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BACKGROUND: Among chronic diseases, diabetes is a frequent focus of performance measurement. Disease-specific indicators based on evidence-based clinical guidelines have been used to evaluate the quality of care. There are worldwide efforts to improve the quality of diabetes care. Measuring the gap is an essential first step toward improving the quality of care. METHODS: In order to better understand the status of quality of diabetes care in Japan, a country with a universal healthcare system, we performed a literature search looking for all studies reporting on quality indicators. In this review, we summarized the studies that have looked at the status of the quality of diabetes care over the last decade. RESULTS: There were a total of 6 studies that reported on process including HbA1c, blood pressure, lipid screening, retinopathy and nephropathy screening and intermediate clinical measures which included percentages of patients reaching targets for HbA1c, blood pressure and LDL-C. Overall, the process measures continue to improve, however the clinical intermediate outcome measures remain suboptimal. CONCLUSION: Despite the improvement in diabetes related process measures, there is limited data on clinical measures. It is necessary to shed more light on the assessment of the quality of diabetes care.

BACKGROUND: The availability of aortic stent-grafts has permitted an obvious change in the management of abdominal aortic aneurysms (AAA). For elective cases open surgical repair has been widely superseded by the use of stent-graft. With the rapid evolution of the endovascular technology, a significant development in stent-graft techniques was achieved in conjunction with a better understanding of how to utilize stent-grafts. METHODS: A multicenter prospective study in which 49 patients were enrolled, they underwent an elective endovascular aneurysm repair (EVAR) procedure for infrarenal AAA in two different institutions, Kasr Al-ainy School of Medicine, Cairo University and King’s College Hospital in London, the selected patients were followed up for 6 months after the procedure. Data relating to demographics and pre-operative comorbidities were recorded. Aneurysm morphology was reviewed by computed tomography angiography scans. Clinical data was collected through operative records and afterward through outpatient clinic follow-up sessions. RESULTS: Overall survival was 94% over a period of 6 months calculated using KaplanMeier Survival Curve. CONCLUSIONS: Endovascular repair resulted in fewer perioperative deaths. This study provides insight into clinical parameters that can be used to stratify patients’ post-EVAR surveillance and need for re-intervention and it came to the conclusion that EVAR could be considered as the standard repair for uncomplicated infrarenal AAA.

Increased outdoor concentrations of fine particulate matter (PM2.5 ) and oxides of nitrogen (NO2 , NOx ) are associated with respiratory and cardiovascular morbidity in adults and children. However, people spend most of their time indoors and this is particularly true for individuals with chronic obstructive pulmonary disease (COPD). Both outdoor and indoor air pollution may accelerate lung function loss in individuals with COPD, but it is not feasible to measure indoor pollutant concentrations in all participants in large cohort studies. We aimed to understand indoor exposures in a cohort of adults (SPIROMICS Air, the SubPopulations and Intermediate Outcome Measures in COPD Study of Air pollution). We developed models for the entire cohort based on monitoring in a subset of homes, to predict mean 2-week-measured concentrations of PM2.5 , NO2 , NOx , and nicotine, using home and behavioral questionnaire responses available in the full cohort. Models incorporating socioeconomic, meteorological, behavioral, and residential information together explained about 60% of the variation in indoor concentration of each pollutant. Cross-validated R2 for best indoor prediction models ranged from 0.43 (NOx ) to 0.51 (NO2 ). Models based on questionnaire responses and estimated outdoor concentrations successfully explained most variation in indoor PM2.5 , NO2 , NOx , and nicotine concentrations.

Background The relationship between 25-hydroxyvitamin D (25-OH-vitamin D) and COPD outcomes remains unclear. Using the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS), we determined associations among baseline 25-OH-vitamin D and cross-sectional and longitudinal lung function and COPD exacerbations. Methods Serum 25-OH-vitamin D level was measured in stored samples from 1,609 SPIROMICS participants with COPD. 25-OH-vitamin D levels were modeled continuously and dichotomized as deficient ( Results Vitamin D deficiency was present in 21% of the cohort and was more prevalent in the younger, active smokers, and blacks. Vitamin D deficiency was independently associated with lower % predicted FEV1 (by 4.11%) at enrollment (95% CI, –6.90% to –1.34% predicted FEV1; P = .004), 1.27% predicted greater rate of FEV1 decline after 1 year (95% CI, –2.32% to –0.22% predicted/y; P = .02), and higher odds of any COPD exacerbation in the prior year (OR, 1.32; 95% CI, 1.00-1.74; P = .049). Each 10-ng/mL decrease in 25-OH-vitamin D was associated with lower baseline lung function (–1.04% predicted; 95% CI, –1.96% to –0.12% predicted; P = .03) and increased odds of any exacerbation in the year before enrollment (OR, 1.11; 95% CI, 1.01-1.22; P = .04). Conclusions Vitamin D deficiency is associated with worse cross-sectional and longitudinal lung function and increased odds of prior COPD exacerbations. These findings identify 25-OH-vitamin D levels as a potentially useful marker of adverse COPD-related outcomes.

OBJECTIVESOwing to the severe donor shortage in Japan, living-donor lobar lung transplantation (LDLLT) remains a valuable option. As only lobes are implanted in LDLLT, grafts may be too small, especially for adult recipients. To overcome this obstacle, we developed right-to-left inverted LDLLT. In this procedure, the right lower lobe, which is 25% bigger than the left lower lobe, is used as the left-side graft instead of the left lower lobe. This study aimed to investigate the characteristics and intermediate outcomes of right-to-left inverted LDLLT.METHODSSince the first right-to-left inverted LDLLT performed in 2014, 48 LDLLTs have been performed in our institution, of which 15 were right-to-left inverted LDLLTs. We reviewed their characteristics and intermediate outcomes.RESULTSThe reasons for choosing an inverted procedure instead of the standard LDLLT were small-for-size graft in 11 cases and anatomical variation of donor vessels in 4 cases. The first patient underwent left single LDLLT using a right lower lobe graft, and the following 14 patients underwent bilateral LDLLT using 2 right lower lobe grafts. A native upper lobe-sparing procedure was additionally applied in 2 patients. No complications occurred in the bronchial and vascular anastomoses. No operative mortality occurred, and all the patients were discharged home after LDLLT. The 3-year survival was 92.3%, with a median follow-up time of 40 months. The donor postoperative course was uneventful, and all the donors returned to their regular routine postoperatively.CONCLUSIONRight-to-left inverted LDLLT is a safe and useful option with encouraging intermediate outcome.

This paper describes the intermediate outcome of one of the initiatives of the ELEXIS project: Transnational Access. The initiative aims at facilitating interaction between lexicographers/researchers from the EU and associated countries and lexicographical communities throughout Europe by giving out travel grants. Several of the grant holders have visited CLARIN centres, have been acquainted with the CLARIN infrastructure and have used CLARIN tools. The paper reports on the scientific outcome of the visits that have taken place so far: the origin of the grant holders, their level of experience, the kind of research projects the grant holders work with and the outcomes of their visits. Every six months ELEXIS releases a call for grants, the fourth call closed January 2020. Since then calls and visits have been suspended due to the COVID-19 situation. So far 23 visits have been granted in total; 13 of these visits have been concluded and the reports of the grant holders are publicly available at the ELEXIS website.

Patient satisfaction is an important intermediate outcome of patient-provider encounters, linking face-to-face interactions between patients and medical professionals with patients' well-being after consultations. Today, physician review websites provide a new venue for the study of patient satisfaction, as patients are utilizing such websites to evaluate their encounters with physicians. This study examined how parents of pediatric patients in China evaluated their pediatricians and factors associated with patient satisfaction through a qualitative content analysis of reviews (n = 7230) on the "Good Doctor Website" (haodf.com), China's largest physician review platform. Reviews were chosen from all reviews of pediatricians in eight top-tier hospitals in four major cities. Three dimensions of patient satisfaction were identified: pediatricians' interpersonal manners (including friendliness, listening to patients, heartfelt encouragement, and clear explanation), ethics (including rejecting red envelopes and kickbacks and cost awareness), and medical competence/overall health outcome. This study contributes to a culturally sensitive understanding of patient satisfaction and further explains the tense physician-patient relationship in China. Practically, our findings can inform the training of pediatricians in China.

The use of costochondral graft is controversial for pediatric temporomandibular joint reconstruction due to its unpredictable growth. The height of the cartilage is directly responsible for the growth capacity of costochondral graft. Even after keeping the cartilage in costochondral graft to a recommended height, overgrowth has been reported. Traditionally during costochondral graft fixation, chin deviation is corrected intraoperatively. The investigators hypothesized that this intraoperative manipulation of mandible to correct chin deviation and maintaining the chin in new position causes excessive stress and strain in the muscular functional matrix. The authors believe that this may be the reason for excessive growth trigger on the grafted side. This study intends to prove the hypothesis of no-intraoperative correction of chin deviation can prevent overgrowth of the costochondral graft. We implied this technique in pediatric temporomandibular joint ankylosis patients managed with osteoarthrectomy and reconstructed with costochondral graft. Patients with at least a follow-up of 30-months were included in the study. The study sample consisted of 20 patients. All the patients had adequate growth with improvement in facial asymmetry. The results of the present study supports our hypothesis of no-intraoperative correction of chin deviation as a technique to prevent overgrowth of costochondral graft. We recommend this technique to allow catch-up of growth rather than acceleration of growth. This change in technique needs more research, randomized controlled trial for reliability and long-term results.

Measuring systemic chronic inflammatory markers in the blood may be one way of understanding the role of inflammation in breast cancer risk, and might provide an intermediate outcome marker in prevention studies. Here, we present the results of a systematic review of prospective epidemiologic studies that examined associations between systemic inflammatory biomarkers measured in blood and breast cancer risk. From 1 January 2014 to 20 April 2020, we identified 18 unique studies (from 16 publications) that examined the association of systemic inflammatory biomarkers measured in blood with breast cancer risk using prospectively collected epidemiologic data. Only one marker, C-reactive protein, was studied extensively (measured in 13 of the 16 publications), and had some evidence of a positive association with breast cancer risk. Evidence associating other inflammatory biomarkers and more comprehensive panels of markers with the development of breast cancer is limited. Future prospective evidence from expanded panels of systemic blood inflammatory biomarkers is needed to establish strong and independent links with breast cancer risk, along with mechanistic studies to understand inflammatory pathways and demonstrate how breast tissue responds to chronic inflammation. This knowledge could ultimately support the development and evaluation of mechanistically driven interventions to reduce inflammation and prevent breast cancer.

It can be difficult to document whether active labor market programs are effective for the long-term unemployed because their transitions to employment are rare. This study examines whether eight measures of employability are useful intermediate outcome measures for the long-term unemployed. We use a repeated survey linked to administrative register data and estimate three-way fixed-effect models. The results show that self-reported health is a useful outcome measure for the given population of long-term unemployed in the following sense: Only this measure both predicts subsequent employment and is positively associated with prior participation in an active labor market program compared with non-participation.

Introduction Mind-body awareness is often viewed as an outcome of using complementary and alternative medicine (CAM). Emerging evidence suggests that mind-body awareness may be an intermediate outcome that contributes to CAM-related outcomes. The current study aimed to test a model of mind-body awareness as an intermediate outcome of CAM use via provider autonomy support that facilitates quality of life and health behaviour changes. Methods Undergraduate students (N = 243, M age = 23.5, 84% female) screened for current CAM use, completed an online survey including questions about their CAM use, perceived outcomes from use of CAM, a measure of CAM provider autonomy support, and a new 8-item measure of Mind-body Awareness (MBA). Results Bivariate analyses confirmed that those with high MBA had higher scores on positive CAM-related health behaviour (diet, weight loss, exercise) and quality of life (sleep quality, mood, energy levels, concentration) changes. Path analysis controlling for demographics and health status tested the proposed model of CAM use predicting provider autonomy support, and in turn MBA and two CAM-related outcomes. The model fit well to the data, CFI = 0.94, TLI = 0.91, RMSEA = 0.03, supporting the hypotheses that CAM use is associated with higher MBA via increased autonomy support, and MBA contributes to quality of life and health behaviour changes. Conclusions Findings extend previous research on mind-body awareness by linking it to CAM-related quality of life and behavioural outcomes in a sample of young adult CAM consumers, and further suggest a route through which provider support may enhance CAM outcomes.

Background Classification of COPD is usually based on the severity of airflow, which may not sensitively differentiate subpopulations. Using a multiscale imaging-based cluster analysis (MICA), we aim to identify subpopulations for current smokers with COPD. Methods Among the SPIROMICS subjects, we analyzed computed tomography images at total lung capacity (TLC) and residual volume (RV) of 284 current smokers. Functional variables were derived from registration of TLC and RV images, e.g. functional small airways disease (fSAD%). Structural variables were assessed at TLC images, e.g. emphysema and airway wall thickness and diameter. We employed an unsupervised method for clustering. Results Four clusters were identified. Cluster 1 had relatively normal airway structures; Cluster 2 had an increase of fSAD% and wall thickness; Cluster 3 exhibited a further increase of fSAD% but a decrease of wall thickness and airway diameter; Cluster 4 had a significant increase of fSAD% and emphysema. Clinically, Cluster 1 showed normal FEV1/FVC and low exacerbations. Cluster 4 showed relatively low FEV1/FVC and high exacerbations. While Cluster 2 and Cluster 3 showed similar exacerbations, Cluster 2 had the highest BMI among all clusters. Conclusions Association of imaging-based clusters with existing clinical metrics suggests the sensitivity of MICA in differentiating subpopulations.

An important objective in humanistic-experiential psychotherapies and particularly emotion-focused psychotherapy (EFT) is to map patterns of change. Effective mapping of the processes and pathways of change requires that in-session processes be linked to in-session resolutions, immediate post-session changes, intermediate outcome, final therapy outcome, and longer-term change. This is a challenging and long-term endeavour. Fine-grained descriptions of in-session processes that lead to resolution of specific interpersonal and intrapersonal issues linked with longer-term outcomes are the foundation of EFT, the process-experiential approach. In this paper, evidence in support of EFT as a treatment approach will be reviewed along with research on two mechanisms of change, viewed as central to EFT, clients' emotional processing and the therapeutic relationship conditions. The implications for psychotherapy research are discussed. Given the methodological constraints, there is a need for more innovative methodologies and strategies to investigate specific psychotherapy processes within and across different approaches to map patterns and mechanisms of change to enhance theory, research, practice, and training.

Many trait measurements are size-dependent, and while we often divide these traits by size before fitting statistical models to control for the effect of size, this approach does not account for allometry and the intermediate outcome problem. We describe these problems and outline potential solutions. Electronic supplementary material The online version of this article (doi:10.1186/s12915-017-0448-5) contains supplementary material, which is available to authorized users.

Background: The phase 3 JAVELIN Renal 101 trial (NCT02684006) demonstrated significantly improved progression-free survival (PFS) with first-line avelumab plus axitinib versus sunitinib in advanced renal cell carcinoma (aRCC). We report updated efficacy data from the second interim analysis. Patients and methods: Treatment-naive patients with aRCC were randomized (1 : 1) to receive avelumab (10 mg/kg) intravenously every 2 weeks plus axitinib (5 mg) orally twice daily or sunitinib (50 mg) orally once daily for 4 weeks (6-week cycle). The two independent primary end points were PFS and overall survival (OS) among patients with programmed death ligand 1–positive (PD-L1+) tumors. Key secondary end points were OS and PFS in the overall population. Results: Of 886 patients, 442 were randomized to the avelumab plus axitinib arm and 444 to the sunitinib arm; 270 and 290 had PD-L1+ tumors, respectively. After a minimum follow-up of 13 months (data cut-off 28 January 2019), PFS was significantly longer in the avelumab plus axitinib arm than in the sunitinib arm {PD-L1+ population: hazard ratio (HR) 0.62 [95% confidence interval (CI) 0.490–0.777]}; one-sided P < 0.0001; median 13.8 (95% CI 10.1–20.7) versus 7.0 months (95% CI 5.7–9.6); overall population: HR 0.69 (95% CI 0.574–0.825); one-sided P < 0.0001; median 13.3 (95% CI 11.1–15.3) versus 8.0 months (95% CI 6.7–9.8)]. OS data were immature [PD-L1+ population: HR 0.828 (95% CI 0.596–1.151); one-sided P = 0.1301; overall population: HR 0.796 (95% CI 0.616–1.027); one-sided P = 0.0392]. Conclusion: Among patients with previously untreated aRCC, treatment with avelumab plus axitinib continued to result in a statistically significant improvement in PFS versus sunitinib; OS data were still immature. Clinical Trial number: NCT02684006.

Background: Central blood pressure values and arterial stiffness have demonstrated to be a useful tool to stratify cardiovascular risk and also as a biomarker. A question that is still unanswered is if hypertension treatment guided by central blood pressure parameters will be even better to promote cardiovascular protection than peripheral one. Methods: With this proposition we have designed an open prospective multicentric randomized protocol to compare central (G1) and peripheral (G2) blood pressure targets during 1 year follow-up concerning target organ damage (carotid intima media thickness, left ventricular hypertrophy, microalbuminuria and pulse wave velocity). OMRON 1100 will be used to access peripheral and Mobil O’Graph to access central blood pressure and pulse wave velocity, TOSHIBA Xsario with longitudinal linear transdutor 7.5 MHz bidimensional mode B to access carotid and left ventricular parameters. Expected Results: This paper aims to describe methodological aspects concerning this research and we expect to find results to answer some open questions about hypertension treatment and cardiovascular protection.

Farmers&rsquo, market implementation holds promise for increasing access to healthy foods. Although rarely measured, purchase data constitute an intermediate outcome between food environment and actual consumption. In a study conducted with two seasonal Fruits and Vegetables (FV) stands in a disadvantaged area of Montr&eacute, al (Canada), we analysed how accessibility, perception, and mobility-related factors were associated with FV purchase. This analysis uses a novel measure of FV purchasing practices based on sales data obtained from a mobile application. A 2016 survey collected information on markets&rsquo, physical access, perceived access to FV in the neighbourhood, usual FV consumption and purchases. Multivariate models were used to analyse three purchasing practice indicators: number of FV portions, FV variety and expenditures. Average shoppers purchased 12 FV portions of three distinct varieties and spent 5$. Shoppers stopping at the market on their usual travel route spent less (p = 0.11), bought fewer portions (p = 0.03) and a lesser FV variety (p &lt, 0.01). FV stands may complement FV dietary intake. Individuals for whom the market is on their usual travel route might make more frequent visits and, therefore, smaller purchases. The novel data collection method allowed analysis of multiple purchase variables, is precise and easy to apply at unconventional points of sales and could be transposed elsewhere.

The empirical evidence that innovation policies often lead to innovation additionality is long-standing. However, innovation is an intermediate outcome. Innovations are important to the extent that they contribute to some broader goal, such as the competitiveness of firms and economies. To this end, we take exporting as an important indicator of competitiveness and investigate whether innovation interventions lead to exporting outcomes. Using the Mannheim Innovation Panel, the current study explores whether innovation interventions at various administrative levels associate with changing export behaviors among German Small- and Medium-sized Enterprise (SMEs). Our results provide evidence of the scope for policymakers to employ innovation interventions as export policy.

Introduction Ventricular septal defect (VSD) is one of the more common congenital heart defects, and aortic regurgitation (AR) is its major complication if it remains unrepaired. We aim to determine the AR incidence in various types of VSD, its immediate and intermediate six to 12-month post-VSD repair outcomes of AR. Methods We conducted a retrospective review of medical records of all children aged 18 years or younger who were diagnosed with single VSD at our institution from 2016 to 2018. VSD was classified according to its location and relation to the tricuspid annulus and semilunar valve. AR severity grading was done according to the American Society of Echocardiography, and vena contracta width (VC) was taken as the main parameter for severity. We defined trivial-to-mild AR as VC width less than 0.3 cm, moderate AR was 0.3-0.6 cm VC width, and severe AR was VC width of more than 0.6 cm. Immediate and intermediate outcomes of surgical closure, such as residual VSD and AR, were observed. Results One hundred ninety patients with isolated single VSD were included in the study. Of those, 114 patients had perimembranous VSD (60.0%), 64 patients had muscular VSD (33.7%), and 12 patients had supracristal VSD (6.3%). The median age of our study cohort was six months, with a male to female ratio of 1.3:1. Aortic valve prolapse (28.9%; n = 55) and AR (23.2%; n = 44) were the most common findings on echocardiographic evaluation of VSD patients. Most cases of VSD with AR had trivial-to-mild AR, (68.2%; n = 30). AR was most commonly seen in supracristal VSD (83.3%; n = 10) followed by perimembranous VSD (28.9%; n = 33). VSD closed spontaneously in 34 patients (17.9%) and 98 patients (51.6%) patients underwent surgery. Residual VSD after surgical closure was present in 57.1% (56) and 17.3% (17) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Similarly, residual AR after surgical closure of VSD was present in 32.7% (32) and 15.3% (15) of the patients immediate postoperatively and six- to 12-month postoperative follow-up, respectively. Conclusion The incidence of AR with VSD was very high in our study; AR was most commonly associated with supracristal VSD. After surgical repair, mild AR decreased with time. Early corrective surgery of VSD can prevent this complication and help improve outcomes.

The aim of this review is to discuss the requirements for effective irrigation of the root canal system and its role in treatment outcome. A review of the literature regarding irrigants, methods of irrigation and regimens was undertaken. It indicates that irrigation is comprised of a multitude of factors, and that effective irrigant delivery and agitation achieves mechanical, chemical and microbiological functions, which are prerequisites for obtaining a clean canal system. However, most studies are ex vivo and assess intermediate outcome values rather than treatment success. Additionally, there is an absence of high-level evidence evaluating the effect of irrigation on the outcome of root canal treatment. Therefore, citing irrigation as a significant factor that affects root canal treatment success cannot be done. This highlights the need to further investigate the prognostic value of irrigation on root canal treatment success.

Stated preference scenarios often describe outcomes to be valued in terms of intermediate biophysical processes or ecosystem services with indirect utility effects, rather than in terms of final, directly welfare‐relevant consequences. This article evaluates whether valid welfare estimates can emerge from this practice. We begin with a theoretical model demonstrating conditions under which stated preference scenarios that include intermediate outcomes will elicit welfare estimates identical to those from parallel scenarios that include associated final outcomes (i.e., convergent validity will hold). The model demonstrates that a necessary condition for convergent validity is the ability of respondents to correctly predict biophysical production functions linking intermediate to final outcomes. Hypotheses from the theoretical model are then evaluated empirically using an application of choice experiments to migratory fish restoration in the U.S. state of Rhode Island. Empirical results are mixed but generally reject convergent validity; welfare estimates are not robust to the use of an intermediate outcome in lieu of a related final outcome in stated preference scenarios, as predicted by theory. Results of the analysis suggest that greater attention should be given to the reliability of welfare estimation when final outcomes cannot be quantified.

We investigated whether hypothermia in newborn piglets could be reduced by applying different thermal aids. The experiment was performed on 150 newborn piglets from 24 sows. Right after birth, the piglets were moved to a wire mesh cage for the first 2 h of life where they experienced 1 of 7 different combinations of flooring (solid vs. slatted) and treatments: control, with no additional thermal aids on a solid floor ( = 26) or a slatted floor ( = 26); built-in floor heating ( = 31) or floor heating as a radiant floor plate on solid floor (FloorPlate; = 19); radiant heater above a solid floor (RadiantC; = 22) or a slatted floor (RadiantSlat; = 18); and provision of straw on a solid floor (Straw; = 8). Piglets' rectal temperature was measured both continuously and manually every 10 min for the first 2 h after birth using a thermal sensor inserted in the rectum of the piglets. The rectal temperature curve was analyzed for differences in the slope of the drop in rectal temperature and the deflection tangent of the curve. Furthermore, differences in average rectal temperature, minimum rectal temperature, rectal temperature 2 h after birth, and time with rectal temperature below 35°C were analyzed. All statistical analyses were performed using a mixed model. All thermal aids/heat solutions resulted in a less steep drop in rectal temperature, a faster recovery, and, for the smaller piglets, also a greater average rectal temperature (except for built-in floor heating) and less time with rectal temperature below 35°C. The most efficient thermal aids to reduce hypothermia in newborn piglets were Straw and RadiantC. Furthermore, Straw, RadiantC, and FloorPlate also eliminated the effect of birth weight on some of these indicators of thermoregulatory success. Otherwise, FloorPlate and RadiantSlat showed an intermediate outcome for most measures. With no heating, piglets on a solid floor experienced more severe hypothermia than piglets on a slatted floor. In conclusion, several types of thermal aids can reduce hypothermia in newborn piglets, but some are more efficient and can partly eliminate the effect of birth weight on hypothermia. These results are especially important in countries where breeding for large litter sizes has resulted in a reduction in average birth weight of the piglets and, thus, creates a greater demand for an early, adequate thermal environment to secure piglet viability.

Parent engagement is an important intermediate outcome in Family Drug Treatment Court (FDTC) and child welfare services. This study explored the utility and reliability of a client satisfaction and engagement survey designed to measure interim outcomes of a Mentor Parent Program, operating in conjunction with a FDTC. Findings suggest the survey is a useful, parsimonious and reliable tool for measuring key dimensions of parent mentor services including client engagement; client-centered support and empowerment; and help with systems navigation and accessing resources. The survey may be adapted for use in other FDTC or parent mentor contexts.

This chapter focuses on the linkages between intermediate marketing outcomes and financial performance. Linking marketing activities and expenditures to cash flow requires three things: (1) the story of how marketing activities and expenditures influence sales or margins; (2) a baseline that indicates what sales would be without marketing activity and expenditures; and (3) a set of intermediate outcome measures that are reliable predictors or antecedents of financial results. This chapter examines these three elements of the marketing/finance linkage.

A cluster randomised trial (CRT) in Burkina Faso was the first to demonstrate that a radio campaign increased health-seeking behaviours, specifically antenatal care attendance, health facility deliveries and primary care consultations for children under 5 years.Under-five consultation data by diagnosis was obtained from primary health facilities in trial clusters, from January 2011 to December 2014. Interrupted time-series analyses were conducted to assess the intervention effect by time period on under-five consultations for separate diagnosis categories that were targeted by the media campaign. The Lives Saved Tool was used to estimate the number of under-five lives saved and the per cent reduction in child mortality that might have resulted from increased health service utilisation. Scenarios were generated to estimate the effect of the intervention in the CRT study areas, as well as a national scale-up in Burkina Faso and future scale-up scenarios for national media campaigns in five African countries from 2018 to 2020.Consultations for malaria symptoms increased by 56% in the first year (95% CI 30% to 88%; p0.001) of the campaign, 37% in the second year (95% CI 12% to 69%; p=0.003) and 35% in the third year (95% CI 9% to 67%; p=0.006) relative to the increase in the control arm. Consultations for lower respiratory infections increased by 39% in the first year of the campaign (95% CI 22% to 58%; p0.001), 25% in the second (95% CI 5% to 49%; p=0.010) and 11% in the third year (95% CI -20% to 54%; p=0.525). Diarrhoea consultations increased by 73% in the first year (95% CI 42% to 110%; p0.001), 60% in the second (95% CI 12% to 129%; p=0.010) and 107% in the third year (95% CI 43% to 200%; p0.001). Consultations for other diagnoses that were not targeted by the radio campaign did not differ between intervention and control arms. The estimated reduction in under-five mortality attributable to the radio intervention was 9.7% in the first year (uncertainty range: 5.1%-15.1%), 5.7% in the second year and 5.5% in the third year. The estimated number of under-five lives saved in the intervention zones during the trial was 2967 (range: 1110-5741). If scaled up nationally, the estimated reduction in under-five mortality would have been similar (9.2% in year 1, 5.6% in year 2 and 5.5% in year 3), equating to 14 888 under-five lives saved (range: 4832-30 432). The estimated number of lives that could be saved by implementing national media campaigns in other low-income settings ranged from 7205 in Burundi to 21 443 in Mozambique.Evidence from a CRT shows that a child health radio campaign increased under-five consultations at primary health centres for malaria, pneumonia and diarrhoea (the leading causes of postneonatal child mortality in Burkina Faso) and resulted in an estimated 7.1% average reduction in under-five mortality per year. These findings suggest important reductions in under-five mortality can be achieved by mass media alone, particularly when conducted at national scale.

Rationale: Despite awareness of chronic obstructive pulmonary disease (COPD) treatment recommendations, uptake is poor. The Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) spans 2010–2016, providing an opportunity to assess integration of 2011 Global Initiative for Obstructive Lung Disease (GOLD) treatment strategies over time in a large observational cohort study. Objectives: To evaluate how COPD treatment aligns with 2011 GOLD strategies and determine factors associated with failure to align with recommendations. Methods: Information on inhaled medication use collected via questionnaire annually for 4 years was compiled into therapeutic classes (long-acting antimuscarinic agent, long-acting β-agonist, inhaled corticosteroids [ICS], and combinations thereof). Medications were not modified by SPIROMICS investigators. 2011 GOLD COPD categories A, B, C, and D were assigned. Alignment of inhaler regimen with first-/second-line GOLD recommendations was determined, stratifying into recommendation aligned or nonaligned. Recommendation-nonaligned participants were further stratified into overuse and underuse categories. Results: Of 1,721 participants with COPD, at baseline, 52% of regimens aligned with GOLD recommendations. Among participants with nonaligned regimens, 46% reported underuse, predominately owing to lack of long-acting inhalers in GOLD category D. Of the 54% reporting overuse, 95% were treated with nonindicated ICS-containing regimens. Among 431 participants with 4 years of follow-up data, recommendation alignment did not change over time. When we compared 2011 and 2017 recommendations, we found that 47% did not align with either set of recommendations, whereas 35% were in alignment with both recommendations. Conclusions: Among SPIROMICS participants with COPD, nearly 50% reported inhaler regimens that did not align with GOLD recommendations. Nonalignment was driven largely by overuse of ICS regimens in milder disease and lack of long-acting inhalers in severe disease.

This panel will highlight papers that have received the Best Paper Award at the SIGMIS CPR conference going back to 2000 (with those since 2004 named the "Magid Igbaria Best Paper Award"). We will start the panel with a high-level over-view of papers that received the Best Paper Award - a sum-mary of the topics, research methods, types of organizations or populations studied, and publication outcomes after receiving the Best Paper Award. The main portion of the panel will feature authors describing how they regard conference papers as part of their research portfolio. A key goal of the panel is to elicit authors' perspectives regarding whether conference papers are end goals themselves, an intermediate outcome that has value to their career only if later published in a journal, or a stepping stone to multiple later options.

Humanities and Social Sciences/Economies and financesJournal articles; International audience; This paper studies decisions under ambiguity when attention is paid to extreme outcomes. In a purely subjective framework, we propose an axiomatic characterization of affine capacities, which are Choquet capacities consisting in an affine transformation of a subjective probability. Our main axiom restricts the well-known Savage’s Sure-Thing Principle to a change in a common intermediate outcome. The representation result is then an affine combination of the expected utility of the valued act and its maximal and minimal utilities.

There are conflicting opinions regarding the optimal waiting time to perform surgery after rupture of supratentorial arteriovenous malformations (AVMs) to achieve the best possible outcome. To analyze factors influencing outcomes for ruptured supratentorial AVMs after surgery, paying particular attention to the timing of the surgery. We retrospectively investigated 59 patients admitted to our center between 2000 and 2014 for surgical treatment of ruptured supratentorial AVMs. We evaluated the effect of timing of surgery and other variables on the outcome at 2-4 months (early outcome), at 12 months (intermediate outcome) after surgery, and at final follow-up at the end of 2016 (late outcome). Age over 40 years (OR 18.4; 95% CI 1.9-172.1; p = 0.011), high Hunt and Hess grade (4 or 5) before surgery (OR 13.5; 95% CI 2.1-89.2; p = 0.007), hydrocephalus on admission (OR 12.9; 95% CI 1.8-94.4; p = 0.011), and over 400 cm(3) bleeding during surgery (OR 11.5; 95% CI 1.5-86.6; p = 0.017) were associated with an unfavorable early outcome. Age over 40 years (OR 62.8; 95% CI 2.6-1524.9; p = 0.011), associated aneurysms (OR 34.7; 95% CI 1.4-829.9; p = 0.029), high Hunt and Hess grade before surgery (OR 29.2; 95% CI 2.6-332.6; p = 0.007), and over 400 cm(3) bleeding during surgery (OR 35.3; 95% CI 1.7-748.7; p = 0.022) were associated with an unfavorable intermediate outcome. Associated aneurysms (OR 8.2; 95% CI 1.2-55.7; p = 0.031), high Hunt and Hess grade before surgery (OR 5.7; 95% CI 1.3-24.3; p = 0.019), and over 400 cm(3) bleeding during surgery (OR 5.8; 95% CI 1.2-27.3; p = 0.027) were associated with an unfavorable outcome at last follow-up. Elapsed time between rupture and surgery did not affect early or final outcome. Early surgery in patients with ruptured supratentorial arteriovenous malformation is feasible strategy, with late results comparable to those achieved with delayed surgery. Many other factors than timing of surgery play significant roles in long-term outcomes for surgically treated ruptured supratentorial AVMs.

Assessing the potential of surrogate markers and surrogate outcomes for replacing a long term outcome is an active area of research. The interest in this topic is partly motivated by increasing pressure from stakeholders to shorten the time required to evaluate the safety and/or efficacy of a treatment or intervention such that treatments deemed safe and effective can be made available to those in need more quickly. Most existing methods in surrogacy evaluation either require strict model assumptions or that primary outcome and surrogate outcome information is available for all study participants. In this paper, we focus on a setting where the primary outcome is subject to censoring and the aim is to quantify the surrogacy of an intermediate outcome, which is also subject to censoring. We define the surrogacy as the proportion of treatment effect on the primary outcome that is explained by the intermediate surrogate outcome information and propose two robust methods to estimate this quantity. We propose both a nonparametric approach that uses a kernel smoothed Nelson-Aalen estimator of conditional survival, and a semiparametric method that derives conditional survival estimates from a landmark Cox proportional hazards model. Simulation studies demonstrate that both approaches perform well in finite samples. Our methodological development is motivated by our interest in investigating the use of a composite cardiovascular endpoint as a surrogate outcome in a randomized study of the effectiveness of angiotensin-converting enzyme (ACE) inhibitors on survival. We apply the proposed methods to quantify the surrogacy of this potential surrogate outcome for the primary outcome, time to death.

Background:Mass media campaign is an integral tool to influence physical activity participant behaviors. The purpose of the systematic review was to identify the effectiveness of mass media campaigns in promoting physical activity.Methods:Literature update from January 2010 to September 2016 was conducted in 13 databases. Full text articles of 128 were screened, and 23 articles (18 campaigns) were selected from the initial 1692 articles.Results:All campaigns involved mass media advertisements to promote physical activity to general individuals (n = 2), adults (8), children (4), older adults (2), and parents of children (n = 2). The campaign evaluation designs included clustered RCT (2), cohort (3), quasi-experimental (9), and cross-sectional (9). Eight articles demonstrated significant campaign impact on proximal, 6 on intermediate, 5 on distal outcomes, and 6 on distal change based on either proximal or intermediate outcome.Conclusion:The current review assessed the outcome evaluation of mass media physical activity campaigns that varied in their respective scope, target population and outcomes measured to identify individual changes at proximal, intermediate, and distal level. Results from formative and process evaluation as well as dose-response and cost-effective analysis are suggested to provide valuable evidence for campaign stakeholders and planners.

Objective The aim of this study was to compare the outcome of eating disorders (EDs) in Japan with that in Western countries. Method Two hundred and thirty-three Japanese women with an ED were followed for 4 to 9 years. We identified fully recovered women (good outcome group), partially recovered women (intermediate outcome group) and women with an active ED (poor outcome group) based on physical, behavioural and psychological indices. Results Ninety-seven subjects were categorized as having a good outcome, 58 as intermediate and 61 as poor, and 17 had died. There was a significant difference in outcome results among the types of ED at intake. Women with both anorexia nervosa and bulimia nervosa, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, at intake had the worst recovery rates. Conclusions These results suggest that the outcome of EDs in Japan is relatively similar to that in Western countries, irrespective of sociocultural background and health systems. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.

Objectives: To evaluate the long-term outcome of adolescents with anorexia nervosa and attempt to define prognostic factors for outcome. Methods: Transversal, descriptive epidemiological study with a strict methodology: minimum interval of 4 years since first admission, evaluation using clearly defined diagnostic criteria (EAT-40 self-evaluation, HSCL, global patient-driven self-evaluation and hetero evaluation: clinical interview and LECE). The 198 subjects are former adolescent anorexics treated at the Hopital d’Enfants (Children’s Hospital) in Nancy (France). Results: Clinical evaluation of the 144 subjects traced showed positive outcome for 68.1%, intermediate outcome for 23.2% and poor outcome for 8.7%. 5 factors for a good prognosis were found (middle socioeconomic class of parents, no prior treatment, hospitalization > 1 month, follow-up

Late-onset schizophrenia (LOS) is a controversial diagnosis, mainly characterized by more positive symptoms and less deterioration. LOS could be considered as either an extreme of typical schizophrenia (but for old age patients, and short duration of the disorder), or an independent group of patients with a specific diagnosis, with no clear evidence in favor or against any of these hypotheses. The aim of the present study is to characterize the memory cognitive profile of LOS patients without related organic factors (N=25), compared to early-onset schizophrenic patients (EOS, N=44), matched for the duration of the disorder, and healthy controls (HC, N=23), matched for the age of patients. Lifetime clinical symptoms and functioning were collected using the DIGS and the PANSS, and components of memory capacity were assessed with the Forward and Backward Digit Span Tasks, Rey Complex Figure and Verbal Fluency Tests. LOS patients were performing significantly better than EOS patients on the digit span task, Rey's complex figure at T1 score and phonemic verbal fluency. However, LOS had significantly lower performances than healthy controls on the digit span task and on both verbal fluency tests. This study provides evidence that LOS had intermediate outcome compared to EOS and controls. LOS can therefore be in line with a dimensional clinical approach of schizophrenia, whereby it presents few memory deficits and few disorganization and negative symptoms with mostly positive symptoms and possibly etiopathogenic specificities. Further studies including more specific memory assessment tests and larger samples are needed to confirm the present finding.

Array comparative genomic hybridization (aCGH) has yet to be fully leveraged in a prognostic setting in chronic lymphocytic leukemia (CLL). Genomic imbalance was assessed in 288 CLL specimens using a targeted array. Based on 20 aberrations in a hierarchical manner, all 228 treatment-naive specimens were classified into a group with poor outcome (20.6%) exhibiting at least one aberration that was univariately associated with adverse outcome (gain: 2p, 3q, 8q, 17q, loss: 7q, 8p, 11q, 17p, 18p), good outcome (32.5%) showing 13q14 loss without any of the other 10 aberrations (gain: 1p, 7p, 12, 18p, 18q, 19, loss: 4p, 5p, 6q, 7p) or intermediate outcome (remainder). The three groups were significantly separated with respect to time to first treatment and overall survival (p < 0.001), and validation of the stratification scheme was performed in two independent datasets. Gain of 3q and 8q, and 17p loss were determined to be independent unfavorable prognostic biomarkers. TP53, NOTCH1 and SF3B1 mutations correlated with the presence of one poor outcome aCGH marker, at a considerably higher frequency than when only considering poor risk aberrations routinely detected by fluorescence in situ hybridization (FISH). These data support genomic imbalance evaluation in CLL by aCGH to assist in risk stratification.