Comparison of pharmacological thrombolysis with mechanical thrombectomy in thrombosed arteriovenous fistulas and grafts: a systemic review and meta-analysis

AIM

To compare the effectiveness and safety of pharmacological thrombolysis and mechanical thrombectomy.

MATERIAL AND METHODS

This review was conducted in accordance with the PRISMA guidelines. Pooled proportions and subgroup analysis were calculated for primary and secondary patency rates, technical success, clinical success, major and minor complications rates.

RESULTS

This systematic review identified a total of 6,492 studies of which 17 studies were included for analysis. A total of 1,089 patients comprising 451 (41.4 %) and 638 (58.6 %) patients who underwent thrombolysis and mechanical thrombectomy procedures, respectively, were analysed. No significant differences were observed between thrombolysis and mechanical thrombectomy procedures in terms of technical success, clinical success, major and minor complications rates, primary and secondary patency rates; however, subgroup analysis of overall arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) demonstrated a significantly higher rate of major complications within the AVF group (p=0.0248).

CONCLUSION

The present meta-analysis suggests that pharmacological thrombolysis and mechanical thrombectomy procedures are similarly effective and safe; however, AVFs are subject to higher major complications compared to AVGs.

Exploring Attitudes Toward "Sugar Relationships" Across 87 Countries: A Global Perspective on Exchanges of Resources for Sex and Companionship

The current study investigates attitudes toward one form of sex for resources: the so-called sugar relationships, which often involve exchanges of resources for sex and/or companionship. The present study examined associations among attitudes toward sugar relationships and relevant variables (e.g., sex, sociosexuality, gender inequality, parasitic exposure) in 69,924 participants across 87 countries. Two self-report measures of Acceptance of Sugar Relationships (ASR) developed for younger companion providers (ASR-YWMS) and older resource providers (ASR-OMWS) were translated into 37 languages. We tested cross-sex and cross-linguistic construct equivalence, cross-cultural invariance in sex differences, and the importance of the hypothetical predictors of ASR. Both measures showed adequate psychometric properties in all languages (except the Persian version of ASR-YWMS). Results partially supported our hypotheses and were consistent with previous theoretical considerations and empirical evidence on human mating. For example, at the individual level, sociosexual orientation, traditional gender roles, and pathogen prevalence were significant predictors of both ASR-YWMS and ASR-OMWS. At the country level, gender inequality and parasite stress positively predicted the ASR-YWMS. However, being a woman negatively predicted the ASR-OMWS, but positively predicted the ASR-YWMS. At country-level, ingroup favoritism and parasite stress positively predicted the ASR-OMWS. Furthermore, significant cross-subregional differences were found in the openness to sugar relationships (both ASR-YWMS and ASR-OMWS scores) across subregions. Finally, significant differences were found between ASR-YWMS and ASR-OMWS when compared in each subregion. The ASR-YWMS was significantly higher than the ASR-OMWS in all subregions, except for Northern Africa and Western Asia.

Why more successful? An analysis of participants' self-monitoring data in an online weight loss intervention

BACKGROUND

Self-monitoring is crucial for behavioral weight loss. However, few studies have examined the role of self-monitoring using mixed methods, which may hinder our understanding of its impact.

METHODS

This study examined self-monitoring data from 61 Chinese adults who participated in a 5-week online group intervention for weight loss. Participants reported their baseline Body Mass Index (BMI), weight loss motivation, and engaged in both daily quantitative self-monitoring (e.g., caloric intake, mood, sedentary behavior, etc.) and qualitative self-monitoring (e.g., daily log that summarizes the progress of weight loss). The timeliness of participants' daily self-monitoring data filling was assessed using a scoring rule. One-way repeated measurement ANOVA was employed to analyze the dynamics of each self-monitoring indicator. Correlation and regression analyses were used to reveal the relationship between baseline data, self-monitoring indicators, and weight change. Content analysis was utilized to analyze participants' qualitative self-monitoring data. Participants were categorized into three groups based on their weight loss outcomes, and a chi-square test was used to compare the frequency distribution between these groups.

RESULTS

After the intervention, participants achieved an average weight loss of 2.52 kg (SD = 1.36) and 3.99% (SD = 1.96%) of their initial weight. Daily caloric intake, weight loss satisfaction, frequency of daily log, and the speed of weight loss showed a downward trend, but daily sedentary time gradually increased. Moreover, regression analysis showed that baseline BMI, weight loss motivation, and timeliness of daily filling predicted final weight loss. Qualitative self-monitoring data analysis revealed four categories and nineteen subcategories. A significant difference in the frequency of qualitative data was observed, with the excellent group reporting a greater number of daily logs than expected in all categories and most subcategories, and the moderate and poor groups reporting less than expected in all categories and most subcategories.

CONCLUSION

The self-monitoring data in short-term online group intervention exhibited fluctuations. Participants with higher baseline BMI, higher levels of weight loss motivation, and timely self-monitoring achieved more weight loss. Participants who achieved greater weight loss reported a higher quantity of qualitative self-monitoring data. Practitioners should focus on enhancing dieters' weight loss motivation and promote adherence to self-monitoring practices.

The 4-item family resilience scale: psychometric evaluation and measurement invariance of the malay version in adolescents and young adults

BACKGROUND

The original Family Resilience Scale (FRS) is a reliable tool to assess family resilience. However, the FRS is based on the United States and parental context. Thus, the usefulness of the FRS for the adolescent and young adult population in Asian countries, particularly Malaysia remains unknown. This study translated the FRS into the Malay language and validated it on Malaysian adolescents and young adults to identify its potential as a self-report tool to assess the resilience level of their family.

METHODS

A total of 351 participants (Mage = 19.75, SDage = 3.29) were recruited in the study using purposive sampling. Confirmatory factor analysis was conducted to examine the factorial structure of the Family Resilience Scale-Malay (FRS-Malay) and measurement invariance between adolescents and young adults. Then, the scale's reliability was investigated using Cronbach's alpha, McDonald's omega coefficients, and composite reliability index. Finally, we examined the discriminant validity of the FRS-Malay by correlating its score with individual resilience score and examined the incremental validity of the scale using hierarchical multiple regression analysis to test if family resilience can explain individual well-being levels beyond and above individual resilience.

RESULTS

The findings of the confirmatory factor analysis suggest that a single-factor model is supported for both age groups. Furthermore, the scale exhibited scalar invariance between adolescents and young adults. The scale also exhibited good reliability, as the value of Cronbach's alpha, McDonald omega coefficients, and composite reliability index were above 0.80. Additionally, the Pearson correlation analysis showed a positive correlation between the FRS-Malay and individual resilience scores, which supports the discriminant validity of the scale. Similarly, the incremental validity of the scale is also supported. Specifically, family resilience had a positive correlation with well-being, even after controlling for individual resilience in the regression analysis.

CONCLUSIONS

The FRS-Malay has demonstrated good reliability and validity. The scale measures the same construct of family resilience across adolescents and young adults, making it suitable for comparisons. Therefore, this unidimensional tool is appropriate for self-reporting their perceived level of family resilience. It is also useful for studying the development and fluctuation of family resilience in the Malaysian context.

Is teacher violence a form of betrayal trauma? Relationship with mental health problems among young adults

BACKGROUND

Childhood trauma is one of the most preventable risk factors for mental health problems. Considering the substantial amount of time that young people spend in school during their early years, it is important to understand the potential impacts of teachers' behaviors on students' mental health.

OBJECTIVES

This study examined the relationship between exposure to teacher violence and mental health problems.

PARTICIPANTS AND SETTING

An international sample of young adults aged 18 to 24 (N = 283).

METHODS

Participants completed self-report measures of childhood trauma, exposure to teacher violence, depressive symptoms, post-traumatic stress, and alcohol misuse.

RESULTS

Exposure to teacher violence could be reliably and validly measured using the Teacher Violence Scale (TVS). Current mental health problems - including depressive symptoms, post-traumatic stress, and alcohol misuse - were associated with exposure to teacher violence during high school years, but not with childhood non-betrayal trauma.

CONCLUSIONS

Our findings expand the application of the betrayal trauma theory to school settings and point to the importance of preventing and managing teacher violence. It is important to provide more support and training to teachers and enhance monitoring measures in schools. More research on the prevalence and correlates of exposure to teacher violence is needed. We also provided first evidence supporting the reliability and validity of the English version of the TVS to facilitate future research.

Validation of the Chinese version of the Rosenberg Self-Esteem Scale: evidence from a three-wave longitudinal study

BACKGROUND

The 10-item Rosenberg Self-Esteem Scale (RSES) is a widely used tool for individuals to self-report their self-esteem; however, the factorial structures of translated versions of the RSES vary across different languages. This study aimed to validate the Chinese version of the RSES in the Chinese mainland using a longitudinal design.

METHODS

A group of healthcare university students completed the RSES across three waves: baseline, 1-week follow-up, and 15-week follow-up. A total of 481 valid responses were collected through the three-wave data collection process. Exploratory factor analysis (EFA) was performed on the baseline data to explore the potential factorial structure, while confirmatory factor analysis (CFA) was performed on the follow-up data to determine the best-fit model. Additionally, the cross-sectional and longitudinal measurement invariances were tested to assess the measurement properties of the RSES for different groups, such as gender and age, as well as across different time points. Convergent validity was assessed against the Self-Rated Health Questionnaire (SRHQ) using Spearman's correlation. Internal consistency was examined using Cronbach's alpha and McDonald's omega coefficients, while test-retest reliability was assessed using intraclass correlation coefficient.

RESULTS

The results of EFA revealed that Items 5, 8, and 9 had inadequate or cross-factor loadings, leading to their removal from further analysis. Analysis of the remaining seven items using EFA suggested a two-factor solution. A comparison of several potential models for the 10-item and 7-item RSES using CFA showed a preference for the 7-item form (RSES-7) with two factors. Furthermore, the RSES-7 exhibited strict invariance across different groups and time points, indicating its stability and consistency. The RSES-7 also demonstrated adequate convergent validity, internal consistency, and test-retest reliability, which further supported its robustness as a measure of self-esteem.

CONCLUSIONS

The findings suggest that the RSES-7 is a psychometrically sound and brief self-report scale for measuring self-esteem in the Chinese context. More studies are warranted to further verify its usability.

Feelings toward lying flatism and attitudes toward singlehood: the mediating role of happiness belief

BACKGROUND

Lying flatism, a new emerging lifestyle by refusing to participate in consumerist lifestyles, is anticipated to be related to singlehood. Based on the Theory of Reasoned Action, we proposed a mediation model to examine the indirect relationship between feelings towards lying flatism and attitudes toward singlehood via individuals' belief in that happiness can be achieved without romantic relationships (happiness belief).

METHODS

Using purposive and snowball sampling methods, 232 single Malaysian young adults participated in an online experiment consisting of a writing task (to manipulate feelings toward lying flatism), single-item measures of manipulation checking and happiness belief, Attitudes toward Singlehood Scale, Negative Stereotyping of Single Persons Scale (a measure of singlism) and Fear of Being Single Scale.

RESULTS

T-Test results support the writing task that successfully induced positive feelings toward lying flatism. Mediation analysis showed that the feelings toward lying flatism measured before the writing task, but not the manipulation of lying flatism, has an indirect relationship with attitudes toward singlehood via happiness belief, after controlling for gender, singlism, and fear of being single.

CONCLUSIONS

The findings offer preliminary support to the hypothetical relationships among feelings towards lying flatism, happiness belief, and attitudes toward singlehood. Implications of the findings are discussed.

Factorial structure, reliability, and construct validity of the Generalized Anxiety Disorder 7-item (GAD-7): Evidence from Malaysia

Generalized anxiety disorder (GAD) is one of the most common mental disorders in Malaysia. Psychometrically sound measurements are urgently needed to assess anxiety symptoms. The extensively used Generalized Anxiety Disorder 7-item (GAD-7) is a promising candidate. However, studies on its factorial validity show mixed findings. While the one-factor solution has been replicated in different cultural contexts, some studies found different factorial structures instead. This study aimed to clarify the factorial validity of the English version of the GAD-7 in the Malaysian context. The responses collected from 1272 emerging to older adults in Malaysia were randomly divided into two halves and submitted to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) respectively. Four acceptable models were explored in EFA ranging from unidimensional factor with 7 items to 3-factor models with 6 items. The four models revealed in EFA and the other competing models found in past studies were then examined and compared using CFA. The 6-item second-order model with a general factor of anxiety and three first-order factors with two items respectively (i.e., GAD-6) showed a more harmonic result and hence, is preferable. Moreover, the GAD-6 and its three subscales also showed satisfactory internal consistency and construct validity. This study uncovers a new and unique factorial structure of the GAD screening tool that fits in the Malaysian context. The scale may reveal GAD symptomatic dimensions that guide clinical interventions.

The Mediating Role of Work Engagement in the Relationship between Executive Functioning Deficits and Employee Well-Being

Executive functioning and its related components have been found to promote well-being. However, there is a limited understanding of the underlying mechanism. Drawing from the job demands-resources and PERMA models, the present study examined the hypothetical mediating role of work engagement in the relationship between executive functioning deficit and well-being among 314 working adults in Malaysia. Participants answered a survey consisting of the Executive Skills Questionnaire-Revised (ESQ-R; a new measure of executive functioning deficits for working adults), Utrecht Work Engagement Scale, Employee Well-Being Scale, and Self-Rated Creativity Scale. Pearson correlation analysis showed that the ESQ-R score was negatively associated with all other target variables, while the latter was positively related to each other. Moreover, supporting the hypotheses, the results of mediation analysis using PROCESS macro found that work engagement mediated the negative relationship between executive functioning deficits and well-being after statistically controlling for the creativity score. The findings not only replicate the beneficial role of executive functioning in employees' well-being but also shed light on the underlying process of the relationship. Implications and directions for future studies are discussed.

Arterial Spin-Labeling Parameters and Their Associations with Risk Factors, Cerebral Small-Vessel Disease, and Etiologic Subtypes of Cognitive Impairment and Dementia

BACKGROUND AND PURPOSE

Cerebral small-vessel disease may alter cerebral blood flow (CBF) leading to brain changes and, hence, cognitive impairment and dementia. CBF and the spatial coefficient of variation can be measured quantitatively by arterial spin-labeling. We aimed to investigate the associations of demographics, vascular risk factors, location, and severity of cerebral small-vessel disease as well as the etiologic subtypes of cognitive impairment and dementia with CBF and the spatial coefficient of variation.

MATERIALS AND METHODS

Three hundred ninety patients with a diagnosis of no cognitive impairment, cognitive impairment no dementia, vascular cognitive impairment no dementia, Alzheimer disease, and vascular dementia were recruited from the memory clinic. Cerebral microbleeds and lacunes were categorized into strictly lobar, strictly deep, and mixed-location and enlarged perivascular spaces into the centrum semiovale and basal ganglia. Total and region-specific white matter hyperintensity volumes were segmented using FreeSurfer. CBF (n = 333) and the spatial coefficient of variation (n = 390) were analyzed with ExploreASL from 2D-EPI pseudocontinuous arterial spin-labeling images in white matter (WM) and gray matter (GM). To analyze the effect of demographic and vascular risk factors as well as the location and severity of cerebral small-vessel disease markers on arterial spin-labeling parameters, we constructed linear regression models, whereas logistic regression models were used to determine the association between arterial spin-labeling parameters and cognitive impairment no dementia, vascular cognitive impairment no dementia, Alzheimer disease, and vascular dementia.

RESULTS

Increasing age, male sex, hypertension, hyperlipidemia, history of heart disease, and smoking were associated with lower CBF and a higher spatial coefficient of variation. Higher numbers of lacunes and cerebral microbleeds were associated with lower CBF and a higher spatial coefficient of variation. Location-specific analysis showed mixed-location lacunes and cerebral microbleeds were associated with lower CBF. Higher total, anterior, and posterior white matter hyperintensity volumes were associated with a higher spatial coefficient of variation. No association was observed between enlarged perivascular spaces and arterial spin-labeling parameters. A higher spatial coefficient of variation was associated with the diagnosis of vascular cognitive impairment no dementia, Alzheimer's disease, and vascular dementia.

CONCLUSIONS

Reduced CBF and an increased spatial coefficient of variation were associated with cerebral small-vessel disease, and more specifically lacunes, whereas cerebral microbleeds and white matter hyperintensities were associated with WM-CBF and GM spatial coefficient of variation. The spatial coefficient of variation was associated with cognitive impairment and dementia, suggesting that hypoperfusion might be the key underlying mechanism for vascular brain damage.

Perceived Social Support Increases Creativity: Experimental Evidence

The literature has consistently shown that social support has a positive relationship with creativity. However, further investigation is needed to clarify the causal relationship between the two constructs. The present study addressed this need by exploring the impact of experimentally induced perceived social support on creativity among young adults. A total of 135 undergraduate students in Malaysia participated in an online experiment. All participants first answered the creative self-efficacy scale and were then randomly allocated to the experimental and control groups. Perceived social support was primed by a writing test and measured by the Multidimensional Scales of Perceived Social Support. Both groups also answered a divergent thinking test (measured for fluency, flexibility, and originality) and a self-rated creativity scale. Multivariate analysis of covariance showed that, after statistically controlling for the effect of creative self-efficacy, participants in the experimental group reported higher scores in perceived social support and all creativity measures than their counterparts in the control group. The results demonstrated that the manipulation is effective and the induced perceived social support leads to higher creativity. Our findings not only offer empirical evidence of the causality of social support and creativity but also has practical value for creativity development.

Psychometric Qualities of the McMaster Family Assessment Device-General Functioning Subscale for Malaysian Samples

Family functioning has been associated with psychological well-being and physical health. The 12-item McMaster Family Assessment Device–General Functioning Subscale (FAD-GF) has been widely used to assess individuals’ overall level of family functioning. However, it has shown an inconsistent factor structure across various studies. The present study investigated its psychometric qualities in two studies with two different adult samples in Malaysia. In Study 1 (N = 417, 55.3% females, 19 to 26 years old), exploratory factor analyses were conducted, and four models were found: a three-factor model with 11 items, a two-factor model with 12 items, and one-factor models with six negatively worded items and six positively worded items, respectively. Study 2 (N = 358, 65.1% females, 18 to 60 years old) compared models found in past studies and those found in Study 1 through confirmatory factor analyses on another sample of adults. Among the six competing models, the two-factor model with three positively worded and three negatively worded items (i.e., FAD-GF-SF) is preferable because it did not require modification and showed a clear-cut result of goodness of fit. The subscales demonstrated satisfactory internal consistency. In conclusion, the FAD-GF-SF is a useful instrument for measuring family functioning in the Malaysian context.

Psychometric Qualities Evaluation of the Interdependent Happiness Scale across Malaysia, Philippines, and India

The nine-item Interdependent Happiness Scale (IHS; Hitokoto & Uchida, 2015) is a self-report of interpersonal happiness that focuses on three dimensions: relationship-oriented happiness, quiescent happiness, and ordinary happiness. Few studies have evaluated the psychometric properties of the IHS in diverse cultural backgrounds and the findings are inconsistent. This study investigated whether the IHS has sound psychometric qualities in three Asian countries. University students from Malaysia (n = 263), Philippines (n = 239), and India (n = 310) answered the IHS and self-rated creativity scale. Confirmatory factor analysis on each sample supported the nine-item second-order model with error covariances. The overall IHS score showed good reliability in all samples. The subscales, however, had mixed results except for the Indian sample. Similarly, the convergent validity test showed mixed results while discriminant validity is supported in all samples except for the quiescent happiness subscale in the Indian sample. Concurrent validity was established across three samples by showing a positive relationship with creativity score. The results highlight that the higher-order structure of the IHS is consistently supported in different cultural contexts. However, some of the items are perceived differently and require further improvement in enhancing the cross-cultural usability of the IHS to measure socially-oriented happiness.

Psychometric Evaluation of the Malay Version of the Family Adaptability and Cohesion Evaluation Scale III for Malaysian Adolescents

The Family Adaptability and Cohesion Scale III (FACES-III) has been widely used to measure an individual’s family functioning in terms of cohesion and adaptability. In Malaysia, the FACES-III has been translated into the Malay language for the community, but its psychometric properties in this context remain unknown. Thus, the purpose of this research is to examine the psychometric properties of the Malay version of the FACES-III in 852 adolescents attending secondary schools in Kuala Lumpur, Malaysia. Data were randomly split into two halves: the exploration sample and the validation sample. Exploratory factor analysis was conducted on the exploration sample and a two-factor model was discovered after removing nine items that showed low factor loading. Then, confirmatory factor analysis was conducted on the validation sample to compare the one-factor models, two-factor models, and three-factor models. Results showed that the 11-item two-factor model (FACES-III-M-SF) was superior to the other competing models. Both the exploratory and confirmatory factor analyses replicated the two-factor structure of the original version of FACES-III. The reliability of the overall scale was consistently good, but the subscale results were mixed. This suggests that researchers should use the overall score, but not the subscale scores, in analyses.

Asian "Guan" Parenting and Life Satisfaction Among Adolescents in Malaysia: The Mediating Role of Filial Piety

Literature on adolescent development has shown that parenting practices have positive relationships with adolescents’ life satisfaction. Adolescents’ life satisfaction improves when they have parents low in psychological control who uphold reciprocal self-disclosure in their communication. Guan parenting was found to correlate positively with adolescents’ development. Therefore, it is methodologically important to replicate the investigation on the relationship between adolescents’ life satisfaction and Guan parenting. Literature suggests that filial piety is shaped by parenting practices and adolescents who perceived intense parental concern, care, and involvement tend to uphold filial piety and express gratitude toward parents which may promote the adolescents’ life satisfaction. In this study, mediation analysis was done to elucidate the relationship among parents’ guan parenting style, filial piety, and life satisfaction on 606 adolescents (M_age=15.07; SD_age=1.03; 52.1% females) in Malaysia. The adolescents were sampled through cluster sampling, and data were collected using self-administered questionnaires. The results showed positive relationship between paternal and maternal guan parenting with filial piety and adolescents’ life satisfaction. Greater parents’ filial piety was linked to higher life satisfaction among adolescents. Findings from the mediation models indicated the association among guan parenting with filial piety, gratitude toward parents, and higher life satisfaction. The findings also offered empirical evidence to the underlying mechanism of how guan parenting could affect adolescent life satisfaction via the mediating role of filial piety. The findings also supported the importance of culture-infused parenting in inculcating adolescents’ filial piety besides establishing its link to life satisfaction in Asian families.

Antecedents of the Attitudes Toward Singlehood Among Young Adults in Malaysia, Japan, and India

With both theories and empirical studies supporting the benefits of having a romantic relationship, there remains an increasing tendency of staying single being documented globally. It is thus important to understand the antecedent factors of such voluntary single movement. Guided by the Investment Model of Commitment (IMC) process, the roles of subjective socioeconomic status (SSES), relational mobility, and desirability of control in attitudes toward singlehood were investigated. A total of 1,108 undergraduate students from Malaysia (n=444), Japan (n=316), and India (n=348) answered an online survey consisting of the Attitudes toward Singlehood Scale, MacArthur Scale of SSES, Relational Mobility Scale, Desirability of Control Scale, Mini-Social Phobia Inventory, and Single Item Narcissism Scale. Hierarchical multiple regression analysis showed a persistent positive relationship between desirability of control, but not socioeconomic status and relational mobility, with attitudes toward singlehood, even after statistically excluding the effects of social anxiety and narcissism. A similar pattern was also observed among those who were currently single. Moreover, an interaction effect of socioeconomic status and relational mobility was found in further exploratory analysis. The results highlight that retaining the autonomy and flexibility of managing one's own life and financial concern are the key reasons young adults prefer staying single to engaging in a romantic relationship. Implications and recommendations for future research are also presented in this study.

Development and validation of a mandarin version of demoralization scale for adolescents and young adults

The impact of demoralization among the general population has received little attention due to the lack of an appropriate measurement. Three studies involving 1,143 high school and undergraduate students in Taiwan were thus conducted to develop and validate a tool to assess demoralization. A pool of 50 items was first developed and administered to high school students. Exploratory factor analysis results supported a 5-factor solution with 15 items (Study 1). Study 2 compared the potential models using confirmatory factor analysis and found the 5-factor second-order model with 15 items the best fit model. The 15-item Mandarin version of Demoralization Scale (DS-M-15) was also found to have good internal consistency, test–retest reliability, and (concurrent and predictive) validity in a sample of undergraduate students (Study 3). Taken together, the converging findings show that the DS-M-15 is a promising tool for assessing demoralization among Chinese adolescents and emerging adults.

The effects of group art therapy on adolescents' self-concept and peer relationship: A mixed-method study

This study examined the effects of group art therapy on self-concept and peer relationships among adolescents using a mixed-method approach. Twelve recruited adolescents from a high school in Northern Taiwan attended weekly 2-h group art therapy sessions for 8 weeks. Through a discovery-oriented approach incorporating focus group interviews and individual interviews, qualitative results revealed that the participants started getting to know themselves better and were able to explore their inner selves while noticing their own emotions. Their self-concept also became more positive along with reduced negative self-concept, increased positive self-concept, and clearer visions towards future goals. Furthermore, the therapy modified adolescents' negative peer relationships by reducing their social anxiety and adjusting their complicated experiences. Participants were found to experience trustable, allied, and compassionate positive peer relationships while having reduced loneliness and improved social skills at the same time. Besides, the participants answered self-concept and peer relationship scales at pre- and post-interventions as well as a 12-month follow-up thereafter. Friedman test on the longitudinal data showed participants reporting consistently higher self-concept and peer relationship at post-intervention and 12-month follow-up than at the pre-intervention stage. Taken together, the findings duly support art therapy in boosting adolescents' self-concept and peer relationships.

The Executive Skills Questionnaire-Revised: Adaptation and Psychometric Properties in the Working Context of Malaysia

Executive functions (EFs) are a set of high-level cognitive and behavioral monitoring skills that are important to employees’ work performance. The 25-item Executive Skills Questionnaire-Revised (ESQ-R) measures executive dysfunction in five dimensions (e.g., emotional regulation). Nevertheless, the usability of this newly developed scale for employees remains unclear. The present study evaluated the psychometric properties of the adopted ESQ-R for working adults in Malaysia. A total of 325 employees responded to an online survey consisted of the ESQ-R, Executive Function Index (EFI), self-rated creativity scale (SRCS), and 9-item Utretch Work Engagement Scale (UWES-9) and Employee Well-being Scale. Several CFAs were conducted to compare three competing models. While all models showed a good fit, the 5-factor second-order model that is in line with the theoretical structure is preferable. The ESQ-R showed excellent internal consistency. Moreover, the ESQ-R score was negatively correlated with EFI, creativity, and UWES-9 scores, supporting the convergent, discriminant, and concurrent validity. The ESQ-R score also explained incremental variance in well-being above and beyond scores of the UWES-9 and SRCS. Taken together, the ESQ-R is a useful tool for assessing employees’ executive dysfunction and suggesting intervention programs helping employees with deficits in EFs.

Self-sampling in Human Papillomavirus screening during and post-COVID-19 pandemic

INTRODUCTION

Cervical cancer is the third most common cancer among Malaysian women. Sarawak, the largest state in Malaysia has consistently recorded the highest cervical cancer rate in the country where nearly half of its population still live in the rural areas and is at increased risk of the disease due to inequitable access to healthcare. The countrywide lockdown due to the COVID-19 pandemic had halted the accessibility to cervical cancer screening programme. The aim of the study is to determine the feasibility of providing primary HPV DNA test using the selfsampling method to the hard-to-reach population in the interior of Sarawak during the COVID-19 pandemic.

MATERIALS AND METHODS

This is a cross-sectional study where women aged between 20-80 years were recruited via convenient sampling from villages in Long Banga, Sarawak over a five-day outreach programme. Cervicovaginal selfsamples were obtained and screened for the presence of high-risk human papillomavirus DNA (HR-HPV) using the careHPVTM Test. A self-administered questionnaire was also administered to determine the sociodemographic and perception towards the self-sampling method.

RESULTS

The 55 women recruited consist of ethnic backgrounds of Penan (58.18%), Kenyah (25.45%), Iban (5.45%), Saban (3.64%), Kelabit (3.64%), Malay (1.82%) and Chinese (1.82%). The prevalence of HR-HPV was 1.85% (n=1/55). Nearly 80% of the women were unemployed, and more than half have had attended primary education. Nine (16.4%) have heard about HPV, and seven (13%) knew HPV infection could cause cervical cancer. Three of them had HPV vaccination, and only one (1.85%) knew the brand of the HPV vaccine. Although 40% preferred self-sampling over clinician-collection, only ten (18.2%) women have completed the self-collection perception questionnaire.

CONCLUSION

Primary HPV DNA screening using the selfsampling method can be carried out in the remote areas during the COVID-19 pandemic without compromising mobility restriction.

Characterization of sedimentary phosphorus in Lake Erie and on-site quantification of internal phosphorus loading

Lake Erie harmful algal blooms and hypoxia are two major environmental problems, and have severe impacts on human health, aquatic ecosystems, and the economy. However, little is known about internal loading of phosphorus (P) from sediments, which pose a challenge for assessing the efficacy of current conservation measures on the improvement of lake water quality. A modified Hedley's extraction procedure was employed to analyze representative sediment samples collected from the Lake Erie basin for assessing sedimentary P stock, potential availability for release into lake water, and internal P loading. Inorganic and organic P in the sediments were characterized by sequential extractions in H₂O, 0.5 M NaHCO₃, 0.1 M NaOH, and 1.0 M HCl, respectively. In the 0 - 10 cm sediment, total P stock was 172, 191, and 170 metric tons km^-2 in the western, central, and eastern basins, respectively. Sedimentary P seems unlikely to contribute to internal P loading in the western basin, while in the eastern basin it can potentially contribute to an internal loading of 359 metric tons P yr^-1. In the central basin, 41% of organic P, 15% of non-HCl extractable inorganic P, and 9.7% of residual P in the 0 - 10 cm sediment is potentially available for release into lake water; in the 10 - 20 cm sediment, organic P extracted by NaHCO₃ and NaOH is also partially available. The central basin potentially contributes to internal P loading at a total amount of 10,599 metric tons yr^-1. Internal P loading may not contribute to HABs in the western basin, but it can cause and maintain hypoxia in the central basin and delay the recovery of lake water quality for a lengthy time period in response to external P reduction measures.

Does reducing radiation levels for procedures affect image quality and radiation to proceduralists? A double-blinded randomised study of two protocols

AIM

To evaluate the ultra-lose dose imaging protocol (ULDP), compared to the standard low-dose imaging protocol (LDP), which are used for haemodialysis access, in terms of radiation exposure and image quality.

MATERIAL AND METHODS

This was a single-centre, institutional review board-approved, prospective, double-blinded randomised controlled study to compare radiation exposure and image quality of the ULDP and LDP. Ten proceduralists, two radiographers, and 11 nurses were enrolled. Radiation exposure during 80 procedures (40 angioplasties and 40 thrombolysis) was recorded (direct radiation to patients from protocol report and scattered radiation to participants from the RaySafe i2 real-time dosimetry system). Baseline characteristics of procedure were recorded. Image quality was assessed subjectively using questionnaires based on the five-point Likert scale after each procedure.

RESULTS

Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses (0.506±0.430 versus 0.847±0.965 μSv/s, p=0.044; 0.571±1.284 versus 1.284±1.007 mGy/s, p<0.001; and 0.052±0.071 versus 0.141±0.185 μSv/s, p=0.005, respectively). No significant difference in image quality or duration of procedure was observed (all p values >0.05).

CONCLUSION

Compared with LDP, the use of ULDP was associated with a significantly lower rate of radiation exposure to proceduralists, patients, and scrub nurses without compromising the image quality or duration of procedure.

Using electronic health records to monitor, augment and evaluate patient care in Singapore

The advent of electronic health records (eHRs) has opened up many opportunities for researchers and practitioners in healthcare to improve human lives. The opportunity to monitor and evaluate events or processes in real time on a large scale is feasible with big data, thereby facilitating timely information and the practice of proactive care. Predictive analytics allows the re-engineering of processes by augmenting them with predictive scores to identify individuals at high risk of adverse events for early intervention. However, to seize these opportunities to improve patient care, alleviating the challenges faced when utilizing eHRs to generate actionable insights is important to unleash the full potential of eHRs. With better access to eHRs and relevant domain experts, it facilitates the appropriate use of eHRs and analytical approaches. To illustrate some of these opportunities and challenges, the following two case studies will be discussed during this presentation: (i) programs developed at an academic health system in Singapore that aim to improve the experience and outcomes of inpatients, and (ii) a nationwide Predictive Model for Admission Prevention in Singapore that identifies suitable discharged inpatients for enrolment into a community-centric program.

Development, validation and translation of psychological tests

In social science research and clinical practice, and in educational settings, psychological tests/scales are being increasingly used because of their reliability and the ease and speed of gathering, comparing and differentiating data. A new scale is usually created when instruments or questionnaires to measure the construct of interest are not be readily available or if existing questionnaires do not fully satisfy requirements. Scales are also translated and revalidated if they are not in the language required. This article takes the reader through steps in developing, validating and translating tests in the field of social sciences.

Could bacteriophages isolated from the sewage be the solution to methicillin-resistant Staphylococcus aureus?

INTRODUCTIONS

The emergence of multidrug-resistant bacteria such as Methicillin-Resistant Staphylococcus aureus (MRSA) complicates the treatment of the simplest infection. Although glycopeptides such as vancomycin still proves to be effective in treating MRSA infections, the emergence of vancomycin-resistant strains limits the long term use of this antibiotic. Bacteriophages are ubiquitous bacterial viruses which is capable of infecting and killing bacteria including its antibiotic-resistant strains. Bactericidal bacteriophages use mechanisms that is distinct from antibiotics and is not affected by the antibioticresistant phenotypes.

OBJECTIVES

The study was undertaken to evaluate the possibility to isolate bacteriolytic bacteriophages against S.aureus from raw sewage water and examine their efficacy as antimicrobial agents in vitro.

METHODS

Bacteriophages were isolated from the raw sewage using the agar overlay method. Isolated bacteriophages were plaque purified to obtain homogenous bacteriophage isolates. The host range of the bacteriophages was determined using the spot test assay against the 25 MRSA and 36 MSSA isolates obtained from the Sarawak General Hospital. Staphylococcus saprophyticus, Staphylococcus sciuri and Staphylococcus xylosus were included as non-SA controls. The identity of the bacteriophages was identified via Transmission Electron Microscopy and genomic size analysis. Their stability at different pH and temperature were elucidated.

RESULTS

A total of 10 lytic bacteriophages infecting S.aureus were isolated and two of them namely ΦNUSA-1 and ΦNUSA-10 from the family of Myoviridae and Siphoviridae respectively exhibited exceptionally broad host range against >80% of MRSA and MSSA tested. Both bacteriophages were specific to S.aureus and stable at both physiologic pH and temperature.

CONCLUSION

This study demonstrated the abundance of S.aureus specific bacteriophages in raw sewage. Their high virulence against both MSSA and MRSA is an excellent antimicrobial characteristic which can be exploited for bacteriophage therapy against MRSA.

Comparing the outcome of monitored anaesthesia care and local anaesthesia for carpal tunnel syndrome surgery by neurosurgeons

INTRODUCTION

Carpal tunnel syndrome (CTS) is the commonest median nerve entrapment neuropathy of the hand, up to 90% of all nerve compression syndromes. The disease is often treated with conservative measures or surgery. The senior author initially intended to treat his own neurosurgical patients concurrently diagnosed with carpal tunnel syndrome in 2014, subsequently, he began to pick up more referrals from the primary healthcare group over the years. This has led to the setup of a peripheral and spine clinic to act as a hub of referrals.

OBJECTIVE

Department of Neurosurgery Sarawak aimed to evaluate the surgical outcome of carpal tunnel release done over five years.

METHODS

The carpal tunnel surgeries were done under local anaesthesia (LA) given by neurosurgeons (Bupivacaine 0.5% or Lignocaine 2%). Monitored anaesthesia care (MAC) was later introduced by our hospital neuroanaesthetist in the beginning of 2018 (Target-controlled infusion propofol and boluses of fentanyl). We looked into our first 17 cases and compared these to the two anaesthesia techniques (LA versus MAC + LA) in terms of patient's pain score based on visual analogue scale (VAS).

RESULTS

Result showed MAC provided excellent pain control during and immediately after the surgery. None experienced anaesthesia complications. There was no difference in pain control at post-operation one month. Both techniques had equal good clinical outcome during patients' clinic follow up.

CONCLUSION

Neurosurgeons provide alternative route for CTS patients to receive surgical treatment. Being a designated pain free hospital, anaesthetist collaboration in carpal tunnel surgery is an added value and improves patients overall experience and satisfaction.

Helical stent (SUPERA™) and drug-coated balloon (Passeo-18 Lux™) for recurrent cephalic arch stenosis: Rationale and design of arch V SUPERA-LUX Study

BACKGROUND

The treatment options for cephalic arch stenosis are limited and standard of care remains at crossroads - none are ideal and there is currently no gold standard. Endovascular techniques are now the preferred primary therapeutic option because they are minimally invasive and better tolerated by haemodialysis patients who have multiple comorbidities. However, conventional plain old balloon angioplasty, bare metal stenting and stent grafts all have their limitations. The aim of this trial is to evaluate whether the helical SUPERA™ stent (Abbott Vascular, Santa Clara, CA, USA), which has a higher degree of flexibility and resistance to compressive forces compared to traditionally laser-cut nitinol stents, combined with a drug-coated balloon (Biotronik Passeo-18 Lux™) to minimize the neointimal hyperplasia effect, can improve patency and reduce reintervention rates.

METHODS AND RESULTS

Arch V SUPERA-LUX is a pilot investigator-initiated single-centre, single-arm prospective study. Twenty patients with a brachiocephalic fistula within 6 months of initial plain old balloon angioplasty for significant cephalic arch stenosis will be recruited for treatment with SUPERA and drug-coated balloon. The primary objectives are immediate angiographic and procedural success, primary patency and functional fistula at 1 week, 8 weeks, 6 and 12 months. The results from eight patients treated prospectively as proof of concept have shown primary patency of 83.3% at 1 year with 100% technical and procedural success rates. Enrolment for the Arch V SUPERA-LUX study is expected to be completed at the end of 2019.

CONCLUSION

The Arch V SUPERA-LUX study is the first trial to evaluate whether SUPERA stent implantation and drug-coated balloon use can provide superior protection against restenosis compared to traditional angioplasty, bare metal stents and stent grafts in recurrent cephalic arch stenosis. Initial pilot results are encouraging but longer follow-up is required to truly test this technique.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov NCT03891693.

Treatment of EGFR T790M-Positive Non-Small Cell Lung Cancer

The treatment of lung cancer has changed dramatically with the development of tyrosine kinase inhibitors (TKIs) that target sensitizing somatic mutations of the epidermal growth factor receptor (EGFR). Despite remarkable initial responses, patients eventually develop progressive disease, with the most common cause of resistance to first-line EGFR TKIs being the acquired T790M mutation. Various third-generation EGFR TKIs have been developed to specifically target this acquired mutation, of which osimertinib is currently the only approved agent. In addition, the eagerly anticipated data from the FLAURA study recently found improved efficacy with increased progression-free survival (PFS) with osimertinib compared to standard of care first-generation EGFR TKIs in the first-line setting. Of note, osimertinib has also demonstrated promising efficacy in patients with known brain metastases. However, as patients invariably develop resistance during treatment with osimertinib, most commonly with the development of triple mutated EGFR (sensitizing mutations/T790M/C797S), which is resistant to all existing EGFR TKIs, efforts are currently ongoing to develop new strategies or novel compounds to specifically target this resistance mechanism.

Nanoscale electrochemical kinetics & dynamics: the challenges and opportunities of single-entity measurements

The development of nanoscale electrochemistry since the mid-1980s has been predominately coupled with steady-state voltammetric (i-E) methods. This research has been driven by the desire to understand the mechanisms of very fast electrochemical reactions, by electroanalytical measurements in small volumes and unusual media, including in vivo measurements, and by research on correlating electrocatalytic activity, e.g., O2 reduction reaction, with nanoparticle size and structure. Exploration of the behavior of nanoelectrochemical structures (nanoelectrodes, nanoparticles, nanogap cells, etc.) of a characteristic dimension λ using steady-state i-E methods generally relies on the well-known relationship, λ2 ∼ Dt, which relates diffusional lengths to time, t, through the coefficient, D. Decreasing λ, by performing measurements at a nanometric length scales, results in a decrease in the effective timescale of the measurement, and provides a direct means to probe the kinetics of steps associated with very rapid electrochemical reactions. For instance, steady-state voltammetry using a nanogap twin-electrode cell of characteristic width, λ ∼ 10 nm, allows investigations of events occurring at timescales on the order of ∼100 ns. Among many other advantages, decreasing λ also increases spatial resolution in electrochemical imaging, e.g., in scanning electrochemical microscopy, and allows probing of the electric double layer. This Introductory Lecture traces the evolution and driving forces behind the "λ2 ∼ Dt" steady-state approach to nanoscale electrochemistry, beginning in the late 1950s with the introduction of the rotating ring-disk electrode and twin-electrode thin-layer cells, and evolving to current-day investigations using nanoelectrodes, scanning nanocells for imaging, nanopores, and nanoparticles. The recent focus on so-called "single-entity" electrochemistry, in which individual and very short redox events are probed, is a significant departure from the steady-state approach, but provides new opportunities to probe reaction dynamics. The stochastic nature of very fast single-entity events challenges current electrochemical methods and modern electronics, as illustrated using recent experiments from the authors' laboratory.

Modeling the Impacts of Manure on Phosphorus Loss in Surface Runoff and Subsurface Drainage

Simulation of phosphorus (P) transfer from manured agricultural lands to water bodies via surface runoff and subsurface drainage is potentially of great help in evaluating the risks and effects of eutrophication under a range of best management practice scenarios. However, it remains a challenge since few models are capable of providing a reasonably accurate prediction of P losses under manure treatment. The Environmental Policy Integrated Climate (EPIC) model was applied to simulate the impacts on dissolved reactive P (DRP) losses through surface runoff and subsurface drainage from a solid cattle manure-amended corn ( L.)-soybean [ (L.) Merr.] rotation on a clay loam soil (Vertisol) located in the Lake Erie region. Simulations of DRP loss in surface runoff and tile drainage were satisfactory; however, EPIC did not consider DRP loss directly from manure, weakening its accuracy in the prediction of DRP loss in surface runoff. Having previously drawn on EPIC-predicted surface runoff to initiate SurPhos (Surface Phosphorus and Runoff Model) predictions of DRP losses strictly in surface runoff, no comparison had been made of differences in manure application impacts on EPIC- or SurPhos-predicted DRP losses-accordingly, this was assessed. The SurPhos improved the estimation of DRP loss in surface runoff (Nash-Sutcliffe coefficient, 0.53), especially when large rain events occurred immediately after or within 6 wk of manure application. Generally, EPIC can capture the impacts of manure application on DRP loss in surface runoff and subsurface drainage; however, coupling of the EPIC and SurPhos models increased the accuracy of simulation of runoff DRP losses.

Modeling phosphorus losses from soils amended with cattle manures and chemical fertilizers

While applied manure/fertilizer is an important source of P loss in surface runoff, few models simulate the direct transfer of phosphorus (P) from soil-surface-applied manure/fertilizer to surface runoff. The SurPhos model was tested with 2008-2010 growing season daily surface runoff data from clay loam experimental plots subject to different manure/fertilizer applications. Model performance was evaluated on the basis of the coefficient of determination (R²), Nash-Sutcliffe efficiency (NSE), percent bias (PBIAS), and the ratio of the root mean square error to the standard deviation of observed values (RSR). The model offered an acceptable performance in simulating soil labile P dynamics (R² = 0.75, NSE = 0.55, PBIAS = 10.43%, and RSR = 0.67) and dissolved reactive P (DRP) loss in surface runoff (R² ≥ 0.74 and NSE ≥ 0.69) for both solid and liquid cattle manure, as well as inorganic fertilizer. Simulated direct P loss in surface runoff from solid and liquid cattle manure accounted for 39% and 40% of total growing season DRP losses in surface runoff. To compensate for the unavailability of daily surface runoff observations under snow melt condition, the whole four years' (2008-2011) daily surface runoff predicted by EPIC (Environmental Policy Integrated Climate) was used as SurPhos input. The accuracy of simulated DRP loss in surface runoff under the different manure/fertilizer treatments was acceptable (R² ≥ 0.55 and NSE ≥ 0.50). For the solid cattle manure treatment, of all annual DRP losses, 19% were derived directly from the manure. Beyond offering a reliable prediction of manure/fertilizer P loss in surface runoff, SurPhos quantified different sources of DRP loss and dynamic labile P in soil, allowing a better critical assessment of different P management measures' effectiveness in mitigating DRP losses.

Long-term Cropping Effects on Partitioning of Water Flow and Nitrate Loss between Surface Runoff and Tile Drainage

Surface runoff and tile drainage are the main pathways for water movement and entry of agricultural nitrate into water resources. The objective of this 5-yr study was to characterize the partitioning of water flow and nitrate loss between these pathways for a humid-temperate Brookston clay loam soil under 54 to 59 yr of consistent cropping and fertilization. Cropping treatments included monoculture corn ( L., MC), continuous bluegrass ( L.) sod (CS), and a corn-oat-alfalfa ( L.)-alfalfa rotation (RC-RO-RA1-RA2). Fertilization treatments included annual fertilizer addition (F) and no fertilizer addition (NF). Tile drainage and surface runoff occurred primarily during the nongrowing season (November-April), and they were highly correlated with the mean saturated hydraulic conductivity of the near-surface soil profile. Tile drainage accounted for 69 to 90% of cumulative water flow and 79 to 96% of cumulative nitrate loss from fertilized rotation and CS, whereas surface runoff accounted for the majority of the nitrate losses in MC (i.e., 75-93% of water flow and 65-96% of nitrate loss). Cumulative nitrate losses were highest in the RC-F (152 kg N ha), RC-NF (101 kg N ha), RA2-F (121 kg N ha), and RA2-NF (75 kg N ha) plots, and these high losses are attributed to N mineralization from the plowed alfalfa and fertilization (if applicable). Fertilization increased cumulative nitrate loss in tile drainage from all treatments, whereas no fertilization increased cumulative nitrate loss in surface runoff from the rotation. Cropping system and fertilization on clay loam soil changed how water flow and nitrate loss were partitioned between tile drainage and surface runoff.

Phase Ib/II randomized, open-label study of doxorubicin and cyclophosphamide with or without low-dose, short-course sunitinib in the pre-operative treatment of breast cancer

Background

Prolonged anti-angiogenic therapy destroys tumor vasculature, whereas vascular-normalizing doses may enhance intra-tumoral drug delivery. We hypothesize that low-dose, short-course sunitinib normalizes vasculature, enhancing chemotherapy efficacy.

Patients and Methods

In phase Ib, treatment-naïve breast cancer patients received four cycles of pre-operative doxorubicin/cyclophosphamide, with sunitinib before each cycle. The optimal dose of sunitinib leading to tumor vessel normalization on immunohistochemistry was identified. In phase II, subjects were randomized to chemotherapy alone or chemotherapy plus sunitinib at the recommended phase II dose (RP2D). Primary endpoint was pathological complete response (pCR) rate. Tumor and functional imaging biomarkers were evaluated serially.

Results

In phase Ib (n=9), sunitinib 12.5 mg daily for 7 days before each chemotherapy was established as RP2D. In phase II, patients receiving chemotherapy plus sunitinib (n=24) had similar pCR rates (5.0% versus 4.3%, p=1.00), but a higher incidence of chemotherapy dose delays (33.3% versus 8.7%, p=0.04), compared to those receiving chemotherapy alone (n=25). The addition of sunitinib to chemotherapy significantly increased vascular normalization index (VNI) and decreased lymphatic vessel density (D2-40) on immunohistochemistry [VNI:25.50±27.94% versus 49.29±31.84%, p=0.034; D2-40:3.29±2.70 versus 1.29±1.54, p=0.014, baseline versus post-cycle 1], and improved perfusion on DCE-MRI (K^trans:12.6±9.6 mL/100 g/min versus 16.3±10.7 mL/100 g/min, baseline versus post-cycle 1, p=0.015). Conversely, immunohistochemical and DCE-MRI parameters were not significantly altered by chemotherapy alone.

Conclusion

Low-dose, short-course sunitinib prior to anthracycline-based chemotherapy in breast cancer patients did not improve pCR and increased chemotherapy dose delays. However, the addition of sunitinib induced compelling pharmacodynamic evidence of vascular normalization. Further studies with alternative cytotoxic regimens should be explored.

Self-reported domain-specific and accelerometer-based physical activity and sedentary behaviour in relation to psychological distress among an urban Asian population

Background

The interpretation of previous studies on the association of physical activity and sedentary behaviour with psychological health is limited by the use of mostly self-reported physical activity and sedentary behaviour, and a focus on Western populations. We aimed to explore the association of self-reported and devise-based measures of physical activity and sedentary behaviour domains on psychological distress in an urban multi-ethnic Asian population.

Methods

From a population-based cross-sectional study of adults aged 18–79 years, data were used from an overall sample (n = 2653) with complete self-reported total physical activity/sedentary behaviour and domain-specific physical activity data, and a subsample (n = 703) with self-reported domain-specific sedentary behaviour and accelerometry data. Physical activity and sedentary behaviour data were collected using the Global Physical Activity Questionnaire (GPAQ), a domain-specific sedentary behaviour questionnaire and accelerometers. The Kessler Screening Scale (K6) and General Health Questionnaire (GHQ-12) were used to assess psychological distress. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals, adjusted for socio-demographic and lifestyle characteristics.

Results

The sample comprised 45.0% men (median age = 45.0 years). The prevalence of psychological distress based on the K6 and GHQ-12 was 8.4% and 21.7%, respectively. In the adjusted model, higher levels of self-reported moderate-to-vigorous physical activity (MVPA) were associated with significantly higher odds for K6 (OR = 1.47 [1.03–2.10]; p-trend = 0.03) but not GHQ-12 (OR = 0.97 [0.77–1.23]; p-trend = 0.79), when comparing the highest with the lowest tertile. Accelerometry-assessed MVPA was not significantly associated with K6 (p-trend = 0.50) nor GHQ-12 (p-trend = 0.74). The highest tertile of leisure-time physical activity, but not work- or transport-domain activity, was associated with less psychological distress using K6 (OR = 0.65 [0.43–0.97]; p-trend = 0.02) and GHQ-12 (OR = 0.72 [0.55–0.93]; p-trend = 0.01). Self-reported sedentary behaviour was not associated with K6 (p-trend = 0.90) and GHQ-12 (p-trend = 0.33). The highest tertile of accelerometry-assessed sedentary behaviour was associated with significantly higher odds for K6 (OR = 1.93 [1.00–3.75]; p-trend = 0.04), but not GHQ-12 (OR = 1.34 [0.86–2.08]; p-trend = 0.18).

Conclusions

Higher levels of leisure-time physical activity and lower levels of accelerometer-based sedentary behaviour were associated with lower psychological distress. This study underscores the importance of assessing accelerometer-based and domain-specific activity in relation to mental health, instead of solely focusing on total volume of activity.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0669-1) contains supplementary material, which is available to authorized users.

Environmental Indicator Principium with Case References to Agricultural Soil, Water, and Air Quality and Model-Derived Indicators

Environmental indicators are powerful tools for tracking environmental changes, measuring environmental performance, and informing policymakers. Many diverse environmental indicators, including agricultural environmental indicators, are currently in use or being developed. This special collection of technical papers expands on the peer-reviewed literature on environmental indicators and their application to important current issues in the following areas: (i) model-derived indicators to indicate phosphorus losses from arable land to surface runoff and subsurface drainage, (ii) glutathione-ascorbate cycle-related antioxidants as early-warning bioindicators of polybrominated diphenyl ether toxicity in mangroves, and (iii) assessing the effectiveness of using organic matrix biobeds to limit herbicide dissipation from agricultural fields, thereby controlling on-farm point-source pollution. This introductory review also provides an overview of environmental indicators, mainly for agriculture, with examples related to the quality of the agricultural soil-water-air continuum and the application of model-derived indicators. Current knowledge gaps and future lines of investigation are also discussed. It appears that environmental indicators, particularly those for agriculture, work efficiently at the field, catchment, and local scales and serve as valuable metrics of system functioning and response; however, these indicators need to be refined or further developed to comprehensively meet community expectations in terms of providing a consistent picture of relevant issues and/or allowing comparisons to be made nationally or internationally.

Modeling Phosphorus Losses through Surface Runoff and Subsurface Drainage Using ICECREAM

Modeling soil phosphorus (P) losses by surface and subsurface flow pathways is essential in developing successful strategies for P pollution control. We used the ICECREAM model to simultaneously simulate P losses in surface and subsurface flow, as well as to assess effectiveness of field practices in reducing P losses. Monitoring data from a mineral-P-fertilized clay loam field in southwestern Ontario, Canada, were used for calibration and validation. After careful adjustment of model parameters, ICECREAM was shown to satisfactorily simulate all major processes of surface and subsurface P losses. When the calibrated model was used to assess tillage and fertilizer management scenarios, results point to a 10% reduction in total P losses by shifting autumn tillage to spring, and a 25.4% reduction in total P losses by injecting fertilizer rather than broadcasting. Although the ICECREAM model was effective in simulating surface and subsurface P losses when thoroughly calibrated, further testing is needed to confirm these results with manure P application. As illustrated here, successful use of simulation models requires careful verification of model routines and comprehensive calibration to ensure that site-specific processes are accurately represented.

Solid Cattle Manure Less Prone to Phosphorus Loss in Tile Drainage Water

Forms (e.g., liquid and solid) of manure influence the risk of P loss after land application. The objective of this study was to investigate the effects of P-based application of various forms of cattle manure (liquid, LCM; or solid, SCM) or inorganic P as triple superphosphate (IP) on soil P losses in tile drainage water. A 4-yr field experiment was conducted in a clay loam soil with a corn ( L.)-soybean [ (L.) Merr.] rotation in the Lake Erie basin. Over the 4 yr, the dissolved reactive P (DRP) flow-weighted mean concentration (FWMC) in tile drainage water was greater under SCM fertilization than under either IP or LCM fertilization. Despite its lower value on an annual basis, DRP FWMC rose dramatically immediately after LCM application. However, the differences in DRP FWMC did not result in detectable differences in DRP loads. Regarding particulate P and total P losses during the 4 yr, they were 68 and 47%, respectively, lower in the soils amended with SCM than in those with IP, whereas both values were similar between IP and LCM treatments. Overall, the P contained in solid cattle manure was less prone to P loss after land application. Accordingly, the present results can provide a basis for manure storage and application of best management practices designed to reduce P losses and improve crop growth.

Third generation EGFR TKIs: current data and future directions

Acquired T790 M mutation is the commonest cause of resistance for advanced non-small cell lung cancer (NSCLC) epidermal growth factor receptor (EGFR) mutant patients who had progressed after first line EGFR TKI (tyrosine kinase inhibitor). Several third generation EGFR TKIs which are EGFR mutant selective and wild-type (WT) sparing were developed to treat these patients with T790 M acquired resistant mutation. Osimertinib is one of the third generation EGFR TKIs and is currently the most advanced in clinical development. Unfortunately, despite good initial response, patients who was treated with third generation EGFR TKI would develop acquired resistance and several mechanisms had been identified and the commonest being C797S mutation at exon 20. Several novel treatment options were being developed for patients who had progressed on third generation EGFR TKI but they are still in the early phase of development. Osimertinib under FLAURA study had been shown to have better progression-free survival over first generation EGFR TKI in the first line setting and likely will become the new standard of care.