Differential Treatment Research Articles

Metabolic adaptation towards glycolysis supports resistance to neoadjuvant chemotherapy in early triple negative breast cancers.

Neoadjuvant chemotherapy (NAC) is the standard of care for patients with early-stage triple negative breast cancers (TNBC). However, more than half of TNBC patients do not achieve a pathological complete response (pCR) after NAC, and residual cancer burden (RCB) is associated with dismal long-term prognosis. Understanding the mechanisms underlying differential treatment outcomes is therefore critical to limit RCB and improve NAC efficiency. Human TNBC cell lines and patient-derived organoids were used in combination with real-time metabolic assays to evaluate the effect of NAC (paclitaxel and epirubicin) on tumor cell metabolism, in particular glycolysis. Diagnostic biopsies (pre-NAC) from patients with early TNBC were analyzed by bulk RNA-sequencing to evaluate the predictive value of a glycolysis-related gene signature. Paclitaxel induced a consistent metabolic switch to glycolysis, correlated with a reduced mitochondrial oxidative metabolism, in TNBC cells. In pre-NAC diagnostic biopsies from TNBC patients, glycolysis was found to be upregulated in non-responders. Furthermore, glycolysis inhibition greatly improved response to NAC in TNBC organoid models. Our study pinpoints a metabolic adaptation to glycolysis as a mechanism driving resistance to NAC in TNBC. Our data pave the way for the use of glycolysis-related genes as predictive biomarkers for NAC response, as well as the development of inhibitors to overcome this glycolysis-driven resistance to NAC in human TNBC patients.

Gender and Social Exclusion in Lake Victoria Basin: A Case of Mara and Simiyu Regions, Tanzania

Tanzania has undertaken several deliberate measures to address the social exclusion of traditionally marginalised groups. Yet, it is still felt by some people that good measures, strategies, and plans implemented in health and education are not handled at the household level. The study was conducted in Bunda TC, Bunda DC, and Busega DC to assess gender and social exclusion in the Lake Victoria basin. Specifically, examining disparities in household children’s education expectations by gender and investigating gendered differentials in health status and care. This study employed a multistage sampling method, combining random and purposive techniques, to select 447 households. Key informants were purposefully chosen for interviews, and 30 households per village were systematically surveyed. Data were collected through various methods, including documentary review and computer-aided personnel interviews, ensuring comprehensive coverage. Findings revealed that the sex of a child influenced the household expectation of the highest education level of children. Financial expectation determines who should be educated. The girls were on the disadvantageous side. The sex of the household head did not distinguish health status, and the exclusion of health care lies not in differential treatment between males and females but in differing affordability and the availability of health facilities. It is recommended that: the right to education of a girl child should be addressed at the household level; measures to improve health care affordability and availability of health facilities should be ensured; the provision of health insurance for all and free health services for complicated health problems of women should be emphasised.

Linear mixed models and latent growth curve models for group comparison studies contaminated by outliers.

The linear mixed model (LMM) and latent growth model (LGM) are frequently applied to within-subject two-group comparison studies to investigate group differences in the time effect, supposedly due to differential group treatments. Yet, research about LMM and LGM in the presence of outliers (defined as observations with a very low probability of occurrence if assumed from a given distribution) is scarce. Moreover, when such research exists, it focuses on estimation properties (bias and efficiency), neglecting inferential characteristics (e.g., power and type-I error). We study power and type-I error rates of Wald-type and bootstrap confidence intervals (CIs), as well as coverage and length of CIs and mean absolute error (MAE) of estimates, associated with classical and robust estimations of LMM and LGM, applied to a within-subject two-group comparison design. We conduct a Monte Carlo simulation experiment to compare CIs and MAEs under different conditions: data (a) without contamination, (b) contaminated by within-subject outliers, (c) contaminated by between-subject outliers, and (d) both contaminated by within- and between-subject outliers. Results show that without contamination, methods perform similarly, except CIs based on S, a robust LMM estimator, which are slightly less close to nominal values in their coverage. However, in the presence of both within- and between-subject outliers, CIs based on robust estimators, especially S, performed better than those of classical methods. In particular, the percentile CI with the wild bootstrap applied to the robust LMM estimators outperformed all other methods, especially with between-subject outliers, when we found the classical Wald-type CI based on the t statistic with Satterthwaite approximation for LMM to be highly misleading. We provide R code to compute all methods presented here. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Heterogeneous Effects of CPAP in Non-Sleepy OSA on CVD Outcomes: Post-hoc Machine Learning Analysis of the ISAACC Trial (ECSACT Study).

Randomized controlled trials of continuous positive airway pressure (CPAP) therapy for cardiovascular disease (CVD) prevention among patients with obstructive sleep apnea (OSA) have been largely neutral. However, given OSA is a heterogeneous disease, there may be unidentified subgroups demonstrating differential treatment effects. Apply a novel data-drive approach to identify non-sleepy OSA subgroups with heterogeneous effects of CPAP on CVD outcomes within the ISAACC study. Participants were randomly partitioned into two datasets. One for training (70%) our machine learning model and a second (30%) for validation of significant findings. Model-based recursive partitioning was applied to identify subgroups with heterogeneous treatment effects. Survival analysis was conducted to compare treatment (CPAP versus usual care [UC]) outcomes within subgroups. A total of 1,224 non-sleepy OSA participants were included. Of fifty-five features entered into our model only two appeared in the final model (i.e., average OSA event duration and hypercholesterolemia). Among participants at or below the model-derived average event duration threshold (19.5 seconds), CPAP was protective for a composite of CVD events (training Hazard Ratio [HR] 0.46, p=0.002). For those with longer event duration (>19.5 seconds), an additional split occurred by hypercholesterolemia status. Among participants with longer event duration and hypercholesterolemia, CPAP resulted in more CVD events compared to UC (training HR 2.24, p=0.011). The point estimate for this harmful signal was also replicated in the testing dataset (HR 1.83, p=0.118). We discovered subgroups of non-sleepy OSA participants within the ISAACC study with heterogeneous effects of CPAP. Among the training dataset, those with longer OSA event duration and hypercholesterolemia had nearly 2.5-times more CVD events with CPAP compared to UC, while those with shorter OSA event duration had roughly half the rate of CVD events if randomized to CPAP.

Prognostic significance of circulating tumor cells and tumor related transcripts in small cell lung cancer: A step further to clinical implementation.

Small-cell lung cancer (SCLC) is a fatal disease with limited treatment options. Circulating tumor cells (CTCs) in liquid biopsy samples may serve as predictive and prognostic biomarkers; but the analysis of CTCs is still challenging. By using microfluidic or density gradient CTC enrichment in combination with immunofluorescent (IF) staining or qPCR of CTC-related transcripts, we achieved a 60.8% to 88.0% positivity in SCLC blood samples. Epithelial and neuroendocrine transcripts including the druggable target DLL3 were associated with shorter overall survival (OS), indicating the clinical value of these markers in terms of differential diagnosis and treatment decisions. High CTC counts and the presence of CTC duplets detected by IF staining were prognostic for OS, and thus may serve as indicators of disease progression or therapy failure. In patient samples with high CTC load detected by IF staining, a concordance of the transcripts positivity in circulating free plasma RNA and CTCs was observed. Our data emphasize the role of CTCs and CTC-related transcripts and underline the clinical value of liquid biopsy analysis in SCLC.

Student-perceived social interactions in university musical ensembles predicted group identification

Group identification is a key process in the development of an individual’s social identity. This study examined whether student-perceived social interactions in university ensembles could shape their group identification. The sample included 517 university students from 7 ensembles of 2 universities in China. Student-perceived teacher–student relationships, peer relationships, cooperation, and equity in university ensembles were measured by the revised College and University Classroom Environment Inventory. Students’ group identification was measured by the questionnaire for identification with art-based groups. Data were collected and further analyzed by structural equation modeling via Amos 23. The results showed that students’ perceptions of teacher–student relationships, peer relationships, and cooperation had positive effects on their identification with the university ensemble, but the teacher’s differential treatment had negative effects on their group identification.

Comparison of Characteristics of Children with Severe Acute and Chronic Malnutrition Hospitalized with Diarrhea.

Children with malnutrition present with aberrant laboratory parameters. This study aimed to identify high-risk diarrheal children with varied nutritional status. The data were obtained from the electronic database of Dhaka Hospital, International Centre for Diarrhoeal Disease Research, Bangladesh from 2019 to 2021. Among 1,068 children under 5 years of age with diarrhea, 177 (14%) had severe acute malnutrition (SAM; weight-for-length/height Z score < -3), 239 children (17%) had severe stunting (SS; length/height-for-age Z score < -3), and 652 did not have malnutrition (weight-for-length/height and weight-for-age and length/height-for-age Z score > -2). We independently assessed the relationship of nutritional profiles with each clinical and laboratory parameter. After adjustment for age and sex in the multiple regression model, hyponatremia (adjusted odds ratio [aOR] = 2.37 [95% CI: 1.52-3.68]; P < 0.001) and dehydration (aOR = 2.42 [95% CI: 1.67-3.52]; P < 0.001) were independently associated with SAM compared with children without malnutrition. In comparison to non-malnutrition, SS was less likely to be associated with acute watery diarrhea (aOR = 0.66 [95% CI: 0.47-0.92]; P = 0.014) but was significantly associated with anemia (aOR = 2.18 [95% CI: 1.57-3.02]; P < 0.001) and thrombocytosis (aOR = 2.43 [95% CI: 1.78-3.32]; P < 0.001). The presence of hypernatremia was substantially lower in children with SAM (aOR = 0.38 [95% CI: 0.22-0.65]; P < 0.001) or SS (aOR = 0.56 [95% CI: 0.35-0.88]; P = 0.012) than in children without malnutrition. Severe stunting was less likely to be associated with dehydration (aOR = 0.44 [95% CI: 0.29-0.67]; P < 0.001) in contrast to SAM. Therefore, children hospitalized with diarrhea may have different clinical and laboratory manifestations depending on their nutritional status and may require differential treatment.

Pretreatment level of serum sialic acid predicts both qualitative and quantitative bone metastases of prostate cancer.

Recently, serum sialic acid (SA) has emerged as a distinct prognostic marker for prostate cancer (PCa) and bone metastases, warranting differential treatment and prognosis for low-volume (LVD) and high-volume disease (HVD). In clinical settings, evaluating bone metastases can prove advantageous. We aimed to establish the correlation between SA and both bone metastasis and HVD in newly diagnosed PCa patients. We conducted a retrospective analysis of 1202 patients who received a new diagnosis of PCa between November 2014 and February 2021. We compared pretreatment SA levels across multiple groups and investigated the associations between SA levels and the clinical parameters of patients. Additionally, we compared the differences between HVD and LVD. We utilized several statistical methods, including the non-parametric Mann-Whitney U test, Spearman correlation, receiver operating characteristic (ROC) curve analysis, and logistic regression. The results indicate that SA may serve as a predictor of bone metastasis in patients with HVD. ROC curve analysis revealed a cut-off value of 56.15 mg/dL with an area under the curve of 0.767 (95% CI: 0.703-0.832, P < 0.001) for bone metastasis versus without bone metastasis and a cut-off value of 65.80 mg/dL with an area under the curve of 0.766 (95% CI: 0.644-0.888, P = 0.003) for HVD versus LVD. Notably, PCa patients with bone metastases exhibited significantly higher SA levels than those without bone metastases, and HVD patients had higher SA levels than LVD patients. In comparison to the non-metastatic and LVD cohorts, the cohort with HVD exhibited higher levels of alkaline phosphatase (AKP) (median, 122.00 U/L), fibrinogen (FIB) (median, 3.63 g/L), and prostate-specific antigen (PSA) (median, 215.70 ng/mL), as well as higher Gleason scores (> 7). Multivariate logistic regression analysis demonstrated that an SA level of > 56.15 mg/dL was independently associated with the presence of bone metastases in PCa patients (OR = 2.966, P = 0.018), while an SA level of > 65.80 mg/dL was independently associated with HVD (OR = 1.194, P = 0.048). The pretreatment serum SA level is positively correlated with the presence of bone metastases.

The global research of artificial intelligence in lung cancer: a 20-year bibliometric analysis.

Lung cancer (LC) is the second-highest incidence and the first-highest mortality cancer worldwide. Early screening and precise treatment of LC have been the research hotspots in this field. Artificial intelligence (AI) technology has advantages in many aspects of LC and widely used such as LC early diagnosis, LC differential classification, treatment and prognosis prediction. This study aims to analyze and visualize the research history, current status, current hotspots, and development trends of artificial intelligence in the field of lung cancer using bibliometric methods, and predict future research directions and cutting-edge hotspots. A total of 2931 articles published between 2003 and 2023 were included, contributed by 15,848 authors from 92 countries/regions. Among them, China (40%) with 1173 papers,USA (24.80%) with 727 papers and the India(10.2%) with 299 papers have made outstanding contributions in this field, accounting for 75% of the total publications. The primary research institutions were Shanghai Jiaotong University(n=66),Chinese Academy of Sciences (n=63) and Harvard Medical School (n=52).Professor Qian Wei(n=20) from Northeastern University in China were ranked first in the top 10 authors while Armato SG(n=458 citations) was the most co-cited authors. Frontiers in Oncology(121 publications; IF 2022,4.7; Q2) was the most published journal. while Radiology (3003 citations; IF 2022, 19.7; Q1) was the most co-cited journal. different countries and institutions should further strengthen cooperation between each other. The most common keywords were lung cancer, classification, cancer, machine learning and deep learning. Meanwhile, The most cited papers was Nicolas Coudray etal.2018.NAT MED(1196 Total Citations). Research related to AI in lung cancer has significant application prospects, and the number of scholars dedicated to AI-related research on lung cancer is continually growing. It is foreseeable that non-invasive diagnosis and precise minimally invasive treatment through deep learning and machine learning will remain a central focus in the future. Simultaneously, there is a need to enhance collaboration not only among various countries and institutions but also between high-quality medical and industrial entities.

Cardiorenal syndrome in geriatric patients

The unfavorable mutual influence of the kidney and heart functions in acute or chronic kidney and/or heart failure has defined the cardiorenal syndrome (CRS) since aconsensus conference in 2004. The pathophysiological considerations and the subsequent treatment approaches determine the classification into five types. The syndrome has ahigh prevalence in geriatric patients. The interactions of medications on one or the other organ system require an interaction of treatment modalities in order to improve the prognosis and prevent acute deterioration. Exact knowledge of the respective indications, differential treatment approaches and specifics in dealing with CRS can improve the current undertreatment due to concerns about side effects.

Abstract TP173: Differential Outcomes and Treatment in Vertebral versus Carotid Artery Dissections: A National Inpatient Sample Study

Introduction: Cervical artery dissection (CAD) involves the carotid (CCAD) or vertebral artery (VCAD). However, limited studies have compared their clinical features and outcomes. Our study utilized a comprehensive nationwide database to discern these differences. Method: We examined non-traumatic CAD-diagnosed patients from the U.S. National Inpatient Sample (2005-2019) using ICD-9 and ICD-10 codes. The evaluation included patient demographics, comorbidities, in-hospital complications, treatment, and costs. Differences between CCAD and VCAD were assessed using survey-weighted stepwise backward logistic regression, followed by propensity score matched adjusted regressions for outcomes. Result: From 2005 to 2019, we identified 157,086 CAD admissions, of which 79.9% (125,477) were spontaneous CADs, with CCAD outnumbering VCAD (67,671 vs. 57,806). Compared to VCAD, CCAD was significantly associated with older age (54 [44-66] vs. 49 [37-62]), Black race (12.6% vs. 8.7%), atrial fibrillation (6.1% vs. 3.7%), hypertension (58.0% vs. 53.9%), fewer concurrent acute ischemic strokes (AIS) (22.1% vs. 24.7%), higher NIHSS (mean NIHSS 7 [2-16] vs. 2 [0-5]), extended stays (4 days [2-8] vs. 4 days [2-7]) and increased hospitalization charges ($52,005 [$25,759-$118,806] vs. $43,199 [$24,116-$85,701]); all P&lt;0.05. Within the concurrent AIS group, the CCAD group also exhibited an increased likelihood for IV thrombolysis (10.7% vs. 5.7%) and mechanical thrombectomy (14.9% vs. 3.7%). After propensity score matching for NIHSS and age, the CCAD group was associated with less death (adjusted odds ratio [aOR] 0.41, 95% CI 0.26-0.65, P&lt;0.001) but a similar home discharge rate (aOR 1.15, 95% CI 0.78-1.69, P=0.480) (Figure). Conclusion: Our study underscores distinct comorbidity profiles and treatment patterns between CCAD and VCAD groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.

Differential treatment close to the election? The relationship between the electoral cycle and the deservingness heuristic

This article investigates whether the electoral cycle – the phenomenon where politicians formulate more generous policy close to elections – is moderated by the deservingness status of the recipient of said generous policy. We argue that strategic politicians will design generous policy only for deserving recipients whose welfare needs are perceived as self-inflicted. To test this, we coded all adopted acts and parliamentary resolutions in the Danish parliament from 1975-2019 that target five societal groups. With linear probability models, we find that politicians do in fact introduce more generous policies for deserving groups close to elections, while the effect of the electoral cycle is non-existent for undeserving groups. Our findings point towards a more disaggregated approach in the study of the electoral cycle.

Differential treatment effect on overall survival (OS) based on early prostate-specific antigen (PSA) response in metastatic hormone-sensitive prostate cancer (mHSPC): A secondary analysis of TITAN trial.

Differential treatment effect on overall survival (OS) based on early prostate-specific antigen (PSA) response in metastatic hormone-sensitive prostate cancer (mHSPC): A secondary analysis of TITAN trial.

The Second Wave of the Fisheries Subsidies Negotiations: Overcapacity, Overfishing, and Other Disciplines

The Agreement on Fisheries Subsidies (AFS) was concluded by the Ministerial Conference of the World Trade Organization (WTO) in June 2022. It was negotiated following the mandate contained in the Sustainable Development Goal (SDG) 14.6 adopted by the United Nations General Assembly in 2015. In the AFS, WTO Members were able to agree on subsidy prohibitions relating to illegal, unreported, and unregulated fishing, overfished stocks and unregulated waters. However, the AFS fails to address part of the SDG 14.6 mandate concerning subsidies contributing to overcapacity and overfishing. For this reason, WTO Members have, shortly after the conclusion of the AFS, engaged in a second wave of negotiations to address the missing elements in SDG 14.6, as well as other provisions left out of the AFS. At the time of writing, the WTO Negotiating Group on Rules has produced a draft text containing the proposals of Members on overcapacity and overfishing, including a sustainability carve-out and special and differential treatment for developing countries. In addition, this text includes a subsidy prohibition with respect to subsidies contingent upon or tied to fishing and fishing related activities in waters outside the subsidizing Member’s jurisdiction and a notification obligation concerning the use of forced labour. The challenge is, therefore, to produce a text that is agreeable to both the representatives of Members sitting at the WTO Ministerial Conference and the stakeholders of each WTO Member who will decide, domestically, whether to ratify the agreement. fisheries subsidies, IUU fishing, overfished stocks, overcapacity, overfishing, forced labour, waters outside the jurisdiction

Differential Treatment and Temporary Protection Arrangements: Discrimination or Legitimate Distinctions?

Abstract This article analyses the differential treatment among refugees inherent to temporary protection arrangements. What was particularly remarkable in the EU’s response to displacement from Ukraine, for instance, was the free access for Ukrainians to EU territory and even free choice to seek protection in any Member State. Thus, the persons under this arrangement are better off initially, and this may seem preferable to the deterrence measures taken in response to other cases of ‘mass influx’ which restricted, rather than facilitated, access to protection. As it may in the longer term be better for some refugees to undergo the ordinary asylum procedure and eventually receive refugee or subsidiary protection status, temporary protection raises complex questions of differential treatment. At the same time, within the ordinary asylum procedure some EU Member States have introduced distinctions resulting in differential treatment of certain refugee categories whose need for protection is perceived to be temporary. This article positions the implementation of the various temporary protection arrangements within the general norms of non-discrimination by analysing key aspects of differential treatment and attempting to identify the boundary between lawful and unlawful distinctions.

The precarious lives of others: studying community, treatment, and precarity in Homebound

Abstract This paper explores themes of precarity, community, and treatment in the novel Homebound (2021) by Puja Changoiwala. The text foregrounds the experiences of migrant workers in India during the COVID-19 pandemic of 2020 as they walked home during a nationwide lockdown. The paper locates itself within discourses on health, differential treatment, and intersectional vulnerabilities which are compounded by factors including gender and poverty. It particularly highlights the concepts of precariousness and precarity as opening up multiple avenues for exploration of the migrants’ experience within the neoliberal political economy. The paper argues that it is the pre-existing precarities that are systemic, epistemic, and gendered, which aggravate the vulnerability of communities in a medical crisis. Furthermore, it looks at how social and medical treatment of the workers facilitates violence at the hands of those who perceive them as the ill-other – the police forces, the public, the healthcare workers, and the media. It also questions the logic that underlines spaces such as pandemic camps, which become sites of control more than care, and where medical treatment is inhered in socio-political biases and constructs. The paper argues that apprehending these experiences of socioeconomic and gendered precarities through literature can aid in developing a complex and sustained engagement with unequal socio-political systems that perpetuate violence and vulnerability.

Who benefits and when? Understanding differential treatment effects of an online professional development program

The quality of educational experiences has a direct impact on children’s development and overall wellbeing. To ensure that children receive high-quality education experiences it is important that educators are trained in current best practices and feel efficacious in the implementation of these practices. Professional development (PD) has shown to be an effective mechanism for addressing educator knowledge and promoting feelings of self-efficacy. However, multiple barriers exist to delivering in-person PD (e.g., time and resource constraints). Online PD represents an attractive alternative for many educators, but the research on the effectiveness of online PD is mixed. The current study evaluates the effectiveness of a series of PD courses designed to promote positive youth development and identifies subgroups of educators who benefitted from the courses more than others. Results indicated improvement in feelings of self-efficacy around the implementation of practices to promote positive youth development, but new teachers in afterschool programs benefitted more than other educators.

Trends and Disparities in Curative-Intent Treatment for Early-Stage Non-Small Cell Lung Cancer: A Population-Based Analysis of Surgery and SBRT.

Despite the increasing adoption of stereotactic body radiotherapy (SBRT) as a recommended alternative for early-stage non-small cell lung cancer (NSCLC), population-based research on racial/ethnic disparities in curative-intent treatment accounting for SBRT remains limited. This study investigated trends and disparities in receiving curative-intent surgery and/or SBRT in a diverse, retrospective cohort. Early-stage NSCLC cases (2005-2017) from the Florida cancer registry were linked to individual-level statewide discharge data containing comorbidities and specific treatment information. Joinpoint regression assessed trends in treatment receipt. Multivariable logistic regression examined associations between race/ethnicity and treatment type. Among 64,999 patients with early-stage NSCLC, 71.6% received curative-intent treatment (surgery and/or SBRT): 73.1%, 72.4%, and 60.3% among Hispanic, White, and Black patients, respectively (P < 0.01). SBRT use increased steeply from 2005 to 2007 and then by 7.9% annually from 2007 to 2017 (P < 0.01); curative-intent surgery remained stable from 2005 to 2014 before declining by 6.2% annually during 2014-2017 (P = 0.04). The Black-White disparity in receipt of curative-intent treatment was significant [ORadj, 0.65; 95% confidence interval (CI), 0.60-0.71]. Patients with Charlson comorbidity index (CCI)≥3 had 36% (ORadj, 0.64; 95% CI, 0.60-0.69) lower odds of receiving curative-intent surgery and no significant difference for SBRT (ORadj, 1.06; 95% CI, 0.93-1.20) compared with CCI = 0. Racial disparities in receiving curative-intent treatment for early-stage NSCLC persist despite the availability of SBRT, suggesting the full potential of curative-intent treatment for early-stage NSCLC remains unachieved. Addressing disparities in early-stage NSCLC requires addressing differential treatment patterns and enhancing accessibility to treatments like underutilized SBRT, particularly for high-comorbidity populations such as Black patients.

Identification of Fatigue Subtypes and Their Correlates in Prevalent Heart Failure: A Secondary Analysis of the Atherosclerosis Risk in Communities Study.

Among patients with heart failure (HF), fatigue is common and linked to quality of life and functional status. Fatigue is hypothesized to manifest as multiple types, with general and exertional components. Unique subtypes of fatigue in HF may require differential assessment and treatment to improve outcomes. We conducted this study to identify fatigue subtypes in persons with prevalent HF in the ARIC study (Atherosclerosis Risk in Communities) and describe the distribution of characteristics across subtypes. We performed a cross-sectional analysis of 1065 participants with prevalent HF at ARIC visit 5 (2011-2013). We measured exertional fatigue using the Modified Medical Research Council Breathlessness scale and general fatigue using the Patient Reported Outcomes Measurement Information System fatigue scale. We used latent class analysis to identify subtypes of fatigue. Number of classes was determined using model fit statistics, and classes were interpreted and assigned fatigue severity rating based on the conditional probability of endorsing survey items given class. We compared characteristics across classes using multinomial regression. Overall, participants were 54% female and 38% Black with a mean age of 77. We identified 4 latent classes (fatigue subtypes): (1) high general/high exertional fatigue (18%), (2) high general/low exertional fatigue (27%), (3) moderate general/moderate exertional fatigue (20%), and (4) low/no general and exertional fatigue (35%). Female sex, Black race, lower education level, higher body mass index, increased depressive symptoms, and higher prevalence of diabetes were associated with higher levels of general and exertional fatigue. We identified unique subtypes of fatigue in patients with HF who have not been previously described. Within subtype, general and exertional fatigue were mostly concordant in severity, and exertional fatigue only occurred in conjunction with general fatigue, not alone. Further understanding these fatigue types and their relationships to outcomes may enhance our understanding of the symptom experience and inform prognostication and secondary prevention efforts for persons with HF.

A Model-Based Approach to the Disentanglement and Differential Treatment of Engaged and Disengaged Item Omissions

Item omissions in large-scale assessments may occur for various reasons, ranging from disengagement to not being capable of solving the item and giving up. Current response-time-based classification approaches allow researchers to implement different treatments of item omissions presumably going back to different mechanisms. These approaches, however, are limited in that they require a clear-cut decision on the underlying missingness mechanism and do not allow to take the uncertainty in classification into account. We present a response-time-based model-based mixture modeling approach that overcomes this limitation. The approach (a) facilitates disentangling item omissions stemming from disengagement from those going back to solution behavior, (b) considers the uncertainty in omission classification, (c) allows for omission mechanisms to vary on the item-by-examinee level, (d) supports investigating person and item characteristics associated with different types of omission behavior, and (e) gives researchers flexibility in deciding on how to handle different types of omissions. The approach exhibits good parameter recovery under realistic research conditions. We illustrate the approach on data from the Programme for the International Assessment of Adult Competencies 2012 and compare it against previous classification approaches for item omissions.