The cost of monitoring in time-based prospective memory.

Time-based prospective memory (TBPM) involves remembering to perform actions at specific times in the future. Several studies suggest that monetary consequences improve prospective remembering; however, the effect of monetary consequences on strategic time monitoring (i.e., clock-checking behaviour) in TBPM is still unknown. The present study investigated how the monetary costs on clock-checking affected TBPM accuracy and strategic time monitoring. Participants performed an ongoing lexical decision task while carrying out a TBPM task every two minutes. Motivational incentives were manipulated across three experimental conditions: a single-cost condition in which missed TBPM responses led to monetary deductions, a double-cost condition in which both missed responses and time monitoring led to monetary deductions, and a control condition with no monetary deductions. Overall, the findings indicated that monetary costs on clock-checking prompted more parsimonious strategic time monitoring behaviour, which negatively impacted TBPM accuracy. These results emphasize the importance of weighing the motivational aspects involved in strategic monitoring, shedding light on the complex relationship between clock-checking behaviour, its consequences, and TBPM performance.

The value of healthy ageing: Estimating the economic value of health using time use data.

INTRODUCTION: Economic arguments in favour of investing in health and health care are important for policy making, yet demonstrating the potential economic gains associated with health at older ages can be empirically challenging due to older peoples' limited attachment to the labour market. METHODS: We develop a novel method to quantify the economic value of health through time use data. Using data on people aged 65 years-old and older from the United Kingdom Time Use Survey (UKTUS) 2014-15, we apply survey-weighted generalized linear models to predict the time spent in non-market productive activities conditional on characteristics including age and self-perceived health. We weight these estimates of predicted minutes spent in each activity using household satellite accounts to quantify the monetary value of time spent engaging in non-market productive activities according to health status and simulate the monetary impact of health gains at older ages. RESULTS: Both age and self-perceived health status were associated with minutes spent in many non-market productive activities. Summing the monetized predictions of minutes spent across all types of activities indicates that being in "very good" instead of "very bad" self-perceived health is associated with an additional production of 439£, 629£ and 598£ (in real 2015 GBP) per month for an average individual aged 65 to 74 years-old, 75 to 84 years-old and 85 years-old and older, respectively. Using our simulation model, if 10% of older people in "very bad" health in the United Kingdom were to transition to "very good" health it could lead to an increase of up to 278£ million through the production of non-market activities. CONCLUSIONS: Health at older ages creates considerable economic value which is not observed using standard national accounting measures. Our method to quantify the monetary value of health can be adapted to other settings to make the economic case for investing in healthy ageing.

Examining district-level disparity and determinants of timeliness of emergency medical services in Maharashtra, India.

The quality of emergency medical services remains a major public health issue in developing countries in terms of access, availability, or timely delivery, owing to high socio-economic and ethnic disparities. Particularly, the timeliness of EMS remains a drawback, leading to higher mortality and morbidity. The aim of the study is to assess the district-level differences and factors that influence ambulance travel time, as there was no study done in the Indian scenario. Sequential Explanatory Design was applied here, which involved a descriptive study and spatial analysis of the call volume and distribution to understand the operational challenges of MEMS, followed by in-depth interviews among medical officers and officials to explore the reasons for the challenges. The data, shared by the Department of Health, Government of Maharashtra, consisted of 38,823 records (emergency: 16,197 and hospital-to-hospital transfer: 22,626), including emergency and hospital-to-hospital transfer calls across 36 districts of Maharashtra for November 2022. Spatial analyses were performed to identify the districts with challenges of timeliness. The average ambulance response time (T) across the districts was reported at 134.5 min for emergency cases and 222.80 min for hospital-to-hospital transfer cases. The total ambulance response time, was classified as preparation time (t1:3.53 min for emergency, 3.69 min for hospital-to-hospital transfer), travel time from base to scene (t2: 23.15 min for emergency, 17.18 min for hospital-to-hospital transfer), time required at scene (t3: 12.12 min for emergency, 14.72 min for hospital-to-hospital transfer), travel time from scene to hospital (t4:39.41 min for emergency, 74.34 min for hospital-to-hospital transfer), patient handover time (t5: 10.85 min for emergency, 13.84 min for hospital-to-hospital transfer), and return from base to hospital (t6: 41.89 min for emergency, 94.72 min for hospital-to-hospital transfer). Multivariate linear regression was conducted to investigate the factors that influence ambulance travel time. The finding identifies that the ambulance travel time increased for the districts with lesser population density, lower road density, fewer hospitals, a higher district area served per ambulance, and a higher population served per ambulance. Additionally, socio-cultural reasons affecting health-seeking behaviour, early closing of healthcare centres, undercapacity and resource-deficit healthcare centres, and overloading of specialised tertiary hospitals were identified as determinants of delay in patient assessment and handover time in qualitative findings. A decisive and multi-sectoral approach is required to address the timeliness of EMS in the Indian context.

Effort cost of harvest affects decisions and movement vigor of marmosets during foraging.

Our decisions are guided by how we perceive the value of an option, but this evaluation also affects how we move to acquire that option. Why should economic variables such as reward and effort alter the vigor of our movements? In theory, both the option that we choose and the vigor with which we move contribute to a measure of fitness in which the objective is to maximize rewards minus efforts, divided by time. To explore this idea, we engaged marmosets in a foraging task in which on each trial they decided whether to work by making saccades to visual targets, thus accumulating food, or to harvest by licking what they had earned. We varied the effort cost of harvest by moving the food tube with respect to the mouth. Theory predicted that the subjects should respond to the increased effort costs by choosing to work longer, stockpiling food before commencing harvest, but reduce their movement vigor to conserve energy. Indeed, in response to an increased effort cost of harvest, marmosets extended their work duration, but slowed their movements. These changes in decisions and movements coincided with changes in pupil size. As the effort cost of harvest declined, work duration decreased, the pupils dilated, and the vigor of licks and saccades increased. Thus, when acquisition of reward became effortful, the pupils constricted, the decisions exhibited delayed gratification, and the movements displayed reduced vigor.

Telemedicine and the assessment of clinician time: a scoping review.

OBJECTIVES: Telemedicine may improve healthcare access and efficiency if it demands less clinician time than usual care. We sought to describe the degree to which telemedicine trials assess the effect of telemedicine on clinicians' time and to discuss how including the time needed to treat (TNT) in health technology assessment (HTA) could affect the design of telemedicine services and studies. METHODS: We conducted a scoping review by searching clinicaltrials.gov using the search term "telemedicine" and limiting results to randomized trials or observational studies registered between January 2012 and October 2023. We then reviewed trial registration data to determine if any of the outcomes assessed in the trials measured effect on clinicians' time. RESULTS: We found 113 studies and of these 78 studies of telemedicine met the inclusion criteria and were included. Nine (12 percent) of the 78 studies had some measure of clinician time as a primary outcome, and 11 (14 percent) as a secondary outcome. Four studies compared direct measures of TNT with telemedicine versus usual care, but no statistically significant difference was found. Of the sixteen studies including indirect measures of clinician time, thirteen found no significant effects, two found a statistically significant reduction, and one found a statistically significant increase. CONCLUSIONS: This scoping review found that clinician time is not commonly measured in studies of telemedicine interventions. Attention to telemedicine's TNT in clinical studies and HTAs of telemedicine in practice may bring attention to the organization of clinical workflows and increase the value of telemedicine.

Infrared Thermography for Real-Time Assessment of the Effectiveness of Scoliosis Braces.

This work proposes an innovative method, based on the use of low-cost infrared thermography (IRT) instrumentation, to assess in real time the effectiveness of scoliosis braces. Establishing the effectiveness of scoliosis braces means deciding whether the pressure exerted by the brace on the patient's back is adequate for the intended therapeutic purpose. Traditionally, the evaluation of brace effectiveness relies on empirical, qualitative assessments carried out by orthopedists during routine follow-up examinations. Hence, it heavily depends on the expertise of the orthopedists involved. In the state of the art, the only objective methods used to confirm orthopedists' opinions are based on the evaluation of how scoliosis progresses over time, often exposing people to ionizing radiation. To address these limitations, the method proposed in this work aims to provide a real-time, objective assessment of the effectiveness of scoliosis braces in a non-harmful way. This is achieved by exploiting the thermoelastic effect and correlating temperature changes on the patient's back with the mechanical pressure exerted by the braces. A system based on this method is implemented and then validated through an experimental study on 21 patients conducted at an accredited orthopedic center. The experimental results demonstrate a classification accuracy slightly below 70% in discriminating between adequate and inadequate pressure, which is an encouraging result for further advancement in view of the clinical use of such systems in orthopedic centers.

Telemedicine as a path to bridging inequities in patients with epilepsy.

OBJECTIVE: Access to epilepsy specialist care is not uniform in the USA, with prominent gaps in rural areas. Understanding the reasons for nonattendance at epilepsy appointments may help identify access hurdles faced by patients. This study was undertaken to better understand clinic absenteeism in epilepsy and how it may be influenced by telemedicine. METHODS: In this retrospective study, social determinants of health were collected for all adult patients scheduled in epilepsy clinic, as either an in-person or telemedicine appointment, at University of Kentucky between July 2021 and December 2022. The primary outcome measure was attendance or absence at the appointment. Subgroup analyses were done to better understand the drivers of attendance at telemedicine visits and evaluate telemedicine utilization by underserved populations. RESULTS: A total of 3025 patient encounters of in-person and telemedicine visits were included. The no-show rate was significantly higher for in-person visits (32%) compared with telemedicine visits (20%, p < .001). A nominal logistic regression model identified seven factors increasing risk of absenteeism, including in-person visits, prior missed appointments, longer lead times to appointment, Medicaid/Medicare as payors, no significant other, lower mean annual income, and minority race. For each $10 000 increase in mean annual income, the odds of missing the appointment decreased by 8% (odds ratio = .92, 95% confidence interval = .89-.96, p < .001). Forty-one percent of underserved population opted for telemedicine visits, and they had a lower no-show rate (22%) as compared with in-person visits (33%, p < .001). Predictors of no-shows to televisits (1382) included Medicare/Medicaid coverage (as opposed to private insurance), no significant others, and a history of missing appointments. SIGNIFICANCE: Telemedicine is effective at improving attendance, overcoming socioeconomic hurdles, and widening access to epilepsy care, particularly among underserved populations. Access to telecare depends on insurance coverage and emphasizes the need to include telemedicine in insurance plans to ensure uniform access to high-quality epilepsy care, irrespective of socioeconomic status.

Measurement of radiologist reporting times: Assessment of precision, comparison of three different measurement techniques and review of potential applications.

INTRODUCTION: Radiologist reporting times are a key component of radiology department workload assessment, but reliable measurement remains challenging. Currently, there are three contenders for this task: median reporting times (MRTs), extracted directly from a department's radiology information system (RIS); study-ascribed times (SATs), using published tables of individual descriptors derived from a combination of measurement and consensus; and radiology reporting figures (RRFs), using published tables of measured times based on modality and numbers of anatomical areas. METHODS: We review these techniques, their possible uses and some potential pitfalls. We discuss the level of precision that can realistically be attained in measuring reporting times, and list the strengths and weaknesses of each technique, comparing them in relation to each of eight potential applications. RESULTS: We believe that SATs are challenging for practical use due to their static nature, absent common descriptors and large number. RRFs are more user-friendly but are also static and require ongoing updates; currently, they do not include ultrasound. MRTs cannot currently be extracted from every RIS, but where available they are easy to use and their dynamic nature provides the most objective data. They underestimate the unmeasurable components of a radiologist's work and therefore the total time spent in a reporting session. CONCLUSION: MRTs are superior to the other methods in flexibility, precision and ease of use. All institutions should have access to this data and we call on vendors of Radiology Information Systems which are currently not capable of providing it to make the necessary modifications.

Do discussions of financial burdens decrease long-term financial toxicity in adolescent and young adult cancer survivors?

PURPOSE: This study aims to evaluate the associations between patient-provider cost discussions with patient-reported out-of-pocket (OOP) spending and long-term financial toxicity (FT) among adolescent and young adult (AYA; 15-39 years old) cancer survivors. METHODS: Using a cross-sectional survey, we assessed the themes and quality of patient discussions with providers about financial needs and general survivorship preparation, quantified patients' levels of FT, and evaluated patient-reported OOP spending. We determined the association between cancer treatment cost discussion and FT using multivariable analysis. In a subset of survivors (n = 18), we conducted qualitative interviews and used thematic analysis to characterize responses. RESULTS: Two hundred forty-seven AYA survivors completed the survey at a mean of 7 years post treatment and with a median COST score of 13. 70% of AYA survivors did not recall having any cost discussion about their cancer treatment with a provider. Having any cost discussion with a provider was associated with decreased FT (ß = 3.00; p = 0.02) but not associated with reduced OOP spending (χ2 = 3.77; p = 0.44). In a second adjusted model, with OOP spending included as a covariate, OOP spending was a significant predictor of FT (ß = - 1.40; p = 0.002). Key qualitative themes included survivors' frustration about the lack of communication related to financial issues throughout treatment and in survivorship, feeling unprepared, and reluctance to seek help. CONCLUSION: AYA patients are not fully informed about the costs of cancer care and FT; the dearth of cost discussions between patients and providers may represent a missed opportunity to reduce costs.

On timing-optimized SiPMs for Cherenkov detection to boost low cost time-of-flight PET.

Objective.Recent SiPM developments and improved front-end electronics have opened new doors in TOF-PET with a focus on prompt photon detection. For instance, the relatively high Cherenkov yield of bismuth-germanate (BGO) upon 511 keV gamma interaction has triggered a lot of interest, especially for its use in total body positron emission tomography (PET) scanners due to the crystal's relatively low material and production costs. However, the electronic readout and timing optimization of the SiPMs still poses many questions. Lab experiments have shown the prospect of Cherenkov detection, with coincidence time resolutions (CTRs) of 200 ps FWHM achieved with small pixels, but lack system integration due to an unacceptable high power uptake of the used amplifiers.Approach.Following recent studies the most practical circuits with lower power uptake (<30 mW) have been implemented and the CTR performance with BGO of newly developed SiPMs from Fondazione Bruno Kessler tested. These novel SiPMs are optimized for highest single photon time resolution (SPTR).Main results.We achieved a best CTR FWHM of 123 ps for 2 × 2 × 3 mm3and 243 ps for 3 × 3 × 20 mm3BGO crystals. We further show that with these devices a CTR of 106 ps is possible using commercially available 3 × 3 × 20 mm3LYSO:Ce,Mg crystals. To give an insight in the timing properties of these SiPMs, we measured the SPTR with black coated PbF2of 2 × 2 × 3 mm3size. We confirmed an SPTR of 68 ps FWHM published in literature for standard devices and show that the optimized SiPMs can improve this value to 42 ps. Pushing the SiPM bias and using 1 × 1 mm2area devices we measured an SPTR of 28 ps FWHM.Significance.We have shown that advancements in readout electronics and SiPMs can lead to improved CTR with Cherenkov emitting crystals. Enabling time-of-flight with BGO will trigger a high interest for its use in low-cost and total-body PET scanners. Furthermore, owing to the prompt nature of Cherenkov emission, future CTR improvements are conceivable, for which a low-power electronic implementation is indispensable. In an extended discussion we will give a roadmap to best timing with prompt photons.

Survival analysis and probability density function of switching heroin model.

We study a switching heroin epidemic model in this paper, in which the switching of supply of heroin occurs due to the flowering period and fruiting period of opium poppy plants. Precisely, we give three equations to represent the dynamics of the susceptible, the dynamics of the untreated drug addicts and the dynamics of the drug addicts under treatment, respectively, within a local population, and the coefficients of each equation are functions of Markov chains taking values in a finite state space. The first concern is to prove the existence and uniqueness of a global positive solution to the switching model. Then, the survival dynamics including the extinction and persistence of the untreated drug addicts under some moderate conditions are derived. The corresponding numerical simulations reveal that the densities of sample paths depend on regime switching, and larger intensities of the white noises yield earlier times for extinction of the untreated drug addicts. Especially, when the switching model degenerates to the constant model, we show the existence of the positive equilibrium point under moderate conditions, and we give the expression of the probability density function around the positive equilibrium point.

Assessment of the Global Variance Effective Size of Subdivided Populations, and Its Relation to Other Effective Sizes.

The variance effective population size ([Formula: see text]) is frequently used to quantify the expected rate at which a population's allele frequencies change over time. The purpose of this paper is to find expressions for the global [Formula: see text] of a spatially structured population that are of interest for conservation of species. Since [Formula: see text] depends on allele frequency change, we start by dividing the cause of allele frequency change into genetic drift within subpopulations (I) and a second component mainly due to migration between subpopulations (II). We investigate in detail how these two components depend on the way in which subpopulations are weighted as well as their dependence on parameters of the model such a migration rates, and local effective and census sizes. It is shown that under certain conditions the impact of II is eliminated, and [Formula: see text] of the metapopulation is maximized, when subpopulations are weighted proportionally to their long term reproductive contributions. This maximal [Formula: see text] is the sought for global effective size, since it approximates the gene diversity effective size [Formula: see text], a quantifier of the rate of loss of genetic diversity that is relevant for conservation of species and populations. We also propose two novel versions of [Formula: see text], one of which (the backward version of [Formula: see text]) is most stable, exists for most populations, and is closer to [Formula: see text] than the classical notion of [Formula: see text]. Expressions for the optimal length of the time interval for measuring genetic change are developed, that make it possible to estimate any version of [Formula: see text] with maximal accuracy.

The principle underlying all evolution, biological, geophysical, social and technological.

This article addresses the main research areas identified in the call for contributions to this special issue. With examples from published articles and books, the present article shows that all the identified areas are already covered by the universal principle underlying all evolution: the constructal law (1996), i.e. the physics law of design evolution in nature (free morphing, flowing, moving systems). The universal principle of evolution belongs in thermodynamics because thermodynamics is a universal science and evolution is a universal phenomenon. The principle unites the natural sciences with the social sciences, and the living with the non-living. It unifies the world of science and its languages (energy, economy, evolution, sustainability, etc.), and brings together the natural and artificial flow architectures, the human made and the not human made. The principle establishes firmly in physics the reality that humans are part of nature. With the principle, physics extends its coverage over phenomena that were previously considered out of reach: social organization, economics and human perceptions. Such phenomena are physical, i.e. facts. The entire world depends on the science of useful things, and benefits greatly from a physics discipline with freedom, life, wealth, time, beauty and future. This article is part of the theme issue 'Thermodynamics 2.0: bridging the natural and social sciences (Part 1)'.

Growth assessment of pure ground-glass nodules on CT: comparison of density and size measurement methods.

PURPOSE: To investigate the differences of size and density measurements in assessing pure ground-glass nodules (pGGNs) growth, and compare the growth rates and growth proportions of the two methods during follow-up period. METHODS: Ninety patients with at least 3 consecutive thin-section chest CTs and confirmed 103 pGGNs on baseline CT were enrolled retrospectively. Using the two definitions of size and density to evaluate pGGNs growth with semi-automated segmentation. Then, the two methods were compared to assess differences in pGGNs growth. RESULTS: For the size and density methods to assess nodule growth, 50.5% and 26.2% showed interval growth at the last CT (p < 0.001). Among the 19 nodules that grew in both size and density, the volume doubling time (VDT) of solid component (mean, 317.1; standard deviation, 224.8 days) was shorter than total VDT (median, 942.8; range, 400.1-2315.9 days) (p < 0.001). Of the 27 growth pGGNs assessed by the density method, the growth rates at years 1 and 2 were 25.9% and 63.0%, while the growth rates of 52 growing nodules assessed by size method were 11.5% and 48.1%, respectively. Twenty of 103 (19.4%) nodules were classified into category 4A lesions, and 7 (6.8%) were 4B lesions. CONCLUSION: Compared to size measurements, observed density increases have a higher proportion of early growth and faster growth rates in growing nodules. Clinicians need to pay close attention to the nodules of new solid components and make timely decision management.

The Cost of Metastatic Prostate Cancer in the United States.

INTRODUCTION: We sought to estimate per patient and annual aggregate health care costs related to metastatic prostate cancer. METHODS: Using the Surveillance, Epidemiology, and End Results-Medicare database, we identified fee-for-service Medicare beneficiaries ages 66 and older diagnosed with metastatic prostate cancer or claims with diagnosis codes for metastatic disease (indicating tumor progression following diagnosis) between 2007 and 2017. We measured annual health care costs and compared costs between cases and a sample of beneficiaries without prostate cancer. RESULTS: We estimate that per-patient annual costs attributable to metastatic prostate cancer are $31,427 (95% CI: $31,219-$31,635; 2019 dollars). Annual attributable costs rose over time, from $28,311 (95% CI: $28,047-$28,575) in 2007-2013 to $37,055 (95% CI: $36,716-$37,394) in 2014-2017. In aggregate, health costs attributable to metastatic prostate cancer are $5.2 to $8.2 billion per year. CONCLUSIONS: The per patient annual health care costs attributable to metastatic prostate cancer are substantial and have increased over time, corresponding to the approval of new oral therapies used in treating metastatic prostate cancer.

Combining mixed effects hidden Markov models with latent alternating recurrent event processes to model diurnal active-rest cycles.

Data collected from wearable devices can shed light on an individual's pattern of behavioral and circadian routine. Phone use can be modeled as alternating processes, between the state of active use and the state of being idle. Markov chains and alternating recurrent event models are commonly used to model state transitions in cases such as these, and the incorporation of random effects can be used to introduce diurnal effects. While state labels can be derived prior to modeling dynamics, this approach omits informative regression covariates that can influence state memberships. We instead propose an alternating recurrent event proportional hazards (PH) regression to model the transitions between latent states. We propose an expectation-maximization algorithm for imputing latent state labels and estimating parameters. We show that our E-step simplifies to the hidden Markov model (HMM) forward-backward algorithm, allowing us to recover an HMM with logistic regression transition probabilities. In addition, we show that PH modeling of discrete-time transitions implicitly penalizes the logistic regression likelihood and results in shrinkage estimators for the relative risk. This new estimator favors an extended stay in a state and is useful for modeling diurnal rhythms. We derive asymptotic distributions for our parameter estimates and compare our approach against competing methods through simulation as well as in a digital phenotyping study that followed smartphone use in a cohort of adolescents with mood disorders.

Cost consequence analysis of waiting for lumbar disc herniation surgery.

The economic repercussions of waiting for lumbar disc surgery have not been well studied. The primary goal of this study was to perform a cost-consequence analysis of patients receiving early vs late surgery for symptomatic disc herniation from a societal perspective. Secondarily, we compared patient factors and patient-reported outcomes. This is a retrospective analysis of prospectively collected data from the CSORN registry. A cost-consequence analysis was performed where direct and indirect costs were compared, and different outcomes were listed separately. Comparisons were made on an observational cohort of patients receiving surgery less than 60 days after consent (short wait) or 60 days or more after consent (long wait). This study included 493 patients with surgery between January 2015 and October 2021 with 272 patients (55.2%) in the short wait group and 221 patients (44.8%) classified as long wait. There was no difference in proportions of patients who returned to work at 3 and 12-months. Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p = 0.804). Time from consent to return to work was longer in the longer wait group corresponding to an additional $11,753.10 mean indirect cost per patient. The short wait group showed increased healthcare usage at 3 months with more emergency department visits (52.6% vs 25.0%, p < 0.032), more physiotherapy (84.6% vs 72.0%, p < 0.001) and more MRI (65.2% vs 41.4%, p < 0.043). This corresponded to an additional direct cost of $518.21 per patient. Secondarily, the short wait group had higher baseline NRS leg, ODI, and lower EQ5D and PCS. The long wait group had more patients with symptoms over 2 years duration (57.6% vs 34.1%, p < 0.001). A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow up in the short wait group (84.0% vs 75.9%, p < 0.040). This cost-consequence analysis of an observational cohort showed decreased costs associated with early surgery of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The early surgery group had more severe symptoms with higher healthcare utilization. This is counterbalanced by the additional productivity loss in the long wait group, which likely have a more chronic disease. From a societal economic perspective, early surgery seems beneficial and should be promoted.

Natural progression of persistent pure ground-glass nodules 10 mm or smaller: long-term observation and risk factor assessment.

PURPOSE: Semi-automatic segmentation was used to investigate the natural progression of pure ground-glass nodules (pGGNs) of 5-10 mm in long-term follow-up and to analyze independent risk factors for subsequent growth. MATERIALS AND METHODS: A total of 154 pGGNs of 5-10 mm from 132 patients with 698 follow-up CT scans were retrospectively identified. Subsequently, enrolled pGGNs were semiautomatically segmented on initial and follow-up CT to obtain diameter, density and volume, thus calculating mass, volume doubling time (VDT), and mass doubling time (MDT). Kaplan‒Meier analysis and multivariate Cox proportional risk regression were performed to explore independent predictors of pGGN growth. We analyzed growth differences among different pathological results of pGGNs confirmed by surgery. The prognosis was analyzed using the total diameter or solid size of the nodules on the last preoperative CT. RESULTS: Among the 85 (55.2%) pGGNs with growth, 5.9%, 51.8%, and 80.0% showed growth within 1, 3, and 5 years, respectively. The median VDT and MDT were 1206.4 (range 349.8-5134.4) days and 1161.3 (range 339.4-6630.4) days, respectively. The multivariate Cox risk regression analysis showed that mean CT attenuation (m-CTA) [hazard ratio (HR) = 2.098, p = 0.010] and roundness index (HR = 1.892, p = 0.021) were independent risk factors for pGGN growth. In total, 67.6% of surgically resected and growing pGGNs were invasive non-mucinous adenocarcinoma (IA), including 2 cases of endpoint events, showing a PSN with solid components of 5.6 mm and a solid nodule with a diameter of 19.9 mm. CONCLUSIONS: pGGNs of 5-10 mm showed an indolent clinical course. Follow-up CT imaging of pGGNs in the latter half of the first two years should be a rational management strategy. Small pGGNs with a larger overall m-CTA and roundness index on baseline CT are more likely to grow.

O inventário de envolvimento paterno revisado: inclusão de pais com filhos pré-escolares / The inventory of father involvement revised: inclusion of fathers with preschool children / El inventario de envolvimiento paterno revisado: inclusión de padres de preescolares

Apesar da importância do envolvimento paterno, sua avaliação persiste desafiadora. No Brasil, o Inventário de Envolvimento Paterno (IFI-BR) vem se mostrando adequado para uso com pais de crianças de 5 a 10 anos. Entretanto, do ponto de vista do desenvolvimento infantil e de intervenções preventivas, seria importante avaliar o envolvimento paterno quando as crianças são mais novas. Assim, este trabalho teve como objetivos: identificar limitações do IFI-BR, quando usado com pais de crianças entre 2 e 10 anos, e avaliar itens para o IFI-BR-revisado. No Estudo 1, 434 pais com filhos no Ensino Infantil ou Fundamental 1 responderam a um questionário sociodemográfico e ao IFI-BR. Com base em análises de dados omissos, estrutura interna e precisão, modificações foram sugeridas, visando à manutenção da estrutura interna original do instrumento. No Estudo 2, 572 pais com filhos na mesma faixa etária responderam a um questionário sociodemográfico e à versão modificada do IFI-BR. Foram comparadas as frequências de dados omissos e estimativas de precisão para os itens originais e modificados, selecionando aqueles que melhor representavam essa amostra de pais para compor a versão revisada do IFI-BR. Esses resultados indicaram evidências adequadas de validade, com base no conteúdo da versão revisada do IFI-BR, quando utilizada para avaliar a qualidade do envolvimento paterno de pais brasileiros com filhos do Ensino Infantil ao Fundamental 1. Após verificadas evidências de validade adicionais, essa versão revisada do IFI-BR poderá ser utilizada, por exemplo, em estudos longitudinais e na avaliação de intervenções precoces com pais.(AU)

Despite the importance assigned to father involvement, evaluating this construct remains a challenge. In Brazil, the Inventário de Envolvimento Paterno (IFI-BR) has showed satisfactory evidence of validity for fathers of children between 5 and 10 years old. From the perspective of child development and preventive interventions, however, evaluating father involvement with younger children is essential. Hence, this study sought to: identify limitations of the IFI-BR for fathers of children between 2 and 10 years old, and evaluate items for a revised IFI-BR. In Study 1, 434 fathers of children in early childhood and primary school settings answered a sociodemographic questionnaire and the IFI-BR. Based on analyses of missing data, internal structure, and reliability, modifications were suggested to maintain the original internal structure. In Study 2, 572 fathers of children in the same age range answered a sociodemographic questionnaire and the modified IFI-BR. After comparison between values for missing data and reliability of the original and modified items, the items that best represented the broader sample of fathers were selected to compose the revised IFI-BR. Results indicated adequate evidence of content validity for the revised IFI-BR when used to assess the involvement of Brazilian fathers with children in early childhood education and primary school settings. After additional evidence has been verified, this revised IFI-BR can be used, for example, in longitudinal studies and to evaluate early interventions with fathers.(AU)

La participación paterna es importante, pero su evaluación sigue siendo desafiadora. En Brasil, el Inventário de Envolvimento Paterno (IFI-BR) demuestra ser adecuado para aplicar a padres de niños de 5 a 10 años de edad. No obstante, desde la perspectiva del desarrollo infantil y de las intervenciones preventivas, sería importante evaluar la participación de los padres de niños más jóvenes. Este estudio tuvo como objetivos: identificar limitaciones del IFI-BR cuando se aplica a padres de niños entre los 2 y 10 años y evaluar ítems para el IFI-BR-revisado. En Estudio 1, 434 padres con hijos en el jardín de infantes o escuela primaria respondieron un cuestionario sociodemográfico y el IFI-BR. Con base en el análisis de datos faltantes, estructura interna y exactitud, se sugirieron modificaciones para mantener la estructura interna original del instrumento. En Estudio 2, 572 padres respondieron un cuestionario sociodemográfico y la versión modificada del IFI-BR. Se compararon las frecuencias de datos faltantes y estimaciones de exactitud para los ítems originales y modificados, seleccionando aquellos que representaban mejor a esta muestra de padres para la versión revisada del IFI-BR. Estos resultados indicaron evidencia adecuada de validez, basada en el contenido de la versión revisada del IFI-BR, cuando se utilizó para evaluar la calidad de la participación de padres brasileños con niños en el jardín de infantes y en la escuela primaria. Después de verificada la evidencia adicional de validez, la versión revisada del IFI-BR se puede utilizar, por ejemplo, en estudios longitudinales y en la evaluación de intervenciones precoz con los padres.(AU)