Categorizing stroke prognosis using different stroke scales

<p><b>Background and Purpose</b>: Stroke severity and dependency are often categorized to allow stratification for randomization or analysis. However, there is uncertainty whether the categorizations used for different stroke scales are equivalent. We investigated the amount of information retained by categorizing severity and dependency, and whether the currently used cut-offs are equivalent across different stroke scales.</p> <p><b>Methods</b>: Stroke severity and dependency have been categorized as mild, moderate, or severe. We studied 2 acute stroke unit cohorts, measuring Scandinavian Stroke Scale (SSS), modified Rankin Scale (mRS), Barthel Index (BI), and modified National Institutes of Health Stroke Scale (mNIHSS). Receiver operating characteristic (ROC) curves were examined to determine the ability of full and categorized scales to predict death and dependency. A weighted kappa analysis assessed agreement between the categorized scales.</p> <p><b>Results</b>: When scales are categorized, the area under the ROC curve is significantly reduced; however, the differences are small and may not be practically important. BI, mRS, and SSS all have excellent agreement with each other when categorized, whereas mNIHSS has substantial agreement with mRS and BI.</p> <p><b>Conclusions</b>: Little predictive information is lost when stroke scales are categorized. There is substantial to almost perfect agreement among categorized scales. Therefore the use and categorization of a variety of stroke severity or dependency scales is acceptable in analyses.</p&gt

EXAMINING THE RELATIONSHIP BETWEEN SPIRITUALITY AND PERSISTENCE OF COMMUNITY COLLEGE GRADUATES WHO MATRICULATE TO THE BACCALAUREATE DEGREE GRANTING INSTITUTION

Community college students, more often than not, face challenges not typical to those of traditional-aged students. They are more likely to attend part-time, tend to be the least academically prepared, more financially challenged, often working, and have a greater likelihood of being single parents. What drives these students to not only graduate from the community college, but go on to continue at four-year institutions? Also, how do these students define, or come to “make meaning” of the force that drives their persistence in higher education? The purpose of this study examines the relationship between spirituality and persistence of Illinois community college students who matriculate to the baccalaureate degree granting institution. The research questions ask the following: (1) How is spirituality defined by community college students who persist?, (2) For community college students who persist, how do they come to “make meaning” of their educational journey?, and (3) What is the relationship between spirituality and community college student persistence? The study utilized qualitative case study methodology employing three separate phases: (1) Survey Questionnaire, (2) Guided Focus Group Discussion, and (3), Face-to-Face Interviews. Responses from the survey questionnaire were coded, further segmented and used to determine those survey participants who would receive invitations for the guided focus group discussion. The guided focus group discussion was recorded and conversation transcribed so that the researcher might establish recurring patterns and emerging themes. From those focus group discussion participants, three participants were selected to take part in the face-to-face interview portion of the study. Through the course of these three phases of data collection, the researcher was able to establish valid conclusions about the relationship between spirituality and community college student persistence

Different associations between body composition and alcohol when assessed by exposure frequency or by quantitative estimates of consumption

Background: Alcohol intake is widely assumed to contribute to excess body fatness, especially among young men; however, the evidence is inconsistent. We have addressed this research question by investigating associations between reported alcohol consumption and body composition from large representative national surveys in a high alcohol‐consuming country with a high obesity prevalence. Methods: The present study comprised a secondary analysis of combined cross‐sectional nationally representative Scottish Health Surveys (1995–2010). Reported alcohol‐drinking frequency was divided into five groups: from ‘nonfrequent drinking’ (reference) to daily/‘almost every day’ among 35 837 representative adults [mean (SD) age: 42.7 (12.7) years (range 18–64 years)]. Quantitative alcohol consumption was categorised into seven groups: from ‘1–7 to ≥50 10 g units per week’. Regression models against measured body mass index (BMI) and waist circumference (WC) were adjusted for age, physical activity, income, smoking, deprivation category and economic status. Results: Among alcohol‐consuming men, heavier drinking (21–28 units per week) was associated with a higher BMI by +1.4 kg m–2 [95% confidence interval (CI) = 1.38–1.43] and higher WC by +3.4 cm (95% CI = 3.2–3.6) than drinking 1–7 units per week. However, those who reported daily drinking frequency were associated with a lower BMI by −2.45 kg m–2 (95% CI = −2.4 to −2.5) and lower WC by −3.7 cm (95% CI = −3.3 to −4.0) than those who reported less‐frequent drinking. Similar associations were found for women. Most of these associations were restricted to subjects aged >30 years. Unexplained variances in BMI and WC are large. Conclusions: Quantitative alcohol consumption and frequency of consumption were positively and inversely associated, respectively, with both BMI and WC among alcohol‐consuming adults. Surveys are needed that evaluate both the quantity and frequency of consumption. The lowest BMI and WC were associated with a ‘Mediterranean’ drinking style (i.e. relatively little, but more frequently)

Acoustic Emission Multi-Parameter Analyzer—AEMPA

A multi-parameter measurement system was designed and built to process signals from acoustic emission (AE) transducers in real time. The system makes selected measurements of each detected AE event as it occurs and stores 23 measured parameters which describe that event in digital form on a standard diskette with IBM format. Measurements recorded on the diskette include information on the shape, magnitude, and frequency content of each AE burst, its timing with respect to location on the specimen under test and its timing with respect to load conditions, pressure, test time, and event count. Over 8000 AE events can be stored on a single diskette at a maximum instantaneous rate of 6000 events/sec and a maximum average rate of 1000 events/sec. Two floppy disk units are included in the system so one can be operational while the diskette is being changed in the other. After a specimen test, the data are transmitted to a remote minicomputer with a standard RS232 interface. Rapid analysis and display of the data by the computer has been demonstrated using up to 8 of the AE parameters at one time in a pattern recognition routine

Filling the intervention gap: service evaluation of an intensive nonsurgical weight management programme for severe and complex obesity

Background: Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2DM). However, no prospective audit and service evaluation of such programmes have been reported. Methods: Following initial feasibility piloting, the Counterweight‐Plus programme was commissioned across a variety of healthcare providers. The programme includes: Screening, TDR (formula low energy diet), food reintroduction and weight loss maintenance, all delivered by staff with 8 h of training, in‐service mentoring, ongoing specialist support and access to medical consultant expertise. Anonymised data are returned centrally for clinical evaluation. Results: Up to December 2016, 288 patients commenced the programme. Mean (SD) baseline characteristics were: age 47.5 (12.7) years, weight 128.0 (32.0) kg, body mass index 45.7 (10.1) kg m−2, n = 76 (26.5%) were male and n = 99 (34.5%) had T2DM. On an intention‐to‐treat (ITT) basis, a loss of ≥15 kg at 12 months was achieved by 48 patients, representing 22.1% of all who started and 40% of those who maintained engagement. For complete cases, mean (95% confidence interval) weight loss was 13.3 (12.1–14.4) kg at 3 months, 16.0 (14.4–17.6) kg at 6 months and 14.2 (12.1–16.3) kg at 12 months (all P < 0.001), with losses to follow‐up of 10.8%, 29.3% and 44.2%, respectively. Mean loss at 12 months by ITT analyses was: single imputation –10.5 (9.5) kg, last observation carried forward –10.9 (11.6) kg and baseline observation carried forward –7.9 (11.1) kg. The presence of diabetes had no significant impact on weight change outcomes. Conclusions: This nonsurgical approach is effective for many individuals with severe and complex obesity, representing an option before considering surgery. The results are equally effective in terms of weight loss for people with T2DM

Associations of BMI, waist circumference, body fat, and skeletal muscle with type 2 diabetes in adults

Aims: Type 2 diabetes (T2D) is known to be associated with high BMI and waist circumference (WC). These measures do not discriminate well between skeletal muscle (SM) and body fat (BF), which may have opposite influences. Methods: We conducted a secondary analysis of population-based data from 58,128 aged 18–85 yrs from Scottish Health Surveys (2003, 2008–2011) and Health Surveys for England (2003–2006, 2008–2013), excluding pregnant women and insulin-treated diabetes. Logistic regression was used to assess associations of known T2D, and of screened HbA1c > 48 mmol/mol (> 6.5%), with sex-specific quintiles of BMI, WC, and BF% and SM% estimated by validated anthropometric equations, adjusted for age, sex, smoking, ethnicity, country, and survey year. Results: As expected, ORs for having known T2D rose with quintiles of BMI (1, 1.5, 2.3, 3.1, and 6.5) and WC (1, 1.8, 2.5, 3.5, and 8.7). Compared to the lowest BF% quintile, OR for having T2D in highest BF% quintile was 11.1 (95% CI = 8.4–14.6). Compared to the highest SM% quintile, OR for having T2D in lowest SM% quintile was 2.0 (1.7–2.4). Of 72 adults with T2D/HbA1c > 6.5% in the lowest quintile of BF%, 27 (37.5%) were in quintile 1 of SM%. Similar patterns of OR were observed for having HbA1c > 6.5% in those without known T2D. Conclusions: Estimated BF% associates strongly with T2D. Low SM% also has a significant association, suggesting a neglected aspect of aetiology within T2D. These two simple measures with biological relevance, available from data collected in most health surveys, may be more useful than the purely statistical terms BMI

Design and Development of an Internationally Applicable Educational Video to Increase Community Awareness in Regions with High Prevalence of Melioidosis and Diabetes

Melioidosis is a neglected tropical disease that causes high morbidity and mortality. Public health awareness is essential for both prevention and early detection of the infection. This project aimed to develop an internationally applicable educational tool to increase community awareness in regions with high prevalence of diabetes and melioidosis. The animation was created with international collaboration. Sixty-four delegates from different cultural backgrounds participated in the survey to evaluate the animation. Feedback was positive, with 85% agreeing that they would use this video for public education and 82% agreeing that the video was culturally appropriate to them in the context of their region. The animation was refined after feedback. To supplement the 3-minute animation, a 13-minute film footage of interviews with clinicians, researchers and patients was also created. These materials have been made available online through the International Melioidosis Network and can be readily downloaded or subtitled in any language using publicly available software, demonstrating the utility of developing low-cost adaptable health education material targeted for widespread use internationally