Longitudinal Cluster Analysis Research Articles

Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis.

The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms. We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out. A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership. These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.

The Influence of Pain Hypersensitivity and Psychological Factors on Pain and Disability in the Transition From Acute to Chronic Low Back Pain: A Longitudinal Exploratory Investigation and Cluster Analysis

Pain hypersensitivity is present in some people with acute low back pain (LBP) and thought to be involved in the development of chronic LBP. Early evidence suggests that pain hypersensitivity in acute LBP precedes poor long-term outcome. We aimed to examine whether the presence of pain hypersensitivity in acute LBP influenced recovery status at 6 months and differentiated how pain and disability changed over time. Participants with acute nonspecific LBP (<6 weeks after pain onset, N = 118) were included in this longitudinal study. Quantitative sensory testing, including pressure and heat pain thresholds, and conditioned pain modulation and questionnaires were compared at baseline and longitudinally (at 3 and 6 months) between recovered and unrecovered participants. Using k-means clustering, we identified subgroups based on baseline sensory measures alone, and in combination with psychological factors, and compared pain and disability outcomes between subgroups. Sensory measures did not differ at baseline or longitudinally between recovered (N = 50) and unrecovered (N = 68) participants. Subgrouping based on baseline sensory measures alone did not differentiate pain or disability outcomes at any timepoint. Participants with high psychological distress at baseline (N = 19) had greater disability, but not pain, at all timepoints than those with low psychological distress, regardless of the degrees of pain sensitivity. Our findings suggest that pain hypersensitivity in acute LBP does not precede poor recovery at 6 months or differentiate how pain and disability change over time. High psychological distress during acute LBP is associated with unremitting and pronounced disability, while pain severity is unaffected. PerspectivePain hypersensitivity is thought to be involved in the transition to chronic LBP. Contradictory to prevailing hypothesis, our findings suggest pain hypersensitivity alone in acute LBP does not precede poor recovery. High psychological distress in acute LBP has a stronger influence than pain hypersensitivity on long-term disability, but not pain outcomes.

Early exposure to sunlight and allergic morbidity: The PARIS birth cohort

The relationship between sunlight and allergies in children has received limited attention from researchers. We sought to explore how early exposure to solar radiation is associated with allergic morbidity within the PARIS birth cohort study.Our research dealt with children who attended at least one of two health checkups: at 18 months (n = 2012) and at 8–9 years (n = 1080). Early exposure to solar radiation was assessed using meteorological data (e.g., solar radiation, temperature, and relative humidity). Children with similar meteorological exposure trajectories were grouped by a longitudinal and multidimensional cluster analysis. The association between solar radiation exposure and allergic morbidity (i.e., allergic sensitization at 18 months and 8–9 years; current asthma, rhinitis, and eczema at 8–9 years) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D supplementation during pregnancy was tested. Four meteorological exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitization at 8–9 years compared to the trajectory with the lowest exposure (p = 0.06). The association was statistically significant in the vitamin D supplementation group. Solar radiation during prenatal and postnatal periods was significantly associated with a lower risk of sensitization at 8–9 years (for one interquartile range (IQR) increase, adjusted odds ratio (aOR): 0.47; 95 % confidence interval (CI): 0.25–0.87 and 0.84; 0.7–1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower risk of asthma at 8–9 years (for one IQR increase, aOR: 0.32; 95 % CI: 0.1–0.96).Early sunlight exposure may reduce the risk of sensitization and asthma in school-aged children, especially in those prenatally exposed to vitamin D. These findings highlight the importance of vitamin D in preventing allergic diseases in children, either through supplementation or sunlight exposure.

Longitudinal Cervical Length Measurements and Spontaneous Preterm Birth in Singleton and Twin Pregnancies

Changes in cervical length in twin pregnancies exhibit various patterns, but it is unclear whether the mechanism underlying spontaneous preterm birth (sPTB) is consistent. The existence of detailed phenomena in singleton pregnancies is also unclear. To explore the different patterns in cervical length trajectories in singleton and twin pregnancies and to analyze whether the immunological mechanisms of sPTB are consistent among these cervical length patterns. This cohort study recruited pregnant individuals who received antenatal care and delivered at Peking University Third Hospital in Beijing, China, between January 1, 2014, and December 31, 2022. Individuals with singleton and twin pregnancies were included. Cervical length measurements and white blood cell (WBC) indicators. The primary outcome was sPTB. Longitudinal trajectory cluster analysis was used to identify patterns of changes in cervical length in singleton and twin pregnancies. A random-effects model with cubic spline was used to fit and compare the longitudinal trajectory of WBC indicators among early preterm birth, moderate to late preterm birth, and term birth. A total of 43 559 pregnant individuals were included; of these, 41 706 had singleton pregnancies (mean [SD)] maternal age, 33.0 [4.0] years) and 1853 had twin pregnancies (mean [SD] maternal age, 33.3 [3.6] years). Two distinct patterns of cervical length changes were observed in both singleton and twin pregnancies: shortened (21 366 singletons and 546 twins) and stable (20 340 singletons and 1307 twins). In singleton pregnancies, WBC count was associated with early sPTB in individuals with both shortened cervix (odds ratio [OR], 1.35; 95% CI, 1.00-1.82) and stable cervix (OR, 1.64; 95% CI, 1.07-2.50). However, for twin pregnancies, the association of WBC count (OR, 3.13; 95% CI, 1.58-6.18) with the risk of early sPTB was observed only in individuals with a shortened cervix. This study identified 2 distinct cervical length patterns: shortened and stable. These patterns revealed 2 preterm birth mechanisms in twin pregnancies, with the immunopathogenesis of sPTB found only in the shortened cervix pattern; in singleton pregnancies, maternal immune response was associated with a higher risk of sPTB regardless of a shortened or stable cervix.

Neonatal Nucleus Accumbens Microstructure Modulates Individual Susceptibility to Preconception Maternal Stress in Relation to Externalizing Behaviors

Maternal stress influences in utero brain development and is a modifiable risk factor for offspring psychopathologies. Reward circuitry dysfunction underlies various internalizing and externalizing psychopathologies. This study examined (1) the association between maternal stress and microstructural characteristics of the neonatal nucleus accumbens (NAcc), a major node of the reward circuitry, and (2) whether neonatal NAcc microstructure modulates individual susceptibility to maternal stress in relation to childhood behavioral problems. K-means longitudinal cluster analysis was performed to determine trajectories of maternal stress measures (Perceived Stress Scale [PSS], hair cortisol) from preconception to the third trimester. Neonatal NAcc microstructural measures (orientation density index [ODI] and intracellular volume fraction [ICVF]) were compared across trajectories. We then examined the interaction between maternal stress and neonatal NAcc microstructure on child internalizing and externalizing behaviors, assessed between ages 3 and 4 years. Two trajectories of maternal stress magnitude ("low"/"high") were identified for both PSS (n= 287) and hair cortisol (n= 336). Right neonatal NAcc ODI (rNAcc-ODI) was significantly lower in "low" relative to "high" PSS trajectories (n= 77, p= .04). PSS at preconception had the strongest association with rNAcc-ODI (r= 0.293, p= .029). No differences in NAcc microstructure were found between hair cortisol trajectories. A significant interaction between preconception PSS and rNAcc-ODI on externalizing behavior was observed (n= 47, p= .047). Our study showed that the preconception period contributes to in utero NAcc development, and that NAcc microstructure modulates individual susceptibility to preconception maternal stress in relation to externalizing problems. In the S-PRESTO population-based cohort study conducted in Singapore with 351 women and their children, higher levels of maternal perceived stress within the year before pregnancy were associated with increased dendritic complexity within offsprings' nucleus accumbens, indicative of a more advanced developmental profile. Variations in right nucleus accumbens microstructure significantly modulated the association between maternal perceived stress at preconception and externalizing behaviors in early childhood. Study findings suggest that maternal stress in the preconception period accelerates in-utero nucleus accumbens development, leading to differential risk to externalizing problems in later childhood.

Patterns of participation and performance at the class level in English online education: A longitudinal cluster analysis of online K-12 after-school education in China

Patterns of participation and performance at the class level in English online education: A longitudinal cluster analysis of online K-12 after-school education in China

Longitudinal Clusters of Long-Term Trajectories in Patients with Early-Onset Chronic Depression: 2 Years of Naturalistic Follow-Up after Extensive Psychological Treatment

Introduction: In clinical trials, mostly group-level treatment effects of repeated cross-sectional measures are analyzed. However, substantial heterogeneity regarding individual symptom profiles and the variability of treatment effects are often neglected, especially over the long-term course. To provide effective personalized treatments, investigations of these characteristics are urgently needed. Methods: Depression severity ratings over 104 weeks of follow-up after year-long treatment with the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or Supportive Psychotherapy (SP) were analyzed. Longitudinal cluster analysis and multinomial logistic regression analysis were conducted to investigate intraindividual trajectories from one of the largest psychotherapy trials in early-onset chronic depression. Results: Two-year post-study-treatment trajectories of N = 188 patients with early-onset chronic depression were grouped into four prototypical clusters. Overall, 16.0% of patients remitted (cluster 1) and most of them did not receive any treatment during the 2-year follow-up. However, 84.0% of patients continued to experience subthreshold (37.2% cluster 2) or major depressive symptoms (46.8% clusters 3–4) and spent on average more than half of the follow-up in pharmacological and psychological treatment. Hierarchical regression analysis indicated that previous study treatment with CBASP or SP did not significantly predict cluster allocation, while baseline variables accounted for a large proportion of explained variance (R² _N = 0.64). Conclusion: While some patients experienced stable remission over 2 years of follow-up, the majority of patients experienced subthreshold or major depressive symptoms regardless of former study treatment with CBASP or SP. This calls for a long-term perspective implementing staging and innovative treatment approaches such as the sequential model or modular psychotherapy.

Exposure to sunlight and allergic morbidity in children (Pollution and Asthma Risk: an Infant Study)

Abstract Background Sunlight relationship with allergies is poorly studied in children. Thus, we examined how early exposure to solar radiation is associated with allergic morbidity in the PARIS birth cohort. Methods This study dealt with children who attended at least one of the two health check-ups: 18 months (n = 2012) and 8/9 years (n = 1080). Early exposure (prenatal and during the first year of life) to solar radiation was assessed using meteorological data (solar radiation, temperature, relative humidity). Children with similar exposure trajectories were grouped by longitudinal and multidimensional cluster analysis. Association of solar radiation exposure with allergic morbidity (i.e. allergic sensitisation at 18 months and 8/9 y., current asthma, rhinitis, and eczema at 8/9 y.) was quantified by multivariable logistic regression models adjusted for potential confounders. The effect modification of maternal vitamin D (VitD) supplementation during pregnancy was also tested. Results Four exposure trajectories were found. The trajectory with the highest exposure to early solar radiation had a reduced risk of sensitisation at 8/9 y. compared to the trajectory with the lowest exposure (p = 0.06). This association was statistically significant in the VitD supplemented subgroup. Solar radiation during pre- and post-natal period was significantly associated with a lower risk of sensitisation at 8/9 y. (for ↗IQR, aOR: 0.47; 95%CI: 0.25-0.87 and 0.84;0.70-1.00, respectively). Increased prenatal exposure to solar radiation was significantly associated with a lower asthma risk at 8/9 y. (for ↗IQR, 0.32; 0.10-0.96). Conclusions Early sunlight exposure may reduce the risk of sensitisation and asthma in school-aged children, especially in those prenatally exposed to VitD intake. These findings highlight the importance of VitD in preventing allergic diseases in children, either through supplementation or sunlight exposure. Key messages • Pre-natal and early postnatal exposure to sunlight could reduce the risk of sensitisation and asthma among school-aged children. • The association may be explained by vitamin D immunomodulatory effect, highlighting its importance in preventing allergic diseases in children through supplementation or sunlight exposure.

Spectral features of non-nutritive suck dynamics in extremely preterm infants.

Non-nutritive suck (NNS) is used to promote ororhythmic patterning and assess oral feeding readiness in preterm infants in the neonatal intensive care unit (NICU). While time domain measures of NNS are available in real time at cribside, our understanding of suck pattern generation in the frequency domain is limited. The aim of this study is to model the development of NNS in the frequency domain using Fourier and machine learning (ML) techniques in extremely preterm infants (EPIs). A total of 117 EPIs were randomized to a pulsed or sham orocutaneous intervention during tube feedings 3 times/day for 4 weeks, beginning at 30 weeks post-menstrual age (PMA). Infants were assessed 3 times/week for NNS dynamics until they attained 100% oral feeding or NICU discharge. Digitized NNS signals were processed in the frequency domain using two transforms, including the Welch power spectral density (PSD) method, and the Yule-Walker PSD method. Data analysis proceeded in two stages. Stage 1: ML longitudinal cluster analysis was conducted to identify groups (classes) of infants, each showing a unique pattern of change in Welch and Yule-Walker calculations during the interventions. Stage 2: linear mixed modeling (LMM) was performed for the Welch and Yule-Walker dependent variables to examine the effects of gestationally-aged (GA), PMA, sex (male, female), patient type [respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD)], treatment (NTrainer, Sham), intervention phase [1, 2, 3], cluster class, and phase-by-class interaction. ML of Welch PSD method and Yule-Walker PSD method measures revealed three membership classes of NNS growth patterns. The dependent measures peak_Hz, PSD amplitude, and area under the curve (AUC) are highly dependent on PMA, but show little relation to respiratory status (RDS, BPD) or somatosensory intervention. Thus, neural regulation of NNS in the frequency domain is significantly different for each identified cluster (classes A, B, C) during this developmental period. Efforts to increase our knowledge of the evolution of the suck central pattern generator (sCPG) in preterm infants, including NNS rhythmogenesis will help us better understand the observed phenotypes of NNS production in both the frequency and time domains. Knowledge of those features of the NNS which are relatively invariant vs. other features which are modifiable by experience will likewise inform more effective treatment strategies in this fragile population.

Longitudinal Principal Component and Cluster Analysis of Azerbaijan’s Agricultural Productivity in Crop Commodities

Understanding long-term agricultural productivity is essential for designing agricultural policies, planning and targeting other economic policies (e.g., industrial policy), and managing agricultural business models. In a developing and oil-rich country such as Azerbaijan, agriculture is among the limited opportunities to diversify oil-based value added and address broad welfare issues, as farmers and agricultural workers account for a large share of total employment and the labor force. However, previous studies have not focused on an empirical assessment of the long-term and subsectoral productivity of crop commodities. Rather, they have used a highly aggregated and short-run perspective, focusing mainly on the impact of the oil sector on agricultural sectors. Here, we applied principal component analysis and hierarchical cluster analysis to identify similarities and differences in the productivity of specific crop commodities (e.g., cotton, tea, grains, tobacco, hay, fruits, and vegetables) between 1950 and 2021. We show that some crops are similar in terms of their variation, growth rates, and transition from the Soviet era to the post-Soviet period. Although the dynamics of change are different for food and non-food crops and for high- and low-productive commodities, it is still possible to narrow down specific subsectors that could reach the same productivity levels. This helps map out the productivity levels of crop commodities over time and across different subsectors, allowing for better policy decisions and resource allocation in the agricultural sector. In addition, we argue about some outlier commodities and their backward status despite extensive government support. Our results provide a common basis for policymakers and businesses to focus specifically on productivity and profitability from an economic standpoint.

Typical disease courses of patients with unipolar depressive disorder after in-patient treatments-results of a cluster analysis of the INDDEP project.

Previously established categories for the classification of disease courses of unipolar depressive disorder (relapse, remission, recovery, recurrence) are helpful, but insufficient in describing the naturalistic disease courses over time. The intention of the present study was to identify frequent disease courses of depression by means of a cluster analysis. For the longitudinal cluster analysis, 555 datasets of patients who participated in the INDDEP (INpatient and Day clinic treatment of DEPression) study, were used. The present study uses data of patients with at least moderate depressive symptoms (major depression) over a follow-up period of 1 year after their in-patient or day-care treatments using the LIFE (Longitudinal Interval Follow-Up Evaluation)-interview. Eight German psychosomatic hospitals participated in this naturalistic observational study. Considering only the Calinski-Harabatz index, a 2-cluster solution gives the best statistical results. In combination with other indices and clinical interpretations, the 5-cluster solution seems to be the most interesting. The cluster sizes are large enough and numerically balanced. The KML-cluster analyses revealed five well interpretable disease course clusters over the follow-up period: "sustained treatment response" (N = 202, 36.4% of the patients), "recurrence" (N = 80, 14.4%), "persisting relapse" (N = 115, 20.7%), "temporary relapse" (N = 95, 17.1%), and remission (N = 63, 11.4%). The disease courses of many patients diagnosed with a unipolar depression do not match with the historically developed categories such as relapse, remission, and recovery. Given this context, the introduction of disease course trajectories seems helpful. These findings may promote the implementation of new therapy options, adapted to the disease courses.

Longitudinal Cluster Analysis of Hemodialysis Patients with COVID-19 in the Pre-Vaccination Era.

Coronavirus disease 2019 (COVID-19) in hemodialysis patients (HD) is characterized by heterogeneity of clinical presentation and outcomes. To stratify patients, we collected clinical and laboratory data in two cohorts of HD patients at COVID-19 diagnosis and during the following 4 weeks. Baseline and longitudinal values were used to build a linear mixed effect model (LME) and define different clusters. The development of the LME model in the derivation cohort of 17 HD patients (66.7 ± 12.3 years, eight males) allowed the characterization of two clusters (cl1 and cl2). Patients in cl1 presented a prevalence of females, higher lymphocyte count, and lower levels of lactate dehydrogenase, C-reactive protein, and CD8 + T memory stem cells as a possible result of a milder inflammation. Then, this model was tested in an independent validation cohort of 30 HD patients (73.3 ± 16.3 years, 16 males) assigned to cl1 or cl2 (16 and 14 patients, respectively). The cluster comparison confirmed that cl1 presented a milder form of COVID-19 associated with reduced disease activity, hospitalization, mortality rate, and oxygen requirement. Clustering analysis on longitudinal data allowed patient stratification and identification of the patients at high risk of complications. This strategy could be suitable in different clinical settings.

A Dynamic Systems Study on Complexity, Accuracy, and Fluency in English Writing Development by Chinese University Students.

This study investigated the development of lexical complexity, sentence complexity, accuracy, and fluency in the English writing of 22 Chinese university students from the perspective of Complex Dynamic Systems Theory (CDST). Compositions were assigned 30 times over the course of one academic year through Pigaiwang, an online platform that automatically evaluates writing. A modified retrodictive modeling approach was adopted. Specifically, a longitudinal cluster analysis was used to examine emergent prototypes. A moving correlation analysis and retrodictive interviews were conducted to study the signature dynamics that produce each prototype. At each collection, the 22 student compositions were classified into two clusters. One cluster contained those students who performed better than average in accuracy, but worse in the other three variables. The other cluster comprised those students with the opposite performance. Students moved continuously between the two clusters; and their change trajectories can be categorized into three prototypes: a continuously stable type, an initially variable and then stable type, and a continuously variable type. Case studies of three students representing the three emergent prototypes indicated that the signature dynamics for the three prototypes were related to dynamic interactions among different variables and dynamic changes in affect-related elements in the form of writing interests, motivation, and strategies. The initial conditions and the feedback from Pigaiwang acted as key control parameters in shaping the prototypes. The continuously variable prototype developed their writing proficiency to the greatest extent and had the most variability. Based upon the findings, implications for teaching L2 writing are discussed.

Trajectories of prenatal alcohol exposure and behavioral outcomes: Findings from a community-based sample

ObjectiveTo characterize patterns of prenatal alcohol exposure (PAE), and determine whether PAE trajectories were associated with behavior from a community-based sample of first-grade children. MethodsUsing data collected as part of the Collaboration of Fetal Alcohol Spectrum Disorders Prevalence study (n = 1663), we performed longitudinal cluster analysis on prenatal alcohol use reported for four time points around conception and pregnancy. From the sample, 638 respondents reported any alcohol use in pregnancy and were included in trajectories for average daily and maximum drinks per drinking day (max DDD). We then estimated the association with behavioral problems measured by the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) with multivariable linear regression. The reference group had 1025 children with no reported PAE. ResultsFive trajectories were selected to describe max DDD patterns: very low/discontinuing (n = 186), low/discontinuing (n = 111), very low/continuing (n = 47), med/high (n = 245), and high (n = 49). Six trajectories best described average daily alcohol use: very low/discontinuing (n = 378), very low/continuing (n = 98), low/continuing (n = 56), low/discontinuing (n = 37), medium/high (n = 35), and high (n = 31). When assessing max DDD trajectories for both the CBCL and TRF, individuals with PAE in the two highest trajectories and the very low/continuing trajectory had more behavioral problems relative to children with no PAE, although confidence intervals for most estimates included the null. PAE modeled as average drinks per day did not predict behavior in any consistent pattern. ConclusionsIn this community-based sample, select PAE trajectories were associated with behavior, even at relatively low levels of PAE that continued later in gestation.

Body mass index, clusters of health behaviour among school-age children and young people in Sweden

Background: A healthy lifestyle for children is important for future health. Aims: To identify temporal patterns of change in body mass index (BMI) and associated health behaviour among 6–16-year-old children and young people in Sweden. Methods: A quantitative design with longitudinal cluster analysis. Findings: School-age children and young people tended to maintain their BMI categories established at the age of 6 years or when they entered the fourth grade, and the categories were stable in age and gender over time. Conclusions: Healthy behaviours affecting BMI should be established before children begin school. Although slight changes in children's categories of BMI may occur once they reach school age, the categories established at preschool generally persist at least until the age of 16 years. Because school-age children and young people generally maintain their categories throughout their school years, early preventive work regarding BMI and health behaviour is needed with particular focus on overweight and obese children and young people.

Infant Feeding Clusters Are Associated With Respiratory Health and Allergy at School Age in the PARIS Birth Cohort

To identify first year of life feeding cohorts and examine associations between respiratory health and allergy at 8 years of age and infant feeding practices.A total of 3446 infants born in Paris, France, were managed from birth to 8 years of age.Questionnaires were collected at 1,3,6,9, and 12 months of life, focusing on breastfeeding, consumption of infant formula (regular, partially hydrolyzed, extensively hydrolyzed, prebiotics and probiotics, and soy), and solid food introduction. Multidimensional longitudinal cluster analysis was used to place children with similar early feeding practices into 5 cohorts. Standardized questionnaires, physician documentation, lung function, fractional exhaled nitric oxide, and specific immunoglobulin E were collected at 8 years of life. These data were used to identify atopic morbidity correlations between feeding cohorts. Multivariable logistic and linear regression models adjusted for early respiratory and allergic outcomes and parental history of allergy.Participants were grouped into 5 feeding clusters on the basis of early feeding patterns: cluster 1 (45%): mostly regular formula; cluster 2 (27%): exclusively breastfed during the first 3 months; cluster 3: (17%) prebiotic or probiotic formula; cluster 4: (7%) partially hydrolyzed formula, and cluster 5: (4%) extensively hydrolyzed or soy formula. Compared with infants in cluster 1, children fed extensively hydrolyzed or soy formula were more likely to have diagnosis of food allergy (cluster 5). Infants fed partially hydrolyzed formula (cluster 4) had a significant lower lung function (forced expiratory volume in 1 second; forced vital capacity), higher fractional exhaled nitric oxide, and higher risk of allergic sensitization at 8 years of life, compared with that of cluster 1. Compared with infants fed mostly regular formula (cluster 1), infants exclusively breastfed during the first 3 months (cluster 2) had a lower rate of asthma diagnosis.Children breastfeeding at least 3 months in this study had protection against developing asthma and food allergy later in life, compared with other feeding groups. Infants with early partially hydrolyzed formula had higher rates of asthma and atopy at 8 years of age, even while controlling for early respiratory or allergic disease and family history of atopy.This supports previous recommendations regarding breastfeeding and the prevention of atopic conditions. The authors caution pediatricians against recommending hydrolyzed or hypoallergenic formulas universally or on the basis of family history alone and highlight potential future morbidity. This study revealed no benefits in preventing atopic disease with prebiotic or probiotic formulas, although the grouping of multiple different types of these formulas in 1 heterogenous group is a significant study limitation. The mechanisms underlying these results deserve further study.

Using Educational Data Mining to Identify and Analyze Student Learning Strategies in an Online Flipped Classroom

Analyzing the learning analytics from a course provides insights that can impact instructional design decisions. This study used educational data mining techniques, specifically a longitudinal k-means cluster analysis, to identify the strategies students used when completing the online portion of an online flipped spreadsheet course. An analysis of these results showed that students did tend to follow a specific learning strategy as they completed this course. However, students also self-regulated to some degree, based on the topic and context of specific lessons. These insights not only improve our understanding about the students taking the course, but they also provide guidance for how the instructional design of the course might be improved. Of note is the practical value of this proof-of-concept study in using educational data mining to improve the instructional design of a course.

Association between lung function of school age children and short-term exposure to air pollution and pollen: the PARIS cohort

BackgroundDaily levels of ambient air pollution and pollen may affect lung function but have rarely been studied together. We investigated short-term exposure to pollen and air pollution in relation to...

Subgroups of failure after surgery for pelvic organ prolapse and associations with quality of life outcomes: a longitudinal cluster analysis

Treatment outcomes after pelvic organ prolapse surgery are often presented as dichotomous "success or failure" based on anatomic and symptom criteria. However, clinical experience suggests that some women with outcome "failures" are asymptomatic and perceive their surgery to be successful and that other women have anatomic resolution but continue to report symptoms. Characterizing failure types could be a useful step to clarify definitions of success, understand mechanisms of failure, and identify individuals who may benefit from specific therapies. This study aimed to identify clusters of women with similar failure patterns over time and assess associations among clusters and the Pelvic Organ Prolapse Distress Inventory, Short-Form Six-Dimension health index, Patient Global Impression of Improvement, patient satisfaction item questionnaire, and quality-adjusted life-year. Outcomes were evaluated for up to 5 years in a cohort of participants (N=709) with stage ≥2 pelvic organ prolapse who underwent surgical pelvic organ prolapse repair and had sufficient follow-up in 1 of 4 multicenter surgical trials conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Surgical success was defined as a composite measure requiring anatomic success (Pelvic Organ Prolapse Quantification system points Ba, Bp, and C of ≤0), subjective success (absence of bothersome vaginal bulge symptoms), and absence of retreatment for pelvic organ prolapse. Participants who experienced surgical failure and attended ≥4 visits from baseline to 60 months after surgery were longitudinally clustered, accounting for similar trajectories in Ba, Bp, and C and degree of vaginal bulge bother; moreover, missing data were imputed. Participants with surgical success were grouped into a separate cluster. Surgical failure was reported in 276 of 709 women (39%) included in the analysis. Failures clustered into the following 4 mutually exclusive subgroups: (1) asymptomatic intermittent anterior wall failures, (2) symptomatic intermittent anterior wall failures, (3) asymptomatic intermittent anterior and posterior wall failures, and (4) symptomatic all-compartment failures. Each cluster had different bulge symptoms, anatomy, and retreatment associations with quality of life outcomes. Asymptomatic intermittent anterior wall failures (n=150) were similar to surgical successes with Ba values that averaged around-1 cm but fluctuated between anatomic success (Ba≤0) and failure (Ba>0) over time. Symptomatic intermittent anterior wall failures (n=82) were anatomically similar to asymptomatic intermittent anterior failures, but women in this cluster persistently reported bothersome bulge symptoms and the lowest quality of life, Short-Form Six-Dimension health index scores, and perceived success. Women with asymptomatic intermittent anterior and posterior wall failures (n=28) had the most severe preoperative pelvic organ prolapse but the lowest symptomatic failure rate and retreatment rate. Participants with symptomatic all-compartment failures (n=16) had symptomatic and anatomic failure early after surgery and the highest retreatment of any cluster. In particular, the following 4 clusters of pelvic organ prolapse surgical failure were identified in participants up to 5 years after pelvic organ prolapse surgery: asymptomatic intermittent anterior wall failures, symptomatic intermittent anterior wall failures, asymptomatic intermittent anterior and posterior wall failures, and symptomatic all-compartment failures. These groups provide granularity about the nature of surgical failures after pelvic organ prolapse surgery. Future work is planned for predicting these distinct outcomes using patient characteristics that can be used for counseling women individually.

Socioeconomic status, well-being and mortality: a comprehensive life course analysis of panel data, Germany, 1984-2016

BackgroundThis study seeks to explore potential causal mechanisms involved in the observed associations between several socioeconomic status (SES) indicators, well-being and mortality, by taking a life course perspective focusing on (i) the trajectory of income and domain-specific well-being indicators, (ii) the influence of different SES indicators on well-being and mortality, (iii) the interactions between those trajectories, and (iv) the associations of the income and domain-specific well-being trajectories with all-cause mortality.MethodsSocioeconomic status is operationalised by net household income, education, employment and marital status. Well-being is measured with two indicators: life satisfaction and satisfaction with health. Data from the German Socio-Economic Panel, collected between 1984 and 2016 and comprising more than 55,000 individuals, are analysed by means of longitudinal k-means cluster analysis, simultaneous equation systems and parametric time-to-death regressions.ResultsThe analyses indicate the presence of large reciprocal effects of the trajectories of income and well-being on each other. However, the results suggest that well-being has a larger influence on income than the opposite, namely, income on well-being. The mortality analysis, on the other hand, revealed that the history of satisfaction with health is a much stronger predictor of longevity than the individual’s income history. Mortality risk was found lower among married individuals and those with tertiary education. In contrast, unemployment was associated with lower income and well-being levels. The findings provide support to the notion that education is a superior SES indicator than income in the investigation of the social determinants of well-being and mortality.ConclusionThe present study provides evidence of large reciprocal effects of income and well-being and emphasises the importance of taking a life course approach in the investigation of the social determinants of health. Several SES indicators and both well-being indicators were found to be highly predictive of all-cause mortality and indicate the presence of cumulative effects related to one’s income and well-being trajectories.