Cumulative Logit Research Articles

Humoral response to SARS-CoV-2 vaccines in people living with HIV

PurposeTo describe the humoral immune response to COVID-19 vaccines in people living with HIV and identify factors associated with the magnitude of anti-SARS-CoV-2 antibody concentrations.MethodsRetrospective analysis of electronic patient files in a big single HIV center in Munich, Germany. Non-parametric methods were used for descriptive and comparative statistics. Generalized linear models were used to analyze associations of general and HIV-specific variables with anti-SARS-CoV-2 antibody concentrations after standard vaccination.ResultOverall, 665 people living with HIV were included into the analysis (median age: 53 [IQR: 43; 59]), 560 [84.2%] males). Median concentration of anti-SARS-CoV-2-antibodies was 1400 (IQR 664; 2130) BAU/mL. In 18 (2.7%) subjects, antibody concentrations below the threshold of 34 BAU/mL were found. Among PLWH with CD4 cell count < 200 cells/µL, median anti-SARS-CoV-2-Abs were 197 (IQR 44.6; 537.2) as compared to 1420 (IQR 687; 2216) for the group ≥ 200 cells/µL (p < 0.001). In a cumulative logit model, a vaccination scheme including an mRNA vaccine [OR: 4.64 (3.58; 6.02)], being female [OR: 2.14 (1.76; 2.61)], and having higher CD4 cells [OR per 100 cells/µL: 1.06 (1.04; 1.08)] were significantly associated with anti-SARS-CoV-2 antibody concentrations in higher quartiles, when adjusted for the time after vaccination.ConclusionWe found a robust antibody response in people living with HIV undergoing standard vaccination against SARS-CoV-2. mRNA-containing vaccination schemes, being female, and having a higher CD4 cell count was associated with a higher concentration of antibodies in people living with HIV in our study sample. Particularly in the subgroup with CD4 cell counts < 200 cells/µL, antibody response was poor.

Mediterranean diet, walking outdoors and polypharmacy in older patients with type II diabetes.

Polypharmacy and its adverse health effects is an emerging public health issue, with increasing prevalence among patients with multiple chronic conditions, such as older adults with diabetes. A healthy lifestyle has been shown to improve both diabetes and polypharmacy incidence. We conducted a cross-sectional study to investigate the association of a healthy lifestyle with polypharmacy and comorbidities in older people with diabetes. All out-patients from January 2013 to June 2015 with type II diabetes aged 65 years or more from a Lazio Region reference centre for diabetes were included in the study. Socio-demographic, clinical and lifestyle data were collected from medical records and through face-to-face standardized questionnaires. The comorbidity-polypharmacy score (CPS) was used to characterize the overall patients' frailty, by assessing concurrently the presence of comorbidities and polypharmacy. The cumulative logit model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Adjusted ORs for age, sex, body mass index, physical activity and cognitive status, showed that CPS score was inversely related to weekly consumption of cruciferous vegetables (OR: 0.56, 95% CI: 0.35-0.90; P-trend = 0.015), leafy green vegetables (OR: 0.54, 95% CI: 0.33-0.87; P-trend = 0.013) and daily intake of fruits (OR: 0.63, 95% CI: 0.41-0.97; P-trend = 0.036). Walking outdoors was found inversely related to CPS score (age- and sex-adjusted OR: 0.60, 95% CI: 0.42-0.86). Our findings suggest that eating some dietary factors present in the Mediterranean diet and walking outdoors regularly is associated with a lower intensity of medicines need to treat comorbidities among older people with diabetes.

Severity of Infestation Levels of Tunga Penetrans in Central, Kenya: A Bayesian Cumulative Logit Model

Tungiasis is a neglected parasitic disease that significantly affects communities, especially in developing countries. This study developed a Bayesian severity of the jigger infestation model and its spatial counterpart. Putative determinants leading to different levels of infestation and the most affected areas were to be identified through the model. We collected data through a cross-sectional study with a multi-stage sampling design. A structured questionnaire was administered in each household to capture variables used for modelling jigger infestations. The severity of jigger infestation categorized for each individual was modelled against all the other predictor variables. It was also integrated with spatial data to determine the spatial distribution pattern of jigger infestation. A Bayesian multinomial logistic regression model was used to assess the association between various predictors and different infestation levels. Specifically, an ordered Bayesian Severity Hierarchical (OBSH) categorical model was obtained. This model was categorical based on the Counties (1-Nyeri, 2-Murang&amp;#39;a and 3-Kiambu). Results from this model showed that for a one-unit decrease in the poverty index at level 1 (individuals categorized as poor) there was about a 69% increase in the severity of jigger infestation. A one-unit increase in the percentage of clay in the soil increased the odds ratio of the severity of jigger infestation by a factor of 11.21 while a high percentage of nitrogen in the soil lowered the severity of infestation.&amp;nbsp; Severity of jigger infestation reduced from the baseline, Nyeri County to Kiambu County. It also increased with increasing altitude due to a decrease in nitrogen levels.

English

Hypertension is the force of blood pushing up against the walls of blood vessels and it is defined as a systolic blood pressure &ge; 140 mm Hg and/or diastolic blood pressure &ge; 90 mm Hg. It is estimated to cause 9.4 million deaths every year. This study aims to conduct ordinal logistic regression analysis of hypertension severity and identifying associated factors for severity of hypertension, using the data of Gondar Univeristy Referral Hospital, North west Ethiopia. &nbsp;The cumulative logit or the proportional odds regression model is one of the popular choices used to study covariate effects on ordinal responses. The proportional odds model was used to model the severity of hypertension and to identify associated factors for its severity. The fit of the model was illustrated with 420 hypertension records obtained from Gondar University Referral Teaching Hospital (in the chronic illness medication and follow up clinic). Findings of this study show that age of patients (OR= 2.195, P = 0.0051), residence (OR= 1.954, P = 0.0008), alcohol use (OR= 2.329, P = 0.0027), using salty foods (OR= 1.970, P = 0.0007), habit of using vegetable/fruit (OR= 0.516, P = 0.0010), doing physical exercise (OR= 0.571, P = 0.0062) and BMI (OR= 3.293, P &lt;0.0001) had significant association with severity of hypertension. Polices and plans have to be put in place to motivate vegetable/fruit users, to decrease the consumption of salty foods,&nbsp; non-alcohol drinkers, normal body mass index and concerned bodies need to implement hypertension prevention strategies. Key words: Hypertension severity, ordinal logistic regression, proportional odds model.

Envelope wages as a new normal? An insight into a pool of prospective quasi-formal workers in the European Union (EU)

PurposeIn spite of millions of quasi-formal workers in the European Union (EU), there is still limited understanding of what motivates workers to participate in these detrimental employment schemes, and why certain groups of workers exhibit higher inclination towards it. This article takes a novel approach by putting prospective envelope wage earners in the centre of this analysis.Design/methodology/approachData from the 2019 Special Eurobarometer on undeclared work are used, and two-level random intercept cumulative logit modelling is applied.FindingsOne in seven fully declared EU workers would have nothing against receiving one part of their wages off-the-books. Manual workers and individuals whose job assumes travelling are the most willing to accept such kind of remuneration, and the same applies to workers with low tax morale and those who perceive the risk of being detected and persecuted as very small. On the other hand, women, older individuals, married persons and employees from large enterprises express the smallest inclination towards envelope wages. The environment in which an individual operates also plays a non-negligible role as the quality of the pension system and the strength of social contract were also identified as significant determinants of workers' readiness to accept envelope wages.Originality/valueThis article fills in the gap in the literature by analysing what workers think about wage under-reporting and what factors drive their willingness to accept envelope wages.

Southern right whales generally appear not to react to transiting research vessels

AbstractReactions of southern right whales (SRWs) related to whale‐watching boats have been reported in Patagonia, but there are no quantitative data showing how these whales react to boats not preforming whale‐watching trips. The objective of this study was to investigate the reaction of SRWs to transiting vessels. Data were collected off the coast of Puerto Madryn city, and were analyzed by means of cumulative logit models, using the whales' intensity of behavioral response as an ordinal dependent variable. During the experimental approaches of a research vessel, we found that the response of SRWs differed depending on the number of whales present. The results of this study show that the probability of response to transiting vessels is low, unless there are only a few whales in a group, or it is a mating group. This response is different from that of an approaching whale‐watching vessel. In this study, the lack of reaction of whales to the research vessel suggests that whales would not consider it as a threat. This study represents an important piece of information for the conservation of southern right whales.

A Stochastic User Equilibrium Formulation for the Cumulative Prospect Theory-Based Cross-Nested Logit

The cumulative prospect theory provides a better description for route choice behavior of the travelers in an uncertain road network environment. In this study, we proposed a multiclass cumulative prospect value- (CPV-) based cross-nested logit (CNL) stochastic user equilibrium (SUE) model. For this model, an equivalent variational inequality (VI) model is provided, and the existence and equivalence of the model solutions are also proved. The method of successive averages (MSA), method of successive weighted averages (MSWA), and self-regulated averaging (SRA) method are designed and compared. In addition, the proposed multiclass CPV-based CNL SUE model is also compared with the multiclass utility value- (UV-) based CNL SUE model. The results show that the path flow assigned by the multiclass CPV-based CNL SUE model is more consistent with the actual situation. The impact of different model parameters on the cumulative prospect value (CPV) is investigated.

Has the COVID-19 pandemic changed food waste perception and behavior? Evidence from Italian consumers

Food waste represents a multi-sectoral issue and influences the economy, society and environment. Considering that over 50% of food waste is generated from household consumption, the issue has been included among the 17 Sustainable Development Goals, with the aim of halving its quantity by 2030. However, the COVID-19 pandemic imposed several variations in the agri-food industry in terms of food manufacturing, storage and distribution, changing at the same time food access, food consumption and food waste behavior. The present paper, through an online-based questionnaire among 831 respondents from Italy and the application of the cumulative logit model, investigates consumer behavior after the lockdown with reference to unpredictable lifestyles, improvements in smart food delivery and never-experienced time management. Results illustrate that always-at-home consumers (forced to stay at home 24 h a day) are more likely to perceive food waste and reduce its amount, whereas discontinuous smart working makes food purchase, preparation and consumption activities even more stressful and complex. Furthermore, smart food delivery tends to increase consumers’ awareness of meals, improving buying decisions and indirectly reducing food waste generation. The unjustifiable prevalence of household food waste represents a major barrier to the achievement of food security, health insurance and hunger reduction, but also the most promising entry point to stress in the achievement of private and public benefits. Thus, the active role of education among young generations must be enhanced.

Are We Happy in Densely Populated Environments? Assessing the Impacts of Density on Subjective Well-Being, Quality of Life, and Perceived Health in Montreal, Canada.

Compact city development has been increasingly promoted as a tool to encourage urban sustainability and to reduce humans’ environmental footprint. The impacts of such urban development on subjective well-being (SWB), Quality of Life (QOL), and perceived health—non-monetary metrics of prosperity—have not been extensively explored in the North American context. This paper delves into the relationship between density and happiness by analyzing a travel survey distributed in Montreal, Quebec, Canada (n = 4,148). A cumulative logit model assessed levels of happiness—as measured by SWB, QOL, and perceived health—against confounding variables such as age, gender, household size, marital status, education, income levels, and residential self-selection, while including neighborhood density as our main policy variable. Results do not show that population density affects perceived health or SWB. However, a small inverse relationship between QOL and population density was observed. Analyzing neighborhood characteristics through their effect on SWB, QOL, and perceived health provides further evidence on the links between the urban landscape and happiness, and the study’s results can inform zoning and land-use policymaking.

Modeling and simulation to predict the degree of disability over time in acute ischemic stroke patients.

Disability in patients with acute stroke varies over time, with the prediction of outcomes being critical for proper management. This study aimed to develop a model to predict the cumulative probability of each modified Rankin Scale (mRS) score over time with inclusion of significant covariates. Longitudinal data obtained from 193 patients, 1–24 months after onset of acute ischemic stroke, were included for a modeling analysis using nonlinear mixed‐effect modeling (NONMEM). After selecting a model that best described the time course of the probability of different mRS scores, potential covariates were tested. Visual predicted check plots, parameter estimates, and decreases in minimum objective function values were used for model evaluation. The inclusion of disease progression (DP) in the baseline proportional odds cumulative logit model significantly improved the model compared to the baseline model without DP. An inhibitory maximum effect (Emax) model was determined to be the best DP model for describing the probability of specific mRS scores over time. In the final model, DP was multiplied with the baseline cumulative logit probability with a baseline adjustment. In addition to differences in lesion volume (DLV), the final model included comorbid diabetes mellitus (DM) and baseline National Institutes of Health Stroke Scale (NIHSS) scores on Emax as statistically significant covariates. This study developed a model including DLV, NIHSS score, and comorbid DM for predicting the disability time course in patients with acute ischemic stroke. This model may help to predict disease outcomes and to develop more appropriate management plans for patients with acute stroke.

Personalized delirium sedation goal (PDSG): Balancing comfort and communication in the last days of life.

12033 Background: Management of patients with agitated terminal delirium is challenging as clinicians try to find a balance between adequate sedation to maximize comfort while retaining communication abilities. A novel approach to tailor care is to ask caregivers for a PDSG by setting an individualized target for sedation. In this study, we examined PDSG using (1) clinical vignettes and (2) as a clinical response criteria in patients enrolled onto a randomized clinical trial. Methods: This is a pre-planned secondary analysis of a double-blind randomized clinical trial examining the sedative effect of chlorpromazine and/or haloperidol in patients with agitated terminal delirium refractory to low dose haloperidol (clinicaltrials.gov: NCT03021486; Lancet Oncol 2020 21:7 989-998). At baseline, caregivers and bedside nurses were independently asked to select the PDSG for 6 patient vignettes that differed by level of agitation (high vs. moderate), ability to communicate (yes or no), and survival (days vs. weeks). There were 5 choices for PDSG, corresponding to RASS scores of 0 (no sedation), -1 to -2, -3, -4 and -5 (deep sedation). Respondents were also asked to select the PDSG for the enrolled study patient, which were assessed against actual RASS scores over the first 24 hours to determine a response. We examined the association between PDSG levels and various patient and respondent characteristics with multi-level cumulative logits models. Results: 68 patients were enrolled and 45 received the masked study interventions (median survival 73 h [95% CI 49,106 h]). 42 caregivers and 40 nurses provided PDSG data. For the case vignettes, 7-31% of caregivers and 20-55% of nurses chose RASS -4 or -5 as PDSG. PDSG was significantly lower for patients who were unable to communicate (odds ratio [OR] 3.1-4.4, P &lt; 0.0001), patients with only days of survival vs. weeks (OR 1.7, 95% confidence interval [CI] 1.2-2.5; P = 0.002) and if the respondent was a bedside nurse (OR = 2.5, 95% CI 1.8-3.6; P &lt; 0.0001). For study patients, 12 (29%) of caregivers and 13 (33%) of nurses selected RASS -4 or -5 as PDSG. After the first 2 hours, 40-61% of patients achieved RASS scores that were within ±1 point of caregiver’s PDSG, with no significant difference detected among treatment groups (P = 0.45). PDSG for study patients was significantly lower if the respondent perceived severe distress related to agitation (OR = 4.4, 95% CI 1.1-17.2; P = 0.03), particularly if the respondent was a bedside nurse (OR = 4.8, 95% CI 1.4-16.2; P = 0.01). Conclusions: PDSG represents a novel response criterion to tailor care for patients with agitated terminal delirium. Lighter sedation was preferred by caregivers compared to nurses, particularly for patients with less agitation, ability to communicate, and longer expected survival. These findings may allow clinicians to better tailor the level of sedation for patients with restlessness/agitation in the last days of life. Clinical trial information: NCT03021486.

804 A Multidisciplinary Approach to Investigating Sleep Practices and Sleep Disturbances on an Inpatient Neurology Unit

Abstract Introduction Minimizing nightly disruptions in the inpatient setting requires a multidisciplinary, collaborative approach. Our aim was to assess staff perceptions and practices of sleep during hospitalization to help identify and prioritize improvement initiatives. Methods An online survey was distributed to inpatient staff (nurses, residents, attendings, APPs) on a neurology unit at an academic medical center. The survey assessed sleep disturbances, sleep knowledge and sleep practices. Responses across groups were analyzed using Cochran Armitage tests. Cumulative logit model was also performed. Results Among the 49 respondents, 75% reported not having the training to diagnose and treat sleep disorders. 51.2% rarely or never asked about sleep quality or duration prior to admission. 29.6% rarely or never tracked the amount and quality of sleep during hospitalization. Reasons for not tracking or considering sleep included “not being a priority”, “no place to document” and “not being there at night.” Overall, staff ranked noise, testing and vital sign checks as most disruptive to sleep quality and temperature as least disruptive. However, nurses perceived medication administration (p=0.0001) and testing (p=0.0296) more disruptive than the ordering providers. Multivariable analysis showed nurses ranked medication administration higher than providers when shift differences were controlled (p&amp;lt; 0.01). Evening/night shift workers ranked pain (p=0.0324) and anxiety (p=0.0360) higher than day shift workers. Those comfortable with diagnosing and treating sleep disorders were more likely to track sleep during admission (p=0.009), allow patients to sleep during medication administration times (p=0.0189) and allow sleep during scheduled lab draws (p=0.0189). Conclusion Our findings indicate that differences in sleep knowledge and sleep perspectives exist across the healthcare team. Possible explanations include training differences, ordering providers not knowing what time medications are administered or when tests are done, teams not clarifying whether nighttime orders are critical and nurses lacking empowerment to notify providers that sleep is being disrupted. Hand offs may need optimization with regards to pain and anxiety. A multidisciplinary approach, particularly between providers/nurses and night/day teams is critical to improve sleep on inpatient units. Our next steps include surveying patients, tracking nightly disruptions using EMR and decreasing unnecessary overnight orders using a team based approach. Support (if any):

Evaluation of the Sociodemographic, Behavioral and Clinical Influences on Complete Antiretroviral Therapy Adherence Among HIV-Infected Adults Receiving Medical Care in Houston, Texas.

IntroductionFew studies have estimated complete antiretroviral therapy (ART) adherence following HIV infection since the advent of the new ART guidelines in 2012. This study determined the prevalence and influence of sociodemographic, behavioral, and clinical factors on complete ART adherence among people living with HIV (PLWH) receiving medical care in Houston/Harris County, Texas.MethodsData from the Houston Medical Monitoring Project survey collected from 2009 to 2014 among 1073 participants were used in this study. The primary outcome evaluated was combined adherence, defined as complete, partial, and incomplete combined adherence based on three ART adherence types—dose, schedule, and instruction adherence. The duration living since initial HIV diagnosis was classified as <5, 5–10 and >10 years. Rao–Scott Chi-square test and multivariable proportional-odds cumulative logit regression models were employed to identify the sociodemographic, behavioral, and clinical characteristics of complete combined adherence among the three groups of PLWH living with HIV infection.ResultsMore than one-half (54.4%) of PLWH had complete, 37.4% had partial, and 8.3% had incomplete combined adherence. Among these PLWH, 52.2% had been infected with HIV for >10 years, and 26.5% and 21.4% were infected for <5 years and 5–10 years, respectively. PLWH who were diagnosed <5 and 5–10 years were two times (aOR=1.71, 95% CI=1.13–2.57; aOR=1.69, 95% CI=1.10–2.59; respectively) more likely to experience complete combined adherence than those with >10 years of infection. Multiple sociodemographic, behavioral, and clinical characteristics were significantly associated with complete adherence and varied by the duration of HIV infection.ConclusionMeasures of adherence should include all adherence types (dose, schedule, instruction), as utilizing a single adherence type will overestimate adherence level in PLWH receiving medical care. Intervention efforts to maintain adherence should target recently infected PLWH, while those aimed at improving adherence should focus on longer infected PLWH.

Primary care nurse practitioner burnout and perceptions of quality of care.

Burnout threatens patient care and clinicians are experiencing challenges within the practice environment. Little is known about nurse practitioner (NP) perceptions of burnout and its relationship to care quality and practice environment. We investigate the relationship between primary care NP burnout on perceptions of care quality and if the practice environment moderates the relationship between burnout and care quality. This is a secondary analysis of cross-sectional survey data from 396 NPs. Burnout and care quality were measured using a single item, but the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Multi-level proportional odds cumulative logit models were built to test for associations between burnout and care quality and for moderation. Total, 25.3% of NPs reported burnout. Odds of perceiving higher quality of care was 85% less for NPs experiencing burnout compared to those not experiencing burnout. Practice environment did not moderate the relationship between burnout and care quality, but with a one unit increase in the practice environment subscales, the odds of NPs perceiving higher care quality increased anywhere from 3.83 to 7.57 times. Burnout is related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality.

Are Aorta Artery Diameter and Inferior Vena Cava Diameter a Reliable Predictor index in Traumatic Patients with Hemorrhagic Shock?

Background: Intravascular volume is the most important factor in determining patients' hemodynamic status. This present study aimed to assay the predictive value of aorta artery diameter and inferior vena cava (IVC) diameter in trauma patients with hemorrhagic shock. Materials and Methods: This was a cross-sectional study conducted on 69 trauma patients who referred to Imam Reza Hospital in Tabriz. Inclusion criteria were all trauma patients with hemorrhagic shock. Patients with diseases such as liver disease,cardiovascular,coronary heart disease and concurrent dehydration were excluded. Odds ratios and Adjusted odds ratios for the risk of events were obtained using cumulative logit ordinal regression model with version 15 of Stata software. Results: There were 58 men (84/1%) and 11 women (15/9%) with an average age of 36.4±12.4 year. Findings showed that for one unit increase in the diameter of the aorta by controlling the effect of other variables, the odds of mortality decreased for 2% compared with hospitalization in ward or intensive care unit (ICU). The reduction was also statistically significant (P=0.037). Furthermore, by modifying the effect of other variables, one unit increase in the diameter of IVC during inhale and exhale, increases the odds of hospitalization in ward or ICU. Conclusion: This study showed that the diameter of the aorta and also the diameter of IVC during inhale and exhale can be used to predict the outcome of trauma patients with hemorrhagic shock and eventually to take steps for emergent and effective treatment.

Mapping and validating stem rust resistance genes directly in self-incompatible genetic resources of winter rye

Key messageIndividual stem rust resistance genes could be directly mapped within self-incompatible rye populations.Genetic resources of rye (Secale cereale L.) are cross-pollinating populations that can be highly diverse and are naturally segregating. In this study, we show that this segregation could be used for mapping stem rust resistance. Populations of pre-selected donors from the Russian Federation, the USA and Austria were tested on a single-plant basis for stem rust resistance by a leaf-segment test with three rust isolates. Seventy-four plants per population were genotyped with a 10 K-SNP chip. Using cumulative logit models, significant associations between the ordinal infection score and the marker alleles could be found. Three different loci (Pgs1, Pgs2, Pgs3) in three populations were highly significant, and resistance-linked markers could be validated with field experiments of an independent seed sample from the original population and were used to fix two populations for resistance. We showed that it is possible to map monogenically inherited seedling resistance genes directly in genetic resources, thus providing a competitive alternative to linkage mapping approaches that require a tedious and time-consuming inbreeding over several generations.

One-year outcomes following physical therapist-led intervention for chronic hip-related groin pain: Ancillary analysis of a pilot multicenter randomized clinical trial.

Evidence related to physical therapist-led intervention for patients with chronic hip-related groin pain (HRGP) is limited. The purpose was to assess sustainability of treatment effects for people with HRGP undergoing two physical therapist-led interventions. We completed an ancillary analysis of a pilot multicenter, randomized clinical trial. Forty-six patients with chronic HRGP, 15-40 years, were enrolled. Patients were randomized to participate in 10 sessions over 12 weeks of either movement pattern training (MoveTrain) or traditional strength/flexibility (Standard). Participants completed self-report questionnaires before treatment and 6 and 12 months after treatment completion. Outcome measures included Hip disability and Osteoarthritis and Outcome Score (HOOS), Patient Specific Functional Scaleand Numeric Pain Rating Scalefor average and worst pain. Continuous data were analyzed with mixed model repeated measures analysis of variance (RM-ANOVA) within each group. Numeric pain rating scale (NPRS) was analyzed using multinomial generalized estimating equations (GEE) with a cumulative logit. Reported p values are from statistical contrasts within the RM-ANOVAs and GEEs testing a priori hypotheses regarding change from pretest to month 6, and pretest to month 12. A total of 43/46 (93.5%) participants completed treatment, 40 (87.0%) completed 6 and 38 (82.6%) completed 12 month questionnaires. At 6 and 12 months, both groups demonstrated clinically significant improvements, compared to pretest, in all subscales of HOOS (p < 0.01), Patient Specific Functional Scale (p < 0.001), and NPRS (p < 0.0001). Among patients with chronic HRGP, both MoveTrain and Standard resulted in improved outcomes that were sustained 12 months after treatment. Further investigation in a larger sample is needed to confirm our findings.

EEG Correlates of Engagement During Assessment

In educational assessment, low engagement is problematic when tests are low stakes for students but have significant consequences for teachers or schools. In the current study, we sought to establish the electroencephalographic (EEG) correlates of engagement and to distinguish engagement from mental effort. Forty university students participated in a simulated GRE® General Test session while scalp EEG was recorded from 128 channels. Participants completed two verbal and two quantitative GRE test blocks for a total of 40 items each, and after each item, rated either their engagement or mental effort on a scale of 1–6. We computed power for seven frequency bands (delta, theta, alpha, beta, and low, medium, and high gamma) across six regions of interest: left hemisphere (LH) and right hemisphere (RH) frontal, temporal, and parietal. Preliminary results suggested that gamma power (30–150 hertz [Hz]) indexed differences between high‐ and low‐engagement ratings. This pattern was similar but weaker for mental effort. A cumulative logit model with cross‐classified random effects determined that high gamma (90–150 Hz) over the LH temporal cortex predicted engagement ratings, while controlling for reaction time and accuracy. However, for effort ratings, reaction time was the sole significant predictor. These results suggest that high gamma may be a correlate of engagement during complex cognitive tasks, but not a correlate of effort. The findings are a promising step toward the goal of objectively measuring engagement during assessment tasks.

Bayesian penalized cumulative logit model for high-dimensional data with an ordinal response.

Many previous studies have identified associations between gene expression, measured using high-throughput genomic platforms, and quantitative or dichotomous traits. However, we note that health outcome and disease status measurements frequently appear on an ordinal scale, that is, the outcome is categorical but has inherent ordering. Identification of important genes may be useful for developing novel diagnostic and prognostic tools to predict or classify stage of disease. Gene expression data are usually high-dimensional, meaning that the number of genes is much larger than the sample size or number of patients. Herein we describe some existing frequentist methods for modeling an ordinal response in a high-dimensional predictor space. Following Tibshirani (1996), who described the LASSO estimate as the Bayesian posterior mode when the regression coefficients have independent Laplace priors, we propose a new approach for high-dimensional data with an ordinal response that is rooted in the Bayesian paradigm. We show that our proposed Bayesian approach outperforms existing frequentist methods through simulation studies. We then compare the performance of frequentist and Bayesian approaches using a study evaluating progression to hepatocellular carcinoma in hepatitis C infected patients.

COVID-19 is having a destructive impact on health-care workers’ mental well-being

BackgroundThe coronavirus disease 2019 (COVID-19) may aggravate workplace conditions that impact health-care workers’ mental health. However, it can also place other stresses on workers outside of their work. This study determines the effect of COVID-19 on symptoms of negative and positive mental health and the workforce’s experience with various sources of support. Effect modification by demographic variables was also studied.MethodsA cross-sectional survey study, conducted between 2 April and 4 May 2020 (two waves), led to a convenience sample of 4509 health-care workers in Flanders (Belgium), including paramedics (40.6%), nurses (33.4%), doctors (13.4%) and management staff (12.2%). About three in four were employed in university and acute hospitals (29.6%), primary care practices (25.7%), residential care centers (21.3%) or care sites for disabled and mental health care. In each of the two waves, participants were asked how frequently (on a scale of 0–10) they experienced positive and negative mental health symptoms during normal circumstances and during last week, referred to as before and during COVID-19, respectively. These symptoms were stress, hypervigilance, fatigue, difficulty sleeping, unable to relax, fear, irregular lifestyle, flashback, difficulty concentrating, feeling unhappy and dejected, failing to recognize their own emotional response, doubting knowledge and skills and feeling uncomfortable within the team. Associations between COVID-19 and mental health symptoms were estimated by cumulative logit models and reported as odds ratios. The needed support was our secondary outcome and was reported as the degree to which health-care workers relied on sources of support and how they experienced them.ResultsAll symptoms were significantly more pronounced during versus before COVID-19. For hypervigilance, there was a 12-fold odds (odds ratio 12.24, 95% confidence interval 11.11–13.49) during versus before COVID-19. Positive professional symptoms such as the feeling that one can make a difference were less frequently experienced. The association between COVID-19 and mental health was generally strongest for the age group 30–49 years, females, nurses and residential care centers. Health-care workers reported to rely on support from relatives and peers. A considerable proportion, respectively, 18 and 27%, reported the need for professional guidance from psychologists and more support from their leadership.ConclusionsThe toll of the crisis has been heavy on health-care workers. Those who carry leadership positions at an organizational or system level should take this opportunity to develop targeted strategies to mitigate key stressors of health-care workers’ mental well-being.