Exploratory Models Research Articles

Automated quality control of T1-weighted brain MRI scans for clinical research datasets: methods comparison and design of a quality prediction classifier

Abstract T1-weighted (T1w) MRI is widely used in clinical neuroimaging for studying brain structure and its changes, including those related to neurodegenerative diseases, and as anatomical reference for analysing other modalities. Ensuring high-quality T1w scans is vital as image quality affects reliability of outcome measures. However, visual inspection can be subjective and time-consuming, especially with large datasets. The effectiveness of automated quality control (QC) tools for clinical cohorts remains uncertain. In this study, we used T1w scans from elderly participants within ageing and clinical populations to test the accuracy of existing QC tools with respect to visual QC and to establish a new quality prediction framework for clinical research use. Four datasets acquired from multiple scanners and sites were used (N = 2438, 11 sites, 39 scanner manufacturer models, 3 field strengths – 1.5T, 3T, 2.9T, patients and controls, average age 71 ± 8 years). All structural T1w scans were processed with two standard automated QC pipelines (MRIQC and CAT12). The agreement of the accept-reject ratings was compared between the automated pipelines and with visual QC. We then designed a quality prediction framework that combines the QC measures from the existing automated tools and is trained on clinical research datasets. We tested the classifier performance using cross-validation on data from all sites together, also examining the performance across diagnostic groups. We then tested the generalisability of our approach when leaving one site out and explored how well our approach generalises to data from a different scanner manufacturer and/or field strength from those used for training, as well as on an unseen new dataset of healthy young participants with movement related artefacts. Our results show significant agreement between automated QC tools and visual QC (Kappa=0.30 with MRIQC predictions; Kappa=0.28 with CAT12’s rating) when considering the entire dataset, but the agreement was highly variable across datasets. Our proposed robust undersampling boost (RUS) classifier achieved 87.7% balanced accuracy on the test data combined from different sites (with 86.6% and 88.3% balanced accuracy on scans from patients and controls respectively). This classifier was also found to be generalisable on different combinations of training and test datasets (average balanced accuracy of leave-one-site-out = 78.2%; exploratory models on field strengths and manufacturers = 77.7%; movement related artefact dataset when including 1% scans in the training = 88.5%). While existing QC tools may not be robustly applicable to datasets comprised of older adults, they produce quality metrics that can be leveraged to train a more robust quality control classifiers for ageing and clinical cohorts.

Associations between sleep health, negative reinforcement learning, and alcohol use among South Florida college students with elevated internalizing symptoms

Associations between sleep health, negative reinforcement learning, and alcohol use among South Florida college students with elevated internalizing symptoms

Financial Concerns Are Common Among Family Surrogate Decision-Makers of Patients With Stroke: A Mixed Methods Study.

Stroke has a large aggregate financial effect, but the prevalence and predictors of cost concerns among family surrogate decision-makers of patients with stroke are unknown. The aim of this study was to explore the prevalence, predictors, and nature of cost concerns among family surrogate decision-makers of patients with stroke. Family surrogate decision-makers of patients with stroke were recruited from a largely biethnic population-based study in Nueces County, TX. The primary outcome was the presence of cost concerns, defined as being "very worried" or "moderately worried" about being able to pay stroke-related medical costs, assessed through surveys conducted at baseline (shortly after stroke) and 3-, 6-, and 12-month poststroke. Potential predictors included clinical and sociodemographic factors for patients and family members, obtained from surveys and medical charts. Exploratory multivariable logistic regression models identified factors associated with cost concerns, adjusting for covariates. We also explored the nature of cost concerns in semistructured interviews with a subset of participants. Of 465 eligible stroke cases, 318 family members of 256 patients with stroke participated. Patients were 52% female, 58% Mexican American (MA), 38% non-Hispanic White (NHW), and 8% other race/ethnicity, mean age 75 (SD 14), and median NIH Stroke Scale score of 12.5 (IQR 5-22). Family members were 76% female, 63% MA, 32% NHW, and 5% other race/ethnicity, mean age 56 (SD 13). Of 256 patients, 118 (46%) had a family member with cost concerns. After adjustment for all covariates, MA ethnicity and lack of insurance were associated with greater cost concerns. Cost concerns decreased over time and were less common among family members who were neither a spouse nor a child of the patient. In semistructured interviews, cost concerns related to postacute care were most frequently mentioned, but concerns regarding hospital costs and nonmedical costs were also common. Nearly half of family surrogate decision-makers of patients with stroke had at least moderate concerns about being able to afford stroke-related medical costs. Lack of adequate insurance and membership in a historically marginalized ethnic group were the strongest predictors of cost concerns.

Assessing the fitting propensity of factor models.

Model selection is an omnipresent issue in structural equation modeling (SEM). When deciding among competing theories instantiated as formal statistical models, a trade-off is often sought between goodness-of-fit and model parsimony. Whereas traditional fit assessment in SEM quantifies parsimony solely as the number of free parameters, the ability of a model to account for diverse data patterns-known as fitting propensity-also depends on the functional form of a model. The present investigation provides a systematic assessment of the fitting propensity of models typically considered and compared in SEM, namely, exploratory and confirmatory factor analysis models positing a different number of latent factors or a different hierarchical structure (single-factor, correlated factors, higher-order, and bifactor models). Furthermore, the behavior of commonly used fit indices (CFI, SRMR, RMSEA, TLI) and information criteria (AIC, BIC) in accounting for fitting propensity was assessed. Although the results demonstrated varying degrees of fitting propensity for the models under scrutiny, these differences were mostly driven by the number of free parameters. There was little evidence for additional differences in the functional form of the compared models. Fit indices adjusting for the number of free parameters such as the RMSEA and TLI thus adequately accounted for differences in fitting propensity. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Impact of low muscle mass and bone mineral density on long-term outcomes of acute ischemic stroke: A prospective study.

Impact of low muscle mass and bone mineral density on long-term outcomes of acute ischemic stroke: A prospective study.

Exploring Explicit Attitudes Toward Disability and Professional Identity Among Occupational Therapy and Other Healthcare Students: A Comparative Study

A cross-sectional survey was conducted with 57 occupational therapy students and 74 students from other health-related fields to explore the relationship between professional identity and explicit attitudes toward disability among university students of occupational therapy and students from other health care fields. Data were analyzed using descriptive statistics, non-parametric correlation analyses, and two exploratory linear regression models. Results indicated that occupational therapy students who felt a stronger sense of commitment and energy in their studies were more likely to hold inclusive views toward people with disabilities (p < .05). Furthermore, those in more advanced academic years who experienced a deeper sense of immersion in their university activities reported a greater appreciation for positive outcomes associated with disability (p < .05). These findings underscore the importance of nurturing engagement and inclusive perspectives throughout the occupational therapy curriculum. These findings highlight the need for occupational therapy curricula that emphasize inclusion to strengthen professional identity. Future studies should validate these findings in larger samples and across diverse educational settings.

Self-reported sleep disturbance and inappropriate z-hypnotic use among older adults in general practice

Background Sleep disorders such as insomnia may occur in old age, potentially leading to z-hypnotic use. However, few studies have explored older adults’ self-reported sleep concerns in relation to z-hypnotic use. We aim to examine this relationship. Methods We conducted a cross-sectional study using a web-based questionnaire to assess sleep disturbances and medication use (z-hypnotics, benzodiazepines, and opioid analgesics) among 5,194 older adults through 21 GPs in southeast Norway. The main outcome, inappropriate z-hypnotic use, was defined as self-reported use for ≥4 weeks at ≥ three times per week. We used descriptive statistics and exploratory logistic regression mixed-effects models for data analysis. Results Among the 687 patients included in the study, 22% (N = 153) reported sleep disturbances. Of these, 84% (N = 575) did not use z-hypnotics, while 16% (N = 112) used z-hypnotics, 63% (N = 71) of these used them inappropriately. (≥4 weeks, ≥ three times per week). Patients with sleep disturbances (OR: 12.1, CI: 6.77 − 21.6, p < 0.001), trouble falling or staying asleep (OR: 14.6, CI: 5.04–42.0, p < 0.001), and multiple reasons for disturbances (pain, overthinking, or a family death) (OR: 3.58, CI: 1.85–6.93, p < 0.001) had higher odds of inappropriate z-hypnotic use compared to those with no or occasional disturbances. Men had lower odds (OR: 0.54, CI: 0.30–0.97, p = 0.039) than women. GP prescribing was not associated with inappropriate use, but men had lower odds (OR: 0.34, CI: 0.14–0.84, p = 0.020) when prescribed by male GPs compared to women prescribed by female GPs. Conclusion A high proportion of patients used z-hypnotics inappropriately. This inappropriate use was associated with experienced sleep disturbances, particularly trouble falling asleep, trouble staying asleep, and multiple reasons for sleep disturbances. The prescribing GP was not significantly associated with inappropriate use.

Prognostic and molecular multi-platform analysis of CALGB 40603 (Alliance) and public triple-negative breast cancer datasets

Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous disease that remains challenging to target with traditional therapies and to predict risk. We provide a comprehensive characterization of 238 stage II-III TNBC tumors with paired RNA and DNA sequencing data from the CALGB 40603 (Alliance) clinical trial, along with 448 stage II-III TNBC tumors with paired RNA and DNA data from three additional datasets. We identify DNA mutations associated with RNA-based subtypes, specific TP53 missense mutations compatible with potential neoantigen activity, and a consistently highly altered copy number landscape. We train exploratory multi-modal elastic net models of TNBC patient overall survival to determine the added impact of DNA-based features to RNA and clinical features. We find that mutations and copy number show little to no prognostic value, while RNA expression features, including signatures of T cell and B cell activity, along with stage, improve stratification of TNBC survival risk.

Cannabinoids in hair and their prospective association with mental and physical health outcomes in adolescents.

Cannabinoids in hair and their prospective association with mental and physical health outcomes in adolescents.

Internal structure, reliability and cross-cultural validity of the Warwick-Edinburgh Mental Wellbeing Scale in three European populations

BackgroundThe Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), a questionnaire designed for the assessment of mental well-being, is widely used in different countries and cultures worldwide. However, there is a lack of...

Nomophobia, Psychopathology, and Smartphone-Inferred Behaviors in Youth With Depression: Longitudinal Study.

Smartphones have become an indispensable part of people's lives, and the fear of being without them, what has been termed "no mobile phone phobia" (nomophobia), is a growing phenomenon. The rise of problematic smartphone use highlights the urgent need to explore the intricate relationship between smartphones and human behavior. However, the connections between nomophobia, mental health indicators, smartphone use patterns, and daily activities remain largely underexplored. This study aimed to explore the relationship between young adults with depression and smartphones and investigate nomophobia by analyzing data obtained from a pilot study of depression in a youth cohort. Exploring nomophobia can enhance our understanding of the dynamics between young adults and smartphone use, potentially empowering them to manage and regulate their smartphone use more effectively. During an 8-week period, data collected via smartphone sensors, such as locations and screen status, were gathered from a cohort of 41 individuals diagnosed with major depressive disorder. In addition to passive-sensing smartphone data, the study collected ecological momentary assessments and psychometric measures, including the Nomophobia Questionnaire, which formed the basis of our investigation. We explored statistical associations among smartphone-derived behavioral features, psychometric indicators, and nomophobia. In addition, we used behavioral and psychometric data to develop regression models demonstrating the prediction of nomophobia levels. Our findings revealed that the level of nomophobia was positively associated with depression and negative affect, lower geolocation movements, and higher comfort with smartphone sensing. The exploratory predictive linear regression models demonstrated the feasibility of predicting an individual's Nomophobia Questionnaire score based on their smartphone sensing data. These models effectively used input features derived from both a combination of smartphone sensing data and psychometric measures and from smartphone sensing data alone. Our work is the first to explore the relationship between nomophobia and smartphone sensor data. It provides valuable insights into the predictors of nomophobia level, contributing to the understanding of the relationship between smartphones and human behavior and paving the way for future studies.

The Importance of Publicity and e-WOM in Strengthening Tourist Intentions to Visit Mount Merapi National Park

Studies of tourist behaviour in the national parks’ context are still scant. Thus, this study examines the effect of publicity, e-WOM, destination image, and destination preference on tourists' intentions to visit Merapi National Park. Data collected in Greater Jakarta involved 233 participants. Data were analysed using exploratory factor analysis and structural equation models. As a result, publicity and e-WOM significantly affect destination preference and destination image. In addition, destination image crucially influences destination preference, and destination preference significantly affects visit intention. These findings broaden the study of national tourism parks and volcano tourism.

White-Water Rafting Tourism: Questioning the Role of Destination Image, Destination Personality, Novelty-Seeking, and Perceived Value in Determining Visit Intention

A plethora of tourist behaviour studies have investigated white-water rafting in the existing literature. However, the factors that cause visit intention used in this study still need to be found. For this reason, this study examines the effect of destination image, novelty-seeking, and perceived value on visit intention. The destination of white-water rafting is a river with a certain level of hardness and route length, as offered by the organizers. There were 224 participants, and they were selected using the convenient sampling method. Data analysis used exploratory factor analysis and structural equation models. This study found a significant effect of destination image on novelty-seeking and perceived value. In addition, novelty-seeking significantly affected visit intention and perceived value, whilst perceived value substantially influences visit intention.

Reassessing the fitting propensity of factor models.

Model complexity is a critical consideration when evaluating a statistical model. To quantify complexity, one can examine fitting propensity (FP), or the ability of the model to fit well to diverse patterns of data. The scant foundational research on FP has focused primarily on proof of concept rather than practical application. To address this oversight, the present work joins a recently published study in examining the FP of models that are commonly applied in factor analysis. We begin with a historical account of statistical model evaluation, which refutes the notion that complexity can be fully understood by counting the number of free parameters in the model. We then present three sets of analytic examples to better understand the FP of exploratory and confirmatory factor analysis models that are widely used in applied research. We characterize our findings relative to previously disseminated claims about factor model FP. Finally, we provide some recommendations for future research on FP in latent variable modeling. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Cultural diversity shaped neolithic subsistence in the Carpathian Basin

Stable carbon and nitrogen isotope analysis from archaeological human and animal bone collagen is a powerful tool to enlighten past socio-agricultural systems and their close links to environmental conditions. To assess whether isotopic patterns are a function of cultural behavior or rather determined by environmental diversity, we test the spatio-temporal effects of conditional and multivariate exploratory and environmental models on stable isotope variability in the Neolithic and Chalcolithic Carpathian Basin (6000–2800 BCE). Our results stress that variation in environmental settings influence both the isotope baselines and the subsistence strategies of early agricultural societies. Major shifts in isotopic patterns are, however, culturally-driven, which is particularly visible with the development and intensification of adapted agropastoral practices from 5500 − 5350 BCE and among the diet between different cultural groups. We conclude that socio-cultural diversity was the main driver of dietary habits and isotopic variability in early agropastoral societies of Neolithic Hungary.

The contribution of cognitive disengagement syndrome symptoms to depressive symptoms among pediatric brain tumor survivors.

Pediatric brain tumor survivors (PBTS) are at risk for neurocognitive late effects that can resemble symptoms of cognitive disengagement syndrome (CDS). In the current study, we compared the CDS symptoms of PBTS to those of healthy comparison classmates (CC) and examined whether CDS might explain group differences in depressive symptoms. We also explored whether CDS symptoms were associated with engagement-based coping strategies and stress responses, thereby testing one mechanism by which CDS could lead to affective difficulties. Data were from a larger, multisite study examining the psychosocial impact of pediatric brain tumors on survivors (ages 8-15; 1- to 5-year post-treatment) and their families. PBTS (n = 68) and CC (n = 64) were matched on age and sex and reported depressive symptoms, coping strategies, and stress responses during a home-based assessment. Caregivers reported child CDS symptoms. Analyses used multiple regression with post hoc bootstrapping to test indirect effects. CDS symptoms were elevated in PBTS compared to CC (d = 0.49, p = .005), and elevated CDS symptoms partially explained higher depressive symptoms for PBTS. Exploratory serial mediation models suggested that coping strategies and stress responses did not account for the relationship between CDS and depressive symptoms. Alternative mechanisms to explain the association between CDS and depressive symptoms are discussed. CDS may be a relevant framework to understand why some PBTS are at risk for depressive symptoms. Although additional research is needed, clinicians should consider screening for CDS symptoms to assess risk for depressive symptoms in survivorship.

Neuroanatomical associations with autistic characteristics in those with acute anorexia nervosa and weight-restored individuals.

Common neuroanatomical regions are associated with both states of anorexia nervosa (AN) and autistic characteristics, but restoration of body mass index (BMI) has been associated with decreased presentation of autistic characteristics in some individuals with AN. This study aims to examine neuroanatomical correlates associated with autistic characteristics in those with acute anorexia nervosa (ac-AN) and those previously diagnosed with AN but whose weight has been restored (WR). In total, 183 individuals (healthy controls [HCs]=67; n[ac-AN]=68; n[WR]=48) from the Brain imaging of Emotion And Cognition of adolescents with Anorexia Nervosa (BEACON) study were included, with autistic characteristics determined in both ac-AN and WR individuals (n=116). To further examine BMI, ac-AN and WR group associations were compared. Random forest regression (RFR) models examined whether autistic characteristics and morphology of the anterior cingulate cortex (ACC), middle frontal gyrus (MFG), and orbitofrontal cortex (OFC) were able to predict future levels of social anhedonia and alexithymia. Group-wise differences were identified within the volume and surface area of the MFG and OFC, which were unrelated to BMI. Autistic characteristics were inversely associated with MFG and ACC volume, with differences in associations between ac-AN and WR groups seen in the surface area of the MFG. RFR models identified moderate-to-weak performance and found that autistic characteristics were not important predictive features in a priori and exploratory models. Findings suggest that the presence of autistic characteristics in those with ac-AN are associated with the volume of the MFG and are unrelated to BMI restoration.

Randomized clinical trial of peer integrated collaborative care intervention after physical injury

ObjectivesThe goal of the current study was to assess the effectiveness of a peer integrated collaborative care intervention for postinjury outcomes.MethodsInjury survivors ≥18 years of age were screened for post-traumatic...

Patient-Reported Experience Measures for In- and Outpatients in Mental Health and Substance Use Services: Psychometric Properties and Results From a Nationwide Survey in Finland.

We implemented the first national patient experience survey, with novel patient-reported experience measures (PREMs), in out- and inpatient mental health and substance use services in Finland. The Outpatient Experience Scale (OPES) and the Inpatient Experience Scale (IPES) were co-designed with experts by experience and professionals. The survey was carried out in 2021 in 435 treatment facilities. We applied bi-factor analysis of ordinal indicators to prespecified and exploratory models. We received 8794 outpatient and 1112 inpatient responses. Both the OPES and the IPES were essentially unidimensional, with high internal consistency (omega 0.98 in both) and strong factor loadings. The Net Promoter Score item was a fairly poor indicator of overall satisfaction. The most positive experiences were related to respect and acceptance, while statements related to receiving information and inclusion of significant others in the treatment process received more critical feedback. The best experience was in integrated mental health and substance use services. Involuntarily admitted patients had the most negative patient experiences. The new PREMs proved to work well in measuring patient experience. Service users generally reported positive experiences. The primary service development need is sharing information with patients.

¿En qué áreas podemos mejorar en artroplastia de rodilla en Hospital Clínico Universidad de Chile? Análisis por grupo relacionado a diagnóstico (GRD) 2018 a 2022

Introduction: Knee arthroplasty (TKA) is crucial for treating severe osteoarthritis. The pandemic decreased the number of procedures, leading to significant waiting list. The Hospital Clínico de la Universidad de Chile (HCUCH) is a leader in these surgeries and seeks to optimize its efficiency. Material and Method: Ecological study. Data from Diagnosis Related Groups (DRG) and Ti-Cares from 2018 to 2022 were analyzed. Knee arthroplasty cases were included and hospital stay, use of intermediate beds, surgical time and operating room efficiency were analyzed through exploratory analysis and statistical models. Results: A total of 658 procedures were recorded. The mean age was 66 years and hospital stay was reduced from 4 to 3 days, with a more pronounced decrease after 2020. The use of intermediate beds was frequent (47.87%). Factors such as age, diabetes and comorbidities influenced this usage, with 2019 and 2021 being protective years. Conclusion: Improving management in HCUCH involves reducing hospital stay, optimizing the use of intermediate beds and increasing operating room efficiency. Strategies such as early discharge and use of technology can achieve greater efficiency in procedures, benefiting both patients and the public health system.