Lower Severity Levels Research Articles

Resilience and psychological trauma among Filipino American women

AimsTo explore the types of traumatic exposure, prevalence of posttraumatic stress disorder (PTSD), and level of resilience in a community sample of Filipino American women (FAW), as well as to investigate the relationships between their PTSD symptoms, history of traumatic exposure, and resilience. MethodA cross-sectional study with a total of 188 adult FAW. ResultsWe observed high levels of resilience and low levels of PTSD symptom severity. The most common form of traumatic exposure was non-interpersonal trauma occurring after the age of 18 years old. We also found a significant correlation between history of traumatic exposure and PTSD and between resilience and PTSD. Resilience was found to have a significant moderating effect on the relationship between traumatic exposure and PTSD. ConclusionsThe results provide preliminary evidence on the buffering and protective properties of FAW's resilience to PTSD despite traumatic exposure.

Vegetation and Soil Fire Damage Analysis Based on Species Distribution Modeling Trained with Multispectral Satellite Data

Forest managers demand reliable tools to evaluate post-fire vegetation and soil damage. In this study, we quantify wildfire damage to vegetation and soil based on the analysis of burn severity, using multitemporal and multispectral satellite data and species distribution models, particularly maximum entropy (MaxEnt). We studied a mega-wildfire (9000 ha burned) in North-Western Spain, which occurred from 21 to 27 August 2017. Burn severity was measured in the field using the composite burn index (CBI). Burn severity of vegetation and soil layers (CBIveg and CBIsoil) was also differentiated. MaxEnt provided the relative contribution of each pre-fire and post-fire input variable on low, moderate and high burn severity levels, as well as on all severity levels combined (burned area). In addition, it built continuous suitability surfaces from which the burned surface area and burn severity maps were built. The burned area map achieved a high accuracy level (κ = 0.85), but slightly lower accuracy when differentiating the three burn severity classes (κ = 0.81). When the burn severity map was validated using field CBIveg and CBIsoil values we reached lower κ statistic values (0.76 and 0.63, respectively). This study revealed the effectiveness of the proposed multi-temporal MaxEnt based method to map fire damage accurately in Mediterranean ecosystems, providing key information to forest managers.

Burn severity analysis in Mediterranean forests using maximum entropy model trained with EO-1 Hyperion and LiDAR data

All ecosystems and in particular ecosystems in Mediterranean climates are affected by fires. Knowledge of the drivers that most influence burn severity patterns as well an accurate map of post-fire effects are key tools for forest managers in order to plan an adequate post-fire response. Remote sensing data are becoming an indispensable instrument to reach both objectives. This work explores the relative influence of pre-fire vegetation structure and topography on burn severity compared to the impact of post-fire damage level, and evaluates the utility of the Maximum Entropy (MaxEnt) classifier trained with post-fire EO-1 Hyperion data and pre-fire LiDAR to model three levels of burn severity at high accuracy. We analyzed a large fire in central-eastern Spain, which occurred on 16–19 June 2016 in a maquis shrubland and Pinus halepensis forested area. Post-fire hyperspectral Hyperion data were unmixed using Multiple Endmember Spectral Mixture Analysis (MESMA) and five fraction images were generated: char, green vegetation (GV), non-photosynthetic vegetation, soil (NPVS) and shade. Metrics associated with vegetation structure were calculated from pre-fire LiDAR. Post-fire MESMA char fraction image, pre-fire structural metrics and topographic variables acted as inputs to MaxEnt, which built a model and generated as output a suitability surface for each burn severity level. The percentage of contribution of the different biophysical variables to the MaxEnt model depended on the burn severity level (LiDAR-derived metrics had a greater contribution at the low burn severity level), but MaxEnt identified the char fraction image as the highest contributor to the model for all three burn severity levels. The present study demonstrates the validity of MaxEnt as one-class classifier to model burn severity accurately in Mediterranean countries, when trained with post-fire hyperspectral Hyperion data and pre-fire LiDAR.

The Broad-Spectrum Impact of Hidradenitis Suppurativa on Quality of Life: A Comparison with Psoriasis

Background/Aim: Hidradenitis suppurativa (HS) is a chronic skin disease with a heavy impact on patients’ quality of life (QoL). The aim of this study was to evaluate in detail the QoL impact of HS comparing it with other skin conditions, and in particular with psoriasis. Methods: Patients with a diagnosis of HS were recruited. QoL was measured using the Skindex-17 questionnaire. Results: Data were available for 69 HS patients. HS had the worst QoL among several skin conditions. Compared to psoriasis the mean symptom score was 69.4 versus 53.7, and the mean psychosocial score was 56.1 versus 32.7. Overall, the scores of patients with HS were higher than those of psoriasis patients on 16 of the 17 items of the Skindex-17. Conclusions: When compared to many different skin conditions, and in particular to psoriasis, HS was the most impairing condition, even at low levels of clinical severity.

The occurrence of potato common scab correlates with the community composition and function of the geocaulosphere soil microbiome

BackgroundSoil microorganisms can mediate the occurrence of plant diseases. Potato common scab (CS) is a refractory disease caused by pathogenic Streptomyces that occurs worldwide, but little is known about the interactions between CS and the soil microbiome. In this study, four soil-root system compartments (geocaulosphere soil (GS), rhizosphere soil (RS), root-zone soil (ZS), and furrow soil (FS)) were analyzed for potato plants with naturally high (H) and low (L) scab severity levels. We aimed to determine the composition and putative function of the soil microbiome associated with potato CS.ResultsThe copy numbers of the scab phytotoxin biosynthetic gene txtAB and the bacterial 16S rRNA gene as well as the diversity and composition of each of the four soil-root system compartments were examined; GS was the only compartment that exhibited significant differences between the H and L groups. Compared to the H group, the L group exhibited a lower txtAB gene copy number, lower bacterial 16S copy number, higher diversity, higher co-occurrence network complexity, and higher community function similarity within the GS microbiome. The community composition and function of the GS samples were further revealed by shotgun metagenomic sequencing. Variovorax, Stenotrophomonas, and Agrobacterium were the most abundant genera that were significantly and positively correlated with the scab severity level, estimated absolute abundance (EAA) of pathogenic Streptomyces, and txtAB gene copy number. In contrast, Geobacillus, Curtobacterium, and unclassified Geodermatophilaceae were significantly negatively correlated with these three parameters. Compared to the function profiles in the L group, several genes involved in “ABC transporters,” the “bacterial secretion system,” “quorum sensing (QS),” “nitrogen metabolism,” and some metabolism by cytochrome P450 were enriched in the H group. In contrast, some antibiotic biosynthesis pathways were enriched in the L group. Based on the differences in community composition and function, a simple model was proposed to explain the putative relationships between the soil microbiome and CS occurrence.ConclusionsThe GS microbiome was closely associated with CS severity in the soil-root system, and the occurrence of CS was accompanied by changes in community composition and function. The differential functions provide new clues to elucidate the mechanism underlying the interaction between CS occurrence and the soil microbiome, and varying community compositions provide novel insights into CS occurrence.

Feasibility of Unmanned Aerial Vehicle Optical Imagery for Early Detection and Severity Assessment of Late Blight in Potato

Assessment of disease incidence and severity at farm scale or in agronomic trials is frequently performed based on visual crop inspection, which is a labor intensive task prone to errors associated with its subjectivity. Therefore, alternative methods to relate disease incidence and severity with changes in crop traits are of great interest. Optical imagery in the visible and near-infrared (Vis-NIR) can potentially be used to detect changes in crop traits caused by pathogen development. Also, cameras on-board of Unmanned Aerial Vehicles (UAVs) have flexible data collection capabilities allowing adjustments considering the trade-off between data throughput and its resolution. However, studies focusing on the use of UAV imagery to describe changes in crop traits related to disease infection are still lacking. More specifically, evaluation of late blight (Phytophthora infestans) incidence in potato concerning early discrimination of different disease severity levels has not been extensively reported. In this article, the description of spectral changes related to the development of potato late blight under low disease severity levels is performed using sub-decimeter UAV optical imagery. The main objective was to evaluate the sensitivity of the data acquired regarding early changes in crop traits related to disease incidence. For that, UAV images were acquired on four dates during the growing season (from 37 to 78 days after planting), before and after late blight was detected in the field. The spectral variability observed in each date was summarized using Simplex Volume Maximization (SiVM), and its relationship with experimental treatments (different crop systems) and disease severity levels (evaluated by visual assessment) was determined based on pixel-wise log-likelihood ratio (LLR) calculation. Using this analytical framework it was possible to identify considerable spectral changes related to late blight incidence in different treatments and also to disease severity level as low as between 2.5 and 5.0% of affected leaf area. Comparison of disease incidence and spectral information acquired using UAV (with 4–5 cm of spatial resolution) and ground-based imagery (with 0.1–0.2 cm of spatial resolution) indicate that UAV data allowed identification of patterns comparable to those described by ground-based images, despite some differences concerning the distribution of affected areas detected within the sampling units and an attenuation in the signal measured. Finally, although aggregated information at sampling unit level provided discriminative potential for higher levels of disease development, focusing on spectral information related to disease occurrence increased the discriminative potential of the data acquired.

Locating gambling problems across a continuum of severity: Rasch analysis of the Quinte Longitudinal Study (QLS)

Addressing gambling problems across a continuum requires understanding of low severity problems, as well as severe levels of problem gambling or disorder. The aims of this study were thus to derive a map of how problematic gambling behaviours and harms are situated across a continuum, and identify the best available indicators of low severity problems to inform assessment and secondary prevention. This involved the Rasch analyses of baseline data from the Quinte Longitudinal Study (QLS); a community-based survey involving random-digit dialling of numbers around Belleville, Canada. Participants were n = 1305 adults with non-zero scores across 26-items from: the Problem Gambling Severity Index (PGSI); the NORC DSM Screen for Gambling Problems (NODS); and the Problem and Pathological Gambling Measure (PPGM). Results indicated that item-level measures except chasing losses provided fit to the Rasch model, and most were clustered within a narrow region of the continuum which resembled addictive disorders. At the most severe end were mainly items about harms, while there were few items representing low severity levels (feeling guilty, betting more than one can afford, attempts to reduce gambling, gambling more than intended). There was Differential Item Functioning (DIF) for several indicators of low severity problems. The findings suggest that measures remain closely aligned with psychiatric models and are suited for discriminating across severe levels of problem gambling or addictive disorder. Although cognitive-affective and behavioural indicators comprise the best available indicators of low severity symptoms, there is an urgent need for improvements in conceptualisation and measurement.

Stress level and health locus of control in parents of hospitalized newborns – preliminary report

Abstract Aim. The study was to assess the level of stress and the health locus of control in parents of hospitalized newborns. Material and methods. The study covered a group of 150 parents of 126 newborns who were hospitalized in the Neonatal Pathology Ward at the University Children’s Hospital in Lublin. The diagnostic survey method was applied with the use of an original questionnaire as well as some standardized tools: Perceived Stress Scale (PSS-10) and Multidimensional Health Locus of Control Scale (MHLC – version B). Results. In more than a half of the subjects (54.0%), a high level of stress was observed. Every fourth (26.1%) parent was characterized by an average level of stress and nearly every fifth (19.3%) by a low level of stress. The highest indicator was characterized by the domain of the internal health control locus. Every fifth parent represented an undifferentiated type - weak or magnifying the impact of others (22.0% and 20.0% respectively). The smallest group of parents (5.3%) belonged to the externally-oriented, strong type. Conclusions. The parents of hospitalized newborns are characterized mainly by high and average levels of stress and low level of severity of health control location within each of its domains. The highest indicator of internal locus control and the influence of others are characterized by parents with low and average levels of stress. The dominant type of locus of health control that characterizes parents is the undifferentiated type – weak and magnifying the impact of others.

Sexual Victimization and Sex-Related Drinking Motives: How Protective is Emotion Regulation?

One in five college women experience sexual victimization (SV), and SV severity is associated with subsequent psychological distress, including sex-related distress. SV severity may also be associated with drinking motives to cope with sex-related distress and to enhance sex (sex-related drinking motives [SRDMs]), particularly if individuals suffer from emotion regulation (ER) difficulties. College women (N = 151) completed a survey assessment of ER, SV history, childhood sexual abuse (CSA), and SRDMs. Twelve regression models assessed six facets of ER as moderators between SV severity and SRDMs. Among women with no or low levels of prior SV severity, women with greater access to ER strategies were less likely to endorse drinking to cope SRDMs. At higher levels of SV severity, women at all levels of access to ER strategies were equally likely to endorse drinking to cope SRDMs, suggesting that access to ER strategies did not mitigate motivations to drink to cope with sex-related distress for these women. Women with severe SV histories may benefit from interventions that build on existing ER strengths or address other factors. However, greater access to ER strategies may serve as a protective factor against SRDMs when SV severity is low.

Clinical severity as a moderator of outcome in psychodynamic and dialectical behavior therapies for borderline personality disorder.

The aim of the present study was to assess the effect of initial level of psychiatric severity on treatment outcome in psychodynamic therapy and dialectical behavior therapy (DBT) for borderline personality disorder (BPD). It was hypothesized that DBT would lead to better outcome for patients with high psychiatric severity, whereas dynamic treatment would lead to better outcome for patients with lower psychiatric severity. Data from the 5th-year follow-up of the Stockholm City Council's and the Karolinska Institute's Psychotherapy Project were used in the present study. A total of 106 female patients diagnosed with BPD with at least 2 past suicide attempts were randomized into object-relational psychotherapy (ORP; based on transference-focused psychotherapy), DBT, and treatment as usual. Patients' baseline global severity index was used as a moderator. Global Assessment of Functioning (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association, 1994]) was used to examine outcome. There was a significant 3-way interaction of Time × Treatment × Severity. Post hoc analyses suggested that patients with lower levels of severity had significantly better outcomes in object-relational psychotherapy. For patients with higher severity, the 3 treatments resulted in similar outcomes in terms of level of functioning. Outcome of treatment for BPD might differ significantly for patients depending on their initial levels of overall psychiatric severity. If our findings are replicated for patients with low severity and supported for a high-severity sample, psychiatric severity can be used as a low-cost and effective tool to match patients with BPD to optimal treatments. (PsycINFO Database Record

A healthy dose of realism: The role of optimistic and pessimistic expectations when facing a downward spiral in health

Rationale and objectivesWhether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health. MethodThis 18-year-long study of community-dwelling older Canadians (n = 132, 72–98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality. ResultsSupport was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic). ConclusionThese findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.

Physician experiences with sodium-glucose cotransporter (SGLT2) inhibitors, a new class of medications in type 2 diabetes, and adverse effects.

The primary aim of our study is to identify physicians who have witnessed a complication attributed to sodium-glucose cotransporter (SGLT2) inhibitors. The secondary aim is to determine the type, severity, and setting of the event (inpatient versus outpatient). Diabetes is an increasing public health burden with 9.9% of Canadians expected to be diagnosed with it in 2020. A prominent change with respect to treatment options since the publication of the revised Diabetes Canada guidelines in May 2016 concerned the SGLT2 inhibitors. Their favorable clinical profile has increased interest among clinicians, but there is still reason for caution. Because these drugs are new, the balance of benefits versus risks is not well understood. We conducted a cross-sectional survey of all in-practice physicians (excluding pediatricians). Data were collected through an online survey. Our survey identified 154 physicians who have identified one or more adverse drug reactions (ADRs) related to SGLT2 inhibitor use. A total of 173 ADRs were identified. In total, 20.6% of family physician respondents had witnessed one or more ADRs. The most common complication is mycotic infection (82 cases) with 47% identified as a low level of severity and occurring mostly in the outpatient setting. The second most common complication is diabetic ketoacidosis (43 cases) with 67% identified as a high level of severity and occurring mostly in the inpatient setting. Other identified complications include hyperkalemia (6 cases), renal insufficiency (15 cases), and even amputation (2 cases). Our survey is the first to document real-world complications from SGLT2 inhibitors. In the outpatient setting, mycotic infections are most common and most often benign. In the inpatient setting, diabetic ketoacidosis is the most common and is severe. This is an important take-home message for family physicians to tailor their practice and vigilance according to the practice setting.

Heart Rate Variability and Cognitive Bias Feedback Interventions to Prevent Post-deployment PTSD: Results from a Randomized Controlled Trial.

There is a long history of pre-deployment PTSD prevention efforts in the military and effective pre-deployment strategies to prevent post-deployment PTSD are still needed. This randomized controlled trial included three arms: heart rate variability biofeedback (HRVB), cognitive bias modification for interpretation (CBM-I), and control. The hypothesis was that pre-deployment resilience training would result in lower post-deployment PTSD symptoms compared with control. Army National Guard soldiers (n = 342) were enrolled in the Warriors Achieving Resilience (WAR) study and analyzed. The outcome was PTSD symptom severity using the PTSD Checklist - Military version (PCL) measured at pre-deployment, 3- and 12-month post-deployment. Due to the repeated measures for each participant and cluster randomization at the company level, generalized linear mixed models were used for the analysis. This study was approved by the Army Human Research Protection Office, Central Arkansas Veterans Healthcare System Institutional Review Board (IRB), and Southeast Louisiana Veterans Health Care System IRB. Overall, there was no significant intervention effect. However, there were significant intervention effects for subgroups of soldiers. For example, at 3-months post-deployment, the HRVB arm had significantly lower PCL scores than the control arm for soldiers with no previous combat zone exposure who were age 30 and older and for soldiers with previous combat zone exposure who were 45 and older (unadjusted effect size -0.97 and -1.03, respectively). A significant difference between the CBM-I and control arms was found for soldiers without previous combat zone exposure between ages 23 and 42 (unadjusted effect size -0.41). Similarly, at 12-months post-deployment, the HRVB arm had significantly lower PCL scores in older soldiers. Pre-deployment resilience training was acceptable and feasible and resulted in lower post-deployment PTSD symptom scores in subgroups of older soldiers compared with controls. Strengths of the study included cluster randomization at the company level, use of iPod device to deliver the resilience intervention throughout the deployment cycle, and minimal disruption of pre-deployment training by using self-paced resilience training. Weaknesses included self-report app use, study personnel not able to contact soldiers during deployment, and in general a low level of PTSD symptom severity throughout the study. In future studies, it would important for the study team and/or military personnel implementing the resilience training to be in frequent contact with participants to ensure proper use of the resilience training apps.

Pathogenicity and toxigenicity of Fusarium verticillioides isolates collected from maize roots, stems and ears in South Africa

Fusarium verticillioides is most frequently associated with maize in South Africa. It colonises maize roots, stems and ears endophytically and causes diseases such as Fusarium ear rot (FER) and stalk rot. Fusarium verticillioides can produce fumonisins, which are toxic secondary metabolites harmful to humans and animals. It is, however, unknown whether endophytic and pathogenic isolates from distinct maize tissues differ in their ability to cause disease and produce fumonisins. In this study, Fusarium spp. were collected from maize roots, stems and kernels for phylogenetic analysis and the F. verticillioides isolates were subjected to pathogenic and toxigenic comparison. The translation elongation 1-α (TEF1) gene of the isolates was sequenced, and a phylogenetic tree constructed with maximum likelihood (ML) and Bayesian interference (BI) inferred. Fumonisin production of F. verticillioides isolates was determined in vitro and in planta by using high performance liquid chromatography, and virulence of the isolates was determined by silk channel inoculation of maize ears under field conditions. F. verticillioides was the species with the highest number of isolates followed by F. temperatum and then F. subglutinans. Phylogenetic analyses clustered the different Fusarium spp. according to species. Fumonisin production by F. verticillioides isolates varied from 0 to 21.3 mg/kg in vitro, and 0–16.2 mg/kg in planta. All the F. verticillioides isolates produced FER symptoms, including isolates from roots and stems. Fusarium verticillioides isolates in South Africa thus presented a species highly diverse in toxigenicity, but not in virulence. This finding has implications for managing mycotoxins in maize, as visible symptoms might be misleading to the actual toxin level present, for example low level of disease severity might represent high fumonisin levels and vice versa. The high numbers of F. temperatum, also a mycotoxin producer highlights the concern that kernels could be contaminated with more than one mycotoxin. Integrated disease management of not only F. verticillioides but all Fusarium spp. should thus focus strongly on reducing fungal contamination of maize and the detoxification of grain with focus on using regionally adapted maize varieties.

Satellite-Based Evaluation of the Post-Fire Recovery Process from the Worst Forest Fire Case in South Korea

The worst forest fire in South Korea occurred in April 2000 on the eastern coast. Forest recovery works were conducted until 2005, and the forest has been monitored since the fire. Remote sensing techniques have been used to detect the burned areas and to evaluate the recovery-time point of the post-fire processes during the past 18 years. We used three indices, Normalized Burn Ratio (NBR), Normalized Difference Vegetation Index (NDVI), and Gross Primary Production (GPP), to temporally monitor a burned area in terms of its moisture condition, vegetation biomass, and photosynthetic activity, respectively. The change of those three indices by forest recovery processes was relatively analyzed using an unburned reference area. The selected unburned area had similar characteristics to the burned area prior to the forest fire. The temporal patterns of NBR and NDVI, not only showed the forest recovery process as a result of forest management, but also statistically distinguished the recovery periods at the regions of low, moderate, and high fire severity. The NBR2.1 for all areas, calculated using 2.1 μm wavelengths, reached the unburned state in 2008. The NDVI for areas with low and moderate fire severity levels became significantly equal to the unburned state in 2009 (p > 0.05), but areas with high severity levels did not reach the unburned state until 2017. This indicated that the surface and vegetation moisture conditions recovered to the unburned state about 8 years after the fire event, while vegetation biomass and health required a longer time to recover, particularly for high severity regions. In the case of GPP, it rapidly recovered after about 3 years. Then, the steady increase in GPP surpassed the GPP of the reference area in 2015 because of the rapid growth and high photosynthetic activity of young forests. Therefore, the concluding scientific message is that, because the recovery-time point for each component of the forest ecosystem is different, using only one satellite-based indicator will not be suitable to understand the post-fire recovery process. NBR, NDVI, and GPP can be combined. Further studies will require more approaches using various terms of indices.

Explaining the relation between pathological gambling and depression: Rumination as an underlying common cause.

Background and aimsSymptoms of pathological gambling (SPG) and depression often co-occur. The nature of this relationship remains unclear. Rumination, which is well known to be associated with depression, might act as a common underlying factor explaining the frequent co-occurrence of both conditions. The aim of this study is to analyze associations between the rumination subfactors brooding and reflection and SPG.MethodsParticipants aged 14–64 years were recruited within an epidemiological study on pathological gambling in Germany. Cross-sectional data of 506 (80.4% male) individuals with a history of gambling problems were analyzed. The assessment included a standardized clinical interview. To examine the effects of rumination across different levels of problem gambling severity, sequential quantile regression was used to analyze the association between the rumination subfactors and SPG.ResultsBrooding (p = .005) was positively associated with the severity of problem gambling after adjusting for reflection, depressive symptoms, and sociodemographic variables. Along the distribution of problem gambling severity, findings hold for all but the lowest severity level. Reflection (p = .347) was not associated with the severity of problem gambling at the median. Along the distribution of problem gambling severity, there was an inverse association at only one quantile.Discussion and conclusionsBrooding might be important in the development and maintenance of problem gambling. With its relations to depression and problem gambling, it might be crucial when it comes to explaining the high comorbidity rates between SPG and depression. The role of reflection in SPG remains inconclusive.

An intelligent algorithm for identification of optimum mix of demographic features for trust in medical centers in Iran.

Healthcare quality is affected by various factors including trust. Patients' trust to healthcare providers is one of the most important factors for treatment outcomes. The presented study identifies optimum mixture of patient demographic features with respect to trust in three large and busy medical centers in Tehran, Iran. The presented algorithm is composed of adaptive neuro-fuzzy inference system and statistical methods. It is used to deal with data and environmental uncertainty. The required data are collected from three large hospitals using standard questionnaires. The reliability and validity of the collected data is evaluated using Cronbach's Alpha, factor analysis and statistical tests. The results of this study indicate that middle age patients with low level of education and moderate illness severity and young patients with high level of education, moderate illness severity and moderate to weak financial status have the highest trust to the considered medical centers. To the best of our knowledge this the first study that investigates patient demographic features using adaptive neuro-fuzzy inference system in healthcare sector. Second, it is a practical approach for continuous improvement of trust features in medical centers. Third, it deals with the existing uncertainty through the unique neuro-fuzzy approach.

Alteration of serum thymus and activation-regulated chemokine level during biologic therapy for psoriasis: Possibility as a marker reflecting favorable response to anti-interleukin-17A agents.

Biologics show great efficacy in treating psoriasis, a chronic inflammatory skin disease. The high cost and side-effects of biologics, dose-reduction, elongation of administration interval and suspension are possible options. However, there has been no reliable biomarker we can use when we consider these moderations in therapy. This study was conducted to test the possibility of using serum thymus and activation-regulated chemokine (TARC) level as an indicator for step down of biologic therapy. Serum TARC level was measured in 70 psoriatic patients at Asahikawa Medical University, and a correlation of TARC and severity of skin lesions was analyzed. Referring to serum TARC level, psoriatic patients can be divided into two groups. One is a population in which serum TARC level is positively correlated with severity of skin lesions, and the other is a population with low psoriatic severity and high TARC level. Serum TARC level was higher in the group that achieved PASI-clear with biologics than in the group which did not achieve PASI-clear. Among biologics, the group treated with secukinumab, an anti-interleukin (IL)-17A agent, showed significantly higher TARC level compared with the group treated with anti-tumor necrosis factor agents. In certain populations achieving PASI-clear, serum TARC level may be a potent marker reflecting better response to IL-17A inhibitors, and in this case step down of treatment for psoriasis is possible.

Critical assessment of the impact of vehicle wandering on rut depth measurement accuracy using 13-point based lasers

Accurate rut depth measurements have a substantial impact on the reliability of pavement performance evaluation, maintenance and rehabilitation (M&R) determination, and M&R funding allocation. To measure pavement rutting, China commonly uses 13-point based lasers. However, based on the 13-point lasers configuration, errors in rut depth measurement are inevitable if the vehicle on which the lasers are mounted wanders. Existing studies have not considered the impact of vehicle wandering on rut depth measurement accuracy and the relationship between rut shape and offset error. In this paper, 10 representative transverse profiles, including both symmetrical and non-symmetrical rut shapes with low and high severity levels of rut depths, were selected from 1100 actual transverse profiles (a 220-m rutting section from a 1.2 km roadway) that were acquired using a 13-point laser bar to simulate the impact of 5 different degrees of vehicle wandering on rut depth measurement accuracy. Results show that vehicle wandering could result in rut depth measurements error of the absolute and relative by as much as 6.4 mm and 29%, respectively. In-depth analyses show that the degree of rut depth measurement error is impacted substantially by the rut shape characteristics, including the position, slope, depth, and pattern of rut shapes (symmetrical and non-symmetrical), and the corresponding direction (right or left) of a vehicle's wandering. For example, a vehicle wandering in the direction opposite to the dominating/severe rut depth will result in a large rut depth measurement error. The contributions of this paper include quantifying the impact of vehicle wandering on rut depth measurement accuracy and identifying the factors, including the rut shape characteristics and characteristics of vehicle wandering, that might reduce rut depth measurement accuracy.

An effective fault diagnosis method for centrifugal chillers using associative classification

Fault diagnosis for centrifugal chillers is very important for saving energy and maintaining optimal operating conditions. A fault diagnosis method for centrifugal chillers is proposed based on the associative classification (AC) algorithm, which constructs an associative classifier by excavating strong rules between fault classes and physical attributes. First, association rules with significant support and high confidence values are discovered. Instead of the Apriori algorithm, FP-growth is adopted to accelerate association rule mining. Second, only association rules named class association rules (CARs) whose consequents are limited to fault classes are preserved. Third, pruned CARs are obtained by means of ranking CARs and pruning the redundant rules according to the concept of “higher rank”. Fourth, a limited number of rules are selected out of pruned CARs based on the AC algorithm to construct an associative classifier. This approach is validated using experimental centrifugal chiller data from the ASHRAE Research Project 1043 (RP-1043). Results demonstrate that this proposed AC-based approach can effectively identify seven common chiller faults at both low and high severity levels and the average correct fault diagnosis ratio can be examined up to 86.3%.