Nagelkerke R2 Research Articles

Newly diagnosed glioblastoma in geriatric (65\u2009+) patients: impact of patients frailty, comorbidity burden and obesity on overall survival

ObjectIncreasing age is a known negative prognostic factor for glioblastoma. However, a multifactorial approach is necessary to achieve optimal neuro-oncological treatment. It remains unclear to what extent frailty, comorbidity burden, and obesity might exert influence on survival in geriatric glioblastoma patients. We have therefore reviewed our institutional database to assess the prognostic value of these factors in elderly glioblastoma patients.MethodsBetween 2012 and 2018, patients aged ≥ 65 years with newly diagnosed glioblastoma were included in this retrospective analysis. Patients frailty was analyzed using the modified frailty index (mFI), while patients comorbidity burden was assessed according to the Charlson comorbidity index (CCI). Body mass index (BMI) was used as categorized variable.ResultsA total of 110 geriatric patients with newly diagnosed glioblastoma were identified. Geriatric patients categorized as least-frail achieved a median overall survival (mOS) of 17 months, whereas most frail patients achieved a mOS of 8 months (p = 0.003). Patients with a CCI > 2 had a lower mOS of 6 months compared to patients with a lower comorbidity burden (12 months; p = 0.03). Multivariate analysis identified “subtotal resection” (p = 0.02), “unmethylated MGMT promoter status” (p = 0.03), “BMI < 30” (p = 0.04), and “frail patient (mFI ≥ 0.27)” (p = 0.03) as significant and independent predictors of 1-year mortality in geriatric patients with surgical treatment of glioblastoma (Nagelkerke's R2 0.31).ConclusionsThe present study concludes that both increased frailty and comorbidity burden are significantly associated with poor OS in geriatric patients with glioblastoma. Further, the present series suggests an obesity paradox in geriatric glioblastoma patients.

A practical method for dealing with missing Glasgow Coma Scale verbal component scores.

The Glasgow Coma Scale (GCS) is used for the assessment of impaired consciousness; however, it is not always possible to test each component, most commonly the verbal component. This affects the derivation of the GCS sum score, which has a role in systems for predicting patient outcome. Imputation of missing scores does not add extra information, but it does allow use of tools for predicting outcome that require complete data. The authors devised a simple and practical tool to employ when verbal component data are missing. They then assessed the tool's utility by application to the GCS-Pupils plus age plus CT findings (GCS-PA CT) prognostic model. The authors inspected data from the International Mission for Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) cohort to characterize the frequency of missing verbal scores. The authors identified a single verbal score to impute for each eye and motor combined sum (EM) score from distributions of verbal scores in a published database of 54,069 patients. The effectiveness of the imputed verbal score was assessed using a dataset containing information from the IMPACT and Corticosteroid Randomisation After Significant Head Injury (CRASH) databases. The authors compared the performance of the prognostic model using actual verbal scores with the performance using imputed verbal scores and assessed the information yield using Nagelkerke's R2 statistic. Verbal data were most commonly missing in patients with no eye opening and with a motor score of 4 or less. The "simple" imputation model that was developed performed as well as a more complex model involving distinct combinations of eye and motor scores. The imputation model consisted of the following: EM scores 2-6, add 1; EM score 7, add 2; EM score 8 or 9, add 4; and EM score 10, add 5 to provide the GCS sum score. Modeling without information about the verbal score reduced the R2 from 32.1% to 31.4% and from 34.9% to 34.0% for predictions of death and favorable outcome at 6 months, respectively, compared with using full verbal score information. This strategy is particularly valuable for imputation in clinical practice, enabling clinicians to make a rapid and reliable determination of the GCS sum score when the verbal component is not testable. This will support clinical communication and decisions based on estimates of injury severity as well as enable estimation of prognosis. The authors suggest that external validation of their imputation strategy and the performance of the GCS-PA charts should be undertaken in other clinical populations.

A-206 “Mittenberg-Type formula for Identifying Feigned ADHD Using WAIS-IV”

Abstract Objective This study utilized logistic regression to determine whether performance patterns on the WAIS-IV subtests could differentiate between genuine-effort and simulated ADHD groups. Method Participants were 355 college students (55.3%% female; 65.7% Caucasian, 23.9% African American, 4.2% Asian; age range 17–51 years, Mage = 20.93 years, SD = 4.63; 76.4% no psychological diagnosis) who completed the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Mean FSIQ for control group was 102.35 and 87.48 for the simulator group. Eighty participants (22.5%) simulated ADHD symptoms, while 276 participants (77.5%) provided genuine effort. Results A logistic regression analysis was performed with known group as the dependent variable and WAIS-IV subtest scaled scores as predictor variables. The final model of five predictor variables (Similarities, Information, Digit Span, Symbol Search, and Coding) significantly predicted group status (χ2 = 140.91, df = 5, N = 355, p &amp;lt; .001). The model accounted for 33% to 50% of the variance (Cox and Snell R2 = .33; Nagelkerke R2 = .50) in performance classification with overall 86% of individuals correctly predicted to their known group. At a cut value of .65 the sensitivity was 69.6% and the specificity was 90.6%. A cut value of.55 the sensitivity was 53.2% and the specificity was at 94.6%. Conclusions These findings are consistent with prior research suggesting discriminant function analysis derived from clinical measures (e.g., WAIS-IV) can be useful as embedded validity measures in distinguishing suspicious and genuine performance. Sensitivity, specificity, and predictive power of the WAIS-IV subtests were acceptable at 5% and 10% false positive rates.

Prognostic tools for hypertrophic scar formation based on fundamental differences in systemic immunity.

Unpredictable hypertrophic scarring (HS) occurs after approximately 35% of all surgical procedures and causes significant physical and psychological complaints. Parallel to the need to understanding the mechanisms underlying HS formation, a prognostic tool is needed. The objective was to determine whether (systemic) immunological differences exist between patients who develop HS and those who develop normotrophic scars (NS) and to assess whether those differences can be used to identify patients prone to developing HS. A prospective cohort study with NS and HS groups in which (a) cytokine release by peripheral blood mononuclear cells (PBMC) and (b) the irritation threshold (IT) after an irritant (sodium lauryl sulphate) patch test was evaluated. Univariate regression analysis of PBMC cytokine secretion showed that low MCP‐1, IL‐8, IL‐18 and IL‐23 levels have a strong correlation with HS (P < .010‐0.004; AUC = 0.790‐0.883). Notably, combinations of two or three cytokines (TNF‐a, MCP‐1 and IL‐23; AUC: 0.942, Nagelkerke R2: 0.727) showed an improved AUC indicating a better correlation with HS than single cytokine analysis. These combination models produce good prognostic results over a broad probability range (sensitivity: 93.8%, specificity 86.7%, accuracy 90,25% between probability 0.3 and 0.7). Furthermore, the HS group had a lower IT than the NS group and an accuracy of 68%. In conclusion, very fundamental immunological differences exist between individuals who develop HS and those who do not, whereas the cytokine assay forms the basis of a predictive prognostic test for HS formation, the less invasive, easily performed irritant skin patch test is more accessible for daily practice.

The needs and service preferences of caregivers of youth with mental health and/or addictions concerns

BackgroundCaregivers experience significant strains as a result of navigating the complex mental health and/or addiction (MHA) system for their youth with MHA issues. We examined the characteristics of Ontario families with youth with MHA issues and their service needs.MethodsA cross-sectional survey study investigated the characteristics and service needs of families with youth with MHA issues across the province of Ontario, Canada. A total of 840 caregivers were recruited.Results259 participants (Mage = 45.94, SD = 7.11) identified as caregiving for at least one youth with MHA issues. The majority of the participants were female (70.7%), married (73.4%), and completed at least some college/Bachelor degree (59.1%). The mean age of youth was 16.72 years (SD = 5.33) and the most frequently reported diagnoses were Depression (30.1%), ADHD (27.8%) and Generalized Anxiety Disorder (21.2%). Regression results demonstrated that presently accessing services, presently seeking services, and higher levels of barriers MHA services were significantly predictive of identifying navigation as helpful for finding appropriate MHA services (χ2(7) = 28.69, p < .001, Nagelkerke R2 = .16). Furthermore, presently accessing services was significantly predictive of identifying case management as helpful (χ2(7) = 29.59, p < .001, Nagelkerke R2 = .156), and of identifying a primary healthcare provider as helpful (χ2(7) = 38.75, p < .001, Nagelkerke R2 = .197) for finding appropriate MHA services.ConclusionIdentifying the nature and extent of youth MHA issues, service needs, and family preferences can inform the development of services that address families’ needs and lend vital support for accessing services within a complex system.

Seeking neutral: A VR-based person-identity-matching task for attentional bias modification – A randomised controlled experiment

BackgroundAttentional bias modification (ABM) aims to reduce anxiety by attenuating bias towards threatening information. The current study incorporated virtual reality (VR) technology and 3-dimensional stimuli with a person-identity-matching (PIM) task to evaluate the effects of a VR-based ABM training on attentional bias and anxiety symptoms. MethodsOne hundred participants with elevated social anxiety were randomised to four training groups. Attentional bias was assessed at pre- and post-training, and anxiety symptoms were assessed at pre-training, post-training, 1-week follow-up, and 3-month follow-up. ResultsChange in anxiety did not correlate with change in bias (r = −0.08). A repeated-measures ANOVA showed no significant difference in bias from pre- to post-ABM, or between groups. For anxiety symptoms, a linear mixed-effects model analysis revealed a significant effect of time. Participants showed reduction in anxiety score at each successive assessment (p < .001, Nagelkerke's pseudo r2 = 0.65). However, no other significant main effect or interactions were found. A clinically significant change analysis revealed that 4% of participants were classified as ‘recovered’ at 3-month follow-up. ConclusionsA single session of VR-based PIM task did not change attentional bias. The significant reduction in anxiety was not specific to active training, and the majority of participants remained clinically unchanged.

Preoperative frailty and outcome in patients undergoing radical cystectomy.

To determine the value of preoperative frailty screening in predicting postoperative severe complications and 1-year mortality in patients undergoing radical cystectomy (RC). Prospective cohort single-centre study in patients undergoing RC from September 2016 to December 2017. Preoperative frailty screening was implemented as standard care and was used to guide shared decision-making during multidisciplinary team meetings. Frailty screening consisted of validated tools to assess physical, mental and social frailty. Patients were considered frail when having two or more frailty characteristics. The primary endpoint was the composite of a severe complication (Clavien-Dindo Grade III-V) within 30days and 1-year all-cause mortality. The secondary endpoints included any complication (Clavien-Dindo II-V), length of stay, readmission within 30days, and all-cause mortality. Logistic regression analysis and the concordance statistic (c-statistic) were used to describe the association and predictive value of preoperative frailty screening. A total of 63 patients were included; 39 (61.9%) were considered frail. Preoperative frailty was associated with a seven-fold increased risk of a severe complication or death 1year after RC [adjusted odds ratio (OR) 7.36, 95% confidence interval (CI) 1.7-31.8; 22 patients]. Compared to the American Society of Anesthesiologists (ASA) score and Charlson Comorbidity Index, frailty showed the best model performance (Nagelkerke R2 0.20) and discriminative ability(c-statistic 0.72, P<0.01) for the primary endpoint. After adding frailty to the conventional ASA risk score, the c-statistic improved by 11% (P<0.01). Overall survival was significantly worse in frail patients (23.2months, 95% CI 18.7-30.1) vs non-frail patients (32.9months, 95% CI 30.0-35.9; P=0.01). Frail patients undergoing RC are at high risk of postoperative adverse outcomes including death. Preoperative frailty screening improves preoperative risk stratification and may be used to guide patient selection for RC.

Financial performance of the United Kingdom's national non-profit sport federations: a binary logistic regression approach

PurposeThe aim of this study was to predict the financial performance of the United Kingdom's (UK) national non-profit sport federations (NNSFs) using financial effectiveness indicators and financial efficiency ratios, as framed by the resource dependency theory and stakeholder theory.Design/methodology/approachThe dependent variable was financial performance quantified as net income. The independent variables were financial effectiveness (measured as total assets and revenues) and financial efficiency (indicated as return on assets, sponsorship efficiency and donation efficiency). With the help of panel data, the study utilised binary logistic regression and Kendall’ tau correlations.FindingsBinary regression results reported a Nagelkerke R2 of 87.5%, with ROA and donation efficiency being the best predictors of financial performance. Results from Kendall’ tau correlations indicated a positive and statistical association between financial performance and financial effectiveness and financial efficiency.Research limitations/implicationsThe study was delimited to UK non-profit sports organisations that had free, useable and publicly available financial data. For top management, donors and policy advocates, the study highlighted the superiority of financial efficiency over financial effectiveness.Originality/valueThe study adds to research, theory and practitioners' perspectives by offering a new way of evaluating financial performance with the combination of financial effectiveness and efficiency and not opinions, a factor uncommon in previous studies.

Morphological Differential Diagnosis of Primary Myelofibrosis and Essential Thrombocythemia with Computer Cluster Analysis of a Megakaryocytic Lineage in Myeloid Tissue

The DBSCAN clustering algorithm, an in-house method of unsupervised machine learning, was used to explore specific histotopographical features of the megakaryocytic lineage in the bone marrow biopsies of patients with JAK2- or CALR-mutated essential thrombocythemia and prefibrotic primary myelofibrosis. Ninety-five bone marrow biopsies of patients with essential thrombocythemia and primary myelofibrosis were investigated to assess the histotopography of megakaryocytes, specifically, the mean number of megakaryocytes in one cluster, as well as the mean number of clusters and megakaryocytes per 1 mm2 of section area. The logistic regression model was statistically significant: χ2 = 14.703, p = 0.023, Nagelkerke R2 = 19.6%. Analysis of the histotopographical features of megakaryocytes allowed correct differentiation between essential thrombocythemia and primary myelofibrosis in 71.6% cases. The differences in the histotopographical features of megakaryocytes in the bone marrow of with JAK2- or CALR-mutated essential thrombocythemia and primary myelofibrosis revealed by the DBSCAN clustering algorithm indicate that a relationship exists between the disease and the pattern of megakaryocytic lineage development that can be used to create a logistic regression model for differentiating these diseases.

Factors influencing design thinking ability in modelling climate smart agricultural practices by under-graduate agriculture students of central agricultural university Imphal: a binary logistic regression modeling

Design thinking a modern human centered problem-solving concept that can be used in the face of complex problems is expected to create meaningful innovations after internalizing the problems of farmers and associating them with Climate Smart Agricultural Practices which is offering array of solutions to enable farmers mitigate the problems of Climate Change. The study aims to identify factors influencing Design Thinking ability among undergraduate students of agriculture in modelling Climate Smart Agricultural Practices. This inquiry was conducted at three Colleges of Agriculture under Central Agricultural University, Imphal, in which B.Sc. (Agriculture) degree is provided. Total of 28 final year students have been randomly selected as respondents for the study. Nine independent variable viz., Age, Gender; OGPA; Competency on ICT; Creative Problem Solving; Ability to Visualize Abstract Ideas; Memory Retention, Aptitude &amp; Reading Behavior; and one dependent variable viz. Operationalization of Design Thinking were considered in the scientific inquiry. The binary logistic regression model was significant at p = 0.037 with AIC &amp; BIC values of 40.86 &amp; 54.18, respectively indicating moderate acceptable explanations of independent variables on outcome of dependent variable. With the subsequent Cox &amp; Snell R2 and Nagelkerke R2 values of 0.471 and 0.629, revealed that the independent variables interacted and explained the significant outcome of the dependent variable in the range of 47.10 to 62.90%. The model identified; Age; Gender; OGPA and Creative Problem Solving had significant effect on Design Thinking. The study suggested that strategies need to be focused on development of students&#8217; Aptitude; Competency on ICT, Memory Retention; Ability to Visualize Abstract Ideas and Reading Behavior.

Evolution and visual outcomes of outer foveolar lucency after surgery for large idiopathic macular hole.

To explore the evolution of outer foveolar lucency (OFL) after vitrectomy and the correlation between OFL and visual acuity (VA) outcome in eyes with large idiopathic macular hole (IMH). In this retrospective study, 244 eyes of 233 subjects with large IMH (diameter > 400μm), who underwent vitrectomy, were included. Preoperative clinical data, postoperative optical coherence tomography (OCT) images, and VA at 1-, 4-, and 10-month visits were documented. The prevalence, incidence, and width of OFL and their correlation with postoperative VA were analyzed. The prevalence of OFL was 10.4% (24/231) at 1month and significantly increased to 30.4% (55/181) at 4months (P < 0.001) and 34.2% (25/73) at 10months (P < 0.001). The incidence was 26.1% (40/153) and 22.0% (9/41) at 4 and 10months, respectively. OFL appeared at 1month while disappeared at 4 or 10months in 8 eyes (50.0%). The presence of OFL at 1month was negatively associated with IMH diameter (Nagelkerke R2 = 0.06; P = 0.02). Eyes with OFL at 4months had better VA at their 4-month visit than eyes without OFL (P = 0.02). Eyes with early-developed OFLs had better VA at 10months than those with later-developed ones (P = 0.02). Width of OFL was not associated with postoperative VA at any point. OFL is not rare in eyes with large IMH after surgery. It can occur gradually and remain during the 10-month follow-up. The presence of OFL appears to have no negative impact on the postoperative VA and it may represent the remodeling of foveal photoreceptors.

Use of cannabis and its products among patients in a tertiary epilepsy center: A cross-sectional survey

PurposeThe purpose of this study was to evaluate whether the topic of using cannabis as a treatment option for epilepsy is relevant among adult patients with the disorder and assess the possible determinant attitudes for having a history of cannabis consumption or being inclined to try it for medical purposes. Material and methodsWilling adult (≥18 years) patients with diagnosed epilepsy participated in a cross-sectional survey study at a tertiary epilepsy center. The questions were related to cannabis use and opinions towards the safety and efficacy profile of cannabis for treating epilepsy. ResultsFrom 250 respondents, 41 (16.4%) reported prior use of cannabis or its preparations (15 [36.6%] for self-treatment). There were 81 (32.4%) participants further interested in cannabis use for treating epilepsy.In a binary regression model (Nagelkerke R2¯ = 0.331), the opinion that cannabis is safer because of its natural origin (β = 0.749, p = 0.027) and the premise of understanding its legal status (β = 0.418, p = 0.024) positively predicted which participants have reported cannabis use. These patients were also more likely to consult internet sources (p = 0.004) and agree that cannabis as an epilepsy treatment option is effective (U = 2231.5, p < 0.001), safe (U = 1822.0, p < 0.001) and has no side effects (U = 2470.5, p = 0.004).Patients who had not tried cannabis were more likely to envision the products as potentially addictive (p = 0.012) and presumably be deterred from using them due to beliefs in harmful effects (β = −0.632, p = 0.025). In general, nonusers were not inclined to try cannabis for treating epilepsy (Md = 2, range 1 to 7). However, those interested in the possibility of using cannabis to treat epilepsy would be more willing to try the respective preparations (p < 0.001). ConclusionAmong adult patients with epilepsy, we report no particularly high rate of cannabis use or interest in applying cannabis for medical purposes. In order to clarify the scientific and legal status of the preparations, treating neurologists should consult prior users and patients interested in the possibility of trying cannabis as an epilepsy remedy.

Demographic, Clinical Features and Outcome Determinants of Thoracic Trauma in Sri Lanka: A Multicentre Prospective Cohort Study.

Prognostic determinants in thoracic trauma are of major public health interest. We intended to describe patterns of thoracic trauma, demographic factors, clinical course, and predictors of outcome in selected tertiary care hospitals in Sri Lanka. A multicentre prospective cohort study was conducted in five leading teaching hospitals from June to September 2017. Patients with thoracic trauma were followed up during the hospital stay. A logistic regression analysis was conducted using in-hospital morbidity as the dichotomous outcome variable. One hundred seventy-one patients were included in the study yielding 1450 (median = 8.5) person-days of observation. Of them, 71.9% (n = 123) were males. The mean age was 45.8 ± 17.9 years. Majority (39.2%, n = 67) were recruited from the National Hospital of Sri Lanka. Automobile accidents were the commonest (62.6%, n = 107), followed by falls (26.9%, n = 46), assaults (8.8%, n = 15), and animal attacks (1.8%, n = 3). The ratio of blunt to penetrating trauma was 5.6 : 1. Injury patterns were rib fractures (80.7%, n = 138), haemothorax (44.4%, n = 76), pneumothorax (44.4%, n = 76), lung contusion (22.8%, n = 39), flail segment (15.8%, n = 27), tracheobronchial trauma (7.0%, n = 12), diaphragmatic injury (2.3%, n = 4), vascular injury (2.3%, n = 4), cardiac contusions (1.1%, n = 2), and oesophageal injury (0.6%, n = 1). Ninety nine (57.9%) had extrathoracic injuries. Majority (63.2%, n = 108) underwent operative management including intercostal tube insertion (60.8%, n = 104), wound exploration (6.4%, n = 11), thoracotomy (4.1%, n = 7), rib reconstruction (4.1%, n = 7), and video-assisted thoracoscopic surgery (2.9%, n = 5). Pneumonia (10.5%, n = 8), bronchopleural fistulae (2.3%, n = 4), tracheaoesophageal fistulae (1.8%, n = 3), empyema (1.2%, n = 2), and myocardial infarction (1.2%, n = 2) were the commonest postoperative complications. The mean hospital stay was 15.6 ± 18.0 days. The in-hospital mortality was 11 (6.4%). The binary logistic regression analysis with five predictors (age, gender, mechanism of injury (automobile/fall/assault), type of trauma (blunt/penetrating), and the presence of extrathoracic injuries) was statistically significant to predict in-hospital morbidity (X2 (6, n = 168) = 13.1; p=0.041), explaining between 7.5% (Cox and Snell R2) and 14.5% (Nagelkerke R2) of variance. The automobile accidents (OR: 2.3, 95% CI = 0.2–26.2) and being males (OR: 2.3, 95% CI = 0.6–9.0) were the strongest predictors of morbidity.

Efficacy of disinfectants and brand reputation on bathing water quality improvement

This study evaluated the antibacterial efficacy of some disinfectants widely used in Nigeria in the elimination of common bacteria found in bathing water. Four (4) skin disinfectants Ivy, Dettol, Izal, and Septol, were added to sterile distilled water containing Escherichia coli (E. coli), Klebsiella spp. and Bacillus spp. which were isolated from a swimming pool. From a total of 288 samples, results revealed that all the antiseptic performed below par in destroying bacillus except for Ivy (41.67 %) and Dettol (12.50 %), which showed tenuous performance in this regard. Septol showed no significant difference in destroying bacteria with a higher number of CFU/100 mL eliminated irrespective of the contact time (p = 0.258). In contrast, Ivy showed high significant difference with bacteria destruction as contact time progressed (p = 0.011). The logistic regression model developed revealed that an increase in dosage promoted the removal of organisms while longer waiting times were only significant for Septol (p = 0.045) and Ivy (p = 0.002). Nagelkerke R2 model fitted properly for Izal and Septol with values of 0.97 and 0.786. The findings of this study showed stark variance among the treatment capacities of these antiseptics. They provided sufficient knowledge in the selection of the available skin disinfectants in the market that are most likely to destroy bacteria in bathing water. Therefore, the inability of these products to correlate with their intended purpose leaves room for re-assessment by their producers and by relevant monitoring agencies in the country to meet the demands of a rapidly growing number of end-users in dire need for improved bathing water quality.

Prognostic value of log odds of positive lymph nodes in patients with resectable oral squamous cell carcinoma

Log odds of positive lymph nodes (LODDS) was reported to be significantly associated with prognosis in several malignant tumors. However, few are the studies on the correlation between LODDS and overall survival (OS) in patients with oral squamous cell carcinoma (OSCC). A retrospective study including 233 patients with OSCC during 2009 to 2013 was conducted. We probed the correlation between clinicopathological factor, LODDS, lymph node ratio (LNR), pN and OS. The potential prognostic factor and the independent factor were calculated using univariate analysis and multivariate analysis respectively. The goodness of fit and the discriminability was analyzed with Somer's D value, Nagelkerke R2 index, and Akaike information criterion (AIC). Kaplan-Meier survival curve of OS was contrasted by log-rank test in LODDS, LNR and pN, respectively. According to the X-tile, the cut-off values are -1.491 and -0.763 for LODDS, 0.024 and 0.133 for LNR. LODDS, LNR and pN were significantly correlated with OS by univariate analysis (P<0.001). Multivariate analysis demonstrated LODDS, LNR and pN as an independent prognostic factors for OS (P<0.01). Compared with pN and LNR models, LODDS showed the strongest predictive power. LODDS was superior to LNR and pN in predicting outcomes in patients with no positive lymph nodes and inadequate neck dissection. LODDS would be incorporated into future N classification, which may be conducive to discern the prognosis of OSCC and make a decision of adjuvant therapy in clinical practice.

Farmland abandonment and its determinants in the different ecological villages of the Koshi river basin, central Himalayas: Synergy of high-resolution remote sensing and social surveys

Globally, there is a noticeable increasing trend in farmland abandonment, which directly affects farmers' livelihood and food security. The abandonment status, its determinants and impact vary by spatial and socioeconomic context. In order to study this important issue, we selected three different villages representing three ecological regions (Mountain, Hill, and Tarai) in the Koshi River Basin (KRB), and applied two methods: the Unmanned Aerial Vehicle (UAV) and a social survey. The UAV captured 3711 images and we carried out 162 households' survey with structured questionnaires. Pix4Dmapper and ArcGIS tools were used for combining and processing the images. On-screen digitalization and binary logistic regression (BLR) were applied to examine the status and determinants of farmland abandonment. The results show a higher proportion of farmland abandonment in the villages located in the Hill and Mountain regions compared to those in the Tarai region. Almost 10.3% area of total land and 22.3% area of total farmland was abandoned in the Hill village. The Tarai village had the least farm abandonment (3.7%). Farmers perceived that climate change (less precipitation, increasing temperatures, and drought), shifting occupations, crops damaged by wildlife, migration, lack of irrigation, and a labor shortage are the leading determinants of farmland abandonment. These factors varied slightly across the different ecological regions. The BLR model was a good fit with Nagelkerke's R2 = 0.776, with a correct model prediction (87.7%) and p = 0.032. The results from the regression model suggest that an increase in temperature (p = 0.000), decrease in rainfall (p = 0.001), lack of machinery used for farm-work (p = 0.000), lack of irrigation (p = 0.000), and reduction of labor-force (p = 0.000) are the main contributing determinants of farmland abandonment. This synergy of high-resolution remote sensing and farmers' perception-based findings facilitates the improvement of land-use governmental policies to improve farmers' quality of life and build sustainable farmland management.

Y-Balance Test Asymmetry and Frontal Plane Knee Projection Angle During Single-leg squat as Predictors of Patellofemoral Pain in Male Military Recruits

ObjectivesInvestigate prospectively whether dynamic balance and frontal plane knee projection angle (FPKPA) are risk factors for the development of patellofemoral pain (PFP) in male military recruits. Study designProspective cohort. SettingMilitary training center. Participants135 male military recruits were followed prospectively for six weeks and the incidence of PFP was documented. Main outcomesBaseline measures of the Y-Balance test (YBT) and two-dimensional FPKPA during single-leg squatting were recorded. Mann–Whitney U tests and logistic regression analysis were utilized to identify possible variables associated with the development of PFP. ResultsA total of 14 male recruits developed PFP during the follow up period. The PFP group had significantly greater asymmetry on the YBT posterolateral direction (mean difference = 3.44 ± 0.57 cm; 95% Confidence Interval [CI] = 2.38–4.51 cm) and greater FPKPA during single-leg squat (mean difference = 5.55°±1.78°; [CI] = 1.81–9.28°) at baseline when compared to controls. Binary logistic regression models revealed that YBT posterolateral asymmetry ≥4.08 cm (Nagelkerke R2 = 0.304; X2 = 21.63; p < 0.001; OR = 5.46; [CI] = 4.47–8.06) and FPKPA ≥ 4.81° (Nagelkerke R2 = 0.249; X2 = 17.46; p < 0.001; OR = 4.65; [CI] = 3.32–9.06) were significantly associated with PFP. ConclusionsMale military recruits with greater asymmetry on the YBT posterolateral direction and FPKPA were at a greater risk of developing PFP.

Seroprevalence of leptospirosis in an endemic mixed urban and semi-urban setting-Acommunity-based study in the district of Colombo, Sri Lanka.

Leptospirosis is endemic in Sri Lanka. There is a need for updated seroprevalence studies in endemic areas, to improve the understanding of disease dynamics, risk factors, control methods, and for clinical diagnosis. The cut-off titres for the microscopic agglutination test (MAT) for diagnosis of acute leptospirosis depend on community seroprevalence, and can vary based on locality and serovar. This study aimed to identify the seroprevalence, geographical determinants, and associations of seropositivity of leptospirosis in the district of Colombo in Sri Lanka, and to determine diagnostic cut-off titres for MAT in the community studied. This study utilized a stratified cluster sampling model in the Colombo district of Sri Lanka, to sample individuals living in urban and semi-urban areas. Serovar specific MAT titres were measured on recruited individuals using a panel of saprophytic (Leptospira biflexa) and 11 pathogenic Leptospira spp. serovars. Associations between environmental risk factors and MAT positivity were examined, with location mapping using GIS software. A total of 810 individuals were included. The mean age was 51.71 years (SD 14.02) with male predominance (60%). A total of 429 (53%) tested positive at a titer of 1/40 or more for the saprophytic Leptospira biflexa serovar Patoc. Pathogenic serovar MAT was positive at a titer of 1/40 or more for at least one serovar in 269 (33.2%) individuals. From the perspective of screening for clinical disease, serovar-specific cut-off titres of 1/80 for Leptospira spp. serovars Hebdomadis, Icterohaemorrhagiae, Pomona, Ratnapura and Patoc, 1/160 for serovars Pyrogenes and Cynopteri, and 1/40 for other serovars were determined, based on the 75th quartile MAT titre for each serovar. Serovar Pyrogenes (15.9%) had the highest seroprevalence, with serovars Ratnapura, Bankinang and Australis accounting for 9.9%, 9.6% and 9.3% respectively. When the proposed new cut-offs were applied, Bankinang(9.6%) Australis(9.3%), Pyrogenes(6.9%) and Ratnapura(6.9%) were the most prevalent serovars. No significant differences in seroprevalence or serovar patterns were noted between urban and semi-urban settings. Individuals seropositive for Australis, Ratnapura and Icterohaemorrhagiae were clustered around main water bodies as well as around smaller tributaries and paddy fields. Those positive for the serovar Pyrogenes were clustered around inland tributaries, smaller water sources and paddy fields. Associations of MAT positivity included high risk occupational exposure, environmental exposure including exposure to floods, bathing in rivers and lakes, using well-water for bathing, contact with stagnant water, propensity to skin injuries, presence of rats in the vicinity, and proximity to water sources. For pathogenic serovars, high-risk occupational exposure remained statistically significant following adjustment for other factors (adjusted OR = 2.408, CI 1.711 to 3.388; p<0.0001; Nagelkerke R2 = 0.546). High risk occupational exposure was determined to be independently associated with seropositivity. Baseline community MAT titres vary according to serovar, and presumably the locality. Testing against saprophytic serovars is unreliable. Thus, diagnostic MAT titre cut-offs should be determined based on region and serovar, and the use of a single diagnostic MAT cut-off for all populations is likely to result in false negatives.

Location and Diameter of Intracranial Meningioma as Predictors of Peritumoral Brain Oedema and Mass Effect

IntroductionThe presence of peritumoral oedema or mass effect with intracranial meningiomas is associated with poor clinical outcomes. This study aimed to investigate magnetic resonance (MR) morphologic features of meningioma, which can predict peritumoral oedema and mass effect. MethodsData of 100 consecutive patients diagnosed with meningioma on MRI brain at the neurosurgical MRI unit, National Hospital of Sri Lanka, reported by a Consultant Radiologist were analysed in a retrospective study. Binary logistic regression models were fitted to identify predictors of perilesional oedema and mass effect. ResultsFemale-to-male ratio was 5.8:1. Patients were aged 18–80 years. Majority (n = 78) were in supratentorial compartment with 16 at parasagittal location. Cerebellopontine angle was the commonest infratentorial site (n = 9). Size of meningiomas ranged from 1.1 to 9.1 cm (largest dimension). Mass effect (n = 68), perilesional oedema (n = 37), and midline deviation (n = 31) were the most commonly reported complications. Maximum diameter of meningioma and its location significantly predicted the presence of perilesional oedema [χ2(2,47) = 6.03, P = .049, Nagelkerke R2 = 18.2%] and mass effect [χ2(2,71) = 16.73, P = .000, Nagelkerke R2 = 39.4%] in two logistic regression models. ConclusionThe probability of mass effect and perilesional oedema increased with the maximum diameter. Meningioma extending to both supratentorial and infratentorial compartments had the highest risk of having concomitant perilesional oedema and mass effect.

Dynamic prediction model to identify young children at high risk of future overweight: Development and internal validation in a cohort study.

SummaryBackgroundPrimary prevention of overweight is to be preferred above secondary prevention, which has shown moderate effectiveness.ObjectiveTo develop and internally validate a dynamic prediction model to identify young children in the general population, applicable at every age between birth and age 6, at high risk of future overweight (age 8).MethodsData were used from the Prevention and Incidence of Asthma and Mite Allergy birth cohort, born in 1996 to 1997, in the Netherlands. Participants for whom data on the outcome overweight at age 8 and at least three body mass index SD scores (BMI SDS) at the age of ≥3 months and ≤6 years were available, were included (N = 2265). The outcome of the prediction model is overweight (yes/no) at age 8 (range 7.4‐10.5 years), defined according to the sex‐ and age‐specific BMI cut‐offs of the International Obesity Task Force.ResultsAfter backward selection in a Generalized Estimating Equations analysis, the prediction model included the baseline predictors maternal BMI, paternal BMI, paternal education, birthweight, sex, ethnicity and indoor smoke exposure; and the longitudinal predictors BMI SDS, and the linear and quadratic terms of the growth curve describing a child's BMI SDS development over time, as well as the longitudinal predictors' interactions with age. The area under the curve of the model after internal validation was 0.845 and Nagelkerke R 2 was 0.351.ConclusionsA dynamic prediction model for overweight was developed with a good predictive ability using easily obtainable predictor information. External validation is needed to confirm that the model has potential for use in practice.