Identifying subgroups of U.S. adults at risk for prolonged television viewing to inform program development

Background
Although adverse health effects of prolonged TV viewing have been increasingly recognized, little population-wide information is available concerning subgroups at greatest risk for this behavior.

Purpose
This study sought to identify, in a U.S. population–derived sample, combinations of variables that defined subgroups with higher versus lower levels of usual TV-viewing time.

Methods
A total of 5556 adults from a national consumer panel participated in the mail survey in 2001 (55% women, 71% white, 13% black, and 11% Hispanic). Nonparametric risk classification analyses were conducted in 2008.

Results
Subgroups with the highest proportions of people watching >14 hours/week of TV were identified and described using a combination of demographic (i.e., lower household incomes, divorced/separated); health and mental health (i.e., poorer rated overall health, higher BMI, more depression); and behavioral (i.e., eating dinner in front of the TV, smoking, less physical activity) variables. The subgroup with the highest rates of TV viewing routinely ate dinner while watching TV and had lower income and poorer health. Prolonged TV viewing also was associated with perceived aspects of the neighborhood environment (i.e., heavy traffic and crime, lack of neighborhood lighting, and poor scenery).

Conclusions
The results can help inform intervention development in this increasingly important behavioral health area.

The value of impulsivity to define subgroups of addicted individuals differing in personality dysfunction, craving, psychosocial adjustment, and wellbeing: A latent class analysis

High impulsivity is common to substance and gambling addictions. Despite these commonalities, there is still substantial heterogeneity on impulsivity levels within these diagnostic groups, and variations in impulsive levels predict higher severity of symptoms and poorer outcomes. We addressed the question of whether impulsivity scores can yield empirically driven subgroups of addicted individuals that will exhibit different clinical presentations and outcomes. We applied latent class analysis (LCA) to trait (UPPS-P impulsive behavior scale) and cognitive impulsivity (Stroop and d2 tests) scores in three predominantly male addiction diagnostic groups: Cocaine with Personality Disorders, Cocaine Non-comorbid, and Gambling and analyzed the usefulness of the resulting subgroups to differentiate personality beliefs and relevant outcomes: Craving, psychosocial adjustment, and quality of life. In accordance with impulsivity scores, the three addiction diagnostic groups are best represented as two separate classes: Class 1 characterized by greater trait impulsivity and poorer cognitive impulsivity performance and Class 2 characterized by lower trait impulsivity and better cognitive impulsivity performance. The two empirically derived classes showed significant differences on personality features and outcome variables (Class 1 exhibited greater personality dysfunction and worse clinical outcomes), whereas conventional diagnostic groups showed non-significant differences on most of these measures. Trait and cognitive impulsivity scores differentiate subgroups of addicted individuals with more versus less severe personality features and clinical outcomes.

Nonparametric discovery of learning patterns and autism subgroups from therapeutic data

Autism Spectrum Disorder (ASD) is growing at a staggering rate, but, little is known about the cause of this condition. Inferring learning patterns from therapeutic performance data, and subsequently clustering ASD children into subgroups, is important to understand this domain, and more importantly to inform evidence-based intervention. However, this data-driven task was difficult in the past due to insufficiency of data to perform reliable analysis. For the first time, using data from a recent application for early intervention in autism (TOBY Play pad), whose download count is now exceeding 4500, we present in this paper the automatic discovery of learning patterns across 32 skills in sensory, imitation and language. We use unsupervised learning methods for this task, but a notorious problem with existing methods is the correct specification of number of patterns in advance, which in our case is even more difficult due to complexity of the data. To this end, we appeal to recent Bayesian nonparametric methods, in particular the use of Bayesian Nonparametric Factor Analysis. This model uses Indian Buffet Process (IBP) as prior on a binary matrix of infinite columns to allocate groups of intervention skills to children. The optimal number of learning patterns as well as subgroup assignments are inferred automatically from data. Our experimental results follow an exploratory approach, present different newly discovered learning patterns. To provide quantitative results, we also report the clustering evaluation against K-means and Nonnegative matrix factorization (NMF). In addition to the novelty of this new problem, we were able to demonstrate the suitability of Bayesian nonparametric models over parametric rivals.

Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling

The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25-75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0-9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners.

Nonparametric discovery and analysis of learning patterns and autism subgroups from therapeutic data

The spectrum nature and heterogeneity within autism spectrum disorders (ASD) pose as a challenge for treatment. Personalisation of syllabus for children with ASD can improve the efficacy of learning by adjusting the number of opportunities and deciding the course of syllabus. We research the data-motivated approach in an attempt to disentangle this heterogeneity for personalisation of syllabus. With the help of technology and a structured syllabus, collecting data while a child with ASD masters the skills is made possible. The performance data collected are, however, growing and contain missing elements based on the pace and the course each child takes while navigating through the syllabus. Bayesian nonparametric methods are known for automatically discovering the number of latent components and their parameters when the model involves higher complexity. We propose a nonparametric Bayesian matrix factorisation model that discovers learning patterns and the way participants associate with them. Our model is built upon the linear Poisson gamma model (LPGM) with an Indian buffet process prior and extended to incorporate data with missing elements. In this paper, for the first time we have presented learning patterns deduced automatically from data mining and machine learning methods using intervention data recorded for over 500 children with ASD. We compare the results with non-negative matrix factorisation and K-means, which being parametric, not only require us to specify the number of learning patterns in advance, but also do not have a principle approach to deal with missing data. The F1 score observed over varying degree of similarity measure (Jaccard Index) suggests that LPGM yields the best outcome. By observing these patterns with additional knowledge regarding the syllabus it may be possible to observe the progress and dynamically modify the syllabus for improved learning.

Behavioural differences between EEG-defined subgroups of children with Attention-Deficit/Hyperactivity Disorder

Objective: This study investigated the presence and nature of EEG clusters within a clinically-referred sample of children with Attention-Deficit/Hyperactivity Disorder (AD/HD), and whether behavioural differences exist between clusters.

Method: Participants were 155 boys with AD/HD and 109 age- and gender-matched controls. EEG was recorded during an eyes-closed resting condition and Fourier transformed to provide estimates for total power, and relative delta, theta, alpha, and beta. EEG data were grouped into 3 regions, and subjected to Cluster Analysis. Behavioural data for each cluster were compared against the remaining AD/HD subjects.

Results: Four EEG clusters were found. These were characterised by (a) elevated beta activity, (b) elevated theta with deficiencies of alpha and beta, (c) elevated slow wave with less fast wave activity, and (d) elevated alpha. An exploratory analysis of behavioural correlates with these EEG subtypes indicated the presence of interesting trends that need further investigation.

Conclusions: This study found that the AD/HD EEG profiles reported in past studies are robust and not substantially affected by the inclusion of children with other comorbid conditions. The observed group differences in behavioural profiles indicated that different patterns of EEG activity have importance in determining behaviour.

Significance: This is the first study to link behavioural profiles of children with AD/HD to specific EEG abnormalities.

Cognitive-behavioural therapy has no effect on disease activity but improves quality of life in subgroups of patients with inflammatory bowel disease: a pilot randomised controlled trial.

BACKGROUND: Studies have demonstrated usefulness of cognitive-behavioural therapy (CBT) in managing distress in inflammatory bowel disease (IBD); however, few have focused on IBD course. The present trial aimed to investigate whether adding CBT to standard treatment prolongs remission in IBD in comparison to standard therapy alone. METHODS: A 2-arm parallel pragmatic randomised controlled trial (+CBT - standard care plus either face-to-face (F2F) or online CBT over 10 weeks versus standard care alone (SC)) was conducted with adult patients in remission. IBD remission at 12 months since baseline was the primary outcome measure while the secondary outcome measures were mental health status and quality of life (QoL). Linear mixed-effect models were used to compare groups on outcome variables while controlling for baseline. RESULTS: Participants were 174 patients with IBD (90 +CBT, 84 SC). There was no difference in remission rates between groups, with similar numbers flaring at 12 months. Groups did not differ in anxiety, depression or coping at 6 or 12 months (p >0.05). When only participants classified as 'in need' (young, high baseline IBD activity, recently diagnosed; poor mental health) were examined in the post-hoc analysis (n = 74, 34 CBT and 40 controls), CBT significantly improved mental QoL (p = .034, d = .56) at 6 months. Online CBT group had a higher score on Precontemplation than the F2F group, which is consistent with less developed coping with IBD in the cCBT group (p = .045). CONCLUSIONS: Future studies should direct psychological interventions to patients 'in need' and attempt to recruit larger samples to compensate for significant attrition when using online CBT. TRIAL REGISTRATION: The protocol was registered on 21/10/2009 with the Australian New Zealand Clinical Trials Registry (ID: ACTRN12609000913279).

A practical approach to monitoring nutrient supplement intake of Australian adults

The adoption, in mid-1995, of the revised food Standard A9, which permits the more liberal addition of nutrients to a range of food products, highlighted the need to obtain information on nutrient intake from supplements to complement the i 995 National Nutrition Survey data on nutrient intake from food. This paper describes the method used to obtain quantitative information on nutrient supplement intake and reports on the prevalence of supplement use in different subgroups of the Australian population. Information on supplement intake was obtained in two Australian Bureau of Statistics Population Survey Monitor surveys in August 1995 and February 1996 using the Therapeutic Goods Administration (TGA) registration numbers to identify individual products. Approximately 18% of men and 29% of women aged 18 years and over reported consuming a nutrient supplement on the day before the survey and these proportions increased to 25% and 35% respectively for consumption during the two weeks before the survey. The prevalence of supplement intake increased with age, education level, socioeconomic status, employment status and with fruit and vegetable intake. The substantial proportion of Australian adults who consume nutrient supplements, and the rapidly changing composition of the Australian food supply in response to changes in food regulation, indicate that there is a need for regular monitoring of nutrient intake from supplements. The use of TGA registration numbers to identify supplements provides a practical way to address this need.

Capitanian (late Guadalupian, permian) global brachiopod palaeobigeography and latitudinal diversity pattern

A global database containing 3365 occurrences, 821 species and 251 genera of the Capitanian (Late Guadalupian, Permian) brachiopod faunas from 24 stations has been analyzed by cluster analysis using the Jaccard and Otsuka coefficients and the probabilistic index of similarity, nonmetric multidimensional scaling and minimum spanning tree. Two supergroups, three groups and six subgroups are revealed and interpreted as representing, respectively, two biotic realms (the Palaeoequatorial and Gondwanan Realms), two regions and six provinces. An additional realm (the Boreal Realm), based on the fauna from Spitsbergen, also appears recognizable although it also shows considerable similarities with southwestern North America and the northern margin of Gondwana as revealed by the statistical analysis. The Palaeoequatorial Realm can be further subdivided into the North America Region and the Asian Tethyan Region. The six biotic provinces are the Cathaysian Province in the Palaeotethys and Mesotethys, the Greenland-Svalbard Province in the Arctic region, the Austrazean Province in eastern Australia and New Zealand, the Grandian Province in western North America and the two transitional zones (the Himalayan Province in the southern temperate zone and the Sino–Mongolian–Japanese Province in the northern temperate zone). Polynomial regression analysis and rarefaction analysis indicate that the generic diversities of brachiopod faunas during the Capitanian peaked in the Palaeoequatorial Cathaysian Province and the two transitional zones (Himalayan Province and Sino–Mongolian–Japanese Province), but fell dramatically in the polar regions. The generic diversity of the Palaeoequatorial Grandian Province is apparently lower than in the two transitional zones of temperate palaeolatitudes, suggesting that the generic diversity of Capitanian brachiopod faunas does not exhibit a strict negative correlation with palaeolatitudes. This in turn would suggest that biogeographical determinants (such as geographical barriers, inhabitable area and ocean currents) other than latitude-related temperature control may also have played an important role in the dispersal of some brachiopods and the characterization of some local provinces and high diversities. The Capitanian global brachiopod palaeobiogeography is generally comparable with those in the Wuchiapingian and Changhsingian, but with some notable differences. These include: (1) that the Grandian Province of the Capitanian in western North America vanished after the end-Guadalupian regression, (2) that the western Tethyan Province of the Lopingian could not be distinguished in the Capitanian, and (3) that the Austrazean Province was larger in area than either in the Wuchiapingian or in the Changhsingian.

Still suffering from the `silo effect`: lingering cultural barriers to collaborative care

This research project sought to draw out the contesting definitions of collaborative care among professional subgroups in maternity services. The paper contrasts medical and social models of knowledge and reports on qualitative evidence from midwives and doctors in Australian hospitals. The evidence indicates that collaborative care is welcomed by both midwives and doctors but that there remains a lingering residue of the ‘silo effect’ of the ‘old’ professionalism, characterized by hierarchical relations, divergent philosophies and competing domains. Although a ‘new professionalism’ has emerged that challenges the old hierarchies and professional dependencies, it too harbours lingering residues of the former dichotomy between midwives and obstetricians. These tensions and enmities will need to be resolved before genuine collaboration may take full effect. The objective is a relationship focused model of care that transcends professional or woman-focused models. The ‘new’ professionalism may be expedited through mediation strategies, a version of which is the ‘sociological intervention method’ discussed in this article.

Culture-specific variation in the flavor profile of soymilks

A modified quantitative descriptive analysis (QDA) method was used to determine sensory profiles of 8 soymilk products: 3 manufactured in Australia, 3 manufactured in Singapore, 1 manufactured in Malaysia, and 1 manufactured in Hong Kong. A panel (n= 7) was selected, trained in descriptive profiling of soymilk, and developed a soymilk language that was used to evaluate the flavor attributes of the soymilk products. A repeated-measure ANOVA showed highly reproducible panel performance, and significant differences in soymilk attributes among all soymilks. A principal component analysis (PCA) revealed 2 main groupings among the soymilks that corresponded to cultural origin: Australia and Asia (Singapore and Hong Kong/Malaysia). Products from Australia were significantly stronger in milky, astringent, salty notes and pale in color, while products from Asia were significantly stronger in beany, cooked beans, sweet, and pandan notes (P < 0.05). In addition, the Asian soymilks could be separated into 2 subgroups, with Singaporean soymilks having deeper color, greater viscosity, and less green flavor than Hong Kong/Malaysia soymilks. Australian produced soymilk is bovine-milk-like compared with Asian soymilk, presumably due to bovine milk being the primary source of milk in Australia. We conclude that culture-specific flavor preferences are a determining factor in flavor profiles of soymilks from geographically distinct regions.

Emergency nurse practitioner care and emergency department patient flow: case-control study

Objective: The present study aimed to compare ED waiting times (for medical assessment and treatment), treatment times and length of stay (LOS) for patients managed by an emergency nurse practitioner candidate (ENPC) with patients managed via traditional ED care. Methods: A case–control design was used. Patients were selected using the three most common ED discharge diagnoses for ENPC managed patients: hand/wrist wounds, hand/wrist fractures and removal of plaster of Paris. The ENPC group (n = 102) consisted of patients managed by the ENPC who had ED discharge diagnoses as mentioned above. The control group (n = 623) consisted of patients with the same ED discharge diagnoses who were managed via traditional ED care. Results: There were no significant differences in median waiting times, treatment times and ED LOS between ENPC managed patients and patients managed via traditional ED processes. There appeared to be some variability between diagnostic subgroups in terms of treatment times and ED LOS. Conclusion: Patient flow outcomes for ENPC managed patients are comparable with those of patients managed via usual ED processes.

Development of a model of the antecedents and consequences of an inclusivie team climate

Exclusion due to the tendency of people to form subgroups based on perceived interpersonal similarities and dissimilarities still prevents many individuals and teams from reaching their full potential. Using research from the social psychology and organisational behaviour literature we examine the relationship between perceived dissimilarity, subgroup formation and team climate and individual team member's responses to the team and propose a model of the antecedents and consequences of individual team members propensity to perceive dissimilarity and an inclusive team climate.

The extent and breadth of benefits from participating in chronic disease self-management courses: a national patient-reported outcomes survey

Objective
To quantify the benefits that people receive from participating in self-management courses and identify subgroups that benefit most.

Methods
People with a wide range of chronic conditions attending self-management courses (N = 1341 individuals) were administered the Health Education Impact Questionnaire (heiQ). Baseline and follow-up data were collected resulting in 842 complete responses. Outcomes were categorized as substantial improvement (effect size, ES ≥ 0.5), minimal/no change (ES −0.49 to 0.49) and substantial decline (ES ≤ −0.5).

Results
On average, one third of participants reported substantial benefits at the end of a course and this ranged from 49% in the heiQ subscale Skill and technique acquisition to 27% in the heiQ subscale Health service navigation. Stratification by gender, age and education showed that younger participants were more likely to benefit, particularly young women. No further subgroup differences were observed.

Conclusion
While the well-being of people with chronic diseases tends to decline, about one third of participants from a wide range of backgrounds show substantial improvements in a range of skills that enable them to self-manage.

Practice implications
These data support the application of self-management courses indicating that they are a useful adjunct to usual care for a modest proportion of attendees.

The attentional blink reveals sluggish attentional shifting in adolescents with specific language impairment

Rapid processing deficits have been the subject of much debate in the literature on specific language impairment (SLI). Hari and Renvall (2001) [Hari, R. & Renvall, H. (2001). Impaired processing of rapid stimulus sequences in dyslexia. Trends in cognitive sciences, 5, 525–532.] proposed that the source of this deficit can be attributed to sluggish attentional shifting abilities. That is, more time is required to shift attention between stimuli. To test this claim, 26 adolescents with SLI (divided into two subgroups to control for differences in non-verbal intelligence) and 14 controls were presented with a rapid serial visual presentation task. In this task participants were asked to detect two visual targets presented serially with distracter items with varying inter-target intervals (i.e., time difference between targets). This task was designed to elicit an attentional blink (AB). The AB describes the phenomenon whereby non-impaired individuals are less likely to report the second of two targets presented within 200–500 ms of each other. After controlling for group differences in non-verbal intelligence, the SLI group was found to be significantly less accurate than the control group at successfully reporting the second target at inter-target intervals of 100, 200, 300, 400 and 800 ms. The results were interpreted to suggest that adolescents with language impairments have an AB which differs from non-impaired individuals in both magnitude and duration.