Calculated Spearman Correlation Research Articles

Characterization of shed baby tooth metal concentrations in Project Viva

Background and Aim: Shed baby teeth can provide retrospective information on early life metal exposure. We described the associations of baby tooth metal levels with maternal blood metal levels during pregnancy and other characteristics. Methods: Project Viva participants (recruited in early pregnancy 1999–2002 in eastern Massachusetts) provided shed baby teeth for metal analysis (As, Ba, Bi, Cd, Co, Cr, Cu, Li, Mg, Mn, Mo, Ni, Pb, Sn, Sr, Zn) using laser ablation-inductively coupled plasma mass spectrometry (LA-ICP-MS, measurement range: 21 weeks before birth to 55 weeks after birth). We measured maternal erythrocyte metals in the first trimester (As, Ba, Cd, Cr, Cu, Mg, Mn, Pb, Sn, Zn) and the second trimester (Pb and Mn) using ICP-MS. We calculated Spearman correlations between erythrocyte metals and dentine metals and used multivariable linear regression to evaluate associations of participants’ characteristics, including mother’s age at enrollment, race/ethnicity, highest educational attainment, household income, smoking during pregnancy, parity, and child’s sex with dentine metal levels. Results: Participants (N=144) were mostly white (72%) and 81% were college graduates, 67% had household incomes >$70,000/year, and 13% smoked during pregnancy. We observed significant positive correlations between erythrocyte and dentine Pb, with the strongest correlation observed between 2nd-trimester erythrocyte Pb and mean of pre-birth dentine Pb (r=0.78, p<0.001, N=86). Smoking during pregnancy, mother’s age, and race/ethnicity were associated with metal levels in the baby tooth. For example, after adjusting for all characteristics mentioned in the methods, smoking during pregnancy was associated with higher dentine Sr (both pre and post-birth) and higher dentine Li post-birth. Conclusions: Maternal blood Pb strongly correlated with prenatal and postnatal dentine Pb. Dentine metal levels varied by some maternal characteristics, which may be useful for understanding the relationship of dentine metal levels with health outcomes in future work.

Variability and correlations of synthetic chemicals in urine from a New York City-based cohort of pregnant women

Fetal exposure to environmental chemicals has been associated with adverse health outcomes in children and later into adulthood. While several studies have examined correlations and variability of non-persistent chemical exposures throughout pregnancy, many do not capture more recent exposures, particularly in New York City. Our goal was to characterize exposure to phthalates, bisphenols, polycyclic aromatic hydrocarbons, and organophosphate pesticides among pregnant women residing in New York City who enrolled in the New York University Children's Health and Environment Study (NYU CHES) between 2016 and 2018. We measured urinary chemical metabolite concentrations in 671 women at early, mid, and late pregnancy (median 10.8, 20.8, and 29.3 weeks, respectively). We calculated Spearman correlation coefficients among chemical concentrations at each measurement time point. We compared changes in population-level urinary metabolites at each stage using paired Wilcoxon signed-rank tests and calculated intraclass correlation coefficients (ICCs) to quantify intra-individual variability of metabolites across pregnancy. Geometric means and ICCs were compared to nine other pregnancy cohorts that recruited women in 2011 or later as well as nationally reported levels from women of child-bearing age. Compared with existing cohorts, women in NYU CHES had higher geometric means of organophosphate pesticides (Σdiethylphosphates = 28.7 nmol/g cr, Σdimethylphosphates = 57.3 nmol/g cr, Σdialkyl phosphates = 95.9 nmol/g cr), bisphenol S (0.56 μg/g cr), and 2-naphthalene (8.98 μg/g cr). Five PAH metabolites and two phthalate metabolites increased between early to mid and early to late pregnancy at the population level. Spearman correlation coefficients for chemical metabolites were generally below 0.50. Intra-individual exposures varied over time, as indicated by low ICCs (0.22–0.88, median = 0.38). However, these ICCs were often higher than those observed in other pregnancy cohorts. These results provide a general overview of the chemical metabolites measured in NYU CHES in comparison to other contemporary pregnancy cohorts and highlight directions for future studies.

A modified pediatric ocular trauma score for predicting visual outcome post open globe injury.

To construct a new pediatric ocular trauma score for predicting visual outcome after open globe injuries (OGI) and to compare it to the ocular trauma score (OTS) and pediatric ocular trauma score (POTS). This is a retrospective chart review study. For each case, the following data were collected: demographics, mechanism of the injury, initial ophthalmologic findings, presented and last follow-up visual acuity (VA), ocular treatments, and final ocular findings. We then analyzed the risk factors for the poor visual outcome (VA ≤ 20/200), and a modified pediatric ocular trauma score (MPOTS) was constructed accordingly and compared to the OTS and POTS for predicting poor outcome. Finally, a different cohort of pediatric OGIs was used for score validation. Forty-five cases were included, significant predicting factors for poor visual outcome were initial VA ≤ 20/200, zone 2-3 locations of injury, presence of retinal detachment, vitreous hemorrhage, hyphema, and iris prolapse at initial presentation. The calculated Spearman correlation coefficients between each system score and poor visual outcome were OTS 0.56, POTS 0.57, and MPOTS 0.64 (P < 0.001 for all). A total of 71 new cases were used as validation cohort, and calculated Spearman correlation coefficients between each system score and poor visual outcome were: OTS 0.50, POTS 0.51, and MPOTS 0.53 (P < 0.001 for all). We suggest a new scoring system for predicting poor final visual outcomes after OGI's in children, which is simpler and more clinically suitable for this study population. It was found to be a better predictor of visual outcome in this scenario compared with existing scoring systems.

Network analysis to determine association between immuno-related toxicities and immune soluble profile in patients treated with anti–PD-1.

2553 Background: Immune checkpoint inhibitors (ICIs) have peculiar, immune-related adverse events (irAEs), as a consequence of interfering with self-tolerance mechanisms. The incidence of irAEs varies by ICI class, administered dose and treatment schedule. The aim of the study was to define a baseline (T0) immune profile (IP) predictive of irAE development. Methods: A prospective, multicenter study evaluating the IP of 79 patients with advanced cancer, treated with anti-PD-1drugs as a first- or second-line setting was performed. The results were then correlated with irAEs onset. The IP was studied by means of multiplex assay, evaluating circulating concentration of 12 cytokines, 5 chemokines, 13 soluble immune checkpoints and 3 adhesion molecules. IDO levels were evaluated through a modified liquid chromatography–tandem mass spectrometry. Data were first pre-processed by performing logarithmic transformation and Shapiro-Wilk-test. A connectivity heatmap was obtained by calculating Spearman correlation coefficients. Two different networks of connectivity were constructed, based on the toxicity profile. Results: Toxicity was predominantly of low/moderate grade. High-grade irAEs were relatively rare, while cumulative toxicity was high (23%). A positive and statistically significant correlation between the cumulative toxicity and IP10 and IL8, sLAG3, sPDL-2 sHEVM, sCD137, sCD27 and sICAM1 was found. Moreover, patients who experienced irAEs had a markedly different connectivity pattern characterized by disruption of most of the paired connections between cytokines (all the connections of the cytokine IL8, most of the connections between the pro-inflammatory chemokines, or all the connections of CD137, CD27, and CD28), while sPDL-2 pair-wise connectivity values seemed to be intensified. Network connectivity analysis identified a total of 187 statistically significant interactions in patients without toxicity and a total of 126 interactions in patients with toxicity. Ninety-eight interactions were common to both networks, while 29 were specifically observed in patients with toxicity. Conclusions: A peculiar pattern of immune dysregulation in patients who develop irAEs was defined. This immune serological profile could lead to the design of a personalized therapeutic strategy in order to prevent, monitor and treat irAEs at an early stage.

Comparison of National Vulnerability Indices Used by the Centers for Disease Control and Prevention for the COVID-19 Response.

Objective:Vulnerability indices use quantitative indicators and geospatial data to examine the level of vulnerability to morbidity in a community. The Centers for Disease Control and Prevention (CDC) uses 3 indices for the COVID-19 response: the CDC Social Vulnerability Index (CDC-SVI), the US COVID-19 Community Vulnerability Index (CCVI), and the Pandemic Vulnerability Index (PVI). The objective of this review was to describe these tools and explain the similarities and differences between them.Methods:We described the 3 indices, outlined the underlying data sources and metrics for each, and discussed their use by CDC for the COVID-19 response. We compared the percentile score for each county for each index by calculating Spearman correlation coefficients (Spearman ρ).Results:These indices have some, but not all, component metrics in common. The CDC-SVI is a validated metric that estimates social vulnerability, which comprises the underlying population-level characteristics that influence differences in health risk among communities. To address risk specific to the COVID-19 pandemic, the CCVI and PVI build on the CDC-SVI and include additional variables. The 3 indices were highly correlated. Spearman ρ for comparisons between the CDC-SVI score and the CCVI and between the CCVI and the PVI score was 0.83. Spearman ρ for the comparison between the CDC-SVI score and PVI score was 0.73.Conclusion:The indices can empower local and state public health officials with additional information to focus resources and interventions on disproportionately affected populations to combat the ongoing pandemic and plan for future pandemics.

Gravity assistance enables liver stiffness measurements to detect liver fibrosis under congestive circumstances.

BACKGROUNDAs survival has been prolonged owing to surgical and medical improvements, liver failure has become a prognostic determinant in patients with congestive heart diseases. Congestive hepatopathy, an abnormal state of the liver as a result of congestion, insidiously proceed toward end-stage liver disease without effective biomarkers evaluating pathological progression. Regular measurements of shear wave elastography cannot qualify liver fibrosis, which is a prognosticator in any type of chronic liver disease, in cases of congestion because congestion makes the liver stiff without fibrosis. We hypothesized that the effects of congestion and fibrosis on liver stiffness can be dissociated by inducing architectural deformation of the liver to expose structural rigidity.AIMTo establish a strategy measuring liver stiffness as a reflection of architectural rigidity under congestion.METHODSTwo-dimensional shear wave elastography (2dSWE) was measured in the supine (Sp) and left decubitus (Ld) positions in 298 consecutive cases as they were subjected to an ultrasound study for various liver diseases. Regions of interest were placed at twelve sites, and the median and robust coefficient of variation were calculated. Numerical data were compared using the Mann-Whitney U or Kruskal-Wallis test followed by Dunn's post-hoc multiple comparisons. The inferior vena cava (IVC) diameters at different body positions were compared using the Wilcoxon matched pairs signed rank test. The number of cases with cardiothoracic ratios greater than or not greater than 50% was compared using Fisher’s exact test. A correlation of 2dSWE between different body positions was evaluated by calculating Spearman correlation coefficients.RESULTSThe IVC diameter was significantly reduced in Ld in subjects with higher 2dSWE values in Ld (LdSWE) than in Sp (SpSWE) (P = 0.007, (average ± SD) 13.9 ± 3.6 vs 13.1 ± 3.4 mm) but not in those with lower LdSWE values (P = 0.32, 13.3 ± 3.5 vs 13.0 ± 3.5 mm). In 81 subjects, SpSWE was increased or decreased in Ld beyond the magnitude of robust coefficient of variation, which suggests that body postural changes induced an alteration of liver stiffness significantly larger than the technical dispersion. Among these subjects, all 37 with normal SpSWE had a higher LdSWE than SpSWE (Normal-to-Hard, SpSWE - LdSWE (∆2dSWE): (minimum-maximum) -0.74 - -0.08 m/sec), whereas in 44 residual subjects with abnormal SpSWE, LdSWE was higher in 27 subjects (Hard-to-Hard, -0.74 - -0.05 m/sec) and lower in 17 subjects (Hard-to-Soft, 0.04 - 0.52 m/sec) than SpSWE. SpSWE was significantly correlated with ∆2dSWE only in Hard-to-Soft (P < 0.0001). ∆2dSWE was larger in each lobe than in the entire liver. When Hard-to-Hard and Hard-to-Soft values were examined for each lobe, fibrosis-4 or platelet counts were significantly higher or lower only for Hard-to-Soft vs Normal-to-Hard cases.CONCLUSIONGravity alters the hepatic architecture during body postural changes, causing outflow blockage in hepatic veins. A rigid liver is resistant to structural deformation. Stiff-liver softening in the Ld position suggests a fibrous liver.

Validation of automated bone age analysis from hand radiographs in a North American pediatric population.

Radiographic bone age assessment by automated software is precise and instantaneous. The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment. We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R2). Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R2=0.96; P<0.0001), with the mean bone age difference of 0.12±0.76years. Bone age comparisons by the two methods remained strongly correlated (P<0.0001) when stratified by gender, common endocrine conditions including growth disorders and early/precocious puberty, and race. In the longitudinal analysis, we also found a strong correlation between the automated software and manual bone age over time (r=0.7852; R2=0.63; P<0.01). Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.

An Analysis of the Factors with Influence on Scientometric Indicators of Researchers from Pedagogical Universities of Ukraine

The article is devoted to a scientometric study of pedagogical universities of Ukraine, involving an analysis of the influence of external and internal factors on the scientometric indicators of researchers from this category of universities, which data were extracted from the scientometric Scopus database. The authors selected seventeen universities forming the population of Ukrainian pedagogical universities which profiles are presented in this database. The following variables were used as external factors: the number of years since the university founding, the number of doctors and candidates of sciences, the population of the city where the university is located. The characteristics of the indexed scientific publications were chosen as the internal factors of influence: the number of authors of each article included in the h-index (one author, 2 to 5 authors, more than 5 authors); type of access to the article (open or closed); “age” of the article; article funding (available or absent); quartile of the journal in which the article is published. All the involved computations were made by the authors in the statistical package SPSS.&#x0D; To identify the impact of external factors on the scientometric indicators of the pedagogical universities, the authors calculated pair correlation coefficients of factor variables with Hirsch index. The impact of internal factors was determined by a series of single-factor analyses of variance, to identify their impact on citation rates of the articles included in the nuclei of h-indexes of universities.&#x0D; The calculated Spearman correlation coefficients between the h-index and the factor variables suggest that there is no significant correlation between the external factors and Hirsch index. That is, none of these external factors affect the scientometric indicators of the pedagogical universities. A series of single-factor analyses of variance showed that the formation of the core h-index of the pedagogical universities was significantly influenced by the internal factors “availability of funding for a particular publication”, “journal’s quartile” and “article’s age”. But an impact of the factors “number of the article’s authors” and “open access to the article” on the formation of the core h-index of the pedagogical universities was not found.

An Association of Influenza Epidemics in Children With Mobile App Data: Population-Based Observational Study in Osaka, Japan.

BackgroundEarly surveillance to prevent the spread of influenza is a major public health concern. If there is an association of influenza epidemics with mobile app data, it may be possible to forecast influenza earlier and more easily.ObjectiveWe aimed to assess the relationship between seasonal influenza and the frequency of mobile app use among children in Osaka Prefecture, Japan.MethodsThis was a retrospective observational study that was performed over a three-year period from January 2017 to December 2019. Using a linear regression model, we calculated the R2 value of the regression model to evaluate the relationship between the number of “fever” events selected in the mobile app and the number of influenza patients ≤14 years of age. We conducted three-fold cross-validation using data from two years as the training data set and the data of the remaining year as the test data set to evaluate the validity of the regression model. And we calculated Spearman correlation coefficients between the calculated number of influenza patients estimated using the regression model and the number of influenza patients, limited to the period from December to April when influenza is prevalent in Japan.ResultsWe included 29,392 mobile app users. The R2 value for the linear regression model was 0.944, and the adjusted R2 value was 0.915. The mean Spearman correlation coefficient for the three regression models was 0.804. During the influenza season (December–April), the Spearman correlation coefficient between the number of influenza patients and the calculated number estimated using the linear regression model was 0.946 (P<.001).ConclusionsIn this study, the number of times that mobile apps were used was positively associated with the number of influenza patients. In particular, there was a good association of the number of influenza patients with the number of “fever” events selected in the mobile app during the influenza epidemic season.

Variability of urinary organophosphate esters (OPEs) during childhood: The HOME Study

BACKGROUND AND AIM: Organophosphate esters (OPEs) are widely used as flame retardants and plasticizers. Previous research has shown that gestational exposure to OPEs is variable, but no studies have examined the patterns and variability of postnatal exposure to our best knowledge. METHODS: In a prospective birth cohort (HOME Study, Cincinnati, OH, USA), we measured urinary OPE metabolite concentrations three times (16 and 26 weeks of gestation, at delivery) during pregnancy and five times (ages 1, 2, 3, 5, 8 years) during childhood. We log10-transformed creatinine-standardized OPE metabolite concentrations. We calculated Spearman correlation coefficients between postnatal OPE metabolites at each time point. We then used linear mixed models to calculate intraclass correlation coefficients (ICCs) for metabolite concentrations across the five postnatal time points. We further examined the association between three prenatal measures and early childhood (ages 1, 2, 3 years) exposure and subsequent metabolite concentrations at ages 5 and 8 years, including the main effect and the interaction term with the subsequent time points of metabolite measurement using linear mixed models. RESULTS:We detected (2-chloroethyl) phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), and diphenyl phosphate (DPHP) in 79 to 100% of children. The median concentrations (µg/g creatinine) were 0.78-4.76 for BCEP, 4.02-7.42 for BDCIPP, and 2.57-11.48 for DPHP. We found moderate correlations between BCEP and BDCIPP (rs: 0.28-0.49, p 0.001) at all time points. ICCs for metabolites across five postnatal time points, however, indicated poor within-person correlation (0.09–0.25). Prenatal urinary DPHP concentrations were positively associated with postnatal DPHP concentrations at some time points. Positive associations between early (1-3 years) and late childhood concentrations (age 8 years) were found for BCEP and BDCIPP. CONCLUSIONS:We found high within-person variability of OPE exposure within children across the first 8 years of life, suggesting that multiple urine samples are needed to characterize children’s exposures to OPEs. KEYWORDS: Chemical exposures, Endocrine disrupting chemicals, Children's environmental health, Environmental epidemiology

Serum cartilage oligomeric matrix protein is correlated with quantitative magnetic resonance imaging and arthroscopic cartilage findings in anterior cruciate ligament deficient knees without osteoarthritic changes.

To investigate the association between serum biomarker [cartilage oligomeric matrix protein (COMP) and matrix metalloproteinase-3 (MMP-3)] levels and clinical, magnetic resonance imaging (MRI), and arthroscopic findings in anterior cruciate ligament (ACL)-deficient knees without osteoarthritic changes on radiographs. Patients with ACL injury of Kellgren-Lawrence grade 0 or 1 were enrolled. Serum COMP and MMP-3 levels were measured preoperatively. Correlations of serum biomarker levels with age, body mass index (BMI), duration from time of injury, Tegner activity scale (TAS) score, Lysholm knee score, International Knee Documentation Committee score, KT-1000 arthrometer measurements, whole-organ MRI score (WORMS), MRI T2 relaxation time, and arthroscopic International Cartilage Research Society (ICRS) grade were assessed by calculating Spearman correlation coefficients. Associations between intraoperative findings (cartilage, meniscus) and serum biomarker levels were determined using the Mann-Whitney U test. Multiple regression analysis was performed to investigate the correlations between serum biomarker levels and MRI and arthroscopic findings. Ninety-eight patients with a mean age of 23.7 years were enrolled. Higher serum COMP level was correlated with older age and higher BMI, TAS score, serum MMP-3 level, WORMS, and T2 relaxation times (medial femur, medial tibia). Multivariate analysis showed that the serum COMP level was independently associated with WORMS and ICRS grade. The serum COMP level was correlated with age, BMI, TAS score, and MMP-3 level in ACL-deficient knees and was independently correlated with WORMS and ICRS grade. Thus, the serum COMP level can help detect cartilage degeneration even in patients without radiographic osteoarthritic changes. Key Points • Serum COMP correlated with WORMS and ICRS grade in ACL deficient knee. • The serum COMP level could help in detecting cartilage degeneration, even in patients with no radiographic osteoarthritic changes.

Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions.

Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = -0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients' median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.

Examining nonprescription syringe sales in Massachusetts and Rhode Island community pharmacies

BackgroundThe role pharmacies play in addressing the opioid crisis and drug-related risks such as injection drug use is evolving. Estimating the prevalence of injection drug use at the community level is challenging because of the stigma of drug use. Many community pharmacies sell nonprescription sterile syringes; thus, pharmacy-level sales of injection equipment may be an indicator of drug-related harms and unmet needs of high-risk populations. ObjectivesTo describe, compare, and assess the convergent validity of staff-reported nonprescription syringe (NPS) sales volume and NPS administrative sales data from community pharmacies in Massachusetts (MA) and Rhode Island (RI). MethodsThis study employed both prospective cross-sectional survey data collection and utilization of administrative pharmacy sales data. Between November 2017 and January 2018, we administered a telephone-based survey to estimate average weekly NPS type and volume for 191 chain pharmacies (CVS Health) located in communities experiencing fatal opioid overdoses above the state’s 2015 annual median rate. For the same time period, we obtained NPS sales data from surveyed pharmacies and all CVS Health pharmacies in the 2 states. We calculated Spearman correlations to assess convergence of average weekly volume between pharmacy staff reports and sales data. ResultsAll pharmacies responded to the survey. Most (98.4%) pharmacies surveyed sold NPS, but 42.0% reported running out of stock monthly or more frequently. Pharmacy staff tended to under-report syringe sales. Staff-reported weekly NPS sales volume was 67,922 versus 70,962 syringes from administrative pharmacy sales data. Spearman correlation between reported and actual NPS sales was 0.40 (95% CI 0.27–0.51). ConclusionThe counts of administrative pharmacy syringe sales data in MA and RI indicate high need, substantial volume, and notable access at community pharmacies. Future research should use NPS sales data rather than self-report data to track emerging trends and tailor local responses.

1067 Electronic FHR monitoring, pH and newborn outcomes – this is as good as it gets

To examine the relationship between umbilical artery (UA) cord gas values and fetal tolerance of labor and/or delivery. We hypothesized the existence of wide biologic variability in fetal tolerance of metabolic acidemia which, if present, would weaken a fundamental assumption underlying the use of EFHRM. A retrospective cohort study of term, singleton fetuses delivered between 2012 and 2020. Universal cord gases were collected. Umbilical cord gas values and Apgar scores were extracted. We calculated Spearman correlation coefficients (CC) and constructed ROC curves for UA pH and base excess (BE) as predictors of Apgar score. Our cohort included cord gas and Apgar scores from 29,787 deliveries. The statistical correlation between UA pH and BE and both 1 and 5 minute Apgar scores was weak or non-existent in both the group as a whole and in all pH range sub-groups (Table 1). ROC curve analysis of pH as a predictor of 5 minute Apgar >=7 showed only an acceptable discrimination (AUC= 0.75 95%CI 0.71-0.79, p< 0.01)) with a similar story for base excess (AUC=0.745 95%CI 0.708-0.782, p< 0.01). Subgroup analysis of deliveries with pH >7.2 or BE >-4 showed even poorer predictive ability (Figure 1). Of 8 newborns who underwent cooling for HIE, 3 (38%) had UA pH > 7.15. The use of EFHRM is predicated upon a documented correlation between certain FHR patterns and UA pH, and an arbitrary, presumed correlation between pH and fetal tolerance of labor/delivery, as reflected in newborn condition. To the extent that the latter relationship is invalid, the former correlation is irrelevant. Our data demonstrate a weak to absent correlation between metabolic acidemia and even short term fetal condition, confirming wide biologic variability in fetal tolerance of the hypoxic stress of labor and significantly weakening this latter assumption. No amount of future tweaking of FHR pattern interpretation is likely to result in improved newborn outcomes given this flaw in one fundamental assumption upon which FHRM is based.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Epigenetic regulation of the Wnt-signaling pathway in CIMP-H BRAFV600E mCRC.

110 Background: BRAFV600E mutation identifies mCRC patients with poor prognosis with only little benefit from standard therapy. Analysis from TCGA revealed that 89% of BRAFV600E CRC tumors were associated with a high CpG island methylator phenotype (CIMP-H), which may result in epigenetic silencing of tumor suppressor genes, while only 29% of BRAF wild-type tumors are CIMP-H. In this study, we define key pathways regulated by global DNA hypermethylation in the context of BRAFV600E mutation. Methods: We analyzed the TCGA Illumina 450k array methylation datasets and RNA-sequencing datasets for 97 CIMP-H CRC tumors (27 BRAFV600E; 69 BRAF WT) identified by five universal CIMP annotations ( p14, p16, MLH1, MINT1, MINT2, MINT31). We defined differential methylation profile according to BRAF mutation status and calculated Spearman correlation between methylation and gene expression to identify CIMP-H BRAF-associated genes. Next, pathways enriched with CIMP-H BRAFV600E tumors were defined using PANTHER pathway analysis. Additionally, β-catenin IHC were conducted on 145 MD Anderson CRC patient samples and compared by CIMP and BRAF status. Results: BRAF mutation is associated with lower rates of APC mutation as has previously been shown (32%, 82%). We identified 6,097 differentially methylated probes by BRAF mutation status (FDR = 10-4), and as expected, our data suggests a higher methylation profile in BRAFV600E mutated tumors compared to BRAF WT. Intriguingly, CIMP-H BRAF-associated genes showed enrichment in the Wnt-signaling and cadherin signaling pathways ( p&lt; 0.0001 (FDR &lt; 0.0001)). Despite the epigenetic Wnt-signaling, nuclear β-catenin expression (as a measure of Wnt activity) in CIMP-H and BRAF tumors remains lower than for non-CIMP, and BRAF wild-type ( p= 0.0003 for comparison of CIMP). Conclusions: Genes under methylation regulation in the BRAF-mutant context showed enrichment in Wnt-signaling pathway. Since BRAFV600E CRC tumors have a low association with APC mutation, this data suggests role of epigenetic regulation of the Wnt-pathway activation. However, as measured by nuclear β-catenin, Wnt activation in these tumors is not as high as traditional APC-mutated CRC tumors. CIMP-H tumors with BRAFV600E mutation is a unique subset of CRC tumor that have Wnt-pathway activation regulated by epigenetic modifications more than a β-catenin activation.

A comparison and analysis of seven gun law permissiveness scales

BackgroundDue to the differences in the way gun law permissiveness scales were created and speculation about the politically motivated underpinnings of the various scales, there have been questions about their reliability.MethodsWe compared seven gun law permissiveness scales, varying by type and sources, for an enhanced understanding of the extent to which choice of a gun law permissiveness scale could affect studies related to gun violence outcomes in the United States. Specifically, we evaluated seven different scales: two rankings, two counts, and three scores, arising from a range of sources. We calculated Spearman correlation coefficients for each pair of scales compared. Cronbach’s standardized alpha and Guttman’s lambda were calculated to evaluate the relative reliability of the scales, and we re-calculated Cronbach’s alpha after systematically omitting each scale to assess whether the omitted scale contributed to lower internal consistency between scales. Factor analysis was used to determine single factor loadings and estimates. We also assessed associations between permissiveness of gun laws and total firearm deaths and suicides in multivariable regression analyses.ResultsAll pairs of scales were highly correlated (average Spearman’s correlation coefficient r = 0.77) and had high relative reliability (Cronbach’s alpha = 0.968, Guttman’s lambda = 0.975). All scales load onto a single factor. The choice of scale did not meaningfully change the parameter estimates for the associations between permissiveness of gun laws and gun deaths and suicides.ConclusionGun law permissiveness scales are highly correlated despite any perceived political agenda, and the choice of gun law permissiveness scale has little effect on study conclusions related to gun violence outcomes.

Development of a Short Form of the Negative Pain Thoughts Questionnaire (NPTQ).

Thoughts affect pain intensity and the magnitude of activity intolerance for a given nociception. The Negative Pain Thoughts Questionnaire (NPTQ) measures common unhelpful cognitive biases regarding pain. A shorter version of the NPTQ could be used in daily practice to improve health by identifying important misconceptions. One hundred and thirty-seven patients seeking specialty musculoskeletal care completed questionnaires addressing demographics, negative pain thoughts, worst-case thinking, resiliency, the magnitude of self-reported activity intolerance, and pain intensity. Patients were randomly allocated to a learning cohort (110 patients, 80%) and a validation cohort (27 patients, 20%). Based on factor analysis of the learning cohort, 4 questions were selected to create the NPTQ short form (NPTQ-SF). Floor and ceiling effects of the NPTQ and NPTQ-SF were analyzed. Psychometric properties of the NPTQ-SF were tested with use of Spearman correlations with the NPTQ. The internal consistency of the NPTQ and NPTQ-SF was analyzed with use of the Cronbach α coefficient. To test external validity, we calculated Spearman correlations with pain intensity, activity intolerance, the Pain Catastrophizing Scale, and the Brief Resiliency Scale in the validation cohort. The Cronbach α was 0.90 for the NPTQ and 0.85 for the NPTQ-SF. The Spearman correlation between NPTQ and NPTQ-SF scores was 0.91 in the learning cohort and 0.93 in the validation cohort. In the validation cohort, there was no difference in the strength of the correlations of the NPTQ and NPTQ-SF with other questionnaires. These findings support the use of a brief, 4-question measure of unhelpful cognitive biases regarding pain in both research and patient care. The NPTQ-SF would benefit from external validation in an independent cohort. The notable influence of common misconceptions (i.e., cognitive bias) on musculoskeletal symptoms can be measured with a brief questionnaire and used as a point of discussion with patients.

Characteristics of exposure to multiple environmental chemicals among pregnant women in Wuhan, China

BackgroundPrevious studies on environmental pollutant exposure during pregnancy have mostly focused on individual chemical substances or single urine measurements. Thus, our understanding of the potential cumulative or interactive effects of exposure is limited. ObjectiveWe aimed to ascertain the characteristics and predictors of exposure to environmental chemicals over three trimesters among pregnant women. MethodsWe measured the concentrations of 34 chemicals in spot urine samples provided by 745 participants in their early, middle, and late pregnancy. We calculated Spearman correlation coefficients (SCC) between exposure levels of multiple chemicals in each trimester. K-means clustering and principal components analysis (PCA) were applied to classify the populations and reduce data dimensionality. We used generalized linear models (GLM) to confirm predictors of each cluster and principal component. ResultsSCC showed that the correlations of chemical concentrations from the same classes were higher than those among concentrations of different classes. Cluster analysis categorized participants into three clusters, and each cluster represented different chemical concentrations. We restricted the principal components to six, which explained more than 50% of the data variations. Several physiological, socio-demographic factors, and behavior patterns were related to different clusters and principal components. ConclusionDistinct exposure patterns and dominant exposure components of multiple environmental chemicals among pregnant women might help research the potential health effects of exposure to chemical mixtures and develop relevant public health interventions.

Assessing the association between tourism and the alcohol urban environment in Barcelona: a cross-sectional study

ObjectivesAlcohol availability and promotion are not distributed equally in the urban context. Evidence shows that the socioeconomic level seems to influence the amount of alcohol-related elements in an area. Some...

Reliability and validity of the adapted Turkish version of the Spinal Appearance Questionnaire

The Spinal Appearance Questionnaire (SAQ), scoliosis specific quality of life questionnaire, was developed to assess the spinal appearance in adolescent idiopathic scoliosis (AIS) patients. The aim of this study is to evaluate the adaptation, validity, and reliability of the Turkish version of the Spinal Appearance Questionnaire (Tr-SAQ). Tr-SAQ and already validated Turkish SRS-22 were applied to 75AIS patients (56 females) twice within a 2-week interval for test-retest reliability. Validity of the Tr-SAQ was assessed with factor analysis, convergent validity, and discriminant validity. Convergent validity was evaluated by calculating Spearman correlation coefficients between Tr-SAQ and SRS-22 self-image domain. Internal consistency and intraclass correlation coefficient (ICC) were evaluated for the determination of reliability. Factor analysis indicated that Tr-SAQ had two factors as appearance (items 1-10) and expectations (items 12-15). Convergent validity test showed a significant negative correlation between the Tr-SAQ appearance score and SRS-22 self-image score (Spearman's r = - 0.6).Test-retest was conducted within a mean of 16.7 (range 14-28) days. Both ICC and Cronbach's α were found to be high (0.98, 0. 91, respectively). The correlations with the major curve magnitude were stronger for the Tr-SAQ Appearance (r = 0.7) and Tr-SAQ Total (r = 0.6) scores than the correlations between the SRS-22 self-image (r = - 0.5) and SRS-22 Total (r = - 0.4) scores. The Turkish version of the SAQ was reliable and valid for clinical use for AIS patients who are native speakers of Turkish. Level I- diagnostic studies.