Bottom 10th Percentile Research Articles

Racial disparities in the pattern of intergenerational neighbourhood mobility.

Neighbourhood context is known to shape one's life chances, but much of neighbourhood disadvantage is passed down from parents to children. The gap in social and economic achievements between Black and White families in the United States may partially be explained by differences in the intergenerational transmission of neighbourhood context. Using census tract socio-economic data, we created a national ranking of US census tracts. We then examined intergenerational neighbourhood mobility using 2828 parent-child pairs from a longitudinal household survey. We found that White children, compared with Black children, were more likely to inherit higher neighbourhood ranks from their parents. Income and education had smaller negative effects on neighbourhood rank for White children than Black children, all other things equal. Black children whose parents were in the bottom 25th percentile neighbourhood rank tended to move up in neighbourhood rank. But by much smaller magnitudes than their White counterparts. Our findings indicate that different patterns of intergenerational neighbourhood mobility between White and Black families may be an important factor for persisting racial disparities in the neighbourhood context.

P110. FACIAL FEMINIZATION IN THE UNITED STATES FROM 2015-2017

PURPOSE: Facial feminization surgery (FFS) is an integral aspect of gender affirming surgery (GAS) for individuals seeking to align secondary sex characteristics with their expressed gender identity. Despite robust evidence for its role in helping treat gender dysphoria, trends, and prevalence of FFS remain unknown. We sought to examine trends in FFS and investigate the payer status of facial feminization procedures in the United States. METHODS: Data from the 2015-2017 National Inpatient Sample collected using ICD-10 diagnosis codes for gender identity disorder were analyzed for FFS procedure codes. RESULTS: 110 of 1,490 (9.1%) GAS patients had FFS. 66.7% were non-Hispanic White, 23.8% Black, and 4.8% Asian and Native American, respectively. 50% of FFS occurred in the West, followed by the Northeast (31.8%), South (13.6%), and Midwest (4.8%) (p = 0.015). 36.4% of cases were self-pay, 31.8% by Medicaid, and 27.3% by private insurance (p < 0.0001). 36.4% were in the bottom 25th percentile of income, 13.6% in the 25th-50th percentile, 18.2% in the 51st-75th percentile, and 22.7% in the top 25th percentile (p = 0.440). CONCLUSION: Roughly 18% of transgender women in our sample received FFS despite its high costs. Unlike GAS, FFS is often considered cosmetic and remains uncovered by most insurance providers. Self-pay remains the most common payer status and rates of FFS are highest in the West. With continued expansion of anti-discrimination policies under the Affordable Care Act, it is critical to monitor trends in FFS to ensure equitable access for transgender patients across the nation.

Editors' Note: Cognitive Activity and Onset Age of Incident Alzheimer Disease Dementia

In their prospective observational cohort study, Dr. Wilson et al. explored the relationship between cognitive activity and incident dementia among consecutive elderly patients from the Rush Memory and Aging Project. The investigators hypothesized that self-reported higher levels of cognitive activity such as reading would be associated with older age of dementia onset in patients with clinical Alzheimer disease (AD). Of the 1903 included patients, 457 (24%) developed possible or probable AD over a mean of 6.8 years (±4.6) of follow-up. In the primary analysis, higher cognitive activity was independently associated with later dementia onset in the accelerated failure time model (estimate 0.026, 95% CI 0.013–0.039). This relationship persisted in multiple other exploratory models, including a model that accounted for sex and educational level, a model which adjusted for early-life cognitive activity (which bore no independent association with dementia), and a model excluding patients with possible AD from outcome events. When the top 10th percentile of patients with high cognitive activity were compared with the bottom 10th percentile, patients in the top 10th percentile developed dementia at a mean of 5 years later (93.6 vs 88.6 years). Dr. Krauss suggests that the hypothesized direction of the association (more cognitive activity → delay in dementia diagnosis) may possibly be reversed and that the low level of cognitive activity in late life may be an early sign of dementia. In an attempt to disprove this alternative hypothesis, the investigators analyzed the relationship between cognitive activity with markers of AD at enrollment and found no association. The authors agree with Dr. Krauss that their study cannot fully disprove the reverse causality hypothesis; however, these data complement previous research that continues to build the argument for an important relationship between cognitive activity and the subsequent symptoms of dementia. In their prospective observational cohort study, Dr. Wilson et al. explored the relationship between cognitive activity and incident dementia among consecutive elderly patients from the Rush Memory and Aging Project. The investigators hypothesized that self-reported higher levels of cognitive activity such as reading would be associated with older age of dementia onset in patients with clinical Alzheimer disease (AD). Of the 1903 included patients, 457 (24%) developed possible or probable AD over a mean of 6.8 years (±4.6) of follow-up. In the primary analysis, higher cognitive activity was independently associated with later dementia onset in the accelerated failure time model (estimate 0.026, 95% CI 0.013–0.039). This relationship persisted in multiple other exploratory models, including a model that accounted for sex and educational level, a model which adjusted for early-life cognitive activity (which bore no independent association with dementia), and a model excluding patients with possible AD from outcome events. When the top 10th percentile of patients with high cognitive activity were compared with the bottom 10th percentile, patients in the top 10th percentile developed dementia at a mean of 5 years later (93.6 vs 88.6 years). Dr. Krauss suggests that the hypothesized direction of the association (more cognitive activity → delay in dementia diagnosis) may possibly be reversed and that the low level of cognitive activity in late life may be an early sign of dementia. In an attempt to disprove this alternative hypothesis, the investigators analyzed the relationship between cognitive activity with markers of AD at enrollment and found no association. The authors agree with Dr. Krauss that their study cannot fully disprove the reverse causality hypothesis; however, these data complement previous research that continues to build the argument for an important relationship between cognitive activity and the subsequent symptoms of dementia.

Could maternal thyroid function during pregnancy affect daughters’ age at menarche through child growth? A mediation analysis

Early menarche is associated with adverse health outcomes during adolescence as well as breast and other reproductive cancers later in adulthood. However, the causes of early menarche and the pathways through which they operate are not fully understood. Though maternal thyroid function during pregnancy affects child growth, and rapid childhood growth is associated with a decreased age at menarche, the relationship between prenatal maternal thyroid function and daughters’ age at menarche has not been examined. We conducted a mediation analysis in a historical cohort of 260 mother-child pairs to estimate the total and indirect effects of maternal prenatal thyroid function on daughters’ age at menarche. No association was observed between thyroid stimulating hormone (TSH) or anti-thyroid peroxidase antibodies (ATPO) and daughters’ age at menarche. Using a sample-specific, a-priori cutoff at the 10th percentile, low levels of maternal free thyroxine (FT4) were associated with earlier daughter age at menarche, with a hazard ratio (95 % CI) of 1.70 (1.02, 2.84) comparing the bottom 10th percentile with the top 90th percentile of exposure levels. Higher maternal FT4 was associated with rapid child weight gain from ages 5–9, and rapid child weight gain from ages 5–9 was associated with earlier age at menarche; the estimated indirect effect of this pathway was null. While maternal FT4 is associated with earlier age at menarche in daughters, this is not mediated by rapid weight gain in our study population, suggesting that maternal FT4 is operating through a different pathway.

Good to Go First? Position Effects in Expert Evaluation of Early-Stage Ventures

There is often considerable anxiety and conflicting advice concerning the benefits of presenting/being evaluated first. We thus investigate how expert evaluators vary in their evaluations of entrepreneurial proposals based upon the order in which they are evaluated. Our research setting is a premiere innovation fund competition in Beijing, China, where the prize money at stake is economically meaningful, and evaluators are quasi-randomly assigned to evaluate written grant proposals without the possibility of peer influence. This enables us to credibly recover a causal position effect. We also theorize and test how heterogeneity in evaluators’ prior (context-specific) judging experience moderates position effects. Overall, we find that a proposal evaluated first requires total assets in the top 10th percentile to merely equal the evaluation of a proposal in the bottom 10th percentile that is not evaluated first. Firm and evaluator fixed-effects models yield consistent findings. We consider evaluation design elements that may mollify these position effects in the discussion section. This paper was accepted by Sridhar Tayur, entrepreneurship and innovation.

Fetal growth velocity references from a Chinese population\u2013based fetal growth study

BackgroundFetal growth velocity standards have yet to be established for the Chinese population. This study aimed to establish such standards suitable for the Chinese population.MethodsWe performed a multicenter, population–based longitudinal cohort study including 9075 low–risk singleton pregnant women. Data were collected from the clinical records of 24 hospitals in 18 provinces of China. Demographic characteristics, reproductive history, fetal ultrasound measurements, and perinatal outcome data were collected. The fetal ultrasound measurements included biparietal diameter (BPD), abdominal circumference (AC), head circumference (HC), and femur diaphysis length (FDL). We used linear mixed models with cubic splines to model the trajectory of four ultrasound parameters and estimate fetal weight. Fetal growth velocity was determined by calculating the first derivative of fetal size curves. We also used logistic regression to estimate the association between fetal growth velocities in the bottom 10th percentile and adverse perinatal outcomes.ResultsFetal growth velocity was not consistent over time or among individuals. The estimated fetal weight (EFW) steadily increased beginning at 12 gestational weeks and peaked at 35 gestational weeks. The maximum velocity was 211.71 g/week, and there was a steady decrease in velocity from 35 to 40 gestational weeks. The four ultrasound measurements increased in the early second trimester; BPD and HC peaked at 13 gestational weeks, AC at 14 gestational weeks, and FDL at 15 gestational weeks. BPD and HC also increased from 19 to 24 and 19 to 21 gestational weeks, respectively. EFW velocity in the bottom 10th percentile indicated higher risks of neonatal complications (odds ratio [OR] = 2.23, 95% confidence interval [CI]: 1.79–2.78) and preterm birth < 37 weeks (OR = 3.68, 95% CI: 2.64–5.14). Sensitivity analyses showed that EFW velocity in the bottom 10th percentile was significantly associated with more adverse pregnancy outcomes for appropriate–for–gestational age neonates.ConclusionsWe established fetal growth velocity curves for the Chinese population based on real–world clinical data. Our findings demonstrated that Chinese fetal growth patterns are somewhat different from those of other populations. Fetal growth velocity could provide more information to understand the risk of adverse perinatal outcomes, especially for appropriate–for–gestational age neonates.

Factors influencing resilience and burnout among resident physicians - a National Survey

BackgroundResidency training exposes young physicians to a challenging and high-stress environment, making them vulnerable to burnout. Burnout syndrome not only compromises the health and wellness of resident physicians but has also been linked to prescription errors, reduction in the quality of medical care, and decreased professionalism. This study explored burnout and factors influencing resilience among U.S. resident physicians.MethodsA cross-sectional study was conducted through an online survey, which was distributed to all accredited residency programs by Accreditation Council of Graduate Medical Education (ACGME). The survey included the Connor-Davidson Resilience Scale (CD-RISC 25), Abbreviated Maslach Burnout Inventory, and socio-demographic characteristics questions. The association between burnout, resilience, and socio-demographic characteristics were examined.ResultsThe 682 respondents had a mean CD-RISC score of 72.41 (Standard Deviation = 12.1), which was equivalent to the bottom 25th percentile of the general population. Males and upper-level trainees were more resilient than females and junior residents. No significant differences in resilience were found associated with age, race, marital status, or training program type. Resilience positively correlated with personal achievement, family, and institutional support (p < 0.001) and negatively associated with emotional exhaustion and depersonalization (p < 0.001).ConclusionsHigh resilience, family, and institutional support were associated with a lower risk of burnout, supporting the need for developing a resilience training program to promote a lifetime of mental wellness for future physicians.

Association Between Iatrogenic Delivery for Suspected Fetal Growth Restriction and Childhood School Outcomes

Timely delivery of infants suspected of having fetal growth restriction (FGR) is a balance between preventing stillbirth and minimizing prematurity, particularly because many infants with suspected FGR have normal growth. To explore the association between iatrogenic delivery for suspected FGR and childhood school outcomes. A retrospective whole-population cohort study linking perinatal data from births 32 weeks' or more gestation between January 1, 2003, to December 31, 2013, to developmental and educational test scores at preparatory school, and at school grades 3, 5, and 7 in Victoria, Australia. Follow-up was concluded in 2019. Suspicion or nonsuspicion of FGR, presence or absence of iatrogenic delivery (defined as early induction of labor or cesarean delivery prior to labor) for suspected FGR, and presence or absence of small for gestational age (SGA). The coprimary outcomes were being in the bottom 10th percentile on 2 or more of 5 developmental domains at school entry and being below the national minimum standard on 2 or more of 5 educational domains in grades 3, 5, or 7. In the birth population of 705 937 infants, the mean gestation at birth was 39.1 (SD, 1.5) weeks and the mean birth weight was 3426 (SD, 517) grams. The birth population linked to 181 902 children with developmental results and 425 717 children with educational results. Compared with infants with severe SGA (birth weight <3rd percentile) not suspected of having FGR, infants with severe SGA delivered for suspected FGR were born earlier (mean gestation, 37.9 weeks vs 39.4 weeks). They also had a significantly increased risk of poor developmental outcome at school entry (16.2% vs 12.7%; absolute difference, 3.5% [95% CI, 0.5%-6.5%]); adjusted odds ratio [aOR], 1.36 [95% CI, 1.07-1.74]) and poor educational outcomes in grades 3, 5, and 7 (for example, in grade 7: 13.4% vs 10.5%; absolute difference, 2.9% [95% CI, 0.4%-5.5%]); aOR, 1.33 [95% CI, 1.04-1.70]). There was no significant difference between infants with normal growth (birth weight ≥10th percentile) delivered for suspected FGR and those not suspected of having FGR in developmental outcome (8.6% vs 8.1%; absolute difference, 0.5% [95% CI, -1.1% to 2.0%]); aOR, 1.17 [95% CI, 0.95-1.45]) or educational outcome in grade 3, 5 or 7, despite being born earlier (mean gestation, 38.0 weeks vs 39.1 weeks). In this exploratory study conducted in Victoria, Australia, iatrogenic delivery of infants with severe SGA due to suspected FGR was associated with poorer school outcomes compared with infants with severe SGA not suspected of having FGR. Iatrogenic delivery of infants with normal growth due to suspected FGR was not associated with poorer school outcomes compared with infants with normal growth not suspected of having FGR.

Oculomotor Training for Poor Saccades Improves Functional Vision Scores and Neurobehavioral Symptoms

ObjectivesTo determine if participants with saccadic dysfunction improved after participating in a standardized oculomotor training program. A secondary objective was to accurately quantify change in saccades after training using eye tracking technology. A third objective was to examine patients’ neurobehavioral symptoms before and after oculomotor training using the Neurobehavioral Symptom Inventory (NSI). DesignA prospective study involving treatment and control group pre-post intervention design. SettingData were collected in eye clinics with a standardized eye tracking equipment setup. ParticipantsParticipants in the bottom 25th percentile for saccadic eye movements (N=92; intervention=46, control=46) who were currently asymptomatic of specific disorder. InterventionsParticipants were randomly assigned to the control or intervention group. The intervention group engaged in 10 minutes of oculomotor training daily for 5 days. Main Outcome MeasuresThe ratio of the peak saccadic velocity over its average velocity (the Q ratio), saccadic targeting, and NSI. ResultsResults revealed significant interactions between control and intervention groups (P=.013). The control group increased 7% from pre to post; however, the intervention group exhibited a 6% decreased from pre to post. Participants in the intervention group demonstrated a 25% improvement in targeting saccade accuracy (P=.021). Additionally, there was a significant reduction in all neurobehavioral factors on the NSI in the intervention group, specifically the affective and cognitive factors relating to poor saccades. ConclusionsFor this population, oculomotor training (Q ratio and saccade accuracy) resulted improved saccadic metrics and a significant reduction in overall symptoms as shown on the NSI. Future participants reported improved symptoms pre- and postintervention. Further research is needed to understand saccadic performance and gaze stability during specific tasks (such as reading).

Prediction of Kidney Allograft Discard Before Procurement: The Kidney Discard Risk Index.

There is an 18.9% discard rate among kidney allografts. Here, we aimed to determine predictors of kidney discard and construct an index to identify high-probability discard kidney allografts prior to procurement. A total of 102 246 potential kidney allograft donors from the Organ Procurement and Transplantation Network database were used in this analysis. The cohort was randomized into 2 groups. The training set included 67% of the cohort and was used to derive a predictive index for discard that comprised 21 factors identified by univariate and multivariate logistic regression analysis. The validation set included 33% and was used to internally validate the kidney discard risk index. In 77.3% of donors, at least 1 kidney was used for transplant, whereas in 22.7% of donors, both kidneys were discarded. The kidney discard risk index was highly predictive of discard with a C statistic of 0.89 (0.88-0.89). The bottom 10th percentile had a discard rate of 0.73%, whereas the top 10th percentile had a discard rate of 83.65%. The 3 most predictive factors for discard were age, creatinine level, and hepatitis C antibody status. We identified 21 factors predictive of discard prior to donor procurement and used these to develop a kidney discard risk index with a C statistic of 0.89.

3D quantitative analysis of diffusion-weighted imaging for predicting the malignant potential of intraductal papillary mucinous neoplasms of the pancreas.

PurposeTo investigate the predictors of intraductal papillary mucinous neoplasms of the pancreas (IPMNs) with high-grade dysplasia, using 2-dimensional (2D) analysis and 3-dimensional (3D) volume-of-interest-based apparent diffusion coefficient (ADC) histogram analysis.Material and methodsThe data of 45 patients with histopathologically confirmed IPMNs with high-grade or low-grade dysplasia were retrospectively assessed. The 2D analysis included lesion-to-spinal cord signal intensity ratio (LSR), minimum ADC value (ADCmin), and mean ADC value (ADCmean). The 3D analysis included the overall mean (ADCoverall mean), mean of the bottom 10th percentile (ADCmean0-10), mean of the bottom 10-25th percentile (ADCmean10-25), mean of the bottom 25-50th percentile (ADCmean25-50), skewness (ADCskewness), kurtosis (ADCkurtosis), and entropy (ADCentropy). Diagnostic performance was compared by analysing the area under the receiver operating characteristic curve (AUC). Inter-rater reliability was assessed by blinded evaluation using the intraclass correlation coefficient.ResultsThere were 16 and 29 IPMNs with high- and low-grade dysplasia, respectively. The LSR, ADCoverall mean, ADCmean0-10, ADCmean10-25, ADCmean25-50, and ADCentropy showed significant between-group differences (AUC = 72-93%; p < 0.05). Inter-rater reliability assessment showed almost perfect agreement for LSR and substantial agreement for ADCoverall mean and ADCentropy. Multivariate logistic regression showed that ADCoverall mean and ADCentropy were significant independent predictors of malignancy (p < 0.05), with diagnostic accuracies of 80% and 73%, respectively.ConclusionADCoverall mean and ADCentropy from 3D analysis may assist in predicting IPMNs with high-grade dysplasia.

Predictive equations for early-life indicators of future body weight in Holstein dairy heifers

It takes an approximate 2-yr investment to raise a replacement heifer from birth to first calving, and selecting the most productive heifers earlier in life could reduce input costs. Daily milk consumption, serum total protein, pneumonia and scours incidences, body size composite, birth weights, and incremental body weights were collected on a commercial dairy farm from October 1, 2015, to January 1, 2019. Holstein calves (n = 5,180) were fed whole pasteurized nonsalable milk with a 30% protein and 5% fat enhancer added at 20 g/L of milk through an automated calf feeding system (feeders = 8) for 60 d on average. Calves were weighed at birth and several other times before calving. Average birth weight of calves was 40.6 ± 4.9 kg (mean ± standard deviation), serum total protein was 6.7 ± 0.63 mg/dL, and cumulative 60-d milk consumption was 508.1 ± 67.3 L with a range of 179.9 to 785.1 L. Daily body weights were predicted for individual animals using a third-order orthogonal polynomial to model body weight curves. The linear and quadratic effects of cumulative 60-d milk consumption, birth weight, feeder, year born, season born, respiratory incidence, scours incidence, and body size composite score were significant when predicting heifer body weight at 400 d (pBW400) of age. There was up to a 263-kg difference in pBW400 between the heaviest and lightest animal. Birth weight had a significant effect on predicted weights up to 400 d, and for every 1-kg increase in birth weight, there was a 2.5-kg increase in pBW400. Quadratic effect of cumulative 60-d milk consumption was significant up to 400 d. We divided 60-d milk consumption into quartiles, and heifers had the highest pBW400 in the third quartile when 60-d consumption was between 507.8 and 552.5 L. Body size composite score showed a 21.5-kg difference in pBW400 between the top and bottom 25th percentile of heifers. Heifers were 4.2 kg lighter at 400 d if treated for respiratory disease 3+ times during the first 60 d of life compared with heifers not treated for respiratory disease. Measurements that can be obtained in the early life of dairy calves continue to influence heifer growth up to 400 d of age.

Care Practices to Promote Patient Engagement in VA Primary Care: Factors Associated With High Performance.

Patient engagement has been broadly defined as the process of actively involving and supporting patients in health care and treatment decision making. The aim of this study was to identify organizational factors that are associated with greater use of patient engagement care practices in Veterans Health Administration primary care clinics. We conducted a cross-sectional analysis of data from the 2016 Patient-Aligned Care Team (PACT) national survey of direct care clinicians (primary care clinicians, registered nurses, and clinical associates). Exploratory factor analysis was used to group conceptually related patient engagement survey items into 3 subscales: planning and goal setting; motivational interviewing; and organizational strategies to promote self-management. Our independent variables included literature-based factors reported to promote team-based care and interdisciplinary collaboration in primary care. We used generalized estimating equations with multivariate logistic regression analysis to identify independent correlates of high performance on each patient engagement domain (top 25th vs bottom 25th percentile). A total of 2,478 direct care clinicians from 609 clinics completed all patient engagement items in the PACT survey. For all patient engagement sub-scales, respondents at high-performing clinics were more likely to report having regular team meetings to discuss performance improvement and having leadership responsible for implementing PACT. For 2 of 3 patient engagement subscales, high performance was also associated with having fully staffed PACT teams (≥3 team members per primary care clinician) and role clarity. Several desirable organizational and contextual factors were associated with high performance of patient engagement care practices. Strategies to improve the organizational functioning of primary care teams may enhance patient engagement in care.

Neural correlates of the Dunning-Kruger effect.

The Dunning-Kruger effect (DKE) is a metacognitive phenomenon of illusory superiority in which individuals who perform poorly on a task believe they performed better than others, yet individuals who performed very well believe they under-performed compared to others. This phenomenon has yet to be directly explored in episodic memory, nor explored for physiological correlates or reaction times. We designed a novel method to elicit the DKE via a test of item recognition while electroencephalography (EEG) was recorded. Throughout the task, participants were asked to estimate the percentile in which they performed compared to others. Results revealed participants in the bottom 25th percentile over-estimated their percentile, while participants in the top 75th percentile under-estimated their percentile, exhibiting the classic DKE. Reaction time measures revealed a condition-by-group interaction whereby over-estimators responded faster than under-estimators when estimating being in the top percentile and responded slower when estimating being in the bottom percentile. Between-group EEG differences were evident between over-estimators and under-estimators during Dunning-Kruger responses, which revealed FN400-like effects of familiarity supporting differences for over-estimators, whereas "old-new" memory event-related potential effects revealed a late parietal component associated with recollection-based processing for under-estimators that was not evident for over-estimators. Findings suggest over- and under-estimators use differing cognitive processes when assessing their performance, such that under-estimators may rely on recollection during memory while over-estimators may draw upon excess familiarity when over-estimating their performance. Episodic memory thus appears to play a contributory role in metacognitive judgements of illusory superiority.

Tailoring Intensity of Active Surveillance for Low-Risk Prostate Cancer Based on Individualized Prediction of Risk Stability

Active surveillance is increasingly recognized as the preferred standard of care for men with low-risk prostate cancer. However, active surveillance requires repeated assessments, including prostate-specific antigen tests and biopsies that may increase anxiety, risk of complications, and cost. To identify and validate clinical parameters that can identify men who can safely defer follow-up prostate cancer assessments. The Canary Prostate Active Surveillance Study (PASS) is a multicenter, prospective active surveillance cohort study initiated in July 2008, with ongoing accrual and a median follow-up period of 4.1 years. Men with prostate cancer managed with active surveillance from 9 North American academic medical centers were enrolled. Blood tests and biopsies were conducted on a defined schedule for least 5 years after enrollment. Model validation was performed among men at the University of California, San Francisco (UCSF) who did not enroll in PASS. Men with Gleason grade group 1 prostate cancer diagnosed since 2003 and enrolled in PASS before 2017 with at least 1 confirmatory biopsy after diagnosis were included. A total of 850 men met these criteria and had adequate follow-up. For the UCSF validation study, 533 active surveillance patients meeting the same criteria were identified. Exclusion criteria were treatment within 6 months of diagnosis, diagnosis before 2003, Gleason grade score of at least 2 at diagnosis or first surveillance biopsy, no surveillance biopsy, or missing data. Active surveillance for prostate cancer. Time from confirmatory biopsy to reclassification, defined as Gleason grade group 2 or higher on subsequent biopsy. A total of 850 men (median [interquartile range] age, 64 [58-68] years; 774 [91%] White) were included in the PASS cohort. A total of 533 men (median [interquartile range] age, 61 [57-65] years; 422 [79%] White) were included in the UCSF cohort. Parameters predictive of reclassification on multivariable analysis included maximum percent positive cores (hazard ratio [HR], 1.30 [95% CI, 1.09-1.56]; P = .004), history of any negative biopsy after diagnosis (1 vs 0: HR, 0.52 [95% CI, 0.38-0.71]; P < .001 and ≥2 vs 0: HR, 0.18 [95% CI, 0.08-0.4]; P < .001), time since diagnosis (HR, 1.62 [95% CI, 1.28-2.05]; P < .001), body mass index (HR, 1.08 [95% CI, 1.05-1.12]; P < .001), prostate size (HR, 0.40 [95% CI, 0.25-0.62]; P < .001), prostate-specific antigen at diagnosis (HR, 1.51 [95% CI, 1.15-1.98]; P = .003), and prostate-specific antigen kinetics (HR, 1.46 [95% CI, 1.23-1.73]; P < .001). For prediction of nonreclassification at 4 years, the area under the receiver operating curve was 0.70 for the PASS cohort and 0.70 for the UCSF validation cohort. This model achieved a negative predictive value of 0.88 (95% CI, 0.83-0.94) for those in the bottom 25th percentile of risk and of 0.95 (95% CI, 0.89-1.00) for those in the bottom 10th percentile. In this study, among men with low-risk prostate cancer, heterogeneity prevailed in risk of subsequent disease reclassification. These findings suggest that active surveillance intensity can be modulated based on an individual's risk parameters and that many men may be safely monitored with a substantially less intensive surveillance regimen.

Cross-sectional and prospective relationship between occupational and leisure-time inactivity and cognitive function in an ageing population: the European Prospective Investigation into Cancer and Nutrition in Norfolk (EPIC-Norfolk) study.

BackgroundThe current evidence for higher physical activity and better cognitive function and lower risk of dementia is strong but not conclusive. More robust evidence is needed to inform public-health policy. We provide further insight into discrepancies observed across studies, reporting on habitual inactivity including that during work.MethodsWe examined cross-sectional and prospective relationships of physical inactivity during leisure and occupation time, with cognitive performance using a validated physical-activity index in a cohort of 8585 men and women aged 40–79 years at baseline (1993–1997) for different domains using a range of cognitive measures. Cognitive testing was conducted between 2006 and 2011 (including a pilot phase 2004–2006). Associations were examined using multinomial logistic-regression adjusting for socio-demographic and health variables as well total habitual physical activity.ResultsInactivity during work was inversely associated with poor cognitive performance (bottom 10th percentile of a composite cognition score): odds ratio (OR) = 0.68 [95% confidence interval (CI) 0.54, 0.86], P = 0.001. Results were similar cross-sectionally: OR = 0.65 (95% CI 0.45, 0.93), P = 0.02. Manual workers had increased risk of poor performance compared with those with an occupation classified as inactive. Inactivity during leisure time was associated with increased risk of poor performance in the cross-sectional analyses only.ConclusionsThe relationship between inactivity and cognition is strongly confounded by education, social class and occupation. Physical activity during leisure may be protective for cognition, but work-related physical activity is not protective. A greater understanding of the mechanisms and confounding underlying these paradoxical findings is needed.

Common carotid flow velocity is associated with cognitive function after carotid endarterectomy

The relationship between ultrasonographic flow parameters and cognitive function has not been well studied. This study aimed to clarify associations between carotid flow velocity (FV) and cognitive function in patients with a history of carotid endarterectomy (CEA). Ninety-four patients who previously underwent CEA participated in this study. The Neurobehavioral Cognitive Status Examination (Cognistat) and Frontal Assessment Battery (FAB) were adopted to assess cognitive functions at a mean of 6.5 ± 3.2 years after CEA. End-diastolic flow velocity (EDV) of the left and right common carotid artery (CCA) was significantly associated with total Cognistat score (p < 0.001) and total FAB score (p < 0.05). Pulsatility index (PI) of the left CCA was significantly associated with total Cognistat score and total FAB score (p < 0.01). A cut-off right CCA EDV of 14.5 cm/s offered the most reliable predictor of the bottom 25th percentile of total Cognistat score (sensitivity 83.3%, specificity 61.0%, area under the curve (AUC) 0.731, p = 0.0060), while a cut-off left CCA PI of 1.83 was the most reliable predictor of the bottom 25th percentile of total FAB score (sensitivity 73.3%, specificity 60.0%, AUC 0.679, p = 0.0179). Left and right CCA EDV correlated with sub-components of comprehension, construction, judgment, programming (p < 0.01), and conceptualization (p < 0.05). Right CCA EDV correlated with similarity (p < 0.01), repetition, naming, and memory (p < 0.05). Left CCA PI correlated with attention, conceptualization (p < 0.01), repetition, construction, similarity, and mental flexibility (p < 0.05), while right CCA PI correlated with construction (p < 0.05). CCA FV may offer useful markers of cognitive functions in patients with a history of CEA.

Exploring how enrolling in an online organic chemistry preparation course relates to students’ self-efficacy

Self-efficacy has a strong influence on the learning and motivation of science students at the postsecondary level, especially in upper division science classes, which are key to student success in science majors. This empirical mixed methods research study (N = 205) examines the associations between students’ participation in an online preparation course and student self-efficacy in organic chemistry. Qualitative content analysis indicated that students benefited from the online preparatory course in the subsequent organic chemistry course series. The analysis of students’ clickstream data indicated that students with self-efficacy ratings in the top 10th percentile exhibited more frequent and consistent engagement with relevant course materials compared to students in the bottom 10th percentile. Notably, linear regression models indicated that participation in the online preparatory course was associated with higher long-term self-efficacy for first-generation college students. These results suggest that online preparatory courses may benefit some students’ self-efficacy in demanding science courses.

A Quantile Regression Approach to Examine Changes in County Unemployment Rates in Indiana during the Great Recession

We take a closer look at changes in county unemployment rates in Indiana during the Great Recession and evaluate how local population and the mix of sectoral employment influence these patterns. Using a quantile regression approach, we specifically observe the impacts on counties on both tails of the changes in unemployment distribution. We find the impact of sectoral composition of a county’s workforce depends on its geographical classification. Overall, greater reliance on pro-cyclical industries, most notably manufacturing, magnifies the increases in unemployment during the recession. This effect is further amplified for MSA counties. In contrast, counter-cyclical industries, education in particular, insulates the counties in the top 10th percentile of the distribution of changes in unemployment rates, and a stronger insulation effect is observed for MSA counties. At the bottom 10th percentile, education marginally amplifies changes in unemployment rates for MSA counties, whereas it insulates non-MSA counties from the same distribution.

Exploratory Study of Apparent Diffusion Coefficient Histogram Metrics in Assessing Pancreatic Malignancy

PurposeTo evaluate whole-lesion 3D-histogram apparent diffusion coefficient (ADC) metrics for assessment of pancreatic malignancy. MethodsForty-two pancreatic malignancies (36 pancreatic adenocarcinoma [PDAC], 6 pancreatic neuroendocrine [PanNET]) underwent abdominal magnetic resonance imaging (MRI) with diffusion-weighted imaging before endoscopic ultrasound biopsy or surgical resection. Two radiologists independently placed 3D volumes of interest to derive whole-lesion histogram ADC metrics. Mann-Whitney tests and receiver operating characteristic analyses were used to assess metrics’ diagnostic performance for lesion histology, T-stage, N-stage, and grade. ResultsWhole-lesion ADC histogram metrics lower in PDACs than PanNETs for both readers (P ≤ .026) were mean ADC (area under the curve [AUC] = 0.787-0.792), mean of the bottom 10th percentile (mean0-10) (AUC = 0.787-0.880), mean of the 10th-25th percentile (mean10-25) (AUC = 0.884-0.917) and mean of the 25th-50th percentile (mean25-50) (AUC = 0.829-0.829). For mean10-25 (metric with highest AUC for identifying PDAC), for reader 1 a threshold > 0.94 × 10−3 mm2/s achieved sensitivity 94% and specificity 83%, and for reader 2 a threshold > 0.82 achieved sensitivity 97% and specificity 67%. Metrics lower in nodal status ≥ N1 than N0 for both readers (P ≤ .043) were mean0-10 (AUC = 0.789-0.822) and mean10-25 (AUC = 0.800-0.822). For mean10-25 (metric with highest AUC for identifying N0), for reader 1 a threshold <1.17 achieved sensitivity 87% and specificity 67%, and for reader 2 a threshold <1.04 achieved sensitivity 87% and specificity 83%. No metric was associated with T-stage (P > .195) or grade (P > .215). ConclusionVolumetric ADC histogram metrics may serve as non-invasive biomarkers of pancreatic malignancy. Mean10-25 outperformed standard mean for lesion histology and nodal status, supporting the role of histogram analysis.