Changes In Scores Research Articles

Development and validation of the caregiver Burden from infant home NGT care instrument

ObjectiveTo design and validate an age and condition-specific health status instrument to best reflect the parental experience caring for these children with complex needs and home Nasogastric Tube (NGT) placement. Study designCombined Qualitative and Quantitative design, testing and implementation for item production and reduction, followed by formal validation by evaluating validity, reliability, and establishing a clinically meaningful change score. SettingsTertiary care, multi-disciplinary aerodigestive center. ParticipantsAll caregivers whose infant met criteria for eligibility for discharge home from the NICU or Special Care Nursery (SCN) with NGT in place were offered inclusion in this group.Intervention/Exposure: Structured qualitative interviews of these caregivers to explore and define these concepts and domains, to item generate and then reduce, and then psychometric analyses. MethodsStructured, moderated qualitative interviews with parents/caregivers of children who have undergone home NGT care of their children for item creation, design, and then reduction. Reliability was assessed by Cronbach alpha analysis. Construct validity and clinically meaningful change score was assessed using various query methods. Main outcome measuresCronbach's alpha to assess reliability, a priori hypotheses validity analyses, and minimally important clinical difference calculation. ResultsScaled scores of this condition specific instrument ranged from 14 to 74 where higher scores indicate better QOL related to managing the NGT. Cronbach's alpha with all 14 items was 0.93. Validity was assessed by a self-assessment question to discriminate between change (95% CI: 8.5–14.1; p < 0.0001) as well as by other comparators to identify the instrument's ability to discriminate among populations where parents felt a difference in experience. The minimally important difference was calculated at 18 points. ConclusionThis represents the initial validation of the first condition and age-specific health status instrument to assess parent experience of caring for infants requiring a home NGT for dysphagia.

The association of fecal incontinence, constipation, and pelvic pain with the course of lower urinary tract symptoms in community-dwelling men and women.

Fecal incontinence, constipation, and pelvic pain are common pelvic floor symptoms (PFS), and frequently coexist with lower urinary tract symptoms (LUTS). However, their association with the longitudinal trajectory of LUTS have not been well described. Our objective was to investigate the association between PFS and the course of LUTS in community-dwelling men and women. Men and women aged ≥16 years were invited to participate in a prospective observational cohort study. At baseline, and after 12 and 24 months, participants filled in the International Consultation on Incontinence Modular Questionnaire (ICIQ-MLUTS and ICIQ-FLUTS) for men and women respectively, the Wexner incontinence and constipation scale, and a questionnaire on pelvic pain. Generalized estimating equations were used to examine the association between change scores in defecation problems and pelvic pain, and LUTS change scores. A total of 694 men and 997 women gave informed consent, with 417 men and 566 women included in the analysis. The mean age was 63.2 ± 12.7 years for men and 58.6 ± 14.8 years for women. The study showed minor changes in LUTS scores over the 0-12 and 12-24-month periods. Generalized estimating equations revealed positive associations between changes in constipation and fecal incontinence and LUTS changes in both sexes. For instance, a one-point increase in Wexner constipation score was associated with 0.376 (0.165, 0.587) points higher LUTS change in men and 0.223 (0.109, 0.336) points in women during the 0-12-month follow-up. However, associations between changes in pain and LUTS scores varied across sexes and time periods. We observed minor changes in LUTS over time and weak associations between PFS and LUTS that sometimes differed between males and females, emphasizing the need for sex-specific considerations. These insights can provide valuable guidance for the development of targeted prevention trials, ultimately aiming to enhance overall pelvic health and patient well-being.

Responsiveness and construct validity of two outcome measures of bilateral upper limb function in patients with chronic stroke

BackgroundStroke is a leading cause of long-term disability among stroke survivors. Despite the availability of numerous stroke rehabilitative therapies, such as mirror therapy, bilateral arm training, and robot-assisted therapy, the recovery of motor function after stroke remains incomplete. Bilateral arm function is a key component in stroke patients to perform activities of daily living and to reflect their functional autonomy.ObjectiveThis clinimetric study investigated and compared the construct validity and responsiveness of 2 bimanual activity outcome measures, the Chedoke Arm and Hand Activity Inventory (CAHAI) and the ABILHAND Questionnaire, in individuals receiving stroke rehabilitation.MethodsThe present study is a secondary analysis following the framework of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). Individuals with chronic stroke (N = 113) were recruited from outpatient rehabilitation settings. Participants received 18 to 20 sessions of robot-assisted therapy, mirror therapy, combined therapy, or conventional rehabilitation for 4 to 6 weeks. The CAHAI, ABILHAND Questionnaire, and a comparison instrument, the Motor Activity Log (MAL), were administered twice at a 4- to 6-week interval to all participants. ABILHAND scores, in logits, were converted from raw ordinal scores into a linear measure.ResultsThere was medium to large correlation of the CAHAI and the MAL (ρ = 0.60–0.62, p &amp;lt; 0.01) as well as the ABILHAND Questionnaire and the MAL (ρ = 0.44–0.51, p &amp;lt; 0.01). Change scores from the initial measurement to the post-intervention measurement demonstrated small to medium correlation of the CAHAI and the MAL (ρ = 0.27–0.31, p &amp;lt; 0.01) and medium to large correlation of the ABILHAND Questionnaire and the MAL (ρ = 0.37–0.41, p &amp;lt; 0.01). Overall, 7 of 8 hypotheses were supported. The hypothesis testing regarding the construct validity and responsiveness of the CAHAI and ABILHAND Questionnaire was confirmed.ConclusionThe CAHAI and ABILHAND Questionnaire are both responsive and suitable to detect changes in bilateral arm functional daily activities in individuals with chronic stroke. Patient-reported outcome measures are recommended to use along with therapist-rated outcome measures for upper limb capacity evaluation in stroke rehabilitation. Further study with a prospective study design to capture specific clinical features of participants and the use of body-worn sensors, such as the arm accelerometer, is suggested.

Body Mass Index and Thoracic Expansion in Post-COVID Dyspnea: A Secondary Analysis.

Dyspnea secondary to lung impairment can persist following the acute phase of COVID-19. Thoracic expansion measurements have been used as a diagnostic tool to evaluate chest wall mobility, respiratory function, and the effects of respiratory muscle strength training. Changes in chest wall mobility may occur because of altered chest biomechanics in individuals with respiratory diseases and an elevated body mass index (BMI). The purpose of this secondary analysis was to evaluate whether BMI influences thoracic expansion or forced expiratory volume over 1 second (FEV1) in individuals with persistent dyspnea following COVID-19. This study assessed the relationship between BMI and thoracic expansion, pulmonary symptoms, and exercise capacity following a home-based pulmonary rehabilitation intervention. A secondary data analysis was conducted with a sample of 19 adults with persistent dyspnea following COVID-19 infection who participated in a 12-week, home-based pulmonary rehabilitation study. Participants received expiratory muscle strength training devices and were instructed to perform pulmonary rehabilitation exercises three times per week over the study period. Pulmonary function, pulmonary symptoms, exercise capacity, and BMI measurements were collected. For analysis, study participants were divided into obese (BMI > 30 kg/m2) or nonobese (BMI < 30 kg/m2) categories. Correlations using the change scores from baseline to 12 weeks between thoracic expansion, FEV1, pulmonary symptoms, and exercise capacity were assessed. In addition, the minimal detectable change (MDC) in thoracic expansion was explored. Thoracic expansion was significantly improved after 12 weeks of training (p = .012) in the nonobese group. There was a significant correlation between the change in walking distance and pulmonary symptoms (r = -.738, p < .001) and in thoracic expansion (r = .544, p = .020), and walking distance, when controlling for BMI, but no change in FEV1. Average MDC was 1.28 for inspiration and 0.91 for expiration. Measurements of thoracic expansion were significantly lower in post-COVID individuals with an increased BMI. Individuals with persistent dyspnea and a higher BMI may require additional measures to increase chest mobility or to detect pulmonary changes following COVID-19.

Single-year change in views of democracy and society and support for political violence in the USA: findings from a 2023 nationally representative survey.

A 2022 survey in the USA found concerningly high prevalences of support for and personal willingness to engage in political violence, of beliefs associated with such violence, and of belief that civil war was likely in the near future. It is important to determine the durability of those findings. Wave 2 of a nationally representative cohort survey was conducted May 18-June 8, 2023; the sample comprised all respondents to 2022's Wave 1. Outcomes are expressed as weighted proportions; changes from 2022 to 2023 are for respondents who participated in both surveys, based on aggregated individual change scores. The completion rate was 84.2%; there were 9385 respondents. After weighting, 50.7% (95% confidence interval (CI) 49.4%, 52.1%) were female; weighted mean (SD) age was 48.5 (25.9) years. About 1 in 20 respondents (5.7%, 95% CI 5.1%, 6.4%) agreed strongly/very strongly that "in the next few years, there will be civil war in the United States," a 7.7% decrease. In 2023, fewer respondents considered violence to be usually/always justified to advance at least 1 of 17 specific political objectives [25.3% (95% CI 24.7%, 26.5%), a 6.8% decrease]. However, more respondents thought it very/extremely likely that within the next few years, in a situation where they consider political violence justified, "I will be armed with a gun" [9.0% (95% CI 8.3%, 9.8%), a 2.2% increase] and "I will shoot someone with a gun" [1.8% (95% CI 1.4%, 2.2%), a 0.6% increase]. Among respondents who considered violence usually/always justified to advance at least 1 political objective, about 1 in 20 also thought it very/extremely likely that they would threaten someone with a gun (5.4%, 95% CI 4.0%, 7.0%) or shoot someone (5.7%, 95% CI 4.3%, 7.1%) to advance such an objective. In this cohort, support for political violence declined from 2022 to 2023, but predictions of firearm use in political violence increased. These findings can help guide prevention efforts, which are urgently needed.

Adenotonsillectomy Versus Watchful Waiting for Children with Obstructive Sleep Apnea Syndrome: A Systematic Review with Meta-Analysis

AbstractThe treatment of children with Obstructive Sleep Apnea Syndrome (OSAS) remains a point of debate among otorhinolaryngologists worldwide. This study aims to comparatively assess the clinical outcomes of adenotonsillectomy (ATE) and watchful waiting in children with OSAS. We searched the databases of PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL), until the 1st of October 2023. Comparative trials assessing the efficacy of adenotonsillectomy and watchful waiting in children with OSAS were considered. The primary outcome measure was the apnea-hypopnea index (AHI), and secondary outcomes included quality of life as measured by OSA-18 score, and mean SpO2 levels. A subgroup analysis evaluating the changes in AHI depending on the severity of the initial disease was also executed. We conducted a random-effects pairwise meta-analysis of change scores to include randomized and non-randomized controlled trials. The quality assessment was carried out by using the Cochrane risk of bias tool for randomized and the ROBINS-I tool for non-randomized trials, respectively. Two randomized and five non-randomized trials were included. There was a statistically significant difference regarding AHI in favor of the ATE group compared to the watchful waiting group (Standardized mean difference [SMD] was − 0.60, 95%CI −0.79 to −0.41, p &lt; 0.001). Likewise, a statistically significant decrease in change scores for OSA-18 between ATE and watchful waiting was noted (SMD was − 0.79, 95%CI −0.97 to −0.61, p &lt; 0.001). On the other hand, there was no significant difference when ATE and watchful waiting groups were compared for SpO2 levels between each other (SMD was 0.52, 95%CI −1.53 to 2.56, p &lt; 0.62). In the subgroup analysis assessing mild OSAS, there was a significant difference in favor of ATE compared to watchful waiting (SMD was −0.91, 95%CI −1.35 to −0.47, p &lt; 0.0001). For mild to moderate OSAS, similar results were noted favoring ATE as well (SMD was − 0.53, 95%CI −0.87 to −0.19, p &lt; 0.003). This study provides evidence of moderate strength supporting the superiority of ATE over the watchful waiting approach in terms of AHI and OSA-18. This also appears to be the case for AHI in children with mild and mild to moderate OSAS.

Development and application of a weighted change score to evaluate interventions for vasomotor symptoms in patients with breast cancer using regression trees: a cohort study

PurposeVasomotor symptoms (VMS) are common among individuals with breast cancer (BC) and poorly managed symptoms are associated with reduced quality of life, treatment discontinuation, and poorer breast cancer outcomes. Direct comparisons among therapies are limited, as prior studies evaluating VMS interventions have utilized heterogeneous change measures which may not fully assess the perceived impact of change in VMS severity.MethodsWe performed a prospective study where BC patients chose one of four categories of interventions to manage VMS. Change in VMS severity at 6 weeks was assessed using the validated Hot Flush Rating Scale (HFRS). A novel weighted change score integrating baseline symptom severity and directionality of change was computed to maximize the correlation between the change score and a perceived treatment effectiveness score. Variables influencing change in VMS severity were included in a regression tree to model factors influencing the weighted change score.Results100 baseline and follow-up questionnaires assessing VMS were completed by 88 patients. Correlations between treatment effectiveness and VMS outcomes strengthened following adjustment for baseline symptoms. Patients with low VMS severity at baseline did not perceive change in treatment effectiveness. Intervention category was predictive of change in HFRS at 6 weeks.ConclusionBaseline symptom severity and the directionality of change (improvement or deterioration of symptoms) influenced the perception of clinically meaningful change in VMS severity. Future interventional studies utilizing the weighted change score should target moderate-high baseline severity patients.

Standardization and other approaches to meta-analyze differences in means.

Meta-analysts often use standardized mean differences (SMD) to combine mean effects from studies in which the dependent variable has been measured with different instruments or scales. In this tutorial we show how the SMD is properly calculated as the difference in means divided by a between-subject reference-group, control-group, or pooled pre-intervention SD, usually free of measurement error. When combining mean effects from controlled trials and crossovers, most meta-analysts have divided by either the pooled SD of change scores, the pooled SD of post-intervention scores, or the pooled SD of pre- and post-intervention scores, resulting in SMDs that are biased and difficult to interpret. The frequent use of such inappropriate standardizing SDs by meta-analysts in three medical journals we surveyed is due to misleading advice in peer-reviewed publications and meta-analysis packages. Even with an appropriate standardizing SD, meta-analysis of SMDs increases heterogeneity artifactually via differences in the standardizing SD between settings. Furthermore, the usual magnitude thresholds for standardized mean effects are not thresholds for clinically important differences. We therefore explain how to use other approaches to combining mean effects of disparate measures: log transformation of factor effects (response ratios) and of percent effects converted to factors; rescaling of psychometrics to percent of maximum range; and rescaling with minimum clinically important differences. In the absence of clinically important differences, we explain how standardization after meta-analysis with appropriately transformed or rescaled pre-intervention SDs can be used to assess magnitudes of a meta-analyzed mean effect in different settings.

The impact of comorbidity status on knee function 1 year after total knee arthroplasty: a population-based cohort study.

Few studies have examined the impact of comorbidity on functional and clinical knee scores after primary total knee arthroplasty (TKA). We compared the effect of having a high Charlson Comorbidity Index (CCI), relative to a low CCI, on changes in the American Knee Society Score (AKSS) functional and clinical scores from baseline to week 52 after TKA in patients with knee osteoarthritis (OA). This population-based cohort study included 22,533 patients identified in the Danish Knee Arthroplasty Register from 1997 to 2021. Patients were classified as having low, medium, or high comorbidity based on CCI. The outcome was defined as the mean change (from preoperative to 1-year post-TKA) in functional and clinical knee scores measured by the AKSS (0-100). The association was analyzed using multiple linear regression by calculating mean change scores adjusting for sex, age, weight, cohabiting status, and baseline AKSS. The prevalence of patients with low, medium, and high comorbidity was 75%, 21%, and 4%, respectively. The mean change score in functional AKSS for patients with high comorbidity was -6 points (95% confidence interval [CI] -7 to -5) compared with low comorbidity. The mean change score in clinical AKSS for patients with high comorbidity was -1 point (CI -2 to 0) compared with low comorbidity. Patients with knee OA and medium or high comorbidity can expect similar improvements in functional and clinical AKSS after TKA to patients with low comorbidity.

Nursing students' awareness of global climate change: A descriptive and cross-sectional study.

This study aimed to determine nursing students' awareness of global climate change. This descriptive and cross-sectional study was conducted with 302 undergraduate nursing students from a foundation university in Northern Cyprus during the spring semester of the 2021-2022 academic year. A descriptive information form and the Awareness Scale of University Students about Global Climate Change (ASUSGCC) were used for data collection. The mean ASUSGCC score was 3.54±0.64, and the participants received the lowest and highest scores from the awareness of the causes of global climate change (3.54±0.64) and awareness of the effects of global climate change on the natural and human environment (4.03±0.70) subscales, respectively. A statistically significant difference was observed between the Global Climate Change scores and the year of education, with fourth-year students obtaining significantly higher scores (p<.05). The study found that nursing students have a moderate level of awareness of global climate change. To raise the level of awareness among these undergraduates, who will be future healthcare professionals, we recommend including climate change awareness in the national nursing curricula.

Non-improvement of atrophic gastritis in cases of gastric cancer after successful Helicobacter pylori eradication therapy.

Helicobacter pylori (H. pylori) infection is closely related to the development of gastric cancer (GC). However, GC can develop even after H. pylori eradication. Therefore, it would be extremely useful if GC could be predicted after eradication. The Kyoto classification score for gastritis (GA) is closely related to cancer risk. However, how the score for GC changes after eradication before onset is not well understood. To investigate the characteristics of the progression of Kyoto classification scores for GC after H. pylori eradication. Eradication of H. pylori was confirmed in all patients using either the urea breath test or the stool antigen test. The Kyoto classification score of GC patients was evaluated by endoscopy at the time of event onset and three years earlier. In addition, the modified atrophy score was evaluated and compared between the GC group and the control GA group. In total, 30 cases of early GC and 30 cases of chronic GA were evaluated. The pathology of the cancer cases was differentiated adenocarcinoma, except for one case of undifferentiated adenocarcinoma. The total score of the Kyoto classification was significantly higher in the GC group both at the time of cancer onset and three years earlier (4.97 vs 3.73, P = 0.0034; 4.2 vs 3.1, P = 0.0035, respectively). The modified atrophy score was significantly higher in the GC group both at the time of cancer onset and three years earlier and was significantly improved only in the GA group (5.3 vs 5.3, P = 0.5; 3.73 vs 3.1, P = 0.0475, respectively). The course of the modified atrophy score is useful for predicting the onset of GC after eradication. Patients with severe atrophy after H. pylori eradication require careful monitoring.

Within-person bidirectional associations between maternal cortisol reactivity and harsh parenting across infancy and toddlerhood.

To understand transactional associations between mothers' biological stress responsivity and parenting behaviors, we examined bidirectional effects between maternal cortisol reactivity to observing their children during distress-eliciting paradigms and harsh parenting across infancy and toddlerhood using longitudinal data from the Family Life Project (N = 1,292, 41.5% African American). Children completed a series of distress-eliciting laboratory paradigms when they were 7, 15, and 24 months old, and mothers observed their children during the paradigms. Maternal cortisol reactivity was computed as a residualized change score from baseline to 20 min postparadigm, controlling for the time of day the saliva sample was collected. Harsh parenting was measured using five items from the Home Observation Measurement of the Environment inventory. A random-intercept cross-lagged panel model revealed that increases in maternal cortisol reactivity at 15 months predicted subsequent increases in harsh parenting at 24 months. Similarly, increases in harsh parenting at 15 months predicted increases in maternal cortisol reactivity at 24 months. Findings indicate that increased cortisol reactivity to children's distress in early toddlerhood may indicate a risk for harsh parenting in late toddlerhood and that increases in harsh parenting can also negatively impact mothers' stress physiology over time. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Estimation of planned and unplanned missing individual scores in longitudinal designs using continuous-time state-space models.

Latent change score (LCS) models within a continuous-time state-space modeling framework provide a convenient statistical approach for analyzing developmental data. In this study, we evaluate the robustness of such an approach in the context of accelerated longitudinal designs (ALDs). ALDs are especially interesting because they imply a very high rate of planned data missingness. Additionally, most longitudinal studies present unexpected participant attrition leading to unplanned missing data. Therefore, in ALDs, both sources of data missingness are combined. Previous research has shown that ALDs for developmental research allow recovering the population generating process. However, it is unknown how participant attrition impacts the model estimates. We have three goals: (a) to evaluate the robustness of the group-level parameter estimates in scenarios with empirically plausible unplanned data missingness; (b) to evaluate the performance of Kalman scores (KS) imputations for individual data points that were expected but unobserved; and (c) to evaluate the performance of KS imputations for individual data points that were outside the age ranged observed for each case (i.e., to estimate the individual trajectories for the complete age range under study). In general, results showed lack of bias in the simulated conditions. The variability of the estimates increased with lower sample sizes and higher missingness severity. Similarly, we found very accurate estimates of individual scores for both planned and unplanned missing data points. These results are very important for applied practitioners in terms of forecasting and making individual-level decisions. R code is provided to facilitate its implementation by applied researchers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effect of moral case deliberation on midwives' knowledge and practice regarding respectful maternity care.

Although there have been reports of misbehavior and disrespectful maternal care by healthcare providers worldwide, there are few intervention studies aimed at promoting respectful care, particularly among midwives. The aim of this study was to examine the effect of Moral Case Deliberation (MCD) on the of midwives' knowledge and practice in the field of respectful maternity care. This semi-experimental study involved 46 midwives working in the maternity departments of two hospitals affiliated with Bushehr University of Medical Sciences in 2023. The two hospitals were randomly divided into control and intervention groups. All midwives from both hospitals were included in the study. The Dilemma Method of MCD was implemented for midwives of intervention hospital. The Midwives' Knowledge and Practice of Respectful Maternity Care scale was used for data collection. It was administered both before and two weeks after the intervention. Data were analyzed using SPSS (version 20). The study was approved by ethics committee of Bushehr University of Medical Sciences in Bushehr, Iran (ethics code: IR.BPUMS.REC.1402.017). All participants provided written informed consent. The intervention group showed a significantly greater increase in knowledge scores from pre-test to post-test compared to the control group (p < .001). The intervention group had a significantly higher mean change score in practice self-assessment and practice peer evaluation, from pre-test to post-test, than in the control group (p < .001). MCD based on the dilemma method can improve practice in the field of respect-oriented midwifery care by increasing knowledge and potentially changing attitudes. The Dilemma Method of MCD improved midwives' knowledge and practice regarding respectful maternity care. This method can be included in the midwifery care quality improvement program to promote respectful maternity care. It is necessary to develop methods for wider dissemination of MCD in the cultural context of Iran.

Interpreting Change in Disorders of Consciousness Using the Coma Recovery Scale-Revised.

The purpose of this study was to differentiate clinically meaningful improvement or deterioration from normal fluctuations in patients with disorders of consciousness (DoC) following severe brain injury. We computed indices of responsiveness for the Coma Recovery Scale-Revised (CRS-R) using data from a clinical trial of 180 participants with DoC. We used CRS-R scores from baseline (enrollment in a clinical trial) and a 4-week follow-up assessment period for these calculations. To improve precision, we transformed ordinal CRS-R total scores (0-23 points) to equal-interval measures on a 0-100 unit scale using Rasch Measurement theory. Using the 0-100 unit total Rasch measures, we calculated distribution-based 0.5 standard deviation (SD) minimal clinically important difference, minimal detectable change using 95% confidence intervals, and conditional minimal detectable change using 95% confidence intervals. The distribution-based minimal clinically important difference evaluates group-level changes, whereas the minimal detectable change values evaluate individual-level changes. The minimal clinically important difference and minimal detectable change are derived using the overall variability across total measures at baseline and 4 weeks. The conditional minimal detectable change is generated for each possible pair of CRS-R Rasch person measures and accounts for variation in standard error across the scale. We applied these indices to determine the proportions of participants who made a change beyond measurement error within each of the two subgroups, based on treatment arm (amantadine hydrochloride or placebo) or categorization of baseline Rasch person measure to states of consciousness (i.e., unresponsive wakefulness syndrome and minimally conscious state). We compared the proportion of participants in each treatment arm who made a change according to the minimal detectable change and determined whether they also changed to another state of consciousness. CRS-R indices of responsiveness (using the 0-100 transformed scale) were as follows: 0.5SD minimal clinically important difference = 9 units, minimal detectable change = 11 units, and the conditional minimal detectable change ranged from 11 to 42 units. For the amantadine and placebo groups, 70% and 58% of participants showed change beyond measurement error using the minimal detectable change, respectively. For the unresponsive wakefulness syndrome and minimally conscious state groups, 54% and 69% of participants changed beyond measurement error using the minimal detectable change, respectively. Among 115 participants (64% of the total sample) who made a change beyond measurement error, 29 participants (25%) did not change state of consciousness. CRS-R indices of responsiveness can support clinicians and researchers in discerning when behavioral changes in patients with DoC exceed measurement error. Notably, the minimal detectable change can support the detection of patients who make a "true" change within or across states of consciousness. Our findings highlight that the continued use of ordinal scores may result in incorrect inferences about the degree and relevance of a change score.

Neuromuscular electrical stimulation for physical function maintenance during hematopoietic stem cell transplantation: Study protocol.

Hematopoietic stem cell transplantation is a common life-saving treatment for hematologic malignancies, though can lead to long-term functional impairment, fatigue, muscle atrophy, with decreased quality of life. Although traditional exercise has helped reduce these effects, it is inconsistently recommended and infrequently maintained, and most patients remain sedentary during and after treatment. There is need for alternative rehabilitation strategies, like neuromuscular electrical stimulation, that may be more amenable to the capabilities of hematopoietic stem cell transplant recipients. Patients receiving autologous HCT are being enroled in a randomized controlled trial with 1:1 (neuromuscular electrical stimulation:sham) design stratified by diagnosis and sex. Physical function, body composition, quality of life, and fatigue are assessed prior to hematopoietic stem cell transplant (prior to initiating preparatory treatment) and 24±5 days post hematopoietic stem cell transplant (Follow-up 1); physical function and quality of life are also assessed 6-months post hematopoietic stem cell transplant (Follow-up 2). The primary outcome is between-group difference in the 6-minute walk test change scores (Follow-up 1-Pre-transplant; final enrolment goal N = 23/group). We hypothesize that 1) neuromuscular electrical stimulation will attenuate hematopoietic stem cell transplant-induced adverse effects on physical function, muscle mass, quality of life, and fatigue compared to sham at Follow-up 1, and 2) Pre-transplant physical function will significantly predict fatigue and quality of life at Follow-up 2. We will also describe feasibility and acceptability of neuromuscular electrical stimulation during hematopoietic stem cell transplant. This proposal will improve rehabilitative patient care and quality of life by determining efficacy and feasibility of a currently underutilized therapeutic strategy aimed at maintaining daily function and reducing the impact of a potent and widely used cancer treatment. This trial is registered with clinicaltrials.gov (NCT04364256).

Farm Household Vulnerability Due to Land and Forest Fire in Peatland Areas in South Sumatra

Land and forest fires in peatland areas in Indonesia have a widespread negative impact on surrounding communities. Possible vulnerabilities relate to economic, social, ecological, livelihoods, and environmental vulnerability. This study aimed to assess household vulnerability due to land and forest fires in peatland areas in Ogan Komering Ilir District in South Sumatra and observe changes in peat ecosystems in those areas. The study was conducted in three peatland hydrological units (PHUs)—(1) PHU Sungai Sugihan–Sungai Lumpur; (2) PHU Sungai Sibumbung–Sungai Batok; and (3) PHU Sungai Saleh–Sungai Sugihan—covering 300 households as samples. Primary data were collected through structured interviews and analyzed descriptively. The analysis revealed the following: (1) PHU Sungai Sibumbung–Sungai Batok had the highest score for livelihood vulnerability and climate change but the lowest score for social, economic, and ecological vulnerability; (2) PHU Sungai Saleh–Sungai Sugihan had the highest score for economic and ecological vulnerability but the lowest score for livelihood vulnerability; (3) PHU Sungai Sugihan–Sungai Lumpur had the highest score for social vulnerability but lowest score for climate change vulnerability; and (4) the number of household members, toddlers, and elderly, and all economic indicators except land ownership, contributed relatively similarly to social vulnerability in all PHUs.

An nLCA approach to support consumer meal decisions: a New Zealand case study of toppings on toast

IntroductionThis study investigates the development and potential application of a nutritional Life Cycle Assessment (nLCA) method to rank meals, using a case study of a “toppings on toast” (ToTs) meal. Methodological issues are investigated in the context of application to support consumers to make more informed food choices at the meal level.MethodsFourteen selected “toppings on toast” (ToTs) commonly consumed in New Zealand (NZ) were evaluated for their climate change impacts and nutritional value using the serve size of each topping as the functional unit (FU). NZ-specific climate change values were obtained from an existing database and recent literature. Nutritional value was calculated using the NRF family of indices – specifically the NRF9.3 and NRF28.3 indices (the latter constructed for this study to include all nutrients in the selected toppings for which reference values were available) and presented in a separate midpoint nutrition impact category. The NRF and climate change scores were assigned quartile-based weights, and the weight of each index score was averaged with that of the climate change score. Based on these average values, the toppings were ranked in two ranking sets (one for each index). In a sensitivity analysis, two alternative reference units were also used (100 g and 100 kcal) to investigate how different FUs influenced the final rankings.ResultsThe results showed that use of one or other NRF index affected the magnitude of the nLCA results; however, the rankings of the ToTs based on the nLCA results did not change much between the two indices. Avocado and peanut butter performed the best (top two ranks), and bacon, butter, and cheese were the poorest performers (bottom two ranks), for both the ranking sets. The toppings which did change ranks mostly moved up or down by only one position. Thus, the results of this case study suggest that the NRF9.3 index is sufficient to determine overall the best, medium, and worst performing toppings in the ToT meal context. However, the results also showed that water-soluble vitamins and unsaturated fats included in the NRF28.3 index contributed significantly to the nutritional scores for most of the toppings and were instrumental in the rank changes for the toppings which are particularly rich in these nutrients.DiscussionThus, for a more diverse range of toppings/meals, an expanded index including these nutrients can generate more nuanced rankings. This study contributes to the nascent but fast-growing nLCA research field, particularly within the meal context. The method used in this case study could be applied in food composition databases, restaurant menus, and websites/apps that provides recipes for meals. However, the study also highlighted the potentially significant variability in climate change and nutritional values in the toppings associated with different production practices, seasonality, and different varieties of the same product. Any future development of nLCA-based meal level rankings should address this variability and communicate it to the consumer.

Teacher autonomy support counters declining trend in intrinsic reading motivation across secondary school

AbstractStudents’ intrinsic motivation to read, which is relevant to all forms of learning, tends to decline throughout secondary school. Based on self-determination theory (SDT), this study examines whether this downward trend is slowed when students perceive greater autonomy support in the classroom. We used large-scale panel data from the NEPS comprising N = 8193 students in Germany who reported their intrinsic motivation to read and their perceived autonomy support from German teachers at annual intervals from fifth to eighth grade. Scalar longitudinal measurement invariance was found for intrinsic reading motivation (IRM) and teacher autonomy support (TAS). A dual change score model showed a decline in IRM and a negative, non-significant decrease in TAS over time. Confirming our hypothesis, the decline in IRM was slowed by earlier levels of TAS. We discuss methods to counteract the decline in intrinsic reading motivation.

Combining endpoint and change data did not affect the summary standardised mean difference in pairwise and network meta-analyses: An empirical study in depression.

When studies use different scales to measure continuous outcomes, standardised mean differences (SMD) are required to meta-analyse the data. However, outcomes are often reported as endpoint or change from baseline scores. Combining corresponding SMDs can be problematic and available guidance advises against this practice. We aimed to examine the impact of combining the two types of SMD in meta-analyses of depression severity. We used individual participant data on pharmacological interventions (89 studies, 27,409 participants) and internet-delivered cognitive behavioural therapy (iCBT; 61 studies, 13,687 participants) for depression to compare endpoint and change from baseline SMDs at the study level. Next, we performed pairwise (PWMA) and network meta-analyses (NMA) using endpoint SMDs, change from baseline SMDs, or a mixture of the two. Study-specific SMDs calculated from endpoint and change from baseline data were largely similar, although for iCBT interventions 25% of the studies at 3 months were associated with important differences between study-specific SMDs (median 0.01, IQR -0.10, 0.13) especially in smaller trials with baseline imbalances. However, when pooled, the differences between endpoint and change SMDs were negligible. Pooling only the more favourable of the two SMDs did not materially affect meta-analyses, resulting in differences of pooled SMDs up to 0.05 and 0.13 in the pharmacological and iCBT datasets, respectively. Our findings have implications for meta-analyses in depression, where we showed that the choice between endpoint and change scores for estimating SMDs had immaterial impact on summary meta-analytic estimates. Future studies should replicate and extend our analyses to fields other than depression.