Values For Pairwise Comparisons Research Articles

P174 Identifying patterns of fatigue across flares in patients with axial spondyloarthritis

Abstract Background/Aims Fatigue is a common and debilitating symptom of axial spondyloarthritis and has a significant negative impact on quality of life for these patients. Previous qualitative and quantitative research indicates that fatigue significantly worsens during flares. There remains uncertainty around the quality and intensity of fatigue before a flare compared with during and after. This understanding could help in diminishing the unpredictability of flares and fatigue which has been identified as a key issue for patients and may aid self-management. The main aim of the current analysis was to determine whether there would be any significant differences in the distribution of fatigue scores depending on patients’ self-reported flare status. Methods The current project involved secondary analysis of patient data collected through the Royal National Hospital for Rheumatic Diseases. A Kruskal Wallis test was conducted utilising anonymised Project Nightingale data from 286 patients collected via a mobile app. Data from a single time point for each patient were analysed. Fatigue was measured via responses to a 5-point scale. Patients’ data were organised into five categories depending on their self-reported flare status. This included flare started, flare continued, flare stopped and no flare. A fifth group was created where patients had reported their fatigue scores the day before a flare started. Results 43% percent of patients were female and 57% percent were male. There was at least one significant difference in rank totals between categories, H (4, n = 286) = 48.38, p < .001. Dunn’s post hoc tests were subsequently performed with Bonferroni adjusted p values for pairwise comparisons and are displayed in the table below. Fatigue was significantly higher in the flare continued category than in the no flare (p <.001), day before flare started (p = .008) and the flare stopped categories (p = .028). Inspection of medians and interquartile ranges suggested that fatigue appeared to be slightly higher the day before a flare started compared with no flare, however there were no other statistically significant differences between categories. Conclusion The results indicate that fatigue was highest during the middle of a flare as opposed to the start or end of a flare or the day before a flare. Future studies could include data at more time points including prior to, during and after flares. As previous literature implies that there may be two types of flare associated with different levels of fatigue, future studies could compare levels of fatigue between patients within these subgroups. This research could facilitate the refinement of interventions with the aim of minimising the unpredictability and impact of fatigue in axSpA patients. Disclosure S. Patel: None. R. Barnett: None. C. Cavill: None. R. Sengupta: Honoraria; R.S. has received honoraria from Abbvie, Biogen, BMS, Eli Lilly, MSD, Novartis, Pfizer, Roche and UCB, all unrelated to this abstract.

A Three-Way Decision Methodology With Regret Theory via Triangular Fuzzy Numbers in Incomplete Multiscale Decision Information Systems

The three-way decision theory provides a three-way philosophical thinking to solve problems, and the regret theory quantifies the risk preferences of decision makers under different psychological behaviors. On the one hand, the combination of these two theories makes models more practical by considering the psychological behaviors of decision makers. On the other hand, we can effectively combine the advantages of the three-way decision theory with the regret theory to highlight the interpretability of decision making processes. In this paper, we propose a novel approximate estimation method for incomplete utility values via the regret theory and establish a wide sense of three-way decision model on incomplete multi-scale decision information systems. First, the degree of consistency for each scale is measured via using the dependency degree, then the optimal subsystem is selected by evaluating the scale selection cost. Further, the incomplete multi-scale evaluation information is transformed into triangular fuzzy numbers via linguistic term sets. Second, in light of fuzzy evaluation values and trade-off factors, an estimation method for incomplete fuzzy subsystems is constructed, which can be used to calculate the utility difference and regret-rejoicing values for pairwise comparisons. Finally, from the perspective of human cognition, the tri-partition and the corresponding decision rules are built by the tolerance degree, and the ranking of objects is calculated by the relative closeness degree. Additionally, multi-aspect comparative and experimental analyses are performed by extensive experiments, and the feasibility, validity and stability of the constructed model are shown by parametric analyses.

Development and validation of risk prediction models for large for gestational age infants using logistic regression and two machine learning algorithms.

Large for gestational age (LGA) is one of the adverse outcomes during pregnancy that endangers the life and health of mothers and offspring. We aimed to establish prediction models for LGA at late pregnancy. Data were obtained from an established Chinese pregnant women cohort of 1285 pregnant women. LGA was diagnosed as >90th percentile of birth weight distribution of Chinese corresponding to gestational age of the same-sex newborns. Women with gestational diabetes mellitus (GDM) were classified into three subtypes according to the indexes of insulin sensitivity and insulin secretion. Models were established by logistic regression and decision tree/random forest algorithms, and validated by the data. A total of 139 newborns were diagnosed as LGA after birth. The area under the curve (AUC) for the training set is 0.760 (95% confidence interval [CI] 0.706-0.815), and 0.748 (95% CI 0.659-0.837) for the internal validation set of the logistic regression model, which consisted of eight commonly used clinical indicators (including lipid profile) and GDM subtypes. For the prediction models established by the two machine learning algorithms, which included all the variables, the training set and the internal validation set had AUCs of 0.813 (95% CI 0.786-0.839) and 0.779 (95% CI 0.735-0.824) for the decision tree model, and 0.854 (95% CI 0.831-0.877) and 0.808 (95% CI 0.766-0.850) for the random forest model. We established and validated three LGA risk prediction models to screen out the pregnant women with high risk of LGA at the early stage of the third trimester, which showed good prediction power and could guide early prevention strategies.

Common BMI and diabetes-related genetic variants: A pilot study among indigenous people in the Brazilian Amazon.

This study was carried out to investigate the frequency of genetic variants related to body mass index (BMI) and type 2 diabetes (T2D) and evaluating the potential impact of risk alleles on susceptibility to these disorders in six indigenous peoples from Brazilian Amazon region. The majority of Fst values for pairwise population comparisons among the indigenous groups are low or moderate. The indigenous people show high values of differentiation with Africans, Europeans and Southeast Asians and moderate values with East Asian and American populations, as expected. The allelic frequencies among indigenous indicate that the majority of associations observed with T2D in continental populations can be replicated in native Amazonians. The genetic risk scores calculated for T2D in indigenous are high and similar to those calculated for Americans and East Asians, while the estimates obtained for obesity are low, probably due to the low frequencies of the risk allele of the FTO gene found in our samples. ADRB3-rs4994 and ABCC8-rs1799854 genes showed a significant association with BMI and waist circumference, and the KCNJ11-rs5219 gene with hyperglycemia. These results emphasize the importance of knowing the genetic variability underlying complex genetic diseases in indigenous peoples and the search for particular or rare variants.

Impact of Late Dosing on Testosterone Suppression with 2 Different Leuprolide Acetate Formulations: In Situ Gel and Microsphere. An Analysis of United States Clinical Data.

Nonadherence to dosing schedules for androgen deprivation therapy increases the risk of testosterone escape for patients with prostate cancer. Two approved formulations of leuprolide acetate, the most commonly prescribed androgen deprivation therapy in the United States, use different extended release delivery technologies: an in situ gel and microspheres. We evaluated the prevalence and impact of late dosing on testosterone suppression for gel and microsphere formulations of leuprolide acetate. We retrospectively analyzed records of patients with prostate cancer treated with gel or microsphere delivery of leuprolide acetate. Analyses used 2 definitions of "month," "28-day" (late dosing after day 28, 84, 112 or 168) and "extended" (late dosing after day 32, 97, 128 and 194). Frequencies of late dosing and associated testosterone values were calculated. A total of 2,038 patients received gel and 8,360 received microsphere formulations of leuprolide acetate. More than 80% and 27% of injections were late for 28-day and extended month, respectively. For 28-day month late injections 10% (gel delivery) and 14% (microsphere delivery) of testosterone values were above 50 ng/dl, and 25% (gel) vs 33% (microsphere) were above 20 ng/dl. For extended month 18% (gel) vs 25% (microsphere) were above 50 ng/dl, and 34% (gel) vs 44% (microsphere) were above 20 ng/dl. Microsphere leuprolide acetate was 1.5 times more likely to have testosterone above 50/20 ng/dl vs gel. Least square mean testosterone was 34 ng/dl (gel) vs 46 ng/dl (microsphere) for 28-day month, and 48 ng/dl (gel) vs 76 ng/dl (microsphere) for extended month. Leuprolide acetate therapies were frequently administered late. Gel formulation demonstrated higher rates of testosterone 50 ng/dl or less and 20 ng/dl or less than microsphere formulation. Optimal testosterone suppression can impact prostate cancer progression and patient survival, and differences in extended release technology for androgen deprivation therapy appear relevant.

Validation of the AJCC8th edition stage in distal bile duct cancer

Purpose: This study evaluated discriminatory value of newly proposed AJCC 8th staging system compared to the AJCC 7th staging system for distal bile duct cancer. Methods: We retrospectively reviewed database of 172 patients who underwent surgery for distal bile duct cancer at a single institute from January 2002 through June 2011. Clinicopathologic characteristics and survival rates were analyzed based on 7th and 8th edition of AJCC staging system, respectively. Results: Among pathologically-stage patients, P values for pairwise comparisons among different 8th AJCC stage were significant(P< 0.05) for stage IIa vs IIb only(P=0.012). C-index for adenocarcinoma was: 0.717 according to the 7th edition of AJCC and 0.717 according to the clinical 8th edition of AJCC. Conclusions: There was no prognostic improvement following new 8th edition of AJCC compared to 7th edition of AJCC.

Validation of AJCC 8th edition stage for gall bladder cancer

Purpose: This study evaluated discriminatory value of newly proposed AJCC 8th staging system compared to the AJCC 7th staging system for gallbladder cancer. Methods: We retrospectively reviewed database of 522 patients who underwent curtive intent surgery for gallbladder cancer at a single institute from January 2006 through June 2016. Clinicopathologic characteristics and survival rates were analyzed based on 7th and 8th edition of AJCC staging system, respectively. Results: There was significant different in survival rates between T2a and T2b(P< 0.001). Among pathologically-stage patients, P values for pairwise comparisons among different 8th AJCC stage were significant(P< 0.05) for stage IIa vs IIb and IIIa vs IIIb. Notably, the new edition improved the power of discrimination slightly in overall survival and disease-free survival (c-indices: 0.711, 0.723) compared with the 7th edition (c-indices:0.698, 0.714). There were no significant difference between N1 vs N2 in both stage group(P=0.578, 0.283). Conclusions: Compared to the 7th system, the 8th system bring significant prognostic improvement for stage IIa vs IIb. However, lymph node staging does not reflect well the prognosis in both classification by number or location based staging system.

Validation of the 8th AJCC staging system for gastric cancer in a population-based setting

ABSTRACTBackground: The aim of this analysis is to validate the prognostic value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for gastric cancer.Methods: Through SEER*Stat program, Surveillance, epidemiology and end results database (2010–2013) was accessed and 8th AJCC stages were reconstructed. Cancer-specific survival analyses according to both 7th and 8th editions were conducted through Kaplan-Meier analysis/log-rank testing and multivariate analysis was conducted through a Cox model.Results: Among pathologically-staged patients, P values for pairwise comparisons among different 8th AJCC stages were significant (<0.05) for all comparisons except for stage IIIC vs. IV; while P values for pairwise comparisons among different 7th AJCC stages were significant (<0.05) for all comparisons except for stage IIIA vs. IIIB and stage IIIC vs. IV. Among clinically-staged patients and according to either the clinical 8th AJCC or the 7th AJCC, significant overlap in outcomes existed between different stages.Among pathologically-staged patients, c-statistic for the pathological 8th system was: 0.762; while for the 7th system, it was: 0.763. Among clinically-staged patients, c-statistic for the clinical 8th system was: 0.634; while for the 7th system, it was: 0.637.Conclusion: Compared to the 7th system, the 8th system does not bring about significant prognostic improvement (for either clinically- or pathologically-staged patients).

Incorporating age into International Germ Cell Consensus Classification (IGCCC): a time to move forward?

ABSTRACTBackground: Older age is a poor prognostic indicator among patients with germ cell tumors. The current study evaluates an age-integrated international germ cell consensus classification (IGCCC) for advanced germ cell tumors.Methods: SEER database (2004–2014) was accessed through SEER*Stat program and both IGCCC and age-integrated IGCCC were calculated based on site of the primary, site of the metastasis and level of tumor markers. Overall survival analyses according to IGCCC and age-integrated IGCCC were conducted through Kaplan-Meier analysis.Results: Overall survival was compared according to IGCCC and age-integrated IGCCC for patients with seminoma and Non-seminomatous germ cell tumors (NSGCTs). P values were significant (P <0.001) for all scenarios. c-index for seminoma for IGCCC was 0.553; c-index for seminoma for age-integrated IGCCC was 0.664;c-index for NSGCTs for IGCCC was 0.729; and c-index for NSGCTs for age-integrated IGCCC was 0.738. A Cox-regression multivariate model of factors affecting cancer-specific survival (adjusted for race and surgical treatment) was conducted. All P values for pair wise comparisons (among different age-integrated IGCCC categories) were significant for both seminoma and NSGCTs (P<0.01).Conclusion: Compared to traditional IGCCC, age-integrated IGCCC is more discriminatory and the new risk groups introduced within it are prognostically relevant.

Assessment of the discriminating value of the 8th AJCC stage grouping for hepatocellular carcinoma

BackgroundThis study seeks to validate the discriminating value of the 8th edition of the American Joint Committee on Cancer (AJCC) staging system for Hepatocellular carcinoma (HCC) amongst patients registered within the surveillance, epidemiology and end results (SEER) database. MethodsThrough SEER*Stat program, SEER database (2010–2013) was queried and 8th AJCC stage groups were reconstructed. Overall and cancer-specific survival analyses according to both 7th and 8th editions were conducted through Kaplan–Meier analysis/log-rank testing and multivariate analysis was conducted through a Cox proportional model. ResultsFor overall and cancer-specific survival assessment according to the 8th edition, P values for pair wise comparisons among different stages were significant (<0.001) in all comparisons except for stage IB vs. II/stage IIIB vs. stage IVA. A modified AJCC 8th staging system was suggested through collapsing stages IB/II into one stage and stages IIIB/IVA into one stage. Overall and cancer-specific survivals were compared according to this modified system and pair wise P value was significant in all comparisons (P < 0.001). ConclusionThere is a minimal improvement in discriminating value for the 8th edition compared to the 7th edition; however, notable overlap in outcomes is still observed between stages IB/II and IIIB/IVA. A modified AJCC 8th system collapsing these overlapping stages may be more clinically relevant.

817P - Prostascore: A simplified tool for predicting outcomes among patients with treatment-naïve advanced prostate cancer

Background: The objective of this study is to propose and validate a new simplified model “prostascore” to help predict the outcomes of treatment-naïve patients with advanced prostate cancer. Methods: Through SEER*Stat program, surveillance, epidemiology and end results (SEER) database was queried for eligible records spanning the period from 2010 to 2013. Multivariate analysis for the candidate prognostic factors (extent of extra-prostatic disease, PSA level and grade) was conducted through a Cox proportional model. Prostascore was then calculated for each patient. Cancer-specific and overall survival analyses according to prostascore were conducted through Kaplan-Meier analysis/log-rank testing. Results: A total of 8727 patients with treatment-naïve advanced prostate cancer and complete baseline data were identified in the period from 2010-2013. The following factors were associated with better cancer-specific survival (isolated regional nodal disease, lower PSA level and lower grade group) (P < 0.0001). Based on the results of the multivariate analysis, the prostascore was described. A prostascore point was given for each of: PSA level ≥ 60 and grade group 4 or 5. The site/distribution of extra-prostatic disease were given the following points: 0 for isolated regional lymph nodes (N1), 1 for non regional lymph deposits (M1a), 2 for bone deposits (M1b) and 3 for other sites (M1c). A total prostascore was then calculated for each case in the cohort (which may range from 0 to 5). After assignment of a prostascore for each patient, cancer-specific and overall survivals were compared according to the score. Pair wise comparisons between all different scores were conducted. For both cancer-specific and overall survival assessment according to the prostascore model, P values for pair wise comparisons among different score points were significant (P<0.0001). Table-1 shows number of patients and three year cancer-specific survival years according to prostascore.Table817P Distribution and 3-year cancer-specific survival rates for different scores in the evaluated cohortScoreN(%)3-year cancer-specific survival rates01024 (11.7%)98%11639 (18.8%)97%2898 (10.3%)91%32161 (24.8%)88%42537 (29.1%)79%5466 (5.4%)76% Open table in a new tab Conclusions: Prostascore is an easy and reliable tool for predicting the outcomes of patients with treatment-naïve advanced prostate cancer. Further validation within the context of other treatment settings and population-based cohorts is recommended. Legal entity responsible for the study: Omar Abdel-Rahman Funding: None Disclosure: All authors have declared no conflicts of interest.

Prostascore: A Simplified Tool for Predicting Outcomes among Patients with Treatment-naive Advanced Prostate Cancer

AimsTo develop and internally validate a new simplified model ‘prostascore’ to help predict the outcomes of treatment-naive patients with advanced prostate cancer. Patients and methodsThrough the SEER*Stat program, the Surveillance, Epidemiology and End Results (SEER) database was queried for eligible records spanning the period from 2010 to 2013. The resulting group of patients was equally divided into two sets: training group (to guide model development) and validation group (to validate the model prediction). Multivariate analysis for the candidate prognostic factors (extent of extra-prostatic disease, prostate-specific antigen [PSA] level and grade) was conducted through a Cox proportional model. Prostascore was then calculated for each patient. Cancer-specific and overall survival analyses according to prostascore were conducted through Kaplan–Meier analysis/Log-rank testing. ResultsIn total, 8727 patients with treatment-naive advanced prostate cancer and complete baseline data were identified in the period from 2010 to 2013. The following factors were associated with better cancer-specific survival in the training set (isolated regional nodal disease, lower PSA level and lower grade group; P < 0.0001). After assignment of a prostascore for each patient, cancer-specific survival was compared according to the score. Pairwise comparisons between all different scores were conducted. For cancer-specific survival evaluation according to the prostascore model, P values for pairwise comparisons among different score points were significant (P < 0.05) in the validation set. ConclusionProstascore is an easy and reliable tool for predicting the outcomes of patients with treatment-naive advanced prostate cancer. Further validation within the context of other treatment settings and population-based cohorts is recommended.

Assessment of the prognostic and discriminating value of the novel bioscore system for breast cancer; a SEER database analysis.

An updated bioscore has been proposed within the context of the 8th edition American Joint Committee on Cancer (AJCC) staging system for breast cancer. This study seeks to validate the discriminating value of this bioscore among non-metastatic breast cancer patients registered within the surveillance, epidemiology, and end results (SEER) database. Through SEER*Stat program, SEER database (2010-2013) was accessed and bioscore was formulated for each patient. Overall and cancer-specific survival analyses according to both bioscore and AJCC pathological stages were conducted through Kaplan-Meier analysis/log-rank testing, and multivariate analysis was conducted through a Cox proportional model. A total of 181030 patients with non-metastatic, surgically treated breast cancer were identified in the period from 2010 to 2013. For overall and cancer-specific survival assessment according to the bioscore system, P values for pairwise comparisons among different score points were significant (P<0.0001) except for the comparison between score 0 and score 1. For cancer-specific survival assessment according to the AJCC stages, P values for pairwise comparisons among different stages were significant (P<0.0001) except for the comparison between stages IIIB and IIIC. For overall survival assessment according to the AJCC stages, P values for pairwise comparisons among different stages were significant (P<0.001) except for the comparison between stages IA and IB. In a multivariate analysis, the following factors were associated with better cancer-specific survival (earlier stage disease, ER positivity, PR positivity, Her2 neu positivity, and nuclear grade) (P<0.0001). The current analysis confirms the prognostic utility of the bioscore system and suggests it may be incorporated into decision-making algorithms for non-metastatic breast cancer.

A Novel Method Aimed at Counteracting the Side Effects Caused by Prostaglandin E&lt;sub&gt;2&lt;/sub&gt; Deficiency During Non-Steroidal Anti-Inflammatory Drug Therapy

Prostaglandin E2 (PGE2) plays key physiological roles within the body's organs and the systemic environment. Non-steroidal anti-inflammatory drugs (NSAIDs) inhibit the biosynthesis of PGE2, which can lead to global PGE2 deficiency, resulting in serious side effects in the gastrointestinal, renal and other systems. In contrast, various pyridine derivatives have been found to increase endogenous PGE2 levels within multiple organs and the systemic environment. We hypothesised that the use of pyridine derivatives (nicotinic acid, nicotine, niceritrol, nicotinyl alcohol, pyridinol carbamate, pyridoxine hydrochloride and pyridostigmine bromide) can recover PGE2 levels during NSAID treatment. Reassessment of experimental data on PGE2 levels in NSAIDs and pyridine derivatives treatment, and in controls from previously published, independent studies. Overall, in all our investigations P values for unpaired or pair-wise comparisons were not statistically significant. We demonstrated that using pyridine derivatives along with NSAIDs, such as nonselective cyclooxygenase (COX) and selective COX-2 inhibitors, does not reduce endogenous PGE2 expression to below basal levels. This finding is based on both in vitro studies using animal and human tissues and in vivo studies performed with healthy volunteers. Using pyridine derivatives to correct a PGE2 deficiency during NSAID treatment is a novel method that we propose can offer a valuable, cost-effective therapeutic approach to preventing and treating the side effects of NSAIDs.

An online quality assurance program for colposcopy in a population-based cervical screening setting in Italy: results on colposcopic impression.

To report the results of an Internet-based colposcopy quality assurance program from a population-based cervical screening service in a large region of northern Italy. In 2010 to 2011, a Web application was made accessible on the Web site of the regional administration. Fifty-nine colposcopists of the registered 65 participated. They logged-in, viewed a posted set of 50 high-quality digital colpophotographs selected by an expert committee, and rated them for colposcopic impression using a 4-tier classification (Negative; abnormal, grade 1 [G1]; abnormal, grade 2 [G2]; suspected invasive cancer [Cancer]) derived from the International Federation for Cervical Pathology and Colposcopy 2002 classification. kappa (κ) coefficients for intercolposcopist agreement and colposcopist-committee agreement were calculated. Colposcopist-committee agreement was greater than intercolposcopist agreement (overall κ 0.69 vs 0.60, p<.001). The κ values for colposcopist-committee agreement were 0.83 on Negative, 0.53 on G1, 0.66 on G2, and 0.80 on Cancer (all p values for pairwise comparisons<.001, except for Negative vs Cancer [p=.078]). There was no systematic tendency for colposcopists to underestimate or overestimate the colposcopic findings (2-tailed sign test, p=.13). Overall colposcopist-committee agreement was greater among patients 35 years or older (p<.001) and for colposcopists with previous quality assurance experiences (p<.01). Only 0.2% of Negative impressions were formulated for a cervical intraepithelial neoplasia grade 2 or worse. As a parallel finding, the impression of Cancer predicted cervical intraepithelial neoplasia grade 2 or less in 0.5% of cases. The histologic substrates of G1 were dispersed over a large spectrum. The reproducibility of colposcopic impression, when classified by trained colposcopists examining high-quality images, is higher than is generally thought.

(1)H-MRS is useful to reinforce the suspicion of primary central nervous system lymphoma prior to surgery.

To assess whether (1)H-MRS may be useful to reinforce the radiological suspicion of PCNSL. In this retrospective study, we included 546 patients with untreated brain tumours in which single-voxel spectroscopy at TE 30ms and 136ms had been performed. The patients were split into two subgroups: "training set" and "test set." Differences between PCNSL and five other types of intracranial tumours were assessed in the test set of patients using the Mann-Whitney U nonparametric test and cut-off values for pair-wise comparisons defined by constructing receiver operating characteristic curves. These thresholds were used to construct classifiers for binary comparison between PCNSL and non-PCNSL. The performance of the obtained classifiers was assessed in the independent test set of patients. Significant differences were found between PCNSL and the other groups evaluated. All bilateral comparisons performed in the test set obtained accuracy values above 70% (71-89%). Lipids were found to be useful to discriminate between PCNSL and glioblastoma/metastasis at short TE. Myo-inositol resonance was found to be very consistent for discriminating between PCNSL and astrocytomas at short TE. (1)H-MRS is useful to reinforce diagnostic suspicion of PCNSL on MRI. • (1) H-MRS can be used to reinforce the diagnostic suspicion of PCNSL. • Lipids can be used to discriminate between PCNSL and GB/MET. • Myo-inositol resonance can be used to discriminate between PCNSL and astrocytomas.

Exercise Frequency Is Related to Psychopathology but Not Neurocognitive Function

In this study, we measured neurocognitive function, perceived stress, quality of life (QOL), and psychopathology in community-dwelling adults, with data contrasted across tertiles of exercise frequency. A group of 998 adults (age 18-85 yr) was measured for neurocognitive function using a computerized neuropsychological test from CNS Vital Signs (Morrisville, NC). They also completed the Brief Symptom Inventory (BSI), which measures psychopathology, as well as the World Health Organization QOL questionnaire and the Perceived Stress Scale. General linear modeling was used to examine relationships between exercise frequency and neurocognitive function, BSI, QOL, and the Perceived Stress Scale. Backward selection in the GLMSELECT procedure in SAS (version 9.1.3; SAS Institute, Inc., Cary, NC) was used to identify confounding variables including age, gender, body mass index, marital status, education level, stress level, alcohol, smoking, and chronic disease. A contrast to test linear trend was performed after adjusting for confounders. Pairwise comparisons were performed across exercise frequency tertiles using the Tukey-Kramer method. P values for trend tests and pairwise comparisons were nonsignificant for all five cognition function domains across exercise frequency tertiles after adjustment for confounders. Age and education level emerged as the best correlates of neurocognitive function. P values for trend were significant for all BSI domains and indices, QOL, and perceived stress, across exercise frequency tertiles. In conclusion, nine BSI psychopathology domains, perceived stress, and QOL but not five neurocognitive function domains were modestly but significantly associated with aerobic exercise frequency in a heterogeneous group of community-dwelling adults after adjustment for demographic and lifestyle factors.

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

Initiation and Use of Public Mental Health Services by Persons With Severe Mental Illness and Limited English Proficiency

The Development and Validation of an Endoscopic Grading System for Barrett’s Esophagus: The Prague C & M Criteria

Barrett's esophagus (BE) is a premalignant condition for esophageal adenocarcinoma, its diagnosis relying initially on recognition of a columnar-lined distal esophagus. We aimed to develop and validate explicit, consensus-driven criteria for the endoscopic diagnosis and grading of BE. An international working group agreed on criteria and developed materials for their formal evaluation using video-endoscopic recordings gathered in a standardized manner in 29 patients. The criteria included assessment of the circumferential (C) and maximum (M) extent of the endoscopically visualized BE segment as well as endoscopic landmarks. The recordings were scored according to these criteria by a separate international panel of 29 endoscopists. The Prague C & M Criteria give explicit guidance on the endoscopic recognition of BE and grading of its extent. The overall reliability coefficients (RC) for the assessment of the C & M extent of the endoscopic BE segment above the gastroesophageal junction were 0.95 and 0.94, respectively. The rates of exact agreement (for C & M values) for pairwise comparisons of individual patient values were 53% and 38%, respectively, whereas the values for agreement within a 2-cm interval were 97% and 95%, respectively. The overall RC for endoscopic recognition of BE >/=1 cm was 0.72, whereas for BE <1 cm, it was 0.22. The RCs for recognizing the location of the gastroesophageal junction and the diaphragmatic hiatus were 0.88 and 0.85, respectively. The Prague C & M Criteria have high overall validity for the endoscopic assessment of visualized BE lengths.

Patterns of genetic variability in Anopheles quadrimaculatis (sensu stricto) (Diptera: Culicidae) populations in eastern Arkansas.

Electrophoretically detectable isozyme differences in 15 populations of Anopheles quadrimaculatus (Say) (sensu stricto) from eastern Arkansas were compared to measure levels of genetic diversity and study the sources of the variation. All of the enzyme loci had 2-7 alleles. Average levels of polymorphism per population were 88.9%. Heterozygotes for alleles of at least 1 of the 9 loci made up an average overall loci of 0.323 +/- 0.078 of the individuals examined. F-statistic analysis suggested a small, but statistically significant interpopulation differentiation of heterozygote frequency. The reduced heterozygote frequency was not attributable to the presence of more than one species in any population nor to the preferential use of oviposition habitats by certain populations within the species. Nei's distance values for pairwise population comparisons were small (<0.06). Correlation between genetic and geographic distance matrices was not significant. Migration among populations in the agricultural areas of the Arkansas delta region is apparently sufficient to homogenize most of the genetic divergence arising because of habitat or geographic isolation between populations in the region.