Dropout Group Research Articles

Medical care for transgender individuals at a hospital in southern Brazil: why do they drop out from our service?

The objective of the study was to investigate dropout rates and discern potential factors contributing to the discontinuation of treatment provided to transgender individuals by the Transdisciplinary Gender Identity Program at the Hospital de Clínicas de Porto Alegre (PROTIG). This study employs a descriptive, cross-sectional, retrospective design to analyze socio-demographic and clinical data obtained from medical records of patients treated at PROTIG between 2000 and 2018. A structured form, devised by PROTIG's professional team, was utilized to extract and evaluate several variables including: age, gender, education level, diagnosis of F64 according to the International Classification of Diseases (ICD-10: Version: 2010), clinical comorbidities (coded by ICD-10), laboratory diagnosis of sexually transmitted infections, distance between patients' residence and the hospital, and year of entry into PROTIG. The patient cohort was stratified into two categories based on their duration of attendance: dropout (defined as attendance for up to 365 days) and non-dropout (attendance exceeding 365 days). Categorical variables between dropout and non-dropout groups were compared using Pearson's chi-square test. Additionally, Poisson regression analysis was utilized, employing a 95% confidence interval (CI) and setting the significance level at 0.05. The study included a total of 888 patients accessing PROTIG, with 275 (31%) classified in the dropout group. Of the patient population, 65.5% (n = 582) self-identified as transgender women, while 34.5% (n = 306) identified as transgender men. Significant differences were noted between the dropout and non-dropout groups. Specifically, differences were noted among transgender women (p < 0.001), individuals with lower levels of education (p < 0.001), those with fewer diagnoses classified under ICD-10 as F64 (p < 0.001), individuals exhibiting fewer clinical comorbidities recorded in ICD-10 (p < 0.001), and those who commenced inclusion in PROTIG after 2010 (p < 0.001). There exists a notable rate of treatment discontinuation among individuals receiving care at PROTIG, with statistically significant variances observed between groups. We posit potential rationales for this discontinuation, informed by care experiences and feedback from group attendees: Increased accessibility to outpatient services in our jurisdiction for Transgender Care, along with heightened societal awareness of gender identity fostering diverse gender expression avenues devoid of reliance on gender-affirming surgical interventions.

The role of ICDS services on early childhood development: A cross-sectional study in Hyderabad, Telangana.

Integrated child development services (ICDS) include supplementary nutrition, nutrition and health education, health check-ups, immunization, preschool education, and referral services targeted at beneficiaries including pregnant and lactating mothers, children below six years, and women of reproductive age. Specific interventions are implemented to support children for a higher developmental outcome. The aims of this study are (1) to compare the development of ICDS beneficiaries in the age group of 4-6 years with the dropouts, (2) to assess caregiver practices among mothers of beneficiaries and the dropouts, and (3) to understand the perceptions of Anganwadi workers (AWWs) on early child development (ECD) and ICDS services. A cross-sectional study was conducted for two months in select Anganwadi centers (AWCs) of Hyderabad. AWCs were selected through multi-stage sampling. Respondents included 114 mothers and five AWWs. Quantitative data was collected by a questionnaire and qualitative data through an interview guide. Proportions were estimated for description. STATA 14.0 was used to find out correlates of development in children through unpaired t-test, Chi-square test, and logistic regression. Thematic analysis was done for qualitative data. About 68.42% and 33.33% of children from the beneficiary group were found to show normal cognitive and emotional development when compared to the dropout group (59.65% and 21.05%, respectively). KAP assessment revealed no significant difference between the mothers of dropouts and beneficiaries. Lack of infrastructure and poor attention to preschool activities were identified as reasons for dropout. Improving infrastructure, capacity building of AWWs, and reducing their workload will help in focusing on ECD-related activities at ICDS centers.

Analysis of Treatment Discontinuation in Orthokeratology: Studying Efficacy, Safety, and Patient Adherence Over Six Months.

This study aimed to evaluate the efficacy, safety, and participant compliance of orthokeratology treatment for the correction of myopic refractive errors over a six-month prospective study and to define the potential reasons for early treatment discontinuation. A total of 32 participants with low-to-moderate myopia were fitted with the spherical model of corneal refractive therapy (CRT) orthokeratology lenses (Paragon Vision Sciences) and followed over six months, with specific attention to alterations in refractive error, corneal topography, and epithelial thickness. Concurrently, participant feedback and reasons for any treatment discontinuation were documented. Significant changes in refractive error and in corneal topography were observed, with approximately 50% of the refractive error being corrected on the first night of use and 100% by the first two weeks ( P <0.001). Central epithelial thickness experienced substantial thinning, reducing to 15.65±4.49 μm (67.38%) ( P <0.001) after 6 months of lens use. Six participants withdrew from this study for varied reasons, including unmet visual expectations and difficulty adhering to the lens-wearing regimen. Notably, the dropout group exhibited higher baseline low-order aberrations and less prolate corneas than those who persisted with the treatment ( P <0.05). Orthokeratology with CRT is efficacious and safe for the correction of low-to-moderate myopia in adults, but a portion of patients discontinue the treatment in the first 6 months of contact lens wear. Special care should be taken when recommending orthokeratology in patients with higher levels of myopia and corneas with less prolate shape, providing more realistic expectations and even changing to dual axis or more sophisticated designs.

Dropout in Andalusian universities: prediction and prevention

Problem and objectiveUniversity dropout is a major problem that affects more than 31,000 students each year in Andalusian universities, with serious personal and social consequences and an economic cost of more than 222 million euros for the region’s public administration. As concluded from the review of explanatory models we reviewed, dropout has a multicausal origin. The purpose of our work is to test the efficacy of the use of a screening for the early detection of the risk of academic dropout in Higher Education in Andalusian universities.ProcedureWe applied a screening instrument adapted for incoming students in public universities in Andalusia. The survey was applied at the beginning of the second semester. In this article we present data from a sample composed of 976 subjects from the universities of Granada UGR, Jaén UJA and Pablo de Olavide de Sevilla UPO.ResultsWith the data obtained we have established the dropout risk group, which includes those students who do not reach an average score of 3.00 in the total screening. There are 34 students representing 3.48% of the sample. Of these 34 students, 26 are women and 8 are men; 20 belong to the UGR, 8 to the UJA and 5 to the UPO. The detection of the risk group will allow the universities to apply preventive measures in a personalized and adjusted way to avoid possible dropout.

Characteristics of Patients Who Drop Out of Anti-Vascular Endothelial Growth Factor Therapy for Macular Edema Associated with Branch Retinal Vein Occlusion.

To investigate the dropout rate of anti-vascular endothelial growth factor (VEGF) treatment for macular edema (ME) secondary to branch retinal vein occlusion (BRVO) and identify the characteristics of dropout cases. We studied 235 eyes of 235 treatment-naïve BRVO-ME patients receiving intravitreal injection of ranibizumab. Additional intravitreal anti-VEGF drug was given when ME relapsed or persisted, and photocoagulation was performed as needed. Adherence until treatment completion was defined as disappearance of ME within 2 years after the first injection without recurrence for more than 6 months or mild ME remaining but no visual deterioration for more than 6 months without additional anti-VEGF drug. In patients with ME recurrence, those who were followed for more than 2 years were considered adherence, and those followed for less than 2 years were considered dropout. The clinical course and background of the two groups were compared. 179 patients (76.2%) adhered to treatment and 56 patients (23.8%) dropped out. Mean follow-up periods in adherence and dropout groups were 23.4 and 7.1 months, respectively. There were no significant differences between the two groups in demographic and baseline factors of age, gender ratio, distance from home to hospital, visual acuity, and foveal thickness (FT). At the last follow-up, visual acuity was significantly poorer in the dropout group than in the adherence group (0.23 vs. 0.11 logMAR, p=0.003), and FT was significantly greater in the dropout group than in the adherence group (316 vs. 273 µm, p=0.002). Reasons for dropout included patient declining further treatment in 12.5%, progression of dementia in 8.9%, others, and unknown in 64.3%. The clinical outcome of patients who dropped out of anti-VEGF therapy for BRVO-ME was worse compared to patients who adhered to therapy, and the reasons for discontinuation varied.

Analysis of the relation between facial asymmetry and users' preference between standard versus customized inset progressive addition lenses

Aims/Purpose: User adaptation to progressive addition lenses (PALs) wear requires accurate facial measurements, mainly naso or interpupillary distances, usually measured with a frame ruler. But facial asymmetries are usually ignored. Measurement of foveal fixation axis (FFA) ‐the line linking directly the fixation point and the fovea‐ allows precise facial asymmetry assessment. This study aimed to compare users' preference between standard versus customized inset PALs in patients with and without facial asymmetry according to their FFA measurement.Methods: A crossed, double blind, randomized study was conducted. Participants were classified according to previous experience with PALs (neophytes, PALs users, dropout, and uncomfortable PALs users) and with (&gt;1.0 mm) or without (≤1.0 mm) facial asymmetry. After a complete eye test, two different PALs (LifeStyle 3i, Hoya) were prescribed in a randomized and masked order (2.5 mm standard inset and FFA customized inset PALs). PAL users' preference between both lenses was collected (subjective opinion) after 30 days of wear. Statistical analysis was performed using SPSS 26 (Chicago, USA). ANOVA was used to compare different groups and Chi‐square was used to analyse the frequency of choice of both PALs.Results: 71 participants (37 women and 34 men) were included. 49 with FFA asymmetry; 56% of them (95%CI 42–71%) preferred customized inset lens (Figure 1) (p = 0.05), in dropout group 67% (95%CI 33–100%). No differences (p &gt; 0.05) in clinical parameters were found between patients with or without FFA asymmetry.Conclusions: Participants with FFA asymmetry preferred customized inset lens, especially dropout patients. Facial asymmetry could be a relevant factor in PALs adaptation and FFA measurement could improve users' satisfaction with customized PALs in patients with facial asymmetry.FIGURE 1 (Left). PALs choice according to the patients' facial asymmetry. (Right). PALs choice according to the patients previous use of PALs.imageFIGURE 1 (Left). PALs choice according to the patients' facial asymmetry. (Right). PALs choice according to the patients previous use of PALs.

Revolutionizing Patient Monitoring in Age-Related Macular Degeneration: A Comparative Study on the Necessity and Efficiency of the AMD VIEWER.

(1) Background: Age-related Macular Degeneration (AMD) is a critical condition leading to blindness, necessitating lifelong clinic visits for management, albeit with existing challenges in monitoring its long-term progression. This study introduced and assessed an innovative tool, the AMD long-term Information Viewer (AMD VIEWER), designed to offer a comprehensive display of crucial medical data-including visual acuity, central retinal thickness, macular volume, vitreous injection treatment history, and Optical Coherent Tomography (OCT) images-across an individual eye's entire treatment course. (2) Methods: By analyzing visit frequencies of patients with a history of invasive AMD treatment, a comparative examination between a Dropout group and an Active group underscored the clinical importance of regular visits, particularly highlighting better treatment outcomes and maintained visual acuity in the Active group. (3) Results: The efficiency of AMD VIEWER was proven by comparing it to manual data input by optometrists, showing significantly faster data display with no errors, unlike the time-consuming and error-prone manual entries. Furthermore, an elicited Net Promoter Score (NPS) of 70 from 10 ophthalmologists strongly endorsed AMD VIEWER's practical utility. (4) Conclusions: This study underscores the importance of regular clinic visits for AMD patients. It suggests the AMD VIEWER as an effective tool for improving treatment data management and display.

Quality of life, exercise capacity, cognition, and mental health of Chilean patients after COVID-19: an experience of a multidisciplinary rehabilitation program at a physical and rehabilitation medicine unit.

Post-COVID disabilities, encompassing physical, cognitive, and psychological aspects, constitute the primary health sequelae for survivors. While the rehabilitation needs post COVID-19 are now well understood, each country possesses unique characteristics in terms of populations, healthcare systems, social dynamics, and economic profiles, necessitating context-specific recommendations. This study aims to address two main objectives: (1) analyze the impact of an 8-week multidisciplinary rehabilitation program on the quality of life, functional capacity, cognition, and mental health adaptations in adults recovering from COVID-19 in northern Chile, and (2) propose a personalized model for predicting program dropouts and responses. A total of 44 subjects were enrolled, forming two groups during the study: a treatment group (n = 32) and a dropout group (n = 12). The treatment group participated in the 8-week multidisciplinary rehabilitation program. The results indicate that (1) After 8 weeks, the quality of life of the patients in the treatment group exhibited significant improvements reflected in all aspects of the Short Form-36 Health Survey (SF36, p < 0.005) and the total score (p < 0.001), with a concurrent decrease in dysfunctionality (p < 0.001). (2) Significant improvements were also observed in various physical performance tests, including the: 6-minute walk test, 1-min sit-to-stand, dynamometry, Tinetti balance, and Berg score (p < 0.001). Moreover, physical therapy led to a reduction in neuropathic symptoms and pain, psychological therapy reduced anxiety and depression, and language therapy enhanced memory and speech (all p < 0.05). (3) Demographic and clinical history characteristics did not predict responses to rehabilitation. (4) A regression model for predicting changes in SF-36 total score, based on physical function, physical role, general health, and mental health, was established based on the data from study (p < 0.01, adjusted R2 = 0.893). (5) Classification models for predicting dropouts achieved 68% accuracy, with key predictors of treatment adherence including diabetes, hypertension, and dyslipidemia, Tinetti balance, physical role, and vitality of SF36, and performance on the 6-minute walk test and 1-minute sit-to-stand. This study demonstrates significant enhancements in quality of life, improved functional performance, and reductions in mental and cognitive burdens within an 8-week rehabilitation program. Additionally, it is possible to identify patients at risk of dropping out using cost-effective, outpatient, and clinically applicable tests.

O.4.2-4 The influence of organized sport participation on health-related fitness development during adolescence

Abstract Purpose Organized sport participation plays particularly big role in promoting adolescents’ physical activity and health-related fitness. However, it remains to be understood how current, past, or complete non-participation in organized sports affect adolescents’ individual trajectories of cardiorespiratory and muscular fitness and whether adolescents benefit from their past participation in organized sports in terms of fitness. Thus, the aim of this research was to study the development of cardiorespiratory and muscular fitness during adolescence in those 1) who continued or started organized sport participation, 2) who dropped out, and 3) who never participated or dropped out before adolescence. Methods In this five-year longitudinal study, which was carried out between 2017-2021, self-reported sport participation data were collected annually, and cardiorespiratory and muscular fitness measurements were collected every other year from 963 participants (Mage = 11.25 ± 0.31). Multi-group parallel latent growth curve model was used to examine initial levels and slopes (rate of change) of cardiorespiratory and muscular fitness simultaneously in each of three sport participation group: 1) continuous, 2) dropout, and 3) non-part. Results Continuous group had significantly higher initial levels of cardiorespiratory and muscular fitness compared to other two groups. Moreover, both continuous and non-part groups had positive slopes of cardiorespiratory and muscular fitness. Although dropout group had significantly higher initial levels of cardiorespiratory and muscular fitness compared to non-part group, the slopes were smaller or not significant. Thus, at the last time point, there were no longer significant differences between these two groups in levels of cardiorespiratory and muscular fitness. Conclusions Continued participation in organized sports promotes adolescents’ health-related fitness. However, as adolescents dropout these health-related fitness improvements seem to be lost. Therefore, it is necessary to consider what could be done so that adolescents who dropout or never participated in organized sports would have equal opportunities to promote their health-related fitness. One reason for dropout is that organized sports tend to get more competitive, time-consuming, and expensive in adolescence. Thus, solution could be low-cost and low-threshold recreational or school-related physical activities that could improve or maintain health-related fitness during adolescence. Funding Source Finnish Ministry of Education and Culture

Rate of Retinal Nerve Fiber Layer Thinning in Glaucomatous Eyes with Optic Disc and Parapapillary Deep-Layer Microvasculature Loss.

Microvasculature dropout in the parapapillary choroidal layer was a more important biomarker of glaucomatous nerve fiber layer thinning when it presented with deep-layer microvasculature of the optic disc rather than when it presents by itself. To characterize open-angle glaucoma (OAG) eyes with optic nerve head (ONH) deep-layer microvasculature dropout (MvD-D) and parapapillary choroidal layer microvasculature dropout (MvD-P) and compare their retinal nerve fiber layer (RNFL) thinning rate. This study included 122 OAG eyes that underwent ≥5 serial spectral-domain optical coherence tomography (OCT) scans during a mean follow-up of 5.4 years. Swept-source OCT angiography (SS-OCTA) was used to evaluate MvD-P and MvD-D. Subjects were classified into three groups according to the presence of MvD-P and MvD-D: (1) no dropout (n=37); (2) solely MvD-P (n=40), and (3) both MvD-P and MvD-D (n=45). The RNFL thinning rate was compared among the three groups, and the associated factors were assessed by Cox proportional hazard analysis. RNFL thinning rates were highest in the group with both MvD-P and MvD-D, followed by the group with solely MvD-P and finally by the no dropout group (-0.24 vs. -0.65 vs. -1.20μm/year, P<0.001). Thinner central corneal thickness (hazard ratio [HR]=0.990, P=0.003), presence of disc hemorrhage (HR=1.802, P=0.035), and coexistence of MvD-P and MvD-D (HR=2.941, P<0.001) were the factors associated with RNFL thinning. The coexistence of MvD-P and MvD-D was associated with faster RNFL thinning than MvD-P alone or no dropout, which suggested that observing the optic disc deep microvasculature along with parapapillary choroidal layer using SS-OCTA may be clinically relevant in monitoring glaucoma progression.

Visual satisfaction with progressive addition lenses prescribed with novel foveal fixation axis measurements

Progressive addition lens (PAL) prescription is usually conducted using the pupillary centre as a reference, which in general does not coincide with the visual axis (kappa distance), and this difference could induce undesired prismatic effects in far and near vision distances and adaptation problems. This study aimed to assess the impact on subjects’ visual satisfaction with PALs prescribed based on foveal fixation axis (FFA) measurements. Two different PALs (LifeStyle 3i, Hoya Lens Iberia) were randomly prescribed [one with a customized inset (the difference between the FFA measurements (Ergofocus®, Lentitech, Spain) at far and near distances and the second with a standard inset (2.5 mm)] to be used by 71 healthy presbyopic volunteers in a prospective double-masked crossover clinical study involving one month of use of each PAL. Patients were self-classified into four groups according to their previous experience with PALs: neophyte, PAL users, PAL drop-out, and uncomfortable PAL users. Visual function and overall satisfaction with each PAL were collected and compared. Ninety-seven percent (95% CI 93–100%) of participants successfully adapted to PALs prescribed with FFA without significant differences (P = 0.26) among the study groups (100% neophyte and uncomfortable PAL users (95% CI 100% in both groups), 89% (95% CI 67–100%) PAL users and 94% (95% CI 82–100%) PAL drop-out group). There were no statistically significant differences in visual function (P > 0.05) between customized and standard inset PALs. Customized and standard inset lenses showed similar satisfaction (P > 0.42) that increased significantly (P < 0.01 without any carry-over effect) after 30 days of wear. PALs prescribed with FFA measurements showed high visual satisfaction, suggesting that these measurements are suitable for prescribing PAL adaptation processes. Additional research is necessary to assess differences in PAL users’ performance with different prescription methods and lens designs.

P-700 preimplantation genetic testing for aneuploidy failed to improve cumulative live birth rate in patients with limited good-quality embryos

Abstract Study question To evaluate whether preimplantation genetic testing for aneuploidy (PGT-A) can improve pregnancy and neonatal outcomes for patients with limited good-quality embryos. Summary answer PGT-A failed to improve cumulative live birth rate or shorten time to pregnancy, but optimized pregnancy outcomes per transfer for patients with limited good-quality embryos. What is known already PGT-A is currently widely used to screen for aneuploidy with the goal of improving live birth rates. Remarkably, previous studies have focused on the effect of PGT-A on cumulative clinical outcomes in women with good pregnancy prognosis. However, it is still unclear whether PGT-A can improve the cumulative pregnancy outcomes in patients with limited good-quality embryos. Study design, size, duration A retrospective cohort study was performed among 1553 women who intended PGT-A for the first time but obtained only two or less good-quality embryos on day 3 after oocyte retrieval from March 2017 to June 2021. Participants/materials, setting, methods A total of 1553 patients were divided into two groups: 997 in the PGT-A group and 556 in the drop-out group of withdrawing PGT-A due to poor embryological outcome. Multivariable logistic regression was performed to adjust for potential confounders when comparing the clinical outcomes between two groups. Main results and the role of chance After adjusting for potential confounding factors, PGT-A group exhibited significantly lower cumulative rates of biochemical pregnancy (19.96% vs. 30.22%, P-adj &amp;lt; 0.001), clinical pregnancy (17.55% vs. 23.38%, P-adj &amp;lt; 0.001) and live birth (14.14% vs. 16.19%, P-adj = 0.005) per oocyte retrieval and longer median time to pregnancy and live birth compared with drop-out group. However, significant increases in rates of biochemical pregnancy (72.16% vs. 35.50%, P-adj &amp;lt; 0.001), clinical pregnancy (61.86% vs. 26.98%, P-adj &amp;lt; 0.001), and live birth (48.45 vs. 18.26%, P-adj &amp;lt; 0.001) per transfer were found in the PGT-A group. No significant differences were observed in cumulative miscarriage and ectopic pregnancy rates, number of ETs needed per live birth and neonatal outcomes. Limitations, reasons for caution This study was limited by the inherent potential bias of retrospective studies and small sample size. Thus, additional studies with larger sample sizes are needed to confirm our findings. Wider implications of the findings PGT-A failed to improve cumulative live birth rate or shorten time to pregnancy, but optimized pregnancy outcomes per transfer for patients with limited good-quality embryos. Trial registration number Not applicable

40-LB: The Association between Changes in Physical Activity Before and After Thyroidectomy and Incident Type 2 Diabetes in Patients with Thyroid Cancer

Background: Thyroid cancer patients who underwent thyroid-stimulating hormone suppression therapy after thyroidectomy is increased a risk for type 2 diabetes mellitus (T2DM). However, whether the changes in physical activity (PA) before and after thyroidectomy in patients with thyroid cancer are associated with T2DM has not been evaluated yet. We investigated the association between changes in PA before and after thyroidectomy and incident T2DM in patients with thyroid cancer. Methods: An observational cohort study of 69,526 thyroid cancer patients who underwent thyroidectomy between 2010 and 2016 was performed using the Korean National Health Information Database. PA was defined as mid-term or vigorous exercise at least 1 day in a week. PA changes over time were divided into four groups: persistent non-exercisers (n = 18,441), new exercisers (n = 14,599), exercise dropouts (n = 11,023), and exercise maintainers (n = 25,463). Results: During mean 4.5 years of follow-up, the incidences per 1,000 person years of T2DM were lower in patients who performed PA before or after thyroidectomy than persistent non-exercisers (10.77 in persistent non-exerciser group, 8.28 in new exerciser group, 8.59 in exercise dropout group, and 7.61 in exercise maintainer group). Compared with the persistent non-exerciser group, the exercise dropout group (adjusted hazard ratio [aHR] 0.81, 95% confidence interval [CI], 0.72-0.91), new exerciser group (aHR 0.87, 95% CI 0.78-0.97), and the exercise maintainer group (aHR 0.84, 95% CI 0.76-0.93) had lower risks of incident T2DM. When we stratified patients according to energy expenditure, PA with &amp;lt; 1,500 metabolic equivalent of task (MET)-min/week in exercise maintainers was associated with lower risk of incident T2DM than non-exercisers, but PA with ≥ 1,500 MET-min/week was not. Conclusion: In patients with thyroid cancer, PA before or after thyroidectomy was associated with lower risk of incident T2DM. Disclosure J. Park: None. H. Park: None. S. Kim: None. Y. Cho: None. K. Han: None. K. Kim: None.

Therapeutic outcome and long-term naturalistic follow-up of female adolescent outpatients with AN: clinical, personality and psychopathology evolution, process indicators and outcome predictors

BackgroundAnorexia nervosa (AN) is a serious mental illness of growing prevalence in childhood and adolescence. Despite its severity, there are still no completely satisfactory evidence-based treatments. Follow-up studies represent the most effective attempt to enlighten treatment effectiveness, outcome predictors and process indicators.MethodsSeventy-three female participants affected with AN were assessed at intake (T0) and at 6 (T1) and 12 (T2) months of an outpatient multimodal treatment program. Nineteen participants were assessed 15 years after discharge (T3). Changes in diagnostic criteria were compared with the chi-square test. Clinical, personality and psychopathology evolution were tested with ANOVA for repeated measures, using the t-test or Wilcoxon test as post-hoc. T0 features among dropout, stable and healed participants were compared. Healed and unhealed groups at long-term follow-up were compared using Mann-Whitney U test. Treatment changes were correlated to each other and with intake features using multivariate regression.ResultsThe rate of complete remission was 64.4% at T2, and 73.7% at T3. 22% of participants maintained a full diagnosis at T2, and only 15.8% at T3. BMI significantly increased at each time-point. A significant decrease of persistence and increase in self-directedness were evidenced between T0 and T2. Interoceptive awareness, drive to thinness, impulsivity, parent-rated, and adolescent-rated general psychopathology significantly decreased after treatment. Lower reward dependence and lower cooperativeness characterized the dropout group. The healed group displayed lower adolescent-rated aggressive and externalizing symptoms, and lower parent-rated delinquent behaviors. BMI, personality and psychopathology changes were related with each other and with BMI, personality and psychopathology at intake.ConclusionA 12-months outpatient multimodal treatment encompassing psychiatric, nutritional and psychological approaches is an effective approach for the treatment of mild to moderate AN in adolescence. Treatment was associated not only with increased BMI but also with positive personality development, and changes in both eating and general psychopathology. Lower relational abilities may be an obstacle to healing. Approaches to treatment resistance should be personalized according to these finding.

A deep convolutional neural network model with two-stream feature fusion and cross-load adaptive characteristics for fault diagnosis

Research aimed at diagnosing rolling bearing faults is of great significance to the health management of equipment. In order to solve the problem that rolling bearings are faced with variable operating conditions and the fault features collected are single in actual operation, a new lightweight deep convolution neural network model called FC-CLDCNN, composed of a convolution pooling dropout group with two-stream feature fusion and cross-load adaptive characteristics, is proposed for rolling bearing fault diagnosis. First, the original vibration signal is transformed into a one-dimensional frequency domain signal and a two-dimensional time-frequency graph by fast Fourier transform and continuous wavelet transform. Then, the one-dimensional frequency domain signal and two-dimensional time-frequency diagram are input into the two channels of the model respectively to extract and recognize the one-dimensional and two-dimensional features. Finally, the one-dimensional and two-dimensional features are combined in the fusion layer, and the fault types are classified in the softmax layer. FC-CLDCNN has the characteristics of two-stream feature fusion, which can give full consideration to the characteristics of rolling bearing fault data, so as to achieve efficient and accurate identification. The Case Western Reserve University (CWRU) dataset is used for training and testing, and it is proved that the proposed model has high classification accuracy and excellent adaptability across loads. The Machinery Failure Prevention Technology (MFPT) dataset was used to validate the excellent diagnostic performance and generalization of the proposed model.

Physical Activity Changes and the Risk of Incident Atrial Fibrillation in Patients With Type 2 Diabetes Mellitus: A Nationwide Longitudinal Follow-up Cohort Study of 1.8 Million Subjects.

We investigated the association between alterations in regular physical activity (PA) and the risk of developing AF in patients with type 2 diabetes mellitus (T2DM) and the optimal PA range based on energy expenditure. In a nationwide database, subjects who underwent health examinations twice at a 2-year interval between 2009 and 2012 were studied. After 1,815,330 patients with T2DM who did not have a history of AF were identified, they were followed until 2018. Regular PA alterations over time were used to divide individuals into four groups: persistent nonexercisers (n = 1,181,837), new exercisers (n = 242,968), exercise dropouts (n = 225,124), and exercise maintainers (n = 165,401). During a mean follow-up period of 5.6 ± 1.3 years, 46,589 cases (2.6%) of new-onset AF occurred. Compared with the persistent nonexerciser group, both the exercise dropout group (adjusted hazard ratio [HR] 0.96, 95% CI 0.94-0.99) and new exerciser group (HR 0.95, 95% CI 0.93-0.98) had lower risks of incident AF. The exercise maintainer group showed the lowest risk (HR 0.91, 95% CI 0.89-0.94). When we stratified patients with T2DM according to energy expenditure, undergoing regular PA with ≥1,500 MET-min/week in new exercisers and ≥1,000 MET-min/week in exercise maintainers was associated with lower risks of incident AF than nonexercisers. In patients with T2DM, starting and maintaining regular PA were both associated with lower risk of incident AF. Optimal PA ranges based on energy expenditure, which were associated with lower risks of incident AF, can be defined.

Is computer-guided implant placement with a flapless approach more accurate than with a flapped surgical approach?

Study design Retrospective cohort study.Cohort selection and data analysis In total, 89 implants were placed in 34 patients (19 men and 15 women; average 62.1 years of age) using computer-guided implant surgery with cone beam computed tomography (CBCT). All patients included in this study were adults and the computed-guided implant surgery was planned according to a digital guide protocol based on CBCT. Group 1 patients received the implants with the guide and flapped surgical approach, Group 2 with the guide and flapless approach. Group 3 was the drop-out group which included other patients in who the implant could not be placed according to the guide. CBCT data from before and after the surgeries were superimposed to evaluate the accuracy of implant positioning among all the groups. The differences in distance of the entry point (deviation distance) and in the degree of the insertion angle (deviation angle) were measured on the superimposed CBCT. Statistical analysis was performed with SPSS software and an independent sample t-test was done to analyse the difference of measurements among the groups.Results The authors observed greater accuracy in Group 2 in terms of deviation distance and angulation when compared to Group 1. The deviated position of the implant fixtures was greater in the drop-out group when compared to the guided groups in terms of the displacement of entrance point and the degree of insertion.Conclusions The authors concluded that flapless guided implant surgery is more accurate than flap guided implant surgery. The results of this study can be useful to clinicians in making decisions between flapless surgical approach and flapped approach when using a guide for implant placement.

Clinical analysis of patients who dropout in oral appliance therapy in obstructive sleep apnea

AbstractAimThe purpose of this study was to characterize patients who received oral appliance (OA) therapy for obstructive sleep apnea (OSA) and to investigate the factors linked to patient dropout from OA therapy.MethodsThis study included 132 patients with OSA. The patients were categorized into an OA user group or a dropout group. Clinical parameters and craniofacial features were compared.ResultsFifty‐seven patients (43.2%) dropped out of OA therapy. The most common reasons for stopping OA therapy, as reported by patients, were unknown (51%), ineffectiveness (16%), strong discomfort not related to the temporomandibular joint TMJ (e.g., tooth or gum pain; 14%), pain in the TMJ (TMJ; 9%), nasal symptoms (4%), excessive salivation (2%), and other reasons (5%). Body mass index (BMI) and the presence or absence of OSA‐related complications (e.g., cardiovascular disease, cerebrovascular disease, and diabetes) were determined by univariate analysis. Age, BMI, facial axis (Fx), and the presence of OSA‐related complications were determined by multivariate logistic analyses to be risk factors for dropping out of OA therapy.ConclusionsThis study found that more patients than anticipated had discontinued OA treatment for various reasons.

고등학생의 인터넷 강의 학습에서 중도 포기에 영향을 미치는 학습자 요인 연구

Low persistence rate is a deep-seated and major challenge of internet-based learning. Since dropout causes a loss to both learners and institutions, preventing dropout is top priority and, for this reason, investigating the dropout factors is inevitable. In order to investigate the effect of schedule management, study attitude, self-control, and self-efficacy on dropout, a survey of high school students has been conducted. As a result of t-test, learners’ responses to four factors showed significant differences between dropout group and completion group. Logistic regression analysis showed that learners seem not to drop out when they have selfcontrol on distractions and when they have high self-efficacy. Based on the results, learners should consider registering online classes and institutions should establish strategies to prevent dropout.

Accuracy of dental implant placement with computer-guided surgery: a retrospective cohort study

BackgroundThe aim of this study was to assess the accuracy of virtual planning of computer-guided surgery based on the actual outcomes of clinical dental implant placement.Methods This retrospective study enrolled patients among whom implant treatment was planned using computer-guided surgery with cone beam computed tomography (CBCT). The patients who received implant according to the guide with the flapless and flapped approach were classified as group 1 and 2, respectively, and the others who could not be placed according to the guide were allocated to the drop-out group. The accuracy of implant placement was evaluated with the superimposition of CBCT.ResultsWe analyzed differences in the deviated distance of the entrance point and deviated angulation of the insertion of implant fixtures. With regard to the surgical approach, group 2 exhibited greater accuracy compared to group 1 in deviation distance (2.22 ± 0.88 and 3.18 ± 0.89 mm, respectively, P < 0.001) and angulation (4.27 ± 2.30 and 6.82 ± 2.71°, respectively, P = 0.001). The limitations of guided surgery were discussed while considering the findings from the drop-out group.ConclusionsComputer-guided surgery demonstrates greater accuracy in implant placement with the flapless approach. Further research should be conducted to enhance the availability of guides for cases with unfavorable residual bone conditions.