Baseline Expectations Research Articles

Metabolic theory of ecology successfully predicts distinct scaling of ectoparasite load on hosts.

The impacts of parasites on hosts and the role that parasites play in ecosystems must be underlain by the load of parasites in individual hosts. To help explain and predict parasite load across a broad range of species, quantitative theory has been developed based on fundamental relationships between organism size, temperature and metabolic rate. Here, we elaborate on an aspect of that 'scaling theory for parasitism', and test a previously unexplored prediction, using new data for total ectoparasite load from 263 wild birds of 42 species. We reveal that, despite the expected substantial variation in parasite load among individual hosts, (i) the theory successfully predicts the distinct increase of ectoparasite load with host body size, indicating the importance of geometric scaling constraints on access to host resources, (ii) ectoparasite load appears ultimately limited by access-not to host space-but to host energy, and (iii) there is a currency-dependent shift in taxonomic dominance of parasite load on larger birds. Hence, these results reveal a seemingly new macroecological pattern, underscore the utility of energy flux as a currency for parasitism and highlight the promise of using scaling theory to provide baseline expectations for parasite load for a diversity of host species.

Relative prey abundance and predator preference predict individual diet variation in prey-switching experiments.

Individual diet specialization appears widespread and has several ecological ramifications. Hypotheses on the causes of diet specialization generally assume prey preferences differ among predator individuals. They then predict how the magnitude of diet variation should change when ecological factors (e.g., intraspecific competition) alter prey abundances. However, the magnitude of diet variation is expected to change with prey abundances due to stochasticity in the foraging process even if all predators share the same prey preferences. Here I show that the relative prey abundance where diet variation is maximized and the magnitudes of diet variation in prey switching experiments are predicted well by a simple stochastic foraging model based only on relative prey abundances and a shared relative prey preference among predators. These results suggest that the effects of stochasticity during foraging may confound studies of individual diet specialization if these effects are not accounted for in experimental design or interpretation. Furthermore, the stochastic foraging model provides simple baseline expectations for theoretical studies on the ecological consequences of diet variation and offers a way forward on quantitative predictions of how ecological factors influence the magnitude of diet variation when stochasticity during foraging and diet specialization occur simultaneously. Last, this study highlights the continued importance of integrating stochasticity into mechanistic ecological hypotheses.

Using database linkages to measure innovation, commercialization, and survival of small businesses

Here, we report the results of an outcomes evaluation of the Small Business Innovation Research (SBIR) and Small Business Technology Transfer (STTR) Programs at the National Institute of General Medical Sciences (NIGMS). Since the programs’ inception, assessments of the SBIR/STTR programs at several federal agencies have utilized surveys of former grantees as the primary source of data. Response rates have typically been low, making non-response bias a potential threat to the validity of some of these studies’ results. Meanwhile, the availability of large publicly-available datasets continues to grow and methods of text mining and linking databases continue to improve. By linking NIGMS grant funding records, U.S. Patent and Trademark Office data, and business intelligence databases, we explored innovation, commercialization and survival for recipients of NIGMS SBIR/STTR funding. In doing so, we were able to more completely assess several key outcomes of the NIGMS SBIR/STTR program. Our evaluation demonstrated that the NIGMS program performed above baseline expectations along all dimensions, and comparably to other federal agency SBIR/STTR grant programs. In addition, we show that the use of extant data increasingly is a viable, less expensive, and more reliable approach to gathering data for evaluation studies.

PF173 RESULTS FROM UKALL60+, A UK PHASE 2 STUDY IN ELDERLY PATIENTS WITH UNTREATED ACUTE LYMPHOBLASTIC LEUKAEMIA

Background:The outcome for older adults with acute lymphoblastic leukaemia (ALL) is unsatisfactory. Few studies have focussed entirely on older patients with ALL, despite an increasing incidence with age.Aims:To establish baseline expectations for CR, event free survival (EFS), OS and quality of life (QOL) measures for older patients of all ages and pre‐morbid states.Methods:UKALL60+ offered five ‘Pathways’ to be decided by investigator and patient choice (Table 1). Any patient with newly diagnosed ALL >60 years (or >55 and unfit for more intensive therapy) was eligible, with no exclusions for co‐morbidities, including concurrent malignancies. Baseline characteristics of each group including Charlson Comorbidity Index, ECOG, Karnofsky, IADL and CRASH scores were collected. The primary endpoint was CR rate after 2 phases of induction. Secondary objectives included EFS and OS, treatment related mortality and QOL.Results:From January 2013 to December 2018, 121 patients were recruited (5 excluded due to misdiagnosis) with a median age of 69 years (Range 55–83). Median follow up was 29.9 months (Range 1 day to 55 months). Table 1 shows treatment allocation by Pathway. Patients allocated the non‐intensive pathway D were significantly older (Median age of 73 cf. 67 years, p < 0.001) and more dependant (IADL score p = 0.04) but had non‐significant differences in co‐morbidities as assessed by CRASH score and Charlson index when compared with the Intensive Pathway B. Cytogenetics or FISH was attempted at diagnosis on 98 patients. The main abnormalities detected were as follows: t(9;22) = 26, t(4;11) = 2, other MLL = 2, low hypodiploidy/near‐triploidy = 14, complex karyotype = 2.The Primary Endpoint of CR rate after 2 phases of induction by Pathway were A (Ph+ve) = 22/24 (92%), B Intensive) 33/48 (69%), C (Intensive+) 5/9 (56%), D (Non‐intensive) 8/18 (44%) and Pathway E 9/15 (60%). At a median follow up of 29 months EFS & OS by Pathway were; A 59% & 61%, B 57% & 71% C 40% & 53% and D 9% & 19%.Grade 3/4 AEs were seen in the majority of patients. The most common toxicities were haematological and infections. The haematological and non‐haematological AE rate was similar in Pathway D to Pathways A‐C both for all AE's and grade 3/4 AE's.Across all Pathways 48 patients have relapsed at a median of 11.4 months. To date 68 deaths have been reported; 52 patients died of ALL and 11 from infection. Non intensive Pathway D enabled patients to spend less time in hospital, particularly in Induction I, with an average of 15 inpatient days compared with 28.5 days for Pathway B (p = 0.002).Summary/Conclusion:Our study reflects the reality that treating ALL in older patients is a difficult balance between efficacy and toxicity. AE rates were high, as expected, but despite this the majority of patients who died did so from ALL. Age but not co‐morbidities as measured by Charlson and CRASH appears to be associated with choice of therapy. Patients treated on the non‐intensive pathway D, although spending less time in hospital had similar AE rates. They had a low CR rate and less than 20% 1 year EFS rate. Patients with Ph+ve disease had a higher CR rate but this did not translate into improved EFS or OS. We noted small numbers of longer‐term survivors and anticipate that forthcoming MRD and correlative science data will shed light on the correlates of good outcome in these persons. The UKALL60+ data will be invaluable as a baseline from which to develop more effective regimens including novel agents.image

Comparison of Expectations and Outcomes in Rheumatoid Arthritis Versus Osteoarthritis Patients Undergoing Total Knee Arthroplasty

BackgroundWe hypothesized that patients undergoing primary total knee arthroplasty (TKA) for rheumatoid arthritis (RA) would have different preoperative expectations compared to osteoarthritis (OA) patients, and that postoperative satisfaction would correlate with specific postoperative pain and functional domains. MethodsThis is a retrospective cohort study of RA patients matched based on age, gender, American Society of Anesthesiologists score, and Charlson Comorbidity Index score 1:2 with OA patients (76 RA, 152 OA) who underwent primary TKA. The Hospital for Special Surgery Knee Replacement Expectations Survey, Visual Analogue Scale for Pain (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and the Short Form-12 (SF-12) were compared at baseline and at 2 years postoperatively. Minimum clinically important differences (MCIDs) were calculated for KOOS and SF-12 subdomains. ResultsPreoperatively, RA patients had lower expectations, worse VAS Pain, and worse KOOS Pain, Symptoms, and Activities of Daily Living (P < .05). However, at 2 years, RA patients had significantly larger improvements in VAS (P = .01) and these 3 KOOS subdomains (P < .05), achieving comparable absolute scores to OA patients. Overall, 86.1% of RA and 87.1% of OA patients were either somewhat or very satisfied with their TKA. Patient satisfaction correlated with VAS Pain and KOOS outcome scores in both groups. RA and OA patients had high rates of achieving MCID in SF-12 physical component scores and all 5 KOOS subdomains. A higher proportion of RA patients achieved MCID in KOOS Symptoms (98.4% vs 77.2%, P < .001). ConclusionRA patients had lower baseline expectations compared to OA patients. However, RA patients had greater improvements in KOOS and SF-12 subdomains, and there was no difference in satisfaction compared to OA patients after TKA.

Evaluation of a School-Based Intervention to Promote Physical Activity and Sport among Young People Aged 11-13 in East London, UK

Due to the alarming increase in overweight/obesity among adolescents in the UK and in response to low levels of PAS (physical activity and sport), initiatives have been developed to promote PAS in vulnerable groups. The purpose of this study is: (1) to evaluate the effect of one such PAS initiative on 11-13 (n = 913) years old young people’s PAS patterns and participation; (2) to assess young peoples’ expectations and perceived benefits of the program; and (3) to make evidenced based recommendations for future interventions. Socio-demographic data, PAS data and perceptions of the program were assessed via questionnaire. Anthropometric data (height, weight, waist circumference) were also measured. Wilcoxon signed-rank tests were used to test for significant differences between baseline and follow-up PAS data. McNemar chi-square tests were used to test for significance between baseline and follow-up expectations data. Wilcoxon signed-rank tests showed a reduction in total PAS (from 39% to 7%) from baseline to follow-up but five sports not currently offered through the national PE (physical education) curriculum (badminton, basketball, volleyball, cricket and rowing) saw an increase in participation. Young people’s perception of the program was positive, with a significant increase in those reporting the program helped them “be more sporty” and “be more healthy” (both significant at P < 0.05). While overall PAS did not increase, sports offered outside of those available as part of the national curriculum for PE were more popular; strengthening the case for further research and supporting the current trend of extending the sports available through PE in schools and school sports to positively contribute to increase in PAS. Future interventions should consider the target population more carefully in the design and implementation of such programs by offering culturally responsive PAS programs.

Patterns of Recovery From Aphasia in the First 2 Weeks After Stroke.

Purpose Recovery from aphasia after stroke has a decelerating trajectory, with the greatest gains taking place early and the slope of change decreasing over time. Despite its importance, little is known regarding evolution of language function in the early postonset period. The goal of this study was to characterize the dynamics and nature of recovery of language function in the acute and early subacute phases of stroke. Method Twenty-one patients with aphasia were evaluated every 2-3 days for the first 15 days after onset of acute ischemic or hemorrhagic stroke. Language function was assessed at each time point with the Quick Aphasia Battery (Wilson, Eriksson, Schneck, & Lucanie, 2018), which yields an overall summary score and a multidimensional profile of 7 different language domains. Results On a 10-point scale, overall language function improved by a mean of 1.07 points per week, confidence interval [0.46, 1.71], with 19 of 21 patients showing positive changes. The trajectory of recovery was approximately linear over this time period. There was significant variability across patients, and patients with more impaired language function at Day 2 poststroke experienced greater improvements over the subsequent 2 weeks. Patterns of recovery differed across language domains, with consistent improvements in word finding, grammatical construction, repetition, and reading, but less consistent improvements in word comprehension and sentence comprehension. Conclusion Overall language function typically improves substantially and steadily during the first 2 weeks after stroke, driven mostly by recovery of expressive language. Information on the trajectory of early recovery will increase the accuracy of prognoses and establish baseline expectations against which to evaluate the efficacy of interventions. Supplemental Material https://doi.org/10.23641/asha.7811876.

Lumbar disc herniation: what has the Spine Patient Outcomes Research Trial taught us?

Intervertebral disc herniation (IDH) can cause back pain and/or radiculopathy and accounts for a significant portion of patients having spinal surgery in the USA. One of the most impactful and well-executed randomized trials to study diagnosis, treatments, and outcomes in patients with three commonly treated spinal conditions was the Spine Patient Outcomes Research Trial (SPORT). This study and the subsequent data analyses have resulted in numerous publications related to IDH. The purpose of this review is to summarize SPORT publications with IDH results to better understand what we have learned from this important landmark trial. Publications utilizing SPORT data that reported findings related to IDH patients were identified from Medline, PubMed, and PubMed Central. The primary findings pertaining to IDH were summarized. There were 25 studies identified reporting findings related to IDH from the SPORT data published between 2004 and 2017. Publications in the following areas were summarized: epidemiology and baseline patient characteristics (1), treatment preferences and expectations (2), radiological and MRI (3), primary study objectives at twoyears (2), fouryears (1) and eightyears (1), subgroup analyses (13), cost-effectiveness (1), and reherniation (1). This report reviewed the current state of SPORT publications related to IDH to identify and summarize what we have learned about diagnosis, patient characteristics, treatments, outcomes, and cost-effectiveness in patients with lumbar disc herniations. Many important findings are now published from this robust trial's data. Clinicians should incorporate these results into their clinical decision-making and during counseling patients presenting with lumbar disc herniations.

Examining the Interactions Between Expectations and tDCS Effects on Motor and Cognitive Performance.

Background: Despite a growing literature and commercial market, the effectiveness of transcranial direct current stimulation (tDCS) remains questionable. Notably, studies rarely examine factors such as expectations of outcomes, which may influence tDCS response through placebo-like effects. Here we sought to determine whether expectations could influence the behavioral outcomes of a tDCS intervention.Methods: Through an initial study and self-replication, we recruited 121 naïve young adults 18–34 years of age (M = 21.14, SD = 3.58; 88 women). We evaluated expectations of tDCS and of motor and cognitive performance at three times: (i) at baseline; (ii) after being primed to have High or Low expectations of outcomes; and (iii) after a single session of sham-controlled anodal tDCS over the left or right motor cortex. Before and after stimulation, participants performed the Grooved Pegboard Test and a choice reaction time task as measures of motor dexterity, response time, and response inhibition.Results: Repeated measures ANOVA revealed that participants had varying, largely uncertain, expectations regarding tDCS effectiveness at baseline. Expectation ratings significantly increased or decreased in response to High or Low priming, respectively, and decreased following the intervention. Response times and accuracy on motor and cognitive measures were largely unaffected by expectation or stimulation conditions. Overall, our analysis revealed no effect attributable to baseline expectations, belief of group assignment, or experimental condition on behavioral outcomes. Subjective experience did not differ based on expectation or stimulation condition.Conclusions: Our results suggest no clear effects of tDCS or of expectations on our performance measures, highlighting the need for further investigations of such stimulation methods.

The Integrated Clinical Education Strategic Initiatives Project-Development of Parameters to Guide Harmonization in Clinical Education: A Scoping Review.

Clinical education curricular models specifically related to integrated clinical education (ICE) vary across physical therapist education programs. The interconnectedness of ICE to the advancement of a shared vision for clinical education in professional physical therapist education needs investigating. The purpose of this scoping review was to: (1) define ICE, (2) define baseline expectations and parameters of ICE, and (3) discern and describe current ICE models. Databases accessed included Medline, MedlinePlus with Full, CINAHL, and CINAHL Plus with full text. A multimodal data collection scoping review was completed. Data collection included survey research, a systematic review of the literature, and a series of focus groups. The McMaster Critical Appraisal Tool assessed methodological study quality. A qualitative, metasynthesis approach was used for data synthesis. Consensus agreement produced results. Twenty-two articles were included in the literature review from the health disciplines of medicine, nursing, physical therapy, occupational therapy, and speech-language pathology. Data synthesis produced 8 parameters defining the factors essential to categorizing clinical education experiences as ICE in physical therapist education. The 8 parameters and ICE definition are supported by a description of models of ICE that currently exist within health profession curricula. Data synthesis followed a qualitative, metasynthesis approach. Themes emerged from the surveys, literature review, and focus group data. Patterns were compared, analyzed, and synthesized to generate the themes and ICE parameters. Selection bias from the literature search could have limited the richness of the model descriptions by unintentional exclusion of articles, and might limit the applicability of results beyond the United States. Sampling bias from survey and focus groups, although purposeful, might have limited a broader description of current viewpoints about ICE. However, the data sources, including multiple health profession perspectives coupled with consensus agreement, provide sound evidence in development of profession-based parameters. The results of this scoping review provide the profession with a standard definition of ICE and parameters that can guide a program in designing a curriculum using ICE experiences as a foundation. A recommended next step is to design education research studies using reliable and valid outcome measures across programs to determine impact and effectiveness of ICE as an educational intervention.

Impact of Open Access to Physician Notes on Radiation Oncology Patients: Results from an Exploratory Survey

PurposeThere is an increasing effort to allow patients open access to their physician notes through electronic medical record portals. However, limited data exist on the impact of such access on oncology patients, and concerns remain regarding potential harms. Therefore, we determined the baseline perceptions and impact of open access to oncology notes on radiation oncology patients. Methods and materialsPatients receiving radiation therapy were provided instructional materials on accessing oncology notes at the time of their initial evaluation. Patients were prospectively surveyed to evaluate baseline interest and expectations before access and to determine the actual usage and impact at the end of their radiation treatment course. ResultsA total of 220 patients were surveyed; 136 (62%) completed the baseline survey, of which 88 (40%) completed the final survey. The majority of participants were age >60 years (n = 83; 61%), and 70 were male (51%). Before accessing the notes, the majority of patients agreed that open access to oncology notes would improve understanding of diagnosis (99%), understanding of treatment side effects (98%), reassurance about treatment goals (96%), and communication with family (99%). All patients who accessed the notes found them to be useful. After accessing the notes, approximately 96%, 94%, and 96% of patients reported an improved understanding of their diagnosis, an improved understanding of treatment side effects, and feeling more reassured about their treatment, respectively. Approximately 11%, 6%, and 4% of patients noted increased worry, increased confusion, and finding information they now regret reading, respectively. Patient age, sex, and specific cancer diagnoses were not predictive of experiencing negative effects from accessing the notes. ConclusionsRadiation oncology patients have a strong interest in open access to their physician notes, and the majority of patients expect and actually report meaningful benefits. These data support strategies to allow more patients with cancer access to their physicians’ notes.

Expectations may influence the effects of transcranial direct current stimulation

Growing interest surrounds transcranial direct current stimulation (tDCS) as a safe and inexpensive method for improving cognitive functions and mood. Nevertheless, tDCS studies rarely examine psychological factors such as expectations of outcomes, which may influence tDCS responsiveness through placebo-like effects. Here we sought to evaluate the potential influence of expectations on tDCS intervention outcomes. We assessed expectations of tDCS outcomes in 88 healthy young adults on three occasions: i) at baseline; ii) after reading information implying either high or low effectiveness of stimulation; and iii) after a single-session of sham-controlled anodal tDCS applied to the left dorsolateral prefrontal cortex, during working memory (WM) training. Participants were largely uncertain about the effectiveness of stimulation in improving cognitive function at baseline. High or low expectation priming using simple positive or cautionary messages significantly increased or decreased expectation ratings, respectively, but ratings significantly decreased following stimulation in all groups. We found greater improvement in participants who received high compared to low expectation priming. Participants who received active stimulation and low expectation priming exhibited the lowest performance, suggesting that expectation priming and stimulation may have interacted. We did not find a significant effect of baseline expectations, belief of group assignment, or individual characteristics on measures of WM and verbal fluency. However, controlling for baseline expectations revealed greater post-intervention improvement on the executive function measures in participants who received high (compared to low) expectation priming. People randomly assigned to receive high expectation priming reported having a more pleasant experience overall, including greater satisfaction. Our findings suggest that expectations of outcomes should be taken into account in tDCS-based experimental studies and clinical trials.

Mental profile mapping: A psychological single-candidate authorship attribution method.

Modern authorship attribution methods are often comprised of powerful yet opaque machine learning algorithms. While much of this work lends itself to concrete outcomes in the form of probability scores, advanced approaches typically preclude deeper insights in the form of psychological interpretation. Additionally, few attribution methods exist for single-candidate authorship problems, most of which require large amounts of supplemental data to perform and none of which rely upon explicitly psychological measures. The current study introduces Mental Profile Mapping, a new authorship attribution technique for single-candidate authorship questions that is founded on previous scientific research pertaining to the nature of language and psychology. In the current study, baseline expectations for results and performance are set using an advanced technique known as “unmasking” on the test case of Aphra Behn, a 17th century English playwright. Following this, Mental Profile Mapping is introduced and tested for its psychometric properties, tested using a “bogus insertion” method, and then applied to canonical Aphra Behn plays. Results from both attribution methods suggest that 2 of 5 questioned plays are likely to have been authored by Behn, with the remaining 3 plays exhibiting a poor fit for Behn’s psychological fingerprint. Mental Profile Mapping results are then decomposed into deeper psychological interpretation, a quality unique to this new method.

Surgical Site Infection after Sternotomy in Low- and Middle-Human Development Index Countries: A Systematic Review.

The burden of cardiovascular disease is increasing in low- and middle-human development index (LMHDI) countries, and cardiac operations are an important component of a comprehensive cardiovascular care package. Little is known about the baseline incidence of surgical site infections (SSIs) among patients undergoing sternotomy in LMHDI countries. A prospectively registered, systematic literature review of articles in the PubMed, Ovid, and Web of Science databases describing the epidemiology and management of SSIs among persons undergoing sternotomy in LMHDI countries was performed. We performed a quantitative synthesis of patients undergoing sternotomy for CABG to estimate published sternotomy SSI rates. Of the 423 abstracts identified after applying search criteria, 14 studies were reviewed in detail. The pooled SSI rate after sternotomy among reviewed studies was 4.3 infections per 100 sternotomies (95% confidence interval [CI] 1.3-6.0 infections per 100 sternotomies), which is comparable to infection rates in high-human development index countries. As the burden of cardiovascular disease in LMHDI settings increases, the ability to provide safe cardiac surgical care is paramount. Describing the baseline SSI rate after sternotomy in LMHDI countries is an important first step in creating baseline expectations for SSI rates in cardiac surgical programs in these settings.

Surgical patient selection and counseling

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm.

Total knee replacement: Are there any baseline factors that have influence in patient reported outcomes?

There is conflicting evidence about what factors influence outcomes after total knee replacement (TKR). The objective is to identify baseline factors that differentiate patients who achieve both, minimal clinically important difference (MCID) and a patient acceptable symptom state (PASS) in pain and function, measured by WOMAC, after TKR from those who do not attain scores above the cutoff in either of these dimensions. One-year prospective multicentre study. Patients completed WOMAC, SF-12, EQ-5D, expectations, other joint problems and sociodemographic data while in the waiting list, and 1-year post-TKR. Dependent variable was a combination of MCID and PASS in both dimensions (yes/no). Univariate analysis was performed to identify variables associated. Exploratory factor analysis (EFA) was performed to study how these variables grouped into different factors. Total sample comprised 492 patients. Mean (SD) age was 71.3 (6.9), and there were a 69.7% of women. Of the total, 106 patients did not attain either MCID or PASS in either dimension, and 230 exceeded both thresholds in both dimensions. In the univariate analysis, 13 variables were associated with belonging to one group or another. These 13 variables were included in EFA; 3 factors were extracted: expectations, mental health, and other joints problems. The percentage of variance explained by the 3 factors was 80.4%. We have found 2 modifiable baseline factors, expectations and mental health, that should be properly managed by different specialist. Indication of TKR should take into account these modifiable factors for improving outcomes after TKR.

ASSESSING NATURAL RESOURCE DAMAGES FOR COMMERCIALLY AND RECREATIONALLY HARVESTED POPULATIONS

Abstract Resource Equivalency Analysis (“REA”) is often used to “right-size” (scale) or calibrate compensatory restoration projects implemented as part of Natural Resource Damage Assessments (“NRDAs”) conducted pursuant to the Oil Pollution Act of 1990 (“OPA”). The basic premise underlying REA is that, if a spill results in the loss of individual members of a population, the public can be compensated via a restoration project which creates individuals that otherwise would not exist. This is because the ecological services provided by a population are proportional to the number of individuals in the population. For example, one could compensate the public for spill-related mortality among shrimp by creating wetland terraces which, the literature suggests, would increase the number of shrimp in the population. REA answers the question, “How many wetland terraces need to be created?” Implicit in the REA construct is the dynamic nature of the population projections. Even with density dependence, population levels fluctuate according to both biological and anthropogenic factors that combine to influence survival, reproductive and growth rates. Thus, if NRDA practitioners are to reliably identify compensatory restoration requirements using REA, it is necessary to: characterize baseline demographic rates; develop a model that uses those baseline demographic rates to project future population levels; and identify the mechanisms that cause post-spill rates to change relative to baseline expectations. One factor that can cause post-spill demographic rates to vary is a spill-related change in human behavior. For example, if a spill-related fishing closure results in the cancelation of 15,000 recreational shrimping trips, shrimp mortality due to fishing will decrease. In this paper we use prior OPA NRDA cases to: review the historical treatment of spill-related closures in REA models used by both DOI/USFWS and NOAA; and illustrate that the REA practitioners’ approach to these spill-related changes in human behavior can (and should) change the NRDA liability construct, particularly with respect to species which are commercially and recreationally harvested.

Definitive management of thigh contusions in athletes: but how definitive? A systematic review

ImportanceThigh contusion is a common injury reported in athletes; however, the optimal treatment guidelines for thigh contusions, potentially leading to haematoma, in the athletic population remain ill-defined. To the best of our knowledge, this is the most comprehensive review of the literature.ObjectiveA systematic review of the literature was performed regarding the appropriate management and timing of non-surgical and surgical intervention of thigh haematomas in athletes to determine an optimal treatment algorithm. Specifically, we aimed to compare these treatment options with respect to time to return to sport.Evidence reviewTwo databases (PubMed and SPORTdiscus) were used in this systematic review. Search terms included ‘thigh contusion’, ‘thigh hematoma’, ‘quadriceps contusion’, ‘quadriceps hematoma’, ‘treatment’, ‘athlete’ and ‘sports’. The inclusion criteria were (1) athletes of any age that sustained thigh contusions caused by sports-related trauma, (2) data relating to treatment outcomes of thigh haematomas, (3) clinical studies with level I–IV of evidence from any year of publication and (4) studies published in English.Findings7 studies met our inclusion criteria and were reviewed, all of which were level IV evidence. 6 of the studies involved non-operative management of the patients, and only one study involved surgical intervention. The average time until return to play across the studies with non-operative treatment was 29.3 days (range of 2–180 days). In the study that treated contusions with surgery, time to return to play was not included in the results.Conclusions and relevanceWhile thigh haematomas are common in sports, sparse literature exists regarding the appropriate timing of conservative management and when surgical intervention is warranted. On average, time to return to play following conservative management of a thigh haematoma is 29.3 days; however, it is currently unknown if operative management may provide an earlier return. This information can be used as baseline expectations when non-operative treatment is employed. If an athlete fails to return to sport at the expected time, further work-up for retained haematoma with the possible need for surgical intervention should be considered.Level of evidenceIV.

A Prospective Study of Predictors of Long-term Opioid Use Among Patients With Chronic Noncancer Pain.

Chronic pain patients at increased risk of unfavorable pain and opioid misuse outcomes may be those most likely to use opioids long-term, but this has not been evaluated prospectively. To ascertain whether pain prognostic risk, problem opioid use risk, and depression predict opioid use 1 year later among patients recently initiating opioid therapy with a moderate likelihood of long-term opioid use. Self-report and electronic health record data were collected from patients aged 45+ years who recently initiated opioid therapy (N=762), in an integrated health care system. Logistic regression models tested whether baseline patient chronic pain prognostic risk, problem opioid use risk, depression, and expectations concerning continued opioid use independently predicted continuing use at 1 year (≥30 d supply in the prior 4 mo). At 1 year, 46% of participants continued to use opioids. Baseline problem opioid use risk score (adjusted odds ratio, 1.15; 95% confidence interval, 1.04-1.26) and expectations about continuing opioid use, but not pain prognostic risk score or depression, were significant predictors of 1-year opioid use. Compared with patients who thought continued opioid use unlikely, those who thought it was extremely or very likely had 4 times the odds of opioid use at 1 year (adjusted odds ratio, 4.05; 95% confidence interval, 2.59-6.31). The strongest predictors of long-term opioid use were not patient-related or medication-related factors, but expectations about using opioids in the future. Asking about such expectations may be the easiest way to identify patients likely to continue opioid use long-term.

Is it best to expect the worst? Influence of patients' side-effect expectations on endocrine treatment outcome in a 2-year prospective clinical cohort study

This study aims to determine the role of patient expectations as potentially modifiable factor of side-effects, quality of life, and adherence to endocrine treatment of breast cancer. A 2-year prospective clinical cohort study was conducted in routine primary care with postoperative patients with hormone-receptor-positive breast cancer, scheduled to start adjuvant endocrine treatment. Structured patient-reported assessments of side-effects, side-effect expectations, quality of life, and adherence took place during the first week post-surgery and after 3 and 24 months of endocrine treatment. Of 111 enrolled patients, at 3 and 24 months, 107 and 88 patients, respectively, were assessed. After 2 years of endocrine treatment, patients reported high rates of side-effects (arthralgia: 71.3%, weight gain: 53.4%, hot flashes: 46.5%), including symptoms not directly attributable to the medication (breathing problems: 28.1%, dizziness: 25.6%). Pre-treatment expectations significantly predicted patient-reported long-term side-effects and quality of life in multivariate models controlling for relevant medical and psychological variables. Relative risk of side-effects after 2 years of endocrine treatment was higher in patients with high negative expectations at baseline than in those with low negative expectations (RR = 1.833, CI 95%, 1.032-3.256). A significant interaction confirmed this expectation effect to be particularly evident in patients with high side-effects at 3 months. Furthermore, baseline expectations were associated with adherence at 24 months (r = -0.25, P = 0.006). Expectations are a genuine factor of clinical outcome from endocrine treatment for breast cancer. Negative expectations increase the risk of treatment-specific side-effects, nocebo side-effects, and non-adherence. Yet, controlled studies are needed to analyze potential causal relationships. Optimizing individual expectations might be a promising strategy to improve side-effect burden, quality of life, and adherence during longer-term drug intake. ClinicalTrials.gov Identifier: NCT02088710.