Repeated Measures Research Articles

Associations between repeated measures of urinary phthalate metabolites and biomarkers of oxidative stress in a rural agricultural cohort of children with asthma

Phthalate exposure is widespread, and studies suggest an adverse relationship with asthma morbidity, including some support for oxidative stress as an underlying pathophysiological mechanism. Urinary phthalate metabolites have been associated with biomarkers of oxidative stress, but data are few in children diagnosed with asthma. We used participant data from the Home Air in Agriculture Pediatric Intervention Trial (HAPI) to examine longitudinal relationships between phthalates and oxidative stress in a cohort of Latino children with asthma residing in an agricultural community. We used linear mixed-effects models to estimate associations between 11 urinary phthalate metabolites (and one summed measure of di-2-ethylhexyl phthalate (DEHP) metabolites, ∑DEHP) and two urinary biomarkers of oxidative stress: a biomarker of lipid peroxidation via measure of 8-isoprostane and a biomarker of DNA/RNA oxidative damage via combined measure of 8-hydroxydeoxyguanosine (8-OHdG), 8-hydroxyguanosine (8-OHG), and 8-hydroxyguanine. Seventy-nine participants provided 281 observations. In covariate-adjusted models, we observed significant positive relationships between all phthalate metabolites and 8-isoprostane, effect sizes ranging from a 9.3 % (95 % CI: 4.2 %–14.7 %) increase in 8-isoprostane for each 100 % increase (i.e., doubling) of mono-(carboxy-isooctyl) phthalate (MCIOP), to a 21.0 % (95 % CI: 14.3 %–28.2 %) increase in 8-isoprostane for each doubling of mono-n-butyl phthalate (MNBP). For each doubling of mono-(carboxy-isononyl) phthalate (MCINP) and mono-ethyl phthalate (MEP), the DNA/RNA oxidative damage biomarker increased by 6.0 % (95 % CI: 0.2 %–12.2 %) and 6.5 % (95 % CI: 1.4 %–11.9 %), respectively. In conclusion, we provide unique data suggesting phthalate exposure is positively associated with oxidative stress in children with asthma. Our repeat measures provide novel identification of a consistent effect of phthalates on oxidative stress in children with asthma via lipid peroxidation. Confirmation in future studies of children with asthma is needed to enhance understanding of the role of phthalates in childhood asthma morbidity.

Using a Computerised Staircase and Incremental Optotype Sizes to Improve Visual Acuity Assessment Accuracy.

Background:Given the impact of visual acuity results on diagnosis and management, it is essential that the test is accurate, determined by factors such as test-retest variability. Standardisation improves accuracy, which can be performed via a computerised staircase methodology. Standard clinical tests with scoring of 0.02 per optotype implies an incremental score per optotype despite optotype size remaining constant on each line. The aim of this study is to establish if near continuous incremental optotype display and scoring improves test-retest variability compared to current testing methods.Methods:A computerised three up, one down adaptive staircase was used to display Kay Picture optotypes on an LCD monitor. Three methods of visual acuity assessment were undertaken: ETDRS, Kay Pictures and computerised Kay Pictures. Tests were performed twice under standard clinical conditions.Results:One hundred nineteen adults were tested. Test-retest variability for computerised Kay pictures was 0.01 logMAR (±0.04, p = 0.001). Good levels of agreement were observed for computerised Kay pictures in terms of test-retest variability, where the test had the smallest mean bias (0.01 logMAR compared to 0.03 and 0.08 logMAR for Kay Pictures and ETDRS respectively) and narrowest limits of agreement. Participants performed better in computerised Kay pictures than Kay Pictures by 0.03 logMAR, and better in ETDRS than computerised Kay pictures by 0.1 logMAR.Conclusion:Computerised Kay pictures exhibited a low test-retest variability, demonstrating it is reliable and repeatable. This repeatability measure is lower than the test-retest variability of the ETDRS and Kay Pictures tests.

A Comparison of Ivermectin and Non Ivermectin Based Regimen for COVID-19 in Abuja: Effects on Virus Clearance, Days-to-discharge and Mortality

Aim: To compare outcomes from ivermectin (IVM) - and non-ivermectin (NIVM)-based treatments for COVID-19 in Abuja, Nigeria.
 Methods: Sixty-one consecutive virology-proven cases were recruited and managed with IVM-based regimes. A subsequent cohort of 26 patients was treated with NIVM due to physician preference, with varying combinations of lopinavir/ritonavir (Alluvia), remdesivir, azithromycin, and enoxapramin. All patients received zinc sulfate, vitamin C and supportive therapy. Propensity matching was carried out as indicated, and Repeat Measures Analysis of Variance (RMANOVA) allowing for time*treatment interaction was carried out for time dependent variables, deriving Likelihood Ratio (LR) and P values.
 Main Outcome Measures: Change in cycle threshold (viral load) over time, positivity status by day 5, improvement in clinical status using myalgia scores, days to discharge (DTD), change in SpO2 and death.
 Results: IVM was associated with a greater and faster reduction in viral clearance (LR=64.2 p< 0.0001 for the N gene): 31% and 95% were negative by days 5 and 14, respectively, versus 0% on NIVM. The mean DTD on IVM was 8.8 days versus 19.4 days, p< 0.0001. IVM proved significantly superior for Myalgia scores, LR= 23.45, P=0.0007. The mortality rate was 0/61 (0%) in IVM but 4/26 (15.3%) in NIVM. Three of the 4 deaths were in females, and 2 had been vaccinated, one fully. The SP02% increased significantly more on IVM (p < 0.0001 RMANOVA) than the NIVM group. C-reactive protein and D-dimer levels dropped significantly more sharply during IVM (P= 0.0068, 0.063), suggesting anti-inflammatory and antifibrinolytic activity.
 Conclusions: The IVM-based regimen caused earlier discharge from treatment and reduced mortality, in addition to clinical and laboratory improvements. Vaccination did not protect some patients from SARS-CoV-2 breakthrough infection and mortality.

Use of a novel flipped classroom intervention to increase medical students’ knowledge of physical activity guidelines

Background: It is important medical students, as tomorrow’s doctors, have knowledge of physical activity (PA) guidelines. Previous data suggests only 14.9% of medical students knew adult PA guidelines. This study aimed to assess how a novel flipped classroom intervention impacted undergraduate medical students’ knowledge of PA guidelines and their confidence applying these in clinical practice. Methods and Results: This study utilised a prospective repeat measures quantitative design to evaluate the educational intervention. Survey results of the intervention group were compared to the comparison group. 45% of students who received the intervention knew adult guidelines, compared to 12% of students who did not receive the intervention (χ²(2, N = 244) = 33.07, p < 0.001). 39% of the intervention group knew child guidelines, compared to 20% who did not receive the intervention (χ²(2, N = 244) = 10.59, p = 0.001). The intervention group felt more confident in PA training and asked for less PA training in the future. Conclusion: The results suggest a flipped classroom intervention had a positive impact on medical students’ knowledge of PA guidelines, and confidence in PA training. Further research is required to assess longer-term impacts of this teaching and follow-up the same year group pre- and post-intervention.

Electrophysiological biomarkers of brain function in CDKL5 deficiency disorder.

CDKL5 deficiency disorder is a debilitating developmental and epileptic encephalopathy for which no targeted treatment exists. A number of promising therapeutics are under development for CDKL5 deficiency disorder but a lack of validated biomarkers of brain function and clinical severity may limit the ability to objectively assess the efficacy of new treatments as they become available. To address this need, the current study quantified electrophysiological measures in individuals with CDKL5 deficiency disorder and the association between these parameters and clinical severity. Visual and auditory evoked potentials, as well as resting EEG, were acquired across 5 clinical sites from 26 individuals with CDKL5 deficiency disorder. Evoked potential and quantitative EEG features were calculated and compared with typically developing individuals in an age- and sex-matched cohort. Baseline and Year 1 data, when available, were analysed and the repeatability of the results was tested. Two clinician-completed severity scales were used for evaluating the clinical relevance of the electrophysiological parameters. Group-level comparisons revealed reduced visual evoked potential amplitude in CDKL5 deficiency disorder individuals versus typically developing individuals. There were no group differences in the latency of the visual evoked potentials or in the latency or amplitude of the auditory evoked potentials. Within the CDKL5 deficiency disorder group, auditory evoked potential amplitude correlated with disease severity at baseline as well as Year 1. Multiple quantitative EEG features differed between CDKL5 deficiency disorder and typically developing participants, including amplitude standard deviation, 1/f slope and global delta, theta, alpha and beta power. Several quantitative EEG features correlated with clinical severity, including amplitude skewness, theta/delta ratio and alpha/delta ratio. The theta/delta ratio was the overall strongest predictor of severity and also among the most repeatable qEEG measures from baseline to Year 1.Together, the present findings point to the utility of evoked potentials and quantitative EEG parameters as objective measures of brain function and disease severity in future clinical trials for CDKL5 deficiency disorder. The results also underscore the utility of the current methods, which could be similarly applied to the identification and validation of electrophysiological biomarkers of brain function for other developmental encephalopathies.

Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records.

Cardiovascular disease (CVD) risk prediction models for individuals with type 2 diabetes are important tools to guide intensification of interventions for CVD prevention. We aimed to assess the added value of incorporating risk factors variability in CVD risk prediction for people with type 2 diabetes. We used electronic health records (EHRs) data from 83 910 adults with type 2 diabetes but without pre-existing CVD from the UK Clinical Practice Research Datalink for 2004-2017. Using a landmark-modelling approach, we developed and validated sex-specific Cox models, incorporating conventional predictors and trajectories plus variability of systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, and glycated haemoglobin (HbA1c). Such models were compared against simpler models using single last observed values or means. The standard deviations (SDs) of SBP, HDL cholesterol and HbA1c were associated with higher CVD risk (P < 0.05). Models incorporating trajectories and variability of continuous predictors demonstrated improvement in risk discrimination (C-index = 0.659, 95% CI: 0.654-0.663) as compared with using last observed values (C-index = 0.651, 95% CI: 0.646-0.656) or means (C-index = 0.650, 95% CI: 0.645-0.655). Inclusion of SDs of SBP yielded the greatest improvement in discrimination (C-index increase = 0.005, 95% CI: 0.004-0.007) in comparison to incorporating SDs of total cholesterol (C-index increase = 0.002, 95% CI: 0.000-0.003), HbA1c (C-index increase = 0.002, 95% CI: 0.000-0.003) or HDL cholesterol (C-index increase= 0.003, 95% CI: 0.002-0.005). Incorporating variability of predictors from EHRs provides a modest improvement in CVD risk discrimination for individuals with type 2 diabetes. Given that repeat measures are readily available in EHRs especially for regularly monitored patients with diabetes, this improvement could easily be achieved.

Mobile daily diaries to characterize stressors and acute health symptoms in an environmental justice neighborhood.

Low-income communities and communities of color face multiple, cumulative environmental and social burdens. Methods development in environmental justice research has largely focused on spatial and quantitative approaches. Less attention has been paid to developing methodologies that help collect information on everyday stressors and quality of life experiences for residents in overburdened communities. Mixed methods approaches can be one way to structure study designs that help consider how residents experience environmental and socioeconomic impacts in a localized community context. In neighborhoods burdened by cumulative stressors, traditional cross-sectional epidemiological research designs can also be challenging, as well as limited or narrow in their application. However, repeat sampling of measures within a vulnerable population can approach a quasi-experimental design and help consider variations within residents in a single neighborhood as well as better parse relationships between exposures and outcomes. Through a community-academic partnership with university partners, local community partners, and a local promotores de salud (community health workers) network, we pilot tested a novel mobile daily diary approach in both English and Spanish in an urban, predominantly immigrant community in South Los Angeles as a potential method to collect information on daily stress, environmental quality, and health status/symptoms. We collected resident responses via a once per day 7-day SMS/text messaging survey. We sought to gather granular data on daily resident experiences of air pollution and environmental hazards. Residents reported acute health symptoms and stressors, with repeat measures demonstrating how residents might rank, categorize, or cope with stressors. We find that residents in environmental justice communities record variation in their daily diary responses and document changes in environmental quality, stressors, and odors. Refining this type of method could enable a more rigorous examination of co-occurrences of environmental quality and acute health symptoms. This approach supports the inclusion of residents in the research process and helps more systematically integrate open-ended environmental health relevant data in environmental justice efforts. Used with measured data such as air monitoring or health measures, mixed methods generated data can help support efforts that aim to alleviate sources of daily stress, alongside efforts to reduce overall pollution burdens. Mobile daily diaries can be one way to capture variable responses to environmental quality, acute health symptoms, and stressors.

Sparse group variable selection for gene-environment interactions in the longitudinal study.

Penalized variable selection for high-dimensional longitudinal data has received much attention as it can account for the correlation among repeated measurements while providing additional and essential information for improved identification and prediction performance. Despite the success, in longitudinal studies, the potential of penalization methods is far from fully understood for accommodating structured sparsity. In this article, we develop a sparse group penalization method to conduct the bi-level gene-environment (G E) interaction study under the repeatedly measured phenotype. Within the quadratic inference function framework, the proposed method can achieve simultaneous identification of main and interaction effects on both the group and individual levels. Simulation studies have shown that the proposed method outperforms major competitors. In the case study of asthma data from the Childhood Asthma Management Program, we conduct G E study by using high-dimensional single nucleotide polymorphism data as genetic factors and the longitudinal trait, forced expiratory volume in 1 s, as the phenotype. Our method leads to improved prediction and identification of main and interaction effects with important implications.

Association between objective measures and parent-reported measures of child tobacco smoke exposure: A secondary data analysis of four trials.

INTRODUCTIONTobacco smoke exposure (TSE) harms children and adults. Studies of childhood TSE exposure often relies on parental reports, but may benefit from objective measures. The objective of our study was to study the relationship between reported and objective measures of TSE.METHODSWe analyzed data from four intervention trials, conducted in clinical or community settings, to identify objective measures most closely associated with parent-reported measures and the optimal set of parent-reported measures for predicting objective measures. We also assessed whether there was a learning curve in reported exposure over time, and the importance of replicate biomarker measures.RESULTSCorrelations between objective and parent-reported measures of child TSE were modest at best, ranging from zero to 0.41. Serum cotinine and urinary cotinine were most strongly associated with parental reports. Parental questions most closely related to biomarkers were number of cigarettes and home smoking rules; together these formed the best set of predictive questions. No trial included all objective measures and all questions, precluding definitive statements about relative advantages. Within-subject repeatability of biomarker measures varied across studies, suggesting that direct pilot data are needed to assess the benefit of replicate measurements.CONCLUSIONSImprovements in objective and parent-reported child exposure measurements are needed to accurately monitor child TSE, evaluate efforts to reduce such exposure, and better protect child health.

An ideographic study into physiology, alcohol craving and lapses during one hundred days of daily life monitoring

IntroductionAlcohol craving is a highly challenging obstacle to achieve long-term abstinence. Making alcohol use disorder patients timely aware of high-risk craving situations may protect them against relapse by prompting them to mobilize their coping resources. Current advances in wearable and smart-phone technology provide novel opportunities for the development of detecting these situations of heightened risk of craving, by enabling continuous tracking of fluctuations in psychological and physiological parameters. The present study therefore aims to determine the association between self-reported craving and relapses, and between heightened physiological activity. Specifically, we measured cardiovascular and electrodermal activity, and self-reported craving during one hundred days in the daily life of people trying to recover from alcoholism. The secondary aim is to study whether the association between physiology and craving can be strengthened by the inclusion of context related psychological parameters. MethodsAn intensive repeated and continuous measures in naturalistic settings case-study design was employed. Ten participants were monitored with wearable bio-sensors and answered multiple questions every three hours on a smartphone app about craving, lapsing and multiple evidence based contextual variables. The association between physiology, craving and lapses was explored using Matthews correlation coefficients both with a current and 3 h lagged design. The contextual variables were included in a decision tree together with the physiological parameters to explore the added effect on the correlation of these contextual variables. ResultsThe association between lapses and craving was highly different across individuals, varying between a weak to a strong association. The association between cardiovascular activity and heightened self-reported craving was negligible to weak, however with a high specificity, meaning that most craving events were accompanied by increase heart rate. However, the association between electrodermal activity and craving was lower than with cardiovascular activity for most participants, both prior (lagged) and during craving. For two of the participants the association between physiology and craving improved by adding contextual variables, however, precision was too low. ConclusionsPeople differ strongly in their bodily reactions and psychological experiences during the first months of their addiction treatment. No individual in our study had unique one-to-one mappings between on the one hand physiological or psychological precursors, and on the other hand craving and (re)lapses. Therefore, detecting high risk craving situations with both physiological activity measured with wearables and psychological precursors to alert people specifically for an imminent (re)lapse, does not seem viable on the basis of the current results. We do see an added benefit of using physiology during treatment, as physiology can help start the conversation about possible high risk craving situations during that week. This would also help the counselor to gain added insights into the fluctuating states of the clients, and help to ameliorate the recall bias of clients. The present study showed the possibility and paved the way for future intensive longitudinal designs integrating both physiological, psychological and contextual factors during the challenging and lengthy recovery from addiction.

Ciliary Muscle Dimension Changes With Accommodation Vary in Myopia and Emmetropia.

PurposeThe purpose of this study was to determine whether accommodation-induced changes in ciliary muscle dimensions vary between emmetropes and myopes, and the effect of the image analysis method.MethodsSeventy adults aged 18 to 27 years consisted of 25 people with emmetropia (spherical equivalent refraction [SER] +0.21 ± 0.36 diopters [D]) and 45 people with myopia (−2.84 ± 1.72 D). There were 23 people with low myopia (>−3 D) and 22 people with moderate myopia (−3 to −6 D). Right eye ciliary muscles were imaged (Visante OCT; Carl Zeiss Meditec) at 0 D and 6 D demands. Measures included ciliary muscle length (CML), ciliary muscle curved length (CMLarc), maximum ciliary muscle thickness (CMTmax), CMT1, CMT2, and CMT3 (fixed distances 1–3 mm from the scleral spur), CM25, CM50, and CM75 (proportional distances 25%–75%). Linear mixed model analysis determined effects of refractive groups, race, and demand on dimensions. Significance was set at P < 0.05.ResultsMyopic eyes had greater CML and CMLarc nasally than emmetropic eyes. Myopic eyes had thicker muscles than emmetropic eyes at nasal positions, except CM25 and CMT3, and at CM75 temporally. During accommodation and only nasally, CML reduced in emmetropic and myopic eyes, and CMLarc reduced in myopic eyes only. During accommodation, both nasally and temporally, muscles thickened anteriorly (CMT1 and CM25) and thinned posteriorly (CMT3 and CM75) except for temporal CM75. Moderate myopic eyes had greater temporal CMLarc than low myopic eyes, and the moderate myopes had thicker muscles both nasally and temporally using fixed and proportional distances.ConclusionsPeople with myopia had longer and thicker ciliary muscles than people with emmetropia. During accommodation, the anterior muscle thickened and the curved nasal muscle length shortened, more in myopic than in emmetropic eyes. The fixed distance method is recommended for repeat measures in the same individual. The proportional distance method is recommended for comparisons between refractive groups.

Heart failure subphenotypes based on repeated biomarker measurements are associated with clinical characteristics and adverse events (Bio-SHiFT study)

BackgroundThis study aimed to identify heart failure (HF) subphenotypes using 92 repeatedly measured circulating proteins in 250 patients with heart failure with reduced ejection fraction, and to investigate their clinical characteristics and prognosis. MethodsClinical data and blood samples were collected tri-monthly until the primary endpoint (PEP) or censoring occurred, with a maximum of 11 visits. The Olink Cardiovascular III panel was measured in baseline samples and the last two samples before the PEP (in 66 PEP cases), or the last sample before censoring (in 184 PEP-free patients). The PEP comprised cardiovascular death, heart transplantation, Left Ventricular Assist Device implantation, and hospitalization for HF. Cluster analysis was performed on individual biomarker trajectories to identify subphenotypes. Then biomarker profiles and clinical characteristics were investigated, and survival analysis was conducted. ResultsClustering revealed three clinically diverse subphenotypes. Cluster 3 was older, with a longer duration of, and more advanced HF, and most comorbidities. Cluster 2 showed increasing levels over time of most biomarkers. In cluster 3, there were elevated baseline levels and increasing levels over time of 16 remaining biomarkers. Median follow-up was 2.2 (1.4–2.5) years. Cluster 3 had a significantly poorer prognosis compared to cluster 1 (adjusted event-free survival time ratio 0.25 (95%CI:0.12–0.50), p < 0.001). Repeated measurements clusters showed incremental prognostic value compared to clusters using single measurements, or clinical characteristics only. ConclusionsClustering based on repeated biomarker measurements revealed three clinically diverse subphenotypes, of which one has a significantly worse prognosis, therefore contributing to improved (individualized) prognostication.

Validity and repeatability of a new inertial measurement unit system for gait analysis on kinematic parameters: Comparison with an optoelectronic system

Inertial measurement unit (IMU) systems are offering promising alternatives to optoelectronic systems for measuring human movement. The objective of this study was to assess the validity of a new inertial measurement system, iSen STT-IWS sensors, with reference to the optoelectronic motion capture system OptiTrack. 22 young participants performed three minutes of treadmill walking at different speeds. Hip, knee and ankle joint angles in the sagittal plane were compared between the two systems. Accuracy and repeatability of iSen IMU measures was evaluated with the Root Mean Square Deviation (RMSD) and Lin’s Concordance Correlation (LCC). A good to tolerable Isen measures’ accuracy was found (RMSD < 10°, LCC > 0.75) and reliability decreased with walking speed. Results indicated excellent test–retest repeatability of the inertial system (Intraclass correlation (ICC) > 0.75). Sagittal kinematic gait estimation using the iSen IMU system can be reliably used for clinical purposes on older adults.

Research on the Effect of MT+FES Training on Sensorimotor Cortex.

Purpose Aiming at the motor recovery of patients with unilateral upper limb motor dysfunction after stroke, we propose a mirror therapy (MT) training method, which uses surface electromyography (sEMG) to identify movements on one side and control the other side to perform functional electrical stimulation (FES) while mirror therapy is used. And we verify the effect of this training method by analyzing the activity changes of the sensorimotor cortex. Method Ten subjects (6 men and 4 women) were randomly divided into two groups according to 3 men and 2 women in each group: the experimental group (n = 5) received FES+MT training, and the control group (n = 5) received MT training. Both groups were trained at a fixed time at 9 : 00 am every day, each time lasting 20 minutes, once a day, 5 days a week, continuous training for 4 weeks, and the training action was elbow flexion training. During the training of the elbow flexion exercise, the experimental group applied FES with a frequency of 30 Hz, a pulse width of 100 μs, and a current of 10 mA to the muscles corresponding to the elbow flexion exercise, and rested for 10 s after 10-s stimulation. We collect the EEG of the elbow flexion motor imagery of all subjects before and after training, and calculate the eigenvalue E, and analyze the effect of FES+MT training on the activity of the cerebral sensorimotor cortex. Results After repeated measure (RM) two-way ANOVA of the two groups, comparing the subjects' μ rhythm elbow flexion motor imagery eigenvalue E, the experimental group (after training) > the control group (after training) > before training. Conclusion The FES+MT training method has obvious activation effect on the cerebral sensorimotor cortex.

Validity of Wearable Monitors and Smartphone Applications to Measure Steps and Distance in Adolescents

The growing popularity of wearable physical activity (PA) monitors and fitness applications (apps) in recent years and the vast amounts of data that they generate present attractive possibilities for surveillance. However, measurement accuracy is indispensable when tracking PA variables to provide meaningful measures of PA. The purpose of this study was to examine the criterion validity of wearable PA monitors and a combination of GPS and accelerometer free of charge smartphone apps, during self-paced outdoor walking and running. Thirty-eight healthy adolescents (15.3±2.0 years) participated in this cross-sectional study. They were fitted with Garmin Forerunner 310XT, Garmin Vivofit, Medisana Vifit, and smartphones running the Runkeeper, Runtastic, Sports Tracker (GPS), Pedometer, Accupedo, Pedometer and Pedometer 2.0 (accelerometer) apps. They were asked to walk and run 1.22 km for each trial and two researchers counted every step taken during trials with a digital tally counter. Validity was evaluated by comparing each device with the criterion measure using Repeated measures analysis of variance (ANOVA), Mean Absolute Percentage Errors (MAPE) and Bland-Altman plots. MAPE were low for Forerunner and GPS apps for distance in both conditions (2.27%- 9.73%), and significantly higher for the accelerometer monitors and apps (6.92%-39.02%). Vivofit (MAPE=6.51%) and Vifit (MAPE=6.66%) accurately estimated the number of steps during walking, however only Vivofit (MAPE=3.95%) was accurate during running. All accelerometer-based apps had high MAPE for step counting (9.87%-40.26%). The findings suggested that GPS monitors and apps were accurate tools for counting distance during walking and running, while accelerometer- based monitors and apps had higher errors. Vivofit provided accurate estimates of step count in both conditions, and Medisana Vifit was valid during walking. Accupedo was the only app with an acceptable step count error.

Neuromodulatory Effects of Adjunctive High Definition Transcranial Direct Current Stimulation (HDtDCS) on Auditory Verbal Hallucinations in Schizophrenia Patients: A Sham Controlled Diffusion Tensor Imaging Study

AimsTo see the neuromodulatory effects of adjunctive HD-tDCS on white matter connectivity by using Diffusion Tensor Imaging (DTI) in schizophrenia patients with Auditory Verbal Hallucinations (AVH)MethodsThis was a randomized, double blind, sham controlled study. 40 patients of schizophrenia with prominent auditory verbal hallucinations and 10 age sex matched healthy controls were selected. The patients were randomly assigned to 2 groups and were given active or sham adjunctive HDtDCS (Active Treatment = 10 sessions of 2 mA current applied for 20 minutes, twice daily for 5 days, at left temporo-parietal Junction (TPJ); Sham treatment = 10 sessions of 1 mA current, twice daily for 5 days was applied for 30 sec at left TPJ). Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed and severity of schizophrenia symptoms and auditory hallucinations were rated on PANSS and PSYRATS-AH at baseline, after 1st week (i.e. end of HDtDCS sessions) and 4 weeks after the end of the HDtDCS sessions). Patients received stable dose of antipsychotics for the total study duration (equivalent to or more than 400 mg of chlorpromazine) to eliminate confounding bias. Fractional anisotropy of left arcuate fasciculus by Diffusion tensor imaging was assessed in healthy controls. DTI data were analysed by DSI Studio software. Statistical analysis was done by SPSS version 25.Results1.Both the patient groups were comparable with regard to socio-demographic variables and baseline clinical variables.2.There was no significant difference in the values of Fractional Anisotropy in Left Arcuate Fasciculus among the patients and healthy controls at baseline.3.The group receiving active adjunctive HDtDCS, showed significant improvement in the frequency domain of AVH over time, in time*group comparison by repeat measure ANOVA with Mauchly's test of sphericity and Greenhouse-Geisser correction [p = 0.011 and partial eta square = 0.129].4.There was no significant difference in change in the Fractional anisotropy of the left arcuate fasciculus noted between the groups over time.5.Application of HDtDCS was not associated with significant side effects, minor itching and mild burning sensation being the only reported side effectsConclusionAdjunctive active HD-tDCS to the left temporo-parietal junction showed a statistically significant improvement in frequency of auditory verbal hallucinations (AVH) in schizophrenia patients, when compared to sham stimulation.

The development and evaluation of a pediatric nurse education program to improve nursing competency for newly graduated nurses in a children’s hospital

Purpose: The purpose of this study is to identify the effects of a standardized educational program to improve nursing competency on newly graduated nurses in a children's hospital after developing and applying a pediatric nurse education program. The effectiveness of the program was confirmed by evaluating the clinical competency and field adaptation.Methods: In the first step, an education program was developed using the analysis, design, development, implementation and evaluation (ADDIE) model. As a second step, a similar experimental study of a single group repeat measures design was conducted to evaluate the clinical competency and field adaptation over time after application of the program. Additionally, a focus group interviews were conducted to collect subjective data on the effects and improvement points of the program.Results: As a result of applying the program, there was a significant change in the clinical competence and the field adaptation of newly graduated nurses in a children’s hospital. The categories derived from the focus group interviews were “getting special guidance,” “better care,” “becoming a nurse at a children's hospital” and “winning together.”Conclusion: It was confirmed that the education program enhances the clinical competency of new nurses in children's hospitals. In addition, it provided the necessary data to understand the experiences of new nurses, help them adapt effectively, and establish appropriate interventions.

Shared Medical Appointments in Weight Management: A Culturally Responsive Process for Aboriginal Women. Translational Trial Results

Introduction: This paper presents a secondary analysis of data from a study of 216 people participating in a trial of program shared medical appointments (PSMA) in weight management. The focus of this paper is the Aboriginal women who participated in this translational research project and who were not reported on specifically in the primary analysis and publication. This paper, therefore, examines the use of PSMA as a culturally safe and responsive procedure to facilitate weight management. Method: Twogroups, totalling 25 Aboriginal women, participated in a 6-session 12-week culturally responsive weight management PSMA. Repeated weight and satisfaction measures at 3, 6 and 12 months were collected. Results: 19 of 25 (76%) Aboriginal women completed the MYU. 16 (84%) lost some weight, and 5 (26%) lost clinically significant weight (&gt; 5%), sustained for 1 year. The participants and providers rated the procedure &gt; 4 on 5-point Likert scales for satisfaction. 95% reported that they preferred MYUs for weight management over 1:1 consultations with their general practitioner. Conclusion: The data indicates that programmed shared medical appointments appear to be a culturally safe and responsive procedure to support the Aboriginal women, in this study, to manage their weight.

Longitudinal analysis of resting energy expenditure and body mass composition in physically active children and adolescents

BackgroundMonitoring body composition and changes in energy expenditure during maturation and growth is significant, as many components can influence body structure in adulthood. In the case of young players, when these changes can influence their strength and power, it seems to be equally important. Our aim was to examine whether resting energy expenditure (REE) and body composition would change after 10 months from baseline in physically active children and adolescents.MethodsWe obtained data from 80 children and adolescents aged 9 to 17 years at two measurement points: the baseline in September 2018 and after 10 months in July 2019. The study was carried out using a calorimeter (Fitmate MED, Cosmed, Rome, Italy), a device used to assess body composition using by the electrical bioimpedance method by means of a segment analyzer (TANITA MC-980). The Student’s t-test and linear regression analysis were used. Using the stepwise forward regression procedure, the selection of factors in a statistically significant way that describes the level of REE was made.ResultsWe noticed that REE was not significantly different between baseline (1596.94 ± 273.01 kcal) and after 10 months (1625.38 ± 253.26 kcal). When analyzing the difference in REE between studies girls, we found body height as a significant predictor. The results of our study show a negative relationship between growth and REE. Differences between sexes and age in REE between baseline and after 10 months were not significant.ConclusionsOur study involving physically active children and adolescents, which used repeated objective measures and longitudinal statistical modeling to analyze them, was unable to demonstrate any interaction between body weight change, body composition measurements, and REE.

Errors of Measurement for Blood Parameters and Physiological and Performance Measures After the Decay of Short-Term Heat Acclimation

Introduction: It is important to determine the accuracy of measurements relative to potential treatment effects, with time intervals between tests. Purpose: The aim of this study was to assess the error of measurement for blood parameters, physiological, and performance measures after the decay of short-term heat acclimation. Methods: Ten trained males (Mean±SD: age 28±7 y; body mass 74.6±4.4 kg; 4.26±0.37 L.min-1; peak power output (PPO) 329±42 W) completed an exercising heat stress test (HST) at baseline, 2nd day after acclimation and then during decay at 1, 2, 3 and 5-6 wks. CoV (95% CI), SE (95% CI) and Pearsons (r) were used for analysis of blood volume (blood, plasma, red cell volume, mean hemoglogin mass); plasma (aldosterone, arginine vasopressin [AVP], total protein, albumin, sodium); physiological (rectal temperature, cardiac frequency) and performance (exercise performance capacity, PPO). Results: The CoV (95% CI), SE (95% CI) and r with a 1-wk interval for blood volume was 2.3% (1.6 to 4.3; 1.9 [1.3 to 3.4 mL.Kg-1]; r=0.93; n=10). After 2-wk and 5-6 wks this had increased to 4.9% (3.4 to 9.3; 3.8 [2.6 to 7.0 mL.Kg-1]; r=0.76; n=9) and 5.5% (3.6 to 12.8; 4.5 [2.9 to 10.0 mL.Kg-1]; r=0.65; n=7) respectively. Conclusions: Blood volume and physiological measures demonstrated the least error one week apart but increased thereafter. Plasma concentrations and performance markers had the greatest error with repeat measures after one week. Therefore, for greater reliability and low measurement error measures should be taken no more than one week a part in repeated experimentation.