Glycaemic control and long-term outcomes following transition from modified intensive insulin therapy to conventional glycaemic control

This retrospective observational cohort study compared glycaemic control and long-term outcomes following transition from a modified intensive insulin therapy (mIIT) regimen to conventional glycaemic control (CGC) in adult patients admitted to a tertiary adult general intensive care unit, during two 24-month periods, before and after the publication of the Normoglycemia in Intensive Care Evaluation and Surviving Using Glucose Algorithm Regulation (NICE-SUGAR) trial. The before NICE-SUGAR cohort received mIIT (target glycaemic ranges 4.4 to 7.0 mmol/l), while the after NICE-SUGAR cohort received CGC (target glycaemic range 7.1 to 9.0 mmol/l). A total of 5202 patients were included in the study. With transition from mIIT to CGC, the mean time-weighted glucose increased from 6.94 mmol/l to 8.2 mmol/l (P <0.0001). A similar increase was observed in other glycaemic indices (mean, highest and lowest glucose values, P <0.0001 for all). The adjusted 90-day odds ratio for mortality decreased by 47% with transition from mIIT to CGC (odds ratio 1.47 (95% confidence interval, 1.22 to 1.78) (P <0.0001). The rate of severe and moderate hypoglycaemia also decreased from 1.2 to 0.4% (P=0.004) and from 23.3 to 5.9% (P <0.0001), respectively. mIIT was associated with an increased risk of moderate and severe hypoglycaemia compared to CGC (odds ratio 3.1 (1.51 to 6.39) (P=0.002), 6.29 (5.1 to 7.75) (P <0.0001)). Changes in recommended glycaemic control were translated into practice, with increased glycaemic indices and decreased rates of severe and moderate hypoglycaemia after the introduction of CGC. The associated decrease in 90-day mortality suggests mIIT was not superior to CGC, despite a lower hypoglycaemia rate than in previous IIT trials. Our findings support the continued use of CGC.

Treatment Implications of Predominant Polarity and the Polarity Index: A Comprehensive Review.

Bipolar disorder (BD) is a serious and recurring condition that affects approximately 2.4% of the global population. About half of BD sufferers have an illness course characterized by either a manic or a depressive predominance. This predominant polarity in BD may be differentially associated with several clinical correlates. The concept of a polarity index (PI) has been recently proposed as an index of the antimanic versus antidepressive efficacy of various maintenance treatments for BD. Notwithstanding its potential clinical utility, predominant polarity was not included in the DSM-5 as a BD course specifier.

Trends in body mass index according to educational attainment for urban Australian adults between 1980 and 2007

BackgroundWe have previously demonstrated that between the years 1980 and 2000, the mean body mass index (BMI) of the urban Australian population increased, with greater increases observed with increasing BMI. The current study aimed to quantify trends over time in BMI according to education between 1980 and 2007.MethodsWe compared data from the 1980, 1983 and 1989 National Heart Foundation Risk Factor Prevalence Studies, 1995 National Nutrition Survey, 2000 Australian Diabetes, Obesity and Lifestyle Study and the 2007 National Health Survey. For survey comparability, analyses were restricted to urban Australian residents aged 25-64 years. BMI was calculated from measured height and weight. The education variable was dichotomised at completion of secondary school. Four age-standardised BMI indicators were compared over time by sex and education: mean BMI, mean BMI of the top five percent of the BMI distribution, prevalence of obesity (BMI⩾30 kg/m(2)), prevalence of class II(+) obesity (BMI⩾35 kg/m(2)).ResultsBetween 1980 and 2007, the mean BMI among men increased by 2.5 kg/m(2) and 1.7 kg/m(2) for those with low and high education levels, respectively, corresponding to increases in obesity prevalence of 20(from 12% to 32%) and 11(10% to 21%) %-points. Among women mean BMI increased by 2.9 kg/m(2) and 2.4 kg/m(2) for those with low and high education levels respectively, corresponding to increases in obesity prevalence of 16(12% to 28%) and 12(7% to 19%) %-points. The prevalence of class II(+) obesity among men increased by 9(1% to 10%) and 4(1% to 5%) %-points for those with low and high education levels, and among women increased by 8(4% to 12%) and 4(2% to 6%) %-points. Absolute and relative differences between education groups generally increased over time.ConclusionsEducational differences in BMI have persisted among urban Australian adults since 1980 without improvement. Obesity prevention policies will need to be effective in those with greatest socio-economic disadvantage if we are to equitably and effectively address the population burden of obesity and its corollaries.International Journal of Obesity accepted article preview online, 16 March 2015. doi:10.1038/ijo.2015.27.

A new monotonicity index for fuzzy rule-based systems

A search in the literature reveals that mathematical conditions (usually sufficient conditions) for the Fuzzy Inference System (FIS) models to satisfy the monotonicity property have been developed. A monotonically-ordered fuzzy rule base is important to maintain the monotonicity property of an FIS. However, it may difficult to obtain a monotonically-ordered fuzzy rule base in practice. We have previously introduced the idea of fuzzy rule relabeling to tackle this problem. In this paper, we further propose a monotonicity index for the FIS system, which serves as a metric to indicate the degree of a fuzzy rule base fulfilling the monotonicity property. The index is useful to provide an indication whether a fuzzy rule base should (or should not) be used in practice, even with fuzzy rule relabeling. To illustrate the idea, the zero-order Sugeno FIS model is exemplified. We add noise as errors into the fuzzy rule base to formulate a set of non-monotone fuzzy rules. As such, the metric also acts as a measure of noise in the fuzzy rule base. The results show that the proposed metric is useful to indicate the degree of a fuzzy rule base fulfilling the monotonicity property.

The Psychometric Equivalence of the Personal Wellbeing Index for Normally Functioning and Homeostatically Defeated Australian Adults

Understanding subjective wellbeing (SWB) at the population level has major implications for governments and policy makers concerned with enhancing the life quality of citizens. The Personal Wellbeing Index (PWI) is a measure of SWB with theoretical and empirical credentials. Homeostasis theory offers an explanation for the nature of SWB data, including the distribution of scores, maintenance and change over time. According to this theory, under normal conditions, the dominant constituent of SWB is Homeostatically Protected Mood (HPMood), which is held within a genetically determined range of values around a set-point. However, in extreme circumstances (e.g., financial hardship, chronic illness), HPMood may dissociate from SWB, as cognitive/emotional reactions to the cause of homeostatic challenge assume control over SWB. This study investigates two groups as people scoring in the positive range for SWB and people who are likely to be experiencing homeostatic defeat/challenge. We test whether the reduced influence of HPMood on SWB due to homeostatic defeat has implications for the validity of SWB measurement. Participants were 45,192 adults (52 % female), with a mean age of 48.88 years (SD = 17.35 years), who participated in the first 23 surveys of the Australian Unity Wellbeing Index over the years 2001–2010. Multiple regression analysis, multiple group confirmatory factor analysis, and Rasch modelling techniques were used to evaluate the psychometric performance of the PWI across the two groups. Results show that while the PWI functioned as intended for the normal group, SWB in the challenged group was lower across all PWI domains, more variable, and the domain scores lacked the strength of inter-correlation observed in the normal, comparison group. These changes are consistent with predictions based on homeostasis theory and one major implication of the findings is that SWB measures may not function equivalently across the entire spectrum of possible domain satisfaction scores.

Toxicity and dose intensity of FOLFOX in patients with increased body mass index

This study was conducted at St James‘s Hospital, Dublin, Ireland, in 2010. It evaluated the dose intensity and toxicities experienced by patients of normal and increased body mass index treated with FOLFOX chemotherapy, and demonstrated that overweight patients may tolerate doses based on actual body weight.

Mapping 100 years of Thornthwaite moisture index: Impact of climate change in Victoria, Australia

Geographer C. W. Thornthwaite proposed in 1948 a moisture index called Thornthwaite Moisture Index (TMI) as part of a water balance model for a new classification system for climate. The importance of TMI climatic classification has been recognised in many areas of knowledge and practice worldwide over the last 60 years. However, although past climate research was focused on developing adequate methods for climate classification, current research is more concerned with understanding the patterns of climate change. The use of TMI as an indicator for climate change is still an incipient area of research. The contributions of this paper are twofold. First, it is to fully document a methodology based on geostatistics adopted to produce a time series of TMI maps that are accurate and have high spatial resolution. The state of Victoria, in Australia, over the last century, is used as the case study. Second, by analysing these maps, the paper presents a general evaluation of the spatial patterns found in Victoria related to moisture variability across space and over time. Some potential implications of the verified moisture changes are discussed, and a number of ideas for further development are suggested. © 2014 Institute of Australian Geographers.

A Cross-Cultural Evaluation of the Personal Wellbeing Index – School Children in Samples of Australian and Portuguese Adolescents

The practice of comparing nations on subjective wellbeing (SWB) is becoming commonplace, with many countries ranked by economists and social scientists alike according to average levels of SWB based on survey responses. Such large, multi-national population surveys have the potential to generate insights into the causes and correlates of SWB within different cultural groups, as well as inform policy regarding how to improve the wellbeing of citizens. At the heart of these large-scale research endeavors are SWB measures that function equivalently between the various participating cultural groups. For this reason, it is concerning that their remains a paucity of research that supports measurement equivalence for many SWB instruments commonly employed. Thus, it remains unclear whether variations in SWB across cultures reflect true differences, or whether these differences reflect measurement biases (e.g., response bias inherent within a particular cultural group). The aim of this study was to examine the psychometric equivalence of the Personal Wellbeing Index–School Children (PWI-SC) in convenience samples of Australian and Portuguese adolescents using multiple-group confirmatory factor analysis. Participants comprising the Australian sample were 1104 Victorian high-school students aged between 12 and 19 years (M = 14.42, SD = 1.63). Participants comprising the Portuguese sample were 573 high-school students living in Portugal aged between 12 and 18 years (M = 14.32, SD = 1.72). The results demonstrated strict factorial invariance between both versions of the PWI-SC, suggesting that this scale measures the same underlying construct in both samples. Moreover, these findings provide preliminary support for quantitative comparisons between Australian and Portuguese adolescents on the SWB variable as valid.

International study of perceived neighbourhood environmental attributes and Body Mass Index: IPEN Adult study in 12 countries

BACKGROUND: Ecological models of health behaviour are an important conceptual framework to address the multiple correlates of obesity. Several single-country studies previously examined the relationship between the built environment and obesity in adults, but results are very diverse. An important reason for these mixed results is the limited variability in built environments in these single-country studies. Therefore, the aim of this study was to examine associations between perceived neighbourhood built environmental attributes and BMI/weight status in a multi-country study including 12 environmentally and culturally diverse countries. METHODS: A multi-site cross-sectional study was conducted in 17 cities (study sites) across 12 countries (Australia, Belgium, Brazil, China, Colombia, Czech Republic, Denmark, Mexico, New Zealand, Spain, the UK and USA). Participants (n = 14222, 18-66 years) self-reported perceived neighbourhood environmental attributes. Height and weight were self-reported in eight countries, and measured in person in four countries. RESULTS: Three environmental attributes were associated with BMI or weight status in pooled data from 12 countries. Safety from traffic was the most robust correlate, suggesting that creating safe routes for walking/cycling by reducing the speed and volume of traffic might have a positive impact upon weight status/BMI across various geographical locations. Close proximity to several local destinations was associated with BMI across all countries, suggesting compact neighbourhoods with more places to walk related to lower BMI. Safety from crime showed a curvilinear relationship with BMI, with especially poor crime safety being related to higher BMI. CONCLUSIONS: Environmental interventions involving these three attributes appear to have international relevance and focusing on these might have implications for tackling overweight/obesity.

Application of a quantitative histological health index for Antarctic rock cod (Trematomus bernacchii) from Davis Station, East Antarctica

A quantitative Histological Health Index (HHI) was applied to Antarctic rock cod (Trematomus bernacchii) using gill, liver, spleen, kidney and gonad to assess the impact of wastewater effluent from Davis Station, East Antarctica. A total of 120 fish were collected from 6 sites in the Prydz Bay region of East Antarctica at varying distances from the wastewater outfall. The HHI revealed a greater severity of alteration in fish at the wastewater outfall, which decreased stepwise with distance. Gill and liver displayed the greatest severity of alteration in fish occurring in close proximity to the wastewater outfall, showing severe and pronounced alteration respectively. Findings of the HHI add to a growing weight of evidence indicating that the current level of wastewater treatment at Davis Station is insufficient to prevent impact to the surrounding environment. The HHI for T. bernacchii developed in this study is recommended as a useful risk assessment tool for assessing in situ, sub-lethal impacts from station-derived contamination in coastal regions throughout Antarctica.

Estimating capability index in multivariate processes using bootstrap sequential sampling procedures

Capability indices in both univariate and multivariate processes are extensively employed in quality control to assess the quality status of production batches before their release for operational use. It is traditionally a measure of the ratio of the allowable process spread and the actual spread. In this paper, we will adopt a bootstrap and sequential sampling procedures to determine the optimal sample size for estimating a multivariate capability index introduced by Pearns et. al. [12]. Bootstrap techniques have the distinct advantage of placing very minimum requirement on the distributions of the underlying quality characteristics, thereby rendering them more relevant under a wide variety of situations. Finally, we provide several numerical examples where the sequential sampling procedures are evaluated and compared.

Estimating Forward Pricing Function: How Efficient is Indian Stock Index Futures Market?

This paper uses Indian stock futures data to explore unbiased expectations and efficient market hypothesis. Having experienced voluminous transactions within a short time span after its establishment, the Indian stock futures market provides an unparalleled case for exploring these issues involving expectation and efficiency. Besides analyzing market efficiency between cash and futures prices using cointegration and error correction frameworks, the efficiency hypothesis is also investigated after explicitly modeling the underlying state of the market (expansion or contraction) through the first-order Markov switching set-up. The results based on Markov switching analysis show that relatively longer time horizon is more effective in eliminating arbitrage opportunities than the short run.

Validation of the personal wellbeing index for people with end stage kidney disease

The quality of life of people with end stage kidney disease (ESKD) has traditionally been measured using instruments that emphasise objective health status. The present study validates an alternative measure, the Personal Wellbeing Index (PWI), which measures subjective wellbeing. An Australian ESKD sample (N = 172, Mean age = 64.04, SD = 14.82) completed the PWI as well as health-specific quality of life measures. The PWI was subject to confirmatory factor analysis, and a series of regressions and between-group comparisons were performed to reveal that it is a psychometrically appropriate measure for this sample. The PWI and health-specific measures each yield different and complementary results. Thus, the PWI is proposed as a complement to existing health-related quality of life tools, in order to broaden understanding of the patient’s subjective experience. The resulting profile is argued to better inform targeted interventions to improve the quality of life of people with ESKD.

Reliability, validity, and responsiveness of the Western Ontario and McMaster Universities osteoarthritis index for elderly patients with a femoral neck fracture

Background: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) has been extensively evaluated in groups of patients with osteoarthritis, yet not in patients with a femoral neck fracture. This study aimed to determine the reliability, construct validity, and responsiveness of the WOMAC compared with the Short Form-12 (SF-12) and the EuroQol 5D (EQ-5D) questionnaires for the assessment of elderly patients with a femoral neck fracture.

Methods: Reliability was tested by assessing the Cronbach alpha. Construct validity was determined with the Pearson correlation coefficient. Change scores were calculated from ten weeks to twelve months of follow-up. Standardized response means and floor and ceiling effects were determined. Analyses were performed to compare the results for patients less than eighty years old with those for patients eighty years of age or older.

Results: The mean WOMAC total score was 89 points before the fracture in the younger patients and increased from 70 points at ten weeks to 81 points at two years postoperatively. In the older age group, these scores were 86, 75, and 78 points. The mean WOMAC pain scores before the fracture and at ten weeks and two years postoperatively were 92, 76, and 87 points, respectively, in the younger age group and 92, 84, and 93 points in the older age group. Function scores were 89, 68, and 79 points for the younger age group and 84, 71, and 73 points for the older age group. The Cronbach alpha for pain, stiffness, function, and the total scale ranged from 0.83 to 0.98 for the younger age group and from 0.79 to 0.97 for the older age group. Construct validity was good, with 82% and 79% of predefined hypotheses confirmed in the younger and older age groups, respectively. Responsiveness was moderate. No floor effects were found. Moderate to large ceiling effects were found for pain and stiffness scales at ten weeks and twelve months in younger patients (18% to 36%) and in the older age group (38% to 53%).

Conclusions: The WOMAC showed good reliability, construct validity, and responsiveness in both age groups of elderly patients with a femoral neck fracture who had been physically and mentally fit before the fracture. The instrument is suitable for use in future clinical studies in these populations.