Distinguishing phenotypes of childhood wheeze and cough using latent class analysis

Airway disease in childhood comprises a heterogeneous group of disorders. Attempts to distinguish different phenotypes have generally considered few disease dimensions. The present study examines phenotypes of childhood wheeze and chronic cough, by fitting a statistical model to data representing multiple disease dimensions. From a population-based, longitudinal cohort study of 1,650 preschool children, 319 with parent-reported wheeze or chronic cough were included. Phenotypes were identified by latent class analysis using data on symptoms, skin-prick tests, lung function and airway responsiveness from two preschool surveys. These phenotypes were then compared with respect to outcome at school age. The model distinguished three phenotypes of wheeze and two phenotypes of chronic cough. Subsequent wheeze, chronic cough and inhaler use at school age differed clearly between the five phenotypes. The wheeze phenotypes shared features with previously described entities and partly reconciled discrepancies between existing sets of phenotype labels. This novel, multidimensional approach has the potential to identify clinically relevant phenotypes, not only in paediatric disorders but also in adult obstructive airway diseases, where phenotype definition is an equally important issue.

THE EFFECTS OF WEB-BASED TECHNOLOGICAL RESOURCES IN A RURAL SCIENCE CLASSROOM

Today’s technology is evolving at an exponential rate. Everyday technology is finding more inroads into our education system. This study seeks to determine if having access to technology, including iPad tablets and a teacher's physical science webpage resources (videos, PowerPoint® presentations, and audio podcasts), assists ninth grade high school students in attaining greater comprehension and improved scientific literacy. Comprehension of the science concepts was measured by comparing current student pretest and post test scores on a teacher-written assessment. The current student post test scores were compared with prior classes’ (2010-2011 and 2009-2010) to determine if there was a difference in outcomes between the technology interventions and traditional instruction. Students entered responses to a technology survey that measured intervention usage and their perception of helpfulness of each intervention. The current year class’ mean composite scores, between the pretest and post test increased by 6.9 points (32.5%). Student composite scores also demonstrated that the interventions were successful in helping a majority of students (64.7%) attain the curriculum goals. The interventions were also successful in increasing student scientific literacy by meeting all of Bloom's cognitive levels that were assessed. When compared with prior 2010-2011 and 2009-2010 classes, the current class received a higher mean post test score indicating a positive effect of the use of technological interventions. The survey showed a majority of students utilized at least some of the technology interventions and perceived them as helpful, especially the videos and PowerPoint® presentations.

Comparison of voxel-based 3-D MRI analysis and subtraction ictal SPECT coregistered to MRI in focal epilepsy

While voxel-based 3-D MRI analysis methods as well as assessment of subtracted ictal versus interictal perfusion studies (SISCOM) have proven their potential in the detection of lesions in focal epilepsy, a combined approach has not yet been reported. The present study investigates if individual automated voxel-based 3-D MRI analyses combined with SISCOM studies contribute to an enhanced detection of mesiotemporal epileptogenic foci. Seven consecutive patients with refractory complex partial epilepsy were prospectively evaluated by SISCOM and voxel-based 3-D MRI analysis. The functional perfusion maps and voxel-based statistical maps were coregistered in 3-D space. In five patients with temporal lobe epilepsy (TLE), the area of ictal hyperperfusion and corresponding structural abnormalities detected by 3-D MRI analysis were identified within the same temporal lobe. In two patients, additional structural and functional abnormalities were detected beyond the mesial temporal lobe. Five patients with TLE underwent epileptic surgery with favourable postoperative outcome (Engel class Ia and Ib) after 3-5 years of follow-up, while two patients remained on conservative treatment. In summary, multimodal assessment of structural abnormalities by voxel-based analysis and SISCOM may contribute to advanced observer-independent preoperative assessment of seizure origin.

The Amplifier - v. 1, no. 6

In this issue...Lydias, Jack Hunter, U. S. Navy, Student Council, Drama class, Petroleum Engineering, G. I. Bill, Air Force ROTC, General Guthrie, Coach Olsen

The Amplifier - v. 2, no. 14

In this issue...Dean Adami, M club, Red Rock, Bernice, Montana, Mineral Club, Mines Football, Sam Worcester, Professor Laity, Western Civilization class

The Amplifier - v. 4, no. 4

In this issue...Dean D. C. McAuliffe, Chelation, Copper Guards, March of Dimes, Ski Club, Coach Simonich, Sigma Rho, Anderson-Carlisle Society, Mineral Club

The Amplifier - v. 8, no. 5

In this issue...Fish and Game Commission, Peace Corps, Great Falls Brewery, George D. McDonald, Glee club, Intramural basketball, Sugar Bowl, Metals Bank

The Amplifier - v. 9, no. 1

In this issue...New Faculty, Orediggers, Anderson-Carlisle, campus parking, cheerleaders, freshman class, Phil Judd, Mineral dressing, Coach Ed Simonich

The Amplifier - v. 9, no. 8

In this issue...Ceramic testing, Bob LeCoure, Butte Civic Center, Rotary Club, Saint Patrick's Day, First-Aid Class, Mine Rescue, Career Day, American Legion Baseball

The Amplifier - v. 9, no. 10

In this issue...Spanish class, Peace Corps, Coast Guard, NASA, Allen Winters, M-Days, Alumni Stadium, Chess Club, Charles Russell, computer class, Columbia Riding Club

Multivariate modelling of responses to conditional items: New possibilities for latent class analysis

Questionnaire data may contain missing values because certain questions do not apply to all respondents. For instance, questions addressing particular attributes of a symptom, such as frequency, triggers or seasonality, are only applicable to those who have experienced the symptom, while for those who have not, responses to these items will be missing. This missing information does not fall into the category 'missing by design', rather the features of interest do not exist and cannot be measured regardless of survey design. Analysis of responses to such conditional items is therefore typically restricted to the subpopulation in which they apply. This article is concerned with joint multivariate modelling of responses to both unconditional and conditional items without restricting the analysis to this subpopulation. Such an approach is of interest when the distributions of both types of responses are thought to be determined by common parameters affecting the whole population. By integrating the conditional item structure into the model, inference can be based both on unconditional data from the entire population and on conditional data from subjects for whom they exist. This approach opens new possibilities for multivariate analysis of such data. We apply this approach to latent class modelling and provide an example using data on respiratory symptoms (wheeze and cough) in children. Conditional data structures such as that considered here are common in medical research settings and, although our focus is on latent class models, the approach can be applied to other multivariate models.

Class-switzched B cells display response to therapeutic B-cell depletion in rheumatoid arthritis

Introduction Reconstitution of peripheral blood (PB) B cells after therapeutic depletion with the chimeric anti-CD20 antibody rituximab (RTX) mimics lymphatic ontogeny. In this situation, the repletion kinetics and migratory properties of distinct developmental B-cell stages and their correlation to disease activity might facilitate our understanding of innate and adaptive B-cell functions in rheumatoid arthritis (RA). Methods Thirty-five 'RTX-naïve' RA patients with active arthritis were treated after failure of tumour necrosis factor blockade in an open-label study with two infusions of 1,000 mg RTX. Prednisone dose was tapered according to clinical improvement from a median of 10 mg at baseline to 5 mg at 9 and 12 months. Conventional disease-modifying antirheumatic drugs were kept stable. Subsets of CD19+ B cells were assessed by flow cytometry according to their IgD and CD27 surface expression. Their absolute number and relative frequency in PB were followed every 3 months and were determined in parallel in synovial tissue (n = 3) or synovial fluid (n = 3) in the case of florid arthritis. Results Six of 35 patients fulfilled the European League Against Rheumatism criteria for moderate clinical response, and 19 others for good clinical response. All PB B-cell fractions decreased significantly in number (P < 0.001) after the first infusion. Disease activity developed independently of the total B-cell number. B-cell repopulation was dominated in quantity by CD27-IgD+ 'naïve' B cells. The low number of CD27+IgD- class-switched memory B cells (MemB) in the blood, together with sustained reduction of rheumatoid factor serum concentrations, correlated with good clinical response. Class-switched MemB were found accumulated in flaring joints. Conclusions The present data support the hypothesis that control of adaptive immune processes involving germinal centre-derived, antigen, and T-cell-dependently matured B cells is essential for successful RTX treatment.

Comment to the book review by Amani Lusekelo / Kommentar zur Rezension von Amani Lusekelo / Commentaire à l récension d'Amani Lusekelo 2009

Mpendwa Amani, Nashukuru sana kwa maoni yako juu ya kitabu changu. Nakubaliana sana na wewe juu ya dhamira ya ubepari ndani ya muktadha wa mashindano ya urembo. Lakini sikutafiti mashindano yanayotokea bara -- utafiti huo ni wa Sabrina Billings (sitaki kuonekana kama nilifanya utafiti huo - nimesoma tasnifu yake ambayo ni nzuri sana). Billings amechapisha utafiti wake hivi karibuni katika Language in Society (2009).