Measurement equivalence of the newly developed Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55)

Summary Objective The aim of this study was to examine measurement equivalence of the newly developed Quality of Life in Childhood Epilepsy Questionnaire (QOLCE-55) across age, sex, and time in a representative sample of children with newly diagnosed epilepsy. Methods Data come from 373 children enrolled in the Health-related Quality of Life in Children with Epilepsy Study (HERQULES), a multisite prospective cohort study. Measurement equivalence was examined using a multiple-group confirmatory factor analysis framework, whereby increasingly stringent parameter constraints are imposed on the model. Comparison groups were stratified based on age (4-7 years vs. 8-12 years), sex (male vs. female), and time (measurement of health-related quality of life at diagnosis vs. 24 months later). Results The QOLCE-55 demonstrated measurement equivalence at the level of strict invariance for each model tested - age: χ2 (3,123) = 4,097.3, p \u3c 0.001; Comparative Fit Index (CFI) = 0.968; Root Mean Square Error of Approximation (RMSEA) = 0.042 (0.038, 0.045); sex: χ2 (3,124) = 4,188.3, p \u3c 0.001; CFI = 0.964; RMSEA = 0.044 (0.040, 0.047); and time: χ2 (3,121) = 5,185.0, p \u3c 0.001; CFI = 0.965; RMSEA = 0.046 (0.043, 0.048). Significance These findings suggest that items comprising the QOLCE-55 are perceived similarly among groups stratified by age, sex, and time and provide further evidence supporting the validity of the scale in children with epilepsy. Health professionals and researchers should be confident that group comparisons made using the QOLCE-55 are unbiased and that any group differences detected are meaningful; that is, not related to differences in the interpretation of items by informants. Future research replicating these findings is encouraged

Prevalence and trajectories of depressive symptoms in mothers of children with newly diagnosed epilepsy

Purpose: To examine the prevalence, trajectories, and predictors of depressive symptoms (DS) in mothers of children with new-onset epilepsy. Methods: A sample of 339 mothers was analyzed from the health-related quality of life in children with epilepsy study assessed four times during the first 24 months after diagnosis. Mothers\u27 DS were measured using the Center for Epidemiological Studies Depression Scale. Trajectories of DS were investigated using group-based trajectory modeling, and maternal, child, and family factors were compared across groups using analysis of variance (ANOVA) and chi square tests. Multinomial logistic regression identified predictors of DS trajectories. Key Findings: A total of 258 mothers completed the study. Prevalence of depression ranged from 30-38% across four times within the first 24 months after their child\u27s diagnosis. Four trajectories of DS were observed: low stable (59%), borderline (25%), moderate increasing (9%), and high decreasing (7%). Using the low stable group as the reference group, the borderline group was younger, had worse family functioning, and fewer family resources; the moderate increasing group was younger, had children with cognitive problems, worse family functioning, and more family demands; and the high decreasing group had less education and children with lower quality of life. Significance: Risk for clinical depression is common among mothers of children with new-onset epilepsy. These mothers are not homogenous, but consist of groups with different trajectories and predictors of DS. Child\u27s cognitive problems was the strongest predictor identified; epilepsy severity did not predict DS trajectory. Health care professionals should consider routinely assessing maternal depression during clinic visits for pediatric epilepsy. © 2010 International League Against Epilepsy

The impact of maternal depressive symptoms on health-related quality of life in children with epilepsy: A prospective study of family environment as mediators and moderators

Purpose: To examine the impact of maternal depressive symptoms (DS) on health-related quality of life (HRQL) in children with new-onset epilepsy and to identify family factors that moderate and mediate this relationship during the first 24 months after epilepsy diagnosis. Methods: A sample of 339 mother-child dyads recruited from pediatric neurologists across Canada in the Health-related Quality of Life in Children with Epilepsy Study. Mothers\u27 and neurologists\u27 reports were collected at four times during the 24-month follow-up. Mothers\u27 DS were measured using the Center for Epidemiological Studies Depression Scale (CES-D) and children\u27s HRQL using the Quality of Life in Childhood Epilepsy (QOLCE). Data were modeled using individual growth curve modeling. Key Findings: Maternal DS were observed to have a negative impact on QOLCE scores at 24 months (β = -0.47, p \u3c 0.0001) and the rate of change in QOLCE scores during follow-up (β = -0.04, p = 0.0250). This relationship was moderated by family resources (β = 0.25, p = 0.0243), and the magnitude of moderation varied over time (β = 0.09, p = 0.0212). Family functioning and demands partially mediated the impact of maternal DS on child HRQL (β = -0.07, p = 0.0007; β = -0.12, p = 0.0006). Significance: Maternal DS negatively impact child HRQL in new-onset epilepsy during the first 24 months after diagnosis. This relationship is moderated by family resources and mediated by family functioning and demands. By adopting family centered approaches, health care professionals may be able to intervene at the maternal or family level to promote more positive outcomes in children. © 2010 International League Against Epilepsy

EFFECT OF WIND LOADS ON NON REGULARLY SHAPED HIGH-RISE BUILDINGS

Wind loads have historically been recognized as one of the most important issue in high-rise buildings analysis and design. In particular, in regions of low seismic intensity, a high-rise building lateral design is controlled by wind loads. In wind analysis, Computational Fluid Dynamics (CFD) and/or wind tunnel testing are required to calculate the external pressures acting on a building. In this paper, two case studies are presented to show how the wind loads are calculated and applied in design. The first case study is based on the CFD results for the New Marina Casablanca Tower in Casablanca, Morocco. The second case study considers the results from the wind tunnel test studies conducted for the Al- Hamra tower, in Kuwait City, Kuwait. The New Marina Casablanca tower is a 167m tall concrete building, with a unique twisting shape generated from the relative rotation of two adjacent floors. Sloped columns are introduced in the perimeter to follow the tower outer geometry and to support the concrete slabs spanning between the central core and the perimeter frame. The effects of wind loads on the twisted geometry has been studied in details since the pressure coefficients are not easily identified for such a complex form. In addition, the effect of the wind loads on the structure presented unique challenges that required innovative structural solutions. The Al-Hamra tower is a 412m tall concrete building with a sculpted twisting form which optimizes the views to the Arabian Gulf while minimizing the solar heat gain. The complex form is realized using sloped walls and vertical columns on the perimeter and a central concrete core. The unique shape of the tower presented several design challenges related to the wind loads on the structure. This paper will discuss the unique challenges and solutions associated with wind loads effect on buildings of unique form

Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design

BackgroundAchieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools.MethodsA sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members’ perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison.ResultsStructural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services.ConclusionsOutcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development

Interrelationships among depression, anxiety, flourishing, and cannabis use in youth

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.addbeh.2018.10.007 © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/Aims The objective of the study was to examine if depression or anxiety was associated with youth cannabis use; and investigate whether flourishing moderates these associations. Methods Students (N = 8179) were recruited from 10 secondary schools (grade 9–12) in Ontario and British Columbia, Canada Self-report questionnaires were used to assess symptoms of depression [CESD-R-10], anxiety [GAD-7], flourishing [Deiner's Flourishing Scale] and cannabis consumption using measures that assess cannabis ever use and frequency of use. Logistic regression and product-term interactions were used to examine the associations between mental health and youth cannabis use, and the potential moderating effect(s) of flourishing. Results In our sample, 33% of participants had ever used cannabis, 51% and 38% reported elevated depressive and anxiety symptoms, respectively. Associations between depression, anxiety, and cannabis use were no longer significant when flourishing was added to the models. In addition, there was no evidence suggesting a moderating effect of flourishing as all interactions were not statistically significant. Instead, robust associations were found between flourishing and cannabis use: mental health and cannabis ever use, mental health and cannabis use frequency. Conclusions Indicators of mental wellbeing, such as flourishing, appear to be associated with a lower likelihood of cannabis use, even after controlling for depression and anxiety. Results suggest prevention strategies for youth cannabis use should aim to foster mental wellbeing among all youth, rather than exclusively targeting those experiencing mental health problems. Future longitudinal studies should test the sequential relationship between cannabis use and changes in both positive and negative mental health

How High? Trends in Cannabis Use Prior to First Admission to Inpatient Psychiatry in Ontario, Canada, between 2007 and 2017

Objectives: To examine the trends in cannabis use within 30 days of first admission to inpatient psychiatry in Ontario, Canada, between 2007 and 2017, and the characteristics of persons reporting cannabis use. Methods: A retrospective cross-sectional analysis was conducted for first-time admissions to nonforensic inpatient psychiatric beds in Ontario, Canada, between January 1, 2007, and December 31, 2017, using data from the Ontario Mental Health Reporting System (N = 81,809). Results: Across all years, 20.1% of patients reported cannabis use within 30 days of first admission. Use increased from 16.7% in 2007 to 25.9% in 2017, and the proportion with cannabis use disorders increased from 3.8% to 6.0%. In 2017, 47.9% of patients aged 18 to 24 and 39.2% aged 25 to 34 used cannabis, representing absolute increases of 8.3% and 10.7%, respectively. Increases in cannabis use were found across almost all diagnostic groups, with the largest increases among patients with personality disorders (15% increase), schizophrenia or other psychotic disorders (14% increase), and substance use disorders (14% increase). A number of demographic and clinical factors were significantly associated with cannabis use, including interactions between schizophrenia and gender (area under the curve = 0.88). Conclusions: As medical cannabis policies in Canada have evolved, cannabis use reported prior to first admission to inpatient psychiatry has increased. The findings of this study establish a baseline for evaluating the impact of changes in cannabis-related policies in Ontario on cannabis use prior to admission to inpatient psychiatry

Trajectories of health-related quality of life in children with epilepsy: A cohort study

Purpose Little is known about subgroups of children with epilepsy who may experience less favorable outcomes over time. The objectives of this study were to document trajectories of health-related quality of life (HRQL) and to identify predictors of the trajectory group in children with new-onset epilepsy. Methods Data were obtained from the Health Related Quality of Life in Children with Epilepsy Study, a prospective multisite study of children 4-12 years old with new-onset epilepsy followed for 24 months. Health-related quality of life was measured using the Quality of Life in Childhood Epilepsy questionnaire. Trajectories of HRQL were investigated using latent class trajectory modeling. Multinomial logistic regression was used to identify child, parent, and family predictors of HRQL trajectories. Key Findings A total of 374 families responded at baseline and 283 (76%) completed the study. Five HRQL trajectories were observed: low-increasing (4%), moderate-decreasing (12%), moderate-increasing (22%), high-increasing (32%), and high-stable (30%). Many children in the low-increasing, moderate-increasing, high-increasing, and high-stable had clinically meaningful improvements in HRQL: 82%, 47%, 63%, and 44%, respectively. In contrast, the majority of children in the moderate-decreasing group (56%) experienced clinically meaningful declines in their HRQL. Factors predicting trajectories were number of antiepileptic drugs prescribed, presence of comorbid behavior or cognitive problems, parent depression, and family functioning and demands. Significance Results suggested that children with epilepsy are not homogenous but rather consist of groups with different trajectories and unique predictors of HRQL. Problems associated with child behavior and cognition were the strongest predictors identified. Given that several risk factors are modifiable, it is important to examine these as potential targets within a family-centered framework to improve HRQL of children with new-onset epilepsy. © Wiley Periodicals, Inc. © 2013 International League Against Epilepsy

Quality of life in children with new-onset epilepsy; A 2-year prospective cohort study

Objectives: To assess health-related quality of life (HRQL) over 2 years in children 4-12 years old with new-onset epilepsy and risk factors. Methods: Data are from a multicenter prospective cohort study, the Health-Related Quality of Life Study in Children with Epilepsy Study (HERQULES). Parents reported on children\u27s HRQL and family factors and neurologists on clinical characteristics 4 times. Mean subscale and summary scores were computed for HRQL. Individual growth curve models identified trajectories of change in HRQL scores. Multiple regression identified baseline risk factors for HRQL 2 years later. Results: A total of 374 (82%) questionnaires were returned postdiagnosis and 283 (62%) of eligible parents completed all 4. Growth rates for HRQL summary scores were most rapid during the first 6 months and then stabilized. About one-half experienced clinically meaningful improvements in HRQL, one-third maintained their same level, and one-fifth declined. Compared with the general population, at 2 years our sample scored significantly lower on one-third of CHQ subscales and the psychosocial summary. After controlling for baseline HRQL, cognitive problems, poor family functioning, and high family demands were risk factors for poor HRQL 2 years later. Conclusions: On average, HRQL was relatively good but with highly variable individual trajectories. At least one-half did not experience clinically meaningful improvements or declined over 2 years. Cognitive problems were the strongest risk factor for compromised HRQL 2 years after diagnosis and may be largely responsible for declines in the HRQL of children newly diagnosed with epilepsy. © 2012 by AAN Enterprises, Inc

Metabolomic profiling of the synergistic effects of melittin in combination with cisplatin on ovarian cancer cells

Melittin, the main peptide present in bee venom, has been proposed as having potential for anticancer therapy; the addition of melittin to cisplatin, a first line treatment for ovarian cancer, may increase the therapeutic response in cancer treatment via synergy, resulting in improved tolerability, reduced relapse, and decreased drug resistance. Thus, this study was designed to compare the metabolomic effects of melittin in combination with cisplatin in cisplatin-sensitive (A2780) and resistant (A2780CR) ovarian cancer cells. Liquid chromatography (LC) coupled with mass spectrometry (MS) was applied to identify metabolic changes in A2780 (combination treatment 5 μg/mL melittin + 2 μg mL cisplatin) and A2780CR (combination treatment 2 μg/mL melittin + 10 μg/mL cisplatin) cells. Principal components analysis (PCA) and orthogonal partial least squares discriminant analysis (OPLS-DA) multivariate data analysis models were produced using SIMCA-P software. All models displayed good separation between experimental groups and high-quality goodness of fit (R2) and goodness of prediction (Q2), respectively. The combination treatment induced significant changes in both cell lines involving reduction in the levels of metabolites in the tricarboxylic acid (TCA) cycle, oxidative phosphorylation, purine and pyrimidine metabolism, and the arginine/proline pathway. The combination of melittin with cisplatin that targets these pathways had a synergistic effect. The melittin-cisplatin combination had a stronger effect on the A2780 cell line in comparison with the A2780CR cell line. The metabolic effects of melittin and cisplatin in combination were very different from those of each agent alone