Backward Stepwise Regression Research Articles

Covariate Selection for Estimating Individual Treatment Effects in Psychotherapy Research: A Simulation Study and Empirical Example

Estimating individual treatment effects (ITEs) is crucial to personalized psychotherapy. It depends on identifying all covariates that interact with treatment, a challenging task considering the many patient characteristics hypothesized to influence treatment outcome. The goal of this study was to compare different covariate-selection strategies and their consequences on estimating ITEs. A Monte Carlo simulation was conducted to compare stepwise regression with and without cross-validation and shrinkage methods. The study was designed to mimic the setting of psychotherapy studies. No single covariate-selection strategy dominated all others across all factor-level combinations and on all performance measures. The least absolute shrinkage and selection operator showed the most accurate out-of-sample predictions, identified the highest number of true treatment-covariate interactions, and estimated ITEs with the highest precision across the most conditions. Domain backward stepwise regression and backward stepwise regression using Bayesian information criterion were least biased in estimating variance of ITEs across the most conditions.

Environmental factors and mobility predict COVID-19 seasonality in the Netherlands

BackgroundWe recently showed that seasonal patterns of COVID-19 incidence and Influenza-Like Illnesses incidence are highly similar, in a country in the temperate climate zone, such as the Netherlands. We hypothesize that in The Netherlands the same environmental factors and mobility trends that are associated with the seasonality of flu-like illnesses are predictors of COVID-19 seasonality as well. MethodsWe used meteorological, pollen/hay fever and mobility data from the Netherlands. For the reproduction number of COVID-19 (Rt), we used daily estimates from the Dutch State Institute for Public Health. For all datasets, we selected the overlapping period of COVID-19 and the first allergy season: from February 17, 2020 till September 21, 2020 (n = 218). Backward stepwise multiple linear regression was used to develop an environmental prediction model of the Rt of COVID-19. Next, we studied whether adding mobility trends to an environmental model improved the predictive power. ResultsThrough stepwise backward multiple linear regression four highly significant (p < 0.01) predictive factors are selected in our combined model: temperature, solar radiation, hay fever incidence, and mobility to indoor recreation locations. Our combined model explains 87.5% of the variance of Rt of COVID-19 and has a good and highly significant fit: F(4, 213) = 374.2, p < 0.00001. This model had a better overall predictive performance than a solely environmental model, which explains 77.3% of the variance of Rt (F(4, 213) = 181.3, p < 0.00001). ConclusionsWe conclude that the combined mobility and environmental model can adequately predict the seasonality of COVID-19 in a country with a temperate climate like the Netherlands. In this model higher solar radiation, higher temperature and hay fever are related to lower COVID-19 reproduction, and higher mobility to indoor recreation locations is related to an increased COVID-19 spread.

Resilience Measured as an Outcome Variable in a Sample of Emergency Medical Service (EMS) Professionals

The construct of resilience is usually entered into statistical models as an independent variable even though scholars assert it should be conceptualised similarly to other post-trauma mental health outcomes (Kalisch et al., 2017). To the best of our knowledge, there are no other published papers using a dependent variable from a standardised resilience assessment and individual trauma exposure item-level responses as predictor variables. 93 Emergency Medical Service (EMS) professionals completed the Life Events Checklist (LEC) and the Brief Resilience Scale (BRS). Each response to all LEC questions was entered into a backwards stepwise regression predicting resilience. The backwards stepwise regression was significant F(7, 85) = 9.14, p &lt; .001 and accounted for 38.3% of the variability in resilience. Gender and LEC items 3, 10, 12, and 13 negatively predicted resilience, whereas prior military service and LEC item 14 (sudden violent death) increased resilience. Even 20 months into the COVID-19 pandemic, EMS professionals continued to serve their communities. Surprisingly, sudden violent death significantly increased resilience (β = .43, p &lt; .001). We concur with scholarship on EMS professionals (before and during the pandemic) that resilience should be thought of as applied when needed (Carbajal et al., 2021; Ponder et al., 2022).

Predicting ICU Mortality in Rheumatic Heart Disease: Comparison of XGBoost and Logistic Regression.

BackgroundRheumatic heart disease (RHD) accounts for a large proportion of Intensive Care Unit (ICU) deaths. Early prediction of RHD can help with timely and appropriate treatment to improve survival outcomes, and the XGBoost machine learning technology can be used to identify predictive factors; however, its use has been limited in the past. We compared the performance of logistic regression and XGBoost in predicting hospital mortality among patients with RHD from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database.MethodsThe patients with RHD in the MIMIC-IV database were divided into two groups retrospectively according to the availability of data and its clinical significance based on whether they survived or died. Backward stepwise regression was used to analyze the independent factors influencing patients with RHD, and to compare the differences between the two groups. The XGBoost algorithm and logistic regression were used to establish two prediction models, and the areas under the receiver operating characteristic curves (AUCs) and decision-curve analysis (DCA) were used to test and compare the models. Finally, DCA and the clinical impact curve (CIC) were used to validate the model.ResultsData on 1,634 patients with RHD were analyzed, comprising 207 who died during hospitalization and 1,427 survived. According to estimated results for the two models using AUCs [0.838 (95% confidence interval = 0.786–0.891) and 0.815 (95% confidence interval = 0.765–0.865)] and DCA, the logistic regression model performed better. DCA and CIC verified that the logistic regression model had convincing predictive value.ConclusionsWe used logistic regression analysis to establish a more meaningful prediction model for the final outcome of patients with RHD. This model might be clinically useful for patients with RHD and help clinicians to provide detailed treatments and precise management.

HIF-pathway genes prognostic for progression-free and overall survival in metastatic clear cell renal cell carcinoma (mccRCC).

370 Background: Clear cell renal cell carcinoma (ccRCC) is characterized by defects in the Von Hippel-Lindau/hypoxia-inducible factor (VHL/HIF) pathway. Several FDA-approved RCC therapies target the products of HIF-response genes. HIF2A is a promising new target and drugs targeting HIF2A are undergoing clinical testing. A better understanding of HIF-related genes may reveal useful biomarkers and drug targets. Methods: Gene expression was determined from 324 archival pretreatment nephrectomy specimens available from the Cancer and Leukemia Group B (CALGB) 90206, a phase III trial of patients treated with INF-α vs. INF-α plus bevacizumab. TaqMan RT-qPCR was performed on the OpenArray platform using RNA extracted from tumor tissue macrodissected based on review of H&amp;E staining by a genitourinary pathologist. HIF pathway genes were assessed across both treatment arms, utilizing the proportional hazards model as predictors of OS and PFS, with time from randomization to death or disease progression as endpoints. Results: A total of 28 HIF-related genes (involved either in canonical or non-canonical HIF regulation) were assessed in univariate PH. Nine of these genes were associated with OS (i.e., HIF2A , VEGFC, VEGFD, TGFA, VHL, CCND1, EGFR, EGLN3 and HSP90AA1); and 6 of them were also associated with PFS (i.e., HIF2A , TGFA, VHL, CCND1 and EGLN3, and HSP90AA1). The HIF isotypes HIF1A and HIF3A were not prognostic, likewise VEGFA and VEGFB. Prolyl hydroxylase domain (PHD) proteins efficiently hydroxylate HIFα in normoxic conditions. PHD isotypes EGLN (1-3) were evaluated and only EGLN3 was associated with OS and PFS. HIF is also regulated by non-canonical pathways that function independent of oxygen concentration. HSP90AA1 was the only non-canonical pathway gene that was prognostic, and it predicted both OS and PFS. When the 9 genes that were prognostic in univariate analysis were used in a backward stepwise multivariate cox regression, VEGFD, TGFA and EGLN3 predicted OS while HIF2A, VHL and TGFA predicted PFS. Conclusions: VHL, HIF2A (but not HIF1A and HIF3A), EGLN3 (but not EGLN1 and EGLN2) and some of the HIF-response genes were prognostic of both OS and PFS. HSP90AA1 was prognostic for OS and PFS, suggesting that the non-canonical HIF pathway also plays a role in disease progression. Future studies should consider these HIF pathway genes as potential drug targets, and as predictors of response to treatments targeting the hypoxia pathway and angiogenesis.[Table: see text]

Switching Coefficients or Automatic Variable Selection: An Application in Forecasting Commodity Returns

In this paper, we conduct a thorough investigation of the predictive ability of forward and backward stepwise regressions and hidden Markov models for the futures returns of several commodities. The predictive performance relative a standard AR(1) benchmark is assessed under both statistical and economic loss functions. We find that the evidence that either stepwise regressions or hidden Markov models may outperform the benchmark under standard statistical loss functions is rather weak and limited to low-volatility regimes. However, a mean-variance investor that adopts flexible forecasting models (especially stepwise predictive regressions) when building her portfolio, achieves large benefits in terms of realized Sharpe ratios and mean-variance utility compared to an investor employing AR(1) forecasts.

Risk factors for ischemic gastrointestinal complications in patients undergoing open cardiac surgical procedures: A single-center retrospective experience.

Ischemic gastrointestinal complications (IGIC) following cardiac surgery are associated with high morbidity and mortality and remain difficult to predict. We evaluated perioperative risk factors for IGIC in patients undergoing open cardiac surgery. All patients that underwent an open cardiac surgical procedure at a tertiary academic center between 2011 and 2017 were included. The primary outcome was IGIC, defined as acute mesenteric ischemia necessitating a surgical intervention or postoperative gastrointestinal bleeding that was proven to be of ischemic etiology and necessitated blood product transfusion. A backward stepwise regression model was constructed to identify perioperative predictors of IGIC. Of 6862 patients who underwent cardiac surgery during the study period, 52(0.8%) developed IGIC. The highest incidence of IGIC (1.9%) was noted in patients undergoing concomitant coronary artery, valvular, and aortic procedures. The multivariable regression identified hypertension (odds ratio [OR] = 5.74), preoperative renal failure requiring dialysis (OR = 3.62), immunocompromised status (OR = 2.64), chronic lung disease (OR = 2.61), and history of heart failure (OR = 2.03) as independent predictors for postoperative IGIC. Pre- or intraoperative utilization of intra-aortic balloon pump or catheter-based assist devices (OR = 4.54), intraoperative transfusion requirement of >4 RBC units(OR = 2.47), and cardiopulmonary bypass > 180 min (OR = 2.28) were also identified as independent predictors for the development of IGIC. We identified preoperative and intraoperative risk factors that independently increase the risk of developing postoperative IGIC after cardiac surgery. A high index of suspicion must be maintained and any deviation from the expected recovery course in patients with the above-identified risk factors should trigger an immediate evaluation with the involvement of the acute care surgical team.

Does predicted age at peak height velocity explain physical performance in U13\u201315 basketball female players?

BackgroundThe aims of the study were (1) to identify the physical fitness and basic anthropometric characteristics of Polish female basketball players aged 13–15 years, (2) to show the effect of maturity timing on the performance in motor tests and basic body composition parameters, (3) to identify the index that contributes most to the prediction of performance in the tests of speed, jumping ability, agility, and endurance.MethodsThe sample included 904 female Polish players (U13–15). In part 1, maturity timing category distribution were examined within across age-groups. Maturity timing was followed by grouping with respect to years before or after the observed peak high velocity (PHV): PHV0 (− 0.50 to 0.49), PHV1 (0.50 to 1.49), PHV2 (1.50 to 2.49) and PHV3 (2.50 to 3.49). In part 2, the relationship between the anthropometric variables, physical fitness performance was assessed based on maturity timing categories (ANCOVA analysis). In part 3, backward stepwise multiple regression analyse quantified the relationship between maturity timing (group of PHV) and physical performance.ResultsANCOVA results (age, body height, and body mass as covariates) showed in the U13 female basketball players significantly higher sprinting (20 m), jumping ability and endurance tests results of the PHV1 group. Better results was observed in U14 female players in PHV1 compared to PHV2 and PHV3 in 20 m and jumping tests but opposite trend was observed for 5 m sprint and endurance test (distance covered and VO2max). U15 basketball players from the PHV3 group were characterized by better results of jumping abilities, endurance, 10 m and 20 m sprint and agility (total, S4) tests. Maturity timing (10 m), chronological age (5 m, 20 m, agility, SVJ, VJ, and VO2max tests), body height (10 m), body mass (10 m, 20 m, VJ, VO2max), and the interaction between body mass and height (SVJ) were significant (adjusted R2 = 0.02–0.10; p < 0.001) predictors of motor skills.ConclusionTrainng content of female basketball players aged 13–15 years old should be adjusted to biological requirements especially in jumping, endurance and 20 m sprint test. The time from peak height velocity (PHV) was a significant predictor only in the 10 m sprint test.

Can Primary School Mathematics Performance Be Predicted by Longitudinal Changes in Physical Fitness and Activity Indicators?

ObjectiveTo determine to what extent physical fitness indicators and/or moderate to vigorous physical activity (MVPA) may account for final mathematics academic performance (APmath) awarded at the end of primary school.MethodsSchool-aged youth were sampled in a repeated-measures, longitudinal design in Grade 6 (∼11 years), and again in Grade 9 (∼14 years). The youth (N = 231, 111 girls) completed a fitness test battery consisting of: flamingo balance test, standing long jump, backward obstacle course, plate tapping, sit ups, sit and reach, handgrip, and 20-m shuttle run. APmath scores were obtained for all children at the end of Grade 5, end of Grade 8, and end of Grade 9 (their final year of primary school). In a sub-sample of Grade 6 youth (N = 50, 29 girls), MVPA was measured objectively via SenseWear Pro Armbands (MVPAOB) for seven consecutive days, with measurements repeated in Grade 9.ResultsMath scores decreased from Grade 6 to 9 for both boys and girls (95%CI: −0.89 to −0.53, p < 0.001). MVPAOB was reduced by ∼45.7 min (−33%) from Grade 6 to 9 (p < 0.01). Significant main and interaction effects are noted for each fitness indicator (p < 0.05). A backward stepwise multiple regression analysis determined significant shared variance in final APmath grade to the change scores from Grade 6 to Grade 9 in: ΔAPmath, Δbackward obstacle course, Δsit and reach, and Δsit-ups [R2 = 0.494, F(4,180) = 43.67, p < 0.0001]. A second regression was performed only for the youth who completed MVPAOB measurements. In this sub-sample, MVPAOB did not significantly contribute to the model.ConclusionLongitudinal changes in youth fitness and their delta change in APmath score accounted for 49.4% of the variance in the final math grade awarded at the end of Grade 9. Aerobic power, upper body strength, and muscular endurance share more common variance to final math grade in boys, whereas whole-body coordination was the more relevant index in girls; this finding suggests that future research exploring the relationship of AP and PF should not be limited to cardiorespiratory fitness, instead encompassing muscular and neuro-muscular components of PF.

Sources of information used by women during pregnancy and the perceived quality

BackgroundAccess to reliable information is critical to women’s experience and wellbeing during pregnancy and childbirth. In our information-rich society, women are exposed to a wide range of information sources. The primary objective of this study was to explore women’s use of information sources during pregnancy and to examine the perceived usefulness and trustworthiness of these sources.MethodA quantitative cross-sectional study of Dutch women's experiences with various information sources during pregnancy, including professional (e.g. healthcare system), and informal sources, divided into conventional (e.g. family or peers) and digital sources (e.g. websites or apps). Exploratory backward stepwise multiple regression was performed to identify associations between the perceived quality of information sources and personal characteristics.ResultsA total of 1922 pregnant women were included in this study. The most commonly used information sources were midwives (91.5%), family or friends (79.3%), websites (77.9%), and apps (61%). More than 80% of women found professional information sources trustworthy and useful, while digital sources were perceived as less trustworthy and useful. Personal factors explain only a small part of the variation in the perceived quality of information sources.ConclusionEven though digital sources are perceived as less trustworthy and useful than professional and conventional sources, they are among the most commonly used sources of information for pregnant women. To meet the information needs of the contemporary generation of pregnant women it is essential that professionals help in the development of digital information sources.

Factors associated with social participation in Brazilian older adults with Alzheimer's disease: A correlational, cross-sectional study.

The occurrence of Alzheimer's disease (AD) can exert a negative impact in social participation in affected older adults. The purpose of this study was to investigate whether social participation in older adults with AD is associated with disease stage and cognitive function as well as the quality of life and depressive symptoms in their caregivers. A correlational, cross-sectional study was conducted in 40 older adults with AD (28 women and 12 men) and 40 caregivers (30 women and 10 men). Social participation was assessed using the 'social participation' domain of the Activities of Daily Living Questionnaire. Disease stage was determined using the Clinical Dementia Rating scale and cognitive function was assessed using Addenbrooke's Cognitive Examination. Quality of life and depressive symptoms in the caregivers were evaluated using the Quality of Life Assessment Scale on Alzheimer's Disease and Beck Depression Inventory respectively. The older adults with AD had a mean percentage of 59.4% on the social participation domain and a mean score of 49.0 for cognitive function. The caregivers had mean scores of 39.1 for quality of life and 9.9 for depressive symptoms. The stepwise backward multiple linear regression model indicated that the predictors analysed together explained 48% of the variability in social participation among older adults with AD. Therefore, lower social participation among older adults with AD is associated with more advanced stages of the disease and cognitive decline in these individuals as well as a lower perception of quality of life and greater levels of depressive symptoms in their caregivers.

Postamputation Cognitive Impairment Is Related to Worse Perceived Physical Function Among Middle-Aged and Older Prosthesis Users

ObjectiveTo compare characteristics between middle-aged and older prosthesis users with and without cognitive impairment and determine whether cognitive impairment contributes to variability in perceived physical function. DesignCross-sectional, observational study SettingGeneral community. ParticipantsAdults 45 years or older, at least 1-year post lower limb amputation (LLA) who were walking independently with a prosthesis (N=119). InterventionNot applicable. Main Outcome MeasuresWe identified cognitive impairment using an education-adjusted Telephone Interview for Cognitive Status-modified score. Perceived physical function was measured using the Prosthesis Mobility Questionnaire. ResultsOf 119 participants (mean age, 62.6±8.2 years; male: 89.1%; vascular etiology: 82.4%; years since amputation: 4.9±4.7 years), 28 (23.5%) had cognitive impairment. Compared with participants without cognitive impairment, those with cognitive impairment were more likely to use an assistive device (60.7% vs 25.3%, P=.002); were older (66.3±7.3 vs 61.5±8.1 years, P=.006) and had more chronic conditions (7.1±3.4 vs 5.4±2.5, P=.004), more depressive symptoms (6.6±5.1 vs 4.2±3.8, P=.008), and worse perceived physical function (2.0±0.6 vs 2.6±0.7, P<.001). Using backward stepwise linear regression, we found that participants with cognitive impairment had worse perceived physical function (standardized parameter estimate [β]=−0.15, P=.02), even after adjusting for depressive symptoms (β=−0.31, P<.001), prosthesis satisfaction (β=0.34, P<.001), number of chronic conditions (β=−0.19, P=.006), and assistive device use (βcane=0.01, P=.93; βother=−0.20, P=.003). Together, these variables explained 59% of perceived physical function variability. ConclusionsCognitive impairment is common and associated with worse perceived physical function post LLA, even after controlling for physical and mental health differences. Tailored rehabilitation interventions may be needed to improve perceived physical function in prosthesis users with cognitive impairment.

Prognostic Nomogram for Rectal Cancer Patients With Tumor Deposits.

AimTumor deposits (TDs) are an aggressive hallmark of rectal cancer, but their prognostic value has not been addressed in current staging systems. This study aimed to construct and validate a prognostic nomogram for rectal cancer patients with TDs.MethodsA total of 1,388 stage III–IV rectal cancer patients who underwent radical surgical resection from the Surveillance, Epidemiology, and End Results (SEER) database were retrospectively analyzed to identify the clinical value of TDs. TD-positive rectal cancer patients in the SEER database were used as the training set to construct a prognostic model, which was validated by Fujian Cancer Hospital. Three models were constructed to predict the prognosis of rectal cancer patients with TDs, including the least absolute shrinkage and selection operator regression (LASSO, model 1), backward stepwise regression (BSR, model 2), and LASSO followed by BSR (model 3). A nomogram was established among the three models.ResultsIn the entire cohort, TD was also identified as an independent risk factor for overall survival (OS), even after adjusting for baseline factors, stage, other risk factors, treatments, and all the included variables in this study (all P < 0.05). Among patients with TDs, model 3 exhibited a higher C-index and area under the curves (AUCs) at 3, 4, and 5 years compared with the American Joint Committee on Cancer staging system both in the training and validation sets (all P < 0.05). The nomogram obtained from model 3 showed good consistency based on the calibration curves and excellent clinical applicability by the decision curve analysis curves. In addition, patients were divided into two subgroups with apparently different OS according to the current nomogram (both P < 0.05), and only patients in the high-risk subgroup were found to benefit from postoperative radiotherapy (P < 0.05).ConclusionWe identified a novel nomogram that could not only predict the prognosis of rectal cancer patients with TDs but also provide reliable evidence for clinical decision-making.

Influence of gender and parental migration on IYCF practices in 6\u201323-month-old tribal children in Banswara district, India: findings from the cross-sectional PANChSHEEEL study

BackgroundThe interdisciplinary Participatory Approach for Nutrition in Children: Strengthening Health, Education, Engineering and Environment Linkages (PANChSHEEEL) study used a participatory approach to develop locally-feasible and tailored solutions to optimise Infant and Young Child Feeding (IYCF) practices at an individual, household, community, and environmental level. This paper aims to evaluate the influence of gender; migration; and Health, Education, Engineering and Environmental (HEEE) factors on IYCF practices, with the primary outcomes being three key complementary-feeding practices of Minimum Dietary Diversity (MDD), Minimum Meal Frequency (MMF) and Minimum Acceptable Diet (MAD).MethodsA cross-sectional survey of 325 households with children aged 6–23 months was conducted in nine purposively selected villages in two blocks of Banswara district, Rajasthan, India. A survey tool was developed, translated into the local language, pre-tested, and administered in a gender-sensitive manner. Data-collection processes were standardized to ensure quality measures. Association of the primary outcome with 27 variables was tested using a Chi-square test (Mantel-Haenszel method); backward stepwise regression analysis was conducted to assess the impact of effect modifiers (gender, parental migration).ResultsHalf of the surveyed children were of each gender, and fathers from half of the households were found to have migrated within the previous year to search for additional income. Parental literacy ranged from 60 to 70%. More than half of the households had access to milk-producing animals. Consumption of each of the seven food groups, eggs (4.7% vs 0.7%; p < 0.02), MDD (10.5% vs 3.2%; p < 0.02) and MAD (9.4% vs 2.6%; p < 0.02) were higher for boys than for girls. After controlling for contextual factors, a male child was 4.1 times more likely to get a diet with MDD and 3.8 times more likely to get a diet with MAD. A child from a non-migrant household was 2.0–2.1 times more likely to get a diet with MDD and MAD as compared to a child from a migrant household. However, this association was not found to be statistically significant after regression. Presence of milk-producing animals in households and consumption of milk/milk products by children in the previous 24 h were the other two strong predictors of MDD and MAD, although access to animal milk in the house did not translate to an increase in consumption of milk/milk products by a child.ConclusionGender discrimination in diet diversity and complementary-feeding practices starts early in childhood with boys having a distinct advantage over girls. In the case of parental migration, further research is required to establish if it has an adverse impact on feeding practices. Emphasis needs to be given to gender issues and other contextual factors when developing strategies to optimise complementary feeding practices.Trial registrationWith UCL ethics [Ethics ID 4032/002] in United Kingdom and with Sigma IRB [10,025/IRB/D/17–18] in India.

Implications of inappropriate prescription of oral nutritional supplements on the quality of life of cancer outpatients: a cross-sectional comparative study

Background and aimsOral nutritional supplements (ONS) are considered a cornerstone in the treatment plan of malnutrition in cancer patients. However, the prevalence of inappropriate prescription of ONS is high. In this study, we aim to investigate the effect of inappropriate oral nutritional supplementation (consisting of prescription of ONS without evident clinical indication, or the absence of ONS when at risk of malnutrition) on the quality of life of cancer outpatients.MethodsA cross-sectional comparative study was conducted in 104 cancer outpatients, receiving ONS without prior malnutrition risk screening (n = 51), and patients not receiving ONS (n = 53). Nutritional risk screening was performed using the abridged patient-generated subjective global assessment (ab-PG-SGA). The quality of life was assessed using EORTC QLQ-C30 version 3.0 questionnaire. Multivariate analysis was conducted to determine the predictors of quality-of-life scales. Age (years), malnutrition (ab-PG-SGA scores), BMI (kg/m2), TSF (mm), MUAC (cm), ONS (yes, no) were entered into the linear regression analysis as predictors (backward stepwise linear regression analysis).ResultsThe prevalence of malnutrition risk (ab-PG-SGA ≥ 6) was 74%. The median score of the ab-PG-SGA for ONS receiving group was significantly higher (p = 0.045). Furthermore, univariate analysis showed that the scores of the global health status (QoL) and the role functioning (RF) scales were significantly lower for the ONS receiving group (p = 0.020 and p = 0.016, respectively). Multivariately, malnutrition, inappropriate ONS prescription, and triceps skin fold were found to be predictors of the RF scale, while malnutrition was the only predictor for the QoL.ConclusionThe inappropriate ONS prescription does not improve nutritional status or quality of life of cancer outpatients.

Estimating team possessions in high-level European basketball competition

The focus of this work is to estimate the number of team possessions in Euroleague basketball for seasons 2017–18, 2018–19 and 2019–20. To achieve this goal, we implemented the approaches proposed by Kubatko, et al. (2007). The statistical analysis on Euroleague data suggests a model similar to the one which is currently used in NBA with one, minor, difference. In Euroleague data, the coefficient of the percentage of the free throw attempts that ends a current possession is slightly higher than the corresponding coefficient in NBA (0.454 vs. 0.44). In a second stage, we have implemented the estimated Euroleague possessions equation in order to construct indicators for the performance evaluation of each Euroleague team. The most important indexes for team performance evaluation are the Net Rating and the Four Factors of Dean Oliver (2003). However, by applying a backwards stepwise regression analysis, a slightly improved model, in terms of fit to the data, has been identified. The new proposed “Three Pillars” model includes the offensive and defensive True Shooting percentage , Offensive Rebound percentage and Turnover percentage. Hence, this new proposed “Three Pillars” model can be used for the performance evaluation of European teams instead of the standard Four Factors model.

Severity of anabolic steroid dependence, executive function, and personality traits in substance use disorder patients in Norway

IntroductionAnabolic androgenic steroids (AAS), including testosterone and synthetic derivatives, are typically used to increase muscle mass. Many users develop a dependence on these substances, contributing to worsened physical and mental health outcomes. Aspects of personality and executive dysfunction may represent underlying vulnerabilities for developing dependence. ObjectiveTo identify levels of AAS dependence within substance use disorder (SUD) treatment patients and assess the relationship between dependence severity and personality traits and executive function (EF). MethodsData were collected from patients at 38 SUD treatment facilities in Norway. Questionnaires were completed for measures of personality and EF. Measures of symptoms of AAS dependence were used in latent class analysis to identify sub-groups of patients, which were evaluated for association with EF and personality traits, and compared with a group of non-AAS using SUD patients. ResultsThree classes were identified; largely reflecting low, moderate, and high symptoms of dependence. Multinomial regression analyses indicated that moderate and high symptoms were associated with several measures of EF and personality traits, particularly self-monitoring, antagonism, disinhibition, and rigid perfectionism while users with low symptoms exhibited higher capacities for emotional control and shift, and lower negative affectivity, relative to non-AAS using SUD patients. Backward stepwise regressions indicated antagonism, and decreased self-monitoring as key personality and cognitive characteristics of SUD patients with severe AAS dependence. ConclusionOur findings indicate that specific executive dysfunctions and personality features, particularly those associated with poor emotional control, reduced empathy, and impulsivity are associated with more severe AAS dependence in the SUD population.

Development and validation of a novel risk score to predict 5-year mortality in patients with acute myocardial infarction in China: a retrospective study.

BackgroundThe disease burden from ischaemic heart disease remains heavy in the Chinese population. Traditional risk scores for estimating long-term mortality in patients with acute myocardial infarction (AMI) have been developed without sufficiently considering advances in interventional procedures and medication. The goal of this study was to develop a risk score comprising clinical parameters and intervention advances at hospital admission to assess 5-year mortality in AMI patients in a Chinese population.MethodsWe performed a retrospective observational study on 2,722 AMI patients between January 2013 and December 2017. Of these patients, 1,471 patients from Changsha city, Hunan Province, China were assigned to the development cohort, and 1,251 patients from Xiangtan city, Hunan Province, China, were assigned to the validation cohort. Forty-five candidate variables assessed at admission were screened using least absolute shrinkage and selection operator, stepwise backward regression, and Cox regression methods to construct the C2ABS2-GLPK score, which was graded and stratified using a nomogram and X-tile. The score was internally and externally validated. The C-statistic and Hosmer-Lemeshow test were used to assess discrimination and calibration, respectively.ResultsFrom the 45 candidate variables obtained at admission, 10 potential predictors, namely, including Creatinine, experience of Cardiac arrest, Age, N-terminal Pro-Brain Natriuretic Peptide, a history of Stroke, Statins therapy, fasting blood Glucose, Left ventricular end-diastolic diameter, Percutaneous coronary intervention and Killip classification were identified as having a close association with 5-year mortality in patients with AMI and collectively termed the C2ABS2-GLPK score. The score had good discrimination (C-statistic = 0.811, 95% confidence intervals (CI) [0.786–0.836]) and calibration (calibration slope = 0.988) in the development cohort. In the external validation cohort, the score performed well in both discrimination (C-statistic = 0.787, 95% CI [0.756–0.818]) and calibration (calibration slope = 0.976). The patients were stratified into low- (≤148), medium- (149 to 218) and high-risk (≥219) categories according to the C2ABS2-GLPK score. The predictive performance of the score was also validated in all subpopulations of both cohorts.ConclusionThe C2ABS2-GLPK score is a Chinese population-based risk assessment tool to predict 5-year mortality in AMI patients based on 10 variables that are routinely assessed at admission. This score can assist physicians in stratifying high-risk patients and optimizing emergency medical interventions to improve long-term survival in patients with AMI.

Stunting and Underweight, but not Wasting are Associated with Delay in Child Development in Southwest Ethiopia.

BackgroundStimulating care during childhood is the foundation for optimal health, learning, productivity, and social well-being throughout the life course. In addition, malnutrition is a major public health concern affecting up to half of children under-five years in Ethiopia. However, evidence on the causal contribution of malnutrition to delay in child development is poorly understood in Ethiopia.ObjectiveTo identify the relationship between different forms of malnutrition and delay in child development among children in Southwest Ethiopia.MethodsA community-based survey was conducted among 507 randomly selected mother–child pairs in the Guraghe Zone, Southwest Ethiopia. A pretested tool and validated anthropometric measurements were used. Anthropometric indices (WFH, WFA, and HFA) were calculated in Anthros software. The data were summarized in mean, median, standard deviation, tables and charts. Bivariable and multivariable binary logistic regression (stepwise backward regression) models were fitted with nutritional status (wasting, stunting and underweight) and other potential factors associated with delay in child developmental. Adjusted odds ratios with 95% confidence intervals and p-values were reported.ResultsA total of 507 mother–child (12–59 months) pairs were included in the survey (97% response rate). The mean ASQ-3 score was 150 (± 23.4), with a minimum and maximum score of 45 and 270, respectively. A total of 149 (29.4%; 95% CI: 25.4–33.4) children had developmental delays, where 17.2%, 16.8%, 13.4%, 10.8%, and 10.1% had delays in gross motor, communication, problem-solving, personal-social, and fine motor skills, respectively. Children of working mothers (AOR=2.9; 1.8, 4.8), preterm births (AOR=3.2; 1.4, 7.0), early initiation of complementary feeding (AOR=2.5; 1.37, 4.6), stunting (AOR=3.0; 1.9, 4.7), underweight (AOR= 2.3; 1.1, 4.7) and low dietary diversity score (AOR=3.1; 1.3, 7.5), were predictors of developmental delay.ConclusionChild development delay is a public health concern and it is strongly associated with stunting, underweight, undiversified dietary consumption, and suboptimal infant and young child feeding practices.

Exploring Evidence Based Practice Implementation by Occupational Therapists: Implications for Fieldwork

A fieldwork education model is used in occupational therapy to develop competency of professional skills, including evidence-based practice (EBP) and clinical reasoning. This quantitative study explored factors influencing implementation rates of EBP in New Zealand registered occupational therapists to better understand students’ experience of evidence-based practice while on fieldwork. An online survey exploring beliefs and practices related to clinical competence, professional reasoning and EBP was conducted. The survey included questions about related beliefs, the measure of Evidence Informed Professional Thinking (EIPT; Benfield & Johnston, 2020), and the Implementation Climate Scale (ICS; Ehrhart et al., 2014). The mean scores on the scales were entered into a linear regression model and backward stepwise regression was used to build a predictive model ascertaining primary influences for EBP implementation. On the measure of EIPT respondents reported infrequent engagement in clinical reasoning and EBP activities. Scores on the ICS results indicate some support of EBP practices in respondents’ workplaces. Habits of critical reflection have the strongest relationship to habits of implementing EBP in daily practice The only other factors significant in the predictive model were focus on EBP, and respondents’ level of education. Habits of critical reflection on practice and clinical reasoning activities have the strongest relationship with EBP engagement. Fieldwork students are likely to observe fieldwork educators who are infrequently engaging in critical activities of reflection and EBP. Development of strategies to enhance and habitualize critical reflection and clinical reasoning will increase EBP implementation rates. Pragmatic strategies between fieldwork educators, educational institutions, and students will likely enhance students’ learning and ultimately enhance overall EBPs in the profession.