Intraindividual Analyses Research Articles

Effect of temporal resolution on calcium scoring: insights from photon-counting detector CT.

To intra-individually investigate the variation of coronary artery calcium (CAC), aortic valve calcium (AVC), and mitral annular calcium (MAC) scores and the presence of blur artifacts as a function of temporal resolution in patients undergoing non-contrast cardiac CT on a dual-source photon counting detector (PCD) CT. This retrospective, IRB-approved study included 70 patients (30 women, 40 men, mean age 78 ± 9 years) who underwent ECG-gated cardiac non-contrast CT with PCD-CT (gantry rotation time 0.25s) prior to transcatheter aortic valve replacement. Each scan was reconstructed at a temporal resolution of 66 ms using the dual-source information and at 125 ms using the single-source information. Average heart rate and heart rate variability were calculated from the recorded ECG. CAC, AVC, and MAC were quantified according to the Agatston method on images with both temporal resolutions. Two readers assessed blur artifacts using a 4-point visual grading scale. The influence of average heart rate and heart rate variability on calcium quantification and blur artifacts of the respective structures were analyzed by linear regression analysis. Mean heart rate and heart rate variability during data acquisition were 76 ± 17 beats per minute (bpm) and 4 ± 6bpm, respectively. CAC scores were smaller on 66 ms (median, 511; interquartile range, 220-978) than on 125 ms reconstructions (538; 203-1050, p < 0.001). Median AVC scores [2809 (2009-3952) versus 3177 (2158-4273)] and median MAC scores [226 (0-1284) versus 251 (0-1574)] were also significantly smaller on 66ms than on 125ms reconstructions (p < 0.001). Reclassification of CAC and AVC risk categories occurred in 4% and 11% of cases, respectively, whereby the risk category was always overestimated on 125ms reconstructions. Image blur artifacts were significantly less on 66ms as opposed to 125 ms reconstructions (p < 0.001). Intra-individual analyses indicate that temporal resolution significantly impacts on calcium scoring with cardiac CT, with CAC, MAC, and AVC being overestimated at lower temporal resolution because of increased motion artifacts eventually leading to an overestimation of patient risk.

Combining atomic force microscopy and fluorescence-based techniques to explore mechanical properties of naive and ischemia-affected brain regions in mice

Knowledge of the brain’s structure and function is essential for understanding processes in health and disease. Histochemical and fluorescence-based techniques have proven beneficial in characterizing brain regions and cellular compositions in pre-clinical research. Atomic force microscopy (AFM) has been introduced for mechanical tissue characterization, which may also help investigate pathophysiological aspects in disease-related models such as stroke. While combining AFM and fluorescence-based techniques, this study explored the mechanical properties of naive and ischemic brain regions in mice. Ischemia-affected regions were identified by the green signal of fluorescein isothiocyanate-conjugated albumin. A semi-automated protocol based on a brain atlas allowed regional allocations to the neocortex, striatum, thalamus, hypothalamus, hippocampus, and fiber tracts. Although AFM led to varying measurements, intra-individual analyses indicated a gradually increased tissue stiffness in the neocortex compared to subcortical areas, i.e., the striatum and fiber tracts. Regions affected by ischemia predominantly exhibited an increased tissue stiffness compared to those of the contra-lateral hemisphere, which might be related to cellular swelling. This study indicated intra-individual differences in mechanical properties among naive and ischemia-affected brain regions. The combination of AFM, semi-automated regional allocations, and fluorescence-based techniques thus qualifies for mechanical characterizations of the healthy and disease-affected brain in pre-clinical research.

Transbronchial needle aspiration combined with cryobiopsy in the diagnosis of mediastinal diseases: a multicentre, open-label, randomised trial

Transbronchial mediastinal cryobiopsy is a novel sampling technique for mediastinal disease. Despite the possibility of lung cancer misdiagnosis, the improved diagnostic yield of this approach for non-lung-cancer lesions compared with standard endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) highlights its diagnostic potential as a complementary technique to conventional biopsy. We aimed to evaluate the safety profile and added value of the combined use of transbronchial mediastinal cryobiopsy and standard EBUS-TBNA for the diagnosis of mediastinal diseases. We conducted an open-label, randomised trial at three hospital sites in Europe and Asia. Eligible patients were aged 15 years or older, with at least one mediastinal lesion of 1 cm or longer in the short axis that required diagnostic bronchoscopy. Participants were randomly assigned (1:1) using a block randomisation scheme generated by a computer (block size of four participants based on a random table from an independent statistician) to the combined use of EBUS-TBNA and transbronchial mediastinal cryobiopsy (combined group) or EBUS-TBNA alone (control group). Because of the nature of the intervention, neither participants nor investigators were masked to group assignment. The coprimary outcomes were differences in procedure-related complications and diagnostic yield (defined as the proportion of participants for whom mediastinal biopsy led to a definitive diagnosis), assessed in the full analysis set, including all the patients who met the eligibility criteria and had a biopsy. A fully paired, intraindividual diagnostic analysis in participants who had both needle aspiration and mediastinal cryobiopsy was conducted, in addition to interindividual comparisons. This trial is now complete and is registered with ClinicalTrials.gov, NCT04572984. Between Oct 12, 2020, and Sept 9, 2021, 297 consecutive patients were assessed for eligibility and 271 were enrolled and randomly assigned to the combined group (n=136) or the control group (n=135). The addition of cryobiopsy to standard sampling significantly increased the overall diagnostic yield for mediastinal lesions, as shown by both interindividual (126 [93%] of 136 participants in the combined group vs 109 [81%] of 135 in the control group; risk ratio [RR] 1·15 [95% CI 1·04-1·26]; p=0·0039) and intraindividual (126 [94%] of 134 vs 110 [82%] of 134; RR 1·15 [95% CI 1·05-1·25]; p=0·0026) analyses. In subgroup analyses in the intraindividual population, diagnostic yields were similar for mediastinal metastasis (68 [99%] of 69 participants in the combined group vs 68 [99%] of 69 in the control group; RR 1·00 [95% CI 0·96-1·04]; p=1·00), whereas the combined approach was more sensitive than standard needle aspiration in benign disorders (45 [94%] of 48 vs 32 [67%] of 48; RR 1·41 [95% CI 1·14-1·74]; p=0·0009). The combined approach also resulted in an improved suitability of tissue samples for molecular and immunological analyses of non-small-cell lung cancer. The incidence of adverse events related to the biopsy procedure did not differ between trial groups, as grade 3-4 airway bleeding occurred in three (2%) patients in the combined group and two (1%) in the control group (RR 0·67 [95% CI 0·11-3·96]; p=1·00). There were no severe complications causing death or disability. The addition of mediastinal cryobiopsy to standard EBUS-TBNA resulted in a significant improvement in diagnostic yield for mediastinal lesions, with a good safety profile. These data suggest that this combined approach is a valid first-line diagnostic tool for mediastinal diseases. National Natural Science Foundation of China.

Longitudinal associations of fiber, vegetable, and fruit intake with quality of life and fatigue in colorectal cancer survivors up to 24 months posttreatment

ABSTRACTBackgroundThe increasing colorectal cancer (CRC) survivor population highlights the need for dietary recommendations in order to enhance health-related quality of life (HRQoL) and alleviate symptoms of fatigue, chemotherapy-induced peripheral neuropathy (CIPN), and gastrointestinal problems.ObjectivesBecause of the therapeutic potential of dietary fiber on the gut, we aim to assess longitudinal associations of postdiagnostic dietary fiber, fruit, and vegetable intake, a major source of dietary fiber, with HRQoL, fatigue, CIPN, and gastrointestinal symptoms in CRC survivors from 6 wk to 24 mo posttreatment.MethodsIn a prospective cohort among stage I–III CRC survivors (n = 459), 5 repeated study measurements between diagnosis and 24 mo posttreatment were executed. Dietary fiber intake and fruit and vegetable intake were measured by 7-d dietary records. HRQoL, fatigue, CIPN, and gastrointestinal symptoms were measured by validated questionnaires. We applied confounder-adjusted linear mixed models to analyze longitudinal associations from 6 wk until 24 mo posttreatment and used hybrid models to disentangle the overall association into intraindividual changes and interindividual differences over time.ResultsHigher dietary fiber intake and fruit and vegetable intake were longitudinally associated with statistically significant better physical functioning and less fatigue. Intraindividual analyses showed that an increase of 10 g/d in dietary fiber within individuals over time was associated with better physical functioning (β: 2.3; 95% CI: 0.1, 4.4), role functioning (ability to perform daily activities; 5.9; 1.5, 10.3), and less fatigue (−4.1; −7.7, −0.5). An average increase in fruit and vegetable intake of 100 g/d between individuals over time was predominantly associated with less fatigue (−2.2; −4.2, −0.3). No associations were found with CIPN and gastrointestinal symptoms.ConclusionsOur results suggest that increasing dietary fiber, fruit, and vegetable intake is related to better physical and role functioning and less fatigue in the first 2 y after the end of treatment for CRC.

Relationships between postural balance, aiming technique and performance in elite rifle shooters

ABSTRACT The aim of the present study was to examine the relationships between postural balance, aiming technique and shooting score among elite rifle shooters at an intra- and inter-individual level. Twelve elite athletes belonging to China national team performed 60 shots under test conditions. Shooting score was used to indicate performance and footscan1.0 force platform was used to measure postural balance variables, while a SCATT MX-02 optoelectronic training device was used to measure aiming technique parameters. Inter-individual analyses indicated that postural balance was negatively correlated with shooting score (r = −0.697, P < 0.05) and aiming accuracy (r = −0.810, P < 0.01). Postural balance showed a positive correlation with the stability of hold (r = 0.923, P < 0.01) and stability of triggering (r = 0.564, P < 0.05). Intra-individual analyses indicated that there was a significant correlation between postural balance and performance, aiming accuracy and stability of hold for all shooters. Postural balance was related to the stability of triggering for six shooters. Postural balance was not statistically significant with aiming time on an intra- and inter-individual basis (P > 0.05). Our data indicated that postural balance was very important in aiming technique and shooting performance among elite rifle shooters. Additional balance programmes should be encouraged to improve a shooter’s postural balance.

The ability of heart rate or perceived exertion to predict oxygen uptake varies across exercise modes in persons with tetraplegia.

Descriptive study. To examine grouped and intra-individual relationships between 1) exercise intensity and heart rate (EI-HR); 2) EI and oxygen uptake (EI-VO2); 3) VO2 and HR (VO2-HR); and 4) perceived exertion and VO2 (PE-VO2) in persons with tetraplegia (C4/5-C8) during different modes of exercise. Community in Winnipeg, Canada. Participants exercised at 3 graded intensities during arm ergometry (ERG), wheeling indoors on cement (MWC), or hand-cycling outdoors (HC). EI (Watts, km/hr) and VO2, HR and PE were recorded. 22 persons completed ERG, 14/22 also completed MWC and 5/22 completed ERG, MWC and HC. Regression analysis of grouped data showed a significant relationship between EI-VO2 but not for EI-HR or HR-VO2. Intra-individual analyses showed a strong correlation (r or ρ > 0.7) for VO2-HR for 16/22 during ERG. In the participants completing multiple exercise modes, a strong VO2-HR relationship was present in 12/14 in ERG, but in only 6/14 in MWC. The 5 persons exercising with all 3 modes had a strong HR-VO2 relationship in 5/5 for ERG, 2/5 in MWC and 1/5 in HC. A strong relationship for PE-VO2 was observed in a higher proportion of participants (versus HR-VO2) during MWC (9/14) and HC (2/4). Within the same individual, the HR-VO2 relationship varies across modes, despite exercising over similar ranges of steady-state VO2. HR appears less able to predict VO2 compared to PE. Based on these new findings, systematic investigation of the HR-VO2 relationship across modes of exercise in tetraplegia is warranted.

On the track of bruxism: quantitative, qualitative and intraindividual analyses of the BruxChecker in daily clinical routine

Introduction Bruxism is a relevant topic in daily dental routine. Bruxism has to be confirmed by instrumental procedures. The BruxChecker (BC) is an inexpensive instrument that does not affect the stomatognathic system while used and is suitable for routine use in diagnostics and follow-ups. A novel digital approach for analyzing BC is described, based on first standard values. Material and Method Within this pilot study, 30 participants (15 males, 15 females) used an upper BC for one night and a lower BC during another night. A standardized digitalization process and a unique software application measured all Tooth Contact Areas (TCAs) on the BC: number and size of each TCAs for each occlusal segment. Results The mean number of TCAs on upper BC is 28.17 (sd +/-7.84), for lower BC 27.70 (sd +/-7.41). The mean size (mm2) of TCAs on upper BC is 71.81 (sd +/-51.27), for lower BC 68.11 (sd +/-42.64). There are only minor, not significant, gender differences regarding the number and size of TCAs. The transversal right-left TCAs distribution is almost symmetrical; a slightly increased difference can be observed for the size of TCAs right and left. The sagittal distribution of the TCAs shows the dominance of the posterior contacts, while the intermediate segments are least involved. Conclusion Within the limits of this pilot study and based on the digital analyses of TCAs on BC, the paper presents first standard values and a two-step systematic individual BC analysis.

The association between circulating levels of vitamin D and inflammatory markers in the first 2 years after colorectal cancer diagnosis.

Background:Calcitriol, the active form of vitamin D, may inhibit colorectal cancer (CRC) progression, which has been mechanistically linked to an attenuation of a pro-inflammatory state. The present study investigated the associations between circulating 25 hydroxy vitamin D3 (25(OH)D3) levels and inflammatory markers (IL10, IL8, IL6, TNFα and hsCRP) in the 2 years following CRC diagnosis.Methods:Circulating 25(OH)D3 levels and inflammatory markers were assessed at diagnosis, after 6, 12 and 24 months from 798 patients with sporadic CRC participating in two prospective cohort studies. Associations between 25(OH)D3 levels and individual inflammatory markers as well as a summary inflammatory z-score were assessed at each time point by multiple linear regression analyses. To assess the association between 25(OH)D3 and inflammatory markers over the course of 2 years, linear mixed model regression analyses were conducted.Results:Higher 25(OH)D3 levels were associated with lower IL6 levels at diagnosis, at 6 months after diagnosis and over the course of 2 years (β −0.06, 95% CI −0.08 to −0.04). In addition, 25(OH)D3 levels were inversely associated with the summary inflammatory z-score at diagnosis and over the course of 2 years (β −0.17, 95% CI −0.25 to −0.08). In addition, a significant inverse association between 25(OH)D3 levels and IL10 was found over the course of 2 years. Intra-individual analyses showed an inverse association between 25(OH)D3 and IL10, IL6 and TNFα. No statistically significant associations between 25(OH)D3 and IL8 and hsCRP levels were observed.Conclusions:Serum 25(OH)D3 levels were inversely associated with the summary inflammatory z-score and in particular with IL6 in the years following CRC diagnosis. This is of potential clinical relevance as IL6 has an important role in chronic inflammation and is also suggested to stimulate cancer progression. Further observational studies should investigate whether a possible 25(OH)D3-associated reduction of inflammatory mediators influences treatment efficacy and CRC recurrence.

Outstanding intraindividual genetic diversity in fissiparous planarians (Dugesia, Platyhelminthes) with facultative sex

BackgroundPredicted genetic consequences of asexuality include high intraindividual genetic diversity (i.e., the Meselson effect) and accumulation of deleterious mutations (i.e., Muller’s Ratchet), among others. These consequences have been largely studied in parthenogenetic organisms, but studies on fissiparous species are scarce. Differing from parthenogens, fissiparous organisms inherit part of the soma of the progenitor, including somatic mutations. Thus, in the long term, fissiparous reproduction may also result in genetic mosaicism, besides the presence of the Meselson effect and Muller’s Ratchet. Dugesiidae planarians show outstanding regeneration capabilities, allowing them to naturally reproduce by fission, either strictly or combined with sex (facultative). Therefore, they are an ideal model to analyze the genetic footprint of fissiparous reproduction, both when it is alternated with sex and when it is the only mode of reproduction.ResultsIn the present study, we generate and analyze intraindividual cloned data of a nuclear and a mitochondrial gene of sexual, fissiparous and facultative wild populations of the species Dugesia subtentaculata. We find that most individuals, independently of their reproductive strategy, are mosaics. However, the intraindividual haplotype and nucleotide diversity of fissiparous and facultative individuals is significantly higher than in sexual individuals, with no signs of Muller’s Ratchet. Finally, we also find that this high intraindividual genetic diversity of fissiparous and facultative individuals is composed by different combinations of ancestral and derived haplotypes of the species.ConclusionsThe intraindividual analyses of genetic diversity point out that fissiparous reproduction leaves a very special genetic footprint in individuals, characterized by mosaicism combined with the Meselson effect (named in the present study as the mosaic Meselson effect). Interestingly, the different intraindividual combinations of ancestral and derivate genetic diversity indicate that haplotypes generated during periods of fissiparous reproduction can be also transmitted to the progeny through sexual events, resulting in offspring showing a wide range of genetic diversity and putatively allowing purifying selection to act at both intraindividual and individual level. Further investigations, using Dugesia planarians as model organisms, would be of great value to delve into this new model of genetic evolution by the combination of fission and sex.

Quadruple Negative Breast Cancers (QNBC) Demonstrate Subtype Consistency among Primary and Recurrent or Metastatic Breast Cancer

PURPOSE: Despite the availability of current standards of care treatments for triple negative breast cancer (TNBC), many patients still die from this disease. Quadruple negative tumors, which are TNBC tumors that lack androgen receptor (AR), represent a more aggressive subtype of TNBC; however, the molecular features are not well understood. METHODS: Immunohistochemistry of estrogen receptor (ER), progesterone receptor (PR), HER2, and AR was determined in 244 primary and 630 recurrent/metastatic site biopsies. Expression was correlated with a panel of 25 cancer-related genes and proteins by IHC and in situ hybridization (ISH). RESULTS: We observed that 80.2% (65 of 81) of primary TNBC tumors and 75.7% (159 of 210) of recurrent/metastatic TNBC tumors are QNBC. Bivariate fit analysis demonstrated that QNBC (n = 224) significantly (P < .03) correlated with younger aged patients at initial biopsy compared to AR positive TNBC patients (n = 51). In paired primary tissue samples and primary to recurrent/metastatic samples, at least 70% Luminal, HER2 enriched, and QNBC subtype did not change molecular profile. But, TNBC seems to be the “unstable” subtype. Within the total cohort, discordance in molecular profiles was identified in both synchronous (20%) and asynchronous (21%) intra-individual analyses. Irrespective of sample type, (Synchronous or Asynchronous), QNBC demonstrated higher concordant than TNBC. IHC and ISH results of the cancer related genes, demonstrated that gene/protein expression differ by molecular profile: TNBC (HR-/HER2-, AR+) and QNBC (HR-/HER2-, AR-). IHC in metastatic tumors, showed that the percentage of tumors positive of EGFR were higher, while PTEN and TLE3 were lower in QNBC compared to TNBC. CONCLUSION: Standard treatment of Breast Cancer (BC) relies on reliable assessment by IHC analysis of ER, PR, and HER2. Our analyses suggest that the heterogeneity of TNBC is at least partially associated with the presence or absence of AR expression, suggesting that QNBC should be considered as a clinically relevant BC subtype. IHC analysis of AR appears to be a practical assay to determine the most aggressive TNBC subtypes and identifies tumors that could benefit from available targeted therapies.

Highly engaged but burned out: intra-individual profiles in the US workforce

PurposeThe purpose of this paper is to use the job demands-resources model to investigate intra-individual engagement-burnout profiles, and demands-resources profiles.Design/methodology/approachA representative sample of the US workforce was surveyed online. Latent profile analysis (LPA) and configural frequency analysis examined intra-individual profiles and their inter-relations.FindingsA negative inter-individual correlation between engagement and burnout suggested that burnout tends to be lower when engagement is high, but intra-individual analyses identified both aligned engagement-burnout profiles (high, moderate, and low on both variables), and discrepant profiles (high engagement – low burnout; high burnout – low engagement). High engagement and burnout co-occurred in 18.8 percent of workers. These workers reported strong mixed (positive and negative) emotions and intended to leave their organization. Another LPA identified three demands-resources profiles: low demands – low resources, but moderate self-efficacy, low workload and bureaucracy demands but moderate information processing demands – high resources, and high demands – high resources. Workers with high engagement – high burnout profiles often reported high demands – high resources profiles. In contrast, workers with high engagement – low burnout profiles often reported profiles of high resources, moderate information processing demands, and low other demands.Originality/valueThis study examined the intersection of intra-individual engagement-burnout profiles and demands-resources profiles. Previous studies examined only one of these sides or relied on inter-individual analyses. Interestingly, many employees appear to be optimally engaged while they are burned-out and considering to leave their jobs. Demands and resources facets were distinguished in the LPA, revealing that some demands were associated with resources and engagement.

Improvement of serum lipids concentration in a general population historical cohort. Why?

BackgroundKnowledge about the harmful effects of high levels of low-density lipoprotein cholesterol (cLDL) in adults increased after the publication of various guidelines, leading to closer control and more treatment. We hypothesized that these health care changes would result in an overall improvement in the lipid profile of the population. ObjectiveTo determine the evolution of the lipid profile in the population of Spain from the Diet and Risk of Cardiovascular Disease in Spain cohort. MethodsA comparison was made between the baseline population-based probabilistically sampled DRECE cohort (DRECE 1 study, 1992–1994, n=4787) and its 13 years later revisit (DRECE 3 study, 2005–2007). A cross-sectional comparison was made of the overall population of DRECE1 and DRECE3, including only individuals aged 20 to 60 years (inter-individual variations). For subjects participating in both DRECE1 and DRECE3 (n=1039), individual variations over time (intra-individual analyses) were examined. ResultsIn the overall population, the prevalence of lipid-lowering therapy increased from 3.8% in DRECE1 to 10.7% in DRECE3. Comparing the lipid profile of the population aged 20–60 years in DRECE1 with the same age group in DRECE3, an overall decrease is observed in total cholesterol from a mean of 203.31mg/dl (SD 43.51) in 1992–1994 to 196.31mg/dl (SD 38.53) in 2005–2007, and in cLDL from a mean of 125.78mg/dl (SD 38.53) to 121.37mg/dl (SD 34.22). The proportion of the population with total cholesterol >200mg/dl decreased from 51% in DRECE1 to 47% in DRECE3, although this difference did not reach statistical significance (p=0.077). As regards the intra-individual analyses, total cholesterol increased from DRECE1 to DRECE3 in men and women younger than 40 years at baseline, but decreased in those who were older. Index of individuality for total cholesterol, cLDL, cHDL and triglycerides ranged from 0.53 to 0.87. ConclusionsThe lipid profile of the Spanish population improved between 1992–1994 and 2005–2007. Within individuals, lipid concentrations, especially total cholesterol and cLDL have increased, although the trend is favorable in the middle-age group (40–59 years). These changes seem to be due to several causes, impacted by dietary and lifestyle factors, and also by a greater emphasis in lipid-lowering therapy in middle-aged people. Lipid parameters had a low index of individuality, which limits their usefulness as population reference values.

Improvement of serum lipids concentration in a general population historical cohort. Why?

BackgroundKnowledge about the harmful effects of high levels of low-density lipoprotein cholesterol (cLDL) in adults increased after the publication of various guidelines, leading to closer control and more treatment. We hypothesized that these health care changes would result in an overall improvement in the lipid profile of the population. ObjectiveTo determine the evolution of the lipid profile in the population of Spain from the Diet and Risk of Cardiovascular Disease in Spain cohort. MethodsA comparison was made between the baseline population-based probabilistically sampled DRECE cohort (DRECE 1 study, 1992–1994, n=4787) and its 13 years later revisit (DRECE 3 study, 2005–2007). A cross-sectional comparison was made of the overall population of DRECE1 and DRECE3, including only individuals aged 20 to 60 years (inter-individual variations). For subjects participating in both DRECE1 and DRECE3 (n=1039), individual variations over time (intra-individual analyses) were examined. ResultsIn the overall population, the prevalence of lipid-lowering therapy increased from 3.8% in DRECE1 to 10.7% in DRECE3. Comparing the lipid profile of the population aged 20–60 years in DRECE1 with the same age group in DRECE3, an overall decrease is observed in total cholesterol from a mean of 203.31mg/dl (SD 43.51) in 1992–1994 to 196.31mg/dl (SD 38.53) in 2005–2007, and in cLDL from a mean of 125.78mg/dl (SD 38.53) to 121.37mg/dl (SD 34.22). The proportion of the population with total cholesterol >200mg/dl decreased from 51% in DRECE1 to 47% in DRECE3, although this difference did not reach statistical significance (p=0.077). As regards the intra-individual analyses, total cholesterol increased from DRECE1 to DRECE3 in men and women younger than 40 years at baseline, but decreased in those who were older. Index of individuality for total cholesterol, cLDL, cHDL and triglycerides ranged from 0.53 to 0.87. ConclusionsThe lipid profile of the Spanish population improved between 1992–1994 and 2005–2007. Within individuals, lipid concentrations, especially total cholesterol and cLDL have increased, although the trend is favorable in the middle-age group (40–59 years). These changes seem to be due to several causes, impacted by dietary and lifestyle factors, and also by a greater emphasis in lipid-lowering therapy in middle-aged people. Lipid parameters had a low index of individuality, which limits their usefulness as population reference values.

The role of daily autonomous and controlled educational goals in students’ academic emotion states: An experience sampling method approach

The present study examines antecedents of university students' academic emotions (Pekrun, Goetz, Titz, & Perry, 2002) in the context of self-determination theory (SDT; Deci & Ryan, 1985; 2000), using real-time assessment and intra-individual analyses. We investigated whether daily autonomous and controlled-motivated educational goals predicted students' academic emotions. University students (N = 55) completed smartphone diaries over 14 consecutive days. The two-week intensive longitudinal data were organized in a hierarchical three-level structure, with situations (Level 1) nested within days (Level 2) nested within students (Level 3). Students' goal motivation was assessed in morning questionnaires, and academic emotions in three daytime questionnaires. The results of the multilevel structural equation models showed that setting self-determined autonomous educational goals predicted positive emotions, whereas controlled motivation predicted negative emotions in everyday academic situations, applying both to within-person processes and between-person differences. Both kinds of goal motivation, autonomous and controlled, were associated with determination in students’ daily lives.

Treatment outcome in orthognathic surgery—A prospective randomized blinded case-controlled comparison of planning accuracy in computer-assisted two- and three-dimensional planning techniques (part II)

PurposeThe aim of the present study was to compare the accuracy of two-dimensional (2D) and three-dimensional (3D) prediction methods. The hypothesis was that a 3D technique would give a more accurate outcome of the postoperative result. Material and methodsPatients with severe class III occlusion were included and planed with both a 2D and 3D prediction technique. They were there after randomly subdivided into a control (2D) and test (3D) group and treated according to the technique randomized for. Cephalometric measurements from 2D and 3D predictions were compared with 12-month follow-up respectively. Together with an analysis of tracing error, placements of 3580 cephalometric markers, 2460 measurements, 680 intra-individual analyses and 1200 preop/postop comparisons were performed in 57 individuals. ResultsStatistically significant differences for accuracy between the two groups were seen for 11/NSL-112/NSL2 and for A-A2 (p < 0.05). Both groups showed a high level of accuracy for SNA and SNB. The test group also showed a relatively high level of accuracy for 11/NSL and for the A-point. No prediction method achieves a perfect accuracy. As expected from this, measuring accuracy within each group showed statistically significant difference for all markers and cephalometric measurements (p < 0.001). Mandibular markers showed greater differences than maxillary markers. ConclusionThe present study indicates an equal high accuracy in predicting facial outcome for both studied techniques. However, in patients with asymmetry the three-dimensional technique has an obvious advantage.

Variability in Radiation Dose From Repeat Identical CT Examinations: Longitudinal Analysis of 2851 Patients Undergoing 12,635 Thoracoabdominal CT Scans in an Academic Health System.

The purpose of this study was to conduct longitudinal analyses of radiation dose data from adult patients undergoing clinically indicated, repeat identical thoracoabdominal CT examinations. Radiation dose data were electronically collected from 2851 subjects undergoing 12,635 repeat identical CT scans (mean number of scans per patient, 4.8; range, 2-33) in one health system. Included CT protocols were chest-abdomen-pelvis with contrast administration (n = 4621 CT studies of 1064 patients), abdomen-pelvis with contrast administration (n = 876 CT studies of 261 patients), renal stone (n = 1053 CT studies of 380 patients), and chest (n = 6085 CT studies of 1146 patients) without contrast administration. A radiation-tracking software infrastructure was adopted to extract data from DICOM headers in PACS. Size-specific dose estimate (SSDE) was calculated. A trend was observed toward global reduction in SSDE values with all protocols investigated (chest-abdomen-pelvis slope, -1.78; abdomen-pelvis slope, -0.82; renal stone slope, -0.83; chest slope, -0.47; p < 0.001 for all comparisons). The intraindividual analyses of radiation dose distribution showed widespread variability in SSDE values across the four protocols investigated (chest-abdomen-pelvis mean coefficient of variance, 14.02 mGy; abdomen-pelvis mean coefficient of variance, 10.26 mGy; renal stone mean coefficient of variance, 34.18 mGy; chest mean coefficient of variance, 6.74 mGy). Although there is a trend toward global reduction in radiation doses, this study showed widespread variability in the radiation dose that each patient undergoing identical repeat thoracoabdominal CT protocols absorbs. These data may provide a foundation for the future development of best-practice guidelines for patient-specific radiation dose monitoring.

Accuracy, reliability, feasibility and nurse acceptance of a subcutaneous continuous glucose management system in critically ill patients: a prospective clinical trial.

BackgroundContinuous glucose monitoring (CGM) has not yet been implemented in the intensive care unit (ICU) setting. The purpose of this study was to evaluate reliability, feasibility, nurse acceptance and accuracy of the Medtronic Sentrino® CGM system in critically ill patients.Methods Sensors were inserted into the subcutaneous tissue of the patient’s thigh, quantifying interstitial glucose concentration for up to 72 h per sensor. Reliability and feasibility analysis included frequency of data display, data gaps and reasons for sensor removal. We surveyed nurse acceptance in a questionnaire. For the accuracy analysis, we compared sensor values to glucose values obtained via blood gas analysis. Potential benefits of CGM were investigated in intra-individual analyses of factors, such as glycemic variability or time in target range achieved with CGM compared to that achieved with intermittent glucose monitoring.ResultsThe device generated 68,655 real-time values from 31 sensors in 20 critically ill patients. 532 comparative blood glucose values were collected. Data were displayed during 32.5 h [16.0/62.4] per sensor, which is 45.1 % of the expected time of 72 h and 84.8 % of 37.9 h actual monitoring time. 21 out of 31 sensors were removed prematurely. 79.1 % of the nursing staff rated the device as not beneficial; the response rate was one-third. Mean absolute relative difference was 15.3 % (CI 13.5–17.0 %). Clarke error grid: 76.9 % zone A, 21.6 % zone B, 0.2 % zone C, 0.9 % zone D, 0.4 % zone E. Bland–Altman plot: mean bias +0.53 mg/dl, limits of agreement +64.6 and −63.5 mg/dl. Accuracy deteriorated during elevated glycemic variability and in the hyperglycemic range. There was no reduction in dysglycemic events during CGM compared to 72 h before and after CGM. If CGM was measuring accurately, it identified more hyperglycemic events when compared to intermittent measurements. This study was not designed to evaluate potential benefits of CGM on glucose control.ConclusionsThe subcutaneous CGM system did not perform with satisfactory accuracy, feasibility, or nursing acceptance when evaluated in 20 medical-surgical ICU patients. Low point accuracy and prolonged data gaps significantly limited the potential clinical usefulness of the CGM trend data. Accurate continuous data display, with a MARD < 14 %, showed potential benefits in a subgroup of our patients.Trial registration NCT02296372; Ethic vote Charité EA2/095/14Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-016-0167-z) contains supplementary material, which is available to authorized users.

Seasonal variations in serum 25-hydroxy vitamin D levels in a Swedish cohort.

To study seasonal inter-individual and intra-individual variations in serum 25-hydroxy vitamin D (25(OH)D) and to explore parameters associated with 25(OH)D in a healthy Swedish adult population. 540 blood donors (60 % men; mean age 41 ± 13 years) and 75 thrombocyte donors (92 % men, aged 46 ± 11 years) were included. Serum was collected during 12 months and analyzed for 25(OH)D and parathyroid hormone (S-iPTH). The blood donors answered questionnaires concerning vitamin D supplements, smoking, physical activity, sunbed use and sun holidays. Repeated serum samples were collected from the thrombocyte donors to study the intra-individual variations in S-25(OH)D. S-25(OH)D varied greatly over the year correlating with the intensity of the UV-B irradiation (r S = 0.326; p < 0.001). During January–March, a S-25(OH)D level below the thresholds of 50 and 75 nmol/L was observed in 58 and 88 %, respectively, and during July–September in 11 and 50 % (p < 0.001). S-25(OH)D was negatively correlated with body mass index and S-iPTH, but was significantly higher in holiday makers in sunny destinations, sunbed users, non-smokers, and in the physically active. The intra-individual analyses showed a mean increase in S-25(OH)D by 8 nmol/L/month between April and August. Approximately 75 % had serum 25(OH)D values <75 nmol/L during 75 % of the year and 50 % had serum 25(OH)D <50 nmol/L during 50 % of the year. Serum 25(OH)D was strongly associated with parameters related to sun exposure, but only weakly with intake of vitamin D supplements.

Why Do Employees Have Better Family Lives When They Are Highly Engaged at Work?

This article presents a within-individual examination of the effects of work engagement on the family domain. A total of 125 employees were asked to respond to daily surveys both at work and at home for a period of two consecutive weeks. Intraindividual analyses revealed that employees’ daily work engagement experiences related positively, within individuals, to work-family interpersonal capitalization, which in turn, related positively to daily family satisfaction and to daily work-family balance. The findings also indicated that both the relationship between work engagement and work-family interpersonal capitalization and the indirect effects of daily work engagement on the family outcomes were stronger for employees with higher intrinsic motivation than for those with lower intrinsic motivation.

The Association Between Schizophrenia and Rheumatoid Arthritis: A Nationwide Population-Based Swedish Study on Intraindividual and Familial Risks

Numerous studies have reported a reduced risk of rheumatoid arthritis (RA) in schizophrenia. The mechanisms are unknown, but recent genome-wide association studies of schizophrenia have shown strong associations with markers spanning the major histocompatibility complex region, indicating a possible role for adaptive immunity also in schizophrenia. In this population-based cohort study, we assess the associations between RA and schizophrenia and the extent to which any observed associations are specific to RA/schizophrenia. We then extend the assessments per RA subtype and to risks in first-degree relatives. The study population included every individual identified in the Swedish Population Register born in Sweden between 1932 and 1989. The risk for RA in schizophrenia was significantly decreased (hazard ratio [HR] = 0.69, 95% CI = 0.59-0.80), but similar reductions were noted for osteoarthritis (a noninflammatory joint disorder) and ankylosing spondylitis (a non-RA inflammatory disorder). Comparable associations were seen in schizoaffective subjects while no significant associations were observed in bipolar disorder. Overall, first-degree relatives of schizophrenia patients were not at reduced risk of RA, but the risk for seronegative RA was significantly decreased in children and siblings of schizophrenia probands (HR = 0.13, 95% CI = 0.02-0.95 and HR = 0.67, 95% CI = 049-0.92, respectively). In conclusion, our intraindividual analyses suggest that differential misclassification bias is an important factor for the observed inverse association and emphasize the need of optimized care-provision for nonpsychiatric symptoms in schizophrenia patients. Our familial analyses indicted the possibility of an inverse coinheritance of schizophrenia and seronegative RA.