A dietary guideline adherence score is positively associated with dietary biomarkers but not lipid profile in healthy children

BACKGROUND: Whether dietary indexes are associated with biomarkers of children's dietary intake is unclear. OBJECTIVE: The study aim was to examine the relations between diet quality and selected plasma biomarkers of dietary intake and serum lipid profile. METHODS: The study sample consisted of 130 children aged 4-13 y (mean ± SD: 8.6 ± 2.9 y) derived by using baseline data from an intervention study. The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises the following 11 components with age-specific criteria: 5 core food groups, whole-grain bread, reduced-fat dairy foods, discretionary foods (nutrient poor; high in saturated fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). A higher score reflects greater compliance with dietary guidelines. Venous blood was collected for measurements of serum lipids, fatty acid composition, plasma carotenoids, lutein, lycopene, and α-tocopherol. Linear regression was used to examine the relation between DGI-CA score (independent variable) and concentrations of biomarkers by using the log-transformed variable (outcome), controlling for confounders. RESULTS: DGI-CA score was positively associated (P < 0.05) with plasma concentrations of lutein (standardized β = 0.17), α-carotene (standardized β = 0.28), β-carotene (standardized β = 0.26), and n-3 (ω-3) fatty acids (standardized β = 0.51) and inversely associated with plasma concentrations of lycopene (standardized β = -0.23) and stearic acid (18:0) (standardized β = -0.22). No association was observed between diet quality and α-tocopherol, n-6 fatty acids, or serum lipid profile (all P > 0.05). CONCLUSION: Diet quality, conceptualized as adherence to national dietary guidelines, is cross-sectionally associated with plasma biomarkers of dietary exposure but not serum lipid profile. This trial was registered with the Australia New Zealand Clinical Trial Registry (www.anztr.org.au) as ACTRN12609000453280.

Default probability for the Jordanian companies: A test of cash flow theory

Abstract
This paper aims to investigate the effect of cash flow and free cash flow on corporate failure in the emerging market in particular Jordan using two samples; matched sample and a cross sectional time-series (panel data) sample representative of 167 Jordanian companies in 1989-2003. LOGIT models are used to outline the relationship between firms’ financial health and the probability of default. Our results show that there is firm’s free cash flow increases corporate failure. The result also shows that the firm’s cash flow decreases corporate failure. Firms’ capital structures are fund a mental in predicting default. Capital structure is seen as the main factor affecting the probability of default as it affects a firm’s ability to access external sources of funds. Jordanian firms depend on short-term debt for both short and long term financing.

Colorectal preOperative surgical score (CrOSS) for mortality in major colorectal surgery

BACKGROUND: Colorectal surgery carries a significant mortality risk, with reported rates of 1-6% for elective surgery and up to 22% in the emergency setting. Both clinicians and patients will benefit from being able to predict the likelihood of death before surgery. Recently, we have described and validated two risk stratification models for colorectal surgery, the Barwon Health 2012 and Association Française de Chirurgie models. However, these models are not suitable for assessment at patient's bedside. The purpose of this study is to develop a simplified preoperative model capable of predicting mortality following colorectal surgery. METHODS: The new model is termed Colorectal preOperative Surgical Score (CrOSS). The development and internal validation of CrOSS was performed using a prospectively maintained colorectal database. External validation was performed using retrospective data. Univariate and multivariate analyses were performed in model development. Calibration and discrimination were used for model validation. RESULTS: There were 474 and 389 consecutive colorectal surgeries at Geelong Hospital and Western Hospital. Overall mortality rates were 5.16% and 1.03%, respectively. Significant predictors for mortality were as follows: age ≥70, urgent operation, albumin ≤30 g/L and congestive heart failure (receiver operating characteristic (ROC) = 0.870, calibration P-value = 0.937). The predicted risk of mortality was stratified according to the risk profile of 0.39-66.51%. When validated externally, CrOSS predicted mortality accurately (ROC = 0.847, calibration P-value = 0.199). CONCLUSIONS: A robust and simple preoperative model has been created to risk-stratify patients for colorectal surgery. This was successfully validated at another tertiary hospital.

Economic evaluation of a psychological intervention for high distress cancer patients and carers: costs and quality-adjusted life years

OBJECTIVE: This study compared the cost-effectiveness of a psychologist-led, individualised cognitive behavioural intervention (PI) to a nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers.

METHODS: This was an economic evaluation conducted alongside a randomised trial of highly distressed adult cancer patients and carers calling cancer helplines. Services used by participants were measured using a resource use questionnaire, and quality-adjusted life years were measured using the assessment of quality of life - eight-dimension - instrument collected through a computer-assisted telephone interview. The base case analysis stratified participants based on the baseline score on the Brief Symptom Inventory. Incremental cost-effectiveness ratio confidence intervals were calculated with a nonparametric bootstrap to reflect sampling uncertainty. The results were subjected to sensitivity analysis by varying unit costs for resource use and the method for handling missing data.

RESULTS: No significant differences were found in overall total costs or quality-adjusted life years (QALYs) between intervention groups. Bootstrapped data suggest the PI had a higher probability of lower cost and greater QALYs for both carers and patients with high distress at baseline. For patients with low levels of distress at baseline, the PI had a higher probability of greater QALYs but at additional cost. Sensitivity analysis showed the results were robust.

CONCLUSIONS: The PI may be cost-effective compared with the nurse-led, minimal contact self-management condition for highly distressed cancer patients and carers. More intensive psychological intervention for patients with greater levels of distress appears warranted.

Climatic, vegetation and edaphic influences on the probability of fire across mediterranean woodlands of south-eastern Australia

 Aim: We investigated how the probability of burning is influenced by the time since fire (TSF) and gradients of climate, soil and vegetation in the fire-prone mediterranean-climate mallee woodlands of south-eastern Australia. This provided insight into the processes controlling contemporary fuel dynamics and fire regimes across biogeographical boundaries, and the consequent effects of climate change on potential shifts in boundaries between fuel systems and fire regimes, at a subcontinental scale. Location: South-eastern Australia. Methods: A desktop-based GIS was used to generate random sampling points across the study region to collect data on intersecting fire interval, rainfall, vegetation and soil type. We used a Bayesian framework to examine the effects of combinations of rainfall, vegetation and soil type on the hazard-of-burning and survival parameters of the Weibull distribution. These analyses identify the nature of environmental controls on the length of fire intervals and the age-dependence of the hazard of burning. Results: Higher rainfall was consistently associated with shorter fire intervals. Within a single level of rainfall, however, the interaction between soil and vegetation type influenced the length of fire intervals. Higher-fertility sands were associated with shorter fire intervals in grass-dominated communities, whereas lower-fertility sands were associated with shorter fire intervals in shrub-dominated communities. The hazard of burning remained largely independent of TSF across the region, only markedly increasing with TSF in shrub-dominated communities at high rainfall. Main conclusions: Rainfall had a dominant influence on fire frequency in the mediterranean-climate mallee woodlands of south-eastern Australia. Predicted changes in the spatial distribution and amount of rainfall therefore have the potential to drive changes in fire regimes, although the effects of soil fertility and rainfall on fire regimes do not align on a simple productivity gradient. Reduced soil fertility may favour plant traits that increase the rate of woody litter fuel accumulation and flammability, which may alter the overriding influence of rainfall gradients on fire regimes.

Transforming the SF-36 to account for death in longitudinal studies with three-year follow-up

BACKGROUND: Analyses of longitudinal health-related quality of life data often exclude participants who die, which limits the generalizability of the results. Methods to incorporate death as a valid score in the Medical Outcomes Study Short-Form (SF-36) have been suggested but need to be evaluated in other populations. OBJECTIVES: We sought to apply a method of transforming the SF-36 Physical Component Score (PCS) to include death. A transformation to estimate the probability of being "healthy" in 3 years, based on the current PCS value, will be developed and validated. SUBJECTS: Women in the Australian Longitudinal Study on Women's Health (ALSWH), ages 70-75 years at Survey 1 in 1996 (n = 12,432), were followed-up at 3 yearly intervals for 6 years. RESULTS: The transformation derived from the ALSWH data provides evidence that the methodology for transforming the PCS to account for deaths is sound. The 3-year equation provided good estimates of the probability of being healthy in 3 years and the method allowed deaths to be included in an analysis of changes in health over time. CONCLUSIONS: For longitudinal studies involving the SF-36 in which subjects have died, we support the recommendation that both the PCS and its transformed value which includes deaths should be analyzed to examine the influence of deaths on the study conclusions. Using study data to derive empirical parameters for the transformations may be appropriate for studies with follow-up intervals of other lengths.

The prevalence of glaucoma in the Melbourne Visual Impairment Project

PURPOSE: The purpose of the study was to determine the prevalence of glaucoma in Melbourne, Australia. METHODS: All subjects were participants in the Melbourne Visual Impairment Project (Melbourne VIP), a population-based prevalence study of eye disease that included residential and nursing home populations. Each participant underwent a standardized eye examination, which included a Humphrey Visual Field test, applanation tonometry, fundus examination including fundal photographs, and a medical history interview. Glaucoma status was determined by a masked assessment and consensus adjudication of visual fields, optic disc photographs, intraocular pressure, and glaucoma history. RESULTS: A total of 3271 persons (83% response rate) participated in the residential Melbourne VIP. The overall prevalence rate of definite primary open-angle glaucoma in the residential population was 1.7% (95% confidence limits = 1.21, 2.21). Of these, 50% had not been diagnosed previously. Only two persons (0.1%) had primary angle-closure glaucoma and six persons (0.2%) had secondary glaucoma. The prevalence of glaucoma increased steadily with age from 0.1% at ages 40 to 49 years to 9.7% in persons aged 80 to 89 years. There was no relationship with gender. The authors examined 403 (90.2% response rate) nursing home residents. The age standardized rate for this component was 2.36% (95% confidence limits = 0, 4.88). CONCLUSION: The rate of glaucoma in Melbourne rises significantly with age. With only half of patients being diagnosed, glaucoma is a major eye health problem and will become increasingly important as the population ages.

Knowledge of glaucoma, and its relationship to self-care practices, in a population sample

OBJECTIVE: To determine the level of knowledge of glaucoma in a population-based sample, and its relationship to self-care practices.

DESIGN AND SUBJECTS: A cluster random sample of the Melbourne population 40 years of age and older was interviewed. One thousand seven hundred and eleven residents living in five randomly selected Melbourne metropolitan suburbs, each consisting of two adjacent census collector districts.

MEASURES: Questions were asked concerning respondents' awareness, knowledge and description of the disease. Respondents were also asked the year of their last visit to their eye health care provider.

RESULTS: Seventy per cent of the sample had heard of glaucoma. However, only 22% provided a description that demonstrated a reasonable understanding of the disease. A lack of awareness and knowledge of glaucoma appeared to be negatively related to self-care practices.

CONCLUSION: Serious deficiencies in the basic knowledge of glaucoma in the community was demonstrated. This has significant public health implications as only a small percentage of the at-risk population may present themselves for assessment and treatment. Informing the community about glaucoma is an important step in promoting preventative ophthalmic care and reducing visual impairment and blindness.

Detecting stepping stones by abnormal causality probability

Locating the real source of the Internet attacks has long been an important but difficult problem to be addressed. In the real world, attackers can easily hide their identities and evade punishment by relaying their attacks through a series of compromised systems or devices called stepping stones. Currently, researchers mainly use similar features from the network traffic, such as packet timestamps and frequencies, to detect stepping stones. However, these features can be easily destroyed by attackers using evasive techniques. In addition, it is also difficult to implement an appropriate threshold of similarity that can help justify the stepping stones. In order to counter these problems, in this paper, we introduce the consistent causality probability to detect the stepping stones. We formulate the ranges of abnormal causality probabilities according to the different network conditions, and on the basis of it, we further implement to self-adaptive methods to capture stepping stones. To evaluate our proposed detection methods, we adopt theoretic analysis and empirical studies, which demonstrate accuracy of the abnormal causality probability. Moreover, we compare our proposed methods with previous works. The result shows that our methods in this paper significantly outperform previous works in the accuracy of detection malicious stepping stones, even when evasive techniques are adopted by attackers.

O trabalho atrapalha os estudos?

Nas últimas décadas a frequência à escola entre os jovens brasileiros aumentou consideravelmente. A porcentagem de crianças, entre 10 e 14 anos de idade que estão matriculados na escola está acima de 95% e na faixa de 15 a 18 anos de idade, cerca de 70%. Vinte anos atrás estes números eram 80% e 50%, respectivamente. Por outro lado, quando se analisa os dados de participação na força de trabalho o quadro é menos otimista: para ambos os grupos, a participação é bastante elevada e tem apresentado comportamento estável ao longo dos anos. Este estuda analisa o efeito da participação no mercado de trabalho sobre o atraso escolar de crianças de nestes dois grupos de faixa etária utilizando a metodologia de emparelhamento por nota de propensão (propensity score matching) de participação no mercado de trabalho. Como seria de se esperar quanto maior a probabilidade de participar maior o atraso escolar. Mas, nosso principal resultado é que em ambos os grupos e mais acentuadamente para os mais jovens, a diferença de atraso entre os que participam e não participam do mercado de trabalho é mais elevado para valores intermediários de probabilidade de trabalhar. Nos valores extremos da distribuição as diferenças não são tão elevadas e muitas vezes não significantes estatisticamente. Isto significa que para os jovens com elevada probabilidade de participar no mercado de trabalho, e que são os que têm o mais elevado grau de atraso escolar, o trabalho em si não é a maior razão para este mal desempenho. Estes resultados sugerem que as políticas públicas para combate ao atraso escolar entre os grupos mais pobres deveriam ser mais abrangentes envolvendo uma ação mais ampla sobre a família e não apenas na erradicação do trabalho infantil e juvenil.

Estudo de caso-controle para desenvolvimento e validação de um questionário de avaliação de abuso sexual em crianças

Objetivos: Desenvolver e validar instrumento que auxilie o pediatra a determinar a probabilidade de ocorrência do abuso sexual em crianças. Métodos: Estudo de caso-controle com 201 crianças que consultaram em ambulatórios de pediatria e locais de referência para vítimas de abuso sexual, entre março e novembro de 2004: grupo caso (com suspeita ou revelação de abuso sexual) e grupo controle (sem suspeita de abuso sexual). Aplicou-se, junto aos responsáveis, um questionário com 18 itens e cinco opções de respostas segundo a escala Likert, abordando comportamento, sintomas físicos e emocionais apresentados pelas crianças. Excluíram-se nove crianças sem controle esfincteriano e um item respondido por poucas pessoas. A validade e consistência interna dos itens foram avaliadas com obtenção de coeficientes de correlação (Pearson, Spearman e Goodman-Kruskal), coeficiente α de Cronbach e cálculo da área da curva ROC. Calculou-se, após, a razão de verossimilhança (RV) e os valores preditivo positivos (VPP) para os cinco itens do questionário que apresentaram os melhores desempenhos. Resultados: Obteve-se um questionário composto pelos cinco itens que melhor discriminaram crianças com e sem abuso sexual em dois contextos. Cada criança recebeu um escore resultante da soma das respostas com pesos de 0 a 4 (amplitude de 0 a 20), o qual, através do teorema de Bayes (RV), indicou sua probabilidade pós-teste (VPP) de abuso sexual. Conclusões: O instrumento proposto é útil por ser de fácil aplicação, auxiliando o pediatra na identificação de crianças vítimas de abuso sexual. Ele fornecerá, conforme o escore obtido, a probabilidade (VPP) de abuso sexual, orientando na conduta de cuidado à criança.

Identification and estimation of interventions using changes in inequality measures

This paper presents semiparametric estimators of changes in inequality measures of a dependent variable distribution taking into account the possible changes on the distributions of covariates. When we do not impose parametric assumptions on the conditional distribution of the dependent variable given covariates, this problem becomes equivalent to estimation of distributional impacts of interventions (treatment) when selection to the program is based on observable characteristics. The distributional impacts of a treatment will be calculated as differences in inequality measures of the potential outcomes of receiving and not receiving the treatment. These differences are called here Inequality Treatment Effects (ITE). The estimation procedure involves a first non-parametric step in which the probability of receiving treatment given covariates, the propensity-score, is estimated. Using the inverse probability weighting method to estimate parameters of the marginal distribution of potential outcomes, in the second step weighted sample versions of inequality measures are computed. Root-N consistency, asymptotic normality and semiparametric efficiency are shown for the semiparametric estimators proposed. A Monte Carlo exercise is performed to investigate the behavior in finite samples of the estimator derived in the paper. We also apply our method to the evaluation of a job training program.

Bounds for the probability distribution function of the linear ACD process

This paper derives both lower and upper bounds for the probability distribution function of stationary ACD(p, q) processes. For the purpose of illustration, I specialize the results to the main parent distributions in duration analysis. Simulations show that the lower bound is much tighter than the upper bound.