supplemental interventions: (a) an experimental explicit, systematic, code-based program or (b) their schools' typical kindergarten reading intervention. Results from separate multilevel structural equation models indicated that among student variables, entry-level alphabet knowledge was positively associated with phonemic and decoding outcomes in both conditions. Entry-level rapid automatized naming also positively influenced decoding outcomes in both conditions. However, its effect on phonemic outcomes was statistically significant only among children in the typical practice comparison condition. Regarding teacher variables, the quality of instruction was associated with significantly higher decoding outcomes in the typical reading intervention condition but had no statistically significant influence on phonemic outcomes in either condition. Among setting variables, instruction in smaller group sizes was associated with better phonemic outcomes in the comparison condition but had no statistically significant influence on outcomes of children in the intervention group. Mode of delivery (i.e., pullout vs. in class) had no statistically significant influence on either outcome variable.

Research into Factors Contributing to Discipline Use and Disproportionality in Major Urban Schools

ERIC Educational Resources Information Center

Mcloughlin, Caven S.; Noltemeyer, Amity L.

2010-01-01

Compared to other school typologies, major urban high poverty schools more frequently use exclusionary discipline and apply these techniques disproportionately to African American students. We explored school demographic variables predicting these two outcomes using data from 440 major urban, high poverty schools. Results suggest a different set…

Early Critical Care Decisions and Outcomes after SCI: Track-SCI

DTIC Science & Technology

2017-09-01

Integrated Machine Learning Algorithms Can Predict Neurologic Impairment in Acute Spinal Cord Injury. American Roentgen Ray Society Annual Meeting...related to AIS at discharge. MCC, MSCC, and TLICS also loaded positively on PC2 (22.7% of variance), while variables concerning cord signal abnormality ...loaded negatively on PC2. PC2 was highly related to the patient undergoing surgical decompression. Variables of signal abnormality were all negatively

Functional Analysis of Problem Behavior: A Systematic Approach for Identifying Idiosyncratic Variables

PubMed Central

Roscoe, Eileen M.; Schlichenmeyer, Kevin J.; Dube, William V.

2015-01-01

When inconclusive functional analysis (FA) outcomes occur, a number of modifications have been made to enhance the putative establishing operation or consequence associated with behavioral maintenance. However, a systematic method for identifying relevant events to test during modified FAs has not been evaluated. The purpose of this study was to develop and evaluate a technology for systematically identifying events to test in a modified FA after an initial FA led to inconclusive outcomes. Six individuals whose initial FA showed little or no responding or high levels only in the control condition participated. An indirect assessment (IA) questionnaire developed for identifying idiosyncratic variables was administered, and a descriptive analysis (DA) was conducted. Results from the IA only or a combination of the IA and DA were used to inform modified FA test and control conditions. Conclusive FA outcomes were obtained with five of the six participants during the modified FA phase. PMID:25930176

A note about high blood pressure in childhood

NASA Astrophysics Data System (ADS)

Teodoro, M. Filomena; Simão, Carla

2017-06-01

In medical, behavioral and social sciences it is usual to get a binary outcome. In the present work is collected information where some of the outcomes are binary variables (1='yes'/ 0='no'). In [14] a preliminary study about the caregivers perception of pediatric hypertension was introduced. An experimental questionnaire was designed to be answered by the caregivers of routine pediatric consultation attendees in the Santa Maria's hospital (HSM). The collected data was statistically analyzed, where a descriptive analysis and a predictive model were performed. Significant relations between some socio-demographic variables and the assessed knowledge were obtained. In [14] can be found a statistical data analysis using partial questionnaire's information. The present article completes the statistical approach estimating a model for relevant remaining questions of questionnaire by Generalized Linear Models (GLM). Exploring the binary outcome issue, we intend to extend this approach using Generalized Linear Mixed Models (GLMM), but the process is still ongoing.

An evaluation of an abstinence education curriculum series: sex can wait.

PubMed

Denny, George; Young, Michael; Rausch, Susan; Spear, Caile

2002-01-01

To examine the effects of an abstinence education curriculum series on student outcomes. The series was taught at upper elementary, junior high, and high school levels. A questionnaire was administered to all intervention and comparison students before and after implementation of the curriculum. At the upper elementary level, the curriculum group had better outcomes on knowledge, self-efficacy, and a more hopeful outlook; at the middle school level no differences; at the high school level, findings favored the curriculum group on attitude, behavioral intent, and sexual behavior variables. Results are encouraging and should be considered by those interested in helping young people postpone sexual involvement.

Non-traditional Serum Lipid Variables and Recurrent Stroke Risk

PubMed Central

Park, Jong-Ho; Lee, Juneyoung; Ovbiagele, Bruce

2014-01-01

Background and Purpose Expert consensus guidelines recommend low-density lipoprotein cholesterol (LDL-C) as the primary serum lipid target for recurrent stroke risk reduction. However, mounting evidence suggests that other lipid parameters might be additional therapeutic targets or at least also predict cardiovascular risk. Little is known about the effects of non-traditional lipid variables on recurrent stroke risk. Methods We analyzed the Vitamin Intervention for Stroke Prevention study database comprising 3680 recent (<120 days) ischemic stroke patients followed up for 2 years. Independent associations of baseline serum lipid variables with recurrent ischemic stroke (primary outcome) and the composite endpoint of ischemic stroke/coronary heart disease (CHD)/vascular death (secondary outcomes) were assessed. Results Of all variables evaluated, only triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio was consistently and independently related to both outcomes: compared with the lowest quintile, the highest TG/HDL-C ratio quintile was associated with stroke (adjusted hazard ratio, 1.56; 95% CI, 1.05−2.32) and stroke/CHD/vascular death (1.39; 1.05−1.83), including adjustment for lipid modifier use. Compared with the lowest quintile, the highest total cholesterol/HDL-C ratio quintile was associated with stroke/CHD/vascular death (1.45; 1.03−2.03). LDL-C/HDL-C ratio, non-HDL-C, elevated TG alone, and low HDL-C alone were not independently linked to either outcome. Conclusions Of various non-traditional lipid variables, elevated baseline TG/HDL-C and TC/HDL-C ratios predict future vascular risk after a stroke, but only elevated TG/HDL-C ratio is related to risk of recurrent stroke. Future studies should assess the role of TG/HDL as a potential therapeutic target for global vascular risk reduction after stroke. PMID:25236873

Exploring the Association of Hospice Care on Patient Experience and Outcomes of Care

PubMed Central

Kleinpell, Ruth; Vasilevskis, Eduard E.; Fogg, Louis; Ely, E. Wesley

2016-01-01

Objective To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe, and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterized. Methods A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organizational characteristics for 236 US hospitals to examine the relationship between hospice utilization and a number of variables that represent care value including hospital care intensity index, hospital deaths, ICU deaths, patient satisfaction, and a number of patient quality indicators. Structural equation modeling was used to demonstrate the effect of hospice use on patient experience of care variables, clinical outcomes of care variables, and efficiency of care variables. Results Hospice admissions in the last 6 months of life were correlated with a number of variables including increases in patient satisfaction ratings (r=0.448, p=0.01) and better pain control (r=0.491, p=0.01), and reductions in hospital days (r=−0.517, p=0.01), fewer deaths in the hospital (r=−0.842, p=0.01), and fewer deaths occurring with an ICU admission during hospitalization (r=−0.358, p=0.01). The structural equation model identified use of hospice care was inversely related to both hospital mortality (−.885) and ICU mortality rate (−.457). Conclusions The results of this investigation demonstrate that greater utilization of hospice care during the last 6-months of life is associated with improved patient experience of care including satisfaction and pain control, as well as clinical outcomes of care including decreased ICU and hospital mortality. PMID:27531840

Can high social capital at the workplace buffer against stress and musculoskeletal pain?: Cross-sectional study.

PubMed

Jay, Kenneth; Andersen, Lars L

2018-03-01

Work-related musculoskeletal pain and stress are both highly prevalent in the working environment and relate well to the biopsychosocial model. While the onset of musculoskeletal pain is often dependent on the biological element of the biopsychosocial model, chronic pain is often influenced by psychological and social factors. Similarly, stress is also influenced by biological, psychological, and social factors. This study investigates the possibility of social capital being a buffer for stress and musculoskeletal pain in a group of female laboratory technicians.Female laboratory technicians (n = 500) replied to questions about stress (Cohens Perceived Stress Scale-10), musculoskeletal pain (0-10 visual analog scale), and social capital at the workplace (bonding [in teams], bridging [between teams], and linking [between teams and leaders]). Outcome variables were stress and musculoskeletal pain and the predictor variable was social capital. General linear models tested the association of the 3 types of social capital (predictor variables) with stress and pain (mutually adjusted outcome variables). Analyses were controlled for age, lifestyle (body mass index, smoking), seniority, and working hours per week.For stress as outcome, moderate and high bonding social capital were different from low social capital with -2.04 (95% confidence interval [CI] -3.33 to -0.76) and -4.56 (95% CI -5.84 to -3.28) points on the Perceived Stress Scale of 0 to 42, respectively. Similarly, moderate and high bridging social capital were different from low social capital with -1.50 (95% CI -2.76 to -0.24) and -4.39 (95% CI -5.75 to -3.03), respectively. For linking, only high social was significantly different from low with -2.94 (95% CI -4.28 to -1.60). None of the 3 types of social capital was associated with musculoskeletal pain.Higher levels of social capital at the workplace appear to buffer against stress, but not against musculoskeletal pain. Intervention studies should investigate whether improving bonding, bridging, and linking social capital at the workplace may be a viable strategy to prevent or reduce work-related stress.

Development of a core outcome set for clinical trials in squamous cell carcinoma: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey.

PubMed

Schlessinger, Daniel I; Iyengar, Sanjana; Yanes, Arianna F; Chiren, Sarah G; Godinez-Puig, Victoria; Chen, Brian R; Kurta, Anastasia O; Schmitt, Jochen; Deckert, Stefanie; Furlan, Karina C; Poon, Emily; Cartee, Todd V; Maher, Ian A; Alam, Murad; Sobanko, Joseph F

2017-07-12

Squamous cell carcinoma (SCC) is a common skin cancer that poses a risk of metastasis. Clinical investigations into SCC treatment are common, but the outcomes reported are highly variable, omitted, or clinically irrelevant. The outcome heterogeneity and reporting bias of these studies leave clinicians unable to accurately compare studies. Core outcome sets (COSs) are an agreed minimum set of outcomes recommended to be measured and reported in all clinical trials of a given condition or disease. Although COSs are under development for several dermatologic conditions, work has yet to be done to identify core outcomes specific for SCC. Outcome extraction for COS generation will occur via four methods: (1) systematic literature review; (2) patient interviews; (3) other published sources; and (4) input from stakeholders in medicine, pharmacy, and other relevant industries. The list of outcomes will be revaluated by the Measuring PRiority Outcome Variables via Excellence in Dermatologic surgery (IMPROVED) Steering Committee. Delphi processes will be performed separately by expert clinicians and patients to condense the list of outcomes generated. A consensus meeting with relevant stakeholders will be conducted after the Delphi exercise to further select outcomes, taking into account participant scores. At the end of the meeting, members will vote and decide on a final recommended set of core outcomes. The Core Outcome Measures in Effectiveness Trials (COMET) organization and the Cochrane Skin Group - Core Outcome Set Initiative (CSG-COUSIN) will serve as advisers throughout the COS generation process. Comparison of clinical trials via systematic reviews and meta-analyses is facilitated when investigators study outcomes that are relevant and similar. The aim of this project is to develop a COS to guide use for future clinical trials.

Predictors of Positive Outcomes in Offspring of Depressed Parents and Non-depressed Parents Across 20 Years

PubMed Central

Verdeli, Helen; Wickramaratne, Priya; Warner, Virginia; Mancini, Anthony; Weissman, Myrna

2014-01-01

Understanding differences in factors leading to positive outcomes in high-risk and low-risk offspring has important implications for preventive interventions. We identified variables predicting positive outcomes in a cohort of 235 offspring from 76 families in which one, both, or neither parent had major depressive disorder. Positive outcomes were termed resilient in offspring of depressed parents, and competent in offspring of non-depressed parents, and defined by two separate criteria: absence of psychiatric diagnosis and consistently high functioning at 2, 10, and 20 years follow-up. In offspring of depressed parents, easier temperament and higher self-esteem were associated with greater odds of resilient outcome defined by absence of diagnosis. Lower maternal overprotection, greater offspring self-esteem, and higher IQ were associated with greater odds of resilient outcome defined by consistently high functioning. Multivariate analysis indicated that resilient outcome defined by absence of diagnosis was best predicted by offspring self-esteem; resilient outcome defined by functioning was best predicted by maternal overprotection and self-esteem. Among offspring of non-depressed parents, greater family cohesion, easier temperament and higher self-esteem were associated with greater odds of offspring competent outcome defined by absence of diagnosis. Higher maternal affection and greater offspring self-esteem were associated with greater odds of competent outcome, defined by consistently high functioning. Multivariate analysis for each criterion indicated that competent outcome was best predicted by offspring self-esteem. As the most robust predictor of positive outcomes in offspring of depressed and non-depressed parents, self-esteem is an important target for youth preventive interventions. PMID:25374449

Effects of categorization method, regression type, and variable distribution on the inflation of Type-I error rate when categorizing a confounding variable.

PubMed

Barnwell-Ménard, Jean-Louis; Li, Qing; Cohen, Alan A

2015-03-15

The loss of signal associated with categorizing a continuous variable is well known, and previous studies have demonstrated that this can lead to an inflation of Type-I error when the categorized variable is a confounder in a regression analysis estimating the effect of an exposure on an outcome. However, it is not known how the Type-I error may vary under different circumstances, including logistic versus linear regression, different distributions of the confounder, and different categorization methods. Here, we analytically quantified the effect of categorization and then performed a series of 9600 Monte Carlo simulations to estimate the Type-I error inflation associated with categorization of a confounder under different regression scenarios. We show that Type-I error is unacceptably high (>10% in most scenarios and often 100%). The only exception was when the variable categorized was a continuous mixture proxy for a genuinely dichotomous latent variable, where both the continuous proxy and the categorized variable are error-ridden proxies for the dichotomous latent variable. As expected, error inflation was also higher with larger sample size, fewer categories, and stronger associations between the confounder and the exposure or outcome. We provide online tools that can help researchers estimate the potential error inflation and understand how serious a problem this is. Copyright © 2014 John Wiley & Sons, Ltd.

Work-life conflict and associations with work- and nonwork-related factors and with physical and mental health outcomes: a nationally representative cross-sectional study in Switzerland

PubMed Central

2009-01-01

Background The aim of the present cross-sectional study was to examine work- and nonwork- related factors and physical and mental health outcomes associated with combined time- and strain-based work-life conflict (WLC) among adult employees living and working in Switzerland as well as possible gender differences in this regard. Methods The data used for the study were taken from wave 6 of the nationally representative Swiss Household Panel (SHP) collected in 2004. The analysis was restricted to 4'371 employees aged 20 to 64 years. Trivariate crosstabulations and multivariate linear and logistic regression analyses stratified by gender were performed in order to calculate gender-specific prevalence rates (%), beta coefficients (β) and crude as well as multiple adjusted odds ratios (OR) as measures of association. Results Every eighth person (12.5%) within the study population has a high or very high WLC score. Prevalence rates are clearly above average in men and women with higher education, in executive positions or managerial functions, in full-time jobs, with variable work schedules, regular overtime, long commuting time to work and job insecurity. Working overtime regularly, having variable work schedules and being in a management position are most strongly associated with WLC in men, whereas in women the level of employment is the strongest explanatory variable by far, followed by variable work schedules and high job status (managerial position). In both men and women, WLC is associated with several physical and mental health problems. Employees with high or very high WLC show a comparatively high relative risk of self-reported poor health, anxiety and depression, lack of energy and optimism, serious backache, headaches, sleep disorders and fatigue. While overall prevalence rate of (very) high WLC is higher in men than in women, associations between degrees of WLC and most health outcomes are stronger in women than in men. Conclusion This important issue which up to now has been largely neglected in public health research needs to be addressed in future public health research and, if the findings are confirmed by subsequent (longitudinal) studies, to be considered in workplace health promotion and interventions in Switzerland as elsewhere. PMID:19943980

Work-life conflict and associations with work- and nonwork-related factors and with physical and mental health outcomes: a nationally representative cross-sectional study in Switzerland.

PubMed

Hämmig, Oliver; Gutzwiller, Felix; Bauer, Georg

2009-11-30

The aim of the present cross-sectional study was to examine work- and nonwork- related factors and physical and mental health outcomes associated with combined time- and strain-based work-life conflict (WLC) among adult employees living and working in Switzerland as well as possible gender differences in this regard. The data used for the study were taken from wave 6 of the nationally representative Swiss Household Panel (SHP) collected in 2004. The analysis was restricted to 4'371 employees aged 20 to 64 years. Trivariate crosstabulations and multivariate linear and logistic regression analyses stratified by gender were performed in order to calculate gender-specific prevalence rates (%), beta coefficients (beta) and crude as well as multiple adjusted odds ratios (OR) as measures of association. Every eighth person (12.5%) within the study population has a high or very high WLC score. Prevalence rates are clearly above average in men and women with higher education, in executive positions or managerial functions, in full-time jobs, with variable work schedules, regular overtime, long commuting time to work and job insecurity. Working overtime regularly, having variable work schedules and being in a management position are most strongly associated with WLC in men, whereas in women the level of employment is the strongest explanatory variable by far, followed by variable work schedules and high job status (managerial position). In both men and women, WLC is associated with several physical and mental health problems. Employees with high or very high WLC show a comparatively high relative risk of self-reported poor health, anxiety and depression, lack of energy and optimism, serious backache, headaches, sleep disorders and fatigue. While overall prevalence rate of (very) high WLC is higher in men than in women, associations between degrees of WLC and most health outcomes are stronger in women than in men. This important issue which up to now has been largely neglected in public health research needs to be addressed in future public health research and, if the findings are confirmed by subsequent (longitudinal) studies, to be considered in workplace health promotion and interventions in Switzerland as elsewhere.

High Intrapatient Variability of Tacrolimus Levels and Outpatient Clinic Nonattendance Are Associated With Inferior Outcomes in Renal Transplant Patients

PubMed Central

Goodall, Dawn L.; Willicombe, Michelle; McLean, Adam G.; Taube, David

2017-01-01

Background Nonadherence to immunosuppressants is associated with rejection and allograft loss. Intrapatient variability (IPV) of immunosuppression levels is a marker of nonadherence. This study describes the impact of IPV of tacrolimus levels in patients receiving a tacrolimus monotherapy immunosuppression protocol. Methods We retrospectively analyzed the outpatient tacrolimus levels of kidney-only transplant patients taken between 6 and 12 months posttransplant. IPV was determined using the coefficient of variance. Results Six hundred twenty-eight patients with a mean number of 8.98 ± 3.81 tacrolimus levels and a mean follow-up of 4.72 ± 2.19 years were included. Multivariate analysis showed death was associated with increasing age (1.04 [1.01-1.07], P = 0.0055), diabetes at time of transplant (2.79 [1.44-5.41], P = 0.0024), and rejection (2.34 [1.06-5.19], P = 0.036). Variables associated with graft loss included the highest variability group (2.51 [1.01-6.27], P = 0.048), mean tacrolimus level less than 5 ng/mL (4.32 [1.94-9.63], P = 0.0003), a high clinic nonattendance rate (1.10 [1.01-1.20], P = 0.03), and rejection (9.83 [4.62-20.94], P < 0.0001). Independent risk factors for rejection were de novo donor-specific antibody (3.15 [1.84-5.39], P < 0.0001), mean tacrolimus level less than 5 ng/mL (2.57 [1.27-5.19], P = 0.00860, and a high clinic nonattendance rate (1.11 [1.05-1.18], P = 0.0005). Conclusions This study shows that high tacrolimus IPV and clinic nonattendance are associated with inferior allograft survival. Interventions to minimize the causes of high variability, particularly nonadherence are essential to improve long-term allograft outcomes. PMID:28795143

Multivariate Bayesian variable selection exploiting dependence structure among outcomes: Application to air pollution effects on DNA methylation.

PubMed

Lee, Kyu Ha; Tadesse, Mahlet G; Baccarelli, Andrea A; Schwartz, Joel; Coull, Brent A

2017-03-01

The analysis of multiple outcomes is becoming increasingly common in modern biomedical studies. It is well-known that joint statistical models for multiple outcomes are more flexible and more powerful than fitting a separate model for each outcome; they yield more powerful tests of exposure or treatment effects by taking into account the dependence among outcomes and pooling evidence across outcomes. It is, however, unlikely that all outcomes are related to the same subset of covariates. Therefore, there is interest in identifying exposures or treatments associated with particular outcomes, which we term outcome-specific variable selection. In this work, we propose a variable selection approach for multivariate normal responses that incorporates not only information on the mean model, but also information on the variance-covariance structure of the outcomes. The approach effectively leverages evidence from all correlated outcomes to estimate the effect of a particular covariate on a given outcome. To implement this strategy, we develop a Bayesian method that builds a multivariate prior for the variable selection indicators based on the variance-covariance of the outcomes. We show via simulation that the proposed variable selection strategy can boost power to detect subtle effects without increasing the probability of false discoveries. We apply the approach to the Normative Aging Study (NAS) epigenetic data and identify a subset of five genes in the asthma pathway for which gene-specific DNA methylations are associated with exposures to either black carbon, a marker of traffic pollution, or sulfate, a marker of particles generated by power plants. © 2016, The International Biometric Society.

Differing Roles of Functional Movement Variability as Experience Increases in Gymnastics

PubMed Central

Busquets, Albert; Marina, Michel; Davids, Keith; Angulo-Barroso, Rosa

2016-01-01

Current theories, like Ecological Dynamics, propose that inter-trial movement variability is functional when acquiring or refining movement coordination. Here, we examined how age-based experience levels of gymnasts constrained differences in emergent movement pattern variability during task performance. Specifically, we investigated different roles of movement pattern variability when gymnasts in different age groups performed longswings on a high bar, capturing the range of experience from beginner to advanced status. We also investigated the functionality of the relationships between levels of inter-trial variability and longswing amplitude during performance. One-hundred and thirteen male gymnasts in five age groups were observed performing longswings (with three different experience levels: beginners, intermediates and advanced performers). Performance was evaluated by analysis of key events in coordination of longswing focused on the arm-trunk and trunk-thigh segmental relations. Results revealed that 10 of 18 inter-trial variability measures changed significantly as a function of increasing task experience. Four of ten variability measures conformed to a U-shaped function with age implying exploratory strategies amongst beginners and functional adaptive variability amongst advanced performers. Inter-trial variability of arm-trunk coordination variables (6 of 10) conformed to a \\-shaped curve, as values were reduced to complete the longswings. Changes in coordination variability from beginner to intermediate status were largely restrictive, with only one variability measure related to exploration. Data revealed how inter-trial movement variability in gymnastics, relative to performance outcomes, needs careful interpretation, implying different roles as task experience changes. Key points Inter-trial variability while performing longswings on a high bar was assessed in a large sample (113 participants) divided into five age groups (form beginners to advanced gymnasts). Longswing assessment allowed us to evaluate inter-trial variability in representative performance context. Coordination variability presented two different configurations across experience levels depending on the variable of interest: either a U-shaped or a L- or \\-shaped graph. Increased inter-trial variability of the functional phase events offered flexibility to adapt the longswing performance in the advanced gymnasts, while decreasing variability in arm-trunk coordination modes was critical to improve longswing and to achieve the most advanced level. In addition, the relationship between variability measures and the global performance outcome (i.e. the swing amplitude) revealed different functional roles of movement variability (exploratory or restrictive) as a function of changes in experience levels. PMID:27274664

Collaborative adaptive landscape management (CALM) in rangelands: Discussion of general principles

USDA-ARS?s Scientific Manuscript database

The management of rangeland landscapes involves broad spatial extents, mixed land ownership, and multiple resource objectives. Management outcomes depend on biophysical heterogeneity, highly variable weather conditions, land use legacies, and spatial processes such as wildlife movement, hydrological...

Glucose variability negatively impacts long-term functional outcome in patients with traumatic brain injury.

PubMed

Matsushima, Kazuhide; Peng, Monica; Velasco, Carlos; Schaefer, Eric; Diaz-Arrastia, Ramon; Frankel, Heidi

2012-04-01

Significant glycemic excursions (so-called glucose variability) affect the outcome of generic critically ill patients but has not been well studied in patients with traumatic brain injury (TBI). The purpose of this study was to evaluate the impact of glucose variability on long-term functional outcome of patients with TBI. A noncomputerized tight glucose control protocol was used in our intensivist model surgical intensive care unit. The relationship between the glucose variability and long-term (a median of 6 months after injury) functional outcome defined by extended Glasgow Outcome Scale (GOSE) was analyzed using ordinal logistic regression models. Glucose variability was defined by SD and percentage of excursion (POE) from the preset range glucose level. A total of 109 patients with TBI under tight glucose control had long-term GOSE evaluated. In univariable analysis, there was a significant association between lower GOSE score and higher mean glucose, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL but not POE 80 to 110. After adjusting for possible confounding variables in multivariable ordinal logistic regression models, higher SD, POE more than 60, POE 80 to 150, and single episode of glucose less than 60 mg/dL were significantly associated with lower GOSE score. Glucose variability was significantly associated with poorer long-term functional outcome in patients with TBI as measured by the GOSE score. Well-designed protocols to minimize glucose variability may be key in improving long-term functional outcome. Copyright © 2012 Elsevier Inc. All rights reserved.

Computational Evaluation of Cochlear Implant Surgery Outcomes Accounting for Uncertainty and Parameter Variability.

PubMed

Mangado, Nerea; Pons-Prats, Jordi; Coma, Martí; Mistrík, Pavel; Piella, Gemma; Ceresa, Mario; González Ballester, Miguel Á

2018-01-01

Cochlear implantation (CI) is a complex surgical procedure that restores hearing in patients with severe deafness. The successful outcome of the implanted device relies on a group of factors, some of them unpredictable or difficult to control. Uncertainties on the electrode array position and the electrical properties of the bone make it difficult to accurately compute the current propagation delivered by the implant and the resulting neural activation. In this context, we use uncertainty quantification methods to explore how these uncertainties propagate through all the stages of CI computational simulations. To this end, we employ an automatic framework, encompassing from the finite element generation of CI models to the assessment of the neural response induced by the implant stimulation. To estimate the confidence intervals of the simulated neural response, we propose two approaches. First, we encode the variability of the cochlear morphology among the population through a statistical shape model. This allows us to generate a population of virtual patients using Monte Carlo sampling and to assign to each of them a set of parameter values according to a statistical distribution. The framework is implemented and parallelized in a High Throughput Computing environment that enables to maximize the available computing resources. Secondly, we perform a patient-specific study to evaluate the computed neural response to seek the optimal post-implantation stimulus levels. Considering a single cochlear morphology, the uncertainty in tissue electrical resistivity and surgical insertion parameters is propagated using the Probabilistic Collocation method, which reduces the number of samples to evaluate. Results show that bone resistivity has the highest influence on CI outcomes. In conjunction with the variability of the cochlear length, worst outcomes are obtained for small cochleae with high resistivity values. However, the effect of the surgical insertion length on the CI outcomes could not be clearly observed, since its impact may be concealed by the other considered parameters. Whereas the Monte Carlo approach implies a high computational cost, Probabilistic Collocation presents a suitable trade-off between precision and computational time. Results suggest that the proposed framework has a great potential to help in both surgical planning decisions and in the audiological setting process.

A Nationwide Survey on Quality of Life and Associated Factors of Adults with High-Functioning Autism Spectrum Disorders

ERIC Educational Resources Information Center

Kamio, Yoko; Inada, Naoko; Koyama, Tomonori

2013-01-01

The psychosocial outcomes of individuals with high-functioning autism spectrum disorder (HFASD) appear to be diverse and are often poor relative to their intellectual or language level. To identify predictive variables that are potentially ameliorable by therapeutic intervention, this study investigated self-reported psychosocial quality of life…

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

PubMed

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

Computer use and stress, sleep disturbances, and symptoms of depression among young adults – a prospective cohort study

PubMed Central

2012-01-01

Background We have previously studied prospective associations between computer use and mental health symptoms in a selected young adult population. The purpose of this study was to investigate if high computer use is a prospective risk factor for developing mental health symptoms in a population-based sample of young adults. Methods The study group was a cohort of young adults (n = 4163), 20–24 years old, who responded to a questionnaire at baseline and 1-year follow-up. Exposure variables included time spent on computer use (CU) in general, email/chat use, computer gaming, CU without breaks, and CU at night causing lost sleep. Mental health outcomes included perceived stress, sleep disturbances, symptoms of depression, and reduced performance due to stress, depressed mood, or tiredness. Prevalence ratios (PRs) were calculated for prospective associations between exposure variables at baseline and mental health outcomes (new cases) at 1-year follow-up for the men and women separately. Results Both high and medium computer use compared to low computer use at baseline were associated with sleep disturbances in the men at follow-up. High email/chat use was negatively associated with perceived stress, but positively associated with reported sleep disturbances for the men. For the women, high email/chat use was (positively) associated with several mental health outcomes, while medium computer gaming was associated with symptoms of depression, and CU without breaks with most mental health outcomes. CU causing lost sleep was associated with mental health outcomes for both men and women. Conclusions Time spent on general computer use was prospectively associated with sleep disturbances and reduced performance for the men. For the women, using the computer without breaks was a risk factor for several mental health outcomes. Some associations were enhanced in interaction with mobile phone use. Using the computer at night and consequently losing sleep was associated with most mental health outcomes for both men and women. Further studies should focus on mechanisms relating information and communication technology (ICT) use to sleep disturbances. PMID:23088719

Computer use and stress, sleep disturbances, and symptoms of depression among young adults--a prospective cohort study.

PubMed

Thomée, Sara; Härenstam, Annika; Hagberg, Mats

2012-10-22

We have previously studied prospective associations between computer use and mental health symptoms in a selected young adult population. The purpose of this study was to investigate if high computer use is a prospective risk factor for developing mental health symptoms in a population-based sample of young adults. The study group was a cohort of young adults (n = 4163), 20-24 years old, who responded to a questionnaire at baseline and 1-year follow-up. Exposure variables included time spent on computer use (CU) in general, email/chat use, computer gaming, CU without breaks, and CU at night causing lost sleep. Mental health outcomes included perceived stress, sleep disturbances, symptoms of depression, and reduced performance due to stress, depressed mood, or tiredness. Prevalence ratios (PRs) were calculated for prospective associations between exposure variables at baseline and mental health outcomes (new cases) at 1-year follow-up for the men and women separately. Both high and medium computer use compared to low computer use at baseline were associated with sleep disturbances in the men at follow-up. High email/chat use was negatively associated with perceived stress, but positively associated with reported sleep disturbances for the men. For the women, high email/chat use was (positively) associated with several mental health outcomes, while medium computer gaming was associated with symptoms of depression, and CU without breaks with most mental health outcomes. CU causing lost sleep was associated with mental health outcomes for both men and women. Time spent on general computer use was prospectively associated with sleep disturbances and reduced performance for the men. For the women, using the computer without breaks was a risk factor for several mental health outcomes. Some associations were enhanced in interaction with mobile phone use. Using the computer at night and consequently losing sleep was associated with most mental health outcomes for both men and women. Further studies should focus on mechanisms relating information and communication technology (ICT) use to sleep disturbances.

Respiratory support in oncology ward setting: a prospective descriptive study.

PubMed

Mishra, Seema; Bhatnagar, Sushma; Gupta, Deepak; Goyal, Gaurav Nirvani; Agrawal, Ravi; Jain, Roopesh; Chauhan, Himanshu

2009-01-01

Mechanical ventilation in cancer patients is a critical issue The present prospective descriptive study was designed (1) to assess the patient population needing respirator support in ward setting at a premier state-run oncology institute in India, (2) to observe and analyze the course of their disease while on respirator, and (3) to coordinate better quality of life measures in cancer patients at the institute based on the present study's outcomes. Beginning from March 2005 to March 2006, all cancer patients who were connected to respirator in the wards were enrolled in the current study. Our anesthesiology department at the cancer institute also has primary responsibility for airway management and mechanical ventilation in high dependency units of oncology wards. Preventilation variables in cancer patients were assessed to judge the futility of mechanical ventilation in ward setting. Subsequently, patients were observed for disease course while on respirator. Final outcome with its etio-pathogenesis was correlated with predicted futility of mechanical ventilation. Over a period of 1 year, 132 (46 men and 86 women) cancer patients with median age 40 years (range 1-75 years) were connected to respirator in oncology wards. Based on the preventilation variables and indications for respirator support, right prediction of medical futility and hospital discharge was made in 77% of patients. Underestimation and overestimation of survival to hospital discharge was made in 10% cases and 13% cases, respectively. Based on preventilation variables, prediction of outcome in cancer patients needing respirator support can be made in 77% cases. This high probability of prediction can be used to educate patients, and their families and primary physicians, for well-informed and documented advance directives, formulated and regularly revised DNAR policies, and judicious use of respirator support for better quality-of-life outcomes.

High transverse skin incisions may reduce wound complications in obese women having cesarean sections: a pilot study.

PubMed

Walton, Robert B; Shnaekel, Kelsey L; Ounpraseuth, Songthip T; Napolitano, Peter G; Magann, Everett F

2017-11-01

Women having cesarean section have a high risk of wound complications. Our objective was to determine whether high transverse skin incisions are associated with a reduced risk of cesarean wound complications in women with BMI greater than 40. A retrospective cohort study was undertaken of parturients ages 18-45 with BMI greater than 40 having high transverse skin incisions from January 2010 to April 2015 at a tertiary maternity hospital. Temporally matched controls had low transverse skin incisions along with a BMI greater than 40. The primary outcome, wound complication, was defined as any seroma, hematoma, dehiscence, or infection requiring opening and evacuating/debriding the wound. Secondary outcomes included rates of endometritis, number of hospital days, NICU admission, Apgar scores, birth weight, and gestational age at delivery. Analysis of outcomes was performed using two-sample t-test or Wilcoxon rank-sum test for continuous variables and Fisher's exact test for categorical variables. Thirty-two women had high transverse incisions and were temporally matched with 96 controls (low transverse incisions). The mean BMI was 49 for both groups. There was a trend toward reduced wound complications in those having high transverse skin incisions, but this did not reach statistical significance (15.63% versus 27.08%, p = .2379). Those having high transverse skin incisions had lower five minute median Apgar scores (8.0 versus 9.0, p = .0021), but no difference in umbilical artery pH values. The high transverse group also had increased NICU admissions (28.13% versus 5.21%, p = .0011), and early gestational age at delivery (36.8 versus 38.0, p = .0272). High transverse skin incisions may reduce the risk of wound complications in parturients with obesity. A study with more power should be considered.

Autonomic Impairment in Severe Traumatic Brain Injury: A Multimodal Neuromonitoring Study.

PubMed

Sykora, Marek; Czosnyka, Marek; Liu, Xiuyun; Donnelly, Joseph; Nasr, Nathalie; Diedler, Jennifer; Okoroafor, Francois; Hutchinson, Peter; Menon, David; Smielewski, Peter

2016-06-01

Autonomic impairment after acute traumatic brain injury has been associated independently with both increased morbidity and mortality. Links between autonomic impairment and increased intracranial pressure or impaired cerebral autoregulation have been described as well. However, relationships between autonomic impairment, intracranial pressure, impaired cerebral autoregulation, and outcome remain poorly explored. Using continuous measurements of heart rate variability and baroreflex sensitivity we aimed to test whether autonomic markers are associated with functional outcome and mortality independently of intracranial variables. Further, we aimed to evaluate the relationships between autonomic functions, intracranial pressure, and cerebral autoregulation. Retrospective analysis of a prospective database. Neurocritical care unit in a university hospital. Sedated patients with severe traumatic brain injury. Waveforms of intracranial pressure and arterial blood pressure, baseline Glasgow Coma Scale and 6 months Glasgow Outcome Scale were recorded. Baroreflex sensitivity was assessed every 10 seconds using a modified cross-correlational method. Frequency domain analyses of heart rate variability were performed automatically every 10 seconds from a moving 300 seconds of the monitoring time window. Mean values of baroreflex sensitivity, heart rate variability, intracranial pressure, arterial blood pressure, cerebral perfusion pressure, and impaired cerebral autoregulation over the entire monitoring period were calculated for each patient. Two hundred and sixty-two patients with a median age of 36 years entered the analysis. The median admission Glasgow Coma Scale was 6, the median Glasgow Outcome Scale was 3, and the mortality at 6 months was 23%. Baroreflex sensitivity (adjusted odds ratio, 0.9; p = 0.02) and relative power of a high frequency band of heart rate variability (adjusted odds ratio, 1.05; p < 0.001) were individually associated with mortality, independently of age, admission Glasgow Coma Scale, intracranial pressure, pressure reactivity index, or cerebral perfusion pressure. Baroreflex sensitivity showed no correlation with intracranial pressure or cerebral perfusion pressure; the correlation with pressure reactivity index was strong in older patients (age, > 60 yr). The relative power of high frequency correlated significantly with intracranial pressure and cerebral perfusion pressure, but not with pressure reactivity index. The relative power of low frequency correlated significantly with pressure reactivity index. Autonomic impairment, as measured by heart rate variability and baroreflex sensitivity, is significantly associated with increased mortality after traumatic brain injury. These effects, though partially interlinked, seem to be independent of age, trauma severity, intracranial pressure, or autoregulatory status, and thus represent a discrete phenomenon in the pathophysiology of traumatic brain injury. Continuous measurements of heart rate variability and baroreflex sensitivity in the neuromonitoring setting of severe traumatic brain injury may carry novel pathophysiological and predictive information.

Histologic prognosticators in feline osteosarcoma: a comparison with phenotypically similar canine osteosarcoma.

PubMed

Dimopoulou, Maria; Kirpensteijn, Jolle; Moens, Hester; Kik, Marja

2008-07-01

To investigate the histologic characteristics of feline osteosarcoma (OS) and compare the histologic data with phenotypically comparable canine OS. The effects of histologic and clinical variables on survival statistics were evaluated. Retrospective study. Cats (n=62) and dogs (22). Medical records of 62 cats with OS were reviewed for clinically relevant data. Clinical outcome was obtained by telephone interview. Histologic characteristics of OS were classified using a standardized grading system. Histologic characteristics in 22 feline skeletal OS were compared with 22 canine skeletal OS of identical location and subtype. Prognostic variables for clinical outcome were determined using multivariate analysis. Feline OS was characterized by moderate to abundant cellular pleomorphism, low mitotic index, small to moderate amounts of matrix, high cellularity, and a moderate amount of necrosis. There was no significant difference between histologic variables in feline and canine OS. Histologic grade, surgery, and mitotic index significantly influenced clinical outcome as determined by multivariate analysis. Tumor invasion into vessels was not identified as a significant prognosticator. Feline and canine skeletal OS have similar histologic but different prognostic characteristics. Prognosis for cats with OS is related to histologic grade and mitotic index of the tumor.

Multivariate analyses of tinnitus complaint and change in tinnitus complaint: a masker study.

PubMed

Jakes, S; Stephens, S D

1987-11-01

Multivariate statistical techniques were used to re-analyse the data from the recent DHSS multi-centre masker study. These analyses were undertaken to three ends. First, to clarify and attempt to replicate the previously found factor structure of complaints about tinnitus. Secondly, to attempt to identify common factors in the change or improvement measures pre- and post-masker treatment. Thirdly, to identify predictors of any such outcome factors. Two complaint factors were identified; 'Distress' and 'intrusiveness'. A series of analyses were conducted on change measures using different numbers of subjects and variables. When only semantic differential scales were used, the change factors were very similar to the complaint factors noted above. When variables measuring other aspects of improvement were included, several other factors were identified. These included; 'tinnitus helped', 'masking effects', 'residual inhibition' and 'matched loudness'. Twenty-five conceptually distinct predictors of outcome were identified. These predictor variables were quite different for different outcome factors. For example, high-frequency hearing loss was a predictor of tinnitus being helped by the masker, and a low frequency match and a low masking threshold predicted therapeutic success on residual inhibition. Decrease in matched loudness was predicted by louder tinnitus initially.

Risk score for pediatric intensive care unit admission in children undergoing hematopoietic stem cell transplantation and analysis of predictive factors for survival.

PubMed

González-Vicent, Marta; Marín, Catalina; Madero, Luis; Sevilla, Julián; Díaz, Miguel Angel

2005-10-01

The authors retrospectively analyzed postransplantation events in 198 children who underwent hematopoietic stem cell transplantation (HSCT) between 1998 and 2002 to obtain a risk score for pediatric intensive care unit (PICU) admission and to ascertain variables predicting a poor outcome. Thirty-six patients (18%) were admitted to the PICU. Median age was 9 years (range 1-18). On univariate analysis, variables significantly associated with PICU admission were male gender (P = 0.01), more than first complete remission (P = 0.003), allogeneic transplantation (P = 0.001), engraftment syndrome (P = 0.03), and acute graft-versus-host disease grade of at least two (P = 0.05). According to this, patients were divided in two levels of risk (low and high), with a respective probability of PICU admission of 8.8 +/- 2.2% and 63.8 +/- 8.8% (P < 0.0001). Seventeen (47%) patients were discharged from the PICU. The probability of event-free survival after PICU admission at 3 years was 24.2 +/- 7%. On univariate analysis, variables with a negative impact on event-free survival were type of transplantation, inotropic support, a C-reactive protein level of at least 10 mg/dL, and a high O-PRISM score. On multivariate analysis, the only variable that influenced event-free survival was the O-PRISM score (< or =10 points, 54.6 +/- 15.3%; >10 points, 8.6 +/- 5.8%; P = 0.007). In conclusion, the risk of PICU admission may be easily estimated using simple variables. A high O-PRISM score at the time of PICU admission predicts a dismal outcome.

Student Self-Reported Learning Outcomes of Field Trips: The pedagogical impact

NASA Astrophysics Data System (ADS)

Lavie Alon, Nirit; Tal, Tali

2015-05-01

In this study, we used the classification and regression trees (CART) method to draw relationships between student self-reported learning outcomes in 26 field trips to natural environments and various characteristics of the field trip that include variables associated with preparation and pedagogy. We wished to examine the extent to which the preparation for the field trip, its connection to the school curriculum, and the pedagogies used, affect students' self-reported outcomes in three domains: cognitive, affective, and behavioral; and the extent the students' socioeconomic group and the guide's affiliation affect students' reported learning outcomes. Given that most of the field trips were guide-centered, the most important variable that affected the three domains of outcomes was the guide's storytelling. Other variables that showed relationships with self-reported outcomes were physical activity and making connections to everyday life-all of which we defined as pedagogical variables. We found no significant differences in student self-reported outcomes with respect to their socioeconomic group and the guide's organizational affiliation.

Changes in patellofemoral alignment do not cause clinical impact after open-wedge high tibial osteotomy.

PubMed

Lee, Yong Seuk; Lee, Sang Bok; Oh, Won Seok; Kwon, Yong Eok; Lee, Beom Koo

2016-01-01

The objectives of this study were (1) to evaluate the clinical and radiologic outcomes of open-wedge high tibial osteotomy focusing on patellofemoral alignment and (2) to search for correlation between variables and patellofemoral malalignment. A total of 46 knees (46 patients) from 32 females and 14 males who underwent open-wedge high tibial osteotomy were included in this retrospective case series. Outcomes were evaluated using clinical scales and radiologic parameters at the last follow-up. Pre-operative and final follow-up values were compared for the outcome analysis. For the focused analysis of the patellofemoral joint, correlation analyses between patellofemoral variables and pre- and post-operative weight-bearing line (WBL), clinical score, posterior slope, Blackburn Peel ratio, lateral patellar tilt, lateral patellar shift, and congruence angle were performed. The minimum follow-up period was 2 years and median follow-up period was 44 months (range 24-88 months). The percentage of weight-bearing line was shifted from 17.2 ± 11.1 to 56.7 ± 12.7%, and it was statistically significant (p < 0.01). Regarding the clinical results, statistical significance was observed using all scores (p < 0.01). In the radiologic evaluation, patellar descent was observed with statistical significance (p < 0.01). Last follow-up lateral patellar tilt was decreased with statistical significance (p < 0.01). In correlation analysis between variables of patellofemoral malalignment, the pre-operative weight-bearing line showed an association with the change in lateral patellar tilt and lateral patellar shift (correlation coefficient: 0.3). After open-wedge high tibial osteotomy, clinical results showed improvement, compared to pre-operative values. The patellar tilt and lateral patellar shift were not changed; however, descent of the patella was observed. Therefore, mild patellofemoral problems should not be a contraindication of the open-wedge high tibial osteotomy. Case series, Level IV.

Association between internalized stigma and depression among HIV-positive persons entering into care in Southern India

PubMed Central

Chan, Brian T; Pradeep, Amrose; Prasad, Lakshmi; Murugesan, Vinothini; Chandrasekaran, Ezhilarasi; Kumarasamy, Nagalingeswaran; Mayer, Kenneth H; Tsai, Alexander C

2017-01-01

Background In India, which has the third largest HIV epidemic in the world, depression and HIV–related stigma may contribute to high rates of poor HIV–related outcomes such as loss to care and lack of virologic suppression. Methods We analyzed data from a large HIV treatment center in southern India to estimate the burden of depressive symptoms and internalized stigma among Indian people living with HIV (PLHIV) entering into HIV care and to test the hypothesis that probable depression was associated with internalized stigma. We fitted modified Poisson regression models, adjusted for sociodemographic variables, with probable depression (PHQ–9 score ≥10 or recent suicidal thoughts) as the outcome variable and the Internalized AIDS–Related Stigma Scale (IARSS) score as the explanatory variable. Findings 521 persons (304 men and 217 women) entering into HIV care between January 2015 and May 2016 were included in the analyses. The prevalence of probable depression was 10% and the mean IARSS score was 2.4 (out of 6), with 82% of participants endorsing at least one item on the IARSS. There was a nearly two times higher risk of probable depression for every additional point on the IARSS score (Adjusted Risk Ratio: 1.83; 95% confidence interval, 1.56–2.14). Conclusions Depression and internalized stigma are highly correlated among PLHIV entering into HIV care in southern India and may provide targets for policymakers seeking to improve HIV–related outcomes in India. PMID:29302315

Violence and Disorder, School Climate, and PBIS: The Relationship among School Climate, Student Outcomes, and the Use of Positive Behavioral Interventions and Supports

ERIC Educational Resources Information Center

Eacho, Thomas Christopher

2013-01-01

The primary purpose of this study was to examine the relationship between school climate and student outcome variables. The secondary purpose was to examine the relationship between the use of Positive Behavioral Interventions and Supports (PBIS) and the same student outcome variables. Variables depicting student perceptions of school climate,…

Apathy and Type 2 Diabetes among American Indians: Exploring the Protective Effects of Traditional Cultural Involvement

PubMed Central

Carlson, Amanda E.; Aronson, Benjamin D.; Unzen, Michael; Lewis, Melissa; Benjamin, Gabrielle J.; Walls, Melissa L.

2017-01-01

In this study we examine relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Participants completed cross-sectional interviewer-assisted paper and pencil surveys. We tested a proposed model using latent variable path analysis in order to understand the relationships between cultural participation, apathy, frequency of high blood sugar symptoms, and health-related quality of life. The model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. No direct effect of cultural participation on either health-related outcome was found; however, cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life. This study highlights a potential pathway of cultural involvement to positive diabetes outcomes. PMID:28529223

Gambling Outcome Expectancies and Gambling Behavior Among African-American Adolescents: Gender as a Moderating Variable.

PubMed

Simmons, Jessica L; Whelan, James P; Meyers, Andrew W; Wickwire, Emerson M

2016-03-01

Most high school adolescents have reported past year gambling, and males gamble more frequently and problematically than females. Ethnic minority adolescents appear to be gambling at a higher rate than Caucasian adolescents. There is evidence indicating that adolescent gambling outcome expectancies are correlated with gambling behavior, but limited evidence that this relation differs by gender. In the present study gender was evaluated as a moderator in the relation between gambling outcome expectancies and gambling behaviors in an African-American high school sample. Males gambled more frequently, gambled more problematically and held more positive gambling outcome expectancies than females. Gender was found to moderate the relations between gambling frequency and the expectations of material gain, affect, self-evaluation and parental approval. Gender also moderated the relations between gambling problems and expectations of affect and self-evaluation. These findings should inform future adolescent gambling prevention and intervention programs.

Behavioral variability in an evolutionary theory of behavior dynamics.

PubMed

Popa, Andrei; McDowell, J J

2016-03-01

McDowell's evolutionary theory of behavior dynamics (McDowell, 2004) instantiates populations of behaviors (abstractly represented by integers) that evolve under the selection pressure of the environment in the form of positive reinforcement. Each generation gives rise to the next via low-level Darwinian processes of selection, recombination, and mutation. The emergent patterns can be analyzed and compared to those produced by biological organisms. The purpose of this project was to explore the effects of high mutation rates on behavioral variability in environments that arranged different reinforcer rates and magnitudes. Behavioral variability increased with the rate of mutation. High reinforcer rates and magnitudes reduced these effects; low reinforcer rates and magnitudes augmented them. These results are in agreement with live-organism research on behavioral variability. Various combinations of mutation rates, reinforcer rates, and reinforcer magnitudes produced similar high-level outcomes (equifinality). These findings suggest that the independent variables that describe an experimental condition interact; that is, they do not influence behavior independently. These conclusions have implications for the interpretation of high levels of variability, mathematical undermatching, and the matching theory. The last part of the discussion centers on a potential biological counterpart for the rate of mutation, namely spontaneous fluctuations in the brain's default mode network. © 2016 Society for the Experimental Analysis of Behavior.

Why significant variables aren't automatically good predictors.

PubMed

Lo, Adeline; Chernoff, Herman; Zheng, Tian; Lo, Shaw-Hwa

2015-11-10

Thus far, genome-wide association studies (GWAS) have been disappointing in the inability of investigators to use the results of identified, statistically significant variants in complex diseases to make predictions useful for personalized medicine. Why are significant variables not leading to good prediction of outcomes? We point out that this problem is prevalent in simple as well as complex data, in the sciences as well as the social sciences. We offer a brief explanation and some statistical insights on why higher significance cannot automatically imply stronger predictivity and illustrate through simulations and a real breast cancer example. We also demonstrate that highly predictive variables do not necessarily appear as highly significant, thus evading the researcher using significance-based methods. We point out that what makes variables good for prediction versus significance depends on different properties of the underlying distributions. If prediction is the goal, we must lay aside significance as the only selection standard. We suggest that progress in prediction requires efforts toward a new research agenda of searching for a novel criterion to retrieve highly predictive variables rather than highly significant variables. We offer an alternative approach that was not designed for significance, the partition retention method, which was very effective predicting on a long-studied breast cancer data set, by reducing the classification error rate from 30% to 8%.

Finding structure in data using multivariate tree boosting

PubMed Central

Miller, Patrick J.; Lubke, Gitta H.; McArtor, Daniel B.; Bergeman, C. S.

2016-01-01

Technology and collaboration enable dramatic increases in the size of psychological and psychiatric data collections, but finding structure in these large data sets with many collected variables is challenging. Decision tree ensembles such as random forests (Strobl, Malley, & Tutz, 2009) are a useful tool for finding structure, but are difficult to interpret with multiple outcome variables which are often of interest in psychology. To find and interpret structure in data sets with multiple outcomes and many predictors (possibly exceeding the sample size), we introduce a multivariate extension to a decision tree ensemble method called gradient boosted regression trees (Friedman, 2001). Our extension, multivariate tree boosting, is a method for nonparametric regression that is useful for identifying important predictors, detecting predictors with nonlinear effects and interactions without specification of such effects, and for identifying predictors that cause two or more outcome variables to covary. We provide the R package ‘mvtboost’ to estimate, tune, and interpret the resulting model, which extends the implementation of univariate boosting in the R package ‘gbm’ (Ridgeway et al., 2015) to continuous, multivariate outcomes. To illustrate the approach, we analyze predictors of psychological well-being (Ryff & Keyes, 1995). Simulations verify that our approach identifies predictors with nonlinear effects and achieves high prediction accuracy, exceeding or matching the performance of (penalized) multivariate multiple regression and multivariate decision trees over a wide range of conditions. PMID:27918183

Intrapersonal Variability in Negative Affect as a Moderator of Accuracy and Bias in Interpersonal Perception.

PubMed

Sadikaj, Gentiana; Moskowitz, D S; Zuroff, David C

2015-08-01

High intrapersonal variability has frequently been found to be related to poor personal and interpersonal outcomes. Little research has examined processes by which intrapersonal variability influences outcomes. This study explored the relation of intrapersonal variability in negative affect (negative affect flux) to accuracy and bias in the perception of a romantic partner's quarrelsome behavior. A sample of 93 cohabiting couples participated in a study using an event-contingent recording (ECR) methodology in which they reported their negative affect, quarrelsome behavior, and perception of their partner's quarrelsome behavior in interactions with each other during a 20-day period. Negative affect flux was operationalized as the within-person standard deviation of negative affect scores across couple interactions. Findings suggested that participants were both accurate in tracking changes in their partner's quarrelsome behavior and biased in assuming their partner's quarrelsome behavior mirrored their own quarrelsome behavior. Negative affect flux moderated both accuracy and bias of assumed similarity such that participants with higher flux manifested both greater tracking accuracy and larger bias of assumed similarity. Negative affect flux may be related to enhanced vigilance to close others' negative behavior, which may explain higher tracking accuracy and propensity to rely on a person's own negative behavior as a means of judging others' negative behavior. These processes may augment these individuals' negative interpersonal behavior, enhance cycles of negative social interactions, and lead to poor intrapersonal and interpersonal outcomes.

The behavioral and health consequences of sleep deprivation among U.S. high school students: relative deprivation matters.

PubMed

Meldrum, Ryan Charles; Restivo, Emily

2014-06-01

To evaluate whether the strength of the association between sleep deprivation and negative behavioral and health outcomes varies according to the relative amount of sleep deprivation experienced by adolescents. 2011 Youth Risk Behavior Survey data of high school students (N=15,364) were analyzed. Associations were examined on weighted data using logistic regression. Twelve outcomes were examined, ranging from weapon carrying to obesity. The primary independent variable was a self-reported measure of average number of hours slept on school nights. Participants who reported deprivations in sleep were at an increased risk of a number of negative outcomes. However, this varied considerably across different degrees of sleep deprivation. For each of the outcomes considered, those who slept less than 5h were more likely to report negative outcomes (adjusted odds ratios ranging from 1.38 to 2.72; p<.05 across all models) relative to sleeping 8 or more hours. However, less extreme forms of sleep deprivation were, in many instances, unrelated to the outcomes considered. Among U.S. high school students, deficits in sleep are significantly and substantively associated with a variety of negative outcomes, and this association is particularly pronounced for students achieving fewer than 5h of sleep at night. Copyright © 2014 Elsevier Inc. All rights reserved.

Relationship between heart rate variability and pulse wave velocity and their association with patient outcomes in chronic kidney disease

PubMed Central

Chandra, Preeti; Sands, Robin L.; Gillespie, Brenda W.; Levin, Nathan W.; Kotanko, Peter; Kiser, Margaret; Finkelstein, Fredric; Hinderliter, Alan; Rajagopalan, Sanjay; Sengstock, David; Saran, Rajiv

2014-01-01

Background: Arterial stiffness and low heart rate variability (HRV) have each been associated with increased cardiovascular risk in a variety of patient populations. We explored the relationship between HRV and pulse wave velocity (PWV measure of arterial stiffness) in patients with chronic kidney disease (CKD prior to ESRD) along with examining their association with the outcomes of cardiovascular disease (CVD), death, and progression to end stage renal disease (ESRD). Methods: The RRI-CKD Study is a 4-center prospective cohort study of CKD stages 3 – 5 (n = 834). A subset underwent both HRV testing by 24-hour Holter and carotid-femoral PWV (n = 240). Multiple linear regression was used to assess predictors of PWV and Cox regression to investigate the association of HRV and PWV with time to first CVD event or death and ESRD. Results: Although several HRV measures were inversely correlated with PWV, this association was attenuated after adjustment for age and/or diabetes and no longer significant after adjustment for C-reactive protein. Low HRV and high PWV were individually associated with increased risk of the composite endpoint of CVD/death in multivariable analysis. The risk of the composite of CVD/death was highest for patients with both low HRV and high PWV. Conclusion: Age, diabetes, and inflammation together explained the inverse association between HRV and PWV. Inflammation may play a role in the pathogenesis of both low HRV and high PWV. The combination of low HRV and high PWV showed the strongest association with a composite CVD outcome. Mechanisms underlying abnormalities in PWV and HRV, and the role of these measures as intermediate outcomes in future trials in CKD patients, merit further study. PMID:24356038

Subventricular zone predicts high velocity of tumor expansion and poor clinical outcome in patients with low grade astrocytoma.

PubMed

Wen, Bing; Fu, Feixian; Hu, Liangbo; Cai, Qiuyi; Xie, Junshi

2018-05-01

The aim of this study is to clarify the association between subventricular zone (SVZ) involvement and velocity of diametric expansion(VDE) in patients with low-grade astrocytoma and also assessed the clinical outcome of those patients. A total of 168 adult patients with newly diagnosed supratentorial low-grade astrocytoma were studied retrospectively. There were 73 patients had SVZ involvement. Patients with SVZ involvement(7.16 ± 6.53 mm/y) had a higher VDE than patients without SVZ involvement(4.38 ± 5.35 mm/y). VDE was modeled as a categorical variable(＜4, ≥4 and, ＜8, ≥8 and, ＜12, ≥12 mm/y). Logistic regression showed that SVZ involvement was associated with high VDE after adjusting by confounding variables. On the univariate analysis, the results showed that tumor involved with SVZ, VDE ≥ 4 mm/y, VDE ≥ 8 mm/y, and VDE ≥ 8 mm/y were significant predictors of a shorter OS, progression-free survival (PFS) and malignant progression-free survival (MFS)(all p ＜0.05). The categorical variables of VDE (＜4 mm/y, ≥4 mm/y and, ＜8 mm/y, ≥8 mm/y and, ＜12 mm/y, ≥12 mm/y) were adjusted by confounding variables in multivariate analysis, respectively. The results indicated that VDE ≥ 8 mm/y, VDE ≥ 12 mm/y were worse prognostic factors for OS, while VDE ≥ 4 mm/y, VDE ≥ 8 mm/y and VDE ≥ 12 mm/y were related to shorter PFS and MFS. In addition, SVZ involvement was prognostic factors in predicting OS and PFS except MFS. Our results demonstrated that SVZ involvement predicted high VDE and worse clinical outcome, and high VDE was associated with poor prognosis in patients with low-grade astrocytoma. Copyright © 2018 Elsevier B.V. All rights reserved.

Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries based on a multicenter analysis: A pediatric trauma society collaborative.

PubMed

Naik-Mathuria, Bindi J; Rosenfeld, Eric H; Gosain, Ankush; Burd, Randall; Falcone, Richard A; Thakkar, Rajan; Gaines, Barbara; Mooney, David; Escobar, Mauricio; Jafri, Mubeen; Stallion, Anthony; Klinkner, Denise B; Russell, Robert; Campbell, Brendan; Burke, Rita V; Upperman, Jeffrey; Juang, David; St Peter, Shawn; Fenton, Stephon J; Beaudin, Marianne; Wills, Hale; Vogel, Adam; Polites, Stephanie; Pattyn, Adam; Leeper, Christine; Veras, Laura V; Maizlin, Ilan; Thaker, Shefali; Smith, Alexis; Waddell, Megan; Drews, Joseph; Gilmore, James; Armstrong, Lindsey; Sandler, Alexis; Moody, Suzanne; Behrens, Brandon; Carmant, Laurence

2017-10-01

Guidelines for nonoperative management (NOM) of high-grade pancreatic injuries in children have not been established, and wide practice variability exists. The purpose of this study was to evaluate common clinical strategies across multiple pediatric trauma centers to develop a consensus-based standard clinical pathway. A multicenter, retrospective review was conducted of children with high-grade (American Association of Surgeons for Trauma grade III-V) pancreatic injuries treated with NOM between 2010 and 2015. Data were collected on demographics, clinical management, and outcomes. Eighty-six patients were treated at 20 pediatric trauma centers. Median age was 9 years (range, 1-18 years). The majority (73%) of injuries were American Association of Surgeons for Trauma grade III, 24% were grade IV, and 3% were grade V. Median time from injury to presentation was 12 hours and median ISS was 16 (range, 4-66). All patients had computed tomography scan and serum pancreatic enzyme levels at presentation, but serial enzyme level monitoring was variable. Pancreatic enzyme levels did not correlate with injury grade or pseudocyst development. Parenteral nutrition was used in 68% and jejunal feeds in 31%. 3Endoscopic retrograde cholangiopancreatogram was obtained in 25%. An organized peripancreatic fluid collection present for at least 7 days after injury was identified in 59% (42 of 71). Initial management of these included: observation 64%, percutaneous drain 24%, and endoscopic drainage 10% and needle aspiration 2%. Clear liquids were started at a median of 6 days (IQR, 3-13 days) and regular diet at a median of 8 days (IQR 4-20 days). Median hospitalization length was 13 days (IQR, 7-24 days). Injury grade did not account for prolonged time to initiating oral diet or hospital length; indicating that the variability in these outcomes was largely due to different surgeon preferences. High-grade pancreatic injuries in children are rare and significant variability exists in NOM strategies, which may affect outcomes and effective resource utilization. A standard clinical pathway is proposed. Therapeutic/care management, level V (case series).

Coping and back problems: analysis of multiple data sources on an entire cross-sectional cohort of Swedish military recruits.

PubMed

Leboeuf-Yde, Charlotte; Larsen, Kristian; Ahlstrand, Ingvar; Volinn, Ernest

2006-05-03

As the literature now stands, a bewildering number and variety of biological, psychological and social factors are, apparently, implicated in back problems. However, if and how these have a direct influence on back problems is not clear. Obesity, for example, has in many studies been shown to be associated with back problems but there is no evidence for a causal link. This could be explained by a dearth of suitably designed studies but also because obesity may be but a proxy for some other, truly explanatory variable. Coping has been linked with, particularly, persistent back problems as well as with health in general. The question is, whether coping could be the explanatory link between, for example, these two variables. A cross-sectional study was undertaken using data from the Swedish Army, consisting of the entire cohort of males (N = 48,502) summoned in 1998 to serve in the military. The purpose of the study was to investigate the relation between five independent variables and two dependent variables ("outcome variables"). The independent variables were two anthropomorphic variables (height and body mass index), two psychological variables (intellectual capacity and coping in relation to stress), and one social variable (type of education). The two outcome variables were back problems and ill health. In particular, we wanted to determine whether controlling for coping would affect the associations between the other four independent variables and the two outcome variables. Data for the analysis come from a battery of standardized examinations, including medical examinations, a test of intellectual capacity, and a test of coping in relation to stress. Each of these examinations was conducted independently of the others. Unadjusted and adjusted odds ratios were calculated for the outcome variables of back problems and ill health. The associations between height, body mass index, intellectual capacity, type of education and the two outcome variables (back problems and ill health) were weak to moderate. Additionally, there were strong associations between coping and the two outcome variables and when controlling for coping the previously noted associations diminished or disappeared, whereas none of the other variables had a large effect on the association between coping and the two outcome variables. Coping emerged as strongly associated with both back problem and ill health and coping had a leveling effect on the associations between the other independent variables and the two outcome variables. This study is noteworthy particularly because the association with coping is so robust. It is a retrospective, cross-sectional study, however, and, as such it raises questions of causality; which - if any - came first, inability to cope or back pain? The results of this study call attention to the need for a prospective study, in which coping is clearly defined. Such a study has been undertaken and will be presented separately. Index terms: back pain, coping, education, height, BMI, intellectual capacity, bio-psycho-social model, epidemiology, cohort, cross-sectional study.

Predicting the In-Hospital Responsiveness to Treatment of Alcoholics. Social Factors as Predictors of Outcome. Brain Damage as a Factor in Treatment Outcome of Chronic Alcoholic Patients.

ERIC Educational Resources Information Center

Mascia, George V.; And Others

The authors attempt to locate predictor variables associated with the outcome of alcoholic treatment programs. Muscia's study focuses on the predictive potential of: (1) response to a GSR conditioning procedure; (2) several personality variables; and (3) age and IQ measures. Nine variables, reflecting diverse perspectives, were selected as a basis…

Revisiting the Impact of NCLB High-Stakes School Accountability, Capacity, and Resources: State NAEP 1990-2009 Reading and Math Achievement Gaps and Trends

ERIC Educational Resources Information Center

Lee, Jaekyung; Reeves, Todd

2012-01-01

This study examines the impact of high-stakes school accountability, capacity, and resources under NCLB on reading and math achievement outcomes through comparative interrupted time-series analyses of 1990-2009 NAEP state assessment data. Through hierarchical linear modeling latent variable regression with inverse probability of treatment…

Creativity of Biology Students in Online Learning: Case Study of Universitas Terbuka, Indonesia

NASA Astrophysics Data System (ADS)

Diki, Diki

This is a study about the effect of students' attitudes of creativity toward their learning achievement and persistence in an online learning program. The study also investigated if there was an effect of indirect effect of attitudes of creativity toward learning achievement and persistence through learning strategies. There are three learning strategies, which are deep-learning, strategic-learning, and surface-learning. The participants were students of the department of biology and the department of biology teacher training in Universitas Terbuka (UT -- Indonesia Open University), a distance learning university in Indonesia. The researcher sent the questionnaire through email to students who lived throughout Indonesia. There were 102 students participated in the survey. The instruments were rCAB test for value and attitudes toward creativity (Runco, 2012) and approaches and Study Skills Inventory for Students (ASSIST) test (Speth, 2013). There were four research questions (RQ) in this study. The first was if there was a relationship between attitudes of creativity and persistence. The researcher used independent samples t test technique for RQ 1. The second was if there is a relationship between attitudes of creativity and learning outcome. The researcher used multiple regressions for RQ2. The third was if there was an indirect relationship between attitudes of creativity and persistence through learning strategy. The fourth question was if there is an indirect relationship between attitudes of creativity and learning outcome through learning strategy. The researcher used multiple regression for RQ3 and path analysis for RQ 4. Controlling variables were age, income, departments, gender, high school GPA, and daily online activities. The result showed that fun, and being unconventional negatively predicted learning outcomes while high school GPA positively predicted learning outcome. Age and high school GPA negatively predicted persistence while being unconventional positively predicted persistence. Two variables of deep-learning strategy predicted learning outcome. There were indirect relationships between attitudes of creativity and learning outcomes through deep-learning strategy.

Geographic dimensions of heat-related mortality in seven U.S. cities.

PubMed

Hondula, David M; Davis, Robert E; Saha, Michael V; Wegner, Carleigh R; Veazey, Lindsay M

2015-04-01

Spatially targeted interventions may help protect the public when extreme heat occurs. Health outcome data are increasingly being used to map intra-urban variability in heat-health risks, but there has been little effort to compare patterns and risk factors between cities. We sought to identify places within large metropolitan areas where the mortality rate is highest on hot summer days and determine if characteristics of high-risk areas are consistent from one city to another. A Poisson regression model was adapted to quantify temperature-mortality relationships at the postal code scale based on 2.1 million records of daily all-cause mortality counts from seven U.S. cities. Multivariate spatial regression models were then used to determine the demographic and environmental variables most closely associated with intra-city variability in risk. Significant mortality increases on extreme heat days were confined to 12-44% of postal codes comprising each city. Places with greater risk had more developed land, young, elderly, and minority residents, and lower income and educational attainment, but the key explanatory variables varied from one city to another. Regression models accounted for 14-34% of the spatial variability in heat-related mortality. The results emphasize the need for public health plans for heat to be locally tailored and not assume that pre-identified vulnerability indicators are universally applicable. As known risk factors accounted for no more than one third of the spatial variability in heat-health outcomes, consideration of health outcome data is important in efforts to identify and protect residents of the places where the heat-related health risks are the highest. Copyright © 2015 Elsevier Inc. All rights reserved.

Associations of High-Dose Melphalan Pharmacokinetics and Outcomes in the Setting of a Randomized Cryotherapy Trial.

PubMed

Cho, Y K; Sborov, D W; Lamprecht, M; Li, J; Wang, J; Hade, E M; Gao, Y; Tackett, K; Williams, N; Benson, D M; Efebera, Y A; Rosko, A E; Devine, S M; Poi, M; Hofmeister, C C; Phelps, M A

2017-09-01

High-dose melphalan followed by autologous stem cell transplantation remains the standard of care for eligible patients with multiple myeloma, but disease response and toxicity, including severe mucositis, varies among patients. Our randomized trial investigated duration of cryotherapy (2 and 6 h) for reduction of mucositis prevalence and severity and explored factors associated with variability in pharmacokinetics and outcomes from melphalan therapy. The results demonstrate that 2-h is at least as effective as 6-h cryotherapy in decreasing severe mucositis. From a population pharmacokinetic model, we identified that fat-free mass, hematocrit, and creatinine clearance were significant covariates, as reported previously. Furthermore, we observed the rs4240803 SLC7A5 polymorphism was significantly associated with pharmacokinetic variability, and pharmacokinetics was associated with both mucositis and neutropenia. However, melphalan exposure was not associated with progression-free or overall survival in our dataset. These findings contribute to ongoing efforts to personalize melphalan dosing in transplant patients. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Subjective response as a consideration in the pharmacogenetics of alcoholism treatment.

PubMed

Roche, Daniel Jo; Ray, Lara A

2015-01-01

Currently available pharmacological treatments for alcoholism have modest efficacy and high individual variability in treatment outcomes, both of which have been partially attributed to genetic factors. One path to reducing the variability and improving the efficacy associated with these pharmacotherapies may be to identify overlapping genetic contributions to individual differences in both subjective responses to alcohol and alcoholism pharmacotherapy outcomes. As acute subjective response to alcohol is highly predictive of future alcohol related problems, identifying such shared genetic mechanisms may inform the development of personalized treatments that can effectively target converging pathophysiological mechanisms that convey risk for alcoholism. The focus of this review is to revisit the association between subjective response to alcohol and the etiology of alcoholism while also describing genetic contributions to this relationship, discuss potential pharmacogenetic approaches to target subjective response to alcohol in order to improve the treatment of alcoholism and examine conceptual and methodological issues associated with these topics, and outline future approaches to overcome these challenges.

Collinearity and Causal Diagrams: A Lesson on the Importance of Model Specification.

PubMed

Schisterman, Enrique F; Perkins, Neil J; Mumford, Sunni L; Ahrens, Katherine A; Mitchell, Emily M

2017-01-01

Correlated data are ubiquitous in epidemiologic research, particularly in nutritional and environmental epidemiology where mixtures of factors are often studied. Our objectives are to demonstrate how highly correlated data arise in epidemiologic research and provide guidance, using a directed acyclic graph approach, on how to proceed analytically when faced with highly correlated data. We identified three fundamental structural scenarios in which high correlation between a given variable and the exposure can arise: intermediates, confounders, and colliders. For each of these scenarios, we evaluated the consequences of increasing correlation between the given variable and the exposure on the bias and variance for the total effect of the exposure on the outcome using unadjusted and adjusted models. We derived closed-form solutions for continuous outcomes using linear regression and empirically present our findings for binary outcomes using logistic regression. For models properly specified, total effect estimates remained unbiased even when there was almost perfect correlation between the exposure and a given intermediate, confounder, or collider. In general, as the correlation increased, the variance of the parameter estimate for the exposure in the adjusted models increased, while in the unadjusted models, the variance increased to a lesser extent or decreased. Our findings highlight the importance of considering the causal framework under study when specifying regression models. Strategies that do not take into consideration the causal structure may lead to biased effect estimation for the original question of interest, even under high correlation.

Human Development Index (HDI) of the maternal country of origin as a predictor of perinatal outcomes - a longitudinal study conducted in Spain.

PubMed

Garcia-Tizon Larroca, S; Arevalo-Serrano, J; Duran Vila, A; Pintado Recarte, M P; Cueto Hernandez, I; Solis Pierna, A; Lizarraga Bonelli, S; De Leon-Luis, J

2017-09-21

In an era of worldwide population displacement, recent studies have identified strong associations between social situations and perinatal outcomes among immigrants. Little is known about the effect of maternal social background on pregnancy outcomes. The Human Development Index (HDI) assesses the following dimensions of human development: life expectancy, education level and income. The objective of our study was to determine if maternal HDI may be used to identify women at increased odds of poor pregnancy outcomes. We conducted a longitudinal population-based study in a tertiary centre in Madrid, Spain. The outcome variables were maternal and perinatal/antenatal mortality, preeclampsia (PE), low birth weight (LBW), gestational diabetes mellitus (GDM), preterm delivery (PTD) before 37 and 34 gestational weeks, abnormal cardiotocography (CTG) during delivery, C-section (CS) due to abnormal CTG, pH < 7.10 at birth, Apgar at 5 min ≤ 7, and resuscitation type ≥3. We performed multivariate logistic regression analyses adjusted for potential confounding variables to evaluate the associations between maternal HDI and perinatal outcomes. In total, 38,719 singleton infants who were born in our maternity ward between 2010 and 2016 and had perinatal outcome data available were included in this study. The neonates of women from medium/low HDI countries had significantly lower odds of low birth weight (LBW) than their very high HDI country counterparts (OR 0.63, 95% CI 0.55-0.72). However, the odds of PTD before 37 gestational weeks and PE were higher in the medium/low HDI group than the very high HDI group (OR 1.26, 95% CI 1.04-1.53; OR 1.35, 95% CI 1.02-1.79, respectively). Poorer neonatal outcomes were identified in the medium/low HDI group than the very high HDI group, including greater odds of abnormal CTG, CS due to abnormal CTG and Apgar 2 ≤ 7 (p < 0.05). Our findings suggest that the infants of mothers from medium/low HDI had lower odds of LBW but higher odds of PTD, PE and poor neonatal outcomes. These results support the hypothesis that maternal HDI can be used to understand the impact of maternal origin on pregnancy outcomes. Further studies are needed to confirm its validity.

Management and Outcomes Following Surgery for Gastrointestinal Typhoid: An International, Prospective, Multicentre Cohort Study.

PubMed

2018-05-03

Gastrointestinal perforation is the most serious complication of typhoid fever, with a high disease burden in low-income countries. Reliable, prospective, contemporary surgical outcome data are scarce in these settings. This study aimed to investigate surgical outcomes following surgery for intestinal typhoid. Two multicentre, international prospective cohort studies of consecutive patients undergoing surgery for gastrointestinal typhoid perforation were conducted. Outcomes were measured at 30 days and included mortality, surgical site infection, organ space infection and reintervention rate. Multilevel logistic regression models were used to adjust for clinically plausible explanatory variables. Effect estimates are expressed as odds ratios (ORs) alongside their corresponding 95% confidence intervals. A total of 88 patients across the GlobalSurg 1 and GlobalSurg 2 studies were included, from 11 countries. Children comprised 38.6% (34/88) of included patients. Most patients (87/88) had intestinal perforation. The 30-day mortality rate was 9.1% (8/88), which was higher in children (14.7 vs. 5.6%). Surgical site infection was common, at 67.0% (59/88). Organ site infection was common, with 10.2% of patients affected. An ASA grade of III and above was a strong predictor of 30-day post-operative mortality, at the univariable level and following adjustment for explanatory variables (OR 15.82, 95% CI 1.53-163.57, p = 0.021). With high mortality and complication rates, outcomes from surgery for intestinal typhoid remain poor. Future studies in this area should focus on sustainable interventions which can reduce perioperative morbidity. At a policy level, improving these outcomes will require both surgical and public health system advances.

Multiple aspects of high school students' strategic processing on reading outcomes: The role of quantity, quality, and conjunctive strategy use.

PubMed

Parkinson, Meghan M; Dinsmore, Daniel L

2018-03-01

While the literature on strategy use is relatively mature, measures of strategy use overwhelmingly measure only one aspect of that use, frequency, when relating that strategy use to performance outcomes. While this might be one important attribute of strategy use, there is increasing evidence that quality and conditional use of cognitive and metacognitive strategies may also be important. This study examines how multiple aspects of strategy use, namely frequency, quality, and conjunctive use of strategies, influence task performance on both well- and ill-structured task outcomes in addition to other concomitant variables that may interact with strategic processing during reading. The sample consisted of 21 high school students enrolled in an upper-level biology class in a suburban school in the north-eastern United States. These participants completed measures of prior knowledge and interest, then read either an expository or persuasive text while thinking aloud. They then completed a passage recall and open-ended response following passage completion. In general, quantity was not positively related to the study outcomes and was negatively related to one of them. Quality of strategy use, on the other hand, was consistently related to positive reading outcomes. The influence of knowledge and interest in terms of strategies is also discussed as well as six cases which illustrate the relation of aspects of strategy use and the other concomitant variables. Evaluating strategy use by solely examining the frequency of strategy use did not explain differences in task performance as well as evaluating the quality and conjunctive use of strategies. Further, important relations between prior knowledge, interest, and the task outcomes appeared to be mediated and moderated by the aspects of strategy use investigated. © 2017 The British Psychological Society.

Size and consistency of problem-solving consultation outcomes: an empirical analysis.

PubMed

Hurwitz, Jason T; Kratochwill, Thomas R; Serlin, Ronald C

2015-04-01

In this study, we analyzed extant data to evaluate the variability and magnitude of students' behavior change outcomes (academic, social, and behavioral) produced by consultants through problem-solving consultation with teachers. Research questions were twofold: (a) Do consultants produce consistent and sizeable positive student outcomes across their cases as measured through direct and frequent assessment? and (b) What proportion of variability in student outcomes is attributable to consultants? Analyses of extant data collected from problem-solving consultation outcome studies that used single-case, time-series AB designs with multiple participants were analyzed. Four such studies ultimately met the inclusion criteria for the extant data, comprising 124 consultants who worked with 302 school teachers regarding 453 individual students. Consultants constituted the independent variable, while the primary dependent variable was a descriptive effect size based on student behavior change as measured by (a) curriculum-based measures, (b) permanent products, or (c) direct observations. Primary analyses involved visual and statistical evaluation of effect size magnitude and variability observed within and between consultants and studies. Given the nested nature of the data, multilevel analyses were used to assess consultant effects on student outcomes. Results suggest that consultants consistently produced positive effect sizes on average across their cases, but outcomes varied between consultants. Findings also indicated that consultants, teachers, and the corresponding studies accounted for a significant proportion of variability in student outcomes. This investigation advances the use of multilevel and integrative data analyses to evaluate consultation outcomes and extends research on problem-solving consultation, consultant effects, and meta-analysis of case study AB designs. Practical implications for evaluating consultation service delivery in school settings are also discussed. Copyright © 2015 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Intercenter Differences in Bronchopulmonary Dysplasia or Death Among Very Low Birth Weight Infants

PubMed Central

Walsh, Michele; Bobashev, Georgiy; Das, Abhik; Levine, Burton; Carlo, Waldemar A.; Higgins, Rosemary D.

2011-01-01

OBJECTIVES: To determine (1) the magnitude of clustering of bronchopulmonary dysplasia (36 weeks) or death (the outcome) across centers of the Eunice Kennedy Shriver National Institute of Child and Human Development National Research Network, (2) the infant-level variables associated with the outcome and estimate their clustering, and (3) the center-specific practices associated with the differences and build predictive models. METHODS: Data on neonates with a birth weight of <1250 g from the cluster-randomized benchmarking trial were used to determine the magnitude of clustering of the outcome according to alternating logistic regression by using pairwise odds ratio and predictive modeling. Clinical variables associated with the outcome were identified by using multivariate analysis. The magnitude of clustering was then evaluated after correction for infant-level variables. Predictive models were developed by using center-specific and infant-level variables for data from 2001 2004 and projected to 2006. RESULTS: In 2001–2004, clustering of bronchopulmonary dysplasia/death was significant (pairwise odds ratio: 1.3; P < .001) and increased in 2006 (pairwise odds ratio: 1.6; overall incidence: 52%; range across centers: 32%–74%); center rates were relatively stable over time. Variables that varied according to center and were associated with increased risk of outcome included lower body temperature at NICU admission, use of prophylactic indomethacin, specific drug therapy on day 1, and lack of endotracheal intubation. Center differences remained significant even after correction for clustered variables. CONCLUSION: Bronchopulmonary dysplasia/death rates demonstrated moderate clustering according to center. Clinical variables associated with the outcome were also clustered. Center differences after correction of clustered variables indicate presence of as-yet unmeasured center variables. PMID:21149431

Estimation of Causal Mediation Effects for a Dichotomous Outcome in Multiple-Mediator Models using the Mediation Formula

PubMed Central

Nelson, Suchitra; Albert, Jeffrey M.

2013-01-01

Mediators are intermediate variables in the causal pathway between an exposure and an outcome. Mediation analysis investigates the extent to which exposure effects occur through these variables, thus revealing causal mechanisms. In this paper, we consider the estimation of the mediation effect when the outcome is binary and multiple mediators of different types exist. We give a precise definition of the total mediation effect as well as decomposed mediation effects through individual or sets of mediators using the potential outcomes framework. We formulate a model of joint distribution (probit-normal) using continuous latent variables for any binary mediators to account for correlations among multiple mediators. A mediation formula approach is proposed to estimate the total mediation effect and decomposed mediation effects based on this parametric model. Estimation of mediation effects through individual or subsets of mediators requires an assumption involving the joint distribution of multiple counterfactuals. We conduct a simulation study that demonstrates low bias of mediation effect estimators for two-mediator models with various combinations of mediator types. The results also show that the power to detect a non-zero total mediation effect increases as the correlation coefficient between two mediators increases, while power for individual mediation effects reaches a maximum when the mediators are uncorrelated. We illustrate our approach by applying it to a retrospective cohort study of dental caries in adolescents with low and high socioeconomic status. Sensitivity analysis is performed to assess the robustness of conclusions regarding mediation effects when the assumption of no unmeasured mediator-outcome confounders is violated. PMID:23650048

Estimation of causal mediation effects for a dichotomous outcome in multiple-mediator models using the mediation formula.

PubMed

Wang, Wei; Nelson, Suchitra; Albert, Jeffrey M

2013-10-30

Mediators are intermediate variables in the causal pathway between an exposure and an outcome. Mediation analysis investigates the extent to which exposure effects occur through these variables, thus revealing causal mechanisms. In this paper, we consider the estimation of the mediation effect when the outcome is binary and multiple mediators of different types exist. We give a precise definition of the total mediation effect as well as decomposed mediation effects through individual or sets of mediators using the potential outcomes framework. We formulate a model of joint distribution (probit-normal) using continuous latent variables for any binary mediators to account for correlations among multiple mediators. A mediation formula approach is proposed to estimate the total mediation effect and decomposed mediation effects based on this parametric model. Estimation of mediation effects through individual or subsets of mediators requires an assumption involving the joint distribution of multiple counterfactuals. We conduct a simulation study that demonstrates low bias of mediation effect estimators for two-mediator models with various combinations of mediator types. The results also show that the power to detect a nonzero total mediation effect increases as the correlation coefficient between two mediators increases, whereas power for individual mediation effects reaches a maximum when the mediators are uncorrelated. We illustrate our approach by applying it to a retrospective cohort study of dental caries in adolescents with low and high socioeconomic status. Sensitivity analysis is performed to assess the robustness of conclusions regarding mediation effects when the assumption of no unmeasured mediator-outcome confounders is violated. Copyright © 2013 John Wiley & Sons, Ltd.

Hierarchical Bayesian spatial models for predicting multiple forest variables using waveform LiDAR, hyperspectral imagery, and large inventory datasets

USGS Publications Warehouse

Finley, Andrew O.; Banerjee, Sudipto; Cook, Bruce D.; Bradford, John B.

2013-01-01

In this paper we detail a multivariate spatial regression model that couples LiDAR, hyperspectral and forest inventory data to predict forest outcome variables at a high spatial resolution. The proposed model is used to analyze forest inventory data collected on the US Forest Service Penobscot Experimental Forest (PEF), ME, USA. In addition to helping meet the regression model's assumptions, results from the PEF analysis suggest that the addition of multivariate spatial random effects improves model fit and predictive ability, compared with two commonly applied modeling approaches. This improvement results from explicitly modeling the covariation among forest outcome variables and spatial dependence among observations through the random effects. Direct application of such multivariate models to even moderately large datasets is often computationally infeasible because of cubic order matrix algorithms involved in estimation. We apply a spatial dimension reduction technique to help overcome this computational hurdle without sacrificing richness in modeling.

Violence as Mediating Variable in Mental Health Disparities Associated to Sexual Orientation Among Mexican Youths.

PubMed

Mendoza-Pérez, Juan Carlos; Ortiz-Hernández, Luis

2018-01-05

In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males.

Evaluating choices by single neurons in the frontal lobe: outcome value encoded across multiple decision variables

PubMed Central

Kennerley, Steven W.; Wallis, Jonathan D.

2009-01-01

Damage to the frontal lobe can cause severe decision-making impairments. A mechanism that may underlie this is that neurons in the frontal cortex encode many variables that contribute to the valuation of a choice, such as its costs, benefits and probability of success. However, optimal decision-making requires that one considers these variables, not only when faced with the choice, but also when evaluating the outcome of the choice, in order to adapt future behaviour appropriately. To examine the role of the frontal cortex in encoding the value of different choice outcomes, we simultaneously recorded the activity of multiple single neurons in the anterior cingulate cortex (ACC), orbitofrontal cortex (OFC) and lateral prefrontal cortex (LPFC) while subjects evaluated the outcome of choices involving manipulations of probability, payoff and cost. Frontal neurons encoded many of the parameters that enabled the calculation of the value of these variables, including the onset and offset of reward and the amount of work performed, and often encoded the value of outcomes across multiple decision variables. In addition, many neurons encoded both the predicted outcome during the choice phase of the task as well as the experienced outcome in the outcome phase of the task. These patterns of selectivity were more prevalent in ACC relative to OFC and LPFC. These results support a role for the frontal cortex, principally ACC, in selecting between choice alternatives and evaluating the outcome of that selection thereby ensuring that choices are optimal and adaptive. PMID:19453638

Poor phonetic perceivers are affected by cognitive load when resolving talker variability

PubMed Central

Antoniou, Mark; Wong, Patrick C. M.

2015-01-01

Speech training paradigms aim to maximise learning outcomes by manipulating external factors such as talker variability. However, not all individuals may benefit from such manipulations because subject-external factors interact with subject-internal ones (e.g., aptitude) to determine speech perception and/or learning success. In a previous tone learning study, high-aptitude individuals benefitted from talker variability, whereas low-aptitude individuals were impaired. Because increases in cognitive load have been shown to hinder speech perception in mixed-talker conditions, it has been proposed that resolving talker variability requires cognitive resources. This proposal leads to the hypothesis that low-aptitude individuals do not use their cognitive resources as efficiently as those with high aptitude. Here, high- and low-aptitude subjects identified pitch contours spoken by multiple talkers under high and low cognitive load conditions established by a secondary task. While high-aptitude listeners outperformed low-aptitude listeners across load conditions, only low-aptitude listeners were impaired by increased cognitive load. The findings suggest that low-aptitude listeners either have fewer available cognitive resources or are poorer at allocating attention to the signal. Therefore, cognitive load is an important factor when considering individual differences in speech perception and training paradigms. PMID:26328675

Poor phonetic perceivers are affected by cognitive load when resolving talker variability.

PubMed

Antoniou, Mark; Wong, Patrick C M

2015-08-01

Speech training paradigms aim to maximise learning outcomes by manipulating external factors such as talker variability. However, not all individuals may benefit from such manipulations because subject-external factors interact with subject-internal ones (e.g., aptitude) to determine speech perception and/or learning success. In a previous tone learning study, high-aptitude individuals benefitted from talker variability, whereas low-aptitude individuals were impaired. Because increases in cognitive load have been shown to hinder speech perception in mixed-talker conditions, it has been proposed that resolving talker variability requires cognitive resources. This proposal leads to the hypothesis that low-aptitude individuals do not use their cognitive resources as efficiently as those with high aptitude. Here, high- and low-aptitude subjects identified pitch contours spoken by multiple talkers under high and low cognitive load conditions established by a secondary task. While high-aptitude listeners outperformed low-aptitude listeners across load conditions, only low-aptitude listeners were impaired by increased cognitive load. The findings suggest that low-aptitude listeners either have fewer available cognitive resources or are poorer at allocating attention to the signal. Therefore, cognitive load is an important factor when considering individual differences in speech perception and training paradigms.

Statistical grand rounds: understanding the mechanism: mediation analysis in randomized and nonrandomized studies.

PubMed

Mascha, Edward J; Dalton, Jarrod E; Kurz, Andrea; Saager, Leif

2013-10-01

In comparative clinical studies, a common goal is to assess whether an exposure, or intervention, affects the outcome of interest. However, just as important is to understand the mechanism(s) for how the intervention affects outcome. For example, if preoperative anemia was shown to increase the risk of postoperative complications by 15%, it would be important to quantify how much of that effect was due to patients receiving intraoperative transfusions. Mediation analysis attempts to quantify how much, if any, of the effect of an intervention on outcome goes though prespecified mediator, or "mechanism" variable(s), that is, variables sitting on the causal pathway between exposure and outcome. Effects of an exposure on outcome can thus be divided into direct and indirect, or mediated, effects. Mediation is claimed when 2 conditions are true: the exposure affects the mediator and the mediator (adjusting for the exposure) affects the outcome. Understanding how an intervention affects outcome can validate or invalidate one's original hypothesis and also facilitate further research to modify the responsible factors, and thus improve patient outcome. We discuss the proper design and analysis of studies investigating mediation, including the importance of distinguishing mediator variables from confounding variables, the challenge of identifying potential mediators when the exposure is chronic versus acute, and the requirements for claiming mediation. Simple designs are considered, as well as those containing multiple mediators, multiple outcomes, and mixed data types. Methods are illustrated with data collected by the National Surgical Quality Improvement Project (NSQIP) and utilized in a companion paper which assessed the effects of preoperative anemic status on postoperative outcomes.

On the Use of a Cumulative Distribution as a Utility Function in Educational or Employment Selection.

DTIC Science & Technology

1981-02-01

monotonic increasing function of true ability or performance score. A cumulative probability function is * then very convenient for describiny; one’s...possible outcomes such as test scores, grade-point averages or other common outcome variables. Utility is usually a monotonic increasing function of true ...r(0) is negative for 8 <i and positive for 0 > M, U(o) is risk-prone for low 0 values and risk-averse for high 0 values. This property is true for

Religiousness and Levels of Hazardous Alcohol Use: A Latent Profile Analysis.

PubMed

Jankowski, Peter J; Hardy, Sam A; Zamboanga, Byron L; Ham, Lindsay S; Schwartz, Seth J; Kim, Su Yeong; Forthun, Larry F; Bersamin, Melina M; Donovan, Roxanne A; Whitbourne, Susan Krauss; Hurley, Eric A; Cano, Miguel Ángel

2015-10-01

Prior person-centered research has consistently identified a subgroup of highly religious participants that uses significantly less alcohol when compared to the other subgroups. The construct of religious motivation is absent from existing examinations of the nuanced combinations of religiousness dimensions within persons, and alcohol expectancy valuations have yet to be included as outcome variables. Variable-centered approaches have found religious motivation and alcohol expectancy valuations to play a protective role against individuals' hazardous alcohol use. The current study examined latent religiousness profiles and hazardous alcohol use in a large, multisite sample of ethnically diverse college students. The sample consisted of 7412 college students aged 18-25 (M age = 19.77, SD age = 1.61; 75% female; 61% European American). Three latent profiles were derived from measures of religious involvement, salience, and religious motivations: Quest-Intrinsic Religiousness (highest levels of salience, involvement, and quest and intrinsic motivations; lowest level of extrinsic motivation), Moderate Religiousness (intermediate levels of salience, involvement, and motivations) and Extrinsic Religiousness (lowest levels of salience, involvement, and quest and intrinsic motivations; highest level of extrinsic motivation). The Quest-Intrinsic Religiousness profile scored significantly lower on hazardous alcohol use, positive expectancy outcomes, positive expectancy valuations, and negative expectancy valuations, and significantly higher on negative expectancy outcomes, compared to the other two profiles. The Extrinsic and Moderate Religiousness profiles did not differ significantly on positive expectancy outcomes, negative expectancy outcomes, negative expectancy valuations, or hazardous alcohol use. The results advance existing research by demonstrating that the protective influence of religiousness on college students' hazardous alcohol use may involve high levels on both quest and intrinsic religious motivation.

Selection of latent variables for multiple mixed-outcome models

PubMed Central

ZHOU, LING; LIN, HUAZHEN; SONG, XINYUAN; LI, YI

2014-01-01

Latent variable models have been widely used for modeling the dependence structure of multiple outcomes data. However, the formulation of a latent variable model is often unknown a priori, the misspecification will distort the dependence structure and lead to unreliable model inference. Moreover, multiple outcomes with varying types present enormous analytical challenges. In this paper, we present a class of general latent variable models that can accommodate mixed types of outcomes. We propose a novel selection approach that simultaneously selects latent variables and estimates parameters. We show that the proposed estimator is consistent, asymptotically normal and has the oracle property. The practical utility of the methods is confirmed via simulations as well as an application to the analysis of the World Values Survey, a global research project that explores peoples’ values and beliefs and the social and personal characteristics that might influence them. PMID:27642219

Cytokines Synergize to Combat Metastatic Neuroblastoma | Center for Cancer Research

Cancer.gov

Neuroblastoma is the most common extracranial solid tumor in children, and clinical outcomes of patients with this disease are quite variable. Prognosis is particularly poor for patients with high-risk tumors (classification based on patients’ age, extent of disease spread, and other biological features).

Bias and Bias Correction in Multi-Site Instrumental Variables Analysis of Heterogeneous Mediator Effects

ERIC Educational Resources Information Center

Reardon, Sean F.; Unlu, Faith; Zhu, Pei; Bloom, Howard

2013-01-01

We explore the use of instrumental variables (IV) analysis with a multi-site randomized trial to estimate the effect of a mediating variable on an outcome in cases where it can be assumed that the observed mediator is the only mechanism linking treatment assignment to outcomes, as assumption known in the instrumental variables literature as the…

Variable selection for confounder control, flexible modeling and Collaborative Targeted Minimum Loss-based Estimation in causal inference

PubMed Central

Schnitzer, Mireille E.; Lok, Judith J.; Gruber, Susan

2015-01-01

This paper investigates the appropriateness of the integration of flexible propensity score modeling (nonparametric or machine learning approaches) in semiparametric models for the estimation of a causal quantity, such as the mean outcome under treatment. We begin with an overview of some of the issues involved in knowledge-based and statistical variable selection in causal inference and the potential pitfalls of automated selection based on the fit of the propensity score. Using a simple example, we directly show the consequences of adjusting for pure causes of the exposure when using inverse probability of treatment weighting (IPTW). Such variables are likely to be selected when using a naive approach to model selection for the propensity score. We describe how the method of Collaborative Targeted minimum loss-based estimation (C-TMLE; van der Laan and Gruber, 2010) capitalizes on the collaborative double robustness property of semiparametric efficient estimators to select covariates for the propensity score based on the error in the conditional outcome model. Finally, we compare several approaches to automated variable selection in low-and high-dimensional settings through a simulation study. From this simulation study, we conclude that using IPTW with flexible prediction for the propensity score can result in inferior estimation, while Targeted minimum loss-based estimation and C-TMLE may benefit from flexible prediction and remain robust to the presence of variables that are highly correlated with treatment. However, in our study, standard influence function-based methods for the variance underestimated the standard errors, resulting in poor coverage under certain data-generating scenarios. PMID:26226129

Variable Selection for Confounder Control, Flexible Modeling and Collaborative Targeted Minimum Loss-Based Estimation in Causal Inference.

PubMed

Schnitzer, Mireille E; Lok, Judith J; Gruber, Susan

2016-05-01

This paper investigates the appropriateness of the integration of flexible propensity score modeling (nonparametric or machine learning approaches) in semiparametric models for the estimation of a causal quantity, such as the mean outcome under treatment. We begin with an overview of some of the issues involved in knowledge-based and statistical variable selection in causal inference and the potential pitfalls of automated selection based on the fit of the propensity score. Using a simple example, we directly show the consequences of adjusting for pure causes of the exposure when using inverse probability of treatment weighting (IPTW). Such variables are likely to be selected when using a naive approach to model selection for the propensity score. We describe how the method of Collaborative Targeted minimum loss-based estimation (C-TMLE; van der Laan and Gruber, 2010 [27]) capitalizes on the collaborative double robustness property of semiparametric efficient estimators to select covariates for the propensity score based on the error in the conditional outcome model. Finally, we compare several approaches to automated variable selection in low- and high-dimensional settings through a simulation study. From this simulation study, we conclude that using IPTW with flexible prediction for the propensity score can result in inferior estimation, while Targeted minimum loss-based estimation and C-TMLE may benefit from flexible prediction and remain robust to the presence of variables that are highly correlated with treatment. However, in our study, standard influence function-based methods for the variance underestimated the standard errors, resulting in poor coverage under certain data-generating scenarios.

Moderation and Mediation in Structural Equation Modeling: Applications for Early Intervention Research

ERIC Educational Resources Information Center

Hopwood, Christopher J.

2007-01-01

Second-generation early intervention research typically involves the specification of multivariate relations between interventions, outcomes, and other variables. Moderation and mediation involve variables or sets of variables that influence relations between interventions and outcomes. Following the framework of Baron and Kenny's (1986) seminal…

[Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

PubMed

Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

2014-02-01

This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

Outcomes Definitions and Statistical Tests in Oncology Studies: A Systematic Review of the Reporting Consistency.

PubMed

Rivoirard, Romain; Duplay, Vianney; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Magne, Nicolas; Bourmaud, Aurelie

2016-01-01

Quality of reporting for Randomized Clinical Trials (RCTs) in oncology was analyzed in several systematic reviews, but, in this setting, there is paucity of data for the outcomes definitions and consistency of reporting for statistical tests in RCTs and Observational Studies (OBS). The objective of this review was to describe those two reporting aspects, for OBS and RCTs in oncology. From a list of 19 medical journals, three were retained for analysis, after a random selection: British Medical Journal (BMJ), Annals of Oncology (AoO) and British Journal of Cancer (BJC). All original articles published between March 2009 and March 2014 were screened. Only studies whose main outcome was accompanied by a corresponding statistical test were included in the analysis. Studies based on censored data were excluded. Primary outcome was to assess quality of reporting for description of primary outcome measure in RCTs and of variables of interest in OBS. A logistic regression was performed to identify covariates of studies potentially associated with concordance of tests between Methods and Results parts. 826 studies were included in the review, and 698 were OBS. Variables were described in Methods section for all OBS studies and primary endpoint was clearly detailed in Methods section for 109 RCTs (85.2%). 295 OBS (42.2%) and 43 RCTs (33.6%) had perfect agreement for reported statistical test between Methods and Results parts. In multivariable analysis, variable "number of included patients in study" was associated with test consistency: aOR (adjusted Odds Ratio) for third group compared to first group was equal to: aOR Grp3 = 0.52 [0.31-0.89] (P value = 0.009). Variables in OBS and primary endpoint in RCTs are reported and described with a high frequency. However, statistical tests consistency between methods and Results sections of OBS is not always noted. Therefore, we encourage authors and peer reviewers to verify consistency of statistical tests in oncology studies.

Outcomes Definitions and Statistical Tests in Oncology Studies: A Systematic Review of the Reporting Consistency

PubMed Central

Rivoirard, Romain; Duplay, Vianney; Oriol, Mathieu; Tinquaut, Fabien; Chauvin, Franck; Magne, Nicolas; Bourmaud, Aurelie

2016-01-01

Background Quality of reporting for Randomized Clinical Trials (RCTs) in oncology was analyzed in several systematic reviews, but, in this setting, there is paucity of data for the outcomes definitions and consistency of reporting for statistical tests in RCTs and Observational Studies (OBS). The objective of this review was to describe those two reporting aspects, for OBS and RCTs in oncology. Methods From a list of 19 medical journals, three were retained for analysis, after a random selection: British Medical Journal (BMJ), Annals of Oncology (AoO) and British Journal of Cancer (BJC). All original articles published between March 2009 and March 2014 were screened. Only studies whose main outcome was accompanied by a corresponding statistical test were included in the analysis. Studies based on censored data were excluded. Primary outcome was to assess quality of reporting for description of primary outcome measure in RCTs and of variables of interest in OBS. A logistic regression was performed to identify covariates of studies potentially associated with concordance of tests between Methods and Results parts. Results 826 studies were included in the review, and 698 were OBS. Variables were described in Methods section for all OBS studies and primary endpoint was clearly detailed in Methods section for 109 RCTs (85.2%). 295 OBS (42.2%) and 43 RCTs (33.6%) had perfect agreement for reported statistical test between Methods and Results parts. In multivariable analysis, variable "number of included patients in study" was associated with test consistency: aOR (adjusted Odds Ratio) for third group compared to first group was equal to: aOR Grp3 = 0.52 [0.31–0.89] (P value = 0.009). Conclusion Variables in OBS and primary endpoint in RCTs are reported and described with a high frequency. However, statistical tests consistency between methods and Results sections of OBS is not always noted. Therefore, we encourage authors and peer reviewers to verify consistency of statistical tests in oncology studies. PMID:27716793

Association of Various Components of Media Literacy and Adolescent Smoking

PubMed Central

Primack, Brian A.; Hobbs, Renee

2010-01-01

Objective To determine which specific aspects of media literacy were most strongly associated with smoking outcomes. Methods Students at a public high school responded to cross-sectional survey items measuring smoking outcomes, components of media literacy, and other variables. Results Of the 1211 participants, 19% were current smokers (N = 216) and 40% of the nonsmokers (N = 342) were susceptible to smoking. In the adjusted models, current smoking was most strongly related to representation-reality domain items, but susceptibility to smoking was associated with each of the media literacy domains. Conclusion Varied relationships exist between individual facets of media literacy and smoking outcomes. PMID:18844513

Prognostic Performance and Reproducibility of the 1973 and 2004/2016 World Health Organization Grading Classification Systems in Non-muscle-invasive Bladder Cancer: A European Association of Urology Non-muscle Invasive Bladder Cancer Guidelines Panel Systematic Review.

PubMed

Soukup, Viktor; Čapoun, Otakar; Cohen, Daniel; Hernández, Virginia; Babjuk, Marek; Burger, Max; Compérat, Eva; Gontero, Paolo; Lam, Thomas; MacLennan, Steven; Mostafid, A Hugh; Palou, Joan; van Rhijn, Bas W G; Rouprêt, Morgan; Shariat, Shahrokh F; Sylvester, Richard; Yuan, Yuhong; Zigeuner, Richard

2017-11-01

Tumour grade is an important prognostic indicator in non-muscle-invasive bladder cancer (NMIBC). Histopathological classifications are limited by interobserver variability (reproducibility), which may have prognostic implications. European Association of Urology NMIBC guidelines suggest concurrent use of both 1973 and 2004/2016 World Health Organization (WHO) classifications. To compare the prognostic performance and reproducibility of the 1973 and 2004/2016 WHO grading systems for NMIBC. A systematic literature search was undertaken incorporating Medline, Embase, and the Cochrane Library. Studies were critically appraised for risk of bias (QUIPS). For prognosis, the primary outcome was progression to muscle-invasive or metastatic disease. Secondary outcomes were disease recurrence, and overall and cancer-specific survival. For reproducibility, the primary outcome was interobserver variability between pathologists. Secondary outcome was intraobserver variability (repeatability) by the same pathologist. Of 3593 articles identified, 20 were included in the prognostic review; three were eligible for the reproducibility review. Increasing tumour grade in both classifications was associated with higher disease progression and recurrence rates. Progression rates in grade 1 patients were similar to those in low-grade patients; progression rates in grade 3 patients were higher than those in high-grade patients. Survival data were limited. Reproducibility of the 2004/2016 system was marginally better than that of the 1973 system. Two studies on repeatability showed conflicting results. Most studies had a moderate to high risk of bias. Current grading classifications in NMIBC are suboptimal. The 1973 system identifies more aggressive tumours. Intra- and interobserver variability was slightly less in the 2004/2016 classification. We could not confirm that the 2004/2016 classification outperforms the 1973 classification in prediction of recurrence and progression. This article summarises the utility of two different grading systems for non-muscle-invasive bladder cancer. Both systems predict progression and recurrence, although pathologists vary in their reporting; suggestions for further improvements are made. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Variability in pathobiology of South Korean H5N1 high-pathogenicity avian influenza virus infection for 5 species of migratory waterfowl

USDA-ARS?s Scientific Manuscript database

The biological outcome of H5N1 high pathogenicity avian influenza (HPAI) virus infection in wild waterfowl is poorly understood. This study examined infectivity and pathobiology of A/chicken/Korea/IS/06 (H5N1) HPAI virus infection in Mute swans (Cygnus olor), Greylag geese (Anser anser), Ruddy Sheld...

Network and Mutual Support for Parents Bereaved Following the Violent Deaths of Their 12- to 28-Year Old Children: A Longitudinal, Prospective Analysis.

ERIC Educational Resources Information Center

Murphy, Shirley A.; Lohan, Janet; Dimond, Margaret; Fan, Juanjuan

1998-01-01

Examines types and frequency of posttreatment contacts among bereaved parents who participated in an experimental support program. Compares those who reported high versus low social support and high versus low numbers of network confidants on selected outcome and coping variables. Number of network confidants did not significantly affect the…

High Intrapatient Variability of Tacrolimus Exposure in the Early Period After Liver Transplantation Is Associated With Poorer Outcomes.

PubMed

Rayar, Michel; Tron, Camille; Jézéquel, Caroline; Beaurepaire, Jean Marie; Petitcollin, Antoine; Houssel-Debry, Pauline; Camus, Christophe; Verdier, Marie Clémence; Dehlawi, Ammar; Lakéhal, Mohamed; Desfourneaux, Véronique; Meunier, Bernard; Sulpice, Laurent; Bellissant, Eric; Boudjema, Karim; Lemaitre, Florian

2018-03-01

Tacrolimus (TAC) is the cornerstone of immunosuppressive regimen in liver transplantation (LT). Its pharmacokinetics is characterized by a high interpatient and intrapatient variability (IPV) leading to an unpredictable dose-response relationship. The aim of our study was to evaluate the impact of TAC IPV (IPV) on graft and patient outcomes after LT. We retrospectively analyzed 812 LT recipients treated with TAC. The IPV of TAC concentrations was estimated by calculating the coefficient of variation (CV) of whole blood trough concentrations. Patients were categorized in 2 groups: low IPV (CV < 40%) and high IPV (CV ≥ 40%). There were significantly more neurologic complications (31.2% vs 16.6%, P < 0.001), cardiovascular complications (19.7% vs 9.7%, P < 0.001), and acute renal failure requiring dialysis (8.5% vs 2.2%, P < 0.001) in the high CV group than in the low CV group. Moreover, graft survival was significantly poorer in the high CV group (hazard ratio, 1.42; 95% confidence interval, 1.04-1.95; P = 0.03). A pretransplantation elevated Model for End-Stage Liver Disease score (P < 0.001) and Child-Pugh grade (P < 0.001) were identified as risk factors for presenting a high CV. A high CV of TAC concentrations was found to be predictive of TAC-related toxicity and poorer survival.

Prestroke physical activity is associated with good functional outcome and arterial recanalization after stroke due to a large vessel occlusion.

PubMed

Ricciardi, Ana Clara; López-Cancio, Elena; Pérez de la Ossa, Natalia; Sobrino, Tomás; Hernández-Pérez, María; Gomis, Meritxell; Munuera, Josep; Muñoz, Lucía; Dorado, Laura; Millán, Mónica; Dávalos, Antonio; Arenillas, Juan F

2014-01-01

Although multiple studies and meta-analyses have consistently suggested that regular physical activity (PhA) is associated with a decreased stroke risk and recurrence, there is limited data on the possible preconditioning effect of prestroke PhA on stroke severity and prognosis. We aimed to study the association of prestroke PhA with different outcome variables in patients with acute ischemic stroke due to an anterior large vessel occlusion. The Prestroke Physical Activity and Functional Recovery in Patients with Ischemic Stroke and Arterial Occlusion trial is an observational and longitudinal study that included consecutive patients with acute ischemic stroke admitted to a single tertiary stroke center. Main inclusion criteria were: anterior circulation ischemic stroke within 12 h from symptom onset; presence of a confirmed anterior large vessel occlusion, and functional independence previous to stroke. Prestroke PhA was evaluated with the International Physical Activity Questionnaire and categorized into mild, moderate and high levels by means of metabolic equivalent (MET) minutes per week thresholds. The primary outcome measure was good functional outcome at 3 months (modified Rankin scale ≤2). Secondary outcomes were severity of stroke at admission, complete early recanalization, early dramatic neurological improvement and final infarct volume. During the study period, 159 patients fulfilled the above criteria. The mean age was 68 years, 62% were men and the baseline NIHSS score was 17. Patients with high levels of prestroke PhA were younger, had more frequently distal occlusions and had lower levels of blood glucose and fibrinogen at admission. After multivariate analysis, a high level of prestroke PhA was associated with a good functional outcome at 3 months. Regarding secondary outcome variables and after adjustment for relevant factors, a high level of prestroke PhA was independently associated with milder stroke severity at admission, early dramatic improvement, early arterial recanalization after intravenous thrombolysis and lower final infarct volume. The beneficial association of prestroke PhA with stroke outcomes was already present with a cutoff point of 1,000 MET min/week, a level of PhA easily achieved by walking 1 h/day during 5 days or by doing a vigorous aerobic activity 1 h/day twice a week. Prestroke PhA is independently associated with favorable stroke outcomes after a large vessel occlusion. Future research on the underlying mechanisms is needed to understand this neuroprotective effect of PhA. © 2014 S. Karger AG, Basel.

The Relations of Cognitive, Behavioral, and Physical Activity Variables to Depression Severity in Traumatic Brain Injury: Reanalysis of Data From a Randomized Controlled Trial.

PubMed

Bombardier, Charles H; Fann, Jesse R; Ludman, Evette J; Vannoy, Steven D; Dyer, Joshua R; Barber, Jason K; Temkin, Nancy R

To explore the relations of cognitive, behavioral, and physical activity variables to depression severity among people with traumatic brain injury (TBI) undergoing a depression treatment trial. Community. Adults (N = 88) who sustained complicated mild to severe TBI within the past 10 years, met criteria for major depressive disorder, and completed study measures. Randomized controlled trial. Participants were randomized to cognitive-behavioral therapy (n = 58) or usual care (n = 42). Outcomes were measured at baseline and 16 weeks. We combined the groups and used regressions to explore the relations among theoretical variables and depression outcomes. Depression severity was measured with the Hamilton Depression Rating Scale and Symptom Checklist-20. Theory-based measures were the Dysfunctional Attitudes Scale (DAS), Automatic Thoughts Questionnaire (ATQ), Environmental Rewards Observation Scale (EROS), and the International Physical Activity Questionnaire (IPAQ). Compared with non-TBI norms, baseline DAS and ATQ scores were high and EROS and IPAQ scores were low. All outcomes improved from baseline to 16 weeks except the DAS. The ATQ was an independent predictor of baseline depression. An increase in EROS scores was correlated with decreased depression. Increasing participation in meaningful roles and pleasant activities may be a promising approach to treating depression after TBI.

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment.

PubMed

Hiller, Wolfgang; Leibbrand, Rolf; Rief, Winfried; Fichter, Manfred M

2002-01-01

Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R(2) = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis. Copyright 2002 S. Karger AG, Basel

Psychopathology and resident status - comparing asylum seekers, refugees, illegal migrants, labor migrants, and residents.

PubMed

Heeren, Martina; Wittmann, Lutz; Ehlert, Ulrike; Schnyder, Ulrich; Maier, Thomas; Müller, Julia

2014-05-01

This study aimed to describe, compare, and predict mental health outcomes of different migrant groups and native residents in Switzerland. Asylum seekers (n=65); refugees holding permanent protection visas (n=34); illegal migrants (n=21); labor migrants (n=26); and residents (n=56) completed an assessment by questionnaire. Main outcome variables were symptoms of posttraumatic stress, anxiety and depression. It was tested whether resident status predicted psychopathology over and above the influence of control variables including social desirability, traumatic event types and post-migration resources. Asylum seekers (54.0%) and refugees (41.4%) fulfilled criteria of PTSD most frequently. Clinically relevant symptoms of anxiety and depression were most frequently reported by asylum seekers (84.6% and 63.1%, resp.) and illegal migrants (both 47.6%). Resident status contributed to psychopathology over and above the influence of control variables. Overall, asylum seekers, refugees, and illegal migrants showed high psychiatric morbidity. Differences in resident status appear to be specifically associated with mental health outcomes. This association persists even when controlling for social desirability, post-migration resources and traumatic events. This emphasizes the importance of current socio-political living conditions for mental health, even with respect to the psychopathological sequelae of past traumatic experiences. Copyright © 2014 Elsevier Inc. All rights reserved.

Can Infants Be "Taught" to Attend to a New Physical Variable in an Event Category? The Case of Height in Covering Events

ERIC Educational Resources Information Center

Wang, Su-hua; Baillargeon, Renee

2008-01-01

As they observe or produce events, infants identify variables that help them predict outcomes in each category of events. How do infants identify a new variable? An explanation-based learning (EBL) account suggests three essential steps: (1) observing contrastive outcomes relevant to the variable; (2) discovering the conditions associated with…

Using Propensity Score Methods to Approximate Factorial Experimental Designs to Analyze the Relationship between Two Variables and an Outcome

ERIC Educational Resources Information Center

Dong, Nianbo

2015-01-01

Researchers have become increasingly interested in programs' main and interaction effects of two variables (A and B, e.g., two treatment variables or one treatment variable and one moderator) on outcomes. A challenge for estimating main and interaction effects is to eliminate selection bias across A-by-B groups. I introduce Rubin's causal model to…

Conditional screening for ultra-high dimensional covariates with survival outcomes

PubMed Central

Hong, Hyokyoung G.; Li, Yi

2017-01-01

Identifying important biomarkers that are predictive for cancer patients’ prognosis is key in gaining better insights into the biological influences on the disease and has become a critical component of precision medicine. The emergence of large-scale biomedical survival studies, which typically involve excessive number of biomarkers, has brought high demand in designing efficient screening tools for selecting predictive biomarkers. The vast amount of biomarkers defies any existing variable selection methods via regularization. The recently developed variable screening methods, though powerful in many practical setting, fail to incorporate prior information on the importance of each biomarker and are less powerful in detecting marginally weak while jointly important signals. We propose a new conditional screening method for survival outcome data by computing the marginal contribution of each biomarker given priorily known biological information. This is based on the premise that some biomarkers are known to be associated with disease outcomes a priori. Our method possesses sure screening properties and a vanishing false selection rate. The utility of the proposal is further confirmed with extensive simulation studies and analysis of a diffuse large B-cell lymphoma dataset. We are pleased to dedicate this work to Jack Kalbfleisch, who has made instrumental contributions to the development of modern methods of analyzing survival data. PMID:27933468

Learner Washback Variability in Standardized Exit Tests

ERIC Educational Resources Information Center

Pan, Yi-Ching

2014-01-01

In much of the world, the issue of accountability and measurement of educational outcomes is highly controversial. Exit testing is part of the movement to ascertain what students have learned and hold institutions and teachers to account. However, compared to the large number of teacher washback studies, learner washback research is lacking…

The Predictive Value of Selection Criteria in an Urban Magnet School

ERIC Educational Resources Information Center

Lohmeier, Jill Hendrickson; Raad, Jennifer

2012-01-01

The predictive value of selection criteria on outcome data from two cohorts of students (Total N = 525) accepted to an urban magnet high school were evaluated. Regression analyses of typical screening variables (suspensions, absences, metropolitan achievement tests, middle school grade point averages [GPAs], Matrix Analogies test scores, and…

Outcomes in patients with mucosal melanomas.

PubMed

Keller, Deborah S; Thomay, Alan A; Gaughan, John; Olszanski, Anthony; Wu, Hong; Berger, Adam C; Farma, Jeffrey M

2013-12-01

Our goal was to evaluate the different subtypes of mucosal melanoma and describe specific variables that predict outcomes. Prospective review of two tertiary care center databases identified 76 mucosal melanoma patients; 73 with complete records were included. Demographic and clinical data were analyzed. Cox regression determined variables impacting recurrence and survival. In the 73 patients, the mean age was 64 years, and 74% were female. Sixty-seven percent presented with lymph node involvement, and 73% had ulcerated tumors. Major sites affected were nasal/palate/oral (36%), vulvar/vaginal/cervical (48%), and anorectal (15%). Mean overall and disease-free survival were 56.9 and 27.2 months. Variables associated with decreased survival included: lymphovascular invasion (HR17.70, P = 0.0093), Caucasian race (HR3.02, P = 0.0362), nasal/palate/oral sub-group (HR1.85, P = 0.026), Breslow thickness (HR1.23, P = 0.00004), T stage (HR1.34, P = 0.0075), M stage (HR3.03, P = 0.0039), and chemotherapy (HR3.13, P = 0.0002). The worst prognosis was seen in the nasal/palate/oral sub-group, with a median overall survival of 9.7 months and recurrence-free time of 4.5 months. This subtype also demonstrated high lymph node positivity, ulceration, and larger tumor size. The nasal, palate, oral subtype has the worst prognosis compared to other mucosal melanoma locations. Studies are ongoing to evaluate pathologic and genomic variables that may predict outcomes. © 2013 Wiley Periodicals, Inc.

Studies of educational interventions and outcomes in diabetic adults: a meta-analysis revisited.

PubMed

Brown, S A

1990-12-01

This paper reports a follow-up of previous meta-analysis research conducted by the author on the effects of diabetes patient education on patient outcomes. An expanded sample of studies and psychological outcome variables were added to the previously studied variables of patient knowledge, self-care behaviors (compliance and skill performance) and metabolic control. The purpose was to determine: (1) the effects of patient education on specific outcome variables; and (2) the relationships between effects of education and characteristics of the studies and/or subjects. Following an extensive literature search, a total of 82 studies were found which met the inclusion criteria for this analysis; 68% were published and 32% were unpublished. Homogeneity analyses of specific patient outcome variables yielded the following results: knowledge effects ranged from 0.49 to 1.05; self-care behavior effects from 0.17 to 0.57, with insulin injection and weight loss associated with the smallest effect sizes; metabolic control from 0.16 to 0.41; and psychological outcomes 0.27. Mean age of the subjects was negatively correlated with knowledge and cholesterol, indicating that the older the mean age of the subjects, the lower the effects of patient education on these variables. Findings of this meta-analysis on the expanded data set were consistent with the previous meta-analysis and lend support to the effectiveness of diabetes patient education in improving patient outcomes.

Punishment induced behavioural and neurophysiological variability reveals dopamine-dependent selection of kinematic movement parameters

PubMed Central

Galea, Joseph M.; Ruge, Diane; Buijink, Arthur; Bestmann, Sven; Rothwell, John C.

2013-01-01

Action selection describes the high-level process which selects between competing movements. In animals, behavioural variability is critical for the motor exploration required to select the action which optimizes reward and minimizes cost/punishment, and is guided by dopamine (DA). The aim of this study was to test in humans whether low-level movement parameters are affected by punishment and reward in ways similar to high-level action selection. Moreover, we addressed the proposed dependence of behavioural and neurophysiological variability on DA, and whether this may underpin the exploration of kinematic parameters. Participants performed an out-and-back index finger movement and were instructed that monetary reward and punishment were based on its maximal acceleration (MA). In fact, the feedback was not contingent on the participant’s behaviour but pre-determined. Blocks highly-biased towards punishment were associated with increased MA variability relative to blocks with either reward or without feedback. This increase in behavioural variability was positively correlated with neurophysiological variability, as measured by changes in cortico-spinal excitability with transcranial magnetic stimulation over the primary motor cortex. Following the administration of a DA-antagonist, the variability associated with punishment diminished and the correlation between behavioural and neurophysiological variability no longer existed. Similar changes in variability were not observed when participants executed a pre-determined MA, nor did DA influence resting neurophysiological variability. Thus, under conditions of punishment, DA-dependent processes influence the selection of low-level movement parameters. We propose that the enhanced behavioural variability reflects the exploration of kinematic parameters for less punishing, or conversely more rewarding, outcomes. PMID:23447607

Birth Order and health: major issues.

PubMed

Elliott, B A

1992-08-01

Birth Order has been described as a variable with a complex relationship to child and adult outcomes. A review of the medical literature over the past 5 years identified 20 studies that investigated the relationship between Birth Order and a health outcome. Only one of the studies established a relationship between Birth Order and a health outcome: third and fourth-born children have a higher incidence of accidents that result in hospitalization. The other demonstrated relationships are each explained by intervening variables or methodological limitations. Although Birth Order is not a strongly independent explanatory factor in understanding health outcomes, it is an important marker variable. Statistically significant relationships between Birth Order and health outcomes yield insights into the ways a family influences an individual's health.

Burn-center quality improvement: are burn outcomes dependent on admitting facilities and is there a volume-outcome "sweet-spot"?

PubMed

Hranjec, Tjasa; Turrentine, Florence E; Stukenborg, George; Young, Jeffrey S; Sawyer, Robert G; Calland, James F

2012-05-01

Risk factors of mortality in burn patients such as inhalation injury, patient age, and percent of total body surface area (%TBSA) burned have been identified in previous publications. However, little is known about the variability of mortality outcomes between burn centers and whether the admitting facilities or facility volumes can be recognized as predictors of mortality. De-identified data from 87,665 acute burn observations obtained from the National Burn Repository between 2003 and 2007 were used to estimate a multivariable logistic regression model that could predict patient mortality with reference to the admitting burn facility/facility volume, adjusted for differences in age, inhalation injury, %TBSA burned, and an additional factor, percent full thickness burn (%FTB). As previously reported, all three covariates (%TBSA burned, inhalation injury, and age) were found to be highly statistically significant risk factors of mortality in burn patients (P value < 0.0001). The additional variable, %FTB, was also found to be a statistically significant determinant, although it did not greatly improve the multivariable model. The treatment/admitting facility was found to be an independent mortality predictor, with certain hospitals having increased odds of death and others showing a protective effect (decreased odds ratio). Hospitals with high burn volumes had the highest risk of mortality. Mortality outcomes of patients with similar risk factors (%TBSA burned, inhalation injury, age, and %FTB) are significantly affected by the treating facility and their admission volumes.

[The Brazilian Hospital Information System and the acute myocardial infarction hospital care].

PubMed

Escosteguy, Claudia Caminha; Portela, Margareth Crisóstomo; Medronho, Roberto de Andrade; de Vasconcellos, Maurício Teixeira Leite

2002-08-01

To analyze the applicability of the Brazilian Unified Health System's national hospital database to evaluate the quality of acute myocardial infarction hospital care. It was evaluated 1,936 hospital admission forms having acute myocardial infarction (AMI) as primary diagnosis in the municipal district of Rio de Janeiro, Brazil, in 1997. Data was collected from the national hospital database. A stratified random sampling of 391 medical records was also evaluated. AMI diagnosis agreement followed the literature criteria. Variable accuracy analysis was performed using kappa index agreement. The quality of AMI diagnosis registered in hospital admission forms was satisfactory according to the gold standard of the literature. In general, the accuracy of the variables demographics (sex, age group), process (medical procedures and interventions), and outcome (hospital death) was satisfactory. The accuracy of demographics and outcome variables was higher than the one of process variables. Under registration of secondary diagnosis was high in the forms and it was the main limiting factor. Given the study findings and the widespread availability of the national hospital database, it is pertinent its use as an instrument in the evaluation of the quality of AMI medical care.

Pluck or Luck: Does Trait Variation or Chance Drive Variation in Lifetime Reproductive Success?

PubMed

Snyder, Robin E; Ellner, Stephen P

2018-04-01

While there has been extensive interest in how intraspecific trait variation affects ecological processes, outcomes are highly variable even when individuals are identical: some are lucky, while others are not. Trait variation is therefore important only if it adds substantially to the variability produced by luck. We ask when trait variation has a substantial effect on variability in lifetime reproductive success (LRS), using two approaches: (1) we partition the variation in LRS into contributions from luck and trait variation and (2) we ask what can be inferred about an individual's traits and with what certainty, given their observed LRS. In theoretical stage- and size-structured models and two empirical case studies, we find that luck usually dominates the variance of LRS. Even when individuals differ substantially in ways that affect expected LRS, unless the effects of luck are substantially reduced (e.g., low variability in reproductive life span or annual fecundity), most variance in lifetime outcomes is due to luck, implying that departures from "null" models omitting trait variation will be hard to detect. Luck also obscures the relationship between realized LRS and individual traits. While trait variation may influence the fate of populations, luck often governs the lives of individuals.

Is the Prediction of Adolescent Outcomes From Early Child Care Moderated by Later Maternal Sensitivity? Results From the NICHD Study of Early Child Care and Youth Development

PubMed Central

Burchinal, Margaret R.; Vandell, Deborah Lowe; Belsky, Jay

2016-01-01

Longitudinal data are used to examine whether effects of early child care are amplified and/or attenuated by later parenting. Analyses tested these interactions using parenting as both a categorical and continuous variable to balance power and flexibility in testing moderation. The most consistent finding was that maternal sensitivity during adolescence accentuated the association between child care quality and adolescent academic-cognitive skills at age 15 years when maternal sensitivity during adolescence was high. This interaction was obtained in analyses with maternal sensitivity as both a categorical and continuous variable. Relations between early child care hours and adolescent behavioral outcomes also were moderated by maternal sensitivity, with longer child care hours predicting more impulsivity and externalizing at age 15 when maternal sensitivity during middle childhood, scored as a categorical variable, was low to moderate and when maternal sensitivity during adolescence, scored as a continuous variable, was lower. These findings suggest that some child care effects are moderated by subsequent parenting and that this moderation may take both linear and nonlinear forms. PMID:23937381

Robotic-Assisted Knee Arthroplasty: An Overview.

PubMed

van der List, Jelle P; Chawla, Harshvardhan; Pearle, Andrew D

2016-01-01

Unicompartmental knee arthroplasty and total knee arthroplasty are reliable treatment options for osteoarthritis. In order to improve survivorship rates, variables that are intraoperatively controlled by the orthopedic surgeon are being evaluated. These variables include lower leg alignment, soft tissue balance, joint line maintenance, and tibial and femoral component alignment, size, and fixation methods. Since tighter control of these factors is associated with improved outcomes of knee arthroplasty, several computer-assisted surgery systems have been developed. These systems differ in the number and type of variables they control. Robotic-assisted systems control these aforementioned variables and, in addition, aim to improve the surgical precision of the procedure. Robotic-assisted systems are active, semi-active, or passive, depending on how independently the systems perform maneuvers. Reviewing the robotic-assisted knee arthroplasty systems, it becomes clear that these systems can accurately and reliably control the aforementioned variables. Moreover, these systems are more accurate and reliable in controlling these variables when compared to the current gold standard of conventional manual surgery. At present, few studies have assessed the survivorship and functional outcomes of robotic-assisted surgery, and no sufficiently powered studies were identified that compared survivorship or functional outcomes between robotic-assisted and conventional knee arthroplasty. Although preliminary outcomes of robotic-assisted surgery look promising, more studies are necessary to assess if the increased accuracy and reliability in controlling the surgical variables leads to better outcomes of robotic-assisted knee arthroplasty.

Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery.

PubMed

Fecso, Andras B; Bhatti, Junaid A; Stotland, Peter K; Quereshy, Fayez A; Grantcharov, Teodor P

2018-03-23

The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery. Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated. A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy. Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS ≤29) remained an independent predictor for major short-term outcomes (odds ratio 6.49), while adjusting for comorbidities and type of procedure. Intraoperative technical performance predicts major short-term outcomes in laparoscopic gastrectomy for cancer. Ongoing assessment and enhancement of surgical skills using modern, evidence-based strategies might improve short-term patient outcomes. Future work should focus on developing and studying the effectiveness of such interventions in laparoscopic gastric cancer surgery.

Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

PubMed

Cleophas, Ton J

2016-01-01

Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method.

Predictors and Moderators of Treatment Response in Childhood Anxiety Disorders: Results from the CAMS Trial

PubMed Central

Compton, Scott N.; Peris, Tara S.; Almirall, Daniel; Birmaher, Boris; Sherrill, Joel; Kendall, Phillip C.; March, John S.; Gosch, Elizabeth A.; Ginsburg, Golda S.; Rynn, Moira A.; Piacentini, John C.; McCracken, James T.; Keeton, Courtney P.; Suveg, Cynthia M.; Aschenbrand, Sasha G.; Sakolsky, Dara; Iyengar, Satish; Walkup, John T.; Albano, Anne Marie

2014-01-01

Objective To examine predictors and moderators of treatment outcomes among 488 youth ages 7-17 years (50% female; 74% ≤ 12 years) with DSM-IV diagnoses of separation anxiety disorder, social phobia, or generalized anxiety disorder who were randomly assigned to receive either cognitive behavior therapy (CBT), sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) in the Child/Adolescent Anxiety Multimodal Study (CAMS). Method Six classes of predictor and moderator variables (22 variables) were identified from the literature and examined using continuous (Pediatric Anxiety Ratings Scale; PARS) and categorical (Clinical Global Impression Scale-Improvement; CGI-I) outcome measures. Results Three baseline variables predicted better outcomes (independent of treatment condition) on the PARS, including low anxiety severity (as measured by parents and independent evaluators) and caregiver strain. No baseline variables were found to predict week 12 responder status (CGI-I). Participant's principal diagnosis moderated treatment outcomes, but only on the PARS. No baseline variables were found to moderate treatment outcomes on week 12 responder status (CGI-I). Discussion Overall, anxious children responded favorably to CAMS treatments. However, having more severe and impairing anxiety, greater caregiver strain, and a principal diagnosis of social phobia were associated with less favorable outcomes. Clinical implications of these findings are discussed. PMID:24417601

Peer Educators and Close Friends as Predictors of Male College Students' Willingness to Prevent Rape

ERIC Educational Resources Information Center

Stein, Jerrold L.

2007-01-01

Astin's (1977, 1991, 1993) input-environment-outcome (I-E-O) model provided a conceptual framework for this study which measured 156 male college students' willingness to prevent rape (outcome variable). Predictor variables included personal attitudes (input variable), perceptions of close friends' attitudes toward rape and rape prevention…

A Conceptual Framework for Graduate Teaching Assistant Professional Development Evaluation and Research

PubMed Central

Reeves, Todd D.; Marbach-Ad, Gili; Miller, Kristen R.; Ridgway, Judith; Gardner, Grant E.; Schussler, Elisabeth E.; Wischusen, E. William

2016-01-01

Biology graduate teaching assistants (GTAs) are significant contributors to the educational mission of universities, particularly in introductory courses, yet there is a lack of empirical data on how to best prepare them for their teaching roles. This essay proposes a conceptual framework for biology GTA teaching professional development (TPD) program evaluation and research with three overarching variable categories for consideration: outcome variables, contextual variables, and moderating variables. The framework’s outcome variables go beyond GTA satisfaction and instead position GTA cognition, GTA teaching practice, and undergraduate learning outcomes as the foci of GTA TPD evaluation and research. For each GTA TPD outcome variable, key evaluation questions and example assessment instruments are introduced to demonstrate how the framework can be used to guide GTA TPD evaluation and research plans. A common conceptual framework is also essential to coordinating the collection and synthesis of empirical data on GTA TPD nationally. Thus, the proposed conceptual framework serves as both a guide for conducting GTA TPD evaluation at single institutions and as a means to coordinate research across institutions at a national level. PMID:27193291

Econometrics in outcomes research: the use of instrumental variables.

PubMed

Newhouse, J P; McClellan, M

1998-01-01

We describe an econometric technique, instrumental variables, that can be useful in estimating the effectiveness of clinical treatments in situations when a controlled trial has not or cannot be done. This technique relies upon the existence of one or more variables that induce substantial variation in the treatment variable but have no direct effect on the outcome variable of interest. We illustrate the use of the technique with an application to aggressive treatment of acute myocardial infarction in the elderly.

Acculturative and Psychological Predictors of Academic-Related Outcomes Among Cambodian American High School Students

PubMed Central

Dinh, Khanh T.; Weinstein, Traci L.; Kim, Su Yeong; Ho, Ivy K.

2009-01-01

This study examined the acculturative and psychosocial predictors of academic-related outcomes among Cambodian American high school students from an urban school district in the state of Massachusetts. Student participants (N = 163) completed an anonymous survey that assessed demographic characteristics, acculturative experiences, intergenerational conflict, depression, and academic-related outcomes. The main results indicated that acculturative and psychosocial variables were significant predictors of academic-related outcomes. Specifically, students' Cambodian cultural orientation was positively associated with their beliefs about the utility of education and sense of school membership, while students' Anglo/White cultural orientation was positively associated with their grade point average, educational aspirations, and sense of school membership. Results also indicated that Cambodian cultural orientation was negatively associated with intergenerational conflict, which in turn was associated with depression. This study provides important information to developers of school-based and family-based prevention and intervention programs by highlighting the acculturative challenges and how academic success can be fostered for Cambodian American students. PMID:20011458

Hospital esophagectomy volume and postoperative length of stay: A systematic review and meta-analysis.

PubMed

Giwa, Femi; Salami, Aitua; Abioye, Ajibola I

2018-01-01

Much attention in the volume-outcomes literature has focused on the empirical impact of surgical caseload on outcomes. However, relevant studies on the association between surgical volume and variables that potentially contribute to healthcare costs are limited. The objective of this study was to systematically elucidate a contemporary analysis of the empirical relationship between hospital esophagectomy volume and postoperative length of stay, a cost-related outcome. OvidSP, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and OpenGrey were searched for relevant articles published from 2000 to 2016. High hospital esophagectomy volume was associated with reduced postoperative length of stay (mean: 3 days; 95%CI: 2.8, 3.2) and risk of prolonged length of stay (RR: 0.80, 95%CI: 0.74, 0.87) in a dose-response fashion. Complex surgeries performed at high surgical volume centers may be associated with overall decrease in postoperative length of stay, a cost-related outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Job Strain and Casual Blood Pressure Distribution: Looking beyond the Adjusted Mean and Taking Gender, Age, and Use of Antihypertensives into Account. Results from ELSA-Brasil

PubMed Central

Juvanhol, Leidjaira Lopes; Melo, Enirtes Caetano Prates; Carvalho, Marilia Sá; Chor, Dóra; Mill, José Geraldo; Griep, Rosane Härter

2017-01-01

Methodological issues are pointed to as the main sources of inconsistencies in studies about the association between job strain and blood pressure (BP)/hypertension. Our aim was to analyze the relationship between job strain and the whole BP distribution, as well as potential differences by gender, age, and use of antihypertensives. Additionally, we addressed issues relating to the operationalization of the exposure and outcome variables that influence the study of their inter-relations. We evaluated the baseline date of 12,038 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008–2010), a multicenter cohort study of 35–74-year-old civil servants. Job strain was assessed by the Demand-Control-Support Questionnaire. The distribution of casual BP by categories of job strain was compared by a combination of exploratory techniques. Participants were classified into three subgroups (normotensives, medicated hypertensives, and unmedicated hypertensives), and analyses were stratified by gender and age. The relationship between job strain and casual BP varied along the whole outcome distribution. Hypertensive participants had greater differences in casual BP by job strain category, especially medicated hypertensives. Differences in casual BP were also greater for systolic than for diastolic BP and for older participants. No differences were encountered by gender. The exclusion of participants susceptible to misclassification for the exposure and outcome variables increased the differences observed between the categories of low and high job strain. In conclusion, the relationship between job strain and casual BP varied along the whole outcome distribution and by use of antihypertensive drugs, age, and BP parameter evaluated. Misclassification for exposure and outcome variables should be considered in analyses of this topic. PMID:28441727

A clinical return-to-work rule for patients with back pain.

PubMed

Dionne, Clermont E; Bourbonnais, Renée; Frémont, Pierre; Rossignol, Michel; Stock, Susan R; Larocque, Isabelle

2005-06-07

Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%). A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

Job Strain and Casual Blood Pressure Distribution: Looking beyond the Adjusted Mean and Taking Gender, Age, and Use of Antihypertensives into Account. Results from ELSA-Brasil.

PubMed

Juvanhol, Leidjaira Lopes; Melo, Enirtes Caetano Prates; Carvalho, Marilia Sá; Chor, Dóra; Mill, José Geraldo; Griep, Rosane Härter

2017-04-22

Methodological issues are pointed to as the main sources of inconsistencies in studies about the association between job strain and blood pressure (BP)/hypertension. Our aim was to analyze the relationship between job strain and the whole BP distribution, as well as potential differences by gender, age, and use of antihypertensives. Additionally, we addressed issues relating to the operationalization of the exposure and outcome variables that influence the study of their inter-relations. We evaluated the baseline date of 12,038 participants enrolled in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) (2008-2010), a multicenter cohort study of 35-74-year-old civil servants. Job strain was assessed by the Demand-Control-Support Questionnaire. The distribution of casual BP by categories of job strain was compared by a combination of exploratory techniques. Participants were classified into three subgroups (normotensives, medicated hypertensives, and unmedicated hypertensives), and analyses were stratified by gender and age. The relationship between job strain and casual BP varied along the whole outcome distribution. Hypertensive participants had greater differences in casual BP by job strain category, especially medicated hypertensives. Differences in casual BP were also greater for systolic than for diastolic BP and for older participants. No differences were encountered by gender. The exclusion of participants susceptible to misclassification for the exposure and outcome variables increased the differences observed between the categories of low and high job strain. In conclusion, the relationship between job strain and casual BP varied along the whole outcome distribution and by use of antihypertensive drugs, age, and BP parameter evaluated. Misclassification for exposure and outcome variables should be considered in analyses of this topic.

A clinical return-to-work rule for patients with back pain

PubMed Central

Dionne, Clermont E.; Bourbonnais, Renée; Frémont, Pierre; Rossignol, Michel; Stock, Susan R.; Larocque, Isabelle

2005-01-01

Background Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. Methods This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18–64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was “return to work in good health” at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. Results The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%– 94%). Interpretation A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome. PMID:15939915

Power calculation for overall hypothesis testing with high-dimensional commensurate outcomes.

PubMed

Chi, Yueh-Yun; Gribbin, Matthew J; Johnson, Jacqueline L; Muller, Keith E

2014-02-28

The complexity of system biology means that any metabolic, genetic, or proteomic pathway typically includes so many components (e.g., molecules) that statistical methods specialized for overall testing of high-dimensional and commensurate outcomes are required. While many overall tests have been proposed, very few have power and sample size methods. We develop accurate power and sample size methods and software to facilitate study planning for high-dimensional pathway analysis. With an account of any complex correlation structure between high-dimensional outcomes, the new methods allow power calculation even when the sample size is less than the number of variables. We derive the exact (finite-sample) and approximate non-null distributions of the 'univariate' approach to repeated measures test statistic, as well as power-equivalent scenarios useful to generalize our numerical evaluations. Extensive simulations of group comparisons support the accuracy of the approximations even when the ratio of number of variables to sample size is large. We derive a minimum set of constants and parameters sufficient and practical for power calculation. Using the new methods and specifying the minimum set to determine power for a study of metabolic consequences of vitamin B6 deficiency helps illustrate the practical value of the new results. Free software implementing the power and sample size methods applies to a wide range of designs, including one group pre-intervention and post-intervention comparisons, multiple parallel group comparisons with one-way or factorial designs, and the adjustment and evaluation of covariate effects. Copyright © 2013 John Wiley & Sons, Ltd.

Article 7: Measures of digit span and verbal rehearsal speed in deaf children following more than 10 years of cochlear implantation

PubMed Central

Pisoni, David; Kronenberger, William; Roman, Adrienne; Geers, Ann

2011-01-01

Precis This paper reports results on the development of immediate memory capacity and verbal rehearsal speed in 112 children with more than ten years of CI use. We found less than half of the sample showed increases in both forward and backward digit spans suggesting disturbances in basic mechanisms related to storage or rehearsal of verbal information. Both spans and verbal rehearsal speeds in elementary school were found to be correlated with speech and language outcomes in high school. These developmental results provide new insights in the elementary neurocognitive information processes associated with high variability in speech and language outcomes. PMID:21832890

Early outcomes of on-pump versus off-pump coronary artery bypass grafting.

PubMed

Hussain, Ghulam; Azam, Hammad; Baig, Mirza Ahmad Raza; Ahmad, Naseem

2016-01-01

To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher's exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups.

Early outcomes of on-pump versus off-pump coronary artery bypass grafting

PubMed Central

Hussain, Ghulam; Azam, Hammad; Baig, Mirza Ahmad Raza; Ahmad, Naseem

2016-01-01

Objectives: To see the early post-operative outcomes of off-pump versus on-pump coronary artery bypass graft surgery. Methods: This retrospective analytical study was conducted at Ch. Pervaiz Elahi Institute of Cardiology Multan, Pakistan. Our Primary outcome variables were; necessity of inotropic support, nonfatal myocardial infarction, ICU stay, nonfatal stroke, new renal failure requiring dialysis and death within 30 days after operation. There were two groups of patients; Group-I (On-pump group) and Group-II (Off-pump Group). SPSS V17 was used for data analysis. Independent sample t-test and Mann Whitney U test were used to compare quantitative Variables. Chi-square test and Fisher’s exact test were used to analyze qualitative variables. P-value ≤ 0.05 was considered significant. Results: Three hundred patients were included in this study. There were no significant difference regarding risk factors except hyper-cholestrolemia which was high in off pump group (p-value 0.05). Angiographic and Echocardiographic characteristics e.g. preoperative ejection fraction, LV function grade and severity of CAD was same between the groups. Mortality risk scores and Priority status for surgery were also same. Regarding post-operative outcomes; Post-op CKMB Levels, need and duration of inotropic support, mechanical ventilation time and ICU stay was significantly less in Off-Pump group (p-value 0.001, <0.0001, 0.006, 0.025 and 0.001 resp.). Peri-operative chest drainage was significantly high in On-pump CABG group (p-value 0.027). Incidence of post-op complications was not statistically different between the groups. Conclusions: At 30 days follow-up, Incidence of myocardial infarction, necessity and duration of inotropic support, ICU stay period and peri-operative bleeding were significantly less in off-pump group. The incidence of neurologic, pulmonary and renal complications was same between the off-pump and on-pump groups. PMID:27648039

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bradshaw, Tyler J.; Bowen, Stephen R.; Deveau, Michael A.

Purpose: Imaging biomarkers of resistance to radiation therapy can inform and guide treatment management. Most studies have so far focused on assessing a single imaging biomarker. The goal of this study was to explore a number of different molecular imaging biomarkers as surrogates of resistance to radiation therapy. Methods and Materials: Twenty-two canine patients with spontaneous sinonasal tumors were treated with accelerated hypofractionated radiation therapy, receiving either 10 fractions of 4.2 Gy each or 10 fractions of 5.0 Gy each to the gross tumor volume. Patients underwent fluorodeoxyglucose (FDG)-, fluorothymidine (FLT)-, and Cu(II)-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM)-labeled positron emission tomography/computed tomography (PET/CT) imaging before therapymore » and FLT and Cu-ATSM PET/CT imaging during therapy. In addition to conventional maximum and mean standardized uptake values (SUV{sub max}; SUV{sub mean}) measurements, imaging metrics providing response and spatiotemporal information were extracted for each patient. Progression-free survival was assessed according to response evaluation criteria in solid tumor. The prognostic value of each imaging biomarker was evaluated using univariable Cox proportional hazards regression. Multivariable analysis was also performed but was restricted to 2 predictor variables due to the limited number of patients. The best bivariable model was selected according to pseudo-R{sup 2}. Results: The following variables were significantly associated with poor clinical outcome following radiation therapy according to univariable analysis: tumor volume (P=.011), midtreatment FLT SUV{sub mean} (P=.018), and midtreatment FLT SUV{sub max} (P=.006). Large decreases in FLT SUV{sub mean} from pretreatment to midtreatment were associated with worse clinical outcome (P=.013). In the bivariable model, the best 2-variable combination for predicting poor outcome was high midtreatment FLT SUV{sub max} (P=.022) in combination with large FLT response from pretreatment to midtreatment (P=.041). Conclusions: In addition to tumor volume, pronounced tumor proliferative response quantified using FLT PET, especially when associated with high residual FLT PET at midtreatment, is a negative prognostic biomarker of outcome in canine tumors following radiation therapy. Neither FDG PET nor Cu-ATSM PET were predictive of outcome.« less

Molecular imaging biomarkers of resistance to radiation therapy for spontaneous nasal tumors in canines.

PubMed

Bradshaw, Tyler J; Bowen, Stephen R; Deveau, Michael A; Kubicek, Lyndsay; White, Pamela; Bentzen, Søren M; Chappell, Richard J; Forrest, Lisa J; Jeraj, Robert

2015-03-15

Imaging biomarkers of resistance to radiation therapy can inform and guide treatment management. Most studies have so far focused on assessing a single imaging biomarker. The goal of this study was to explore a number of different molecular imaging biomarkers as surrogates of resistance to radiation therapy. Twenty-two canine patients with spontaneous sinonasal tumors were treated with accelerated hypofractionated radiation therapy, receiving either 10 fractions of 4.2 Gy each or 10 fractions of 5.0 Gy each to the gross tumor volume. Patients underwent fluorodeoxyglucose (FDG)-, fluorothymidine (FLT)-, and Cu(II)-diacetyl-bis(N4-methylthiosemicarbazone) (Cu-ATSM)-labeled positron emission tomography/computed tomography (PET/CT) imaging before therapy and FLT and Cu-ATSM PET/CT imaging during therapy. In addition to conventional maximum and mean standardized uptake values (SUV(max); SUV(mean)) measurements, imaging metrics providing response and spatiotemporal information were extracted for each patient. Progression-free survival was assessed according to response evaluation criteria in solid tumor. The prognostic value of each imaging biomarker was evaluated using univariable Cox proportional hazards regression. Multivariable analysis was also performed but was restricted to 2 predictor variables due to the limited number of patients. The best bivariable model was selected according to pseudo-R(2). The following variables were significantly associated with poor clinical outcome following radiation therapy according to univariable analysis: tumor volume (P=.011), midtreatment FLT SUV(mean) (P=.018), and midtreatment FLT SUV(max) (P=.006). Large decreases in FLT SUV(mean) from pretreatment to midtreatment were associated with worse clinical outcome (P=.013). In the bivariable model, the best 2-variable combination for predicting poor outcome was high midtreatment FLT SUV(max) (P=.022) in combination with large FLT response from pretreatment to midtreatment (P=.041). In addition to tumor volume, pronounced tumor proliferative response quantified using FLT PET, especially when associated with high residual FLT PET at midtreatment, is a negative prognostic biomarker of outcome in canine tumors following radiation therapy. Neither FDG PET nor Cu-ATSM PET were predictive of outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

Cluster subgroups based on overall pressure pain sensitivity and psychosocial factors in chronic musculoskeletal pain: Differences in clinical outcomes.

PubMed

Almeida, Suzana C; George, Steven Z; Leite, Raquel D V; Oliveira, Anamaria S; Chaves, Thais C

2018-05-17

We aimed to empirically derive psychosocial and pain sensitivity subgroups using cluster analysis within a sample of individuals with chronic musculoskeletal pain (CMP) and to investigate derived subgroups for differences in pain and disability outcomes. Eighty female participants with CMP answered psychosocial and disability scales and were assessed for pressure pain sensitivity. A cluster analysis was used to derive subgroups, and analysis of variance (ANOVA) was used to investigate differences between subgroups. Psychosocial factors (kinesiophobia, pain catastrophizing, anxiety, and depression) and overall pressure pain threshold (PPT) were entered into the cluster analysis. Three subgroups were empirically derived: cluster 1 (high pain sensitivity and high psychosocial distress; n = 12) characterized by low overall PPT and high psychosocial scores; cluster 2 (high pain sensitivity and intermediate psychosocial distress; n = 39) characterized by low overall PPT and intermediate psychosocial scores; and cluster 3 (low pain sensitivity and low psychosocial distress; n = 29) characterized by high overall PPT and low psychosocial scores compared to the other subgroups. Cluster 1 showed higher values for mean pain intensity (F (2,77)  = 10.58, p < 0.001) compared with cluster 3, and cluster 1 showed higher values for disability (F (2,77)  = 3.81, p = 0.03) compared with both clusters 2 and 3. Only cluster 1 was distinct from cluster 3 according to both pain and disability outcomes. Pain catastrophizing, depression, and anxiety were the psychosocial variables that best differentiated the subgroups. Overall, these results call attention to the importance of considering pain sensitivity and psychosocial variables to obtain a more comprehensive characterization of CMP patients' subtypes.

Pain One Week After an Emergency Department Visit for Acute Low Back Pain Is Associated With Poor Three-month Outcomes.

PubMed

Friedman, Benjamin W; Conway, John; Campbell, Caron; Bijur, Polly E; John Gallagher, E

2018-05-16

Low back pain (LBP) is responsible for more than 2.5 million visits to U.S. emergency departments (EDs) annually. Nearly 30% of patients who present to an ED with acute LBP report functional impairment or pain 3 months later. These patients are at risk of chronic LBP, a highly debilitating condition. In this study, we assessed whether three variables assessable shortly after symptom onset could independently predict poor 3-month outcomes among LBP patients who present to an ED. This was a planned analysis of data from two randomized comparative effectiveness studies of patients with acute, nontraumatic, nonradicular LBP. Patients were enrolled during an ED visit, contacted by telephone 1 week after the ED visit, and then followed up by telephone 3 months later. The coprimary 3-month outcomes were LBP-related functional impairment and persistent moderate or severe LBP. Two of the three hypothesized predictor variables were assessed during the index visit: 1) the STarT Back Screening Tool score, a nine-item, multidimensional tool validated and widely used in the outpatient setting, and 2) the patient's own anticipated duration of LBP. The third hypothesized predictor was presence of pain assessed by phone 1 week after the ED visit. We then determined whether these three predictor variables were independently associated with poor outcomes at 3 months, after controlling for medication received, age, and sex. A total of 354 patients were enrolled. Of these, 309 (87%) provided 3-month impairment data and 311 (88%) provided 3-month pain data. At 3 months, 122 of 309 (39%) patients reported functional impairment and 51 of 311(16%) patients reported moderate or severe LBP. Among the three hypothesized predictor variables, 58 of 352 (16%) patients with available data reported a moderate or high STarT Back Screening Tool score, 35 of 321 (11%) patients with available data reported anticipated duration of LBP > 1 week, and 235 of 346 (68%) patients reported pain at 1-week telephone follow-up. After age, sex, and medication received were controlled for in a multivariable logistic regression model, only pain at 1 week was independently associated with 3-month impairment (odds ratio [OR] = 2.42, 95% CI = 1.39-4.22) and 3-month moderate or severe pain (OR = 3.83, 95% CI = 1.53-9.58). More than one-third of patients reported functional impairment 3 months after an ED visit for acute, nontraumatic, nonradicular LBP. Moderate or severe LBP was less common, reported in about half as many patients (16%). Of the three hypothesized predictor variables, only persistent pain at 1 week was independently associated with poor outcomes at 3 months. Despite its important role in the outpatient setting, the STarT Back Tool was not associated with poor outcomes in this ED cohort. © 2018 by the Society for Academic Emergency Medicine.

Relative Gains, Losses, and Reference Points in Probabilistic Choice in Rats

PubMed Central

Marshall, Andrew T.; Kirkpatrick, Kimberly

2015-01-01

Theoretical reference points have been proposed to differentiate probabilistic gains from probabilistic losses in humans, but such a phenomenon in non-human animals has yet to be thoroughly elucidated. Three experiments evaluated the effect of reward magnitude on probabilistic choice in rats, seeking to determine reference point use by examining the effect of previous outcome magnitude(s) on subsequent choice behavior. Rats were trained to choose between an outcome that always delivered reward (low-uncertainty choice) and one that probabilistically delivered reward (high-uncertainty). The probability of high-uncertainty outcome receipt and the magnitudes of low-uncertainty and high-uncertainty outcomes were manipulated within and between experiments. Both the low- and high-uncertainty outcomes involved variable reward magnitudes, so that either a smaller or larger magnitude was probabilistically delivered, as well as reward omission following high-uncertainty choices. In Experiments 1 and 2, the between groups factor was the magnitude of the high-uncertainty-smaller (H-S) and high-uncertainty-larger (H-L) outcome, respectively. The H-S magnitude manipulation differentiated the groups, while the H-L magnitude manipulation did not. Experiment 3 showed that manipulating the probability of differential losses as well as the expected value of the low-uncertainty choice produced systematic effects on choice behavior. The results suggest that the reference point for probabilistic gains and losses was the expected value of the low-uncertainty choice. Current theories of probabilistic choice behavior have difficulty accounting for the present results, so an integrated theoretical framework is proposed. Overall, the present results have implications for understanding individual differences and corresponding underlying mechanisms of probabilistic choice behavior. PMID:25658448

Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease.

PubMed

Lindholm, Daniel; Lindbäck, Johan; Armstrong, Paul W; Budaj, Andrzej; Cannon, Christopher P; Granger, Christopher B; Hagström, Emil; Held, Claes; Koenig, Wolfgang; Östlund, Ollie; Stewart, Ralph A H; Soffer, Joseph; White, Harvey D; de Winter, Robbert J; Steg, Philippe Gabriel; Siegbahn, Agneta; Kleber, Marcus E; Dressel, Alexander; Grammer, Tanja B; März, Winfried; Wallentin, Lars

2017-08-15

Currently, there is no generally accepted model to predict outcomes in stable coronary heart disease (CHD). This study evaluated and compared the prognostic value of biomarkers and clinical variables to develop a biomarker-based prediction model in patients with stable CHD. In a prospective, randomized trial cohort of 13,164 patients with stable CHD, we analyzed several candidate biomarkers and clinical variables and used multivariable Cox regression to develop a clinical prediction model based on the most important markers. The primary outcome was cardiovascular (CV) death, but model performance was also explored for other key outcomes. It was internally bootstrap validated, and externally validated in 1,547 patients in another study. During a median follow-up of 3.7 years, there were 591 cases of CV death. The 3 most important biomarkers were N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT), and low-density lipoprotein cholesterol, where NT-proBNP and hs-cTnT had greater prognostic value than any other biomarker or clinical variable. The final prediction model included age (A), biomarkers (B) (NT-proBNP, hs-cTnT, and low-density lipoprotein cholesterol), and clinical variables (C) (smoking, diabetes mellitus, and peripheral arterial disease). This "ABC-CHD" model had high discriminatory ability for CV death (c-index 0.81 in derivation cohort, 0.78 in validation cohort), with adequate calibration in both cohorts. This model provided a robust tool for the prediction of CV death in patients with stable CHD. As it is based on a small number of readily available biomarkers and clinical factors, it can be widely employed to complement clinical assessment and guide management based on CV risk. (The Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy Trial [STABILITY]; NCT00799903). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Relationship of Religiousness and Religious Coping with Quality of Life among War Trauma Survivors.

PubMed

Fadilpašić, Senadin; Maleč, Daniel; Džubur-Kulenović, Alma

2017-09-01

Long-term posttraumatic outcomes such as quality of life are dependent on a series of factors from the very exposure to traumatic events and stress appraisals, personality traits, posttraumatic growth, symptoms of Posttraumatic stress disorder (PTSD) and different coping strategies to religiousness and religious coping styles. Except of exposure to traumatic events and related stress, all other variables may have indirect mediating effects on long-term posttraumatic outcomes. The main aim of this cross-sectional study is to explore relative independent contribution of these variables in the explanation of quality of life among war trauma survivors, with a special emphasis on the variables of religiousness and religious coping. The research was conducted on 353 subjects who experienced war related traumatic events during the war in Bosnia and Herzegovina (B&H). The data was collected through several self-report measuring instruments: Manchester Short Assessment of Quality of Life, Stressors Check List (SCL); Religiousness Scale, Social Support Resources Scale; Religious Problem-Solving Scale, Brief RCOPE, Posttraumatic Growth Inventory and Mississippi Scale for PTSD. According to the results of the study, experience of loss and frequent exposure to war trauma and high levels on the primary stress appraisals, self-directing coping style and PTSD-symptoms were associated with lower perceived quality of life among the subjects. High levels of extrinsic religious orientation, effect of religiousness on social behavior, positive religious coping and posttraumatic growth were associated with higher perceived quality of life among subjects. These variables showed significant independent contribution to the prediction of the values on quality of life. Results of the study have a scientific significance in understanding the importance and mediating role of religiousness and religious coping for quality of life perception as one of long-term posttraumatic outcomes. Effects of religiousness on social behavior and positive religious coping showed particularly significant contribution across all prediction models for the quality of life.

Drug Concentration Thresholds Predictive of Therapy Failure and Death in Children With Tuberculosis: Bread Crumb Trails in Random Forests

PubMed Central

Swaminathan, Soumya; Pasipanodya, Jotam G.; Ramachandran, Geetha; Hemanth Kumar, A. K.; Srivastava, Shashikant; Deshpande, Devyani; Nuermberger, Eric; Gumbo, Tawanda

2016-01-01

Background. The role of drug concentrations in clinical outcomes in children with tuberculosis is unclear. Target concentrations for dose optimization are unknown. Methods. Plasma drug concentrations measured in Indian children with tuberculosis were modeled using compartmental pharmacokinetic analyses. The children were followed until end of therapy to ascertain therapy failure or death. An ensemble of artificial intelligence algorithms, including random forests, was used to identify predictors of clinical outcome from among 30 clinical, laboratory, and pharmacokinetic variables. Results. Among the 143 children with known outcomes, there was high between-child variability of isoniazid, rifampin, and pyrazinamide concentrations: 110 (77%) completed therapy, 24 (17%) failed therapy, and 9 (6%) died. The main predictors of therapy failure or death were a pyrazinamide peak concentration <38.10 mg/L and rifampin peak concentration <3.01 mg/L. The relative risk of these poor outcomes below these peak concentration thresholds was 3.64 (95% confidence interval [CI], 2.28–5.83). Isoniazid had concentration-dependent antagonism with rifampin and pyrazinamide, with an adjusted odds ratio for therapy failure of 3.00 (95% CI, 2.08–4.33) in antagonism concentration range. In regard to death alone as an outcome, the same drug concentrations, plus z scores (indicators of malnutrition), and age <3 years, were highly ranked predictors. In children <3 years old, isoniazid 0- to 24-hour area under the concentration-time curve <11.95 mg/L × hour and/or rifampin peak <3.10 mg/L were the best predictors of therapy failure, with relative risk of 3.43 (95% CI, .99–11.82). Conclusions. We have identified new antibiotic target concentrations, which are potential biomarkers associated with treatment failure and death in children with tuberculosis. PMID:27742636

Stochastic satisficing account of confidence in uncertain value-based decisions

PubMed Central

Bahrami, Bahador; Keramati, Mehdi

2018-01-01

Every day we make choices under uncertainty; choosing what route to work or which queue in a supermarket to take, for example. It is unclear how outcome variance, e.g. uncertainty about waiting time in a queue, affects decisions and confidence when outcome is stochastic and continuous. How does one evaluate and choose between an option with unreliable but high expected reward, and an option with more certain but lower expected reward? Here we used an experimental design where two choices’ payoffs took continuous values, to examine the effect of outcome variance on decision and confidence. We found that our participants’ probability of choosing the good (high expected reward) option decreased when the good or the bad options’ payoffs were more variable. Their confidence ratings were affected by outcome variability, but only when choosing the good option. Unlike perceptual detection tasks, confidence ratings correlated only weakly with decisions’ time, but correlated with the consistency of trial-by-trial choices. Inspired by the satisficing heuristic, we propose a “stochastic satisficing” (SSAT) model for evaluating options with continuous uncertain outcomes. In this model, options are evaluated by their probability of exceeding an acceptability threshold, and confidence reports scale with the chosen option’s thus-defined satisficing probability. Participants’ decisions were best explained by an expected reward model, while the SSAT model provided the best prediction of decision confidence. We further tested and verified the predictions of this model in a second experiment. Our model and experimental results generalize the models of metacognition from perceptual detection tasks to continuous-value based decisions. Finally, we discuss how the stochastic satisficing account of decision confidence serves psychological and social purposes associated with the evaluation, communication and justification of decision-making. PMID:29621325

Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

PubMed

Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

2016-07-01

The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Multiple Measures of Outcome in Assessing a Prison-Based Drug Treatment Program

ERIC Educational Resources Information Center

Prendergast, Michael L.; Hall, Elizabeth A.; Wexler, Harry K.

2003-01-01

Evaluations of prison-based drug treatment programs typically focus on one or two dichotomous outcome variables related to recidivism. In contrast, this paper uses multiple measures of outcomes related to crime and drug use to examine the impact of prison treatment. Crime variables included self-report data of time to first illegal activity,…

Variability in Outcome for Children with an ASD Diagnosis at Age 2

ERIC Educational Resources Information Center

Turner, Lauren M.; Stone, Wendy L.

2007-01-01

Background: Few studies have examined the variability in outcomes of children diagnosed with autism spectrum disorder (ASD) at age 2. Research is needed to understand the children whose symptoms--or diagnoses--change over time. The objectives of this study were to examine the behavioral and diagnostic outcomes of a carefully defined sample of…

¿Y ahora qué? Anticipated immigration status barriers and Latina/o high school students' future expectations.

PubMed

McWhirter, Ellen Hawley; Ramos, Karina; Medina, Cynthia

2013-07-01

Latina/o high school students without documentation face a challenging situation when they graduate from high school, with pathways to work and postsecondary education stymied by their immigration status. We examined the effects of anticipated barriers associated with immigration status, age, and sex on the dependent variables of vocational outcome expectations, anticipated external and internal barriers, and postsecondary schooling plans in a sample of 475 Latina/o high school students. Findings include that students anticipating immigration status problems had lower vocational outcome expectations and anticipated more external barriers to pursuing their postsecondary plans. Latina girls and older high school students anticipating immigration status problems were more likely to plan to attend 2-year rather than 4-year colleges, and less likely to plan on postsecondary education, respectively. Implications for practice, policy, and research are discussed. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Insecticide treated bednet strategy in rural settings: can we exploit women's decision making power?

PubMed

Tilak, Rina; Tilak, V W; Bhalwar, R

2007-01-01

Use of insecticide treated bednets in prevention of malaria is a widely propagated global strategy, however, its use has been reported to be influenced and limited by many variables especially gender bias. A cross sectional field epidemiological study was conducted in a rural setting with two outcome variables, 'Bednet use'(primary outcome variable) and 'Women's Decision Making Power' which were studied in reference to various predictor variables. Analysis reveals a significant effect on the primary outcome variable 'Bednet use' of the predictor variables- age, occupation, bednet purchase decision, women's decision making power, husband's education and knowledge about malaria and its prevention. The study recommends IEC on treated bednets to be disseminated through TV targeting the elderly women who have better decision making power and mobilizing younger women who were found to prefer bednets for prevention of mosquito bites for optimizing the use of treated bednets in similar settings.

Patterns of Therapist Variability: Therapist Effects and the Contribution of Patient Severity and Risk

ERIC Educational Resources Information Center

Saxon, David; Barkham, Michael

2012-01-01

Objective: To investigate the size of therapist effects using multilevel modeling (MLM), to compare the outcomes of therapists identified as above and below average, and to consider how key variables--in particular patient severity and risk and therapist caseload--contribute to therapist variability and outcomes. Method: We used a large…

Relationships between Admission Variables and Outcome Variables in a Special Education Graduate Program

ERIC Educational Resources Information Center

LaFave, Matthew

2012-01-01

The need for well-prepared special education teachers has made it important to examine how to best select candidates for special education teacher education programs, or at least to determine which, if any, admission variables relate to program outcome measures. This study used archival data from 148 students to investigate the relationships among…

Home healthcare nurse retention and patient outcome model: discussion and model development.

PubMed

Ellenbecker, Carol Hall; Cushman, Margaret

2012-08-01

This paper discusses additions to an empirically tested model of home healthcare nurse retention. An argument is made that the variables of shared decision-making and organizational commitment be added to the model based on the authors' previous research and additional evidence from the literature. Previous research testing the home healthcare nurse retention model established empirical relationships between nurse, agency, and area characteristics to nurse job satisfaction, intent to stay, and retention. Unexplained model variance prompted a new literature search to augment understanding of nurse retention and patient and agency outcomes. Data come from the authors' previous research, and a literature search from 1990 to 2011 on the topics organizational commitment, shared decision-making, nurse retention, patient outcomes and agency performance. The literature provides a rationale for the additional variables of shared decision-making and affective and continuous organizational commitment, linking these variables to nurse job satisfaction, nurse intent to stay, nurse retention and patient outcomes and agency performance. Implications for nursing.  The new variables in the model suggest that all agencies, even those not struggling to retain nurses, should develop interventions to enhance nurse job satisfaction to assure quality patient outcomes. The new nurse retention and patient outcome model increases our understanding of nurse retention. An understanding of the relationship among these variables will guide future research and the development of interventions to create and maintain nursing work environments that contribute to nurse affective agency commitment, nurse retention and quality of patient outcomes. © 2011 Blackwell Publishing Ltd.

Influential input classification in probabilistic multimedia models

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maddalena, Randy L.; McKone, Thomas E.; Hsieh, Dennis P.H.

1999-05-01

Monte Carlo analysis is a statistical simulation method that is often used to assess and quantify the outcome variance in complex environmental fate and effects models. Total outcome variance of these models is a function of (1) the uncertainty and/or variability associated with each model input and (2) the sensitivity of the model outcome to changes in the inputs. To propagate variance through a model using Monte Carlo techniques, each variable must be assigned a probability distribution. The validity of these distributions directly influences the accuracy and reliability of the model outcome. To efficiently allocate resources for constructing distributions onemore » should first identify the most influential set of variables in the model. Although existing sensitivity and uncertainty analysis methods can provide a relative ranking of the importance of model inputs, they fail to identify the minimum set of stochastic inputs necessary to sufficiently characterize the outcome variance. In this paper, we describe and demonstrate a novel sensitivity/uncertainty analysis method for assessing the importance of each variable in a multimedia environmental fate model. Our analyses show that for a given scenario, a relatively small number of input variables influence the central tendency of the model and an even smaller set determines the shape of the outcome distribution. For each input, the level of influence depends on the scenario under consideration. This information is useful for developing site specific models and improving our understanding of the processes that have the greatest influence on the variance in outcomes from multimedia models.« less

Predicting Well-being Longitudinally for Mothers Rearing Offspring with Intellectual and Developmental Disabilities

PubMed Central

Grein, Katherine A.; Glidden, Laraine Masters

2014-01-01

Background Well-being outcomes for parents of children with intellectual and developmental disabilities (IDD) may vary from positive to negative at different times and for different measures of well-being. Predicting and explaining this variability has been a major focus of family research for reasons that have both theoretical and applied implications. Methods The current study used data from a 23-year longitudinal investigation of adoptive and birth parents of children with IDD to determine which early child, mother, and family characteristics would predict the variance in maternal outcomes 20 years after their original measurement. Using hierarchical regression analyses, we tested the predictive power of variables measured when children were 7 years old on outcomes of maternal well-being when children were 26 years old. Outcome variables included maternal self-report measures of depression and well–being. Results Final models of well-being accounted for 20% to 34% of variance. For most outcomes, Family Accord and/or the personality variable of Neuroticism (emotional stability/instability) were significant predictors, but some variables demonstrated a different pattern. Conclusions These findings confirm that 1) Characteristics of the child, mother, and family during childhood can predict outcomes of maternal well-being 20 years later; and 2) Different predictor-outcome relationships can vary substantially, highlighting the importance of using multiple measures to gain a more comprehensive understanding of maternal well-being. These results have implications for refining prognoses for parents and for tailoring service delivery to individual child, parent, and family characteristics. PMID:25185956

Housing Costs, Zoning, and Access to High-Scoring Schools

ERIC Educational Resources Information Center

Rothwell, Jonathan

2012-01-01

The first section of this paper surveys academic research on educational achievement with an emphasis on the relative effects of schools and families in shaping educational outcomes. A methodology section provides a summary of data sources and defines the main variables measured. The paper then examines differences in school test score performance…

Toward a Second Language Socialization Perspective: Issues in Study Abroad Research

ERIC Educational Resources Information Center

Wang, Chilin

2010-01-01

The last few decades have seen a proliferation of research on study abroad (SA). A review of SA research literature shows general inconsistencies and inconclusiveness on certain issues, particularly on SA outcomes and their factors. This article discusses such inconsistencies in terms of the highly variable contexts and vastly unstable nature of…

The Debate on Maturational Constraints in Bilingual Development: A Perspective from First-Language Attrition

ERIC Educational Resources Information Center

Schmid, Monika S.

2014-01-01

A controversial topic in research on second-language acquisition is whether residual variability and optionality in high-proficiency late second-language (L2) learners is merely the outcome of cross-linguistic transfer, competition, and processing limitations, or whether late learners have an underlying representational deficit due to maturational…

A Framework for the Initiation of Networked Improvement Communities

ERIC Educational Resources Information Center

Russell, Jennifer Lin; Bryk, Anthony S.; Dolle, Jonathan R.; Gomez, Louis M.; Lemahieu, Paul G.; Grunow, Alicia

2017-01-01

Background/Context: Educators around the country are working individually and collectively to improve teaching and learning. Despite marked progress in some places driven by these improvement efforts, overall progress in the education field has been slow and outcomes remain highly variable. This is partly because the field is not organized to…

Student Resiliency: A Mixed Methods Analysis of Counseling Group Effects

ERIC Educational Resources Information Center

Pickering, Cyril E.

2015-01-01

Student resiliency, or the internal resources that an individual possesses that enables success despite adversity, is a variable of interest, particularly for students who are at-risk for negative outcomes in school. This study examined the group counseling efforts of an alternative high school, looking at how group composition influenced the…

Spanish High School Students' Interests in Technology: Applying Social Cognitive Career Theory

ERIC Educational Resources Information Center

Inda-Caro, Mercedes; Rodríguez-Menéndez, Carmen; Peña-Calvo, José-Vicente

2016-01-01

The authors have examined the relative contribution of personal (emotional state, gender-role attitudes), contextual (perceived social supports and barriers), and cognitive (self-efficacy beliefs, outcome expectations) variables to technological interests in a sample (N = 2,364) of 10th-grade Spanish students. The results of path analysis…

Risk factor outcome comparison between exercise-based cardiac rehabilitation, traditional care, and an educational workshop.

PubMed

Adams, Jenny L; Nuss, Terri; Banks, Carolyn; Hartman, Julie; Segrest, Wendy; Spears, Joanne; Yount, Phyllis; Bryant, Lona

2007-01-01

This study examined risk factor outcomes among patients who attended cardiac rehabilitation sessions, those who received traditional care, and those who attended Leap for Life workshops. A non-equivalent, three-group design was used in this observational study. Baseline and 12-month measurements were collected for 217 participants. Analysis of covariance was performed to determine differences between groups on outcome variables. The only significant finding was in participants with an initial high-density lipoprotein value of less than 40. High-density lipoprotein levels increased more in the cardiac rehabilitation group than in the traditional care group (30.54 to 37.48 versus 30.17 to 33.67 [F= 4.577, p = .035]). Based on these findings, a strong case can be made for the transition to more individually intense and focused risk factor modification strategies for patients in cardiac rehabilitation programs.

The Statin–Iron Nexus: Anti-Inflammatory Intervention for Arterial Disease Prevention

PubMed Central

DePalma, Ralph G.; Shamayeva, Galina; Chow, Bruce K.

2013-01-01

Objectives. We postulated the existence of a statin–iron nexus by which statins improve cardiovascular disease outcomes at least partially by countering proinflammatory effects of excess iron stores. Methods. Using data from a clinical trial of iron (ferritin) reduction in advanced peripheral arterial disease, the Iron and Atherosclerosis Study, we compared effects of ferritin levels versus high-density lipoprotein to low-density lipoprotein ratios (both were randomization variables) on clinical outcomes in participants receiving and not receiving statins. Results. Statins increased high-density lipoprotein to low-density lipoprotein ratios and reduced ferritin levels by noninteracting mechanisms. Improved clinical outcomes were associated with lower ferritin levels but not with improved lipid status. Conclusions. There are commonalities between the clinical benefits of statins and the maintenance of physiologic iron levels. Iron reduction may be a safe and low-cost alternative to statins. PMID:23409890

Under-Five Mortality in High Focus States in India: A District Level Geospatial Analysis

PubMed Central

Kumar, Chandan; Singh, Prashant Kumar; Rai, Rajesh Kumar

2012-01-01

Background This paper examines if, when controlling for biophysical and geographical variables (including rainfall, productivity of agricultural lands, topography/temperature, and market access through road networks), socioeconomic and health care indicators help to explain variations in the under-five mortality rate across districts from nine high focus states in India. The literature on this subject is inconclusive because the survey data, upon which most studies of child mortality rely, rarely include variables that measure these factors. This paper introduces these variables into an analysis of 284 districts from nine high focus states in India. Methodology/Principal Findings Information on the mortality indicator was accessed from the recently conducted Annual Health Survey of 2011 and other socioeconomic and geographic variables from Census 2011, District Level Household and Facility Survey (2007–08), Department of Economics and Statistics Divisions of the concerned states. Displaying high spatial dependence (spatial autocorrelation) in the mortality indicator (outcome variable) and its possible predictors used in the analysis, the paper uses the Spatial-Error Model in an effort to negate or reduce the spatial dependence in model parameters. The results evince that the coverage gap index (a mixed indicator of district wise coverage of reproductive and child health services), female literacy, urbanization, economic status, the number of newborn care provided in Primary Health Centers in the district transpired as significant correlates of under-five mortality in the nine high focus states in India. The study identifies three clusters with high under-five mortality rate including 30 districts, and advocates urgent attention. Conclusion Even after controlling the possible biophysical and geographical variables, the study reveals that the health program initiatives have a major role to play in reducing under-five mortality rate in the high focus states in India. PMID:22629412

An exploration of workplace social capital as an antecedent of occupational safety and health climate and outcomes in the Chinese education sector.

PubMed

Tang, Jessica Janice; Leka, Stavroula; Hunt, Nigel; MacLennan, Sara

2014-07-01

It is widely acknowledged that teachers are at greater risk of work-related health problems. At the same time, employee perceptions of different dimensions of organizational climate can influence their attitudes, performance, and well-being at work. This study applied and extended a safety climate model in the context of the education sector in Hong Kong. Apart from safety considerations alone, the study included occupational health considerations and social capital and tested their relationships with occupational safety and health (OSH) outcomes. Seven hundred and four Hong Kong teachers completed a range of questionnaires exploring social capital, OSH climate, OSH knowledge, OSH performance (compliance and participation), general health, and self-rated health complaints and injuries. Structural equation modeling (SEM) was used to analyze the relationships between predictive and outcome variables. SEM analysis revealed a high level of goodness of fit, and the hypothesized model including social capital yielded a better fit than the original model. Social capital, OSH climate, and OSH performance were determinants of both positive and negative outcome variables. In addition, social capital not only significantly predicted general health directly, but also had a predictive effect on the OSH climate-behavior-outcome relationship. This study makes a contribution to the workplace social capital and OSH climate literature by empirically assessing their relationship in the Chinese education sector.

Sexual Self Schema as a Moderator of Sexual and Psychological Outcomes for Gynecologic Cancer Survivors

PubMed Central

Andersen, Barbara L.; Fowler, Jeffrey M.; Maxwell, G. Larry

2008-01-01

Abstract Gynecologic cancer patients are at high risk for emotional distress and sexual dysfunction. The present study tested sexual self schema as an individual difference variable that might be useful in identifying those at risk for unfavorable outcomes. First, we tested schema as a predictor of sexual outcomes,including bodychangestress. Second,we examined schema as a contributor to broader quality of life outcomes, specifically as a moderator of the relationship between sexual satisfaction and psychological statue (depressive symptoms and quality of life). A cross-sectional design was used. Gynecologic cancer survivors (N = 175) 2−10 years post treatment were assessed during routine follow up. In regression analyses controlling for sociodemographic variables, patients' physical symptoms/signs as evaluated by nurses, health status, and extent of partner sexual difficulties, sexual self schema accounted for significant variance in the prediction of current sexual behavior, responsiveness, and satisfaction. Moreover, schema moderated the relationship between sexual satisfaction and psychological outcomes, suggesting that a positive sexual self schema might “buffer” patients from depressive symptoms when their sexual satisfaction is low. Furthermore, the combination of a negative sexual self schema and low sexual satisfaction might heighten survivors' risk for psychological distress, including depressive symptomatology. These data support the consideration of sexual self schema as a predictor of sexual morbidity among gynecologic cancer survivors. PMID:18418707

Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety.

PubMed

Hedman, Erik; Andersson, Erik; Lekander, Mats; Ljótsson, Brjánn

2015-01-01

Severe health anxiety can be effectively treated with exposure-based Internet-delivered cognitive behavior therapy (ICBT), but information about which factors that predict outcome is scarce. Using data from a recently conducted RCT comparing ICBT (n = 79) with Internet-delivered behavioral stress management (IBSM) (n = 79) the presented study investigated predictors of treatment outcome. Analyses were conducted using a two-step linear regression approach and the dependent variable was operationalized both as end state health anxiety at post-treatment and as baseline-to post-treatment improvement. A hypothesis driven approach was used where predictors expected to influence outcome were based on a previous predictor study by our research group. As hypothesized, the results showed that baseline health anxiety and treatment adherence predicted both end state health anxiety and improvement. In addition, anxiety sensitivity, treatment credibility, and working alliance were significant predictors of health anxiety improvement. Demographic variables, i.e. age, gender, marital status, computer skills, educational level, and having children, had no significant predictive value. We conclude that it is possible to predict a substantial proportion of the outcome variance in ICBT and IBSM for severe health anxiety. The findings of the present study can be of high clinical value as they provide information about factors of importance for outcome in the treatment of severe health anxiety. Copyright © 2014 Elsevier Ltd. All rights reserved.

Scaling Factor Variability and Toxicokinetic Outcomes in Children

EPA Science Inventory

Abstract title: Scaling Factor Variability and Toxicokinetic Outcomes in ChildrenBackgroundBiotransformation rates (Vmax) extrapolated from in vitro data are used increasingly in human physiologically based pharmacokinetic (PBPK) models. PBPK models are widely used in human hea...

The role of message framing in promoting MMR vaccination: evidence of a loss-frame advantage.

PubMed

Abhyankar, Purva; O'Connor, Daryl B; Lawton, Rebecca

2008-01-01

This study examined the effects of message framing on intentions to obtain the measles, mumps and rubella (MMR) vaccine for one's child and investigated whether Theory of Planned Behaviour (TPB) and perceived outcome efficacy variables mediate and/or moderate message framing effects. One hundred and forty women read either a loss-framed or gain-framed message and then completed measures assessing their intentions to obtain the MMR vaccine for their child, and TPB and outcome efficacy variables. Exposure to the loss frame increased intentions to obtain the MMR vaccine and influenced perceptions of outcome efficacy. This suggests that outcome efficacy, but not other TPB variables may mediate framing effects within the context of MMR vaccination. Message frame, in addition to TPB variables, significantly predicted unique variance in behavioural intentions. These findings are discussed within the context of Prospect Theory, perceived risk and prevention/detection behaviours.

Patient or treatment centre? Where are efforts invested to improve cancer patients' psychosocial outcomes?

PubMed Central

Carey, ML; Clinton-McHarg, T; Sanson-Fisher, RW; Campbell, S; Douglas, HE

2011-01-01

The psychosocial outcomes of cancer patients may be influenced by individual-level, social and treatment centre predictors. This paper aimed to examine the extent to which individual, social and treatment centre variables have been examined as predictors or targets of intervention for psychosocial outcomes of cancer patients. Medline was searched to find studies in which the psychological outcomes of cancer patient were primary variables. Papers published in English between 1999 and 2009 that reported primary data relevant to psychosocial outcomes for cancer patients were included, with 20% randomly selected for further coding. Descriptive studies were coded for inclusion of individual, social or treatment centre variables. Intervention studies were coded to determine if the unit of intervention was the individual patient, social unit or treatment centre. After random sampling, 412 publications meeting the inclusion criteria were identified, 169 were descriptive and 243 interventions. Of the descriptive papers 95.0% included individual predictors, and 5.0% social predictors. None of the descriptive papers examined treatment centre variables as predictors of psychosocial outcomes. Similarly, none of the interventions evaluated the effectiveness of treatment centre interventions for improving psychosocial outcomes. Potential reasons for the overwhelming dominance of individual predictors and individual-focused interventions in psychosocial literature are discussed. PMID:20646035

National Databases for Neurosurgical Outcomes Research: Options, Strengths, and Limitations.

PubMed

Karhade, Aditya V; Larsen, Alexandra M G; Cote, David J; Dubois, Heloise M; Smith, Timothy R

2017-08-05

Quality improvement, value-based care delivery, and personalized patient care depend on robust clinical, financial, and demographic data streams of neurosurgical outcomes. The neurosurgical literature lacks a comprehensive review of large national databases. To assess the strengths and limitations of various resources for outcomes research in neurosurgery. A review of the literature was conducted to identify surgical outcomes studies using national data sets. The databases were assessed for the availability of patient demographics and clinical variables, longitudinal follow-up of patients, strengths, and limitations. The number of unique patients contained within each data set ranged from thousands (Quality Outcomes Database [QOD]) to hundreds of millions (MarketScan). Databases with both clinical and financial data included PearlDiver, Premier Healthcare Database, Vizient Clinical Data Base and Resource Manager, and the National Inpatient Sample. Outcomes collected by databases included patient-reported outcomes (QOD); 30-day morbidity, readmissions, and reoperations (National Surgical Quality Improvement Program); and disease incidence and disease-specific survival (Surveillance, Epidemiology, and End Results-Medicare). The strengths of large databases included large numbers of rare pathologies and multi-institutional nationally representative sampling; the limitations of these databases included variable data veracity, variable data completeness, and missing disease-specific variables. The improvement of existing large national databases and the establishment of new registries will be crucial to the future of neurosurgical outcomes research. Copyright © 2017 by the Congress of Neurological Surgeons

Multivariate outcome prediction in traumatic brain injury with focus on laboratory values.

PubMed

Nelson, David W; Rudehill, Anders; MacCallum, Robert M; Holst, Anders; Wanecek, Michael; Weitzberg, Eddie; Bellander, Bo-Michael

2012-11-20

Traumatic brain injury (TBI) is a major cause of morbidity and mortality. Identifying factors relevant to outcome can provide a better understanding of TBI pathophysiology, in addition to aiding prognostication. Many common laboratory variables have been related to outcome but may not be independent predictors in a multivariate setting. In this study, 757 patients were identified in the Karolinska TBI database who had retrievable early laboratory variables. These were analyzed towards a dichotomized Glasgow Outcome Scale (GOS) with logistic regression and relevance vector machines, a non-linear machine learning method, univariately and controlled for the known important predictors in TBI outcome: age, Glasgow Coma Score (GCS), pupil response, and computed tomography (CT) score. Accuracy was assessed with Nagelkerke's pseudo R². Of the 18 investigated laboratory variables, 15 were found significant (p<0.05) towards outcome in univariate analyses. In contrast, when adjusting for other predictors, few remained significant. Creatinine was found an independent predictor of TBI outcome. Glucose, albumin, and osmolarity levels were also identified as predictors, depending on analysis method. A worse outcome related to increasing osmolarity may warrant further study. Importantly, hemoglobin was not found significant when adjusted for post-resuscitation GCS as opposed to an admission GCS, and timing of GCS can thus have a major impact on conclusions. In total, laboratory variables added an additional 1.3-4.4% to pseudo R².

Independent and combined influence of homeownership, occupation, education, income, and community poverty on physical health in persons with arthritis.

PubMed

Callahan, Leigh F; Martin, Kathryn Remmes; Shreffler, Jack; Kumar, Deepak; Schoster, Britta; Kaufman, Jay S; Schwartz, Todd A

2011-05-01

To examine the independent and combined influence of individual- and community-level socioeconomic status (SES) measures on physical health status outcomes in people with self-reported arthritis. From 2004-2005, 968 participants completed a telephone survey assessing health status, chronic conditions, community characteristics, and sociodemographic variables. Individual-level SES measures used included homeownership, occupation (professional or not), educational attainment (less than high school, high school degree, and more than high school), and income (<$15,000, $15,000-$45,000, and >$45,000). Community poverty (2000 US Census block group percentage of individuals living below the poverty line [low, medium, and high]) was used as a community-level SES measure. Outcomes were physical functioning (Medical Outcomes Study Short Form 12 version 2 physical component summary [PCS]), functional disability (Health Assessment Questionnaire [HAQ]), and the Centers for Disease Control and Prevention (CDC) Health-Related Quality of Life (HRQOL) Healthy Days physical and limited activity days, and were analyzed via multivariable regressions. When entered separately, all individual-level SES variables were significantly (P < 0.01) associated with poorer PCS, HAQ, and CDC HRQOL scores. A higher magnitude of effect was seen for household income, specifically <$15,000 per year in final models with all 4 individual SES measures and community poverty. The magnitude of effect for education is reduced and marginally significant for the PCS and number of physically unhealthy days. No effects were seen for occupation, homeownership, and community poverty. Findings confirm that after adjusting for important covariates, lower individual- and community-level SES measures are associated with poorer physical health outcomes, while household income is the strongest predictor (as measured by both significance and effect) of poorer health status in final models. Studies not having participant-reported income available should make use of other SES measures, as they do independently predict physical health. Copyright © 2011 by the American College of Rheumatology.

[Relationship between job satisfaction and patient safety culture].

PubMed

Merino-Plaza, María José; Carrera-Hueso, Francisco Javier; Roca-Castelló, María Rosa; Morro-Martín, María Dolores; Martínez-Asensi, Amparo; Fikri-Benbrahim, Narjis

2017-05-19

To evaluate the relationship between safety culture and job satisfaction in a medium-stay hospital, showing the relationships between the dimensions that define both constructs and identifying the dimensions with the greatest impact on both variables. Cross-sectional study conducted in 2015, using the Basque Health Service Job Satisfaction Survey and the Spanish version of the «Hospital Survey on Patient Safety» questionnaire (Agency for Healthcare Research and Quality). Result Variables: high job satisfaction and high degree of perceived security (score ≥75th percentile). Predictor variables: socio-demographic characteristics and perception of the evaluated dimensions. The association between variables was quantified by adjusted odds ratio (OR) and the 95% confidence interval. The mean job satisfaction was 7.21 (standard deviation [SD]: 2.01) and the mean of perceived safety was 7.48 (SD=1.98). The 75th percentile of the distribution in both cases was 9. The socio-demographic variables had little significance, while a positive perception of many of the considered dimensions, was associated with high perception of the result variables. In the data analysis were obtained multiple significant correlations and cross-relations between the dimensions that define both constructs, as well as between the degree of satisfaction of the dimensions considered and the outcome variables. The results obtained evidenced the relationship between job satisfaction and safety culture and quantify the association degree between the studied variables. The adjusted OR identifies the variables most strongly associated with the effect and helps to select improvement areas. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The Fear-Avoidance Components Scale (FACS): Responsiveness to Functional Restoration Treatment in a Chronic Musculoskeletal Pain Disorder (CMPD) Population.

PubMed

Neblett, Randy; Mayer, Tom G; Williams, Mark J; Asih, Sali; Cuesta-Vargas, Antonio I; Hartzell, Meredith M; Gatchel, Robert J

2017-12-01

To assess the clinical validity and factor structure of the Fear-Avoidance Components Scale (FACS), a new fear-avoidance measure. In this study, 426 chronic musculoskeletal pain disorder patients were admitted to a Functional Restoration Program (FRP). They were categorized into 5 FACS severity levels, from subclinical to extreme, at admission, and again at discharge. Associations with objective lifting performance and other patient-reported psychosocial measures were determined at admission and discharge, and objective work outcomes for this predominantly disabled cohort, were assessed 1 year later. Those patients in the severe and extreme FACS severity groups at admission were more likely to "drop out" of treatment than those in the lower severity groups (P=0.05). At both admission and discharge, the FACS severity groups were highly and inversely correlated with objective lifting performance and patient-reported fear-avoidance-related psychosocial variables, including kinesiophobia, pain intensity, depressive symptoms, perceived disability, perceived injustice, and insomnia (Ps<0.001). All variables showed improvement at FRP discharge. Patients in the extreme FACS severity group at discharge were less likely to return to, or retain, work 1 year later (P≤0.02). A factor analysis identified a 2-factor solution. Strong associations were found among FACS scores and other patient-reported psychosocial and objective lifting performance variables at both admission and discharge. High discharge-FACS scores were associated with worse work outcomes 1 year after discharge. The FACS seems to be a valid and clinically useful measure for predicting attendance, physical performance, distress, and relevant work outcomes in FRP treatment of chronic musculoskeletal pain disorder patients.

The renal protective effect of angiotensin receptor blockers depends on intra-individual response variation in multiple risk markers.

PubMed

Schievink, Bauke; de Zeeuw, Dick; Parving, Hans-Henrik; Rossing, Peter; Lambers Heerspink, Hiddo Jan

2015-10-01

Angiotensin receptor blockers (ARBs) are renoprotective and targeted to blood pressure. However, ARBs have multiple other (off-target) effects which may affect renal outcome. It is unknown whether on-target and off-target effects are congruent within individuals. If not, this variation in short term effects may have important implications for the prediction of individual long term renal outcomes. Our aim was to assess intra-individual variability in multiple parameters in response to ARBs in type 2 diabetes. Changes in systolic blood pressure (SBP), albuminuria, potassium, haemoglobin, cholesterol and uric acid after 6 months of losartan treatment were assessed in the RENAAL database. Improvement in predictive performance of renal outcomes (ESRD or doubling serum creatinine) for each individual using ARB-induced changes in all risk markers was assessed by the relative integrative discrimination index (RIDI). SBP response showed high variability (mean -5.7 mmHg, 5(th) to 95(th) percentile -36.5 to +24.0 mmHg) between individuals. Changes in off-target parameters also showed high variability between individuals. No congruency was observed between responses to losartan in multiple parameters within individuals. Using individual responses in all risk markers significantly improved renal risk prediction (RIDI 30.4%, P < 0.01) compared with using only SBP changes. Results were successfully replicated in two independent trials with irbesartan, IDNT and IRMA-2. In this post hoc analysis we showed that ARBs have multiple off-target effects which vary between and within individuals. Combining all ARB-induced responses beyond SBP provides a more accurate prediction of who will benefit from ARB therapy. Prospective trials are required to validate these findings. © 2015 The British Pharmacological Society.

Comparison of methods for the analysis of relatively simple mediation models.

PubMed

Rijnhart, Judith J M; Twisk, Jos W R; Chinapaw, Mai J M; de Boer, Michiel R; Heymans, Martijn W

2017-09-01

Statistical mediation analysis is an often used method in trials, to unravel the pathways underlying the effect of an intervention on a particular outcome variable. Throughout the years, several methods have been proposed, such as ordinary least square (OLS) regression, structural equation modeling (SEM), and the potential outcomes framework. Most applied researchers do not know that these methods are mathematically equivalent when applied to mediation models with a continuous mediator and outcome variable. Therefore, the aim of this paper was to demonstrate the similarities between OLS regression, SEM, and the potential outcomes framework in three mediation models: 1) a crude model, 2) a confounder-adjusted model, and 3) a model with an interaction term for exposure-mediator interaction. Secondary data analysis of a randomized controlled trial that included 546 schoolchildren. In our data example, the mediator and outcome variable were both continuous. We compared the estimates of the total, direct and indirect effects, proportion mediated, and 95% confidence intervals (CIs) for the indirect effect across OLS regression, SEM, and the potential outcomes framework. OLS regression, SEM, and the potential outcomes framework yielded the same effect estimates in the crude mediation model, the confounder-adjusted mediation model, and the mediation model with an interaction term for exposure-mediator interaction. Since OLS regression, SEM, and the potential outcomes framework yield the same results in three mediation models with a continuous mediator and outcome variable, researchers can continue using the method that is most convenient to them.

Causal inference with measurement error in outcomes: Bias analysis and estimation methods.

PubMed

Shu, Di; Yi, Grace Y

2017-01-01

Inverse probability weighting estimation has been popularly used to consistently estimate the average treatment effect. Its validity, however, is challenged by the presence of error-prone variables. In this paper, we explore the inverse probability weighting estimation with mismeasured outcome variables. We study the impact of measurement error for both continuous and discrete outcome variables and reveal interesting consequences of the naive analysis which ignores measurement error. When a continuous outcome variable is mismeasured under an additive measurement error model, the naive analysis may still yield a consistent estimator; when the outcome is binary, we derive the asymptotic bias in a closed-form. Furthermore, we develop consistent estimation procedures for practical scenarios where either validation data or replicates are available. With validation data, we propose an efficient method for estimation of average treatment effect; the efficiency gain is substantial relative to usual methods of using validation data. To provide protection against model misspecification, we further propose a doubly robust estimator which is consistent even when either the treatment model or the outcome model is misspecified. Simulation studies are reported to assess the performance of the proposed methods. An application to a smoking cessation dataset is presented.

Relationship of left ventricular hypertrophy and diastolic function with cardiovascular and renal outcomes in African Americans with hypertensive chronic kidney disease.

PubMed

Peterson, Gail E; de Backer, Tine; Contreras, Gabriel; Wang, Xuelei; Kendrick, Cynthia; Greene, Tom; Appel, Lawrence J; Randall, Otelio S; Lea, Janice; Smogorzewski, Miroslaw; Vagaonescu, Tudor; Phillips, Robert A

2013-09-01

African Americans with hypertension are at high risk for adverse outcomes from cardiovascular and renal disease. Patients with stage 3 or greater chronic kidney disease have a high prevalence of left ventricular (LV) hypertrophy and diastolic dysfunction. Our goal was to study prospectively the relationships of LV mass and diastolic function with subsequent cardiovascular and renal outcomes in the African American Study of Kidney Disease and Hypertension cohort study. Of 691 patients enrolled in the cohort, 578 had interpretable echocardiograms and complete relevant clinical data. Exposures were LV hypertrophy and diastolic parameters. Outcomes were cardiovascular events requiring hospitalization or causing death; a renal composite outcome of doubling of serum creatinine or end-stage renal disease (censoring death); and heart failure. We found strong independent relationships between LV hypertrophy and subsequent cardiovascular (hazard ratio, 1.16; 95% confidence interval, 1.05-1.27) events, but not renal outcomes. After adjustment for LV mass and clinical variables, lower systolic tissue Doppler velocities and diastolic parameters reflecting a less compliant LV (shorter deceleration time and abnormal E/A ratio) were significantly (P<0.05) associated with future heart failure events. This is the first study to show a strong relationship among LV hypertrophy, diastolic parameters, and adverse cardiac outcomes in African Americans with hypertension and chronic kidney disease. These echocardiographic risk factors may help identify high-risk patients with chronic kidney disease for aggressive therapeutic intervention.

Genetic variation in alpha2-adrenoreceptors and heart rate recovery after exercise

PubMed Central

Kohli, Utkarsh; Diedrich, André; Kannankeril, Prince J.; Muszkat, Mordechai; Sofowora, Gbenga G.; Hahn, Maureen K.; English, Brett A.; Blakely, Randy D.; Stein, C. Michael

2015-01-01

Heart rate recovery (HRR) after exercise is an independent predictor of adverse cardiovascular outcomes. HRR is mediated by both parasympathetic reactivation and sympathetic withdrawal and is highly heritable. We examined whether common genetic variants in adrenergic and cholinergic receptors and transporters affect HRR. In our study 126 healthy subjects (66 Caucasians, 56 African Americans) performed an 8 min step-wise bicycle exercise test with continuous computerized ECG recordings. We fitted an exponential curve to the postexercise R-R intervals for each subject to calculate the recovery constant (kr) as primary outcome. Secondary outcome was the root mean square residuals averaged over 1 min (RMS1min), a marker of parasympathetic tone. We used multiple linear regressions to determine the effect of functional candidate genetic variants in autonomic pathways (6 ADRA2A, 1 ADRA2B, 4 ADRA2C, 2 ADRB1, 3 ADRB2, 2 NET, 2 CHT, and 1 GRK5) on the outcomes before and after adjustment for potential confounders. Recovery constant was lower (indicating slower HRR) in ADRA2B 301–303 deletion carriers (n = 54, P = 0.01), explaining 3.6% of the interindividual variability in HRR. ADRA2A Asn251Lys, ADRA2C rs13118771, and ADRB1 Ser49Gly genotypes were associated with RMS1min. Genetic variability in adrenergic receptors may be associated with HRR after exercise. However, most of the interindividual variability in HRR remained unexplained by the variants examined. Noncandidate gene-driven approaches to study genetic contributions to HRR in larger cohorts will be of interest. PMID:26058836

Tutorial in Biostatistics: Instrumental Variable Methods for Causal Inference*

PubMed Central

Baiocchi, Michael; Cheng, Jing; Small, Dylan S.

2014-01-01

A goal of many health studies is to determine the causal effect of a treatment or intervention on health outcomes. Often, it is not ethically or practically possible to conduct a perfectly randomized experiment and instead an observational study must be used. A major challenge to the validity of observational studies is the possibility of unmeasured confounding (i.e., unmeasured ways in which the treatment and control groups differ before treatment administration which also affect the outcome). Instrumental variables analysis is a method for controlling for unmeasured confounding. This type of analysis requires the measurement of a valid instrumental variable, which is a variable that (i) is independent of the unmeasured confounding; (ii) affects the treatment; and (iii) affects the outcome only indirectly through its effect on the treatment. This tutorial discusses the types of causal effects that can be estimated by instrumental variables analysis; the assumptions needed for instrumental variables analysis to provide valid estimates of causal effects and sensitivity analysis for those assumptions; methods of estimation of causal effects using instrumental variables; and sources of instrumental variables in health studies. PMID:24599889

Bias and Bias Correction in Multisite Instrumental Variables Analysis of Heterogeneous Mediator Effects

ERIC Educational Resources Information Center

Reardon, Sean F.; Unlu, Fatih; Zhu, Pei; Bloom, Howard S.

2014-01-01

We explore the use of instrumental variables (IV) analysis with a multisite randomized trial to estimate the effect of a mediating variable on an outcome in cases where it can be assumed that the observed mediator is the only mechanism linking treatment assignment to outcomes, an assumption known in the IV literature as the exclusion restriction.…

Outpatient rehabilitation care process factors and clinical outcomes among patients discharged home following unilateral total knee arthroplasty.

PubMed

Brennan, Gerard P; Fritz, Julie M; Houck, L T C Kevin M; Hunter, Stephen J

2015-05-01

Research examining care process variables and their relationship to clinical outcomes after total knee arthroplasty has focused primarily on inpatient variables. Care process factors related to outpatient rehabilitation have not been adequately examined. We conducted a retrospective review of 321 patients evaluating outpatient care process variables including use of continuous passive motion, home health physical therapy, number of days from inpatient discharge to beginning outpatient physical therapy, and aspects of outpatient physical therapy (number of visits, length of stay) as possible predictors of pain and disability outcomes of outpatient physical therapy. Only the number of days between inpatient discharge and outpatient physical therapy predicted better outcomes, suggesting that this may be a target for improving outcomes after total knee arthroplasty for patients discharged directly home. Copyright © 2014 Elsevier Inc. All rights reserved.

Is work engagement related to work ability beyond working conditions and lifestyle factors?

PubMed

Airila, Auli; Hakanen, Jari; Punakallio, Anne; Lusa, Sirpa; Luukkonen, Ritva

2012-11-01

To examine the associations of age, lifestyle and work-related factors, and particularly work engagement with the work ability index (WAI) and its sub-dimensions. Step-wise regression analysis with a sample of Finnish firefighters (n = 403) was used. The outcome variables were the WAI and its six sub-dimensions. The independent variables consisted of age, lifestyle variables (alcohol consumption, BMI, smoking, physical exercise, and sleep problems), working conditions (job demands, physical workload, supervisory relations, and task resources), and work engagement. The outcome variables and all the variables related to lifestyle, working conditions, and work engagement were measured in 2009. Work ability at baseline 10 years earlier was adjusted for in the models. Work engagement, age, physical exercise, sleep problems, and physical workload were associated with the WAI. All independent variables, except BMI and alcohol consumption, were associated with at least one sub-dimension of the WAI after controlling the baseline WAI. Lifestyle variables, working conditions, and work engagement were more strongly related to the subjective WAI sub-dimensions than to the two more objective WAI sub-dimensions. Work engagement was significantly associated with work ability even after adjusting for various factors, indicating its importance in promoting work ability. Other key factors for good work ability were frequent exercise, good sleep, non-smoking, low job demands, low physical workload, and high task resources. More specifically, this study suggests that in maintaining work ability, it is valuable not only to promote lifestyle factors or working conditions, but also to enhance employees' positive state of work engagement.

Intraindividual variability in reaction time predicts cognitive outcomes 5 years later.

PubMed

Bielak, Allison A M; Hultsch, David F; Strauss, Esther; Macdonald, Stuart W S; Hunter, Michael A

2010-11-01

Building on results suggesting that intraindividual variability in reaction time (inconsistency) is highly sensitive to even subtle changes in cognitive ability, this study addressed the capacity of inconsistency to predict change in cognitive status (i.e., cognitive impairment, no dementia [CIND] classification) and attrition 5 years later. Two hundred twelve community-dwelling older adults, initially aged 64-92 years, remained in the study after 5 years. Inconsistency was calculated from baseline reaction time performance. Participants were assigned to groups on the basis of their fluctuations in CIND classification over time. Logistic and Cox regressions were used. Baseline inconsistency significantly distinguished among those who remained or transitioned into CIND over the 5 years and those who were consistently intact (e.g., stable intact vs. stable CIND, Wald (1) = 7.91, p < .01, Exp(β) = 1.49). Average level of inconsistency over time was also predictive of study attrition, for example, Wald (1) = 11.31, p < .01, Exp(β) = 1.24. For both outcomes, greater inconsistency was associated with a greater likelihood of being in a maladaptive group 5 years later. Variability based on moderately cognitively challenging tasks appeared to be particularly sensitive to longitudinal changes in cognitive ability. Mean rate of responding was a comparable predictor of change in most instances, but individuals were at greater relative risk of being in a maladaptive outcome group if they were more inconsistent rather than if they were slower in responding. Implications for the potential utility of intraindividual variability in reaction time as an early marker of cognitive decline are discussed. (c) 2010 APA, all rights reserved

Influence of Flow Sequencing Attributed to Climate Change and Climate Variability on the Assessment of Water-dependent Ecosystem Outcomes

NASA Astrophysics Data System (ADS)

Wang, J.; Nathan, R.; Horne, A.

2017-12-01

Traditional approaches to characterize water-dependent ecosystem outcomes in response to flow have been based on time-averaged hydrological indicators, however there is increasing recognition for the need to characterize ecological processes that are highly dependent on the sequencing of flow conditions (i.e. floods and droughts). This study considers the representation of flow regimes when considering assessment of ecological outcomes, and in particular, the need to account for sequencing and variability of flow. We conducted two case studies - one in the largely unregulated Ovens River catchment and one in the highly regulated Murray River catchment (both located in south-eastern Australia) - to explore the importance of flow sequencing to the condition of a typical long-lived ecological asset in Australia, the River Red Gum forests. In the first, the Ovens River case study, the implications of representing climate change using different downscaling methods (annual scaling, monthly scaling, quantile mapping, and weather generator method) on the sequencing of flows and resulting ecological outcomes were considered. In the second, the Murray River catchment, sequencing within a historic drought period was considered by systematically making modest adjustments on an annual basis to the hydrological records. In both cases, the condition of River Red Gum forests was assessed using an ecological model that incorporates transitions between ecological conditions in response to sequences of required flow components. The results of both studies show the importance of considering how hydrological alterations are represented when assessing ecological outcomes. The Ovens case study showed that there is significant variation in the predicted ecological outcomes when different downscaling techniques are applied. Similarly, the analysis in the Murray case study showed that the drought as it historically occurred provided one of the best possible outcomes for River Red Gum forests when compared to other re-arrangements of flow within the same drought. These results have implications for the way we represent climate change impacts and drought risk assessments where ecological outcomes are a key management objective.

Access to health programs at the workplace and the reduction of work presenteeism: a population-based cross-sectional study.

PubMed

Bustillos, Arnaldo Sanchez; Trigoso, Oswaldo Ortiz

2013-11-01

To examine access to health programs at workplace as a determinant of presenteeism among adults. Data source was a subsample of the 2009-2010 Canadian Community Health Survey. The outcome was self-reported reduced activities at work (presenteeism). The explanatory variable was self-reported access to a health program at workplace. Logistic regression was used to measure the association between outcome and explanatory variables adjusting for potential confounders. Adjusting for sex, age, education, income, work stress, and chronic conditions, presenteeism was not associated with having access to a health program at workplace (adjusted odds ratio, 1.23; 95% confidence interval, 0.91 to 1.65). The odds of presenteeism were higher in workers who reported high work stress and those with chronic medical conditions. This study found that access to health programs at workplace is not significantly associated with a decline in presenteeism.

Fragile and Enduring Positive Affect: Implications for Adaptive Aging.

PubMed

Ong, Anthony D; Ram, Nilam

2017-01-01

There is robust evidence linking interindividual differences in positive affect (PA) with adaptive psychological and physical health outcomes. However, recent research has suggested that intraindividual variability or fluctuations in PA states over time may also be an important predictor of individual health outcomes. Here, we report on research that focuses on PA level and various forms of PA dynamics (variability, instability, inertia, and reactivity) in relation to health. PA level refers to the average level of positive feelings. In contrast, PA dynamics refer to short-term changes in PA that unfold over time. We discuss how consideration of both PA level and PA dynamics can provide a framework for reconciling when high PA is conducive or detrimental to health. We conclude that more work on PA dynamics is needed, especially in combination with PA level, and suggest productive questions for future inquiry in this area. © 2016 S. Karger AG, Basel.

Clinical and Serological Predictors of Suicide in Schizophrenia and Major Mood Disorders.

PubMed

Dickerson, Faith; Origoni, Andrea; Schweinfurth, Lucy A B; Stallings, Cassie; Savage, Christina L G; Sweeney, Kevin; Katsafanas, Emily; Wilcox, Holly C; Khushalani, Sunil; Yolken, Robert

2018-03-01

Persons with serious mental illness are at high risk for suicide, but this outcome is difficult to predict. Serological markers may help to identify suicide risk. We prospectively assessed 733 persons with a schizophrenia spectrum disorder, 483 with bipolar disorder, and 76 with major depressive disorder for an average of 8.15 years. The initial evaluation consisted of clinical and demographic data as well as a blood samples from which immunoglobulin G antibodies to herpes viruses and Toxoplasma gondii were measured. Suicide was determined using data from the National Death Index. Cox proportional hazard regression models examined the role of baseline variables on suicide outcomes. Suicide was associated with male sex, divorced/separated status, Caucasian race, and elevated levels of antibodies to Cytomegalovirus (CMV). Increasing levels of CMV antibodies were associated with increasing hazard ratios for suicide. The identification of serological variables associated with suicide might provide more personalized methods for suicide prevention.

Marijuana use trajectories during college predict health outcomes nine years post-matriculation

PubMed Central

Arria, Amelia M.; Caldeira, Kimberly M.; Bugbee, Brittany A.; Vincent, Kathryn B.; O’Grady, Kevin E.

2015-01-01

Background Several studies have linked marijuana use with a variety of health outcomes among young adults. Information about marijuana’s long-term health effects is critically needed. Methods Data are from a ten-year study of 1,253 young adults originally recruited as first-year college students and assessed annually thereafter. Six trajectories of marijuana use during college (Non-Use, Low-Stable, Early-Decline, College-Peak, Late-Increase, Chronic) were previously derived using latent variable growth mixture modeling. Nine health outcomes assessed in Year 10 (modal age 27) were regressed on a group membership variable for the six group trajectories, holding constant demographics, baseline health status, and alcohol and tobacco trajectory group membership. Results Marijuana trajectory groups differed significantly on seven of the nine outcomes (functional impairment due to injury, illness, or emotional problems; psychological distress; subjective well-being; and mental and physical health service utilization; all ps<.001), but not on general health rating or body mass index. Non-Users fared better than the Late-Increase and Chronic groups on most physical and mental health outcomes. The declining groups (Early-Decline, College-Peak) fared better than the Chronic group on mental health outcomes. The Late-Increase group fared significantly worse than the stable groups (Non-Use, Low-Stable, Chronic) on both physical and mental health outcomes. Conclusions Even occasional or time-limited marijuana use might have adverse effects on physical and mental health, perhaps enduring after several years of moderation or abstinence. Reducing marijuana use frequency might mitigate such effects. Individuals who escalate their marijuana use in their early twenties might be at especially high risk for adverse outcomes. PMID:26778758

Dynamic regulation of partner abundance mediates response of reef coral symbioses to environmental change.

PubMed

Cunning, R; Vaughan, N; Gillette, P; Capo, T R; Matté, J L; Baker, A C

2015-05-01

Regulating partner abunclance may allow symmotic organisms to mediate interaction outcomes, facilitating adaptive responses to environmental change. To explore the capacity for-adaptive regulation in an ecologically important endosymbiosis, we studied the population dynamics of symbiotic algae in reef-building corals under different abiotic contexts. We found high natural variability in symbiont abundance in corals across reefs, but this variability converged to different symbiont-specific abundances when colonies were maintained under constant conditions. When conditions changed seasonally, symbiont abundance readjusted to new equilibria. We explain these patterns using an a priori model of symbiotic costs and benefits to the coral host, which shows that the observed changes in symbiont abundance are consistent with the maximization of interaction benefit under different environmental conditions. These results indicate that, while regulating symbiont abundance helps hosts sustain maximum benefit in a dynamic environment, spatiotemporal variation in abiotic factors creates a broad range of symbiont abundances (and interaction outcomes) among corals that may account for observed natural variability in performance (e.g., growth rate) and stress tolerance (e.g., bleaching susceptibility). This cost or benefit framework provides a new perspective on the dynamic regulation of reef coral symbioses and illustrates that the dependence of interaction outcomes on biotic and abiotic contexts may be important in understanding how diverse mutualisms respond to environmental change.

Distraction arthroplasty compared to other cartilage preservation procedures in patients with post-traumatic arthritis: a systematic review.

PubMed

Rivera, Jessica C; Beachler, Jason A

2018-01-23

Post-traumatic arthritis (PTA) is characterized by the deterioration of articular cartilage temporally associated with an articular injury. With a paucity of literature comparing joint preservation techniques, we performed a systematic review of the literature intending to describe and summarize the results of ankle distraction arthroplasty as it compares with studies on tibio-talar microfracture, allograft, and autograft for ankle joint preservation in the post-traumatic population under 50 years of age. Research databases were searched and abstracts screened for relevance on our topic of interest. Abstracts meeting screening criteria with high interobserver reliability underwent full-manuscript review and coding for pertinent citation, study level, treatment, and outcome variables. Outcome variables for patient-reported pain scales, validated outcome measurement tools, radiographic progression, reoperation/re-treatment rates, and complication rates were recorded. Out of 105 unique citations, 10 publications were included. The distraction arthroplasty studies had 36 out of 181 patients requiring reoperation for complications (19.9%), while other joint-preserving procedures studies had 40 out of 177 patients requiring reoperations for complications (22.6%). Clinical outcome scores at mean follow-up time ranging from 2 to 10 years between studies were similar. Reported results for a variety of cartilage preservation procedures, including distraction arthroplasty, are satisfactory and reoperation rates for complication are similar. Limitations in available data and underlying study quality affect synthesis of the results therein. While distraction arthroplasty is an option for cartilage preservation in patients with PTA of the ankle, the technique is highly specialized which may affect the external validity. III.

Adolescent outcomes and opportunities in a Canadian province: looking at siblings and neighbors.

PubMed

Roos, Leslie L; Walld, Randy; Witt, Julia

2014-05-26

Well-organized administrative data with large numbers of cases (building on linked files from several government departments) and a population registry facilitate new studies of population health and child development. Analyses of family relationships and a number of outcomes--educational achievement, health, teen pregnancy, and receipt of income assistance--are relatively easy to conduct using several birth cohorts. Looking both at means/proportions and at sibling correlations enriches our study of opportunity and well-being in late adolescence. With observational research possibly exaggerating the causal effects of risk factors, sibling comparisons involving individuals sharing both many family characteristics and many genes help deal with such criticisms. This paper uses a rich dataset from one Canadian province (Manitoba) covering a wide range of geographical areas (cities to rural regions). Influences on opportunity and well-being are analyzed looking at both means/proportions and sibling correlations. We measure a variety of outcomes that may reflect different causal influences. A creative application of linear programming advances the use of data on residential location. Predicting educational achievement using available variables was much easier than predicting adolescent health status (R-square of .200 versus R-square of .043). Low levels of educational achievement, high levels of teenage pregnancy, and high sibling correlations outside Winnipeg and within Winnipeg's lower income areas highlight inequalities across socioeconomic and geographic backgrounds. Stratifying our analyses by different variables, such as income quintiles, reveals differences in means and correlations within outcomes and across groups. Particular events--changes in mother's marital status and in place of residence--were associated with less favorable outcomes in late adolescence. Our findings suggest a paradox: Canadian developmental outcomes through late adolescence appear quite similar to those in the United States, even though intergenerational mobility in Canada is closer to mobility in the Nordic countries than to that in the United States.

Adolescent outcomes and opportunities in a Canadian province: looking at siblings and neighbors

PubMed Central

2014-01-01

Background Well-organized administrative data with large numbers of cases (building on linked files from several government departments) and a population registry facilitate new studies of population health and child development. Analyses of family relationships and a number of outcomes--educational achievement, health, teen pregnancy, and receipt of income assistance--are relatively easy to conduct using several birth cohorts. Looking both at means/proportions and at sibling correlations enriches our study of opportunity and well-being in late adolescence. With observational research possibly exaggerating the causal effects of risk factors, sibling comparisons involving individuals sharing both many family characteristics and many genes help deal with such criticisms. Methods This paper uses a rich dataset from one Canadian province (Manitoba) covering a wide range of geographical areas (cities to rural regions). Influences on opportunity and well-being are analyzed looking at both means/proportions and sibling correlations. We measure a variety of outcomes that may reflect different causal influences. A creative application of linear programming advances the use of data on residential location. Results Predicting educational achievement using available variables was much easier than predicting adolescent health status (R-square of .200 versus R-square of .043). Low levels of educational achievement, high levels of teenage pregnancy, and high sibling correlations outside Winnipeg and within Winnipeg’s lower income areas highlight inequalities across socioeconomic and geographic backgrounds. Stratifying our analyses by different variables, such as income quintiles, reveals differences in means and correlations within outcomes and across groups. Particular events--changes in mother’s marital status and in place of residence--were associated with less favorable outcomes in late adolescence. Conclusion Our findings suggest a paradox: Canadian developmental outcomes through late adolescence appear quite similar to those in the United States, even though intergenerational mobility in Canada is closer to mobility in the Nordic countries than to that in the United States. PMID:24884832

Goals and Objectives to Optimize the Value of an Acute Pain Service in Perioperative Pain Management.

PubMed

Le-Wendling, Linda; Glick, Wesley; Tighe, Patrick

2017-12-01

As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.

Are We All in the Same Boat? The Role of Perceptual Distance in Organizational Health Interventions.

PubMed

Hasson, Henna; von Thiele Schwarz, Ulrica; Nielsen, Karina; Tafvelin, Susanne

2016-10-01

The study investigates how agreement between leaders' and their team's perceptions influence intervention outcomes in a leadership-training intervention aimed at improving organizational learning. Agreement, i.e. perceptual distance was calculated for the organizational learning dimensions at baseline. Changes in the dimensions from pre-intervention to post-intervention were evaluated using polynomial regression analysis with response surface analysis. The general pattern of the results indicated that the organizational learning improved when leaders and their teams agreed on the level of organizational learning prior to the intervention. The improvement was greatest when the leader's and the team's perceptions at baseline were aligned and high rather than aligned and low. The least beneficial scenario was when the leader's perceptions were higher than the team's perceptions. These results give insights into the importance of comparing leaders' and their team's perceptions in intervention research. Polynomial regression analyses with response surface methodology allow three-dimensional examination of relationship between two predictor variables and an outcome. This contributes with knowledge on how combination of predictor variables may affect outcome and allows studies of potential non-linearity relating to the outcome. Future studies could use these methods in process evaluation of interventions. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Public figure announcements about cancer and opportunities for cancer communication: a review and research agenda.

PubMed

Noar, Seth M; Willoughby, Jessica Fitts; Myrick, Jessica Gall; Brown, Jennifer

2014-01-01

Announcements by public figures and celebrities about cancer diagnosis or death represent significant events in public life. But what are the substantive effects of such events, if any? The purpose of this article is to systematically review studies that examined the impact of public figure cancer announcements on cancer-oriented outcomes. Using comprehensive search procedures, we identified k = 19 studies that examined 11 distinct public figures. The most commonly studied public figures were Jade Goody, Kylie Minogue, Nancy Reagan, and Steve Jobs, with the most common cancers studied being breast (53%), cervical (21%), and pancreatic (21%) cancer. Most studies assessed multiple outcome variables, including behavioral outcomes (k = 15), media coverage (k = 10), information seeking (k = 8), cancer incidence (k = 3), and interpersonal communication (k = 2). Results fairly consistently indicated that cancer announcements from public figures had meaningful effects on many, if not most, of these outcome variables. While such events essentially act as naturally occurring interventions, the effects tend to be relatively short term. Gaps in this literature include few contemporary studies of high-profile public figures in the United States and a general lack of theory-based research. Directions for future research as well as implications for cancer communication and prevention are discussed.

Social Variables Affecting Mate Preferences, Copulation and Reproductive Outcome in a Pack of Free-Ranging Dogs

PubMed Central

Valsecchi, Paola; Natoli, Eugenia

2014-01-01

Mating and reproductive outcome is often determined by the simultaneous operation of different mechanisms like intra-sexual competition, mating preferences and sexual coercion. The present study investigated how social variables affected mating outcome in a pack of free-ranging dogs, a species supposed to have lost most features of the social system of wolves during domestication. We found that, although the pack comprised multiple breeding individuals, both male copulation success and female reproductive success were positively influenced by a linear combination of dominance rank, age and leadership. Our results also suggest that mate preferences affect mating outcome by reinforcing the success of most dominant individuals. In particular, during their oestrous period bitches clearly searched for the proximity of high-ranking males who displayed affiliative behaviour towards them, while they were more likely to reject the males who intimidated them. At the same time, male courting effort and male-male competition for receptive females appeared to be stronger in the presence of higher-ranking females, suggesting a male preference for dominant females. To our knowledge, these results provide the first clear evidence of social regulation of reproductive activities in domestic dogs, and suggest that some common organizing mechanisms may contribute to shape the social organization of both dogs and wolves. PMID:24905360

Prognostic factors of a favorable outcome following a supervised exercise program for soldiers with sub-acute and chronic low back pain.

PubMed

Perron, Marc; Gendron, Chantal; Langevin, Pierre; Leblond, Jean; Roos, Marianne; Roy, Jean-Sébastien

2018-04-02

Low back pain (LBP) encompasses heterogeneous patients unlikely to respond to a unique treatment. Identifying sub-groups of LBP may help to improve treatment outcomes. This is a hypothesis-setting study designed to create a clinical prediction rule (CPR) that will predict favorable outcomes in soldiers with sub-acute and chronic LBP participating in a multi-station exercise program. Military members with LBP participated in a supervised program comprising 7 stations each consisting of exercises of increasing difficulty. Demographic, impairment and disability data were collected at baseline. The modified Oswestry Disability Index (ODI) was administered at baseline and following the 6-week program. An improvement of 50% in the initial ODI score was considered the reference standard to determine a favorable outcome. Univariate associations with favorable outcome were tested using chi-square or paired t-tests. Variables that showed between-group (favorable/unfavorable) differences were entered into a logistic regression after determining the sampling adequacy. Finally, continuous variables were dichotomized and the sensitivity, specificity and positive and negative likelihood ratios were determined for the model and for each variable. A sample of 85 participants was included in analyses. Five variables contributed to prediction of a favorable outcome: no pain in lying down (p = 0.017), no use of antidepressants (p = 0.061), FABQ work score < 22.5 (p = 0.061), fewer than 5 physiotherapy sessions before entering the program (p = 0.144) and less than 6 months' work restriction (p = 0.161). This model yielded a sensitivity of 0.78, specificity of 0.80, LR+ of 3.88, and LR- of 0.28. A 77.5% probability of favorable outcome can be predicted by the presence of more than three of the five variables, while an 80% probability of unfavorable outcome can be expected if only three or fewer variables are present. The use of prognostic factors may guide clinicians in identifying soldiers with LBP most likely to have a favorable outcome. Further validation studies are needed to determine if the variables identified in our study are treatment effect modifiers that can predict success following participation in the multi-station exercise program. ClinicalTrials.gov Identifier: NCT03464877 registered retrospectively on 14 March 2018.

Incremental change or initial differences? Testing two models of marital deterioration.

PubMed

Lavner, Justin A; Bradbury, Thomas N; Karney, Benjamin R

2012-08-01

Most couples begin marriage intent on maintaining a fulfilling relationship, but some newlyweds soon struggle, and others continue to experience high levels of satisfaction. Do these diverse outcomes result from an incremental process that unfolds over time, as prevailing models suggest, or are they a manifestation of initial differences that are largely evident at the start of the marriage? Using 8 waves of data collected over the first 4 years of marriage (N = 502 spouses, or 251 newlywed marriages), we tested these competing perspectives first by identifying 3 qualitatively distinct relationship satisfaction trajectory groups and then by determining the extent to which spouses in these groups were differentiated on the basis of (a) initial scores and (b) 4-year changes in a set of established predictor variables, including relationship problems, aggression, attributions, stress, and self-esteem. The majority of spouses exhibited high, stable satisfaction over the first 4 years of marriage, whereas declining satisfaction was isolated among couples with relatively low initial satisfaction. Across all predictor variables, initial values afforded stronger discrimination of outcome groups than did rates of change in these variables. Thus, readily measured initial differences are potent antecedents of relationship deterioration, and studies are now needed to clarify the specific ways in which initial indices of risk come to influence changes in spouses' judgments of relationship satisfaction. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Incremental Change or Initial Differences? Testing Two Models of Marital Deterioration

PubMed Central

Lavner, Justin A.; Bradbury, Thomas N.; Karney, Benjamin R.

2012-01-01

Most couples begin marriage intent on maintaining a fulfilling relationship, but some newlyweds soon struggle while others continue to experience high levels of satisfaction. Do these diverse outcomes result from an incremental process that unfolds over time, as prevailing models suggest, or are they a manifestation of initial differences that are largely evident at the start of the marriage? Using eight waves of data collected over the first 4 years of marriage (N = 502 spouses, or 251 newlywed marriages), we tested these competing perspectives first by identifying three qualitatively distinct relationship satisfaction trajectory groups and then by determining the extent to which spouses in these groups were differentiated on the basis of (a) initial scores and (b) 4-year changes in a set of established predictor variables, including relationship problems, aggression, attributions, stress, and self-esteem. The majority of spouses exhibited high, stable satisfaction over the first four years of marriage, whereas declining satisfaction was isolating among couples with relatively low initial satisfaction. Across all predictor variables, initial values afforded stronger discrimination of outcome groups than did rates of change in these variables. Thus, readily-measured initial differences are potent antecedents of relationship deterioration, and studies are now needed to clarify the specific ways in which initial indices of risk come to influence changes in spouses’ judgments of relationship satisfaction. PMID:22709260

CAN INFANTS BE “TAUGHT” TO ATTEND TO A NEW PHYSICAL VARIABLE IN AN EVENT CATEGORY? THE CASE OF HEIGHT IN COVERING EVENTS

PubMed Central

Wang, Su-hua; Baillargeon, Renée

2009-01-01

As they observe or produce events, infants identify variables that help them predict outcomes in each category of events. How do infants identify a new variable? An explanation-based learning (EBL) account suggests three essential steps: (1) observing contrastive outcomes relevant to the variable; (2) discovering the conditions associated with these outcomes; and (3) generating an explanation for the condition-outcome regularity discovered. In Experiments 1–3, 9-month-old infants watched events designed to “teach” them the variable height in covering events. After watching these events, designed in accord with the EBL account, the infants detected a height violation in a covering event, three months earlier than they ordinarily would have. In Experiments 4–6, the “teaching” events were modified to remove one of the EBL steps, and the infants no longer detected the height violation. The present findings thus support the EBL account and help specify the processes by which infants acquire their physical knowledge. PMID:18177635

The Influence of Co-Morbidity and Other Health Measures on Dental and Medical Care Use among Medicare beneficiaries 2002

PubMed Central

Chen, Haiyan; Moeller, John; Manski, Richard J.

2011-01-01

Objective To assess the impact of co-morbidity and other health measures on the use of dental and medical care services among the community-based Medicare population with data from the 2002 Medicare Current Beneficiary Survey. Methods A co-morbidity index is the main independent variable of our study. It includes oral cancer as a co-morbidity condition and was developed from Medicare claims data. The two outcome variables indicate whether a beneficiary had a dental visit during the year and whether the beneficiary had an inpatient hospital stay during the year. Logistic regressions estimated the relationship between the outcome variables and co-morbidity after controlling for other explanatory variables. Results High scores on the co-morbidity index, high numbers of self-reported physical limitations, and fair or poor self-reported health status were correlated with higher hospital use and lower dental care utilization. Similar results were found for other types of medical care including medical provider visits, outpatient care, and prescription drugs. A multiple imputation technique was used for the approximate 20% of the sample with missing claims, but the resulting co-morbidity index performed no differently than the index constructed without imputation. Conclusions Co-morbidities and other health status measures are theorized to play either a predisposing or need role in determining health care utilization. The study’s findings confirm the dominant role of these measures as predisposing factors limiting access to dental care for Medicare beneficiaries and as need factors producing higher levels of inpatient hospital and other medical care for Medicare beneficiaries. PMID:21972460

Predicting well-being longitudinally for mothers rearing offspring with intellectual and developmental disabilities.

PubMed

Grein, K A; Glidden, L M

2015-07-01

Well-being outcomes for parents of children with intellectual and developmental disabilities (IDD) may vary from positive to negative at different times and for different measures of well-being. Predicting and explaining this variability has been a major focus of family research for reasons that have both theoretical and applied implications. The current study used data from a 23-year longitudinal investigation of adoptive and birth parents of children with IDD to determine which early child, mother and family characteristics would predict the variance in maternal outcomes 20 years after their original measurement. Using hierarchical regression analyses, we tested the predictive power of variables measured when children were 7 years old on outcomes of maternal well-being when children were 26 years old. Outcome variables included maternal self-report measures of depression and well-being. Final models of well-being accounted for 20% to 34% of variance. For most outcomes, Family Accord and/or the personality variable of Neuroticism (emotional stability/instability) were significant predictors, but some variables demonstrated a different pattern. These findings confirm that (1) characteristics of the child, mother and family during childhood can predict outcomes of maternal well-being 20 years later; and (2) different predictor-outcome relationships can vary substantially, highlighting the importance of using multiple measures to gain a more comprehensive understanding of maternal well-being. These results have implications for refining prognoses for parents and for tailoring service delivery to individual child, parent and family characteristics. © 2014 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Genetic instrumental variable regression: Explaining socioeconomic and health outcomes in nonexperimental data

PubMed Central

DiPrete, Thomas A.; Burik, Casper A. P.; Koellinger, Philipp D.

2018-01-01

Identifying causal effects in nonexperimental data is an enduring challenge. One proposed solution that recently gained popularity is the idea to use genes as instrumental variables [i.e., Mendelian randomization (MR)]. However, this approach is problematic because many variables of interest are genetically correlated, which implies the possibility that many genes could affect both the exposure and the outcome directly or via unobserved confounding factors. Thus, pleiotropic effects of genes are themselves a source of bias in nonexperimental data that would also undermine the ability of MR to correct for endogeneity bias from nongenetic sources. Here, we propose an alternative approach, genetic instrumental variable (GIV) regression, that provides estimates for the effect of an exposure on an outcome in the presence of pleiotropy. As a valuable byproduct, GIV regression also provides accurate estimates of the chip heritability of the outcome variable. GIV regression uses polygenic scores (PGSs) for the outcome of interest which can be constructed from genome-wide association study (GWAS) results. By splitting the GWAS sample for the outcome into nonoverlapping subsamples, we obtain multiple indicators of the outcome PGSs that can be used as instruments for each other and, in combination with other methods such as sibling fixed effects, can address endogeneity bias from both pleiotropy and the environment. In two empirical applications, we demonstrate that our approach produces reasonable estimates of the chip heritability of educational attainment (EA) and show that standard regression and MR provide upwardly biased estimates of the effect of body height on EA. PMID:29686100

Genetic instrumental variable regression: Explaining socioeconomic and health outcomes in nonexperimental data.

PubMed

DiPrete, Thomas A; Burik, Casper A P; Koellinger, Philipp D

2018-05-29

Identifying causal effects in nonexperimental data is an enduring challenge. One proposed solution that recently gained popularity is the idea to use genes as instrumental variables [i.e., Mendelian randomization (MR)]. However, this approach is problematic because many variables of interest are genetically correlated, which implies the possibility that many genes could affect both the exposure and the outcome directly or via unobserved confounding factors. Thus, pleiotropic effects of genes are themselves a source of bias in nonexperimental data that would also undermine the ability of MR to correct for endogeneity bias from nongenetic sources. Here, we propose an alternative approach, genetic instrumental variable (GIV) regression, that provides estimates for the effect of an exposure on an outcome in the presence of pleiotropy. As a valuable byproduct, GIV regression also provides accurate estimates of the chip heritability of the outcome variable. GIV regression uses polygenic scores (PGSs) for the outcome of interest which can be constructed from genome-wide association study (GWAS) results. By splitting the GWAS sample for the outcome into nonoverlapping subsamples, we obtain multiple indicators of the outcome PGSs that can be used as instruments for each other and, in combination with other methods such as sibling fixed effects, can address endogeneity bias from both pleiotropy and the environment. In two empirical applications, we demonstrate that our approach produces reasonable estimates of the chip heritability of educational attainment (EA) and show that standard regression and MR provide upwardly biased estimates of the effect of body height on EA. Copyright © 2018 the Author(s). Published by PNAS.

Negative control exposure studies in the presence of measurement error: implications for attempted effect estimate calibration

PubMed Central

Sanderson, Eleanor; Macdonald-Wallis, Corrie; Davey Smith, George

2018-01-01

Abstract Background Negative control exposure studies are increasingly being used in epidemiological studies to strengthen causal inference regarding an exposure-outcome association when unobserved confounding is thought to be present. Negative control exposure studies contrast the magnitude of association of the negative control, which has no causal effect on the outcome but is associated with the unmeasured confounders in the same way as the exposure, with the magnitude of the association of the exposure with the outcome. A markedly larger effect of the exposure on the outcome than the negative control on the outcome strengthens inference that the exposure has a causal effect on the outcome. Methods We investigate the effect of measurement error in the exposure and negative control variables on the results obtained from a negative control exposure study. We do this in models with continuous and binary exposure and negative control variables using analysis of the bias of the estimated coefficients and Monte Carlo simulations. Results Our results show that measurement error in either the exposure or negative control variables can bias the estimated results from the negative control exposure study. Conclusions Measurement error is common in the variables used in epidemiological studies; these results show that negative control exposure studies cannot be used to precisely determine the size of the effect of the exposure variable, or adequately adjust for unobserved confounding; however, they can be used as part of a body of evidence to aid inference as to whether a causal effect of the exposure on the outcome is present. PMID:29088358

Negative control exposure studies in the presence of measurement error: implications for attempted effect estimate calibration.

PubMed

Sanderson, Eleanor; Macdonald-Wallis, Corrie; Davey Smith, George

2018-04-01

Negative control exposure studies are increasingly being used in epidemiological studies to strengthen causal inference regarding an exposure-outcome association when unobserved confounding is thought to be present. Negative control exposure studies contrast the magnitude of association of the negative control, which has no causal effect on the outcome but is associated with the unmeasured confounders in the same way as the exposure, with the magnitude of the association of the exposure with the outcome. A markedly larger effect of the exposure on the outcome than the negative control on the outcome strengthens inference that the exposure has a causal effect on the outcome. We investigate the effect of measurement error in the exposure and negative control variables on the results obtained from a negative control exposure study. We do this in models with continuous and binary exposure and negative control variables using analysis of the bias of the estimated coefficients and Monte Carlo simulations. Our results show that measurement error in either the exposure or negative control variables can bias the estimated results from the negative control exposure study. Measurement error is common in the variables used in epidemiological studies; these results show that negative control exposure studies cannot be used to precisely determine the size of the effect of the exposure variable, or adequately adjust for unobserved confounding; however, they can be used as part of a body of evidence to aid inference as to whether a causal effect of the exposure on the outcome is present.

Application of the theory of reasoned action to environmental behaviors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Duquette, R.D.

The applicability of Ajzen and Fishbein's Theory of Reasoned Action (1980) to environmental behaviors was examined. Trained interviewers conducted a telephone survey employing random digit dialing with random selection of individuals within households; 388 individuals completed interviews. A preliminary study was conducted to identify salient outcomes (advantages and disadvantages), referents (individuals or groups), and activities associated with protecting the environment. The main study questionnaire was based upon the most frequently identified outcomes, referents, and activities, using the procedures of Ajzen and Fishbein (1980). A pilot test indicated that the ..cap alpha.. coefficients of all subscales were greater than .70. Inmore » addition to the theory variables, the external variables of occupation and education were assessed. The relationships between the theory variables were examined using correlational and multiple regression techniques. Though weaker than in previous studies, all the theoretical relationships were in the hypothesized direction. Analysis of variance, used to examine the external variables, found significant differences among occupational groups and educational levels with regard to intention to protect the environment. Polluters scored lower on intention than individuals with non-polluting or not applicable occupations. Individuals with a high school diploma or less were lower on intention and were significantly less favorable toward protecting the environment than those with some college or a college degree.« less

Quantifying the process and outcomes of person-centered planning.

PubMed

Holburn, S; Jacobson, J W; Vietze, P M; Schwartz, A A; Sersen, E

2000-09-01

Although person-centered planning is a popular approach in the field of developmental disabilities, there has been little systematic assessment of its process and outcomes. To measure person-centered planning, we developed three instruments designed to assess its various aspects. We then constructed variables comprising both a Process and an Outcome Index using a combined rational-empirical method. Test-retest reliability and measures of internal consistency appeared adequate. Variable correlations and factor analysis were generally consistent with our conceptualization and resulting item and variable classifications. Practical implications for intervention integrity, program evaluation, and organizational performance are discussed.

Network Mendelian randomization: using genetic variants as instrumental variables to investigate mediation in causal pathways

PubMed Central

Burgess, Stephen; Daniel, Rhian M; Butterworth, Adam S; Thompson, Simon G

2015-01-01

Background: Mendelian randomization uses genetic variants, assumed to be instrumental variables for a particular exposure, to estimate the causal effect of that exposure on an outcome. If the instrumental variable criteria are satisfied, the resulting estimator is consistent even in the presence of unmeasured confounding and reverse causation. Methods: We extend the Mendelian randomization paradigm to investigate more complex networks of relationships between variables, in particular where some of the effect of an exposure on the outcome may operate through an intermediate variable (a mediator). If instrumental variables for the exposure and mediator are available, direct and indirect effects of the exposure on the outcome can be estimated, for example using either a regression-based method or structural equation models. The direction of effect between the exposure and a possible mediator can also be assessed. Methods are illustrated in an applied example considering causal relationships between body mass index, C-reactive protein and uric acid. Results: These estimators are consistent in the presence of unmeasured confounding if, in addition to the instrumental variable assumptions, the effects of both the exposure on the mediator and the mediator on the outcome are homogeneous across individuals and linear without interactions. Nevertheless, a simulation study demonstrates that even considerable heterogeneity in these effects does not lead to bias in the estimates. Conclusions: These methods can be used to estimate direct and indirect causal effects in a mediation setting, and have potential for the investigation of more complex networks between multiple interrelated exposures and disease outcomes. PMID:25150977

The Influences and Outcomes of Phonological Awareness: A Study of MA, PA and Auditory Processing in Pre-Readers with a Family Risk of Dyslexia

ERIC Educational Resources Information Center

Law, Jeremy M.; Wouters, Jan; Ghesquière, Pol

2017-01-01

The direct influence of phonological awareness (PA) on reading outcomes has been widely demonstrated, yet PA may also exert indirect influence on reading outcomes through other cognitive variables such as morphological awareness (MA). However, PA's own development is dependent and influenced by many extraneous variables such as auditory…

Components of a Model for Forecasting Future Status of Selected Social Indicators. Department of Education Project on Social Indicators. Technical Report No. 3.

ERIC Educational Resources Information Center

Collazo, Andres; And Others

Since a great number of variables influence future educational outcomes, forecasting possible trends is a complex task. One such model, the cross-impact matrix, has been developed. The use of this matrix in forecasting future values of social indicators of educational outcomes is described. Variables associated with educational outcomes are used…

Relations and effects of transformational leadership: a comparative analysis with traditional leadership styles.

PubMed

Molero, Fernando; Cuadrado, Isabel; Navas, Marisol; Morales, J Francisco

2007-11-01

This study has two main goals: (a) to compare the relationship between transformational leadership and other important leadership styles (i.e., democratic versus autocratic or relations- and task-oriented leadership) and (b) to compare the effects of transformational leadership and the other styles on some important organizational outcomes such as employees' satisfaction and performance. For this purpose, a sample of 147 participants, working in 35 various work-teams, was used. Results show high correlations between transformational leadership, relations-oriented, democratic, and task-oriented leadership. On the other hand, according to the literature, transformational leadership, especially high levels, significantly increases the percentage of variance accounted for by other leadership styles in relevant organizational outcome variables (subordinates' performance, satisfaction and extra effort).

Narcissism, Perceived Social Status, and Social Cognition and Their Influence on Aggression

ERIC Educational Resources Information Center

Gumpel, Thomas P.; Wiesenthal, Vered; Söderberg, Patrik

2015-01-01

This study had three primary goals: to explore the relationship between narcissism, participant roles, and aggression; to examine the role of gender as a moderating influence on narcissism-based aggression; and to examine how these variables work together to influence aggressive outcomes in a sample of aggressive middle and high school students.…

Suicide Attempts within 12 Months of Treatment for Substance Use Disorders

ERIC Educational Resources Information Center

Britton, Peter C.; Conner, Kenneth R.

2010-01-01

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment…

Testing Causal Impacts of a School-Based SEL Intervention Using Instrumental Variable Techniques

ERIC Educational Resources Information Center

Torrente, Catalina; Nathanson, Lori; Rivers, Susan; Brackett, Marc

2015-01-01

Children's social-emotional skills, such as conflict resolution and emotion regulation, have been linked to a number of highly regarded academic and social outcomes. The current study presents preliminary results from a causal test of the theory of change of RULER, a universal school-based approach to social and emotional learning (SEL).…

The Moderating Effects of Culture on Peer Deviance and Alcohol Use among High-Risk African-American Adolescents

ERIC Educational Resources Information Center

Nasim, Aashir; Belgrave, Faye Z.; Jagers, Robert J.; Wilson, Karen D.; Owens, Kristal

2007-01-01

African-American adolescents have lower rates of alcohol consumption than White youth. However, African-American youth suffer disproportionately more adverse social, mental, and physical health outcomes related to alcohol use. Affiliating with negative peers is a risk factor for alcohol initiation and consumption. Cultural variables have shown…

Analysis of Subsequent Educational Decisions of High School Dropouts and Their Life Outcomes.

ERIC Educational Resources Information Center

Chan, Chi-Keung; Kato, Kentaro; Davenport, Ernest C., Jr.; Guven, Kamil

This study used data for a representative sample of 8th graders from the National Educational Longitudinal Study of 1988. The intent was to (1) compare student's dropout status with variables such as demographics, academic and economic factors, limited English proficiency status, and other risk factors of dropping out, (2) distinguish factors…

Subtypes in 22q11.2 Deletion Syndrome Associated with Behaviour and Neurofacial Morphology

ERIC Educational Resources Information Center

Sinderberry, Brooke; Brown, Scott; Hammond, Peter; Stevens, Angela F.; Schall, Ulrich; Murphy, Declan G. M.; Murphy, Kieran C.; Campbell, Linda E.

2013-01-01

22q11.2 deletion syndrome (22q11DS) has a complex phenotype with more than 180 characteristics, including cardiac anomalies, cleft palate, intellectual disabilities, a typical facial morphology, and mental health problems. However, the variable phenotype makes it difficult to predict clinical outcome, such as the high prevalence of psychosis among…

Latent class analysis derived subgroups of low back pain patients - do they have prognostic capacity?

PubMed

Molgaard Nielsen, Anne; Hestbaek, Lise; Vach, Werner; Kent, Peter; Kongsted, Alice

2017-08-09

Heterogeneity in patients with low back pain is well recognised and different approaches to subgrouping have been proposed. One statistical technique that is increasingly being used is Latent Class Analysis as it performs subgrouping based on pattern recognition with high accuracy. Previously, we developed two novel suggestions for subgrouping patients with low back pain based on Latent Class Analysis of patient baseline characteristics (patient history and physical examination), which resulted in 7 subgroups when using a single-stage analysis, and 9 subgroups when using a two-stage approach. However, their prognostic capacity was unexplored. This study (i) determined whether the subgrouping approaches were associated with the future outcomes of pain intensity, pain frequency and disability, (ii) assessed whether one of these two approaches was more strongly or more consistently associated with these outcomes, and (iii) assessed the performance of the novel subgroupings as compared to the following variables: two existing subgrouping tools (STarT Back Tool and Quebec Task Force classification), four baseline characteristics and a group of previously identified domain-specific patient categorisations (collectively, the 'comparator variables'). This was a longitudinal cohort study of 928 patients consulting for low back pain in primary care. The associations between each subgroup approach and outcomes at 2 weeks, 3 and 12 months, and with weekly SMS responses were tested in linear regression models, and their prognostic capacity (variance explained) was compared to that of the comparator variables listed above. The two previously identified subgroupings were similarly associated with all outcomes. The prognostic capacity of both subgroupings was better than that of the comparator variables, except for participants' recovery beliefs and the domain-specific categorisations, but was still limited. The explained variance ranged from 4.3%-6.9% for pain intensity and from 6.8%-20.3% for disability, and highest at the 2 weeks follow-up. Latent Class-derived subgroups provided additional prognostic information when compared to a range of variables, but the improvements were not substantial enough to warrant further development into a new prognostic tool. Further research could investigate if these novel subgrouping approaches may help to improve existing tools that subgroup low back pain patients.

Insight, self-stigma and psychosocial outcomes in Schizophrenia: a structural equation modelling approach.

PubMed

Lien, Y-J; Chang, H-A; Kao, Y-C; Tzeng, N-S; Lu, C-W; Loh, C-H

2018-04-01

Poor insight is prevalent in patients with schizophrenia and has been associated with acute illness severity, medication non-adherence and poor treatment outcomes. Paradoxically, high insight has been associated with various undesirable outcomes, including low self-esteem, depression and low subjective quality of life (QoL) in patients with schizophrenia. Despite the growing body of studies conducted in Western countries supporting the pernicious effects of improved insight in psychosis, which bases on the level of self-stigma, the effects are unclear in non-Western societies. The current study examined the role of self-stigma in the relationship between insight and psychosocial outcomes in a Chinese population. A total of 170 outpatients with schizophrenia spectrum disorders were recruited from two general university hospitals. Sociodemographic data and clinical variables were recorded and self-report scales were employed to measure self-stigma, depression, insight, self-esteem and subjective QoL. Structural equation modelling (SEM) was used to analyse the cross-sectional data. High levels of self-stigma were reported by 39% of the participants (n = 67). The influences of insight, self-stigma, self-esteem and depression on subjective QoL were confirmed by the SEM results. Our model with the closest fit to the data (χ 2 = 33.28; df = 20; p = 0.03; χ 2/df = 1.66; CFI = 0.98; TLI = 0.97; RMSEA = 0.06) demonstrated that self-stigma might fully mediate the association of insight with low self-esteem, depression and poor subjective QoL. High insight into illness contributed to self-stigma, which caused low self-esteem and depression and, consequently, low QoL. Notably, insight did not directly affect self-esteem, depression or QoL. Furthermore, the association of insight with poor psychosocial outcomes was not moderated by self-stigma. Our findings support the mediating model of insight relevant to the poor psychosocial outcomes of individuals diagnosed with schizophrenia in non-Western societies, in which self-stigma plays a pivotal role. These findings elucidate the direct and indirect effects of insight on psychosocial outcomes and imply that identifying and correcting self-stigma in people with schizophrenia could be beneficial. Additional studies are required to identify whether several other neurocognitive or psychosocial variables mediate or moderate the association of insight with self-esteem, depression and QoL in patients with schizophrenia. Studies with detailed longitudinal assessments are necessary to confirm our findings.

Predictors of vision impairment in Multiple Sclerosis.

PubMed

Sanchez-Dalmau, Bernardo; Martinez-Lapiscina, Elena H; Pulido-Valdeolivas, Irene; Zubizarreta, Irati; Llufriu, Sara; Blanco, Yolanda; Sola-Valls, Nuria; Sepulveda, Maria; Guerrero, Ana; Alba, Salut; Andorra, Magi; Camos, Anna; Sanchez-Vela, Laura; Alfonso, Veronica; Saiz, Albert; Villoslada, Pablo

2018-01-01

Visual impairment significantly alters the quality of life of people with Multiple Sclerosis (MS). The objective of this study was to identify predictors (independent variables) of visual outcomes, and to define their relationship with neurological disability and retinal atrophy when assessed by optical coherence tomography (OCT). We performed a cross-sectional analysis of 119 consecutive patients with MS, assessing vision using high contrast visual acuity (LogMar), 2.5% and 1.25% low contrast visual acuity (Sloan charts), and color vision (Hardy-Rand-Rittler plates). Quality of vision is a patient reported outcome based on an individual's unique perception of his or her vision and was assessed with the Visual Functioning Questionnaire-25 (VFQ-25) with the 10 neuro-ophthalmologic items. MS disability was assessed using the expanded disability status scale (EDSS), the MS functional composite (MSFC) and the brief repetitive battery-neuropsychology (BRB-N). Retinal atrophy was assessed using spectral domain OCT, measuring the thickness of the peripapillar retinal nerve fiber layer (pRNFL) and the volume of the ganglion cell plus inner plexiform layer (GCIPL). The vision of patients with MS was impaired, particularly in eyes with prior optic neuritis. Retinal atrophy (pRNFL and GCIPL) was closely associated with impaired low contrast vision and color vision, whereas the volume of the GCIPL showed a trend (p = 0.092) to be associated with quality of vision. Multiple regression analysis revealed that EDSS was an explanatory variable for high contrast vision after stepwise analysis, GCIPL volume for low contrast vision, and GCIPL volume and EDSS for color vision. The explanatory variables for quality of vision were high contrast vision and color vision. In summary, quality of vision in MS depends on the impairment of high contrast visual acuity and color vision due to the disease.

Distribution of Helicobacter pylori virulence markers in patients with gastroduodenal diseases in a region at high risk of gastric cancer.

PubMed

Wang, Ming-yi; Chen, Cheng; Gao, Xiao-zhong; Li, Jie; Yue, Jing; Ling, Feng; Wang, Xiao-chun; Shao, Shi-he

2013-01-01

Helicobacter pylori (H. pylori) is a major human pathogen that is responsible for various gastroduodenal diseases. We investigated the prevalence of H. pylori virulence markers in a region at high risk of gastric cancer. One hundred and sixteen H. pylori strains were isolated from patients with gastroduodenal diseases. cagA, the cagA 3' variable region, cagPAI genes, vacA, and dupA genotypes were determined by PCR, and some amplicons of the cagA 3' variable region, cagPAI genes and dupA were sequenced. cagA was detected in all strains. The cagA 3' variable region of 85 strains (73.3%) was amplified, and the sequences of 24 strains were obtained including 22 strains possessing the East Asian-type. The partial cagPAI presented at a higher frequency in chronic gastritis (44.4%) than that of the severe clinical outcomes (9.7%, p < 0.001). The most prevalent vacA genotypes were s1a/m2 (48.3%) and s1c/m2 (13.8%). Thirty-six strains (31.0%) possessed dupA and sequencing of dupA revealed an ORF of 2449-bp. The prevalence of dupA was significantly higher in strains from patients with the severe clinical outcomes (40.3%) than that from chronic gastritis (20.4%, p = 0.02). The high rate of East Asian-type cagA, intact cagPAI, virulent vacA genotypes, and the intact long-type dupA may underlie the high risk of gastric cancer in the region. Copyright © 2013 Elsevier Ltd. All rights reserved.

When is affect variability bad for health? The association between affect variability and immune response to the influenza vaccination.

PubMed

Jenkins, Brooke N; Hunter, John F; Cross, Marie P; Acevedo, Amanda M; Pressman, Sarah D

2018-01-01

This study addresses methodological and theoretical questions about the association between affect and physical health. Specifically, we examine the role of affect variability and its interaction with mean levels of affect to predict antibody (Ab) levels in response to an influenza vaccination. Participants (N=83) received the vaccination and completed daily diary measures of affect four times a day for 13days. At one and four months post-vaccination, blood was collected from the participants to assess Ab levels. Findings indicate that affect variability and its interaction with mean levels of affect predict an individual's immune response. Those high in mean positive affect (PA) who had more PA variability were more likely to have a lower Ab response in comparison to those who had high mean PA and less PA variability. Although it did not interact with mean negative affect (NA), NA variability on its own was associated with Ab response, whereby those with less NA variability mounted a more robust immune response. Affect variability is related to immune response to an influenza vaccination and, in some cases, interacts with mean levels of affect. These oscillations in affective experiences are critical to consider in order to unpack the intricacies of how affect influences health. These findings suggest that future researchers should consider the important role of affect variability on physical health-relevant outcomes as well as examine the moderating effect of mean affect levels. Copyright © 2017 Elsevier Inc. All rights reserved.

Maternal anxiety: a 5-year review of an intervention study.

PubMed

Barnett, B; Schaafsma, M F; Guzman, A M; Parker, G B

1991-03-01

Primiparous women were divided into groups according to their post-partum trait anxiety scores. Professional or non-professional support for the first 12 months was offered to two subgroups of high trait anxiety subjects. At the 5-year follow-up the high-anxiety mothers (n = 57) manifested more psychological and social pathology than moderate- and low-anxiety mothers (n = 43), and their children also showed signs of poorer adaptation. There was evidence of improved outcome for mothers in the professional intervention group, but not for their children. Child psychopathology was predicted best by maternal psychosocial variables, and to a lesser extent by child temperament variables. The relation of infant attachment and temperament measures to subsequent psychopathology is discussed.

Feasibility of Report Cards for Measuring Anesthesiologist Quality for Cardiac Surgery.

PubMed

Glance, Laurent G; Hannan, Edward L; Fleisher, Lee A; Eaton, Michael P; Dutton, Richard P; Lustik, Stewart J; Li, Yue; Dick, Andrew W

2016-05-01

In creating the Merit-Based Incentive Payment System, Congress has mandated pay-for-performance (P4P) for all physicians, including anesthesiologists. There are currently no National Quality Forum-endorsed risk-adjusted outcome metrics for anesthesiologists to use as the basis for P4P. Using clinical data from the New York State Cardiac Surgery Reporting System, we conducted a retrospective observational study of 55,436 patients undergoing cardiac surgery between 2009 and 2012. Hierarchical logistic regression modeling was used to examine the variation in in-hospital mortality or major complications (Q-wave myocardial infarction, renal failure, stroke, and respiratory failure) among anesthesiologists, controlling for patient demographics, severity of disease, comorbidities, and hospital quality. Although the variation in performance among anesthesiologists was statistically significant (P = 0.025), none of the anesthesiologists in the sample was classified as a high- or low-performance outliers. The contribution of anesthesiologists to outcomes represented 0.51% of the overall variability in patient outcomes (intraclass correlation coefficient [ICC] = 0.0051; 95% confidence interval [CI], 0.002-0.014), whereas the contribution of hospitals to patient outcomes was 2.90% (ICC = 0.029; 95% CI, 0.017-0.050). The anesthesiologist median odds ratio (MOR) was 1.13 (95% CI, 1.08-1.24), suggesting that the variation between anesthesiologist was modest, whereas the hospital MOR was 1.35 (95% CI, 1.25-1.48). In a separate analysis, the contribution of surgeons to overall outcomes represented 1.76% of the overall variability in patient outcomes (ICC = 0.018, 95% CI, 0.010-0.031), and the surgeon MOR was 1.26 (95% CI, 1.19-1.37). Twelve of the surgeons were identified as performance outliers. The impact of anesthesiologists on the total variability in cardiac surgical outcomes was probably about one-fourth as large as the surgeons' contribution. None of the anesthesiologists caring for cardiac surgical patients in New York State over a 3+ year period were identified as performance outliers. The use of a performance metric based on death or major complications for P4P may not be feasible for cardiac anesthesiologists.

Cheating, breakup, and divorce: is Facebook use to blame?

PubMed

Clayton, Russell B; Nagurney, Alexander; Smith, Jessica R

2013-10-01

The purpose of the present study was to investigate the relationship between using the social networking site known as Facebook and negative interpersonal relationship outcomes. A survey of 205 Facebook users aged 18-82 was conducted using a 16-question online survey to examine whether high levels of Facebook use predicted negative relationship outcomes (breakup/divorce, emotional cheating, and physical cheating). It was hypothesized that those with higher levels of Facebook use would demonstrate more negative relationship outcomes than those with lower use. The study then examined whether these relationships were mediated by Facebook-related conflict. Furthermore, the researchers examined length of relationship as a moderator variable in the aforementioned model. The results indicate that a high level of Facebook usage is associated with negative relationship outcomes, and that these relationships are indeed mediated by Facebook-related conflict. This series of relationships only holds for those who are, or have been, in relatively newer relationships of 3 years or less. The current study adds to the growing body of literature investigating Internet use and relationship outcomes, and may be a precursor to further research investigating whether Facebook use attributes to the divorce rate, emotional cheating, and physical cheating.

Effect of smoking status on the efficacy of the SMART regimen in high risk asthma.

PubMed

Pilcher, Janine; Patel, Mitesh; Reddel, Helen K; Pritchard, Alison; Black, Peter; Shaw, Dominick; Holt, Shaun; Weatherall, Mark; Beasley, Richard

2016-07-01

The optimal management of people with asthma with a significant smoking history is uncertain. The aim of this study was to determine whether the efficacy/safety profile of single combination inhaled corticosteroid (ICS)/long acting beta-agonist (LABA) inhaler maintenance and reliever therapy is influenced by smoking status. We undertook secondary analyses from an open-label 24-week randomized study of 303 high risk adult asthma patients randomized to budesonide/formoterol 200/6-µg-metred dose inhaler for maintenance (two actuations twice daily) and either budesonide/formoterol 200/6-µg-metred dose inhaler one actuation ('single ICS/LABA maintenance and reliever therapy (SMART)' regimen) or salbutamol 100 µg 1-2 actuations for symptom relief ('Standard' regimen). Smoking status was classified in to three groups, as 'current', 'ex' or 'never', and a smoking/treatment interaction term tested for each outcome variable. The primary outcome variable was number of participants with at least one severe exacerbation. There were 59 current, 97 ex and 147 never smokers included in the analyses. The smoking status/treatment interaction term was not statistically significant for any of the outcome measures. With adjustment for smoking status, the number of participants with severe exacerbations was lower with the SMART regimen (OR 0.45, 95% CI: 0.26-0.77, P = 0.004; P value for interaction between smoking status and treatment 0.29). We conclude that the favourable safety/efficacy profile of the SMART regimen applies to patients with high risk asthma, irrespective of smoking status. © 2016 Asian Pacific Society of Respirology.

Weight-loss intervention using implementation intentions and mental imagery: a randomised control trial study protocol.

PubMed

Hattar, Anne; Hagger, Martin S; Pal, Sebely

2015-02-27

Overweight and obesity are major health problems worldwide. This protocol describes the HEALTHI (Healthy Eating and Active LifesTyle Health Intervention) Program, a 12-week randomised-controlled weight-loss intervention that adopts two theory-based intervention techniques, mental imagery and implementation intentions, a behaviour-change technique based on planning that have been shown to be effective in promoting health-behaviour change in previous research. The effectiveness of goal-reminder text messages to augment intervention effects will also be tested. The trial will determine the effects of a brief, low cost, theory-based weight-loss intervention to improve dietary intake and physical activity behaviour and facilitate weight-loss in overweight and obese individuals. Overweight or obese participants will be randomly allocated to one of three conditions: (1) a psycho-education plus an implementation intentions and mental imagery condition; (2) a psycho-education plus an implementation intentions and mental imagery condition with text messages; or (3) a psycho-education control condition. The intervention will be delivered via video presentation to increase the intervention's applicability in multiple contexts and keep costs low. We hypothesise that the intervention conditions will lead to statistically-significant changes in the primary and secondary outcome variables measured at 6 and 12 weeks post-intervention relative to the psycho-education control condition after controlling for baseline values. The primary outcome variable will be body weight and secondary outcome variables will be biomedical (body mass, body fat percentage, muscle mass, waist-hip circumference ratio, systolic and diastolic blood pressure, low-density lipoprotein, high-density lipoprotein, total cholesterol, triglycerides, blood glucose and insulin levels), psychological (quality of life, motivation, risk perception, outcome expectancy, intention, action self-efficacy, maintenance self-efficacy, goal setting and planning), and behavioural (self-reported diet intake, and physical activity involvement) measures. We also expect the intervention condition augmented with text messages to lead to statistically significant differences in the primary and secondary outcome variables at the follow up periods after controlling for baseline values. The planned trial will test the effectiveness of the theory-based HEALTHI program intervention to reduce weight and salient psychological, biomedical, and behavioural outcomes in overweight and obese adults. The study has been designed to maximise applicability to real world settings and could be integrated into existing weight management practices. ACTRN: ACTRN12613001274763. Registration date 19/11/2013.

Abbreviation of the Follow-Up NIH Stroke Scale Using Factor Analysis

PubMed Central

Raza, Syed Ali; Frankel, Michael R.; Rangaraju, Srikant

2017-01-01

Background The NIH Stroke Scale (NIHSS) is a 15-item measure of stroke-related neurologic deficits that, when measured at 24 h, is highly predictive of long-term functional outcome. We hypothesized that a simplified 24-h scale that incorporates the most predictive components of the NIHSS can retain prognostic accuracy and have improved interrater reliability. Methods In a post hoc analysis of the Interventional Management of Stroke-3 (IMS-3) trial, we performed principal component (PC) analysis to resolve the 24-h NIHSS into PCs. In the PCs that explained the largest proportions of variance, key variables were identified. Using these key variables, the prognostic accuracies (area under the curve [AUC]) for good outcome (3-month modified Rankin Scale [mRS] 0–2) and poor outcome (mRS 5–6) of various abbreviated NIHSS iterations were compared with the total 24-h NIHSS. The results were validated in the NINDS intravenous tissue plasminogen activator (NINDS-TPA) study cohort. Based on previously published data, interrater reliability of the abbreviated 24-h NIHSS (aNIHSS) was compared to the total 24-h NIHSS. Results In 545 IMS-3 participants, 2 PCs explained 60.8% of variance in the 24-h NIHSS. The key variables in PC1 included neglect, arm and leg weakness; while PC2 included level-of-consciousness (LOC) questions, LOC commands, and aphasia. A 3-variable aNIHSS (aphasia, neglect, arm weakness) retained excellent prognostic accuracy for good outcome (AUC = 0.90) as compared to the total 24-h NIHSS (AUC = 0.91), and it was more predictive (p < 0.001) than the baseline NIHSS (AUC = 0.73). The prognostic accuracy of the aNIHSS for good outcome was validated in the NINDS-TPA trial cohort (aNIHSS: AUC = 0.89 vs. total 24-h NIHSS: 0.92). An aNIHSS >9 predicted very poor outcomes (mRS 0–2: 0%, mRS 4–6: 98.5%). The estimated interrater reliability of the aNIHSS was higher than that of the total 24-h NIHSS across 6 published datasets (mean weighted kappa 0.80 vs. 0.73, p < 0.001). Conclusions At 24 h following ischemic stroke, aphasia, neglect, and arm weakness are the most prognostically relevant neurologic findings. The aNIHSS appears to have excellent prognostic accuracy with higher reliability and may be clinically useful. PMID:28968607

Pain Sensitivity Subgroups in Individuals With Spine Pain: Potential Relevance to Short-Term Clinical Outcome

PubMed Central

Bialosky, Joel E.; Robinson, Michael E.

2014-01-01

Background Cluster analysis can be used to identify individuals similar in profile based on response to multiple pain sensitivity measures. There are limited investigations into how empirically derived pain sensitivity subgroups influence clinical outcomes for individuals with spine pain. Objective The purposes of this study were: (1) to investigate empirically derived subgroups based on pressure and thermal pain sensitivity in individuals with spine pain and (2) to examine subgroup influence on 2-week clinical pain intensity and disability outcomes. Design A secondary analysis of data from 2 randomized trials was conducted. Methods Baseline and 2-week outcome data from 157 participants with low back pain (n=110) and neck pain (n=47) were examined. Participants completed demographic, psychological, and clinical information and were assessed using pain sensitivity protocols, including pressure (suprathreshold pressure pain) and thermal pain sensitivity (thermal heat threshold and tolerance, suprathreshold heat pain, temporal summation). A hierarchical agglomerative cluster analysis was used to create subgroups based on pain sensitivity responses. Differences in data for baseline variables, clinical pain intensity, and disability were examined. Results Three pain sensitivity cluster groups were derived: low pain sensitivity, high thermal static sensitivity, and high pressure and thermal dynamic sensitivity. There were differences in the proportion of individuals meeting a 30% change in pain intensity, where fewer individuals within the high pressure and thermal dynamic sensitivity group (adjusted odds ratio=0.3; 95% confidence interval=0.1, 0.8) achieved successful outcomes. Limitations Only 2-week outcomes are reported. Conclusions Distinct pain sensitivity cluster groups for individuals with spine pain were identified, with the high pressure and thermal dynamic sensitivity group showing worse clinical outcome for pain intensity. Future studies should aim to confirm these findings. PMID:24764070

The Methodology of Clinical Studies Used by the FDA for Approval of High-Risk Orthopaedic Devices.

PubMed

Barker, Jordan P; Simon, Stephen D; Dubin, Jonathan

2017-05-03

The purpose of this investigation was to examine the methodology of clinical trials used by the U.S. Food and Drug Administration (FDA) to determine the safety and effectiveness of high-risk orthopaedic devices approved between 2001 and 2015. Utilizing the FDA's online public database, this systematic review audited study design and methodological variables intended to minimize bias and confounding. An additional analysis of blinding as well as the Checklist to Evaluate a Report of a Nonpharmacological Trial (CLEAR NPT) was applied to the randomized controlled trials (RCTs). Of the 49 studies, 46 (94%) were prospective and 37 (76%) were randomized. Forty-seven (96%) of the studies were controlled in some form. Of 35 studies that reported it, blinding was utilized in 21 (60%), of which 8 (38%) were reported as single-blinded and 13 (62%) were reported as double-blinded. Of the 37 RCTs, outcome assessors were clearly blinded in 6 (16%), whereas 15 (41%) were deemed impossible to blind as implants could be readily discerned on imaging. When the CLEAR NPT was applied to the 37 RCTs, >70% of studies were deemed "unclear" in describing generation of allocation sequences, treatment allocation concealment, and adequate blinding of participants and outcome assessors. This study manifests the highly variable reporting and strength of clinical research methodology accepted by the FDA to approve high-risk orthopaedic devices.

Consideration of What May Influence Student Outcomes on Alternate Assessment.

ERIC Educational Resources Information Center

Browder, Diane M.; Fallin, Kathy; Davis, Stephanie; Karvonen, Meagan

2003-01-01

This article describes variables that may influence alternate assessment outcomes for students with disabilities and offers recommendations to enhance student achievement. These variables include technical quality, curriculum access, data collection, instructional effectiveness, risk factors, and resources allocated to instruction. Two of four…

Does adherence to treatment mediate the relationship between patients' treatment outcome expectancies and the outcomes of pain intensity and recovery from acute low back pain?

PubMed

Haanstra, Tsjitske M; Kamper, Steven J; Williams, Christopher M; Spriensma, Alette S; Lin, Chung-Wei Christine; Maher, Christopher G; de Vet, Henrica C W; Ostelo, Raymond W J G

2015-08-01

It is believed that patients' expectancies about the effectiveness of treatment influence their treatment outcomes, but the working mechanism is rarely studied in patients with low back pain. Theoretical models suggest that adherence to treatment may be an important pathway. The aim of this study was to assess the mediating role of adherence to treatment in the relationship between expectancies and the outcomes of recovery and pain intensity in patients with acute low back pain. This study used data from a randomized placebo-controlled trial of paracetamol for acute low back pain. Expectancies were measured with the Credibility Expectancy Questionnaire. Adherence was measured with a medication diary. Pain intensity was recorded daily in a diary on a 0 to 10 pain scale, and recovery was defined as the first of 7 consecutive days scoring 0 or 1 on a 6-point pain scale. Cox regression (dependent variable: recovery) and linear mixed-model analyses (dependent variable: daily pain intensity scores) were performed. The "difference in coefficients" approach was used to establish mediation. A total of 1573 participants were included in current analyses. There was a small but highly significant relationship between expectancies and outcomes; 3.3% of the relationship between expectancies and recovery and 14.2% of the relationship between expectancies and pain intensity were mediated by adherence to treatment. This study does not convincingly support the theory that adherence is a key pathway in the relationship between treatment outcome expectancies and recovery and pain intensity in this acute low back pain population.

Bias due to two-stage residual-outcome regression analysis in genetic association studies.

PubMed

Demissie, Serkalem; Cupples, L Adrienne

2011-11-01

Association studies of risk factors and complex diseases require careful assessment of potential confounding factors. Two-stage regression analysis, sometimes referred to as residual- or adjusted-outcome analysis, has been increasingly used in association studies of single nucleotide polymorphisms (SNPs) and quantitative traits. In this analysis, first, a residual-outcome is calculated from a regression of the outcome variable on covariates and then the relationship between the adjusted-outcome and the SNP is evaluated by a simple linear regression of the adjusted-outcome on the SNP. In this article, we examine the performance of this two-stage analysis as compared with multiple linear regression (MLR) analysis. Our findings show that when a SNP and a covariate are correlated, the two-stage approach results in biased genotypic effect and loss of power. Bias is always toward the null and increases with the squared-correlation between the SNP and the covariate (). For example, for , 0.1, and 0.5, two-stage analysis results in, respectively, 0, 10, and 50% attenuation in the SNP effect. As expected, MLR was always unbiased. Since individual SNPs often show little or no correlation with covariates, a two-stage analysis is expected to perform as well as MLR in many genetic studies; however, it produces considerably different results from MLR and may lead to incorrect conclusions when independent variables are highly correlated. While a useful alternative to MLR under , the two -stage approach has serious limitations. Its use as a simple substitute for MLR should be avoided. © 2011 Wiley Periodicals, Inc.

Artificial Neural Network System to Predict the Postoperative Outcome of Percutaneous Nephrolithotomy.

PubMed

Aminsharifi, Alireza; Irani, Dariush; Pooyesh, Shima; Parvin, Hamid; Dehghani, Sakineh; Yousofi, Khalilolah; Fazel, Ebrahim; Zibaie, Fatemeh

2017-05-01

To construct, train, and apply an artificial neural network (ANN) system for prediction of different outcome variables of percutaneous nephrolithotomy (PCNL). We calculated predictive accuracy, sensitivity, and precision for each outcome variable. During the study period, all adult patients who underwent PCNL at our institute were enrolled in the study. Preoperative and postoperative variables were recorded, and stone-free status was assessed perioperatively with computed tomography scans. MATLAB software was used to design and train the network in a feed forward back-propagation error adjustment scheme. Preoperative and postoperative data from 200 patients (training set) were used to analyze the effect and relative relevance of preoperative values on postoperative parameters. The validated adequately trained ANN was used to predict postoperative outcomes in the subsequent 254 adult patients (test set) whose preoperative values were serially fed into the system. To evaluate system accuracy in predicting each postoperative variable, predicted values were compared with actual outcomes. Two hundred fifty-four patients (155 [61%] males) were considered the test set. Mean stone burden was 6702.86 ± 381.6 mm 3 . Overall stone-free rate was 76.4%. Fifty-four out of 254 patients (21.3%) required ancillary procedures (shockwave lithotripsy 5.9%, transureteral lithotripsy 10.6%, and repeat PCNL 4.7%). The accuracy and sensitivity of the system in predicting different postoperative variables ranged from 81.0% to 98.2%. As a complex nonlinear mathematical model, our ANN system is an interconnected data mining tool, which prospectively analyzes and "learns" the relationships between variables. The accuracy and sensitivity of the system for predicting the stone-free rate, the need for blood transfusion, and post-PCNL ancillary procedures ranged from 81.0% to 98.2%.The stone burden and the stone morphometry were among the most significant preoperative characteristics that affected all postoperative outcome variables and they received the highest relative weight by the ANN system.

Testing Components of a Self-Management Theory in Adolescents With Type 1 Diabetes Mellitus.

PubMed

Verchota, Gwen; Sawin, Kathleen J

The role of self-management in adolescents with type 1 diabetes mellitus is not well understood. The purpose of the research was to examine the relationship of key individual and family self-management theory, context, and process variables on proximal (self-management behaviors) and distal (hemoglobin A1c and diabetes-specific health-related quality of life) outcomes in adolescents with type 1 diabetes. A correlational, cross-sectional study was conducted to identify factors contributing to outcomes in adolescents with Type 1 diabetes and examine potential relationships between context, process, and outcome variables delineated in individual and family self-management theory. Participants were 103 adolescent-parent dyads (adolescents ages 12-17) with Type 1 diabetes from a Midwest, outpatient, diabetes clinic. The dyads completed a self-report survey including instruments intended to measure context, process, and outcome variables from individual and family self-management theory. Using hierarchical multiple regression, context (depressive symptoms) and process (communication) variables explained 37% of the variance in self-management behaviors. Regimen complexity-the only significant predictor-explained 11% of the variance in hemoglobin A1c. Neither process variables nor self-management behaviors were significant. For the diabetes-specific health-related quality of life outcome, context (regimen complexity and depressive symptoms) explained 26% of the variance at step 1; an additional 9% of the variance was explained when process (self-efficacy and communication) variables were added at step 2; and 52% of the variance was explained when self-management behaviors were added at Step 3. In the final model, three variables were significant predictors: depressive symptoms, self-efficacy, and self-management behaviors. The individual and family self-management theory can serve as a cogent theory for understanding key concepts, processes, and outcomes essential to self-management in adolescents and families dealing with Type 1 diabetes mellitus.

The contribution of psychological factors to recovery after mild traumatic brain injury: is cluster analysis a useful approach?

PubMed

Snell, Deborah L; Surgenor, Lois J; Hay-Smith, E Jean C; Williman, Jonathan; Siegert, Richard J

2015-01-01

Outcomes after mild traumatic brain injury (MTBI) vary, with slow or incomplete recovery for a significant minority. This study examines whether groups of cases with shared psychological factors but with different injury outcomes could be identified using cluster analysis. This is a prospective observational study following 147 adults presenting to a hospital-based emergency department or concussion services in Christchurch, New Zealand. This study examined associations between baseline demographic, clinical, psychological variables (distress, injury beliefs and symptom burden) and outcome 6 months later. A two-step approach to cluster analysis was applied (Ward's method to identify clusters, K-means to refine results). Three meaningful clusters emerged (high-adapters, medium-adapters, low-adapters). Baseline cluster-group membership was significantly associated with outcomes over time. High-adapters appeared recovered by 6-weeks and medium-adapters revealed improvements by 6-months. The low-adapters continued to endorse many symptoms, negative recovery expectations and distress, being significantly at risk for poor outcome more than 6-months after injury (OR (good outcome) = 0.12; CI = 0.03-0.53; p < 0.01). Cluster analysis supported the notion that groups could be identified early post-injury based on psychological factors, with group membership associated with differing outcomes over time. Implications for clinical care providers regarding therapy targets and cases that may benefit from different intensities of intervention are discussed.

The developmental effects of HIV and alcohol: a comparison of gestational outcomes among babies from South African communities with high prevalence of HIV and alcohol use.

PubMed

Donald, Kirsten A M; Fernandez, Anne; Claborn, Kasey; Kuo, Caroline; Koen, Nastassja; Zar, Heather; Stein, Dan J

2017-05-08

There is growing evidence of the negative impact of alcohol on morbidity and mortality of individuals living with HIV but limited evidence of in utero effects of HIV and alcohol on exposure on infants. We conducted a population-based birth cohort study (N = 667 mother-infant dyads) in South Africa to investigate whether maternal alcohol use and HIV affected gestational outcomes. Descriptive data analysis was conducted for all variables using frequency distributions, measures of central tendency, and estimates of variance. Hierarchical multiple regression was conducted to determine whether maternal alcohol use, maternal HIV status and other risk factors (socioeconomic status, smoking, depression) predicted infant outcomes. Our results showed severity of recent alcohol use and lifetime alcohol use predicted low birth weight. Similarly lifetime alcohol use predicted shorter infant length, smaller head length, smaller head circumference, and early gestational age. However, HIV status was not a significant predictor of gestational outcomes. The unexpected finding that maternal HIV status did not predict any of the gestational outcomes may be due to high rates of ART usage among HIV-infected mothers. The potentially negative effects of HIV on gestational outcomes may have been attenuated by improved maternal health due to high coverage of antiretroviral treatment in South Africa. Interventions are needed to reduce alcohol consumption among pregnant mothers and to support healthy growth and psychosocial development of infants.

Verbal short-term memory development and spoken language outcomes in deaf children with cochlear implants.

PubMed

Harris, Michael S; Kronenberger, William G; Gao, Sujuan; Hoen, Helena M; Miyamoto, Richard T; Pisoni, David B

2013-01-01

Cochlear implants (CIs) help many deaf children achieve near-normal speech and language (S/L) milestones. Nevertheless, high levels of unexplained variability in S/L outcomes are limiting factors in improving the effectiveness of CIs in deaf children. The objective of this study was to longitudinally assess the role of verbal short-term memory (STM) and working memory (WM) capacity as a progress-limiting source of variability in S/L outcomes after CI in children. Longitudinal study of 66 children with CIs for prelingual severe-to-profound hearing loss. Outcome measures included performance on digit span forward (DSF), digit span backward (DSB), and four conventional S/L measures that examined spoken-word recognition (Phonetically Balanced Kindergarten word test), receptive vocabulary (Peabody Picture Vocabulary Test ), sentence-recognition skills (Hearing in Noise Test), and receptive and expressive language functioning (Clinical Evaluation of Language Fundamentals Fourth Edition Core Language Score; CELF). Growth curves for DSF and DSB in the CI sample over time were comparable in slope, but consistently lagged in magnitude relative to norms for normal-hearing peers of the same age. For DSF and DSB, 50.5% and 44.0%, respectively, of the CI sample scored more than 1 SD below the normative mean for raw scores across all ages. The first (baseline) DSF score significantly predicted all endpoint scores for the four S/L measures, and DSF slope (growth) over time predicted CELF scores. DSF baseline and slope accounted for an additional 13 to 31% of variance in S/L scores after controlling for conventional predictor variables such as: chronological age at time of testing, age at time of implantation, communication mode (auditory-oral communication versus total communication), and maternal education. Only DSB baseline scores predicted endpoint language scores on Peabody Picture Vocabulary Test and CELF. DSB slopes were not significantly related to any endpoint S/L measures. DSB baseline scores and slopes taken together accounted for an additional 4 to 19% of variance in S/L endpoint measures after controlling for the conventional predictor variables. Verbal STM/WM scores, process measures of information capacity, develop at an average rate in the years after cochlear implantation, but were found to consistently lag in absolute magnitude behind those reported for normal-hearing peers. Baseline verbal STM/WM predicted long-term endpoint S/L outcomes, but verbal STM slopes predicted only endpoint language outcomes. Verbal STM/WM processing skills reflect important underlying core elementary neurocognitive functions and represent potential intervention targets for improving endpoint S/L outcomes in pediatric CI users.

Clinical outcomes and frontal plane two-dimensional biomechanics during the 30-second single leg stance test in patients before and after hip abductor tendon reconstructive surgery.

PubMed

Huxtable, Rose E; Ackland, Timothy R; Janes, Gregory C; Ebert, Jay R

2017-07-01

Hip abductor tendon tears are a common cause of Greater Trochanteric Pain Syndrome. Conservative treatments are often ineffective and surgical reconstruction may be recommended. This study investigated the improvement in clinical outcomes and frontal plane two-dimensional biomechanics during a 30-second single leg stance test, in patients undergoing reconstruction. We hypothesized that clinical scores and pertinent biomechanical variables would significantly improve post-surgery, and these outcomes would be significantly correlated. Twenty-one patients with symptomatic tendon tears underwent reconstruction. Patients were evaluated pre-surgery, and at 6 and 12months post-surgery, using patient-reported outcome measures, assessment of hip abductor strength and six-minute walk capacity. Frontal plane, two-dimensional, biomechanical variables including pelvis-on-femur angle, pelvic drop, trunk lean and lateral pelvic shift, were evaluated throughout a 30-second single leg stance test. ANOVA evaluated outcomes over time, while Pearson's correlations investigated associations between clinical scores, pain, functional and biomechanical outcome variables. While clinical and functional measures significantly improved (P<0.05) over time, no significant group differences (P>0.05) were observed in biomechanical variables from pre- to post-surgery. While five patients displayed a positive Trendelenburg sign pre-surgery, only one was positive post-surgery. Clinical outcomes and biomechanical variables during the single leg stance test were not correlated. Despite improvements in clinical and functional measures over time, biomechanical changes during a weight bearing single leg stance test were not significantly different following tendon repair. Follow up beyond 12months may be required, whereby symptomatic relief may precede functional and biomechanical improvement. Copyright © 2017 Elsevier Ltd. All rights reserved.

Web-based questionnaires to assess perinatal outcome proved to be valid.

PubMed

van Gelder, Marleen M H J; Vorstenbosch, Saskia; Derks, Lineke; Te Winkel, Bernke; van Puijenbroek, Eugène P; Roeleveld, Nel

2017-10-01

The objective of this study was to validate a Web-based questionnaire completed by the mother to assess perinatal outcome used in a prospective cohort study. For 882 women with an estimated date of delivery between February 2012 and February 2015 who participated in the PRegnancy and Infant DEvelopment (PRIDE) Study, we compared data on pregnancy outcome, including mode of delivery, plurality, gestational age, birth weight and length, head circumference, birth defects, and infant sex, from Web-based questionnaires administered to the mothers 2 months after delivery with data from obstetric records. For continuous variables, we calculated intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs), whereas sensitivity and specificity were determined for categorical variables. We observed only very small differences between the two methods of data collection for gestational age (ICC, 0.91; 95% CI, 0.90-0.92), birth weight (ICC, 0.96; 95% CI, 0.95-0.96), birth length (ICC, 0.90; 95% CI, 0.87-0.92), and head circumference (ICC, 0.88; 95% CI, 0.80-0.93). Agreement between the Web-based questionnaire and obstetric records was high as well, with sensitivity ranging between 0.86 (termination of pregnancy) and 1.00 (four outcomes) and specificity between 0.96 (term birth) and 1.00 (nine outcomes). Our study provides evidence that Web-based questionnaires could be considered as a valid complementary or alternative method of data collection. Copyright © 2017 Elsevier Inc. All rights reserved.

Physiology, intervention, and outcome: three critical questions about cerebral tissue oxygen saturation monitoring.

PubMed

Meng, Lingzhong; Gruenbaum, Shaun E; Dai, Feng; Wang, Tianlong

2018-05-01

The balance between cerebral tissue oxygen consumption and supply can be continuously assessed by cerebral tissue oxygen saturation (SctO2) monitor. A construct consisting of three sequential questions, targeting the physiology monitored, the intervention implemented, and the outcomes affected, is proposed to critically appraise this monitor. The impact of the SctO2-guided care on patient outcome was examined through a systematic literature search and meta-analysis. We concluded that the physiology monitored by SctO2 is robust and dynamic, fragile (prone to derangement), and adversely consequential when deranged. The inter-individual variability of SctO2 measurement advocates for an intervention threshold based on a relative, not absolute, change. The intra-individual variability has multiple determinants which is the foundation of intervention. A variety of therapeutic options are available; however, none are 100% efficacious in treating cerebral dys-oxygenation. The therapeutic efficacy likely depends on both an appropriate differential diagnosis and the functional status of the regulatory mechanisms of cerebral blood flow. Meta-analysis based on five randomized controlled trials suggested a reduced incidence of early postoperative cognitive decline after major surgeries (RR= 0.53; 95% CI: 0.33-0.87; I2 =82%; P=0.01). However, its effects on other neurocognitive outcomes remain unclear. These results need to be interpreted with caution due to the high risks of bias. Quality RCTs based on improved intervention protocols and standardized outcome assessment are warranted in the future.

Protocols and Hospital Mortality in Critically Ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study.

PubMed

Sevransky, Jonathan E; Checkley, William; Herrera, Phabiola; Pickering, Brian W; Barr, Juliana; Brown, Samuel M; Chang, Steven Y; Chong, David; Kaufman, David; Fremont, Richard D; Girard, Timothy D; Hoag, Jeffrey; Johnson, Steven B; Kerlin, Mehta P; Liebler, Janice; O'Brien, James; O'Keefe, Terence; Park, Pauline K; Pastores, Stephen M; Patil, Namrata; Pietropaoli, Anthony P; Putman, Maryann; Rice, Todd W; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Martin, Greg S

2015-10-01

Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized ICUs have superior patient outcomes compared with less highly protocolized ICUs. Observational study in which participating ICUs completed a general assessment and enrolled new patients 1 day each week. A total of 6,179 critically ill patients. Fifty-nine ICUs in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study. None. The primary exposure was the number of ICU protocols; the primary outcome was hospital mortality. A total of 5,809 participants were followed prospectively, and 5,454 patients in 57 ICUs had complete outcome data. The median number of protocols per ICU was 19 (interquartile range, 15-21.5). In single-variable analyses, there were no differences in ICU and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in ICUs with a high versus low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p = 0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between ICUs with high versus low numbers of protocols for lung protective ventilation in acute respiratory distress syndrome (47% vs 52%; p = 0.28) and for spontaneous breathing trials (55% vs 51%; p = 0.27). Clinical protocols are highly prevalent in U.S. ICUs. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality.

Emergency Preparedness Safety Climate and Other Factors Associated With Mental Health Outcomes Among World Trade Center Disaster Evacuees.

PubMed

Sherman, Martin F; Gershon, Robyn R; Riley, Halley E M; Zhi, Qi; Magda, Lori A; Peyrot, Mark

2017-06-01

We examined psychological outcomes in a sample of participants who evacuated from the World Trade Center towers on September 11, 2011. This study aimed to identify risk factors for psychological injury that might be amenable to change, thereby reducing adverse impacts associated with emergency high-rise evacuation. We used data from a cross-sectional survey conducted 2 years after the attacks to classify 789 evacuees into 3 self-reported psychological outcome categories: long-term psychological disorder diagnosed by a physician, short-term psychological disorder and/or memory problems, and no known psychological disorder. After nonmodifiable risk factors were controlled for, diagnosed psychological disorder was more likely for evacuees who reported lower "emergency preparedness safety climate" scores, more evacuation challenges (during exit from the towers), and evacuation-related physical injuries. Other variables associated with increased risk of psychological disorder outcome included gender (female), lower levels of education, preexisting physical disability, preexisting psychological disorder, greater distance to final exit, and more information sources during egress. Improving the "emergency preparedness safety climate" of high-rise business occupancies and reducing the number of egress challenges are potential strategies for reducing the risk of adverse psychological outcomes of high-rise evacuations. Focused safety training for individuals with physical disabilities is also warranted. (Disaster Med Public Health Preparedness. 2017;11:326-336).

Dynamic Latent Trait Models with Mixed Hidden Markov Structure for Mixed Longitudinal Outcomes.

PubMed

Zhang, Yue; Berhane, Kiros

2016-01-01

We propose a general Bayesian joint modeling approach to model mixed longitudinal outcomes from the exponential family for taking into account any differential misclassification that may exist among categorical outcomes. Under this framework, outcomes observed without measurement error are related to latent trait variables through generalized linear mixed effect models. The misclassified outcomes are related to the latent class variables, which represent unobserved real states, using mixed hidden Markov models (MHMM). In addition to enabling the estimation of parameters in prevalence, transition and misclassification probabilities, MHMMs capture cluster level heterogeneity. A transition modeling structure allows the latent trait and latent class variables to depend on observed predictors at the same time period and also on latent trait and latent class variables at previous time periods for each individual. Simulation studies are conducted to make comparisons with traditional models in order to illustrate the gains from the proposed approach. The new approach is applied to data from the Southern California Children Health Study (CHS) to jointly model questionnaire based asthma state and multiple lung function measurements in order to gain better insight about the underlying biological mechanism that governs the inter-relationship between asthma state and lung function development.

Water Polo Game-Related Statistics in Women’s International Championships: Differences and Discriminatory Power

PubMed Central

Escalante, Yolanda; Saavedra, Jose M.; Tella, Victor; Mansilla, Mirella; García-Hermoso, Antonio; Dominguez, Ana M.

2012-01-01

The aims of this study were (i) to compare women’s water polo game-related statistics by match outcome (winning and losing teams) and phase (preliminary, classificatory, and semi-final/bronze medal/gold medal), and (ii) identify characteristics that discriminate performances for each phase. The game-related statistics of the 124 women’s matches played in five International Championships (World and European Championships) were analyzed. Differences between winning and losing teams in each phase were determined using the chi-squared. A discriminant analysis was then performed according to context in each of the three phases. It was found that the game-related statistics differentiate the winning from the losing teams in each phase of an international championship. The differentiating variables were both offensive (centre goals, power-play goals, counterattack goal, assists, offensive fouls, steals, blocked shots, and won sprints) and defensive (goalkeeper-blocked shots, goalkeeper-blocked inferiority shots, and goalkeeper-blocked 5-m shots). The discriminant analysis showed the game-related statistics to discriminate performance in all phases: preliminary, classificatory, and final phases (92%, 90%, and 83%, respectively). Two variables were discriminatory by match outcome (winning or losing teams) in all three phases: goals and goalkeeper-blocked shots. Key pointsThe preliminary phase that more than one variable was involved in this differentiation, including both offensive and defensive aspects of the game.The game-related statistics were found to have a high discriminatory power in predicting the result of matches with shots and goalkeeper-blocked shots being discriminatory variables in all three phases.Knowledge of the characteristics of women’s water polo game-related statistics of the winning teams and their power to predict match outcomes will allow coaches to take these characteristics into account when planning training and match preparation. PMID:24149356

Viability and invasive potential of hybrids between yellow toadflax (Linaria vulgaris) and Dalmatian toadflax (Linaria dalmatica)

Treesearch

Marie F. S. Turner

2012-01-01

Although outcomes of hybridization are highly variable, it is now considered to play an important role in evolution, speciation, and invasion. Hybridization has recently been confirmed between populations of yellow (or common) toadflax (Linaria vulgaris) and Dalmatian toadflax (Linaria dalmatica) in the Rocky Mountain region of the United States. The presence of hybrid...

Mental and Social Health Impacts the Use of Protective Behavioral Strategies in Reducing Risky Drinking and Alcohol Consequences

ERIC Educational Resources Information Center

LaBrie, Joseph W.; Kenney, Shannon R.; Lac, Andrew; Garcia, Jonathan A.; Ferraiolo, Paul

2009-01-01

The present study is the first to examine the moderating effects of mental and social health status in the relationship between protective behavioral strategies utilized to reduce high-risk drinking (e.g., alternating alcoholic and nonalcoholic drinks or avoiding drinking games) and alcohol outcomes (drinking variables and alcohol-related negative…

Project SUCCESS' Effects on Substance Use-Related Attitudes and Behaviors: A Randomized Controlled Trial in Alternative High Schools

ERIC Educational Resources Information Center

Clark, Heddy Kovach; Ringwalt, Chris L.; Shamblen, Stephen R.; Hanley, Sean M.

2011-01-01

Using a randomized controlled effectiveness trial, we examined the effects of Project SUCCESS on a range of secondary outcomes, including the program's mediating variables. Project SUCCESS, which is based both on the Theory of Reasoned Action and on Cognitive Behavior Theory, is a school-based substance use prevention program that targets…

Outcome of Endodontically Treated Teeth Diagnosed With Cracked Tooth

DTIC Science & Technology

2015-06-01

However, variable symptoms complicate the diagnosis (9). In a study of 32 patients presenting with diffuse longstanding orofacial pain eventually...883-92. 22)Byrnjulsen A, Fristad I, Grevstad T, Hals-Kvinnsland I. Incompletely fractured teeth associated with diffuse longstanding orofacial pain ...cracked tooth is highly associated with discomfort. Patients often describe a momentary, sudden, sharp, lancinating pain that results in continuous tooth

Measuring Networking as an Outcome Variable in Undergraduate Research Experiences

PubMed Central

Hanauer, David I.; Hatfull, Graham

2015-01-01

The aim of this paper is to propose, present, and validate a simple survey instrument to measure student conversational networking. The tool consists of five items that cover personal and professional social networks, and its basic principle is the self-reporting of degrees of conversation, with a range of specific discussion partners. The networking instrument was validated in three studies. The basic psychometric characteristics of the scales were established by conducting a factor analysis and evaluating internal consistency using Cronbach’s alpha. The second study used a known-groups comparison and involved comparing outcomes for networking scales between two different undergraduate laboratory courses (one involving a specific effort to enhance networking). The final study looked at potential relationships between specific networking items and the established psychosocial variable of project ownership through a series of binary logistic regressions. Overall, the data from the three studies indicate that the networking scales have high internal consistency (α = 0.88), consist of a unitary dimension, can significantly differentiate between research experiences with low and high networking designs, and are related to project ownership scales. The ramifications of the networking instrument for student retention, the enhancement of public scientific literacy, and the differentiation of laboratory courses are discussed. PMID:26538387

Implicit Theories, Expectancies, and Values Predict Mathematics Motivation and Behavior across High School and College.

PubMed

Priess-Groben, Heather A; Hyde, Janet Shibley

2017-06-01

Mathematics motivation declines for many adolescents, which limits future educational and career options. The present study sought to identify predictors of this decline by examining whether implicit theories assessed in ninth grade (incremental/entity) predicted course-taking behaviors and utility value in college. The study integrated implicit theory with variables from expectancy-value theory to examine potential moderators and mediators of the association of implicit theories with college mathematics outcomes. Implicit theories and expectancy-value variables were assessed in 165 American high school students (47 % female; 92 % White), who were then followed into their college years, at which time mathematics courses taken, course-taking intentions, and utility value were assessed. Implicit theories predicted course-taking intentions and utility value, but only self-concept of ability predicted courses taken, course-taking intentions, and utility value after controlling for prior mathematics achievement and baseline values. Expectancy for success in mathematics mediated associations between self-concept of ability and college outcomes. This research identifies self-concept of ability as a stronger predictor than implicit theories of mathematics motivation and behavior across several years: math self-concept is critical to sustained engagement in mathematics.

Chimeric Antigen Receptor T-Cells (CAR T-Cells) for Cancer Immunotherapy - Moving Target for Industry?

PubMed

Salmikangas, Paula; Kinsella, Niamh; Chamberlain, Paul

2018-05-31

The first CD19 CAR T-cell products, Kymriah and Yescarta, are entering the US market and also being evaluated for marketing authorization in the EU. This breakthrough has expanded the interest and also investments towards novel chimeric antigen receptor (CAR) designs, both for hematological malignancies and solid tumors. At the same time, there is active development in moving from autologous products to allogeneic, off-the-shelf -products. New manufacturing technologies are also emerging for production of these complex genetically-modified cells and even decentralized manufacturing in hospitals is under consideration. However, the high potency of CAR T-cells is associated with toxicity and not all patients respond to the treatment. In addition, the number of patient and product variables impacting the clinical outcome is high. The race towards novel CAR T treatment options for cancer patients has begun, but without careful design of the constructs and overall understanding of the factors that impact the ultimate outcome in each case, the road towards commercial success may be long and winding. This review discusses the product- and patient-related variables that may pose challenges for the industry and developers both from the scientific and regulatory perspective.

Comparison of outcomes and other variables between conference abstracts and subsequent peer-reviewed papers involving pre-harvest or abattoir-level interventions against foodborne pathogens.

PubMed

Snedeker, Kate G; Campbell, Mollie; Totton, Sarah C; Guthrie, Alessia; Sargeant, Jan M

2010-11-01

Accuracy in the reporting of studies in conference abstracts is important because the majority of studies in such abstracts are never further detailed in peer-reviewed publications, and data from such abstracts may be used in systematic reviews. Previous research on interventional studies in human biomedicine indicates that there is no guarantee of consistency between a conference abstract and paper in the reporting of results and other key variables. However, no research has been done to determine if this lack of reporting consistency in abstracts and papers extends to interventional studies in pre-harvest/harvest-level food safety. The goal of this study was to compare outcome results and other key variables between conference abstracts and subsequent peer-reviewed publications describing studies of pre-harvest and abattoir-level interventions against foodborne pathogens, and to determine whether the agreement in the results or key variables was associated with the time to full publication. A systematic search identified 59 conference abstracts with matching peer-reviewed papers (matches), and data on variables including outcome measures and results, pathogens, species, interventions, overall efficacy of intervention, sample size and housing were extracted from both the conference abstracts and the papers. The matching of variables between abstracts and papers was described, and logistic regression used to test for associations between variable matching and time to publication. Sample size was only provided for both abstract and paper in 24 matches; the same sample size was reported in 20 of these matches. Most other variables were reported in the majority of abstracts/papers, and with the exception of outcomes and intervention effect, the reporting of variables was relatively consistent. There was no significant difference in the numbers of authors, with the first author the same in 78.3% of matches. Of 231 outcome measures reported in both abstracts and papers, nearly one third (77% or 32.2%) had different results, with 32 changing direction of effect. More than a quarter of matches involved at least one significant change in outcome result. The overall conclusion on the efficacy of the intervention changed in 10.7% of matches. There was a significant association between increased time to publication and differences in the number of authors, and having fewer outcome measures in the abstract reported in the paper. These results suggest that data from conference abstracts should be considered with caution. Copyright © 2010 Elsevier B.V. All rights reserved.

Linguistic Input, Electronic Media, and Communication Outcomes of Toddlers with Hearing Loss

PubMed Central

Ambrose, Sophie E.; VanDam, Mark; Moeller, Mary Pat

2013-01-01

Objectives The objectives of this study were to examine the quantity of adult words, adult-child conversational turns, and electronic media in the auditory environments of toddlers who are hard of hearing (HH) and to examine whether these variables contributed to variability in children’s communication outcomes. Design Participants were 28 children with mild to severe hearing loss. Full-day recordings of children’s auditory environments were collected within 6 months of their 2nd birthdays by utilizing LENA (Language ENvironment Analysis) technology. The system analyzes full-day acoustic recordings, yielding estimates of the quantity of adult words, conversational turns, and electronic media exposure in the recordings. Children’s communication outcomes were assessed via the receptive and expressive scales of the Mullen Scales of Early Learning at 2 years of age and the Comprehensive Assessment of Spoken Language at 3 years of age. Results On average, the HH toddlers were exposed to approximately 1400 adult words per hour and participated in approximately 60 conversational turns per hour. An average of 8% of each recording was classified as electronic media. However, there was considerable within-group variability on all three measures. Frequency of conversational turns, but not adult words, was positively associated with children’s communication outcomes at 2 and 3 years of age. Amount of electronic media exposure was negatively associated with 2-year-old receptive language abilities; however, regression results indicate that the relationship was fully mediated by the quantity of conversational turns. Conclusions HH toddlers who were engaged in more conversational turns demonstrated stronger linguistic outcomes than HH toddlers who were engaged in fewer conversational turns. The frequency of these interactions was found to be decreased in households with high rates of electronic media exposure. Optimal language-learning environments for HH toddlers include frequent linguistic interactions between parents and children. To support this goal, parents should be encouraged to reduce their children’s exposure to electronic media. PMID:24441740

Motor abundance and control structure in the golf swing.

PubMed

Morrison, A; McGrath, D; Wallace, E S

2016-04-01

Variability and control structure are under-represented areas of golf swing research. This study investigated the use of the abundant degrees of freedom in the golf swing of high and intermediate skilled golfers using uncontrolled manifold (UCM) analysis. The variance parallel to (VUCM) and orthogonal to (VOrth) the UCM with respect to the orientation and location of the clubhead were calculated. The higher skilled golfers had proportionally higher values of VUCM than lower skilled players for all measured outcome variables. Motor synergy was found in the control of the orientation of the clubhead and the combined outcome variables but not for clubhead location. Clubhead location variance zeroed-in on impact as has been previously shown, whereas clubhead orientation variance increased near impact. Both skill levels increased their control over the clubhead location leading up to impact, with more control exerted over the clubhead orientation in the early downswing. The results suggest that to achieve higher skill levels in golf may not lie simply in optimal technique, but may lie more in developing control over the abundant degrees of freedom in the body. Copyright © 2016 Elsevier B.V. All rights reserved.

BIOCHEMICAL HOMEOSTASIS AND BODY GROWTH ARE RELIABLE END POINTS IN CLINICAL NUTRITION TRIALS

USDA-ARS?s Scientific Manuscript database

Studies of biochemical homeostasis and/or body growth have been included as outcome variables in most nutrition trials in paediatric patients. Moreover, these outcome variables have provided important insights into the nutrient requirements of infants and children, and continue to do so. Examples ...

Sample Size Limits for Estimating Upper Level Mediation Models Using Multilevel SEM

ERIC Educational Resources Information Center

Li, Xin; Beretvas, S. Natasha

2013-01-01

This simulation study investigated use of the multilevel structural equation model (MLSEM) for handling measurement error in both mediator and outcome variables ("M" and "Y") in an upper level multilevel mediation model. Mediation and outcome variable indicators were generated with measurement error. Parameter and standard…

Family, Community, and Educational Outcomes in South Asia

ERIC Educational Resources Information Center

Chudgar, Amita; Shafiq, M. Najeeb

2010-01-01

In this article, we review research on the economics and sociology of education to assess the relationships between family and community variables and children's educational outcomes in South Asia. At the family level, we examine the variables of family socioeconomic status (SES), parental education, family structure, and religion and caste. At…

Culture-Specific Variables That May Affect Employment Outcomes for Mexican-American Youth with Disabilities.

ERIC Educational Resources Information Center

Meier-Kronick, Nancy

This paper reviews variables specific to the Mexican-American culture that might influence work-related behavior and outcomes for youths with disabilities from this population. Areas covered include: parental/family network; cultural view of disability; religious influences; acculturation levels; language issues; education and employment…

How Important Are Health Care Expenditures for Life Expectancy? A Comparative, European Analysis.

PubMed

van den Heuvel, Wim J A; Olaroiu, Marinela

2017-03-01

The relationship between health care expenditures and health care outcomes, such as life expectancy and mortality, is complex. Research outcomes show different and contradictory results on this relationship. How and why health care expenditures affect health outcomes is not clear. A causal link between the two is not proven. Without such knowledge, effects of increase/decrease in health care expenses on health outcomes may be overestimated/underestimated. This study analyzes the relationship between life expectancy at birth and expenditures on health care, taking into account expenditures of social production and education, as well as the quantity and quality of health care provisions and lifestyles. This is a cross-sectional study, analyzing national data of 31 European countries. First, the bivariate correlation between the dependent variable and independent variables are calculated and described. Next a forward linear regression analysis is applied. The data are derived from standardized, comparative data bases as available in the Organisation for Economic Co-operation and Development and Eurostat. Health care expenditures are assessed as a percentage of the Gross Domestic Product (GDP). Health care expenditures are not the main determinant of life expectancy at birth, but social protection expenditures are. The regression analysis shows that in countries that spend a high percentage of their GDP on social protection, that have fewer curative beds and low infant mortality, whose citizens report fewer unmet health care needs and drink less alcohol, citizens have a significant longer life expectancy. To realize high life expectancy of citizens, policy measures have to be directed on investment in social protection expenditures, on improving quality of care, and on promoting a healthy life style. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Heart rate variability is a predictor of mortality in chronic kidney disease: a report from the CRIC Study.

PubMed

Drawz, Paul E; Babineau, Denise C; Brecklin, Carolyn; He, Jiang; Kallem, Radhakrishna R; Soliman, Elsayed Z; Xie, Dawei; Appleby, Dina; Anderson, Amanda H; Rahman, Mahboob

2013-01-01

Low heart rate variability (HRV) is a risk factor for adverse outcomes in the general population. We aimed to determine the factors associated with HRV and evaluate the association between low HRV and clinical outcomes in patients with chronic kidney disease (CKD). A 10-second electrocardiogram was obtained at baseline in the Chronic Renal Insufficiency Cohort (CRIC) Study. HRV was measured by the standard deviation of all R-R intervals (SDNN) and the root mean square of successive differences between R-R intervals (RMSSD). In 3,245 CRIC participants with available baseline SDNN and RMSSD, lower HRV was associated with older age, lack of exercise, heart failure, elevated phosphorus and hemoglobin A1c, and low estimated glomerular filtration rate. After a median follow-up of 4.2 years, in fully adjusted models, lower HRV was not associated with renal [SDNN: hazard rate, HR = 0.96 (95% confidence interval, CI 0.88-1.05); RMSSD: HR = 0.97 (95% CI 0.88-1.07)] or cardiovascular outcomes [SDNN: HR = 1.02 (95% CI 0.92-1.13); RMSSD: HR = 1.00 (95% CI 0.90-1.10)]. There was a nonlinear relationship between RMSSD and all-cause mortality with increased risk with both low and high RMSSD (p = 0.04). In a large cohort of patients with CKD, multiple risk factors for renal and cardiovascular diseases were associated with lower HRV. Lower HRV was not associated with increased risk for renal or cardiovascular outcomes, but both low and high RMSSD were associated with increased risk for all-cause mortality. In conclusion, HRV measured by RMSSD may be a novel and independent risk factor for mortality in CKD patients. © 2013 S. Karger AG, Basel.

Variable effects of high-dose adrenaline relative to standard-dose adrenaline on resuscitation outcomes according to cardiac arrest duration.

PubMed

Jeung, Kyung Woon; Ryu, Hyun Ho; Song, Kyung Hwan; Lee, Byung Kook; Lee, Hyoung Youn; Heo, Tag; Min, Yong Il

2011-07-01

Adjustment of adrenaline (epinephrine) dosage according to cardiac arrest (CA) duration, rather than administering the same dose, may theoretically improve resuscitation outcomes. We evaluated variable effects of high-dose adrenaline (HDA) relative to standard-dose adrenaline (SDA) on resuscitation outcomes according to CA duration. Twenty-eight male domestic pigs were randomised to the following 4 groups according to the dosage of adrenaline (SDA 0.02 mg/kg vs. HDA 0.2mg/kg) and duration of CA before beginning cardiopulmonary resuscitation (CPR): 6 min SDA, 6 min HDA, 13 min SDA, or 13 min HDA. After the predetermined duration of untreated ventricular fibrillation, CPR was provided. All animals in the 6 min SDA, 6 min HDA, and 13 min HDA groups were successfully resuscitated, while only 4 of 7 pigs in the 13 min SDA group were successfully resuscitated (p=0.043). HDA groups showed higher right atrial pressure, more frequent ventricular ectopic beats, higher blood glucose, higher troponin-I, and more severe metabolic acidosis than SDA groups. Animals of 13 min groups showed more severe metabolic acidosis and higher troponin-I than animals of 6 min groups. All successfully resuscitated animals, except two animals in the 13 min HDA group, survived for 7 days (p=0.121). Neurologic deficit score was not affected by the dose of adrenaline. HDA showed benefit in achieving restoration of spontaneous circulation in 13 min CA, when compared with 6 min CA. However, this benefit did not translate into improved long-term survival or neurologic outcome. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Outcome of transarterial treatment of dural arteriovenous fistulas with direct or indirect cortical venous drainage.

PubMed

Mantilla, Daniel; Le Corre, Marine; Cagnazzo, Federico; Gascou, Gregory; Eker, Omer; Machi, Paolo; Riquelme, Carlos; Dargazanli, Cyril; Costalat, Vincent; Bonafe, Alain; Lefevre, Pierre-Henri

2018-01-30

Transarterial Onyx embolization is an effective treatment for patients with intracranial dural arteriovenous fistula (DAVF). A study was performed to determine whether the clinical and radiological outcomes after transarterial Onyx treatment were affected by the type of cortical venous drainage (direct vs indirect) of high-grade DAVF. Between May 2006 and December 2014, demographic data, clinical presentation, angiographic characteristics, and treatment-related outcomes were collected for 54 patients divided into two groups (intracranial DAVF with direct and indirect cortical venous drainage). Continuous variables were compared with the two-tailed t test and categorical variables with the χ 2 test. Statistical significance was set at P<0.05. Fifty-two patients (71% with direct and 29% with indirect cortical venous drainage) underwent Onyx embolization. Immediate complete occlusion after treatment was observed in about 55% of patients without between-group difference. During the long-term follow-up, complete angiographic occlusion was achieved in 83% of patients. Specifically, 15 additional patients (40%) in the direct cortical venous drainage group progressed to complete occlusion, but only one (6%) in the indirect cortical venous drainage group. Overall, the rate of complete occlusion was higher in patients with DAVF with direct cortical venous drainage (92%) than in those with DAVF with indirect cortical venous drainage (62.5%) (P=0.01). The rate of permanent treatment-related complications was 4%, mostly related to ischemic events. Overall, 80.5% of patients had a good neurological outcome (modified Rankin Scale score 0-2). Transarterial Onyx embolization of intracranial high-grade DAVF is safe and effective, particularly for lesions with direct cortical venous drainage. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The mediating role of avoidance coping between intimate partner violence (IPV) victimization, mental health, and substance abuse among women experiencing bidirectional IPV.

PubMed

Flanagan, Julianne C; Jaquier, Véronique; Overstreet, Nicole; Swan, Suzanne C; Sullivan, Tami P

2014-12-15

Avoidance coping is consistently linked with negative mental health outcomes among women experiencing intimate partner violence (IPV). This study extended the literature examining the potentially mediating role of avoidance coping strategies on both mental health and substance use problems to a highly generalizable, yet previously unexamined population (i.e., women experiencing bidirectional IPV) and examined multiple forms of IPV (i.e., psychological, physical, and sexual) simultaneously. Among a sample of 362 women experiencing bidirectional IPV, four separate path models were examined, one for each outcome variable. Avoidance coping mediated the relationships between psychological and sexual IPV victimization and the outcomes of PTSD symptom severity, depression severity, and drug use problems. Findings indicate nuanced associations among IPV victimization, avoidance coping, and mental health and substance use outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

A longitudinal comparison of consumer-directed and agency-directed personal assistance service programmes among persons with physical disabilities.

PubMed

Clark, Mary J; Hagglund, Kristofer J; Sherman, Ashley K

2008-01-01

To compare outcomes for persons who were enrolled in an agency-directed personal assistance services (PAS) programme and then changed to a consumer-directed PAS programme. A convenience sample was used for this longitudinal study. In-home interviews were conducted by a trained data collector from April 2000 to December 2001. Participants reported more satisfaction and safety with personal assistance, and fewer unmet needs after receiving consumer-directed services than after receiving agency-directed services. Other variables related to outcomes included race and ethnicity, employment, functional status, unmet needs, and the level of confidence in obtaining help if assistance is unavailable. Participants (74%) also reported high rates of unmet needs in the past month. Consumer-directed PAS enhances outcomes for many persons with disabilities. Self-reported outcomes are affected by many factors that could be addressed in PAS program development.

Reference-dependent risk sensitivity as rational inference.

PubMed

Denrell, Jerker C

2015-07-01

Existing explanations of reference-dependent risk sensitivity attribute it to cognitive imperfections and heuristic choice processes. This article shows that behavior consistent with an S-shaped value function could be an implication of rational inferences about the expected values of alternatives. Theoretically, I demonstrate that even a risk-neutral Bayesian decision maker, who is uncertain about the reliability of observations, should use variability in observed outcomes as a predictor of low expected value for outcomes above a reference level, and as a predictor of high expected value for outcomes below a reference level. Empirically, I show that combining past outcomes using an S-shaped value function leads to accurate predictions about future values. The theory also offers a rationale for why risk sensitivity consistent with an inverse S-shaped value function should occur in experiments on decisions from experience with binary payoff distributions. (c) 2015 APA, all rights reserved).

The influence of the built environment on adverse birth outcomes.

PubMed

Woods, N; Gilliland, J; Seabrook, J A

2017-01-01

Adverse birth outcomes are associated with neonatal morbidity and mortality, and higher risk for coronary heart disease, non-insulin-dependent diabetes and hypertension in adulthood. Although there has been considerable research investigating the association between maternal and environmental factors on adverse birth outcomes, one risk factor, not fully understood, is the influence of the built environment. A search of MEDLINE, Scopus, and Cochrane was conducted to find articles assessing the influence of the built environment on preterm birth (PTB), low birth weight (LBW), and small-for-gestational-age (SGA). In total, 41 studies met our inclusion criteria, and were organized into nine categories: Roadways, Greenness, Power Plants, Gas Stations/Wells, Waste Management, Power Lines, Neighborhood Conditions, Food Environment, and Industry. The most common built environmental variable was roads/traffic, encompassing 17/41 (41%) of the articles reviewed, of which 12/17 (71%) found a significant small to moderate association between high traffic exposure and adverse birth outcomes.

Controlled assessment of the efficacy of occlusal stabilization splints on sleep bruxism.

PubMed

van der Zaag, Jacques; Lobbezoo, Frank; Wicks, Darrel J; Visscher, Corine M; Hamburger, Hans L; Naeije, Machiel

2005-01-01

To assess the efficacy of occlusal stabilization splints in the management of sleep bruxism (SB) in a double-blind, parallel, controlled, randomized clinical trial. Twenty-one participants were randomly assigned to an occlusal splint group (n = 11; mean age = 34.2 +/- 13.1 years) or a palatal splint (ie, an acrylic palatal coverage) group (n = 10; mean age = 34.9 +/- 11.2 years). Two polysomnographic recordings that included bilateral masseter electromyographic activity were made: one prior to treatment, the other after a treatment period of 4 weeks. The number of bruxism episodes per hour of sleep (Epi/h), the number of bursts per hour (Bur/h), and the bruxism time index (ie, the percentage of total sleep time spent bruxing) were established as outcome variables at a 10% maximum voluntary contraction threshold level. A general linear model was used to test both the effects between splint groups and within the treatment phase as well as their interaction for each outcome variable. Neither occlusal stabilization splints nor palatal splints had an influence on the SB outcome variables or on the sleep variables measured on a group level. In individual cases, variable outcomes were found: Some patients had an increase (33% to 48% of the cases), while others showed no change (33% to 48%) or a decrease (19% to 29%) in SB outcome variables. The absence of significant group effects of splints in the management of SB indicates that caution is required when splints are indicated, apart from their role in the protection against dental wear. The application of splints should therefore be considered at the individual patient level.

Failure to recognize preoperatively high-risk endometrial carcinoma is associated with a poor outcome.

PubMed

Di Cello, Annalisa; Rania, Erika; Zuccalà, Valeria; Venturella, Roberta; Mocciaro, Rita; Zullo, Fulvio; Morelli, Michele

2015-11-01

To evaluate the misdiagnosis between endometrial biopsy and definitive surgical pathology and to assess whether the failure in recognizing preoperatively high-risk endometrial carcinoma (EC) can impact oncological outcomes. A retrospective study was conducted to evaluate patients with EC diagnosed by preoperative endometrial biopsy who subsequently underwent surgical staging between 2006 and 2013 at our institution. In patients with a surgical diagnosis of high-risk EC, histotype and grade change between the endometrial biopsy and surgical specimen (discordance diagnosis) were evaluated and correlated to survival outcomes. Cox's regression model for multivariable analysis was used to evaluate the effect of several variables (age, stage, discordance in diagnosis, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy) on the survival rate. Data from 447 patients were reviewed. Among 109 women with surgical diagnosis of high-risk EC, 35 (32.1%) were preoperatively misdiagnosed. Of these 35 women, 24 (68.6%) cases were upgraded to grade 3, and 11 (3.4%) were upgraded to serous or clear cell type in the definitive specimen. The 5-year overall survival (OS; 70.2 vs. 86.8%; p=0.029), disease-specific survival (DSS; 72.5 vs. 88.2%; p=0.039) and recurrence free survival (RFS; 62.6 vs. 82.5%; p=0.024) were significantly lower in the high-risk EC patients who were preoperatively undiagnosed in the endometrial biopsy compared with patients with an appropriate preoperative histological diagnosis. Controlling for age, stage, co-morbidities, frozen section, extensive surgical staging and adjuvant chemotherapy, multivariable analysis revealed that discordance in diagnosis was associated with poorer survival outcomes. Failure to recognize preoperatively high-risk ECs is associated with worse outcomes. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation.

PubMed

McMillan, Matthew T; Soi, Sameer; Asbun, Horacio J; Ball, Chad G; Bassi, Claudio; Beane, Joal D; Behrman, Stephen W; Berger, Adam C; Bloomston, Mark; Callery, Mark P; Christein, John D; Dixon, Elijah; Drebin, Jeffrey A; Castillo, Carlos Fernandez-Del; Fisher, William E; Fong, Zhi Ven; House, Michael G; Hughes, Steven J; Kent, Tara S; Kunstman, John W; Malleo, Giuseppe; Miller, Benjamin C; Salem, Ronald R; Soares, Kevin; Valero, Vicente; Wolfgang, Christopher L; Vollmer, Charles M

2016-08-01

To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P < 0.00001) and octreotide (odds ratio 3.30, P < 0.00001). When adjusting for risk, performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.

Climate Change and Human Health Impacts in the United States: An Update on the Results of the U.S. National Assessment

PubMed Central

Ebi, Kristie L.; Mills, David M.; Smith, Joel B.; Grambsch, Anne

2006-01-01

The health sector component of the first U.S. National Assessment, published in 2000, synthesized the anticipated health impacts of climate variability and change for five categories of health outcomes: impacts attributable to temperature, extreme weather events (e.g., storms and floods), air pollution, water- and food-borne diseases, and vector- and rodent-borne diseases. The Health Sector Assessment (HSA) concluded that climate variability and change are likely to increase morbidity and mortality risks for several climate-sensitive health outcomes, with the net impact uncertain. The objective of this study was to update the first HSA based on recent publications that address the potential impacts of climate variability and change in the United States for the five health outcome categories. The literature published since the first HSA supports the initial conclusions, with new data refining quantitative exposure–response relationships for several health end points, particularly for extreme heat events and air pollution. The United States continues to have a very high capacity to plan for and respond to climate change, although relatively little progress has been noted in the literature on implementing adaptive strategies and measures. Large knowledge gaps remain, resulting in a substantial need for additional research to improve our understanding of how weather and climate, both directly and indirectly, can influence human health. Filling these knowledge gaps will help better define the potential health impacts of climate change and identify specific public health adaptations to increase resilience. PMID:16966082

["Who profits?" - patient characteristics as outcome predictors in psychosomatic rehabilitation].

PubMed

Oster, J; Müller, G; Wietersheim, J von

2009-04-01

The study was to examine how far treatment success in psychosomatic rehabilitation can be predicted from patients' characteristics. The aim of this study included the development of outcome criteria, the analysis of bivariate correlations, as well as development and examination of multivariate models. The motivation for dealing with job-related problems was evaluated separately. Data were available from admission, discharge and three-months follow-up. The data of 463 patients were included. Generated were success criteria concerning sociomedical development, health as well as the ability to work. All success criteria were dichotomized. In the criteria defined, successful outcomes were found in 40 to 60% of the patients. In the bivariate analyses, it was shown that many sick days before rehabilitation, applications for pension, severe disability, high impairment, and suggestion for rehabilitation by the insurance agency, have basically negative effects on success. Correlations with the variables concerning motivation for dealing with job-related problems were rather weak. In multivariate model development, models of different quality were found. For prediction of working ability at discharge, there was an explained variance of nearly 60%. In the other success criteria as well, explained variance amounted to over 20%. The models consist of different constellations of variables, the number of sick days before rehabilitation, variables of application for pension and severity of the impairment frequently included. In case of a current sick leave, rehabilitation should be started early, sociomedical problems have to be dealt with explicitly, and rehabilitation should be accompanied by preparatory and aftercare measures.

Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice.

PubMed

Bovenschen, H J; Van de Kerkhof, P C M

2010-04-01

Safety and clinical effectiveness of clobetasol-17 propionate 0.05% shampoo have been shown in patients with scalp psoriasis. First, to evaluate treatment satisfaction, user convenience safety and effectiveness of clobetasol-17 propionate 0.05% shampoo treatment in daily clinical practice. Second, to identify subgroup variables that may predict treatment success or failure. A total of 56 patients with scalp psoriasis were treated with short-contact clobetasol-17 propionate 0.05% shampoo once daily for 4 weeks. Data on treatment satisfaction, user convenience, safety and effectiveness were assessed on a 7-point Likert scale using postal questionnaires. Subgroup analyses were performed to identify variables that may predict treatment outcome. A total of 41 patients returned both questionnaires (73%). Positive treatment satisfaction and user convenience were reported by 66% and 79% of patients respectively. Patient-rated indicators for disease severity improved by 39-46% (P < 0.05%). No major side-effects were reported. Subgroup analyses did not reveal any statistically significant patient variable that may predict treatment outcome. However, a tendency towards improved treatment satisfaction was observed in patients who had received fewer topical antipsoriatic treatments previously (P > 0.05). Short-contact treatment with clobetasol-17 propionate 0.05% shampoo has high user convenience and patient satisfaction rates. Moreover, the treatment is well-tolerated and efficacious from patients' perspective. Subgroup analyses did not reveal factors predicting treatment outcome, although treatment success tended to be more evident in patients who had received fewer treatments previously.

'Trifecta' after radical prostatectomy: is there a standard definition?

PubMed

Borregales, Leonardo D; Berg, William T; Tal, Oded; Wambi, Chris; Kaufman, Sarah; Gaya, Jose M; Urzúa, Cristian; Badani, Ketan K

2013-07-01

To determine the extent of variability in the definitions of the 'trifecta' after radical prostatectomy (undetectable PSA, urinary continence and potency) to be found in the literature. To establish a consensus definition of the trifecta in an effort to standardize criteria and reporting. A systematic review of published articles found in the PubMed database for the period from January 2003 to March 2012 was performed. The search queries included the keywords 'radical prostatectomy,' 'prostatectomy outcome,' and 'trifecta'. A total of 86 publications were identified of which 14 were used for analysis. Eight different definitions of biochemical recurrence were reported, the most common definition being PSA ≥0.2 ng/mL. The definition of potency was the most variable. Ten different definitions of potency were found, with the most common being 'having erections sufficient for intercourse with or without a phosphodiesterase-5 inhibitor'. Nine different definitions of continence were found. The most common definition of continence was 'wearing no pads'. Only six of the 14 articles used validated questionnaires in their outcome measures. The definitions of trifecta reported in the literature are highly variable. We propose the following consensus definition based on our analysis: (1) PSA >0.2 ng/mL with confirmatory value; (2) attainment of erections sufficient for intercourse with or without oral pharmacological agents; (3) wearing zero pads. This consensus definition should be considered when designing studies and reporting outcomes of radical prostatectomy. © 2013 BJU International.

Resilience in highly stressed urban children: concepts and findings.

PubMed Central

Cowen, E. L.; Wyman, P. A.; Work, W. C.

1996-01-01

The Rochester Child Resilience Project is a coordinated set of studies of the correlates and antecedents of outcomes relating to resilience among profoundly stressed urban children. The studies have been conducted over the course of the past decade. Based on child test data, parent, teacher, and self ratings of child adjustment, and in-depth individual interviews with parents and children, a cohesive picture has developed of child and family milieu variables that consistently differentiate children with resilient versus stress-affected outcomes within this highly stressed sample. Resilient children are characterized by an easy temperament and higher IQ; sound parent/child relationships; a parent's sense of efficacy; the parent's own wellness, especially mental health; and the child's perceived competence, realistic control, empathy, and social problem-solving. PMID:8982521

Psychological contract breach and outcomes: Combining meta-analysis and structural equation models.

PubMed

Topa Cantisano, Gabriela; Morales Domínguez, J Francisco; Depolo, Marco

2008-08-01

In this study, meta-analytic procedures were used to examine the relationships between psychological contract perceived breach and certain outcome variables, such as organizational commitment, job satisfaction and organizational citizenship behaviours (OCB). Our review of the literature generated 41 independent samples in which perceived breach was used as a predictor of these personal and organizational outcomes. A medium effect size (ES) for desirable outcomes (job satisfaction, organizational commitment, organizational trust, OCB and performance) was obtained (r=-.35). For undesirable outcomes (neglect in role duties and intention to leave), ES were also medium (r=.31). When comparing attitudinal (job satisfaction, organizational commitment, organizational trust) and behavioural outcomes (OCB, neglect in role duties and performance), a stronger ES was found for attitudinal (r=-.24) than for behavioural outcomes (r=-.11). Potential moderator variables were examined, and it was found that they explained only a percentage of variability of primary studies. Structural equation analysis of the pooled meta-analytical correlation matrix indicated that the relationships of perceived breach with satisfaction, OCB, intention to leave and performance are fully mediated by organizational trust and commitment. Results are discussed in order to suggest theoretical and empirical implications.

Predicting Medical Students’ Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries

PubMed Central

Warnke, Ingeborg; Gamma, Alex; Buadze, Maria; Schleifer, Roman; Canela, Carlos; Strebel, Bernd; Tényi, Tamás; Rössler, Wulf; Rüsch, Nicolas; Liebrenz, Michael

2018-01-01

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students’ perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students’ attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies. PMID:29593577

Predicting Medical Students' Current Attitudes Toward Psychiatry, Interest in Psychiatry, and Estimated Likelihood of Working in Psychiatry: A Cross-Sectional Study in Four European Countries.

PubMed

Warnke, Ingeborg; Gamma, Alex; Buadze, Maria; Schleifer, Roman; Canela, Carlos; Strebel, Bernd; Tényi, Tamás; Rössler, Wulf; Rüsch, Nicolas; Liebrenz, Michael

2018-01-01

Psychiatry as a medical discipline is becoming increasingly important due to the high and increasing worldwide burden associated with mental disorders. Surprisingly, however, there is a lack of young academics choosing psychiatry as a career. Previous evidence on medical students' perspectives is abundant but has methodological shortcomings. Therefore, by attempting to avoid previous shortcomings, we aimed to contribute to a better understanding of the predictors of the following three outcome variables: current medical students' attitudes toward psychiatry, interest in psychiatry, and estimated likelihood of working in psychiatry. The sample consisted of N  = 1,356 medical students at 45 medical schools in Germany and Austria as well as regions of Switzerland and Hungary with a German language curriculum. We used snowball sampling via Facebook with a link to an online questionnaire as recruitment procedure. Snowball sampling is based on referrals made among people. This questionnaire included a German version of the Attitudes Toward Psychiatry Scale (ATP-30-G) and further variables related to outcomes and potential predictors in terms of sociodemography (e.g., gender) or medical training (e.g., curriculum-related experience with psychiatry). Data were analyzed by linear mixed models and further regression models. On average, students had a positive attitude to and high general interest in, but low professional preference for, psychiatry. A neutral attitude to psychiatry was partly related to the discipline itself, psychiatrists, or psychiatric patients. Female gender and previous experience with psychiatry, particularly curriculum-related and personal experience, were important predictors of all outcomes. Students in the first years of medical training were more interested in pursuing psychiatry as a career. Furthermore, the country of the medical school was related to the outcomes. However, statistical models explained only a small proportion of variance. The findings indicate that particularly curriculum-related experience is important for determining attitudes toward psychiatry, interest in the subject and self-predicted professional career choice. We therefore encourage the provision of opportunities for clinical experience by psychiatrists. However, further predictor variables need to be considered in future studies.

Assessing the Impact of Socioeconomic Variables on Small Area Variations in Suicide Outcomes in England

PubMed Central

Congdon, Peter

2012-01-01

Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas. PMID:23271304

Assessing the impact of socioeconomic variables on small area variations in suicide outcomes in England.

PubMed

Congdon, Peter

2012-12-27

Ecological studies of suicide and self-harm have established the importance of area variables (e.g., deprivation, social fragmentation) in explaining variations in suicide risk. However, there are likely to be unobserved influences on risk, typically spatially clustered, which can be modeled as random effects. Regression impacts may be biased if no account is taken of spatially structured influences on risk. Furthermore a default assumption of linear effects of area variables may also misstate or understate their impact. This paper considers variations in suicide outcomes for small areas across England, and investigates the impact on them of area socio-economic variables, while also investigating potential nonlinearity in their impact and allowing for spatially clustered unobserved factors. The outcomes are self-harm hospitalisations and suicide mortality over 6,781 Middle Level Super Output Areas.

Neighbourhood immigration, health care utilization and outcomes in patients with diabetes living in the Montreal metropolitan area (Canada): a population health perspective.

PubMed

Vanasse, Alain; Courteau, Josiane; Orzanco, Maria Gabriela; Bergeron, Patrick; Cohen, Alan A; Niyonsenga, Théophile

2015-04-09

Understanding health care utilization by neighbourhood is essential for optimal allocation of resources, but links between neighbourhood immigration and health have rarely been explored. Our objective was to understand how immigrant composition of neighbourhoods relates to health outcomes and health care utilization of individuals living with diabetes. This is a secondary analysis of administrative data using a retrospective cohort of 111,556 patients living with diabetes without previous cardiovascular diseases (CVD) and living in the metropolitan region of Montreal (Canada). A score for immigration was calculated at the neighbourhood level using a principal component analysis with six neighbourhood-level variables (% of people with maternal language other than French or English, % of people who do not speak French or English, % of immigrants with different times since immigration (<5 years, 5-10 years, 10-15 years, 15-25 years)). Dependent variables were all-cause death, all-cause hospitalization, CVD event (death or hospitalization), frequent use of emergency departments, frequent use of general practitioner care, frequent use of specialist care, and purchase of at least one antidiabetic drug. For each of these variables, adjusted odds ratios were estimated using a multilevel logistic regression. Compared to patients with diabetes living in neighbourhoods with low immigration scores, those living in neighbourhoods with high immigration scores were less likely to die, to suffer a CVD event, to frequently visit general practitioners, but more likely to visit emergency departments or a specialist and to use an antidiabetic drug. These differences remained after controlling for patient-level variables such as age, sex, and comorbidities, as well as for neighbourhood attributes like material and social deprivation or living in the urban core. In this study, patients with diabetes living in neighbourhoods with high immigration scores had different health outcomes and health care utilizations compared to those living in neighbourhoods with low immigration scores. Although we cannot disentangle the individual versus the area-based effect of immigration, these results may have an important impact for health care planning.

Social Support, Help-Seeking, and Mental Health Outcomes Among Veterans in Non-VA Facilities: Results from the Veterans’ Health Study

PubMed Central

Adams, Richard E.; Urosevich, Thomas G.; Hoffman, Stuart N.; Kirchner, H. Lester; Hyacinthe, Johanna C.; Figley, Charles R.; Boscarino, Joseph J.; Boscarino, Joseph A.

2017-01-01

Using a stress process model, the authors examined social and psychological resources to better understand mental health outcomes among veterans. For this study, we surveyed 700 U.S. veterans who were outpatients in the Geisinger Health System. Independent variables included demographic factors, stressful and traumatic events, social support measures, and psychosocial factors. Using logistic regression, the authors examined 4 types of social connections: social support, help-seeking support, social capital, and other mental health support to predict mental health outcomes, including posttraumatic stress disorder, depression, suicide ideation, alcohol misuse, mental health service use, and Veterans Affairs service use. Results suggested that help-seeking support since deployment was a risk factor for 5 adverse outcomes, whereas social support was protective for 1 outcome. We concluded that high levels of help-seeking support since deployment among veterans was associated with a higher prevalence of mental health problems. These findings were unexpected and suggest the need for additional social support-related research among veterans. PMID:29098116

Bias, Confounding, and Interaction: Lions and Tigers, and Bears, Oh My!

PubMed

Vetter, Thomas R; Mascha, Edward J

2017-09-01

Epidemiologists seek to make a valid inference about the causal effect between an exposure and a disease in a specific population, using representative sample data from a specific population. Clinical researchers likewise seek to make a valid inference about the association between an intervention and outcome(s) in a specific population, based upon their randomly collected, representative sample data. Both do so by using the available data about the sample variable to make a valid estimate about its corresponding or underlying, but unknown population parameter. Random error in an experiment can be due to the natural, periodic fluctuation or variation in the accuracy or precision of virtually any data sampling technique or health measurement tool or scale. In a clinical research study, random error can be due to not only innate human variability but also purely chance. Systematic error in an experiment arises from an innate flaw in the data sampling technique or measurement instrument. In the clinical research setting, systematic error is more commonly referred to as systematic bias. The most commonly encountered types of bias in anesthesia, perioperative, critical care, and pain medicine research include recall bias, observational bias (Hawthorne effect), attrition bias, misclassification or informational bias, and selection bias. A confounding variable is a factor associated with both the exposure of interest and the outcome of interest. A confounding variable (confounding factor or confounder) is a variable that correlates (positively or negatively) with both the exposure and outcome. Confounding is typically not an issue in a randomized trial because the randomized groups are sufficiently balanced on all potential confounding variables, both observed and nonobserved. However, confounding can be a major problem with any observational (nonrandomized) study. Ignoring confounding in an observational study will often result in a "distorted" or incorrect estimate of the association or treatment effect. Interaction among variables, also known as effect modification, exists when the effect of 1 explanatory variable on the outcome depends on the particular level or value of another explanatory variable. Bias and confounding are common potential explanations for statistically significant associations between exposure and outcome when the true relationship is noncausal. Understanding interactions is vital to proper interpretation of treatment effects. These complex concepts should be consistently and appropriately considered whenever one is not only designing but also analyzing and interpreting data from a randomized trial or observational study.

Tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign trial: Rationale and design.

PubMed

Liu, Liping; Wang, Yilong; Meng, Xia; Li, Na; Tan, Ying; Nie, Ximing; Liu, Dacheng; Zhao, Xingquan

2017-04-01

Rationale Acute intracerebral hemorrhage inflicts a high-economic and -health burden. Computed tomography angiography spot sign is a predictor of hematoma expansion, is associated with poor clinical outcome and is an important stratifying variable for patients treated with haemostatic therapy. Aims We aim to compare the effect of treatment with tranexamic acid to placebo for the prevention of hemorrhage growth in patients with high-risk acute intracerebral hemorrhage with a positive spot sign. Design The tranexamic acid for acute intracerebral hemorrhage growth predicted by spot sign (TRAIGE) is a prospective, multicenter, placebo-controlled, double-blind, investigator-led, randomized clinical trial that will include an estimated 240 participants. Patients with intracerebral hemorrhage demonstrating symptom onset within 8 h and with the spot sign as a biomarker for ongoing hemorrhage, and no contraindications for antifibrinolytic therapy, will be enrolled to receive either tranexamic acid or placebo. The primary outcome measure is the presence of hemorrhage growth defined as an increase in intracerebral hemorrhage volume >33% or >6 ml from baseline to 24 ± 2 h. The secondary outcomes include safety and clinical outcomes. Conclusion The TRAIGE trial evaluates the efficacy of haemostatic therapy with tranexamic acid in the prevention of hemorrhage growth among high-risk patients with acute intracerebral hemorrhage.

Contextual or general stress outcomes: making choices through caregiving appraisals.

PubMed

Braithwaite, V

2000-12-01

This study contributes to the debate on general versus contextual measures of caregiver well-being through examining the differential relationships of caregiving appraisals to outcomes. Six dimensions of caregiving appraisal were examined as predictors of minor psychiatric symptoms, affect balance, and burden. Burden was high, symptoms were high, and affect was poor when caregivers held appraisals that reflected (a) low personal resiliency and (b) a conflict-ridden and dysfunctional relationship with the care receiver. When caregivers reported expending (c) considerable energy in maintaining their social networks, burden was also high, with some risk of symptoms, but affect was positive. The fourth appraisal, (d) a close loving caregiver-care receiver relationship, was positively correlated with general well-being, but was not related to burden. The fifth appraisal, (e) dealing with a heavy workload in providing care, was linked with poor affect, but neither symptoms nor burden. Finally, (f) caring at a distance was related to burden, but not to the general outcome measures. These findings suggest that the foci of research questions might be usefully located within an appraisal framework, and that this framework might then provide guidance for the choice of appropriate outcome variables. In many cases, however, a deeper understanding ensues from assessing both contextual and general well-being.

Evaluation of variable selection methods for random forests and omics data sets.

PubMed

Degenhardt, Frauke; Seifert, Stephan; Szymczak, Silke

2017-10-16

Machine learning methods and in particular random forests are promising approaches for prediction based on high dimensional omics data sets. They provide variable importance measures to rank predictors according to their predictive power. If building a prediction model is the main goal of a study, often a minimal set of variables with good prediction performance is selected. However, if the objective is the identification of involved variables to find active networks and pathways, approaches that aim to select all relevant variables should be preferred. We evaluated several variable selection procedures based on simulated data as well as publicly available experimental methylation and gene expression data. Our comparison included the Boruta algorithm, the Vita method, recurrent relative variable importance, a permutation approach and its parametric variant (Altmann) as well as recursive feature elimination (RFE). In our simulation studies, Boruta was the most powerful approach, followed closely by the Vita method. Both approaches demonstrated similar stability in variable selection, while Vita was the most robust approach under a pure null model without any predictor variables related to the outcome. In the analysis of the different experimental data sets, Vita demonstrated slightly better stability in variable selection and was less computationally intensive than Boruta.In conclusion, we recommend the Boruta and Vita approaches for the analysis of high-dimensional data sets. Vita is considerably faster than Boruta and thus more suitable for large data sets, but only Boruta can also be applied in low-dimensional settings. © The Author 2017. Published by Oxford University Press.

Variable compensation in Primary Healthcare: a report on the experience in Curitiba, Rio de Janeiro, Brazil, and Lisbon, Portugal.

PubMed

Poli Neto, Paulo; Faoro, Nilza Teresinha; Prado Júnior, José Carlos do; Pisco, Luís Augusto Coelho

2016-05-01

How professionals are compensated may affect how they perform their tasks. Fixed compensation may take the form of wages, payment for productivity or capitation. In addition to fixed compensation, there are numerous mechanisms for variable compensation. This article describes the experience of Curitiba and Rio de Janeiro in Brazil, and Lisbon in Portugal, using different models of performance-based compensation. In all three of these examples, management felt the need to offer monetary reward to achieve certain goals. The indicators analyzed the structure, processes and outcomes, and assessed professionals individual and as part of healthcare teams. In Lisbon, variable compensation can be as high as 40% of the base wage, while in Curitiba and Rio de Janeiro it is limited to 10%. Despite the growing use of this management tool in Brazil and the world, further studies are required to analyze the effectiveness of variable compensation.

Masculine role adherence and outcomes among men with traumatic brain injury.

PubMed

Schopp, Laura H; Good, Glenn E; Barker, Katharine B; Mazurek, Micah O; Hathaway, Stefani L

2006-10-01

Traumatic brain injury (TBI) is a significant health problem disproportionately affecting men and is often associated with changes in masculine role functioning in life domains such as vocational functioning, sexual and inter-personal functioning and personal independence. These changes could have serious implications for men's adjustment following injury. The aim of this study was to examine the relations among traditional masculine role adherence, psychosocial adjustment and rehabilitation outcomes in men with TBI. A correlational design was chosen to examine the relations among variables. Spearman correlations and Wilcoxon Rank Sum tests were used to examine relationships between masculine role variables and outcome variables. The study included 33 men with TBI who had been discharged from inpatient rehabilitation within 5 years. Participants completed surveys on traditional masculine gender role adherence and gender role conflict and additional data, including measures of functional outcome, life satisfaction, psychosocial outcomes and earnings, were obtained through the TBI Model System longitudinal data collection system. The results revealed significant associations between masculine role adherence and satisfaction with life, follow-up earnings and FIM change from admission to discharge. In the current study, particular masculine role variables corresponded to different functional and psychological outcomes. Understanding these differences provides new directions for treatment and offers important information about aspects of traditional masculine roles that may enhance or hinder adjustment to injury.

Human embryo culture media comparisons.

PubMed

Pool, Thomas B; Schoolfield, John; Han, David

2012-01-01

Every program of assisted reproduction strives to maximize pregnancy outcomes from in vitro fertilization and selecting an embryo culture medium, or medium pair, consistent with high success rates is key to this process. The common approach is to replace an existing medium with a new one of interest in the overall culture system and then perform enough cycles of IVF to see if a difference is noted both in laboratory measures of embryo quality and in pregnancy. This approach may allow a laboratory to select one medium over another but the outcomes are only relevant to that program, given that there are well over 200 other variables that may influence the results in an IVF cycle. A study design that will allow for a more global application of IVF results, ones due to culture medium composition as the single variable, is suggested. To perform a study of this design, the center must have a patient caseload appropriate to meet study entrance criteria, success rates high enough to reveal a difference if one exists and a strong program of quality assurance and control in both the laboratory and clinic. Sibling oocytes are randomized to two study arms and embryos are evaluated on day 3 for quality grades. Inter and intra-observer variability are evaluated by kappa statistics and statistical power and study size estimates are performed to bring discriminatory capability to the study. Finally, the complications associated with extending such a study to include blastocyst production on day 5 or 6 are enumerated.

Drug Concentration Thresholds Predictive of Therapy Failure and Death in Children With Tuberculosis: Bread Crumb Trails in Random Forests.

PubMed

Swaminathan, Soumya; Pasipanodya, Jotam G; Ramachandran, Geetha; Hemanth Kumar, A K; Srivastava, Shashikant; Deshpande, Devyani; Nuermberger, Eric; Gumbo, Tawanda

2016-11-01

 The role of drug concentrations in clinical outcomes in children with tuberculosis is unclear. Target concentrations for dose optimization are unknown.  Plasma drug concentrations measured in Indian children with tuberculosis were modeled using compartmental pharmacokinetic analyses. The children were followed until end of therapy to ascertain therapy failure or death. An ensemble of artificial intelligence algorithms, including random forests, was used to identify predictors of clinical outcome from among 30 clinical, laboratory, and pharmacokinetic variables.  Among the 143 children with known outcomes, there was high between-child variability of isoniazid, rifampin, and pyrazinamide concentrations: 110 (77%) completed therapy, 24 (17%) failed therapy, and 9 (6%) died. The main predictors of therapy failure or death were a pyrazinamide peak concentration <38.10 mg/L and rifampin peak concentration <3.01 mg/L. The relative risk of these poor outcomes below these peak concentration thresholds was 3.64 (95% confidence interval [CI], 2.28-5.83). Isoniazid had concentration-dependent antagonism with rifampin and pyrazinamide, with an adjusted odds ratio for therapy failure of 3.00 (95% CI, 2.08-4.33) in antagonism concentration range. In regard to death alone as an outcome, the same drug concentrations, plus z scores (indicators of malnutrition), and age <3 years, were highly ranked predictors. In children <3 years old, isoniazid 0- to 24-hour area under the concentration-time curve <11.95 mg/L × hour and/or rifampin peak <3.10 mg/L were the best predictors of therapy failure, with relative risk of 3.43 (95% CI, .99-11.82).  We have identified new antibiotic target concentrations, which are potential biomarkers associated with treatment failure and death in children with tuberculosis. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.

Where You Live Matters: Localising Environmental Impacts on Health, Nutrition and Poverty in Cambodia Using Small Area Estimation Techniques

NASA Astrophysics Data System (ADS)

Nilsen, K.; van Soesbergen, A.; Matthews, Z.

2016-12-01

Socioeconomic development depends on local environments. However, the scientific evidence quantifying the impact of environmental factors on health, nutrition and poverty at subnational levels is limited. This is because socioeconomic indicators are derived from sample surveys representative only at aggregate levels compared to environmental variables mostly available in high-resolution grids. Cambodia was selected because of its commitment to development in the context of a rapidly deteriorating environment. Having made considerable progress since 2005, access to health services is limited, a quarter of the population is still poor and 40% rural children are malnourished. Cambodia is also facing considerable environmental challenges including high deforestation rates, land degradation and natural hazards. Addressing existing gaps in the knowledge of environmental impacts on health and livelihoods, this study applies small area estimation (SAE) to quantify health, nutritional and poverty outcomes in the context of local environments. SAE produces reliable subnational estimates of socioeconomic outcomes available only from sample surveys by combining them with information from auxiliary sources (census). A model is used to explain common trades across areas and a random effect structure is applied to explain the observed extra heterogeneity. SAE models predicting health, nutrition and poverty outcomes excluding and including contextual environmental variables on natural hazards vulnerability, forest cover, climate, and agricultural production are compared. Results are mapped at regional and district levels to spatially assess the impacts of environmental variation on the outcomes. Inter and intra-regional inequalities are also estimated to examine the efficacy of health/socioeconomic policy targeting based on geographic location. Preliminary results suggest that localised environmental factors have considerable impacts on the indicators estimated and should therefore not be ignored. While there are large regional differences, pockets of malnutrition, poverty and inequitable health outcomes within regions are identified. The inequality decomposition shows under and over-coverage of geographical targeting when environmental factors are taken into account.

Influence of Pulmonary Nodules on Chest Computed Tomography and Risk of Recurrence in Stage IV Wilms Tumor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kirkland, Robert S.; Nanda, Ronica H., E-mail: rhazari@emory.edu; Alazraki, Adina

Purpose: Chest computed tomography (CT) is currently accepted as the main modality for initial disease staging and response assessment in Wilms tumor (WT). However, there is great variability in the number and size of lung metastases at the time of diagnosis and after induction chemotherapy. There is a lack of clinical evidence as to how this variability in tumor burden affects choice of therapy and disease outcome. This study sought to evaluate a previously proposed lung metastases risk stratification system based on CT findings and clinical outcomes in stage IV WT patients. Methods and Materials: Thirty-five pediatric patients with amore » diagnosis of stage IV WT with evaluable pre- and postdiagnosis CT scans between 1997 and 2012 were included in the analysis. Patients were divided into low-, intermediate-, and high-risk categories based on the size and number of pulmonary metastases before and after 6 weeks of chemotherapy. Association of the lung risk groups with lung recurrence-free survival and overall survival at each time point was analyzed with relevant covariates. Results: Risk group distribution both at diagnosis and after induction chemotherapy was not influenced by tumor histology. Initial risk grouping suggested an association with disease-free survival at 5 years (P=.074); however, the most significant correlation was with postinduction chemotherapy disease status (P=.027). In patients with an intermediate or high burden of disease after 6 weeks of chemotherapy, despite receiving whole-lung and boost irradiation, survival outcomes were poorer. Conclusions: Pulmonary tumor burden in stage IV WT on chest CT can predict disease outcome. Patients with intermediate- or low-risk disease, especially after induction therapy, have a higher risk for recurrence. After prospective validation, this method may become a valuable tool in adaptation of therapy to improve outcome.« less

[Why are some high achievers on the course final exam unsuccessful on the proficiency exam in English?].

PubMed

Matsunuma, Mitsuyasu

2009-04-01

This study examined why some high achievers on the course final exam were unsuccessful on the proficiency exam in English. We hypothesized that the learning motives and learning behaviors (learning strategy, learning time) had different effects on the outcomes of the exams. First, the relation between the variables was investigated using structural equation modeling. Second, the learning behaviors of students who got good marks on both exams were compared with students who did well only on the course final exam. The results were as follows. (a) Learning motives influenced test performance via learning behaviors. (b) Content-attached motives influenced all variables concerning learning behaviors. (c) Content-detached motives influenced all variables concerning learning behaviors that were related only to the course final exam. (d) The students who got good marks on both exams performed the learning behaviors that were useful on the proficiency exam more frequently than the students who did well only on the course final exam.

Delta Scuti Variables

NASA Astrophysics Data System (ADS)

Handler, Gerald

2009-09-01

We review recent research on Delta Scuti stars from an observer's viewpoint. First, some signposts helping to find the way through the Delta Scuti jungle are placed. Then, some problems in studying individual pulsators in the framework of asteroseismology are given before a view on how the study of these variables has benefited (or not) from past and present high-precision asteroseismic space missions is presented. Some possible pitfalls in the analysis of data with a large dynamical range in pulsational amplitudes are pointed out, and a strategy to optimize the outcome of asteroseismic studies of Delta Scuti stars is suggested. We continue with some views on ``hybrid'' pulsators and interesting individual High Amplitude Delta Scuti stars, and then take a look on Delta Scuti stars in stellar systems of several different kinds. Recent results on pre-main sequence Delta Scuti stars are discussed as are questions related to the instability strip of these variables. Finally, some remarkable new theoretical results are highlighted before, instead of a set of classical conclusions, questions to be solved in the future, are raised.

Timing matters: change depends on the stage of treatment in cognitive behavioral therapy for panic disorder with agoraphobia.

PubMed

Gloster, Andrew T; Klotsche, Jens; Gerlach, Alexander L; Hamm, Alfons; Ströhle, Andreas; Gauggel, Siegfried; Kircher, Tilo; Alpers, Georg W; Deckert, Jürgen; Wittchen, Hans-Ulrich

2014-02-01

The mechanisms of action underlying treatment are inadequately understood. This study examined 5 variables implicated in the treatment of panic disorder with agoraphobia (PD/AG): catastrophic agoraphobic cognitions, anxiety about bodily sensations, agoraphobic avoidance, anxiety sensitivity, and psychological flexibility. The relative importance of these process variables was examined across treatment phases: (a) psychoeducation/interoceptive exposure, (b) in situ exposure, and (c) generalization/follow-up. Data came from a randomized controlled trial of cognitive behavioral therapy for PD/AG (n = 301). Outcomes were the Panic and Agoraphobia Scale (Bandelow, 1995) and functioning as measured in the Clinical Global Impression scale (Guy, 1976). The effect of process variables on subsequent change in outcome variables was calculated using bivariate latent difference score modeling. Change in panic symptomatology was preceded by catastrophic appraisal and agoraphobic avoidance across all phases of treatment, by anxiety sensitivity during generalization/follow-up, and by psychological flexibility during exposure in situ. Change in functioning was preceded by agoraphobic avoidance and psychological flexibility across all phases of treatment, by fear of bodily symptoms during generalization/follow-up, and by anxiety sensitivity during exposure. The effects of process variables on outcomes differ across treatment phases and outcomes (i.e., symptomatology vs. functioning). Agoraphobic avoidance and psychological flexibility should be investigated and therapeutically targeted in addition to cognitive variables. PsycINFO Database Record (c) 2014 APA, all rights reserved.

The ethical allocation of scarce resources in surgery: implants and cost

PubMed Central

Gross, Michael

1997-01-01

This paper is a discussion of the factors involved in instituting a bulk purchasing program for surgical supplies. An improved understanding of the surgical procedure of joint arthroplasty must relate to the variability in surgical methods that achieve patient outcomes. An understanding of the outcomes in relation to the expected duration of the success of an implant and the high costs associated with a revision earlier than expected must be factored into the budget and costs of implants. The ethical implications of choosing one implant over another are considered. A more uniform outcome assessment with respect to surgical activities is needed and potential savings related to other operating-room costs must be examined. Optimizing the implant to patient requirements is the goal within the framework of current fiscal constraints. PMID:9416251

REFLECTIVE PRACTICE IN ORGANIZATIONAL LEARNING, CULTURAL SELF-UNDERSTANDING, AND COMMUNITY SELF-STRENGTHENING.

PubMed

Sparrow, Joshua

2016-11-01

The infant mental health field can amplify its effects when it extends its purview beyond the dyad to the larger contexts in which infants and adult caregivers interact and develop over time. Within health, mental health, education, and other human service organizations, the quality of relationships is a critical variable in the individual-level outcomes that such organizations seek. The goals of this work and the means for accomplishing them are highly dependent on human qualities and interactions that are shaped by organizational processes. In communities, too, processes that shape relationships also strongly influence child-, family-, and community-level outcomes. The Touchpoints approach to reflective practice can guide relational processes among professionals, parents, and infants in organizations and communities that influence these outcomes. © 2016 Michigan Association for Infant Mental Health.

Quantifying Geographic Variation in Health Care Outcomes in the United States before and after Risk-Adjustment.

PubMed

Rosenberg, Barry L; Kellar, Joshua A; Labno, Anna; Matheson, David H M; Ringel, Michael; VonAchen, Paige; Lesser, Richard I; Li, Yue; Dimick, Justin B; Gawande, Atul A; Larsson, Stefan H; Moses, Hamilton

2016-01-01

Despite numerous studies of geographic variation in healthcare cost and utilization at the local, regional, and state levels across the U.S., a comprehensive characterization of geographic variation in outcomes has not been published. Our objective was to quantify variation in US health outcomes in an all-payer population before and after risk-adjustment. We used information from 16 independent data sources, including 22 million all-payer inpatient admissions from the Healthcare Cost and Utilization Project (which covers regions where 50% of the U.S. population lives) to analyze 24 inpatient mortality, inpatient safety, and prevention outcomes. We compared outcome variation at state, hospital referral region, hospital service area, county, and hospital levels. Risk-adjusted outcomes were calculated after adjusting for population factors, co-morbidities, and health system factors. Even after risk-adjustment, there exists large geographical variation in outcomes. The variation in healthcare outcomes exceeds the well publicized variation in US healthcare costs. On average, we observed a 2.1-fold difference in risk-adjusted mortality outcomes between top- and bottom-decile hospitals. For example, we observed a 2.3-fold difference for risk-adjusted acute myocardial infarction inpatient mortality. On average a 10.2-fold difference in risk-adjusted patient safety outcomes exists between top and bottom-decile hospitals, including an 18.3-fold difference for risk-adjusted Central Venous Catheter Bloodstream Infection rates. A 3.0-fold difference in prevention outcomes exists between top- and bottom-decile counties on average; including a 2.2-fold difference for risk-adjusted congestive heart failure admission rates. The population, co-morbidity, and health system factors accounted for a range of R2 between 18-64% of variability in mortality outcomes, 3-39% of variability in patient safety outcomes, and 22-70% of variability in prevention outcomes. The amount of variability in health outcomes in the U.S. is large even after accounting for differences in population, co-morbidities, and health system factors. These findings suggest that: 1) additional examination of regional and local variation in risk-adjusted outcomes should be a priority; 2) assumptions of uniform hospital quality that underpin rationale for policy choices (such as narrow insurance networks or antitrust enforcement) should be challenged; and 3) there exists substantial opportunity for outcomes improvement in the US healthcare system.

All-on-4® Treatment Concept for the Rehabilitation of the Completely Edentulous Mandible: A 7-Year Clinical and 5-Year Radiographic Retrospective Case Series with Risk Assessment for Implant Failure and Marginal Bone Level.

PubMed

Maló, Paulo; de Araújo Nobre, Miguel; Lopes, Armando; Ferro, Ana; Gravito, Inês

2015-10-01

Studies are needed to evaluate long-term outcomes of the All-on-4® treatment concept (Nobel Biocare AB) for rehabilitation of edentulous mandibles by assessing marginal bone levels and risk indicators for implant failure. To evaluate 7-year clinical outcomes and 5-year radiographic outcomes of the All-on-4 treatment concept. This retrospective case series included patients admitted for implant rehabilitations in the mandible, who were followed for 7 years clinically and 5 years radiographically. Primary outcome measures were cumulative prosthetic and implant survival using patient as the unit of analysis (Kaplan-Meier product limit estimator). Secondary outcome measure was marginal bone level (MBL) at 5 years. Variables associated with implant failure were analyzed using the Cox proportional hazards regression model to calculate hazard ratios (HRs) with 95% confidence intervals (CIs). Binary logistic regression was used to compute odds ratio (OR) with 95% CIs for variables associated with MBL ≥2.8 mm at 5 years. A total of 324 patients (194 women, 130 men, average age = 58.9 years) were rehabilitated with 1,296 implants supporting 324 full-arch fixed immediately loaded mandibular prostheses. Sixty-four patients (19.8%) were lost to follow-up. Prosthetic survival was 323/324 (99.7%), and 14 patients lost 18 implants, with an estimated cumulative survival rate of 95.4% at 7 years. Variables associated with implant failure were smoking (HR = 5.28; 95% CI: 1.33, 20.91]) and the learning curve effect (0.69 < HR < 0.33 for more experienced levels). Mean MBL at 5 years was 1.81 mm (95% CI: 1.70, 1.92), and smoking was associated with MBL ≥2.8 mm (OR = 2.4; 95% CI: 1.02, 5.62). The high implant and prosthetic survival rates and excellent MBL outcome confirm the predictability and safety of the All-on-4 treatment concept over a longer term than previously reported. © 2014 Wiley Periodicals, Inc.

Outcomes of laparoscopic resection of Meckel's diverticulum are equivalent to open laparotomy.

PubMed

Ezekian, Brian; Leraas, Harold J; Englum, Brian R; Gilmore, Brian F; Reed, Christopher; Fitzgerald, Tamara N; Rice, Henry E; Tracy, Elisabeth T

2018-03-15

Meckel's diverticulum (MD) is a common congenital anomaly caused by failure of involution of the omphalomesenteric duct. Enthusiasm for minimally invasive surgery (MIS) in children has burgeoned as technologies have advanced, but the outcomes of laparoscopic resection in comparison to open laparotomy for MD remain poorly defined. We queried a large national database to compare current practice patterns and clinical outcomes between surgical approaches for MD in the pediatric population. The National Surgical Quality Improvement Program-Pediatric (NSQIP-Ped) database was queried for patients undergoing surgical intervention for MD (2011-2014). Patients were stratified by surgical approach. Baseline characteristics, intraoperative variables, and perioperative complications were compared by univariate analysis using Pearson's χ 2 test for categorical variables and Kruskall-Wallis test for continuous variables. Primary outcomes of interest were length of stay (LOS), rate of readmission, and 30-day mortality. Secondary outcomes included operative time, anesthesia time, postoperative complications, and rates of reoperation. A total of 148 cases of MD were identified, of which 73 (49.3%) were initially managed with a laparoscopic approach and 75 (50.7%) were managed with an open approach. We found a high rate of conversion from laparoscopy to an open approach (20/73 or 27.4%). The median age of the laparoscopic group was higher than the open group (8.3 vs. 2.5years, p<0.001). Operative and anesthesia time, LOS, 30-day mortality, post-operative complications, and rates of reoperation and readmission were similar between groups (all p>0.05). Nearly half of all resections for MD in children are now approached laparoscopically. This approach has equivalent outcomes to traditional open laparotomy. More widespread use of a hybrid approach with laparoscopy and exteriorization of the small bowel through an extended port site may facilitate avoiding open laparotomy. Routine conversion to open for palpation of the MD or segmental small bowel resection should be avoided in the absence of compelling intra-operative findings or operative complications. Level III (retrospective comparative study). Copyright © 2018 Elsevier Inc. All rights reserved.

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis.

PubMed

Richardson, Emma M; Schüz, Natalie; Sanderson, Kristy; Scott, Jennifer L; Schüz, Benjamin

2017-06-01

Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer. Copyright © 2016 John Wiley & Sons, Ltd.

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy.

PubMed

Cafagna, Gianluca; Seghieri, Chiara

2017-01-09

There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47-0.94; OR age > 75 years 0.72, 95% CI:0.54-0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58-0.93). Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75 years. Our findings suggest that the educational component should not be underestimated in order to improve short-term outcomes, which are considered as performance measures at the hospital level. Hospital managers might consider strategies that are sensitive to patients with low SES, such as providing post-hospitalization support to less-educated patients and promoting a healthier lifestyle, to improve both health equity and performance outcomes.

Trends and Divergences in Childhood Income Dynamics, 1970-2010.

PubMed

Hill, Heather D

2018-01-01

Earnings and income variability have increased since the 1970s, particularly at the bottom of the income distribution. Considerable evidence suggests that childhood income levels-captured as average or point-in-time yearly income-are associated with numerous child and adult outcomes. The importance to child development of stable proximal processes during childhood suggests that income variability may also be important, particularly if it is unpredictable, unintentional, or does not reflect an upward trend in family income. Using the Panel Study of Income Dynamics, this study documents trends since the 1970s in three dimensions of childhood income dynamics: level, variability, and growth (n=7991). The analysis reveals that income variability during childhood has grown over time, while income growth rates have not. In addition, the economic context of childhood has diverged substantially by socioeconomic status, race, and family structure, with the most disadvantaged children facing a double-whammy of low income and high variability. © 2018 Elsevier Inc. All rights reserved.

Outpatient Cocaine Abuse Treatment: Predictors of Success.

ERIC Educational Resources Information Center

Westhuis, David J.; Gwaltney, Lisa; Hayashi, Reiko

2001-01-01

Uses data from the U.S. Army's Alcohol and Drug Abuse Prevention and Control Program to analyze which treatment and demographic variables have an effect on cocaine treatment outcomes. Results suggest the following treatment variables had an effect on outcomes: type of treatment; length of time in treatment; and the length of time since the patient…

How Do Different Background Variables Predict Learning Outcomes?

ERIC Educational Resources Information Center

Kallio, Manne; Metsärinne, Mika

2017-01-01

This article is a part of a research project aimed to find out how different background variables are related to learning outcomes in school subject Sloyd as found in the national evaluation of the Finnish National Board of Education. Results from this larger research project were previously published in this journal, where pupils' readiness for…

Education and Health Matters: School Nurse Interventions, Student Outcomes, and School Variables

ERIC Educational Resources Information Center

Wolfe, Linda C.

2013-01-01

This paper presents findings from a quantitative, correlational study that examined selected school nursing services, student academic outcomes, and school demographics. Ex post facto data from the 2011-2012 school year of Delaware public schools were used in the research. The selected variables were school nurse interventions provided to students…

Virtual Teaming and Collaboration Technology: A Study of Influences on Virtual Project Outcomes

ERIC Educational Resources Information Center

Broils, Gary C.

2014-01-01

The purpose of this quantitative correlational study was to explore the relationships between the independent variables, contextual factors for virtual teams and collaboration technology, and the dependent variable, virtual project outcomes. The problem leading to the need for the study is a lower success rate for virtual projects compared to…

Meta-analysis of correlates of provider behavior in medical encounters.

PubMed

Hall, J A; Roter, D L; Katz, N R

1988-07-01

This article summarizes the results of 41 independent studies containing correlates of objectively measured provider behaviors in medical encounters. Provider behaviors were grouped a priori into the process categories of information giving, questions, competence, partnership building, and socioemotional behavior. Total amount of communication was also included. All correlations between variables within these categories and external variables (patient outcome variables or patient and provider background variables) were extracted. The most frequently occurring outcome variables were satisfaction, recall, and compliance, and the most frequently occurring background variables were the patient's gender, age, and social class. Average correlations and combined significance levels were calculated for each combination of process category and external variable. Results showed significant relations of small to moderate average magnitude between these external variables and almost all of the provider behavior categories. A theory of provider-patient reciprocation is proposed to account for the pattern of results.

A Protective Factors Model for Alcohol Abuse and Suicide Prevention among Alaska Native Youth

PubMed Central

Allen, James; Mohatt, Gerald V.; Fok, Carlotta Ching Ting; Henry, David; Burkett, Rebekah

2014-01-01

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen at al., 2006; Mohatt, Hazel et al., 2004; Mohatt, Rasmus et al., 2004). Participants included 413 rural Alaska Native youth ages 12-18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse. PMID:24952249

Does habituation matter? Emotional processing theory and exposure therapy for acrophobia.

PubMed

Baker, Aaron; Mystkowski, Jayson; Culver, Najwa; Yi, Rena; Mortazavi, Arezou; Craske, Michelle G

2010-11-01

Clinically, there is wide subscription to emotional processing theory (EPT; Foa & Kozak, 1986) as a model of therapeutic effectiveness of exposure therapy: EPT purports that exposure is maximal when (1) fear is activated (IFA), (2) fear subsides within sessions (WSH), and (3) fear subsides between sessions (BSH). This study examined these assumptions, using in vivo exposure therapy for 44 students scoring high on acrophobia measures. Results indicated that no EPT variables were consistently predictive of treatment outcome. No support was found for IFA or WSH; measures of BSH were predictive of short-term change, but these effects were attenuated at follow-up. Furthermore, EPT variables were not predictive of each other as previously hypothesized, indicating the variables are not functionally related. Copyright © 2010 Elsevier Ltd. All rights reserved.

Global Dental Research Productivity and Its Association With Human Development, Gross National Income, and Political Stability.

PubMed

Allareddy, Veerasathpurush; Allareddy, Veeratrishul; Rampa, Sankeerth; Nalliah, Romesh P; Elangovan, Satheesh

2015-09-01

The objective of this study is to examine the associations between country level factors (such as human development, economic productivity, and political stability) and their dental research productivity. This study is a cross-sectional analysis of bibliometric data from Scopus search engine. Human Development Index (HDI), Gross National Income per capita (GNI), and Failed State Index measures were the independent variables. Outcomes were "Total number of publications (articles or articles in press) in the field of dentistry" and "Total number of publications in the field of dentistry per million population." Non-parametric tests were used to examine the association between the independent and outcome variables. During the year 2013, a total of 11,952 dental research articles were published across the world. The top 5 publishing countries were United States, Brazil, India, Japan, and United Kingdom. "Very High" HDI countries had significantly higher number of total dental research articles and dental research articles per million population when compared to the "High HDI," "Medium HDI," and "Low HDI" countries (p < 0.0001). There was a significant linear relationship between the GNI quartile income levels and outcome metrics (p ≤ 0.007). Countries which were highly politically stable were associated with significantly higher dental research productivity (p < 0.0001). There appears to be a regional concentration of articles with just five countries contributing to over 50% of all articles. The human development and economic development of a country are linearly correlated with dental research productivity. Dental research productivity also increases with increasing political stability of a country. Copyright © 2015 Elsevier Inc. All rights reserved.

Acute heart failure in the emergency department: a follow-up study.

PubMed

Fabbri, Andrea; Marchesini, Giulio; Carbone, Giorgio; Cosentini, Roberto; Ferrari, Annamaria; Chiesa, Mauro; Bertini, Alessio; Rea, Federico

2016-02-01

Acute heart failure (AHF) is a major public health issue due to high incidence and poor prognosis. Only a few studies are available on the long-term prognosis and on outcome predictors in the unselected population attending the emergency department (ED) for AHF. We carried out a 1-year follow-up analysis of 1234 consecutive patients from selected Italian EDs from January 2011 to June 2012 for an episode of AHF. Their prognosis and outcome-associated factors were tested by Cox proportional hazard model. Patients' mean age was 84, with 66.0% over 80 years and 56.2% females. Comorbidities were present in over 50% of cases, principally a history of acute coronary syndrome, chronic obstructive pulmonary disease, diabetes, chronic kidney disease, valvular heart disease. Death occurred within 6 h in 24 cases (1.9%). At 30-day follow-up, death was registered in 123 cases (10.0%): 110 cases (89.4%) died of cardiovascular events and 13 (10.6%) of non-cardiovascular causes (cancer, gastrointestinal hemorrhages, sepsis, trauma). At 1-year follow-up, all-cause death was recorded in 50.1% (over 3 out of 4 cases for cardiovascular origin). Six variables (older age, diabetes, systolic arterial pressure <110 mm/Hg, high NT pro-BNP, high troponin levels and impaired cognitive status) were selected as outcome predictors, but with limited discriminant capacity (AUC = 0.649; SE 0.015). Recurrence of AHF was registered in 31.0%. The study identifies a cluster of variables associated with 1-year mortality in AHF, but their predictive capacity is low. Old age and the presence of comorbidities, in particular diabetes are likely to play a major role in dictating the prognosis.

Time to antibiotics and outcomes in cancer patients with febrile neutropenia

PubMed Central

2014-01-01

Background Febrile neutropenia is an oncologic emergency. The timing of antibiotics administration in patients with febrile neutropenia may result in adverse outcomes. Our study aims to determine time-to- antibiotic administration in patients with febrile neutropenia, and its relationship with length of hospital stay, intensive care unit monitoring, and hospital mortality. Methods The study population was comprised of adult cancer patients with febrile neutropenia who were hospitalized, at a tertiary care hospital, between January 2010 and December 2011. Using Multination Association of Supportive Care in Cancer (MASCC) risk score, the study cohort was divided into high and low risk groups. A multivariate regression analysis was performed to assess relationship between time-to- antibiotic administration and various outcome variables. Results One hundred and five eligible patients with median age of 60 years (range: 18–89) and M:F of 43:62 were identified. Thirty-seven (35%) patients were in MASCC high risk group. Median time-to- antibiotic administration was 2.5 hrs (range: 0.03-50) and median length of hospital stay was 6 days (range: 1–57). In the multivariate analysis time-to- antibiotic administration (regression coefficient [RC]: 0.31 days [95% CI: 0.13-0.48]), known source of fever (RC: 4.1 days [95% CI: 0.76-7.5]), and MASCC high risk group (RC: 4 days [95% CI: 1.1-7.0]) were significantly correlated with longer hospital stay. Of 105 patients, 5 (4.7%) died & or required ICU monitoring. In multivariate analysis no variables significantly correlated with mortality or ICU monitoring. Conclusions Our study revealed that delay in antibiotics administration has been associated with a longer hospital stay. PMID:24716604

Disorganized attachment and inhibitory capacity: predicting externalizing problem behaviors.

PubMed

Bohlin, Gunilla; Eninger, Lilianne; Brocki, Karin Cecilia; Thorell, Lisa B

2012-04-01

The aim of the present study was to investigate whether attachment insecurity, focusing on disorganized attachment, and the executive function (EF) component of inhibition, assessed at age 5, were longitudinally related to general externalizing problem behaviors as well as to specific symptoms of ADHD and Autism spectrum disorder (ASD), and callous-unemotional (CU) traits. General externalizing problem behaviors were also measured at age 5 to allow for a developmental analysis. Outcome variables were rated by parents and teachers. The sample consisted of 65 children with an oversampling of children with high levels of externalizing behaviors. Attachment was evaluated using a story stem attachment doll play procedure. Inhibition was measured using four different tasks. The results showed that both disorganized attachment and poor inhibition were longitudinally related to all outcome variables. Controlling for initial level of externalizing problem behavior, poor inhibition predicted ADHD symptoms and externalizing problem behaviors, independent of disorganized attachment, whereas for ASD symptoms no predictive relations remained. Disorganized attachment independently predicted CU traits.

Introduction of Transplant Registry Unified Management Program 2 (TRUMP2): scripts for TRUMP data analyses, part I (variables other than HLA-related data).

PubMed

Atsuta, Yoshiko

2016-01-01

Collection and analysis of information on diseases and post-transplant courses of allogeneic hematopoietic stem cell transplant recipients have played important roles in improving therapeutic outcomes in hematopoietic stem cell transplantation. Efficient, high-quality data collection systems are essential. The introduction of the Second-Generation Transplant Registry Unified Management Program (TRUMP2) is intended to improve data quality and more efficient data management. The TRUMP2 system will also expand possible uses of data, as it is capable of building a more complex relational database. The construction of an accessible data utilization system for adequate data utilization by researchers would promote greater research activity. Study approval and management processes and authorship guidelines also need to be organized within this context. Quality control of processes for data manipulation and analysis will also affect study outcomes. Shared scripts have been introduced to define variables according to standard definitions for quality control and improving efficiency of registry studies using TRUMP data.

Incorporating coping into an expectancy framework for explaining drinking behaviour.

PubMed

Hasking, Penelope A; Oei, Tian P S

2008-01-01

Expectancy Theory has offered much in the way of understanding alcohol use and abuse, and has contributed greatly to prevention and treatment initiatives. However although many cognitive-behavioural treatment approaches are based on expectancy constructs, such as outcome expectancies and self-efficacy, high relapse rates imply that expectancy theory may be too narrow in scope, and that additional variables need to be examined if a comprehensive understanding of drinking behaviour, and better treatment outcomes, are to be achieved. We suggest that the coping strategies an individual employs present one such set of variables that have largely been neglected from an expectancy framework. Although coping skills training is routinely used in prevention and treatment of alcohol problems, coping research has suffered from a poor theoretical framework. In this paper we review the existing research relating expectancies, self-efficacy and coping to drinking behaviour and propose a model which explains both social and dependent drinking, by incorporating coping into an expectancy theory framework. We also outline research and clinical implications of the proposed model.

Predictors of Engagement in Family Mediation and Outcomes for Families that Fail to Engage.

PubMed

Morris, Megan; Halford, W Kim; Petch, Jemima; Hardwick, David

2018-03-01

An important limitation to the effectiveness of family mediation in assisting separated parents is parents failing to engage in the mediation process. In 524 parents who presented to a telephone-based mediation service, 113 (22%) initiating parents withdrew from mediation before the other parent was invited to participate, 241 (46%) initiating parents had respondent parents who declined to participate in mediation, and 170 cases (33%) completed mediation. We tested whether socio-demographic variables, psychological distress, coparental acrimony, parenting problems, or children's behavioral difficulties predicted mediation engagement. High interparental acrimony predicted failure to engage in mediation, but none of the other variables predicted mediation engagement. We followed a sample of 131 families that did not mediate and found they showed elevated psychological distress, acrimony, parenting problems and child adjustment difficulties, which remained unchanged 6 months later. Further research is needed to explore strategies to enhance respondent parent engagement with mediation, and to address the negative outcomes for those separated families not proceeding with mediation. © 2016 Family Process Institute.

Role of Parent and Peer Relationships and Individual Characteristics in Middle School Children's Behavioral Outcomes in the Face of Community Violence

PubMed Central

Salzinger, Suzanne; Rosario, Margaret; Feldman, Richard S.; Ng-Mak, Daisy S.

2010-01-01

This study examines processes linking inner-city community violence exposure to subsequent internalizing and externalizing problems. Hypothesized risk and protective factors from three ecological domains -- children's parent and peer relationships and individual characteristics -- were examined for mediating, moderating or independent roles in predicting problem behavior among 667 children over three years of middle school. Mediation was not found. However, parent and peer variables moderated the association between exposure and internalizing problems. Under high exposure, normally protective factors (e.g., attachment to parents) were less effective in mitigating exposure's effects than under low exposure; attachment to friends was more effective. Individual competence was independently associated with decreased internalizing problems. Variables from all domains, and exposure, were independently associated with externalizing problems. Protective factors (e.g., parent attachment) predicted decreased problems; risk factors (e.g., friends' delinquency) predicted increased problems. Results indicate community violence reduction as essential in averting inner-city adolescents' poor behavioral outcomes. PMID:21643493

Random Survival Forest in practice: a method for modelling complex metabolomics data in time to event analysis.

PubMed

Dietrich, Stefan; Floegel, Anna; Troll, Martina; Kühn, Tilman; Rathmann, Wolfgang; Peters, Anette; Sookthai, Disorn; von Bergen, Martin; Kaaks, Rudolf; Adamski, Jerzy; Prehn, Cornelia; Boeing, Heiner; Schulze, Matthias B; Illig, Thomas; Pischon, Tobias; Knüppel, Sven; Wang-Sattler, Rui; Drogan, Dagmar

2016-10-01

The application of metabolomics in prospective cohort studies is statistically challenging. Given the importance of appropriate statistical methods for selection of disease-associated metabolites in highly correlated complex data, we combined random survival forest (RSF) with an automated backward elimination procedure that addresses such issues. Our RSF approach was illustrated with data from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam study, with concentrations of 127 serum metabolites as exposure variables and time to development of type 2 diabetes mellitus (T2D) as outcome variable. Out of this data set, Cox regression with a stepwise selection method was recently published. Replication of methodical comparison (RSF and Cox regression) was conducted in two independent cohorts. Finally, the R-code for implementing the metabolite selection procedure into the RSF-syntax is provided. The application of the RSF approach in EPIC-Potsdam resulted in the identification of 16 incident T2D-associated metabolites which slightly improved prediction of T2D when used in addition to traditional T2D risk factors and also when used together with classical biomarkers. The identified metabolites partly agreed with previous findings using Cox regression, though RSF selected a higher number of highly correlated metabolites. The RSF method appeared to be a promising approach for identification of disease-associated variables in complex data with time to event as outcome. The demonstrated RSF approach provides comparable findings as the generally used Cox regression, but also addresses the problem of multicollinearity and is suitable for high-dimensional data. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

Scarring of Soft Tissues Following Apical Surgery: Visual Assessment of Outcomes One Year After Intervention Using the Bern and Manchester Scores.

PubMed

von Arx, Thomas; Janner, Simone Fm; Hänni, Stefan; Bornstein, Michael M

The successful outcome of apical surgery is usually defined by absence of clinical signs and symptoms and resolution of previous periapical radiolucencies. However, little attention is given to soft tissue scarring. The present study evaluated the severity of gingival and mucosal scarring 1 year following apical surgery of 52 teeth. Clinical pictures taken at the 1-year examination were rated by three observers using specific scarring scores. The overall repeatability of the two scores was high (85.3%), whereas the overall reproducibility was relatively low (44.2%). None of the tested variables proved significant for influencing scar severity.

The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables.

PubMed

Rafiei, Sima; Pourreza, Abolghasem

2013-06-01

Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities.

Intradetrusor onabotulinumtoxinA injections for refractory neurogenic detrusor overactivity incontinence: do we need urodynamic investigation for outcome assessment?

PubMed

Koschorke, Miriam; Leitner, Lorenz; Sadri, Helen; Knüpfer, Stephanie C; Mehnert, Ulrich; Kessler, Thomas M

2017-12-01

To evaluate if urinary continence in patients with refractory neurogenic detrusor overactivity (NDO) incontinence after intradetrusor onabotulinumtoxinA injections is sufficient for appropriate outcome assessment or if urodynamic investigation (UDI) is needed. A consecutive series of 148 patients undergoing intradetrusor onabotulinumtoxinA injections for refractory NDO incontinence were prospectively evaluated. Patients underwent UDI before and at 6 weeks after onabotulinumtoxinA injections. The primary outcome was the prevalence of maximum storage detrusor pressure (Pdet max storage) of >40 cmH 2 O in continent patients at 6 weeks after treatment. The secondary outcomes were treatment effects on other clinical and video-urodynamic variables. At 6 weeks after intradetrusor onabotulinumtoxinA injections, 98 of the 148 patients (66%) with NDO incontinence were continent. Of these patients, 18 (18%, confidence interval 12-27%) had a Pdet max storage of >40 cmH 2 O. Gender, underlying neurological disorder, and high Pdet max storage before treatment appear to increase the risk of poor urodynamic outcomes. Urinary continence is not sufficient for outcome assessment after intradetrusor onabotulinumtoxinA injections, as high intravesical pressures threatening the upper urinary tract may be missed in a relevant proportion of continent patients. Therefore, we strongly recommend UDI as a routine part of the follow-up. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Do patient characteristics predict outcome in the outpatient treatment of chronic tinnitus?

PubMed

Kröner-Herwig, Birgit; Zachriat, Claudia; Weigand, Doreen

2006-12-06

Various patient characteristics were assessed before offering a treatment to reduce tinnitus related distress to 57 individuals suffering from chronic idiopathic tinnitus. Patients were randomly assigned to a cognitive-behavioral tinnitus coping training (TCT) and a habituation-based training (HT) modelled after Tinnitus Retraining Therapy (TRT) as conceived by Jastreboff. Both trainings were conducted in groups. It was hypothesized that comorbidity regarding mental disorders or psychopathological symptoms (DSM-IV diagnoses, SCL-90R score) and a high level of dysfunctional cognitions relating to tinnitus would have a negative effect on therapy outcome while both trainings proved to be highly efficacious for the average patient. Also further patient features (assessed at baseline) were explored as potential predictors of outcome. None of the hypotheses was corroborated by the data. On the contrary, a higher number of diagnoses was associated with better outcome (statistical trend) and a higher extent of annoyance and interference led to a larger positive change in patients if treated by TCT. No predictor could be identified for long-term success (follow-up ≥18 months) except regarding education. The higher the educational level, the larger was the improvement in HT patients. It is concluded that therapy outcome of TCT and HT can not reliably be predicted by patient characteristics and that early variables of the therapeutic process should be analysed as potentially predicting subsequent therapeutic outcome.

Do patient characteristics predict outcome in the outpatient treatment of chronic tinnitus?

PubMed Central

Kröner-Herwig, Birgit; Zachriat, Claudia; Weigand, Doreen

2006-01-01

Various patient characteristics were assessed before offering a treatment to reduce tinnitus related distress to 57 individuals suffering from chronic idiopathic tinnitus. Patients were randomly assigned to a cognitive-behavioral tinnitus coping training (TCT) and a habituation-based training (HT) modelled after Tinnitus Retraining Therapy (TRT) as conceived by Jastreboff. Both trainings were conducted in groups. It was hypothesized that comorbidity regarding mental disorders or psychopathological symptoms (DSM-IV diagnoses, SCL-90R score) and a high level of dysfunctional cognitions relating to tinnitus would have a negative effect on therapy outcome while both trainings proved to be highly efficacious for the average patient. Also further patient features (assessed at baseline) were explored as potential predictors of outcome. None of the hypotheses was corroborated by the data. On the contrary, a higher number of diagnoses was associated with better outcome (statistical trend) and a higher extent of annoyance and interference led to a larger positive change in patients if treated by TCT. No predictor could be identified for long-term success (follow-up ≥18 months) except regarding education. The higher the educational level, the larger was the improvement in HT patients. It is concluded that therapy outcome of TCT and HT can not reliably be predicted by patient characteristics and that early variables of the therapeutic process should be analysed as potentially predicting subsequent therapeutic outcome. PMID:19742075

Associations of educational attainment, occupation, and community poverty with hip osteoarthritis.

PubMed

Cleveland, Rebecca J; Schwartz, Todd A; Prizer, Lindsay P; Randolph, Randy; Schoster, Britta; Renner, Jordan B; Jordan, Joanne M; Callahan, Leigh F

2013-06-01

To examine cross-sectional baseline data from the Johnston County Osteoarthritis Project for the association between individual and community socioeconomic status (SES) measures with hip osteoarthritis (OA) outcomes. We analyzed data on 3,087 individuals (68% white and 32% African American). Educational attainment and occupation were used as individual measures of SES. Census block group household poverty rate was used as a measure of community SES. Hip OA outcomes included radiographic OA and symptomatic OA in one or both hip joints. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association of each hip OA outcome with each SES variable separately, and then with all SES measures simultaneously. Associations between hip OA outcomes and SES variables were evaluated for effect modification by race and sex. Living in a community of high household poverty rate showed independent associations with hip radiographic OA in one or both hips (OR 1.50, 95% CI 1.18-1.92) and bilateral (both hips) radiographic OA (OR 1.87, 95% CI 1.32-2.66). Similar independent associations were found between low educational attainment among those with symptomatic OA in one or both hips (OR 1.44, 95% CI 1.09-1.91) or bilateral symptomatic OA (OR 1.91, 95% CI 1.08-3.39), after adjusting for all SES measures simultaneously. No significant associations were observed between occupation and hip OA outcomes, nor did race or sex modify the associations. Our data provide evidence that hip OA outcomes are associated with both education and community SES measures, associations that remained after adjustment for covariates and all SES measures. Copyright © 2013 by the American College of Rheumatology.

A comparison of pregnancy outcomes in Ghanaian women with varying dietary diversity: a prospective cohort study protocol

PubMed Central

Saaka, Mahama; Siassi, Fereydoun; Qorbani, Mostafa; Yavari, Parvaneh; Danquah, Ina; Sotoudeh, Gity

2016-01-01

Introduction Poor dietary intake during pregnancy can have negative repercussions on the mother and fetus. This study therefore aims to explore the dietary diversity (DD) of pregnant women and its associations with pregnancy outcomes among women in Northern Ghana. The main outcome variables to be measured are gestational weight gain and birth weight. Methods and analysis A prospective cohort study design will be used and 600 pregnant women in their first trimester will be systematically recruited at health facilities and followed until delivery. In three follow-up visits after recruitment, information on sociodemographic and general characteristics, physical activity (International Physical Activity Questionnaire (IPAQ) short form, dietary intake (24-hour food recall), anthropometry and pregnancy outcomes will be collected. DD will be measured three times using the minimum DD-women (MDD-W) indicator and the mean of the three values overall will be used to determine low (<5 food groups) and high (≥5 food groups) DD. Data will be analysed using SPSS. Comparisons between groups (categorical data) will be made using the χ2 test for proportions, and t-tests and ANOVA will be performed on continuous variables. Regression analysis will be used to identify independent outcome predictors while controlling for possible confounding factors. The results may help to identify differences in DD between healthy and unhealthy pregnancy outcomes. Ethics and dissemination The study protocol has been approved by the ethics committee of Tehran University of Medical Sciences and the ethical review committee of the Tamale Teaching Hospital. Written informed consent will be obtained from all subjects. The results will be published in due course. PMID:27655259

Reverse dipper pattern of blood pressure at 3 months is associated with inflammation and outcome after renal transplantation.

PubMed

Ibernon, Meritxell; Moreso, Francesc; Sarrias, Xavier; Sarrias, Maria; Grinyó, Josep M; Fernandez-Real, José M; Ricart, Wifredo; Serón, Daniel

2012-05-01

Cardiovascular disease is the major cause of morbidity and mortality after renal transplantation. It has been shown that both traditional and transplant-specific risk factors contribute to the high cardiovascular burden after renal transplantation The aim is to evaluate the association among ambulatory blood pressure monitoring (ABPM) at 3 months, inflammation and graft outcome. ABPM at 3 months was performed in 126 consecutive renal transplants. According to the nocturnal reduction of systolic blood pressure (SBP), dipper (ΔSBP ≥ 10%), non-dipper (0 < ΔSBP < 10%) and reverse dipper (SBP nocturnal rise) pattern were defined. The outcome variable was the combination of any cardiovascular event and graft failure for any reason. Circadian blood pressure pattern was dipper (n = 22), non-dipper (n = 65) and reverse dipper (n = 39). Reverse dipper pattern was associated with pre-transplant diabetes (18 versus 2%, P = 0.004), body mass index (26.9 ± 5.0 versus 24.8 ± 3.8 kg/m(2), P = 0.001), calcineurin inhibitor treatment (74 versus 54%, P = 0.001) and serum soluble tumour necrosis factor receptor 2 levels (18 ± 15 versus 11 ± 6 ng/mL, P = 0.010). During 45 ± 11 months of follow-up, 22 patients reached the combined outcome variable. Multivariate Cox regression analysis showed that reverse dipper pattern [relative risk (RR): 3.50 and 95% confidence interval (CI): 1.36-8.93; P = 0.009] and creatinine clearance (RR: 0.94 and 95% CI: 0.91-0.98, P = 0.003) were independently associated with outcome. The reverse dipper circadian pattern is associated with inflammation and constitutes an independent predictor of graft outcome.

Dysglycemia, Glycemic Variability, and Outcome After Cardiac Arrest and Temperature Management at 33°C and 36°C.

PubMed

Borgquist, Ola; Wise, Matt P; Nielsen, Niklas; Al-Subaie, Nawaf; Cranshaw, Julius; Cronberg, Tobias; Glover, Guy; Hassager, Christian; Kjaergaard, Jesper; Kuiper, Michael; Smid, Ondrej; Walden, Andrew; Friberg, Hans

2017-08-01

Dysglycemia and glycemic variability are associated with poor outcomes in critically ill patients. Targeted temperature management alters blood glucose homeostasis. We investigated the association between blood glucose concentrations and glycemic variability and the neurologic outcomes of patients randomized to targeted temperature management at 33°C or 36°C after cardiac arrest. Post hoc analysis of the multicenter TTM-trial. Primary outcome of this analysis was neurologic outcome after 6 months, referred to as "Cerebral Performance Category." Thirty-six sites in Europe and Australia. All 939 patients with out-of-hospital cardiac arrest of presumed cardiac cause that had been included in the TTM-trial. Targeted temperature management at 33°C or 36°C. Nonparametric tests as well as multiple logistic regression and mixed effects logistic regression models were used. Median glucose concentrations on hospital admission differed significantly between Cerebral Performance Category outcomes (p < 0.0001). Hyper- and hypoglycemia were associated with poor neurologic outcome (p = 0.001 and p = 0.054). In the multiple logistic regression models, the median glycemic level was an independent predictor of poor Cerebral Performance Category (Cerebral Performance Category, 3-5) with an odds ratio (OR) of 1.13 in the adjusted model (p = 0.008; 95% CI, 1.03-1.24). It was also a predictor in the mixed model, which served as a sensitivity analysis to adjust for the multiple time points. The proportion of hyperglycemia was higher in the 33°C group compared with the 36°C group. Higher blood glucose levels at admission and during the first 36 hours, and higher glycemic variability, were associated with poor neurologic outcome and death. More patients in the 33°C treatment arm had hyperglycemia.

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

Is voluntary certification of tropical agricultural commodities achieving sustainability goals for small-scale producers? A review of the evidence

NASA Astrophysics Data System (ADS)

DeFries, Ruth S.; Fanzo, Jessica; Mondal, Pinki; Remans, Roseline; Wood, Stephen A.

2017-03-01

Over the last several decades, voluntary certification programs have become a key approach to promote sustainable supply chains for agricultural commodities. These programs provide premiums and other benefits to producers for adhering to environmental and labor practices established by the certifying entities. Following the principles of Cochrane Reviews used in health sciences, we assess evidence to evaluate whether voluntary certification of tropical agricultural commodities (bananas, cocoa, coffee, oil palm, and tea) has achieved environmental benefits and improved economic and social outcomes for small-scale producers at the level of the farm household. We reviewed over 2600 papers in the peer-review literature and identified 24 cases of unique combinations of study area, certification program, and commodity in 16 papers that rigorously analyzed differences between treatment (certified households) and control groups (uncertified households) for a wide range of response variables. Based on analysis of 347 response variables reported in these papers, we conclude that certification is associated on average with positive outcomes for 34% of response variables, no significant difference for 58% of variables, and negative outcomes for 8% of variables. No significant differences were observed for different categories of responses (environmental, economic and social) or for different commodities (banana, coffee and tea), except negative outcomes were significantly less for environmental than other outcome categories (p = 0.01). Most cases (20 out of 24) investigated coffee certification and response variables were inconsistent across cases, indicating the paucity of studies to conduct a conclusive meta-analysis. The somewhat positive results indicate that voluntary certification programs can sometimes play a role in meeting sustainable development goals and do not support the view that such programs are merely greenwashing. However, results also indicate that certification is not a panacea to improve social outcomes or overall incomes of smallholder farmers. Rigorous analysis, standardized criteria, and independent evaluation are needed to assess effectiveness of certification programs in the future.

Investing in improved performance of national tuberculosis programs reduces the tuberculosis burden: analysis of 22 high-burden countries, 2002-2009.

PubMed

Akachi, Yoko; Zumla, Alimuddin; Atun, Rifat

2012-05-15

To assess the impact of investment in national tuberculosis programs (NTPs) on NTP performance and tuberculosis burden in 22 high-burden countries, as determined by the World Health Organization (WHO). Estimates of annual tuberculosis burden and NTP performance indicators and control variables during 2002-2009 were obtained from the Organization for Economic Cooperation and Development, the WHO, the World Bank, and the Penn World Table for the 22 high-burden countries. Panel data analysis was performed using the outcome variables tuberculosis incidence, prevalence, and mortality and the key explanatory variables Partnership case detection rate and treatment success rate, controlling for gross domestic product per capita, population structure, and human immunodeficiency virus (HIV) prevalence. A $1 per capita (general population) higher NTP budget (including domestic and external sources) was associated with a 1.9% (95% confidence interval, .12%-3.6%) higher estimated case detection rate the following year for the 22 high-burden countries between 2002 and 2009. In the final models, which corrected for autocorrelation and heteroskedasticity, achieving the STOP TB Partnership case detection rate target of >70% was associated with significantly (P < .01) lower tuberculosis incidence, prevalence, and mortality the following year, even when controlling for general economic development and HIV prevalence as potential confounding variables. Increased investment in NTPs was significantly associated with improved performance and with a downward trend in the tuberculosis burden in the 22 high-burden countries during 2002-2009.

Analysis of Genome-Wide Association Studies with Multiple Outcomes Using Penalization

PubMed Central

Liu, Jin; Huang, Jian; Ma, Shuangge

2012-01-01

Genome-wide association studies have been extensively conducted, searching for markers for biologically meaningful outcomes and phenotypes. Penalization methods have been adopted in the analysis of the joint effects of a large number of SNPs (single nucleotide polymorphisms) and marker identification. This study is partly motivated by the analysis of heterogeneous stock mice dataset, in which multiple correlated phenotypes and a large number of SNPs are available. Existing penalization methods designed to analyze a single response variable cannot accommodate the correlation among multiple response variables. With multiple response variables sharing the same set of markers, joint modeling is first employed to accommodate the correlation. The group Lasso approach is adopted to select markers associated with all the outcome variables. An efficient computational algorithm is developed. Simulation study and analysis of the heterogeneous stock mice dataset show that the proposed method can outperform existing penalization methods. PMID:23272092

Just tell me what to do: bringing back experimenter control in active contingency tasks with the command-performance procedure and finding cue density effects along the way.

PubMed

Hannah, Samuel D; Beneteau, Jennifer L

2009-03-01

Active contingency tasks, such as those used to explore judgments of control, suffer from variability in the actual values of critical variables. The authors debut a new, easily implemented procedure that restores control over these variables to the experimenter simply by telling participants when to respond, and when to withhold responding. This command-performance procedure not only restores control over critical variables such as actual contingency, it also allows response frequency to be manipulated independently of contingency or outcome frequency. This yields the first demonstration, to our knowledge, of the equivalent of a cue density effect in an active contingency task. Judgments of control are biased by response frequency outcome frequency, just as they are also biased by outcome frequency. (c) 2009 APA, all rights reserved

Body fat distribution in perinatally HIV-infected and HIV-exposed but uninfected children in the era of highly active antiretroviral therapy: outcomes from the Pediatric HIV/AIDS Cohort Study

USDA-ARS?s Scientific Manuscript database

Associations between abnormal body fat distribution and clinical variables are poorly understood in pediatric HIV disease. Our objective was to compare total body fat and its distribution in perinatally HIV-infected and HIV-exposed but uninfected (HEU) children and to evaluate associations with clin...

Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

PubMed Central

Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

2015-01-01

Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

A conceptual framework of outcomes for caregivers of assistive technology users.

PubMed

Demers, Louise; Fuhrer, Marcus J; Jutai, Jeffrey; Lenker, James; Depa, Malgorzata; De Ruyter, Frank

2009-08-01

To develop and validate the content of a conceptual framework concerning outcomes for caregivers whose recipients are assistive technology users. The study was designed in four stages. First, a list of potential key variables relevant to the caregivers of assistive technology users was generated from a review of the existing literature and semistructured interviews with caregivers. Second, the variables were analyzed, regrouped, and partitioned, using a conceptual mapping approach. Third, the key areas were anchored in a general stress model of caregiving. Finally, the judgments of rehabilitation experts were used to evaluate the conceptual framework. An important result of this study is the identification of a complex set of variables that need to be considered when examining the experience of caregivers of assistive technology users. Stressors, such as types of assistance, number of tasks, and physical effort, are predominant contributors to caregiver outcomes along with caregivers' personal resources acting as mediating factors (intervening variables) and assistive technology acting as a key moderating factor (effect modifier variable). Recipients' use of assistive technology can enhance caregivers' well being because of its potential for alleviating a number of stressors associated with caregiving. Viewed as a whole, this work demonstrates that the assistive technology experience of caregivers has many facets that merit the attention of outcomes researchers.

Bayesian methods to determine performance differences and to quantify variability among centers in multi-center trials: the IHAST trial.

PubMed

Bayman, Emine O; Chaloner, Kathryn M; Hindman, Bradley J; Todd, Michael M

2013-01-16

To quantify the variability among centers and to identify centers whose performance are potentially outside of normal variability in the primary outcome and to propose a guideline that they are outliers. Novel statistical methodology using a Bayesian hierarchical model is used. Bayesian methods for estimation and outlier detection are applied assuming an additive random center effect on the log odds of response: centers are similar but different (exchangeable). The Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) is used as an example. Analyses were adjusted for treatment, age, gender, aneurysm location, World Federation of Neurological Surgeons scale, Fisher score and baseline NIH stroke scale scores. Adjustments for differences in center characteristics were also examined. Graphical and numerical summaries of the between-center standard deviation (sd) and variability, as well as the identification of potential outliers are implemented. In the IHAST, the center-to-center variation in the log odds of favorable outcome at each center is consistent with a normal distribution with posterior sd of 0.538 (95% credible interval: 0.397 to 0.726) after adjusting for the effects of important covariates. Outcome differences among centers show no outlying centers. Four potential outlying centers were identified but did not meet the proposed guideline for declaring them as outlying. Center characteristics (number of subjects enrolled from the center, geographical location, learning over time, nitrous oxide, and temporary clipping use) did not predict outcome, but subject and disease characteristics did. Bayesian hierarchical methods allow for determination of whether outcomes from a specific center differ from others and whether specific clinical practices predict outcome, even when some centers/subgroups have relatively small sample sizes. In the IHAST no outlying centers were found. The estimated variability between centers was moderately large.

Predictors of the number of under-five malnourished children in Bangladesh: application of the generalized poisson regression model

PubMed Central

2013-01-01

Background Malnutrition is one of the principal causes of child mortality in developing countries including Bangladesh. According to our knowledge, most of the available studies, that addressed the issue of malnutrition among under-five children, considered the categorical (dichotomous/polychotomous) outcome variables and applied logistic regression (binary/multinomial) to find their predictors. In this study malnutrition variable (i.e. outcome) is defined as the number of under-five malnourished children in a family, which is a non-negative count variable. The purposes of the study are (i) to demonstrate the applicability of the generalized Poisson regression (GPR) model as an alternative of other statistical methods and (ii) to find some predictors of this outcome variable. Methods The data is extracted from the Bangladesh Demographic and Health Survey (BDHS) 2007. Briefly, this survey employs a nationally representative sample which is based on a two-stage stratified sample of households. A total of 4,460 under-five children is analysed using various statistical techniques namely Chi-square test and GPR model. Results The GPR model (as compared to the standard Poisson regression and negative Binomial regression) is found to be justified to study the above-mentioned outcome variable because of its under-dispersion (variance < mean) property. Our study also identify several significant predictors of the outcome variable namely mother’s education, father’s education, wealth index, sanitation status, source of drinking water, and total number of children ever born to a woman. Conclusions Consistencies of our findings in light of many other studies suggest that the GPR model is an ideal alternative of other statistical models to analyse the number of under-five malnourished children in a family. Strategies based on significant predictors may improve the nutritional status of children in Bangladesh. PMID:23297699

Neurointerventional Treatment in Acute Stroke. Whom to Treat? (Endovascular Treatment for Acute Stroke: Utility of THRIVE Score and HIAT Score for Patient Selection)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fjetland, Lars, E-mail: lars.fjetland@lyse.net; Roy, Sumit, E-mail: sumit.roy@sus.no; Kurz, Kathinka D., E-mail: kathinka.dehli.kurz@sus.no

2013-10-15

Purpose: Intra-arterial therapy (IAT) is used increasingly as a treatment option for acute stroke caused by central large vessel occlusions. Despite high rates of recanalization, the clinical outcome is highly variable. The authors evaluated the Houston IAT (HIAT) and the totaled health risks in vascular events (THRIVE) score, two predicting scores designed to identify patients likely to benefit from IAT. Methods: Fifty-two patients treated at the Stavanger University Hospital with IAT from May 2009 to June 2012 were included in this study. We combined the scores in an additional analysis. We also performed an additional analysis according to high agemore » and evaluated the scores in respect of technical efficacy. Results: Fifty-two patients were evaluated by the THRIVE score and 51 by the HIAT score. We found a strong correlation between the level of predicted risk and the actual clinical outcome (THRIVE p = 0.002, HIAT p = 0.003). The correlations were limited to patients successfully recanalized and to patients <80 years. By combining the scores additional 14.3 % of the patients could be identified as poor candidates for IAT. Both scores were insufficient to identify patients with a good clinical outcome. Conclusions: Both scores showed a strong correlation to poor clinical outcome in patients <80 years. The specificity of the scores could be enhanced by combining them. Both scores were insufficient to identify patients with a good clinical outcome and showed no association to clinical outcome in patients aged {>=}80 years.« less

Leg pain and psychological variables predict outcome 2-3 years after lumbar fusion surgery.

PubMed

Abbott, Allan D; Tyni-Lenné, Raija; Hedlund, Rune

2011-10-01

Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

Standard care quality determines treatment outcomes in control groups of HAART-adherence intervention studies: implications for the interpretation and comparison of intervention effects.

PubMed

de Bruin, Marijn; Viechtbauer, Wolfgang; Hospers, Harm J; Schaalma, Herman P; Kok, Gerjo

2009-11-01

Clinical trials of behavioral interventions seek to enhance evidence-based health care. However, in case the quality of standard care provided to control conditions varies between studies and affects outcomes, intervention effects cannot be directly interpreted or compared. The objective of the present study was to examine whether standard care quality (SCQ) could be reliably assessed, varies between studies of highly active antiretroviral HIV-adherence interventions, and is related to the proportion of patients achieving an undetectable viral load ("success rate"). Databases were searched for relevant articles. Authors of selected studies retrospectively completed a checklist with standard care activities, which were coded to compute SCQ scores. The relationship between SCQ and the success rates was examined using meta-regression. Cronbach's alpha, variability in SCQ, and relation between SCQ and success rate. Reliability of the SCQ instrument was high (Cronbach's alpha = .91). SCQ scores ranged from 3.7 to 27.8 (total range = 0-30) and were highly predictive of success rate (p = .002). Variation in SCQ provided to control groups may substantially influence effect sizes of behavior change interventions. Future trials should therefore assess and report SCQ, and meta-analyses should control for variability in SCQ, thereby producing more accurate estimates of the effectiveness of behavior change interventions. PsycINFO Database Record (c) 2009 APA, all rights reserved.

Simplified method to isolate highly pure canine pancreatic islets.

PubMed

Woolcott, Orison O; Bergman, Richard N; Richey, Joyce M; Kirkman, Erlinda L; Harrison, L Nicole; Ionut, Viorica; Lottati, Maya; Zheng, Dan; Hsu, Isabel R; Stefanovski, Darko; Kabir, Morvarid; Kim, Stella P; Catalano, Karyn J; Chiu, Jenny D; Chow, Robert H

2012-01-01

The canine model has been used extensively to improve the human pancreatic islet isolation technique. At the functional level, dog islets show high similarity to human islets and thus can be a helpful tool for islet research. We describe and compare 2 manual isolation methods, M1 (initial) and M2 (modified), and analyze the variables associated with the outcomes, including islet yield, purity, and glucose-stimulated insulin secretion (GSIS). Male mongrel dogs were used in the study. M2 (n = 7) included higher collagenase concentration, shorter digestion time, faster shaking speed, colder purification temperature, and higher differential density gradient than M1 (n = 7). Islet yield was similar between methods (3111.0 ± 309.1 and 3155.8 ± 644.5 islets/g, M1 and M2, respectively; P = 0.951). Pancreas weight and purity together were directly associated with the yield (adjusted R(2) = 0.61; P = 0.002). Purity was considerably improved with M2 (96.7% ± 1.2% vs 75.0% ± 6.3%; P = 0.006). M2 improved GSIS (P = 0.021). Independently, digestion time was inversely associated with GSIS. We describe an isolation method (M2) to obtain a highly pure yield of dog islets with adequate β-cell glucose responsiveness. The isolation variables associated with the outcomes in our canine model confirm previous reports in other species, including humans.

Simplified Method to Isolate Highly Pure Canine Pancreatic Islets

PubMed Central

Woolcott, Orison O.; Bergman, Richard N.; Richey, Joyce M.; Kirkman, Erlinda L.; Harrison, L. Nicole; Ionut, Viorica; Lottati, Maya; Zheng, Dan; Hsu, Isabel R.; Stefanovski, Darko; Kabir, Morvarid; Kim, Stella P.; Catalano, Karyn J.; Chiu, Jenny D.; Chow, Robert H.

2015-01-01

Objectives The canine model has been used extensively to improve the human pancreatic islet isolation technique. At the functional level, dog islets show high similarity to human islets and thus can be a helpful tool for islet research. We describe and compare 2 manual isolation methods, M1 (initial) and M2 (modified), and analyze the variables associated with the outcomes, including islet yield, purity, and glucose-stimulated insulin secretion (GSIS). Methods Male mongrel dogs were used in the study. M2 (n = 7) included higher collagenase concentration, shorter digestion time, faster shaking speed, colder purification temperature, and higher differential density gradient than M1 (n = 7). Results Islet yield was similar between methods (3111.0 ± 309.1 and 3155.8 ± 644.5 islets/g, M1 and M2, respectively; P = 0.951). Pancreas weight and purity together were directly associated with the yield (adjusted R2 = 0.61; P = 0.002). Purity was considerably improved with M2 (96.7% ± 1.2% vs 75.0% ± 6.3%; P = 0.006). M2 improved GSIS (P = 0.021). Independently, digestion time was inversely associated with GSIS. Conclusions We describe an isolation method (M2) to obtain a highly pure yield of dog islets with adequate β-cell glucose responsiveness. The isolation variables associated with the outcomes in our canine model confirm previous reports in other species, including humans. PMID:21792087

Protocols and Hospital Mortality in Critically ill Patients: The United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study

PubMed Central

Sevransky, Jonathan E.; Checkley, William; Herrera, Phabiola; Pickering, Brian W.; Barr, Juliana; Brown, Samuel M; Chang, Steven Y; Chong, David; Kaufman, David; Fremont, Richard D; Girard, Timothy D; Hoag, Jeffrey; Johnson, Steven B; Kerlin, Mehta P; Liebler, Janice; O'Brien, James; O'Keefe, Terence; Park, Pauline K; Pastores, Stephen M; Patil, Namrata; Pietropaoli, Anthony P; Putman, Maryann; Rice, Todd W.; Rotello, Leo; Siner, Jonathan; Sajid, Sahul; Murphy, David J; Martin, Greg S

2015-01-01

Objective Clinical protocols may decrease unnecessary variation in care and improve compliance with desirable therapies. We evaluated whether highly protocolized intensive care units have superior patient outcomes compared with less highly protocolized intensive care units. Design Observational study in which participating intensive care units completed a general assessment and enrolled new patients one day each week. Setting and Patients 6179 critically ill patients across 59 intensive care units in the United States Critical Illness and Injury Trials Group Critical Illness Outcomes Study Interventions: None Measurements and Main Results The primary exposure was the number of intensive care unit protocols; the primary outcome was hospital mortality. 5809 participants were followed prospectively and 5454 patients in 57 intensive care units had complete outcome data. The median number of protocols per intensive care unit was 19 (IQR 15 to 21.5). In single variable analyses, there were no differences in intensive care unit and hospital mortality, length of stay, use of mechanical ventilation, vasopressors, or continuous sedation among individuals in intensive care units with a high vs. low number of protocols. The lack of association was confirmed in adjusted multivariable analysis (p=0.70). Protocol compliance with two ventilator management protocols was moderate and did not differ between intensive care units with high vs. low numbers of protocols for lung protective ventilation in ARDS (47% vs. 52%; p=0.28) and for spontaneous breathing trials (55% vs. 51%; p=0.27). Conclusions Clinical protocols are highly prevalent in United States intensive care units. The presence of a greater number of protocols was not associated with protocol compliance or patient mortality. PMID:26110488

Depression and smoking characteristics among HIV-positive smokers in Russia: A cross-sectional study.

PubMed

Lasser, Karen E; Lunze, Karsten; Cheng, Debbie M; Blokhina, Elena; Walley, Alexander Y; Tindle, Hilary A; Quinn, Emily; Gnatienko, Natalia; Krupitsky, Evgeny; Samet, Jeffrey H

2018-01-01

Globally, persons with HIV infection, depression and substance use disorders have a higher smoking prevalence and smoke more heavily than other populations. These associations have not been explored among Russian smokers with HIV infection and substance use disorders. The purpose of this study was to examine the relationship between the presence of depressive symptoms and smoking outcomes in an HIV-positive cohort of Russian smokers with a history of substance use disorders (alcohol and/or drug use disorders). We performed a cross-sectional secondary data analysis of a cohort of HIV-positive regular smokers with a history of substance use disorders recruited in St. Petersburg, Russia in 2012-2015. The primary outcome was heavy smoking, defined as smoking > 20 cigarettes per day. Nicotine dependence (moderate-very high) was a secondary outcome. The main independent variable was a high level of depressive symptoms in the past 7 days (defined as CES-D > = 24). We used multivariable logistic regression to examine associations between depressive symptoms and the outcomes, controlling for age, sex, education, income, running out of money for housing/food, injection drug use, and alcohol use measured by the AUDIT. Among 309 regular smokers, 79 participants (25.6%) had high levels of depressive symptoms, and 65 participants (21.0%) were heavy smokers. High levels of depressive symptoms were not significantly associated with heavy smoking (adjusted odds ratio [aOR] 1.50, 95% CI 0.78-2.89) or with moderate-very high levels of nicotine dependence (aOR 1.35, 95% CI 0.75-2.41). This study did not detect an association between depressive symptoms and smoking outcomes among HIV-positive regular smokers in Russia.

Molecular Classification Substitutes for the Prognostic Variables Stage, Age, and MYCN Status in Neuroblastoma Risk Assessment.

PubMed

Rosswog, Carolina; Schmidt, Rene; Oberthuer, André; Juraeva, Dilafruz; Brors, Benedikt; Engesser, Anne; Kahlert, Yvonne; Volland, Ruth; Bartenhagen, Christoph; Simon, Thorsten; Berthold, Frank; Hero, Barbara; Faldum, Andreas; Fischer, Matthias

2017-12-01

Current risk stratification systems for neuroblastoma patients consider clinical, histopathological, and genetic variables, and additional prognostic markers have been proposed in recent years. We here sought to select highly informative covariates in a multistep strategy based on consecutive Cox regression models, resulting in a risk score that integrates hazard ratios of prognostic variables. A cohort of 695 neuroblastoma patients was divided into a discovery set (n=75) for multigene predictor generation, a training set (n=411) for risk score development, and a validation set (n=209). Relevant prognostic variables were identified by stepwise multivariable L1-penalized least absolute shrinkage and selection operator (LASSO) Cox regression, followed by backward selection in multivariable Cox regression, and then integrated into a novel risk score. The variables stage, age, MYCN status, and two multigene predictors, NB-th24 and NB-th44, were selected as independent prognostic markers by LASSO Cox regression analysis. Following backward selection, only the multigene predictors were retained in the final model. Integration of these classifiers in a risk scoring system distinguished three patient subgroups that differed substantially in their outcome. The scoring system discriminated patients with diverging outcome in the validation cohort (5-year event-free survival, 84.9±3.4 vs 63.6±14.5 vs 31.0±5.4; P<.001), and its prognostic value was validated by multivariable analysis. We here propose a translational strategy for developing risk assessment systems based on hazard ratios of relevant prognostic variables. Our final neuroblastoma risk score comprised two multigene predictors only, supporting the notion that molecular properties of the tumor cells strongly impact clinical courses of neuroblastoma patients. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Re-construction of action awareness depends on an internal model of action-outcome timing.

PubMed

Stenner, Max-Philipp; Bauer, Markus; Machts, Judith; Heinze, Hans-Jochen; Haggard, Patrick; Dolan, Raymond J

2014-04-01

The subjective time of an instrumental action is shifted towards its outcome. This temporal binding effect is partially retrospective, i.e., occurs upon outcome perception. Retrospective binding is thought to reflect post-hoc inference on agency based on sensory evidence of the action - outcome association. However, many previous binding paradigms cannot exclude the possibility that retrospective binding results from bottom-up interference of sensory outcome processing with action awareness and is functionally unrelated to the processing of the action - outcome association. Here, we keep bottom-up interference constant and use a contextual manipulation instead. We demonstrate a shift of subjective action time by its outcome in a context of variable outcome timing. Crucially, this shift is absent when there is no such variability. Thus, retrospective action binding reflects a context-dependent, model-based phenomenon. Such top-down re-construction of action awareness seems to bias agency attribution when outcome predictability is low. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Re-construction of action awareness depends on an internal model of action-outcome timing

PubMed Central

Stenner, Max-Philipp; Bauer, Markus; Machts, Judith; Heinze, Hans-Jochen; Haggard, Patrick; Dolan, Raymond J.

2014-01-01

The subjective time of an instrumental action is shifted towards its outcome. This temporal binding effect is partially retrospective, i.e., occurs upon outcome perception. Retrospective binding is thought to reflect post-hoc inference on agency based on sensory evidence of the action – outcome association. However, many previous binding paradigms cannot exclude the possibility that retrospective binding results from bottom-up interference of sensory outcome processing with action awareness and is functionally unrelated to the processing of the action – outcome association. Here, we keep bottom-up interference constant and use a contextual manipulation instead. We demonstrate a shift of subjective action time by its outcome in a context of variable outcome timing. Crucially, this shift is absent when there is no such variability. Thus, retrospective action binding reflects a context-dependent, model-based phenomenon. Such top-down re-construction of action awareness seems to bias agency attribution when outcome predictability is low. PMID:24555983

Do women fare worse? A metaanalysis of gender differences in outcome after traumatic brain injury.

PubMed

Farace, E; Alves, W M

2000-01-01

The purpose of this metaanalysis was to investigate possible gender differences in TBI sequelae. The case fatality rates in patients after TBI have previously been shown to be significantly higher in women as compared with men. A quantitative review of published studies of TBI outcome revealed eight studies (20 outcome variables) of TBI in which outcome was reported separately for men and women. Outcome was worse in women than in men for 85% of the measured variables, with an average effect size of -0.15. Although clinical opinion is often that women tend to experience better outcomes than do men after TBI, the opposite pattern was suggested in the results of this metaanalysis. However, this conclusion is limited by the fact that in only a small percentage of the total published reports on TBI outcome was outcome described separately for each sex. A careful, prospective study of sex differences in TBI outcome is clearly needed.

Interventions to modify sexual risk behaviours for preventing HIV in homeless youth

PubMed Central

Naranbhai, Vivek; Karim, Quarraisha Abdool; Meyer-Weitz, Anna

2013-01-01

Background Homeless youth are at high risk for HIV infection as a consequence of risky sexual behavior. Interventions in homeless youth are challenging. Assessment of the effectiveness of interventions to modify sexual risk behaviours for preventing HIV in homeless youth is needed. Objectives To evaluate and summarize the effectiveness of interventions for modifying sexual risk behaviours and preventing transmission of HIV among homeless youth. Search methods We searched electronic databases (CENTRAL, Medline, EMBASE, AIDSearch, Gateway, PsycInfo, LILACS), reference lists of eligible articles, international health agency publication lists, and clinical trial registries. The search was updated January 2010. We contacted authors of published reports and other key role players. Selection criteria Randomized studies of interventions to modify sexual risk behavior (biological, self-report sexual-risk behavior or health seeking behavior) in homeless youth (12–24 years). Data collection and analysis Data from eligible studies were extracted by two reviewers. We assessed risk of bias per the Cochrane Collaborations tool. None of the eligible studies reported any primary biological outcomes for this review and the reporting of self-report sexual risk behavior outcomes was highly variable across studies precluding calculation of summary measures of effect; we present the outcomes descriptively for each study. We contacted authors for missing or ambiguous data. Results We identified three eligible studies after screening a total of 255 unique records. All three were performed in the United States of America and recruited substance-abusing male and female adolescents (total N=615) through homeless shelters into randomised controlled trials of independent and non-overlapping behavioural interventions. The three trials differed in theoretical background, delivery method, dosage (number of sessions,) content and outcome assessments. Overall, the variability in delivery and outcomes precluded estimation of summary of effect measures. We assessed the risk of bias to be high for each of the studies. Whilst some effect of the interventions on outcome measures were reported, heterogeneity and lack of robustness in these studies necessitate caution in interpreting the effectiveness of these interventions. Authors’ conclusions The body of evidence does not permit conclusions on the impact of interventions to modify sexual risk behaviour in homeless youth. More research is required. While the psychosocial and contextual factors that fuel sexual risk behaviours among homeless youth challenge stringent methodologies of RCT’s, novel ways for program delivery and trial retention are in need of development. Future trials should endeavour to comply with rigorous methodology in design, delivery, outcome measurement and reporting. PMID:21249691

Gender Roles and Acculturation: Relationships With Cancer Screening Among Vietnamese American Women

PubMed Central

Nguyen, Anh B.; Clark, Trenette T.; Belgrave, Faye Z.

2017-01-01

The aim of this study was to examine the influence of demographic variables and the interplay between gender roles and acculturation on breast and cervical cancer screening outcomes among Vietnamese American women. Convenience sampling was used to recruit 100 Vietnamese women from the Richmond, VA, metropolitan area. Women were recruited to participate in a larger cancer screening intervention. All participants completed measures on demographic variables, gender roles, acculturation, and cancer screening variables. Findings indicated that traditional masculine gender roles were associated with increased self-efficacy for breast and cervical cancer screening. Higher levels of acculturation were associated with higher probability of having had a Papanicolaou test. In addition, acculturation moderated the relationship between traditional female gender roles and cancer screening variables. For highly acculturated women, higher levels of feminine gender roles predicted higher probability of having had a previous clinical breast exam and higher levels of self-efficacy for cervical cancer screening, while the opposite was true for lower acculturated women. The findings of this study indicate the important roles that sociodemographic variables, gender roles, and acculturation play in affecting health attitudes and behaviors among Vietnamese women. These findings also help to identify a potentially high-risk subgroup and existing gaps that need to be targeted by preventive interventions. PMID:24491129

Gender roles and acculturation: relationships with cancer screening among Vietnamese American women.

PubMed

Nguyen, Anh B; Clark, Trenette T; Belgrave, Faye Z

2014-01-01

The aim of this study was to examine the influence of demographic variables and the interplay between gender roles and acculturation on breast and cervical cancer screening outcomes among Vietnamese American women. Convenience sampling was used to recruit 100 Vietnamese women from the Richmond, VA, metropolitan area. Women were recruited to participate in a larger cancer screening intervention. All participants completed measures on demographic variables, gender roles, acculturation, and cancer screening variables. Findings indicated that traditional masculine gender roles were associated with increased self-efficacy for breast and cervical cancer screening. Higher levels of acculturation were associated with higher probability of having had a Papanicolaou test. In addition, acculturation moderated the relationship between traditional female gender roles and cancer screening variables. For highly acculturated women, higher levels of feminine gender roles predicted higher probability of having had a previous clinical breast exam and higher levels of self-efficacy for cervical cancer screening, while the opposite was true for lower acculturated women. The findings of this study indicate the important roles that sociodemographic variables, gender roles, and acculturation play in affecting health attitudes and behaviors among Vietnamese women. These findings also help to identify a potentially high-risk subgroup and existing gaps that need to be targeted by preventive interventions.

Estimation of high risk pregnancy contributing to perinatal morbidity and mortality from a birth population-based regional survey in 2010 in China.

PubMed

Sun, Libo; Yue, Hongni; Sun, Bo; Han, Liangrong; Tian, Zhaofang; Qi, Meihua; Lu, Shuyan; Shan, Chunming; Luo, Jianxin; Fan, Yujing; Li, Shouzhong; Dong, Maotian; Zuo, Xiaofeng; Zhang, Yixing; Lin, Wenlong; Xu, Jinzhong; Heng, Yongbo

2014-09-30

Neonatal mortality reduction in China over past two decades was reported from nationwide sampling surveys, however, how high risk pregnancy affected neonatal outcome is unknown. The objective of this study was to explore relations of pregnancy complications and neonatal outcomes from a regional birth population. In a prospective, cross-sectional survey of complete birth population-based data file from 151 level I-III hospitals in Huai'an region in 2010, pregnancy complications were analyzed for perinatal morbidity and mortality in association with maternal and perinatal characteristics, hospital levels, mode of delivery, newborn birth weight and gestational age, using international definition for birth registry and morbidities. Pregnancy complications were found in 10% of all births, in which more than 70% were delivered at level II and III hospitals associated with higher proportions of fetal and neonatal death, preterm birth, death at delivery and congenital anomalies. High Cesarean section delivery was associated with higher pregnancy complications, and more neonatal critical illnesses. The pregnancy complications related perinatal morbidity and mortality in level III were 2-4 times as high as in level I and II hospitals. By uni- and multi-variate regression analysis, impact of pregnancy complications was along with congenital anomalies and preterm birth, and maternal child-bearing age and school education years contributing to the prevalence. This survey revealed variable links of pregnancy complications to perinatal outcome in association with very high Cesarean section deliveries, which warrants investigation for causal relations between high risk pregnancy and neonatal outcome in this emerging region.

[Relationship between the ankle-arm index determined by Doppler ultrasonography and cardiovascular outcomes and amputations, in a group of patients with type 2 diabetes mellitus from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán].

PubMed

Miranda Garduño, Luis Miguel; Bermúdez Rocha, Rocío; Gómez Pérez, Francisco J; Aguilar Salinas, Carlos A

2011-01-01

An ankle/arm index < 0.90 and ≥ 1.41 is considered as abnormal. This study was aimed to investigate the prevalence of peripheral arterial disease through the identification of the ankle/arm index using Doppler ultrasound, and the possible association between pathological ankle/arm index and the micro- and macrovascular complications of diabetes and amputation. The ankle/arm index was determined in outpatient type 2 diabetic subjects. There were the following variables: age and cardiovascular outcomes. To find if the ankle/arm index is related to the cardiovascular outcomes or with the presence of micro- or macrovascular complications we determined the index of correlation of Pearson and also used logistic regression methods to analyze the association between ankle/arm index with the categorical variables. We calculated the ankle/arm index in 242 patients. The prevalence of ischemic ankle/arm index (< 0.90) was 13.6%. The Pearson correlation coefficient for ankle/arm index pathological and cardiovascular outcomes was 0.180 (p = 0.005), amputation 0.130 (p < 0.05), retinopathy 0.132 (p < 0.05), and nephropathy 0.158 (p = 0.01). In logistic regression analysis, the factors associated with pathological ankle/arm index were age > 51 years, cardiovascular outcomes, and amputation. With the Mann Whitney U test we found that a relationship exists between pathological and amputation iliotibial band (p < 0.05). Diabetic patients have a high prevalence of pathological ankle/arm index.

Does socioeconomic status predict course and outcome in patients with psychosis?

PubMed

Samele, C; van Os, J; McKenzie, K; Wright, A; Gilvarry, C; Manley, C; Tattan, T; Murray, R

2001-12-01

We examined the relationship between socioeconomic status (SES) and course and outcome of patients with psychosis. Two hypotheses were examined: a) patients with higher best-ever SES will have better course and outcome than those with lower best-ever SES, and b) patients with greater downward drift in SES will have poorer course and outcome than those with less downward drift. Data were drawn from the baseline and 2-year follow-up assessments of the UK700 Case Management Trial of 708 patients with severe psychosis. The indicators of SES used were occupational status and educational achievement. Drift in SES was defined as change from best-ever occupation to occupation at baseline. For the baseline data highly significant differences were found between best-ever groups and negative symptoms (non-manual vs. unemployed--coef -10.5, p=0.000, 95% CIs 5.1-15.8), functioning (non-manual vs. unemployed--coef -0.6, p=0.000, 95% CIs 0.3 to -0.8) and unmet needs (manual vs. unemployed - coef 0.5, p=0.004, 95% CIs 0.2-0.9). No significant differences between best-ever groups were found for days in hospital, symptoms, perceived quality of life and dissatisfaction with services. Significant differences for clinical and social variables were found between drift and non-drift SES groups. There were no significant findings between educational groups and clinical and social variables. Best-ever occupation, but not educational qualifications, appeared to predict prognosis in patients with severe psychosis. Downward drift in occupational status did not result in poorer illness course and outcome.

Heart Rate Variability as a Feeding Intervention Outcome Measure in the Preterm Infant.

PubMed

Pados, Britt F; Thoyre, Suzanne M; Knafl, George J; Nix, William Brant

2017-10-01

Feeding interventions for preterm infants aim to reduce the physiologic stress of feeding to promote growth. Heart rate variability (HRV) is a potential noninvasive measure of physiologic stress that may be useful for evaluating efficacy of feeding interventions. To evaluate whether HRV is a sensitive measure of physiologic stress compared with standard physiologic outcomes in the context of a feeding intervention study. This was a secondary analysis of a within-subjects, cross-over design study comparing usual care feeding with a gentle, coregulated (CoReg) feeding approach in 14 infants born less than 35 weeks' postmenstrual age. HRV indices were calculated from electrocardiogram data and compared with standard physiologic outcomes, including oxygen saturation (Spo2), respiratory rate (RR), apnea, heart rate (HR), and bradycardia. Data were analyzed using linear mixed modeling. Infants fed using the CoReg approach had fewer apneic events and higher RR, suggesting they were able to breathe more during feeding. No statistically significant differences were found in SpO2, HR, bradycardia, or high frequency power (the most commonly reported measure of HRV). Infants fed using the usual care approach had significantly higher SD12, a measure of HRV indicating randomness in the HR, which is a potential indicator of elevated stress. SD12 was more sensitive to stress than SpO2, HR, and bradycardia. The utility of HRV as a measure of feeding outcomes in clinical practice needs further exploration. Further exploration of HRV as an intervention outcome measure is needed, particularly evaluating nonlinear indices, such as SD12.

Congenital hypothyroidism: influence of disease severity and L-thyroxine treatment on intellectual, motor, and school-associated outcomes in young adults.

PubMed

Oerbeck, Beate; Sundet, Kjetil; Kase, Bengt F; Heyerdahl, Sonja

2003-10-01

To describe intellectual, motor, and school-associated outcome in young adults with early treated congenital hypothyroidism (CH) and to study the association between long-term outcome and CH variables acting at different points in time during early development (CH severity and early L-thyroxine treatment levels [0-6 years]). Neuropsychological tests were administered to all 49 subjects with CH identified during the first 3 years of the Norwegian neonatal screening program (1979-1981) at a mean age of 20 years and to 41 sibling control subjects (mean age: 21 years). The CH group attained significantly lower scores than control subjects on intellectual, motor, and school-associated tests (total IQ: 102.4 [standard deviation: 13] vs 111.4 [standard deviation: 13]). Twelve (24%) of the 49 CH subjects had not completed senior high school, in contrast to 6% of the control subjects. CH severity (pretreatment serum thyroxine [T4]) correlated primarily with motor tests, whereas early L-thyroxine treatment levels were related to verbal IQ and school-associated tests. In multiple regression analysis, initial L-thyroxine dose (beta = 0.32) and mean serum T4 level during the second year (beta = 0.48) predicted Verbal IQ, whereas mean serum T4 level during the second year (beta = 0.44) predicted Arithmetic. Long-term outcome revealed enduring cognitive and motor deficits in young adults with CH relative to control subjects. Verbal functions and Arithmetic were associated with L-thyroxine treatment variables, suggesting that more optimal treatment might be possible. Motor outcome was associated with CH severity, indicating a prenatal effect.

The role of beginner’s luck in learning to prefer risky patches by socially foraging house sparrows

PubMed Central

2013-01-01

Although there has been extensive research on the evolution of individual decision making under risk (when facing variable outcomes), little is known on how the evolution of such decision-making mechanisms has been shaped by social learning and exploitation. We presented socially foraging house sparrows with a choice between scattered feeding wells in which millet seeds were hidden under 2 types of colored sand: green sand offering ~80 seeds with a probability of 0.1 (high risk–high reward) and yellow sand offering 1 seed with certainty (low risk–low reward). Although the expected benefit of choosing variable wells was 8 times higher than that of choosing constant wells, only some sparrows developed a preference for variable wells, whereas others developed a significant preference for constant wells. We found that this dichotomy could be explained by stochastic individual differences in sampling success during foraging, rather than by social foraging strategies (active searching vs. joining others). Moreover, preference for variable or constant wells was related to the sparrows’ success during searching, rather than during joining others or when picking exposed seeds (i.e., they learn when actively searching in the sand). Finally, although for many sparrows learning resulted in an apparently maladaptive risk aversion, group living still allowed them to enjoy profitable variable wells by occasionally joining variable-preferring sparrows. PMID:24137046

Client Predictors of Short-term Psychotherapy Outcomes among Asian and White American Outpatients

PubMed Central

Kim, Jin E.; Zane, Nolan W.; Blozis, Shelley A.

2015-01-01

Purpose To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients. Method Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pre-treatment, and outcomes were measured post-fourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators. Results Higher levels of somatic symptoms predicted lower psychosocial functioning at post-treatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style. Conclusions Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes. PMID:22836681

Predictors of burnout, work engagement and nurse reported job outcomes and quality of care: a mixed method study.

PubMed

Van Bogaert, Peter; Peremans, Lieve; Van Heusden, Danny; Verspuy, Martijn; Kureckova, Veronika; Van de Cruys, Zoë; Franck, Erik

2017-01-01

High levels of work-related stress, burnout, job dissatisfaction, and poor health are common within the nursing profession. A comprehensive understanding of nurses' psychosocial work environment is necessary to respond to complex patients' needs. The aims of this study were threefold: (1) To retest and confirm two structural equation models exploring associations between practice environment and work characteristics as predictors of burnout (model 1) and engagement (model 2) as well as nurse-reported job outcome and quality of care; (2) To study staff nurses' and nurse managers' perceptions and experiences of staff nurses' workload; (3) To explain and interpret the two models by using the qualitative study findings. This mixed method study is based on an explanatory sequential study design. We first performed a cross-sectional survey design in two large acute care university hospitals. Secondly, we conducted individual semi-structured interviews with staff nurses and nurse managers assigned to medical or surgical units in one of the study hospitals. Study data was collected between September 2014 and June 2015. Finally, qualitative study results assisted in explaining and interpreting the findings of the two models. The two models with burnout and engagement as mediating outcome variables fitted sufficiently to the data. Nurse-reported job outcomes and quality of care explained variances between 52 and 62%. Nurse management at the unit level and workload had a direct impact on outcome variables with explained variances between 23 and 36% and between 12 and 17%, respectively. Personal accomplishment and depersonalization had an explained variance on job outcomes of 23% and vigor of 20%. Burnout and engagement had a less relevant direct impact on quality of care (≤5%). The qualitative study revealed various themes such as organisation of daily practice and work conditions; interdisciplinary collaboration, communication and teamwork; staff nurse personal characteristics and competencies; patient centeredness, quality and patient safety. Respondents' statements corresponded closely to the models' associations. A deep understanding of various associations and impacts on studied outcome variables such as risk factors and protective factors was gained through the retested models and the interviews with the study participants. Besides the softer work characteristics - such as decision latitude, social capital and team cohesion - more insight and knowledge of the hard work characteristic workload is essential.

Attributions of responsibility and recovery within a no-fault insurance compensation system.

PubMed

Thompson, Jason; Berk, Michael; O'Donnell, Meaghan; Stafford, Lesley; Nordfjaern, Trond

2014-08-01

Although a great deal of literature supports the negative relationship between postinjury health outcomes and compensation, it has not fully examined the relative influence of the diverse factors that underlie compensable status. In particular, this study sought to understand the relative influence that attributions of responsibility for accidents have on mental and physical health outcomes. Using a structural equation modeling approach, we assessed the strength of relationships between demographic and accident circumstance variables, and postinjury mental and physical health for 934 road-trauma survivors compensated under a single no-fault insurance system. Analysis of direct and indirect effects demonstrated that although a range of standard demographic and accident circumstance variables influenced health outcomes, by far the greatest effect was generated from perceptions of responsibility for the accident. People who reported lower levels of responsibility for their accident showed significantly poorer mental and physical health outcomes. Perceptions of responsibility for accidents are strongly associated with postaccident mental and physical health outcomes within compensable road trauma populations. Future studies should control for attributions of responsibility when assessing the effect of compensation, or any other variable, on health outcomes among injured populations. Mechanisms underlying the effect of attributions of responsibility on outcomes, particularly in relation to its association with self-blame, warrant further exploration.

LB01.06: VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOMES IN FELODIPINE EVENT REDUCTION STUDY.

PubMed

Zhang, Y; Zhang, X; Liu, L; Zanchetti, A

2015-06-01

Many antihypertensive outcome trials have shown that visit-to-visit blood pressure variability is correlated closely with clinical outcomes in hypertensive patients. The objective of the study was to investigate the relationship between visit-to-visit blood pressure variability (BPV) and the major cardiovascular outcomes in the Chinese hypertensive patients. Felodipine Event Reduction (FEVER) study was a double-blind, randomized trial on 9711 Chinese hypertensive patients, in whom cardiovascular outcomes were significantly reduced by more intense therapy achieving a mean of 138 mmHg SBP compared with less-intense therapy achieving a mean of 142 mmHg. Visit-to-visit BPV during the follow-up period [defined as standard deviation (SD), coefficient of variation (CV), and average real variability(ARV)] was derived from casual cuff BP measures after six months follow-up until the end of the study. Hazard ratios (HRs), for the incidence of CVD associated with SD, CV, and ARV of SBP and DBP were calculated using Cox proportional hazard models. Overall predictive power [area under receiver operating characteristic (AUC ROC) curve] of the level of blood pressure, blood pressure variability and other baseline characteristics was calculated. In FEVER study, visit-to-visit variability in SBP were significant predictors of subsequent stroke [eg, hazard ratios [HR] for ARV, SD and CV was 1.071 (95% CI: 1.025-1.118), 1.373 (95% CI: 1.159-1.626) and 0.572 (95% CI: 0.451-0,726)]. Visit-to-visit variability in DBP were also showed similar trend [eg, HR for ARV, SD and CV was 1.066 (95% CI: 0.992-1.145), 1.931 (95% CI: 1.435-2.598) and 0.558 (95% CI: 0.438-0,710)]. However, using the analysis of AUC ROC analysis, the risk importance sequence of the stroke events in this cohort was level of SBP, age, level of DBP ARV, SD, sex, CV and treatment. Visit-to-visit blood pressure variability has some effects on the cardiovascular outcomes in the Chinese hypertensive patents in the cohort in FEVER Study. However, blood pressure per se is even more important for the development of stroke in this group of patients.

Goal orientation, perceived task outcome and task demands in mathematics tasks: effects on students' attitude in actual task settings.

PubMed

Seegers, Gerard; van Putten, Cornelis M; de Brabander, Cornelis J

2002-09-01

In earlier studies, it has been found that students' domain-specific cognitions and personal learning goals (goal orientation) influence task-specific appraisals of actual learning tasks. The relations between domain-specific and task-specific variables have been specified in the model of adaptive learning. In this study, additional influences, i.e., perceived task outcome on a former occasion and variations in task demands, were investigated. The purpose of this study was to identify personality and situational variables that mediate students' attitude when confronted with a mathematics task. Students worked on a mathematics task in two subsequent sessions. Effects of perceived task outcome at the first session on students' attitude at the second session were investigated. In addition, we investigated how differences in task demands influenced students' attitude. Variations in task demands were provoked by different conditions in task-instruction. In one condition, students were told that the result on the test would add to their mark on mathematics. This outcome orienting condition was contrasted with a task-orienting condition where students were told that the results on the test would not be used to give individual grades. Participants were sixth grade students (N = 345; aged 11-12 years) from 14 primary schools. Multivariate and univariate analyses of (co)variance were applied to the data. Independent variables were goal orientation, task demands, and perceived task outcome, with task-specific variables (estimated competence for the task, task attraction, task relevance, and willingness to invest effort) as the dependent variables. The results showed that previous perceived task outcome had a substantial impact on students' attitude. Additional but smaller effects were found for variation in task demands. Furthermore, effects of previous perceived task outcome and task demands were related to goal orientation. The resulting pattern confirmed that, in general, performance-oriented learning goals emphasised the negative impact of failure experiences, whereas task-oriented learning goals had a strengthening effect on how success experiences influenced students' attitude.

Predictions: From Public School Teacher Salaries to Student Outcomes.

ERIC Educational Resources Information Center

Murgo, Nicholas J.; Walsh, Tammy King

A study of 28 school districts in Rhode Island was done in 1992 to examine the hypothesis that there is a positive correlation between teacher salaries and state aid. The study was originally designed to gather information about teacher salaries and the variables related to them, but was expanded to cover student outcomes and variables related to…

Predictors of pain and disability outcomes in one thousand, one hundred and eight patients who underwent lumbar discectomy surgery.

PubMed

Cook, Chad E; Arnold, Paul M; Passias, Peter G; Frempong-Boadu, Anthony K; Radcliff, Kristen; Isaacs, Robert

2015-11-01

A key component toward improving surgical outcomes is proper patient selection. Improved selection can occur through exploration of prognostic studies that identify variables which are associated with good or poorer outcomes with a specific intervention, such as lumbar discectomy. To date there are no guidelines identifying key prognostic variables that assist surgeons in proper patient selection for lumbar discectomy. The purpose of this study was to identify baseline characteristics that were related to poor or favourable outcomes for patients who undergo lumbar discectomy. In particular, we were interested in prognostic factors that were unique to those commonly reported in the musculoskeletal literature, regardless of intervention type. This retrospective study analysed data from 1,108 patients who underwent lumbar discectomy and had one year outcomes for pain and disability. All patient data was part of a multicentre, multi-national spine repository. Ten relatively commonly captured data variables were used as predictors for the study: (1) age, (2) body mass index, (3) gender, (4) previous back surgery history, (5) baseline disability, unique baseline scores for pain for both (6) low back and (7) leg pain, (8) baseline SF-12 Physical Component Summary (PCS) scores, (9) baseline SF-12 Mental Component Summary (MCS) scores, and (10) leg pain greater than back pain. Univariate and multivariate logistic regression analyses were run against one year outcome variables of pain and disability. For the multivariate analyses associated with the outcome of pain, older patients, those with higher baseline back pain, those with lesser reported disability and higher SF-12 MCS quality of life scores were associated with improved outcomes. For the multivariate analyses associated with the outcome of disability, presence of leg pain greater than back pain and no previous surgery suggested a better outcome. For this study, several predictive variables were either unique or conflicted with those advocated in general prognostic literature, suggesting they may have value for clinical decision making for lumbar discectomy surgery. In particular, leg pain greater than back pain and older age may yield promising value. Other significant findings such as quality of life scores and prior surgery may yield less value since these findings are similar to those that are considered to be prognostic regardless of intervention type.

Identifying the independent effect of HbA1c variability on adverse health outcomes in patients with Type 2 diabetes.

PubMed

Prentice, J C; Pizer, S D; Conlin, P R

2016-12-01

To characterize the relationship between HbA 1c variability and adverse health outcomes among US military veterans with Type 2 diabetes. This retrospective cohort study used Veterans Affairs and Medicare claims for veterans with Type 2 diabetes taking metformin who initiated a second diabetes medication (n = 50 861). The main exposure of interest was HbA 1c variability during a 3-year baseline period. HbA 1c variability, categorized into quartiles, was defined as standard deviation, coefficient of variation and adjusted standard deviation, which accounted for the number and mean number of days between HbA 1c tests. Cox proportional hazard models predicted mortality, hospitalization for ambulatory care-sensitive conditions, and myocardial infarction or stroke and were controlled for mean HbA 1c levels and the direction of change in HbA 1c levels during the baseline period. Over a mean 3.3 years of follow-up, all HbA 1c variability measures significantly predicted each outcome. Using the adjusted standard deviation measure for HbA 1c variability, the hazard ratios for the third and fourth quartile predicting mortality were 1.14 (95% CI 1.04, 1.25) and 1.42 (95% CI 1.28, 1.58), for myocardial infarction and stroke they were 1.25 (95% CI 1.10, 1.41) and 1.23 (95% CI 1.07, 1.42) and for ambulatory-care sensitive condition hospitalization they were 1.10 (95% CI 1.03, 1.18) and 1.11 (95% CI 1.03, 1.20). Higher baseline HbA 1c levels independently predicted the likelihood of each outcome. In veterans with Type 2 diabetes, greater HbA 1c variability was associated with an increased risk of adverse long-term outcomes, independently of HbA 1c levels and direction of change. Limiting HbA 1c fluctuations over time may reduce complications. © 2016 Diabetes UK.

Clustering of metabolic and cardiovascular risk factors in the polycystic ovary syndrome: a principal component analysis.

PubMed

Stuckey, Bronwyn G A; Opie, Nicole; Cussons, Andrea J; Watts, Gerald F; Burke, Valerie

2014-08-01

Polycystic ovary syndrome (PCOS) is a prevalent condition with heterogeneity of clinical features and cardiovascular risk factors that implies multiple aetiological factors and possible outcomes. To reduce a set of correlated variables to a smaller number of uncorrelated and interpretable factors that may delineate subgroups within PCOS or suggest pathogenetic mechanisms. We used principal component analysis (PCA) to examine the endocrine and cardiometabolic variables associated with PCOS defined by the National Institutes of Health (NIH) criteria. Data were retrieved from the database of a single clinical endocrinologist. We included women with PCOS (N = 378) who were not taking the oral contraceptive pill or other sex hormones, lipid lowering medication, metformin or other medication that could influence the variables of interest. PCA was performed retaining those factors with eigenvalues of at least 1.0. Varimax rotation was used to produce interpretable factors. We identified three principal components. In component 1, the dominant variables were homeostatic model assessment (HOMA) index, body mass index (BMI), high density lipoprotein (HDL) cholesterol and sex hormone binding globulin (SHBG); in component 2, systolic blood pressure, low density lipoprotein (LDL) cholesterol and triglycerides; in component 3, total testosterone and LH/FSH ratio. These components explained 37%, 13% and 11% of the variance in the PCOS cohort respectively. Multiple correlated variables from patients with PCOS can be reduced to three uncorrelated components characterised by insulin resistance, dyslipidaemia/hypertension or hyperandrogenaemia. Clustering of risk factors is consistent with different pathogenetic pathways within PCOS and/or differing cardiometabolic outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Personality as a predictor of weight loss maintenance after surgery for morbid obesity.

PubMed

Larsen, Junilla K; Geenen, Rinie; Maas, Cora; de Wit, Pieter; van Antwerpen, Tiny; Brand, Nico; van Ramshorst, Bert

2004-11-01

Personality characteristics are assumed to underlie health behaviors and, thus, a variety of health outcomes. Our aim was to examine prospectively whether personality traits predict short- and long-term weight loss after laparoscopic adjustable gastric banding. Of patients undergoing laparoscopic adjustable gastric banding, 168 (143 women, 25 men, 18 to 58 years old, mean 37 years, preoperative BMI 45.9 +/- 5.6 kg/m(2)) completed the Dutch Personality Questionnaire on average 1.5 years before the operation. The relationship between preoperative personality and short- and long-term postoperative weight loss was determined using multilevel regression analysis. The average weight loss of patients progressively increased to 10 BMI points until 18 months after surgery and stabilized thereafter. A lower baseline BMI, being a man, and a higher educational level were associated with a lower weight loss. None of the personality variables was associated with weight outcome at short-term follow-up. Six of seven personality variables did not predict long-term weight outcome. Egoism was associated with less weight loss in the long-term postoperative period. The effect sizes of the significant predictions were small. None of the personality variables predicted short-term weight outcome, and only one variable showed a small and unexpected association with long-term weight outcome that needs confirmation. This suggests that personality assessment as intake psychological screening is of little use for the prediction of a poor or successful weight outcome after bariatric surgery.

Combining biological and psychosocial baseline variables did not improve prediction of outcome of a very-low-energy diet in a clinic referral population.

PubMed

Sumithran, P; Purcell, K; Kuyruk, S; Proietto, J; Prendergast, L A

2018-02-01

Consistent, strong predictors of obesity treatment outcomes have not been identified. It has been suggested that broadening the range of predictor variables examined may be valuable. We explored methods to predict outcomes of a very-low-energy diet (VLED)-based programme in a clinically comparable setting, using a wide array of pre-intervention biological and psychosocial participant data. A total of 61 women and 39 men (mean ± standard deviation [SD] body mass index: 39.8 ± 7.3 kg/m 2 ) underwent an 8-week VLED and 12-month follow-up. At baseline, participants underwent a blood test and assessment of psychological, social and behavioural factors previously associated with treatment outcomes. Logistic regression, linear discriminant analysis, decision trees and random forests were used to model outcomes from baseline variables. Of the 100 participants, 88 completed the VLED and 42 attended the Week 60 visit. Overall prediction rates for weight loss of ≥10% at weeks 8 and 60, and attrition at Week 60, using combined data were between 77.8 and 87.6% for logistic regression, and lower for other methods. When logistic regression analyses included only baseline demographic and anthropometric variables, prediction rates were 76.2-86.1%. In this population, considering a wide range of biological and psychosocial data did not improve outcome prediction compared to simply-obtained baseline characteristics. © 2017 World Obesity Federation.

On assessing the quality of physicians' clinical judgment: the search for outcome variables.

PubMed

Wainer, Howard; Mee, Janet

2004-12-01

A primary question that must be resolved in the development of tasks to assess the quality of physicians' clinical judgment is, "What is the outcome variable?" One natural choice would seem to be the correctness of the clinical decision. In this article, we use data on the diagnosis of urinary tract infections among young girls to illustrate why, in many clinical situations, this is not a useful variable. We propose instead a judgment weighted by the relative costs of an error. This variable has the disadvantage of requiring expert judgment for scoring, but the advantage of measuring the construct of interest.

Effect of Adding McKenzie Syndrome, Centralization, Directional Preference, and Psychosocial Classification Variables to a Risk-Adjusted Model Predicting Functional Status Outcomes for Patients With Lumbar Impairments.

PubMed

Werneke, Mark W; Edmond, Susan; Deutscher, Daniel; Ward, Jason; Grigsby, David; Young, Michelle; McGill, Troy; McClenahan, Brian; Weinberg, Jon; Davidow, Amy L

2016-09-01

Study Design Retrospective cohort. Background Patient-classification subgroupings may be important prognostic factors explaining outcomes. Objectives To determine effects of adding classification variables (McKenzie syndrome and pain patterns, including centralization and directional preference; Symptom Checklist Back Pain Prediction Model [SCL BPPM]; and the Fear-Avoidance Beliefs Questionnaire subscales of work and physical activity) to a baseline risk-adjusted model predicting functional status (FS) outcomes. Methods Consecutive patients completed a battery of questionnaires that gathered information on 11 risk-adjustment variables. Physical therapists trained in Mechanical Diagnosis and Therapy methods classified each patient by McKenzie syndromes and pain pattern. Functional status was assessed at discharge by patient-reported outcomes. Only patients with complete data were included. Risk of selection bias was assessed. Prediction of discharge FS was assessed using linear stepwise regression models, allowing 13 variables to enter the model. Significant variables were retained in subsequent models. Model power (R(2)) and beta coefficients for model variables were estimated. Results Two thousand sixty-six patients with lumbar impairments were evaluated. Of those, 994 (48%), 10 (<1%), and 601 (29%) were excluded due to incomplete psychosocial data, McKenzie classification data, and missing FS at discharge, respectively. The final sample for analyses was 723 (35%). Overall R(2) for the baseline prediction FS model was 0.40. Adding classification variables to the baseline model did not result in significant increases in R(2). McKenzie syndrome or pain pattern explained 2.8% and 3.0% of the variance, respectively. When pain pattern and SCL BPPM were added simultaneously, overall model R(2) increased to 0.44. Although none of these increases in R(2) were significant, some classification variables were stronger predictors compared with some other variables included in the baseline model. Conclusion The small added prognostic capabilities identified when combining McKenzie or pain-pattern classifications with the SCL BPPM classification did not significantly improve prediction of FS outcomes in this study. Additional research is warranted to investigate the importance of classification variables compared with those used in the baseline model to maximize predictive power. Level of Evidence Prognosis, level 4. J Orthop Sports Phys Ther 2016;46(9):726-741. Epub 31 Jul 2016. doi:10.2519/jospt.2016.6266.

Instrumental variables estimation of exposure effects on a time-to-event endpoint using structural cumulative survival models.

PubMed

Martinussen, Torben; Vansteelandt, Stijn; Tchetgen Tchetgen, Eric J; Zucker, David M

2017-12-01

The use of instrumental variables for estimating the effect of an exposure on an outcome is popular in econometrics, and increasingly so in epidemiology. This increasing popularity may be attributed to the natural occurrence of instrumental variables in observational studies that incorporate elements of randomization, either by design or by nature (e.g., random inheritance of genes). Instrumental variables estimation of exposure effects is well established for continuous outcomes and to some extent for binary outcomes. It is, however, largely lacking for time-to-event outcomes because of complications due to censoring and survivorship bias. In this article, we make a novel proposal under a class of structural cumulative survival models which parameterize time-varying effects of a point exposure directly on the scale of the survival function; these models are essentially equivalent with a semi-parametric variant of the instrumental variables additive hazards model. We propose a class of recursive instrumental variable estimators for these exposure effects, and derive their large sample properties along with inferential tools. We examine the performance of the proposed method in simulation studies and illustrate it in a Mendelian randomization study to evaluate the effect of diabetes on mortality using data from the Health and Retirement Study. We further use the proposed method to investigate potential benefit from breast cancer screening on subsequent breast cancer mortality based on the HIP-study. © 2017, The International Biometric Society.

A Conceptual Framework for Graduate Teaching Assistant Professional Development Evaluation and Research.

PubMed

Reeves, Todd D; Marbach-Ad, Gili; Miller, Kristen R; Ridgway, Judith; Gardner, Grant E; Schussler, Elisabeth E; Wischusen, E William

2016-01-01

Biology graduate teaching assistants (GTAs) are significant contributors to the educational mission of universities, particularly in introductory courses, yet there is a lack of empirical data on how to best prepare them for their teaching roles. This essay proposes a conceptual framework for biology GTA teaching professional development (TPD) program evaluation and research with three overarching variable categories for consideration: outcome variables, contextual variables, and moderating variables. The framework's outcome variables go beyond GTA satisfaction and instead position GTA cognition, GTA teaching practice, and undergraduate learning outcomes as the foci of GTA TPD evaluation and research. For each GTA TPD outcome variable, key evaluation questions and example assessment instruments are introduced to demonstrate how the framework can be used to guide GTA TPD evaluation and research plans. A common conceptual framework is also essential to coordinating the collection and synthesis of empirical data on GTA TPD nationally. Thus, the proposed conceptual framework serves as both a guide for conducting GTA TPD evaluation at single institutions and as a means to coordinate research across institutions at a national level. © 2016 T. D. Reeves et al. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Explanatory variables for adult patients' self-reported recovery after acute lateral ankle sprain.

PubMed

van Rijn, Rogier M; Willemsen, Sten P; Verhagen, Arianne P; Koes, Bart W; Bierma-Zeinstra, Sita M A

2011-01-01

Longitudinal research on musculoskeletal disorders often makes use of a single measure of recovery, despite the large variation in reported recovery that exists. Patients with an acute ankle sprain often experience no pain or functional disability following treatment, yet report not being fully recovered, or vice versa. The purpose of this study was to find explanatory variables for reporting recovery by analyzing the extent to which different outcomes (eg, pain intensity) were associated with recovery and how baseline scores of different variables influence this association in adult patients after acute lateral ankle sprain. This was a cohort study based on data collected in a randomized controlled trial (RCT). This study was constructed within the framework of an RCT. One hundred two patients who incurred an acute ankle sprain were included. Recovery, pain intensity, giving way of the ankle, and Ankle Function Score (AFS) were assessed during the RCT at baseline and at 4 weeks, 8 weeks, 3 months, and 12 months postinjury. Mean differences were calculated between baseline and follow-up. Associations were calculated using linear mixed models, and the influence of baseline scores on these associations was determined using linear regression with interaction. Associations were found between recovery and the mean differences of pain during running on flat and rough surfaces (4 and 8 weeks, 3 months) and between recovery and the mean difference of giving way of the ankle during walking on a rough surface (8 weeks, 3 months). This study used data collected from an RCT. Therefore, the study was limited to the outcomes measured in that trial, and some explanatory factors easily could have been missed. This study is the first to identify explanatory variables for reporting recovery in adults after ankle sprain. Pain intensity and giving way of the ankle measured during high ankle load activities make it easier to measure and to generalize recovery in this population and should be the primary outcome measures of interest. This study indicates the huge need to reach consensus about primary outcome measures for research in patients sustaining ankle sprains.

Temporal and quantitative associations of electronic fetal heart rate monitoring patterns and neonatal outcomes†.

PubMed

Ogunyemi, Dotun; Jovanovski, Andrew; Friedman, Perry; Sweatman, Brittany; Madan, Ichchha

2018-04-06

The objective of this study is to evaluate the associations of electronic fetal heart rate monitoring (EFM) patterns and adverse neonatal outcomes Study design: From 2013 to 2016; 12,067 term, singleton deliveries in labor ≥2 h with abnormal EFM defined as absent accelerations, variable, late or prolonged decelerations, tachycardia, bradycardia, or minimal variability were analyzed as any documentation during labor, in first hour and last hour of labor. Outcomes were composite neonatal adverse outcomes, neonatal intensive care unit (NICU) admission, neonatal hypoxia, neonatal hypoglycemia, umbilical artery pH, and base excess. Independent associations were ascertained using regression analysis. Significant independent associations occurred between any abnormal EFM during the last hour and five adverse neonatal outcomes; between abnormal EFM at any time and one adverse neonatal outcome while there was none with the first hour of labor. In the last hour, accelerations had significant negative associations with three adverse neonatal outcomes, while prolonged decelerations, late decelerations, tachycardia, and bradycardia had significant positive associations with three adverse neonatal outcomes. Throughout labor, increasing accelerations events were significantly negatively correlated with all adverse neonatal outcomes, while increasing frequency of late, variable, and prolonged decelerations were positively associated with five adverse neonatal outcomes. Hierarchical analysis showed that bradycardia/tachycardia contributed only 0.8%, while all EFM periodic changes contributed 1%; the addition of the frequencies of abnormal EFM events contributed 0.6% to the variance in umbilical artery pH and base excess. Terminal EFM patterns are independently associated with neonatal outcomes. Accelerations are protective of adverse neonatal outcomes. Increasing frequency of EFM patterns overtime contributes to neonatal outcome.

A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.

PubMed

Farrelly, Matthew C; Loomis, Brett R; Han, Beth; Gfroerer, Joe; Kuiper, Nicole; Couzens, G Lance; Dube, Shanta; Caraballo, Ralph S

2013-03-01

We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking.

Children who screen positive for autism at 2.5 years and receive early intervention: a prospective naturalistic 2-year outcome study

PubMed Central

Spjut Jansson, Birgitta; Miniscalco, Carmela; Westerlund, Joakim; Kantzer, Anne-Katrin; Fernell, Elisabeth; Gillberg, Christopher

2016-01-01

Background Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. Methods Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis – Intensive Learning (IL) – in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions. Results There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. Conclusion The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child’s function and behavior throughout the intervention period. PMID:27621636

A Comprehensive Examination of the Influence of State Tobacco Control Programs and Policies on Youth Smoking

PubMed Central

Loomis, Brett R.; Han, Beth; Gfroerer, Joe; Kuiper, Nicole; Couzens, G. Lance; Dube, Shanta; Caraballo, Ralph S.

2013-01-01

Objectives. We examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking). Methods. We combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels. Results. Per capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws. Conclusions. Smoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking. PMID:23327252

Early-Onset Bipolar Disorder: Characteristics and Outcomes in the Clinic.

PubMed

Connor, Daniel F; Ford, Julian D; Pearson, Geraldine S; Scranton, Victoria L; Dusad, Asha

2017-12-01

To assess patient characteristics and clinician-rated outcomes for children diagnosed with early-onset bipolar disorder in comparison to a depressive disorders cohort from a single clinic site. To assess predictors of bipolar treatment response. Medical records from 714 consecutive pediatric patients evaluated and treated at an academic tertiary child and adolescent psychiatry clinic between 2006 and 2012 were reviewed. Charts of bipolar children (n = 49) and children with depressive disorders (n = 58) meeting study inclusion/exclusion criteria were compared on variables assessing clinical characteristics, treatments, and outcomes. Outcomes were assessed by using pre- and post-Clinical Global Impressions (CGI)-Severity and Children's Global Assessment Scale (CGAS) scores, and a CGI-Improvement score ≤2 at final visit determined responder status. Bipolar outcome predictors were assessed by using multiple linear regression. Clinic prevalence rates were 6.9% for early-onset bipolar disorder and 1.5% for very early-onset bipolar disorder. High rates of comorbid diagnoses, symptom severity, parental stress, and child high-risk behaviors were found in both groups. The bipolar cohort had higher rates of aggression and higher lifetime systems of care utilization. The final CGI and CGAS outcomes for unipolar depression patients differed statistically significantly from those for the bipolar cohort, reflecting better clinical status and more improvement at outcome for the depression patients. Both parent-reported Child Behavior Checklist total T-score at clinic admission and the number of lifetime systems-of-care for the child were significantly and inversely associated with improvement for the bipolar cohort. Early-onset bipolar disorder is a complex and heterogeneous psychiatric disorder. Evidence-based treatment should emphasize psychopharmacology with adjunctive family and individual psychotherapy. Strategies to improve engagement in treatment may be especially important. Given high rates of high-risk behaviors in these youth, regular mental health follow-up to assess safety is important. Additional evidence-based treatments for pediatric bipolar disorder are needed.

Estimating the Effects of Parental Divorce and Death With Fixed Effects Models.

PubMed

Amato, Paul R; Anthony, Christopher J

2014-04-01

The authors used child fixed effects models to estimate the effects of parental divorce and death on a variety of outcomes using 2 large national data sets: (a) the Early Childhood Longitudinal Study, Kindergarten Cohort (kindergarten through the 5th grade) and (b) the National Educational Longitudinal Study (8th grade to the senior year of high school). In both data sets, divorce and death were associated with multiple negative outcomes among children. Although evidence for a causal effect of divorce on children was reasonably strong, effect sizes were small in magnitude. A second analysis revealed a substantial degree of variability in children's outcomes following parental divorce, with some children declining, others improving, and most not changing at all. The estimated effects of divorce appeared to be strongest among children with the highest propensity to experience parental divorce.

Growth Modeling with Non-Ignorable Dropout: Alternative Analyses of the STAR*D Antidepressant Trial

PubMed Central

Muthén, Bengt; Asparouhov, Tihomir; Hunter, Aimee; Leuchter, Andrew

2011-01-01

This paper uses a general latent variable framework to study a series of models for non-ignorable missingness due to dropout. Non-ignorable missing data modeling acknowledges that missingness may depend on not only covariates and observed outcomes at previous time points as with the standard missing at random (MAR) assumption, but also on latent variables such as values that would have been observed (missing outcomes), developmental trends (growth factors), and qualitatively different types of development (latent trajectory classes). These alternative predictors of missing data can be explored in a general latent variable framework using the Mplus program. A flexible new model uses an extended pattern-mixture approach where missingness is a function of latent dropout classes in combination with growth mixture modeling using latent trajectory classes. A new selection model allows not only an influence of the outcomes on missingness, but allows this influence to vary across latent trajectory classes. Recommendations are given for choosing models. The missing data models are applied to longitudinal data from STAR*D, the largest antidepressant clinical trial in the U.S. to date. Despite the importance of this trial, STAR*D growth model analyses using non-ignorable missing data techniques have not been explored until now. The STAR*D data are shown to feature distinct trajectory classes, including a low class corresponding to substantial improvement in depression, a minority class with a U-shaped curve corresponding to transient improvement, and a high class corresponding to no improvement. The analyses provide a new way to assess drug efficiency in the presence of dropout. PMID:21381817

The Efficacy of a Family-Based Intervention Program on Childhood Obesity: A Quasi-Experimental Design.

PubMed

Chen, Chia-Ying; Kao, Chia-Chan; Hsu, Hsiu-Yueh; Wang, Ruey-Hsia; Hsu, Shu-Hua

2015-10-01

The purpose of this quasi-experimental study was to assess the efficacy of a family-based (FB) weight-loss and behavior-modification intervention among overweight/obese children (age 9-11 years) and their parents in Taiwan. The intervention group (52 child-parent dyads) participated in an FB program for 7 weeks. The control group (55 child-parent dyads) received an educational pamphlet about obesity prevention. The children's body mass index (BMI) z-scores were the primary outcome variable. The parents' BMI, high-calorie (HC) food-intake behaviors, screen-related behaviors, and restrictions on children's consumption of HC foods and screen-related behaviors and the availability of HC foods at home were the secondary outcome variables. Outcome variables were measured at baseline (T0), at the end of the intervention (T1), and 4 weeks after the end of the intervention (T2). A linear mixed model was used to assess the efficacy of the FB program. Results indicated that the children's BMI z-scores decreased significantly more from T0 to T2 in the experimental group than in the control group. The decreases in parents' HC food-intake behaviors and availability of HC foods at home and the increase in parental restrictions on children's consumption of HC foods were significantly greater in the experimental than in the control group from T0 to T1 and T0 to T2. The FB program was effective in modifying parental behaviors and the weight of overweight/obese children in a Taiwanese population. © The Author(s) 2015.

Asymptomatic Alzheimer disease: Defining resilience.

PubMed

Hohman, Timothy J; McLaren, Donald G; Mormino, Elizabeth C; Gifford, Katherine A; Libon, David J; Jefferson, Angela L

2016-12-06

To define robust resilience metrics by leveraging CSF biomarkers of Alzheimer disease (AD) pathology within a latent variable framework and to demonstrate the ability of such metrics to predict slower rates of cognitive decline and protection against diagnostic conversion. Participants with normal cognition (n = 297) and mild cognitive impairment (n = 432) were drawn from the Alzheimer's Disease Neuroimaging Initiative. Resilience metrics were defined at baseline by examining the residuals when regressing brain aging outcomes (hippocampal volume and cognition) on CSF biomarkers. A positive residual reflected better outcomes than expected for a given level of pathology (high resilience). Residuals were integrated into a latent variable model of resilience and validated by testing their ability to independently predict diagnostic conversion, cognitive decline, and the rate of ventricular dilation. Latent variables of resilience predicted a decreased risk of conversion (hazard ratio < 0.54, p < 0.0001), slower cognitive decline (β > 0.02, p < 0.001), and slower rates of ventricular dilation (β < -4.7, p < 2 × 10 -15 ). These results were significant even when analyses were restricted to clinically normal individuals. Furthermore, resilience metrics interacted with biomarker status such that biomarker-positive individuals with low resilience showed the greatest risk of subsequent decline. Robust phenotypes of resilience calculated by leveraging AD biomarkers and baseline brain aging outcomes provide insight into which individuals are at greatest risk of short-term decline. Such comprehensive definitions of resilience are needed to further our understanding of the mechanisms that protect individuals from the clinical manifestation of AD dementia, especially among biomarker-positive individuals. © 2016 American Academy of Neurology.

The Moderating Role of Power Distance on the Relationship between Employee Participation and Outcome Variables

PubMed Central

Rafiei, Sima; Pourreza, Abolghasem

2013-01-01

Background: Many organisations have realised the importance of human resource for their competitive advantage. Empowering employees is therefore essential for organisational effectiveness. This study aimed to investigate the relationship between employee participation with outcome variables such as organisational commitment, job satisfaction, perception of justice in an organisation and readiness to accept job responsibilities. It further examined the impact of power distance on the relationship between participation and four outcome variables. Methods: This was a cross sectional study with a descriptive research design conducted among employees and managers of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran. A questionnaire as a main procedure to gather data was developed, distributed and collected. Descriptive statistics, Pearson correlation coefficient and moderated multiple regression were used to analyse the study data. Results: Findings of the study showed that the level of power distance perceived by employees had a significant relationship with employee participation, organisational commitment, job satisfaction, perception of justice and readiness to accept job responsibilities. There was also a significant relationship between employee participation and four outcome variables. The moderated multiple regression results supported the hypothesis that power distance had a significant effect on the relationship between employee participation and four outcome variables. Conclusion: Organisations in which employee empowerment is practiced through diverse means such as participating them in decision making related to their field of work, appear to have more committed and satisfied employees with positive perception toward justice in the organisational interactions and readiness to accept job responsibilities. PMID:24596840

Exploring Team Passing Networks and Player Movement Dynamics in Youth Association Football

PubMed Central

Coutinho, Diogo; Santos, Sara; Lago-Penas, Carlos; Jiménez, Sergio; Sampaio, Jaime

2017-01-01

Understanding how youth football players base their game interactions may constitute a solid criterion for fine-tuning the training process and, ultimately, to achieve better individual and team performances during competition. The present study aims to explore how passing networks and positioning variables can be linked to the match outcome in youth elite association football. The participants included 44 male elite players from under-15 and under-17 age groups. A passing network approach within positioning-derived variables was computed to identify the contributions of individual players for the overall team behaviour outcome during a simulated match. Results suggested that lower team passing dependency for a given player (expressed by lower betweenness network centrality scores) and high intra-team well-connected passing relations (expressed by higher closeness network centrality scores) were related to better outcomes. The correlation between the dyads’ positioning regularity and the passing density showed a most likely higher correlation in under-15 (moderate effect), indicating a possible more dependence of the ball position rather than in the under-17 teams (small/unclear effects). Overall, this study emphasizes the potential of coupling notational analyses with spatial-temporal relations to produce a more functional and holistic understanding of teams’ sports performance. Also, the social network analysis allowed to reveal novel key determinants of collective performance. PMID:28141823

Short-Term Outcomes of Minimally Invasive Esophagectomy for Carcinoma In Patients with Liver Cirrhosis.

PubMed

Sozzi, Marco; Siboni, Stefano; Asti, Emanuele; Bonitta, Gianluca; Bonavina, Luigi

2017-06-01

Open esophagectomy is a high-risk procedure in patients with liver cirrhosis. With the advent of minimally invasive surgical techniques, the overall morbidity and mortality rates of esophagectomy have decreased. The aim of this study was to describe short-term outcomes of minimally invasive esophagectomy in patients with proven liver cirrhosis. Retrospective observational cohort study. Demographics, preoperative clinical characteristics, and outcomes of patients undergoing minimally invasive esophagectomy for carcinoma were analyzed. Patients with concomitant liver cirrhosis were compared to patients without liver cirrhosis undergoing similar surgical procedures. In addition, variables possibly associated with postoperative morbidity and mortality in patients with cirrhosis were investigated. Out of 443 patients undergoing minimally invasive esophagectomy, 18 (4.1%) had concomitant liver cirrhosis. Demographics and preoperative clinical variables were similar in the 2 patient groups. While the overall morbidity rate was similar, the 90-day mortality rate was significantly higher in patients with liver cirrhosis (P = .023). There was a significantly higher rate of sepsis and anastomotic, respiratory, and hemorrhagic complications in patients with liver cirrhosis who died in the postoperative period. Minimally invasive esophagectomy is feasible in patients with liver cirrhosis. Future strategies should focus on total minimally invasive procedures and early recognition of surgical complications.

Can platelet-rich plasma (PRP) improve bone healing? A comparison between the theory and experimental outcomes.

PubMed

Malhotra, Angad; Pelletier, Matthew H; Yu, Yan; Walsh, William R

2013-02-01

The increased concentration of platelets within platelet-rich plasma (PRP) provides a vehicle to deliver supra-physiologic concentrations of growth factors to an injury site, possibly accelerating or otherwise improving connective tissue regeneration. This potential benefit has led to the application of PRP in several applications; however, inconsistent results have limited widespread adoption in bone healing. This review provides a core understanding of the bone healing mechanisms, and corresponds this to the factors present in PRP. In addition, the current state of the art of PRP preparation, the key aspects that may influence its effectiveness, and treatment outcomes as they relate specifically to bone defect healing are presented. Although PRP does have a sound scientific basis, its use for bone healing appears only beneficial when used in combination with osteoconductive scaffolds; however, neither allograft nor autograft appear to be appropriate carriers. Aggressive processing techniques and very high concentrations of PRP may not improve healing outcomes. Moreover, many other variables exist in PRP preparation and use that influence its efficacy; the effect of these variables should be understood when considering PRP use. This review includes the essentials of what has been established, what is currently missing in the literature, and recommendations for future directions.

Practice and transfer of the frequency structures of continuous isometric force.

PubMed

King, Adam C; Newell, Karl M

2014-04-01

The present study examined the learning, retention and transfer of task outcome and the frequency-dependent properties of isometric force output dynamics. During practice participants produced isometric force to a moderately irregular target pattern either under a constant or variable presentation. Immediate and delayed retention tests examined the persistence of practice-induced changes of force output dynamics and transfer tests investigated performance to novel (low and high) irregular target patterns. The results showed that both constant and variable practice conditions exhibited similar reductions in task error but that the frequency-dependent properties were differentially modified across the entire bandwidth (0-12Hz) of force output dynamics as a function of practice. Task outcome exhibited persistent properties on the delayed retention test whereas the retention of faster time scales processes (i.e., 4-12Hz) of force output was mediated as a function of frequency structure. The structure of the force frequency components during early practice and following a rest interval was characterized by an enhanced emphasis on the slow time scales related to perceptual-motor feedback. The findings support the proposition that there are different time scales of learning at the levels of task outcome and the adaptive frequency bandwidths of force output dynamics. Copyright © 2014 Elsevier B.V. All rights reserved.

The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis

PubMed Central

Perl, Jeffrey; Davies, Simon J.; Lambie, Mark; Pisoni, Ronald L.; McCullough, Keith; Johnson, David W.; Sloand, James A.; Prichard, Sarah; Kawanishi, Hideki; Tentori, Francesca; Robinson, Bruce M.

2016-01-01

♦ Background: Extending technique survival on peritoneal dialysis (PD) remains a major challenge in optimizing outcomes for PD patients while increasing PD utilization. The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable practices associated with improvements in PD technique and patient survival. In collaboration with the International Society for Peritoneal Dialysis (ISPD), PDOPPS seeks to standardize PD-related data definitions and provide a forum for effective international collaborative clinical research in PD. ♦ Methods: The PDOPPS is an international prospective cohort study in Australia, Canada, Japan, the United Kingdom (UK), and the United States (US). Each country is enrolling a random sample of incident and prevalent patients from national samples of 20 to 80 sites with at least 20 patients on PD. Enrolled patients will be followed over an initial 3-year study period. Demographic, comorbidity, and treatment-related variables, and patient-reported data, will be collected over the study course. The primary outcome will be all-cause PD technique failure or death; other outcomes will include cause-specific technique failure, hospitalizations, and patient-reported outcomes. ♦ Results: A high proportion of the targeted number of study sites has been recruited to date in each country. Several ancillary studies have been funded with high momentum toward expansion to new countries and additional participation. ♦ Conclusion: The PDOPPS is the first large, international study to follow PD patients longitudinally to capture clinical practice. With data collected, the study will serve as an invaluable resource and research platform for the international PD community, and provide a means to understand variation in PD practices and outcomes, to identify optimal practices, and to ultimately improve outcomes for PD patients. PMID:26526049

The Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS): Unifying Efforts to Inform Practice and Improve Global Outcomes in Peritoneal Dialysis.

PubMed

Perl, Jeffrey; Davies, Simon J; Lambie, Mark; Pisoni, Ronald L; McCullough, Keith; Johnson, David W; Sloand, James A; Prichard, Sarah; Kawanishi, Hideki; Tentori, Francesca; Robinson, Bruce M

2016-01-01

♦ Extending technique survival on peritoneal dialysis (PD) remains a major challenge in optimizing outcomes for PD patients while increasing PD utilization. The primary objective of the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) is to identify modifiable practices associated with improvements in PD technique and patient survival. In collaboration with the International Society for Peritoneal Dialysis (ISPD), PDOPPS seeks to standardize PD-related data definitions and provide a forum for effective international collaborative clinical research in PD. ♦ The PDOPPS is an international prospective cohort study in Australia, Canada, Japan, the United Kingdom (UK), and the United States (US). Each country is enrolling a random sample of incident and prevalent patients from national samples of 20 to 80 sites with at least 20 patients on PD. Enrolled patients will be followed over an initial 3-year study period. Demographic, comorbidity, and treatment-related variables, and patient-reported data, will be collected over the study course. The primary outcome will be all-cause PD technique failure or death; other outcomes will include cause-specific technique failure, hospitalizations, and patient-reported outcomes. ♦ A high proportion of the targeted number of study sites has been recruited to date in each country. Several ancillary studies have been funded with high momentum toward expansion to new countries and additional participation. ♦ The PDOPPS is the first large, international study to follow PD patients longitudinally to capture clinical practice. With data collected, the study will serve as an invaluable resource and research platform for the international PD community, and provide a means to understand variation in PD practices and outcomes, to identify optimal practices, and to ultimately improve outcomes for PD patients. Copyright © 2016 International Society for Peritoneal Dialysis.

An Examination of the Impact That Selected School Characteristics Have on the Academic Achievement of Students Attending High Schools in South Carolina

ERIC Educational Resources Information Center

McCord, Gregory A.

2014-01-01

The impact of school locale, size and poverty levels (SES) on student achievement has been of great interest in school research for more than the last five decades. The increasing public demand to hold schools accountable for their effects on student outcomes lends urgency to the task of exploring variables related to student achievement that are…

Predictors of stroke in patients with impaired glucose tolerance: results from the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research trial.

PubMed

Preiss, David; Giles, Thomas D; Thomas, Laine E; Sun, Jie-Lena; Haffner, Steven M; Holman, Rury R; Standl, Eberhard; Mazzone, Theodore; Rutten, Guy E; Tognoni, Gianni; Chiang, Fu-Tien; McMurray, John J V; Califf, Robert M

2013-09-01

Risk factors for stroke are well-established in general populations but sparsely studied in individuals with impaired glucose tolerance. We identified predictors of stroke among participants with impaired glucose tolerance in the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial. Cox proportional-hazard regression models were constructed using baseline variables, including the 2 medications studied, valsartan and nateglinide. Among 9306 participants, 237 experienced a stroke over 6.4 years. Predictors of stroke included classical risk factors such as existing cerebrovascular and coronary heart disease, higher pulse pressure, higher low-density lipoprotein cholesterol, older age, and atrial fibrillation. Other factors, including previous venous thromboembolism, higher waist circumference, lower estimated glomerular filtration rate, lower heart rate, and lower body mass index, provided additional important predictive information, yielding a C-index of 0.72. Glycemic measures were not predictive of stroke. Variables associated with stroke were similar in participants with no prior history of cerebrovascular disease at baseline. The most powerful predictors of stroke in patients with impaired glucose tolerance included a combination of established risk factors and novel variables, such as previous venous thromboembolism and elevated waist circumference, allowing moderately effective identification of high-risk individuals.

Feasibility of a community intervention for the prevention of suicide and alcohol abuse with Yup'ik Alaska Native youth: the Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies.

PubMed

Mohatt, Gerald V; Fok, Carlotta Ching Ting; Henry, David; Allen, James

2014-09-01

The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies evaluated the feasibility of a community intervention to prevent suicide and alcohol abuse among rural Yup'ik Alaska Native youth in two remote communities. The intervention originated in an Indigenous model of protection, and its development used a community based participatory research process. Feasibility assessment aimed to assess the extent to which (1) the intervention could be implemented in rural Alaska Native communities, and (2) the intervention was capable of producing measurable effects. Scales maximally sensitive to change were derived from earlier measurement work, and the study contrasted implementation process and outcomes across the two communities. In one community, medium dose response effects (d = .30-.50), with dose defined as number of intervention activities attended, were observed in the growth of intermediate protective factors and ultimate variables. In the other community, medium dose effects were observed for one intermediate protective factor variable, and small dose effects were observed in ultimate variables. Differences across communities in resources supporting intervention explain these contrasting outcomes. Results suggest implementation in these rural Alaska settings is feasible when sufficient resources are available to sustain high levels of local commitment. In such cases, measureable effects are sufficient to warrant a prevention trial.

A protective factors model for alcohol abuse and suicide prevention among Alaska Native youth.

PubMed

Allen, James; Mohatt, Gerald V; Fok, Carlotta Ching Ting; Henry, David; Burkett, Rebekah

2014-09-01

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41-59, 2006; Mohatt et al. in Am J Commun Psychol 33:263-273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12-18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.

Disclosure control using partially synthetic data for large-scale health surveys, with applications to CanCORS.

PubMed

Loong, Bronwyn; Zaslavsky, Alan M; He, Yulei; Harrington, David P

2013-10-30

Statistical agencies have begun to partially synthesize public-use data for major surveys to protect the confidentiality of respondents' identities and sensitive attributes by replacing high disclosure risk and sensitive variables with multiple imputations. To date, there are few applications of synthetic data techniques to large-scale healthcare survey data. Here, we describe partial synthesis of survey data collected by the Cancer Care Outcomes Research and Surveillance (CanCORS) project, a comprehensive observational study of the experiences, treatments, and outcomes of patients with lung or colorectal cancer in the USA. We review inferential methods for partially synthetic data and discuss selection of high disclosure risk variables for synthesis, specification of imputation models, and identification disclosure risk assessment. We evaluate data utility by replicating published analyses and comparing results using original and synthetic data and discuss practical issues in preserving inferential conclusions. We found that important subgroup relationships must be included in the synthetic data imputation model, to preserve the data utility of the observed data for a given analysis procedure. We conclude that synthetic CanCORS data are suited best for preliminary data analyses purposes. These methods address the requirement to share data in clinical research without compromising confidentiality. Copyright © 2013 John Wiley & Sons, Ltd.

Meditation-induced changes in high-frequency heart rate variability predict smoking outcomes

PubMed Central

Libby, Daniel J.; Worhunsky, Patrick D.; Pilver, Corey E.; Brewer, Judson A.

2012-01-01

Background: High-frequency heart rate variability (HF-HRV) is a measure of parasympathetic nervous system (PNS) output that has been associated with enhanced self-regulation. Low resting levels of HF-HRV are associated with nicotine dependence and blunted stress-related changes in HF-HRV are associated with decreased ability to resist smoking. Meditation has been shown to increase HF-HRV. However, it is unknown whether tonic levels of HF-HRV or acute changes in HF-HRV during meditation predict treatment responses in addictive behaviors such as smoking cessation. Purpose: To investigate the relationship between HF-HRV and subsequent smoking outcomes. Methods: HF-HRV during resting baseline and during mindfulness meditation was measured within two weeks of completing a 4-week smoking cessation intervention in a sample of 31 community participants. Self-report measures of smoking were obtained at a follow up 17-weeks after the initiation of treatment. Results: Regression analyses indicated that individuals exhibiting acute increases in HF-HRV from resting baseline to meditation smoked fewer cigarettes at follow-up than those who exhibited acute decreases in HF-HRV (b = −4.89, p = 0.008). Conclusion: Acute changes in HF-HRV in response to meditation may be a useful tool to predict smoking cessation treatment response. PMID:22457646

Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations.

PubMed

Landau, Sabine; Emsley, Richard; Dunn, Graham

2018-06-01

Random allocation avoids confounding bias when estimating the average treatment effect. For continuous outcomes measured at post-treatment as well as prior to randomisation (baseline), analyses based on (A) post-treatment outcome alone, (B) change scores over the treatment phase or (C) conditioning on baseline values (analysis of covariance) provide unbiased estimators of the average treatment effect. The decision to include baseline values of the clinical outcome in the analysis is based on precision arguments, with analysis of covariance known to be most precise. Investigators increasingly carry out explanatory analyses to decompose total treatment effects into components that are mediated by an intermediate continuous outcome and a non-mediated part. Traditional mediation analysis might be performed based on (A) post-treatment values of the intermediate and clinical outcomes alone, (B) respective change scores or (C) conditioning on baseline measures of both intermediate and clinical outcomes. Using causal diagrams and Monte Carlo simulation, we investigated the performance of the three competing mediation approaches. We considered a data generating model that included three possible confounding processes involving baseline variables: The first two processes modelled baseline measures of the clinical variable or the intermediate variable as common causes of post-treatment measures of these two variables. The third process allowed the two baseline variables themselves to be correlated due to past common causes. We compared the analysis models implied by the competing mediation approaches with this data generating model to hypothesise likely biases in estimators, and tested these in a simulation study. We applied the methods to a randomised trial of pragmatic rehabilitation in patients with chronic fatigue syndrome, which examined the role of limiting activities as a mediator. Estimates of causal mediation effects derived by approach (A) will be biased if one of the three processes involving baseline measures of intermediate or clinical outcomes is operating. Necessary assumptions for the change score approach (B) to provide unbiased estimates under either process include the independence of baseline measures and change scores of the intermediate variable. Finally, estimates provided by the analysis of covariance approach (C) were found to be unbiased under all the three processes considered here. When applied to the example, there was evidence of mediation under all methods but the estimate of the indirect effect depended on the approach used with the proportion mediated varying from 57% to 86%. Trialists planning mediation analyses should measure baseline values of putative mediators as well as of continuous clinical outcomes. An analysis of covariance approach is recommended to avoid potential biases due to confounding processes involving baseline measures of intermediate or clinical outcomes, and not simply for increased precision.

Teachers' and students' work-culture variables associated with positive school outcome.

PubMed

Goldwater, O D; Nutt, R L

1999-01-01

Little is known about the relationship between teachers' family-of-origin variables, impacting their work attitudes and interpersonal skills, and students' academic outcome. This study investigated whether goodness of fit between teachers' and students' backgrounds is associated with subjective grading and objective achievement at school. One hundred one seventh graders and twenty of their teachers completed the Self-Report Family Inventory. Similarity between teachers' and students' work-culture variables was associated with the subjective grading practices of teachers. The self-report data also revealed effective teacher and successful student profiles.

Factors affecting exits from homelessness among persons with serious mental illness and substance use disorders.

PubMed

Gabrielian, Sonya; Bromley, Elizabeth; Hellemann, Gerhard S; Kern, Robert S; Goldenson, Nicholas I; Danley, Megan E; Young, Alexander S

2015-04-01

We sought to understand the housing trajectories of homeless consumers with serious mental illness (SMI) and co-occurring substance use disorders (SUD) and to identify factors that best predicted achievement of independent housing. Using administrative data, we identified homeless persons with SMI and SUD admitted to a residential rehabilitation program from December 2008 to November 2011. Our primary outcome measure was independent housing status. On a random sample (N = 36), we assessed a range of potential predictors of housing outcomes, including symptoms, cognition, and social/community supports. We used the Residential Time-Line Follow-Back (TLFB) Inventory to gather housing histories since exiting rehabilitation and to identify housing outcomes. We used Recursive Partitioning (RP) to identify variables that best differentiated participants by these outcomes. We identified 3 housing trajectories: stable housing (n = 14), unstable housing (n = 15), and continuously engaged in housing services (n = 7). In RP analysis, 2 variables (Symbol Digit Modalities Test [SDMT], a neurocognitive speed of processing measure, and Behavior and Symptom Identification Scale [BASIS-24] Relationships subscale, which quantifies symptoms affecting relationships) were sufficient to capture information provided by 26 predictors to classify participants by housing outcome. Participants predicted to continuously engage in services had impaired processing speeds (SDMT score < 32.5). Among consumers with SDMT score ≥ 32.5, those predicted to achieve stable housing had fewer interpersonal symptoms (BASIS-24 Relationships subscale score < 0.81) than those predicted to have unstable housing. This model explains 57% of this sample's variability and 14% of this population's variability in housing outcomes. Because cognition and symptoms influencing relationships predicted housing outcomes for homeless adults with SMI and SUD, cognitive and social skills training may be useful for this population. © Copyright 2015 Physicians Postgraduate Press, Inc.

Benzoate treatment and the glycine index in nonketotic hyperglycinaemia.

PubMed

Van Hove, J L K; Vande Kerckhove, K; Hennermann, J B; Mahieu, V; Declercq, P; Mertens, S; De Becker, M; Kishnani, P S; Jaeken, J

2005-01-01

High-dose benzoate treatment aimed at reducing plasma glycine levels to normal reduces seizures and increases wakefulness in patients with nonketotic hyperglycinaemia (NKH). Since benzoate metabolism is dependent on the available glycine pool, and since the glycine pool is variably affected by the deficiency in the glycine cleavage enzyme system, we examined the importance of interpatient variability in benzoate requirement. To correct for the dietary glycine contribution, the glycine index was introduced as the molar requirement of benzoate dose necessary to normalize plasma glycine levels and subtracting from that the dietary glycine intake, both corrected for weight. The glycine index varied between 3.62 and 4.87 mmol/kg per day in five patients with a poor neurodevelopmental outcome and between 0.92 and 1.90 mmol/kg per day in four patients with a better neurodevelopmental outcome, and was 2.54 mmol/kg per day in a single patient with an intermediate outcome. The glycine index was stable over time within each patient. Exceeding the balance by either increasing food glycine intake or decreasing the benzoate dose resulted in increased glycine levels. Exceeding the glycine tolerance by increasing benzoate resulted in elevated and toxic levels of benzoate. The glycine index is a stable, individually specific parameter in patients with NKH. It has clinical consequences for the dose of benzoate required and the role of dietary management. Through its correlation with neurodevelopmental outcome, the glycine index points to potential genetic factors that could contribute to the psychomotor retardation in NKH.

Impact of urinary incontinence on medical rehabilitation inpatients.

PubMed

Mallinson, Trudy; Fitzgerald, Colleen M; Neville, Cynthia E; Almagor, Orit; Manheim, Larry; Deutsch, Anne; Heinemann, Allen

2017-01-01

To determine the prevalence of urinary incontinence (UI) and its association with rehabilitation outcomes in patients receiving inpatient medical rehabilitation in the United States. A retrospective, cohort study of 425,547 Medicare patients discharged from inpatient rehabilitation facilities (IRFs) in 2005. We examined prevalence of UI at admission and discharge for 5 impairment groups. We examined the impact of demographics, health, and functional status on the primary outcome, change in continence status, and secondary outcomes of discharge location and 6-month mortality. Approximately one-quarter (26.6%) of men were incontinent at admission compared to 22.2% of women. In all diagnostic groups, continence status remains largely unchanged from admission to discharge. Patients who are older, have cognitive difficulties, less functional improvement, and longer lengths of stay (LOS), are more likely to remain incontinent, compared to those who improved, after controlling for patient factors and clinical variables. UI was significantly associated with discharge to another post-acute setting (PAC). For orthopedic patients, UI was associated with a 71% increase in the likelihood of discharge to an institutional setting after controlling for patient factors and clinical variables. UI was not associated with death at 6 months post-discharge. UI is highly prevalent in IRF patients and is associated with increased likelihood of discharge to institutional care, particularly for orthopedic patients. Greater attention to identifying and treating UI in IRF patients may reduce medical expenditures and improve other outcomes. Neurourol. Urodynam. 36:176-183, 2017. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Does the width of the surgical margin of safety or premalignant dermatoses at the negative surgical margin affect outcome in surgically treated penile cancer?

PubMed

Gunia, Sven; Koch, Stefan; Jain, Anjun; May, Matthias

2014-03-01

To evaluate the prognostic impact of the width of negative surgical margins (NSM) and associated and preinvasive lesions at the NSM in patients with penile squamous cell cancer (PSC). Enrolling 87 patients with NSM who underwent surgery for PSC, the archived margin slides and entirely wax-embedded surgical margins were retrieved from the pathology files. After step sections were cut, margins were stained with antibodies against CK5/6, p16, p53 and Ki-67 and subjected to in situ hybridisation for high-risk human papillomavirus (HPV). All NSM were histologically examined for squamous hyperplasia (SH), lichen sclerosus (LS) and subtypes of penile intraepithelial neoplasia (PeIN). Then, histological findings were correlated with cancer-specific mortality (CSM, median follow-up 34 months; IQR 6-70). All NSM were negative for high-risk HPV and exhibited SH (p16 and p53 negative, Ki-67 variably positive), LS (p16 negative, variable p53 and Ki-67 positivity) and differentiated PeIN (dPeIN; p16 negative, Ki-67 positive, variable p53 positivity) in 28 (32%), 30 (34%) and 22 (25%) cases, respectively, whereas PeIN subtypes other then dPeIN did not occur. Pathological tumour stage was the only independent predictive parameter with respect to CSM in the multivariable analysis (p=0.001). SH, LS and dPeIN are frequent histological findings at the NSM of surgically treated PSC. However, neither the width of the NSM nor dPeIN, LS or SH at the NSM influences prognostic outcome.

Fractal analysis for assessing tumour grade in microscopic images of breast tissue

NASA Astrophysics Data System (ADS)

Tambasco, Mauro; Costello, Meghan; Newcomb, Chris; Magliocco, Anthony M.

2007-03-01

In 2006, breast cancer is expected to continue as the leading form of cancer diagnosed in women, and the second leading cause of cancer mortality in this group. A method that has proven useful for guiding the choice of treatment strategy is the assessment of histological tumor grade. The grading is based upon the mitosis count, nuclear pleomorphism, and tubular formation, and is known to be subject to inter-observer variability. Since cancer grade is one of the most significant predictors of prognosis, errors in grading can affect patient management and outcome. Hence, there is a need to develop a breast cancer-grading tool that is minimally operator dependent to reduce variability associated with the current grading system, and thereby reduce uncertainty that may impact patient outcome. In this work, we explored the potential of a computer-based approach using fractal analysis as a quantitative measure of cancer grade for breast specimens. More specifically, we developed and optimized computational tools to compute the fractal dimension of low- versus high-grade breast sections and found them to be significantly different, 1.3+/-0.10 versus 1.49+/-0.10, respectively (Kolmogorov-Smirnov test, p<0.001). These results indicate that fractal dimension (a measure of morphologic complexity) may be a useful tool for demarcating low- versus high-grade cancer specimens, and has potential as an objective measure of breast cancer grade. Such prognostic value could provide more sensitive and specific information that would reduce inter-observer variability by aiding the pathologist in grading cancers.

Big data and computational biology strategy for personalized prognosis.

PubMed

Ow, Ghim Siong; Tang, Zhiqun; Kuznetsov, Vladimir A

2016-06-28

The era of big data and precision medicine has led to accumulation of massive datasets of gene expression data and clinical information of patients. For a new patient, we propose that identification of a highly similar reference patient from an existing patient database via similarity matching of both clinical and expression data could be useful for predicting the prognostic risk or therapeutic efficacy.Here, we propose a novel methodology to predict disease/treatment outcome via analysis of the similarity between any pair of patients who are each characterized by a certain set of pre-defined biological variables (biomarkers or clinical features) represented initially as a prognostic binary variable vector (PBVV) and subsequently transformed to a prognostic signature vector (PSV). Our analyses revealed that Euclidean distance rather correlation distance measure was effective in defining an unbiased similarity measure calculated between two PSVs.We implemented our methods to high-grade serous ovarian cancer (HGSC) based on a 36-mRNA predictor that was previously shown to stratify patients into 3 distinct prognostic subgroups. We studied and revealed that patient's age, when converted into binary variable, was positively correlated with the overall risk of succumbing to the disease. When applied to an independent testing dataset, the inclusion of age into the molecular predictor provided more robust personalized prognosis of overall survival correlated with the therapeutic response of HGSC and provided benefit for treatment targeting of the tumors in HGSC patients.Finally, our method can be generalized and implemented in many other diseases to accurately predict personalized patients' outcomes.

Comparison of different volumes of high intensity interval training on cardiac autonomic function in sedentary young women.

PubMed

Bhati, Pooja; Bansal, Vishal; Moiz, Jamal Ali

2017-08-24

Purpose The present study was conducted to compare the effects of low volume of high intensity interval training (LVHIIT) and high volume of high intensity interval training (HVHIIT) on heart rate variability (HRV) as a primary outcome measure, and on maximum oxygen consumption (VO2max), body composition, and lower limb muscle strength as secondary outcome measures, in sedentary young women. Methods Thirty-six participants were recruited in this study. The LVHIIT group (n = 17) performed one 4-min bout of treadmill running at 85%-95% maximum heart rate (HRmax), followed by 3 min of recovery by running at 70% HRmax, three times per week for 6 weeks. The HVHIIT group (n = 15) performed four times 4-min bouts of treadmill running at 85%-95% HRmax, interspersed with 3-min of recovery by running at 70% HRmax, 3 times per week for 6 weeks. All criterion measures were measured before and after training in both the groups. Results Due to attrition of four cases, data of 32 participants was used for analysis. A significant increase in high frequency (HF) power (p < 0.001) and decrease in the ratio of low frequency to high frequency power (LF/HF) ratio (p < 0.001) in HRV parameters, was observed post-HVHIIT, whereas, these variables did not change significantly (HF: p = 0.92, LF/HF ratio: p = 0.52) in LVHIIT group. Nevertheless, both the interventions proved equally effective in improving aerobic capacity (VO2max), body composition, and muscle strength. Conclusion The study results suggest that both LVHIIT and HVHIIT are equally effective in improving VO2max, body composition, and muscle strength, in sedentary young women. However, HVHIIT induces parasympathetic dominance as well, as measured by HRV.

High-risk driving attitudes and everyday driving violations of car and racing enthusiasts in Ontario, Canada.

PubMed

Yildirim-Yenier, Zümrüt; Vingilis, Evelyn; Wiesenthal, David L; Mann, Robert E; Seeley, Jane

2015-01-01

Attitudes and individual difference variables of car and racing enthusiasts regarding high-risk behaviors of street racing and stunt driving have recently been investigated. Positive attitudes toward high-risk driving, personality variables such as driver thrill seeking, and other self-reported risky driving acts were associated with these behaviors. However, probable relationships among high-risk driving tendencies, everyday driving behaviors, and negative road safety outcomes have remained largely unexamined. This study aimed to investigate the associations among car and racing enthusiasts' high-risk driving attitudes, self-reported everyday driving violations (i.e., ordinary and aggressive violations), and self-reported negative outcomes (i.e., collisions and driving offense citations). A web-based survey was conducted with members and visitors of car club and racing websites in Ontario, Canada. Data were obtained from 366 participants. The questionnaire included 4 attitude measures-(1) attitudes toward new penalties for Ontario's Street Racers, Stunt and Aggressive Drivers Legislation; (2) attitudes toward new offenses of stunt driving under the same legislation; (3) general attitudes toward street racing and stunt driving; (4) comparison of street racing with other risky driving behaviors-self-reported driving violations (i.e., ordinary and aggressive violations); self-reported collisions and offense citations; and background and driving questions (e.g., age, driving frequency). Results revealed that attitudes toward stunt driving offenses negatively and general attitudes toward street racing and stunt driving positively predicted ordinary violations, which, in turn, predicted offense citations. Moreover, general attitudes toward street racing and stunt driving positively predicted aggressive violations, which, in turn, predicted offense citations. The findings indicate that positive high-risk driving attitudes may be transferring to driving violations in everyday traffic, which mediates driving offense citations.

Perioperative Near-Infrared Spectroscopy Monitoring in Neonates With Congenital Heart Disease: Relationship of Cerebral Tissue Oxygenation Index Variability With Neurodevelopmental Outcome.

PubMed

Spaeder, Michael C; Klugman, Darren; Skurow-Todd, Kami; Glass, Penny; Jonas, Richard A; Donofrio, Mary T

2017-03-01

To evaluate the value of perioperative cerebral near-infrared spectroscopy monitoring using variability analysis in the prediction of neurodevelopmental outcomes in neonates undergoing surgery for congenital heart disease. Retrospective cohort study. Urban, academic, tertiary-care children's hospital. Neonates undergoing surgery with cardiopulmonary bypass for congenital heart disease. Perioperative monitoring of continuous cerebral tissue oxygenation index by near-infrared spectroscopy and subsequent neurodevelopmental testing at 6, 15, and 21 months of age. We developed a new measure, cerebral tissue oxygenation index variability, using the root mean of successive squared differences of averaged 1-minute cerebral tissue oxygenation index values for both the intraoperative and first 24-hours postoperative phases of monitoring. There were 62 neonates who underwent cerebral tissue oxygenation index monitoring during surgery for congenital heart disease and 44 underwent subsequent neurodevelopmental testing (12 did not survive until testing and six were lost to follow-up). Among the 44 monitored patients who underwent neurodevelopmental testing, 20 (45%) had abnormal neurodevelopmental indices. Patients with abnormal neurodevelopmental indices had lower postoperative cerebral tissue oxygenation index variability when compared with patients with normal indices (p = 0.01). Adjusting for class of congenital heart disease and duration of deep hypothermic circulatory arrest, lower postoperative cerebral tissue oxygenation index variability was associated with poor neurodevelopmental outcome (p = 0.02). We found reduced postoperative cerebral tissue oxygenation index variability in neonatal survivors of congenital heart disease surgery with poor neurodevelopmental outcomes. We hypothesize that reduced cerebral tissue oxygenation index variability may be a surrogate for impaired cerebral metabolic autoregulation in the immediate postoperative period. Further research is needed to investigate clinical implications of this finding and opportunities for using this measure to drive therapeutic interventions.

Reproductive outcome in 3 families with a satellited chromosome 4 with review of the literature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arn, P.H.; Younie, L.; Russo, S.

We describe 3 families segregating for a translocation of the nucleolus organizer region (NOR) onto chromosome 4. Review of previously reported cases of translocations involving NOR and chromosome 4 shows that these translocations may be associated with variable reproductive outcomes. We provide evidence that imprinting is not the mechanism responsible for the variable reproductive outcomes in the case of satellited 4p chromosomes; this may offer indirect support for a ribosomal gene position effect. Translocated ribosomal genes may influence the expression of neighboring genes and could explain the variable phenotypes in individuals with satellited nonacrocentric chromosomes. We recommend that prenatal counselingmore » of individuals with satellited nonacrocentric chromosomes should be cautious. 23 refs., 2 figs., 1 tab.« less

Effect of dental pain and caries on the quality of life of Brazilian preschool children.

PubMed

Freire, Maria do Carmo Matias; Corrêa-Faria, Patrícia; Costa, Luciane Rezende

2018-04-09

To investigate the impact of dental pain on daily performances among five-year-old Brazilian children. The study used data of 7,280 five-year-old children participating in the 2010 Brazilian Oral Health Survey (SBBrasil 2010 Project). Children were clinically examined and their parents or carers were interviewed at their homes. The outcome was the prevalence of the oral impacts on daily performance, and the explanatory variable was dental pain in the last six months. Other independent variables were children's gender and skin color/race, family income, household overcrowding, and caries experience (dmft). Rao-Scott test and Poisson regression for complex samples were carried out. The prevalence of impacts on daily performances was 26.1% (95%CI 22.3-30.2). Significant associations were found between the outcome and pain, caries experience, and sociodemographic variables. After adjusting for the independent variables, only pain and caries remained significant. Impacts on daily performances were more frequent among children with pain (PR = 1.14, 95%CI 1.06-1.23) compared to those without pain. Children with low dmft (PR = 1.90, 95%CI 1.39-2.60) and those with high dmft (PR = 3.53, 95%CI 2.78-4.49) had a higher prevalence of impact than those with no caries experience. Dental pain and caries had strong negative impacts on the five-year-old children's daily performances regardless of their demographic and socioeconomic characteristics.

Postoperative seizure outcome-guided machine learning for interictal electrocorticography in neocortical epilepsy.

PubMed

Park, Seong-Cheol; Chung, Chun Kee

2018-06-01

The objective of this study was to introduce a new machine learning guided by outcome of resective epilepsy surgery defined as the presence/absence of seizures to improve data mining for interictal pathological activities in neocortical epilepsy. Electrocorticographies for 39 patients with medically intractable neocortical epilepsy were analyzed. We separately analyzed 38 frequencies from 0.9 to 800 Hz including both high-frequency activities and low-frequency activities to select bands related to seizure outcome. An automatic detector using amplitude-duration-number thresholds was used. Interictal electrocorticography data sets of 8 min for each patient were selected. In the first training data set of 20 patients, the automatic detector was optimized to best differentiate the seizure-free group from not-seizure-free-group based on ranks of resection percentages of activities detected using a genetic algorithm. The optimization was validated in a different data set of 19 patients. There were 16 (41%) seizure-free patients. The mean follow-up duration was 21 ± 11 mo (range, 13-44 mo). After validation, frequencies significantly related to seizure outcome were 5.8, 8.4-25, 30, 36, 52, and 75 among low-frequency activities and 108 and 800 Hz among high-frequency activities. Resection for 5.8, 8.4-25, 108, and 800 Hz activities consistently improved seizure outcome. Resection effects of 17-36, 52, and 75 Hz activities on seizure outcome were variable according to thresholds. We developed and validated an automated detector for monitoring interictal pathological and inhibitory/physiological activities in neocortical epilepsy using a data-driven approach through outcome-guided machine learning. NEW & NOTEWORTHY Outcome-guided machine learning based on seizure outcome was used to improve detections for interictal electrocorticographic low- and high-frequency activities. This method resulted in better separation of seizure outcome groups than others reported in the literature. The automatic detector can be trained without human intervention and no prior information. It is based only on objective seizure outcome data without relying on an expert's manual annotations. Using the method, we could find and characterize pathological and inhibitory activities.

Educational outcomes associated with childhood obesity in the United States: cross-sectional results from the 2011–2012 National Survey of Children’s Health

PubMed Central

2015-01-01

Background Past research examining the effects of childhood obesity has largely focused on its projected effects into adulthood. However, there is emerging evidence that childhood obesity may have more immediate effects on school-related outcomes. We examine a range of educational attainment indicators to examine the possible pathway between obesity status and academic performance, while investigating the proximal effects of childhood obesity on health and utilization of health services, and whether these variables attenuate the relationship between obesity status and educational outcomes. Methods Data for the current study come from the 2011-2012 National Survey of Children’s Health, which details the impacts of childhood obesity on a range of outcomes among a nationally representative sample of children and adolescents aged 10-17 years (N=45,255). Educational outcomes (school absences, school problems, repeating a grade and school engagement) were modeled by logistic regression as a function of BMI, overall health status, health care utilization, and a range of sociodemographic variables. Results BMI status was significantly associated with all educational outcomes (p<0.001 for all), overall health status (p<0.001), and health care utilization (p=0.016). Prior to adjustment for covariates, obese children were significantly more likely to have school absences and school problems, to repeat a grade, and to have lower school engagement than non-overweight children. After adjustment for sociodemographic and health/healthcare variables, these outcomes remained significant for all but repeating a grade. The odds of having school problems, repeating a grade, and low school engagement that were associated with obesity were attenuated by the addition of sociodemographic variables into the model, while the addition of health and health care variables in the model decreased the odds of school absences. Conclusions This study provides evidence that increased weight status in children is associated with poorer educational outcomes. While recognizing that these are cross-sectional data, we suggest that 1) health-related and sociodemographic factors should be a focus point of intervention, and 2) a socio-structural approach including Coordinated School Health intervention is crucial to reducing childhood obesity and improving educational outcomes in this population. PMID:26222699

Speech outcomes in Parkinson's disease after subthalamic nucleus deep brain stimulation: A systematic review.

PubMed

Aldridge, Danielle; Theodoros, Deborah; Angwin, Anthony; Vogel, Adam P

2016-12-01

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in reducing motor symptoms for many individuals with Parkinson's disease (PD). However, STN DBS does not appear to influence speech in the same way, and may result in a variety of negative outcomes for people with PD (PWP). A high degree of inter-individual variability amongst PWP regarding speech outcomes following STN DBS is evident in many studies. Furthermore, speech studies in PWP following STN DBS have employed a wide variety of designs and methodologies, which complicate comparison and interpretation of outcome data amongst studies within this growing body of research. An analysis of published evidence regarding speech outcomes in PWP following STN DBS, according to design and quality, is missing. This systematic review aimed to analyse and coalesce all of the current evidence reported within observational and experimental studies investigating the effects of STN DBS on speech. It will strengthen understanding of the relationship between STN DBS and speech, and inform future research by highlighting methodological limitations of current evidence. Copyright © 2016 Elsevier Ltd. All rights reserved.

Illusion of control: the role of personal involvement.

PubMed

Yarritu, Ion; Matute, Helena; Vadillo, Miguel A

2014-01-01

The illusion of control consists of overestimating the influence that our behavior exerts over uncontrollable outcomes. Available evidence suggests that an important factor in development of this illusion is the personal involvement of participants who are trying to obtain the outcome. The dominant view assumes that this is due to social motivations and self-esteem protection. We propose that this may be due to a bias in contingency detection which occurs when the probability of the action (i.e., of the potential cause) is high. Indeed, personal involvement might have been often confounded with the probability of acting, as participants who are more involved tend to act more frequently than those for whom the outcome is irrelevant and therefore become mere observers. We tested these two variables separately. In two experiments, the outcome was always uncontrollable and we used a yoked design in which the participants of one condition were actively involved in obtaining it and the participants in the other condition observed the adventitious cause-effect pairs. The results support the latter approach: Those acting more often to obtain the outcome developed stronger illusions, and so did their yoked counterparts.