Defining Spatial Epidemiology: A Systematic Review and Re-orientation.

BACKGROUND: Spatial epidemiology has emerged as an important subfield of epidemiology over the past quarter century. We trace the origins of spatial epidemiology and note that its emergence coincided with technological developments in spatial statistics and geography. We hypothesize that spatial epidemiology makes important contributions to descriptive epidemiology and analytic risk-factor studies but is not yet aligned with epidemiology's current focus on causal inference and intervention. METHODS: We conducted a systematic review of studies indexed in PubMed that used the term "spatial epidemiolog*" in the title, abstract, or keywords. Excluded articles were not written in English, examined disease in animals, or reported biologic pathogen distribution only. We coded the included papers into five categories (review, demonstration of method, descriptive, analytic, and intervention) and recorded the unit of analysis (i.e., individual vs. ecological). We additionally examined articles coded as analytic ecologic studies using scales for lexical content. RESULTS: A total of 482 articles met the inclusion criteria, including 76 reviews, 117 demonstrations of methods, 122 descriptive studies, 167 analytic studies, and 0 intervention studies. Demonstration studies were most common from 2006 to 2014, and analytic studies were most common after 2015. Among the analytic ecologic studies, those published in later years used more terms relevant to spatial statistics (incidence rate ratio =1.3; 95% confidence interval [CI] = 1.1, 1.5) and causal inference (incidence rate ratio =1.1; 95% CI = 1.1, 1.2). CONCLUSIONS: Spatial epidemiology is an important and growing subfield of epidemiology. We suggest a re-orientation to help align its practice with the goals of contemporary epidemiology.

Generalizability theory distinguishes between state and trait anxiety.

Accurate distinction between state and trait anxiety is necessary for assessment and monitoring of individual anxiety levels over time and developing effective interventions to reduce anxiety. Generalizability theory (G-theory) is a suitable method to distinguish between state and trait and to evaluate reliability of test scores and sources of measurement error in the assessment of affective conditions. We applied G-theory to the widely used 40-item State and Trait Anxiety Inventory (STAI) completed by 139 participants on three occasions separated by 2-week intervals. The results show that both subscales of the STAI demonstrated excellent reliability for test scores in measuring trait anxiety with high generalizability of scores across occasions and persons (G = 0.84-0.92). The most dynamic aspects of state anxiety were identified in both subscales including satisfaction, nervousness, feelings of pleasure, perceived failure, calmness, feeling inadequate, and sensitivity to disappointments and this informed the development of a more sensitive state anxiety scale presented here. The STAI trait subscale and the proposed sensitive state subscale can be used to more accurately distinguish between state and trait anxiety. The most dynamic aspects of anxiety identified using G-theory are more amenable and need to be considered as the primary target of interventions aiming at reducing anxiety. More comprehensive assessment of state anxiety may benefit from the development of a longer scale informed by G-theory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Optoelectronic measurement of wrist movements in various casts and orthoses used in scaphoid fractures.

We developed an optoelectronic motion analysis protocol to measure anatomical and functional ranges of wrist motion in Colles'-type and scaphoid-type splints and casts. The protocol was used to study the restriction of wrist motion in casts and splints in ten healthy volunteers. Scaphoid-type casts were no more restrictive to wrist motion than Colles'-type casts, but casts were significantly more restrictive than removable splints. Removable splints were more restrictive than no immobilization. Results suggest there is no benefit in using scaphoid-type casts rather than Colles'-type casts to reduce wrist motion.

A Dual X-Ray Absorptiometry Validated Geometric Model for the Calculation of Body Segment Inertial Parameters of Young Females.

The purpose of this study was to validate a new geometric solids model, developed to address the lack of female-specific models for body segment inertial parameter estimation. A second aim was to determine the effect of reducing the number of geometric solids used to model the limb segments on model accuracy. The full model comprised 56 geometric solids, the reduced model comprised 31, and the basic model comprised 16. Predicted whole-body inertial parameters were compared with direct measurements (reaction board, scales), and predicted segmental parameters with those estimated from whole-body dual x-ray absorptiometry scans for 28 females. The percentage root mean square error (%RMSE) for whole-body volume was <2.5% for all models and 1.9% for the full model. The %RMSE for whole-body center of mass location was <3.2% for all models. The %RMSE whole-body mass was <3.3% for the full model. The RMSE for segment masses was <0.5 kg (<0.5%) for all segments; Bland-Altman analysis showed the full and reduced models could adequately model thigh, forearm, foot, and hand segments, but the full model was required for the trunk segment. The proposed model was able to accurately predict body segment inertial parameters for females; more geometric solids are required to more accurately model the trunk.

Can activities of daily living contribute to EMG normalization for gait analysis?

This study aims to examine alternative methods of normalization that effectively reflect muscle activity as compared to Maximal Voluntary Contraction (MVC). EMG data recorded from knee flexion-extension muscles in 10 control subjects during the stance phase of the gait cycle were examined by adopting different approaches of normalization: MVC, Mean and Peak Dynamic during gait cycles, (MDM and PDM, respectively), Peak Dynamic during activities of daily living (ADLs), (*PDM), and a combination of ADLs and MVC(**PDM). Intra- and inter-individual variability were calculated to determine reliability and similarity to MCV. **PDM showed excellent reliability across subjects in comparison to MVC, where variance ratio ranged from 0.43-0.99 for **PDM and 0.79-1.08 for MVC. Coefficient of variability showed a similar trend to Variance Ratio, ranging from 0.60-1.25 for **PDM and 1.97-3.92 for MVC. Both MVC and **PDM, and to some extent *PDM, demonstrated good-to-excellent relative amplitude's matching; i.e. root mean square difference and absolute difference were both around 0.08 for Vastus medialis to about 4 for Medial gastrocnemius. It was concluded that **PDM and *PDM were reliable, **PDM mirrored MVC and thus could be used as an alternative to MVC for subjects who are unable to provide the required effort for MVC testing. Where MVC testing is not possible, *PDM is the next preferred option.

The effect of signal acquisition and processing choices on ApEn values: towards a "gold standard" for distinguishing effort levels from isometric force records.

Approximate entropy (ApEn) is frequently used to identify changes in the complexity of isometric force records with ageing and disease. Different signal acquisition and processing parameters have been used, making comparison or confirmation of results difficult. This study determined the effect of sampling and parameter choices by examining changes in ApEn values across a range of submaximal isometric contractions of the first dorsal interosseus. Reducing the sample rate by decimation changed both the value and pattern of ApEn values dramatically. The pattern of ApEn values across the range of effort levels was not sensitive to the filter cut-off frequency, or the criterion used to extract the section of data for analysis. The complexity increased with increasing effort levels using a fixed 'r' value (which accounts for measurement noise) but decreased with increasing effort level when 'r' was set to 0.1 of the standard deviation of force. It is recommended isometric force records are sampled at frequencies >200Hz, template length ('m') is set to 2, and 'r' set to measurement system noise or 0.1SD depending on physiological process to be distinguished. It is demonstrated that changes in ApEn across effort levels are related to changes in force gradation strategy.

Personalized exon skipping strategies to address clustered non-deletion dystrophin mutations.

Antisense oligomer induced exon skipping is showing promise as a therapy to reduce the severity of Duchenne muscular dystrophy. To date, the focus has been on excluding single exons flanking frame-shifting deletions in the dystrophin gene. However, a third of all Duchenne muscular dystrophy causing mutations are more subtle DNA changes. Thirty nine dystrophin exons are potentially frame-shifting and mutations in these will require the targeted removal of exon blocks to generate in-frame transcripts. We report that clustered non-deletion mutations in the dystrophin gene respond differently to different antisense oligomer preparations targeting the same dual exon block, the removal of which bypasses the mutation and restores the open reading-frame. The personalized nature of the responses to antisense oligomer application presents additional challenges to the induction of multi-exon skipping with a single oligomer preparation.

Improving generalist end of life care: national consultation with practitioners, commissioners, academics, and service user groups.

OBJECTIVE: To identify major concerns of national and local importance in the provision, commissioning, research, and use of generalist end of life care. DESIGN: A national consultation and prioritising exercise using a modified form of the nominal group technique. PARTICIPANTS: Healthcare practitioners, commissioners, academics, and representatives of user and voluntary groups. SETTING: Primary and secondary care, specialist palliative care, and academic and voluntary sectors in England and Scotland. RESULTS: 74% of those invited (210/285) participated. The stage of life to which "end of life care" referred was not understood in a uniform way. Perceptions ranged from a period of more than a year to the last few days of life. Prominent concerns included difficulties in prognosis and the availability of adequate support for patients with advanced non-malignant disease. Generalists in both primary and secondary care were usually caring for only a few patients approaching the end of life at any one time at a point in time. It was therefore challenging to maintain skills and expertise particularly as educational opportunities were often limited. End of life care took place among many other competing and incentivised activities for general practitioners in the community. More needs to be known about models of end of life care and how these can be integrated in a generalist's workload. A greater evidence base is needed about the effectiveness and application of current tools such as the gold standards framework and Liverpool care pathway and about models of palliation in patients with diseases other than cancer. CONCLUSIONS: Definitions of end of life care need clarification and standardisation. A greater evidence base is needed to define models of good practice together with a commitment to provide education and training and adequate resources for service provision. More needs to be known about the context of provision and the influence of competing priorities and incentives.

Individual contributory factors in teacher stress: the role of achievement striving and occupational commitment.

Workplace stress and its impact upon retention levels are becoming an increasing concern within the teaching profession (Brown, Davis, & Johnson, 2002; Jarvis, 2002). Research has largely focused upon the effects of environmental factors, whilst noting that it is the interplay between the individual and the environment which may hold the key to understanding this problem (Cox, 1978; Parkes, 1994). Identifying individual contributory factors is essential in understanding why, under the same environmental conditions, some people suffer much greater levels of stress than others. This study examined the influence of Type A behaviour, personal achievement strivings, occupational commitment, gender and nature/experience of teaching on perceived workplace stress within the teaching profession (N = 95). It was predicted that perceived stress would be strongest amongst those reporting higher levels of these factors. A multiple regression analysis indicated that there was a positive relationship between Type A behaviour, personal achievement strivings, and perceived stress. The relationship between perceived stress and occupational commitment, however, was found to be negative. The possible explanations for these findings, and potential implications, are discussed. Future research plans are outlined for exploring the relationships between these individual contributory factors and environmental stressors.