A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

Purpose: We aimed to construct a nonlinear regression model through Extreme Gradient Boost (XGBoost) to predict functional outcome 1 year after surgical decompression for patients with acute spinal cord injury (SCI).Methods: We prospectively enrolled 249 patients with acute SCI from 5 primary orthopedic centers from June 1, 2016, to June 1, 2020. We identified a total of 6 predictors with three aspects: 1) clinical characteristics, including age, American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission, level of injury and baseline ASIA motor score (AMS); 2) MR imaging, mainly including Brain and Spinal Injury Center (BASIC) score; 3) surgical timing, specifically comparing whether surgical decompression was received within 24 hours or not. We assessed the SCIM score at 1 year after the operation as the functional outcome index. XGBoost was used to build a nonlinear regression prediction model through the method of boosting integrated learning.Results: We successfully constructed a nonlinear regression prediction model through XGBoost and verified the credibility. The average absolute value of the difference between the predicted value and the actual value is 3.72 (t=1.29, P=0.203), ranging from 0 to 8.44. AMS and age ranked first and second in predicting the functional outcome.Conclusion: We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and we found that age and AMS play the most important role in predicting the functional outcome.Trial registration: ClinicalTrials.gov identifier: NCT03103516.

Quality of Life After Definitive Linear Accelerator-based Stereotactic Radiotherapy for Prostate Cancer: a Longitudinal Study

Background: Prostate cancer is the second most common malignancy worldwide, and the majority of patients are diagnosed with localized disease. We examined patients’ quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer. Method: We included patients who were treated between 2016 and 2020. Inclusion criteria were adenocarcinoma of the prostate; class risk of low, intermediate, and high; and a World Health Organization performance status of 0–2. Quality of life was measured using the Functional Assessment of Cancer Therapy-Prostate (FACT-P). Results: A total of 439 patients were treated with SBRT, with a median age of 73 years old. The median follow-up period was 34 months. FACT-P Trial Outcome Index (p < 0.0001), FACT-General (p = 0.0003), and FACT-P-Total (p < 0.0001) scores declined at 1 month post-SBRT, then recovered and returned to the same level as before treatment at 3–4 months post-SBRT. The decrease in quality of life in the first month was particularly remarkable in patients who received long-term hormone injections (36%). One month after the end of SBRT, about 22% of patients experienced "quite a bit” or more troubling side effects. Conclusions: This study showed longitudinal changes in quality of life by FACT-P after SBRT for prostate cancer. Overall, prostate SBRT was well tolerated.

A mixed methods exploration of the role of multi-family groups in community treatment of patients with depression and anxiety in Pakistan

Background An open, non-controlled trial was conducted to explore the feasibility, experiences and outcomes of multi-family groups in community mental health care of patients with depression and anxiety. Methods The study was conducted in community settings within the catchment area of a free of cost primary care center in Karachi, Pakistan. 30 patients with symptoms of depression and anxiety, their caregivers and 3 lay counsellors were recruited enrolled in the study between May–September 2019. Patients were enrolled for monthly multi-family group meetings conducted over 6 months in groups of 5–6 patients and 1–2 nominated caregivers each. Meetings were facilitated by the non-specialist trained counsellors. The primary outcome was quality of life (assessed using Manchester Short Assessment of Quality of Life) and secondary outcomes were symptoms of depression and anxiety (assessed on Aga Khan University Depression and Anxiety Scale), social outcomes (Social Outcome Index), and caregiver burden (Burden Assessment Scale). Change in all measures was assessed pre and 6-month post intervention using t-test. In-depth interviews were conducted with 7 patients, 7 caregivers and the 3 lay counsellors. Results A total of 36 family intervention meetings were conducted with six groups with a total of 30 patients, 34 caregivers and 3 counsellors. Between baseline and the end of the intervention, subjective quality of life increased significantly from 3.34 to 4.58 (p < 0.001, 95% CI 0.93–1.54). Self-reported depression and anxiety scores reduced from 34.7 to 19.5 (p < 0.001, 95% CI 10.8–19.8) and the Social Outcome Index improved from 3.63 to 4.52 (p < 0.001, 95% CI 0.39–1.39). There was no change in family burden. Participants reported that the group meetings were seen as a safe space for shared learning, and that the experience helped improve self-regulation of emotions and behaviors and instilled a sense of belonging. Conclusion Multi-family groups in community treatment of common mental health disorders facilitated by non-specialist mental health service providers is feasible, experienced positively and has the potential for large and positive effects on subjective quality of life, self-reported depression and anxiety, and objective social outcomes. Trial Registration: ISRCTN, ISRCTN12299326. Registered 05 June 2019. Retrospectively registered, https://doi.org/10.1186/ISRCTN12299326.

Combination between Mifepristone and Methotrexate to Treat Ectopic Pregnancy: A Systematic Review Protocol

Background: In recent years, the morbidity of ectopic pregnancy and the proportion of young and childless patients have increased year by year, which makes it important to early diagnose EP, effectively save patients' lives and furthest preserve their fertility. Methotrexate and mifepristone are most widely used in conservative treatments, however, there is no accurate conclusion about which therapy is better. Therefore, the aims in this meta-analysis are, on the one hand, to systematically analyze the efficacy of mifepristone combined with methotrexate in the treatment of ectopic pregnancy through existing studies, and to draw scientific conclusions. On the other hand, to fill the gap of relevant analysis in China and abroad, to evaluate the advantages and disadvantages of inclusion trials and propose improvement measures and scientific designing schemes. Methods: Six electronic databases will be searched, including PubMed, Embase, Cochrane Library, the China National Knowledge Infrastructure(CNKI), Chinese Science and Technology Periodical Database (VIP), and Wanfang Database (WF). Literature from October 2015 to October 2020 on randomized controlled trials will be searched, without any language or publication restriction. Search terms include mifepristone, methotrexate, ectopic pregnancy, and random (free word/synonym expansion). Included in a randomized controlled trial, the treatment group was treated with mifepristone combined with methotrexate, and the control group was treated with mifepristone alone. Revman 5.4 (provided by Cochrane) will be used to evaluate the quality of the literature, and the corresponding effect model will be selected to analyze the results. The cure rate will be the main outcome index, and the remaining outcome measures after literature inclusion will be the secondary outcome indexes. Result: Only when we finish this meta-analysis can we get the result. Discussion: The results of this study will provide reliable evidence for the efficacy of mifepristone combined with methotrexate therapy in the treatment of ectopic pregnancy.

A Functional Outcome Prediction Model of Acute Traumatic Spinal Cord Injury Based on Extreme Gradient Boost

Purpose: We aimed to construct a nonlinear regression model through Extreme Gradient Boost (XGBoost) to predict functional outcome 1 year after surgical decompression for patients with acute spinal cord injury (SCI).Methods: We prospectively enrolled 249 patients with acute SCI from 5 primary orthopedic centers from June 1, 2016, to June 1, 2020. We identified a total of 6 predictors with three aspects: 1) clinical characteristics, including age, American Spinal Injury Association (ASIA) Impairment Scale (AIS) at admission, level of injury and baseline ASIA motor score (AMS); 2) MR imaging, mainly including Brain and Spinal Injury Center (BASIC) score; 3) surgical timing, specifically comparing whether surgical decompression was received within 24 hours or not. We assessed the SCIM score at 1 year after the operation as the functional outcome index. XGBoost was used to build a nonlinear regression prediction model through the method of boosting integrated learning.Results: We successfully constructed a nonlinear regression prediction model through XGBoost and verified the credibility. The average absolute value of the difference between the predicted value and the actual value is 3.72 (t=1.29, P=0.203), ranging from 0 to 8.44. AMS and age ranked first and second in predicting the functional outcome.Conclusion: We verified the feasibility of using XGBoost to construct a nonlinear regression prediction model for the functional outcome of patients with acute SCI, and we found that age and AMS play the most important role in predicting the functional outcome.Trial registration: ClinicalTrials.gov identifier: NCT03103516.

Maternal health and health-related behaviours and their associations with child health: Evidence from an Australian birth cohort

Objective This study investigates the associations between maternal health and health-related behaviours (nutrition, physical activity, alcohol consumption and smoking) both during pregnancy and up to 15 months from childbirth and children’s health outcomes during infancy and adolescence (general health, presence of a chronic illness, and physical health outcome index). Methods This study used Wave 1 (2004) and Wave 7 (2016) data from the Longitudinal Survey of Australian Children (LSAC). We measured mothers’ general health, presence of a medical condition during pregnancy and mental health during pregnancy or in the year after childbirth. We subsequently measured the children’s general health, presence of a medical condition, and physical health outcome index at ages 0–1 (infancy) and 12–13 (adolescence). Binary logistic and linear regression analyses were performed to examine the association between the mothers’ health-related variables and their children’s health. Results Our results showed that poor general health of the mother in the year after childbirth was associated with higher odds of poor health in infants and adolescents in all three dimensions: poor general health (OR: 3.13, 95% CI: 2.16–4.52 for infants; OR: 1.39, 95% CI: 0.95–2.04 for adolescents), presence of a chronic condition (OR: 1.47, 95% CI: 1.19–1.81 for adolescents) and lower physical health score (b = −0.94, p-value <0.05 for adolescents). Our study also revealed that the presence of a chronic condition in mothers during pregnancy significantly increased the likelihood of the presence of a chronic condition in their offspring during infancy (OR: 1.31, 95% CI: 1.12–1.54) and during adolescence (OR: 1.45, 95% CI: 1.20–1.75). The study found that stressful life events faced by mothers increase the odds of poor general health or any chronic illness during adolescence, while stress, anxiety or depression during pregnancy and psychological distress in the year after childbirth increase the odds of any chronic illness during infancy. Conclusions The present study found evidence that poor maternal physical and mental health during pregnancy or up to 15 months from childbirth has adverse health consequences for their offspring as measured by general health, presence of chronic health conditions, and physical health index scores. This suggests that initiatives to improve maternal physical and mental health would not only improve child health but would also reduce the national health burden.

Retrospective Cohort Study of Neonatal Blood Transfusion in China

Background: Blood transfusion treatment is extremely important for newborns，but the threshold of neonatal blood transfusion is not same in different countries, which may be due to differences in regions, races and nationalities, as well as medical conditions and treatment methods. Up to now, there are not enough clinical studies and prospective follow-up to determine the suitable threshold for Chinese newborns. Therefore, it is important to establish a retrospective and prospective multicenter cohort study to evaluate whether the blood transfusion scheme is suitable for newborns in China.Methods: This is a retrospective cohort study of neonatal blood transfusion and prospective follow-up from January 1, 2017 to June 30, 2021, aim to evaluate the effect of restricted and unrestricted blood transfusion on neonatal health. Diagnosis and blood transfusion data of 5,669 newborns between January 1, 2017 and June 30, 2018 from 46 hospitals in China were analyzed through retrospective study and followed up for 1w,1m and 3y after discharge. The variable data of newborns and their mothers was collected in this cohort study with 280 variables and 2.98 million data volumes including in the database. The primary outcome index of the study was death, and the secondary outcome index was complications during hospitalization, hospitalization time, NICU hospitalization days and hospitalization expenses.Discussion: The groups were grouped by birth weight, and each group was defined as a restricted and unrestricted cohort according to the Recommended Program for Neonatal Blood Transfusion (5th Edition), and evaluate applicability of this scheme for Chinese newborns based on outcome indicators. According to the neonatal treatment data, a appropriate neonatal blood transfusion threshold and neonatal blood transfusion program for China would be determined.

Use of Robotic Pet in a Distributed Layout Elderly Housing with Services: A Case Study on Elderly People with Cognitive Impairment

In recent years, robotic pets have been used by many countries worldwide as a method for treating behavioral and psychological symptoms of dementia (BPSD). The seal robot PARO was loaned intermittently to a distributed layout elderly housing with services over a seven-month period, during which it was observed that three residents with cognitive dysfunctions showed improvements in their BPSD and the nursing care load of the staff was reduced during the periods when PARO was present. The objective of this study is to investigate, through a case study, the effects of intermittent interaction with PARO on those with cognitive dysfunctions and the staff workers. The short version of the Dementia Behavior Disturbance Scale (DBD-13) was used as the medical outcome index, and the KJ method was used to analyze the qualitative data, such as staff reports and interviews. The results show that the DBD-13 total scores reduced during the periods when PARO was present and increased during the periods when PARO was absent. The KJ method yielded similar findings. The use of DBD-13 and the KJ method complemented the results of each other and increased the persuasive power of the findings. By using the KJ method, it was further determined that the workload of the staff was reduced, allowing them to recuperate, which reconfirmed the value of PARO. Further case studies will be undertaken in the future with the aim of constructing a methodology for implementing case studies.

Health-related quality of life (HRQoL) in patients (pts) with myelodysplastic syndromes (MDS) in the Connect Myeloid Disease Registry.

7040 Background: At diagnosis, disease risk and transfusion burden (TB) can impact HRQoL in pts with MDS. The impact of disease status and higher transfusion requirements on HRQoL has not been well studied. We used data from the Connect Myeloid Disease Registry, an ongoing, prospective, observational cohort study that includes adult pts with lower-risk (LR) and higher-risk (HR) MDS, to investigate factors influencing baseline (BL) and subsequent HRQoL. Methods: BL and Month 6 (M6) data from pts enrolled from Dec 12, 2013 to Mar 6, 2020 (data cutoff) were analyzed. Pts were stratified by International Prognostic Scoring System (IPSS) risk (LR, HR), treatment (Tx) within 45 days post-enrollment (no Tx, best supportive care [BSC], active Tx), and TB 16 weeks post-BL (non-transfusion dependent [NTD], low TB [LTB]; 1−3 transfusions, high TB [HTB]: ≥4 transfusions). Pts completed EQ-5D, FACT-An trial outcome index (TOI), and FACT-Fatigue (FACT-F) questionnaires at BL and quarterly thereafter. Clinically meaningful change, based on minimally important differences, was defined as a change of ±0.07 for EQ-5D, ±6 for FACT-An TOI, and ±3 for FACT-F. Results: At data cutoff, 830 (489 LR, 341 HR) pts were enrolled. Median age was 74 years. 278 pts received no initial Tx, 161 BSC, and 378 active Tx. At BL, 470 were NTD, 197 LTB, and 163 HTB. Of 670 pts still on-study at M6, 462 completed the questionnaires at both BL and M6. At BL , clinically meaningful differences were observed in FACT-An TOI and FACT-F scores, but not EQ-5D, between LR- and HR-MDS and the Tx subgroups . From BL to M6, no clinically meaningful changes were observed in mean scores for each questionnaire. For the TB subgroups, meaningful differences were observed at BL in FACT-An TOI and FACT-F scores, but not EQ-5D (Table). From BL to M6, meaningful decreases in scores were reported by 26%, 30%, and 35% of NTD, LTB, and HTB pts in EQ-5D, 41%, 43%, and 48% for FACT-An TOI, and 40%, 42%, and 48% for FACT-F; increases were reported by 19%, 19%, and 20% pts for EQ-5D, 31%, 32%, and 39% for FACT-An TOI, and 30%, 39%, and 40% for FACT-F. Conclusions: This preliminary analysis suggests that pts with HR-MDS, and transfusion-dependent pts, generally had worse HRQoL at BL, providing further support to initiating active Tx in pts with TB. Possible limitations of the analysis are lower completion rates in pts with more severe disease, and EQ-5D may not capture changes in these subgroups at M6. A longer follow-up may help delineate the impact of Tx on HRQoL assessments in pts with MDS. Clinical trial information: NCT01688011. [Table: see text]

Burst Beliefs – Methodological Problems in the Balloon Analogue Risk Task and Implications for Its Use

Studies in the field of psychology often employ (computerized) behavioral tasks, aimed at mimicking real-world situations that elicit certain actions in participants. Such tasks are for example used to study risk propensity, a trait-like tendency towards taking or avoiding risk. One of the most popular tasks for gauging risk propensity is the Balloon Analogue Risk Task (BART; Lejuez et al., 2002), which has been shown to relate well to self-reported risk-taking and to real-world risk behaviors. However, despite its popularity and qualities, the BART has several methodological shortcomings, most of which have been reported before, but none of which are widely known. In the present paper, four such problems are explained and elaborated on: a lack of clarity as to whether decisions are characterized by uncertainty or risk; censoring of observations; confounding of risk and expected value; and poor decomposability into adaptive and maladaptive risk behavior. Furthermore, for every problem, a range of possible solutions is discussed, which overall can be divided into three categories: using a different, more informative outcome index than the standard average pump score; modifying one or more task elements; or using a different task, either an alternative risk-taking task (sequential or otherwise), or a custom-made instrument. It is important to make use of these solutions, as applying the BART without accounting for its shortcomings may lead to interpretational problems, including false-positive and false-negative results. Depending on the research aims of a given study, certain shortcomings are more pressing than others, indicating the (type of) solutions most needed. By combining solutions and openly discussing shortcomings, researchers may be able to modify the BART in such a way that it can operationalize risk propensity without substantial methodological problems.