The effect of SGLT2 inhibition on prostate cancer: Mendelian randomization and observational analysis using electronic healthcare and cohort data.

We evaluated the effect of sodium-glucose cotransporter 2 (SGLT2) inhibition on prostate cancer by evidence triangulation. Using Mendelian randomization, we found that genetically proxied SGLT2 inhibition reduced the risk of overall (odds ratio = 0.56, 95% confidence interval [CI] = 0.38 to 0.82; 79,148 prostate cancer cases and 61,106 controls), advanced, and early-onset prostate cancer. Using electronic healthcare data (nSGLT2i = 24,155; nDPP4i = 24,155), we found that the use of SGLT2 inhibitors was associated with a 23% reduced risk of prostate cancer (hazard ratio = 0.77, 95% CI = 0.61 to 0.99) in men with diabetes. Using data from two prospective cohorts (n4C = 57,779; nUK_Biobank = 165,430), we found little evidence to support the association of HbA1c with prostate cancer, implying a non-glycemic effect of SGLT2 inhibition on prostate cancer. In summary, this study provides multiple layers of evidence to support the beneficial effect of SGLT2 inhibition on reducing prostate cancer risk. Future trials are warranted to investigate whether SGLT2 inhibitors can be recommended for prostate cancer prevention.

An observational analysis of the impact of indoor residual spraying in two distinct contexts of Burkina Faso.

BACKGROUND: Indoor residual spraying (IRS) is a cornerstone malaria control intervention in Burkina Faso. From 2018 to 2021, non-pyrethroid IRS was implemented annually in two regions of Burkina Faso with distinct malaria transmission patterns, concurrently with annual seasonal malaria chemoprevention (SMC), and a mass insecticide-treated net (ITN) distribution in 2019. METHODS: A retrospective quasi-experimental approach was used to evaluate the impact of the 2018, 2020, and 2021 IRS campaigns on routinely reported confirmed malaria case incidence at health facilities. The 2019 campaign was excluded due to lack of data reporting during a health sector strike. Controlled interrupted time series models were fit to detect changes in level and trend in malaria case incidence rates following each IRS campaign when compared to the baseline period 24-months before IRS. IRS districts Solenzo (Sudano-Sahelien climate), and Kampti (tropical climate) were compared with neighbouring control districts and the analyses were stratified by region. Modelled health facility catchment population estimates based on travel time to health facilities and weighted by non-malaria outpatient visits were used as an offset. The study period encompassed July 2016 through June 2022, excluding July 2018 to June 2019. RESULTS: District-level population and structure coverage achieved by IRS campaigns was greater than 85% in 2018, 2020, and 2021 in Solenzo and Kampti. In Solenzo a significant difference in malaria case incidence rates was detected after the 2018 campaign (IRR = 0.683; 95% CI 0.564-0.827) when compared to the control district. The effect was not detected following the 2020 or 2021 IRS campaigns. In Kampti, estimated malaria incidence rates were between 36 and 38% lower than in the control district following all three IRS campaigns compared to the baseline period. CONCLUSIONS: Implementation of IRS in Kampti, a tropical region of Burkina Faso, appeared to have a consistent significant beneficial impact on malaria case rates. An initial positive impact in Solenzo after the first IRS campaign was not sustained in the successive evaluated IRS campaigns. This study points to a differential effect of IRS in different malaria transmission settings and in combination with ITN and SMC implementation.

Age at Menopause and the Risk of Stroke: Observational and Mendelian Randomization Analysis in 204 244 Postmenopausal Women.

Background Observational studies have shown that women with an early menopause are at higher risk of stroke compared with women with a later menopause. However, associations with stroke subtypes are inconsistent, and the causality is unclear. Methods and Results We analyzed data of the UK Biobank and EPIC-CVD (European Prospective Investigation Into Cancer and Nutrition-Cardiovascular Diseases) study. A total of 204 244 postmenopausal women without a history of stroke at baseline were included (7883 from EPIC-CVD [5292 from the subcohort], 196 361 from the UK Biobank). Pooled mean baseline age was 58.9 years (SD, 5.8), and pooled mean age at menopause was 47.8 years (SD, 6.2). Over a median follow-up of 12.6 years (interquartile range, 11.8-13.3), 6770 women experienced a stroke (5155 ischemic strokes, 1615 hemorrhagic strokes, 976 intracerebral hemorrhages, and 639 subarachnoid hemorrhages). In multivariable adjusted observational Cox regression analyses, the pooled hazard ratios per 5 years younger age at menopause were 1.09 (95% CI, 1.07-1.12) for stroke, 1.09 (95% CI, 1.06-1.13) for ischemic stroke, 1.10 (95% CI, 1.04-1.16) for hemorrhagic stroke, 1.14 (95% CI, 1.08-1.20) for intracerebral hemorrhage, and 1.00 (95% CI, 0.84-1.20) for subarachnoid hemorrhage. When using 2-sample Mendelian randomization analysis, we found no statistically significant association between genetically proxied age at menopause and risk of any type of stroke. Conclusions In our study, earlier age at menopause was related to a higher risk of stroke. We found no statistically significant association between genetically proxied age at menopause and risk of stroke, suggesting no causal relationship.

Using Trial and Observational Data to Assess Effectiveness: Trial Emulation, Transportability, Benchmarking, and Joint Analysis.

Comparisons between randomized trial analyses and observational analyses that attempt to address similar research questions have generated many controversies in epidemiology and the social sciences. There has been little consensus on when such comparisons are reasonable, what their implications are for the validity of observational analyses, or whether trial and observational analyses can be integrated to address effectiveness questions. Here, we consider methods for using observational analyses to complement trial analyses when assessing treatment effectiveness. First, we review the framework for designing observational analyses that emulate target trials and present an evidence map of its recent applications. We then review approaches for estimating the average treatment effect in the target population underlying the emulation: using observational analyses of the emulation data alone; and using transportability analyses to extend inferences from a trial to the target population. We explain how comparing treatment effect estimates from the emulation against those from the trial can provide evidence on whether observational analyses can be trusted to deliver valid estimates of effectiveness - a process we refer to as benchmarking - and, in some cases, allow the joint analysis of the trial and observational data. We illustrate different approaches using a simplified example of a pragmatic trial and its emulation in registry data. We conclude that synthesizing trial and observational data - in transportability, benchmarking, or joint analyses - can leverage their complementary strengths to enhance learning about comparative effectiveness, through a process combining quantitative methods and epidemiological judgements.

Both indirect maternal and direct fetal genetic effects reflect the observational relationship between higher birth weight and lower adult bone mass.

BACKGROUND: Birth weight is considered not only to undermine future growth, but also to induce lifelong diseases; the aim of this study is to explore the relationship between birth weight and adult bone mass. METHODS: We performed multivariable regression analyses to assess the association of birth weight with bone parameters measured by dual-energy X-ray absorptiometry (DXA) and by quantitative ultrasound (QUS), independently. We also implemented a systemic Mendelian randomization (MR) analysis to explore the causal association between them with both fetal-specific and maternal-specific instrumental variables. RESULTS: In the observational analyses, we found that higher birth weight could increase the adult bone area (lumbar spine, ß-coefficient= 0.17, P < 2.00 × 10-16; lateral spine, ß-coefficient = 0.02, P = 0.04), decrease bone mineral content-adjusted bone area (BMCadjArea) (lumbar spine, ß-coefficient= - 0.01, P = 2.27 × 10-14; lateral spine, ß-coefficient = - 0.05, P = 0.001), and decrease adult bone mineral density (BMD) (lumbar spine, ß-coefficient = - 0.04, P = 0.007; lateral spine; ß-coefficient = - 0.03, P = 0.02; heel, ß-coefficient = - 0.06, P < 2.00 × 10-16), and we observed that the effect of birth weight on bone size was larger than that on BMC. In MR analyses, the higher fetal-specific genetically determined birth weight was identified to be associated with higher bone area (lumbar spine; ß-coefficient = 0.15, P = 1.26 × 10-6, total hip, ß-coefficient = 0.15, P = 0.005; intertrochanteric area, ß-coefficient = 0.13, P = 0.0009; trochanter area, ß-coefficient = 0.11, P = 0.03) but lower BMD (lumbar spine, ß-coefficient = - 0.10, P = 0.01; lateral spine, ß-coefficient = - 0.12, P = 0.0003, and heel ß-coefficient = - 0.11, P = 3.33 × 10-13). In addition, we found that the higher maternal-specific genetically determined offspring birth weight was associated with lower offspring adult heel BMD (ß-coefficient = - 0.001, P = 0.04). CONCLUSIONS: The observational analyses suggested that higher birth weight was associated with the increased adult bone area but decreased BMD. By leveraging the genetic instrumental variables with maternal- and fetal-specific effects on birth weight, the observed relationship could be reflected by both the direct fetal and indirect maternal genetic effects.

Match Analysis in Women's Tennis on Clay, Grass and Hard Courts.

(1) Background: Performance indicators in tennis such as service effectiveness, rally length or final shots are key factors in determining the winner of the match, although there is little research in the female category. The purpose of this research is to understand the game model in female tennis based on the type of surface. (2) Methods: A total of 2759 points were analyzed from three Grand Slam tournaments from 2019 on three different surfaces. We used observational methodology. (3) Results: The effectiveness of the first service was 62.4% on clay, 64.2% on grass and 67.5% on hard court. With the second service, effectiveness reduced in 5.5%, 11.2% and 14.5% from the first service, respectively. The service direction determines the efficiency and duration of the rally. The highest efficiency occurs with first serves to the T zone or wide zone (regardless of the service side) in short rallies (from 64.9% on clay to 86.3% on hard court). Serving to the centre reduces the chances of success (between 53.1% and 69.9%) and increases the rally length. Between 64.8% (clay) and 75.9% (hard court) of points played on first serve ended in a short rally, while on second serve it was 56.2% (clay) to 61.7% (grass). (4) Conclusions: The data of the effectiveness of the sequences of specific plays can help in the trainings of professional female tennis players.

Healthcare Utilization and Costs Associated with New-Onset Pain in a Medicare Population.

BACKGROUND: Chronic pain is a common and growing problem in the United States with variable strategies for its treatment. Surgical interventions are necessary in some cases but not required for all patients with new-onset pain. For some patients, interventional pain management (IPM) techniques can treat chronic pain without the cost or risk associated with surgical intervention. OBJECTIVE: The objective of this study was to compare healthcare utilization and costs for new-onset chronic pain treated by IPM specialists to those treated by providers with surgical specialties (i.e., orthopedists and neurosurgeons). STUDY DESIGN: This was a retrospective observational study of qualifying patients over 36-months (2016-2019). SETTING: This study was conducted using 100% Medicare FFS Parts A, B, and Prescription Drug Event (PDE) Part D data, including enrollment and claims. METHODS: Patients with a diagnosis of pain were identified in the claims data. Twelve months of pre-period claims were examined to ensure the incident diagnosis of pain, and 2 additional pain diagnoses were required after initial diagnosis. Patients were assigned either to the IPM cohort or a Surgical cohort based on the specialty of the provider involved in their first pain-related visit after initial diagnosis. Key outcomes, such as the utilization of healthcare services and cost of care, were evaluated for both cohorts over the 24-months following the index diagnosis of pain. RESULTS: 106,658 beneficiaries were included in the study with roughly 36% in the IPM cohort. Patients in the IPM cohort were less healthy and had lower incomes in the baseline period compared to the Surgical cohort. Fewer members of the IPM cohort had an inpatient stay in the 24-months post index pain diagnosis (40% compared to 43% in the surgery cohort) and the IPM cohort had fewer patients with a post-acute care stay (29% compared to 31% in the inpatient stay cohort). The IPM cohort had lower risk-adjusted total costs of care than the Surgical cohort, driven by lower inpatient, outpatient, and post-acute care costs. LIMITATIONS: Retrospective claims data may not include some factors important to patients with a pain diagnosis (such as over-the-counter medications, holistic treatments, or pain scores). CONCLUSION(S): By shifting patients from higher-cost and more invasive surgical procedures, IPM's multidisciplinary approach to pain treatment can reduce surgical utilization and costs for certain chronic pain patients. This shift away from more expensive surgical treatments fits well with Medicare's move toward value-based care, driven by a focus on patient outcomes including health care utilization and costs.

Causal analyses of existing databases: no power calculations required.

Observational databases are often used to study causal questions. Before being granted access to data or funding, researchers may need to prove that "the statistical power of their analysis will be high." Analyses expected to have low power, and hence result in imprecise estimates, will not be approved. This restrictive attitude towards observational analyses is misguided. A key misunderstanding is the belief that the goal of a causal analysis is to "detect" an effect. Causal effects are not binary signals that are either detected or undetected; causal effects are numerical quantities that need to be estimated. Because the goal is to quantify the effect as unbiasedly and precisely as possible, the solution to observational analyses with imprecise effect estimates is not avoiding observational analyses with imprecise estimates, but rather encouraging the conduct of many observational analyses. It is preferable to have multiple studies with imprecise estimates than having no study at all. After several studies become available, we will meta-analyze them and provide a more precise pooled effect estimate. Therefore, the justification to withhold an observational analysis of preexisting data cannot be that our estimates will be imprecise. Ethical arguments for power calculations before conducting a randomized trial which place individuals at risk are not transferable to observational analyses of existing databases. If a causal question is important, analyze your data, publish your estimates, encourage others to do the same, and then meta-analyze. The alternative is an unanswered question.

Psychotherapeutic processes associated with couple therapy discontinuance: An observational analysis using the rapid marital interaction coding system.

Premature discontinuation presents challenges to couple clients and therapists alike. Although couple therapy has demonstrated efficacy and effectiveness, little is known about the mechanisms that contribute to couple therapy completion. This study presents the results of an observational inquiry into the psychotherapeutic processes associated with treatment discontinuance using clinical data. Using observational coding of the Rapid Marital Interaction Coding System (RMICS) researchers sought to examine differences in in-session interactions between couple members in a matched sample of therapy continuers and discontinuers. Results indicate that specifically for female partners, the absence of positive interactions is linked to therapy discontinuation. Clinical implications of these findings are presented and discussed.

Combining next-generation indoor residual spraying and drug-based malaria control strategies: observational evidence of a combined effect in Mali.

BACKGROUND: Ségou Region in central Mali is an area of high malaria burden with seasonal transmission. The region reports high access to and use of long-lasting insecticidal nets (LLINs), though the principal vector, Anopheles gambiae, is resistant to pyrethroids. From 2011 until 2016, several high-burden districts of Ségou also received indoor residual spraying (IRS), though in 2014 concerns about pyrethroid resistance prompted a shift in IRS products to a micro-encapsulated formulation of the organophosphate insecticide pirimiphos-methyl. Also in 2014, the region expanded a pilot programme to provide seasonal malaria chemoprevention (SMC) to children aged 3-59 months in two districts. The timing of these decisions presented an opportunity to estimate the impact of both interventions, deployed individually and in combination, using quality-assured passive surveillance data. METHODS: A non-randomized, quasi-experimental time series approach was used to analyse monthly trends in malaria case incidence at the district level. Districts were stratified by intervention status: an SMC district, an IRS district, an IRS + SMC district, and control districts that received neither IRS nor SMC in 2014. The numbers of positive rapid diagnostic test (RDT +) results reported at community health facilities were aggregated and epidemiological curves showing the incidence of RDT-confirmed malaria cases per 10,000 person-months were plotted for the total all-ages and for the under 5 year old (u5) population. The cumulative incidence of RDT + malaria cases observed from September 2014 to February 2015 was calculated in each intervention district and compared to the cumulative incidence reported from the same period in the control districts. RESULTS: Cumulative peak-transmission all-ages incidence was lower in each of the intervention districts compared to the control districts: 16% lower in the SMC district; 28% lower in the IRS district; and 39% lower in the IRS + SMC district. The same trends were observed in the u5 population: incidence was 15% lower with SMC, 48% lower with IRS, and 53% lower with IRS + SMC. The SMC-only intervention had a more moderate effect on incidence reduction initially, which increased over time. The IRS-only intervention had a rapid, comparatively large impact initially that waned over time. The impact of the combined interventions was both rapid and longer lasting. CONCLUSION: Evaluating the impact of IRS with an organophosphate and SMC on reducing incidence rates of passive RDT-confirmed malaria cases in Ségou Region in 2014 suggests that combining the interventions had a greater effect than either intervention used individually in this high-burden region of central Mali with pyrethroid-resistant vectors and high rates of household access to LLINs.

Enhancing Learner Motivation and Classroom Social Climate: A Mixed Methods Approach.

The aim of this study was to analyze how motivation and classroom social climate was enhanced in the teaching-learning context throughout a Pedagogical Model of Personal and Social Responsibility (TPSR) implementation using a mixed method approach. An educational program was applied during an academic year in a student sample of primary and secondary school. A total of 44 sessions with 54 participants, between 11 and 16 years old (M = 13.41 years, SD = 1.73) were video-recorded. A multilevel triangulation design of mixed method research was applied to merge: (a) the Observational System of Teaching Oriented Responsibility (OSTOR), which revealed how the students' behavior patterns shifted an alongside the interventions with (b) a set of five complementary questionnaires: Motivation toward Education Scale (EME), Responsibility Questionnaire (PSRQ), Basic Psychological Needs Questionnaire (PNSE), Questionnaire to assess social school climate (CECSCE) and Questionnaire of School Violence (CUVE). The mixed methods design confirmed that both the observational and the inferential analysis show an improvement of the TPSR implementation in the student's responsibility and satisfaction and the social climate of the classroom. The other variables, although they were also improved, did not do it significantly; all the motivation dimensions showed higher values, except for amotivation and violence.

The Association Between Care Coordination and Preventive Care Among Children With Special Health Care Needs.

Care coordination (CC) has shown positive outcomes among children with special health care needs (CSHCN); however, the association between CC and well-child care (WCC) visits is unknown. We hypothesize that CSHCN who receive CC are more likely to attend the recommended WCC visits. A retrospective cohort analysis was conducted of patients aged 15 months attending the Arizona Children's Center clinic. Logistic regression models explored the association between children receiving CC and attending the recommended minimum WCC visits before 15 months of age. CC was associated with higher odds of proper WCC attendance (any CC service, adjusted odds ratio = 2.14, 95% confidence interval = 1.75-2.62; high level of CC, adjusted odds ratio = 2.61, 95% confidence interval = 1.73-3.94). Pediatric CC is associated with greater up-to-date status of the WCC schedule among CSHCN 15 months of age, and higher odds among children who receive higher levels of CC. Further research is needed to validate findings.

Accuracy of Functional Movement Screen Deep Squat Scoring and the Influence of Optimized Scoring Criteria: A 3-Dimensional Kinematic Approach.

CONTEXT: The deep squat (DS) test is a component of the functional movement screen, which is used to assess the quality of fundamental movement patterns; however, the accuracy of the DS has not been studied. The DS is a complex, total body movement pattern with evaluation required at several points along the kinematic chain. OBJECTIVE: To assess the accuracy of DS scoring by an athletic trainer, physical therapist, and exercise science professional via a comparative analysis with kinematic data (KD) and to identify scoring criteria that would improve agreement between raters and KD scores. DESIGN: Cross-sectional study. SETTING: Motion analysis laboratory. PARTICIPANTS: A rater from each of 3 movement science disciplines rated the DS of 23 male college athletes (20.3 [1.2] y; 70.5 [3.5] kg). INTERVENTIONS: Subjects were outfitted with reflective markers and asked to perform the DS. The DS performance was scored by 3 raters and kinematic analysis. Subsequently, the optimal set of criteria that minimized the difference between mode rater score and KD was determined via a Nelder-Mead simplex optimization routine. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were calculated using SPSS (version 23; IBM, Armonk, NY) to determine tester agreement with the KD score and between the mode score and KD score. RESULTS: Agreement was poor for the athletic trainer (ICC = .387), physical therapist (ICC = .298), exercise science professional (ICC = .378), and raters' DS scores when compared with the KD. Agreement was poor for the mode score when compared with KD prior to optimization and good following optimization (ICC = .830), thereby allowing identification of specific scoring errors. CONCLUSIONS: Agreement for DS scores is poor when compared with KD; however, it may be improved with optimization of DS scoring criteria.

Relationship between Serum 25(OH)D and Depression: Causal Evidence from a Bi-Directional Mendelian Randomization Study.

The relationship between depression and vitamin D deficiency is complex, with evidence mostly from studies affected by confounding and reverse causality. We examined the causality and direction of the relationship between 25-hydroxyvitamin D (25(OH)D) and depression in bi-directional Mendelian randomization (MR) analyses using information from up to 307,618 white British participants from the UK Biobank and summary results from the SUNLIGHT (n = 79,366) and Psychiatric Genomics consortia (PGC 113,154 cases and 218,523 controls). In observational analysis, the odds of depression decreased with higher 25(OH)D concentrations (adjusted odds ratio (OR) per 50% increase 0.95, 95%CI 0.94-0.96). In MR inverse variance weighted (IVW) using the UK Biobank, there was no association between genetically determined serum 25(OH)D and depression (OR per 50% higher 0.97, 95%CI 0.90-1.05) with consistent null association across all MR approaches and in data from PGC consortium. In contrast, genetic liability to depression was associated with lower 25(OH)D concentrations (MR IVW -3.26%, -4.94%--1.55%), with the estimates remaining generally consistent after meta-analysing with the consortia. In conclusion, we found genetic evidence for a causal effect of depression on lower 25(OH)D concentrations, however we could not confirm a beneficial effect of nutritional vitamin D status on depression risk.

An evidence based framework for the Temporal Observational Analysis of Teamwork in healthcare settings.

OBJECTIVE: Effective teamwork is critical to patient safety across multiple healthcare settings. However, current observational tools assessing teamwork performance tend to be developed for specific settings or tasks and do not capture temporal features of interaction. This study aimed to develop a valid and reliable observational teamwork behaviour framework, which is based on healthcare practice, applicable across a variety of healthcare contexts and can be used to capture temporal team dynamics. METHODS: Team interactions were audio-visually recorded during routine simulation training at two large clinical education centres specialising in physical and mental healthcare. The framework was based on theoretical models of teamwork and was developed in three steps: 1-micro analysis of verbal and nonverbal behaviour during recorded scenarios (n = 20); 2-iterative test and refine cycles; 3-final behavioural framework applied to a cohort of acute emergency scenarios (n = 9) by two raters to assess inter-rater agreement. RESULTS: The framework contains twenty-three specific verbal and nonverbal behaviours that can be identified during observations. Behaviours are grouped conceptually based on their function resulting in thirteen behavioural functions, which cluster into five overarching teamwork domains. Inter-rater agreement was excellent (Cohen's Kappa = .84, SE = 0.03). CONCLUSION: We present a valid and reliable behavioural framework, grounded in teamwork theory and empirical observations of clinical team behaviour. This framework enables analysis of the nuances and temporal features of clinical practice in depth and across a wide range of clinical contexts and settings. Use of this framework will advance our understanding of teamworking in healthcare.

Development of a Knockout Competition in Basketball: A Study of the Spanish Copa del Rey.

Performance in basketball has been widely studied with regard to the results of the game using competition statistics. Few studies have analyzed the play process from a dynamic viewpoint regarding tactical actions and styles of play. The general objective of this research was to analyze the development in the styles of play of the teams participating in the Spanish Copa del Rey by studying the development of ball possessions (from start to finish) and the styles of play (attack and defense phases). The specific aim was to identify the relations between how possessions end and the style of play, as well as the relation between the duration of possession and the action of shooting and efficacy of the possession. All the matches corresponding to the Spanish Copa del Rey in basketball in the seasons 2015/2016, 2016/2017, and 2017/2018 were analyzed, comprising a total of 3,865 possessions. To this end, two groups of variables were characterized, which made it possible to define play, the development of possession (start and finish), and the style of play (attack and defense phase). An exploratory and descriptive analysis of the situational variables, development of possession, and style of play was carried out to characterize the competition. The Chi-squared test and Cramer's V coefficient were used to estimate the association among the categorical variables, interpreting the association among the categories using contingency tables. The results show a greater number of attacks in the final stages of the matches, with short possessions that end in baskets or rebounds, and positional attacks and individual half-court defenses predominating. There were more shots in positional attacks and more fouls in transitions. It also was apparent that the competition is developing from 1 year to another. The Spanish Copa del Rey competition changes from season to season, revealing slight modifications in the teams' styles of play, although there is stability in the fundamental play parameters, like the predominance of man-to-man defense, the duration of the attacks, and the use of screens. The style of play conditions the finalization of the possession.

Variations of Network Centralities Between Playing Positions in Favorable and Unfavorable Close and Unbalanced Scores During the 2018 FIFA World Cup.

The purpose of this study is twofold: (i) analyze the variations of network centralities between close (difference of goals equal to one) and unbalanced (difference of goals equal to or greater than two) scores; and (ii) compare the centrality levels between playing positions. The passing sequences that occurred during the 64 matches played by the 32 national teams that participated in the 2018 FIFA World Cup were analyzed and coded. The network centralities of degree prestige and degree centrality were calculated based on the weighted adjacency matrices built from the passing sequences. The results reveal that higher degree centralities of midfielders occurred in unfavorable (lost) unbalanced scores (p = 0.046; ES (effect size) = 0.472). Moreover, in favorable (won) matches the higher values of degree centrality of central defenders (p = 0.014; ES: 0.458) and defensive midfielders (p = 0.004; ES: 0.715) were also found in unbalanced scores. The comparisons between positions revealed that the highest and significant degree prestige levels were found in defensive midfielders in both close (12.10%) and unbalanced scores (10.95%). In conclusion, it is possible to observe that winning by an unbalanced score significantly increased the centrality levels of the wingers and forwards in comparison to close scores. Moreover, it was also found that independent of the final score or the unbalanced score level, the defensive midfielders were the most prominent or recruited players during the passing sequences.

Optimizing Education: A Mixed Methods Approach Oriented to Teaching Personal and Social Responsibility (TPSR).

This methodological article provides a Mixed Method approach to analyze how the Teaching Personal and Social Responsibility (TPSR) Model is feasible to enhance student's autonomy. The objective is to detect how teachers' behavior-oriented patterns shift in response to continuing professional development to reinforce TPSR strategies. We compared the application of TPSR by three teachers who had previously attended a training course for this model, with that of an expert in the model. A total of 44 sessions of primary and secondary school semesters in various subjects, taught by all four teachers and comprising 120 students. A mixed-method approach followed in the study involved: (a) the Observational System of Teaching Oriented Responsibility (OSTOR), which revealed how the teachers' behavior patterns shifted over their interventions, and (b) the Tool for Assessing Responsibility-Based Education (TARE 2.0.), which focused on perceived behaviors by teachers and student behaviors. Data analysis was conducted for (a) the T-pattern detection technique, (b) polar coordinate analysis to obtain detailed sequences of instruction, and (c) descriptive and correlational analysis from the TARE. The mixed-method analysis of data confirms how the TPSR improved the teaching behaviors of the three teachers in training compared with the expert teacher.

Translational medicine in the Age of Big Data.

The ability to collect, store and analyze massive amounts of molecular and clinical data is fundamentally transforming the scientific method and its application in translational medicine. Collecting observations has always been a prerequisite for discovery, and great leaps in scientific understanding are accompanied by an expansion of this ability. Particle physics, astronomy and climate science, for example, have all greatly benefited from the development of new technologies enabling the collection of larger and more diverse data. Unlike medicine, however, each of these fields also has a mature theoretical framework on which new data can be evaluated and incorporated-to say it another way, there are no 'first principals' from which a healthy human could be analytically derived. The worry, and it is a valid concern, is that, without a strong theoretical underpinning, the inundation of data will cause medical research to devolve into a haphazard enterprise without discipline or rigor. The Age of Big Data harbors tremendous opportunity for biomedical advances, but will also be treacherous and demanding on future scientists.

An observational analysis of the impact of indoor residual spraying with non-pyrethroid insecticides on the incidence of malaria in Ségou Region, Mali: 2012-2015.

BACKGROUND: Ségou Region in Central Mali is an area of high malaria burden with seasonal transmission, high access to and use of long-lasting insecticidal nets (LLINs), and resistance to pyrethroids and DDT well documented in Anopheles gambiae s.l. (the principal vector of malaria in Mali). Ségou has recently received indoor residual spraying (IRS) supported by Mali's collaboration with the US President's Malaria Initiative/Africa Indoor Residual Spraying programme. From 2012 to 2015, two different non-pyrethroid insecticides: bendiocarb in 2012 and 2013 and pirimiphos-methyl in 2014 and 2015, were used for IRS in two districts. This report summarizes the results of observational analyses carried out to assess the impact of these IRS campaigns on malaria incidence rates reported through local and district health systems before and after spraying. METHODS: A series of retrospective time series analyses were performed on 1,382,202 rapid diagnostic test-confirmed cases of malaria reported by district routine health systems in Ségou Region from January 2012 to January 2016. Malaria testing, treatment, surveillance and reporting activities remained consistent across districts and years during the study period, as did LLIN access and use estimates as well as An. gambiae s.l. insecticide resistance patterns. Districts were stratified by IRS implementation status and all-age monthly incidence rates were calculated and compared across strata from 2012 to 2014. In 2015 a regional but variable scale-up of seasonal malaria chemoprevention complicated the region-wide analysis; however IRS operations were suspended in Bla District that year so a difference in differences approach was used to compare 2014 to 2015 changes in malaria incidence at the health facility level in children under 5-years-old from Bla relative to changes observed in Barouéli, where IRS operations were consistent. RESULTS: During 2012-2014, rapid reductions in malaria incidence were observed during the 6 months following each IRS campaign, though most of the reduction in cases (70% of the total) was concentrated in the first 2 months after each campaign was completed. Compared to non-IRS districts, in which normal seasonal patterns of malaria incidence were observed, an estimated 286,745 total fewer cases of all-age malaria were observed in IRS districts. The total cost of IRS in Ségou was around 9.68 million USD, or roughly 33.75 USD per case averted. Further analysis suggests that the timing of the 2012-2014 IRS campaigns (spraying in July and August) was well positioned to maximize public health impact. Suspension of IRS in Bla District after the 2014 campaign resulted in a 70% increase in under-5-years-old malaria incidence rates from 2014 to 2015, significantly greater (p = 0.0003) than the change reported from Barouéli District, where incidence rates remained the same. CONCLUSIONS: From 2012 to 2015, the annual IRS campaigns in Ségou are associated with several hundred thousand fewer cases of malaria. This work supports the growing evidence that shows that IRS with non-pyrethroid insecticides is a wise public health investment in areas with documented pyrethroid resistance, high rates of LLIN coverage, and where house structures and population densities are appropriate. Additionally, this work highlights the utility of quality-assured and validated routine surveillance and well defined observational analyses to rapidly assess the impact of malaria control interventions in operational settings, helping to empower evidence-based decision making and to further grow the evidence base needed to better understand when and where to utilize new vector control tools as they become available.