Servants of two (or more) masters: Accounting for the complexity of intraparty candidate selection methods

Intraparty candidate selection methods are the drivers of many topics of interest to political scientists. Their operationalization, however, is made complicated because they tend to involve multiple selectorates that differ in their levels of inclusiveness and centralization and that play various roles within the process. This complexity poses a challenge for large- n comparative studies. Drawing on the Political Parties DataBase Round Two to analyze candidate selection methods in 184 parties from 35 democracies, we highlight the inadequacy of the currently available measures to correctly account for this complexity in large- n studies and offer improvements on this front. Specifically, we propose a continuous measure of inclusiveness that better captures the complexity of candidate selection methods and a new measure of complexity to facilitate future analyses into this feature. We recommend that scholars in other cross-national projects consider adopting similar or improved coding strategies in order to better capture these complexities.

Language emergence can take multiple paths: Using motion capture to track axis use in Nicaraguan Sign Language

Research on emergent sign languages suggests that younger sign languages may make greater use of the z-axis, moving outwards from the body, than more established sign languages when describing the relationships between participants and events (Padden, Meir, Aronoff, and Sandler, 2010). This has been suggested to reflect a transition from iconicity rooted in the body (Meir, Padden, Aronoff, and Sandler, 2007) towards a more abstract schematic iconicity. We present the results of an experimental investigation into the use of axis by signers of Nicaraguan Sign Language (NSL). We analysed 1074 verb tokens elicited from NSL signers who entered the signing community at different points in time between 1974 and 2003. We used depth and motion tracking technology to quantify the position of signers’ wrists over time, allowing us to build an automated and continuous measure of axis use. We also consider axis use from two perspectives: a camera-centric perspective and a signer-centric perspective. In contrast to earlier work, we do not observe a trend towards increasing use of the x-axis. Instead we find that signers appear to have an overall preference for the z-axis. However, this preference is only observed from the camera-centric perspective. When measured relative to the body, signers appear to be making approximately equal use of both axes, suggesting the preference for the z-axis is largely driven by signers moving their bodies (and not just their hands) along the z-axis. We argue from this finding that language emergence patterns are not necessarily universal and that use of the x-axis may not be a prerequisite for the establishment of a spatial grammar.

Prevalence and burden of multiple sclerosis-related fatigue: a systematic literature review

Background Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS). Methods Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data. Results The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS. Conclusion Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.

Fear of Falling in Older Adults: A Scoping Review of Recent Literature

Background Fear of falling (FOF) is prevalent among older adults and associated with adverse health outcomes. Over recent years a substantial body of research has emerged on its epidemiology, associated factors, and consequences. This scoping review summarizes the FOF literature published between April 2015 and March 2020 in order to inform current practice and identify gaps in the literature. Methods A total of 439 articles related to FOF in older adults were identified, 56 selected for full-text review, and 46 retained for data extraction and synthesis. Results The majority of included studies were cross-sectional. Older age, female sex, previous falls, worse physical performance, and depressive symptoms were the factors most consistently associated with FOF. Studies that measured FOF with a single question reported a significantly lower prevalence of FOF than those using the Falls Efficacy Scale, a continuous measure. FOF was associated with higher likelihoods of future falls, short-term mortality, and functional decline. Conclusions Comparisons between studies were limited by inconsistent definition and measurement of FOF, falls, and other characteristics. Consensus on how to measure FOF and which participant characteristics to evaluate would address this issue. Gaps in the literature include clarifying the relationships between FOF and cognitive, psychological, social, and environmental factors.

Hysteretic device characteristics indicate cardiac contractile state for guiding mechanical circulatory support device use

Background Acute heart failure and cardiogenic shock remain highly morbid conditions despite prompt medical therapy in critical care settings. Mechanical circulatory support (MCS) is a promising therapy for these patients, yet remains managed with open-loop control. Continuous measure of cardiac function would support and optimize MCS deployment and weaning. The nature of indwelling MCS provides a platform for attaining this information. This study investigates how hysteresis modeling derived from MCS device signals can be used to assess contractility changes to provide continuous indication of changing cardiac state. Load-dependent MCS devices vary their operation with cardiac state to yield a device–heart hysteretic interaction. Predicting and examining this hysteric relation provides insight into cardiac state and can be separated by cardiac cycle phases. Here, we demonstrate this by predicting hysteresis and using the systolic portion of the hysteresis loop to estimate changes in native contractility. This study quantified this measurement as the enclosed area of the systolic portion of the hysteresis loop and correlated it with other widely accepted contractility metrics in animal studies (n = 4) using acute interventions that alter inotropy, including a heart failure model. Clinical validation was performed in patients (n = 8) undergoing Impella support. Results Hysteresis is well estimated from device signals alone (r = 0.92, limits of agreement: − 0.18 to 0.18). Quantified systolic area was well correlated in animal studies with end-systolic pressure–volume relationship (r = 0.84), preload recruitable stroke work index (r = 0.77), and maximum slope of left ventricular pressure (dP/dtmax) (r = 0.95) across a range of inotropic conditions. Comparable results were seen in patients with dP/dtmax (r = 0.88). Diagnostic capability from ROC analysis yielded AUC measurements of 0.92 and 0.90 in animal and patients, respectively. Conclusions Mechanical circulatory support hysteretic behavior can be well modeled using device signals and used to estimate contractility changes. Contractility estimate is correlated with other accepted metrics, captures temporal trends that elucidate changing cardiac state, and is able to accurately indicate changes in inotropy. Inherently available during MCS deployment, this measure will guide titration and inform need for further intervention.

Exploring the Relationship between Demographic Isolation and Professional Experiences of Black and Latinx Teachers

Educational leaders throughout the United States have repeatedly emphasized the importance of increasing the number of Black and Latinx teachers in American schools. Prior qualitative work suggests that Black and Latinx teachers who are demographically isolated in their schools often report negative experiences. Drawing on theories of proportional representation in organizations, we use Tennessee statewide survey and administrative data to examine whether self-reported professional experiences of Black and Latinx teachers are different when they are demographically isolated. We estimate models using two measures of demographic isolation: a continuous measure and a theoretically generated ordinal measure. We find that, for Black teachers, the percentage of Black teachers in the school is positively associated with teachers’ perceived satisfaction and support and with the frequency of collaboration. There is also some evidence of threshold effects of demographic isolation for Black teachers, as Black teachers in schools in which at least 60% of fellow teachers are Black report significantly higher satisfaction and support than other Black teachers. Our models do not find any associations between isolation and professional experience for Latinx teachers, but a small sample size and lack of variation in demographic isolation among Latinx teachers makes it difficult to estimate these associations. Our findings suggest that both ordinal and continuous measures of demographic isolation may be useful when examining relationships between demographic isolation and workplace experiences. Because we study factors linked to turnover in prior research, these analyses can contribute to the broader discussion about the retention of Black and Latinx teachers.

Systematic Review and Meta-Analysis of L-Methylfolate Augmentation in Depressive Disorders

Objectives Partial response to pharmacotherapy is common in major depressive disorder (MDD) and many patients require alternative pharmacotherapy or augmentation, including adjunctive L-methylfolate. Given that L-methylfolate augmentation is rarely included in major clinical practice guidelines, we sought to systematically review evidence for L-methylfolate augmentation in adults with MDD and to examine its efficacy meta-analytically. Methods We systematically searched PubMed for articles up to December 31, 2020, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. Included studies were published in peer-reviewed, English-language journals and examined L-methylfolate adjunctive therapy in depressive disorders or its effect on antidepressant response. A fixed- and random-effects meta-analysis and risk of bias assessment using the Cochrane Risk of Bias Tool were conducted. Results Qualitative assessment of nine articles (N=6,707 patients) suggests that adjunctive L-methylfolate improved antidepressant response. In the meta-analysis of categorical Hamilton Rating Scale for Depression-17 response, (three studies, N=483) adjunctive L-methylfolate was associated with a small effect versus antidepressant monotherapy (relative risk: 1.25, 95% confidence interval [CI]=1.08 to 1.46, p=0.004). A meta-analysis of four studies (N=507) using a continuous measure of depressive symptoms showed a similar effect of adjunctive L-methylfolate (standardized mean difference=− 0.38, 95% CI=− 0.59 to−0.17, p=0.0003). Conclusion Adjunctive L-methylfolate may have modest efficacy in antidepressant-treated adults with MDD.

Fatigue in Incident Peritoneal Dialysis and Mortality: A Real-World Side-by-Side Study in Brazil and the United States

Background: We tested if fatigue in incident Peritoneal Dialysis associated with an increased risk for mortality, independently from main confounders. Methods: We conducted a side-by-side study from two of incident PD patients in Brazil and the United States. We used the same code to independently analyze data in both countries during 2004 to 2011. We included data from adults who completed KDQOL-SF vitality subscale within 90 days after starting PD. Vitality score was categorized in four groups: >50 (high vitality), >=40 to <=50 (moderate vitality), >35 to <40 (moderate fatigue), <=35 (high fatigue; reference group). In each country's cohort, we built four distinct models to estimate the associations between vitality (exposure) and all-cause mortality (outcome): (i) Cox regression model; (ii) competitive risk model accounting for technique failure events; (iii) multilevel survival model of clinic-level clusters; (iv) multivariate regression model with smoothing splines treating vitality as a continuous measure. Analyses were adjusted for age, comorbidities, PD modality, hemoglobin, and albumin. A mixed-effects meta-analysis was used to pool hazard ratios (HRs) from both cohorts to model mortality risk for each 10-unit increase in vitality. Results: We used data from 4,285 PD patients (Brazil n=1,388 and United States n=2,897). Model estimates showed lower vitality levels within 90 days of starting PD were associated with a higher risk of mortality, which was consistent in Brazil and the United States cohorts. In the multivariate survival model, each 10-unit increase in vitality score was associated with lower risk of all-cause mortality in both cohorts (Brazil HR=0.79 [95%CI 0.70 to 0.90] and United States HR=0.90 [95%CI 0.88 to 0.93], pooled HR=0.86 [95%CI 0.75 to 0.98]). Results for all models provided consistent effect estimates. Conclusions: Among patients in Brazil and the United States, lower vitality score in the initial months of PD was independently associated with all-cause mortality.

Low Etanercept Concentrations in Children With Obesity and Juvenile Idiopathic Arthritis

OBJECTIVE To evaluate the impact of obesity on etanercept (ETN) drug exposure in children with juvenile idiopathic arthritis (JIA). METHODS We conducted a pilot, cross-sectional, observational study in a real-world cohort of children with JIA receiving ETN as standard of care from a single center. We analyzed the relationship between body size and ETN plasma concentrations, adjusting for dosage. Body size was analyzed as a continuous measure using weight and body mass index (BMI) percentiles and categorically using BMI percentile classifications according to the CDC guidelines. RESULTS We enrolled a total of 29 children. Each child provided one plasma sample for ETN concentration measurement, and all participants were receiving subcutaneous ETN dosed weekly. We observed that the ETN concentration normalized for dose decreased significantly as a function of weight (p = 0.004) and BMI percentile (p = 0.04). Similarly, we observed a progressive decline in mean and median dose-normalized concentrations across higher body size categories. Because of reaching maximum ETN dosage (50 mg), 7 of 8 children (87.5%) with obesity received a weight-based dosage &lt; 0.8 mg/kg/dose. CONCLUSIONS We found that higher body weight and BMI percentile are significantly and negatively associated with ETN drug serum concentration, accounting for differences in dosing. Our data suggest that children who are obese may be routinely under-dosed using current dosing strategies. Inadequate dosing may increase the risk for therapeutic failure and long-term morbidity in a developing child. As a result, characterizing adequate drug exposure in children of all sizes is an important step toward precision dosing.

Informational Measure of Symmetry vs. Voronoi Entropy and Continuous Measure of Entropy of the Penrose Tiling. Part II of the “Voronoi Entropy vs. Continuous Measure of Symmetry of the Penrose Tiling”

The notion of the informational measure of symmetry is introduced according to: Hsym(G)=−∑i=1kP(Gi)lnP(Gi), where P(Gi) is the probability of appearance of the symmetry operation Gi within the given 2D pattern. Hsym(G) is interpreted as an averaged uncertainty in the presence of symmetry elements from the group G in the given pattern. The informational measure of symmetry of the “ideal” pattern built of identical equilateral triangles is established as Hsym(D3)= 1.792. The informational measure of symmetry of the random, completely disordered pattern is zero, Hsym=0. The informational measure of symmetry is calculated for the patterns generated by the P3 Penrose tessellation. The informational measure of symmetry does not correlate with either the Voronoi entropy of the studied patterns nor with the continuous measure of symmetry of the patterns. Quantification of the “ordering” in 2D patterns performed solely with the Voronoi entropy is misleading and erroneous.