Profile Likelihood Biclustering

Biclustering, the process of simultaneously clustering the rows and columns of a data matrix, is a popular and effective tool for finding structure in a high-dimensional dataset. Many biclustering procedures appear to work well in practice, but most do not have associated consistency guarantees. To address this shortcoming, we propose a new biclustering procedure based on profile likelihood. The procedure applies to a broad range of data modalities, including binary, count, and continuous observations. We prove that the procedure recovers the true row and column classes when the dimensions of the data matrix tend to infinity, even if the functional form of the data distribution is misspecified. The procedure requires computing a combinatorial search, which can be expensive in practice. Rather than performing this search directly, we propose a new heuristic optimization procedure based on the Kernighan-Lin heuristic, which has nice computational properties and performs well in simulations. We demonstrate our procedure with applications to congressional voting records, and microarray analysis.Comment: 40 pages, 11 figures; R package in development at https://github.com/patperry/biclustp

Association of Breakfast Intake with Obesity, Dietary and Physical Activity Behavior Among Urban School-Aged Adolescents in Delhi, India: Results of a Cross-Sectional Study

In developed countries, regular breakfast consumption is inversely associated with excess weight and directly associated with better dietary and improved physical activity behaviors. Our objective was to describe the frequency of breakfast consumption among school-going adolescents in Delhi and evaluate its association with overweight and obesity as well as other dietary, physical activity, and sedentary behaviors. Methods: Design: Cross-sectional study. Setting: Eight schools (Private and Government) of Delhi in the year 2006. Participants: 1814 students from 8th and 10th grades; response rate was 87.2%; 55% were 8th graders, 60% were boys and 52% attended Private schools. Main outcome measures: Body mass index, self-reported breakfast consumption, diet and physical activity related behaviors, and psychosocial factors. Data analysis: Mixed effects regression models were employed, adjusting for age, gender, grade level and school type (SES). Results: Significantly more Government school (lower SES) students consumed breakfast daily as compared to Private school (higher SES) students (73.8% vs. 66.3%; p<0.01). More 8th graders consumed breakfast daily vs. 10th graders (72.3% vs. 67.0%; p<0.05). A dose-response relationship was observed such that overall prevalence of overweight and obesity among adolescents who consumed breakfast daily (14.6%) was significantly lower vs. those who only sometimes (15.2%) or never (22.9%) consumed breakfast (p<0.05 for trend). This relationship was statistically significant for boys (15.4 % vs. 16.5% vs. 26.0; p<0.05 for trend) but not for girls. Intake of dairy products, fruits and vegetables was 5.5 (95% CI 2.4-12.5), 1.7 (95% CI 1.1-2.5) and 2.2 (95% CI 1.3-3.5) times higher among those who consumed breakfast daily vs. those who never consumed breakfast. Breakfast consumption was associated with greater physical activity vs. those who never consumed breakfast. Positive values and beliefs about healthy eating; body image satisfaction; and positive peer and parental influence were positively associated with daily breakfast consumption, while depression was negatively associated. Conclusion: Daily breakfast consumption is associated with less overweight and obesity and with healthier dietary-and physical activity-related behaviors among urban Indian students. Although prospective studies should confirm the present results, intervention programs to prevent or treat childhood obesity in India should consider emphasizing regular breakfast consumption.Obesity Prevention Center, University of MinnesotaPRIME program of the University of Texas, School of Public Health (Stigler, PI)Center for Health Promotion and Disease Prevention Research in Underserved Population

Peer-Led, School-Based Nutrition Education for Young Adolescents: Feasibility and Process Evaluation of the TEENS Study

Peer education has become a popular strategy for health promotion interventions with adolescents, but it has not been used widely in school‐based nutrition education. This paper describes and reports on the feasibility of the peer leader component of school‐based nutrition intervention for young adolescents designed to increase fruit and vegetable intakes and lower-fat foods. About 1,000 seventh‐grade students in eight schools received the nutrition intervention. Of these, 272 were trained as peer leaders to assist the teacher in implementing the activities. Results from a multicomponent process evaluation based on peer leader and classroom student feedback, direct classroom observation, and teacher ratings and interviews are presented. Results show that peer‐led nutrition education approaches in schools are feasible and have high acceptability among peer leaders, classroom students, and teachers

Communicating with Patients and Their Families About Palliative and End-of-Life Care: Comfort and Educational Needs of Nurses

Introduction: Effectively discussing palliative care with patients and families requires knowledge and skill. The purpose of this study was to determine perceived needs of inpatient nurses for communicating with patients and families about palliative and end-of-life (EoL) care. Method: A non-experimental design was used. In total, 60 inpatient nurses from one hospital in Idaho completed the End of Life Professional Caregiver Survey (EPCS), which examines three domains: patient and family-centered communication, cultural and ethical values, and effective care delivery. Results: The number of years’ experience nurses had (F(9,131.57)=2.22, p=0.0246; Wilk\u27s ^=0.709) and the unit they worked on (F(6,110)=2.49, p=0.0269; Wilk\u27s ^=0.775) had a significant effect on their comfort discussing EoL and palliative care with patients and their families. For all three domains, years of nursing experience was positively associated with comfort in communicating about EoL care. Oncology nurses were most comfortable with regard to patient and family-centered communication. Discussion: The success and sustainability of this service is dependent on education for health-care providers. Studies are needed to determine the most effective ways to meet this educational challenge

Influencing healthful food choices in school and home environments: results from the TEENS study.

Background. The purpose of this research is to examine the effects of an intervention designed to increase the availability of fruits, vegetables and lower fat foods in homes and schools. This research is part of the TEENS study, a school-based intervention study. Methods. Sixteen schools in Minnesota were recruited to be in the study, and approximately 3600 middle school students in the eight intervention schools were exposed to a multi-component intervention. The TEENS intervention included classroom-based curricula, family newsletters, and changes in the school food environment including increasing more healthful options on a la carte and on the school lunch line. In addition to student-level outcomes, changes in availability of fruits, vegetables, and lower fat snacks in home and school environments were evaluated. The TEENS study was conducted from 1997 to 2000. Results. Parents of students in intervention schools reported making healthier choices when grocery shopping as compared to parents of students in control schools (P = 0.01). No intervention effects were evident from a home food inventory. Compared to control schools, intervention schools offered (P = 0.04) and sold (P = 0.07) a higher proportion of healthier foods on a la carte, but no effects were seen for fruit and vegetables sales as part of the regular meal pattern lunch. Conclusion. Our results show mixed results for positively influencing adolescents\u27 school and home environments

Developing a School Functioning Index for Middle Schools

Despite widespread recognition of schools\u27 role in the healthy development of youth, surprisingly little research has examined the relationships between schools\u27 overall functioning and the health‐related behavior of students. School functioning could become an important predictor of students\u27 health‐related behavior and may be amenable to intervention. This paper describes the development and testing of the School Functioning Index (SFI) as a first step in investigating this question. The index was developed for use with middle schools and conceived as a predictor of students\u27 violent behavior, with the potential for extending research applications to additional health and social behaviors. Using social cognitive theory, social ecological theory, and social disorganization theory as guides, three domains were identified to operationalize school functioning and identify candidate SFI items: 1) resources available to the school and students; 2) stability of the school population; and 3) the schools\u27 performance as a socializing agent for students. Data for candidate SFI items were collected from public archives and directly from 16 middle schools participating in a school‐based dietary intervention study. Data collection from schools, particularly concerning student aggressive behavior and disciplinary actions, presented challenges. The final SFI comprised nine items and demonstrated good internal consistency and variability. The SFI was modestly correlated in expected directions with violence and other health behaviors. This work supports the feasibility of combining multiple school‐level indicators to create a measure of overall school functioning. Further investigation of validity and more acceptable data collection methods are warranted

Punch Injuries: Insights into Intentional Closed Fist Injuries

Objectives: This study sought to investigate the patterns of injury resulting from a punch mechanism and to investigate the associated psychopathology present in patients with these injuries.Methods: Retrospective analysis of patients with hand radiographs ordered from the emergency department allowed for identification of patients with a punch mechanism. We recorded injury patterns and queried patients’ medical records for associated psychopathology.Results: 1,292 patients underwent hand radiographs during a one-year time period; 172 patients (13%) were radiographed following an intentional punch injury, identifying 76 fractures in 70 patients. Males contributed a greater proportion of patients presenting with punch injury when compared to females (80% vs. 20%). Males were more likely to sustain fracture from a punch mechanism (48% vs. 11%, OR 7 [95% CI 2.3-20.9]), but were less likely to have preexisting documented psychiatric disease (23% vs. 49%, OR 3.1 [95% CI 1.4-6.7]). Of all fractures, 61% were to the fifth metacarpal, 21% were to the remainder of the metacarpals, and the remaining were fractures to phalanges and bones of the wrist.Conclusion: Women are less likely to present with punch injury and are less likely to sustain a fracture when they do present but have more associated psychiatric disease. Both men and women presenting with punch injuries have a higher prevalence of psychiatric disease than the background incidence in the population as a whole. Although punch injuries result in a significant number of boxer fractures, a number of other injuries are associated with punch mechanisms. [West J Emerg Med. 2011;12(1):6-10.

Are Differences in Exposure to a Multicomponent School-Based Intervention Associated With Varying Dietary Outcomes in Adolescents?

Multicomponent interventions are recommended for health behavior change among adolescents. However, it is difficult to disentangle the effects of multiple intervention components. This article reports outcomes associated with varying levels of exposure to a school-based nutrition intervention, Teens Eating for Energy and Nutrition at School (TEENS). Four incremental exposureswere possible: (1) control group, (2) school environment interventions only, (3) classroom plus environment interventions, and (4) peer leaders plus classroom plus environment interventions. Patterns suggesting dose response were observed, with peer leaders reporting the largest increases in fruit, vegetable, and lower fat food consumption. Students exposed to classroom plus environment interventions also improved, whereas students exposed only to school environment interventions showed trends toward choosing lower fat foods and declining fruit intake and no change in vegetable intake. Control students’ choices remained stable. Future studies may investigate mechanisms for peer leaders’ changes, maximizing curriculum effectiveness, and improving environmental interventions

Predictors of Violent Behavior in an Early Adolescent Cohort: Similarities and Differences Across Genders

The authors assessed a cohort of 2,335 students from the Minneapolis, Minnesota, area to identify predictors of violent behavior and to determine whether the predictors varied by gender. The sample was 76% White; boys and girls were equally represented. The majority lived with two parents. A measure of violent behavior collected at the end of the eighth-grade year (2000) was entered into Poisson regression against baseline data collected at the beginning of the seventh-grade year (1998). Predictors of violent behavior influencing both boys and girls included depressive symptoms, perceived invulnerability to negative future events, paternal nonauthoritative behavior, and drinking alcohol. Additional predictors of violent behavior specific to girls included both risk and protective factors