Growing up in a mainstream world: a retrospective enquiry into the childhood experiences of young adults with a physical disability.

Children with disabilities are at greater risk of developing mental health problems than their peers, yet the emotional well-being of this group is largely overlooked and there is scant literature about children with a mobility disability. This study examined the retrospective experiences of growing up with mobility disability. The sample comprised of 16-25 year olds with mobility disability. A thematic analysis, informed by grounded theory was used. Themes identified included a common socio educational journey, conflict between care and independence in school and the impact of being singled out because of disability out side school. The result was a range of psycho-social issues that affected participants view of themselves and the world around them. The study also looked at what the participants found helpful in dealing with the emotional impact of their disability. Whilst some sought help through talking therapies, others found involvement in disability sport was helpful

Testing Sparsity Assumptions in Bayesian Networks

Bayesian network (BN) structure discovery algorithms typically either make assumptions about the sparsity of the true underlying network, or are limited by computational constraints to networks with a small number of variables. While these sparsity assumptions can take various forms, frequently the assumptions focus on an upper bound for the maximum in-degree of the underlying graph $\nabla_G$. Theorem 2 in Duttweiler et. al. (2023) demonstrates that the largest eigenvalue of the normalized inverse covariance matrix ($\Omega$) of a linear BN is a lower bound for $\nabla_G$. Building on this result, this paper provides the asymptotic properties of, and a debiasing procedure for, the sample eigenvalues of $\Omega$, leading to a hypothesis test that may be used to determine if the BN has max in-degree greater than 1. A linear BN structure discovery workflow is suggested in which the investigator uses this hypothesis test to aid in selecting an appropriate structure discovery algorithm. The hypothesis test performance is evaluated through simulations and the workflow is demonstrated on data from a human psoriasis study

Relative Sparsity for Medical Decision Problems

Existing statistical methods can estimate a policy, or a mapping from covariates to decisions, which can then instruct decision makers (e.g., whether to administer hypotension treatment based on covariates blood pressure and heart rate). There is great interest in using such data-driven policies in healthcare. However, it is often important to explain to the healthcare provider, and to the patient, how a new policy differs from the current standard of care. This end is facilitated if one can pinpoint the aspects of the policy (i.e., the parameters for blood pressure and heart rate) that change when moving from the standard of care to the new, suggested policy. To this end, we adapt ideas from Trust Region Policy Optimization (TRPO). In our work, however, unlike in TRPO, the difference between the suggested policy and standard of care is required to be sparse, aiding with interpretability. This yields ``relative sparsity," where, as a function of a tuning parameter, $\lambda$, we can approximately control the number of parameters in our suggested policy that differ from their counterparts in the standard of care (e.g., heart rate only). We propose a criterion for selecting $\lambda$, perform simulations, and illustrate our method with a real, observational healthcare dataset, deriving a policy that is easy to explain in the context of the current standard of care. Our work promotes the adoption of data-driven decision aids, which have great potential to improve health outcomes.Comment: 53 pages, 7 figures, 2 table

A Bayesian partial membership model for multiple exposures with uncertain group memberships

We present a Bayesian partial membership model that estimates the associations between an outcome, a small number of latent variables, and multiple observed exposures where the number of latent variables is specified a priori. We assign one observed exposure as the sentinel marker for each latent variable. The model allows non-sentinel exposures to have complete membership in one latent group, or partial membership across two or more latent groups. MCMC sampling is used to determine latent group partial memberships for the non-sentinel exposures, and estimate all model parameters. We compare the performance of our model to competing approaches in a simulation study and apply our model to inflammatory marker data measured in a large mother-child cohort of the Seychelles Child Development Study (SCDS). In simulations, our model estimated model parameters with little bias, adequate coverage, and tighter credible intervals compared to competing approaches. Under our partial membership model with two latent groups, SCDS inflammatory marker classifications generally aligned with the scientific literature. Incorporating additional SCDS inflammatory markers and more latent groups produced similar groupings of markers that also aligned with the literature. Associations between covariates and birth weight were similar across latent variable models and were consistent with earlier work in this SCDS cohort. Supplementary materials accompanying this paper appear online.</p

Neuropsychological Measures of Attention and Impulse Control among 8-Year-Old Children Exposed Prenatally to Organochlorines

Background: We previously reported associations between organochlorines and behaviors related to attention deficit hyperactivity disorder among boys and girls at 8 years of age using a teacher’s rating scale for a birth cohort in New Bedford, Massachusetts (USA)

Does prenatal methylmercury exposure from fish consumption affect blood pressure in childhood?

INTRODUCTION: Prenatal exposure to organic methylmercury (MeHg) from seafood consumption has been reported to increase children's blood pressure (BP). A report from the Faroe Islands noted significantly increased diastolic and systolic BP in 7-year-old children as prenatal MeHg exposure increased. The Faroese diet includes sea mammals that contain MeHg, cadmium, and other pollutants. We examined this relationship in the Seychelles Islands to determine if it was present in a society exposed primarily to MeHg from consuming ocean fish. METHODS: We obtained BP at ages 12 and 15 years on children with known prenatal MeHg exposure enrolled in the Seychelles Child Development Study (SCDS). We examined the association between prenatal MeHg exposure and BP using longitudinal models and linear regression adjusted for relevant covariates. RESULTS: Blood pressure at both ages was associated with BMI, height and maternal hypertension during pregnancy as expected. No association between prenatal MeHg exposure and BP was present in girls at either age or in either sex at age 12 years. At age 15 years diastolic BP in boys increased with increasing prenatal MeHg exposure, while systolic BP was unaffected. SUMMARY: It is unclear whether the association between prenatal MeHg exposure and diastolic BP seen in 15-year-old boys is of biological significance or if it is a chance finding. However, the finding is intriguing and deserves further study

Prenatal Organochlorine and Methylmercury Exposure and Memory and Learning in School-Age Children in Communities Near the New Bedford Harbor Superfund Site, Massachusetts

Background: Polychlorinated biphenyls (PCBs), organochlorine pesticides, and methylmercury (MeHg) are environmentally persistent with adverse effects on neurodevelopment. However, especially among populations with commonly experienced low levels of exposure, research on neurodevelopmental effects of these toxicants has produced conflicting results. Objectives: We assessed the association of low-level prenatal exposure to these contaminants with memory and learning. Methods: We studied 393 children, born between 1993 and 1998 to mothers residing near a PCB-contaminated harbor in New Bedford, Massachusetts. Cord serum PCB, DDE (dichlorodiphenyldichloroethylene), and maternal peripartum hair mercury (Hg) levels were measured to estimate prenatal exposure. Memory and learning were assessed at 8 years of age (range, 7–11 years) using the Wide Range Assessment of Memory and Learning (WRAML), age-standardized to a mean ± SD of 100 ± 15. Associations with each WRAML index—Visual Memory, Verbal Memory, and Learning—were examined with multivariable linear regression, controlling for potential confounders. Results: Although cord serum PCB levels were low (sum of four PCBs: mean, 0.3 ng/g serum; range, 0.01–4.4), hair Hg levels were typical of the U.S. fish-eating population (mean, 0.6 μg/g; range, 0.3–5.1). In multivariable models, each microgram per gram increase in hair Hg was associated with, on average, decrements of –2.8 on Visual Memory (95% CI: –5.0, –0.6, p = 0.01), –2.2 on Learning (95% CI: –4.6, 0.2, p = 0.08), and –1.7 on Verbal Memory (95% CI: –3.9, 0.6, p = 0.14). There were no significant adverse associations of PCBs or DDE with WRAML indices. Conclusions: These results support an adverse relationship between low-level prenatal MeHg exposure and childhood memory and learning, particularly visual memory. Citation: Orenstein ST, Thurston SW, Bellinger DC, Schwartz JD, Amarasiriwardena CJ, Altshul LM, Korrick SA. 2014. Prenatal organochlorine and methylmercury exposure and memory and learning in school-age children in communities near the New Bedford Harbor Superfund Site, Massachusetts. Environ Health Perspect 122:1253–1259; http://dx.doi.org/10.1289/ehp.130780

Statistical competencies for medical research learners: What is fundamental?

IntroductionIt is increasingly essential for medical researchers to be literate in statistics, but the requisite degree of literacy is not the same for every statistical competency in translational research. Statistical competency can range from 'fundamental' (necessary for all) to 'specialized' (necessary for only some). In this study, we determine the degree to which each competency is fundamental or specialized.MethodsWe surveyed members of 4 professional organizations, targeting doctorally trained biostatisticians and epidemiologists who taught statistics to medical research learners in the past 5 years. Respondents rated 24 educational competencies on a 5-point Likert scale anchored by 'fundamental' and 'specialized.'ResultsThere were 112 responses. Nineteen of 24 competencies were fundamental. The competencies considered most fundamental were assessing sources of bias and variation (95%), recognizing one's own limits with regard to statistics (93%), identifying the strengths, and limitations of study designs (93%). The least endorsed items were meta-analysis (34%) and stopping rules (18%).ConclusionWe have identified the statistical competencies needed by all medical researchers. These competencies should be considered when designing statistical curricula for medical researchers and should inform which topics are taught in graduate programs and evidence-based medicine courses where learners need to read and understand the medical research literature

Quantization and spacetime topology

We consider classical and quantum dynamics of a free particle in de Sitter's space-times with different topologies to see what happens to space-time singularities of removable type in quantum theory. We find analytic solution of the classical dynamics. The quantum dynamics is solved by finding an essentially self-adjoint representation of the algebra of observables integrable to the unitary representations of the symmetry group of each considered gravitational system. The dynamics of a massless particle is obtained in the zero-mass limit of the massive case. Our results indicate that taking account of global properties of space-time enables quantization of particle dynamics in all considered cases.Comment: Class. Quantum Grav. 20 (2003) 2491-2507; no figures, RevTeX

Polyunsaturated fatty acid status and methylmercury exposure are not associated with leukocyte telomere length in mothers or their children in the Seychelles Child Development Study

Background: Leukocyte telomere length (TL) is associated with age-related diseases and early mortality, but there is a lack of data on the determinants of TL in early life. Evidence suggests that dietary intake ofmarine n-3 (v-3) polyunsaturated fatty acids (PUFAs) is protective of telomere attrition, yet the effect of methylmercury exposure, also found in fish, on TL is unknown. Objective: The aim of this study was to investigate the associations between prenatal PUFA status, methylmercury exposure, and TL in mothers and children in the SCDS (Seychelles Child Development Study), for whom fish consumption is high. Methods: Blood samples collected from 229 mothers (at 28 wk gestation and delivery) and children (at 5 y of age) in the SCDS first nutrition cohort were analyzed for PUFA concentrations. Prenatal mercury was measured in maternal hair collected at delivery. Postnatalmercury was alsomeasured in children's hair samples with the use of a cumulativemetric derived from values obtained at 3-5 y of age. Relative TL wasmeasured in blood obtained from mothers at delivery, in cord blood, and in children at 5 y of age by quantitative polymerase chain reaction. Linear regression models were used to investigate the associations between PUFA status, methylmercury exposure, and TL. Results: Neither prenatal PUFA status or methylmercury exposure was associated with TL of the mother or child or with TL attrition rate. However, a higher prenatal n-6:n-3 PUFA ratiowas significantly associated with longer TLs in the mothers (β = 0.001, P = 0.048). Child PUFA status andmethylmercury exposurewere not associated with child TL. However, higher family Hollingshead socioeconomic status (SES) scores at 9 mo of agewere significantly associatedwith longer TLs in cord blood (β = 0.005, P=0.03). Conclusions: We found no evidence that PUFA status or methylmercury exposure are determinants of TL in either the mother or child. However, our results support the hypothesis that family SES may be associated with child TL