Entry Periods Research Articles

Parenting stress in caregiver-mediated interventions for toddlers with autism: An application of quantile regression mixed models.

Traditional longitudinal modeling approaches require normally distributed data and do not account for sample heterogeneity. Parenting stress, in particular, can be difficult to model across time without transforming the data as it is usually high for caregivers of children with ASD. This study used novel linear quantile mixed models (LQMMs) to model non-normal parent stress scores across two caregiver-mediated interventions involving toddlers with ASD. The sample included 86 caregiver-child dyads who were randomized to either a parent-only psychoeducational intervention or hands-on parent training in a naturalistic developmental intervention. Child and parent-related domains of the Parenting Stress Index (PSI) were the primary outcomes in this study. The PSI was collected at entry, 10-week exit, 3-month follow-up, and 6-month follow-up periods. Separate LQMMs were used to model five specific quantiles ( of the two PSI domains across the complete intervention timeline. These five quantiles effectively modeled the entire conditional distribution of parenting stress scores. The LQMMs indicated that child-related parenting stress decreased across all quantiles within both interventions, with no difference in the rate of parenting stress change between the intervention groups. For parent-related parenting stress, the effect of intervention depended on the group's stress level; some parents increased their perceived stress within the hands-on intervention at the 3-month follow-up. Overall, this study demonstrated that the use of LQMMs yielded additional information, beyond traditional longitudinal models, regarding the relationship between parenting stress within two caregiver-mediated intervention protocols. This study also discussed the methodological contributions and potential future applications of LQMMs. LAY SUMMARY: This study used a newer longitudinal modeling technique to examine how parenting stress changed across two caregiver-mediated interventions for toddlers with ASD. Results showed that certain parents in the JASPER condition might require additional support as they exit the study and enter into their first follow-up period. It was also determined that this new modeling technique could be a valuable tool to analyze highly variable data often present in ASD intervention studies.

Bolivian migration and ethnic subsidiarity in Chilean sulphur and borax high-altitude mining (1888–1946)

ABSTRACT Bolivian migration in borax and sulphur high-altitude mining was fundamental in sustaining industrial capitalism in northern Chile. In this paper, we quantify and characterize Bolivian migration in the border mining camps of the municipality of Ollagüe, through the analysis of 335 migratory files, dating from 1888 to 1946. We focus on the Bolivian presence in eight villages and camps involved in sulphur and borax mining. We present the entry periods of Bolivian workers, as well as their origin, trade and profession, gender, marital status, age, and literacy. Results give an account of the central role played by the Bolivian migrant labour force for the development of non-metallic and high-altitude mining industries in the region. It is concluded that the capitalist expansion in the Chilean border was sustained by an ethnic subsidiarity of an international subordinate workforce.

Substantial decline in heavily treated therapy-experienced persons with HIV with limited antiretroviral treatment options

Historically, a high burden of resistance to antiretroviral therapy (ART) in heavily treatment-experienced (HTE) persons with HIV (PWH) resulted in limited treatment options (LTOs). We evaluated the prevalence, risk factors, and virologic control of HTE PWH with LTO throughout the modern ART era. We examined all ART-experienced PWH in care between 2000 and 2017 in the Centers for AIDS Research Network of Integrated Clinical Systems cohort. We computed the annual prevalence of HTE PWH with LTO defined as having two or less available classes with two or less active drugs per class based on genotypic data and cumulative antiretroviral resistance. We used multivariable Cox proportional hazards models to examine risk of LTO by 3-year study entry periods adjusting for demographic and clinical characteristics. Among 27 133 ART-experienced PWH, 916 were classified as having LTO. The prevalence of PWH with LTO was 5.2-7.5% in 2000-2006, decreased to 1.8% in 2007, and remained less than 1% after 2012. Persons entering the study in 2009-2011 had an 80% lower risk of LTO compared with those entering in 2006-2008 (adjusted hazard ratio 0.20; 95% confidence interval: 0.09-0.42). We found a significant increase in undetectable HIV viral loads among PWH ever classified as having LTO from less than 30% in 2001 to more than 80% in 2011, comparable with persons who never had LTO. Results of this large multicenter study show a dramatic decline in the prevalence of PWH with LTO to less than 1% with the availability of more potent drugs and a marked increase in virologic suppression in the current ART era.

Tunnel ventilation during construction and diffusion of hazardous gases studied by numerical simulations

Proper ventilation of tunnels has remained a serious issue for many years. However, only empirical methods are currently utilised for estimating ventilation time scales in construction scheduling. In this study, the forced ventilation system used in tunnels under construction was investigated through computational fluid dynamics modelling. The effects of influencing factors, such as the duct position, distance between the ventiduct mouth and the working face, air velocity in the duct, and cross-sectional area of the tunnel, were examined, and the flow field and CO concentration distributions in the tunnel space were determined. The obtained results revealed that the zone near the working face can be divided into a jet zone, backflow zone, and vortex zone. Pollutant discharge was strongly related to the flow field distribution. The CO concentration distributions were calculated from the data sets generated by various models, and a ventilation time estimation function was derived for the entire tunnel construction period. The blasting cycle can be significantly shortened by allowing construction workers to enter the tunnel within the calculated entry periods, and necessary construction procedures can be reasonably implemented. The flow field distribution and time dependence of the CO concentration deduced in this study can be extended and applied to other similar projects.

Adjustment for Propensity Score in Nonrandomized Clinical Studies: Comparison of Sivelestat Versus Conventional Therapy for Acute Lung Injury in Acute Respiratory Distress Syndrome.

To confirm the effectiveness of sivelestat, a clinical trial was conducted comparing sivelestat with conventional treatment in an open, nonrandomized, multicenter study of patients with systemic inflammatory response syndrome (SIRS)-associated acute lung injury. The primary endpoint was ventilator-free days (VFD). This study adopted a "cluster entry" method to control for patient selection bias arising from the unblinded and nonrandomized clinical trial. Thus, all patients in the same hospital during the same entry period entered the same treatment arm, and entry periods did not overlap. In the primary analysis of VFD, adjusted mean VFD values were compared between groups using the inverse probability of treatment weighted (IPTW) method, based on propensity score, for control of confounding factors. There were 374 patients in the sivelestat group and 168 in the conventional therapy group. The primary analysis confirmed that sivelestat was effective (between-group difference of adjusted mean was 3.5 [2-sided 95% confidence interval, 1.3-5.8]; P = .0022). In general, a study where all patients in the same cluster enter the same treatment arm has within-cluster correlations, which need to be considered in the study analysis. However, in analysis using the IPTW method, it is usual to use a robust variance estimator, the sandwich variance estimator, which is consistent regardless of whether the specification of within-cluster correlation structure is correct. Thus, in the analysis using the IPTW method, it was found that it was not necessary to adopt any other adjustment method for within-cluster correlation.

Teaching Shared Decision Making to Family Medicine Residents: A Descriptive Study of a Web-Based Tutorial.

BackgroundDECISION+2, a Web-based tutorial, was designed to train family physicians in shared decision making (SDM) regarding the use of antibiotics for acute respiratory infections (ARIs). It is currently mandatory for second-year family medicine residents at Université Laval, Quebec, Canada. However, little is known about how such tutorials are used, their effect on knowledge scores, or how best to assess resident participation.ObjectiveThe objective of our study was to describe the usage of this Web-based training platform by family medicine residents over time, evaluate its effect on their knowledge scores, and identify what kinds of data are needed for a more comprehensive analysis of usage and knowledge acquisition.MethodsWe identified, collected, and analyzed all available data about participation in and current usage of the tutorial and its before-and-after 10-item knowledge test. Residents were separated into 3 log-in periods (2012-2013, 2013-2014, and 2014-2015) depending on the day of their first connection. We compared residents’ participation rates between entry periods (Cochran-Armitage test), assessed the mean rank of the difference in total scores and category scores between pre- and posttest (Wilcoxon signed-rank test), and compared frequencies of each. Subsequent to analyses, we identified types of data that would have provided a more complete picture of the usage of the program and its effect on knowledge scores.ResultsThe tutorial addresses 3 knowledge categories: diagnosing ARIs, treating ARIs, and SDM regarding the use of antibiotics for treating ARIs. From July 2012 to July 2015, all 387 second-year family medicine residents were eligible to take the Web-based tutorial. Out of the 387 eligible residents, 247 (63.8%) logged in at least once. Their participation rates varied between entry periods, most significantly between the 2012-2013 and 2013-2014 cohorts (P=.006). For the 109 out of 387 (28.2%) residents who completed the tutorial and both tests, total and category scores significantly improved between pre- and posttest (all P values <.001). However, the frequencies of those answering correctly on 2 of the 3 SDM questions did not increase significantly (P>.99, P=.25). Distribution of pre- or posttest total and category scores did not increase between entry periods (all P values >.1). Available data were inadequate for evaluating the associations between the tutorial and its impact on the residents’ scores and therefore could tell us little about its effect on increasing their knowledge.ConclusionResidents’ use of this Web-based tutorial appeared to increase between entry periods following the changes to the SDM program, and the tutorial seemed less effective for increasing SDM knowledge scores than for diagnosis or treatment scores. However, our results also highlight the need to improve data availability before participation in Web-based SDM tutorials can be properly evaluated or knowledge scores improved.

Abstract P131: The Effects of Weight Loss on Liver Function in Obese Hypertensive Patients

Objective: Insulin resistance and visceral adiposity are predisposing factors for fatty liver disease. This study was undertaken to evaluate the weight loss effects on liver function (ALT, AST, GGT). Methods: 90 overweight/obese, mild hypertensive men without medications or liver dysfunction were randomized into the 3 weight loss (WL) regimens over 24 weeks. WL was achieved with i) a mild calorie restricted diet alone (D alone; 1800kcal/day, 55% carbohydrate, 30% protein, 15% fat), ii) mild exercise alone (EX alone; 1-hr walking), or iii) a combination with a mild calorie restricted diet + exercise (D+EX) over 24 weeks. BMI, waist/hip ratio (W/H), total body fat-mass, blood pressure (BP), plasma norepinephrine (NE), fasting insulin, glucose, HOMA-IR, total cholesterol (Tch), triglyceride (TG), and liver function (ALT, AST, GGT) were measured every 4 weeks over 24 weeks with WL. Results: At entry period, BMI, fat-mass, W/H, BP levels, plasma NE, HOMA-IR, Tch, TG, ALT, AST, and GGT were similar between the 3 groups. At 24 weeks, the D+EX group had significantly higher prevalence of normalizations of BMI and BP levels (53.3%, 56.7%, respectively) compared to the D alone (13.3%, 23.3%, 30.0%) or EX alone (26.6%, 23.3%). In the D alone group, significant decreases in plasma NE and TG was observed at 2 weeks followed by significant reductions in Tch, body weight, fat mass, and HOMA at 8 weeks. Significant reductions in W/H, BP and GGT were also observed at 8 weeks, and ALT and AST decreased gradually but significantly at 12 weeks. On the other hand, in the EX alone group, significant fat loss and significant reduction in W/H, HOMA-IR and GGT were observed at 4 weeks. Body weight and plasma NE decreased significantly at 8 weeks, and significant BP reduction and decreases in TG and Tch were occurred at 12 weeks followed by decreases in ALT and AST at 16 weeks. Reductions in GGT were similar between the D alone and D+EX groups, but the groups including D had greater reduction in GGT, ALT and AST compared to the EX alone group. In the combination group (D+EX group), every improvement was observed earlier and stronger. Significant suppression on plasma NE and TG was at 2 weeks, decreases in HOMA, Tch, weight, fat-mass, W/H, systolic BP and GGT were at 4 weeks, and diastolic BP, ALT, and AST were at 8 weeks. In all subjects, reductions in HOMA-IR preceded to decreases in liver function parameters (GGT, ALT, and AST), and reductions in GGT was followed by decreases in ALT or AST. In multiple regression analyses, at both period of entry and 24-week, HOMA-IR was a significant determinant for GGT, TG and Tch. At entry and 24-week periods, Tch, but not TG, was a significant determinant for GGT, ALT, and AST. Conclusions: Improvement of insulin resistance associated with WL may play an important role of improvement of liver function during lifestyle modifications. WL is an effective treatment for fatty liver disease associated with obesity.

Quantitative and qualitative analysis of labour market integration of young people

In recent years there has been a resurge of interest in young people's employment problems, the focus of labour economists and sociologists during the Seventies and Eighties, also covering countries with apparently good employment situations (such as Sweden, Germany and United Kingdom). This interest is timely and Europe-wide, prompted by escalating youth unemployment, difficulties in the transition from school to the labour market and the precariousness of short-term employment alternating with unemployment. Even countries with a high level of adult employment and some of the best labour-market performances have encountered problems in recent years. The unfavourable position of young people in the labour market is evident across Europe. Figure 1 (Annex 1)2 shows the youth-to-adult unemployment ratio (15-29 versus 30-59) in the 27 member countries, where Lithuania shows the lowest, followed by Germany, and Italy the highest ratio, followed by Sweden and UK, countries with a youth-to-adult unemployment ratio of over 3. The same figure indicates an increase of this ratio between 2000 and 2005, the most striking example being Sweden, whose youth-to-adult unemployment ratio rose from 1.6 in 2000 to over 3 in 2005. Also in UK, Cyprus and Austria we find a strong deterioration of this ratio. The only, slight improvements can be found in Finland, Greece, Italy, Lithuania, Luxembourg, Netherlands and Poland. Evidently, that the integration of young people in the labour market is becoming increasingly difficult, subject to long entry periods in which unemployment alternates with atypical contracts (see Figure 2, Annex 1). The more or less stable level of the youth to total employment ratio from 2000 to 2005 (except for Luxembourg, rising from 4 in 2000 to almost 6 in 2005, Romania dropping from 4 in 2000 to under 3 in 2005 and Cyprus with the lowest value in 2005, around 1.5, slightly less than in 2000, see Figure 4, Annex 1) shows that temporary employment is becoming widespread among the young. The share of under 12-month contracts ranges from 28-29% in Greece and the Netherlands to 55% in Spain, 59% in Sweden and 66% in Finland (see Table 16, Annex 1). The accession of the EU 12 has had repercussions on the mean age of women at childbirth (on average the new member countries have an age two years below the mean, see Table 32, Annex 1) and on other elements such as the level of human capital, performances on the labour market, and the age of entry in the labour market. However, these gaps seem to be narrowing, revealing an alarming general picture. This chapter will explore the reasons for this insufficient labour-market integration through the statistical-econometric analysis of quantitative data, based on EUROSTAT source and qualitative data. The first section illustrates the indicators of youth labour-market integration in the 27 member states, discussing the reasons for insufficient labour- market integration. The second section estimates how indicators of human capital affect the labour-market integration of young people. The third section analyses how labour-market institutions and differences in employment protection legislation are responsible for differences in the size of youth employment. The forth section describes the contribution young people make to the labour force and economic growth and provide recommendations to improve the labour market integration of young people.

Innovation of educational process of mathematics of military officers

The education and training process at UoD is markedly military orientated. It develops the students in independence, creativity, endurance, devotion and self-discipline. The graduates are generally educated at university level ready for wide range of career positions both in military and civilian lives. However, education does not restrict to only certain entry periods of one's life. It has become a continuous life-long process and blended learning is an important part of it.The aim of this paper is to give information about education process of mathematics of military officers in daily and combined study. Moreover, the author will present a multimedia CDs created at UoD which are used during the educational process.

昼間睡眠時の緩徐眼球運動と睡眠段階の移行期間

Slow eye movements (SEMs) were analyzed in 28 young adult females during daytime sleep. Data from transitional periods of each EEG stage were obtained by accumulating its epoch series synchronized to the onset or termination of the other stages. Sleepiness was reported by the subject by pressing a button switch. SEMs were prominent at the transitional period of stage W approaching the onset of stage 1 (sleep tendency). They declined with deepening of sleep at the transitional periods of EEG stages 22 and 2, and disappeared completely during slow wave sleep (SWS) periods. The recovery of SEMs occurred towards awakening at every EEG transitional period except for SWS. The individual difference in the appearance of SEMs was partly explained by a positive correlation with stage 3 latency: the longer the latency was, the larger the mean SEMs. Perceived sleepiness increased in proportion to SEMs during the entry and re-entry periods to sleep. These results suggest that SEMs are strongly associated with a wake-sleep transition.

The advantage of being first and competition between firms

It is frequently suggested that the first brand in a product market enjoys a price advantage over its imitators due to imperfect information about product quality. This article considers the effect of this advantage on prices and market shares in a dominant firm price leadership model. An established firm with a price advantage faces free entry by firms producing unbranded products (generics). In equilibrium, the first brand enjoys a market share advantage over entrants in entry and post entry periods. If the initial price disadvantage is large, entry will not occur.

The Mosquito Fauna and Climate of native Huts at Kisumu, Kenya

The Mosquito Fauna and Climate of native Huts at Kisumu, Kenya