University of Toronto: Journal Publishing Services
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Identifying Cough Trajectories to Predict Asthma Outcomes: Insights from Growth Based Trajectory Modelling and Generalized Estimating Equations
No full textBackground: Coughing is common in early childhood. While often benign, cough could be an early sign of chronic pediatric conditions, such as asthma, which are associated with adverse long-term effects. Therefore, understanding the temporal pattern of coughing is essential to inform timely prevention, diagnosis, and treatment.
Objectives: This study aimed to identify distinct cough trajectories from infancy (3 months) to preschool (up to 5 years of age) using parent-reported data from 3,454 children in the CHILD Cohort Study. We then examined how these patterns relate to health outcomes and healthcare-seeking behaviours.
Methods: Group-based trajectory modeling (GBTM) was applied to classify participants into latent subgroups with similar cough trajectories. Model selection was based on BIC, AIC, posterior probabilities, and clinical interpretability. Generalized Estimating Equations (GEE) were subsequently used to assess associations between cough trajectories and respiratory morbidity, including asthma, unscheduled doctor visits, emergency department/hospital visits, and medication use.
Results: A three-group model, including never/infrequent, early-onset, and late-onset cough, was selected based on the lowest BIC and AIC values, with median posterior probabilities exceeding 70%. Using GEEs, we found that membership in the late-onset cough trajectory was significantly associated with increased risk of unscheduled doctor visits and bronchodilator use by preschool, after adjusting for confounders. No significant associations were observed between early-onset cough and respiratory outcomes after confounder adjustment.
Conclusions: Late-onset cough (starting at 3-4 years) was associated with increased bronchodilator use and primary healthcare utilization, suggesting it may be an early marker of respiratory vulnerability. These findings underscore the importance of cough and its timing in identifying children at risk for persistent respiratory morbidity
L’arte dell’inganno: Machiavelli and the Execution of the Florentine Captain-General Paolo Vitelli
No full textThis article addresses Niccolò Machiavelli’s role in a five-century-long controversy surrounding the execution of the Florentine captain-general Paolo Vitelli in October 1499. The official letters and dispatches Machiavelli wrote shortly before and after the event portrayed Vitelli as a traitor, thus defending the Signoria’s decision to execute the captain. In chapter 12 of The Prince, however, Machiavelli changes his tone, implying that it was not the alleged treason but the captain’s fame and Florentine insecurity that lead to his death. Given that many contemporaries praised Vitelli and seriously doubted his guilt, Machiavelli’s ambivalent positioning requires explanation. By way of the first sustained analysis of the Vitelli affair, this article will shed new light on Machiavelli’s early involvement in Florence’s political machinations. It will show how Machiavelli, as a loyal servant to his beloved Republic, coordinated, defended, and justified in his writings the course of action against Vitelli.Cet article traite du rôle joué par Nicolas Machiavel dans une controverse longue de cinq siècles : l’exécution du capitaine général florentin Paolo Vitelli en octobre 1499. Les lettres et dépêches officielles rédigées par Machiavel peu avant et après l’événement présentaient Vitelli comme un traître, justifiant ainsi la décision de la Signoria d’exécuter le capitaine. Dans le chapitre 12 du Prince, Machiavel change toutefois de ton, laissant entendre que ce n’est pas la trahison présumée, mais la renommée du capitaine et l’insécurité florentine qui ont conduit à l’exécution. Étant donné que de nombreux contemporains ont fait l’éloge de Vitelli et sérieusement mis en doute sa culpabilité, la position ambivalente de Machiavel nécessite une explication. À travers la première analyse approfondie de l’affaire Vitelli, cet article jette un nouvel éclairage sur les premières interventions de Machiavel dans les intrigues politiques florentines. Il montre comment Machiavel, en loyal serviteur de sa république bien-aimée, a coordonné, défendu et justifié dans ses écrits les manœuvres entreprises contre Vitelli
Elucidating the effects of dialect contact on Lebanese and Palestinian Arabic in Beirut: A Variationist Perspective
No full textFocusing on dialect contact in Beirut, this study investigates whether Palestinian Arabic (PA) is converging with Lebanese Arabic (LA), the majority variety, in different linguistic components. Using the comparative variationist framework (Poplack and Tagliamonte 2001), the study combines synchronic and diachronic data sources to compare two variables in LA and PA: a phonological variable known as imala, involving the word-medial raising of /a:/ to [e:], and future temporal reference. Results reveal evidence of contact-induced change in PA in terms of word-medial imala, while the future system in PA diverges from that in LA. The findings for imala are consonant with previous claims that socially salient aspects of segmental phonology are particularly susceptible to convergent change (Trudgill 1986), because speakers’ awareness of word-medial imala and its iconic association with LA facilitate its adoption. On the other hand, the future is not subject to social assessment or normative commentary of any kind. These findings attest to the propensity of phonological and indexical variables to engage in convergent change
Early Interventions of Conduct Problems in At-Risk Youth: Strategies of Coordinated Communication
No full textPlaidoyer en faveur du jeu dans les bibliothèques universitaires
No full textAcademic libraries are evolving beyond their traditional role as centers for study and research. With growing concern over student stress, burnout, and wellbeing, libraries have an opportunity to support student success through creative means, including play. Play is often misunderstood and undervalued in adulthood, yet research shows it offers profound benefits. This perspective piece argues that academic libraries are uniquely positioned to offer students the opportunity and permission to engage in play, and that play has benefits to existing academic library spaces. Presenting three arguments examining the benefits of play in adulthood, for post-secondary students, and in academic libraries, this article advocates that play is a natural extension to the work being done to support students in academic library spaces.Les bibliothèques universitaires évoluent au-delà de leur rôle traditionnel de centres d\u27étude et de recherche. Face aux préoccupations croissantes concernant le stress, l\u27épuisement professionnel et le bien-être des étudiant.e.s, les bibliothèques ont la possibilité de favoriser la réussite des étudiant.e.s par des moyens créatifs, notamment le jeu. Le jeu est souvent mal compris et sous-estimé à l\u27âge adulte, mais des recherches montrent qu\u27il offre des avantages considérables. Cet article de réflexion soutient que les bibliothèques universitaires sont particulièrement bien placées pour offrir aux étudiant.e.s la possibilité et la permission de jouer, et que le jeu présente des avantages pour les espaces existants des bibliothèques universitaires. Présentant trois arguments qui examinent les avantages du jeu à l\u27âge adulte, pour les étudiant.e.s de l\u27enseignement supérieur et dans les bibliothèques universitaires, cet article soutient que le jeu est un prolongement naturel du travail effectué pour soutenir les étudiants dans les espaces des bibliothèques universitaires
AI-Driven Sleep Optimization for Mental Health Recovery using Reinforcement Learning
No full textBackground: Sleep deprivation is closely associated with a higher risk of depressive symptoms and can significantly impair psychological well-being. However, the ideal amount of sleep varies significantly across individuals. Reinforcement Learning (RL), a machine learning paradigm that optimizes decisions through trial and error, offers a promising approach to personalize sleep interventions for mental health improvement.
Objectives: This project applied RL to identify optimized sleep durations associated with improved depressive symptoms, as measured by changes in Patient Health Questionnaire-9 (PHQ-9) scores. Data from approximately 4000 participants in the 2017–2020 National Health and Nutrition Examination Survey (NHANES) cohort were used, which included demographic, behavioral, and mental health variables. The long-term goal is to incorporate additional individual factors, such as physical activity, in future design of therapeutic interventions
Methods: A Deep Q-Learning (DQN) RL model represented states as depression severity with aggregated PHA-9, actions as sleep duration adjustments, and rewards as improvements in depression severity. An epsilon-greedy policy was applied to the process, which balanced trying new sleep durations (i.e., exploration) with mostly choosing the current best-known duration (i.e., exploitation) to ensure optimal outcomes.
Results: The RL model identified that sleep duration adjustments were associated with significant reductions in depression severity . Despite variability in responsiveness, participants benefited from consistent, modest changes in sleep habits with recommended durations of 7-9 hours, aligning with the clinically optimal range.
Conclusions: RL-guided sleep optimization shows promise for improving depressive symptoms in responsive individuals. These results underscore the potential of AI-driven behavioral treatments in real-world healthcare settings, particularly within personalized care model
Reciprocal Association Between Endometriosis and Depressive Symptoms: Using Data from NHANES 2005–2006
No full textIntroduction: Endometriosis, a chronic inflammatory condition affecting approximately 10% of reproductive-aged women, is frequently underdiagnosed and commonly co-occurs with depressive symptoms. However, the nature and directionality of this association remain unclear. Prior work (Hu et al., 2023) has linked depressive symptom severity to endometriosis, but not the reverse association. We aimed to (1) reproduce Hu et al.’s findings linking depressive symptoms to endometriosis, (2) examine the association in the opposite direction, and (3) assess the robustness of both associations using matched analyses.
Methods: Using data from NHANES’s 2005–2006 cycle, we conducted (1) survey-weighted logistic regression with endometriosis (yes/no) as the outcome and PHQ-9 scores (continuous and categorical) as the exposures; (2) linear and multinomial regression with PHQ-9 scores (continuous and categorical: none/moderate/severe) as outcomes and endometriosis status as the exposure; and (3) exact and nearest-neighbor matching on age, race, and income, followed by conditional logistic regression. Preliminary exploration of machine learning methods (e.g., causal forests) was also conducted.
Results: The reverse association analysis indicated a significant relationship between endometriosis and moderate (vs. no) depressive symptom severity (OR = 2.11, 95% CI: 1.12–4.00). Matched analyses further strengthened both associations (endometriosis as outcome: OR = 2.87, 95% CI: 1.42–5.80; depressive symptoms (yes/no) as outcome: OR = 2.32, 95% CI: 1.21–4.45).
Discussion: While evidence supports a reciprocal association between endometriosis and depressive symptoms, the cross-sectional design limits causal interpretation. Findings highlight the clinical value of screening for depressive symptoms in patients with endometriosis, and vice versa, warranting future causal investigation
Colorectal Neoplasia in Young Adults
No full textBackground: Colorectal cancer (CRC) is a significant health concern globally, being the second leading cause of cancer-related deaths in men and a third in women within Canada with a growing trend among young adults worldwide. However, research on colorectal neoplasia in young adults, particularly in Southeast Asia, is limited.
Objectives: The goal of the study is to identify risk factors associated with advanced colorectal neoplasia (ACN) in young adults and propose an evidence-based age cut-off for CRC screening.
Methods: We conducted a retrospective cohort study of 130 young adult patients in the Philippines. Patient demographic and clinical variables, such as age, gender, family history of CRC, location of the lesion and type of service, were analyzed. A multivariable logistic regression model was used to determine significant predictors of ACN. Multiple predictive models were trained using three-fold cross-validation. An age cut-off was determined using the receiver operating characteristic (ROC) curve.
Results: We identified age, gender, family history, and lesion location to be the significant predictors of ACN. The odds of ACN increased with age (OR [95% CI]: 1.10 [1.05, 1.16]), in females (2.62 [1.07, 6.75]), and among individuals with a family history of CRC (13.5 [3.12, 97.0]). Left-sided lesions such as lesions in the descending colon (5.78 [1.31, 29.0]) were more strongly associated with ACN than the right-sided lesions in the cecum and ascending colon. The ROC curve identified 36 years as the optimal age cut-off for ACN risk stratification.
Conclusions: These findings can inform health policy to improve early detection of CRC and provide a foundation for revising the recommended age for CRC screening in young adults, particularly in the Philippines