Applying Neural Network Models to Predict Recurrent Maltreatment in Child Welfare Cases with Static and Dynamic Risk Factors

Risk assessment in child welfare has a long tradition of being based on models that assume the likelihood of recurrent maltreatment is a linear function of its various predictors: Gambrill & Shlonsky, 2000). Despite repeated testing of many child, parent, family, maltreatment incident, and service delivery variables, no consistent set of findings have emerged to describe the set of risk and protective factors that best account for increases and decreases in the likelihood of recurrent maltreatment. Shifts in predictors\u27 statistical significance, strength, and direction of effects coupled with evidence of risk assessment models\u27 poor predictive accuracy have led to questions regarding the fit between assumptions of linearity and the true relationship between the likelihood of recurrent maltreatment and its predictors: Gambrill & Shlonsky, 2000, 2001; Knoke & Trocmé, 2005). Hence, this dissertation study uses a distinctly nonlinear approach to modeling the likelihood of recurrent maltreatment by employing a combination of random forest and neural network models to identify the predictors that best explain the risk of recurrent maltreatment. The risk of recurrent maltreatment was assessed for a cohort of children living in a large Midwestern metropolitan area who were first reported for maltreatment between January 1, 1993 and January 1, 2002. Administrative child welfare records for 6,747 children were merged with administrative records from income maintenance, mental health, special education, juvenile justice, and criminal justice systems in order to identify the effects that various public sector service system contacts have on the risk of recurrent maltreatment. Each child was followed for a period of at least seven years to identify the risk of recurrent maltreatment in relationship to a second report for maltreatment. Post-hoc analyses comparing the predictive validity of the neural network model and a binary logistic regression model with random intercepts shows that the neural network model was superior in its predictive validity with an area under the ROC curve of 0.7825 in comparison with an area under the ROC curve of 0.7552 for the logistic regression model. Additional post-hoc analyses provided empirical insight into the four prominent risk factors and four risk moderating service variables that best explain variation in the risk of recurrent maltreatment. Specifically, the number of income maintenance spells received, community-level poverty, the child\u27s age at the first maltreatment report, and the parent\u27s status as the perpetrator of the first maltreatment incident defined 21 risk-based groups where the average probability of recurrent maltreatment was dependent upon values for the four primary risk factors, and the risk of maltreatment was moderated by juvenile court involvement, special education eligibility, receipt of CPS family centered services, and the child\u27s receipt of a mental health/substance abuse service in the community. Findings are discussed within a Risk-Need-Responsivity theory of service delivery: Andrews & Bonta, 2006), which links the empiricism of risk assessment with the clinical implementation of a preventive service delivery plan through the identified modifiable risk factors that drive the likelihood of recurrent maltreatment

Elevated blood pressure, heart rate and body temperature in mice lacking the XL alpha s protein of the Gnas locus is due to increased sympathetic tone

NEW FINDINGS: What is the central question of this study? Previously, we showed that Gnasxl knock-out mice are lean and hypermetabolic, with increased sympathetic stimulation of adipose tissue. Do these mice also display elevated sympathetic cardiovascular tone? Is the brain glucagon-like peptide-1 system involved? What is the main finding and its importance? Gnasxl knock-outs have increased blood pressure, heart rate and body temperature. Heart rate variability analysis suggests an elevated sympathetic tone. The sympatholytic reserpine had stronger effects on blood pressure, heart rate and heart rate variability in knock-out compared with wild-type mice. Stimulation of the glucagon-like peptide-1 system inhibited parasympathetic tone to a similar extent in both genotypes, with a stronger associated increase in heart rate in knock-outs. Deficiency of Gnasxl increases sympathetic cardiovascular tone. Imbalances of energy homeostasis are often associated with cardiovascular complications. Previous work has shown that Gnasxl-deficient mice have a lean and hypermetabolic phenotype, with increased sympathetic stimulation of adipose tissue. The Gnasxl transcript from the imprinted Gnas locus encodes the trimeric G-protein subunit XLαs, which is expressed in brain regions that regulate energy homeostasis and sympathetic nervous system (SNS) activity. To determine whether Gnasxl knock-out (KO) mice display additional SNS-related phenotypes, we have now investigated the cardiovascular system. The Gnasxl KO mice were ∼20 mmHg hypertensive in comparison to wild-type (WT) littermates (P≤ 0.05) and hypersensitive to the sympatholytic drug reserpine. Using telemetry, we detected an increased waking heart rate in conscious KOs (630 ± 10 versus 584 ± 12 beats min(−1), KO versus WT, P≤ 0.05). Body temperature was also elevated (38.1 ± 0.3 versus 36.9 ± 0.4°C, KO versus WT, P≤ 0.05). To investigate autonomic nervous system influences, we used heart rate variability analyses. We empirically defined frequency power bands using atropine and reserpine and verified high-frequency (HF) power and low-frequency (LF) LF/HF power ratio to be indicators of parasympathetic and sympathetic activity, respectively. The LF/HF power ratio was greater in KOs and more sensitive to reserpine than in WTs, consistent with elevated SNS activity. In contrast, atropine and exendin-4, a centrally acting agonist of the glucagon-like peptide-1 receptor, which influences cardiovascular physiology and metabolism, reduced HF power equally in both genotypes. This was associated with a greater increase in heart rate in KOs. Mild stress had a blunted effect on the LF/HF ratio in KOs consistent with elevated basal sympathetic activity. We conclude that XLαs is required for the inhibition of sympathetic outflow towards cardiovascular and metabolically relevant tissues

Using Wearable Technology to Quantify Physical Activity Recovery: Secondary Report From the AFTER (App-Facilitated Tele-Rehabilitation) Program for COVID-19 Survivors Randomized Study

Background: Knowledge on physical activity recovery after COVID-19 survival is limited. The AFTER (App-Facilitated Tele-Rehabilitation) program for COVID-19 survivors randomized participants, following hospital discharge, to either education and unstructured physical activity or a telerehabilitation program. Step count data were collected as a secondary outcome, and we found no significant differences in total step count trajectories between groups at 6 weeks. Further step count data were not analyzed. Objective: The purpose of this analysis was to examine step count trajectories and correlates among all participants (combined into a single group) across the 12-week study period. Methods: Linear mixed models with random effects were used to model daily steps over the number of study days. Models with 0, 1, and 2 inflection points were considered, and the final model was selected based on the highest log-likelihood value. Results: Participants included 44 adults (41 with available Fitbit [Fitbit LLC] data). Initially, step counts increased by an average of 930 (95% CI 547-1312; PPPP Conclusions: Participants showed a marked improvement in daily step counts during the first 3 weeks of the study, followed by more gradual improvement in the remaining 9 weeks. Physical activity data and step count recovery trajectories may be considered surrogates for physiological recovery, although further research is needed to examine this relationship

The health profile of people living with Parkinson\u27s Disease managed in a comprehensive care setting

Background: Globally there are few reports of the impairments, disabilities and medications used in people living with idiopathic Parkinson’s disease. Caregiver characteristics and caregiver burden have seldom been reported. We examined the health status in a large cohort of people living with Parkinson’s disease and their caregivers managed in a comprehensive health care setting. Methods/Design: A prospective, cross sectional analysis of impairments, disabilities and Parkinson’s disease medication use was conducted in a sample of 100 people with Parkinson’s disease rated I-IV on the modified Hoehn & Yahr scale. Participants were recruited from the Victorian Comprehensive Parkinson Program in Melbourne, Australia. Their caregivers were invited to provide their views on the burden of care, services provided and support received. Results: The severity of impairments and disabilities was strongly associated with disease duration (mean of 5.5 years). Those with long standing disease or more severe disease also used more Parkinson’s disease medications and participated in fewer social roles than people who were newly diagnosed or mildly affected. The severity of impairments was strongly correlated with limitations in performing activities of daily living. Limitations in performing daily activities were also found to be a significant contributing factor for health-related quality of life (PDQ-39 SI β=0.55, p=0.000; EQ-5D SI β=0.43, p=0.001). People with Parkinson’s disease lived at home with relatives. The average caregiver was a spouse or child providing approximately 3.5 hours of care per day, with the capacity to provide 9.4 hours per day and had provided care for four years. Additional support was high (63%) for 2.5 hours per day. Conclusion: The comprehensive care setting of this cohort describes a relatively benign condition despite a wide range of disease duration and severity. This report provides a baseline with which to compare other delivery models

Prospective Telehealth Analysis of Functional Performance, Frailty, Quality of Life, and Mental Health after COVID-19 hospitalization

Background COVID-19 is a global pandemic with poorly understood long-term consequences. Determining the trajectory of recovery following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation. The purpose of this study was to prospectively evaluate recovery following COVID-19 hospitalization. Methods Participants age 18 years or older who were hospitalized for ≥24 h due to COVID-19 completed phone/video call virtual assessments (including the 10-time chair rise test) and survey forms at three time points (2–6, 12, and 18 weeks) after hospital discharge. Univariate logistic and linear regression models assessed the associations of the outcomes with primary predictors (categorical age, sex, race/ethnicity group, and categorical pre-hospitalization frailty) at baseline; the same were used to assess differences in change from week 2–6 (continuous outcomes) or outcome persistence/worsening (categorical) at last contact. Results One hundred nine adults (age 53.0 [standard deviation 13.1]; 53% female) participated including 43 (39%) age 60 or greater; 59% identified as an ethnic and/or racial minority. Over 18 weeks, the mean time to complete the 10-time chair rise test decreased (i.e., improved) by 6.0 s (95% CI: 4.1, 7.9 s; p \u3c 0.001); this change did not differ by pre-hospital frailty, race/ethnicity group, or sex, but those age ≥ 60 had greater improvement. At weeks 2–6, 67% of participants reported a worse Clinical Frailty Scale category compared to their pre-hospitalization level, whereas 42% reported a worse frailty score at 18 weeks. Participants who did not return to pre-hospitalization levels were more likely to be female, younger, and report a pre-hospitalization category of ‘very fit’ or ‘well’. Conclusions We found that functional performance improved from weeks 2–6 to 18 weeks of follow-up; that incident clinical frailty developed in some individuals following COVID-19; and that age, sex, race/ethnicity, and pre-hospitalization frailty status may impact recovery from COVID-19. Notably, individuals age 60 and older were more likely than those under age 45 years to return to their pre-hospitalization status and to make greater improvements in functional performance. The results of the present study provide insight into the trajectory of recovery among a representative cohort of individuals hospitalized due to COVID-19. Background Coronavirus disease (COVID)-19 is a global pandemic with poorly understood long-term consequences. Recent data suggest that even mild cases of COVID-19 can result in significant long-term morbidity [1]. Determining the trajectory of recovery in patients following COVID-19 hospitalization is critical for prioritizing care, allocating resources, facilitating prognosis, and informing rehabilitation

Drug and alcohol trajectories among adults with schizophrenia: Data from the CATIE study

The primary aim is to describe drug and alcohol trajectories in adults with schizophrenia