Linear Mixed-effects Model Analysis Research Articles

Can Increased Sodium Intake Reduce Exercise-associated Hyponatremia?

The primary risk factor for exercise-associated hyponatremia is overhydration, but other factors can play a role, including Na+ losses and intakes. PURPOSE: To test the efficacy of a CHO-containing (6%) beverage with 60 vs. 21 mmol/L on plasma [Na+] when consumed to nearly match mass loss, while cycling in the heat. METHODS: In a randomized, crossover study, 10 males (VO2max 60 ± 3 mL/min/kg, 75 ± 5 kg, 20-50 y) cycled (55% VO2max) in the heat (34 °C) for 3 h while consuming a beverage containing either 21 mmol/L Na+ (L) or 60 mmol/L Na+ (H). Beverage volume was based on body mass changes in 1 h pre-trials under similar conditions. Blood was sampled every 30 min. Tc, HR, and body mass were monitored. Linear mixed effects model analysis of variance was conducted with Subject as a random effect, and Diet and Time as fixed effects. T-tests were conducted on single measures. RESULTS: Not all subjects completed 3 h of exercise, with mean exercise time being 175 min on both L and H. Mean fluid intake was (3.3 ± 0.6 L, 3.4 ± 0.7 L, resp.; p=0.45). Body mass change was (-0.39 ± 0.31, -0.20 ± 0.36 kg, resp.; p=0.09). Plasma sodium decreased over time on L, whereas increased slightly on H (p< 0.001), with mean rate of change being (-0.6 ± 0.6 mmol/L/h, 0.6 ± 0.6 mmol/L/h, resp.; p =0.057). At ride completion, four subjects were hyponatremic (plasma [Na+] < 135 mmol/L) on L, and only one on H. No differences in end Tc (38.6 ± 0.8, 38.6 ± 0.8 °C, resp.; p=0.90) or end HR (147 ± 31, 157 ± 24 bpm, resp.; p=0.39) were observed. CONCLUSION: Consumption of a beverage with sodium concentration of 60 mmol/L has advantage over one with a concentration typically found in sports drinks (21 mmol/L), preventing plasma sodium reduction during long-lasting exercise in the heat.

Cortical Venous Redness Represents Tissue Circulation Status in Patients With Moyamoya Disease.

Venous oxygen saturation (SO2) is measured in medical fields to assess tissue circulation insufficiency. This study aimed to elucidate the use of a cortical venous redness measurement to evaluate hemodynamic changes during revascularization surgery for patients with moyamoya disease. In this retrospective case-series analysis, we first quantitatively measured and correlated SO2 and R intensity of 24-bit color digital red-green-blue pictures of blood samples from 3 volunteers. Subsequently, based on intraoperative digital pictures of 29 patients with moyamoya disease, we measured the R intensities of a cortical vein near the anastomosis site before and after anastomosis. Cerebral blood flow (CBF) at the site was measured using a single-photon emission computed tomography before and 1 to 3 days after surgery. Venous R intensity and CBF were measured twice by 4 raters, and their correlations were examined using generalized linear mixed effect model and linear regression analysis. A strong linear correlation was found between blood R intensity and its SO2 (coefficients, 0.522; 95% confidence interval, 0.364-0.680, using generalized linear mixed effect model). Venous R intensity before the anastomosis was not correlated with preoperative CBF (coefficients, 0.000352; 95% confidence interval, -0.000369 to 0.00107, by generalized linear mixed effect); however, the increases in venous R intensity after anastomosis were correlated with postoperative increases in CBF (R2, 0.367; 95% confidence interval, 0.116-0.618 to 0.548; 95% confidence interval, 0.331-0.764, by linear regression analysis). Cortical venous redness represented impaired CBF and could be a useful parameter for assessing hemodynamic changes during revascularization surgery.

Integration of Traditional and Metabolomics Biomarkers Identifies Prognostic Metabolites for Predicting Responsiveness to Nutritional Intervention against Oxidative Stress and Inflammation

Various statistical approaches can be applied to integrate traditional and omics biomarkers, allowing the discovery of prognostic markers to classify subjects into poor and good prognosis groups in terms of responses to nutritional interventions. Here, we performed a prototype study to identify metabolites that predict responses to an intervention against oxidative stress and inflammation, using a data set from a randomized controlled trial evaluating Korean black raspberry (KBR) in sedentary overweight/obese subjects. First, a linear mixed-effects model analysis with multiple testing correction showed that four-week consumption of KBR significantly changed oxidized glutathione (GSSG, q = 0.027) level, the ratio of reduced glutathione (GSH) to GSSG (q = 0.039) in erythrocytes, malondialdehyde (MDA, q = 0.006) and interleukin-6 (q = 0.006) levels in plasma, and seventeen NMR metabolites in urine compared with those in the placebo group. A subsequent generalized linear mixed model analysis showed linear correlations between baseline urinary glycine and N-phenylacetylglycine (PAG) and changes in the GSH:GSSG ratio (p = 0.008 and 0.004) as well as between baseline urinary adenine and changes in MDA (p = 0.018). Then, receiver operating characteristic analysis revealed that a two-metabolite set (glycine and PAG) had the strongest prognostic relevance for future interventions against oxidative stress (the area under the curve (AUC) = 0.778). Leave-one-out cross-validation confirmed the accuracy of prediction (AUC = 0.683). The current findings suggest that a higher level of this two-metabolite set at baseline is useful for predicting responders to dietary interventions in subjects with oxidative stress and inflammation, contributing to the emergence of personalized nutrition.

Correlation of Visuospatial Ability and EEG Slowing in Patients with Parkinson's Disease.

Background. Visuospatial dysfunction is among the first cognitive symptoms in Parkinson's disease (PD) and is often predictive for PD-dementia. Furthermore, cognitive status in PD-patients correlates with quantitative EEG. This cross-sectional study aimed to investigate the correlation between EEG slowing and visuospatial ability in nondemented PD-patients. Methods. Fifty-seven nondemented PD-patients (17 females/40 males) were evaluated with a comprehensive neuropsychological test battery and a high-resolution 256-channel EEG was recorded. A median split was performed for each cognitive test dividing the patients sample into either a normal or lower performance group. The electrodes were split into five areas: frontal, central, temporal, parietal, and occipital. A linear mixed effects model (LME) was used for correlational analyses and to control for confounding factors. Results. Subsequently, for the lower performance, LME analysis showed a significant positive correlation between ROCF score and parietal alpha/theta ratio (b = .59, p = .012) and occipital alpha/theta ratio (b = 0.50, p = .030). No correlations were found in the group of patients with normal visuospatial abilities. Conclusion. We conclude that a reduction of the parietal alpha/theta ratio is related to visuospatial impairments in PD-patients. These findings indicate that visuospatial impairment in PD-patients could be influenced by parietal dysfunction.

Schroth Physiotherapeutic Scoliosis-Specific Exercises Added to the Standard of Care Lead to Better Cobb Angle Outcomes in Adolescents with Idiopathic Scoliosis - an Assessor and Statistician Blinded Randomized Controlled Trial.

BackgroundThe North American non-surgical standard of care for adolescent idiopathic scoliosis (AIS) includes observation and bracing, but not exercises. Schroth physiotherapeutic scoliosis-specific exercises (PSSE) showed promise in several studies of suboptimal methodology. The Scoliosis Research Society calls for rigorous studies supporting the role of exercises before including it as a treatment recommendation for scoliosis.ObjectivesTo determine the effect of a six-month Schroth PSSE intervention added to standard of care (Experimental group) on the Cobb angle compared to standard of care alone (Control group) in patients with AIS.MethodsFifty patients with AIS aged 10–18 years, with curves of 10°-45° and Risser grade 0–5 were recruited from a single pediatric scoliosis clinic and randomized to the Experimental or Control group. Outcomes included the change in the Cobb angles of the Largest Curve and Sum of Curves from baseline to six months. The intervention consisted of a 30–45 minute daily home program and weekly supervised sessions. Intention-to-treat and per protocol linear mixed effects model analyses are reported.ResultsIn the intention-to-treat analysis, after six months, the Schroth group had significantly smaller Largest Curve than controls (-3.5°, 95% CI -1.1° to -5.9°, p = 0.006). Likewise, the between-group difference in the square root of the Sum of Curves was -0.40°, (95% CI -0.03° to -0.8°, p = 0.046), suggesting that an average patient with 51.2° at baseline, will have a 49.3° Sum of Curves at six months in the Schroth group, and 55.1° in the control group with the difference between groups increasing with severity. Per protocol analyses produced similar, but larger differences: Largest Curve = -4.1° (95% CI -1.7° to -6.5°, p = 0.002) and (95% CI -0.8 to 0.2, p = 0.006).ConclusionSchroth PSSE added to the standard of care were superior compared to standard of care alone for reducing the curve severity in patients with AIS.Trial RegistrationNCT01610908

Feasibility and Potential Benefits of a Web-Based Intervention Delivered Acutely After Mild Traumatic Brain Injury in Adolescents: A Pilot Study.

There is a paucity of evidence-based interventions for mild traumatic brain injury (mTBI). To evaluate the feasibility and potential benefits of an interactive, Web-based intervention for mTBI. Emergency department and outpatient settings. Of the 21 adolescents aged 11 to 18 years with mTBI recruited from November 2013 to June 2014 within 96 hours of injury, 13 completed the program. Prospective, open pilot. The Web-based Self-Management Activity-restriction and Relaxation Training (SMART) program incorporates anticipatory guidance and psychoeducation, self-management and pacing of cognitive and physical activities, and cognitive-behavioral principles for early management of mTBI in adolescents. Primary: Daily Post-Concussion Symptom Scale (PCSS). Secondary: Daily self-reported ratings of activities and satisfaction survey. Average time from injury to baseline testing was 14.0 (standard deviation = 16.7) hours. Baseline PCSS was 23.6 (range: 0-46), and daily activity was 1.8 (range: 0-5.75) hours. Repeated-measures, generalized linear mixed-effects model analysis demonstrated a significant decrease of PCSS at a rate of 2.0 points per day that stabilized after about 2 weeks. Daily activities, screen time, and physical activity increased by 0.06 (standard error [SE] = 0.04, P = .09), 0.04 (SE = 0.02, P = .15), and 0.03 (SE = 0.02, P = .05) hours per day, respectively, over the 4-week follow-up. Satisfaction was rated highly by parents and youth. Self-Management Activity-restriction and Relaxation Training is feasible and reported to be helpful and enjoyable by participants. Future research will need to determine the comparative benefits of SMART and ideal target population.

The influence of personality traits on occupant behavioural patterns

Occupant behaviour in office buildings and its driving forces have been investigated intensely. Despite huge individual differences, these analyses are mainly performed on aggregated levels. Attempts are scarce to explain underlying mechanisms which personal characteristics lead to observed differences. This study presents a unique analysis of the influence of personality traits on four types of behavioural patterns – clothing adjustments, window opening, blind closing, and interactions with a ceiling fan – and two dimensions of thermal perception – sensation and preference. As personality traits, three of the Big Five personality traits describing human personality, namely neuroticism, extraversion, and openness to new experiences, together with the concepts of general and thermo-specific self-efficacy were analysed. The data set used derived from experimental studies in a semi-controlled climate chamber with single occupied offices consisting of 65 subjects. Throughout the analysis, multivariate logistic, linear, and ordinal mixed effect model analyses were performed. According to the results, all personality traits lead to significant differences between behavioural patterns. Thermal sensation was affected significantly by extraversion, thermal preference by neuroticism, openness and thermo-specific self-efficacy. Together with additional experimental and field studies these results can form a basis for theory-driven occupant behavioural profiles used in building performance simulation.

Barriers to Viral Suppression Among Female Sex Workers: Role of Structural and Intimate Partner Dynamics.

Despite global evidence that sex workers (SWs) are disproportionately impacted by HIV, data on HIV treatment outcomes among SWs living with HIV remains sparse. This study examined the correlates of undetectable plasma viral load (pVL) among street- and off-street SWs living with HIV and on antiretroviral therapy (ART) in Metro Vancouver, Canada. Analyses drew on data (2010-2014) from a longitudinal cohort of SWs (An Evaluation of Sex Workers Health Access) and confidential linkages with the Drug Treatment Program (DTP) data on ART dispensation and outcomes. Bivariate and multivariable generalized linear mixed-effects models were used to identify longitudinal correlates of undetectable pVL (<50 copies/mL). Of the 72 SWs living with HIV who had ever used ART, 38.9% had an undetectable pVL at baseline. Although 84.7% had undetectable pVL at least once over the study period, 18.1% exhibited sustained undetectable pVL. In multivariable generalized linear mixed-effects model analyses, ≥95% pharmacy refill adherence (adjusted odds ratio (AOR) = 4.21; 95% confidence interval (CI) 2.16 to 8.19) and length of time since diagnosis (AOR = 1.06; 95% CI: 1.00 to 1.13) were positively correlated with undetectable pVL. Having an intimate male partner (AOR = 0.35; 95% CI: 0.16 to 0.78) and being homelessness were negatively correlated with undetectable pVL (AOR = 0.22; 95% CI: 0.10 to 0.47). There is a need to more closely consider the social and structural contexts that shape SWs' experiences on ART and impact treatment outcomes, including the gendered power dynamics within intimate partnerships. Future research on HIV care among SWs is urgently needed, alongside structural and community-led interventions to support SWs' access to and retention in care.

Environmental parameters linked to the last migratory stage of barnacle geese en route to their breeding sites

The migration timing of birds can be controlled by endogenous parameters. However, little is known about how environmental parameters influence the timing of migration and which have the greatest influence at different stages of migration. In this study we identified the main environmental parameters that correlate with the timing of the last stage of spring migration for the barnacle goose, Branta leucopsis. GPS tracking data were registered for 12 barnacle geese (in 2008–2010) on the Russian flyway and 17 (2006–2010) on the Svalbard flyway. A linear mixed-effect model and principal component analysis were used to retrieve statistically significant parameters. Departure date from the last staging site on the Russian flyway was related to daylength, temperature, cloud cover and barometric pressure, and on the Svalbard flyway to a food availability index and daylength. Arrival date at the Russian breeding site was related to cloud cover and barometric pressure en route and the food availability index and temperature at the breeding site. For the Svalbard flyway, temperature and cloud cover en route and the food availability index, wind, temperature and cloud cover at the breeding site were significantly related to arrival date at the breeding site. Our study highlights the importance of environmental parameters including food, weather and daylength for the last stage of goose spring migration. We found different priorities in selecting the environmental parameters in migration timing decisions between Svalbard and Russian barnacle geese which fly over sea and over land, respectively. Identifying the key factors that act as cues during the final stages of spring migration is important when assessing the possible effects of climate change on the timing of migration for a highly selective herbivore such as the barnacle goose.

Da Vinci© Skills Simulator™: is an early selection of talented console surgeons possible?

To investigate whether the learning curve of robotic surgery simulator training depends on the probands' characteristics, such as age and prior experience, we conducted a study of six distinct proband groups, using the da Vinci Skills Simulator: experienced urological robotic surgeons, surgeons with experience as da Vinci tableside assistants, urological surgeons with laparoscopic experience, urological surgeons without laparoscopic experience, and complete novices aged 25 and younger and 40 and older. The results showed that all experienced robotic surgeons reached expert level (>90%, as defined previously in the literature) within the first three repetitions and remained on a high level of performance. All other groups performed worse. Tableside assistants, laparoscopically experienced surgeons, and younger novices showed a better performance in all exercises than surgeons without laparoscopic experience and older novices. A linear mixed-effects model analysis demonstrated no significant difference in learning curves between proband groups in all exercises except the RW1 exercise for the younger proband group. In summary, we found that performance in robotic surgery, measured by performance scores in three virtual simulator modules using the EndoWrist techniques, was dependent on age and prior experience with robotic and laparoscopic surgery. However, and most importantly, the learning curve was not significantly affected by these factors. This suggests that the da Vinci Skills Simulator™ is a useful practice tool for everyone learning or performing robotic surgery, and that early selection of talented surgeons is neither possible nor necessary.

Influence of instream habitat and water chemistry on amphibians in channelized agricultural headwater streams

The widespread use of stream channelization and subsurface tile drainage for removing water from agricultural fields has led to the development of numerous channelized agricultural headwater streams within agricultural watersheds of the Midwestern United States, Canada, and Europe. Channelized agricultural headwater streams have been documented to serve as habitat for amphibians, but information on amphibian habitat relationships within these streams is lacking and needed for developing effective conservation strategies. We quantified instream habitat, water chemistry, and sampled amphibians from seven sites in three channelized streams in Cedar Creek, Indiana in 2008 and 2009 and five sites in five channelized streams in Upper Big Walnut Creek, Ohio in 2009. We conducted an indirect gradient analysis involving the use of principal component analysis and generalized linear mixed effect model analysis to determine which variables had the greatest influence on amphibian community and population structure. Overall, amphibian community and population structure was most strongly correlated with water chemistry rather than instream habitat within channelized agricultural headwater streams in Indiana and Ohio. Eleven of 12 amphibian response variables were most strongly correlated with either a water chemistry gradient of nitrate+nitrite and acetochlor, a gradient of total nitrogen and ammonia, or a gradient of simazine and total phosphorus. Only one amphibian response variable was most strongly correlated with an instream habitat gradient of dissolved oxygen and water depth. Our results suggest that conservation strategies that target reductions of nutrients and herbicides will provide the greatest benefits for amphibians within channelized agricultural headwater streams.

Oral health-related quality of life changes after placement of immediately loaded single implants in healed alveolar ridges or extraction sockets: a 5-year prospective follow-up study.

The impact of single implants on oral health-related quality of life (OHRQoL) is scarcely investigated, especially when combined with immediate placement and loading in extraction sockets. The aim was to describe prospectively the changes of OHRQoL with single implants placed in the esthetic zone in healed ridges or in extraction sockets after 5years. Ninety-six patients, enrolled at three clinical centers, received 102 single implants placed in a healed ridge (n=54 implants/50 patients) or in extraction sockets (n=48 implants/46 patients). Implants were immediately provisionalized, and permanent crowns were cemented after 12weeks. Oral health impact profile questionnaires (OHIP-14) were completed before surgery, after 1 (provisional crown), 6 (permanent crown), 12 and 60months, respectively. The overall OHIP-14 score pertains to seven domains with two items each and was assessed on a Likert scale of 0-4 (0=never and 4=very often). The evolution of the total OHIP-14 score and changes within all OHIP domains over time and between groups were assessed with a linear mixed-effect model analysis. After 5years, overall implant survival was 98%. The total OHIP-14 score for both groups combined decreased from 0.50 at baseline to 0.17 at 6months (P<0.001), indicative of improvement. For both groups, this remained stable up to 5years (P=0.41). However, after 5years, the total OHIP-14 score revealed a statistically significantly higher improvement in the healed group compared with the extraction group (P=0.027). Missing a single tooth in the maxillary esthetic zone leads to limited OHRQoL problems as reflected by a low overall OHIP score. However, OHRQoL improves less in the extraction group, reflecting that replacing a missing tooth is perceived as more beneficial than replacing a present tooth.

Child readers’ eye movements in reading Thai

It has recently been found that adult native readers of Thai, an alphabetic scriptio continua language, engage similar oculomotor patterns as readers of languages written with spaces between words; despite the lack of inter-word spaces, first and last characters of a word appear to guide optimal placement of Thai readers’ eye movements, just to the left of word-centre. The issue addressed by the research described here is whether eye movements of Thai children also show these oculomotor patterns. Here the effect of first and last character frequency and word frequency on the eye movements of 18 Thai children when silently reading normal unspaced and spaced text was investigated. Linear mixed-effects model analyses of viewing time measures (first fixation duration, single fixation duration, and gaze duration) and of landing site location revealed that Thai children’s eye movement patterns were similar to their adult counterparts. Both first character frequency and word frequency played important roles in Thai children’s landing sites; children tended to land their eyes further into words, close to the word centre, if the word began with higher frequency first characters, and this effect was facilitated in higher frequency words. Spacing also facilitated more effective use of first character frequency and it also assisted in decreasing children’s viewing time. The use of last-character frequency appeared to be a later development, affecting mainly single fixation duration and gaze duration. In general, Thai children use the same oculomotor control mechanisms in reading spaced and unspaced texts as Thai adults, who in turn have similar oculomotor control as readers of spaced texts. Thus, it appears that eye movements in reading converge on the optimal landing site using whatever cues are available to guide such placement.

A prognostic tool to predict severe acute pancreatitis in pediatrics.

Approximately 15-20% of pediatric patients with acute pancreatitis (AP) develop severe disease. Severity scoring tools were developed for adult patients, but have limitations when applied in children. We aimed to identify early predictors of severe acute pancreatitis (SAP) on hospital admission for early risk stratification of patients. Retrospective review of AP admissions was conducted. The derivation cohort included cases at Cincinnati Children's Hospital Medical Center (CCHMC) between 2009 and 2013. Clinical data collected during the first 24h of admission were analyzed and a predictive model was derived through statistical analysis. The performance of the model was evaluated in a validation cohort from 2 more institutions other than CCHMC. In the derivation cohort 19% of the 284 admissions were SAP. A generalized linear mixed effect model analysis revealed that lipase, albumin and white blood count (WBC) play a role in the development of SAP (area under the receiver operating curve (AUROC 0.76)). In the validation cohort of 165 AP cases, SAP ranged from 8 to 20% at the three institutions. Performance of the model in this cohort was comparable to the derivation model (AUROC 0.77). There were 369 encounters in the combined derivation and validation pool (AUROC 0.76). The prognostic severity tool with 3 variables (lipase, albumin, and WBC) obtained within 24h of admission can be applied to predict SAP in pediatric patients.

Local versus distal transplantation of human neural stem cells following chronic spinal cord injury

Background ContextPrevious studies have demonstrated functional recovery of rats with spinal cord contusions after transplantation of neural stem cells adjacent to the site of acute injury. PurposeThe purpose of the study was to determine if the local or distal injection of neural stem cells can cause functional difference in recovery after chronic spinal cord injury. Study Design/SettingTwenty-four adult female Long-Evans hooded rats were randomized into four groups, with six animals in each group: two experimental and two control groups. Functional assessment was measured after injury and then weekly for 6 weeks using the Basso, Beattie, and Bresnahan locomotor rating score. Data were analyzed using two-sample t test and linear mixed-effects model analysis. MethodsPosterior exposure and laminectomy at the T10 level was used. Moderate spinal cord contusion was induced by the Multicenter Animal Spinal Cord Injury Study Impactor with 10-g weight dropped from a height of 25 mm. Experimental subjects received either a subdural injection of human neural stem cells (hNSCs) locally at the injury site or intrathecal injection of hNSCs through a separate distal laminotomy 4 weeks after injury. Controls received control media injection either locally or distally. ResultsA statistically significant functional improvement in subjects that received hNSCs injected distally to the site of injury was observed when compared with the control (p=.042). The difference between subjects that received hNSCs locally and the control did not reach statistical significance (p=.085). ConclusionsThe transplantation of hNSCs into the contused spinal cord of a rat led to significant functional recovery of the spinal cord when injected distally but not locally to the site of chronic spinal cord injury.

Using a gene expression signature when controversy exists regarding the indication for adjuvant systemic treatment reduces the proportion of patients receiving adjuvant chemotherapy: a nationwide study.

The Dutch national guideline advises use of gene-expression signatures, such as the 70-gene signature (70-GS), in case of ambivalence regarding the benefit of adjuvant chemotherapy (CT). In this nationwide study, the impact of 70-GS use on the administration of CT in early breast cancer patients with a dubious indication for CT is assessed. Patients within a national guideline directed indication area for 70-GS use who were surgically treated between November 2011 and April 2013 were selected from the Netherlands Cancer Registry database. The effect of 70-GS use on the administration of CT was evaluated in guideline- and age-delineated subgroups addressing potential effect of bias by linear mixed-effect modeling and instrumental variable (IV) analyses. A total of 2,043 patients within the indicated area for 70-GS use were included, of whom 298 received a 70-GS. Without use of the 70-GS, 45% of patients received CT. The 70-GS use was associated with a 9.5% decrease in CT administration (95% confidence interval (CI): -15.7 to -3.3%) in linear mixed-effect model analyses and IV analyses showed similar results (-9.9%; 95% CI: -19.3 to -0.4). In patients in whom the Dutch national guidelines suggest the use of a gene-expression profile, 70-GS use is associated with a 10% decrease in the administration of adjuvant CT.Genet Med 18 7, 720-726.Genetics in Medicine (2016); 18 7, 720-726. doi:10.1038/gim.2015.152.

Effects of white matter lesions on trunk stability during dual-task walking among older adults with mild cognitive impairment.

The linkage between gait and cognition has been shown in cases of white matter lesion (WML) that affect gait in older adults. Dual-task walking is believed to be cognitively demanding and to alter trunk movement, and gait impairment in people with mild cognitive impairment (MCI) is highlighted under this condition. However, the association between dual-task walking and structural changes in the brain, particularly with WML, in people with MCI is still unclear. The aim of this study was to examine the association between trunk stability during dual-task walking and WML in 560 older adults with MCI. We measured magnetic resonance imaging (MRI) and gait variables. Gait variables included harmonic ratio in vertical, mediolateral, and anteroposterior directions, analyzed using a tri-axial accelerometer attached to the lower trunk. Walking conditions were normal walking and dual-task walking (counting backwards while walking) conditions. Demographical data and brain atrophy were measured as covariates. Subjects were classified into non-severe WML (n = 451, mean age = 73.2 years) and severe WML (n = 109, mean age = 75.9 years) groups. Linear mixed-effects model analysis controlled for covariates showed dual-task-related changes in all harmonic ratios associated with WML (p < 0.05). Even after adjustment for executive function, harmonic ratio in the mediolateral direction was significantly associated with WML (p < 0.05). Our findings revealed that WMLs were associated with trunk stability in dual-task walking. Further studies are required to investigate the neural basis for deficits in gait ability among MCI subjects.

The Adolescent Behavioral Activation Program: Adapting Behavioral Activation as a Treatment for Depression in Adolescence

This study aimed to examine implementation feasibility and initial treatment outcomes of a behavioral activation (BA) based treatment for adolescent depression, the Adolescent Behavioral Activation Program (A-BAP). A randomized, controlled trial was conducted with 60 clinically referred adolescents with a depressive disorder who were randomized to receive either 14 sessions of A-BAP or uncontrolled evidenced-based practice for depression. The urban sample was 64% female, predominantly Non-Hispanic White (67%), and had an average age of 14.9 years. Measures of depression, global functioning, activation, and avoidance were obtained through clinical interviews and/or through parent and adolescent self-report at preintervention and end of intervention. Intent-to-treat linear mixed effects modeling and logistic regression analysis revealed that both conditions produced statistically significant improvement from pretreatment to end of treatment in depression, global functioning, and activation and avoidance. There were no significant differences across treatment conditions. These findings provide the first step in establishing the efficacy of BA as a treatment for adolescent depression and support the need for ongoing research on BA as a way to enhance the strategies available for treatment of depression in this population.

Soil microbial community composition does not predominantly determine the variance of heterotrophic soil respiration across four subtropical forests.

To explore the importance of soil microbial community composition on explaining the difference in heterotrophic soil respiration (Rh) across forests, a field investigation was conducted on Rh and soil physiochemical and microbial properties in four subtropical forests in southern China. We observed that Rh differed significantly among forests, being 2.48 ± 0.23, 2.31 ± 0.21, 1.83 ± 0.08 and 1.56 ± 0.15 μmol m−2 s−1 in the climax evergreen broadleaf forest (BF), the mixed conifer and broadleaf forest (CF), the conifer plantation (CP), and the native broadleaved species plantation (BP), respectively. Both linear mixed effect model and variance decomposition analysis indicated that soil microbial community composition derived from phospholipid fatty acids (PLFAs) was not the first-order explanatory variable for the Rh variance across the forests, with the explanatory power being 15.7%. Contrastingly, vegetational attributes such as root biomass (22.6%) and soil substrate availability (18.6%) were more important for explaining the observed Rh variance. Our results therefore suggest that vegetation attributes and soil carbon pool size, rather than soil microbial community composition, should be preferentially considered to understand the spatial Rh variance across the subtropical forests in southern China.

Efficacy and safety of sitagliptin in Japanese patients with type 2 diabetes.

BackgroundThe aim of this study was to investigate the clinical efficacy and safety of sitagliptin in Japanese patients with type 2 diabetes.MethodsA total of 3,247 subjects treated with sitagliptin were retrospectively recruited. Glucose parameters were collected at baseline, and 1, 3 and 6 months after initiation of sitagliptin. In addition, we explored factors that can be used to predict sitagliptin-induced reduction in HbA1c using linear mixed effect model. Factors associated with hypoglycemic events were examined by logistic analyses.ResultsWe analyzed the available data of 3,201 subjects (1,287 females). Treatment of sitagliptin significantly reduced HbA1c level from 7.44±1.20% at baseline to 6.73±0.99% at 6 months (P < 0.0001). Linear mixed effect model analyses demonstrated that reduction of HbA1c was associated with higher baseline HbA1c level, younger age, lower BMI and sitagliptin monotherapy. During this study, 82 cases of hypoglycemia were recorded. Logistic analyses indicated that hypoglycemic events were more frequent in female patients, and patients with low BMI, long history of type 2 diabetes, high HbA1c and on combination therapy experienced. Other adverse events were rare and mild.ConclusionsSitagliptin is effective for diabetic management and generally well tolerated in Japanese patients with type 2 diabetes. This trial was registered with UMIN (no. 000004121).