A modified Wald interval for the area under the ROC curve (AUC) in diagnostic case-control studies

Sociocultural and economic conditions interact with biological processes throughout the course of life determining vulnerability or resilience in old age. The scope of this study was to investigate relationships between social vulnerability (gender, age and income); individual vulnerability (comorbidities, signs and symptoms, functional ability, perceived social support and perceived health), and programmatic vulnerability (indices of dependence on the public health system, social vulnerability and access to health services) in a sample of individuals aged 65 and more. 688 elderly people were interviewed in a single data gathering session in their homes in 88 selected urban census sectors in Campinas. 470 of the interviewees were women, with more comorbidities and more signals and symptoms, though more socially engaged in AADL and IADL than men. Mean age was 72.28 ± 5.41; mean family income = 4.72 ± 5.28 minimum wages. The variables with most explanatory power over the joint variation of the data were access and use of health services, levels of social vulnerability and dependence on public healthcare services, and family income. Social conditions as well as family income coexist with individual vulnerability in old age

Cheyne-Stokes Respiration and Prognosis in Modern-Treated Congestive Heart Failure

In patients with congestive heart failure (CHF), a high prevalence of sleep-disordered breathing has been described. Cheyne-Stokes respiration (CSR) is present in up to 40% of patients with CHF. During the last decade, the medical treatment has been substantially improved. This study was designed to analyze the prognosis of CSR in modern-treated patients with CHF. For this purposes, in 57 patients with CHF who received modern treatment, a 5-year follow-up after initial full night polysomnography was performed. The mean follow-up period was 38 ± 18 months. Mean age was 62 ± 13 years and the mean ejection fraction was 25 ± 7 percent. Respiratory polygraphy revealed CSR with a respiratory disturbance index >5 per hour of sleep in 39 of 57 patients. Twelve patients died. CSR was only characterized by a tendency of worsening (log-rank test, p = 0.25). However, there was a significant difference toward positive outcome for patients who received cardiac resynchronization therapy (log-rank test, p = 0.036). Using Multivariate Cox’s proportional hazard regression with the factors resynchronization and CSR, the effect of resynchronization was almost significant (p = 0.08). In conclusion, no significant change of Cheyne-Stokes prevalence can be found in our small group of modern-treated patients with CHF. Cardiac resynchronization therapy was associated with improved patient outcome

Meta-analysis of diagnostic accuracy studies with multiple thresholds – comparison of different approaches

Methods for standard meta-analysis of diagnostic test accuracy studies are well established and understood. For the more complex case in which studies report test accuracy across multiple thresholds, several approaches have recently been proposed. These are based on similar ideas, but make different assumptions. In this article, we apply four different approaches to data from a recent systematic review in the area of nephrology and compare the results. The four approaches use: a linear mixed effects model, a Bayesian multinomial random effects model, a time-to-event model and a nonparametric model, respectively. In the case study data, the accuracy of neutrophil gelatinase-associated lipocalin for the diagnosis of acute kidney injury was assessed in different scenarios, with sensitivity and specificity estimates available for three thresholds in each primary study. All approaches led to plausible and mostly similar summary results. However, we found considerable differences in results for some scenarios, for example, differences in the area under the receiver operating characteristic curve (AUC) of up to 0.13. The Bayesian approach tended to lead to the highest values of the AUC, and the nonparametric approach tended to produce the lowest values across the different scenarios. Though we recommend using these approaches, our findings motivate the need for a simulation study to explore optimal choice of method in various scenarios

Is synesthesia more common in patients with Asperger syndrome?

There is increasing evidence from case reports that synesthesia is more common in individuals with autism spectrum conditions (ASC). Further, genes related to synesthesia have also been found to be linked to ASC and, similar to synaesthetes, individuals with ASC show altered brain connectivity and unusual brain activation during sensory processing. However, up to now a systematic investigation of whether synesthesia is more common in ASC patients is missing. The aim of the current pilot study was to test this hypothesis by investigating a group of patients diagnosed with Asperger Syndrome (AS) using questionnaires and standard consistency tests in order to classify them as grapheme-color synaesthetes. The results indicate that there are indeed many more grapheme-color synaesthetes among AS patients. This finding is discussed in relation to different theories regarding the development of synesthesia as well as altered sensory processing in autism

Magnetic transitions and isotropic versus anisotropic magnetic behaviour of [CH3NH3][M(HCOO)3] M = Mn2+, Co2+, Ni2+, Cu2+ metal–organic perovskites

Here we present an in-depth study of the magnetic properties of a family of metal–organic perovskites ABX3, [CH3NH3][M(HCOO)3] in which A = CH3NH3+ is the methylammonium cation, B = M is a divalent metal cation (Mn2+, Co2+, Ni2+ or Cu2+), and X is the formate anion (HCOO−). The magnetic properties have been measured on powdered samples and along the different orientations of mm-sized single crystals. They display spin-canted weak ferromagnetism with Néel temperatures of 8.0 K (Mn2+), 15.7 K (Co2+) and 34 K (Ni2+), which are inversely proportional to the ionic radii of the metal cations. The Cu2+ member displays low-dimensional magnetism as a result of orbital ordering of the Cu2+ d orbitals originating from a Jahn–Teller distortion. Pulsed-field magnetization experiments (fields of up to 60 T at temperatures down to 0.6 K) show that Mn2+, Co2+ and Ni2+ formates display cation-characteristic spin flop transitions. A saturation magnetization value of 5 μB (at 12.5 T) was observed for Mn2+, meanwhile the Co2+ formate shows an orientation dependent quasi saturation (5.1 μB at 21 T along [101] vs. 5.8 μB at 26 T along [010]). The different isotropic/anisotropic behaviour can be explained by the orbital contribution to the magnetic responseThe Spanish authors are grateful for financial support from Ministerio de Economía y Competitividad (MINECO) (Spain) and EU under the project ENE2014-56237-C4-4-R, and Xunta de Galicia under the project GRC2014/042. L. C. G.-A. acknowledges UDC for a predoctoral fellowship and Fundación Barrié for the research stay grant at LANL. Work at LANL, A. P. H. and B. P.-D.'s visit to LANL were funded by the Laboratory Directed Research and Development program at LANL. The NHMFL pulsed-field facility is funded by the U.S. National Science Foundation through Cooperative Grant No. DMR-1157490, the State of Florida, and the U.S. Department of EnergyS

Evaluation of two family-based intervention programs for children affected by rare disease and their families – research network (CARE-FAM-NET): study protocol for a rater-blinded, randomized, controlled, multicenter trial in a 2x2 factorial design

Background: Families of children with rare diseases (i.e., not more than 5 out of 10,000 people are affected) are often highly burdened with fears, insecurities and concerns regarding the affected child and its siblings. Although families caring for children with rare diseases are known to be at risk for mental disorders, the evaluation of special programs under high methodological standards has not been conducted so far. Moreover, the implementation of interventions for this group into regular care has not yet been accomplished in Germany. The efficacy and cost-effectiveness of a family-based intervention will be assessed. Methods/design: The study is a 2x2 factorial randomized controlled multicenter trial conducted at 17 study centers throughout Germany. Participants are families with children and adolescents affected by a rare disease aged 0 to 21 years. Families in the face-to-face intervention CARE-FAM, online intervention WEP-CARE or the combination of both will be treated over a period of roughly 6 months. Topics discussed in the interventions include coping, family relations, and social support. Families in the control condition will receive treatment as usual. The primary efficacy outcome is parental mental health, measured by the Structured Clinical Interview for DSM-IV (SCID-I) by blinded external raters. Further outcomes will be assessed from the parents’ as well as the children’s perspective. Participants are investigated at baseline, 6, 12 and 18 months after randomization. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed. Discussion: This paper describes the implementation and evaluation of two family-based intervention programs for Children Affected by Rare Disease and their Family’s Network (CARE-FAM-NET) in German standard care. A methodologically challenging study design is used to reflect the complexity of the actual medical care situation. This trial could be an important contribution to the improvement of care for this highly burdened group. Trial registration: German Clinical Trials Register: DRKS00015859 (registered 18 December 2018) and ClinicalTrials.gov: NCT04339465 (registered 8 April 2020). Protocol Version: 15 August 2020 (Version 6.1). Trial status: Recruitment started on 1 January 2019 and will be completed on 31 March 2021. © 2020, The Author(s)

Preterm children’s long-term academic performance after adaptive computerized training : an efficacy and process analysis of a randomized controlled trial

Background: Adaptive computerized interventions may help improve preterm children’s academic success, but randomized trials are rare. We tested whether a math training (XtraMath®) versus an active control condition (Cogmed®; working memory) improved school performance. Training feasibility was also evaluated. Methods: Preterm born first graders, N = 65 (28–35 + 6 weeks gestation) were recruited into a prospective randomized controlled multicenter trial and received one of two computerized trainings at home for 5 weeks. Teachers rated academic performance in math, reading/writing, and attention compared to classmates before (baseline), directly after (post), and 12 months after the intervention (follow-up). Total academic performance growth was calculated as change from baseline (hierarchically ordered—post test first, follow-up second). Results: Bootstrapped linear regressions showed that academic growth to post test was significantly higher in the math intervention group (B = 0.25 [95% confidence interval: 0.04–0.50], p = 0.039), but this difference was not sustained at the 12-month follow-up (B = 0.00 [−0.31 to 0.34], p = 0.996). Parents in the XtraMath group reported higher acceptance compared with the Cogmed group (mean difference: −0.49, [−0.90 to −0.08], p = 0.037). Conclusions: Our findings do not show a sustained difference in efficacy between both trainings. Studies of math intervention effectiveness for preterm school-aged children are warranted. Impact: Adaptive computerized math training may help improve preterm children’s short-term school performance. Computerized math training provides a novel avenue towards intervention after preterm birth. Well-powered randomized controlled studies of math intervention effectiveness for preterm school-aged children are warranted

Achtsamkeitsorientierte Ansätze der Suchtprävention und -therapie bei Kindern und Jugendlichen

Hintergrund: Das Jugendalter gilt als vulnerable Phase für die Entwicklung von Suchtstörungen und der Anteil von jungen Menschen, die davon betroffen sind, ist hoch. Für die Entstehung und Aufrechterhaltung abhängigen Verhaltens sind Probleme in der exekutiven Kontrolle und Regulation von Gefühlen, Gedanken und Verhalten zentral. Das Thema Achtsamkeit ist in der Öffentlichkeit sehr präsent. Zahlreiche Studien belegen den Nutzen achtsamkeitsbasierter Interventionsansätze zur Stärkung exekutiver Regulation von Stress und Verhaltensimpulsen bei Suchtstörungen sowie deren komorbider psychischer Begleitsymptomatik. Methoden: Selektive Literaturrecherche zu Achtsamkeit und substanzbezogenen Störungen bei Kindern und Jugendlichen. Ergebnisse: Bisherige Studien beziehen sich weitestgehend auf Erwachsene. Empirische Evidenz zur Einschätzung des suchtpräventiven und -therapeutischen Nutzens von Achtsamkeitsprogrammen bei Kindern und Jugendlichen fehlt bislang. Im Rahmen des laufenden Forschungsverbunds „IMAC-Mind: Verbesserung der psychischen Gesundheit und Verringerung von Suchtgefahr im Kindes- und Jugendalter durch Achtsamkeit: Mechanismen, Prävention und Behandlung“ werden multifaktorielle Risikoprofile für Suchterkrankungen untersucht und in achtsamkeitsorientierte Interventionsmodelle überführt. Schlussfolgerung: Der Beitrag leitet Forschungsbedarfe zu Suchterkrankungen und Achtsamkeit aus einer kinder- und jugendspezifischen Perspektive ab und informiert über die Teilprojekte