The longitudinal interplay between negative and positive symptom trajectories in patients under antipsychotic treatment: a post hoc analysis of data from a randomized, 1-year pragmatic trial

BACKGROUND: Schizophrenia is a highly heterogeneous disorder with positive and negative symptoms being characteristic manifestations of the disease. While these two symptom domains are usually construed as distinct and orthogonal, little is known about the longitudinal pattern of negative symptoms and their linkage with the positive symptoms. This study assessed the temporal interplay between these two symptom domains and evaluated whether the improvements in these symptoms were inversely correlated or independent with each other. METHODS: This post hoc analysis used data from a multicenter, randomized, open-label, 1-year pragmatic trial of patients with schizophrenia spectrum disorder who were treated with first- and second-generation antipsychotics in the usual clinical settings. Data from all treatment groups were pooled resulting in 399 patients with complete data on both the negative and positive subscale scores from the Positive and Negative Syndrome Scale (PANSS). Individual-based growth mixture modeling combined with interplay matrix was used to identify the latent trajectory patterns in terms of both the negative and positive symptoms. Pearson correlation coefficients were calculated to examine the relationship between the changes of these two symptom domains within each combined trajectory pattern. RESULTS: We identified four distinct negative symptom trajectories and three positive symptom trajectories. The trajectory matrix formed 11 combined trajectory patterns, which evidenced that negative and positive symptom trajectories moved generally in parallel. Correlation coefficients for changes in negative and positive symptom subscale scores were positive and statistically significant (P < 0.05). Overall, the combined trajectories indicated three major distinct patterns: (1) dramatic and sustained early improvement in both negative and positive symptoms (n = 70, 18%), (2) mild and sustained improvement in negative and positive symptoms (n = 237, 59%), and (3) no improvement in either negative or positive symptoms (n = 82, 21%). CONCLUSIONS: This study of symptom trajectories over 1 year shows that changes in negative and positive symptoms were neither inversely nor independently related with each other. The positive association between these two symptom domains supports the notion that different symptom domains in schizophrenia may depend on each other through a unified upstream pathological disease process

Intimate partner violence and utilization of maternal health care services in Addis Ababa, Ethiopia

published_or_final_versio

Exploring differential item functioning in the SF-36 by demographic, clinical, psychological and social factors in an osteoarthritis population

The SF-36 is a very commonly used generic measure of health outcome in osteoarthritis (OA). An important, but frequently overlooked, aspect of validating health outcome measures is to establish if items work in the same way across subgroup of a population. That is, if respondents have the same 'true' level of outcome, does the item give the same score in different subgroups or is it biased towards one subgroup or another. Differential item functioning (DIF) can identify items that may be biased for one group or another and has been applied to measuring patient reported outcomes. Items may show DIF for different conditions and between cultures, however the SF-36 has not been specifically examined in an osteoarthritis population nor in a UK population. Hence, the aim of the study was to apply the DIF method to the SF-36 for a UK OA population. The sample comprised a community sample of 763 people with OA who participated in the Somerset and Avon Survey of Health. The SF-36 was explored for DIF with respect to demographic, social, clinical and psychological factors. Well developed ordinal regression models were used to identify DIF items. Results: DIF items were found by age (6 items), employment status (6 items), social class (2 items), mood (2 items), hip v knee (2 items), social deprivation (1 item) and body mass index (1 item). Although the impact of the DIF items rarely had a significant effect on the conclusions of group comparisons, in most cases there was a significant change in effect size. Overall, the SF-36 performed well with only a small number of DIF items identified, a reassuring finding in view of the frequent use of the SF-36 in OA. Nevertheless, where DIF items were identified it would be advisable to analyse data taking account of DIF items, especially when age effects are the focus of interest

Antibodies to the Mr 64,000 (64K) protein in islet cell antibody positive non-diabetic individuals indicate high risk for impaired Beta-cell function

A prospective study of a normal childhood population identified 44 islet cell antibody positive individuals. These subjects were typed for HLA DR and DQ alleles and investigated for the presence of antibodies to the Mr 64,000 (64K) islet cell antigen, complement-fixing islet cell antibodies and radiobinding insulin autoantibodies to determine their potency in detecting subjects with impaired Beta-cell function. At initial testing 64K antibodies were found in six of 44 islet cell antibody positive subjects (13.6%). The same sera were also positive for complement-fixing islet cell antibodies and five of them had insulin autoantibodies. During the follow-up at 18 months, islet cell antibodies remained detectable in 50% of the subjects studied. In all six cases who were originally positive, 64K antibodies were persistently detectable, whereas complement-fixing islet cell antibodies became negative in two of six and insulin autoantibodies in one of five individuals. HLA DR4 (p < 0.005) and absence of asparic acid (Asp) at position 57 of the HLA DQ chain (p < 0.05) were significantly increased in subjects with 64K antibodies compared with control subjects. Of 40 individuals tested in the intravenous glucose tolerance test, three had a first phase insulin response below the first percentile of normal control subjects. Two children developed Type 1 (insulin-dependent) diabetes mellitus after 18 and 26 months, respectively. Each of these subjects was non-Asp homozygous and had persistent islet cell and 64K antibodies. We conclude that 64K antibodies, complement-fixing islet cell antibodies and insulin autoantibodies represent sensitive serological markers in assessing high risk for a progression to Type 1 diabetes in islet cell antibody positive non-diabetic individuals

Appealing avatars from 3D body scans: Perceptual effects of stylization

Advances in 3D scanning technology allow us to create realistic virtual avatars from full body 3D scan data. However, negative reactions to some realistic computer generated humans suggest that this approach might not always provide the most appealing results. Using styles derived from existing popular character designs, we present a novel automatic stylization technique for body shape and colour information based on a statistical 3D model of human bodies. We investigate whether such stylized body shapes result in increased perceived appeal with two different experiments: One focuses on body shape alone, the other investigates the additional role of surface colour and lighting. Our results consistently show that the most appealing avatar is a partially stylized one. Importantly, avatars with high stylization or no stylization at all were rated to have the least appeal. The inclusion of colour information and improvements to render quality had no significant effect on the overall perceived appeal of the avatars, and we observe that the body shape primarily drives the change in appeal ratings. For body scans with colour information, we found that a partially stylized avatar was most effective, increasing average appeal ratings by approximately 34%

Stress in nurses : stress-related affect and its determinants examined over the nursing day

Peer reviewedPostprin

Does oral sodium bicarbonate therapy improve function and quality of life in older patients with chronic kidney disease and low-grade acidosis (the BiCARB trial)? Study protocol for a randomized controlled trial

Date of acceptance: 01/07/2015 © 2015 Witham et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Acknowledgements UK NIHR HTA grant 10/71/01. We acknowledge the financial support of NHS Research Scotland in conducting this trial.Peer reviewedPublisher PD

The galaxy-mass correlation function measured from weak lensing in the Sloan Digital Sky Survey

We present galaxy-galaxy lensing measurements over scales 0.025 to 10 h(-1) Mpc in the Sloan Digital Sky Survey (SDSS). Using a flux-limited sample of 127,001 lens galaxies with spectroscopic redshifts and mean luminosity [L] similar to L-* and 9,020,388 source galaxies with photometric redshifts, we invert the lensing signal to obtain the galaxy-mass correlation function xi(gm). We find xi(gm) is consistent with a power law, xi(gm) (r = r(0))(-gamma), with best-fit parameters gamma = 1.79 +/- 0.06 and r(0) (5.4 +/- 0.7) (0.27/Omega(m))(1/gamma) h(-1) Mpc. At fixed separation, the ratio xi(gg)/xi(gm) = b/r, where b is the bias and r is the correlation coefficient. Comparing with the galaxy autocorrelation function for a similarly selected sample of SDSS galaxies, we find that b/r is approximately scale-independent over scales 0.2 - 6.7 h(-1) Mpc, with mean [b/r] = (1.3 +/- 0.2) (Omega(m)/0.27). We also find no scale dependence in b/r for a volume-limited sample of luminous galaxies (-23.0 < M-r < -21.5). The mean b/r for this sample is [b/r](Vlim) = (2.0 +/- 0.7) (Omega(m)/0.27). We split the lens galaxy sample into subsets based on luminosity, color, spectral type, and velocity dispersion and see clear trends of the lensing signal with each of these parameters. The amplitude and logarithmic slope of xi(gm) increase with galaxy luminosity. For high luminosities (L similar to 5 L-*), xi(gm) deviates significantly from a power law. These trends with luminosity also appear in the subsample of red galaxies, which are more strongly clustered than blue galaxies