Machine learning-based comparison of factors influencing estimated glomerular filtration rate in Chinese women with or without non-alcoholic fatty liver.

BACKGROUND: The prevalence of non-alcoholic fatty liver (NAFLD) has increased recently. Subjects with NAFLD are known to have higher chance for renal function impairment. Many past studies used traditional multiple linear regression (MLR) to identify risk factors for decreased estimated glomerular filtration rate (eGFR). However, medical research is increasingly relying on emerging machine learning (Mach-L) methods. The present study enrolled healthy women to identify factors affecting eGFR in subjects with and without NAFLD (NAFLD+, NAFLD-) and to rank their importance. AIM: To uses three different Mach-L methods to identify key impact factors for eGFR in healthy women with and without NAFLD. METHODS: A total of 65535 healthy female study participants were enrolled from the Taiwan MJ cohort, accounting for 32 independent variables including demographic, biochemistry and lifestyle parameters (independent variables), while eGFR was used as the dependent variable. Aside from MLR, three Mach-L methods were applied, including stochastic gradient boosting, eXtreme gradient boosting and elastic net. Errors of estimation were used to define method accuracy, where smaller degree of error indicated better model performance. RESULTS: Income, albumin, eGFR, High density lipoprotein-Cholesterol, phosphorus, forced expiratory volume in one second (FEV1), and sleep time were all lower in the NAFLD+ group, while other factors were all significantly higher except for smoking area. Mach-L had lower estimation errors, thus outperforming MLR. In Model 1, age, uric acid (UA), FEV1, plasma calcium level (Ca), plasma albumin level (Alb) and T-bilirubin were the most important factors in the NAFLD+ group, as opposed to age, UA, FEV1, Alb, lactic dehydrogenase (LDH) and Ca for the NAFLD- group. Given the importance percentage was much higher than the 2nd important factor, we built Model 2 by removing age. CONCLUSION: The eGFR were lower in the NAFLD+ group compared to the NAFLD- group, with age being was the most important impact factor in both groups of healthy Chinese women, followed by LDH, UA, FEV1 and Alb. However, for the NAFLD- group, TSH and SBP were the 5th and 6th most important factors, as opposed to Ca and BF in the NAFLD+ group.

Machine Learning Prediction of Prediabetes in a Young Male Chinese Cohort with 5.8-Year Follow-Up.

The identification of risk factors for future prediabetes in young men remains largely unexamined. This study enrolled 6247 young ethnic Chinese men with normal fasting plasma glucose at the baseline (FPGbase), and used machine learning (Mach-L) methods to predict prediabetes after 5.8 years. The study seeks to achieve the following: 1. Evaluate whether Mach-L outperformed traditional multiple linear regression (MLR). 2. Identify the most important risk factors. The baseline data included demographic, biochemistry, and lifestyle information. Two models were built, where Model 1 included all variables and Model 2 excluded FPGbase, since it had the most profound effect on prediction. Random forest, stochastic gradient boosting, eXtreme gradient boosting, and elastic net were used, and the model performance was compared using different error metrics. All the Mach-L errors were smaller than those for MLR, thus Mach-L provided the most accurate results. In descending order of importance, the key factors for Model 1 were FPGbase, body fat (BF), creatinine (Cr), thyroid stimulating hormone (TSH), WBC, and age, while those for Model 2 were BF, white blood cell, age, TSH, TG, and LDL-C. We concluded that FPGbase was the most important factor to predict future prediabetes. However, after removing FPGbase, WBC, TSH, BF, HDL-C, and age were the key factors after 5.8 years.

Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using Fibular Allograft in Patients With Skipped Multifocal Pyogenic Spondylodiscitis.

OBJECTIVE: Skipped multifocal pyogenic spondylodiscitis is a rare presentation of spinal infection. In our institution, we used the single posterior approach for circumferential debridement and anterior reconstruction with fibular allograft for treatment. This study aimed to ascertain the viability and reliability of this technique for these difficult cases. METHODS: Nine patients with skipped pyogenic spondylodiscitis who received our treatment method from January 2012 to December 2019 were enrolled in this study. Visual analog scale scores, causative agents, laboratory data, comorbidities, and complications were recorded. The patients' clinical conditions were evaluated based on modified Brodsky's criteria, visual analogue scale, and Oswestry Disability Index. RESULTS: All the patients achieved infection eradication without repeat surgical treatment. The average visual analog scale score was 8.4 (range, 8-9) before operation, which decreased to 1.9 (range, 1-3) 1 year after the surgery. No patient experienced severe complications such as neurologic deterioration or fixation failure. All patients achieved a good or excellent outcome based on modified Brodsky's criteria. The Oswestry Disability Index improved from 80.4 (range, 70-86) preoperatively to 25.1 (range, 20-32) 1 year after the surgery. CONCLUSIONS: In our case series, good clinical outcomes and high successful rates could be achieved through the single-stage posterior-only approach. This could be considered an alternative method to manage patients with skipped pyogenic spondylodiscitis.

Intervention initiatives to raise young people's interest and participation in STEM.

For nearly a decade, two science interventions anchored in project-based learning (PBL) principles have been shown to increase student science learning in 3rd grade and high school physical science classes. Both interventions employed a randomized control trial of several thousand students (N = 3,271 in 3rd grade and N = 4,238 in 10th, 11th, and 12th grades). Incorporating a rich background of research studies and reports, the two interventions are based on the ideas of PBL as well as the National Academies of Science's publications, including how children learn; how science learning and instruction can be transformed; and the performance expectations for science learning articulated in the Next Generation of Science Standards. Results show significant positive increases in student academic, social, and emotional learning in both elementary and secondary school. These findings can be traced, in part, to carefully crafted experiential participatory activities and high-quality instructional materials which act as strong facilitators for knowledge acquisition and use. Reviewing the innovations undertaken by these two interventions, this article describes the importance of studying social and emotional factors 'in situ', using the Experience Sampling Method (ESM), that can motivate and engage students in science learning in both elementary and secondary school. Using these 'in situ' data collection (N = 596 students in 3rd and N = 1412 students in 10th, 11th, and 12th grades) along with case studies and repeated measures analysis gave deep insights into emotional and social development for young children and adolescents. These methods should continue to be considered when trying to understand key factors of improving engagement in science.

The Heterogeneous Effects of Participation in Shadow Education on Mental Health of High School Students in Taiwan.

The effect of shadow education or private supplementary education (PSE) on school achievement has been prolifically studied, but its impact on well-being remains understudied. This study examines the heterogeneous effect of PSE participation on school achievement and depression symptoms among high schoolers in Taiwan. The study uses panel data of the Taiwan Upper Secondary Database (TUSD) in the 2014 and 2015 academic years. We join the inverse-probability-of-treatment weighting (IPTW) approach and the seemingly unrelated regression (SUR) model to estimate the effects of PSE participation patterns on two correlated outcomes, comprehensive assessment of high school entrance examination and self-reported depression symptoms in the 11th grade. The latent class analysis identifies five PSE participation patterns: always-taker, early-adopter, dropout, late-adopter, and explorer, to predict the effect of PSE on the scores of entrance examination and later depression symptoms in high school (n = 7708, mean age = 15.33). The findings suggest that PSE participation in junior high is positively associated with academic achievement. However, PSE participation also increases depression symptoms, particularly in the case of always-takers. In other words, while always-takers increase their school achievement in transition into high school, their risks of suffering from depression are also higher than their peers.

Using antibiotic cement nail with multiple screws fixation as a single-stage salvage procedure for patient with infected tibiotalocalcaneal arthrodesis: A case report.

Tibiotalocalcaneal (TTC) arthrodesis with retrograde nail is a widely used treatment option for severe ankle arthropathy. With inherent biomechanical benefits in axial loading and strong bending stiffness, high union rate and good clinical outcomes have been reported in the literature. However, some undesired complications, such as osteomyelitis or implant failure, can develop after this procedure. Herein, we report the case of an 86-year-old man with right ankle osteomyelitis after TTC arthrodesis with retrograde nail. After removing the previous implants and extensive debridement, we used an antibiotic cement nail with multiple screws fixation as a salvage procedure in the same operation. The patient fully recovered without further surgical treatment.

The exploration of the knowledge, attitudes and practice behaviors of advanced care planning and its related predictors among Taiwanese nurses.

BACKGROUND: Despite the documented and well known patient benefits of ACP, the completion of ACP, only a minority of patients, during the advanced or EOL stage of their illnesses, receive such care. The misconceptions about ACP for healthcare providers, such as nurses, might become potential barriers to the effective implication of ACP. Also, from the transcultural perspective, it is evident essential to explore Taiwanese nurses' attitudes, knowledge, and actions of ACP. The purposes of this study were to explore the implication of ACP or hospice care for nurses caring for non-cancer chronic illness patients at a regional teaching hospital in Taiwan; and, to identify predictors of those nurses' knowledge, attitudes, and actions toward ACP. METHODS: This cross-sectional study with a purposive sample of 218 nurses was conducted at a teaching hospital in southern Taiwan. Structured questionnaires were employed and data were analyzed with descriptive statistics, t-test, one-way ANOVAs, Pearson's correlation and multiple regressions. RESULTS: 16.1% of Taiwanese physicians actively initiated ACP issues or conversations with patients or their family members. Nurses' attitudes toward ACP were fairly positive but their knowledge about ACP was insufficient and actions of ACP were not positively executed. The predictors of ACP-Knowledge (ACP-K) included position title, education hours and lacking of educational training. The predictors of ACP-Attitude (ACP-A) included ACP-K and "fear of patient or family member not accepting", whereas ACP-A, position title, "patients do not feel necessary" and "not sure physician's concern" were the predictors of ACP-Act. CONCLUSION: Continuous education and training for nurses regarding ACP needs to be improved by taking those predictors found in this current study into account, and more studies on the nurse's role in ACP also should be further examined. TRIAL REGISTRATION: KAFGH 106-012. Date of registration 1 May 2017.

Sexual Orientation and Diabetes During the Transition to Adulthood.

Purpose: The purpose of this study was to examine how sexual orientation in adolescence and young adulthood was linked to diabetes risk. Methods: Data were drawn from the 1994-2008 National Longitudinal Study of Adolescent to Adult Health. The baseline sample included 4330 girls and 3510 boys ages 12-18. Guided by the life course approach, we considered both the timing and continuity of sexual orientation-broadly defined by sexual identity, sexual attraction, sexual contact, and romantic/sexual relationships-by differentiating respondents into four categories: sexual minority in both adolescence and adulthood, sexual minority in adulthood only, sexual minority in adolescence only, and heterosexual in both adolescence and young adulthood. Diabetes was identified using A1c and glucose biomarkers and self-reports of diabetes diagnosis or medication use. Results: Results from logistic regression models indicated that in comparison with their continuously heterosexual counterparts, respondents reporting sexual minority status in adulthood only or continuously in both adolescence and adulthood had higher diabetes risk in adulthood. However, respondents reporting sexual minority status in adolescence only were not different in diabetes risk in adulthood. The association between diabetes risk and continuous sexual minority status was stronger among women than among men. Conclusions: Sexual minority health disparities emerge early in the life course during adolescence and young adulthood. These findings highlight the importance of designing and implementing policies and public programs to alleviate minority stress early in life to reduce health disparities.

Linking perceived discrimination during adolescence to health during mid-adulthood: Self-esteem and risk-behavior mechanisms.

RATIONALE: The literature on the effect of perceived discrimination on health has three gaps. First, the long-term relationship between perceived discrimination and health is underexplored. Second, the mechanisms through which perceived discrimination affects health remain unclear. Third, most studies focus on racial/ethnic discrimination, and other aspects of discrimination are overlooked. OBJECTIVE: This study aims to fill these gaps by testing a research framework that links the discriminatory experience during adolescence to an individual's health during mid-adulthood via self-esteem and risk behaviors at early adulthood. METHOD: Structural equation modeling is applied to the National Longitudinal Survey of Youth, 1979 Cohort (N = 6478). RESULTS: The discriminatory experience during adolescence imposes an adverse impact on health during mid-adulthood even after accounting for other potential covariates, a detrimental effect lasting for over 30 years. In addition, while perceived discrimination reduces self-esteem at early adulthood, it affects only mental health during mid-adulthood, rather than general health. Finally, the discriminatory experience promotes risk behaviors at early adulthood and the risk behaviors subsequently compromise health during mid-adulthood. CONCLUSIONS: Using a life course perspective, we find that the effect of perceived discrimination is more profound than the literature suggested and that risk behaviors may account for approximately 17% of the total effect of perceived discrimination on health. Our findings highlight the importance of early interventions in coping with perceived discrimination during adolescence.

Differential investments and opportunities: How do neighborhood conditions moderate the relationship between perceived housing discrimination and social capital?

Though the adverse consequences of perceived housing discrimination have been documented, little is known about whether such experience undermines one's social capital in a neighborhood and even less is about whether and how this relationship is altered by neighborhood features. We proposed a framework that simultaneously considers within-individual and between-neighborhood processes. We applied multilevel structural equation models to data from Philadelphia (n = 9987) and found that (a) perceived housing discrimination was negatively associated with one's social capital even after other confounders were considered, (b) this negative association could be partly explained by the proliferated daily stress and anxiety mechanisms, (c) differential exposures to neighborhood social disadvantage accounted for the variation in social capital across neighborhoods, and (d) the adverse association between perceived housing discrimination and social capital could be attenuated by neighborhood stability. The findings suggested that appropriate interventions should buffer the negative association of perceived housing discrimination with social capital.

Expression Pattern and Clinicopathological Relevance of the Indoleamine 2,3-Dioxygenase 1/Tryptophan 2,3-Dioxygenase Protein in Colorectal Cancer.

Aims. Cancer cells use the indoleamine 2,3-dioxygenase 1 (IDO1) pathway to suppress the host's immune response in order to facilitate survival, growth, invasion, and metastasis of malignant cells. Higher IDO1 expression was shown to be involved in colorectal cancer (CRC) progression and to be correlated with impaired clinical outcome. However, the potential correlation between the expression of IDO1 in a CRC population with a low mutation rate of the APC gene remains unknown. Material and Methods. Tissues and blood samples were collected from 192 CRC patients. The expressions of IDO1, tryptophan 2,3-dioxygenase (TDO2), and beta-catenin proteins were analyzed by immunohistochemistry. Microsatellite instability (MSI) was determined by PCR amplification of microsatellite loci. Results. The results showed that high IDO1 or TDO2 protein expression was associated with characteristics of more aggressive phenotypes of CRC. For the first time, they also revealed a positive correlation between the abnormal expression of beta-catenin and IDO1 or TDO2 proteins in a CRC population with a low mutation rate of APC. Conclusion. We concluded that an IDO1-regulated molecular pathway led to abnormal expression of beta-catenin in the nucleus/cytoplasm of CRC patients with low mutation rate of APC, making IDO1 an interesting target for immunotherapy in CRC.

A component-centered meta-analysis of family-based prevention programs for adolescent substance use.

Although research has documented the positive effects of family-based prevention programs, the field lacks specific information regarding why these programs are effective. The current study summarized the effects of family-based programs on adolescent substance use using a component-based approach to meta-analysis in which we decomposed programs into a set of key topics or components that were specifically addressed by program curricula (e.g., parental monitoring/behavior management,problem solving, positive family relations, etc.). Components were coded according to the amount of time spent on program services that targeted youth, parents, and the whole family; we also coded effect sizes across studies for each substance-related outcome. Given the nested nature of the data, we used hierarchical linear modeling to link program components (Level 2) with effect sizes (Level 1). The overall effect size across programs was .31, which did not differ by type of substance. Youth-focused components designed to encourage more positive family relationships and a positive orientation toward the future emerged as key factors predicting larger than average effect sizes. Our results suggest that, within the universe of family-based prevention, where components such as parental monitoring/behavior management are almost universal, adding or expanding certain youth-focused components may be able to enhance program efficacy.

Examining the complexity and variation of health care system distrust across neighborhoods: Implications for preventive health care.

PURPOSE: Recently, the institutional performance model has been used to explain the increased distrust of health care system by arguing that distrust is a function of individuals' perceptions on the quality of life in neighborhood and social institutions. We examined (1) whether individuals assess two dimensions of distrust consistently, (2) if the multilevel institutional performance model explains the variation of distrust, and (3) how distrust patterns affect preventive health care behaviors. METHODOLOGY: Using data from 9,497 respondents in 914 census tracts (neighborhoods) in Philadelphia, we examined the patterns of how individuals evaluate the competence and values distrust using the Multilevel Latent Class Analysis (MLCA), and then investigated how neighborhood environment factors are associated with distrust patterns. Finally, we used regression to examine the relationships between distrust patterns and preventive health care. FINDINGS: The MLCA identified four distrust patterns: Believers, Doubters, Competence Skeptics, and Values Skeptics. We found that 55 % of the individuals evaluated competence and values distrust coherently, with Believers reporting low levels and Doubters having high levels of distrust. Competence and Values Skeptics assessed distrust inconsistently. Believers were the least likely to reside in socioeconomically disadvantaged and racially segregated neighborhoods than other patterns. In contrast to Doubters, Believers were more likely to use preventive health care, even after controlling for other socioeconomic factors including insurance coverage. PRACTICAL IMPLICATIONS: Our findings suggest that distrust patterns are function of neighborhood conditions and distrust patterns are associated with preventive health care. This study provides important policy implications for health care and future interventions.

Characterization of IS26-composite transposons and multidrug resistance in conjugative plasmids from Enterobacter cloacae.

SHV-12 is the most widespread resistance determinant of Enterobacter cloacae in Taiwan; however, blaSHV-12 has rarely been mobilized. Six multidrug-resistant E. cloacae isolates were collected. After conjugal transfer, plasmid profiling and analysis of incompatibility groups was performed to characterize the genetic context of blaSHV-12 -containing fragments. The presence of mobile genetic elements was demonstrated by PCR, cloning, sequencing and bioinformatics analyses. Four different ß-lactamase genes (blaTEM-1 , blaSHV-12 , blaCTX-M-3 and/or blaCTX-M-14 ) were observed in the conjugative plasmids belonging to the IncHI2 (n = 4), IncI1 or IncP incompatibility groups. The IS26-blaSHV-12 -IS26 locus was located in five different genetic environments. A novel structural organization of a class 1 integron with the aac(6')-IIc cassette truncated by IS26 was identified in one isolate. Thus, blaSHV-12 was obtained from different plasmids through IS26-mediated homologous recombination. IS26 plays a vital role in the distribution of mobile resistance elements between different plasmids found in multidrug-resistant E. cloacae isolates.

Isolation and characterization of a novel lysine racemase from a soil metagenomic library.

A lysine racemase (lyr) gene was isolated from a soil metagenome by functional complementation for the first time by using Escherichia coli BCRC 51734 cells as the host and d-lysine as the selection agent. The lyr gene consisted of a 1,182-bp nucleotide sequence encoding a protein of 393 amino acids with a molecular mass of about 42.7 kDa. The enzyme exhibited higher specific activity toward lysine in the l-lysine-to-d-lysine direction than in the reverse reaction.