Longitudinal and cross-sectional modelling of health related quality of life in people with cystic fibrosis

People with cystic fibrosis (CF) must endure up to four hours treatment per day to maintain health and are vulnerable to complications. The Cystic Fibrosis Quality of Life Questionnaire was developed to measure health related quality of life (HRQoL) in the UK. Most studies on HRQoL are cross-sectional in design with HRQoL measured once per patient. However, the Cystic Fibrosis Quality of Life Questionnaire has been used to monitor HRQoL longitudinally with measures taken over a 12 year period at one clinic in the UK. These data were modelled with a binomial distribution for a domain score and with fixed and random coefficients for the patient-level clinical and demographic variables. The longitudinal study included 182 patients whose HRQoL was first measured within a single calendar year and were then followed-up. These data provided an opportunity to compare, directly and by simulation, the modelling of a cross-sectional with the modelling of a longitudinal study and so provided insights into the statistical merits of longitudinal studies compared to cross-sectional studies in HRQoL

Sacrificed: Ontario Healthcare Workers in the Time of COVID-19

Healthcare workers (HCWs) in Ontario, Canada have faced unprecedented risks during the COVID-19 pandemic. They have been infected at an elevated rate compared to the general public. HCWs have argued for better protections with minimal success. A worldwide shortage of N95s and comparable respirators appears to have influenced guidelines for protection, which stand at odds with increasing scientific evidence. In-depth interviews were conducted with ten frontline HCWs about their concerns. They reported that the risk of contracting COVID-19 and infecting family members has created intense anxiety. This, in conjunction with understaffing and an increased workload, has resulted in exhaustion and burnout. HCWs feel abandoned by their governments, which failed to prepare for an inevitable epidemic, despite recommendations. The knowledge that they are at increased risk of infection due to lack of protection has resulted in anger, frustration, fear, and a sense of violation that may have long-lasting implications

An educational intervention to prevent overweight in pre-school years: a cluster randomised trial with a focus on disadvantaged families

Background: Early prevention is a promising strategy for reducing obesity in childhood, and Early Years settings are ideal venues for interventions. This work evaluated an educational intervention with the primary aim of preventing overweight and obesity in pre-school children. Methods: A pragmatic, cluster randomised trial with a parallel, matched-pair design was undertaken. Interventions were targeted at both the cluster (Early Years’ Centres, matched by geographical area) and individual participant level (families: mother and 2-year old child). At the cluster level, a staff training intervention used the educational resource Be Active, Eat Healthy. Policies and provision for healthy eating and physical activity were evaluated at baseline and 12-months. The intervention at participant level was the Healthy Heroes Activity Pack: delivered over 6 months by Centre staff to promote healthy eating and physical activity in a fun, interactive way. Child and parent height and weight were measured at four time-points over two years. The trial primary outcome was the change in BMI z-score of the child between ages 2 and 4 years. Secondary outcomes consisted of parent-reported measures administered at baseline and two-year follow-up. Results: Five pairs of Early Years’ Centres were recruited. Four pairs were analysed as one Centre withdrew (47 intervention families; 34 control families). At the cluster level, improvement in Centre policies and practices was similar for both groups (p=0.830). At the participant level, the intervention group reduced their mean BMI z-score between age 2 and 4 years (p=0.002; change difference 0.49; 95% CI 0.17 to 0.80) whereas the control group showed increasing BMI z-score throughout. Changes in parent-reported outcomes and parent BMI (p=0.582) were similar in both groups. Conclusions: The Healthy Heroes educational resource deterred excess weight gain in pre-school children from poor socioeconomic areas. With training, Early Years’ staff can implement the Healthy Heroes programme. Trial Registration Number ISRCTN22620137 Registered 21st December 201

A reference relative time-scale as an alternative to chronological age for cohorts with long follow-up

Background: Epidemiologists have debated the appropriate time-scale for cohort survival studies; chronological age or time-on-study being two such time-scales. Importantly, assessment of risk factors may depend on the choice of time-scale. Recently, chronological or attained age has gained support but a case can be made for a ‘reference relative time-scale’ as an alternative which circumvents difficulties that arise with this and other scales. The reference relative time of an individual participant is the integral of a reference population hazard function between time of entry and time of exit of the individual. The objective here is to describe the reference relative time-scale, illustrate its use, make comparison with attained age by simulation and explain its relationship to modern and traditional epidemiologic methods. Results: A comparison was made between two models; a stratified Cox model with age as the time-scale versus an un-stratified Cox model using the reference relative time-scale. The illustrative comparison used a UK cohort of cotton workers, with differing ages at entry to the study, with accrual over a time period and with long follow-up. Additionally, exponential and Weibull models were fitted since the reference relative time-scale analysis need not be restricted to the Cox model. A simulation study showed that analysis using the reference relative time-scale and analysis using chronological age had very similar power to detect a significant risk factor and both were equally unbiased. Further, the analysis using the reference relative time-scale supported fully-parametric survival modelling and allowed percentile predictions and mortality curves to be constructed. Conclusions: The reference relative time-scale was a viable alternative to chronological age, led to simplification of the modelling process and possessed the defined features of a good time-scale as defined in reliability theory. The reference relative time-scale has several interpretations and provides a unifying concept that links contemporary approaches in survival and reliability analysis to the traditional epidemiologic methods of Poisson regression and standardised mortality ratios. The community of practitioners has not previously made this connection

Incentives as connectors : insights into a breastfeeding incentive intervention in a disadvantaged area of North-West England

PMID: 22458841 [PubMed - indexed for MEDLINE] PMCID: PMC3414740 Free PMC ArticlePeer reviewedPublisher PD

International home economics

The conference was planned to serve the interests of those who wish to work in home economics programs abroad and those who are concerned with the education of international students in the universities and colleges of the United States. Approximately 165 home economists from other states and from foreign countries I including the African and Latin American countries I participated in the conference.https://lib.dr.iastate.edu/card_reports/1026/thumbnail.jp

Depicting the tree of life in museums: guiding principles from psychological research

The Tree of Life is revolutionizing our understanding of life on Earth, and, accordingly, evolutionary trees are increasingly important parts of exhibits on biodiversity and evolution. The authors argue that in using these trees to effectively communicate evolutionary principles, museums need to take into account research results from cognitive, developmental, and educational psychology while maintaining a focus on visitor engagement and enjoyment. Six guiding principles for depicting evolutionary trees in museum exhibits distilled from this research literature were used to evaluate five current or recent museum trees. One of the trees was then redesigned in light of the research while preserving the exhibit’s original learning goals. By attending both to traditional factors that influence museum exhibit design and to psychological research on how people understand diagrams in general and Tree of Life graphics in particular, museums can play a key role in fostering 21st century scientific literacy

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Archives, Memory, and Interfaces with the Past

Archival interfaces are criticalnodes in archival systems where archivistsnegotiate and exercise power over theconstitution and representation of archives. Drawing on notions of interfaces from physical,technological, and computer systems, archivalinterfaces are both a metaphor for archivists'roles as intermediaries between documentaryevidence and its readers and a tangible set ofstructures and tools that place archivaldocuments in a context and provide aninterpretative framework. Interfaces in moderninstitutions and technological systems areneither natural nor neutral. In probingarchival interfaces, what may appear as neutraland objective processes are revealed as placeswhere archivists determine what constituteslegitimate evidence of the past and shapesocial memories. The emergence of computerinterfaces as an increasingly common mode ofuser interaction with archives demands thatarchivists confront the interpretative natureof their work and exploit opportunities toplace themselves visibly in the interfaces theyconstruct.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41817/1/10502_2004_Article_5096450.pd