Protocol for a randomized controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: The Decentering in Adolescence Study (DECADES)

Introduction. Decentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (e.g. difficult thoughts, memories, and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap. Methods and analysis. Adolescents, recruited from partnering schools in the UK and the EU (n = 48 per group, age range = 16-19 years), will be randomised to complete of five-weeks of decentering training, or form an active control group that will take part in in light physical exercise and cognitive training. The co-primary training outcomes include a self-reported decentering inventory (i.e. the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological wellbeing. The initial statistical analysis will use mixed-model analysis of variance (ANOVA) to estimate the effect of training condition on self-rated inventories across three timepoints: baseline, mid-intervention and post-intervention. Additionally, experience sampling data will be initially interrogated using hierarchical linear models. Ethics and dissemination. This study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (intern)-national conferences, academic institutes and through publication in peer-reviewed journals.

Failure Analysis in Multiple TKA Revisions—Periprosthetic Infections Remain Surgeons’ Nemesis

Background: The aim of this study was to categorize reasons for failure and to analyze the survivorship of multiple total knee arthroplasty (TKA) revisions. Methods: The study retrospectively evaluated all multiple TKA revisions performed between 2005 and 2015 at the authors’ institutions. Sixty-three patients (35 female, 28 male, age 64 ± 10 years, follow-up 55 ± 36 months) underwent a total of 157 re-revision TKA surgeries (range 2–5). The revision indications were divided up into main diagnoses. Survivorship was evaluated by mixed model analysis. Results: The main overall reason for re-revision was periprosthetic joint infection (PJI) (48%), followed by instability (12%), polyethylene wear (11%), malpositioning (8%), and aseptic loosening (8%). Survivorship shortened with an increasing number of revision surgeries (p = 0.003). While PJI was in 38% of all cases, the reason for the first revision, incidence increased constantly with the number of revisions (48% at second revision, 55% at third revision, 86% at fourth revision, and 100% at fifth revision, p = 0.022). If periprosthetic infection caused the first revision, patients showed an average of two more septic revisions at follow-up than patients with an aseptic first revision indication (p < 0.001). In 36% of cases, the reason for follow-up surgery in case of periprosthetic infection was again PJI. Conclusion: The probability of survival of the implanted knee arthroplasty is significantly reduced with each subsequent revision. Periprosthetic infection is the main cause of multiple revisions.

Association between housing and health of refugees and asylum seekers in Germany: explorative cluster and mixed model analysis

Background Accommodation for asylum seekers and refugees (ASR) in Germany differs in many ways depending on a range of political, structural, social, and environmental factors. These contextual differences present a challenge for assessing health impacts of refugee accommodation. We aimed to devise a broad typology of refugee accommodation that allows to assess associations between housing and health of ASR. Methods We performed a cluster analysis of population-based, cross-sectional secondary data in Germany to identify clusters of refugee accommodation. We then assessed health disparities across clusters by performing bivariate analysis and linear mixed model regression analysis. Results We identified four clusters, three of them reflected different types of private accommodation and one pointed to collective accommodation. The collective accommodation cluster clearly differed from the private accommodation clusters in terms of space, area, level of restrictions, social connections and respondent satisfaction. Across private accommodation clusters we also found differences in space, area, and level of restrictions. In regression analysis, belonging to one of the private accommodation cluster was significantly associated with better mental health compared to belonging to the collective accommodation cluster. Physical health was significantly lower in one private accommodation cluster characterized by poor access to public transport and a higher level of restrictions compared to a private accommodation cluster showing better connections and a lower level of restrictions. Conclusion We demonstrate that unfavourable conditions cluster in collective accommodation with negative outcomes for mental health but not for physical health. We also found health disparities across types of private accommodation. We conclude that housing plays a role in the production of health inequalities in ASR but needs to be assessed in a differentiated, multidimensional way.

Emotional Prosody Recognition Enhances and Progressively Complexifies From Childhood to Adolescence

Background: Emotional prosody is the result of the dynamic variation of acoustical non-verbal aspects of language that allow people to convey and recognize emotions. Understanding how this recognition develops during childhood to adolescence is the goal of the present paper. We also aim to test the maturation of the ability to perceive mixed emotions in voice. Methods: We tested 133 children and adolescents, aged between 6 and 17 years old, exposed to 4 kinds of emotional (anger, fear, happiness, and sadness) and neutral linguistic meaningless stimuli. Participants were asked to judge the type and degree of perceived emotion on continuous scales. Results: By means of a general linear mixed model analysis, as predicted, a significant interaction between age and emotion was found. The ability to recognize emotions significantly increased with age for all emotional and neutral vocalizations. Girls recognized anger better than boys, who instead confused fear with neutral prosody more than girls did. Across all ages, only marginally significant differences were found between anger, happiness, and neutral versus sadness, which was more difficult to recognize. Finally, as age increased, participants were significantly more likely to attribute mixed emotions to emotional prosody, showing the progressive complexification of the emotional content representation that young adults perceived in emotional prosody. Conclusions: The ability to identify basic emotions from linguistically meaningless stimuli develops from childhood to adolescence. Interestingly, this maturation was not only evidenced in the accuracy of emotion detection, but also in a complexification of emotion attribution in prosody.

model-based radiostereometric analysis (RSA) randomized control trial evaluating the stability of the cementless Taperloc hip stem: the TapHip study

Background and purpose – The Taperloc Complete hip is the successor of the Taperloc hip, aiming to increase range of motion and optimizing femoral fit with intermediate stem sizes. We evaluated whether these design changes affect fixation, and this RSA study compares 2-year migration. Patients and methods – In this prospective, multi-arm study, 100 patients were randomized to cementless total hip arthroplasty (THA) with Taperloc Complete full profile (TCFP), Taperloc Complete reduced distal (TCRD), Taperloc full profile (TFP), or Taperloc reduced distal (TRD). Migration was measured with model-based RSA postoperatively, and after 3, 12, and 24 months. Results – Results based on mixed-model analysis on 2-year postoperative RSA data from 74 patients showed similar subsidence (mm) in the first 3 months (mean [95% CI] TCFP 0.44 [0.20–0.69], TCRD 0.91 [0.40–1.42], TFP 0.71 [0.22–1.19], TRD 1.25 [0.58–1.91]) and stabilization afterwards. The TCFP showed statistically significantly less retroversion (°) at 2-year postoperatively compared with TFP and TCRD (mean [95% CI] TCFP: –0.13 [–0.64 to 0.38], TCRD: 0.84 [0.35–1.33], TFP: 0.56 [0.12–1.00], TRD: 0.37 [–0.35 to 1.09]). Interpretation – As expected in successful cementless THA, RSA shows stabilization after initial subsidence. Based on these results the Taperloc Complete stem is expected to have similar long-term fixation to the Taperloc stems. The reduced distal groups have larger, but statistically non-significant, initial migration compared with the TCFP group, which could be due to implantation in Dorr B, C femur types. It may be important to consider the femur shape for choosing a full profile or reduced distal stem to minimize migration.

Discovery of Single Nucleotide Polymorphisms for Resistance to Abnormal Vertical Growth in Macadamia

Abnormal vertical growth (AVG) syndrome is a serious threat to the Australian macadamia industry as it decreases the yield of nuts by as much as 70% per annum. A lack of information on the cause of AVG has hindered the development of an effective disease management strategy. Discovery of genetic markers associated with disease resistance can be used as tool for rapid selection of elite cultivars, hence helps in efficient disease management. Differences in field susceptibility of macadamia cultivars provide an opportunity for discovery of genetic markers that are associated with host resistance. REML mixed model analysis was performed to estimate the AVG rating of 51 cultivars from multiple origins using phenotypic data from 359 trees planted in four sites. Most of the Hawaiian cultivars were found as susceptible, while selections from the Australian macadamia industry breeding program were predominantly resistant. All the cultivars were genotyped for 13,221 DArTseq-based single nucleotide polymorphism (SNP) markers. A bulked sample analysis was performed using 20 genotypes each at the extremes of AVG phenotypic ratings. Ten SNP markers were predicted to be associated with AVG resistance and two arbitrarily selected SNP markers were validated using PCR and Sanger sequencing. Our findings suggest that AVG resistance in the commercial cultivars may be derived from the genomic introgression of Macadamia tetraphylla through interspecific hybridization. The results may support marker-assisted selection for macadamia germplasm with AVG resistance.

The Sex Difference in Gait Speed: How Do Sociodemographic, Lifestyle, Social, and Health Determinants Contribute?

This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among women compared to men. Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55-81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3-4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) for socio-demographic, lifestyle, social and health determinants of gait speed. On average, women had a 0.054 m/s (95%CI:0.076-0.033, adjusted for height and age) lower mean gait speed compared to men. Higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). Lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In conclusion, both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among women aged 55 years and older. The identified (modifiable) contributing factors should be taking into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice.

Underestimation of Heritability across the Molecular Layers of the Gene Expression Process

We investigated the extent of the heritability underestimation for molecules from an infinitesimal model in mixed model analysis. To this end, we estimated the heritability of transcription, ribosome occupancy, and translation in lymphoblastoid cell lines from Yoruba individuals. Upon considering all genome-wide nucleotide variants, a considerable underestimation in heritability was observed for mRNA transcription (−0.52), ribosome occupancy (−0.48), and protein abundance (−0.47). We employed a mixed model with an optimal number of nucleotide variants, which maximized heritability, and identified two novel expression quantitative trait loci (eQTLs; p < 1.0 × 10−5): rs11016815 on chromosome 10 that influences the transcription of SCP2, a trans-eGene on chromosome 1—whose expression increases in response to MGMT downregulation-induced apoptosis, the cis-eGene of rs11016815—and rs1041872 on chromosome 11 that influences the ribosome occupancy of CCDC25 on chromosome 8 and whose cis-eGene encodes ZNF215, a transcription factor that potentially regulates the translation speed of CCDC25. Our results suggest that an optimal number of nucleotide variants should be used in a mixed model analysis to accurately estimate heritability and identify eQTLs. Moreover, a heterogeneous covariance structure based on gene identity and the molecular layers of the gene expression process should be constructed to better explain polygenic effects and reduce errors in identifying eQTLs.

Spectral organ fingerprints for intraoperative tissue classification with hyperspectral imaging

Visual discrimination of tissue during surgery can be challenging since different tissues appear similar to the human eye. Hyperspectral imaging (HSI) removes this limitation by associating each pixel with high-dimensional spectral information. While previous work has shown its general potential to discriminate tissue, clinical translation has been limited due to the method's current lack of robustness and generalizability. Specifically, it had been unknown whether variability in spectral reflectance is primarily explained by tissue type rather than the recorded individual or specific acquisition conditions. The contribution of this work is threefold: (1) Based on an annotated medical HSI data set (9,059 images from 46 pigs), we present a tissue atlas featuring spectral fingerprints of 20 different porcine organs and tissue types. (2) Using the principle of mixed model analysis, we show that the greatest source of variability related to HSI images is the organ under observation. (3) We show that HSI-based fully-automatic tissue differentiation of 20 organ classes with deep neural networks is possible with high accuracy (> 95 %). We conclude from our study that automatic tissue discrimination based on HSI data is feasible and could thus aid in intraoperative decision making and pave the way for context-aware computer-assisted surgery systems and autonomous robotics.