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The hazard function plays a central role in survival analysis. In a homogeneous population, the distribution of the time to event, described by the hazard, is the same for each individual. Heterogeneity in the distributions can be accounted for by including covariates in a model for the hazard, for instance a proportional hazards model. In this model, individuals with the same value of the covariates will have the same distribution. It is natural to think that not all covariates that are thought to influence the distribution of the survival outcome are included in the model. This implies that there is unobserved heterogeneity; individuals with the same value of the covariates may have different distributions. One way of accounting for this unobserved heterogeneity is to include random effects in the model. In the context of hazard models for time to event outcomes, such random effects are called frailties, and the resulting models are called frailty models. In this tutorial, we study frailty models for survival outcomes. We illustrate how frailties induce selection of healthier individuals among survivors, and show how shared frailties can be used to model positively dependent survival outcomes in clustered data. The Laplace transform of the frailty distribution plays a central role in relating the hazards, conditional on the frailty, to hazards and survival functions observed in a population. Available software, mainly in R, will be discussed, and the use of frailty models is illustrated in two different applications, one on center effects and the other on recurrent events.Sparassis crispa (SC), known as cauliflower mushroom, possesses a wide variety of health-promoting properties and a high content of β-glucans. Its nutritional properties are enhanced by fermentation. In this study, we examined the efficacy of Lactobacillus-fermented (lacto-fermented) SC against obesity using a zebrafish model. We first fermented SC by Lactobacillus paracasei, denoted as lacto-fermented SC (L-SC), for 48 h and then orally administered SC or L-SC to diet-induced obese zebrafish for 4 weeks. Results demonstrated that the L-SC group (20 μg/gBW/day) significantly (P less then .01) suppressed body weight gain and ameliorated lipid accumulation in liver tissues, whereas SC did not exhibit antiobesity effects. We further performed expression analysis of genes related to lipid metabolism in the liver and visceral adipose tissues (VAT) in L-SC-administered fish. In liver tissues, L-SC upregulated (P less then .05) expression of genes involved in peroxisome proliferator-activated receptor alpha pathways, suggesting that the lipid-lowering property of L-SC is caused by activation of beta-oxidation. In VAT, L-SC did not show significant changes between the experimental groups. No difference was observed between the β-glucan contents of SC (43.8 g/100 g) and L-SC (44.3 g/100 g); however, β-glucan levels in the hot-water extracts increased 20-fold in L-SC (37.2 g/100 g) compared with those in SC (1.8 g/100 g). In summary, lacto-fermentation of SC enhances its lipid-lowering property and can prevent hepatic steatosis through activation of beta-oxidation. Dietary supplementation of fermented L-SC as a functional food may be suitable for obesity prevention and reduction in the prevalence of obesity-related diseases.Background Research suggests that acute alcohol consumption impairs processing of emotional faces. As emotion processing plays a key role in effective social interaction, these impairments may be one mechanism by which alcohol changes social behaviour. This study investigated the effect of individual differences on this relationship by comparing emotion recognition performance after acute alcohol consumption in individuals with high and low trait aggression. Methods Regular non-dependent drinkers, either high or low in trait aggression participated in a double-blind placebo-controlled experiment (N = 88, 50% high trait aggressive). Participants attended two sessions. In one they consumed an alcoholic drink (0.4 g/kg) and in the other they consumed a matched placebo. They then completed two computer-based tasks one measured global and emotion-specific recognition performance across six primary emotions (anger, sadness, happiness, disgust, fear, surprise), the other measured processing bias of two ambiguously expressive faces (happy-angry/happy-sad). Results There was evidence of poorer global emotion recognition after alcohol. In addition, there was evidence of poorer sensitivity to sadness and fear after alcohol. There was also evidence for a reduced bias towards happiness following alcohol and weak evidence for an increased bias towards sadness. Conclusions These findings suggest that alcohol impairs global emotion recognition. They also highlight a reduced ability to detect sadness and fearful facial expressions. As sadness and fear are cues of submission and distress (i.e. function to curtail aggression), failure to successfully detect these emotions when intoxicated may increase the likelihood of aggressive responding. This coupled with a reduced bias towards seeing happiness may collectively contribute to aggressive behaviour.Background Access barriers are all situations or conditions that limit seeking, receiving or enjoying benefits offered by the health system. This set of situations translates into underutilization of the services offered. In Colombia, there is little information about barriers to accessing medical care in general, and even less in the specific field of mental health. Aim To determine the barriers to accessing psychiatric care in outpatients in Santa Marta, Colombia. selleck chemicals llc Methods The authors designed a cross-sectional study with a non-probability sample of adult patients who consulted between August and December 2018. The barriers to access were measured with a 20-item version of the Barriers to Access to Care Evaluation (BACE) scale. Results A total of 247 patients participated; they were between 18 and 82 years (mean (M) = 47.5, standard deviation (SD) = 13.9). A total of 69 (27.9%) patients classified as having major attitudinal barriers; 62 (25.1%) patients, major barriers related to stigma-discrimination; and 41 (16.
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