Binary Measures Research Articles

Wasserstein barycenter for link prediction in temporal networks

Abstract We propose a flexible link forecast methodology for weighted temporal networks. Our probabilistic model estimates the evolving link dynamics among a set of nodes through Wasserstein barycentric coordinates arising within the optimal transport theory. Optimal transport theory is employed to interpolate among network evolution sequences and to compute the probability distribution of forthcoming links. Besides generating point link forecasts for weighted networks, the methodology provides the probability that a link attains weights in a certain interval, namely a quantile of the weights distribution. We test our approach to forecast the link dynamics of the worldwide Foreign Direct Investments network and of the World Trade Network, comparing the performance of the proposed methodology against several alternative models. The performance is evaluated by applying non-parametric diagnostics derived from binary classifications and error measures for regression models. We find that the optimal transport framework outperforms all the competing models when considering quantile forecast. On the other hand, for point forecast, our methodology produces accurate results that are comparable with the best performing alternative model. Results also highlight the role played by model constraints in the determination of future links emphasising that weights are better predicted when accounting for geographical rather than economic distance.

Social engagement and depressive symptoms mediate the relationship between age-related hearing loss and cognitive status.

Age-related hearing loss (ARHL) is the third leading cause of years lived with disability. Connections among ARHL, depressive symptoms, social engagement and cognitive status are increasingly reported but the underlying mechanisms leading to these relationships are largely unknown. Exploring these mechanisms is a worthy goal, especially in older adults. This study aimed to examine the mediating effect of social engagement and depressive symptoms on the relationship between ARHL and cognitive status. Structural equation modeling (SEM) with path analysis were performed with data from a cross-sectional study conducted in 11 community centers in 2021, which assessed older adults' intrinsic and sensory capacities using the WHO ICOPE framework. Demographic information, health profile, a binary measure of hearing capacity, depressive symptoms, social engagement, and cognitive status of participants were gathered. A total of 304 participants were included. ARHL was positively associated with depressive symptoms (β=0.18, p=0.009) and negatively related to social engagement (β=-0.13, p=0.026). Social engagement was positively associated with cognitive status (β=0.17, p=0.005) and negatively associated with depressive symptoms (β=-0.23, p<0.001). Greater depressive symptoms were negatively associated with the participants' cognition (β=-0.13, p=0.009). Both social engagement (β=-0.02, p=0.029) and depressive symptoms (β=-0.02, p=0.032) mediated the negative associations between ARHL and cognitive status. Addressing hearing loss, depressive symptoms, and enhancing social engagement should be investigated as a potential means of minimizing cognitive decline. Well-designed studies are needed to comprehensively inform the clinical practice development, particularly large prospective studies that will facilitate further elucidate possible causal mechanisms behind these observed associations.

On the Q statistic with constant weights in meta-analysis of binary outcomes

BackgroundCochran’s Q statistic is routinely used for testing heterogeneity in meta-analysis. Its expected value (under an incorrect null distribution) is part of several popular estimators of the between-study variance, tau ^2. Those applications generally do not account for use of the studies’ estimated variances in the inverse-variance weights that define Q (more explicitly, Q_{IV}). Importantly, those weights make approximating the distribution of Q_{IV} rather complicated.MethodsAs an alternative, we are investigating a Q statistic, Q_F, whose constant weights use only the studies’ arm-level sample sizes. For log-odds-ratio (LOR), log-relative-risk (LRR), and risk difference (RD) as the measures of effect, we study, by simulation, approximations to distributions of Q_{IV} and Q_F, as the basis for tests of heterogeneity.ResultsThe results show that: for LOR and LRR, a two-moment gamma approximation to the distribution of Q_F works well for small sample sizes, and an approximation based on an algorithm of Farebrother is recommended for larger sample sizes. For RD, the Farebrother approximation works very well, even for small sample sizes. For Q_{IV}, the standard chi-square approximation provides levels that are much too low for LOR and LRR and too high for RD. The Kulinskaya et al. (Res Synth Methods 2:254–70, 2011) approximation for RD and the Kulinskaya and Dollinger (BMC Med Res Methodol 15:49, 2015) approximation for LOR work well for n ge 100 but have some convergence issues for very small sample sizes combined with small probabilities.ConclusionsThe performance of the standard chi ^2 approximation is inadequate for all three binary effect measures. Instead, we recommend a test of heterogeneity based on Q_F and provide practical guidelines for choosing an appropriate test at the .05 level for all three effect measures.

Traffic Safety Pyramid Based on Visual Navigation Distraction: A Naturalistic Study on App-Taxis

Evidence suggests that mobile phone navigation applications (MPNAs) may reduce road traffic safety by causing a visual distraction. This study aimed to (i) identify a list of road safety-related events (RSREs) that could occur while looking at the MPNA, (ii) examine the effect of app-taxFi drivers’ glances at MPNA on missing of RSREs, (iii) develop any potential new indicator in road traffic safety, and (iv) develop a pyramid of traffic incidents. This study investigated 36 app-taxi drivers in real road traffic circumstances. Data were collected by video recording using a double-lens camera. The events that occurred while the app-taxi driver was looking at the MPNA were extracted, recorded, and classified. A time span of less than one second and a new indicator, namely “seeing the event BEFORE visual distraction” (seBvd), were examined. The data were analyzed using descriptive statistics and non-parametric tests with a significance level of 0.05 in SPSS 18. A list of 23 events was identified. The most frequent event was “presence of pedestrians across the road” (including crossing the road and beside the road 36%). The number of glances at the MPNA had a significant correlation with time span ≤1 s ( p = 0.001, r &lt; 0.6). The total time of looking at the MPNA had a significant correlation with time span &gt;1 s ( p = 0.001, r &lt; 0.6). A pyramid of traffic incidents was developed based on the results. The new seBvd indicator is a binary (positive; negative) surrogate safety measure that can be useful in evaluating the effect of visual distraction on road traffic safety. The introduced pyramid of traffic incidents seems useful in traffic safety.

Influence of setting-dependent contacts and protective behaviours on asymptomatic SARS-CoV-2 infection amongst members of a UK university

We survey 62 users of a university asymptomatic SARS-CoV-2 testing service on details of their activities, protective behaviours and contacts in the 7 days prior to receiving a positive or negative SARS-CoV-2 PCR test result in the period October 2020–March 2021. The resulting data set is novel in capturing very detailed social contact history linked to asymptomatic disease status during a period of significant restriction on social activities. We use this data to explore 3 questions: (i) Did participation in university activities enhance infection risk? (ii) How do contact definitions rank in their ability to explain test outcome during periods of social restrictions? (iii) Do patterns in the protective behaviours help explain discrepancies between the explanatory performance of different contact measures? We classify activities into settings and use Bayesian logistic regression to model test outcome, computing posterior model probabilities to compare the performance of models adopting different contact definitions. Associations between protective behaviours, participant characteristics and setting are explored at the level of individual activities using multiple correspondence analysis (MCA). We find that participation in air travel or non-university work activities was associated with a positive asymptomatic SARS-CoV-2 PCR test, in contrast to participation in research and teaching settings. Intriguingly, logistic regression models with binary measures of contact in a setting performed better than more traditional contact numbers or person contact hours (PCH). The MCA indicates that patterns of protective behaviours vary between setting, in a manner which may help explain the preference for any participation as a contact measure. We conclude that linked PCR testing and social contact data can in principle be used to test the utility of contact definitions, and the investigation of contact definitions in larger linked studies is warranted to ensure contact data can capture environmental and social factors influencing transmission risk.

Bisphenol A substitutes and childhood obesity at 7years: a cross-sectional study in Shandong, China.

Bisphenol A (BPA) substitutes, such as bisphenol S (BPS) and bisphenol AF (BPAF), are increasingly used due to restrictions on BPA usage, a known endocrine disrupting chemical and putative obesogen. However, little is known about the obesogenic effects of exposure to BPA substitutes in children. A total of 426 children aged 7years old originally recruited from Laizhou Wan Birth Cohort in Shandong, China, during 2010-2013 participated in the 2019-2020 survey. Urinary BPA and its substitutes including BPS, BPAF, bisphenol B (BPB), bisphenol AP (BPAP), bisphenol Z (BPZ), and bisphenol P (BPP) were determined. Anthropometric measures including height, weight, waist circumference, and body fat percentage were assessed, and overweight/obesity was defined as BMI z-score ≥ 85th percentile. Linear and logistic regressions were used on continuous and binary obesity measures, respectively, and weighted quantile sum (WQS) regression was further used to estimate the mixture effects of exposure to diverse bisphenols, and sex-stratified analysis was performed. BPA substitutes were widely detected (> 75%) in children's urine samples. A positive association with obesity measures was consistently observed for urinary BPS and BPAF, i.e., BMI z-score, waist circumference, and overweight/obesity. Further analysis from the WQS regression model demonstrated a positive association between bisphenol mixtures and all measures of obesity, with BPAF contributing the greatest weighing to the observed associations. Sex difference might exist as the positive associations were only significant in boys. No significant association was found between obesity and BPA or other BPA substitutes. Our study adds to mounting evidence that BPA substitutes BPS and BPAF are linked to obesity in children, especially in boys. Further longitudinal studies with larger sample size with continued biomonitoring these chemicals and their obesogenic effects are necessary.

Intimate partner violence victimization during pregnancy increases risk of postpartum depression among urban adolescent mothers in South Africa

BackgroundIt is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study’s purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers.MethodsAdolescent mothers (14–19 years) were recruited at a regional hospital’s maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6–9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates.ResultsNearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6–9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97–2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06–2.49; p = 0.03).ConclusionsPoor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers’ well-being and their baby’s health.

Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing.

Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Perceived parental alcohol problems and psychosomatic complaints among adolescents in Sweden

IntroductionFor adolescents, parental problem drinking can be regarded as a chronic stressor, negatively affecting their health. There is limited knowledge and a relative lack of empirical evidence on this topic, especially in Sweden. The aim of the current study was to examine perceived parental alcohol problems and the links with psychosomatic complaints among adolescents in Sweden. MethodsData were obtained from the Swedish Council for Information on Alcohol and Other Drugs’ national survey of 2021, collected amongst 9,032 students in grades 9 (∼15–16 years) and 11 (∼17–18 years). Perceived parental alcohol problems were measured by the Children of Alcoholics Screening Test (CAST-6) scale, using a cutoff at ≥ 3. Psychosomatic complaints were captured by a binary measure based on the frequency of headache, stomach ache, feeling depressed or down, difficulties to fall asleep, and sleeping poorly at night. Sociodemographic characteristics included gender, grade, parental education, and parental country of birth. Descriptive analyses with chi2 tests and binary logistic regression analyses were performed. ResultsAdolescents with perceived parental alcohol problems had higher odds of reporting psychosomatic complaints compared with adolescents without perceived parental drinking problems, even when adjusting for sociodemographic characteristics. Girls, grade 11 students, adolescent with at least one parent born in Sweden, and those without university-educated parents were more likely to report parental alcohol problems. ConclusionsThe findings highlight adolescents with perceived parental alcohol problems need support. The school, being an arena where adolescents spend much of their time, may play a vital role in this regard.

Optimizing the Construction of Outcome Measures for Impact Evaluations of Intimate Partner Violence Prevention Interventions.

Most impact evaluations of intimate partner violence (IPV) prevention interventions use binary measures of "any" versus "no" physical and/or sexual IPV as their primary outcome measure, missing opportunities to capture nuance. In this study, we reanalyzed secondary data from six randomized controlled trials conducted in low- and middle-income countries-Bandebereho (Rwanda), Becoming One (Uganda), Indashyikirwa (Rwanda), MAISHA CRT01, MAISHA CRT02 (Tanzania), Stepping Stones Creating Futures (South Africa), and Unite for a Better Life (Ethiopia), to assess how different conceptualizations and coding of IPV variables can influence interpretations of the impact of an intervention. We compared the standard outcome measures to new measures that reflect the severity and intensity of violence and whether interventions prevent new cases of IPV or reduce or stop ongoing violence. Results indicate that traditional binary indicators masked some of the more subtle intervention effects, and the use of the new indicators allowed for a better understanding of the impacts of the interventions. Conclusions on whether a program is perceived "to work" are highly influenced by the IPV outcomes that the investigators choose to report, and how they are measured and coded. Lack of attention to outcome choice and measurement could lead to prematurely abandoning strategies useful for violence reduction or missing essential insights into how programs may or may not affect IPV. While these results must be interpreted cautiously, given differences in intervention types, the underlying prevalence of violence, sociodemographic factors, sample sizes, and other contextual differences across the trial sites, they can help us move toward a new approach to reporting multiple outcomes that allow us to unpack the "impact" of an intervention by assessing intervention effect by the severity of violence and type of prevention, whether primary and secondary.

Opioid use and opioid use disorder in mono and dual-system users of veteran affairs medical centers.

Efforts to achieve opioid guideline concordant care may be undermined when patients access multiple opioid prescription sources. Limited data are available on the impact of dual-system sources of care on receipt of opioid medications. We examined whether dual-system use was associated with increased rates of new opioid prescriptions, continued opioid prescriptions and diagnoses of opioid use disorder (OUD). We hypothesized that dual-system use would be associated with increased odds for each outcome. This retrospective cohort study was conducted using Veterans Administration (VA) data from two facilities from 2015 to 2019, and included active patients, defined as Veterans who had at least one encounter in a calendar year (2015-2019). Dual-system use was defined as receipt of VA care as well as VA payment for community care (non-VA) services. Mono users were defined as those who only received VA services. There were 77,225 dual-system users, and 442,824 mono users. Outcomes were three binary measures: new opioid prescription, continued opioid prescription (i.e., received an additional opioid prescription), and OUD diagnosis (during the calendar year). We conducted a multivariate logistic regression accounting for the repeated observations on patient and intra-class correlations within patients. Dual-system users were significantly younger than mono users, more likely to be women, and less likely to report white race. In adjusted models, dual-system users were significantly more likely to receive a new opioid prescription during the observation period [Odds ratio (OR) = 1.85, 95% confidence interval (CI) 1.76-1.93], continue prescriptions (OR = 1.24, CI 1.22-1.27), and to receive an OUD diagnosis (OR = 1.20, CI 1.14-1.27). The prevalence of opioid prescriptions has been declining in the US healthcare systems including VA, yet the prevalence of OUD has not been declining at the same rate. One potential problem is that detailed notes from non-VA visits are not immediately available to VA clinicians, and information about VA care is not readily available to non-VA sources. One implication of our findings is that better health system coordination is needed. Even though care was paid for by the VA and presumably closely monitored, dual-system users were more likely to have new and continued opioid prescriptions.

Neonatal and perinatal mortality in the urban continuum: a geospatial analysis of the household survey, satellite imagery and travel time data in Tanzania

IntroductionRecent studies suggest that the urban advantage of lower neonatal mortality in urban compared with rural areas may be reversing, but methodological challenges include misclassification of neonatal deaths and stillbirths,...

169 COPD Care for Patients in Rural Clinics: A Mixed Methods Evaluation

OBJECTIVES/GOALS: To assess barriers and recommendations for improving delivery of care for chronic obstructive pulmonary disease (COPD) in rural clinics, we assessed COPD care metrics and obtained perspectives of primary care providers (PCPs) who practice in rural clinics. METHODS/STUDY POPULATION: Quantitative retrospective analysis of patients with COPD using VA data. We included patients whose primary care clinic is located in a rural VA Midwest Health Care Network (HCN) facility and quantified binary measures for receipt of: spirometry, pulmonary specialty care, and optimal inhaler therapy (regimen with LAMA or LABA monotherapy) Qualitative semi-structured individual interviews of PCPs (physicians, nurse practitioners, and physician assistants) whose clinics are located in a rural VA Midwest HCN facility. We elicited perceived barriers to and recommendations for receiving spirometry, pulmonary specialty care, and optimal inhaler therapy from PCPs. RESULTS/ANTICIPATED RESULTS: 6,350 rural patients had a new diagnosis of COPD in 2016-2019. 48.4% had spirometry, 14.4% had pulmonary encounters, and among patients who were prescribed long-acting inhaler therapy, 48.8% received optimal inhaler regimens. Rural PCPs (n=14) highlighted lack of access to spirometry, pulmonary specialty care, and clinic staff support in local clinics and suggested: 1) leveraging the expertise of pharmacists in COPD management and 2) improving access to resources, including use of telehealth technologies. DISCUSSION/SIGNIFICANCE: Less than 50% of rural COPD patients received recommended diagnostic testing and therapy. Resource limitations in rural clinics were the main barrier. The main recommendation was to leverage pharmacists’ expertise in COPD care. These findings provide a pathway forward to improving rural COPD care.

Risk of adverse newborn outcomes among women who experienced physical and psychological intimate partner abuse during pregnancy in Ghana's northern region

BackgroundIntimate partner violence (IPV) is common worldwide. However, the health effects of exposure to IPV during pregnancy are significantly more severe. We investigated the relationship between exposure to IPV during pregnancy and the risk of preterm and low birthweight births among women in Ghana's northern region. MethodsWe recruited 402 postnatal women aged 15–49 years from five selected public health facilities in the Tamale Metropolis of the northern region of Ghana. Using Kobo Collect, information on a wide range of factors, including exposure to IPV during the last pregnancy and pregnancy outcomes, was collected electronically. Multiple logistic regression analyses were conducted in Stata to determine the associations between prenatal exposure to IPV and binary measures of gestational age at birth and birthweight. ResultsOverall, 35.1% (95% CI: 30.5, 39.9) of the respondents experienced IPV during their recent pregnancy; 6.7% (95% CI: 4.6, 9.6) experienced physical IPV; and 34.8% (95% CI: 30.3, 39.6) experienced psychological IPV. The prevalence of preterm and low birthweight deliveries was 18.9% (95% CI: 15.4, 23.1) and 9.0% (95% CI: 6.5, 12.2), respectively. Prenatal exposure to IPV was linked to poor newborn outcomes by multivariable binary regression models. Women who suffered IPV during their last pregnancy were three times more likely to deliver low birthweight babies (AOR = 3.12: 95% CI: 1.42, 6.84). Exposed women were also about twice as likely to deliver prematurely, although this association was not statistically significant (AOR = 1.81; 95% CI: 0.97, 3.38). ConclusionExposure to IPV during pregnancy increases a woman's risk of delivering prematurely and having a low birthweight baby. IPV screening should be a regular part of ANC, so that pregnant women who are experiencing IPV can be monitored and supported to avoid adverse outcomes for their babies.

Development and validation of a hospital frailty risk measure using Canadian clinical administrative data.

Accessible measures specific to the Canadian context are needed to support health system planning for older adults living with frailty. We sought to develop and validate the Canadian Institute for Health Information (CIHI) Hospital Frailty Risk Measure (HFRM). Using CIHI administrative data, we conducted a retrospective cohort study involving patients aged 65 years and older who were discharged from Canadian hospitals from Apr. 1, 2018, to Mar. 31, 2019. We used a 2-phase approach to develop and validate the CIHI HFRM. The first phase, construction of the measure, was based on the deficit accumulation approach (identification of age-related conditions using a 2-year look-back). The second phase involved refinement into 3 formats (continuous risk score, 8 risk groups and binary risk measure), with assessment of their predictive validity for several frailty-related adverse outcomes using data to 2019/20. We assessed convergent validity with the United Kingdom Hospital Frailty Risk Score. The cohort consisted of 788 701 patients. The CIHI HFRM included 36 deficit categories and 595 diagnosis codes that cover morbidity, function, sensory loss, cognition and mood. The median continuous risk score was 0.111 (interquartile range 0.056-0.194, equivalent to 2-7 deficits); 35.1% (n = 277 000) of the cohort were found at risk of frailty (≥ 6 deficits). The CIHI HFRM showed satisfactory predictive validity and reasonable goodness-of-fit. For the continuous risk score format (unit = 0.1), the hazard ratio (HR) for 1-year risk of death was 1.39 (95% confidence interval [CI] 1.38-1.41), with a C-statistic of 0.717 (95% CI 0.715-0.720); the odds ratio for high users of hospital beds was 1.85 (95% CI 1.82-1.88), with a C-statistic of 0.709 (95% CI 0.704-0.714), and the HR of 90-day admission to long-term care was 1.91 (95% CI 1.88-1.93), with a C-statistic of 0.810 (95% CI 0.808-0.813). Compared with the continuous risk score, using a format of 8 risk groups had similar discriminatory ability and the binary risk measure had slightly weaker performance. The CIHI HFRM is a valid tool showing good discriminatory power for several adverse outcomes. The tool can be used by decision-makers and researchers by providing information on hospital-level prevalence of frailty to support system-level capacity planning for Canada's aging population.

Violated factors in building citizen-centric e-government websites: insights from the performance of the federal, state and local governments websites in Malaysia

PurposeCommon evaluation tools on e-government websites are available globally and locally to standardise and improve the quality of information and services. However, a commonly ignored aspect is the way to obtain detailed measurements of factors influencing citizen centricity; in other words, how official websites cater to the needs and contributions of citizens at different levels of government. Thus, this paper aims to apply a citizen-centric framework in evaluating the e-government websites of three different levels of authority in Malaysia: federal, state and local.Design/methodology/approachThe adapted citizen-centric checklist for e-government websites (aCCEW) with 40 characteristics across four components – openness (21), transparency (5), participation (10) and responsiveness (4) – was adopted to evaluate case studies of 36 government agency websites in Malaysia. Any conformity between the characteristics was marked using a binary measure, and the citizen-centric value was calculated for each component/characteristic.FindingsThrough website observations, ratings and descriptive comparisons, this study found that the aCCEW is a useful tool, especially for identifying certain critically violated factors. These were deficiencies in e-decision-making, revealing successful initiatives created through open data, revealing fund transfers and expenditure records and the level of social media responsiveness.Research limitations/implicationsThe research contributes theoretically by improvising characteristics in the CCEW to become aCCEW and testing it in multiple levels of government in Malaysia to see its applicability to be adopted in other similar research of e-governments. This could become a new benchmark through the additional research insights it offers into similar perspectives of public values realisation in e-government website design that focuses on more than merely functionality. Attempt to relate the violated factors and strengths of aCCEW website design components to the level of centralisation (power) of federal, state and local governments was also genuine in the e-government research.Practical implicationsRegardless of the many different government systems, federal, state and local governments can benchmark the examples assessed in this study, rethink their power relationships, and further improve their e-platforms to suit the contexts of their users/residents’ needs and contributions.Originality/valueTo the best of the authors’ knowledge, this study contributed to the first Malaysia-based research that identifies and compares factors that contribute to citizen-centric e-government website building at the federal, state and local government levels. The discussion adds value by comparing different systems and levels of e-government websites to their power possession.

Data presentation of results from randomized cancer clinical trials. The case for trials in advanced cervical cancer. A critical appraisal.

In the last four decades, median survival has increased in advanced cervical cancer from 7.1 with single-agent cisplatin to 24 months with doublet chemotherapy plus bevacizumab plus pembrolizumab. Coinciding with the irruption of targeted therapy, we observe higher pricing of novel cancer drugs and results presentation aimed to positively impact the audience. The first could result in poor drug affordability and financial toxicity, while the second can give patients a magnified sense of progress. In this review, we briefly comment on study designs that may favor obtaining positive results but, most notably, how results are presented pertaining the latest randomized clinical trials in advanced cervical cancer. We found that survival results are expressed in Hazard Risk (HR) reductions but communicated as a Relative Risk (RR) reduction for death. The HR of the control to the experimental regimen is given by exp[β]. An HR of 0.7 means an HR reduction of 30%. Risk reduction derived from HR may lead to a belief that the intervention can eliminate the chance of the event occurring, but decreased HR means a reduction in the speed of the event to happen, not the chances to occur. On the contrary, the "risk reduction" based on RR means that patients have less chance of having the event because RR is a binary measure (alive or dead). Further, Absolute Risks and Number-To-Treat (NNT), in addition to Relative Risk, are omitted. The issue of how the results of cancer clinical trials are presented deserves open discussion. After all, it is the patient's right to make an informed decision for embarking on any cancer treatment.

The Nolan Index: A Quantitative Measure of List Similarities

Several ethnobiological studies have used the Jaccard Index, a qualitative, binary measure, to compare group similarities and differences in lists of plant and animal species, medicinals, foods, cultural utilities, and so on. We extend this effort by formulating the Nolan Index, a new, more precise quantitative measure of the relative frequency of listed items to compare similarities and differences between groups . It is deployed here to evaluate the degree of similarity of free-listed, wild plants between novices and experts in rural Missouri.

Multicenter automatic detection of invasive carcinoma on breast whole slide images.

Breast cancer is one of the most prevalent cancers worldwide and pathologists are closely involved in establishing a diagnosis. Tools to assist in making a diagnosis are required to manage the increasing workload. In this context, artificial intelligence (AI) and deep-learning based tools may be used in daily pathology practice. However, it is challenging to develop fast and reliable algorithms that can be trusted by practitioners, whatever the medical center. We describe a patch-based algorithm that incorporates a convolutional neural network to detect and locate invasive carcinoma on breast whole-slide images. The network was trained on a dataset extracted from a reference acquisition center. We then performed a calibration step based on transfer learning to maintain the performance when translating on a new target acquisition center by using a limited amount of additional training data. Performance was evaluated using classical binary measures (accuracy, recall, precision) for both centers (referred to as "test reference dataset" and "test target dataset") and at two levels: patch and slide level. At patch level, accuracy, recall, and precision of the model on the reference and target test sets were 92.1% and 96.3%, 95% and 87.8%, and 73.9% and 70.6%, respectively. At slide level, accuracy, recall, and precision were 97.6% and 92.0%, 90.9% and 100%, and 100% and 70.8% for test sets 1 and 2, respectively. The high performance of the algorithm at both centers shows that the calibration process is efficient. This is performed using limited training data from the new target acquisition center and requires that the model is trained beforehand on a large database from a reference center. This methodology allows the implementation of AI diagnostic tools to help in routine pathology practice.

An exploratory analysis of divergent patterns in reading progression during a tablet-based literacy program

We conducted exploratory research on divergent patterns in reading progression among early grade learners in a low-resourced community to identify key determinants of high versus low reading progress. The sample comprised 30 learners who were purposively selected from participants in a 13-month tablet-based literacy program at a peri-urban Malawi primary school to represent high and low progressing readers. We employed stepwise logistic regression to test the independent contributions of (1) a composite measure of home literacy and language environment, and (2) a direct assessment of working memory skills, to a binary measure of reading progress status, controlling for children’s age. Our results showed that children’s working memory skills uniquely predicted high versus low progress in reading over and above other known predictors of early literacy development. These findings point to the importance of working memory skills as a key determinant of reading progress in the context of a tablet-based literacy program in a developing country. As education technology programs proliferate in low-income countries, results from our study offer an evidence-based strategy for identifying and supporting learners who are at risk for non-progress in reading during a tablet-based literacy intervention.