Effect Sizes For Group Differences Research Articles

Characterizing Walking Behaviors in Aged Residential Care Using Accelerometry, With Comparison Across Care Levels, Cognitive Status, and Physical Function: Cross-Sectional Study.

Walking is important for maintaining physical and mental well-being in aged residential care (ARC). Walking behaviors are not well characterized in ARC due to inconsistencies in assessment methods and metrics as well as limited research regarding the impact of care environment, cognition, or physical function on these behaviors. It is recommended that walking behaviors in ARC are assessed using validated digital methods that can capture low volumes of walking activity. This study aims to characterize and compare accelerometry-derived walking behaviors in ARC residents across different care levels, cognitive abilities, and physical capacities. A total of 306 ARC residents were recruited from the Staying UpRight randomized controlled trial from 3 care levels: rest home (n=164), hospital (n=117), and dementia care (n=25). Participants' cognitive status was classified as mild (n=87), moderate (n=128), or severe impairment (n=61); physical function was classified as high-moderate (n=74) and low-very low (n=222) using the Montreal Cognitive Assessment and the Short Physical Performance Battery cutoff scores, respectively. To assess walking, participants wore an accelerometer (Axivity AX3; dimensions: 23×32.5×7.6 mm; weight: 11 g; sampling rate: 100 Hz; range: ±8 g; and memory: 512 MB) on their lower back for 7 days. Outcomes included volume (ie, daily time spent walking, steps, and bouts), pattern (ie, mean walking bout duration and alpha), and variability (of bout length) of walking. Analysis of covariance was used to assess differences in walking behaviors between groups categorized by level of care, cognition, or physical function while controlling for age and sex. Tukey honest significant difference tests for multiple comparisons were used to determine where significant differences occurred. The effect sizes of group differences were calculated using Hedges g (0.2-0.4: small, 0.5-0.7: medium, and 0.8: large). Dementia care residents showed greater volumes of walking (P<.001; Hedges g=1.0-2.0), with longer (P<.001; Hedges g=0.7-0.8), more variable (P=.008 vs hospital; P<.001 vs rest home; Hedges g=0.6-0.9) bouts compared to other care levels with a lower alpha score (vs hospital: P<.001; Hedges g=0.9, vs rest home: P=.004; Hedges g=0.8). Residents with severe cognitive impairment took longer (P<.001; Hedges g=0.5-0.6), more variable (P<.001; Hedges g=0.4-0.6) bouts, compared to those with mild and moderate cognitive impairment. Residents with low-very low physical function had lower walking volumes (total walk time and bouts per day: P<.001; steps per day: P=.005; Hedges g=0.4-0.5) and higher variability (P=.04; Hedges g=0.2) compared to those with high-moderate capacity. ARC residents across different levels of care, cognition, and physical function demonstrate different walking behaviors. However, ARC residents often present with varying levels of both cognitive and physical abilities, reflecting their complex multimorbid nature, which should be considered in further work. This work has demonstrated the importance of considering a nuanced framework of digital outcomes relating to volume, pattern, and variability of walking behaviors among ARC residents.

Test-Retest Reliability of Functional Connectivity in Adolescents With Depression

BackgroundThe test-retest reliability of functional magnetic resonance imaging is critical to identifying reproducible biomarkers for psychiatric illness. Recent work has shown how reliability limits the observable effect size of brain-behavior associations, hindering detection of these effects. However, while a fast-growing literature has explored both univariate and multivariate reliability in healthy individuals, relatively few studies have explored reliability in populations with psychiatric illnesses or how this interacts with age. MethodsHere, we investigated functional connectivity reliability over the course of 1 year in a longitudinal cohort of 88 adolescents (age at baseline = 15.63 ± 1.29 years; 64 female) with major depressive disorder (MDD) and without MDD (healthy volunteers [HVs]). We compared a univariate metric, intraclass correlation coefficient, and 2 multivariate metrics, fingerprinting and discriminability. ResultsAdolescents with MDD had marginally higher mean intraclass correlation coefficient (μMDD = 0.34, 95% CI, 0.12–0.54; μHV = 0.27, 95% CI, 0.05–0.52), but both groups had poor average intraclass correlation coefficients (<0.4). Fingerprinting index was greater than chance and did not differ between groups (fingerprinting indexMDD = 0.75; fingerprinting indexHV = 0.91; Poisson tests p < .001). Discriminability indicated high multivariate reliability in both groups (discriminabilityMDD = 0.80; discriminabilityHV = 0.82; permutation tests p < .01). Neither univariate nor multivariate reliability was associated with symptom severity or edge-level effect size of group differences. ConclusionsOverall, we found little evidence for a relationship between depression and reliability of functional connectivity during adolescence. These findings suggest that biomarker identification in depression is not limited due to reliability compared with healthy samples and support the shift toward multivariate analysis for improved power and reliability.

Altered longitudinal structural connectome in paediatric mild traumatic brain injury: an Advancing Concussion Assessment in Paediatrics study.

Advanced diffusion-weighted imaging techniques have increased understanding of the neuropathology of paediatric mild traumatic brain injury (i.e. concussion). Most studies have examined discrete white-matter pathways, which may not capture the characteristically subtle, diffuse and heterogenous effects of paediatric concussion on brain microstructure. This study compared the structural connectome of children with concussion to those with mild orthopaedic injury to determine whether network metrics and their trajectories across time post-injury differentiate paediatric concussion from mild traumatic injury more generally. Data were drawn from of a large study of outcomes in paediatric concussion. Children aged 8-16.99 years were recruited from five paediatric emergency departments within 48 h of sustaining a concussion (n = 360; 56% male) or mild orthopaedic injury (n = 196; 62% male). A reliable change score was used to classify children with concussion into two groups: concussion with or without persistent symptoms. Children completed 3 T MRI at post-acute (2-33 days) and/or chronic (3 or 6 months, via random assignment) post-injury follow-ups. Diffusion-weighted images were used to calculate the diffusion tensor, conduct deterministic whole-brain fibre tractography and compute connectivity matrices in native (diffusion) space for 90 supratentorial regions. Weighted adjacency matrices were constructed using average fractional anisotropy and used to calculate global and local (regional) graph theory metrics. Linear mixed effects modelling was performed to compare groups, correcting for multiple comparisons. Groups did not differ in global network metrics. However, the clustering coefficient, betweenness centrality and efficiency of the insula, cingulate, parietal, occipital and subcortical regions differed among groups, with differences moderated by time (days) post-injury, biological sex and age at time of injury. Post-acute differences were minimal, whereas more robust alterations emerged at 3 and especially 6 months in children with concussion with persistent symptoms, albeit differently by sex and age. In the largest neuroimaging study to date, post-acute regional network metrics distinguished concussion from mild orthopaedic injury and predicted symptom recovery 1-month post-injury. Regional network parameters alterations were more robust and widespread at chronic timepoints than post-acutely after concussion. Results suggest that increased regional and local subnetwork segregation (modularity) and inefficiency occurs across time after concussion, emerging after post-concussive symptom resolve in most children. These differences persist up to 6 months after concussion, especially in children who showed persistent symptoms. While prognostic, the small to modest effect size of group differences and the moderating effects of sex likely would preclude effective clinical application in individual patients.

Visual attention span capacity in developmental dyslexia: A meta-analysis

The visual attention span (VAS) deficit theory of developmental dyslexia (DD) indicates that impaired VAS may cause reading disabilities. However, whether people with dyslexia have VAS deficit is still controversial. The current review evaluates the literature regarding the relationship between VAS and poor reading, as it also examines the possible moderators in measuring the VAS capacity of individuals with dyslexia. A total of 25 papers, with participants of 859 readers with dyslexia and 1048 typically developing readers were included in the meta-analysis. The sample sizes, means and standard deviations (SDs) of the scores in VAS tasks were extracted separately from the two groups, which were used to calculate the effect sizes of group differences in SDs and means by the robust variance estimation model. Results showed higher SDs and lower averages of the VAS test scores for readers with dyslexia than those for typically developing readers, revealing high individual variability and remarkable deficits in VAS of DD. Further subgroup analyses showed that the characteristics of VAS tasks, background languages, and participants modulated the group differences in VAS capacities. Particularly, the partial report task with symbols of relatively high visual complexity and key pressing may be the optimal measurement of VAS skills. A greater VAS deficit in DD was observed in more opaque languages, with a trend of developmental increase in attention deficit, especially at the primary school level. Moreover, this VAS deficit seemed to be independent of the phonological deficit of dyslexia. These findings to some extent supported the VAS deficit theory of DD and (partially) explained the controversial relationship between VAS impairment and reading disabilities.

Cognitive factor structure and measurement invariance between healthy controls and patients with major depressive disorder

Cognitive impairments are crucial in functional outcomes of major depressive disorder (MDD). The effectiveness of currently available treatment methods for cognitive deficits is suboptimal. A cognitive test battery is often applied to evaluate cognition with multiple interrelated and difficult-to-interpret outcomes. Generating cognitive factor scores after the confirmation of a common cognitive structure and measurement invariance between healthy controls (HCs) and patients may aid in understanding cognition further. This methodology has been applied for several neuropsychiatric disorders, but not for MDD. Therefore, we conducted a series of exploratory factor analyses (EFA), confirmatory factor analyses (CFA), and multiple groups CFA (MGCFA) for a cognitive test battery in HCs and patients with MDD. The initial EFA of 106 HCs yielded a three-factor model—comprising attention, memory, and executive function. The CFA confirmed the initial model in other 94 HCs with revisions, which reasonably fit the cognitive data of 54 patients with MDD. MGCFA supported the measurement invariance of the determined model between HCs and patients with MDD. The associations of cognitive factor scores with age or education and the effect sizes of group differences in cognitive factor scores externally validated the determined model. In conclusion, this is the first study to demonstrate the measurement invariance of a cognitive model between HCs and patients with MDD using MGCFA. The measurement invariance substantiated valid group comparisons of factor scores and their relationships with other markers. The current results may be applicable for the development of improved treatment strategies for cognitive impairments in MDD.

An Instrumental Measure of Hand and Facial Movement Abnormalities in Patients With Schizophrenia.

IntroductionMovement disorders have been suggested to be a cardinal component of schizophrenia. With increased research interests in this area, instrumental measures are needed. This study was to examine if the motion capture system was reliable in measuring hand and facial bradykinesia and dyskinesia and more sensitive to detecting movement differences between schizophrenia patients and healthy people than traditional rating scales.MethodsSixteen schizophrenia patients and 20 control subjects were recruited. Hand and facial bradykinesia and dyskinesia were measured using the motion capture system and rated using the Extrapyramidal Symptom Rating Scale and the Abnormal Involuntary Movement Scale.ResultsThe system showed strong test–retest reliability and generated larger effect sizes of group differences than did the rating scales.ConclusionsThe results may support researchers and clinical practitioners to apply the system to sensitively measuring the hand and facial movement symptoms in schizophrenia patients, which contributes to gaining a deep understanding of movement issues in schizophrenia.

Differences in Squat Jump, Linear Sprint, and Change-of-Direction Performance among Youth Soccer Players According to Competitive Level.

The aim of this investigation was to analyze significant differences in performance depending on the level of play (elite vs. amateur) in youth soccer players (under 17 years. old (U17) and U19). A cross-sectional study was conducted, and 45 elite and amateur male youth soccer players (16.56 ± 0.9 years old) were evaluated in their performances in squat jump (SJ), 10 m linear sprint (LS), 20 m LS, 505 agility test (505) and Illinois agility test (IAT). Differences in performances were analyzed with a 2 × 2 MANOVA, post-hoc ANOVAs, and Hedges’ g (g) for pairwise comparisons of subgroups (level of play and age group). This investigation showed that the elite player performance was significantly (p < 0.05) better in all performance tests than amateur players in both age groups. Interestingly, this investigation showed that the more complex the target exercise, the larger the effect sizes for group differences (SJ: g = 0.64–1.18, LS: g = 0.05–2.23, change-of-direction (COD): g = 3.01–6.84). The SJ, LS, 505, and IAT may prove useful in talent selection test batteries to separate between competitive levels in youth soccer players.

Glutamatergic and GABAergic metabolite levels in schizophrenia-spectrum disorders: a meta-analysis of 1H-magnetic resonance spectroscopy studies.

The glutamate (Glu) and gamma aminobutyric acid (GABA) hypotheses of schizophrenia were proposed in the 1980s. However, current findings on those metabolite levels in schizophrenia have been inconsistent, and the relationship between their abnormalities and the pathophysiology of schizophrenia remains unclear. To summarize the nature of the alterations of glutamatergic and GABAergic systems in schizophrenia, we conducted meta-analyses of proton magnetic resonance spectroscopy (1H-MRS) studies examining these metabolite levels. A systematic literature search was conducted using Embase, Medline, PsycINFO, and PubMed. Original studies that compared four metabolite levels (Glu, glutamine [Gln], Glx [Glu+Gln], and GABA), as measured by 1H-MRS, between individuals at high risk for psychosis, patients with first-episode psychosis, or patients with schizophrenia and healthy controls (HC) were included. A random-effects model was used to calculate the effect sizes for group differences in these metabolite levels of 18 regions of interest between the whole group or schizophrenia group and HC. Subgroup analysis and meta-regression were performed based on the status of antipsychotic treatment, illness stage, treatment resistance, and magnetic field strength. One-hundred-thirty-four studies met the eligibility criteria, totaling 7993 participants with SZ-spectrum disorders and 8744 HC. 14 out of 18 ROIs had enough numbers of studies to examine the group difference in the metabolite levels. In the whole group, Glx levels in the basal ganglia (g = 0.32; 95% CIs: 0.18-0.45) were elevated. Subgroup analyses showed elevated Glx levels in the hippocampus (g = 0.47; 95% CIs: 0.21-0.73) and dorsolateral prefrontal cortex (g = 0.25; 95% CIs: 0.05-0.44) in unmedicated patients than HC. GABA levels in the MCC were decreased in the first-episode psychosis group compared with HC (g = -0.40; 95% CIs: -0.62 to -0.17). Treatment-resistant schizophrenia (TRS) group had elevated Glx and Glu levels in the MCC (Glx: g = 0.7; 95% CIs: 0.38-1.01; Glu: g = 0.63; 95% CIs: 0.31-0.94) while MCC Glu levels were decreased in the patient group except TRS (g = -0.17; 95% CIs: -0.33 to -0.01). Increased glutamatergic metabolite levels and reduced GABA levels indicate that the disruption of excitatory/inhibitory balance may be related to the pathophysiology of schizophrenia-spectrum disorders.

A multicenter feasibility randomized controlled trial to assess the impact of incremental versus conventional initiation of hemodialysis on residual kidney function

Twice-weekly hemodialysis, as part of incremental initiation, has reported benefits including preservation of residual kidney function (RKF). To explore this, we initiated a randomized controlled feasibility trial examining 55 incident hemodialysis patients with urea clearance of 3 ml/min/1.73 m2 or more across four centers in the United Kingdom randomized to standard or incremental schedules for 12 months. Incremental hemodialysis involved twice-weekly sessions, upwardly adjusting hemodialysis dose as RKF was lost, maintaining total (Dialysis+Renal) Std Kt/V above 2. Standard hemodialysis was thrice weekly for 3.5-4 hours, minimum Dialysis Std Kt/V of 2. Primary outcomes were feasibility parameters and effect size of group differences in rate of loss of RKF at six months. Health care cost impact and patient-reported outcomes were explored. Around one-third of patients met eligibility criteria. Half agreed to randomization; 26 received standard hemodialysis and 29 incremental. At 12 months, 21 incremental patients remained in the study vs 12 in the standard arm with no group differences in the urea clearance slope. Ninety-two percent of incremental and 75% of standard arm patients had a urea clearance of 2 ml/min/1.73 m2 or more at six months. Serious adverse events were less frequent in incremental patients (Incidence Rate Ratio 0.47, confidence interval 0.27-0.81). Serum bicarbonate was significantly lower in incremental patients indicating supplementation may be required. There were three deaths in each arm. Blood pressure, extracellular fluid and patient-reported outcomes were similar. There was no signal of benefit of incremental hemodialysis in terms of protection of RKF or Quality of Life score. Median incremental hemodialysis costs were significantly lower compared to standard hemodialysis. Thus, incremental hemodialysis appears safe and cost-saving in incident patients with adequate RKF, justifying a definitive trial.

“A Part of Our Family”? Effects of Psychiatric Service Dogs on Quality of Life and Relationship Functioning in Military-Connected Couples

Posttraumatic stress disorder (PTSD) can have corrosive impacts on family relationships and individual functioning. Emerging evidence has shown that psychiatric service dogs may be an effective complementary treatment for military veterans with PTSD, benefiting veterans’ mental and social health. However, few studies have examined the effects of psychiatric service dogs on the family members of veterans, specifically their partners. Mixed-methods data from 60 veteran-partner dyads examined individual and relationship functioning among partners of veterans paired with a service dog (service dog group; n = 37) and those awaiting placement (waitlist group; n = 23). While there were no statistically significant differences across groups, the effect sizes for group differences suggested that partners in the service dog group (relative to those on the waitlist) may experience higher levels of resilience and companionship, and lower levels of anger, social isolation, and work impairment. A topical survey of partner qualitative data within the service dog group indicated that service dogs provided more benefits than challenges. Partners reported improvements in veteran functioning, family relationships, and partners’ quality of life. Results, although preliminary, suggest that psychiatric service dogs may provide modest positive experiences for some veteran family systems.

Metaphor processing in autism: A systematic review and meta-analysis

Impairments related to figurative language understanding have been considered to be one of the diagnostic and defining features of autism. Metaphor comprehension and production in autism spectrum disorder (ASD) as compared to typically developing (TD) individuals have been investigated for around thirty years, generally showing an overall advantage for TD groups. We present a preregistered systematic review and meta-analysis including a total of 15 studies that fulfilled our set of inclusion criteria (notably, ASD and TD groups matched in chronological age and verbal- or full-scale IQ). Along with accuracy, we also analyzed group differences in reaction time in the studies that reported them. The results revealed a medium-to-large group difference favoring TD over ASD groups based on accuracy measures, as well as a similar overall advantage for TD groups based on reaction times. There was reliable heterogeneity in effect sizes for group differences in accuracy, which was mostly explained by the effect of verbal intelligence, with differences in metaphor processing being smaller for participants with better verbal skills. Some of the variation in effect sizes may also be attributed to differences in types of metaphor processing tasks. We also evaluated the quality of the studies included in the meta-analysis, and the evidence relating to the potential presence of publication bias.

Toward quantitative neuroimaging biomarkers for Friedreich's ataxia at 7 Tesla: Susceptibility mapping, diffusion imaging, R2 and R1 relaxometry.

Friedreich's ataxia (FRDA) is a rare genetic disorder leading to degenerative processes. So far, no effective treatment has been found. Therefore, it is important to assist the development of medication with imaging biomarkers reflecting disease status and progress. Ten FRDA patients (mean age 37 ± 14 years; four female) and 10 age‐ and sex‐matched controls were included. Acquisition of magnetic resonance imaging (MRI) data for quantitative susceptibility mapping, R 1, R 2 relaxometry and diffusion imaging was performed at 7 Tesla. Results of volume of interest (VOI)‐based analyses of the quantitative data were compared with a voxel‐based morphometry (VBM) evaluation. Differences between patients and controls were assessed using the analysis of covariance (ANCOVA; p < 0.01) with age and sex as covariates, effect size of group differences, and correlations with disease characteristics with Spearman correlation coefficient. For the VBM analysis, a statistical threshold of 0.001 for uncorrected and 0.05 for corrected p‐values was used. Statistically significant differences between FRDA patients and controls were found in five out of twelve investigated structures, and statistically significant correlations with disease characteristics were revealed. Moreover, VBM revealed significant white matter atrophy within regions of the brainstem, and the cerebellum. These regions overlapped partially with brain regions for which significant differences between healthy controls and patients were found in the VOI‐based quantitative MRI evaluation. It was shown that two independent analyses provided overlapping results. Moreover, positive results on correlations with disease characteristics were found, indicating that these quantitative MRI parameters could provide more detailed information and assist the search for effective treatments.

A cross-sectional examination of the home food environments ofmothers who have undergone metabolic and bariatric surgery: apilotstudy.

Healthful dietary changes after metabolic and bariatric surgery (MBS) may benefit not only patients, but the type and/or availability of foods/beverages in the family home food environment (HFE) overall, thereby reducing obesogenic environmental risks to child offspring in the home. Few studies have investigated the family HFE after MBS. To examine whether the HFE of mothers post-MBS differed from the HFE of mothers of normal weight, overweight, and with obesity using an open home food inventory. Cincinnati, Ohio and Newark, Delaware. Thirty-two mothers with a child (6-12 yr) participated (8 post-MBS, 8 normal weight, 8 overweight, 8 with obesity) in a pilot study. Research personnel recorded all foods and beverages in the home. Per person total energy and servings of fruits, vegetables, sugar-sweetened beverages, and energy-dense snack foods in the HFE were examined using 1-way analyses of variance and Cohen's d effect sizes. Mothers in the post-MBS group had significantly fewer servings of sugar-sweetened beverages available per person compared with mothers with obesity (P = .01). Effect sizes for group differences indicated total energy, sugar-sweetened beverages, and servings of fruits and vegetables were generally medium to large, most with lower mean values for the post-MBS group relative to comparator groups. These findings, while preliminary, highlight areas for future research and add to an emerging literature on obesogenic risks to offspring in the post-MBS home, a known subgroup at high risk for severe obesity.

Auditory frequency discrimination in developmental dyslexia: A meta-analysis.

Auditory frequency discrimination has been used as an index of sensory processing in developmental language disorders such as dyslexia, where group differences have often been interpreted as evidence for a basic deficit in auditory processing that underpins and constrains individual variability in the development of phonological skills. Here, we conducted a meta‐analysis to evaluate the cumulative evidence for group differences in frequency discrimination and to explore the impact of some potential moderator variables that could contribute to variability in effect‐size estimations across studies. Our analyses revealed mean effect sizes for group differences on frequency discrimination tasks on the order of three‐quarters of a standard deviation, but in the presence of substantial inter‐study variability in their magnitude. Moderator variable analyses indicated that factors related both to participant variability on behavioural and cognitive variables associated with the dyslexia phenotype, and to variability in the task design, contributed to differences in the magnitude of effect size across studies. The apparently complex pattern of results was compounded by the lack of concurrent, standardised metrics of cognitive and reading component skills across the constituent studies. Differences on sensory processing tasks are often reported in studies of developmental disorders, but these need to be more carefully interpreted in the context of non‐sensory factors, which may explain significant inter‐ and intra‐group variance in the dependent measure of interest.

Differences in Symptom Clusters at Baseline Testing among Student Athletes with ADHD or Migraines

Abstract Purpose This study was designed to determine whether the factor structure of the Post-Concussion Symptom Scale (PCSS) is consistent (i.e., invariant) in subgroups of youth with pre-existing attention-deficit/hyperactivity disorder (ADHD) or migraines. A four-factor model of the PCSS has empirical support (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective symptoms), and the current investigation examined (i) whether this model is invariant across athletes with and without ADHD or migraines and (ii) group differences across symptom clusters. Methods Participants included a large sample of adolescent athletes (N=39,242; 54.4% boys; 13–18 years-old, M=15.50±1.27 years), among which 2,543 reported ADHD and 2,638 reported having migraines. The 22-item PCSS was administered at pre-season baseline. Statistical analyses included invariance testing across ADHD and migraine groups. Good fit was defined as CFI≥0.95. Effect sizes for group differences in symptom clusters were calculated. Results Configural invariance was established across participants with and without ADHD (CFI=0.967) and with and without migraines (CFI=0.965); however, weak invariance was not established for either diagnostic group. Effect sizes (Cohen’s d) of group differences varied by symptom cluster: cognitive-sensory (ADHD=0.44; migraine=0.38), sleep-arousal (0.33, 0.37), vestibular-somatic (0.17, 0.45), and affective (0.27, 0.28). Conclusion Although the four-factor model has been previously published and replicated among healthy student athletes, this model was only partially invariant for participants with ADHD or migraines. The cognitive-sensory factor showed the largest differences based on ADHD, whereas the vestibular-somatic factor showed the largest differences based on migraine history.

A Four-Factor Symptom Model for Student Athletes with and without Prior Concussions

Abstract Purpose This study was designed to determine whether the factor structure of the Post-Concussion Symptom Scale (PCSS) is consistent (i.e., invariant) in subgroups of youth stratified by their history of prior concussions. A four-factor model of the PCSS has empirical support (i.e., cognitive-sensory, sleep-arousal, vestibular-somatic, and affective symptoms), and the current investigation examined (i) whether this model is invariant across athletes with 0, 1, or ≥2 prior concussions and (ii) group differences across symptom clusters. Methods Participants included a large sample of adolescent athletes (54.4% boys; 13–18 years-old, M=15.50±1.27 years) with 0 (n=32,668), 1 (n=4,110), or ≥2 prior concussions (n=1,681) administered the 22-item PCSS at pre-season baseline. Measurement invariance was tested (good fit=CFI≥0.95; significant change-in-fit=∆CFI≥0.01) and effect sizes for group differences in symptom clusters were calculated. Results The four-factor model showed configural (CFI=0.968) and weak invariance (∆CFI=0.006), but not strong invariance. Comparisons based on concussion history across symptom clusters indicated very small differences between athletes with 0 and 1 prior concussion(s) (d=0.05-0.15), slightly larger differences between athletes with 1 and ≥2 prior concussion(s) (d=0.12-0.24), and modestly larger differences between athletes with 0 and ≥2 prior concussion(s) (d=0.17-0.35). Conclusion These findings support partial invariance of the four-factor PCSS model across athletes with and without a history of concussion. The association with prior concussion was greatest for cognitive-sensory symptoms and smallest for vestibular symptoms. Future research should explore whether alternative factor models are invariant across athletes with different numbers of prior concussions.

Gait characteristics and functional outcomes during early follow-up are comparable in patients with calcaneal fractures treated by either the sinus tarsi or the extended lateral approach

BackgroundTo overcome the substantial functional loss after calcaneal fractures (CF), surgical treatment currently consists of two strategies, namely the commonly used extended lateral approach (ELA) and the less invasive sinus tarsi approach (STA). Despite the comparable anatomical restoration, the biomechanical and functional outcome of these strategies during early rehabilitation has not yet been investigated. Research questionTo evaluate changes in gait characteristics and functional development in patients with CF treated by either STA or ELA. MethodsA total of 56 patients with unilateral CF were included in this retrospective study. 26 patients were treated by ELA while 30 patients underwent surgery through the STA. Functional and biomechanical measurements were performed at follow-up periods of three and six months. Foot and ankle kinetics and kinematics were extracted using instrumented gait analysis with a multi segment foot model. Physical and mental components of the Short Form 36 (SF-36) and total scoring of the AOFAS hindfoot scale were used for functional evaluation. Statistical analysis was performed using Mann Whitney and Student’s t-test. Effect sizes of group differences were calculated using Cohen’s d. ResultsComparisons between ELA and STA showed no significant difference regarding the biomechanical and functional outcome. Within-group comparisons showed significant (p < 0.05) improvements from three to six month follow-up. Ankle joint and hindfoot kinematics showed increased mobility during walking of up to 34% and 26%, respectively. Maximum ankle joint moment also improved by up to 34% while vertical ground reaction force increased by 8%. Functional outcome only revealed significant changes in the physical component of SF-36. SignificanceELA and STA treatments revealed comparable functional improvements in patients with unilateral intraarticular calcaneal fractures during early rehabilitation. The less invasive STA provides adequate restoration of dynamic foot function and could serve as a viable alternative to the commonly used ELA.

Cognitive Impairment in Fibromyalgia: A Meta-Analysis of Case-Control Studies.

Cognitive dysfunction has been reported in individuals with fibromyalgia. However, findings regarding cognitive function examined using neuropsychological tests have been inconsistent. The aim of the study was to determine domain-specific cognitive impairment in patients with fibromyalgia compared with healthy controls. We conducted a meta-analysis that systematically searched six databases (PubMed, Ovid MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) for articles published before September 2017. Twenty-three case-control studies with a total of 2096 participants were included in the meta-analysis. Cognitive function was significantly lower (g = 0.87, 95% confidence interval [CI] = 0.60-1.15) in individuals with fibromyalgia than in healthy controls. Large effect sizes were found in learning/memory and attention/psychomotor speed (g = 0.94, p = .013; g = 1.22, p < .001, respectively); medium effect sizes were reported in executive function and working memory (g = 0.72, p < .001; g = 0.75, p < .001, respectively). Depression and anxiety scores were associated with the effect size of group differences in cognitive function (B = 0.11, p < .001, 95% CI = 0.09-0.13; B = 0.02, p < .001, 95% CI = 0.01-0.02, respectively). Cognitive impairment across different cognitive domains was found in individuals with fibromyalgia compared with healthy controls. Mood states (depression and anxiety) may explain the heterogeneity across studies.

Reducing Israeli-Jewish Pupils’ Outgroup Prejudice with a Mindfulness and Compassion-Based Social-Emotional Program

This study evaluated the effectiveness of a newly developed mindfulness and compassion-based social-emotional intervention, Call to Care-Israel (C2C-I), in reducing prejudiced attitudes of Israeli-Jewish youth toward the Israeli-Palestinian outgroup. The C2C-I combines social-cognitive and social-emotional driven mindfulness and compassion practice into one program to create a community of care and cultivate compassion toward the self and others. Three hundred twenty-four Israeli-Jewish 3rd–5th graders (ngirls = 137) from three elementary schools in central Israel were assigned by partial randomization to the C2C-I intervention (nC2CI = 175) or a wait-list control group. Outgroup prejudice was assessed by three measures—stereotyping, affective prejudice, and readiness for social contact—at pre- and post-intervention, as well as at a 6-month follow-up. Results showed that, compared to control group participants, those in the C2C-I intervention significantly reduced affective prejudice toward and negative stereotyping about the Israeli-Palestinian outgroup, while simultaneously increasing their readiness to engage in social contact with Israeli-Palestinian youth. Importantly, the significant effects found in the C2C-I group were maintained at the 6-month follow-up—a period that involved a violent escalation in the Israeli-Palestinian conflict—while further deterioration in intergroup attitudes emerged for the control group. High effect sizes for group differences in all prejudice measures emerged, further highlighting the robust impact of the C2C-I program. These results have significant implications for implementing C2C-I mindfulness and compassion-based practices in order to promote positive intergroup relations in areas characterized by ethnic tension and violent conflict.

Flortaucipir F 18 Quantitation Using Parametric Estimation of Reference Signal Intensity.

PET imaging of tau pathology in Alzheimer disease may benefit from the use of white matter reference regions. These regions have shown reduced variability compared with conventional cerebellar regions in amyloid imaging. However, they are susceptible to contamination from partial-volume blurring of tracer uptake in the cortex. We present a new technique, PERSI (Parametric Estimation of Reference Signal Intensity), for flortaucipir F 18 count normalization that leverages the advantages of white matter reference regions while mitigating potential partial-volume effects. Methods: Subjects with a clinical diagnosis of Alzheimer disease, mild cognitive impairment, or normal cognition underwent T1-weighted MRI and florbetapir imaging (to determine amyloid [Aβ] status) at screening and flortaucipir F 18 imaging at single or multiple time points. Flortaucipir F 18 images, acquired as 4 × 5 min frames 80 min after a 370-MBq injection, were motion-corrected, averaged, and transformed to Montreal Neurological Institute (MNI) space. The PERSI reference region was calculated for each scan by fitting a bimodal gaussian distribution to the voxel-intensity histogram within an atlas-based white matter region and using the center and width of the lower-intensity peak to identify the voxel intensities to be included. Four conventional reference regions were also evaluated: whole cerebellum, cerebellar gray matter, atlas-based white matter, and subject-specific white matter. SUVr (standardized uptake value ratio) was calculated for a statistically defined neocortical volume of interest. Performance was evaluated with respect to test-retest variability in a phase 2 study of 21 subjects (5-34 d between scans). Baseline variability in controls (SD of SUVr and ΔSUVr) and effect sizes for group differences (Cohen d; Aβ-positive impaired vs. Aβ-negative normal) were evaluated in another phase 2 study with cross-sectional data (n = 215) and longitudinal data (n = 142/215; 18 ± 2 mo between scans). Results: PERSI showed superior test-retest reproducibility (1.84%) and group separation ability (cross-sectional Cohen d = 9.45; longitudinal Cohen d = 2.34) compared with other reference regions. Baseline SUVr variability and ΔSUVr were minimal in Aβ control subjects with no specific flortaucipir F 18 uptake (SUVr, 1.0 ± 0.04; ΔSUVr, 0.0 ± 0.02). Conclusion: PERSI reduced variability while enhancing discrimination between diagnostic cohorts. Such improvements could lead to more accurate disease staging and robust measurements of changes in tau burden over time for the evaluation of putative therapies.