Categorical Measures Research Articles

COVID-19 Pandemic Driven Knowledge, Attitude, Clinical Practice, Distress Reactions, and Post-Traumatic Growth of Dental Care Providers in Riyadh City, Saudi Arabia: A Cross-Sectional Study

Objective: The present study aimed to assess knowledge, attitude, clinical practices, distress reactions, and post-traumatic growth of dentists during the COVID-19 pandemic in Riyadh City. Methodology: An online questionnaire was developed to assess various dental professionals from both governmental and private sectors during the early COVID-19 outbreak in Riyadh City, Saudi Arabia. The questionnaire was framed to assess the demographic variables, knowledge, attitude, and clinical practices towards handling the COVID-19 pandemic. Furthermore, the general anxiety disorder-7 (GAD-7), worry questionnaire items, short form of post-traumatic growth inventory (PTGI-SF), and life satisfaction questionnaire items were developed to assess the anxiety, worries, post-traumatic growth, and life satisfaction of dental care providers following the traumatic events. Data were analysed using SPSS 22.0 and R environment ver.3.2.2. Continuous measurement results were presented as mean ± SD, and categorical measurements results were presented in number (%). Results: Our study's significant findings revealed that a majority of the dentists were in the age group of 21-30 and practiced general dentistry. The study participants in age groups 51–60 and 41–50 years old showed more liability in perceiving COVID-19 as an extremely dangerous disease than 31–40 and 21–30 age groups. The majority of respondents (63.4%) had an anxiety scale score of greater than 40, followed by 22.8% with scores 20-40 and 13.9% with scores less than 20, respectively. The mean scores for the GAD-7 and the worry items were 8.24 ± 3.21 and 13.92 ± 4.77, respectively. The data showed that most survey participants had adopted moderate post-traumatic changes during the pandemic, as evident by their mean score of 34.17 ± 3.40. The life satisfaction of the participants was neutral, as demonstrated by their mean score of 20.16 ± 4.03. Conclusion: This study’s findings delineated that the COVID-19 pandemic situation has influenced dentists' mental health, with a moderate level of anxiety, and worries among other psychological symptoms. Furthermore, there was adequate knowledge regarding the COVID-19 among dentists; however, the pandemic affected the financial conditions of the respondents. There was a moderate level of post-traumatic growth and neutral life satisfaction of the dental providers.

From Office-Based Treatment to Telehealth: Comparing Clinical Outcomes and Patient Participation in a Psychiatric Intensive Outpatient Program with a Large Transdiagnostic Sample.

Introduction: Patient participation and clinical outcomes of a precoronavirus disease 2019 (COVID-19) office-based transdiagnostic psychiatric intensive outpatient program (IOP) were compared with those of telehealth IOP during COVID-19. Materials and Methods: Weeks of enrollment, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) assessments, and sociodemographic and clinical factors (including group track and diagnosis) were collected during pre-COVID-19 (n = 191) and during COVID-19 (n = 200). Continuous and categorical measures of GAD-7 and PHQ-9 were analyzed; potential sociodemographic and clinical covariates to scores were also explored. Results: There were no statistically significant differences in participation between time periods. Associations were observed between PHQ-9/GAD-7 score improvement and number of assessments. Significant score reductions occurred in both periods, and differences in change scores were not significant. Sociodemographic and clinical factors were not significantly different between time periods. Patients with commercial insurance had significantly higher improvement in both mean and categorical PHQ-9 scores (t = 2.77, p = 0.006; χ2 = 10.47, df = 1, p = 0.001) and GAD-7 scores (t = 2.29, p = 0.023; χ2 = 8.58, df = 1, p = 0.003) than those with public insurance. Patients with anxiety disorders had significantly greater improvements (F = 4.49, p = 0.004; χ2 = 9.15, df = 3, p = 0.027) in GAD-7 during COVID-19. Discussion: Significant improvements in PHQ-9/GAD-7 scores and measures of participation were not significantly different between telehealth and office-based IOP, nor were they greatly influenced by clinical or sociodemographic factors. Further study is needed of possible care disparities for publicly insured patients. Conclusion: Despite some limitations, telehealth IOP appears to be a clinically appropriate option for a diverse sociodemographic and diagnostically heterogeneous psychiatric population.

Interfragmentary approach total hip replacement in unstable intertrochanteric femur fracture in elderly shows better clinical result compare to standard posterior approach

Introduction: Hip fracture is the most common fracture in elderly patients, with the rate of morbidity increasing is the main issues. The clinical as well functional outcomes are influenced by many factors, which includes patient condition, type of fracture, and definite treatment weather replacement or fixation. Patient and methodology: We carry out study in our center 54 patients presented to our center with unstable Intertrochanteric Femur Fracture with age more than 70 years old. Twenty Six of them (group 1) underwent standard posterior approach and 28 (group 2) underwent interfragmentary approach. Those patient with cognitive disorder and other neuromuscular disorder was excluded in this study. All of them was treated with Uncemented Total Hip Repalcement and Trochanteric Cable Plate with same type of implant. Statistical analysis: Latest version of SPSS software package was used for the statistical analysis of data. Categorical measurements were given as numbers and percentage values, whereas continuous measurements were given as mean and SD values (median and minimum–maximum when necessary). Their mean age was 82 (70-90) years, 14 males and 40 females with BMI is 20.2 (19.8-22.1.). Result: According to comparison of the groups, it was found that the rate of dislocation was statistically significantly higher in patient underwent posterolateral approach compare to interfragmentary approach. Trochanteric non union also is higher in group 1 compare to group 2. Conclusion: The option of Total Hip Repalcement with Trochanteric Grip Plate in elderly patient with osteoporotic bone through interfragmentary approach, give immediate stability and allow weight bearing and show good functional outcome with no complication at short term period.

Antenatal Corticosteroids Decrease the Risk of Composite Neonatal Respiratory Morbidity in Planned Early Term Cesarean Deliveries.

While administration of antenatal corticosteroids prior to term elective cesarean deliveries has been shown in international randomized controlled trials to decrease the rates of respiratory distress syndrome and transient tachypnea of the newborn, this is not a standard practice in the United States. We aim to determine if the administration of antenatal corticosteroids for fetal lung maturation within 1 week of scheduled early term cesarean delivery resulted in decreased composite respiratory morbidity. Historical cohort study including women who underwent scheduled early term cesarean delivery of a singleton, non-anomalous neonate at Mount Sinai Hospital between May 2015 and August 2019, comparing those who completed a course of antenatal corticosteroids within 1 week of delivery to those who did not. The primary outcome was composite respiratory morbidity defined as respiratory distress syndrome, transient tachypnea of the newborn, and neonatal intensive care unit admission for respiratory morbidity. Maternal and neonatal characteristics were compared between groups using t-tests or Wilcoxon-Rank Sum tests for continuous measures and Chi-square or Fisher's exact tests for categorical measures, as appropriate. The outcomes were assessed using logistic regression. History of preterm birth was significantly higher in those who received antenatal corticosteroids compared with those who did not (24.0 vs. 10.9%, p = 0.01). Neonates who were not exposed to antenatal corticosteroids were more likely to experience the composite respiratory morbidity compared with those who were exposed (RR 4.1, 95% CI 1.2-13.7; p = 0.02). Between 37 and 38 weeks, neonates who did not receive steroids were at increased risk of composite respiratory morbidity (RR 11.7, 95% CI 1.5-89.0, p < 0.01), however, there was no difference for those born between 38 and 39 weeks. Betamethasone course administered prior to planned early term cesarean delivery was associated with a statistically significant reduction in the neonatal composite respiratory morbidity compared with routine management. · Steroids administered prior to scheduled cesarean lead to decreased neonatal respiratory morbidity.. · Steroid administration was not associated with increased adverse neonatal outcomes.. · Steroid administration was most beneficial between 37 and 38 weeks..

Using motion‐based technology to measure movement confidence among people with dementia and mild cognitive impairment

AbstractBackgroundMovement confidence is defined as “a person’s feeling or sense of adequacy in a movement situation.” It is proposed that those who are ‘movement confident’ are more likely to partake in movement situations (e.g., exercise) and enjoy doing so. However, the concept and measurement of movement confidence has not been explored among people with dementia and MCI, who can benefit from participating in activities involving physical movement, such as exercise.MethodParticipants with dementia and MCI (n=28; 53.6% female) were recruited from four community‐based adult day programs to participate in a 10‐week Xbox Kinect bowling intervention to see whether the intervention impacted their balance, movement confidence, and cognition. As part of the data collection procedure, video recordings were taken during the first, middle, and final week of the intervention and coded using video analysis software, to measure movement confidence. Count and percentage data were examined, and the coding scheme used to create a categorical measure of movement confidence. Count, percentage, and categorical data were analyzed descriptively and also compared across the study using a series of related‐samples Wilcoxon signed rank tests.ResultAmong those who completed the study, movement confidence was high at the start and did not significantly decline over time (Z‐score=‐0.359, p=0.719), suggesting a potential maintenance effect of the intervention. Various behaviours signifying movement confidence during the motion‐based activity, such as hip shifting, knee bending, change in base of support, and willingness to move were captured using both the movement confidence coding scheme and categorial measure. The coding scheme, categorical measure, and implications will be further described.ConclusionThis study is the first to examine the complex construct of movement confidence among people with dementia and MCI, paving the way for future investigations. This study is also the first to create an observational, categorical measure of movement confidence which could potentially be used by clinicians (e.g., physiotherapists) to quickly score the movement confidence of people with dementia and MCI in various movement situations.

Classification random forest with exact conditioning for spatial prediction of categorical variables

Machine learning methods are increasingly used for spatially predicting a categorical target variable when spatially exhaustive predictor variables are available within the study region. Even though these methods exhibit competitive spatial prediction performance, they do not exactly honor the categorical target variable's observed values at sampling locations by construction. On the other side, competitor geostatistical methods perfectly match the categorical target variable's observed values at sampling locations by essence. In many geoscience applications, it is often desirable to perfectly match the observed values of the categorical target variable at sampling locations, especially when the categorical target variable's measurements can be reasonably considered error-free. This paper addresses the problem of exact conditioning of machine learning methods for the spatial prediction of categorical variables. It introduces a classification random forest-based approach in which the categorical target variable is exactly conditioned to the data, thus having the exact conditioning property like competitor geostatistical methods. The proposed method extends a previous work dedicated to continuous target variables by using an implicit representation of the categorical target variable. The basic idea consists of transforming the ensemble of classification tree predictors' (categorical) resulting from the traditional classification random forest into an ensemble of signed distances (continuous) associated with each category of the categorical target variable. Then, an orthogonal representation of the ensemble of signed distances is created through the principal component analysis, thus allowing to reformulate the exact conditioning problem as a system of linear inequalities on principal component scores. Then, the sampling of new principal component scores ensuring the data's exact conditioning is performed via randomized quadratic programming. The resulting conditional signed distances are turned out into an ensemble of categorical outputs, which perfectly honor the categorical target variable's observed values at sampling locations. Then, the majority vote is used to aggregate the ensemble of categorical outputs. The effectiveness of the proposed method is illustrated on a simulated dataset for which ground-truth is available and showcased on a real-world dataset, including geochemical data. A comparison with geostatistical and traditional machine learning methods show that the proposed technique can perfectly match the categorical target variable's observed values at sampling locations while maintaining competitive out-of-sample predictive performance.

Systematic review support received and needed by researchers: a survey of libraries supporting Ontario medical schools.

IntroductionFinding efficient ways to meet the growing demand for library systematic review support is imperative for facilitating the production of high-quality research. The objectives of this study were threefold: 1) to ascertain the systematic review support provided by health sciences libraries at Ontario medical schools and their affiliated hospitals, 2) to determine the perceived educational needs by researchers at these institutions, and 3) to assess the potential usefulness of freely available, online educational modules for researchers that discuss all stages of the systematic review process.MethodsWe conducted a cross-sectional survey in June and July of 2020. Data was analyzed and presented using median and interquartile range (IQR) for continuous measures, and in proportions for categorical measures.Results13 of 19 libraries invited provided usable data. Most libraries spent more time supporting systematic reviews via collaboration and participation than by providing educational support. The perceived needs of library users were contrary to the perceived gaps in researcher support provided by the library/institution. All libraries reported they would find freely available, online educational modules useful for training researchers.DiscussionThe next steps for our inter-professional research team will be to develop freely available, online education modules that introduce researchers to all stages of the systematic review process. These modules cannot replace the value that direct support from librarians, biostatisticians or methodology experts can provide, however, they may offer a more efficient way for libraries to familiarize researchers and trainees with best practices and universally accepted reporting guidelines for performing a high-quality review.

Re-examining thresholds of continuous democracy measures

ABSTRACT Scholars frequently dichotomize continuous measures of democracy by setting a regime cut-off. However, such cut-offs often lack theoretical or empirical justifications, making the resulting classifications difficult to interpret conceptually. We investigate this challenge involving three major continuous democracy measures: the Freedom House score (FH), the Polity score, and the Regime of the World (RoW) that is based on the V-Dem's Electoral Democracy Index (EDI). We develop a framework to empirically derive thresholds using categorical democracy measures as benchmarks. Our analyses find that the cut-offs that yield the highest consistency with the classifications of BMR, CGV, and GWF are 3.5 for FH, 5 for Polity and 0.39 for EDI/RoW. These levels are lower than the conventional cut-offs, implying less demanding democratic standards. Consequently, the conventional cut-offs (2.5 for FH, 6 for Polity and 0.5 for EDI/RoW) endeavour to reflect more stringent standards of democracy than what these dichotomous measures employ.

Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases.

There are conflicting reports on outcome trends following radical cystectomy (RC) for bladder cancer. Evolution of modern bladder cancer management and its impact on outcomes was analyzed using a longitudinal cohort of 3,347 patients who underwent RC at an academic center between 1971 and 2018. Outcomes included recurrence-free survival (RFS) and overall survival (OS). Associations were assessed using univariable and multivariable models. In all, 70.9% of cases underwent open RC in the last decade, although trend for robot-assisted RC rose since 2009. While lymphadenectomy template remained consistent, nodal submission changed to anatomical packets in 2002 with increase in yield (p <0.001). Neoadjuvant chemotherapy (NAC) use increased with time with concomitant decrease in adjuvant chemotherapy; this was notable in the last decade (p <0.001) and coincided with improved pT0N0M0 rate (p=0.013). Median 5-year RFS and OS probabilities were 65% and 55%, respectively. Advanced stage, NAC, delay to RC, lymphovascular invasion and positive margins were associated with worse RFS (all, multivariable p <0.001). RFS remained stable over time (p=0.73) but OS improved (5-year probability, 1990-1999 51%, 2010-2018 62%; p=0.019). Among patients with extravesical and/or node-positive disease, those who received NAC had worse outcomes than those who directly underwent RC (p ≤0.001). Despite perioperative and surgical advances, and improved pT0N0M0 rates, there has been no overall change in RFS trend following RC, although OS rates have improved. While patients who are downstaged with NAC derive great benefit, our real-world experience highlights the importance of preemptively identifying NAC nonresponders who may have worse post-RC outcomes.

Community-Level Economic Distress, Race, and Risk of Adverse Outcomes After Heart Failure Hospitalization Among Medicare Beneficiaries.

Socioeconomic disadvantage is a strong determinant of adverse outcomes in patients with heart failure. However, the contribution of community-level economic distress to adverse outcomes in heart failure may differ across races and ethnicities. Patients of self-reported Black, White, and Hispanic race and ethnicity hospitalized with heart failure between 2014 and 2019 were identified from the Medicare MedPAR Part A 100% Files. We used patient-level residential ZIP code to quantify community-level economic distress on the basis of the Distressed Community Index (quintile 5: economically distressed versus quintiles 1-4: nondistressed). The association of continuous and categorical measures (distressed versus nondistressed) of Distressed Community Index with 30-day, 6-month, and 1-year risk-adjusted mortality, readmission burden, and home time were assessed separately by race and ethnicity groups. The study included 1 611 586 White (13.2% economically distressed), 205 840 Black (50.6% economically distressed), and 89 199 Hispanic (27.3% economically distressed) patients. Among White patients, living in economically distressed (versus nondistressed) communities was significantly associated with a higher risk of adverse outcomes at 30-day and 1-year follow-up. Among Black and Hispanic patients, the risk of adverse outcomes associated with living in distressed versus nondistressed communities was not meaningfully different at 30 days and became more prominent by 1-year follow-up. Similarly, in the restricted cubic spline analysis, a stronger and more graded association was observed between Distressed Community Index score and risk of adverse outcomes in White patients (versus Black and Hispanic patients). Furthermore, the association between community-level economic distress and risk of adverse outcomes for Black patients differed in rural versus urban areas. Living in economically distressed communities was significantly associated with a higher risk of mortality and lower home time at 1-year follow-up in rural areas but not urban areas. The association between community-level economic distress and risk of adverse outcomes differs across race and ethnic groups, with a stronger association noted in White patients at short- and long-term follow-up. Among Black patients, the association of community-level economic distress with a higher risk of adverse outcomes is less evident in the short term and is more robust and significant in the long-term follow-up and rural areas.

Association of the CYP39A1 G204E Genetic Variant with Increased Risk of Glaucoma and Blindness in Patients with Exfoliation Syndrome

Carriers of functionally deficient mutations in the CYP39A1 gene have been recently reported to have a 2-fold increased risk of exfoliation syndrome (XFS). The aim of this study was to evaluate the risk of blindness and related clinical phenotypes of XFS patients carrying the loss-of-function CYP39A1 G204E mutation in comparison with XFS patients without any CYP39A1 mutation. Retrospective case study. A total of 35 patients diagnosed with XFS carrying the CYP39A1 G204E mutation and 150 XFS patients without any CYP39A1 mutation who were randomly selected from the Japanese XFS cohort. Two-sided Fisher exact test with an alpha level < 0.05 was used to estimate the significance of the calculated odds ratio (OR) for all categorical measures. Comparisons between groups of subjects were performed using linear mixed effect models with group as random effect and taking possible dependence between eyes within a subject into account. Primary analysis compared the incidence of blindness (defined as visual acuity [VA] < 0.05 decimal), prevalence of exfoliation glaucoma (XFG), history of glaucoma surgery, and indices of glaucoma severity such as visual field (VF) mean deviation (MD), intraocular pressure (IOP), and vertical cup-disc ratio (CDR) between CYP39A1 G204E carriers and those without any CYP39A1 mutation. The overall risk for blindness was significantly higher in XFS patients carrying the CYP39A1 G204E variant (10/35 [28.6%]) compared with XFS patients without any CYP39A1 mutations (8/150 [5.4%]; odds ratio [OR], 7.1; 95% confidence interval [CI], 2.7-20.2]; P < 0.001). A higher proportion of XFS patients with the CYP39A1 G204E mutation (23/35 [65.7%]) had evidence of XFG in at least 1 eye compared with the comparison group (41/150 [27.3%]; OR, 5.1; 95% CI, 2.4-11.4]; P < 0.0001). Significantly higher peak IOP, larger vertical CDR, and worse VF MD were also found in CYP39A1 G204E variant carriers (P < 0.001). Additionally, patients with the CYP39A1 G204E mutation (18/35 [51.4%]) required more laser or glaucoma surgical interventions compared with those without any CYP39A1 mutation (32/150 [21.3%], P < 0.001). Patients with XFS carrying the CYP39A1 G204E mutation had significantly increased risk of blindness, higher occurrence of XFG, and more severe glaucoma compared with patients with XFS without any CYP39A1 mutation.

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors

Chimeric Antigen Receptor T-Cell Therapy Treatment Patterns: A Retrospective Cohort Analysis of Relapsed or Refractory Diffuse Large B-Cell Lymphoma Patients in the US

IntroductionPatients with relapsed or refractory Diffuse large-B-cell lymphoma (RR DLBCL) have historically had limited treatment options. The approval of chimeric antigen receptor T-cell (CAR T) therapy in 2017 offered a significant survival benefit for patients with RR DLBCL beyond second line of therapy. While CAR T therapy is primarily administered in inpatient settings, anecdotal evidence suggests that outpatient CAR T therapy administration may be increasing as clinicians gain experience. We conducted an analysis of real-world CAR T treatment patterns to provide evidence on current CAR T use.MethodsA retrospective analysis of the Anlitiks All-Payor Claims (AAPC) data for services rendered from April 2017 to December 2020 was conducted. The database includes fully adjudicated pharmacy and medical claims of patients that are insured through Medicare, Medicaid, or commercial plans covering over 80% of the US healthcare system. RR DLBCL patients (ICD-9/10-CMs 200.x, 202.8x; C83.3x, C84.6x, C84.7x, C85.2x) with a first claim (index date) for CAR T therapy (axicabtagene ciloleucel [axi-cel], tisagenlecleucel [tisa-cel], or unspecified CAR T agent) from October 2017 to September 2020, with ≥180 days of pre-index and ≥ 90 days of post-index follow-up were identified. Patient demographics, clinical characteristics, comorbidities, and treatment patterns including setting of CAR T infusion (inpatient/outpatient), time from leukapheresis to CAR T infusion, and incidence of CAR T-associated AEs and costs were analyzed. We utilized chi-square tests (categorical measures), t-tests, and Wilcoxon-Rank Sum tests (continuous measures) where appropriate. Logistic regression and Cox proportional hazards models were used to identify predictors of setting of CAR T infusion and time from leukapheresis to CAR T infusion.ResultsOf the 1,175 patients with RR DLBCL treated with CAR T therapy, 82.9% were infused inpatient. Overall, 61.5% (n=722) of patients were male, the mean age was 60.3 (±12.3) years, 46.5% (n=546) were commercially insured, 6.5% (n=77) had Medicare, 1.4% (n=16) had Medicaid, 44% (n=517) and 1.6% (n=19) had unknown and other insurance types, respectively. Outpatient CAR T infusion increased slightly from 15.9% in 2017 to 18.3% in 2018, then dropped to 17.2% in 2019 and 16.1% in 2020. Baseline patient characteristics are summarized in Table 1.While median time from leukapheresis to CAR T infusion was similar for inpatient (28 days) and outpatient (31 days) settings, it was 24 days for axi-cel and 41 days for tisa-cel (p<0.001), nearly two times longer for the tisa-cel cohort as compared to the axi-cel cohort (HR: 2.04, 95% CI: 1.54-2.70). Medicare patients had a significantly lower likelihood of undergoing CAR T infusion in the inpatient setting (OR: 0.14, 95% CI: 0.08-0.23, p<0.001) compared to commercial, Medicaid, and patients with other insurance types.ConclusionsIn this claims-based analysis, more than 4 in 5 patients received CAR T therapy infusions in inpatient settings and the majority of patients with known insurance type were commercially insured. Axi-cel patients had a shorter time from leukapheresis to CAR T infusion compared to tisa-cel patients; opportunities to narrow this pre-treatment window still exist. Overall, there appears to be no clear trend in the pattern of CAR T infusion settings. Additional analyses on AE patterns and cost are underway to better understand therapeutic decision making. [Display omitted] DisclosuresSeyedin: Kite, A Gilead Company: Consultancy. Thornton Snider: Kite, a Gilead Company: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company; Gilead: Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Rajagopalan: Kite, A Gilead Company: Consultancy. Wade: Amgen: Consultancy; Kite, A Gilead Company: Consultancy; Allergan: Consultancy. Gergis: Kite, A Gilead Company: Consultancy.

Improving the health assistant in nursing employment model through entry to practice nursing student perceptions: a cross-sectional study

Background: A model employing entry to practice nursing students as health assistants in nursing (HANs) was developed to support the nursing workforce. Objective: This research examines the perceived benefits of being employed as a HAN to graduate entry to practice nursing students. Design: Cross-sectional study Methods: A web-based 33-item questionnaire was open to entry to practice nursing students employed as a HAN. Categorical measures were summarised using descriptive statistics. Qualitative comments were analysed thematically. Results: Of the 39 enrolled participants, 38 (97.4%) completed the study. Fifteen students (39.5%) commenced a graduate year in 2019, 12 (31.6%) commenced a graduate year in 2020 and 11 (28.9%) will commence a graduate year in 2021. The participants viewed HAN employment as an opportunity to further develop as nurses and suggested that the HAN scope of practice expand to include their existing nursing scope of practice, thereby optimising their learning experience. Conclusion: The HAN model is viewed as a valuable model of employment by entry to practice nursing students; however, the HAN scope of practice is viewed as too limited and not conducive to self-development. This may impact on the retention of HAN employees as they transition to registered graduate nurse employment. Impact statement: Graduate entry to practice nursing students offer direction on how to improve the Health Assistants in Nursing employment model.

The Effect of Gender on the Response to Stress among Mortuary Workers A Pilot Study

Background: Working in the mortuary, where there is human dissection, is emotionally painful. In Iraq, the condition is not good because of the nature of the mortality, the incidence and the gender factors; we analyse this, in the current paper. Patients and Methods: A Depression Anxiety Stress Scale 21(DASS 21) Arabic version Scale was performed on 20 staff working in the mortuary of Azadi Teaching Hospital in Kirkuk city-Iraq. There were 20 workers, the sex ratio for male: female was 14:6. The DASS 21 scale is a quantitative measure of distress along 3 axes of depression, anxiety and stress among otherwise normal population; it is not a categorical measure of clinical diagnoses. Results: The impact of dealing with dead bodies, victims of violence in the war area, seems to have affected both genders in general. The female gender, however, seems to have had the psychological state worse affected, and among the 3 categories, there was higher incidence of depression among the female gender. Conclusion: The health authorities need to monitor the mortuary staff psychological profile on regular basis and find means to reduce the incidence of depression, anxiety and stress, especially among the workers. The occupation is associated with psychological distress especially among female gender.

Receiver operating characteristic plot and area under the curve with binary classifiers: pragmatic analysis of cognitive screening instruments.

Aim: To examine whether receiver operating characteristic plots and area under the curve (AUC) values may be potentially misleading when assessing cognitive screening instruments as binary predictors rather than as categorical or continuous scales. Materials & methods: AUC was calculated using different methods (rank-sum, diagnostic odds ratio) using data from test accuracy studies of two binary classifiers of cognitive status (applause sign, attended with sign), a screener producing categorical data (Codex), and a continuous scale screening test (Mini-Addenbrooke's Cognitive Examination). Results: For all screeners, AUC calculated using diagnostic odds ratio method was greater than using rank-sum method. When Codex and Mini-Addenbrooke's Cognitive Examination were analyzed as binary (single fixed threshold) tests, AUC using rank-sum method was lower than when screeners were analyzed as categorical or continuous scales, respectively. Conclusion: If cognitive screeners producing categorical or continuous measures are dichotomized, calculated AUC may be an underestimate, thus affecting screening test accuracy.

Association of Psychological Resilience With Healthy Lifestyle and Body Weight in Young Adulthood

PurposeChildhood adversity is associated with adverse health outcomes, in part owing to its effects on healthy lifestyle. We examined whether psychological resilience to adversity may promote healthier behaviors and body weight in young adulthood. MethodsData are from the Growing Up Today Study, a longitudinal cohort of young adults (n = 3,767) who are children of participants of the Nurses' Health Study II, a separate longitudinal cohort. After characterizing psychological resilience as per levels of adversity exposure before the age of 18 years and young adult psychological health (defined by a composite of low psychological distress and high positive affect), we derived a categorical measure by cross-classifying adversity (exposed vs. unexposed) and psychological health (high vs. lower). We considered five outcomes self-reported at baseline (2010) and five years later: healthy body weight and four healthy lifestyle components including being a nonsmoker, moderate alcohol consumption, regular physical activity, and healthy diet. Poisson regression models evaluated associations of each outcome with psychological resilience, comparing psychologically resilient individuals with those who were not resilient or who were unexposed to adversity, adjusting for relevant covariates. ResultsWe did not identify differences between psychologically resilient individuals and those unexposed to adversity who were psychologically healthy with respect to meeting recommendations for most healthy lifestyle components and associations were largely stable over time. Across most outcomes, nonresilient individuals were less likely to be healthy relative to resilient individuals. ConclusionsPsychological resilience may disrupt negative effects of childhood adversity on having a healthy lifestyle in young adulthood.

Using Delaunay triangulation to sample whole-specimen color from digital images.

Color variation is one of the most obvious examples of variation in nature, but biologically meaningful quantification and interpretation of variation in color and complex patterns are challenging. Many current methods for assessing variation in color patterns classify color patterns using categorical measures and provide aggregate measures that ignore spatial pattern, or both, losing potentially important aspects of color pattern.Here, we present Colormesh, a novel method for analyzing complex color patterns that offers unique capabilities. Our approach is based on unsupervised color quantification combined with geometric morphometrics to identify regions of putative spatial homology across samples, from histology sections to whole organisms. Colormesh quantifies color at individual sampling points across the whole sample.We demonstrate the utility of Colormesh using digital images of Trinidadian guppies (Poecilia reticulata), for which the evolution of color has been frequently studied. Guppies have repeatedly evolved in response to ecological differences between up‐ and downstream locations in Trinidadian rivers, resulting in extensive parallel evolution of many phenotypes. Previous studies have, for example, compared the area and quantity of discrete color (e.g., area of orange, number of black spots) between these up‐ and downstream locations neglecting spatial placement of these areas. Using the Colormesh pipeline, we show that patterns of whole‐animal color variation do not match expectations suggested by previous work.Colormesh can be deployed to address a much wider range of questions about color pattern variation than previous approaches. Colormesh is thus especially suited for analyses that seek to identify the biologically important aspects of color pattern when there are multiple competing hypotheses or even no a priori hypotheses at all.

Risk factors for developing epilepsy in children with cerebral pals

Aim. To identify the most important risk factors affecting the development of epilepsy in children with cerebral palsy.&#x0D; Methods. The study included 160 cerebral palsy patients with and without epilepsy who received treatment at the Baku Children's Neurological Hospital. The patients were divided into 2 groups. The first group consisted of 110 (68.7%) patients with cerebral palsy and epilepsy, and the second group consisted of 50 (31.3%) patients with cerebral palsy. The age of children ranged from 1 to 14 years. Statistical data processing was performed by using the SPSS software version 16.0. The Chi-square test was used to compare categorical measurements. T-test for independent groups was used for comparison between groups of continuous measurements. Binary logistic regression was used for determining the risk factors. In all tests, the level of statistical significance was set at p 0.05.&#x0D; Results. There was no significant difference in age and gender distribution between groups (p=0.492 and p=0.818, respectively). 10 (9.1%) children in the main group had a positive family history of epilepsy (odds ratio 8.08, p=0.028). Neonatal seizures were observed in 25 (22.7%) children in the main group and 3 (6%) children in the control group (odds ratio 4.4, p=0.010). The presence of infection during pregnancy in the mother was found in both the main (39.1%) and control (20%) groups (odds ratio 2.6, p=0.018). Level IV of the Gross Motor Function Classification System (GMFCS) was the most frequent among patients with epilepsy (odds ratio 12.8; p=0.035). The incidence rate of epilepsy among cerebral palsy patients was 68.7%. The mean age of onset of seizures was 19.226.6 months. The most frequent epileptic seizures (55.5%) occurred in spastic quadriplegic cerebral palsy.&#x0D; Conclusion. The presence of a positive family history of epilepsy, neonatal seizures, maternal infection during pregnancy and severe GMFCS level were identified as factors for the development of epilepsy in patients with cerebral palsy; premature birth, presence of hypoxic-ischemic injury, low birth weight, consanguineous marriage, multiple pregnancies, or gender were not identified as risk factors for the development of epilepsy in children.

The diminishing precision of memory for time.

Knowing when an event took place can provide several benefits to episodic memory, such as distinguishing among multiple traces, learning sequences of events, and guiding a search strategy. As a tool for understanding memory, time is particularly appealing given its ever-changing quality, the constant possibility to associate it with encoded events, and the ease with which it can be targeted at retrieval. Whereas studies of episodic retrieval typically employ categorical and probabilistic measures of retrieval success, characterizing a continuous feature such as time warrants measures particularly sensitive to the fidelity, or precision, of retrieved information. Here, we adapt a paradigm for assessing the fine-grained precision of retrieval to understand the nature of judging the time at which a memory was encoded. Subjects studied a series of pictures and then undertook a test in which they placed each picture, as precisely as possible, along a continuous time line representing the study list. Based on mixture-modeling analyses of the test response errors, the primary results were that temporal judgments were less accurate with passing time, and this change was due to diminished precision as opposed to an increased rate of guessing. Moreover, although we observed a negligible influence of guessing, subjects exhibited a clear effect of bias that favored recent responses. Together, in contrast to numerous studies of memory for other continuous features (e.g., color and location), our findings demonstrate a novel pattern of decision factors, suggesting that the retrieval of time might highlight distinct attributes of episodic memory.