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The time period over which relevant symptoms shifts unfold is not uniform across individuals. This article proposes an adaptation of the Reliable Change Index (RCI) to detect symptom changes of varying durations in individual patients' time series: the Duration-Adjusted RCI (DARCI). The DARCI proportionally raises the RCI cut-off to account for its extension over additional time increments, resulting in different DARCI thresholds for different change durations. The method is illustrated with a simulation study of depressive symptom time series with varying degrees of discontinuity and overall mean change, and four empirical case examples from two clinical samples. The results suggest that the DARCI may be particularly useful for identifying symptom shifts that appear relatively abrupt, which can help indicate when a patient is showing significant improvement or deterioration. Its ease of use makes it suitable for application in clinical contexts and a promising method for exploring transitions in psychiatric populations. [ABSTRACT FROM AUTHOR]

This article proposes a powerful alternative to the t-test of the null hypothesis that a coefficient in a linear regression is equal to zero when a regressor is mismeasured. We assume there are two contaminated measurements of the regressor of interest. We allow the two measurement errors to be nonclassical in the sense that they may both be correlated with the true regressor, they may be correlated with each other, and we do not require any location normalizations on the measurement errors. We propose a new maximal t-statistic that is formed from the regression of the outcome onto a maximally weighted linear combination of the two measurements. The critical values of the test are easily computed via a multiplier bootstrap. In simulations, we show that this new test can be significantly more powerful than t-statistics based on OLS or IV estimates. Finally, we apply the proposed test to a study of returns to education based on twin data from the UK. With our maximal t-test, we can discover statistically significant returns to education when standard t-tests do not. [ABSTRACT FROM AUTHOR]

Aim: Routine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services. Method: The article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence. Findings: Responses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective. Conclusions: The responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice. [ABSTRACT FROM AUTHOR]

While mitochondria are susceptible to environmental detriments, little is known about potential associations between arsenic metabolites and mitochondria DNA copy number (mtDNAcn). We attempted to examine whether maternal urinary arsenic metabolite levels in different trimesters were related to neonatal cord blood mtDNAcn. We included 819 mother-newborn pairs embedded in an in-progress birth cohort survey performed from April 2014 to October 2016 in Wuhan, China. We determined maternal urinary arsenic species concentrations in different trimesters. We determined cord blood mtDNAcn using quantitative real-time polymerase chain reaction. In covariate-adjusted models, each one-unit increment of dimethylated arsenic (DMA) and total arsenic (TAs) in the third trimester was related to 8.43% (95% CI 1.13%, 16.26%) and 12.15% (95% CI 4.35%, 20.53%) increases in mtDNAcn, respectively. The dose–response trend with statistical significance was observed across tertiles of DMA and TAs in the third trimester with mtDNAcn (DMA percent changes (%Δ) = 25.60 (95% CI 6.73, 47.82), for the highest vs the lowest tertile (P = 0.02); TAs %Δ = 40.31 (95% CI 19.25, 65.10), for the highest vs the lowest tertile (P = 0.0002)). These findings may prove the relationships between prenatal arsenic species levels and neonatal mitochondrial dysfunction. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the impact of clinically significant weight change on outcomes related to IVF cycle performance? SUMMARY ANSWER While individual weight loss did not significantly impact ovarian response to stimulation or other cycle outcome parameters in our study, some positive associations were found for individual weight gain. WHAT IS KNOWN ALREADY The role of weight-change in patients undergoing IVF has been largely studied by comparing weight loss in different cohorts of patients stratified by a static BMI. Specifically, obesity has been extensively studied in relation to its negative effects on assisted or unassisted conception outcomes and ovulatory function. Previous research has shown conflicting results, while BMI, which is commonly used as a marker of obesity, may not accurately reflect the underlying factors affecting fertility in obese patients. STUDY DESIGN, SIZE, DURATION This study utilized a retrospective within-patient repeated measurement analysis design to assess the impact of weight change on IVF outcomes in cycles where all embryos were cryopreserved at the blastocyst stage for transfer at a later date. PARTICIPANTS/MATERIALS, SETTING, METHODS The study was conducted at an academically affiliated fertility center. The data included 961 women who underwent at least two IVF cycles between December 2014 and June 2020, with documented short-term weight gain (n = 607) or weight loss (n = 354) within 1 year from their initial IVF cycle. Multivariable generalized estimating equations (GEE) and generalized linear mixed models (GLMM) were employed to assess associations between weight change and outcomes across cycles. MAIN RESULTS AND THE ROLE OF CHANCE The multivariable models indicated that weight loss did not show any significant associations with the numbers of oocytes retrieved, or mature oocytes, the fertilization rate or the blastulation rate. However, weight gain demonstrated a minor positive association with the number of oocytes retrieved in both GEE models (coefficient: 0.01, 95% CI: 0.00–0.01) and GLMM models (0.01, 95% CI: 0.01–0.00). There was also a potential increase in the fertilization rate with weight gain, as indicated by a positive coefficient in both GEE models (coefficient: 0.01, 95% CI: 0.00–0.02) and GLMM models (coefficient: 0.01, 95% CI: 0.00–0.01). However, the association between weight gain and the embryo blastulation rate was not statistically significant in any model. LIMITATIONS, REASONS FOR CAUTION This study focused on cycle performance parameters instead of reproductive outcomes, which restricted our ability to evaluate the impact of weight change on cumulative live birth rates. Additionally, the study did not account for variables such as stimulation protocols, potentially introducing confounding factors and limiting the generalizability of the results. WIDER IMPLICATIONS OF THE FINDINGS Although obesity is associated with adverse obstetrical risks, there is less evidence of adverse reproductive outcomes in IVF cycles. We therefore recommend that an IVF cycle should not be delayed due to weight, so that the patient is not adversely affected by increasing age. The IVF cycle should aim to freeze all embryos, so that embryo transfer can then occur after weight loss, so as to limit the recognized obstetrical risks. STUDY FUNDING/COMPETING INTEREST(S) The study was not funded and there were no competing interests. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Context: The implementation of landscape-management decisions is often blocked because actors disagree in their perception of the problem at hand. These conflicts can be explained with the concept of problem framing, which argues that actors' problem perspectives are shaped by their interests. Recent literature suggests that social learning through deliberative processes among actors enables shared solutions to complex landscape-management conflicts. Methods: To examine these assumptions, a participatory process on integrated water-resource-management in a Swiss Alpine region was systematically evaluated using a quasi-experimental intervention-research design. The involved actors' problem perspectives were elicited before and after the participatory processes using qualitative interviews and standardized questionnaires. Furthermore, a standardized survey was sent to a sample of regional residents (N = 2000) after the participatory process to measure the diffusion of actors' social learning to the wider public. Results: The data analysis provided systematic evidence that a convergence of involved actors' problem perspectives, which were found to differ considerably before the intervention, had taken place during the participatory process. Furthermore, it determined diffusion effects of actors' social learning to the wider public in terms of its attitude towards participatory regional planning. Conclusions: The findings confirm the expected mechanism of social learning through deliberative processes and demonstrate it as a promising approach to implementing landscape-management decisions successfully. The catalyzing role of shared interests among actors suggests that landscape-management decisions should be implemented by participatory integrated planning on the regional level, which would require a new, strategic role of regional institutions. [ABSTRACT FROM AUTHOR]

In the present study, we aimed to evaluate the genotype-phenotype relation in patients with biotinidase enzyme deficiency based on repeated biotinidase enzyme measurements. The hospital file information of patients with biotinidase, enzyme deficiency was assessed retrospectively, and the relationship between the BTD gene mutations analysis results and biotinidase enzyme activity following the first and repeated enzyme activity assessments was analyzed. One-hundred-ten patients were included. In the first enzyme evaluation, profound biotinidase enzyme deficiency was identified in 15 (13.6 %), partial biotinidase enzyme deficiency in 63 (57.3 %), and heterozygous biotinidase enzyme deficiency in 32 (29.1 %) of the patients. The BTD genetic analysis revealed 42 (38.2 %) homozygous, 42 (38.2 %) heterozygous, and 26 (23.6 %) compound heterozygous variants. The most common homozygous variant, p.Asp444His, was evaluated with 130 repeated enzyme measurements and was consistent with a partial biotinidase enzyme deficiency in 55.4 % of cases, heterozygous biotinidase enzyme deficiency in 43.8 % of cases, and profound biotinidase enzyme deficiency in one (0.8 %) case. Clinical symptoms developed in 17 patients during follow-up, of which 70.6 % were related to neurodevelopment. The most common variant was homozygous p.Asp444His (29.4 %) among the patients who developed symptoms. This is the first study to date to evaluate the genotype-phenotype relationship in patients with biotinidase deficiency through repeated measurements of biotinidase enzyme activity. The study reveals that biotinidase enzyme activity alone is inadequate for diagnosing biotinidase enzyme deficiency or evaluating disease severity, as genetic investigations are also required for a definitive diagnosis of biotinidase enzyme deficiency. [ABSTRACT FROM AUTHOR]

The purpose of this article was to introduce 5 basic concepts, calculation methods, a clinical trial example and its SAS implementation related to the mixed model. The basic concepts include fixed effects, random effects, random coefficients, mixed models, and multilevel models. The calculation methods involved the classical calculation method and the Bayesian calculation method of the mixed model. An example of the clinical trial involved the effect of three drugs on the ability to breathe in people with asthma. This paper gave the whole process of using SAS software to implement the quantitative data in the example, including constructing 6 repeated measurement design quantitative data mixed models based on the mixed procedure and the bglimm procedure. The output results were explained, and all the mixed models constructed were compared based on the evaluation statistics of the model fitting effect, and the optimal mixed model suitable for the data in the paper was obtained. [ABSTRACT FROM AUTHOR]

The paper explores a testing problem which involves four hypotheses, that is, based on observations of two random variables X and Y, we wish to discriminate between four possibilities: identical survival functions, stochastic dominance of X over Y, stochastic dominance of Y over X, or crossing survival functions. Four-decision testing procedures for repeated measurements data are proposed. The tests are based on a permutation approach and do not rely on distributional assumptions. One-sided versions of the Cramér–von Mises, Anderson–Darling, and Kolmogorov–Smirnov statistics are utilized. The consistency of the tests is proven. A simulation study shows good power properties and control of false-detection errors. The suggested tests are applied to data from a psychophysical experiment. [ABSTRACT FROM AUTHOR]

ObjectiveTo investigate the stability of cadmium-induced renal injury biomarkers in community adults with low environmental exposure. MethodsThe participants of the survey were 80 permanent residents aged 40 – 69 years living in local areas at least 10 years (63 in an area with relatively heavy environmental cadmium pollution and 17 in an area with similar social and economic development to those of the contaminated area but with low environmental cadmium pollution) in Gansu province. Peripheral blood and morning urine samples of the participants were collected three times in November 2019, November 2020 and December 2020, for detections of blood cadmium, urinary cadmium, urinary β2-microglobulin (Uβ2-MG), urinary N-acetyl-β-D-glucosaminidase (UNAG), urinary retinol binding protein (URBP), urinary metallothionein (UMT) and urinary micro-albumin (UALB), respectively. Relevant information of the participants were collected simultaneously with questionnaire interviews. Descriptive statistics with variance analysis and Chi-square test were performed on the data collected. ResultsThe main effects of time on blood cadmium, UALB, UMT and URBP were not statistically significant (all P > 0.05). The main effects of time on urinary cadmium, UNAG and Uβ2-MG were statistically significant (all P < 0.001). Pairwise comparison showed that there were no significant differences in blood cadmium, UALB, UMT and URBP levels among detections at the three time points (all P > 0.05); but the levels of urinary cadmium in the second and third detection were significantly higher than that in the first detection (both P < 0.001); the level of urinary cadmium in the third detection was significantly higher than that in the second detection (P < 0.01); the UNAG level of the second detection was significantly higher than that of the first detection and the third detection (both P < 0.001). There was no significant difference in UNAG level between the first test and the third test (P > 0.05). The Uβ2-MG level in the third detection was significantly higher than that in the first and the second detection (both P < 0.001). There was no significant difference in Uβ2-MG level between the first and second detection (P > 0.05). ConclusionBlood cadmium, UALB, UMT and URBP are less affected by time effect and of good stability; while urine cadmium, UNAG and Uβ2-MG are more affected by time effect and of poor stability.

If respondents recognize repeated survey questions and remember their previous responses, this can result in measurement error. Most studies to date that have investigated respondents’ recall of their prior answers have done so in the context of repeated measurements within one cross-sectional survey. The present study extends this research to a longitudinal panel context by investigating whether respondents remember their previous responses to different types of survey questions (beliefs, attitudes, and behaviors) from a previous wave in a probability-based online panel in Germany. We find evidence that some respondents remember their responses from a previous panel wave even after four months, but at a considerably lower rate than previous studies found within a single cross-sectional survey. Respondents who could not remember their response were most commonly off by only a single scale point. Respondents remembered their responses to different types of questions at different rates and were more likely remember an extreme response. Female respondents were more likely to remember their responses, but we find no link to age, education, perceived response burden, survey enjoyment or online panel experience. As respondents could not remember their previous responses in most cases and we find little evidence for a systematic variation of memory effects across groups of respondents, we conclude that the potential for measurement error due to memory effects across panel waves is low after four or more than four months.

We study the evolution of a quantum particle in a harmonic potential whose position and momentum are repeatedly monitored. A back-action of measuring devices is accounted for. Our model utilizes a generalized measurement corresponding to the positive operator-valued measure. We assume that upon measurement, the particle’s wavefunction is projected onto one of the possible detector states depending on the observed result. We chose these post-measurement states to be moving Gaussian wavepackets. The wavefunction quantum Monte Carlo formalism is used to simulate single quantum trajectories of the particle. We show how classical trajectories emerge in the course of observation and study in detail the dispersion of position and momentum of the particle. [ABSTRACT FROM AUTHOR]

Background: Previous reports suggested the clinical predictions of survival (CPS) and prognostic scores had similar accuracy in patients with days to weeks of life. Objective: We aimed to evaluate and compare the accuracy of CPS by attending physicians, residents, and nurses in an acute palliative care unit at a medical center. Methods: This was a 1-year prospective cohort study. Survival prediction was made within 3 days after patients' admission and re-evaluated every week until patients' discharge or death. Associated factors of accurate survival predictions were also explored by multivariate logistic regression. Results: A total of 179 inpatients were recruited and 115 of them were included in this analysis. The mean age of participants was 72.9 years and the average length of actual survival was 11.5 ± 12.0 days. For patients with survival within 30 days, the medical staff tended to overestimate their life span. The predictions made by physicians and nurses showed much closer to actual survival length through repeated estimations. Patients with metastatic cancer (odds ratio: OR 2.77, 95% CI 1.23-6.22) or cognitive impairment (OR 2.39, 95% CI 1.12-5.11) had higher associations with accurate CPS. Poor performance status of ECOG (OR 1.82, 95% CI 1.09-3.02) and dysphagia (OR 2.01, 95% CI 1.07-3.77) were significant predictors for accurate CPS in patients with the survival of less than 2 weeks. Conclusions: The accuracy of CPS between different medical staff did not reveal significant differences in the study. The importance of re-evaluation for patients' survival length in clinical practice is worthy of attention. [ABSTRACT FROM AUTHOR]

We performed this study to clarify the dynamic changes in maternal manganese (Mn) concentration during pregnancy and its association with spontaneous preterm birth (SPB). A nested case–control study was conducted based on the Beijing Birth Cohort Study (BBCS) from 2018 to 2020. Singleton pregnancy women aged 18–44 (n = 488) were involved in the study, including 244 cases of SPB and 244 controls. All of the participants provided blood samples twice (in their first and third trimesters). Inductively coupled plasma mass spectrometry (ICP-MS) was used for the laboratory analysis, and unconditional logistic regression was used for the statistical analysis. We found that the maternal Mn levels were significantly higher in the third trimester than those in the first trimester (median: 1.23 vs. 0.81 ng/mL). The SPB risk was increased to 1.65 (95% CI: 1.04–2.62, p = 0.035) in the highest Mn level (third tertile) in the third trimester, especially in normal-weight women (OR: 2.07, 95% CI: 1.18–3.61, p = 0.011) or non-premature rupture of membrane (PROM) women (OR: 3.93, 95% CI: 2.00–7.74, p < 0.001). Moreover, a dose-dependent relationship exists between the SPB risk and maternal Mn concentration in non-PROM women (P trend < 0.001). In conclusion, dynamic monitoring of maternal Mn level during pregnancy would be helpful for SPB prevention, especially in normal-weight and non-PROM women. [ABSTRACT FROM AUTHOR]

The current note discusses the analysis of data on a response variable collected at different time points, when the same experimental design is used at each time point. The mean response depends on a number of factors as well as on the time point at which it is measured. The parameters of the model are estimated using the generalized least squares method. A simulation study is conducted and the estimate of the variance-covariance matrix of the parameter estimators is obtained using the Jackknife technique. [ABSTRACT FROM AUTHOR]

Secure residential care (SRC) is criticized for several reasons. Therefore, in many countries, the general policy is to limit the length of stay of adolescents in SRC. However, research on length of stay and treatment effects of SRC on adolescents' behavioral problems is sparse. Using single case experimental designs with time-series, forty adolescents referred to SRC completed a questionnaire on behavioral and attention problems every two weeks during a baseline (A) and treatment period (B). Two-level regression analyses were used to investigate the effects of SRC on behavioral and attention problems. In addition, we tested whether length of stay moderated effectiveness. On the individual level, the treatment showed a positive statistically significant effect on the behavioral problems of 0%-8% of the adolescents and a statistically significant negative effect on behavioral problems was found in 3%-10% of the adolescents. On the group level, adolescents showed no significant decrease in problem behavior or attention problems from baseline to discharge. Length of stay did not moderate the results. Based on the results we conclude that most adolescents fail to improve. In addition, length of stay was not associated with effectiveness, nor could it be explained by adolescents' characteristics., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Shunya Tatara,1,2 Fumiatsu Maeda,1,3 Yoshinosuke Tsukahara,4 Tomoya Handa,2,5 Kiyoshi Yaoeda3,6,7 1Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata, Japan; 2Department of Vision Science, Faculty of Sensory and Motor Control, Kitasato University Graduate School of Medical Science, Sagamihara, Kanagawa, Japan; 3Field of Orthoptics and Visual Sciences, Major in Medical and Rehabilitation Sciences, Niigata University of Health and Welfare Graduate School, Niigata, Japan; 4Department of Ophthalmology, University of Yamanashi, Chuo, Yamanashi, Japan; 5Orthoptics and Visual Science, Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Sagamihara, Kanagawa, Japan; 6Department of Ophthalmology, Yaoeda Eye Clinic, Nagaoka, Niigata, Japan; 7Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, JapanCorrespondence: Shunya TataraDepartment of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, 1398 Shimami-cho, kita-ku, Niigata-shi, Niigata, 950-3198, JapanTel/Fax +81 25 257 4752Email tatara@nuhw.ac.jpPurpose: Intraocular pressure (IOP) measured using a noncontact tonometer is evaluated by performing multiple measurements because IOP is affected by the ocular pulse. We investigated the relationship between value fluctuations in multiple measurements during noncontact tonometer measurements and cardiac rate.Materials and Methods: Forty-two healthy subjects were included and IOP was measured using a noncontact tonometer. The measurement was performed three times each for the right eye and the left eye, for a total of six times. Blood pressure and cardiac rate were measured at the same time as the IOP measurement. Using repeated-measures analysis of variance, we examined whether the measured IOP and cardiac rate fluctuate throughout the day over the course of 4 days.Results: There was a fluctuation in the IOP in a sequence only on day 1 of the four measurement days (P < 0.001). The IOP on day 1 tended to be high for the first and second measurements (P = 0.0111– 0.0015). Systolic blood pressure and diastolic blood pressure did not fluctuate over the 4 days (P = 0.6247 and 0.7132), but cardiac rate was high only on day 1 (P = 0.0276).Conclusion: The IOP on day 1 tended to be high in the first and second measurements. The IOP measured on days 2– 4 did not fluctuate during the sequence of measurements. The cardiac rate measured at the same time as the IOP was high only on the first day.Keywords: intraocular pressure, noncontact tonometer, blood pressure, cardiac rate, repeated measurement

A crucial assumption of survey measurements is that respondents carefully perceive, reflect upon, and provide a response to a given question and that this process is independent of respondents’ memory of their responses to previous questions. A violation of this assumption may considerably affect parameter estimations. Despite this possibility, there is little research on when and to what extent such violations occur. To shed light on such memory effects, we investigate the ability of respondents to recall their answers to three types of survey questions (attitudes, behaviors, and beliefs) within one wave of an online panel survey. We find that respondents’ ability to recall their answers is highest for behavior questions and lowest for belief questions, and higher for respondents with extreme responses than respondents with non-extreme responses. We find no difference across respondents with different levels of panel experience and the devices used to complete the survey.

Little is known about the reliability of postural sway measures in healthy elderly adults. Moreover, there is no standardized balance test protocols such as an efficient number of repeated measurements for older people. Therefore, we investigated test-retest reliability of center of pressure (COP) variables during static balance performance in elderly adults. Twenty-five elderly adults (15 elderly men and 10 elderly women) were asked to perform quiet standing balance test on a self-developed force platform. COP-based variables, i.e., COP mean distance, sway area, mean velocity, mean frequency, maximum frequency, and maximum power amplitude were derived from the COP data. For the test-retest reliability of each COP-based variable, intraclass correlation coefficient (ICC) was assessed in two-trials and three-trials of balance test. Mean velocity showed the highest ICC values in all directions (ICC = 0.832–0.922). Frequency domain variables presented lower reliability than time domain variables. Additionally, elderly adults did not affect the number of repeated measurements in most postural balance variables. These results suggest that time domain variables are more reliable variables than frequency domain variable and that balance test of two trials might be rather effective for elderly adults. These findings can be used to develop an optimal protocol of static balance test and select postural balance variables for elderly adults. [ABSTRACT FROM AUTHOR]

Many study designs in social science research rely on repeated measurements implying that the same respondents are asked the same (or nearly the same) questions at least twice. An assumption made by such study designs is that respondents second answer does not depend on their first answer. However, if respondents recall their initial answer and base their second answer on it memory effects may affect the survey outcome. In this study, I investigate respondents' recall ability and memory effects within the same survey and randomly assign respondents to a device type (PC or smartphone) and a response format (response scale or text field) for reporting their previous answer. While the results reveal no differences regarding device types, they reveal differences regarding response formats. Respondents' recall ability is higher when they are provided with the response scale again than when they are only provided with a text field (without displaying the response scale again). The same finding applies to the size of estimated memory effects. This study provides evidence that the size of memory effects may have been overestimated in previous studies. [ABSTRACT FROM AUTHOR]

Objective: We aimed to investigate whether urinary metal mixtures are associated with the homeostasis of inflammatory mediators in middle-aged and older adults. Methods: A four-visit repeated-measures study was conducted with 98 middle-aged and older adults from five communities in Beijing, China. Only one person was lost to follow-up at the third visit. Ultimately, 391 observations were included in the analysis. The urinary concentrations of 10 metals were measured at each visit using inductively coupled plasma mass spectrometry (ICP-MS) with a limit of detection (LOD) ranging from 0.002 to 0.173 µg/L, and the detection rates were all above 84%. Similarly, 14 serum inflammatory mediators were measured using a Beckman Coulter analyzer and the Bio-Plex MAGPIX system. A linear mixed model (LMM), LMM with least absolute shrinkage and selection operator regularization (LMMLASSO), and Bayesian kernel machine regression (BKMR) were adopted to explore the effects of urinary metal mixtures on inflammatory mediators. Results: In LMM, a two-fold increase in urinary cesium (Cs) and chromium (Cr) was statistically associated with −35.22% (95% confidence interval [CI]: −53.17, −10.40) changes in interleukin 6 (IL-6) and −11.13% (95 %CI: −20.67, −0.44) in IL-8. Urinary copper (Cu) and selenium (Se) was statistically associated with IL-6 (88.10%, 95%CI: 34.92, 162.24) and tumor necrosis factor-alpha (TNF-α) (22.32%, 95%CI: 3.28, 44.12), respectively. Similar results were observed for the LMMLASSO and BKMR. Furthermore, Cr, Cs, Cu, and Se were significantly associated with other inflammatory regulatory network mediators. For example, urinary Cs was statistically associated with endothelin-1, and Cr was statistically associated with endothelin-1 and intercellular adhesion molecule 1 (ICAM-1). Finally, the interaction effects of Cu with various metals on inflammatory mediators were observed. Conclusion: Our findings suggest that Cr, Cs, Cu, and Se may disrupt the homeostasis of inflammatory mediators, providing insight into the potential pathophysiological mechanisms of metal mixtures and chronic diseases.

Fumiatsu Maeda,1,2 Kiyoshi Yaoeda,3,4 Shunya Tatara,1,5 Yoshinosuke Tsukahara,2 Atsushi Miki6,7 1Department of Orthoptics and Visual Sciences, Faculty of Medical Technology, Niigata University of Health and Welfare, Niigata,Japan; 2Field of Orthoptics and Visual Sciences, Major in Medical and Rehabilitation Sciences, Graduate School of Health and Welfare, Niigata University of Health and Welfare, Niigata, Japan; 3Department of Ophthalmology, Yaoeda Eye Clinic, Nagaoka, Niigata, Japan; 4Division of Ophthalmology and Visual Sciences, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; 5Department of Vision Science, Faculty of Sensory and Motor Control, Kitasato University Graduate School of Medical Science, Sagamihara, Kanagawa, Japan; 6Department of Ophthalmology, Kawasaki Medical School, Kurashiki, Okayama, Japan; 7Department of Orthoptics, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki, Okayama, JapanCorrespondence: Kiyoshi YaoedaDivision of Ophthalmology, Yaoeda Eye Clinic, 2-1649-1 Naga-Chou, Nagaoka, Niigata 940-0053, JapanTel +81 258 32 0833Fax +81 258 32 9690Email surumeoyaji800@yahoo.co.jpPurpose: We investigated whether or not intrasession or intersession fluctuations in intraocular pressure occur in healthy people using a noncontact tonometer.Materials and Methods: A noncontact tonometer was used to measure intraocular pressure in the bilateral eyes of healthy subjects for 5 consecutive days. Paired t-tests and one- and two-way repeated-measures analyses of variance were performed for the acquired data. A p-value < 0.05 was considered to indicate statistical significance.Results: Eighty eyes of 40 healthy subjects were enrolled in the study. On day 1, intraocular pressure was significantly higher in the right eye than in the left eye (P = 0.014). The one-way repeated-measures analysis of variance revealed that intraocular pressure in the left eye was significantly lower on day 1 than on days 2 to 5 (P = 0.000– 0.018); however, there were no significant differences among intraocular pressures measured on days 1 to 5 in the right eye. The two-way repeated-measures analysis of variance revealed no significant difference in intraocular pressure between the right and left eyes (P = 0.913).Conclusion: Although measurements using the noncontact tonometer were relatively stable, intraocular pressure was high on day 1.Keywords: intraocular pressure, noncontact tonometer, normal subject, repeated measurement, intrasession variability

This study was conducted to compare the growth curve models using general linear and multi-level linear growth models and to determine the differences in growth in broiler chickens. For this purpose, a data set containing live weight records of 74 male broiler chickens was used. The measurements were recorded individually, once a week, from hatching to the sixth week. For the analysis of the data, five different growth models, two of the general linear models, and three of the multi-level linear models were used. To find the model that best explains the change; log-likelihood (ll), Akaike information criterion (AIC), Bayes information criterion (BIC), corrected Akaike information criterion (AICC) and Likelihood ratio test (LRT) were used. The results of the study showed that multi-level growth models make more precise predictions than general linear models, and the model that best describes growth is the “random intercept and random slope quadratic growth model” with the smallest fit criteria. According to this model, it was demonstrated that the chickens had significantly different weights since hatching, where the linear and quadratic effect on growth was significant in male broiler chickens, and that individual differences continued significantly during the period of growth.

There seems to be a scarcity in literature investigating day-to-day warm-up (WU) variations. We investigated day-to-day variation of psychophysiological responses during Fédération Internationale de Football Association (FIFA) 11+ and dynamic warm-up (DWU) exercises. Twenty-one male collegiate soccer players were randomly assigned to the FIFA 11+ (n = 10) or DWU group (n = 11). Each group performed the assigned WU protocol on three different occasions with a 48-h interval in between. The inter-day variation of the heart rate (HR), time distribution of HR zones, heart rate variability (HRV), estimated energy expenditure (EE), blood lactate (BL) concentration, and the Borg rating of perceived exertion (RPE) were recorded. A two-way repeated measures of analysis of variance was used to compare the differences in chosen variables [group (2) × day (3)]. The coefficient of variation was used to determine the dispersion of the variables over the sessions. The interclass correlation coefficient (ICC) with a two-way random model and a single measure (ICC2,1) was used to determine inter-day reliability. There were no significant differences in time spent at particular HR zones and EE in both groups. The FIFA 11+ exercises showed high reliability of exercise duration, average HR (HRaverage), minimal HR (HRmin), peak HR (HRpeak), and post-exercise RPE. In the DWU group, high reliability was found only in HRaverage, HRpeak, and post-exercise RPE. The FIFA 11+ exercises showed similar EE, exercise HR patterns, BL, and RPE compared to the DWU. The FIFA 11+ program is an intense WU protocol with a characteristically low variation of day-to-day exercise HR and RPE responses. [ABSTRACT FROM AUTHOR]

Trude Eid Robsahm,1 Steinar Tretli,1 Peter Abusdal Torjesen,2 Ronnie Babigumira,1 Gary G Schwartz31The Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway; 2The Hormone Laboratory, Department of Endocrinology, Oslo University Hospital Health Authority, Oslo, Norway; 3Department of Population Health, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USAPurpose: Circulating 25-hydroxyvitamin D (25-OHD) levels have been inversely associated with cancer death, but the nature of this relationship is unclear. We investigated this association using repeated measurements of serum 25-OHD.Patients and methods: Pre-diagnostic serum samples were collected in population health surveys in Norway (1973–2004). Participants who subsequently developed cancer (1984–2004) provided a second serum sample at the time of cancer diagnosis. Samples were stored in the Janus Serum Bank. Repeated samples existed from 202 breast cancers, 193 lung cancers, 124 lymphomas, and 37 colon cancers. Serum 25-OHD was measured via competitive radioimmunoassay. Cox regression models assessed associations between 25-OHD and cancer-specific death (case fatality) through 2012, given as hazard ratios (HRs) with 95% confidence intervals (CIs).Results: The median time between pre-diagnostic and diagnostic samples was 14.4 years. The median 25-OHD levels were 63.3 and 62.5 nmol/L, respectively. During follow-up, 313 cancer deaths occurred. Compared to low pre-diagnostic 25-OHD levels (

Online sexual harassment (OSH) appears to be a relatively frequent phenomenon, particularly for older adolescents. It is also a gendered experience. Compared to their male peers, female adolescents are more likely to experience OSH and find it upsetting. This study sought to explore the role of resilience in explaining the association between online sexual harassment (OSH) and negative mood (i.e., depression and anxiety symptoms) among female adolescents. Using data from a panel sample of 477 female Croatian adolescents (age at baseline = 15.8 years; SD = 0.48) and two-wave cross-lagged path analysis, we investigated OSH, changes in depression/anxiety symptoms, association between OSH and negative mood, and the role of resilience. During the 26-month period under observation, OSH and negative mood were associated cross-sectionally, but not longitudinally. This suggests the negative mood effects of OSH exposure may be short-lived or that factors other than OSH explain changes in negative mood over time. Resilience was consistently and negatively associated with negative mood, but not OSH. In adolescent girls with low levels of resilience, OSH was associated with negative mood; no such relationship was observed among their highly resilient peers. Experiences other than OSH appear to be more pertinent in predicting symptoms of negative mood in older adolescent girls over time. Given that resilience attenuated the relationship between OSH and negative mood, efforts to increase resilience to online challenges may be more helpful than efforts to limit or control young people's online exposure. [ABSTRACT FROM AUTHOR]

Repeated measurement designs have been growing in popularity in the fields of Organizational Behavior and Work and Organizational Psychology. This brings up questions regarding the appropriateness of time-lag choices and validity of justification used to make time-lag decisions in the current literature. We start by explaining how time-lag choices are typically made and explain issues associated with these approaches. Next, we provide some insights into how an optimal time-lag decision should be made and the importance of time-sensitive theory building in helping guide these decisions. Finally, we end with some brief suggestions as to how authors can move forward by urging them to explicitly address temporal dynamics in their research, and by advocating for descriptive studies with short time-lags, which are needed to uncover how the changes happen over time. [ABSTRACT FROM AUTHOR]

Exposure to phthalates poses potential to damage multiple organs and system in the body. However, limited data are available regarding effects of seasonal exposure levels of phthalates and indicators reflecting inflammatory response. We designed a pilot study with repeated measures. We recruited 106 eligible habitants from Wuhan city, China. They completed questionnaires, physical examinations and provided urine specimens in winter and summer seasons. We found that urinary levels of low-molecular-weight phthalate metabolites were higher in summer than in winter (all P

Background: Mitochondria are sensitive to environmental toxicants due to the limited repair capacity. Exposure to benzotriazoles (BTRs) and benzothiazoles (BTHs) may contribute to adverse health outcomes through oxidative stress, which may interfere with mitochondrial function. However, the mitochondrial effects of exposure to BTs (BTRs and BTHs) have not yet been elucidated, particularly in human investigations. Objectives: We examined the associations between trimester-specific urinary BTRs and BTHs concentrations and cord blood mitochondrial DNA copy number (mtDNAcn) in a prospective birth cohort. Methods: The present study included 742 mother-infant pairs who participated in a birth cohort between 2014 and 2015 in Wuhan and had data on urinary concentrations of BTRs and BTHs and mtDNAcn in cord blood. Concentrations of BTs were repeatedly measured in maternal urine samples at different trimesters using high performance liquid chromatography-tandem mass spectrometry. Relative mtDNAcn in umbilical cord blood was analyzed by quantitative real-time polymerase chain reaction. Generalized estimating equations were used to evaluate the associations between BTs exposure across gestation and mtDNAcn in cord blood. Results: In the present study, we observed a positive association between urinary 2-methylthio-benzothiazole (2-MeS-BTH) concentrations in the first trimester and cord blood mtDNAcn, with marginal significance [percent changes (%Δ) = 3.97, 95% confidence interval (CI): −0.05, 8.16, p = 0.05], while urinary 2-amino-benzothiazole concentrations in the third trimester were significantly negatively associated with cord blood mtDNAcn (%Δ = −5.89, 95% CI: −10.32, −1.24). Similar patterns of associations were demonstrated between urinary 1-H-benzotriazole (1-H-BTR) and xylyltriazole concentrations in the third trimester and cord blood mtDNAcn (%Δ = −4.18 to −3.23). In sex-specific analysis, we identified that maternal urinary 1-H-BTR in the first trimester and 2-MeS-BTH in the third trimester were positively associated with cord blood mtDNAcn among male infants but not female (P for interaction = 0.05 for 1-H-BTR, P for interaction = 0.05 for 2-MeS-BTH, respectively). Conclusions: We found evidence that prenatal exposure to BTRs and BTHs were associated with cord blood mtDNAcn alternation, and these associations were modified by infant gender. Further investigations are needed to corroborate these findings.

‘Animal personality’ is considered to be developed through complex interactions of an individual with its surrounding environment. How can we quantify the ‘personality’ of an individual? Quantifying intra- and inter-individual variability of behavior, or individual behavioral type, appears to be a prerequisite in the study of animal personality. We propose a statistical method from a predictive point of view to measure the appropriateness of our assumption of ‘individual’ behavior in repeatedly measured behavioral data from several individuals. For a model case, we studied the sponge crab Lauridromia dehaani known to make and carry a ‘cap’ from a natural sponge for camouflage. Because a cap is most likely to be rebuilt and replaced repeatedly, we hypothesized that each individual crab would grow a unique behavioral type and it would be observed under an experimentally controlled environmental condition. To test the hypothesis, we conducted behavioral experiments and employed a new Bayesian model-based comparison method to examine whether crabs have individual behavioral types in the cap making behavior. Crabs were given behavioral choices by using artificial sponges of three different sizes. We modeled the choice of sponges, size of the trimmed part of a cap, size of the cavity of a cap, and the latency to produce a cap, as random variables in 26 models, including hierarchical models specifying the behavioral types. In addition, we calculated the marginal-level widely applicable information criterion (mWAIC) values for hierarchical models to evaluate and compared them with the non-hierarchical models from the predictive point of view. As a result, the crabs of less than about 9 cm in size were found to make caps from the sponges. The body size explained the behavioral variables namely, choice, trimmed cap characteristics, and cavity size, but not latency. Furthermore, we captured the behavioral type as a probabilistic distribution structure of the behavioral data by comparing WAIC. Our statistical approach is not limited to behavioral data but is also applicable to physiological or morphological data when examining whether some group structure exists behind fluctuating empirical data.

OBJECTIVE: Low-back pain (LBP) is a massive health problem. Sitting at work has been suggested to be both a risk and protective factor for LBP. Thus, the objective of this study was to investigate the association between total and temporal patterns of objectively measured sitting duration and individual time course of LBP. METHODS: The analysis was performed among 665 participants from the DPhacto cohort of mainly blue-collar workers. Sitting at work was measured by accelerometry at baseline, expressed in total duration and temporal pattern [% of working time spent in brief bursts (≤5 minutes), moderate (>5 – ≤20 minutes) and prolonged periods (>20 minutes)] of sitting. Time course of LBP (0–10 scale) were collected by monthly text messages across one year. Linear mixed models were applied to investigate the association, adjusting for potential confounders. RESULTS: Significant negative associations between sitting duration at work and adjusted time course of LBP were found; total sitting (B -0.01, 95% CI -0.01– -0.004), brief bursts (B -0.01, 95% CI -0.02– -0.01), moderate (B -0.01, 95% CI -0.01– -0.008) and prolonged periods (B -0.01, 95% CI -0.02– -0.01). Meaning, a 5-minute increase of sitting at work will correspond to a decrease in one year time course of LBP by -0.05 points. CONCLUSION: Longer duration of total and temporal sitting periods at work was significantly associated with a favorable time course of LBP. This finding shows sitting at work to be beneficial for LBP, among populations of mainly blue-collar workers, by protecting from LBP aggravation.

Monitoring temporal changes in antigen levels, such as disease-related markers in medical care or airborne allergens in environmental medicine, has been increasing in importance because it allows one to notice the level exceeding a threshold in real time, which helps the early detection or prevention of diseases. In this study, we have developed a reusable immunosensor that exploits surface plasmon resonance (SPR) and a pH-resistant protein, ORLA85, for rapid and repeated (semicontinuous) immunoassays. After the sensor development, a model experiment using mouse (mIgG) and anti-mouse (a-mIgG) antibodies was performed. In the experiment, the sensitivity of the developed SPR immunosensor was initially evaluated using various concentrations of a-mIgG. The limit of detection of the sensor for a-mIgG was 14.2 ng/mL (0.09 nM) and the dynamic range was 138-30000 ng/mL (0.86-187.5 nM). In 10 repeated measurements of a-mIgG, the sensor signals returned to the baseline after removing a-mIgG using an acidic solution with pH 1. The measurement time was 15 min and the coefficient of variation of the sensor outputs was 7.5%. These results indicated that the developed SPR immunosensor had potential for semicontinuous measurement, suggesting its application to monitoring systems for the early detection and prevention of diseases. [ABSTRACT FROM AUTHOR]

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Multiple imputation (MI) is increasingly popular for handling multivariate missing data. Two general approaches are available in standard computer packages: MI based on the posterior distribution of incomplete variables under a multivariate (joint) model, and fully conditional specification (FCS), which imputes missing values using univariate conditional distributions for each incomplete variable given all the others, cycling iteratively through the univariate imputation models. In the context of longitudinal or clustered data, it is not clear whether these approaches result in consistent estimates of regression coefficient and variance component parameters when the analysis model of interest is a linear mixed effects model (LMM) that includes both random intercepts and slopes with either covariates or both covariates and outcome contain missing information. In the current paper, we compared the performance of seven different MI methods for handling missing values in longitudinal and clustered data in the context of fitting LMMs with both random intercepts and slopes. We study the theoretical compatibility between specific imputation models fitted under each of these approaches and the LMM, and also conduct simulation studies in both the longitudinal and clustered data settings. Simulations were motivated by analyses of the association between body mass index (BMI) and quality of life (QoL) in the Longitudinal Study of Australian Children (LSAC). Our findings showed that the relative performance of MI methods vary according to whether the incomplete covariate has fixed or random effects and whether there is missingnesss in the outcome variable. We showed that compatible imputation and analysis models resulted in consistent estimation of both regression parameters and variance components via simulation. We illustrate our findings with the analysis of LSAC data. [ABSTRACT FROM AUTHOR]

Anxiety and depression are severe public health problems worldwide. The effects of ozone exposure on anxious and depressive symptoms remain largely unknown, especially in China. We evaluated the associations between ozone exposure and depression and anxiety among middle-aged and older adults across China. A multi-center community-based repeated measurement study among middle-aged and older adults was conducted from 2017 to 2018 in 11 provinces in China. The status of depression and anxiety was measured using Patient Health Questionnaire-9 (PHQ-9) and the generalized anxiety disorder seven-item (GAD-7) scale at the cut-off point of five, respectively. Concentrations of multiple ozone metrics were collected from real-time monitoring stations. The multilevel logistic regression model with random intercept was used to evaluate the effects of ambient ozone on anxiety and depression over different exposure windows. After adjusting for potential confounders, a 10 μ g /m ^3 increase in the three months moving average of ozone was associated with the risk of anxiety [odds ratio (OR) = 1.25; 95% confidence interval (CI): 1.15; 1.37] and depression (OR = 1.17; 95% CI: 1.08; 1.27). A significantly positive modification effect of temperature on associations between ozone and anxiety was also found, while there is no interaction for depression. Exposure-response curves showed that there may be a threshold for the effect of ozone exposure on anxiety and depression over the three months moving average concentrations, with similar patterns observed at different temperature levels. People over 65 years old were at significantly higher risks of ozone-associated depression, while anxiety was more strongly associated with ozone in hypertensive patients. Our study supports the theory that anxiety and depression is associated with mid-term ozone exposure in China, and temperatures significantly enhanced their associations. These findings may have significant implications for promoting prevention activities regarding mental disorders and approaches in reducing the disease burden by simultaneously controlling air pollution and mitigating climate change.

Background: Clinical practice guidelines recommended that hypertension in children and adolescents should be defined based on elevated blood pressure (BP) on at least three separate occasions. Therefore, in the present study, we aimed to estimate the prevalence of hypertension based on three separate visits among Chinese children and adolescents and to examine its relationship with obesity.Methods: A school-based cross-sectional survey was performed in children and adolescents in Jinan, China between September 2012 and September 2014. A total of 7,832 children and adolescents aged 6–17 years were included. Anthropometric data and BP were measured by trained examiners. Elevated BP was defined as BP ≥ 95th percentile for age and sex based on the Chinese reference data. Participants with elevated BP at the first visit underwent a second visit 2 weeks later, and a third visit was conducted if BP was still high at the second visit. Hypertension was defined as having an elevated BP at all three visits. Obesity was defined in three ways by using body mass index, waist circumference, and waist-to-height ratio.Results: The prevalence of elevated BP decreased substantially across three separate visits, with the prevalence of 17.2, 8.6, and 4.9%, respectively. Obesity was an independent risk factor for elevated BP during each visit. Based on the body mass index, obesity was associated with higher risk of elevated BP, with the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of 8.6 (6.8–11.0), 12.5 (9.1–17.3), and 14.0 (8.9–22.2), respectively, at the first, second and third visit. The ORs of elevated BP were similar in association with obesity defined by waist circumference or waist-to-height ratio.Conclusions: The prevalence of hypertension based on three visits was ~5% in Chinese children and adolescents. There was a dose-response relationship between obesity and elevated BP across three visits.

The possibility of dithiobis(succinimidyl propionate) (DSP) for repeated immunoassay with a surface acoustic wave (SAW) immunosensor was explored. In the sensor, DSP was used to modify a gold-coated quartz sensing area of a SAW device by forming a self-assembled monolayer on the gold surface. In a model sandwich assay using mouse (mIgG) and anti-mouse (a-mIgG) antibodies, the primary antibody, mIgG, firstly reacted with N-hydroxysuccinimide ester groups of DSP and was immobilized on the SAW device to fabricate the SAW immunosensor. Optimization of adsorption time of mIgG revealed that both degrees of adsorption and immobilization of mIgG reached a saturation at 30 min although the immobilization was more dependent on the adsorption time. Through characterization of the DSP-modified SAW immunosensor, a high selectivity, with which no sensor output was observed from various kinds of secondary antibodies except for a-mIgG, along with 8-fold shorter measurement time (15 min) than that of enzyme-linked immunosorbent assay were obtained. Furthermore, 10 repeated measurement of a-mIgG demonstrated a high reproducibility of the sensor output (coefficient of variation of 7.0%). These validate the utility of DSP in the SAW immunosensor for rapid and repeated measurement of antigens. Image 1 • Dithiobis(succinimidyl propionate) for repeated immunoassay is explored. • DSP-modified SAW immunosensor allowed for rapid and selective immunoassay. • 10 repeated model sandwich assay shows high reproducibility of the sensor output. [ABSTRACT FROM AUTHOR]

Background Little is known about changes in blood fatty acid compositions over time and the correlates of any changes in a general population. Objective The aim of this study was to estimate changes in 27 individual plasma phospholipid fatty acids and fatty acid groups over time, and to identify potential correlates of these changes. Methods Plasma phospholipid fatty acids were profiled at 3 time-points (1993–1997, 1998–2000, 2004–2011) among 722 participants in the European Prospective Investigation into Cancer and Nutrition-Norfolk Study, UK. Linear regression models were used to estimate both 1) mean changes over time in 27 individual fatty acids and 8 prespecified fatty acid groups and 2) associations of changes in dietary and lifestyle factors with changes in the 8 fatty acid groups, mutually adjusted for dietary/lifestyle factors and other confounders. The prespecified fatty acid groups were odd-chain saturated fatty acids (SFAs), even-chain SFAs, very-long-chain SFAs, marine n–3 polyunsaturated fatty acids (PUFAs), plant n–3 PUFA, n–6 PUFAs, monounsaturated fatty acids (MUFAs), and trans-fatty acids (TFAs). Results Adjusted for confounders, fatty acid concentrations decreased for odd-chain SFAs (annual percentage difference in mol percentage: −0.63%), even-chain SFAs (−0.05%), n–6 PUFAs (−0.25%), and TFAs (−7.84%). In contrast, concentrations increased for marine n–3 PUFAs (1.28%) and MUFAs (0.45%), but there were no changes in very-long-chain SFAs or plant n–3 PUFA. Changes in fatty acid levels were associated with consumption of different food groups. For example, a mean 100 g/d increase in fatty fish intake was associated with a 19.3% greater annual increase in marine n–3 PUFAs. Conclusions Even-chain SFAs and TFAs declined and marine n–3 PUFAs increased over time. These changes were partially explained by changes in dietary habits, and could potentially help interpret associations of baseline fatty acid composition with future disease risk. [ABSTRACT FROM AUTHOR]

Multilevel models have become popular models for analyzing longitudinal data over past two decades. Longitudinal designs are common specially in medical science, where data is recorded on patients more than two times. As the data is collected on the same patients repeatedly over time, it is more likely that observations are correlated with each other. When the observations are correlated and the data have nested structure, traditional methods give biased estimates of the parameters, as they require the assumption of independence. The present study is concerned with exploring the effect of misspecification of level-I errors covariance structure in multilevel model for longitudinal data. The fixed effects were estimated with little to no bias, and accurate type-I error rates were observed under all the specifications of the covariance structure for the test of fixed effects. Random effects were estimated poorly for most of the conditions. Overestimated variances of the level-II random effects were accompanied by the underestimated level-I variance. The covariance between intercept and slope was underestimated in all conditions. The over specification of the covariance matrix of level-I errors gave better estimates than correct specification, under-specification and general misspecification. [ABSTRACT FROM AUTHOR]

Abstract Background Several epidemiological studies have shown that blood pressure changes with temperature based on the daily temperature and linear relationship assumption. However, little is known about the true curve shape of the relationship between temperature and blood pressure. Objectives The objective of this study was to investigate the non-linear relationship between hourly temperature and blood pressure. Methods This is a prospective panel study comprising 100 participants in Suzhou, China. The blood pressure of each participant was measured >50 times between October 2013 and January 2016. Hourly temperature data were derived from the nearest monitoring station owned by the China Meteorological Administration. A Distributed Lag Nonlinear Model (DLNM) was used to investigate the relationship between hourly temperature and blood pressure. Results We found that the relationship between hourly temperature and blood pressure was parabolic. Short-term exposure to hourly temperatures had significant cold and heat effects on systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). The hourly temperature had a significant lag effect on blood pressure, with a lag time of 0–5 h. Alcohol users were more sensitive to the cold effects of hourly temperature, and the diabetic population was more sensitive to the heat effects of hourly temperature on PP. Conclusion Temperature imparts short-term effects on blood pressure. Therefore, timely protective measures during cold waves or cold weather are beneficial to maintain stable blood pressure levels to reduce the risk of blood pressure related diseases. Highlights • Short-term exposure to hourly temperatures had significant cold and heat effects on blood pressure. • The hourly temperature had a significant lag effect on blood pressure, with the lag time of 0–5 h. • Timely protective measures during cold weather are beneficial to maintain stable blood pressure levels. [ABSTRACT FROM AUTHOR]

Previous researches have assessed the relationships of urinary arsenic metabolism with type 2 diabetes (T2D) and glucose-insulin homeostasis, but the results were controversial, and potential mechanisms remain largely unclear. This study aimed to investigate the cross-sectional and longitudinal associations of urinary arsenic metabolism with T2D prevalence and glucose changes in relatively higher arsenic exposure, and further to evaluate the underlying roles of oxidative damage in these relationships. We included 796 participants at baseline, among them 509 participants were followed up after 2 years. Logistic regression model and leave-one-out approach were applied to evaluate the associations of arsenic metabolism with T2D prevalence. Linear mixed model was conducted to estimate the relationship of arsenic metabolism with glycemic changes over two years. The associations between arsenic metabolism and indicators of oxidative stress were assessed with a linear regression model. We further performed mediation analysis to investigate the role of oxidative stress in the associations of arsenic metabolism with 2-year change of glucose levels. Higher urinary MMA% increased T2D prevalence and baseline glucose levels. MMA% was positively associated with 2-year change of glucose levels. Moreover, we observed significant dose-response relationship between MMA% and 8-hydroxy-2-deoxyguanosine (8-OHdG). However, the mediating role of 8-OHdG in the association of MMA% and 2-year change of glucose levels was not observed in this population. In this population exposure to relatively higher arsenic levels, higher MMA% contributed to increased T2D prevalence and glucose homeostasis disorder. Arsenic metabolism also affected oxidative stress levels, especially 8-OHdG. Further studies are required to investigate the potential mechanisms. [Display omitted] • Higher MMA% increased T2D prevalence in a population with relatively high As levels. • MMA% was positively associated with 2-year change of glucose levels. • There was a significant dose-response relationship between MMA% and 8-OHdG. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Procedural justice perceptions are shown to be associated with minor psychiatric disorders, long sickness absence spells, and poor self-rated health, but previous studies have rarely considered how changes in procedural justice influence changes in health. METHODS: Data from four consecutive biennial waves of the Swedish Longitudinal Survey of Health (SLOSH) (N=5854) were used to examine trajectories of self-rated health. Adjusting for age, sex, socioeconomic position, and marital status, we studied the predictive power of change in procedural justice perceptions using individual growth curve models within a multilevel framework. RESULTS: The results show that self-rated health trajectories slowly decline over time. The rate of change was influenced by age and sex, with older people and women showing a slower rate. After adjusting for age, sex, socioeconomic position, and marital status, procedural justice was significantly associated with self-rated health. Also, improvements in procedural justice were associated with improvements in self-rated health. Additionally, a reverse relationship with and change in self-rated health predicting procedural justice was found. CONCLUSIONS: Our findings support the idea that procedural justice at work is a crucial aspect of the psychosocial work environment and that changes towards more procedural justice could influence self-rated health positively. The reciprocal association of procedural justice and self-rated health warrants further research.

OBJECTIVES: The aim of this paper was to investigate if objectively measured daily duration of forward bending of the trunk increases the risk of the development or aggravation of low-back pain (LBP) over one year in a working blue-collar population by examining (i) the incidence rate of LBP among workers reporting no LBP at baseline, and (ii) the aggravation of LBP among workers reporting LBP at baseline. METHODS: Using data from the Danish Physical Activity Cohort with Objective Measurements (DPhacto), the study measured forward bending of the trunk (>60˚) at work (FBW) and during leisure time (FBL), diurnally with accelerometers, and LBP with one-year monthly self-reports among 682 blue-collar workers from 15 workplaces. The development of LBP was investigated with Cox’s proportional hazards model (N=200), and the aggravation of LBP was investigated with mixed model for repeated measurements (N=482). RESULTS: Workers with no LBP at baseline had a FBW median of 7.9 minutes/day. Workers with LBP at baseline had a FBW median of 7.3 minutes/day. No significant associations were found between daily duration of forward bending of the trunk and development or aggravation of LBP. Similar results were found in the secondary analyses, in which FBL, different degrees of forward bending (>30˚ and >90˚), and varying follow-up time since measurement were considered. CONCLUSION: Using objective measurements of forward bending and monthly follow-up of LBP over one year, this study did not confirm the hypothesis of a positive association between daily duration of forward bending and LBP.

Kawaguchi, Koch, and Wang (2011) provide methodology and applications for a stratified Mann-Whitney estimator that addresses the same comparison between two randomized groups for a strictly ordinal response variable as the van Elteren test statistic for randomized clinical trials with strata. The sanon package provides the implementation of the method within the R programming environment. The usage of sanon is illustrated with five examples. The first example is a randomized clinical trial with eight strata and a univariate ordinal response variable. The second example is a randomized clinical trial with four strata, two covariables, and four ordinal response variables. The third example is a crossover design randomized clinical trial with two strata, one covariable, and two ordinal response variables. The fourth example is a randomized clinical trial with seven strata (which are managed as a categorical covariable), three ordinal covariables with missing values, and three ordinal response variables with missing values. The fifth example is a randomized clinical trial with six strata, a categorical covariable with three levels, and three ordinal response variables with missing values.

Abstract Background Fetuses are susceptible to phthalates, known endocrine disrupting chemicals, within sensitive windows of development. It is crucial to determine the major sources of phthalates to reduce exposure. This study aims to examine the associations between usage patterns of personal care products (PCPs) and urinary levels of phthalate metabolites across pregnancy in a multi-hospital based birth cohort. Methods During 2012–2015, we conducted a birth cohort study named the Taiwan Mother Infant Cohort Study (TMICS). Usage patterns of PCPs were obtained using structured questionnaires during the third trimester of pregnancy. Spot urine samples were collected at each trimester, and levels of eleven phthalate metabolites were measured by liquid chromatography tandem mass spectrometry. The association of PCPs use with urinary phthalate metabolite concentrations was assessed using GEE models. Results Among the 1676 pregnant women participated in TMICS, 281 who provided two or three urine samples across pregnancy were included. The levels of several phthalate metabolites were significantly associated with the use of PCPs, particularly leave-on PCPs. With the increasing use of skin toners (11.7%; 95% CI: 1.5%, 22.9%), lipsticks (13.2%; 95% CI: 4.6%, 22.5%), and essential oils (21.8%; 95% CI: 9.1%, 36.0%), individuals are exposed to higher concentrations of mono-ethyl phthalate (MEP). Additionally, a positive trend was found regarding the number of leave-on PCPs used and the measured change in MEP concentrations (P for trend = 0.01). Other positive associations included MBzP and body lotions (7.9%; 95% CI: 0.1%, 16.2%). With regard to rinse-off PCPs, we found a positive association between urinary MBzP and shampoo use, and a negative association between urinary MMP and face wash. Conclusion Leave-on PCPs were found to be a more probable source of phthalate exposure than the use of rinse-off PCPs. We suggest pregnant women reduce the frequency of leave-on PCPs use during pregnancy to avoid such phthalate exposure. Graphical abstract Unlabelled Image Highlights • Most phthalate metabolites were detected in >80% of pregnant women's urine samples. • Phthalate metabolites showed weak to moderate reproducibility across the pregnancy. • MEP was associated with increasing uses leave-on personal care products (PCPs). • The more number the use of leave-on PCPs, the higher concentrations of MEP in urine. • Use of leave-on PCPs was considered a relevant phthalate source in Taiwan. [ABSTRACT FROM AUTHOR]