Most existing cognitive diagnosis models (CDMs) assume attributes are binary latent variables, which may be oversimplified in practice. This article introduces a higher-order CDM with ordinal attributes for dichotomous response data. The proposed model can either incorporate domain experts' knowledge or learn from the data empirically by regularizing model parameters. A sequential item response model was employed for joint attribute distribution to accommodate the sequential mastery mechanism. The expectation-maximization algorithm was employed for model estimation, and a simulation study was conducted to assess the recovery of model parameters. A set of real data was also analyzed to assess the viability of the proposed model in practice.
  Vitamin D deficiency is widespread worldwide. In this study, we aimed to evaluate the effect of a nano encapsulated form of vitamin D used for fortifying low-fat dairy products (milk and yogurt) on anthropometric indices, glycemic status, and lipid profile in subjects with abdominal obesity.
 
  In a totally (quadruple) blinded, randomized, and parallel-controlled trial, 306 individuals with abdominal obesity were randomly allocated to one of four groups fortified low-fat yogurt (FY, 1500 IU nano encapsulated vitamin D
  per 150 g/d), non-fortified low-fat yogurt (nFY), fortified low-fat milk (FM, 1500 IU nano encapsulated vitamin D
  per 200 g/d), non-fortified low-fat milk (nFM), for 10 weeks (nFM and nFY, were considered as the control groups). Anthropometric and biochemical parameters were measured at baseline and after a ten-week trial in Mashhad, Iran.
 
  After the ten-week intervention, we found a significant increase in serum concentration of 25(OH)D in both the FM and FY groups compared to the respective control groups (19.10 ± 5.69 ng/mL and 20.88 ± 5.76 ng/mL respectively, 
   < .001). We observed a significant reduction in weight to hip ratio (
   = .04) and a significant improvement in triglyceride (
   < .001) and HDL-C (
   = .01) only in FM group compared to nFM group. Also, we found a significant reduction in fasting serum insulin (
   < .001), and a significant improvement of HOMA-IR (
   < .001) and QUICKI (
   < .001) in both intervention groups compared to their placebos.
 
  An intake of fortified dairy products containing nano-encapsulated vitamin D
  was associated with an improvement in some measures of anthropometric indices, glucose homeostasis, and lipid profiles, particularly in individuals receiving fortified milk. Hence, along with other benefits, fortification of dairy products with vitamin D may be an effective approach to improve some cardiometabolic indicators, such as insulin resistance.
 
  IRCT20101130005280N27.
 IRCT20101130005280N27.Assessments of the overall health status of people living alone are important for developing health promotion programs and delivering appropriate health services.  https://www.selleckchem.com/Bcl-2.html  In the context of universal social health insurance system of South Korea, the relationship between failure to access health-care and self-rated health among adults living alone has given little attention. In addition, the influence of objective financial status on self-rated health in adults living alone has not explored so far. The sample of the present study comprised 4,852 adults who participated in the cross-sectional 2015 Korea National Health and Nutrition Examination Survey. The main finding was that the unmet health-care needs resulting from the inability to access health-care services during the previous 12 months was independently associated with fair or poor self-rated health, especially for women living alone. Having an income below the subsistence level was significantly associated with fair or poor self-rated health among women living alone. The findings of this study demonstrate the need for policies enabling appropriate delivery of health-care services, especially for women living alone. It is necessary to provide community-based monitoring programs related to general health for women living alone with a household income below the minimum cost-of-living.Purpose Gastrointestinal cancers (GICs) account for about a quarter of cancers. Lately, the circulating microRNAs as a non-invasive biomarker for identifying and monitoring diseases have been recognized. Several studies have examined the role of miR-21 in digestive system carcinoma. We conducted a meta-analysis to assess the diagnostic role of miR-21 in GICs.Methods Seventeen studies involving 1700 individuals were included in this meta-analysis. The pooled sensitivity, specificity, PLR, NLR, DOR, AUC, SROC, and Q* index were calculated based on true-positive, true-negative, false-negative, and false-positive. Moreover, the subgroup analyses have been performed for miR-21 based on sample types (serum/plasma), normalized genes (U6, miR-16, and miR-39), and ethnicity.Results The pooled sensitivity 0.722 (95% CI 0.70-0.74), specificity 0.820 (95% CI 0.801-0.838), PLR 4.375 (95% CI 3.226-5.933), NLR 0.308 (95% CI 0.239-0.398), DOR 16.06 (95% CI 9.732-26.53) as well as AUC 0.86, and Q* index 0.79 represented the high-grade diagnostic precision of miR-21 in identifying GICs (ESCC, GC, CRC, HCC, and PC).Conclusion This meta-analysis demonstrated that circulating miR-21 levels can be used to monitor the digestive system carcinomas. Therefore, miR-21 can be a useful biomarker of progression and fair diagnosis in GICs patients.This study aimed to comprehensively analyze the effect of empty-nest on mental health and behaviors of the older population and explore the urban-rural differences. Data from the Cohort of Older People Health and Environment Controllable Factors were used, including 1071 older people aged 60 or over from a rural and an urban. Mental health, daily life behaviors, chronic physical diseases, and activities of daily living were evaluated. Logistic regression was used. The prevalence of empty-nest in older people was 55.0% in urban and 58.7% in rural. The empty-nest older people in urban were more likely to participate in physical exercise (OR[95%CI] 1.55[1.03-2.31]), while the empty-nest older people in rural had lower rate of smoking (OR[95%CI] 0.46[0.28-0.76]) and religious belief (OR[95%CI] 1.61[1.01-2.58]), and higher prevalence of depression (OR[95%CI] 1.55[1.03-2.35]) and higher level of total cholesterol (OR[95%CI] 1.51[1.03-2.19]) compared with the non-empty-nest older people. In conclusion, the prevalence of empty-nest in older people was high both in rural and urban in China.