Terms Of Effect Size Research Articles

Neurocognitive predictors of confabulation in Schizophrenia

Confabulations, or false memories, are observed in various disorders, including schizophrenia. In forensic psychiatric assessment, this is problematic, particularly when garnering a clinical history and detailed account of the index offense(s) from the individual being charged. This study sought to quantitatively synthesize the existing literature regarding the frequency of confabulations in schizophrenia and its neurocognitive correlates. The keywords “schizophrenia” and “psychosis” were systematically canvassed in combination with “confabulation,” “false memory,” and “false memories” on PsycINFO, PubMed, and Scopus. Inclusion criteria included the following: (1) Participant samples that included the patients with schizophrenia and healthy controls; (2) commercially available neuropsychological test measures were employed (i.e., no experimental paradigms were considered); (3) quantitative data (i.e., means and standard deviations) was available so that an effect size could be computed; (4) published findings in peer-reviewed academic journals and written in English. Studies examining high-risk or first-episode psychosis groups were excluded. Five studies were included in the final analysis. Effect sizes in terms of Cohen’s d were calculated for number of confabulations made. When available, the correlations between confabulation and neurocognitive variables were recorded. The findings suggest that patients with schizophrenia confabulated more than healthy controls for new information if it was related to old information. The relationship between confabulations and neurocognitive variables was inconsistent. Together, the results from this quantitative review has important implications for interviewing techniques in forensic psychiatric assessment. Specifically, the assessor should take great care not to ask leading questions or introduce unverified, contextual information into the interview, as it may result in a confabulation, rather than a more accurate account of the event.

Professional issues in maternal mental health scale (PIMMHS): The development and initial validation of a brief and valid measure.

INTRODUCTIONThe life-threatening consequences of perinatal mental health problems (PMHP) are well documented. Midwives are ideally placed to effectively identify women at risk and facilitate early intervention. However, a multitude of factors contribute to failure in recognition and treatment. It would be of value for service providers to be able to identify key professional issues in their own context. The present study sought to develop and evaluate a ‘professional issues in maternal mental health’ scale (PIMMHS), explore its psychometric properties and potential application.METHODSA cross-sectional design and instrument evaluation approach was taken to investigate the psychometric properties of the PIMMHS. A total of 266 student midwives from 10 UK institutions completed the PIMMHS via Survey Monkey.RESULTSPIMMHS comprises two sub-scales of emotion/communication (PIMMHSEmotion sub-scale) and training (PIMMHS-Training sub-scale). Both PIMMHS subscales demonstrate adequate divergent and convergent validity. Sub-optimal internal consistency was observed for the training sub-scale, however, the PIMMHS-Training had a more impressive effect size in terms of known-groups discriminant validity compared to PIMMHS-Emotion.CONCLUSIONSThe PIMMHS appears to be a sound psychometric instrument for assessing professional issues that influence the practice of student midwives in PMH. The PIMMHS could support education providers to identify areas for curriculum development, as well as maternity services in proactive assessment of service provision, to identify training and service development opportunities.

Prolonged-release fampridine in multiple sclerosis: clinical data and real-world experience. Report of an expert meeting.

Prolonged-release (PR) fampridine is the only approved medication to improve walking in multiple sclerosis (MS), having been shown to produce a clinically meaningful improvement in walking ability in the subset of MS patients with Expanded Disability Status Scale 4–7. Recent responder subgroup analyses in the phase III ENHANCE study show a large effect size in terms of an increase of 20.58 points on the patient-reported 12-item MS Walking Scale in the 43% of patients classified as responders to PR-fampridine, corresponding to a standardized response mean of 1.68. Use of PR-fampridine in clinical practice varies across Europe, depending partly on whether it is reimbursed. A group of European MS experts met in June 2017 to discuss their experience with using PR-fampridine, including their views on the patient population for treatment, assessment of treatment response, re-testing and re-treatment, and stopping criteria. This article summarizes the experts’ opinions on how PR-fampridine can be used in real-world clinical practice to optimize the benefits to people with MS with impaired walking ability.

Is computer-assisted instruction more effective than other educational methods in achieving ECG competence among medical students and residents? Protocol for a systematic review and meta-analysis

IntroductionAlthough ECG interpretation is an essential skill in clinical medicine, medical students and residents often lack ECG competence. Novel teaching methods are increasingly being implemented and investigated to improve ECG...

Impact of Game-Based Health Promotion Programs on Body Mass Index in Overweight/Obese Children and Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Sedentary lifestyle is growing among children and adolescents that may contribute to problems such as overweight and obesity. Consequently, interventions to improve weight loss in this population are necessary. The aim of this current review was to evaluate the effectiveness of game-based interventions to reduce body mass index (BMI) among children who were overweight or obese. All randomized controlled trials with a game-based approach for lowering weight in obese/overweight youths aged 5-18 years old were identified from January 2005 to June 2017 across PubMed, Web of Science, Embase, Scopus, and ScienceDirect. Two independent reviewers completed data extraction sheets on information such as sample size, country of origin, age of participants, type of interventions, and BMI change from pre- to posttest. A consensus on collected data was obtained, and a final list of studies meeting inclusion and exclusion criteria was arrived at. Data were analyzed using Comprehensive Meta-analysis software, and effect size was measured by standardized mean difference (SMD) and Hedges' g measure. Heterogeneity and publication bias were also examined using I2 index and funnel plot. A total of 388 articles were identified from electronic and manuals' searches. After deletion of duplicated articles, 138 articles remained that were then screened in terms of relevance. Of those, 41 articles were examined to determine eligibility. Finally, 10 articles met inclusion/exclusion criteria and were entered into the quantitative meta-analysis. Results indicated a small but significant effect size in terms of BMI reduction [SMD, -0.234; standard error (SE), 0.069] among included studies. The average BMI z-score reduction was -0.181 (SE, 0.071). Trials which used other types of interventions along with active game-based approaches achieved greater effect sizes than single game-based interventions. There was a significant difference between studies based on their country of origin, BMI value, and intervention type. Those conducted in United States, those including participants with BMI ≥30, and studies with multicomponent intervention reported a higher reduction of BMI than others. However, no significant difference in BMI was found in terms of variables such as age, sample size, type of participant (overweight/obese), intervention duration, or participant gender. No publication bias was identified, and studies were homogenous (I2 = 22.5%). Interventions that involve active gaming may produce small effects in terms of improving BMI among children who are overweight/obese. Therefore, we recommend that supplemental interventions be used to enhance the effectiveness of game-based interventions.

Developmentally Specific Associations Between CNR1 Genotype and Cannabis Use Across Emerging Adulthood.

Previous studies have found preliminary evidence for associations between common single-nucleotide polymorphisms (SNPs) in the cannabinoid receptor gene CNR1 and cannabis use and dependence. The present study examined a set of eight independent SNPs in or near CNR1 in relation to cannabis use measured longitudinally across emerging adulthood. Using latent growth curve modeling of 10 waves of longitudinal data spanning mean ages 18.4-23.8 years in a sample of non-Hispanic White individuals (n = 334), we tested if genotype at each CNR1 SNP was associated with both level and growth of cannabis use over time. Peer group drug use, a known correlate of individual use, was evaluated as a time-varying predictor of cannabis use and as a moderator of the relationship between SNPs and individual use. After correction for multiple comparisons, one SNP, rs806374, was significantly associated with individual differences in level-but not growth-of cannabis use over time, such that C carriers were more likely to use cannabis more frequently at study onset (around age 18). Peer drug use was a predictor of individual cannabis use that grew in terms of effect size with time, but did not significantly moderate the effect of rs806374 genotype. C carriers at rs806374 may be at specific risk for increased odds of use during the transition out of high school (around age 18). Future studies should investigate potential mechanisms at this developmental stage, including individual differences in subjective response, innate tolerance, reinforcement mechanisms, or general liability for substance misuse.

The Effect of Gender on School Administrators and Teachers’ Perceptions of Learning Organization: A Meta-Analysis Study

The purpose of this research is to combine effect sizes of the quantitative studies that revealed the effect of gender on school administrators and teachers’ perceptions of learning organization and examine with the meta-analytical method if if there is a significant difference in effect in terms of the factors of publication type, research area, education level, scale preparation, the validity and reliability status of scales and the researcher’s gender. In literature review, it was determined that 66 studies on the research topic, which consist of doctoral dissertation, master dissertation, research paper and conference proceeding were conducted. Off all these studies, 21 studies, having appropriate data related to genders of school administrators and teachers and coding protocol were included in the this research. The sample of the study consisted of 7156 participants of which were 3955 males and 3201 were females. Standardized means difference was calculated to measure the effect size. According to the research results, the calculated effect size (SMD) for the random effect model was g=-0,020 [-0,087; 0,047], which indicated that male school administrators and teachers were more favored. In addition, it was found that there was no difference in any effect size in terms of the publication type, research area, education level, scale preparation, validity and reliability status of scales and researcher’s gender.

Play seriously: Effectiveness of serious games and their features in motor rehabilitation. A meta-analysis.

Evidence for the effectiveness of serious games (SGs) and their various features is inconsistent in the motor rehabilitation field, which makes evidence based development of SGs a rare practice. To investigate the effectiveness of SGs in motor rehabilitation for upper limb and movement/balance and to test the potential moderating role of SGs features like feedback, activities, characters and background. We ran a meta-analysis including 61 studies reporting randomized controlled trials (RCTs), controlled trials (CTs) or case series designs in which at least one intervention for motor rehabilitation included the use of SGs as standalone or in combination. There was an overall moderate effect of SGs on motor indices, d = 0.59, [95% CI, 0.48, 0.71], p < 0.001. Regarding the game features, only two out of 17 moderators were statistically different in terms of effect sizes: type of activity (combination of group with individual activities had the highest effects), and realism of the scenario (fantasy scenarios had the highest effects). While we showed that SGs are more effective in improving motor upper limb and movement/balance functions compared to conventional rehabilitation, there were no consistent differences between various game features in their contribution to effects. Further research should systematically investigate SGs features that might have added value in improving effectiveness.

Gene expression profiles and signaling mechanisms in \u03b12B-adrenoceptor-evoked proliferation of vascular smooth muscle cells

Backgroundα2-adrenoceptors are important regulators of vascular tone and blood pressure. Regulation of cell proliferation is a less well investigated consequence of α2-adrenoceptor activation. We have previously shown that α2B-adrenoceptor activation stimulates proliferation of vascular smooth muscle cells (VSMCs). This may be important for blood vessel development and plasticity and for the pathology and therapeutics of cardiovascular disorders. The underlying cellular mechanisms have remained mostly unknown. This study explored pathways of regulation of gene expression and intracellular signaling related to α2B-adrenoceptor-evoked VSMC proliferation.ResultsThe cellular mechanisms and signaling pathways of α2B-adrenoceptor-evoked proliferation of VSMCs are complex and include redundancy. Functional enrichment analysis and pathway analysis identified differentially expressed genes associated with α2B-adrenoceptor-regulated VSMC proliferation. They included the upregulated genes Egr1, F3, Ptgs2 and Serpine1 and the downregulated genes Cx3cl1, Cav1, Rhoa, Nppb and Prrx1. The most highly upregulated gene, Lypd8, represents a novel finding in the VSMC context. Inhibitor library screening and kinase activity profiling were applied to identify kinases in the involved signaling pathways. Putative upstream kinases identified by two different screens included PKC, Raf-1, Src, the MAP kinases p38 and JNK and the receptor tyrosine kinases EGFR and HGF/HGFR. As a novel finding, the Src family kinase Lyn was also identified as a putative upstream kinase.Conclusionsα2B-adrenoceptors may mediate their pro-proliferative effects in VSMCs by promoting the activity of bFGF and PDGF and the growth factor receptors EGFR, HGFR and VEGFR-1/2. The Src family kinase Lyn was also identified as a putative upstream kinase. Lyn is known to be expressed in VSMCs and has been identified as an important regulator of GPCR trafficking and GPCR effects on cell proliferation. Identified Ser/Thr kinases included several PKC isoforms and the β-adrenoceptor kinases 1 and 2. Cross-talk between the signaling mechanisms involved in α2B-adrenoceptor-evoked VSMC proliferation thus appears to involve PKC activation, subsequent changes in gene expression, transactivation of EGFR, and modulation of kinase activities and growth factor-mediated signaling. While many of the identified individual signals were relatively small in terms of effect size, many of them were validated by combining pathway analysis and our integrated screening approach.

The six-spot-step test - a new method for monitoring walking ability in patients with chronic inflammatory polyneuropathy.

The aim of this study was to evaluate whether the six-spot-step test (SSST) is more suitable for monitoring walking ability in patients with chronic inflammatory polyneuropathy than the timed 25-foot-walking test (T25FW). In the SSST, participants have to walk as quickly as possible across a field measuring 1 × 5 m, while kicking blocks out of five circles on the floor. Sixty-two patients and 61 controls performed the SSST and T25FW. Patients also performed the overall disability sumscore, INCAT sensory sumscore, Medical Research Council sumscore, and 9-hole-peg-test. Twenty-one patients treated with intravenous immunoglobulin (IVIG) every 4-6 weeks were tested prior to and 2-3 weeks after treatment and judged change in their own clinical condition using the patient global impression of change (PGIC) scale. In patients, SSST ranged from 5.7 to 26.8 s and T25FW ranged from 3.6 to 12.9 s. Intra-class correlation between repeated tests was 0.97 for SSST and 0.95 for T25FW. Correlation with the additional tests was stronger for SSST than T25FW. In IVIG-treated patients, the mean change in walking time was -2.3 s for SSST and -0.6 s for T25FW. The SSST showed larger responsiveness in terms of effect size, standardized response means, and relative efficiency. Both ambulation tests correlated moderately to PGIC. The SSST may be superior to the T25FW in terms of dynamic range, floor effect, and responsiveness which makes the SSST a possible alternative for monitoring walking ability in patients with chronic inflammatory polyneuropathy.

Tree squirrel abundance and demography in managed coniferous forests of British Columbia are within the range of natural fluctuations of old-growth stands

The American red squirrel (Tamiasciurus hudsonicus Exrleben) and northern flying squirrel (Glaucomys sabrinus Shaw) are important mammal species in coniferous forests that are widely distributed across temperate and boreal ecological zones. Although T. hudsonicus and G. sabrinus apparently prefer late-successional forests, their population dynamics show no clear pattern in young second-growth and old-growth conifer forests. We used a compilation of study results that had standardized methodology and sampling effort to compare tree squirrel responses across a range of forest conditions. We tested the hypotheses (H) that abundance, reproduction, recruitment, and survival would be higher in (H1) old-growth than second-growth stands, (H2) unthinned than thinned second-growth stands, and (H3) lightly than heavily thinned stands. Tree squirrel populations in old-growth stands were considered the “standard” treatment to which other treatments in second-growth stands (unthinned and variously thinned) were compared. Thinned stands were grouped into low, medium, and high densities of trees. Datasets from seven published studies included 2804 Tamiasciurus and 837 G. sabrinus individuals, 25 study years, and 158 trapping periods. Mean abundance of Tamiasciurus was similar among treatment stands, ranging from 0.62 to 1.29·ha−1. Mean numbers of G. sabrinus were highest in old-growth stands at 0.65·ha−1, followed by the low- and medium-density stands at 0.50·ha−1, the high-density stands at 0.25·ha−1, and finally the unthinned second-growth stands at a low of 0.12·ha−1. In terms of effect size, mean proportional change in abundance, relative to that within old-growth stands, of both squirrel species in the three thinned stands were within the range of natural fluctuations in old-growth stands. Populations of Tamiasciurus in the unthinned stands were not within the range of fluctuations in the old-growth stands. Mean number of successful pregnancies and total recruits were similar among stands for Tamiasciurus, with variability in female breeding and winter survival. Mean number of recruits of G. sabrinus was highest in old-growth stands with no other differences in demographic attributes among stands. The biological significance of these differences in demographic variables was small in terms of effect sizes. Tamiasciurus and G. sabrinus seem to persist in a relatively broad range of young managed forest habitats, as well as in old-growth stands.

Statistical properties of four effect-size measures for mediation models

This project examined the performance of classical and Bayesian estimators of four effect size measures for the indirect effect in a single-mediator model and a two-mediator model. Compared to the proportion and ratio mediation effect sizes, standardized mediation effect-size measures were relatively unbiased and efficient in the single-mediator model and the two-mediator model. Percentile and bias-corrected bootstrap interval estimates of ab/sY, and ab(sX)/sY in the single-mediator model outperformed interval estimates of the proportion and ratio effect sizes in terms of power, Type I error rate, coverage, imbalance, and interval width. For the two-mediator model, standardized effect-size measures were superior to the proportion and ratio effect-size measures. Furthermore, it was found that Bayesian point and interval summaries of posterior distributions of standardized effect-size measures reduced excessive relative bias for certain parameter combinations. The standardized effect-size measures are the best effect-size measures for quantifying mediated effects.

Balancing food and density‐dependence in the spatial distribution of an interference‐prone forager

Foraging distributions are thought to be density‐dependent, because animals not only select for a high availability and quality of resources, but also avoid conspecific interference. Since these processes are confounded, their relative importance in shaping foraging distributions remains poorly understood. Here we aimed to rank the contribution of density‐dependent and density‐independent effects on the spatio‐temporal foraging patterns of eurasian oystercatchers. In our intertidal study area, tides caused continuous variation in oystercatcher density, providing an opportunity to disentangle conspecific interference and density‐independent interactions with the food landscape. Spatial distributions were quantified using high‐resolution individual tracking of foraging activity and location. In a model environment that included a realistic reconstruction of both the tides and the benthic food, we tested a family of behaviour‐based optimality models against these tracking data. Density‐independent interactions affected spatial distributions much more strongly than conspecific interference, even in an interference‐prone species like oystercatchers. Spatial distributions were governed by avoidance of bill injury costs, selection for high interference‐free intake rates and a decreasing availability of benthic bivalve prey after their exposure. These density‐independent interactions outweighed interference competition in terms of effect size. We suggest that the bottleneck in our mechanistic understanding of foraging distributions may be primarily the role of density‐independent prey attributes unrelated to intake rates, like damage costs in the case of oystercatchers foraging on perilous prey. At a landscape scale, above the finest inter‐individual distances, effects of conspecific interaction on spatial distributions may have been overemphasised.

Electroretinographic anomalies in medicated and drug free patients with major depression: Tagging the developmental roots of major psychiatric disorders

The retina is tagged as an approachable part of the brain due to its common embryonic origin and appears as a promising site of investigation for psychiatric disorders. Retinal function is assessed best with the electroretinogram (ERG), which was obtained in a large sample of patients with major depressive disorder and matched controls. ERG cone and rod luminance response functions were recorded in non-dilated eyes in 100 major depressive disorder patients (MDD) and 100 controls, (mean age of 42.8 and 40.9y. o. respectively). Amongst MDD patients, 17 were drug free (mean age 41.2y. o). In medicated patients, at the cone level, a prolonged b-wave was observed (p≤0.01). In drug free patients a prolonged b-wave was discovered only when averaging the implicit time of the 3 highest b-wave amplitudes of the photopic hill. For the medicated patients, the mixed rods/cones a-wave was reduced (p=0.01) whereas a trend (p=0.06) was observed for the pure rod b-wave (reduced) and the mixed rods/cones (reduced and prolonged; p=0.05). In drug free patients, a similar pattern could be observed in terms of effect sizes. Overall, medicated and drug free MDD patients shared some deficits suggesting that some anomalies are present above and beyond the effect of medication. Of interest, the prolonged cone and reduced rod amplitude were reported by our group in schizophrenia patients, suggesting a common neurodevelopmental root of major psychiatric disorders.

Expected or Completed? Comparing Two Measures of Education and Their Relationship with Social Inequalities in Health Among Young Adults

Similarly to other age groups, there are significant social inequalities in health among young adults (YA). Education is thought to be the most appropriate indicator of YA socioeconomic status (SES), yet it is often in progress at that age and may not be representative of future achievement. Therefore, scholars have explored YA ‘expected’ education as a proxy of SES. However, no study has examined how it compares to the more common SES indicator, ‘completed’ education. Using data from 1457 YA surveyed twice over a two year period, we describe associations between participants’ completed and expected education at baseline and completed education at follow-up. We then compare associations between these two measures and three health outcomes—smoking status, self-rated mental health, and participation in physical activity and sports—at baseline and followup using regression models. At baseline, half of the participants were imputed a higher ‘expected’ level than that ‘completed’ at that time. In regression models, ‘expected’ and ‘completed’ education were strongly associated with all outcomes and performed slightly differently in terms of effect size, statistical significance, and model fit. ‘Expected’ education offers a good approximation of future achievement. More importantly, ‘expected’ and ‘completed’ education variables can be conceptualized as complementary indicators associated with inequalities in health in YA. Using both may help better understand social inequalities in health in YA.

Determinants of age-specific undernutrition in children aged less than 2years-the Bangladesh context.

Globally, undernutrition affects nearly half of all children aged less than 5years. It is more prominent in low- and middle-income countries. This study aimed to identify the age-specific risk factors for different categories of undernutrition among Bangladeshi children aged less than 2years. Data of 10,291 children aged less than 2years were collected between October 2011 to November 2013 through the Food Security Nutritional Surveillance Project in Bangladesh. Simple logistic regression established bivariate relationships between the categories of undernutrition and the relevant risk factors. Multiple logistic regression constructed the age-specific regression models depicting the independent association and effect size of the risk factors contributing to the various categories of undernutrition among study population. Stunting was prevalent among 30.9% of the study children, whereas 9.7% were wasted and 24.9% were underweight. Being a male child, increase in age, maternal body mass index and education, and household food insecurity were the strongest predictors for all categories of undernutrition in terms of effect size. Our study shows that the different categories of childhood undernutrition have different age-specific risk factors. Maternal body mass index and household food insecurity were the common age-specific risk factors for all categories of undernutrition. We expect our findings to enhance the existing evidence base for the risk factors of undernutrition among children aged less than 2 years.

The Efficacy of Individual Community Reinforcement and Family Training (CRAFT) for Concerned Significant Others of Problem Gamblers

Treatment options for concerned significant others (CSOs) of problem gamblers are limited, and available treatments focus exclusively on the distress of CSOs. Community Reinforcement and Family Training (CRAFT) is a comprehensive treatment program for CSOs of substance abusers that has been shown to reduce CSO distress in addition to the substance abuser's alcohol or drug behaviour. CRAFT capitalizes on the well-documented fact that family members have considerable influence on the substance abuser's decision to enter treatment. The present study modified the CRAFT approach into an individual treatment format for CSOs of problem gamblers and examined its efficacy in comparison to a CRAFT self-help workbook in a randomized clinical trial. A total of 31 participants were recruited. No statistical differences were found between the groups; however, effect sizes indicated that participants who received the CRAFT individual intervention seemed to have better outcomes than did those who received the CRAFT workbook (decreased days and dollars gambled by the gambler and improved CSO functioning). No differences between groups were found for gambler treatment entry rates over the follow-up period in terms of effect sizes. The results provide initial, but limited, support for the CRAFT approach delivered to CSOs of treatment-resistant problem gamblers in an individual treatment format compared with the self-help workbook format. Further research with larger sample sizes is needed to gauge the efficacy of the CRAFT individual intervention compared with the CRAFT self-help workbook.

Clinical Medical Students’ Experiences of Unprofessional Behaviour and How These Should Inform Approaches to Teaching of Professionalism

This article was migrated. The article was marked as recommended. Objectives:This mixed method research explores unprofessional behaviour experienced by clinical Medical students, during clinical training in Ireland; with a view to obtaining learning points that inform future design of modules on Professionalism. It also looks at the impact of these on students and the relationship between gender/ethnicity and students' experiences of these behaviours. Methods:A survey using the QUBPI (Queens University Belfast Professionalism Index) questionnaire was disseminated among a random sample of 139 (100% response rate) fourth year medical students in College from February to May 2014 to identify the frequency and nature of unprofessional behaviours experienced. Subsequently, 10 semi structured interviews were conducted with two students from each of the five blocks of students completing their Psychiatry Clinical placement during the year. This was to obtain in-depth insights into students' experiences, the impact of these and to establish learning points from these. These different types of data were then analysed iteratively using SPSS and NVIVO software respectively, to allow for triangulation, member checking and reflexivity. Results:There was no significant difference in students' experiences of unprofessional behaviour based on Gender, entry level (graduate or under-graduate entry) or Ethnicity. There was however a moderate/small effect size in terms of male vs. female gender and ethnicity (Caucasian vs. non-Caucasian) (Males=Cohen's d of 0.38, females=Cohen's D of 0.2) which could be explained by the fact that in group and out group dynamics rise such that as students move away from the dominant mentor/teacher characteristic, they may start to experience or perceive the occurrence of higher levels of unprofessional behaviour. The Qualitative arm of the study confirm that some students even experience marked levels of discrimination; with students' often been shouted out/criticised publicly during clinical training. Conclusions:More practical vignettes/role playing of common ethical dilemmas should be introduced into Professionalism training and these should not target only students, but also mentors to reduce students' experiences of unprofessional behaviours. Feedback training and awareness of contextual issues in Medical clinical training must be provided to clinical trainers.

Two SNPs Associated With Spontaneous Dizygotic Twinning: Effect Sizes and How We Communicate Them.

In a recent GWAS of spontaneous dizygotic twinning, Mbarek et al. (The American Journal of Human Genetics, 2016, Vol 98, pp. 898-908) identified two SNPs, rs11031006 (near FSHB) and rs17293443 (in SMAD3). In the present note, we address the question how to present the results in terms of effect sizes in a manner that is comprehensible to the general audience (e.g., mothers of twins, readership of newspapers). We propose to avoid the standard effect sizes such as odds ratios and relative risk as these require some knowledge of probability theory. Rather, we convey the results in terms of the conditional probabilities, but expressed in natural language.

The importance of the microbiome in epidemiologic research

PurposeThe human microbiome is the community of microorganisms that live on and in the body. Currently, most applications of microbiome analysis derive from the perspective of discovery and characterization. The completion of the NIH Human Microbiome and the European MetaHIT projects will change the focus to studying the role of the microbiome on human health and disease. MethodsRecent developments in technology and bioinformatics have afforded an opportunity to explore more fully the importance of community structure, detection of pathogens, and community interactions. The current state of microbiome research in terms of effect size, power calculations, how stratification on community classes can increase this power, and the importance of study design and power in reproducibility is reviewed. ResultsWork is needed to characterize microbiome development, ecological stability, and variation. Development and implementation of variance stabilization techniques should replace rarefaction of data, which reduces study power, in future research. ConclusionsEpidemiologists have most of the tools necessary to explore the relationship between the microbiome and human health. Further development of tools for large-scale multivariate data sets will be helpful. Applying the methods of epidemiology will be critical in translating research results to preventive interventions and population health.