A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep

Background In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process. Methods The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines. Results Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years). Conclusions To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Evaluation of Microvascular Patterns Alone Using Endocytoscopy with Narrow-Band Imaging for Diagnosing Gastric Cancer

<b><i>Introduction:</i></b> Although endocytoscopy (EC) with narrow-band imaging (NBI) is effective in diagnosing gastric cancer, no diagnostic system has been validated. We explored a specific diagnostic system for gastric cancer using EC with NBI. <b><i>Methods:</i></b> Equal numbers of images from cancerous and noncancerous areas (114 images each) were assessed by endoscopists with (development group: 33) and without (validation group: 28) specific training in magnifying endoscopy with NBI. Microvascular and microsurface patterns (MS) in each image were evaluated. Lesions were diagnosed as cancerous when patterns were deemed “irregular.” The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of a diagnosis according to patterns on EC with NBI (microvascular pattern [MV] alone, MS alone, and both) were evaluated and compared between groups to determine the diagnostic performance. <b><i>Results:</i></b> In the development and validation groups, diagnoses based on the MV alone had significantly higher accuracy (91.7% vs. 76.3%, <i>p</i> &#x3c; 0.0001 and 92.5% vs. 67.5%, <i>p</i> &#x3c; 0.0001, respectively) and sensitivity (88.6% vs. 68.3%, <i>p</i> &#x3c; 0.0001 and 89.5% vs. 38.6%, <i>p</i> &#x3c; 0.0001, respectively) than those based on the MS alone. In both groups, there were no significant differences in diagnostic accuracy between using the MV alone and both patterns. <b><i>Discussion/Conclusion:</i></b> Evaluation of the MV alone is a simple and accurate diagnostic method for gastric cancer. This system could find widespread applications in clinical practice.

HiTOP Assessment of Externalizing Antagonism and Disinhibition

This article outlines the Phase 1 efforts of the HiTOP Measure Development group for externalizing constructs, which include disinhibited externalizing, antagonistic externalizing, attention deficit hyperactivity disorder, substance use, and externalizing/maladaptive behaviors. We provide background on the constructs included and the process and issues involved in developing a measure for this diverse range of psychopathology symptoms, traits, and behaviors.

Prognostic Nomogram in Children and Adolescents With Central Nervous System Germ Cell Tumors

Background: The prognostic risk factors for primary central nervous system (CNS) germ cell tumors (GCTs) in children and adolescents remain controversial. This study aimed to develop and validate a nomogram that predicts 5-and 10-year survival rates for CNS GCTs in children and adolescents.Methods: Pediatric with intracranial GCTs in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018 were analyzed. All GCTs children were randomly divided into the development group (70%) and the validation group (30%). The least absolute shrinkage and selection operator (LASSO) was used to screen the characteristic variables, and the 5- and 10-year survival probability nomogram was constructed. The accuracy of the nomogram was evaluated by consistency index (C-index), calibration plot, receiver operating characteristic curve (ROC), decision curve analysis (DCA) and survival curve.Results: We identified 819 cases of CNS GCTs in children. Three variables (histology, site and size) were selected by lasso regression to construct the nomogram. The C-index of the development group and verification group is 0.744 and 0.759. According to the time points of 5 and 10 years, the area under the curve of the development group is 0.753 and 0.696, and the verification set is 0.787 and 0.718. The results show that the prognostic nomogram developed by us has good accuracy.Conclusions: This is the first prognostic nomogram of CNS GCTs in children and adolescents. It can effectively predict the 5- and 10-year survival probability of children. It provides a useful prediction tool for clinicians.

A deep learning quantified stroma-immune score to predict survival of patients with stage II–III colorectal cancer

Background Profound heterogeneity in prognosis has been observed in colorectal cancer (CRC) patients with intermediate levels of disease (stage II–III), advocating the identification of valuable biomarkers that could improve the prognostic stratification. This study aims to develop a deep learning-based pipeline for fully automatic quantification of immune infiltration within the stroma region on immunohistochemical (IHC) whole-slide images (WSIs) and further analyze its prognostic value in CRC. Methods Patients from two independent cohorts were divided into three groups: the development group (N = 200), the internal (N = 134), and the external validation group (N = 90). We trained a convolutional neural network for tissue classification of CD3 and CD8 stained WSIs. A scoring system, named stroma-immune score, was established by quantifying the density of CD3+ and CD8+ T-cells infiltration in the stroma region. Results Patients with higher stroma-immune scores had much longer survival. In the development group, 5-year survival rates of the low and high scores were 55.7% and 80.8% (hazard ratio [HR] for high vs. low 0.39, 95% confidence interval [CI] 0.24–0.63, P < 0.001). These results were confirmed in the internal and external validation groups with 5-year survival rates of low and high scores were 57.1% and 78.8%, 63.9% and 88.9%, respectively (internal: HR for high vs. low 0.49, 95% CI 0.28–0.88, P = 0.017; external: HR for high vs. low 0.35, 95% CI 0.15–0.83, P = 0.018). The combination of stroma-immune score and tumor-node-metastasis (TNM) stage showed better discrimination ability for survival prediction than using the TNM stage alone. Conclusions We proposed a stroma-immune score via a deep learning-based pipeline to quantify CD3+ and CD8+ T-cells densities within the stroma region on WSIs of CRC and further predict survival.

Prognostic Nomogram in Children and Adolescents with Central Nervous System Germ Cell Tumors

Background: The prognostic risk factors for primary central nervous system (CNS) germ cell tumors (GCTs) in children and adolescents remain controversial. This study aimed to develop and validate a nomogram that predicts 5-and 10-year survival rates for CNS GCTs in children and adolescents.Methods: Pediatric with intracranial GCTs in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2018 were analyzed. All GCTs children were randomly divided into the development group (70%) and the validation group (30%). The least absolute shrinkage and selection operator (LASSO) was used to screen the characteristic variables, and the 5- and 10-year survival probability nomogram was constructed. The accuracy of the nomogram was evaluated by consistency index (C-index), calibration plot, receiver operating characteristic curve (ROC), decision curve analysis (DCA) and survival curve.Results: We identified 819 cases of CNS GCTs in children. Three variables (histology, site and size) were selected by lasso regression to construct the nomogram. The C-index of the development group and verification group is 0.744 and 0.759. According to the time points of 5 and 10 years, the area under the curve of the development group is 0.753 and 0.696, and the verification set is 0.787 and 0.718. The results show that the prognostic nomogram developed by us has good accuracy.Conclusions: This is the first prognostic nomogram of CNS GCTs in children and adolescents. It can effectively predict the 5- and 10-year survival probability of children. It provides a useful prediction tool for clinicians.

Exploring women’s development group leaders’ support to maternal, neonatal and child health care: A qualitative study in Tigray region, Ethiopia

Background Community health workers and volunteers are vital for the achievement of Universal Health Coverage also in low-income countries. Ethiopia introduced community volunteers called women’s development group leaders in 2011. These women have responsibilities in multiple sectors, including promoting health and healthcare seeking. Objective We aimed to explore women’s development group leaders’ and health workers’ perceptions on these volunteers’ role in maternal, neonatal and child healthcare. Methods A qualitative study was conducted with in-depth interviews and focus group discussions with women’s development group leaders, health extension workers, health center staff, and woreda and regional health extension experts. We adapted a framework of community health worker performance, and explored perceptions of the women’s development group program: inputs, processes and performance. Interviews were recorded, transcribed, and coded prior to translation and thematic analysis. Results The women’s development group leaders were committed to their health-related work. However, many were illiterate, recruited in a sub-optimal process, had weak supervision and feedback, lacked training and incentives and had weak knowledge on danger signs and care of neonates. These problems demotivated these volunteers from engaging in maternal, neonatal and child health promotion activities. Health extension workers faced difficulties in managing the numerous women’s development group leaders in the catchment area. Conclusion The women’s development group leaders showed a willingness to contribute to maternal and child healthcare but lacked support and incentives. The program requires some redesign, effective management, and should offer enhanced recruitment, training, supervision, and incentives. The program should also consider continued training to develop the leaders’ knowledge, factor contextual influences, and be open for local variations.

Prediction of Best Corrected Visual Acuity with Hard Contact Lenses for Keratoconus Patients

Background: To develop a prediction formula for best corrected visual acuity with hard contact lenses (HCL-BCVA) and to identify clinical factors linearly related to HCL-BCVA in keratoconus patients. Methods: This retrospective study examined clinical data derived from 198 eyes of 131 keratoconus patients. The subjects were divided into a development group (102 eyes of 68 subjects) and a validation group (96 eyes of 63 subjects) on the basis of the date of their examination. HCL-BCVA measurement and anterior segment–optical coherence tomography (AS-OCT) were performed. A prediction formula for HCL-BCVA based on AS-OCT measurements was then developed. Single regression analysis was performed to identify clinical factors linearly related to HCL-BCVA. Results: Stepwise multiple regression analysis yielded a prediction formula for HCL-BCVA in keratoconus patients, with the correlation coefficient of the multiple regression equation being 0.728 (R2 = 0.530) for the development group. Application of the prediction formula to the validation group yielded a correlation coefficient for the multiple regression equation of 0.641 (R2 = 0.411). Single regression analysis identified anterior corneal refractive power, posterior corneal refractive power, and high-order aberrations as factors that are linearly correlated with HCL-BCVA, with R values of 0.606, -0.617, and 0.506, respectively. Conclusion: HCL-BCVA in keratoconus patients was predictable on the basis of AS-OCT measurements. Cutoff values for clinical factors found to correlate with HCL-BCVA may prove informative with regard to treatment options to maintain a favorable visual acuity in keratoconus patients.

Facilities Development And Socialization Of Bule-Brazilians In Buckets (Guide For The Event Of Community Economic Independence)

Gresik, one of the industrial cities in Indonesia, has recorded that more than 1000 workers have been laid off. The increasing unemployment in Gresik makes the government have to work extra hard to help the community's problems. However, the burden of this community's powerlessness cannot be transferred to the government all the time. Even though the government is still very busy with the unresolved COVID-19 cases. The Community Service proposed by the UMG Industrial Engineering team took the theme of Fish Cultivation in Buckets (Fish farming in buckets), which is better known as aquaponics. The concept of Fish farming in buckets itself is to unite plants and fish in a bucket, resulting in a symbiotic mutualism that is very beneficial for both parties. The object of this research will be conducted at the Industrial Engineering Study Program, University of Muhammadiyah Gresik (TI-UMG) by giving invitations to residents of Yosowilangun Gresik, especially the FAMILY WELFARE DEVELOPMENT group and the Yatim Mandiri foundation. The reason why the debriefing is preferred to the FAMILY WELFARE DEVELOPMENT and Yatim Mandiri groups is none other than the fact that FAMILY WELFARE DEVELOPMENT is a collection of housewives where it is likely that some of the heads of their families will be laid off. And the Yatim Mandiri Foundation is here to support the improvement of the economic independence of the orphan group.