Strong social relationships consistently predict the quality of both physical and mental health. Society commonly recognizes the marriage relationship as one of the most committed, enduring relationships. While marital status alone can strongly predict health, it appears that moderating factors exist in this association. The quality of one's marriage can have a greater effect on health than marital status alone. We conducted a meta-analysis examining the strength of the influence that marital quality has on physical health, specifically indicated by mortality rates. To identify relevant articles, we searched multiple online databases (Embase, Psycinfo, Family and Society Studies Worldwide, and Academic Search Ultimate) up to May, 2021. We included studies that had a measure of marital quality linked with a measure of mortality. We identified 23 articles, with a combined total of 73,492 participants. We pre-registered this analysis with the PROSPERO International Prospective Register of Systematic Reviews Registration #CRD42020145352. Members of the research team coded each relevant article for the variables in the study. We then analyzed the data using random effects models. Results indicated that a statistically significant relationship exists between marital quality and survival across all studies reviewed, with high-quality marriage being positively associated with improved survival rates (OR = 1.265, 95% CI = 1.08 to 1.48, p = .003, n = 10, HR = 1.15, 95% CI = 1.05 to 1.26, p = .004, n = 12). Moderation analyses identified that the association tended to be much stronger when studies evaluated patients with a physical illness than when studies involved community samples with ostensibly normal levels of physical health. Thus the influence of marital quality on longevity is most pronounced when one of the spouses has poor health. These results support an increased focus on marital considerations in psychology, public health, and medical care.

Objective: to compare dietary treatments and their effectiveness in reducing seizures through a systematic review and meta-analysis of clinical trials Methods: Using the PRISMA Method, the Primo database was searched to find peer-reviewed articles where researchers compared one treatment against another. The treatments of choice present in all studies are the Ketogenic Diet and the Modified Atkins Diet. Due to the nature of the experiments, the Ketogenic Diet was considered the control, as it was coined first. Results: Of the 450 articles identified, 378 met the primary peer review threshold and 190 were classified as Open Access. Eight met eligibility and were included in this review. 443 patients across all studies were assigned either a Ketogenic Diet or a Modified Atkins Diet for a median period of 3 months. 48.17% of MAD patients had a significant decrease in seizure frequency, compared to 61.11% of patients under KD. As much as the ketogenic diet showed better results overall, there was no statistical difference in the odds of achieving a significant reduction in seizures using either diet. Significance: Trials suggest that while there was not a significant difference in this study between the ketogenic diet and the modified Atkins diet, there was a trend for ketogenic diets to be more effective than the more recent Modified Atkins diet for drug-resistant epileptics. However, the sample size needs to be increased before a more accurate determination can be made.

Genome-wide microarray technology has facilitated the systematic discovery of diagnostic biomarkers of cancers and other pathologies. However, meta-analyses of published arrays using melanoma as a test cancer has uncovered significant inconsistences that hinder advances in clinical practice. In this study a computational model for the integrated analysis of microarray datasets is proposed in order to provide a robust ranking of genes in terms of their relative significance; both genome-wide relative significance (GWRS) and genome-wide global significance (GWGS). When applied to five melanoma microarray datasets published between 2000 and 2011, a new 12-gene diagnostic biomarker signature for melanoma was defined (i.e., EGFR, FGFR2, FGFR3, IL8, PTPRF, TNC, CXCL13, COL11A1, CHP2, SHC4, PPP2R2C, and WNT4). Of these, CXCL13, COL11A1, PTPRF and SHC4 are components of the MAPK pathway and were validated by immunocyto- and immunohisto-chemistry. These proteins were found to be overexpressed in metastatic and primary melanoma cells in vitro and in melanoma tissue in situ compared to melanocytes cultured from healthy skin epidermis and normal healthy human skin. One challenge for the integrated analysis of microarray data is that the microarray data are produced using different platforms and bio-samples, e.g. including both cell line- and biopsy-based microarray datasets. In order to address these challenges, the computational model was further enhanced the stratification of datasets into either biopsy or cell line derived datasets, and via the weighting of microarray data based on quality criteria of data. The methods enhancement was applied to 14 microarray datasets of three cancers (breast, prostate, and melanoma) based on classification accuracy and on the capability to identify predictive biomarkers. Four novel measures for evaluating the capability to identify predictive biomarkers are proposed: (1) classifying independent testing data using wrapper feature selection with machine leaning, (2) assessing the number of common genes with the genes retrieved in independent testing data, (3) assessing the number of common genes with the genes retrieved in across multiple training datasets, (4) assessing the number of common genes with the genes validated in the literature. This enhancement of computational approach (i) achieved reliable classification performance across multiple datasets, (ii) recognized more significant genes into the top-ranked genes as compared to the genes detected by the independent test data, and (iii) detected more meaningful genes than were validated in previous melanoma studies in the literature.

The larynx is the mammalian organ of vocalization. Humans have a degree of control over this organ considerably beyond the abilities of other primates, most notably in our control over the larynx during speech. Although there is an abundance of research on the neural basis of speech, relatively little of this research has focused on the control of the larynx. First, I performed a meta-analysis to search for brain areas responsible for making explicit judgments about affective prosody to identify candidate premotor areas in prefrontal cortex that may also plan the affective component of affective prosody (Chapter 2). The inferior frontal gyrus pars orbitalis was the only prefrontal region preferentially engaged by affective vocalizations. Second, I used functional magnetic resonance imaging to determine whether there are discrete neural systems for producing innate-affective versus arbitrary non-affective vocalizations in the human brain, as has been predicted from non-human primate models (Chapter 3). The vocal-motor system demonstrated a lack of specialization since both types of vocalizations engaged the entire network. Third, I searched for brain areas that were preferentially engaged during vocal imitation (Chapter 4), which is a key process in vocal learning. Vocal imitation preferentially engaged a cortico-striate network similar to that predicted from avian models of vocal imitation. Finally, I performed a meta-analysis to explore the neural basis of persistent developmental stuttering (Chapter 5), a speech disorder that is associated with poor control of the laryngeal muscles. Among other brain areas, primary motor regions controlling the larynx were abnormally activated in the brains of people who stutter. Together these studies advance our knowledge of the human vocal-motor system, how it relates to that in other species, and how this system may be disrupted in persistent developmental stuttering. I discuss remaining gaps in our knowledge that will be the focus of my future research. / Dissertation / Doctor of Philosophy (PhD) / One hallmark of the human species is our ability to talk. This dissertation describes a body of research that uses modern brain imaging technology ¬to study the brain systems that underlie this ability in humans –referred to as the vocal-motor system. It then compares this system in humans to the closest equivalent in monkeys, since monkeys lack this ability but share relatively recent common ancestry with humans. It also makes comparisons with the brains of songbirds, since the ability of juvenile songbirds to learn songs may share similarities with the human ability to learn speech. Finally, it looks at the potential dysfunction of this system in the brains of people who stutter.

Background and Objectives: Mesothelin, identified as a tumor-associated biomarker, is more often overexpressed in triple receptor-negative breast cancer (TNBC) than in common luminal breast tumor subtype or normal tissues. The objective of this systematic review is to determine the association between the expressions of mesothelin with survival outcomes in patients with TNBC. Methods We searched the following electronic databases: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, PubMed, and Web of Science with no time or language restriction till May 19, 2016. Any prospective or retrospective longitudinal studies that investigate the prognosis of TNBC with mesothelin baseline measurement were selected. Two reviewers independently assessed every article for inclusion, extracted data, and assessed the methodological quality of every eligible trial. Pooled measures of associations were summarized with meta-analyses. Results and conclusions Among the 592 patients with TNBC included in the four eligible studies, 269 patients (45.4%) demonstrated mesothelin expression. For the primary outcome OS, we found the trend toward decreased survival for patients with mesothelin-positive TNBC than those without mesothelin expression. We also found that for long-term OS, the association was statistically significant (OR = 0.46; 95% CI= 0.30 to 0.73; P< 0.001). For the secondary outcomes, we found that mesothelin expression in patients with TNBC was associated with lower DFS and higher overall mortality than those without mesothelin expression. Despite the limitations of sample size, this present study shows a significant association between mesothelin expressions and survival outcomes in patients with TNBC. Patients with mesothelin-positive TNBC could benefit from mesothelin-targeted immunotherapies recently in the development. / Thesis / Master of Science (MSc) / It is unclear whether mesothelin expression in triple-negative breast cancer (TNBC) is an independent prognostic marker for survival. To the best of our knowledge, no systematic review or meta-analysis has ever been done on this topic. The present systematic review aims to evaluate the role of mesothelin as a prognostic marker for TNBC. The primary objective of this review is to synthesize available evidence on the association between the expression of mesothelin and overall survival (OS) of patients with TNBC. The secondary objectives include determining the relationship between the expression of mesothelin and disease-free survival (DFS), distant metastases, and mortality. Despite some limitations, this study shows a significant association between mesothelin expressions and long-term OS rate as well as DFS rate and mortality rate in patients with TNBC. Mesothelin has a prognostic significance for patients with mesothelin based on our findings. Patients with mesothelin-positive TNBC could benefit from mesothelin-targeted immunotherapies in development.

Neurocognitive events after surgery, can occur as an acute event, such as postoperative delirium (POD) or in the form of decline in cognitive performance in the early or delayed postoperative period such as postoperative cognitive dysfunction (POCD). Neurocognitive events are patient- important outcomes which are associated with an increased risk of adverse outcomes. Surgery has been suggested to be a trigger for POD and to be associated with cognitive decline after surgery. Postoperative pain is common after surgery, and it is biologically plausible for pain to play a role in the development of neurocognitive outcomes. This thesis comprises six chapters focusing on pain and neurocognitive outcomes after non-cardiac surgery in older patients. Chapter 1 is an introduction and rationale for the included studies. Chapter 2 is a protocol for a series of systematic reviews to summarize the evidence regarding the association between postoperative pain (acute and chronic) and opioid-sparing pain management strategies for acute and chronic postoperative pain, and the incidence of POD and POCD. Chapter 3 reports the results of a systematic review and dose-response meta-analysis of observational studies evaluating the association of postoperative pain and POD and POCD. Chapter 4 describes a methodological approach to evaluate the robustness of meta-analyses with POD as an outcome to the variation in the methods (timing and frequency) of POD assessment. Chapter 5 presents the results of the Co-TELESURGE study, a longitudinal prospective cohort study of perioperative cognitive trajectories in older adults who were waiting for elective non-cardiac surgery during the COVID-19 pandemic. Chapter 6 discusses the key findings, limitations, implications for research, future recommendations and final conclusions of the research presented in this doctoral thesis. / Thesis / Doctor of Philosophy (PhD)

Background: Cannabis is increasingly used for management of chronic pain; however, the benefits and harms of this therapy remain uncertain. We conducted a systematic review to inform harms associated with inhaled cannabis for chronic pain. Methods: We searched MEDLINE, EMBASE, PsychInfo, and Web of Science for non-randomized studies reporting on harms associated with inhaled cannabis use, from inception to October 6, 2021. We used random-effects models for meta-analyses and assessed the certainty of evidence using the GRADE approach. Results: We identified 29 eligible studies enrolling 174,562 participants that reported 145 adverse events. Moderate certainty evidence suggests inhaled cannabis use is probably associated with dry mouth (prevalence: 56%; 95%CI 49 to 64), thirst (prevalence: 44%; 95% CI 33 to 55), fatigue (prevalence: 38%; 95%CI 31 to 45), nausea (prevalence: 17%; 95%CI 8 to 27), increased appetite (prevalence: 13%; 95%CI 9 to 18), dizziness (prevalence: 10%; 95%CI 6 to 14), diarrhea (prevalence: 9%; 95%CI 3 to 18), confusion (prevalence: 9%; 95%CI 5 to 13), mood changes (prevalence: 8%; 95%CI 4 to 15), hallucinations (prevalence: 7%; 95%CI 4 to 10), amnesia (prevalence: 6%; 95%CI 3 to 11), impaired coordination (prevalence: 5%; 95%CI 4 to 6), and disorientation (prevalence: 3%; 95%CI 1 to 7). Moderate certainty evidence shows that, compared to non-users, inhaling cannabis is probably associated with increased risk of shortness of breath (risk difference [RD]: 7%; 95%CI 4 to 10). Conclusions: Our review found moderate certainty evidence that dry mouth, thirst, and fatigue are probably frequently experienced with inhaled cannabis use. Several other adverse events are also probable associated with inhaled cannabis use but were less common. Rigorously conducted cohort studies are needed to inform harms associated with inhaled medical cannabis for chronic pain. / Thesis / Master of Science (MSc) / Increasing recognition of harms associated with long-term opioid therapy for management of chronic pain has generated enthusiasm for alternatives, including medical cannabis which is often consumed through inhalation. This review assesses the harms associated with the use of inhaled cannabis for management of chronic pain. Among serious adverse events, we found that inhaled cannabis is likely associated with amnesia, disorientation, impaired coordination, hallucinations, confusion, dizziness, chronic wheeze, and shortness of breath. Inhaled cannabis may be associated with palpitations, paranoia, anxiety, and cannabis dependence. The effects of inhaled cannabis on lung cancer, depression, and psychosis were uncertain. Among less serious adverse events, we found that inhaled cannabis is likely associated with thirst, fatigue, increased appetite, nausea, mood changes, diarrhea, and dry mouth. Inhaled cannabis may be associated with red eyes, vomiting, phlegm, asthma, and cough. The effects of inhaled cannabis on euphoria and irritability were uncertain.

The prevalence rate of childhood obesity has increased rapidly worldwide. The childhood obesity epidemic is associated with many adverse health consequences in children as well as a financial burden for a nation’s economy. A meta-analysis was conducted to investigate the effectiveness of school-based childhood obesity prevention programs in preventing childhood obesity. The objectives of this study were to 1) identify the most effective childhood obesity prevention programs through effect size comparison, and 2) identify important program components that affect the effectiveness of the intervention through subgroup analysis. The Comprehensive Meta-Analysis (CMA) program was used for all statistical analyses. Results of the meta-analysis demonstrated that the summary effect size was small (d = 0.039, 95% confidence interval). The school-based program identified in the meta-analysis as the most effective had a d value of 0.368. Subgroup analyses were performed because this meta-analysis study was heterogeneous (Q = 167.774, p = 0.001) with an I2 value of 68.410%. The subgroup moderators were length of program duration, age of participants, nutrition, physical activity, parental involvement, specialist involvement, and theory based versus non-theory based intervention programs. Subgroup analyses demonstrated that significant differences (p < 0.05) occurred among the moderator components. Programs that targeted younger children less than ten years old and programs that were theory based were more effective. The meta-analysis study contained publication bias because the funnel plot was skewed and smaller studies were missing. To further explore the publication bias problem, Classic fail-safe N and Duval and Tweedie’s trim and fill analyses were performed. Classic fail-safe N indicated that two programs were missing from the present study to achieve a non-biased result. The Duval and Tweedie’s trim and fill analysis demonstrated that a small mean effect size difference was detected between the present observed studies and the unbiased effect size. The small mean effect size difference indicated that the results and the reported effect sizes in this meta-analysis study were valid.

No description available.

No description available.