Probabilistic standards of proof, their complements and the errors that are expected to flow from them

Probability theory provides insights into the levels at which standards of proof are set. An analysis is provided of the rates of errors that flow from different standards, a necessary element of which is an assumption as to the level of certainty achieved in the flow of cases. Where one party is required to satisfy a standard of proof, a complementary standard is imposed on the other party

Factores de riesgo para íleo postquirúrgico prolongado en pacientes sometidos a cirugía abdominal

El objetivo de este estudio fue determinar la existencia de factores de riesgo para íleo postoperatorio prolongado en pacientes mayores 18, de ambos sexos, sometidos a cirugía abdominal del Hospital Regional Docente de Trujillo durante los años 2015 a 2022. Materiales y métodos: Se realizó un estudio de tipo casos y controles de pacientes mayores de 18 años, de ambos sexos sometidos a cirugía abdominal en el Hospital Regional Docente de Trujillo durante los años 2015-2022. Se verificó a los pacientes que necesitaron cirugía por alguna patología abdominal, para más tarde distinguir a los pacientes con íleo postoperatorio prolongado e identificar sus factores de riesgo. Resultados: Este presente estudio incluyó un total de 396 pacientes que fueron sometidos a alguna cirugía abdominal en el servicio de cirugía, fueron 66 pacientes pertenecientes al grupo casos y 330 controles. Nuestros factores de riesgo identificados en nuestra investigación fueron cirugía abdominal previa, tabaquismo activo, tiempo quirúrgico mayor a 3 horas, creación de ostomía, tipo de cirugía, hipoalbuminemia y tipo de anestesia fueron un total de 89.4%(59), 84.85%(56), 83.33%(55), 72.73%(48), 97.0%(64), 80.3%(53) y 75.8%(50) respectivamente, teniendo asociación significativa con un (p <0.05), además tuvieron un OR 6.77, 6.47, 3.2, 2.47, 4.93, 4.12 y 3.32 respectivamente, mientras que de las variables intervinientes como la perdida sanguínea, obesidad, el número de comorbilidades, diagnóstico prequirúrgico y las comorbilidades tienen asociación significativa (p <0.001). Conclusiones: Existen factores de riesgo para íleo postoperatorio prolongado en pacientes sometidos a cirugía abdominal, estos fueron la cirugía abdominal previa, cirugía abierta, hipoalbuminemia, anestesia general, el tabaquismo activo y tiempo quirúrgico mayor de 3 horas.The objective of this study was to determine the existence of risk factors for prolonged postoperative ileus in patients over 18 of both sexes, undergoing abdominal surgery during the year 2015 to 2022. Materials and methods: A case-control study was carried out on patients over 18 years of age, of both sexes, undergoing abdominal surgery at the Trujillo Regional Teaching Hospital between 2015-2022. Patients who needed surgery for some abdominal pathologies were verified, to later distinguish patients with prolonged postoperative ileus and identify their risk factors. Results: This present study included a total of 396 patients who underwent abdominal surgery in the surgery service, 66 patients belonging to the case group and 330 controls. Our risk factors identified in our research were previous abdominal surgery, active smoking, surgical time greater than 3 hours, ostomy creation, type of surgery, hypoalbuminemia and type of anesthesia were a total of 89.4%(59), 84.85%(56), 83.33%(55), 72.73%(48), 97.0%(64), 80.3%(53) and 75.8%(50) respectively, having a significant association with a (p <0.05), they also had an OR 6.77, 6.47, 3.2, 2.47, 4.93, 4.12 and 3.32 respectively, while the intervening variables such as blood loss, obesity, the number of comorbidities, pre-surgical diagnosis and comorbidities have a significant association (p <0.001). Conclusions: There are risk factors for prolonged postoperative ileus in patients undergoing abdominal surgery, these were previous abdominal surgery, open surgery, hypoalbuminemia, active smoking, and surgical time greater than 3 hoursTesi

Change in device-measured physical activity assessed in childhood and adolescence in relation to depressive symptoms: a general population-based cohort study

Aim: Evidence for a link between physical activity and mental health in young people is hampered by methodological shortcomings. Using repeat assessments of device-measured physical activity, we examined the association of within-individual variation in free-living activity over 7 years with depressive symptoms. Methods: This was a prospective cohort study of a nationally representative sample of children born in the UK (n=4898). Physical activity was quantified using accelerometry at ages 7 and 14. The main outcome was depressive symptoms, based on the Short Mood and Feelings Questionnaire, assessed at age 14. Results: After adjustment for socioeconomic status, body mass index and psychological problems at baseline, a higher level of light-intensity activity at age 7 in girls was associated with a lower likelihood of having depressive symptoms at follow-up (OR, 0.79; 95% CI 0.61 to 1.00), although no associations were observed for moderate to vigorous activity or sedentary behaviour. Girls who transitioned from low baseline activity to higher levels at follow-up experienced a lower risk of depressive symptoms (OR, 0.60; 95% CI 0.39 to 0.92) compared with the inactive reference category. Null associations were observed in boys. Participants who consistently met the current recommendation of 60 min/day of moderate to vigorous activity both at 7 and 14 years of age experienced the lowest risk of depressive symptoms (OR, 0.55; 95% CI 0.34 to 0.88). Conclusion: To prevent depressive symptoms in adolescence, policies to increase physical activity from mid-childhood may have utility

Association of childhood psychomotor coordination with survival up to 6 decades later

Importance: Poorer performance on standard tests of motor coordination in children has emerging links with sedentary behavior, obesity, and functional capacity in later life. These observations are suggestive of an untested association of coordination with health outcomes, including mortality. Objective: To examine the association of performance on a series of psychomotor coordination tests in childhood with mortality up to 6 decades later. Design, Setting, and Participants: The British National Child Development Study (1958 Birth Cohort Study) is a prospective cohort study based on a nationally representative sample of births from England, Scotland, and Wales. A total of 17 415 individuals had their gross and fine motor psychomotor coordination assessed using 9 tests at ages 11 and 16 years. Data analysis for the present study was conducted from October 2016 to December 2019. Main Outcomes and Measures: All-cause mortality as ascertained from a vital status registry and survey records. Results: In this birth cohort study of 17 415 individuals who underwent a series of psychomotor coordination tests in childhood, follow up was conducted over several decades. Of the analytical sample of 12 678 individuals, 51% were male, and 72% came from a lower social group. Mortality surveillance between ages 12 and 58 years in an analytical sample of 17 062 men and women yielded 1072 deaths (766 661 person-years at risk). In survival analyses with adjustment for sex, higher scores on 7 of the 9 childhood coordination tests were associated with a lower risk of mortality in a stepwise manner. After controlling for early-life socioeconomic, health, cognitive, and developmental factors, lower mortality was statistically significantly associated with 3 tests: ball catching at age 11 years (0-8 vs 10 catches: hazard ratio [HR], 1.57; 95% CI, 1.19-2.07), match-picking at age 11 years (>50 vs 0-36 seconds: HR, 1.33; 95% CI, 1.09-1.63), and hopping at age 16 years (very unsteady vs very steady: HR, 1.28; 95% CI, 1.01-1.63). Conclusions and Relevance: The results of this cohort study suggest that childhood motor coordination is associated with lower mortality up to middle-age; these findings require replication

Probabilistic Standards of Proof, Their Complements and the Errors that that are Expected to Flow from Them

Probability theory provides insights into the levels at which standards of proof are set. An analysis is provided of the rates of errors that flow from different standards, a necessary element of which is an assumption as to the level of certainty achieved in the flow of cases. Where one party is required to satisfy a standard of proof, a complementary standard is imposed on the other party

Expansion of Comprehensive Screening of Male Sexually Transmitted Infection Clinic Attendees with \u3cem\u3eMycoplasma genitalium\u3c/em\u3e and \u3cem\u3eTrichomonas vaginalis\u3c/em\u3e Molecular Assessment: a Retrospective Analysis

Of 1,493 encounters of males at a sexually transmitted infection (STI) clinic in a community with a high prevalence of STI, Chlamydia trachomatis was detected in 8.7% and Neisseria gonorrhoeae was detected in 6.6%. Additional Trichomonas vaginalis and Mycoplasma genitalium screening found 17.4% and 23.9% of the encounters, respectively, to be positive for STI. STI agents were detected in 13.7% of urine specimens; addition of pharyngeal and rectal collections to the analysis resulted in detection of STI agents in 19.0% and 23.9% of encounters, respectively. A total of 101 (23.8%) encounters of identified STI involved sole detection of M. genitalium. Expansion of the STI analyte panel (including M. genitalium) and additional specimen source sampling within a comprehensive STI screening program increase identification of male STI carriers

Socioeconomic status as a risk factor for dementia death:individual participant meta-analysis of 86 508 men and women from the UK

Background Life-course socioeconomic factors may have a role in dementia aetiology but there is a current paucity of studies. Meta-analyses of individual participant data would considerably strengthen this evidence base. Aims To examine the association between socioeconomic status in early life and adulthood with later dementia death. Method Individual participant meta-analysis of 11 prospective cohort studies (1994-2004, n = 86 508). Results Leaving full-time education at an earlier age was associated with an increased risk of dementia death in women (fully adjusted hazard ratio (HR) for age ⩽14 v. age ⩾16: HR = 1.76, 95% CI 1.23-2.53) but not men. Occupational social class was not statistically significantly associated with dementia death in men or women. Conclusions Lower educational attainment in women was associated with an increased risk of dementia-related death independently of common risk behaviours and comorbidities

Pulse rate reactivity in childhood as a risk factor for adult hypertension: the 1970 Birth Cohort Study

Purpose: Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in childhood and risk of hypertension in adulthood. Methods: A total of 6,507 participants (51.6% female) underwent clinical examination at 10 years of age that involved measurement of blood pressure, body mass index, and pulse rate pre- and post-examination. Hypertension was ascertained by self-reported doctor diagnosis 32 years later at age 42. Results: On average, there was a reduction in pulse rate after the medical examination (-1.2±8.2 bpm), although nearly a third of the sample recorded an increase in pulse rate of ≥3bpm. A total of 488 (7.5%) study members developed hypertension at follow-up. After adjustment for a range of covariates including resting blood pressure and body mass index in childhood, a heightened pulse rate response to the examination (≥3bpm) was associated with greater risk of hypertension in adulthood (odds ratio = 1.30, 95% CI, 1.02, 1.67). The association persisted whether we modelled pulse rate as an absolute measure (post examination) or a change score. Conclusion: These observational data suggest that elevated childhood cardiovascular reactivity could increase risk for hypertension in adulthood

Behaviour of non-donor specific antibodies during rapid re-synthesis of donor specific HLA antibodies after antibody incompatible renal transplantation

Background: HLA directed antibodies play an important role in acute and chronic allograft rejection. During viral infection of a patient with HLA antibodies, the HLA antibody levels may rise even though there is no new immunization with antigen. However it is not known whether the converse occurs, and whether changes on non-donor specific antibodies are associated with any outcomes following HLA antibody incompatible renal transplantation. Methods: 55 patients, 31 women and 24 men, who underwent HLAi renal transplant in our center from September 2005 to September 2010 were included in the studies. We analysed the data using two different approaches, based on; i) DSA levels and ii) rejection episode post transplant. HLA antibody levels were measured during the early post transplant period and corresponding CMV, VZV and Anti-HBs IgG antibody levels and blood group IgG, IgM and IgA antibodies were quantified. Results: Despite a significant DSA antibody rise no significant non-donor specific HLA antibody, viral or blood group antibody rise was found. In rejection episode analyses, multiple logistic regression modelling showed that change in the DSA was significantly associated with rejection (p = 0.002), even when adjusted for other antibody levels. No other antibody levels were predictive of rejection. Increase in DSA from pre treatment to a post transplant peak of 1000 was equivalent to an increased chance of rejection with an odds ratio of 1.47 (1.08, 2.00). Conclusion: In spite of increases or decreases in the DSA levels, there were no changes in the viral or the blood group antibodies in these patients. Thus the DSA rise is specific in contrast to the viral, blood group or third party antibodies post transplantation. Increases in the DSA post transplant in comparison to pre-treatment are strongly associated with occurrence of rejection

Pulse rate reactivity in childhood as a risk factor for adult hypertension: the 1970 Birth Cohort Study

Purpose: Cardiovascular reactivity to mental stress has been used as a tool to predict short-term hypertension risk in adults but the impact of cardiovascular reactivity in childhood on hypertension in adulthood is unknown. Using the 1970 British Cohort study, we examined the association between pulse rate reactivity in childhood and risk of hypertension in adulthood. Methods: A total of 6,507 participants (51.6% female) underwent clinical examination at 10 years of age that involved measurement of blood pressure, body mass index, and pulse rate pre- and post-examination. Hypertension was ascertained by self-reported doctor diagnosis 32 years later at age 42. Results: On average, there was a reduction in pulse rate after the medical examination (-1.2±8.2 bpm), although nearly a third of the sample recorded an increase in pulse rate of ≥3bpm. A total of 488 (7.5%) study members developed hypertension at follow-up. After adjustment for a range of covariates including resting blood pressure and body mass index in childhood, a heightened pulse rate response to the examination (≥3bpm) was associated with greater risk of hypertension in adulthood (odds ratio = 1.30, 95% CI, 1.02, 1.67). The association persisted whether we modelled pulse rate as an absolute measure (post examination) or a change score. Conclusion: These observational data suggest that elevated childhood cardiovascular reactivity could increase risk for hypertension in adulthood