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PubMed1991

Family needs and coping strategies during illness crisis.

This descriptive study was conducted to explore family needs and coping behaviors when faced with the stress of a family member's critical illness. Family systems, crisis, and coping theories provided the conceptual frameworks for this study. A convenience sample of 30 family members of 22 critically ill patients completed the Critical Care Family Needs Inventory and the Jalowiec Coping Scale and responded to a seven-item semi-structured questionnaire. The need to know the patient's prognosis was identified as most important on the basis of item mean scores. The top ten identified needs centered around the need for assurance, information, and proximity. Hope was the most frequently used method of coping. Seven of the top ten coping methods most frequently used were also identified by family members as being most effective. Coping styles labeled confronting and optimistic were found to be most useful and effective overall. Nursing interventions described by family members as helpful included: the provision of information, emotional support, and competence and manner of the nurse.

Adaptation, Psychological↗

PubMed2006

Modeling and simulation of sexual activity daily diary data of patients with female sexual arousal disorder treated with sildenafil citrate (Viagra).

PURPOSE: To develop a model to explore the dose-response of sildenafil citrate in patients with female sexual arousal disorder (FSAD) based on telephone sexual activity daily diary (TSADD) data obtained in double-blind, placebo controlled clinical studies. MATERIALS: Data were available on 614 patients with FSAD. A parametric model (Weibull distribution) was developed to describe the probability density function of the time between sexual events. Orgasm satisfaction scores and overall sexual satisfaction scores were simultaneously modeled as ordered categorical variables. Simulations were performed to evaluate the expected clinical response in patients with FSAD. RESULTS: The expected time between sexual events was approximately 3.5 days. Satisfaction scores increased with time to achieve a plateau after 3 to 4 weeks on treatment. The expected probability of satisfying orgasm (score of 3 and higher) ranged from 34.7% for placebo to 41.6% for 100 mg sildenafil citrate. Treatment effect (difference from placebo) was 6.9% for 100 mg sildenafil citrate, ranging from 0.6 to 24.7% for testosterone levels of 0.1 to 4.0 pg/ml. The treatment effect in postmenopausal women was larger than in premenopausal women. CONCLUSION: A modeling and simulation framework to support drug development in FSAD was developed. Sildenafil citrate demonstrated a dose-dependent effect in patients with FSAD.

Adult↗

PubMed1990

Discerning the latent structure of hypothetical psychosis proneness through admixture analysis.

The application of psychometric procedures to a normal population sample to detect individuals with increased liability for schizophrenia is a useful methodological adjunct to the traditional genetic high-risk strategy. A necessary and reasonable step in the process of establishing the utility of a viable psychometric index of schizotypy is the formal investigation of the latent structure of psychometric values. The present study used admixture analysis to examine the distribution of scores on the Perceptual Aberration Scale (PAS), an objective measure of hypothetical psychosis-proneness, in a randomly ascertained sample of 18-year-old university students (n = 707). We applied parametric methods that assumed normally distributed component distributions; viewed in this context, our results are hypothesis-generating and not definitive confirmation of specific hypotheses. Within our methodological framework, the results provide strong evidence for the commingling of normal distributions, even after allowing for unequal variances across components and after removing skewness. The overall distribution of power-transformed data is consistent with the existence of three qualitatively distinct classes of PAS responders. We discuss our results in light of Meehl's model of schizotaxia, a "mixed model" of inheritance of liability to schizophrenia, and we review the methodological implications of our findings for future research.

Adolescent↗

PubMed2000

Undernutrition in relation to childhood infections: a prospective study in the Sudan.

OBJECTIVE: The aim of the study was to examine the relationships between nutritional status and diarrhoea and respiratory infections. DESIGN: Prospective cohort study within the framework of a randomized double-blind placebo-controlled intervention trial. SETTING: In rural communities in the Khartoum and Gezira regions, in Northern Sudan. SUBJECTS: 28,753 Sudanese pre-school children between 6 months and 6 y old. METHODS: Relative risks of subsequent diarrhoea and respiratory infections in relation to nutritional status measured by anthropometry (Z-scores of height-for-age (H/A), weight-for-height (W/H), and weight-for-age (W/A), which reflect stunting, wasting and underweight, respectively) were estimated using odds ratios from logistic regression adjusting for various covariates. RESULTS: H/A, W/H and W/A were significantly and inversely associated with subsequent diarrhoea and febrile diarrhoea (P for trend <0.001) with risks being 2.00 times higher (95% confidence interval, CI (1.64, 2.43)) among children with W/A Z-scores below -4 Z, and 1.75 times higher (95% CI (1.56, 1.96)) among those with a W/A Z-score between -4 and -3 Z compared with children having a W/A Z-score > or =1. Age, gender, region of residence and seasonality modified these associations. Also, febrile cough was inversely associated with W/A and W/H (P<0.03), with risks ranging from 1.41 times higher (95% CI (1.02, 1.97)) to 1.21 times higher (95% CI (1.04, 1.41)) in the group of underweight children with W/A Z-scores below -4 and between -2 and -1 Z, all compared with normally nourished children (> or =-1 Z). CONCLUSIONS: The reduction of severe but also mild and moderate undernutrition is necessary through nutrition, health and socio-economic improvement in order to prevent morbidity.

Body Weight↗

PubMedDate not supplied

Respiratory intensive care unit resource use and outcomes in Taiwan.

Based on a revision of Donabedian's classic structure, process, and outcome conceptual framework, this study examined the relationship between resource use (length of stay) and outcome (transfer status) in two respiratory intensive care units (ICUs). Medical records of respiratory ICU patients (N = 194) from a medical center in northern Taiwan were reviewed. Data collection focused on patient demographic profile (age, gender, and medical diagnosis), Acute Physiology and Chronic Health Evaluation (APACHE) score, nursing diagnoses, ICU length of stay, and transfer status. The results indicate that patients with lower APACHE scores and more nursing diagnoses had a longer ICU length of stay. In addition, both the number of nursing diagnoses and APACHE scores significantly explained the variance in the length of stay. Nonetheless, a higher APACHE score was correlated with a poor transfer status. These findings indicate that, in addition to the traditional indicators, nursing diagnoses may be a vital variable in predicting ICU length of stay. The results also imply that patients with lower APACHE scores are in better physical condition and are therefore institutionalized longer in ICUs.

APACHE↗

PubMed2000

Medical and veterinary students' structural knowledge of pulmonary physiology concepts.

PURPOSE: The goal of this study was to assess quantitatively medical and veterinary students' knowledge structures of 12 pulmonary physiology concepts before and after receiving a focused instructional block. The "goodness of fit" and internal consistency reliability of the students' knowledge structures were evaluated. Indexes of the students' structural knowledge were correlated with customary measures of student learning of the same concepts. METHOD: Knowledge structures were assessed using a questionnaire that requested similarity judgments about all possible pairs of the concepts: n(n - 1)/2 = 66 pairs. The similarity judgment data were analyzed using the individual differences (INDSCAL) model of multidimensional scaling (MDS). Dimension weights for individual students were then correlated with their final examination scores. RESULTS: A four-dimensional MDS solution provided the best structural fit to the pairwise concept-similarity data. Dimension 1 ranges from control of breathing to lung gas exchange. Dimension 2 ranges from control of breathing to respiratory mechanics. Dimension 3 separates perfusion from diffusion. Dimension 4 addresses ventilatory control. Hierarchical concept clusters are located within this framework. However, indexes of structural learning did not correlate with other measures of knowledge about the same concepts. CONCLUSION: The study outcomes, in contrast to research in other fields, suggest that structural knowledge in this domain differs from knowledge assessed by standard examinations. Further research involving other basic science or clinical concept sets is needed to verify or refute this finding.

Education, Medical↗

PubMed2005

Perceptron learning of pairwise contact energies for proteins incorporating the amino acid environment.

Although a coarse-grained description of proteins is a simple and convenient way to attack the protein folding problem, the construction of a global pairwise energy function which can simultaneously recognize the native folds of many proteins has resulted in partial success. We have sought the possibility of a systematic improvement of this pairwise-contact energy function as we extended the parameter space of amino acids, incorporating local environments of amino acids, beyond a 20 x 20 matrix. We have studied the pairwise contact energy functions of 20 x 20, 60 x 60, and 180 x 180 matrices depending on the extent of parameter space, and compared their effect on the learnability of energy parameters in the context of a gapless threading, bearing in mind that a 20 x 20 pairwise contact matrix has been shown to be too simple to recognize the native folds of many proteins. In this paper, we show that the construction of a global pairwise energy function was achieved using 1006 training proteins of a homology of less than 30%, which include all representatives of different protein classes. After parametrizing the local environments of the amino acids into nine categories depending on three secondary structures and three kinds of hydrophobicity (desolvation), the 16290 pairwise contact energies (scores) of the amino acids could be determined by perceptron learning and protein threading. These could simultaneously recognize all the native folds of the 1006 training proteins. When these energy parameters were tested on the 382 test proteins of a homology of less than 90%, 370 (96.9%) proteins could recognize their native folds. We set up a simple thermodynamic framework in the conformational space of decoys to calculate the unfolded fraction and the specific heat of real proteins. The different thermodynamic stabilities of E.coli ribonuclease H (RNase H) and its mutants were well described in our calculation, agreeing with the experiment.

Amino Acids↗

PubMed1996

Electrodermal lability in anxiety disorders.

Twenty-eight anxiety patients, aged below 50 years, were diagnosed according to DSM-III-R criteria (panic disorder with and without agoraphobia, generalised anxiety disorder, and anxiety disorder not otherwise specified). The patients were characterised by high levels of state and trait anxiety and neuroticism, compared with the controls. However, there were no differences between patients and controls in electrodermal habituation rate, non-specific activity, or skin resistance level. When the patients were divided into electrodermally labile and stable subjects, significant differences were found between patients and controls in both electrodermal activity and Eysenck's personality dimensions. The labile patients were more introverted and attained higher psychoticism scores than either the stable patients or controls. Duration of anxiety symptoms removed the difference found in extroversion, but not in any other variable. The results are discussed in relation to the utility of electrodermal measurements in validation of diagnostic entities. It is concluded, that from the psychophysiological point of view, anxiety disorders may be examined within a dimensional framework.

Adult↗

PubMed1978

Signs and symptoms as predictors of outcome: a report from the International Pilot Study of Schizophrenia.

The prognostic significance of signs and symptoms taken individually rather than in diagnostic clusters was investigated in 61 schizophrenic patients seen at 5-year follow-up in the Washington Center of the International Pilot Study of Schizophrenia. Best and worst outcome patients (Ns = 20) were selected on the basis of total outcome score from a reliable 9-item schedule; 21 middle-outcome patients were excluded. Data from these two groups were analyzed to determine which signs and symptoms assessed 5 years previously were associated with outcome. Only restricted affect predicted poor outcome: depression, anxiety, and nuclear symptoms of schizophrenia were not significant predictors. The findings are discussed within the conceptual framework of productive and defect symptoms.

Adolescent↗

PubMed2026

Construction and validation of a β-hydroxybutyrylation-related molecular model for predicting prognosis of papillary thyroid carcinoma.

BACKGROUND: Papillary thyroid carcinoma (PTC) usually has a favorable prognosis, yet a subset of patients develops persistent, recurrent, or biologically aggressive disease. The clinical relevance of lysine β-hydroxybutyrylation (Kbhb)-related transcriptional programs in PTC remains unclear. Accordingly, this study aimed to characterize Kbhb-related molecular heterogeneity in PTC, construct a prognostic signature, and explore its association with the tumor microenvironment (TME). METHODS: Transcriptomic and clinical data from PTC samples within The Cancer Genome Atlas Thyroid Carcinoma (TCGA-THCA) cohort were analyzed to identify Kbhb-related differentially expressed genes (DEGs), define molecular subtypes, construct a prognostic signature, and characterize tumor microenvironmental features. Single-cell RNA-sequencing data from PTC were further used to explore the cellular distribution of representative genes. RESULTS: We identified 51 Kbhb-related DEGs in PTC and defined two Kbhb molecular subtypes. The Kbhb_C2 subtype showed shorter progression-free interval (PFI) and a more immune- and stroma-enriched microenvironment. A six-gene prognostic signature comprising TARID, CDSN, PIMREG, KLRC1, SYT13, and NPR3 was then established. High-risk patients had significantly worse PFI in the full, training, and testing cohorts, with 1-, 3-, and 5-year areas under the curve (AUCs) of 0.715, 0.793, and 0.771, respectively, in the full cohort. High-risk tumors also exhibited higher stromal, immune, and ESTIMATE scores, altered immune infiltration, and increased expression of multiple immune checkpoint molecules. Single-cell analysis confirmed distinct cell-type-specific expression patterns of representative genes. CONCLUSIONS: Kbhb-related transcriptional programs define clinically relevant molecular heterogeneity in PTC and are closely associated with prognosis and TME remodeling. The identified six-gene signature provides a biologically interpretable framework for risk stratification in PTC.

Papillary thyroid carcinoma (PTC)↗

PubMed2026

Predicting 5-Year Mortality in Non-Small-Cell Lung Cancer Using the Korean Central Cancer Registry: Model Development and Validation Study.

BACKGROUND: Non-small-cell lung cancer (NSCLC) is one of the most common cancers and a leading cause of cancer-related mortality, making prognostic prediction clinically essential. Machine learning models are increasingly used to assess prognosis; however, developing systems that combine high discrimination with clear, clinically interpretable reasoning remains challenging. OBJECTIVE: This study aimed to develop deep learning models that predict 5-year mortality in NSCLC using data from the Korea Central Cancer Registry and quantify feature importance through permutation testing. METHODS: We identified 3144 patients diagnosed between 2014 and 2017 who had complete clinical data, pulmonary function test results, histological information, genomic data, and staging details. After preprocessing, the cohort was divided into stratified training, validation, and test sets in a 70%-15%-15% ratio. Five models were tuned using Hyperband across 10 predefined feature groups. The primary evaluation metric was the area under the receiver operating characteristic curve (AUC); additional metrics included accuracy, F1-score, precision, and recall. Groupwise permutation importance was calculated for each model, and the concordance of importance rankings was assessed using the Friedman test. RESULTS: All 5 models yielded comparable discrimination values on the test set (AUC=0.875-0.879). Model A was selected as the primary model and achieved an AUC of 0.879, an accuracy of 0.806, an F1-score of 0.824, and a Brier score of 0.142. Permuting the stage resulted in the largest decrease in AUC (0.217), followed by the pulmonary function test (0.016). Gene mutation had a modest overall impact but became more influential within the adenocarcinoma subset. The Friedman test showed no statistically significant differences in importance rankings across the models (P=.93). CONCLUSIONS: A grouped-input deep learning framework achieved discrimination comparable to a conventional Cox proportional hazards model using the same routine clinical variables for 5-year mortality prediction in NSCLC. Group-level permutation importance provided stable and reproducible insights into the clinical factors influencing risk, which may guide future model refinement and clinical decision-making.

Humans↗

PubMedDate not supplied

On the use of EEG features towards person identification via neural networks.

Person identification based on spectral information extracted from the EEG is addressed in this work a problem that has not yet been seen in a signal processing framework. Spectral features are extracted non-parametrically from real EEG data recorded from healthy individuals. Neural network classification is applied on these features using a Learning Vector Quantizer in an attempt to experimentally investigate the connection between a person's EEG and genetically specific information. The proposed method, compared with previously proposed methods, has yielded encouraging correct classification scores in the range of 80% to 100% (case-dependent). These results are in agreement with previous research showing evidence that the EEG carries genetic information.

Adult↗

PubMed2025

Polygenic scores capture genetic modification of the adiposity-cardiometabolic risk factor relationship.

Polygenic scores (PGSs) that can predict response to interventions can facilitate precision medicine and are detectable in observational datasets as PGS-by-exposure (PGS×E) interactions. PGSs based on interactions (iPGSs) or variance effects (vPGSs) may be more powerful than standard PGSs for detecting PGS×E, but these have yet to be systematically compared. We describe a generalized pipeline for developing and comparing these PGS types and apply it to detect genetic modification of the relationship between adiposity (measured by BMI) and a broad set of cardiometabolic risk factors. Our applied analysis in the UK Biobank identified significant PGS×BMI for 16/20 risk factors, most consistently for the iPGS approach. Many interactions replicated in All of Us (AoU); for example, we observed a 72% larger BMI-alanine aminotransferase association in the top iPGS decile in AoU. Our study provides a framework for the comparison of PGS×E strategies and informs efforts toward clinically useful response-focused PGSs.

Humans↗

PubMed2006

Roles of nuclear cardiology, cardiac computed tomography, and cardiac magnetic resonance: Noninvasive risk stratification and a conceptual framework for the selection of noninvasive imaging tests in patients with known or suspected coronary artery disease.

This review deals with noninvasive imaging for risk stratification and with a conceptual approach to the selection of noninvasive tests in patients with suspected or known chronic coronary artery disease (CAD). Already widely acknowledged with SPECT, there is an increasing body of literature data demonstrating that CT coronary calcium assessment is also of prognostic value. The amount of coronary atherosclerosis, as can be extrapolated from CT coronary calcium score, has been shown to be highly predictive of cardiac events. The principal difference between myocardial perfusion SPECT (MPS) and CT coronary calcium for prognostic application appears to be that the former is an excellent tool for assessing short-term risk, thus effectively guiding decisions regarding revascularization. In contrast, the atherosclerosis imaging methods are likely to provide greater long-term risk assessment and, thus, are more useful in determination of the need for aggressive medical prevention measures. Although the more recent development of CT coronary angiography is promising for diagnosis, there has been no information to date regarding the prognostic value of the CT angiographic data. Similarly, cardiac MRI has not yet been adequately studied for its prognostic content. The selection of the most appropriate test for a given patient depends on the specific question being asked. In patients with a very low likelihood of CAD, no imaging test may be required. In screening the remaining asymptomatic patients, atherosclerosis imaging may be beneficial. In symptomatic patients, MPS, CT coronary angiography, and cardiac MRI play important roles. We consider it likely that, with an increased emphasis on prevention and a concomitant aging of the population, many forms of noninvasive cardiac imaging will continue to grow, with nuclear cardiology continuing to grow.

Atherosclerosis↗

PubMed1985

The assessment of analogical thinking modifiability among regular, special education, disadvantaged, and mentally retarded children.

The objectives of the current study were (a) to develop a measure of children's analogical thinking modifiability (CATM) based on the Feuerstein, Rand, and Hoffman (1979) theory of dynamic assessment of cognitive modifiability, (b) to compare the performance of groups assumed to be differentially modified by intervention, (c) to compare CATM performance with performance on a conventional test, and (d) to study qualitative changes after a learning process. Subjects were disadvantaged, regular, and special education kindergarten children (N = 140), and mentally retarded children (N = 20). The CATM was administered together with the Ravens Colored Progressive Matrices (RCPM) in a balanced order. Disadvantaged and regular children achieved higher gain scores than other groups in both none-or-all and partial credit methods (p less than .01). The MR and the special education groups showed small gains according to the none-or-all credit method; however, according to the partial credit method, the MR group showed high gains and the special education group a performance decrease. Performance scores on the CATM were higher than on the RCPM, especially in comparison to the B8-B12 items--differences reach a peak of 61% and 67% for the disadvantaged and regular groups, respectively. Qualitative analysis indicated that form mistakes were most resistant to change, whereas color mistakes were most easy to modify. Results were explained within Feuerstein's theoretical framework of cognitive modifiability. Impaired cognitive functions as well as analytic versus synthetic processes were suggested to explain group differences.

Adolescent↗

PubMed2004

Fetal vascular obstructive lesions: nosology and reproducibility of placental reaction patterns.

The purpose of this study was to assemble and test the reliability of a complete set of the placental reaction patterns seen with chronic fetal vascular obstruction in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with fetal vascular obstructive lesions, 6 controls) were reviewed blindly by seven pathologists after agreement on a standard set of diagnostic criteria. Majority vote served as the gold standard and 80% of the 180 diagnoses rendered (9 diagnoses each for 20 cases) were agreed upon by at least six of the seven scores. The sensitivity of individual diagnosis relative to the group consensus averaged 83% (range, 69-100%) and specificity averaged 91% (range, 86-100%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2, poor; 0.2-0.6, fair/moderate; > 0.6, substantial. Kappa values for lesions of distal villi were generally superior to those for lesions involving large fetal vessels: avascular villi (0.49), villous stromal-vascular karyorrhexis (0.58), and villitis of unknown etiology (VUE) with stem villitis and avascular villi (0.65) versus large vessel thrombi (any vessel, 0.34; chorionic plate vessel, 0.40) and intimal fibrin cushions (recent, 0.47; remote, 0.78). Reproducibility for a global impression of any villous change consistent with chronic fetal vascular obstruction was substantial (0.63), while that for a more severe subgroup was moderate (0.44). Three points are worthy of emphasis. Our system separately recognizes, but later combines, uniformly avascular villi and villous stromal-vascular karyorrhexis as manifestations of the same underlying process. We propose that this combined group of villous lesions be dichotomized with the terms fetal thrombotic vasculopathy or extensive avascular villi (and/or villous stromal-vascular karyorrhexis) being reserved for the group with 15 or more affected terminal villi per section. Scattered foci of avascular villi (and/or villous stromal-vascular karyorrhexis) could be used to describe less severe cases. Finally, we distinguish VUE with stem villitis and avascular villi (obliterative fetal vasculopathy) as a distinct process with substantial perinatal morbidity.

Blood Vessels↗

PubMed1996

Effects of affective-semantic mode of item presentation in balanced self-report scales: biased construct validity of the Zung Self-rating Depression Scale.

The widely applied procedure of balancing self-report instruments by including positively and negatively keyed items is exemplified by the Zung Self-rating Depression Scale (SDS). Investigation of the influence of the symptom-positive and symptom-negative item modes on the SDS in a depressed population resulted in two major findings. First, the reversed scoring of the symptom-negative items resulted in higher mean item scores. Secondly, factor analyses of the SDS in the present study and in previous research revealed that the semantic modes of item presentation were represented in the factor structure of the SDS. These findings were confirmed by analyses with the State-Trait Anxiety Inventory (STAI) and by previous factor analytical research with balanced instruments and were interpreted within the framework of the theory of Positive and Negative Affect. The present data cast doubts on the construct validity of the SDS as a measure of depressive symptomatology due to the presence of the negatively keyed items and suggest reconsideration of the use of balanced instruments for minimization of the acquiescence response set.

Adult↗

PubMed2005

Alternative factor models and factorial invariance of the GHQ-12: a large sample analysis using confirmatory factor analysis.

This study tested alternative factor models of the General Health Questionnaire-12 (GHQ-12), based on previous research findings, with a large sample using confirmatory factor analysis. An alternative models framework was used to test 6 factor analytic models. A 3-factor model was the best explanation of the sample data. The 3 factors were labeled Anxiety-Depression, Social Dysfunction, and Loss of Confidence. The model was found to be factorially invariant between men and women. The utility of the 3 subscales, as opposed to the total GHQ-12 score, is questioned as they appear to provide little information beyond that of a general factor.

Anxiety↗