Stratification Variables Research Articles

Implementation strategies for monitoring adherence in real time (iSMART): A pilot randomized trial.

9115 Background: Helping patients to manage symptoms and adhere to oral anticancer agents (OACAs) is a major challenge in oncology. OACAs cause side effects that can lead to suboptimal adherence if not optimally managed, contributing to decreased effectiveness. Low-cost, text messaging approaches have shown promise, but have not been robustly studied in oncology. Guided by principles from implementation and behavioral science, we developed and tested the effect of an augmented intelligence chatbot on OACA adherence and symptom burden in patients with advanced lung cancer. Methods: We conducted a two-arm pilot randomized trial (NCT04347161) to evaluate the effect of the chatbot on OACA adherence and symptom burden compared to usual care. The chatbot engages patients via text messaging and applies natural language processing and machine learning to learn from interactions. Core functionalities include: 1) motivational daily adherence reminders, 2) longitudinal symptom monitoring with self-management support, and 3) bidirectional communication with clinical teams. Participants included English-speaking patients with advanced lung cancer treated with any of 9 OACAs targeting EGFR, ALK, or ROS-1. The primary outcome was 12-week adherence, measured using the microelectronic monitoring system (MEMS) and defined dichotomously if the patient achieved ≥95% adherent days or not. Secondary outcomes were assessed at baseline and 12 weeks using validated survey instruments, including symptom burden using the Edmonton Symptom Assessment System Total Distress Score (range 0-90), health-related quality of life (HRQOL) using EQ-5D-3L (range 0-100), and usability using Health-ITUES (range 1-5). We used multivariable logistic regression adjusting for stratification variables to test the chatbot’s effect on adherence (intent-to-treat analysis) and evaluated mean differences (by arm) in secondary outcomes using Fisher’s exact test. Results: From February 2021 to August 2022, 75 patients across 4 sites enrolled (median age 65 years, 64% female, 88% White, 21.3% high school education or lower); 50.7% (n=38) were randomized to intervention. Compared to usual care, we observed no significant differences in adherence in the intervention arm (78.8% vs 81.8%; aOR=1.7 95% CI: 0.3-9.4). However, in contrast to those in usual care, participants in the intervention arm had significantly greater decreases in symptom burden (mean difference: -2.7 vs 2.6; p<0.05) and increases in HRQOL (mean difference: 4.1 vs -4.8; p<0.05) from baseline to 12 weeks. Overall chatbot usability was high (mean score=3.9). Conclusions: In this pilot randomized trial, an augmented intelligence chatbot successfully reduced symptom burden and improved HRQOL but did not significantly alter OACA adherence. Chatbots are a potentially scalable strategy for improving symptom management that warrant study in larger randomized trials. Clinical trial information: NCT04347161 .

Surface and thermocline ocean circulation intensity changes in the western Arabian Sea during ∼172 kyr

The relationship between monsoon-induced productivity and ocean circulation over millennial timescales is crucial. However, a study regarding the circulation of the western Arabian Sea (WAS) needs to be conducted. Understanding the seasonal, surface, and thermocline ocean circulation throughout the glacial-Interglacial period in the WAS is also elusive and essential. The long distant Antarctic Intermediate Water (AAIW) flow, and Sub-antarctic Mode Water (SAMW) penetration to the north side of the equator in the Indian Ocean needs to be understood and underlined using the micropaleontological (planktonic foraminiferal assemblages) and geochemical analysis such as oxygen isotope of Globigerinoides ruber and Neogloboquadrina dutertrei (δ18OG.ruber and δ18ON.dutertrei) in this study. Furthermore, understanding the variations in paleoproductivity, upper oceanic water column stratification, surface mixing, and thermocline layer variability in the WAS is also helpful. According to the results, the variation in the upwelling intensity during Glacial-Interglacial and monsoon variation suggest the upper water stratification/vertical mixing in the WAS. Here, we provide new evidence of poorly ventilated water mass in our region. Our results indicate that enhanced northward expansion of AAIW coincides with the weakening of summer monsoon during glacial periods except mid-MIS4, reflected by isotopic study and assemblages. In this context, depleted δ18ON. dutertrei value and high concentration of Globorotalia menardii (G. menardii) were due to lack/absence of AAIW ventilation and SAMW; therefore, warming occurred in the mid-MIS4.

Plasma and Urinary Biomarkers Improve Prediction of Mortality through 1 Year in Intensive Care Patients: An Analysis from FROG-ICU.

This study aimed to assess the value of blood and urine biomarkers in addition to routine clinical variables in risk stratification of patients admitted to ICU. Multivariable prognostic models were developed in this post hoc analysis of the French and EuRopean Outcome ReGistry in Intensive Care Units study, a prospective observational study of patients admitted to ICUs. The study included 2087 patients consecutively admitted to the ICU who required invasive mechanical ventilation or a vasoactive agent for more than 24 h. The main outcome measures were in-ICU, in-hospital, and 1 year mortality. Models including only SAPS II or APACHE II scores had c-indexes for in-hospital and 1 year mortality of 0.64 and 0.65, and 0.63 and 0.61, respectively. The c-indexes for a model including age and estimated glomerular filtration rate were higher at 0.69 and 0.67, respectively. Models utilizing available clinical variables increased the c-index for in-hospital and 1 year mortality to 0.80 and 0.76, respectively. The addition of biomarkers and urine proteomic markers increased c-indexes to 0.83 and 0.78. The commonly used scores for risk stratification in ICU patients did not perform well in this study. Models including clinical variables and biomarkers had significantly higher predictive values.

Assessment of treatment response to dendritic cell vaccine in patients with glioblastoma using a multiparametric MRI-based prediction model.

Autologous tumor lysate-loaded dendritic cell vaccine (DCVax-L) is a promising treatment modality for glioblastomas. The purpose of this study was to investigate the potential utility of multiparametric MRI-based prediction model in evaluating treatment response in glioblastoma patients treated with DCVax-L. Seventeen glioblastoma patients treated with standard-of-care therapy + DCVax-L were included. When tumor progression (TP) was suspected and repeat surgery was being contemplated, we sought to ascertain the number of cases correctly classified as TP + mixed response or pseudoprogression (PsP) from multiparametric MRI-based prediction model using histopathology/mRANO criteria as ground truth. Multiparametric MRI model consisted of predictive probabilities (PP) of tumor progression computed from diffusion and perfusion MRI-derived parameters. A comparison of overall survival (OS) was performed between patients treated with standard-of-care therapy + DCVax-L and standard-of-care therapy alone (external controls). Additionally, Kaplan-Meier analyses were performed to compare OS between two groups of patients using PsP, Ki-67, and MGMTpromoter methylation status as stratification variables. Multiparametric MRI model correctly predicted TP + mixed response in 72.7% of cases (8/11) and PsP in 83.3% (5/6) with an overall concordance rate of 76.5% with final diagnosis as determined by histopathology/mRANO criteria. There was a significant concordant correlation coefficient between PP values and histopathology/mRANO criteria (r = 0.54; p = 0.026). DCVax-L-treated patients had significantly prolonged OS than those treated with standard-of-care therapy (22.38 ± 12.8 vs. 13.8 ± 9.5months, p = 0.040). Additionally, glioblastomas with PsP, MGMT promoter methylation status, and Ki-67 values below median had longer OS than their counterparts. Multiparametric MRI-based prediction model can assess treatment response to DCVax-L in patients with glioblastoma.

Stratified Sampling: Some Associated Problems

Stratified sampling has been commonly used in many large-scale surveys. The two inter-related problems of determining strata boundaries where strata have to be developed using some variable(s) whose values can be accessed while designing the survey and of allocating the total sample size among the strata have been studied during a long period, initially without involving mathematical programming and subsequently using concurrent developments in constrained optimization methods and algorithms. The present article provides a critique of some of these studies, especially those dealing with multiple stratification variables and multiple parameters to be estimated. AMS Subject Classification: 62D05

Does substance use disorder treatment completion reduce the risk of treatment readmission in Chile?

BackgroundRecovery from substance use disorders (SUD) often entails multiple treatment episodes, which clashes with a context of a treatment system with limited resources and long waiting. Treatment retention and completion have been pointed out as key elements for sustainable achievement; however, most of the evidence generated focuses on opioids and injected substances, which is hardly transferable to the Latin American context. ObjectivesThis study aims to estimate the effect of SUD treatment completion on the risk of being readmitted to a SUD treatment in Chile. MethodsWe conducted a retrospective analysis on a database of 107,559 treatment episodes from 85,048 adult patients admitted to SUD treatment during 2010–2019 in Chile. We adjusted two separate Prentice Williams and Petersen Gap Time models, to explore the association between treatment completion (vs. non-completion) and up to the third treatment readmission among residential and ambulatory modalities while controlling for time-varying covariates. To examine whether the effect of treatment completion differs between events, we included an interaction term with the stratification variable. ResultsWe found that completing the treatment cuts readmission risk for the first event by 17% (Average Hazard Ratio [95% CI] = 0.83 [0.78, 0.88]) and by 14% for the second entry (Average Hazard Ratio [95% CI] = 0.86 [0.78, 0.94]) in ambulatory treatments. We did not find evidence that completing a treatment reduces the readmission risk for residential treatments or third attempts in ambulatory ones. ConclusionTreatment completion was associated with benefits in cutting readmission risk for the first and second episodes in ambulatory treatments among Chilean adults. It is important to explore different mechanisms than treatment retention for residential treatments.

Mind the gap: Data availability, accessibility, transparency, and credibility during the COVID-19 pandemic, an international comparative appraisal.

Data transparency has played a key role in this pandemic. The aim of this paper is to map COVID-19 data availability and accessibility, and to rate their transparency and credibility in selected countries, by the source of information. This is used to identify knowledge gaps, and to analyse policy implications. The availability of a number of COVID-19 metrics (incidence, mortality, number of people tested, test positive rate, number of patients hospitalised, number of patients discharged, the proportion of population who received at least one vaccine, the proportion of population fully vaccinated) was ascertained from selected countries for the full population, and for few of stratification variables (age, sex, ethnicity, socio-economic status) and subgroups (residents in nursing homes, inmates, students, healthcare and social workers, and residents in refugee camps). Nine countries were included: Bangladesh, Indonesia, Iran, Nigeria, Turkey, Panama, Greece, the UK, and the Netherlands. All countries reported periodically most of COVID-19 metrics on the total population. Data were more frequently broken down by age, sex, and region than by ethnic group or socio-economic status. Data on COVID-19 is partially available for special groups. This exercise highlighted the importance of a transparent and detailed reporting of COVID-19 related variables. The more data is publicly available the more transparency, accountability, and democratisation of the research process is enabled, allowing a sound evidence-based analysis of the consequences of health policies.

Perioperative toripalimab + platinum-doublet chemotherapy vs chemotherapy in resectable stage II/III non-small cell lung cancer (NSCLC): Interim event-free survival (EFS) analysis of the phase III Neotorch study.

425126 Background: Adjuvant and neoadjuvant immunotherapy have been approved by US FDA to treat early-stage NSCLC. However, the optimal neoadjuvant and adjuvant treatment, including duration of treatment, are unknown. We present the interim results of a randomized, double-blind, placebo-controlled, phase III trial to evaluate the efficacy and safety of perioperative toripalimab plus chemotherapy followed by toripalimab maintenance vs chemotherapy in resectable stage III NSCLC. Methods: Patients with stage II/III resectable NSCLC, without EGFR/ALK alterations for non-squamous NSCLC, were randomly assigned 1:1 to receive 240 mg toripalimab or placebo combined with chemotherapy Q3W for 3 cycles before surgery and one cycle after surgery, followed by toripalimab or placebo monotherapy Q3W for 13 cycles. Stratification variables for randomization included disease stage, histopathologic subtype, PD-L1 expression and surgical procedure. Primary endpoints were EFS by investigator and major pathological response (MPR) rate by a blinded independent pathologic review (BIPR) in the stage III and the ITT populations. Secondary endpoints included overall survival (OS), pathologic complete response (pCR) rate, EFS by independent review committee (IRC), and safety. A planned interim analysis was performed on the primary endpoint of EFS in the stage III subjects. Results: A total of 404 patients with stage III NSCLC were randomly assigned to toripalimab (n=202) or placebo (n=202). By the data cutoff date (November 30, 2022), the median follow-up was 18.3 months. Baseline characteristics were well balanced between the two arms. EFS was significantly improved in the toripalimab arm, HR=0.40, 95% CI (0.277-0.565), P<0.0001, and crossed the pre-specified efficacy boundary. The median EFS was not reached in the toripalimab arm and 15.1 months in the placebo arm. A consistent effect on EFS, favoring toripalimab, was observed in all subgroups. The MPR and pCR rates per BIPR were also higher in the toripalimab arm, 48.5% vs 8.4% and 24.8% vs 1.0%, respectively. The OS results showed a trend favoring toripalimab. The incidence of Grade ≥3 adverse events (AEs) (63.4% vs 54.0%), fatal AEs related to toripalimab/placebo (0.5% vs 0%) and AEs leading to discontinuation of toripalimab/placebo (9.4% vs 7.4%) were comparable between the two arms. However, the incidence of immune-related AEs (42.1% vs 22.8%) was more frequent in the toripalimab arm. Conclusions: The addition of toripalimab to perioperative chemotherapy showed statistically significant improvements in EFS for patients with stage III NSCLC with a manageable safety profile. Patients will be followed for overall survival. Clinical trial information: NCT04158440 .

Solution predictive Bayesian networks knacks for entropy optimized second-order slip velocity free convective nanofluid flow along Darcy-Forchheimer porous medium

The aim of this study is to present incompressible, steady entropy optimized second-order slip velocity free convective nanofluid flow along Darcy–Forchheimer porous medium through neural network backpropagation with Bayesian Regularization Approach (NNBPBRA) under the influence of heat sink/source and viscous dissipation. The viscous dissipation effects and radiative heat flux are also employed in the presented fluid flow system. Nanomaterials are silicon dioxide and molybdenum disulfide, using water as the base fluid. To obtain the reference dataset for NNBPBRA, the ODEs which are obtained after simplifications of original fluid flow system in terms of PDEs with the appropriate application of transformation mechanism are solved numerically using state of the art numerical method. The outcome in terms of solution and error analyses plots for the modification of different parameters are interpreted using these reference datasets. The error histograms, regression analyses, and MSE indices are used to validate the performance of NNBP-BRA. In the presence of slip parameters and stratification variables, the skin friction coefficient, i.e. surface drag force, and heat transfer rate, i.e. Nusselt number, are also evaluated. The outcomes show that as the Brinkman number increases, the rate of entropy formation increases, but the temperature falls as the stratification parameter increases.

Phytoplankton pigment dynamics in marine lake fluctuating between stratified and holomictic euxinic conditions

Biomass dynamics in the marine lake are strongly dependent on seasonal variability in vertical stratification, indicating rapid adaptation of phytoplankton to short-term changes in the water column. A small marine lake (Rogoznica Lake, Croatia), which fluctuates between stably stratified and holomictic euxinic conditions, was used as a model to study the phytoplankton responses to environmental perturbations, in particular the anoxic stress, caused by periodic holomixia. The epilimnion showed significant temporal and vertical variability with a chlorophyll a subsurface maximum with the highest biomass near the chemocline. Fucoxanthin-containing biomass (diatoms) dominated in the epilimnion in colder seasons and was first to recover after holomictic euxinic events. The shift towards the smaller groups prevailed during highly stratified water column conditions in warmer seasons. Results for the hypolimnion were more enigmatic, with high concentrations of alloxanthin, zeaxanthin, and violaxanthin indicating the presence of a viable small-size mixotrophic community under extreme conditions.

Outpatient balloon catheter vs inpatient prostaglandin for induction of labor: a randomized trial

Approximately 1 in 4 pregnant women undergo induction of labor. Meta-analyses have shown that mechanical methods of induction of labor are safe and effective, as is starting induction in an outpatient setting. However, few studies have evaluated outpatient balloon catheter induction in comparison with pharmacologic methods. This study aimed to determine whether women who underwent outpatient induction of labor with a balloon catheter would have a lower cesarean delivery rate than women who underwent inpatient induction of labor with vaginal prostaglandin E2 without an increase in adverse maternal or neonatal events. This was a superiority randomized controlled trial. The eligibility criteria were pregnant women (nullipara and multipara) with a live singleton fetus in vertex presentation with any medical comorbidity who underwent planned induction of labor at term and who had an initial modified Bishop Score of 0 to 6 at 1 of 11 public maternity hospitals in New Zealand. The intervention groups were outpatient single balloon catheter induction in comparison with inpatient vaginal prostaglandin E2 induction. The primary hypothesis was that participants who started their induction at home with a balloon catheter would have a lower risk for cesarean delivery than participants who started their induction with prostaglandins and remained in hospital throughout. The primary outcome was cesarean delivery rate. Participants were randomized using a centralized secure online randomization website in a 1:1 ratio, stratified by parity and hospital. The participants and outcome assessors were not blinded to group allocation. An intention-to-treat analysis with adjustment for stratification variables was used. A total of 539 participants were randomized to outpatient balloon catheter induction, and 548 participants were randomized to inpatient prostaglandin induction; the mode of birth was reported for all participants. The cesarean delivery rate was 41.0% among participants allocated to outpatient balloon induction and 35.2% among those allocated to inpatient prostaglandin induction (adjusted odds ratio, 1.27; 95% confidence interval, 0.98-1.65). Women in the outpatient balloon catheter group were more likely to have artificial rupture of membranes and to received oxytocin and an epidural. No differences were found in the rates of adverse maternal or neonatal events. Outpatient balloon catheter induction was not found to reduce the cesarean delivery rate when compared with inpatient vaginal prostaglandin E2 induction. However, the use of balloon catheters in an outpatient setting does not seem to increase the rate of adverse events for mothers or babies and can be offered routinely.

PD09-04 PREDICTION OF 90-DAY MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER IN LARGE-SCALE MULTICENTER COLLABORATION STUDY

PD09-04 PREDICTION OF 90-DAY MORTALITY AFTER RADICAL CYSTECTOMY FOR BLADDER CANCER IN LARGE-SCALE MULTICENTER COLLABORATION STUDY

Impact of Synoptic Wind Intensification and Relaxation on the Dynamics and Heat Budget of the South Senegalese Upwelling Sector

Abstract In addition to their well-known seasonal cycle, eastern boundary upwelling systems (EBUS) undergo modulation on shorter synoptic to intraseasonal time scales. Energetic intensifications and relaxations of upwelling-favorable winds with 5–10-day typical time scales can impact the EBUS dynamics and biogeochemical functioning. In this work the dynamical effects of wind-forced synoptic fluctuations on the South Senegalese Upwelling Sector (SSUS) are characterized. The region geomorphology is unique with its wide continental shelf and a major coastline discontinuity at its northern edge. The ocean response to synoptic events is explored using a modeling framework that involves applying idealized synoptic wind intensification or relaxation to a five-member climatological SSUS ensemble run. Model evaluation against sparse midshelf in situ observations indicates qualitative agreement in terms of synoptic variability of temperature, stratification, and ocean currents, despite a moderate but systematic bias in current intensity. Modeled synoptic wind and heat flux fluctuations produce clear modulations of all dynamical variables with robust SSUS-scale and mesoscale spatial patterns. A mixed layer heat budget analysis is performed over the continental shelf to uncover the dominant processes involved in SSUS synoptic variability. Modulations of horizontal advection and atmospheric forcing are the leading-order drivers of heat changes during either wind intensification or relaxation while vertical dynamics is of primary importance only in a very localized area. Also, modest asymmetries in the oceanic responses to upwelling intensification and relaxation are only identified for meridional velocities. This brings partial support to the hypothesis that synoptic variability has a modest net effect on the climatological state and functioning of upwelling systems dynamics.

Link Between Equatorial Wind Anomalies and Intraseasonal Eddies in the Northeastern Bay of Bengal

AbstractFeatures and mechanism of intraseasonal cyclonic and anticyclonic eddy generation in the northeastern Bay of Bengal (NE‐BoB) are investigated using satellite observations, ocean reanalysis, and related wind forcing data. Our results suggest that the intraseasonal cyclonic (anticyclonic) eddies generated in the NE‐BoB can be primarily attributed to intraseasonal easterly (westerly) wind anomalies in the equatorial Indian Ocean, which provokes the upwelling (downwelling) Kelvin wave (KW) traveling along the equator and subsequently the eastern boundary through the Preparis Channel into the NE‐BoB. Anomalous equatorial zonal wind can result in a strong intraseasonal subsurface flow along the KW waveguide located on the continental slope, and this KW‐associated subsurface flow is essential to the formation process of both anticyclonic and cyclonic eddies in the NE‐BoB. A seasonal difference in the response of sea level anomaly (SLA) to the KW‐associated subsurface flow is revealed, which can be explained by the seasonal variability of stratification along the waveguide. The eddy related SLA shows a considerable correlation coefficient of −0.58 with the accumulated transport caused by KW‐associated subsurface flows through the Preparis Channel when it lags 18 days, indicating a possible eddy generation mechanism that the KW‐associated subsurface flow dominated net horizontal inflow (outflow) causes vertical stretching (shrinking) of the subsurface layer, which in turn triggers an anticyclonic (cyclonic) eddy.

Comparing restrictive versus liberal oxygen strategies for trauma patients: The TRAUMOX2 trial-Statistical analysis plan.

The international advanced trauma life support guidelines recommend that all severely injured trauma patients receive supplemental oxygen based on very limited evidence. The TRAUMOX2 trial randomises adult trauma patients to a restrictive or liberal oxygen strategy for 8 h. The primary composite outcome consists of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome). This manuscript presents the statistical analysis plan for TRAUMOX2. Patients are randomised 1:1 in variable block sizes of four, six and eight, stratified by including centre (pre-hospital base or trauma centre) and tracheal intubation at inclusion. The trial will include 1420 patients to be able to detect a 33% relative risk reduction with the restrictive oxygen strategy of the composite primary outcome with 80% power at the 5% significance level. We will conduct modified intention-to-treat analyses on all randomised patients and per-protocol analyses for the primary composite outcome and key secondary outcomes. The primary composite outcome and two key secondary outcomes will be compared between the two allocated groups using logistic regression reported as odds ratios with 95% confidence intervals adjusted for the stratification variables as in the primary analysis. A p-value below 5% will be considered statistically significant. A Data Monitoring and Safety Committee has been established to conduct interim analyses after inclusion of 25% and 50% of the patients. This statistical analysis plan of the TRAUMOX2 trial will minimise bias and add transparency to the statistics applied in the analysis of the trial. The results will add evidence on restrictive and liberal supplemental oxygen strategies for trauma patients. EudraCT number: 2021-000556-19; ClinicalTrials.gov identifier: NCT05146700 (date of registration: 7 December 2021).

What drives the decadal variability in sea surface salinity and stratification over the tropical Indian Ocean?

What drives the decadal variability in sea surface salinity and stratification over the tropical Indian Ocean?

Interannual variability and mechanism of ocean stratification over the Kuroshio Extension region in the warm season

Interannual variability and mechanism of ocean stratification over the Kuroshio Extension region in the warm season

Association of Education With Dementia Incidence Stratified by Ethnicity and Nativity in a Cohort of Older Asian American Individuals

High education protects against dementia, but returns on educational attainment may be different across sociodemographic groups owing to various social factors. Asian American individuals are a growing and diverse group, but little research has assessed dementia determinants in this population. To examine the association of education with dementia in a large cohort of Asian American individuals, stratifying by ethnicity and nativity. This cohort study used electronic health record (EHR) and survey data from the Research Program on Genes, Environment, and Health and the California Men's Health Study surveys (2002-2020). Data are from Kaiser Permanente Northern California, an integrated health care delivery system. This study used a volunteer sample who completed the surveys. Participants included Chinese, Filipino, and Japanese individuals who were aged 60 to less than 90 years without a dementia diagnosis in the EHR at the time of the survey (baseline) and who had 2 years of health plan coverage before baseline. Data analysis was performed from December 2021 to December 2022. The main exposure was educational attainment (college degree or higher vs less than a college degree), and the main stratification variables were Asian ethnicity and nativity (born in the US or born outside the US). The primary outcome was incident dementia diagnosis in the EHR. Dementia incidence rates were estimated by ethnicity and nativity, and Cox proportional hazards and Aalen additive hazards models were fitted for the association of college degree or higher vs less than a college degree with time to dementia, adjusting for age (timescale), sex, nativity, and an interaction between nativity and college degree. Among 14 749 individuals, the mean (SD) age at baseline was 70.6 (7.3) years, 8174 (55.4%) were female, and 6931 (47.0%) had attained a college degree. Overall, among individuals born in the US, those with a college degree had 12% lower dementia incidence (HR, 0.88; 95% CI, 0.75-1.03) compared with those without at least a college degree, although the confidence interval included the null. The HR for individuals born outside the US was 0.82 (95% CI, 0.72-0.92; P = .46 for the college degree by nativity interaction). The findings were similar across ethnicity and nativity groups except for Japanese individuals born outside the US. These findings suggest that college degree attainment was associated with lower dementia incidence, with similar associations across nativity. More work is needed to understand determinants of dementia in Asian American individuals and to elucidate mechanisms linking educational attainment and dementia.

Rates of malignancies among patients with moderate to severe atopic dermatitis: a retrospective cohort study

ObjectivesPatients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients...

Smartphone-supported behavioural weight loss treatment in adults with severe obesity: study protocol for an exploratory randomised controlled trial (SmartBWL)

IntroductionBehavioural weight loss (BWL) treatment is the standard evidence-based treatment for severe obesity (SO; body mass index ≥40.0 kg/m2 or ≥35.0 kg/m2 with obesity-related comorbidity), leading to moderate weight loss...