Cutting-Edge Statistical Methods for a Life-Course Approach

Advances in research methods, data collection and record keeping, and statistical software have substantially increased our ability to conduct rigorous research across the lifespan. In this article, we review a set of cutting-edge statistical methods that life-course researchers can use to rigorously address their research questions. For each technique, we describe the method, highlight the benefits and unique attributes of the strategy, offer a step-by-step guide on how to conduct the analysis, and illustrate the technique using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development. In addition, we recommend a set of technical and empirical readings for each technique. Our goal was not to address a substantive question of interest but instead to provide life-course researchers with a useful reference guide to cutting-edge statistical methods.     

Emperipolesis and S100 expression may be seen in cutaneous xanthogranulomas: A multi‐institutional observation

Cutaneous Rosai‐Dorfman disease (RDD) can be difficult to distinguish from other non‐Langerhans cell histiocytoses, particularly xanthogranuloma (XG). Pathologists use S100 immunoreactivity, abundant plasma cells, and the presence of emperipolesis to distinguish RDD from XG. However, S100 expression has been reported in XG and, in practice, we have occasionally observed emperipolesis in cases that were otherwise clinically and pathologically consistent with XG. We present 10 cases of XG with emperipolesis and variable S100 immunoreactivity. Histologically, 7 cases were most in keeping with XG, and a histologic differential of XG versus RDD was raised in the remaining 3 cases. All 10 cases were clinically consistent with XG. Notably, none of these cases showed abundant plasma cells. Nine cases showed variable S100 immunostaining, ranging from focal/weak expression, to focal/strong, diffuse/moderate, and diffuse/strong expression. Histiocytes in all cases were CD68 positive and CD1a negative. We conclude that emperipolesis and S100 expression in a skin biopsy cannot reliably distinguish XG from cutaneous manifestations of RDD. Clinical correlations are essential, as are histologic clues to a diagnosis of classic XG that include an abundance of foamy mononuclear cells, Touton giant cells, and an absence of pale‐stained histiocytes, abundant plasma cells, fibrosis, or vascular proliferation.     

Comparison of a single vs. a four intradermal sterile water injection for relief of lower back pain for women in labour: A randomised controlled trial

Objectivesterile water injections are a simple, safe, effective, non-pharmacological technique for relieving back pain in labour, however the number of injections required to achieve optimal analgesia is unknown. The objective of this trial was to evaluate the degree and duration of analgesia provided by a single injection of sterile water, compared to four injections.Designrandomised controlled non-inferiority trial.Participants and settingthree hundred and five women in labour at term, requesting analgesia for back pain were recruited from two metropolitan hospitals in Brisbane, Australia.Interventionparticipants were randomly assigned to receive either one (n=147) or four (n=158) sterile water injections.Outcome measuresdifference in self-reported pain measured using a visual analogue scale (VAS) between baseline and 30 mins post-intervention. The clinically acceptable margin of difference was defined as ≤1 cm on the VAS between the single injection compared to four injection technique. Secondary outcomes include VAS score on injection and 10, 60, 90 and 120 mins post-intervention, analgesia use, mode of birth and maternal satisfaction.Findingsthe mean difference in the pre and post (30 mins) injection scores between two groups was ?1.48 cm (95% CI ?2.10, ?0.86) in favour of the FI technique, however the injection pain associated with the FI was significantly greater than that of the SI technique (p<0.001). There were no significant differences between the two groups in terms of other analgesic use, mode of birth or maternal satisfaction.Conclusionthe four injection technique was associated with increased level of analgesia at 30 mins post-intervention compared to the single injection, but also a greater degree of injection pain.     

Development,functional organization,and evolution of vertebrate axial motor circuits

Neuronal control of muscles associated with the central body axis is an ancient and essential function of the nervous systems of most animal species. Throughout the course of vertebrate evolution, motor circuits dedicated to control of axial muscle have undergone significant changes in their roles within the motor system. In most fish species, axial circuits are critical for coordinating muscle activation sequences essential for locomotion and play important roles in postural correction. In tetrapods, axial circuits have evolved unique functions essential to terrestrial life, including maintaining spinal alignment and breathing. Despite the diverse roles of axial neural circuits in motor behaviors, the genetic programs underlying their assembly are poorly understood. In this review, we describe recent studies that have shed light on the development of axial motor circuits and compare and contrast the strategies used to wire these neural networks in aquatic and terrestrial vertebrate species.     

Mrs. Doubtfire Mentoring Program: Helping Children in Residential Care Transition to Bedtime

An exploratory qualitative study was conducted for the Mrs. Doubtfire mentoring program designed to connect volunteers with young children (6–11 years) in residential care to help with the bedtime transition and develop positive relationships with caring adults. Details of the program are provided. Positive effects on the agency, staff, volunteers, and children are discussed. Mrs. Doubtfire provides an innovative approach to meeting needs of children in residential care while also building strong community relationships and dedicated volunteers.     

A Closer Look at Racism and Heterosexism in Medical Students’ Clinical Decision-Making Related to HIV Pre-Exposure Prophylaxis (PrEP): Implications for PrEP Education

Social biases among healthcare providers could limit PrEP access. In this survey study of 115 US medical students, we examined associations between biases (racism and heterosexism) and PrEP clinical decision-making and explored prior PrEP education as a potential buffer. After viewing a vignette about a PrEP-seeking MSM patient, participants reported anticipated patient behavior (condomless sex, extra-relational sex, and adherence), intention to prescribe PrEP to the patient, biases, and background characteristics. Minimal evidence for racism affecting clinical decision-making emerged. In unadjusted analyses, heterosexism indirectly affected prescribing intention via all anticipated behaviors, tested as parallel mediators. Participants expressing greater heterosexism more strongly anticipated increased risk behavior and adherence problems, which were associated with lower prescribing intention. The indirect effect via condomless sex remained significant adjusting for background characteristics. Prior PrEP education did not buffer any indirect effects. Heterosexism may compromise PrEP provision to MSM and should be addressed in PrEP-related medical education.     

Impact of Clinical and Laboratory Standards Institute breakpoint changes on susceptibility rates of cephalosporins in uncomplicated urinary tract infections caused by Enterobacteriaceae

Breakpoint changes may impact cephalosporin susceptibility rates in uncomplicated urinary tract infections (uUTIs). Applying the ≤16-mg/L breakpoint to urine cultures from adult women in an academic health system resulted in cefazolin being the most active uUTI antimicrobial, with 86.9% susceptibility, compared to levofloxacin (80%), nitrofurantoin (76.5%), and sulfamethoxazole-trimethoprim (72.6%).     

Isolated coarctation of the aorta in the fetus: A diagnostic challenge

Isolated coarctation of the aorta (CoA) is estimated by the Centers for Disease Control and Prevention to account for 4%–6% of all congenital heart disease (CHD) in the United States, with a reported prevalence of ~4 per 10 000 live births. Prenatal recognition of coarctation is important as it may improve neonatal survival and reduce morbidity. However, despite advances in imaging and the trend toward detailed aortic arch assessment as part of a comprehensive fetal echocardiogram, isolated CoA may still elude prenatal detection, with potentially lethal consequences if the diagnosis is not suspected and the patent ductus arteriosus (PDA) closes spontaneously in postnatal life. The purpose of this review is to outline the methods of antenatal aortic arch evaluation in the current era, discuss “red flags” that raise the suspicion for CoA, including associated anomalies and serve as a repository of the most up to date information regarding its diagnosis in utero and its perinatal management. Other aortic arch abnormalities, such as interrupted aortic arch, or CoA associated with complex single ventricles, are not included in this review.