Previous Time Points Research Articles

Cancer survivors' cancellations of healthcare appointments during the COVID-19 pandemic: Associations with anxiety and depression.

Though it is well-documented that cancer survivors experienced healthcare delays during the COVID-19 pandemic, who initiated those delays has not been examined. This longitudinal study distinguishes rates of patient-from provider-cancelled healthcare appointments at three timepoints during the pandemic, and examines psychosocial factors associated with patient-cancelled appointments. Cancer survivors (N=147) in the United States completed psychosocial and health behavior measures three times between May and December 2020. We examined rates of patient- and provider-cancelled healthcare appointments, including cancer screening appointments, at each timepoint and change between timepoints. Logistic regression was used to determine if anxiety symptoms, depression symptoms, and COVID-19 fears were associated with self-cancelled healthcare appointments. In May 2020, one third (33.79%) of participants reported one or more self-cancelled appointments within the prior 2months and nearly half (45.89%) reported one or more provider-cancelled appointments. Rates of provider-cancelled appointments decreased to 35.71% in June/July 2020 and to 9.24% in November/December 2020 (both reflected p<0.05 reductions compared to the previous timepoint). Rates of self-cancelled appointments, however, remained more stable (ps>0.144). In June/July and November/December 2020, higher depression and anxiety symptoms, but not COVID-19 fears, were associated with greater likelihood of self-cancelled appointments. Cancer survivors cancelled their healthcare appointments at a stable rate even as provider-cancelled appointments declined. Depression and anxiety symptoms, but not COVID-19 concerns, were associated with patient cancellations. Interventions that address anxiety and depression symptoms may help to promote adherence to cancer survivorship care during the pandemic.

Response and Dynamics of Renal Function in Transplantation-Eligible Multiple Myeloma Patients Treated with a Novel Agent: The CAREMM-2201 Study

Newly diagnosed multiple myeloma (NDMM) frequently results in renal impairment (RI), and its natural course has not been fully elucidated in the era of novel agents. We aimed to identify the dynamics of renal function after autologous stem cell transplantation (ASCT) following induction treatment using a novel agent in transplantation-eligible NDMM patients with RI (estimated glomerular filtration rate [eGFR] ≤50 mL/min/1.73 m2) at diagnosis. The factors associated with achieving a renal response based on the term renal benefit regardless of baseline eGFR were investigated as well. In a multicenter registry database including 1795 patients with plasma cell disorder, 140 transplantation-eligible NDMM patients who developed RI at the time of initiation of treatment for NDMM were identified. They received protocol-based treatment (PBT) consisting of induction treatment using proteasome inhibitors and/or immunomodulatory drugs followed by ASCT. MM and renal responses were evaluated using the International Myeloma Working Group response criteria. To evaluate the standardized improvement of renal function irrespective of baseline eGFR, renal benefit was defined as a sustained (for at least 3 months) increase in eGFR >15 mL/min/1.73 m2. The mean patient age was 54.7 ± 7.4 years. With a mean baseline eGFR of 24.8 ± 13.9, the renal complete response (renalCR) and renal benefit rates were 49.3% and 67.9%, respectively. In a multivariable analysis, the 3 factors significantly associated with reduced likelihood of achieving both renalCR and renal benefit were age ≥55 years, light chain type NDMM, and failure to improve eGFR by 5 mL/min/1.73 m2 with supportive care when measured 3 days prior to induction therapy and at the initiation of chemotherapy. Hypertension and advanced eGFR also were associated with poor renalCR achievement. The mean eGFR improved until the time of ASCT and then decreased gradually over time. The mean eGFR improved significantly until 4 months post-PBT compared with each eGFR at previous time points, but this significant improvement disappeared by 5 months post-PBT. In a subgroup of patients who developed RI after undergoing ASCT (n=55), the eGFR increased temporarily at 1 month post-ASCT; however, this improvement reverted to baseline at 2 months post-ASCT. Among another subgroup of 27 patients who were dialysis-dependent at the time of initial treatment, 18 (66.7%) were no longer dialysis-dependent after a median of 60 days. The best renal response was acquired early during the PBT period, and ASCT did not have a robust impact on the renal outcome. Patients who failed to achieve a renal benefit should be provided with the best supportive care for chronic kidney disease, and this simplified criterion for evaluating the renal response needs to be validated in larger studies before it can be recommended. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

토의·토론 활동과 창의성 간의 종단적 관계 분석

This study analyzed the longitudinal relationship between discussion/debate activities and creativity using data from the 2nd and 5th years of the Busan Education Longitudinal Study (BELS) 2016. Descriptive statistics and correlation analysis for each variable and autoregressive cross delay models were analyzed using longitudinal data for 4 years from 5th grade to 2nd grade of middle school of 2,359 students in Busan. As a result, first, there was a positive correlation between discussion/debate activities and creativity. Second, discussion/debate activities and creativity were stable over time. Third, the discussion/debate activity for the previous time point had a significant positive effect on the creativity for the next time, and it was found that the creativity for the previous time point also had a significant positive effect on the discussion/debate activity for the next time point. Thus, when the longitudinal relationship between discussion/debate activity and creativity was analyzed, it was found that there was a positive influence relationship in both directions. Based on this, the following were suggested. First, it is necessary to continuously present various types of discussion/debate activities to students in the educational field. Also, it is necessary to develop and disseminate various teaching and learning strategies for developing students' abilities. Second, it is necessary to maximize the effect by strengthening the virtuous cycle structure based on the continuous positive influence between discussion/debate activities and creativity. In addition, in the development and dissemination of various teaching and learning strategies, it should be possible to continuously strengthen their virtuous cycle structure and increase its effectiveness.

Health-related quality of life from 20 to 32 years of age in very low birth weight individuals: a longitudinal study

BackgroundPreterm birth with very low birth weight (VLBW, birth weight < 1500 g) is associated with health problems later in life. How VLBW individuals perceive their physical and mental health-related quality of life (HRQoL) is important to understand their putative burden of disease. Previous studies have shown mixed results, and longitudinal studies into adulthood have been requested. This study aimed to investigate differences in HRQoL between preterm VLBW and term born individuals at 32 years of age, and to study changes in HRQoL from 20 to 32 years.MethodsIn a geographically based longitudinal study, 45 VLBW and 68 term born control participants completed the Short Form 36 Health Survey (SF-36) at 32 years of age. Data from three previous timepoints was also available (20, 23 and 28 years of age). The SF-36 yields eight domain scores as well as a physical and a mental component summary. Between-group differences in these variables were investigated. We also performed subgroup analyses excluding individuals with disabilities, i.e., cerebral palsy and/or low estimated intelligence quotient.ResultsAt 32 years of age, the physical component summary was 5.1 points lower (95% confidence interval (CI): 8.6 to 1.6), and the mental component summary 4.1 points lower (95% CI: 8.4 to − 0.3) in the VLBW group compared with the control group. For both physical and mental component summaries there was an overall decline in HRQoL from 20 to 32 years of age in the VLBW group. When we excluded individuals with disabilities (n = 10), group differences in domain scores at 32 years were reduced, but physical functioning, bodily pain, general health, and role-emotional scores remained lower in the VLBW subgroup without disabilities compared with the control group.ConclusionWe found that VLBW individuals reported lower HRQoL than term born controls at 32 years of age, and that HRQoL declined in the VLBW group from 20 to 32 years of age. This was in part, but not exclusively explained by VLBW individuals with disabilities.

Longitudinal associations among peer pressure, moral disengagement and cyberbullying perpetration in adolescents

Peer pressure is considered one of the top reasons adolescents participate in various risk behaviors, but the mechanism of peer pressure and adolescents' cyberbullying perpetration is unclear. The current study examined the longitudinal associations between peer pressure and adolescents' cyberbullying perpetration across three years, taking into account moral disengagement as a potential mediator and family socioeconomic status and gender as moderators of the associations. A sample of 2407 Chinese adolescents (Mage at baseline = 12.75 years) completed measurements of peer pressure, cyberbullying perpetration, moral disengagement, and family socioeconomic status at 3-time points with 1-year intervals. The results showed that peer pressure directly predicted subsequent cyberbullying perpetration. Cyberbullying perpetration at time 1 significantly predicted peer pressure and moral disengagement at time 2 only. Moral disengagement played a mediating role between peer pressure and cyberbullying perpetration across time. The relation between peer pressure and moral disengagement was more robust for adolescents with low family socioeconomic status than those with high family socioeconomic status. Compared to boys, girls who experienced high peer pressure at previous time points were more likely to have high peer pressure at subsequent time points. These findings provide a new scientific basis for the intervention of adolescents' cyberbullying perpetration.

Substance use and self-harm emergency department presentations during COVID19: evidence from a National Clinical Programme for Self-Harm.

Given the evidence that drinking patterns and self-harm hospital presentations have changed during COVID-19, this study aimed to examine any change in self-harm and suicide-related ideation presentations, together with any possible contribution made by alcohol or substance misuse, to Irish Emergency Departments in 2020, compared with 2018 and 2019. A population-based cohort with self-harm and suicide-related ideation presenting to Irish hospitals derived from the National Clinical Programme for Self-Harm was analysed. Descriptive analyses were conducted based on sociodemographic variables and types of presentation for the period January to August 2020 and compared with the same period in 2018 and 2019. Binomial regression analyses were performed to investigate the independent effect of demographic characteristics and pre/during COVID-19 periods on the use of substances as contributory factors in the self-harm and suicide-related ideation presentations. 12,075 presentations due to self-harm and suicide-related ideation were recorded for the periods January-August 2018-2020 across nine emergency departments. The COVID-19 year was significantly associated with substances contributing to self-harm and suicide-related ideation ED presentations (OR = 1.183; 95% CI, 1.075-1.301, p < 0.001). No changes in the demographic characteristics were found for those with self-harm or suicide-related ideation across the years. Suicide-related ideation seemed to be increased after May 2020 compared with previous years. In terms of self-harm episodes with comorbid drug and alcohol overdose and poisoning, these were significantly increased in January-August 2020, compared with previous timepoints (χ2 = 42.424, df = 6, p < 0.001). An increase in suicide-related ideation and substance-related self-harm presentations may indicate longer term effects of the pandemic and its relevant restrictions. Future studies might explore whether those presenting with ideation will develop a risk of suicide in post-pandemic periods.

Second Booster BNT162b2 Restores SARS-CoV-2 Humoral Response in Patients With Multiple Myeloma, Excluding Those Under Anti-BCMA Therapy.

COVID-19 vaccination leads to a less intense humoral response in patients with multiple myeloma (MM) compared with healthy individuals, whereas the SARS-CoV-2-specific immunity fades over time. The purpose of this study was to explore the kinetics of SARS-CoV-2 neutralizing antibodies (NAbs) in patients with MM after vaccination with the BNT162b2 mRNA vaccine, focusing on their response before (B4D) and at 1 month after the fourth vaccination (M1P4D). Overall, 201 patients with a median age of 67 years were included, whereas 114 (56.7%) were men. The median NAbs levels B4D were 80.0% (±3.5%) and at M1P4D they increased to a median value of 96.1% (±3.7%). The NAb values at M1P4D were similar to those at 1 month post the third dose and superior to all previous timepoints. At M1P4D, the NAbs levels of all the treatment groups increased, apart from the anti-BCMA group. A significant increase in median NAbs values was observed for those receiving CD38-based treatment (n = 43, from 71.0% B4D to 96.0% at M1P4D) and those who did not receive CD38- or BCMA-targeted therapy (n = 137, from 89.6% B4D to 96.3% at M1P4D). Regarding the patients under BCMA-based therapy (n = 21), there was no remarkable increase in NAbs values following the second booster shot (from 3.0% B4D to 4.0% at M1P4D). In conclusion, booster vaccination with the BNT162b2 results in a substantially improved humoral response against SARS-CoV-2 in patients with MM. Anti-BCMA treatment remains an adverse predictive factor for NAbs response; thus, tailored prevention measures should be considered for this patient subgroup.

부모의 학대와 청소년의 공격성 사이의 종단적 관계

The purpose of this study is to longitudinally analyze how parental abuse perceived by adolescents and adolescent aggression change over time and the reciprocal causal relationship between the two variables. For this purpose, autoregressive cross-lagged modeling was applied using panel data from the Korea Children and Youth Panel Survey 2010 (KCYPS 2010). Specifically, data surveyed at three points in elementary school 6 (2012), middle school 2 (2014), and high school 1 (2016) among the data of the elementary 4 panel of KCYPS 2010 were used as the study object. As a result of the study, first, the parental abuse perceived by adolescents remained stable over time. Second, adolescent aggression remained stable over time. Third, parental abuse perceived by adolescents at the previous time point had a positive effect on the adolescent aggression at the later time point. Fourth, adolescent aggression at the previous time point had a positive effect on parental abuse perceived by the adolescents at the later time point. Finally, we discussed the establishment of educational measures that can lead adolescents to live an adaptive and healthy life while growing from elementary school to high school.

학교-직장 이행기 청년의 부정적 자기개념, 진로자기효능감, 직업가치관의 종단적 관계

Objectives This study conducted analysis to examine longitudinal relationships among the negative self-concepts, career self-efficacy, and occupational values of young people experiencing school-to-work transition periods that affect job decisions and choices. Methods For this, an autoregressive cross-lagged model was utilized on data from the 8th (2014) to 12th (2018) Youth Panels of the Korea Employment Information Service, which provides representative statistics on the youth labor market and school life. Results The main results were as follows. First, negative self-concepts, career self-efficacy, and occupational values during the college period stably predicted those in the future during the working period and previous early working periods stably predicted working periods after two years. The autoregressive parameters of negative self-concepts and career self-efficacy appeared lower than those of occupational values, showing that the variability of negative self-concepts or career self-efficacy can be more dynamic than that of occupational values. Second, higher occupational values of previous points in time led to higher career self-efficacy and less negative self-concepts at later points in time, verifying that occupational values are an extremely important factor in the lives of young people experiencing school-to-work transition periods. Conclusions Based on these research results, verifications were made that education on occupational values must be conducted at sites of career education and further, this provided implications regarding the importance of career education program management, the roles of universities, and counseling intervention.

Neutralising reactivity against SARS-CoV-2 Delta and Omicron variants by vaccination and infection history

BackgroundThe continuous emergence of SARS-CoV-2 variants of concern (VOC) with immune escape properties, such as Delta (B.1.617.2) and Omicron (B.1.1.529), questions the extent of the antibody-mediated protection against the virus. Here we investigated the long-term antibody persistence in previously infected subjects and the extent of the antibody-mediated protection against B.1, B.1.617.2 and BA.1 variants in unvaccinated subjects previously infected, vaccinated naïve and vaccinated previously infected subjects.MethodsBlood samples collected 15 months post-infection from unvaccinated (n=35) and vaccinated (n=41) previously infected subjects (Vo’ cohort) were tested for the presence of antibodies against the SARS-CoV-2 spike (S) and nucleocapsid (N) antigens using the Abbott, DiaSorin, and Roche immunoassays. The serum neutralising reactivity was assessed against B.1, B.1.617.2 (Delta), and BA.1 (Omicron) SARS-CoV-2 strains through micro-neutralisation. The antibody titres were compared to those from previous timepoints, performed at 2- and 9-months post-infection on the same individuals. Two groups of naïve subjects were used as controls, one from the same cohort (unvaccinated n=29 and vaccinated n=20) and a group of vaccinated naïve healthcare workers (n=61).ResultsWe report on the results of the third serosurvey run in the Vo’ cohort. With respect to the 9-month time point, antibodies against the S antigen significantly decreased (P=0.0063) among unvaccinated subjects and increased (P<0.0001) in vaccinated individuals, whereas those against the N antigen decreased in the whole cohort. When compared with control groups (naïve Vo’ inhabitants and naïve healthcare workers), vaccinated subjects that were previously infected had higher antibody levels (P<0.0001) than vaccinated naïve subjects. Two doses of vaccine elicited stronger anti-S antibody response than natural infection (P<0.0001). Finally, the neutralising reactivity of sera against B.1.617.2 and BA.1 was 4-fold and 16-fold lower than the reactivity observed against the original B.1 strain.ConclusionsThese results confirm that vaccination induces strong antibody response in most individuals, and even stronger in previously infected subjects. Neutralising reactivity elicited by natural infection followed by vaccination is increasingly weakened by the recent emergence of VOCs. While immunity is not completely compromised, a change in vaccine development may be required going forward, to generate cross-protective pan-coronavirus immunity in the global population.

Inferring Gene Regulatory Networks From Single-Cell Transcriptomic Data Using Bidirectional RNN.

Accurate inference of gene regulatory rules is critical to understanding cellular processes. Existing computational methods usually decompose the inference of gene regulatory networks (GRNs) into multiple subproblems, rather than detecting potential causal relationships simultaneously, which limits the application to data with a small number of genes. Here, we propose BiRGRN, a novel computational algorithm for inferring GRNs from time-series single-cell RNA-seq (scRNA-seq) data. BiRGRN utilizes a bidirectional recurrent neural network to infer GRNs. The recurrent neural network is a complex deep neural network that can capture complex, non-linear, and dynamic relationships among variables. It maps neurons to genes, and maps the connections between neural network layers to the regulatory relationship between genes, providing an intuitive solution to model GRNs with biological closeness and mathematical flexibility. Based on the deep network, we transform the inference of GRNs into a regression problem, using the gene expression data at previous time points to predict the gene expression data at the later time point. Furthermore, we adopt two strategies to improve the accuracy and stability of the algorithm. Specifically, we utilize a bidirectional structure to integrate the forward and reverse inference results and exploit an incomplete set of prior knowledge to filter out some candidate inferences of low confidence. BiRGRN is applied to four simulated datasets and three real scRNA-seq datasets to verify the proposed method. We perform comprehensive comparisons between our proposed method with other state-of-the-art techniques. These experimental results indicate that BiRGRN is capable of inferring GRN simultaneously from time-series scRNA-seq data. Our method BiRGRN is implemented in Python using the TensorFlow machine-learning library, and it is freely available at https://gitee.com/DHUDBLab/bi-rgrn.

Choroidal modifications assessed by means of choroidal vascularity index after oral eplerenone treatment in chronic central serous chorioretinopathy.

To investigate choroidal vascularity index (CVI) changes after oral eplerenone treatment in chronic central serous chorioretinopathy (cCSC) using the Spectral-domain (SD)-Optical Coherence Tomography (OCT) with enhanced depth imaging (EDI) mode. Thirty-six eyes of 18 patients suffering from cCSC with monolateral foveal subretinal fluid (FSRF) successfully treated with oral eplerenone treatment and 18 age-matched healthy subjects were enroled in this retrospective study. EDI-OCT images obtained using Heidelberg Spectralis OCT device in patients with cCSC and FSRF (group 1); fellow eye (group 2) or healthy patients (healthy) were exported and then imported into image analysis ImageJ software for subsequent quantitative analysis. The main outcome measures were luminal area (LA) and CVI. A higher value of CVI was detected in group 1 compared to healthy eyes (p = 0.006). LA and CVI significantly reduced during follow up in group 1 and group 2. LA at 120 days was significantly lower compared to all previous time points both in group 1 and group 2 (p < 0.001). Median and [1st -3rd quartile] CVI values were 0.8 [0.7; 1.1] at baseline, 0.8 [0.7; 0.9] at 30 days; 0.7 [0.6; 0.9] at 60 and 90 days and 0.6 [0.5; 0.8] at 120 days in group 1 (p = 0.007) and 0.7 [0.6; 0.9] at baseline, 0.7 [0.7; 0.8] at 30 days; 0.7 [0.6; 0.7] at 60 and 90 days and 0.6 [0.6; 0.7] at 120 days in group 2 (p = 0.018). Choroidal vascularity index reduced in cCSC patients after oral eplerenone treatment during follow up both in eyes with SRF and fellow eyes thus demonstrating the effectiveness of mineral corticoid receptor antagonists in recovering choroidal morphology.

Facing salient and non-salient time sequence orientation types expressed by adverbs in English, Mandarin and Serbian

AbstractThis article intends to provide insight into how speakers of English, Mandarin, and Serbian perceive spatio-temporal relations expressed by specific pairs of adverbials. In two studies participants were presented with simple sentences describing the metaphorical movement of events on the timeline (e.g., “The meeting was moved from the morning to the afternoon.”) and were asked to decide whether the event had been moved along the sagittal, vertical or transverse axis (forward/backward, up/down, left/right). The main aim of the first study, which was conducted with 104 native speakers of Serbian, was to explore the effects of axis-orientation and individual time units on participants’ preferences and response times. The target time units used were dates, hours, months, days of the week, and years. The results showed significant differences in response times between the transverse and sagittal axis conditions on the one hand (with shorter reaction times), and the vertical axis condition on the other. Moreover, the distribution of answers showed a high degree of inconsistency when it came to moving events to a previous point in time. The main aim of the second study was to identify potential differences in responses and response times to different orientations and time units between four experimental groups: native speakers of English with no second language, native speakers of English with knowledge of a second language, native speakers of Mandarin (with English as a second language), and native speakers of Serbian (also with English as a second language). The study was conducted with 126 participants. The design of the second study was largely parallel to that of the first, but it involved three trials and different time units (parts of the day, days of the week and months). The Mandarin speakers gave the quickest responses in the first two trials when deciding on the vertical axis. Moreover, reaction times were significantly shorter in the parts-of-the-day condition (e.g., “morning”, “afternoon”), across the three trials. In addition, Mandarin speakers showed an inverted trend in responses on the sagittal axis compared to the remaining three groups. While some of our results corroborate previous research on the topic, the study also provides novel empirical evidence on how Serbian speakers conceptualize time using spatial terms.

A combination of the K-L and S-P approaches for treating acetabular posterior wall factures accompanied by femoral head fractures with open reduction and internal fixation

BackgroundIn clinical practice, acetabular posterior wall fracture combined with femoral head fracture is rare. However, with the increasing number of engineering and traffic accidents, such fractures, have increased significantly in recent years. This paper aims to explore the clinical efficiency of the Kocher-Langenbeck (K-L) and Smith-Petersen (S-P) combined approaches for open reduction and internal fixation (ORIF) of acetabular posterior wall fractures accompanied by femoral head fractures (Pipkin type IV fractures).MethodsA retrospective study was conducted on 8 patients who underwent open reduction and internal fixation (ORIF) of Pipkin type IV fractures through the K-L combined with S-P approach in our hospital from January 2015 to January 2020. All 8 patients were successfully operated on without serious complications, such as important blood vessel and nerve damage, with an operation time of 143.8 ± 44.38 min and intraoperative blood loss of 225 ± 70.71 ml. Perioperative data were recorded. The Harris score was used to evaluate the clinical effect. Fracture reduction quality was evaluated according to the Matta radiological standard. The grade of ectopic ossification was evaluated by the Brooker grading method, and the stage of femoral head necrosis was evaluated by Ficat-Arlet staging.ResultsThe Harris score increased significantly from 57.38 ± 4.779 at 3 months, to 76.13 ± 3.682 at 6 months, 88.25 ± 3.495 at 12 months, and 92.13 ± 2.232 at 36 months postoperatively. After statistical analysis, compared with the previous observation time point, the data comparison differences between the groups were statistically significant. P < 0.001, P < 0.001, P < 0.05). By the time of the latest follow-up, 6 of the 8 patients had recovered to the level of pre-injury sports capacity. In contrast, the other 2 patients remained below the level of pre-injury sports capacity. In terms of imaging evaluation, the quality of fracture reduction on radiographs was graded as excellent in 6 patients and good in 2 patients according to Matta’s criteria. At the last follow-up, no heterotopic ossification or femoral head necrosis was found in of all the images. In addition, the hip joint space was normal in 6 cases, mildly narrowed in 1 case, and clearly narrowed in 1 case.ConclusionsThe K-L combined with S-P approach provides effective exposure for the reduction and fixation of Pipkin type IV fractures and achieves satisfactory clinical outcomes.

The Analysis of a Causal Relationship between Career Maturity and Academic Achievement on Korean Adolescents Using Autoregressive Cross-Lagged Modeling.

Academic achievement and career maturity are closely related, but an understanding of the causal direction is lacking. The purpose of this study was to analyze the causal relationship between career maturity and academic achievement using autoregressive cross-lagged modeling. This study analyzed the data of 888 adolescents (mean age = 15.90) from the Youth Panel Survey. Autoregressive modeling indicates that academic achievement and career maturity remained stable over time. Higher academic achievement at a previous time point was associated with higher academic achievement at the next time point and similarly for career maturity. Moreover, as a result of cross-lagged effects, academic achievement at one time had a positive effect on career maturity at the next time point, while career maturity at one time had a positive impact on academic achievement at the next time point. In other words, there was a bidirectional effect between academic achievement and career maturity. This study implies that researchers and educators should consider career maturity as well as academic achievement for career guidance.

Reciprocal Relationships Between Perceived Supportive School Climate and Self-reported Truancy: A Longitudinal Study from Grade 6 to Grade 9

ABSTRACT This longitudinal study of 1,066 Finnish students examined bidirectional reciprocal relationships between changes in perceived supportive school climate and changes in self-reported truancy from the last year of primary school (Grade 6) to the last year of lower secondary school (Grade 9). The results of the random intercept cross-lagged panel model showed, first, that a decrease in positive perceptions of school climate at the previous time point predicted more self-reported truancy at the following time point. Second, an increase in self-reported truancy predicted less positive perceptions of supportive school climate. The study indicates that students’ perceptions of supportive school climate and truancy negatively predict each other over time. Thus, school climate can serve as a target for prevention and intervention efforts to tackle truancy. Moreover, effectively addressing truancy may lead to a more favorable student view of school climate.

Numerical solution of the Cauchy problem for Volterra integrodifferential equations with difference kernels

We consider the problems of the numerical solution of the Cauchy problem for an evolutionary equation with memory when the kernel of the integral term is a difference one. The computational implementation is associated with the need to work with an approximate solution for all previous points in time. In this paper, the considered nonlocal problem is transformed into a local one; a loosely coupled equation system with additional ordinary differential equations is solved. This approach is based on the approximation of the difference kernel by the sum of exponentials. Estimates for the stability of the solution concerning the initial data and the right-hand side for the corresponding Cauchy problem are obtained. Two-level schemes with weights with convenient computational implementation are constructed and investigated. The theoretical consideration is supplemented by the results of the numerical solution of the integrodifferential equation when the kernel is the stretching exponential function.

Determinants of the Physician Global Assessment of Disease Activity and Influence of Contextual Factors in Early Axial Spondyloarthritis.

ObjectiveTo investigate determinants of the physician global assessment (PhGA) of disease activity and the influence of the contextual factors on this relationship in patients with early axial spondyloarthritis (SpA).MethodsFive‐year data of DESIR, a cohort of early axial SpA, were analyzed. Univariable generalized estimating equations (GEEs) were used to investigate contributory explanatory effects of various potential determinants of PhGA. Effect modification by contextual factors (age, sex, and educational level) was tested, and if significant, models were stratified. Autoregressive GEE models (i.e., models adjusted for PhGA at the previous time point) were used to confirm a longitudinal relationship.ResultsA total of 708 patients were included. Higher Bath Ankylosing Spondylitis Disease Activity Index individual questions, swollen joint count in 28 joints (SJC28), tender joint count in 53 joints, Maastricht Ankylosing Spondylitis Enthesitis Score, C‐reactive protein (CRP) level, and Bath Ankylosing Spondylitis Metrology Index score were associated with a higher PhGA. Sex and age were effect modifiers of SJC28; the contributory effect of SJC28 was largest in the younger male stratum (β = 1.07 [95% confidence interval (95% CI) 0.71, 1.43]), and the smallest in the older female stratum (β = 0.13 [95% CI 0.04, 0.22]). Autoregressive GEE models revealed the same determinants as having a longitudinal association with PhGA and the same pattern of effect modification.ConclusionPatients’ subjective symptoms, peripheral arthritis and enthesitis, higher CRP level, and impaired spinal mobility contribute to explaining PhGA in patients with early axial SpA, irrespective of sex and age. Intriguingly, physicians consider the presence of swollen joints as more important in males than in females.

A Prospective Cohort Study of Stability in Preferred Place of Death Among Patients With Stage IV Cancer in Singapore.

Advance care planning (ACP) involves documentation of patients' preferred place of death (PoD). This assumes that patients' preferred PoD will not change over time; yet, evidence for this is inconclusive. We aimed to assess the extent and correlates of change in patients' preferred PoD over time. Using data from a cohort study of patients with advanced cancer in Singapore, we analyzed preferred PoD (home vs institution including hospital, hospice, and nursing home vs unclear) among 466 patients every 6 months for a period of 2 years. At each time point, we assessed the proportion of patients who changed their preferred PoD from the previous time point. Using a multinomial logistic regression model, we assessed patient factors (demographics, understanding of disease stage, ACP, recent hospitalization, quality of life, symptom burden, psychologic distress, financial difficulty, prognosis) associated with change in their preferred PoD. More than 25% of patients changed their preferred PoD every 6 months, with no clear trend in change toward home or institution. Patients psychologically distressed at the time of the survey had increased likelihood of changing their preferred PoD to home (relative risk ratio [RRR], 1.02; 95% CI, 1.00-1.05) and to an institution (RRR, 1.06; 95% CI, 1.02-1.10) relative to no change in preference. Patients hospitalized in the past 6 months were more likely to change their preferred PoD to home (RRR, 1.56; 95% CI, 1.07-2.29) and less likely to change to an institution (RRR, 0.50; 95% CI, 0.28-0.88) relative to no change in preference. The present study provides evidence of instability in the preferred PoD of patients with advanced cancer. ACP documents need to be updated regularly to ensure they accurately reflect patients' current preference.

Dynamics of the baroreflex sensitivity during combined anesthesia with sevoflurane or propofol: a randomized trial

INTRODUCTION: A significant number of complications is still a serious problem in abdominal surgery. It is known that patients with low baroreflex sensitivity are more prone to hemodynamic instability during general anesthesia, which allows them to be identified as a risk group. OBJECTIVE: To evaluate the dynamics of baroreflex sensitivity (BRS) during major abdominal surgery in patients with different risk of critical incidents under combined anesthesia with propofol or sevoflurane. MATERIALS AND METHODS: A randomized study was conducted in 160 patients (80 high-risk and 80 low-risk patients), who were randomized into subgroups according to the type of anesthesia (propofol or sevoflurane) to assess the effect of the type of anesthesia critical incidents and baroreflex dynamics. RESULTS: After the induction there was a trend towards a decrease in BRS, while in subgroups with initially low values of BRS, it decreased below 3 ms/mmHg. After the end of operation and 6 hours after extubation, there were no significant changes in comparison with intraoperative values. Evaluation of BRS after 24 hours showed that BRS in all subgroups was significantly higher than at previous time points, but did not return to baseline values. At 6 hours postoperatively, in low-risk patients, BRS values were below 3 ms/mmHg in 12.5 % with propofol, and in 10 % with sevoflurane, in high-risk patients — in 45 % and 42.5 % of cases, respectively. At 24 hours, in the low-risk group, only two patients in the propofol anesthesia group and one in the sevoflurane anesthesia subgroup experienced this dysfunction. CONCLUSIONS: Both anesthesia with propofol and anesthesia with sevoflurane lead to a decrease in the sensitivity of the arterial baroreflex, which is not fully restored 24 hours after the end of the operation. High-risk patients with initially reduced baroreflex sensitivity show more frequent postoperative baroreflex dysfunction.