Social Competence and Executive Functioning in Adolescents Following a Mild Traumatic Brain Injury

A traumatic brain injury (TBI) is one of the most common injuries sustained by adolescents and a leading cause of death and long-term disability. The vast majority of these cases are mild and yet they can cause a range of difficulties across multiple domains which can negatively impact upon a person’s social functioning. The aim of this study was to determine whether adolescents who have sustained a mild TBI would differ from their uninjured peers in regards to social competence. A secondary aim was to investigate whether there was a relationship between an adolescent’s level of social competence and their executive functioning abilities. This investigation involved a population-based sample of 30 young adolescents who had sustained a mild TBI between the age of 12 and 15 years. Parental and/or self-report ratings of behaviour and executive function, as well as a performance-based measure of cognition were explored at 12 months post-injury. These adolescents were then compared to a community recruited, age-matched sample of their TBI-free peers. A composite scale of social competence based on observable behaviours was formulated. The results showed adolescents with a mild TBI demonstrated greater difficulties with socially competent behaviours compared to their uninjured peers. These difficulties were found to centre around aspect of their behavioural functioning, particularly regarding their regulation and inhibition of behaviour. Higher levels of dysfunction in the mild TBI sample were also found for parental ratings of behaviours associated with executive functions. A relationship between the Social Competence Index and executive function was not found. However, a relationship between the Social Competence Index and composite measures of cognitive functioning was. Suggesting there are more cognitions behind socially competent behaviour than the domain of executive functions alone. These findings highlight the need for post-injury screening for behavioural and social difficulties, with interventions implemented as required, to reduce the risk of on-going social impairment

Ten-Year Survival after Liver Resection for Colorectal Metastases: Systematic Review and Meta-Analysis

Background. Liver resection in metastatic colorectal cancer is proved to result in five-year survival of 25–40%. Several factors have been investigated to look for prognostic factors stratifications such as resection margins, node involvement in the primary disease, and interval between the primary disease and liver metastases. Methods. We searched MEDLINE and EMBASE for studies that reported ten-year survival. Metaanalysis was performed to analyse the effect of recognised prognostic factors on cure rate for colorectal metastases. The meta-analysis was performed according to Ottawa-Newcastle method of analysis for nonrandomised trials and according to the guidelines of the PRISMA. Results. Eleven studies were included in the analysis, which showed a ten-year survival rate of 12–36%. Factors that have favourable impact are clear resection margin, low level of CEA, single metastatic deposit, and node negative disease. The only factor that excluded patients from cure is the positive status of the resection margin. Conclusion. Predicted ten-year survival after liver resection for colorectal metastases varies from 12 to 36%. Only positive resection margins resulted in no 10-year survivors. No patient can be excluded from consideration for liver resection so long the result is negative margins

Asymptotically simple solutions of the vacuum Einstein equations in even dimensions

We show that a set of conformally invariant equations derived from the Fefferman-Graham tensor can be used to construct global solutions of the vacuum Einstein equations, in all even dimensions. This gives, in particular, a new, simple proof of Friedrich's result on the future hyperboloidal stability of Minkowski space-time, and extends its validity to even dimensions.Comment: 25p

Protecting the conformal symmetry via bulk renormalization on Anti deSitter space

The problem of perturbative breakdown of conformal symmetry can be avoided, if a conformally covariant quantum field phi on d-dimensional Minkowski spacetime is viewed as the boundary limit of a quantum field Phi on d+1-dimensional anti-deSitter spacetime (AdS). We study the boundary limit in renormalized perturbation theory with polynomial interactions in AdS, and point out the differences as compared to renormalization directly on the boundary. In particular, provided the limit exists, there is no conformal anomaly. We compute explicitly the "fish diagram" on AdS_4 by differential renormalization, and calculate the anomalous dimension of the composite boundary field phi^2 with bulk interaction Phi^4.Comment: 40 page

Cost-Effectiveness Analysis of Early Reading Programs: A Demonstration With Recommendations for Future Research

We review the value of cost-effectiveness analysis for evaluation and decision making with respect to educational programs and discuss its application to early reading interventions. We describe the conditions for a rigorous cost-effectiveness analysis and illustrate the challenges of applying the method in practice, providing examples of programs for which we have estimated costs, but find effectiveness data lacking in comparability. We provide a demonstration of how cost-effectiveness analysis can be applied to two early reading programs: the Wilson Reading System and Corrective Reading. We use existing effectiveness data from an experimental evaluation in which the programs were implemented under similar conditions and the use of common outcomes measures for both programs yielded data that are comparable. We combine these data with cost data we collected using the ingredients method to calculate cost-effectiveness ratios for the alphabetics domain. A complete picture of the relative cost-effectiveness of each program could be provided if effectiveness metrics were available for fluency, vocabulary, and comprehension. We highlight the obstacles to applying cost-effectiveness analysis more frequently and recommend strategies for improving the availability of the requisite data

Preadmission antidepressant use and bladder cancer: a population-based cohort study of stage at diagnosis, time to surgery, and surgical outcomes

BACKGROUND: Among cancer patients, prior antidepressant use has been associated with impaired survival. This could be due to differences in stage at diagnosis, in receipt of treatment, or in treatment complications. The purpose of this study was, therefore, to examine if preadmission antidepressant use in patients with bladder cancer is associated with tumor stage at diagnosis, rate of cystectomy, and surgical outcomes, including survival. METHODS: We performed a registry-based cohort study including all patients with incident invasive bladder cancer in Denmark 2005-2015. Exposure was defined as redemption of two or more antidepressant prescriptions one year before cancer diagnosis. We compared tumor stage using logistic regression, postsurgical inpatient length of stay using linear regression, and other outcomes using Cox regression. All results were adjusted for age, sex, comorbidity, and marital status. RESULTS: Among 10,427 bladder cancer patients, 10% were antidepressant users. At diagnosis, 51% of users and 52% of non-users had muscle-invasive disease. However, upon adjustment for age, sex, comorbidity, and marital status, users had lower odds of muscle-invasive disease (adjusted odds ratio 0.86 (95% confidence interval (CI) 0.74-0.99)). Among patients with muscle-invasive disease, fewer users than non-users had surgery within three months (15% vs. 24%, adjusted hazard ratio (aHR) 0.75 (95% CI 0.59-0.95)). Of 2532 patients undergoing surgery, 6% were antidepressant users. Postsurgical inpatient length of stay did not differ between users and non-users. The 30-day cumulative incidence of readmission was higher for users (41% vs. 33%, aHR 1.33 (95% CI 1.05-1.67)), while the 90-day incidence of postoperative procedures was 44% for users and 38% for non-users (aHR 1.18 (95% CI 0.93-1.51)). One-year mortality was comparable in users (15%) and non-users (14%). CONCLUSIONS: Antidepressant use in bladder cancer patients was associated with less advanced stage at diagnosis and lower rate of cystectomy. After cystectomy, users had higher rate of readmission and postoperative procedures than non-users, but we found no difference in length of stay or one-year mortality. The results point to the importance of differentiated clinical care according to individual patient characteristics

Economic instruments for population diet and physical activity behaviour change: a systematic scoping review.

BACKGROUND: Unhealthy diet and low levels of physical activity are common behavioural factors in the aetiology of many non-communicable diseases. Recent years have witnessed an upsurge of policy and research interest in the use of taxes and other economic instruments to improve population health. OBJECTIVE: To assemble, configure and analyse empirical research studies available to inform the public health case for using economic instruments to promote dietary and physical activity behaviour change. METHODS: We conducted a systematic scoping review of evidence for the effects of specific interventions to change, or general exposure to variations in, prices or income on dietary and physical activity behaviours and corollary outcomes. Systematic electronic searches and parallel snowball searches retrieved >1 million study records. Text mining technologies were used to prioritise title-abstract records for screening. Eligible studies were selected, classified and analysed in terms of key characteristics and principal findings, using a narrative, configuring synthesis focused on implications for policy and further research. RESULTS: We identified 880 eligible studies, including 192 intervention studies and 768 studies that incorporated evidence for prices or income as correlates or determinants of target outcomes. Current evidence for the effects of economic instruments and exposures on diet and physical activity is limited in quality and equivocal in terms of its policy implications. Direct evidence for the effects of economic instruments is heavily skewed towards impacts on diet, with a relative lack of evidence for impacts on physical activity. CONCLUSIONS: The evidence-based case for using economic instruments to promote dietary and physical activity behaviour change may be less compelling than some proponents have claimed. Future research should include measurement of people's actual behavioural responses using study designs capable of generating reliable causal inferences regarding intervention effects. Policy implementation needs to be carefully aligned with evaluation planning and design

Pinpointing needles in giant haystacks: use of text mining to reduce impractical screening workload in extremely large scoping reviews.

In scoping reviews, boundaries of relevant evidence may be initially fuzzy, with refined conceptual understanding of interventions and their proposed mechanisms of action an intended output of the scoping process rather than its starting point. Electronic searches are therefore sensitive, often retrieving very large record sets that are impractical to screen in their entirety. This paper describes methods for applying and evaluating the use of text mining (TM) technologies to reduce impractical screening workload in reviews, using examples of two extremely large-scale scoping reviews of public health evidence (choice architecture (CA) and economic environment (EE)). Electronic searches retrieved >800,000 (CA) and >1 million (EE) records. TM technologies were used to prioritise records for manual screening. TM performance was measured prospectively. TM reduced manual screening workload by 90% (CA) and 88% (EE) compared with conventional screening (absolute reductions of ≈430 000 (CA) and ≈378 000 (EE) records). This study expands an emerging corpus of empirical evidence for the use of TM to expedite study selection in reviews. By reducing screening workload to manageable levels, TM made it possible to assemble and configure large, complex evidence bases that crossed research discipline boundaries. These methods are transferable to other scoping and systematic reviews incorporating conceptual development or explanatory dimensions

Improving Early Literacy: Cost-Effectiveness Analysis of Effective Reading Programs

This study is a cost-effectiveness analysis of seven early literacy programs that have all been previously identified as effective at improving reading outcomes for students in Grades K-3. We use the ingredients method to collect cost data for each program and compare the cost-effectiveness of programs serving students in the same grade level