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BackgroundUnrelieved chemotherapy-induced nausea (CIN) occurs 48% of patients undergoing chemotherapy and is one of the most debilitating symptoms that patients report.ObjectiveThe aims of this study were to identify subgroups of patients with distinct CIN profiles and determine how these subgroups differed on demographic and clinical characteristics; severity, frequency, and distress of CIN; and the co-occurrence of common gastrointestinal symptoms.MethodsPatients (n = 1343) completed demographic questionnaire and Memorial Symptom Assessment Scale 6 times over 2 cycles of chemotherapy. Latent class analysis was used to identify subgroups of patients with distinct CIN profiles. Differences among these subgroups were evaluated using parametric and nonparametric statistics.ResultsFour distinct CIN profiles were identified: none (40.8%), increasing-decreasing (21.5%), decreasing (8.9%), and high (28.8%). Compared with the none class, patients in the high class were younger, had a lower annual household income, had child care responsibilities, had a lower Karnofsky Performance Status score and a higher Self-administered Comorbidity Questionnaire score, and were more likely to have received chemotherapy on a 14-day cycle and a highly emetogenic chemotherapy regimen. In addition, patients in the high class reported high occurrence rates for dry mouth, feeling bloated, diarrhea, lack of appetite, abdominal cramps, difficulty swallowing, mouth sores, weight loss, and change in the way food tastes.ConclusionsThat 60% of the patients reported moderate to high CIN occurrence rates confirms that this unrelieved symptom is a significant clinical problem.Implications for practiceNurses need to evaluate patients' level of adherence to their antiemetic regimen and make appropriate referrals for physical therapy, psychological services, and dietary counseling.

Alzheimer's disease (AD) affects Latinos disproportionately. One of the reasons underlying this disparity may be type 2 diabetes (T2D) that is a risk factor for AD. The purpose of this study was to examine the associations of T2D and AD blood biomarkers and the differences in these associations between Mexican Americans and non-Hispanic Whites. This study was a secondary analysis of baseline data from the observational Health and Aging Brain Study: Health Disparities (HABS-HD) that investigated factors underlying health disparities in AD in Mexican Americans in comparison to non-Hispanic Whites. HABS-HD participants were excluded if they had missing data or were large outliers (z-scores >|4|) on a given AD biomarker. Fasting blood glucose and glycosylated hemoglobin (HbA1c) levels were measured from clinical labs. T2D was diagnosed by licensed clinicians. Plasma amyloid-beta 42 and 40 (Aβ42/42) ratio, total tau (t-tau), and neurofilament light (NfL) were measured via ultra-sensitive Simoa assays. The sample sizes were 1,552 for Aβ42/40 ratio, 1,570 for t-tau, and 1,553 for NfL. Mexican Americans were younger (66.6±8.7 vs. 69.5±8.6) and had more female (64.9% female vs. 55.1%) and fewer years of schooling (9.5±4.6 vs. 15.6±2.5) than non-Hispanic Whites. Mexican Americans differed significantly from non-Hispanic Whites in blood glucose (113.5±36.6 vs. 99.2±17.0) and HbA1c (6.33±1.4 vs. 5.51±0.6) levels, T2D diagnosis (35.3% vs. 11.1%), as well as blood Aβ42/40 ratio (.051±.012 vs..047±.011), t-tau (2.56±.95 vs. 2.33±.90), and NfL levels (16.3±9.5 vs. 20.3±10.3). Blood glucose, blood HbA1c, and T2D diagnosis were not related to Aβ42/40 ratio and t-tau but explained 3.7% of the variation in NfL (p <.001). Blood glucose and T2D diagnosis were not, while HbA1c was positively (b = 2.31, p <.001, β = 0.26), associated with NfL among Mexican Americans. In contrast, blood glucose, HbA1c, and T2D diagnosis were negatively (b = -0.09, p <.01, β = -0.26), not (b = 0.34, p =.71, β = 0.04), and positively (b = 3.32, p <.01, β = 0.33) associated with NfL, respectively in non-Hispanic Whites. To conclude, blood glucose and HbA1c levels and T2D diagnosis are associated with plasma NfL levels, but not plasma Aβ and t-tau levels. These associations differ in an ethnicity-specific manner and need to be further studied as a potential mechanism underlying AD disparities. [ABSTRACT FROM AUTHOR]

We designed an Internet survey to identify the educational priorities that parents have for their children with autism spectrum disorders and to examine the relation between these priorities and the children's level of adaptive behavior functioning. The survey listed 54 skills/behaviors (e.g., toileting, expressing wants and needs, and tantrums) representing 10 adaptive behavior domains (e.g., self-care, communication, and problem behavior). Parents rated their child's current level of ability/performance with respect to each skill/behavior and indicated the extent to which training/treatment was a priority. Ninety surveys were completed during the 8-month data collection period. The top 10 treatment priorities represented skills/behaviors from six different domains. Results supported the view that parent priorities tended to be higher in areas where children have the greatest deficits or show emerging skills. The results suggest there may be value in targeting the assessment of children's deficits and emergent skills for treatment planning. (Contains 2 tables and 2 figures.)

The authors examined the robustness of multilevel linear growth curve modeling to misspecification of an autoregressive moving average process. As previous research has shown (J. Ferron, R. Dailey, & Q. Yi, 2002; O. Kwok, S. G. West, & S. B. Green, 2007; S. Sivo, X. Fan, & L. Witta, 2005), estimates of the fixed effects were unbiased, and Type I error rates for the tests of the fixed effects were generally accurate when the present authors correctly specified or underspecified the model. However, random effects were poorly estimated under many conditions, even under correct model specification. Further, fit criteria performed inconsistently and were especially inaccurate when small sample sizes and short series lengths were combined. With the exception of elevated Type I error rates that occurred under some conditions, the best performance was obtained by use of an unstructured covariance matrix at the first level of the growth curve model. (Contains 4 tables.)

Due to the clustered nature of field data, multi-level modeling has become commonly used to analyze data arising from educational field experiments. While recent methodological literature has focused on multi-level mediation analysis, relatively little attention has been devoted to mediation analysis when three levels (e.g., student, class, school) are present in a study setting. This article presents analysis models that can be used to test indirect effects in experimental designs having three levels where random assignment is at the third (school) or second (class) level and where the indirect effect may be random. In the presentation, simulated datasets are used to illustrate model specification and results interpretation for hypothetical three-level educational experiments involving mediation and moderation of treatment effects. (Contains 6 tables and 3 figures.)

The hierarchical linear model (HLM) is now commonly accepted as a useful modeling approach for multilevel data resulting from randomized field experiments. When multiple outcomes of interest exist, a multivariate extension of the conventional univariate HLM offers advantages over the usual application of separate HLM analyses for each of the outcomes. In this article, the authors review these advantages, discuss the device that allows the univariate HLM procedure to model multiple outcomes, and present a series of multivariate models that would be useful in addressing typical questions in field experiments. In addition to the multivariate multilevel versions of basic analysis of variance (ANOVA) or analysis of covariance (ANCOVA) designs, the authors present more complex models that allow the testing of moderation and mediation of the treatment effect. The various analyses are illustrated with computer generated data for a hypothetical scenario. (Contains 2 tables and 4 figures.)

The Behavior Flexibility Rating Scale (BFRS) is designed to assess insistence on sameness or lack of behavioral flexibility, which is often associated with autism and other developmental disabilities. This study was designed to assess the factor structure of this scale for a sample of 968 individuals with autism, Asperger's syndrome, and Down syndrome. To establish factorial validity, an exploratory factor analysis (EFA) was conducted with half of the sample, with a confirmatory factor analysis (CFA) conducted with the remaining cases to cross-validate the model obtained with the EFA. The factor analyses supported the presence of two factors--Interruption/Disruption and Position/Location. However, further analysis suggested the presence of a third factor, Interpersonal Mishaps, for the Asperger's syndrome group.

Shows how one can combine a large-scale planned variation experimental design and multilevel analysis to address research questions that go beyond the issue of overall treatment effectiveness. Uses data from a simulated field experiment to describe the multilevel models that can be used. (SLD)

Introduction: Chronic overlapping pain conditions (COPCs), such as chronic low back pain (cLBP) and fibromyalgia, frequently cooccur and incur substantial healthcare costs. However, to date, much focus has been placed on individual anatomically based chronic pain conditions, whereas little is known about the mechanisms underlying progression to multiple (more than 1) COPCs. This study aims to address the gap by investigating the role of common and modifiable risk factors, specifically sleep and circadian rhythm disturbances, in the development of multiple COPCs., Methods: The study will enroll 300 participants with cLBP, including 200 with cLBP only and 100 with cLBP plus other COPCs (ie, fibromyalgia, temporomandibular disorders, irritable bowel syndrome, and chronic headaches) and follow them up for 12 months. Sleep and circadian rhythms will be assessed using wireless sleep electroencephalography, 24-hour evaluation of the rhythm of urinary 6-sulfatoxymelatonin, actigraphy, and sleep diaries. Pain amplification using quantitative sensory testing, psychological distress using validated self-report measures, and the number of pain sites using a pain body map will also be assessed., Perspectives: This research aims to (1) comprehensively characterize sleep/circadian disturbances in individuals with single and multiple COPCs using multimodal in-home assessments; (2) examine the associations between sleep/circadian disturbances, changes in pain amplification, and psychological distress; and (3) investigate the relationship among these factors and the progression in the number of pain sites, a proxy for multiple COPCs. The findings will provide insights into the mechanisms leading to multiple COPCs, potentially informing treatment and prevention strategies for these complex conditions., Competing Interests: M.J.R. has a patent pending for a sleep neural network-based sleep-stage classifier with intended applications to wireless sleep-EEG devices. None of the other authors have conflicts of interests.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.)

Study Objectives: The coronavirus disease 2019 (COVID-19) pandemic impact on infant sleep (IS) is understudied. The purpose of this study was to examine the relationships between family impact and distress from COVID-19 pandemic stressors, parental insomnia symptoms, infant temperamental negative affectivity, and parent-reported IS., Methods: Parents from the Phoenix metropolitan area with a full-term healthy infant (<1 year) were recruited from February 27, 2021, to August 7, 2021. A sample of 70 parents (baby age 5.5 ± 3.5 months; parental age: 31.7 ± 5.0 years) completed the COVID-19 Exposure and Family Impact Survey (CEFIS) Impact and Distress scales, the Insomnia Severity Index (ISI), the Infant Behavioral Questionnaire-Revised Negative Affectivity subscale (IBQ-R-NA), and the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Based on the transactional model of IS, path analyses were conducted to identify the direct effect of CEFIS scores and the indirect effects of parental ISI and infant IBQ-R-NA scores on BISQ-R scores., Results: The parent sample was predominantly female (94.3%), white (72.9%), and married or in a domestic partnership (98.6%). Although COVID-19 pandemic impact and distress were not directly related to parent-reported IS, pandemic distress was negatively related to parent-reported IS indirectly through infant negative affectivity, including BISQ-R total score (β = -0.14, 95% CI [-0.32, -0.01]) and IS subscale score (β = -0.12, 95% CI [-0.27, -0.01])., Conclusions: Heightened COVID-19 pandemic family distress was related to poorer parent-reported IS through greater parent-reported infant negative affectivity, suggesting the importance of addressing family stress and emotional regulation during crises., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)