Mixtures of multivariate generalized linear models with overlapping clusters

With the advent of ubiquitous monitoring and measurement protocols, studies have started to focus more and more on complex, multivariate and heterogeneous datasets. In such studies, multivariate response variables are drawn from a heterogeneous population often in the presence of additional covariate information. In order to deal with this intrinsic heterogeneity, regression analyses have to be clustered for different groups of units. Up until now, mixture model approaches assigned units to distinct and non-overlapping groups. However, not rarely these units exhibit more complex organization and clustering. It is our aim to define a mixture of generalized linear models with overlapping clusters of units. This involves crucially an overlap function, that maps the coefficients of the parent clusters into the the coefficient of the multiple allocation units. We present a computationally efficient MCMC scheme that samples the posterior distribution of the parameters in the model. An example on a two-mode network study shows details of the implementation in the case of a multivariate probit regression setting. A simulation study shows the overall performance of the method, whereas an illustration of the voting behaviour on the US supreme court shows how the 9 justices split in two overlapping sets of justices.Comment: 24 pages, 3 figure

Teachers’ stress experiences during COVID-19-related emergency remote teaching: Results from an exploratory study

The study provides a portrait of teachers’ stress experience in the face of the needed introduction of information systems (IS) during COVID-19-related emergency remote teaching. Researchers contacted the headmasters at several Italian schools, who choose teacher’s representatives. The latters shared the online questionnaire among colleagues; the teachers voluntarily decided to participate. The cross-sectional study involved 237 Italian teachers (81.5% female; Mage = 50.20; SDage = 8.87). This survey wanted to detect information systems-related distress and eustress on the job, and technostress creators and inhibitors. Descriptive statistics, correlational analyses, and a multiple regression model using structural equation modeling were run. As according to the model, IS-related distress and eustress on the job were the dependent variables, technostress creators and inhibitors the independent ones, and respondents’ gender and age the control ones. Both technostress creators and inhibitors showed significant relationships with IS-related distress and eustress. Technostress creators showed a positive relationship with IS-related distress and a negative one with IS-related eustress; conversely, technostress inhibitors showed an opposite pattern of relationships. Only technostress creators significantly associate to both age and gender in the model, suggesting that older, female teachers tended to experience more technostress creators. Due to the increases in remote work, the awareness of IS-related stress experiences represents a key factor to evaluate work-related risks and prevent stress-related problems. The results from this study suggest that using technologies can represent both a threat to one’s well-being, highlighting the need to provide adequate trainings and support, but also a resource for personal enrichment

Management training for hospital administrators: sentinel lymph-node biopsy under local anaesthetic for carcinoma of the breast–organizational and economic impact

This study compares sentinel lymph-node biopsy carried out at the time of removal of the primary breast tumour, under general anaesthetic, with sentinel lymph-node biopsy carried out under local anaesthetic prior to the main operation. It compares the total cost of the two treatment approaches, in terms of average income and of their impact on the subsequent programming of operations and hence on waiting lists and income

Corneal involvement in rheumatoid arthritis: an vivo confocal study

PURPOSE. To analyze the in vivo morphology of corneal cells and nerves in patients with rheumatoid arthritis (RA), with or without secondary Sj\uf6gren\u2019s syndrome (SSII), and to investigate the correlations between corneal alterations and RA activity. METHODS. Fifty patients with RA and 30 age- and gender-matched control subjects were studied. SSII was diagnosed according to the American-European Consensus Group criteria, and RA activity was evaluated by the Lansbury index (LI). Confocal microscopy was used to investigate corneal thickness, the number of epithelial and stromal cells, and keratocyte hyperreflectivity. In addition, the sub-basal plexus was assessed for the number, tortuosity, and reflectivity of the nerve fibers and the presence of beadlike formations. RESULTS. Sixteen percent of patients with RA also had SSII. Between the SSII and non-SSII groups, no significant differences were found in the LI or in the clinical and confocal variables. Significant differences were present between patients with RA and control subjects for all the variables studied except nerve reflectivity. In patients with RA with and without SSII, LI correlated significantly with the number of beadlike formations and the number of hyperreflective, activated keratocytes. CONCLUSIONS. Confocal microscopy of patients with RA showed several changes in corneal cells and nerves. The number of beadlike formations and the number of activated keratocytes could be interpreted as confocal signs of ocular surface disease activity. These correlations with the index of systemic disease activity, LI, may provide insight regarding the pathogenic mechanisms of dry eye in patients with RA

Monitoring Chronic Myeloid Leukemia: How Molecular Tools May Drive Therapeutic Approaches

More than 15 years ago, imatinib entered into the clinical practice as a “magic bullet”; from that point on, the prognosis of patients affected by chronic myeloid leukemia (CML) became comparable to that of aged-matched healthy subjects. The aims of treatment with tyrosine kinase inhibitors (TKIs) are for complete hematological response after 3 months of treatment, complete cytogenetic response after 6 months, and a reduction of the molecular disease of at least 3 logs after 12 months. Patients who do not reach their goal can switch to another TKI. Thus, the molecular monitoring of response is the main consideration of management of CML patients. Moreover, cases in deep and persistent molecular response can tempt the physician to interrupt treatment, and this “dream” is possible due to the quantitative PCR. After great international effort, today the BCR-ABL1 expression obtained in each laboratory is standardized and expressed as “international scale.” This aim has been reached after the establishment of the EUTOS program (in Europe) and the LabNet network (in Italy), the platforms where biologists meet clinicians. In the field of quantitative PCR, the digital PCR is now a new and promising, sensitive and accurate tool. Some authors reported that digital PCR is able to better classify patients in precise “molecular classes,” which could lead to a better identification of those cases that will benefit from the interruption of therapy. In addition, digital PCR can be used to identify a point mutation in the ABL1 domain, mutations that are often responsible for the TKI resistance. In the field of resistance, a prominent role is played by the NGS that enables identification of any mutation in ABL1 domain, even at sub-clonal levels. This manuscript reviews how the molecular tools can lead the management of CML patients, focusing on the more recent technical advances

Enteral bleeding in a former preterm girl with short bowel syndrome: Do not miss the diagnosis

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Duration of untreated illness and depression severity are associated with cognitive impairment in mood disorders

Introduction: In this study we estimated the rate and the trajectory of cognitive impairment in a naturalistic sample of outpatients with major depressive disorder (MDD) and bipolar disorder (BD) and its correlation with different variables. Materials and methods: An overall sample of 109 outpatients with MDD or BD was assessed for multiple clinical variables, including duration of untreated illness (DUI), and tested using the Montreal Cognitive Assessment (MoCA) during Major Depressive Episodes (MDE) and after remission. Correlations between MoCA scores and the clinical variables were then computed. Results: About 50% of patients with MDD and BD showed mild cognitive impairment during MDE. Improvement of cognitive function between depression and remission was significant, even though residual symptoms were observed especially in the most impaired patients. Of note, cognitive performance during depression was negatively associated with depression severity and DUI. Discussion: Present findings confirm available evidence about patterns of cognitive impairment in mood disorders, in terms of prevalence and persistence beyond remission in most severe cases. Moreover, a longer DUI was associated with worse cognitive performance during depression, and consequently with poorer outcome, underlining the importance of prompt treatment of these disorders also in light of a cognitive perspective. Keywords: bipolar disorder, cognitive dysfunction, duration of untreated illness, major depressive disorder, Montreal cognitive assessmen