Small Differences In Magnitude Research Articles

Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery

To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion. Retrospective cohort study. Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified. Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D. The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm's canal stent (SCS) devices, as well as incidence of anisometropia. A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was-0.36±0.91D,-0.31±0.85D, and-0.39±0.88D respectively (P=0.019). Mean logarithm of the minimum angle of resolution VA was 0.10±0.20, 0.08±0.19, and 0.14±0.26 respectively (P=0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P=0.217). At POM6, mean SEs were-0.38±0.97D (CE/goniotomy),-0.35±0.81D (CE/SCS), and-0.40±0.91D (CE alone; P=0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was-0.36±0.73D (CE/goniotomy),-0.24±0.84D (CE/SCS), and-0.45±0.81D (CE alone; P<0.001). Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful. Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

Examining the Impact of the COVID-19 Pandemic on Elementary Students’ Internalizing and Externalizing Behaviors in Schools Implementing Tiered Systems

Examining the Impact of the COVID-19 Pandemic on Elementary Students’ Internalizing and Externalizing Behaviors in Schools Implementing Tiered Systems

Music and Visual Imagery: Electroencephalographic Evidence of General and Modality-Specific Activity Patterns

There is a substantial corpus of evidence about the shared brain mechanism between imagery and perception. However, the psychophysiological exploration concerning possible mechanisms underlying modality-independent mental imagery and how much it involves or depends on other cognitive processes, such as attention and memory, is still scant. To address this, we performed an electroencephalographic (EEG) study to compare brain activity related to auditory/musical and visual imagery to identify shared and specific activity patterns. The electrical brain activity of 12 musicians was measured while they perceived or imagined either auditory or visual stimuli with two levels of complexity. Mean power differences were calculated between tasks and conditions for alpha, beta, and gamma bands. For the alpha band, an increase in mean relative power was observed in occipital and parietal areas throughout the paradigm. Regarding level of complexity of the imagery tasks, same-modality contrasts (i.e., auditory simple vs. auditory complex) showed small-magnitude differences in power that were only significant for a few locations along the midline. However, when comparing across imagery modalities (i.e., auditory simple vs. visual simple), the significantly different locations increased in number and were mainly distributed in central and occipital regions, where differences were positive for mean alpha power and negative for beta and gamma bands. With respect to resting (baseline) power, the main differences were observed as a wider distribution of beta power increments in relation to visual imagery tasks, and similarities were identified for both auditory and visual imagery tasks as an increase in gamma power in right frontal locations, increased frontal and pre-frontal beta power, and some bilateral parietal increased beta power. These results seem to support the hypothesis that mental imagery, to some extent, involves areas related to memory retrieval, attention, semantic processing, and motor preparation, in addition to the primary areas corresponding to each sensory modality.

A-36 Performance of Children with Attention Deficit/Hyperactivity Disorder on the Sway Medical Mobile Balance and Cognitive Tests

Abstract Purpose There is a recognized need for more research relating to preseason balance and cognitive testing, as part of a sport-related concussion medical management program, for middle school children. We examined if preseason baseline performance on the Sway Medical Mobile Balance and Cognitive Tests differs by self-reported ADHD diagnosis in 12- and 13-year-old children. Methods Data from 2,501 children (49.1% girls) between 12- and 13-years-old (mean=13.64 years, standard deviation=0.48), tested in 2022, without a self-reported concussion in the past 6 months, were examined. Mann-Whitney U tests were used to compare balance and four cognitive test scores between children with and without self-reported ADHD, stratified by gender, and significance was set at p&amp;lt;.01. Results There were no significant differences on balance testing for boys or girls with ADHD compared to those without ADHD. Boys with ADHD performed slightly slower on the Impulse Control (p=.001, Hedge’s g=.14) and Inspection Time (p=.002, g=.22) tests than boys without ADHD. Girls with ADHD performed slightly slower on the Reaction Time test (p=.001, g=.33) than girls without ADHD. No differences were found on the Memory test for girls or boys. Conclusions Middle school aged boys and girls with ADHD did not perform worse on balance testing and some of the cognitive tests compared to children without ADHD. There were small magnitude differences on timed tests of Impulse Control and Inspection Time for boys and Reaction Time for girls, with youth who self-reported having ADHD performing slower than youth without ADHD.

Comparative Safety of BNT162b2 and mRNA-1273 Vaccines in a Nationwide Cohort of US Veterans

The risk of adverse events has been found to be low for participants receiving the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna Inc) vaccines in randomized trials. However, a head-to-head comparison of their safety for a broader range of potential adverse events over longer follow-up and in larger and more diverse populations is lacking, to our knowledge. To compare the head-to-head safety in terms of risk of adverse events of the BNT162b2 and mRNA-1273 vaccines in the national health care databases of the US Department of Veterans Affairs, the largest integrated health care system in the US. In this cohort study, the electronic health records of US veterans who received a first dose of the BNT162b2 or mRNA-1273 vaccine between January 4 and September 20, 2021, were used. Recipients of each vaccine were matched in a 1:1 ratio according to their risk factors. Vaccination with either the BNT162b2 vaccine, with a second dose scheduled 21 days later, or the mRNA-1273 vaccine, with a second dose scheduled 28 days later. A large panel of potential adverse events was evaluated; the panel included neurologic events, hematologic events, hemorrhagic stroke, ischemic stroke, myocardial infarction, other thromboembolic events, myocarditis or pericarditis, arrhythmia, kidney injury, appendicitis, autoimmune events, herpes zoster or simplex, arthritis or arthropathy, and pneumonia. Risks over 38 weeks were estimated using the Kaplan-Meier estimator. Among 433 672 persons included in the matched vaccine groups, the median age was 69 years (IQR, 60-74 years), 93% of individuals were male, and 20% were Black. Estimated 38-week risks of adverse events were generally low after administration of either the BNT162b2 or the mRNA-1273 vaccine. Compared with the mRNA-1273 group, the BNT162b2 group had an excess per 10 000 persons of 10.9 events (95% CI, 1.9-17.4 events) of ischemic stroke, 14.8 events (95% CI, 7.9-21.8 events) of myocardial infarction, 11.3 events (95% CI, 3.4-17.7 events) of other thromboembolic events, and 17.1 events (95% CI, 8.8-30.2 events) of kidney injury. Estimates were largely similar among subgroups defined by age (<40, 40-69, and ≥70 years) and race (Black, White), but there were higher magnitudes of risk differences of ischemic stroke among older persons and White persons, kidney injury among older persons, and other thromboembolic events among Black persons. Small-magnitude differences between the 2 vaccines were seen within 42 days of the first dose, and few differences were seen within 14 days of the first dose. The findings of this cohort study suggest that there were few differences in risk of adverse events within 14 days of the first dose of either the BNT162b2 or the mRNA-1273 vaccine and small-magnitude differences within 42 days of the first dose. The 38-week risks of adverse events were low in both vaccine groups, although risks were lower for recipients of the mRNA-1273 vaccine than for recipients of the BNT162b2 vaccine. Although the primary analysis was designed to detect safety events unrelated to SARS-CoV-2 infection, the possibility that these differences may partially be explained by a lower effectiveness of the BNT162b2 vaccine in preventing the sequelae of SARS-CoV-2 infection compared with the mRNA-1273 vaccine could not be ruled out. These findings may help inform decision-making in future vaccination campaigns.

An Experimental Investigation to Determine the Effect of Tube Material on the Tubeside Heat Transfer Performance of the Enhanced 1EHT Three Dimensional Heat Transfer Tube

Condensation heat transfer characteristics were experimentally investigated over a wide range of operating conditions in order to determine the heat transfer performance inside horizontal, smooth and enhanced heat transfer tubes; using R410A in tubes produced of copper and stainless steel. Experimental data was verified and results were compared to the performance measured in a smooth tube. Results indicate that the condensation heat transfer coefficient (HTC) enhancement ratio is in the range from 1.15 to 2.05 for the 1EHT tube and for the HX tube it ranged from 1.18 to 1.69. Smooth tube heat transfer performance was slightly affected by the thermal conductivity of the tube; however, larger enhancements are found in the enhanced tubes.Heat transfer coefficients increase with an increase of mass velocities. When the mass flux increases, the liquid flow becomes more turbulent and the liquid film becomes thinner; this reduces the thermal resistance and enhances the heat transfer. Heat transfer performance for low mass velocities rise slowly, showing only a small difference in magnitude. Performance increase is larger at high mass flux rates than that those found at low mass fluxes. The influence of thermal conductivity on the condensation heat transfer of the enhanced horizontal tubes was discussed. Better heat transfer performance occurs in tubes produced of a higher thermal conductivity material (copper) or in tubes with a smaller diameter.

Prosodic alignment toward emotionally expressive speech: Comparing human and Alexa model talkers

This study tests whether individuals vocally align toward emotionally expressive prosody produced by two types of interlocutors: a human and a voice-activated artificially intelligent (voice-AI) assistant. Participants completed a word shadowing experiment of interjections (e.g., “Awesome”) produced in emotionally neutral and expressive prosodies by both a human voice and a voice generated by a voice-AI system (Amazon's Alexa). Results show increases in participants’ word duration, mean f0, and f0 variation in response to emotional expressiveness, consistent with increased alignment toward a general ‘positive-emotional’ speech style. Small differences in emotional alignment by talker category (human vs. voice-AI) parallel the acoustic differences in the model talkers’ productions, suggesting that participants are mirroring the acoustics they hear. The similar responses to emotion in both a human and voice-AI talker support accounts of unmediated emotional alignment, as well as computer personification: people apply emotionally-mediated behaviors to both types of interlocutors. While there were small differences in magnitude by participant gender, the overall patterns were similar for women and men, supporting a nuanced picture of emotional vocal alignment.

Perfiles de rechazo escolar: Identificación y comparación entre adolescentes ecuatorianos y chilenos

School refusal behavior is defined as any child or youth’s difficulty to attend classes or to remain in the school. This behavior could be based or not on anxiety and prevalence rates from 5 to 28 % if it is considered any type of rejection towards the school. Adolescents demonstrating school refusal behaviors are very likely to demonstrate poorer academic performance, more stress, behavior problems and family conflicts. The psychological, social and educational relevance of the present study is due to the scarce of previous studies that have evaluated the school refusal behavior in Latin America and the high dropout rates that they face in this region. This study is focused on two countries, Ecuador and Chile, in order to identify possible differences regarding school refusal behavior scores between adolescents in both countries. The aim of this investigation was to examine the mean differences scores on school refusal behavior and the formation of school refusal behavior profiles in Ecuadorian and Chilean adolescents to determine whether these results differ from one another based on the geographical origin. In this study participated a total of 4266 students aged between 13 and 17 years old from Ecuador ( M = 14.83, SD = 1.86; N = 1588) and Chile ( M = 15.23; SD = 1.26; N = 2678). These students were selected by cluster random sampling. The measure used to assess the school refusal behavior was the School Refusal Assessment Scale-Revised (SRAS-R). The SRAS-R is a self-report measure that assesses the relative strength of four proposed functions, or maintaining variables, of school refusal behavior: Factor I. Avoidance of school-based stimuli that provoke Negative Affectivity; Factor II. Escape from aversive Social/Evaluative situations at school; Factor III. Pursuit of Attention from Significant others; and Factor IV. Pursuit of Tangible Reinforcement outside of school. The SRAS-R was administered during the school day (a session of approximately 20 minutes) in groups who completed the scale anonymously in accordance with the ethical standards and also emphasizing the voluntary nature of the test. Regarding the results, mean differences scores on school refusal behavior revealed statistically significant differences of small magnitude with Chilean students reaching higher mean scores in school refusal behavior in order to pursuit the attention from significant others and to obtain tangible reinforces external to the school, in comparison with their equals from Ecuador. Cluster analysis confirmed four school refusal profiles in both countries: Low School Refusal Behavior (characterized by low school refusal behavior scores for the four factors of the SRAS-R), High School Refusal Behavior (characterized by high school refusal behavior scores for the four factors of the SRAS-R), Anxious School Refusal Behavior (profile that combines high scores on the first three factors of the SRAS-R and moderate scores for the fourth) and Absentee School Refusal Behavior (profile that combines moderate levels for the first three factors of the SRAS-R but high in the fourth factor). The results revealed a small variability between the school refusal behavior profiles across the countries. However, Chilean adolescents scored significantly higher than Ecuadorians in school refusal based on the search for tangible external reinforcements. The results of this research supported a low variability of the findings according to the country. The generalization of these results supports the transcultural validity of the SRAS-R and emphasizes that Ecuador and Chile share a similar situation regarding school refusal behavior. Some limitations of this work are considered, and they are proposed as future lines of research. To conclude, the results are discussed taking into account the defining cultural characteristics of each country.

A multi-country dynamic factor model with stochastic volatility for euro area business cycle analysis.

This paper develops a dynamic factor model that uses euro area country‐specific information on output and inflation to estimate an area‐wide measure of the output gap. Our model assumes that output and inflation can be decomposed into country‐specific stochastic trends and a common cyclical component. Comovement in the trends is introduced by imposing a factor structure on the shocks to the latent states. We moreover introduce flexible stochastic volatility specifications to control for heteroscedasticity in the measurement errors and innovations to the latent states. Carefully specified shrinkage priors allow for pushing the model towards a homoscedastic specification, if supported by the data. Our measure of the output gap closely tracks other commonly adopted measures, with small differences in magnitudes and timing. To assess whether the model‐based output gap helps in forecasting inflation, we perform an out‐of‐sample forecasting exercise. The findings indicate that our approach yields superior inflation forecasts, both in terms of point and density predictions.

Understanding cognitive impairment in mood disorders: mediation analyses in the UK Biobank cohort.

Cognitive impairment is strongly linked with persistent disability in people with mood disorders, but the factors that explain cognitive impairment in this population are unclear. To estimate the total effect of (a) bipolar disorder and (b) major depression on cognitive function, and the magnitude of the effect that is explained by potentially modifiable intermediate factors. Cross-sectional study using baseline data from the UK Biobank cohort. Participants were categorised as having bipolar disorder (n = 2709), major depression (n = 50 975) or no mood disorder (n = 102 931 and n = 105 284). The outcomes were computerised tests of reasoning, reaction time and memory. The potential mediators were cardiometabolic disease and psychotropic medication. Analyses were informed by graphical methods and controlled for confounding using regression, propensity score-based methods and G-computation. Group differences of small magnitude were found on a visuospatial memory test. Z-score differences for the bipolar disorder group were in the range -0.23 to -0.17 (95% CI -0.39 to -0.03) across different estimation methods, and for the major depression group they were approximately -0.07 (95% CI -0.10 to -0.03). One-quarter of the effect was mediated via psychotropic medication in the bipolar disorder group (-0.05; 95% CI -0.09 to -0.01). No evidence was found for mediation via cardiometabolic disease. In a large community-based sample in middle to early old age, bipolar disorder and depression were associated with lower visuospatial memory performance, in part potentially due to psychotropic medication use. Mood disorders and their treatments will have increasing importance for population cognitive health as the proportion of older adults continues to grow. I.J.D. is a UK Biobank participant. J.P.P. is a member of the UK Biobank Steering Committee.

A global record of single-layered ice cloud properties and associated radiative heating rate profiles from an A-Train perspective

A record of global single-layered ice cloud properties has been generated using the CloudSat and CALIPSO Ice Cloud Property Product (2C-ICE) during the period 2007–2010. These ice cloud properties are used as inputs for the NASA Langley modified Fu–Liou radiative transfer model to calculate cloud radiative heating rate profiles and are compared with the NASA CERES observed top-of-atmosphere fluxes. The radiative heating rate profiles calculated in the CloudSat/CALIPSO 2B-FLXHR-LIDAR and CCCM_CC products are also examined to assess consistency and uncertainty of their properties using independent methods. Based on the methods and definitions used herein, single-layered ice clouds have a global occurrence frequency of ~ 18%, with most of them occurring in the tropics above 12 km. Zonal mean cloud radiative heating rate profiles from the three datasets are similar in their patterns of SW warming and LW cooling with small differences in magnitude; nevertheless, all three datasets show that the strongest net heating (> + 1.0 K day−1) occurs in the tropics (latitude ~ 50°). Differences in radiative heating rates are also assessed based on composites of the 2C-ICE ice water path (IWP) and total column water vapor (TCWV) mixing ratio to facilitate model evaluation and guide ice cloud parameterization improvement. Positive net cloud radiative heating rates are maximized in the upper troposphere for large IWPs and large TCWV, with an uncertainty of 10–25% in the magnitude and vertical structure of this heating.

Analysis of the aerosol and the ozone observations at a southwest peninsular coastal station using microtops sunphotometer

This study analyses the variations of aerosol optical depth, total column ozone and water vapour, measured by a Microtops-II (MICRO-processor based Total Ozone Portable Spectrometer) ozonometer/sunphotometer over a coastal station in southwest peninsular India, Kochi. Observations of ozone and aerosols are analysed for a period, May 2012 to May 2013. Satellite data sets available over the region are also analysed, and a comparison is made with the in situ data. Sunphotometer measured 1020 nm aerosol optical depth (AOD) shows a temporal variability with an increase in AOD during the summer (high value of 0.35 in May 2012) and fewer values near 0.2 during the winter and the post-monsoon seasons. Satellite observations also show a similar pattern of variability with high AOD during the summer. Water vapour is maximum (near 3.5 cm) during the pre-monsoon and the summer monsoon and minimum (below 2 cm in January 2013) during the winter. Ozone shows seasonal variability with a minimum concentration during the winter (230 Dobson Unit (DU) in January 2013) and maximum (280 DU in May 2012) during the summer. OMI (Ozone measuring Instrument) onboard Aura satellite overestimates the column ozone by 10 DU in comparison with the Microtops ozonometer. However, the sunphotometer and satellite observations show a similar pattern of temporal variability with a small difference in magnitude during certain months. The zonal ozone distribution shows a seasonal variability with a reverse gradient between the summer and the winter.

Gait biomechanics in individuals with patellar tendon and hamstring tendon anterior cruciate ligament reconstruction grafts

Anterior cruciate ligament reconstruction (ACLR) restores joint stability following ACL injury but does not attenuate the heightened risk of developing knee osteoarthritis. Additionally, patellar tendon (PT) grafts incur a greater risk of osteoarthritis compared to hamstring grafts (HT). Aberrant gait biomechanics, including greater loading rates (i.e. impulsive loading), are linked to the development of knee osteoarthritis. However, the role of graft selection on walking gait biomechanics linked to osteoarthritis is poorly understood, thus the purpose of this study was to compare walking gait biomechanics between individuals with HT and PT grafts. Ninety-eight (74 PT; 24 HT) subjects with a history of ACLR performed walking gait at a self-selected speed from which the peak vertical ground reaction force (vGRF) during the first 50% of the stance phase and its instantaneous loading rate, peak internal knee extension and valgus moments, and peak knee flexion and varus angles were obtained. When controlling for time since ACLR and quadriceps strength, there were no differences in any kinetic or kinematic variables between graft types. While not significant, 44% of the PT cohort were identified as impulsive loaders (displaying a heelstrike transient in the majority of walking trials) compared to only 25% of the HT cohort (odds ratio = 2.3). This more frequent observation of impulsive loading may contribute to the greater risk of osteoarthritis with PT grafts. Future research is necessary to determine if impulsive loading and small magnitude differences between graft types contribute to osteoarthritis risk when extrapolated over thousands of steps per day.

Abuse Potential of Buprenorphine/Samidorphan Combination Compared to Buprenorphine and Placebo: A Phase 1 Randomized Controlled Trial

Buprenorphine/samidorphan combination (BUP/SAM) is an opioid system modulator being investigated as adjunctive treatment for major depressive disorder. BUP/SAM is a fixed-dose combination of buprenorphine, a partial μ-opioid receptor agonist and κ-opioid receptor antagonist, and samidorphan, a μ-opioid receptor antagonist added to address the abuse and dependence potential of buprenorphine. In this study, we assessed the effect of samidorphan on the abuse potential of buprenorphine in the BUP/SAM combination in nondependent, recreational, adult opioid users (ClinicalTrials.gov ID: NCT02413281). Participants were randomized to 6 treatments in a blinded, Williams crossover design: placebo, BUP/SAM at the intended therapeutic dose (2mg/2mg), at 4-fold (8mg/8mg) and 8-fold (16mg/16mg) the therapeutic dose, and buprenorphine alone (8mg and 16mg). The primary end point was maximum effect (Emax ) on the visual analog scale for "at the moment" Drug Liking. Emax of Drug Liking for the BUP/SAM 2mg/2mg dose was similar to that for placebo (median within-subject difference [90% confidence interval]: 2.5 [0.0-9.0]). The supratherapeutic doses of BUP/SAM showed differences of small magnitude on Drug Liking Emax compared to placebo. Drug Liking Emax for all BUP/SAM doses were significantly lower than those observed for either buprenorphine dose alone. Fewer participants reported adverse events associated with abuse potential with BUP/SAM than with buprenorphine alone, and the overall safety profile of BUP/SAM was consistent with prior reports in healthy volunteers. These findings indicate that samidorphan substantially reduces the abuse potential of buprenorphine in the BUP/SAM combination.

The Relationship Between Screen Time and Sleep Duration in Children

Excess screen time (ST), low sleep duration (SLD), and physical inactivity, are risk factors for childhood obesity. Also, excess ST has been associated with poorer sleep quality and shorter SLD. The American Sleep Foundation recommends 9-11 hours of sleep per night for school aged children. PURPOSE: To determine the relationship between ST and SLD among children who participated in a school based nutrition and physical activity intervention. METHODS: Cross sectional analysis of 5th grade public school students (N =742, mean age 10.5 years, range 9-13 years). Participants self-reported their ST, SLD, and wake time. RESULTS: A Pearson correlation coefficient indicated a small but significant negative correlation between ST and SLD (r = -0.13, p < 0.01). A one-way ANOVA comparison between three groups categorized into “low”, “medium”, and “high” ST levels showed a significant difference in SLD between groups (F 2,739) = 6.82, p < 0.001). Post hoc comparisons using the Tukey HSD test indicated the mean SLD for the low ST group (M =10.17, SD =1.20) was significantly higher compared to the SLD in the high ST group (M = 9.77, SD =1.29), but the Cohen’s effect size value (d = 0.34) indicated a small difference in magnitude. CONCLUSIONS: The results suggest an inverse relationship between ST and SLD. The children categorized with low ST had significantly higher SLD versus children with high ST, though the mean hours of sleep for all groups met current recommendations. Intervention studies in youth should consider incorporating strategies to decrease ST in youth not only increase physical activity, but also to improve SLP duration. Funding Sources: -Blue Cross Blue Shield Foundation of Michigan; -Michigan State University Extension USDA Supplemental Nutrition Assistance Program; -Superior Health Foundation, Marquette MI.

Control of glycemia and blood pressure in British adults with diabetes mellitus and subsequent therapy choices: a comparison across health states

BackgroundTo examine the intensity of glycemic and blood pressure control in British adults with diabetes mellitus and whether control levels or treatment deintensification rates differ across health states.MethodsRetrospective cohort study using primary care electronic medical records (the United Kingdom Health Improvement Network Database) for adults with diabetes diagnosed at least 6 months before the index HbA1C and systolic blood pressure (SBP) measurements (to give their primary care physicians time to achieve treatment goals). We used prescribing records for 6 months pre/post the index measurements to determine who had therapy subsequently deintensified (based on “glycemic therapy score” and “antihypertensive therapy score” derived from number and dosage of medications).ResultsOf 292,170 individuals with diabetes, HbA1C < 6% or SBP < 120 mmHg after at least 6 months of management was less common in otherwise fit patients (15.0 and 12.7%) than in those who were mildly frail (16.6 and 13.2%) or moderately–severely frail (20.2 and 17.0%, both p < 0.0001). In the next 6 months, only 44.7% of those with HbA1C < 6% had glycemic therapy reduced (44.4% of fit, 47.1% of mildly frail, and 41.5% of moderate-severely frail patients) and 39.8% of those with SBP < 120 had their antihypertensives decreased (39.3% of fit, 43.0% of mildly frail, and 46.7% of moderate-severely frail patients). On the other hand, more individuals exhibited higher than recommended levels for HbA1C or SBP after the first 6 months of therapy (37.3, 33.4, and 31.3% of fit, mildly frail, and moderately–severely frail patients had HbA1C > 7.5% and 46.6, 51.4, and 48.5% had SBP > 140 mmHg). The proportions of patients with HbA1C or SBP out of recommended treatment ranges changed little 6 months later despite frequent (median 14 per year) primary care visits.ConclusionsGlycemic and hypertensive control exhibited statistically significant but small magnitude differences across frailty states. Medication deintensification was uncommon, even in frail patients below SBP and HbA1C targets. SBP levels were more likely to be outside recommended treatment ranges than glycemic levels.Trial registration As this study is a retrospective secondary analysis of electronic medical record data and not a health care intervention trial it was not registered

Parental preferences toward genomic sequencing for non-medically actionable conditions in children: a discrete-choice experiment.

PurposeApplication of whole exome and whole genome sequencing is likely to increase in clinical practice, public health contexts, and research. We examined how parental preferences for learning information from genome-scale testing is influenced by the characteristics of non-medically actionable genetic disorders in children, and assessed if preferences differed by gender and between African-American and White respondents.MethodsWe conducted a web-based discrete choice experiment with 1 289 parents of young children. Participants completed “choice tasks” using pairs of profiles describing sequencing results for hypothetical genetic disorders, selected the profile they believed would be more important to know, and answered questions that measured their level of distress.ResultsThe likelihood that the disorder would develop given a true-positive test result was most important to parents. Parents showed greater interest in learning sequencing results for disease profiles with more severe manifestations. This was associated with greater distress. Differences by gender and race reflected small differences in magnitude, not direction.ConclusionParents’ preferred learning results about genetic disorders with more severe manifestations, even when this knowledge was associated with increased distress. These results may help clinicians support parental decision making by revealing which types of sequencing results parents are interested in learning.

Respiratory and Muscular Perceived Exertion During Official Games in Professional Soccer Players.

The aim of this study was to assess the respiratory and muscular session ratings of perceived exertion (PE) after official soccer matches over an extended period of time (ie, 2 competition seasons) in relation to playing time (>20, 20-45, 45-70, and >70 min) and to determine the between-matches variability of both scores in young professional soccer players. Forty players belonging to the same reserve team of a Spanish La Liga club participated in this study. Respiratory and muscular PE were collected 10 min after every game. A total of 841 individual PE ratings were undertaken on outfield players. The differences between match respiratory and muscular load differ depending on the playing time, the respiratory PE being greater for the players that competed less than 45 min (effect size = -0.45 ± 0.45 for the 20- to 45-min group) and the muscular PE greater for players that played more than 45 min (effect size = 0.23 ± 0.30, for the 45- to 70-min group). Match-to-match PE variability was considerable (CV = 14-54%) for all levels of participation, but it was lower the longer the players participated. Playing time influenced the relative exertion that players' respiratory and leg musculature were exposed to during a game, suggesting that differential PE scores might provide a more accurate evaluation of match-imposed internal load. However, the small-magnitude differences between respiratory and muscular session ratings of PE observed in the current study might question the practical relevance of assessing both scores.

The effect of elbow flexor fatigue on spine kinematics and muscle activation in response to sudden loading at the hands

Sudden loads, originating at either the hands or the feet, can cause injury to spine structures. As muscles are primarily responsible for stabilization following a perturbation, the effect of spine muscle fatigue in this context has been well investigated. However, the effect of fatigue of arm muscles, which can help control perturbations originating at the hands, on the spine is unknown. The purpose of this study was to determine if the magnitude of spine flexion or the pre-activation, reflex amplitude, and reflex latency of spine muscles were altered by elbow flexor fatigue during a sudden loading (6.8kg) perturbation at the hands. Elbow flexor fatigue was induced by an isometric 30% maximal elbow flexion moment until failure. Results demonstrate that spine kinematics were not altered in the presence of elbow flexor fatigue. Small magnitude differences in trunk muscle pre- and peak activation indicate that the presence of elbow flexor fatigue does not necessitate substantially greater spine muscle action under the tested conditions. Despite fatigued elbow flexors, the arm muscles were sufficiently able to control the perturbation. Interestingly, 5/14 participants demonstrated altered reflex latencies in all observed muscles that lasted up to 10min after the fatiguing task.

Bi-normalized response spectra and seismic intensity in Bucharest for 1986 and 1990 Vrancea seismic events

The Vrancea subcrustal earthquakes of August 30, 1986 and May 30, 1990 are the two most recent seismic events that have occurred in Romania with moment magnitudes MW ≥ 6.9. The spectral analysis of the strong ground motions recorded in Bucharest reveals that despite small differences in magnitude between the 1986 and 1990 earthquakes, their frequency contents are very different, sometimes even opposing. The main focus of this study is to conduct a comparative analysis of the response spectra in terms of the bi-normalized response spectra (BNRS) proposed by Xu and Xie (2004 and 2007) for strong ground motions recorded in Bucharest during these two seismic events. The mean absolute acceleration and relative velocity response spectra for the two earthquakes are discussed and compared. Furthermore, the mean bi-normalized absolute acceleration and normalized relative velocity response spectra with respect to the control period TC are computed for the ground motions recorded in Bucharest in 1986 and 1990. The predominant period TP is also used in this study for the normalization of the spectral period axis. Subsequently, the methodology proposed by Martinez-Perreira and Bommer (1998) is applied in order to estimate the seismic intensity of the two events. The results are discussed and several conclusions regarding the possibility of using the bi-normalized response spectra (BNRS) are given.