Path analysis examining relationships among antecedents of anxiety, multidimensional state anxiety, and triathlon performance

The official published version of this article can be found at the link below. This is a authors’ draft of the paper: Copyright @ Perceptual and Motor Skills, 1995The study explored predictive paths for antecedents of anxiety, state anxiety responses, and performance. Male triathletes (N = 175) completed a modified Competitive State Anxiety Inventory-2 which included the original intensity scale and a direction scale of Jones and Swain. They also completed a 23-item Prerace Questionnaire which measured antecedents of anxiety among triathletes. Factor analysis of intercorrelations for the Prerace Questionnaire identified six factors similar to those found in 1995 by the present authors. Path analysis to predict state anxiety from antecedents of anxiety indicated that rated intensity of anxiety was predicted by the perceived difficulty of race goals and by perceived readiness. Direction of anxiety was predicted by coach's influence, recent form, and perceived readiness. Path analysis to predict performance from state-anxiety scores and antecedents of anxiety indicated that recent form predicted performance directly without mediation of anxiety responses. Anxiety scores did not predict performance. The findings support the notion that intensity and direction of anxiety responses have different antecedents

Use and perceived effectiveness of pre-competition mood regulation strategies among athletes

The well-established link between mood and sport performance highlights a need for athletes to develop mood regulation strategies. The present study investigated such strategies among 195 volunteer athletes. Participants completed the Regulation of Feelings Scale, a 37-item measure assessing frequency of use and perceived effectiveness of strategies to reduce feelings of anger, confusion, depression, fatigue, tension, and increase feelings of vigour on the day of a competition. The most popular strategies were “engage in physical pre-competition activities”, “spend time alone”, “give myself a pep talk”, “talk to someone about my feelings”, and “use humour”. Frequency of use and perceived effectiveness of strategies varied according to the specific mood dimension athletes sought to regulate. Strategies did not differ by gender, type of sport, or level of competition, but the order in which strategies were presented to the athletes influenced their responses. Exploratory factor analyses for each of the six mood dimensions did not support a theoretical model, which proposed that mood regulation strategies can be grouped into four types – behavioural distraction, behavioural engagement, cognitive distraction, and cognitive engagement. The present findings provide a rich source of information that may help to guide interventions among applied practitioners

A computational investigation of kinetoplastid trans-splicing

Trans-splicing is an unusual process in which two separate RNA strands are spliced together to yield a mature mRNA. We present a novel computational approach which has an overall accuracy of 82% and can predict 92% of known trans-splicing sites. We have applied our method to chromosomes 1 and 3 of Leishmania major, with high-confidence predictions for 85% and 88% of annotated genes respectively. We suggest some extensions of our method to other systems

A Systematic Review of Data-Driven Approaches to Item Difficulty Prediction.

Assessment quality and validity is heavily reliant on the quality of items included in an assessment or test. Difficulty is an essential factor that can determine items and tests’ overall quality. Therefore, item difficulty prediction is extremely important in any pedagogical learning environment. Data-driven approaches to item difficulty prediction are gaining more and more prominence, as demonstrated by the recent literature. In this paper, we provide a systematic review of data-driven approaches to item difficulty prediction. Of the 148 papers that were identified that cover item difficulty prediction, 38 papers were selected for the final analysis. A classification of the different approaches used to predict item difficulty is presented, together with the current practices for item difficulty prediction with respect to the learning algorithms used, and the most influential difficulty features that were investigated

Mitral paravalvular abscess with left ventriculo-atrial fistula in a patient on dialysis

Background: Infective endocarditis in hemodialysis patients is challenging but is becoming more common recently. Case report: A 64-year-old man with end-stage renal disease on hemodialysis presented with infective endocarditis of mitral valve and coronary artery disease after commencing training for home hemodialysis. During a course of antibiotic treatment the patient developed left ventriculo-atrial fistula due to mitral paravalvular abscess. Abscess debridement followed by reconstruction of the mitral annulus with fresh autologous pericardial patch and mitral valve replacement using a mechanical prosthesis with concomitant coronary artery bypass grafting was performed successfully. Conclusion: Timely diagnosis, proper antibiotic treatment and early surgical intervention including aggressive debridement should improve the outcome of this high-risk disease. © 2009 Kitamura et al; licensee BioMed Central Ltd.Tadashi Kitamura, James Edwards, Suchi Khurana and Robert G Stukli

Alternative regression models to assess increase in childhood BMI

<p>Abstract</p> <p>Background</p> <p>Body mass index (BMI) data usually have skewed distributions, for which common statistical modeling approaches such as simple linear or logistic regression have limitations.</p> <p>Methods</p> <p>Different regression approaches to predict childhood BMI by goodness-of-fit measures and means of interpretation were compared including generalized linear models (GLMs), quantile regression and Generalized Additive Models for Location, Scale and Shape (GAMLSS). We analyzed data of 4967 children participating in the school entry health examination in Bavaria, Germany, from 2001 to 2002. TV watching, meal frequency, breastfeeding, smoking in pregnancy, maternal obesity, parental social class and weight gain in the first 2 years of life were considered as risk factors for obesity.</p> <p>Results</p> <p>GAMLSS showed a much better fit regarding the estimation of risk factors effects on transformed and untransformed BMI data than common GLMs with respect to the generalized Akaike information criterion. In comparison with GAMLSS, quantile regression allowed for additional interpretation of prespecified distribution quantiles, such as quantiles referring to overweight or obesity. The variables TV watching, maternal BMI and weight gain in the first 2 years were directly, and meal frequency was inversely significantly associated with body composition in any model type examined. In contrast, smoking in pregnancy was not directly, and breastfeeding and parental social class were not inversely significantly associated with body composition in GLM models, but in GAMLSS and partly in quantile regression models. Risk factor specific BMI percentile curves could be estimated from GAMLSS and quantile regression models.</p> <p>Conclusion</p> <p>GAMLSS and quantile regression seem to be more appropriate than common GLMs for risk factor modeling of BMI data.</p

The implications of “pay-for-performance” reimbursement for Otolaryngology – Head and Neck Surgery

Objective: To introduce otolaryngologists to outcomes-linked reimbursement ( pay-for-performance ), identify clinical practice implications and recommend changes for successful transition from the traditional pay-for-effort reimbursement model. Study design: Policy review Results: Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, pay-for-performance programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Since performance criteria for reimbursement have not yet been proposed within Otolaryngology-Head and Neck Surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation. Conclusion: Pay-for-performance reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists

Anti-nausea effects and pharmacokinetics of ondansetron, maropitant and metoclopramide in a low-dose cisplatin model of nausea and vomiting in the dog: a blinded crossover study

Nausea is a subjective sensation which is difficult to measure in non-verbal species. The aims of this study were to determine the efficacy of three classes of antiemetic drugs in a novel low dose cisplatin model of nausea and vomiting and measure change in potential nausea biomarkers arginine vasopressin (AVP) and cortisol. A four period cross-over blinded study was conducted in eight healthy beagle dogs of both genders. Dogs were administered 18 mg/m2 cisplatin intravenously, followed 45 min later by a 15 min infusion of either placebo (saline) or antiemetic treatment with ondansetron (0.5 mg/kg; 5-HT3 antagonist), maropitant (1 mg/kg; NK1 antagonist) or metoclopramide (0.5 mg/kg; D2 antagonist). The number of vomits and nausea associated behaviours, scored on a visual analogue scale, were recorded every 15 min for 8 h following cisplatin administration. Plasma samples were collected to measure AVP, cortisol and antiemetic drug concentrations

Oral rehydration versus intravenous therapy for treating dehydration due to gastroenteritis in children: a meta-analysis of randomised controlled trials

BACKGROUND: Despite treatment recommendations from various organizations, oral rehydration therapy (ORT) continues to be underused, particularly by physicians in high-income countries. We conducted a systematic review of randomised controlled trials (RCTs) to compare ORT and intravenous therapy (IVT) for the treatment of dehydration secondary to acute gastroenteritis in children. METHODS: RCTs were identified through MEDLINE, EMBASE, CENTRAL, authors and references of included trials, pharmaceutical companies, and relevant organizations. Screening and inclusion were performed independently by two reviewers in order to identify randomised or quasi-randomised controlled trials comparing ORT and IVT in children with acute diarrhea and dehydration. Two reviewers independently assessed study quality using the Jadad scale and allocation concealment. Data were extracted by one reviewer and checked by a second. The primary outcome measure was failure of rehydration. We analyzed data using standard meta-analytic techniques. RESULTS: The quality of the 14 included trials ranged from 0 to 3 (Jadad score); allocation concealment was unclear in all but one study. Using a random effects model, there was no significant difference in treatment failures (risk difference [RD] 3%; 95% confidence intervals [CI]: 0, 6). The Mantel-Haenzsel fixed effects model gave a significant difference between treatment groups (RD 4%; 95% CI: 2, 5) favoring IVT. Based on the four studies that reported deaths, there were six in the IVT groups and two in ORT. There were no significant differences in total fluid intake at six and 24 hours, weight gain, duration of diarrhea, or hypo/hypernatremia. Length of stay was significantly shorter for the ORT group (weighted mean difference [WMD] -1.2 days; 95% CI: -2.4,-0.02). Phlebitis occurred significantly more often with IVT (number needed to treat [NNT] 33; 95% CI: 25,100); paralytic ileus occurred more often with ORT (NNT 33; 95% CI: 20,100). These results may not be generalizable to children with persistent vomiting. CONCLUSION: There were no clinically important differences between ORT and IVT in terms of efficacy and safety. For every 25 children (95% CI: 20, 50) treated with ORT, one would fail and require IVT. The results support existing practice guidelines recommending ORT as the first course of treatment in appropriate children with dehydration secondary to gastroenteritis

Arterial oxygen content is precisely maintained by graded erythrocytotic responses in settings of high/normal serum iron levels, and predicts exercise capacity: an observational study of hypoxaemic patients with pulmonary arteriovenous malformations.

Oxygen, haemoglobin and cardiac output are integrated components of oxygen transport: each gram of haemoglobin transports 1.34 mls of oxygen in the blood. Low arterial partial pressure of oxygen (PaO2), and haemoglobin saturation (SaO2), are the indices used in clinical assessments, and usually result from low inspired oxygen concentrations, or alveolar/airways disease. Our objective was to examine low blood oxygen/haemoglobin relationships in chronically compensated states without concurrent hypoxic pulmonary vasoreactivity.165 consecutive unselected patients with pulmonary arteriovenous malformations were studied, in 98 cases, pre/post embolisation treatment. 159 (96%) had hereditary haemorrhagic telangiectasia. Arterial oxygen content was calculated by SaO2 x haemoglobin x 1.34/100.There was wide variation in SaO2 on air (78.5-99, median 95)% but due to secondary erythrocytosis and resultant polycythaemia, SaO2 explained only 0.1% of the variance in arterial oxygen content per unit blood volume. Secondary erythrocytosis was achievable with low iron stores, but only if serum iron was high-normal: Low serum iron levels were associated with reduced haemoglobin per erythrocyte, and overall arterial oxygen content was lower in iron deficient patients (median 16.0 [IQR 14.9, 17.4]mls/dL compared to 18.8 [IQR 17.4, 20.1]mls/dL, p<0.0001). Exercise tolerance appeared unrelated to SaO2 but was significantly worse in patients with lower oxygen content (p<0.0001). A pre-defined athletic group had higher Hb:SaO2 and serum iron:ferritin ratios than non-athletes with normal exercise capacity. PAVM embolisation increased SaO2, but arterial oxygen content was precisely restored by a subsequent fall in haemoglobin: 86 (87.8%) patients reported no change in exercise tolerance at post-embolisation follow-up.Haemoglobin and oxygen measurements in isolation do not indicate the more physiologically relevant oxygen content per unit blood volume. This can be maintained for SaO2 ≥78.5%, and resets to the same arterial oxygen content after correction of hypoxaemia. Serum iron concentrations, not ferritin, seem to predict more successful polycythaemic responses