Housing Stability and Hepatitis C Infection for Young Adults Who Inject Drugs: Examining the Relationship of Consistent and Intermittent Housing Status on HCV Infection Risk.

Housing status affects drug using behaviors, but less is known about the relationship between housing patterns and hepatitis C virus (HCV) infection. HCV-negative young people who inject drugs (PWID) were enrolled into a prospective cohort (2003-2019) with quarterly study visits. We used Cox regression to estimate the independent association of recent housing status (housed vs. unhoused, housing stability, and housing trajectory) on HCV incidence. Among 712 participants, 245 incident HCV infections occurred over 963.8 person-years (py) (cumulative incidence 24.4/100 py). An inverse relationship between time housed and HCV incidence was observed (always unhoused 45.0/100 py, 95% confidence interval (CI) 37.1, 54.5; variably housed 18.0/100 py, 95% CI 15.0, 21.3; and always housed 7.0/100 py, 95% CI 3.0, 17.3). In Cox regression models controlling for confounders, those unhoused versus housed at baseline had a 1.9-fold increased infection risk (95% CI 1.4, 2.6). Those always unhoused versus always housed had a 1.5 times greater risk of HCV (95% CI 1.0, 2.3), and those spending a portion of time in stable housing a lower risk (adjusted relative hazard 0.05, 95% CI 0.3, 0.9) with a similar trend for those being housed for less time. Young adult PWID experiencing both recent and chronic states of being unhoused are at elevated risk for HCV infection. Importantly for this group of PWID, our findings indicate that some frequency of residential housing significantly reduces HCV infection risk

External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study

© 2015 The Authors.Study objective The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE s

External Validation of the STONE Score, a Clinical Prediction Rule for Ureteral Stone: An Observational Multi-institutional Study

STUDY OBJECTIVE: The STONE score is a clinical decision rule that classifies patients with suspected nephrolithiasis into low-, moderate-, and high-score groups, with corresponding probabilities of ureteral stone. We evaluate the STONE score in a multi-institutional cohort compared with physician gestalt and hypothesize that it has a sufficiently high specificity to allow clinicians to defer computed tomography (CT) scan in patients with suspected nephrolithiasis. METHODS: We assessed the STONE score with data from a randomized trial for participants with suspected nephrolithiasis who enrolled at 9 emergency departments between October 2011 and February 2013. In accordance with STONE predictors, we categorized participants into low-, moderate-, or high-score groups. We determined the performance of the STONE score and physician gestalt for ureteral stone. RESULTS: Eight hundred forty-five participants were included for analysis; 331 (39%) had a ureteral stone. The global performance of the STONE score was superior to physician gestalt (area under the receiver operating characteristic curve=0.78 [95% confidence interval {CI} 0.74 to 0.81] versus 0.68 [95% CI 0.64 to 0.71]). The prevalence of ureteral stone on CT scan ranged from 14% (95% CI 9% to 19%) to 73% (95% CI 67% to 78%) in the low-, moderate-, and high-score groups. The sensitivity and specificity of a high score were 53% (95% CI 48% to 59%) and 87% (95% CI 84% to 90%), respectively. CONCLUSION: The STONE score can successfully aggregate patients into low-, medium-, and high-risk groups and predicts ureteral stone with a higher specificity than physician gestalt. However, in its present form, the STONE score lacks sufficient accuracy to allow clinicians to defer CT scan for suspected ureteral stone

Exemplar Training and a Derived Transformation of Function in Accordance with Symmetry: II

The main purpose of the present study was to determine whether exemplar training in symmetry relations would readily facilitate the transformation of function in accordance with symmetry, when subjects were not provided with explicit name training. The study also examined whether pretraining that was formally similar to the symmetry test, but did not reinforce symmetry relations, would have the same facilitative effect as exemplar training. Sixteen children, aged between 4 and 5 years, were employed across three experiments (i.e., 4 children each in Experiments 1 and 2, and 8 children in Experiment 3). In Experiment 1, subjects were trained in an action-object conditional discrimination using familiar actions and objects (e.g., when the experimenter waved, choosing a toy car was reinforced, and when the experimenter clapped, choosing a doll was reinforced). Subjects were then exposed to a test for derived object-action symmetry relations (e.g., experimenter presents toy car-*child waves and experimenter presents doll-*child claps). Across subsequent sessions, a multiple-baseline design was used to introduce exemplar training (i.e., explicit symmetry training) for those subjects who failed the symmetry test. Experiment 2 replicated Experiment 1, except that the trained and tested relations were reversed (i.e., train object-action, test action-object relations). Experiment 3 replicated Experiment 1, except that subjects were exposed to object-action pretraining. Across Experiments 1 and 2, none of the 8 subjects show derived objectaction (Experiment 1) or action-object (Experiment 2) symmetry until they received explicit symmetry training. Pretraining objectaction responding in Experiment 3 appeared to facilitate symmetry, but only for 4 of the 8 subjects. For the 4 subjects who failed , symmetry emerged following exposure to exemplar training. Overall, the data are consistent with Relational Frame Theory