Temporal Pattern of Co-Development of Internalizing and Externalizing Problem Behaviors: An Application of Bivariate Mixed-Effects Models.

BACKGROUND: Although previous research has shown that internalizing and externalizing behavior problems often co-occur, the relationship between the developmental trajectories of these two types of behavior problems is understudied. The co-occurring evolutions of developmental trajectories of two behaviors has two components: 1) the correlation between the slopes of two behavior profiles (termed the association of the evolutions); and 2) the marginal correlation of two development trajectory profiles, which is the development of correlation between internalizing and externalizing behavior over time (termed the evolution of the association). The association of the evolutions and the evolution of the association have not been fully explored in the context of the development of internalizing and externalizing behavior problems among kindergarteners in the United States. METHODS: The random-effects approach for joint modeling of multivariate longitudinal profiles was used to evaluate the co-development and its temporal pattern of internalizing and externalizing behavior problems on a nationally representative sample of 9791 kindergarteners from the Early Childhood Longitudinal Study-Kindergarten Class of 1998-99 (ECLS-K). RESULTS: There was a moderate positive association between the evolutions of the two behavior problems with correlation coefficient of 0.319. The evolution of association between the two behaviors was increasing over time with the correlation coefficient from 0.195 at the Fall of kindergarten to 0.291 by the time of fifth grade in general. Race and age groups act differently on the evolution of association. The associations were getting stronger for the Asian group and older groups than their peer groups. CONCLUSION: This investigation of the association of evolutions and the evolution of association between the internalizing and externalizing behaviors show that the two problem behaviors reciprocally reinforce each other and lead to increases in the other in a moderate strength and the strength is increasing over time.

The Association of Robot-assisted Versus Pure Laparoscopic Radical Nephrectomy with Perioperative Outcomes and Hospital Costs.

BACKGROUND: Although robot assistance can facilitate the advantages of minimally invasive surgery, it is unclear whether it offers benefits in settings in which laparoscopic surgery has been established as the standard of care. OBJECTIVE: To examine the comparative effectiveness of robot-assisted laparoscopic radical nephrectomy (RALRN) and laparoscopic radical nephrectomy (LRN) using a nationwide data set. DESIGN, SETTING, AND PARTICIPANTS: 8316 adults who underwent RALRN or LRN for non-urothelial renal cancer from the Nationwide Inpatient Sample from 2010 to 2013. INTERVENTION: RALRN and LRN. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The associations of surgical approach with perioperative outcomes and total hospital costs were evaluated using multivariable logistic regression. RESULTS AND LIMITATIONS: Over the study period, utilization of RALRN increased from 46% to 69%. Compared to LRN, RALRN was associated with lower rates of intraoperative (0.9% vs 1.8%; p<0.001) and postoperative complications (20.4% vs 27.2%; p<0.001), but there were no differences in perioperative blood transfusion (5.6% vs 6.2%; p=0.27) and prolonged hospitalization (7.2% vs 7.1%; p=0.81). RALRN was also significantly associated with higher total hospital costs (median $16 207 vs $15 037; p<0.001). In multivariable analyses, RALRN remained independently associated with a lower risk of intraoperative (odds ratio [OR] 0.50; p=0.001) and postoperative complications (OR 0.72; p<0.001) but not perioperative blood transfusion (OR 1.10; p=0.34), and with a higher risk of prolonged hospitalization (OR 1.29; p=0.007) and higher mean total hospital costs (+$1468; p<0.001). There was no effect modification by hospital volume. CONCLUSIONS: Although RALRN was independently associated with a reduction in perioperative complications compared to LRN, it was associated with prolonged hospitalization and higher total hospital costs. These relationships must be interpreted in light of potential differences in case mix. PATIENT SUMMARY: Although robot-assisted laparoscopic radical nephrectomy was independently associated with a reduction in perioperative complications compared to laparoscopic radical nephrectomy, it was associated with prolonged hospitalization and higher total hospital costs.

In Vivo Assessment of Potential Therapeutic Approaches for USH2A-Associated Diseases.

Mutations in USH2A gene account for most cases of Usher syndrome type II (USH2), characterized by a combination of congenital hearing loss and progressive vision loss. In particular, approximately 30% of USH2A patients harbor a single base pair deletion, c.2299delG, in exon 13 that creates a frameshift and premature stop codon, leading to a nonfunctional USH2A protein. The USH2A protein, also known as usherin, is an extremely large transmembrane protein (5202 aa), which limits the use of conventional AAV-mediated gene therapy; thus development of alternative approaches is required for the treatment of USH2A patients. As usherin contains multiple repetitive domains, we hypothesize that removal of one or more of those domains encoded by mutant exon(s) in the USH2A gene may reconstitute the reading frame and restore the production of a shortened yet adequately functional protein. In this study, we deleted the exon 12 of mouse Ush2a gene (corresponding to exon 13 of human USH2A) using CRISPR/Cas9-based exon-skipping approach and revealed that a shortened form of Ush2a that lacks exon 12 (Ush2a-∆Ex12) is produced and localized correctly in the cochlea. When the Ush2a-∆Ex12 allele is expressed on an Ush2a null background, the Ush2a-∆Ex12 protein can successfully restore the impaired hair cell structure and the auditory function in the Ush2a-/- mice. These results demonstrate that CRISPR/Cas9-based exon-skipping strategy holds a great therapeutic potential for the treatment of USH2A patients.

Land desertification monitoring and assessment in Yulin of Northwest China using remote sensing and geographic information systems (GIS).

The objective of this study is to develop techniques for assessing and analysing land desertification in Yulin of Northwest China, as a typical monitoring region through the use of remotely sensed data and geographic information systems (GIS). The methodology included the use of Landsat TM data from 1987, 1996 and 2006, supplemented by aerial photos in 1960, topographic maps, field work and use of other existing data. From this, land cover, the Normalised Difference Vegetation Index (NDVI), farmland, woodland and grassland maps at 1:100,000 were prepared for land desertification monitoring in the area. In the study, all data was entered into a GIS using ILWIS software to perform land desertification monitoring. The results indicate that land desertification in the area has been developing rapidly during the past 40 years. Although land desertification has to some extent been controlled in the area by planting grasses and trees, the issue of land desertification is still serious. The study also demonstrates an example of why the integration of remote sensing with GIS is critical for the monitoring of environmental changes in arid and semi-arid regions, e.g. in land desertification monitoring in the Yulin pilot area. However, land desertification monitoring using remote sensing and GIS still needs to be continued and also refined for the purpose of long-term monitoring and the management of fragile ecosystems in the area.