Treatment Effect Size Research Articles

Rapid cycle deliberate practice for an ECMO emergency simulation training for nurses: A quasi-experimental study

BackgroundThe air entering the ECMO circuit is considered a mechanical emergency with a high mortality rate. Team training for nurses is necessary to handle these emergencies. MethodQuasi-experimental pre- and post-intervention study. Data were collected from October 2021 to February 2022 at a hospital in Rio de Janeiro, Brazil. The intervention was the Rapid Cycle Deliberate Practice simulation training. The analysis included comparing performance between pre and post-test, time to action, and satisfaction and self-confidence. Inferential statistics and intervention effect size were calculated. Results28 nurses participated in the research. Performance scores increased by 44.1% in the post-test, with an average reduction of 3.54 minutes in time spent on actions (p < .0001). The effect size of the intervention was high, and participants were satisfied and self-confident. ConclusionRCDP can be applied as a simulation strategy for training in the management of an arterial air ECMO emergency, with improved participant performance.

Application of Highly Optimised Structured Teaching Method in Training of Trainer Programme

The growing awareness of the big differences between teachers has led to an ongoing dialogue among educators, researchers, and policy makers on how to improve teaching practices. The highly optimised structured teaching (HOST) teaching method is an effective and efficient teaching framework using evidence-based strategies and an innovative teaching structure. This study introduces the result of using the HOST teaching method in a train the trainer programme. A random group of trained participants in the training of trainer program was selected and asked to self-assess their learning by answering a questionnaire about their knowledge and skills they gained from the programme. Then the effect size of HOST intervention is calculated by comparing the pre and post self-assessment scores. The result shows a very high effect of the HOST teaching method. The study concluded that the HOST method is recommended to be used in training.

The dose-response relationship in physical activity interventions: Does greater duration, number of sessions, and contact time enhance behavior change?

We tested whether an intervention's dosage influences health behavior change. Intervention dosage was indexed by the duration of the intervention, the number of sessions, and total contact time in treatment arms of trials to promote physical activity. The research comprised two studies. In Study 1, we synthesized 161 meta-analyses of physical activity interventions to examine the relationship between intervention dosage and intervention impact on physical activity. Study 2 comprised a reanalysis of primary studies. The relationship between the indices of dosage and intervention effect sizes was assessed in 23.6% of meta-analyses, and associations did not differ from zero in 70%-85% of tests (Study 1). In Study 2, we retrieved 838 tests for duration, 370 tests for the number of sessions, and 167 tests for contact time. Duration had a very small negative association with effect sizes (b = -.002, 95% confidence interval [-.003, -.001]); number of sessions and contact time were not related to intervention effectiveness. An exploratory study (N = 50) indicated that health psychology researchers overestimated the association between dosage and effect sizes (restimates > .25). Although physical activity interventions with a higher dosage are expected to be more effective, the findings showed no relationship between dosage and intervention impact. Intervention dosage may moderate the influence of intervention content rather than directly determine physical activity change. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Transcranial direct current stimulation for obsessive compulsive disorder: A systematic review and CONSORT evaluation.

This systematic review was prospectively registered with PROSPERO (CRD42023426005) and the data collected in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The quality of reporting of included studies was evaluated in accordance with the CONSORT statement. Eleven randomized controlled trials were identified. Evaluation of the reviewed studies revealed low levels of overall compliance with the CONSORT statement highlighting the need for improved reporting. Key areas included insufficient information about - the intervention (for replicability), participant flow, recruitment, and treatment effect sizes. Study discussions did not fully consider limitations and generalizability, and the discussion/interpretation of the findings were often incongruent with the results and therefore misleading. Only two studies reported a significant difference between sham and active tDCS for OCD outcomes, with small effect sizes noted. The variability in protocols, lack of consistency in procedures, combined with limited significant findings, makes it difficult to draw any meaningful conclusions about the effectiveness of tDCS for OCD. Future studies need to be appropriately powered, empirically driven, randomized sham-controlled clinical trials.

PsicoCare: a pilot randomized controlled trial testing a psychological intervention combining cognitive-behavioral treatment and positive psychology therapy in acute coronary syndrome patients.

Although psychological factors play a significant role in the onset and prognosis of acute coronary syndrome (ACS), psychological interventions (PIs) are rarely included in cardiac rehabilitation (CR) programs due to inconclusive evidence regarding specific intervention components and effect sizes. This study aimed to assess the efficacy of a PI based on cognitive-behavioral treatment (CBT) and positive psychology therapy (PPT) in improving psychological and clinical outcomes in patients with ACS. This PsicoCare trial was an open-label randomized controlled trial that compared a combined CBT and PPT-based PI (the PsicoCare program) with a standard CR program (control group). We recruited 87 ACS patients, and psychological outcomes, functional capacity, biochemical and anthropometric measures, and clinical outcomes were assessed at baseline, 2 months, and 9 months after the ACS event. The PsicoCare group showed significant improvements in depression, anger traits, anger-in, and anger control-out compared to the control group. Additionally, the PsicoCare intervention was associated with the improved maintenance of cognitive function, social support, and spiritual coping styles, while the control group showed deterioration in these areas. Patients experiencing severe ACS showed significant improvement in personal strength and meaning as a result of the PsicoCare intervention. However, no significant effects were observed on anxiety, anger-out, emotion regulation skills, dispositional optimism, other personal strengths, or quality of life. Both groups demonstrated similar improvements in functional capacity and clinical outcomes. The study suggests that CBT and PPT-based PIs may offer additional benefits for ACS patients, particularly regarding their psychological health. Further larger trials are required to confirm these findings. identifier, NCT05287061.

Effects of whey-derived lactopeptide β-lactolin on cognitive performance in mild cognitive impairment: a randomized, double-blind, placebo-controlled trial

ABSTRACT Objective This study aimed to investigate the effects of a long-term intervention with β-lactolin, a tetrapeptide (sequence: glycine-threonine-tryptophan-tyrosine) derived from milk, on cognitive performance in individuals with mild cognitive impairment (MCI). Methods A randomized, double-blind, placebo-controlled trial was conducted. We recruited 48 participants aged 50 years or older with the Japanese version of the Mini-Mental State Examination (MMSE-J) score of 24–28 and a Clinical Dementia Rating (CDR) score of 0.5. Participants were administered β-lactolin (1.8 mg daily) or placebo for 24 weeks. The primary outcomes were the MMSE-J and the Japanese version of the Montreal Cognitive Assessment (MoCA-J) scores for cognitive function. Results A total of 422 individuals were screened, 48 of whom were included in this study. The MMSE-J and MoCA-J scores showed no significant differences between the groups. In the intra-group comparison of the MoCA-J delayed recall score, a significant difference was observed in the β-lactolin group after 12 and 24 weeks of intervention (p = 0.0256, p = 0.0175, respectively). Furthermore, the subgroup analysis stratified for females only showed a significant difference in MoCA-J total score in the β-lactolin group after 24 weeks of intervention (p = 0.0253). Conclusion β-lactolin intake does not significantly improve cognitive function in MCI in an inter-group comparison; nevertheless, the MoCA-J delayed recall score was significantly improved in the β-lactolin group. The number of participants was lower than planned, limiting the confirmation of the effectiveness of β-lactolin on MCI. This report demonstrated the effect size of β-lactolin intervention in MCI, contributing insights for future research.

Examining Working Memory Training for Healthy Adults-A Second-Order Meta-Analysis.

Enhancing working memory performance in cognitively and physically healthy individuals is a popular area of research. The results from a large number of studies have now been summarized in multiple meta-analyses. In these reviews, various training methods have been examined, including mindfulness training, adaptive working memory training, physical activity training, and video game training, to examine whether working memory capacity can be improved. This report aggregated the results of these meta-analyses using second-order meta-analytic approaches to ascertain the extent to which working memory functioning can be enhanced in healthy adults. A total of six meta-analyses of randomized controlled trials that compared working memory interventions to a control group were included in the analyses. These studies were identified after systematically searching three electronic databases: APA PsycInfo, ERIC and Medline. Collectively, the meta-analyses investigated the effects of cognitive programs, mindfulness, video games and physical activity on working memory. Only meta-analyses undertaken with healthy adults aged between 18 and 55 years were included in the report. The results revealed an average improvement in working memory across the included studies compared to the control groups. The findings indicated a small yet significant enhancement in working memory, with a standardized mean difference of 0.335 (95% CI [0.223; 0.447], p < .001). Further analysis tests for superiority effects between the different working memory training programs revealed no significant differences between intervention effect sizes. Based on the findings, it can be concluded that the working memory capacity of healthy adults can be improved through training. However, the effect size is small, so the utility of this type of training in real-life improvements in cognition may be minimal. The evidence does not indicate that one type of working memory training is superior to another.

Based -evidence, an intervention study to improve sleep quality in awake adult ICU patients: a prospective, single-blind, clustered controlled trial

BackgroundEvidence-based guidelines advocate promoting sleep in intensive care unit (ICU) patients, yet many patients experience poor sleep quality. We sought to develop a collaborative evidence-based intervention with healthcare providers and assess whether evidence-based sleep interventions could improve sleep quality in awake adult ICU patients.MethodsWe conducted a prospective, nonrandomized cluster control trial in two intensive care units (ICUs) at a tertiary general teaching hospital in China. Patients aged 18 years or older who stayed in the ICU for one night or more and were conscious were eligible for enrollment. We only blinded the patients, not the outcome assessors. On the basis of evidence-based practice and clinical reality, we developed intervention measures for the intervention group, which mainly included four aspects: reducing environmental noise in the ICU, adjusting nursing actions, modifying nighttime lighting, and other measures. The assessment tools used were wearable actigraphy sleep monitoring devices and the Richards-Campbell Sleep Questionnaire (RCSQ). The primary outcomes were patient sleep quality, including total sleep time, deep sleep time, light sleep time, rapid eye movement (REM) time, number of awakenings, overall sleep score, and patients' self-assessment of their sleep quality that night. The data collected were analyzed via SPSS and Mplus statistical software for between-group analysis, pre-post comparison, profile analysis, and calculation of the intervention effect size.ResultsFrom September 1, 2023, to January 31, 2024, 713 patients underwent eligibility assessment, and ultimately 246 patients were included in the analysis, with 125 in the intervention group and 121 in the control group. Comparative analysis revealed no statistically significant differences in sleep quality between the two groups when the duration in the ICU = 1 night (P > 0.05), with a small intervention effect size. However, the intervention group had higher sleep quality scores (sleep monitoring wristband: 57.74 ± 22.55 > 57.72 ± 19.39; RCSQ questionnaire: 60.58 ± 22.14 > 57.61 ± 24.4) and total sleep time (440.42 ± 262.11 > 420.31 ± 236.89), a lower awakening frequency (3.98 ± 2.69 < 6.09 ± 4.66) and a lower awakening frequency (3.976 ± 2.693 < 6.09 ± 4.664) than did the control group. The sleep quality of patients who stayed in the ICU for > 1 night significantly improved in all the parameters except rapid eye movement time (min) according to the pre-post-test analyses (P < 0.05), with a medium to large intervention effect size and favorable intervention effects.ConclusionEvidence-based interventions significantly improve sleep quality in ICU patients hospitalized for more than one day. However, our results do not support the improvement of sleep quality in patients admitted to the ICU for one day.Clinical trial registration: ChiCTR2300075763, Registered 14 September 2023—Retrospectively registered, https://www.chictr.org.cn/bin/userProject

Effect of interventions for health care students to develop positive attitude toward the elderly: A meta-analysis study.

The rise in the elderly population all over the world has led to an increase in the health care needs of elderly individuals. Thus, health care professionals need programs to help them develop positive attitudes toward the elderly during their education process. This study aims to explore the effect of interventions that encourage health care students to develop positive attitudes toward the elderly. In this research utilizing the meta-analysis method, searches were conducted across eight databases. Following the screening process, a total of 14 101 studies were retrieved, of which 13 were ultimately included in the meta-analysis. Following the meta-analysis, the effect size of interventions for positive attitude development toward the elderly was found to be statistically significant at 0.422 (95% confidence interval, 0.013-0.830; P = 0.043). Thirteen studies in which the effect of interventions for positive attitude development toward the elderly was examined revealed that the effect was moderately in favor of the experimental group. Although there are a large number of studies in the literature that aim to develop positive attitudes toward the elderly, well-designed studies with high methodological quality are needed to obtain high level evidence. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2024; ••: ••-••.

A Hearing Intervention and Health-Related Quality of Life in Older Adults

Health-related quality of life is a critical health outcome and a clinically important patient-reported outcome in clinical trials. Hearing loss is associated with poorer health-related quality-of-life in older adults. To investigate the 3-year outcomes of hearing intervention vs health education control on health-related quality of life. This secondary analysis of a randomized clinical trial included participants treated for hearing loss at multiple US centers between 2018 and 2019 with 3-year follow-up completed in 2022. Eligible participants were aged 70 to 84 years, had untreated hearing loss, and were without substantial cognitive impairment. Participants were randomized (1:1) to hearing intervention or health education control and followed every 6 months. Hearing intervention (provision of hearing aids and related technologies, counseling, education) or health education control (individual sessions covering topics relevant to chronic disease, disability prevention). Three-year change in the RAND-36 physical and mental health component scores over 3 years. The 8 individual domains of health-related quality-of-life were additionally assessed. Outcomes measured at baseline and at 6-month, 1-year, 2-year, and 3-year follow-ups. Intervention effect sizes estimated using a 2-level linear mixed effects model under the intention-to-treat principle. A total of 977 participants were analyzed (mean [SD] age, 76.8 [4.0] years; 523 female [53.5%]; 112 Black [11.5%], 858 White [87.8%]; 521 had a Bachelor's degree or higher [53.4%]), with 490 in the hearing intervention and 487 in the control group. Over 3 years, hearing intervention (vs health education control) had no significant association with physical (intervention, -0.49 [95% CI, -3.05 to 2.08]; control, -0.92 [95% CI, -3.39 to 1.55]; difference, 0.43 [95% CI, -0.64 to 1.51]) or mental (intervention, 0.38 [95% CI, -1.58 to 2.34]; control, -0.09 [95% CI, -1.99 to 1.81]; difference, 0.47 [95% CI, -0.41 to 1.35]) health-related quality of life. In this secondary analysis of a randomized clinical trial, hearing intervention had no association with physical and mental health-related quality-of-life over 3 years among older adults with hearing loss. Additional intervention strategies may be needed to modify health-related quality among older adults with hearing loss. ClinicalTrials.gov Identifier: NCT03243422.

The influence of intervention fidelity on treatment effect estimates in clinical trials of complex interventions: A meta-epidemiological study

BackgroundRandomized clinical trials (RCT) provide the most reliable estimates of treatment effectiveness for therapeutic interventions. However, flaws in their design and conduct may bias treatment effect estimates, leading to over or underestimation of the true intervention effect. This is especially relevant for complex interventions, such as those in rehabilitation, which are multifaceted and tailored for individual patients or providers, leading to variations in delivery and treatment effects. ObjectiveTo assess whether poor intervention fidelity, the faithfulness of the intervention delivered in an RCT to what was intended in the trial protocol, influences (biases) estimates of treatment effects derived from meta-analysis of rehabilitation RCTs. MethodsIn this meta-epidemiological study of 19 meta-analyses and 204 RCTs published between 2010–2020, we evaluated the difference in intervention effects between RCTs in which intervention fidelity was monitored and those in which it was absent. We also conducted random-effects meta-regression to measure associations between intervention fidelity, risk of bias (ROB), study sample size, and treatment effect estimates. ResultsThere was a linear relationship between fidelity and treatment effect sizes across RCTs, even after adjusting for ROB and study sample size. Higher degrees of fidelity were associated with smaller but more precise treatment effect estimates (d= -0.23 95% CI: -0.38, -0.74). Lower or absent fidelity was associated with larger, less precise estimates. Adjusting for fidelity reduced pooled treatment effect estimates in 4 meta-analyses from moderate to small or from small to no negligible or no effect, highlighting how poor fidelity can bias meta-analyses’ results. ConclusionPoor or absent intervention fidelity in RCTs may lead to overestimation of observed treatment effects, skewing the conclusions from individuals studies and systematic reviews with meta-analyses when pooled. Caution is needed when interpreting the results of complex intervention RCTs when fidelity is not monitored or is monitored but not reported.

Effectiveness of a Motivational Interviewing-Based Intervention in Decreasing Risky Alcohol Use in Primary Care Patients in Spain: A Controlled Clinical Trial

Objective: Our study aimed to evaluate the effectiveness of an intervention based on Motivational Interviewing (MI) performed by healthcare professionals in Primary Care (PC) patients with risky alcohol use through a multicenter, two-arm parallel, cluster-randomized, open-label controlled clinical trial. Methods: PC professionals were randomized into two groups: an Experimental Group (EG) and a Control Group (CG). The study was carried out in PC centers of the Andalusian Health Service, located in Cordoba, Spain. An MI-based approach was implemented with patients recruited in the EG, while health advice was provided to those included in the CG. The follow-up period was 12 months, with five visits scheduled. The consumption of standard drinking units per week was quantified, and risky alcohol use was estimated using the Alcohol Use Disorders Identification Test (AUDIT). An intention-to-treat statistical analysis was performed. Relative risk (RR), absolute risk reduction (ARR) and the number of subjects needed to treat (NNT) were used to estimate the intervention effect size. Results: A total of 268 patients were included, 148 in the EG and 120 in the CG. Considering the quantification of risky alcohol use, the ARR at 12 months after baseline visit was 16.46% (95% CI: 5.37–27.99), with an NNT of 6 (95% CI: 4–19). According to the AUDIT, the ARR at 12 months was 13.15% (95% CI: 2.73–24.24%), and the NNT was 8 (95% CI: 4–37). Conclusions: We concluded that MI is more effective than the usual health advice in decreasing risky alcohol use in patients treated in PC.

Effect of physical activity on social communication impairments in children with autism spectrum disorder: A meta-analysis

This meta-analysis aims to systematically evaluate if different physical activities (PA) improve the social communication impairments (SCI) seen in children with autism spectrum disorder (ASD). For this meta-analysis, five databases (Web of Science, PubMed and Cochrane Library database in English, and CNKI and Wanfang Data Knowledge Service Platform in Chinese) were searched from database inception to September 11, 2024. The eligibility criteria included (1) study population comprised children with ASD, with no gender restriction; (2) experimental group consisted of a PA intervention; (3) control group consisted of nonPA interventions or routine activities; (4) outcomes were assessed using validated SCI scales (e.g., social cognition, social motivation, and/or social awareness); and (5) study design involved a randomized parallel group design. The quality of the evidence for each study was assessed using the Cochrane Risk of Bias tool. From a pool of 2714 potentially relevant articles, 17 were eligible for inclusion in this review. The results of overall response of PA intervention to SCI illustrated a Medium degree of statistical heterogeneity between studies (I2 = 53.3 %, p < 0.01); the effect size of PA intervention on SCI (expressed as standardized mean difference) was −0.34 (95 % CI: −0.57, −0.11), which was statistically significant. SCI of autistic children could be potentially improved by PA interventions, though further research is needed to clarify if benefits achieve clinical significance in addition to statistical significance. Proper design of PA interventions (45–90 min per session, more than 3 times per week and for 8–12 weeks) may enhance their effectiveness in treating SCI in children with ASD.

The effects of exercise on antenatal depression: a systematic review and meta-analysis.

The aim of this study was to conduct a systematic evaluation of exercise interventions' effectiveness on antenatal depressive symptoms in pregnant women and to investigate the impact of different intervention factors on the relationship between exercise and antenatal depressive symptoms. We conducted comprehensive searches in several databases, including PubMed, Embase, Web of Science, Cochrane Library, and others. The search period covered from database inception to May 2023. After thorough screening, a total of 7 papers with 524 subjects were included in the analysis. The meta-analysis revealed that the overall effect size of exercise intervention on antenatal depressive symptoms in pregnant women was SMD = -0.41, with a 95% confidence interval of [-0.78, -0.05], and P = 0.03, indicating a significant improvement in depressive symptoms due to exercise intervention during the antenatal period. However, some degree of heterogeneity was observed among the studies, with I² = 74%, P = 0.0007. The results indicate that exercise interventions significantly contribute to the improvement of antenatal depressive symptoms in pregnant women, as inferred from the combined findings of the studies. Notably, static exercise intervention showed better results than dynamic exercise intervention. Moreover, interventions conducted before 20 weeks' gestation had superior outcomes compared to those conducted after 20 weeks' gestation, and interventions lasting longer than the trimester duration exhibited more favorable effects than shorter interventions. However, to validate these findings and optimise exercise intervention protocols for better antenatal maternal depressive symptom management, larger sample sizes and more comprehensive studies are required, given the observed heterogeneity and potential limitations in the present study. https://www.crd.york.ac.uk/prospero/ PROSPERO, identifier (CRD42023422315).

Augmentative and Alternative Communication Interventions in Critical and Acute Care With Mechanically Ventilated and Tracheostomy Patients: A Scoping Review.

Communication with nonspeaking patients is a critical challenge of person-centered care. This scoping review aimed to map the literature on augmentative and alternative communication (AAC) interventions for nonspeaking mechanically ventilated and tracheostomy patients in critical and acute care settings. Electronic database, ancestry, and forward citation searches were conducted using eligibility criteria established a priori. Data were extracted, synthesized, and summarized according to scoping review methodology. Studies were categorized by type of intervention and summarized in terms of purpose, participants, design, quality appraisal (including validity and reliability of selected efficacy measures), and efficacy. Small-to-large treatment effect sizes indicated demonstrable impact on patient health and communication efficacy with high-tech and no-tech visual interface-based interventions and systematic nurse training interventions. Treatment effects primarily pertained to dependent variables of patient anxiety, communication satisfaction, comfort, symptom self-reporting, and nursing practice changes. There is a paucity of high-quality AAC intervention research for mechanically ventilated and tracheostomy patients in critical and acute care settings. Emergent evidence suggests that select visual interface and nurse training interventions can impact efficacy of patient-provider communication and patients' overall health. https://doi.org/10.23641/asha.26506102.

A Bayesian reanalysis of the CULPRIT-SHOCK trial.

The optimal revascularization strategy for patients with acute myocardial infarction (AMI), cardiogenic shock (CS), and multivessel disease remains controversial. The CULPRIT-SHOCK trial compared culprit lesion-only vs. immediate multivessel percutaneous coronary intervention (PCI), providing important data but leaving efficacy questions unresolved. To address lingering uncertainties and gain deeper insights, we performed a Bayesian reanalysis of the CULPRIT-SHOCK trial data. We conducted a Bayesian re-analysis of the CULPRIT-SHOCK trial data using non-informative, sceptical, and enthusiastic priors. Relative risks (RRs) with 95% highest posterior density (HPD) intervals were calculated. We defined the minimal clinically important difference (MCID) as RR < 0.84. We performed subgroup analyses for key patient characteristics and assessed secondary outcomes and safety endpoints. Probabilities of benefit, achieving MCID, and harm were computed. Results are presented as median RR with probabilities of effect sizes. Bayesian reanalysis showed a median RR of 0.82 (95% HPD 0.66-1.04) with a non-informative prior, indicating a 95% probability of benefit and 59% probability of achieving MCID. Subgroup analyses revealed potentially stronger effects in males (RR 0.78, 73% probability of MCID), patients without diabetes (RR 0.76, 79% probability of MCID), and those with non-anterior ST-segment elevation MI (STEMI; RR 0.74, 76% probability of MCID). Secondary outcomes suggested potential benefits in mortality (RR 0.85) and need for renal replacement therapy (RR 0.72) but increased risks of recurrent MI (RR 2.84) and urgent revascularization (RR 2.88). Our Bayesian reanalysis provides intuitive insights by quantifying probabilities of treatment effect sizes, offering further evidence favouring the culprit lesion-only PCI strategy in AMI patients with CS and multivessel disease. The analysis demonstrates a high probability of overall benefit, with a notable chance of achieving a minimally clinically important difference, particularly in specific subgroups. These findings not only support the consideration of culprit lesion-only PCI in certain patient populations but also underscore the need for careful risk-benefit assessment. Furthermore, our hypothesis-generating subgroup analyses, which show varying probabilities of achieving MCID, illuminate promising avenues for future targeted investigations in this critical patient population.

Increased global warming potential during freeze-thaw cycle is primarily due to the contribution of N2O rather than CO2

While freeze-thaw cycle (FTC) can influence greenhouse gas emissions, the specific greenhouse gas that responds most strongly to FTC, as well as the underlying mechanisms, remain unclear. Here, we conducted a meta-analysis to explore the responses of global warming potential (GWP) and the fluxes of CO2 and N2O to FTC. Our results showed that FTC treatment significantly increased GWP, N2O flux, cumulative GWP, and cumulative N2O emissions by 23.1 %, 53.2 %, 14.5 %, and 164.6 %, respectively, but did not affect CO2 flux, indicating that the enhanced GWP during the FTC period may be primarily due to the contribution of N2O flux rather than CO2 flux. The responses of GWP (+68.6 %), CO2 (+21.0 %), and N2O fluxes (+136.3 %) in croplands was higher than those in other ecosystems, exhibiting a strong dependence on ecosystem types. The effect size of FTC treatment on greenhouse gas emissions escalated with decreasing freezing temperature and diminished with increasing FTC frequency. Moreover, mean annual temperature (MAT) and FTC patterns were key factors influencing GWP during the FTC period. These findings provide critical insights into the variations in greenhouse gas emissions due to FTC and its influencing factors, allowing for more accurate predictions of the future impact of global climate change on GWP.

Feasibility of a home-based home videogaming intervention with a family-centered approach for children with cerebral palsy: a randomized multiple baseline single-case experimental design

BackgroundWorldwide, children with cerebral palsy (CP) living in underserved communities face barriers to accessing motor therapy services. This study assessed the implementation and effectiveness of an 8-week, upper limb (UL) home-based intervention with a movement-tracking videogame (Bootle Blast) in Costa Rican children with CP.MethodsChildren established a weekly playtime goal and two UL activities of daily living (ADLs) that they would like to improve on. A multiple-baseline, single-case experimental design, was used with the Performance Quality Rating Scale (PQRS) as the repeated measure to track changes in performance of the selected ADLs between the baseline (usual care) and intervention (Bootle Blast) phases. The Canadian Occupational Performance Measure (COPM), the Box and Blocks Test (BBT) and the Children’s Hand-Use Experience Questionnaire (CHEQ) were collected before and after the intervention. Technical barriers were documented during weekly video calls with a monitoring therapist. Treatment effect size, slope changes and percentage of non-overlapping data were identified for the PQRS. Descriptive statistics summarized results for the BBT, CHEQ, videogame logs (e.g., playtime) and technical barriers.ResultsFifteen children participated and 13 completed the intervention. Both participants who dropped out did so after completing baseline assessments, but before experiencing Bootle Blast. Children’s mean active playtime (i.e., mini-games targeting the UL) across the 8-weeks was 377 min, while mean total time spent engaging with Bootle Blast (active + passive play time [e.g., time navigating menus, reviewing rewards]) was 728 min. In total, eight technical issues (from five children) were reported, and all but three were resolved within 48 h. Partial effectiveness was associated with the intervention. Specifically, 85% of participants improved on the PQRS and 69% achieved clinically important improvements ≥ 2 points in performance on the COPM. Children improved by 1.8 blocks on average on the BBT, while on the CHEQ, five children had a clinically important increase of 10% of the total number of UL activities performed with both hands.ConclusionBootle Blast is a feasible and effective option to facilitate access and engage children with cerebral palsy in UL home rehabilitation.Trial registration Trial registration number: NCT05403567.

Positive Airway Pressure, Mortality, and Cardiovascular Risk in Older Adults With Sleep Apnea

Positive airway pressure (PAP) is the first-line treatment for obstructive sleep apnea (OSA), but evidence on its beneficial effect on major adverse cardiovascular events (MACE) and mortality prevention is limited. To determine whether PAP initiation and utilization are associated with lower mortality and incidence of MACE among older adults with OSA living in the central US. This retrospective clinical cohort study included Medicare beneficiaries with 2 or more distinct OSA claims identified from multistate, statewide, multiyear (2011-2020) Medicare fee-for-service claims data. Individuals were followed up until death or censoring on December 31, 2020. Analyses were performed between December 2021 and December 2023. Evidence of PAP initiation and utilization based on PAP claims after OSA diagnosis. All-cause mortality and MACE, defined as a composite of myocardial infarction, heart failure, stroke, or coronary revascularization. Doubly robust Cox proportional hazards models with inverse probability of treatment weights were used to estimate treatment effect sizes controlling for sociodemographic and clinical factors. Among 888 835 beneficiaries with OSA included in the analyses (median [IQR] age, 73 [69-78] years; 390 598 women [43.9%]; 8115 Asian [0.9%], 47 122 Black [5.3%], and 760 324 White [85.5%] participants; median [IQR] follow-up, 3.1 [1.5-5.1] years), those with evidence of PAP initiation (290 015 [32.6%]) had significantly lower all-cause mortality (hazard ratio [HR], 0.53; 95% CI, 0.52-0.54) and MACE incidence risk (HR, 0.90; 95% CI, 0.89-0.91). Higher quartiles (Q) of annual PAP claims were progressively associated with lower mortality (Q2 HR, 0.84; 95% CI, 0.81-0.87; Q3 HR, 0.76; 95% CI, 0.74-0.79; Q4 HR, 0.74; 95% CI, 0.72-0.77) and MACE incidence risk (Q2 HR, 0.92; 95% CI, 0.89-0.95; Q3 HR, 0.89; 95% CI, 0.86-0.91; Q4 HR, 0.87; 95% CI, 0.85-0.90). In this cohort study of Medicare beneficiaries with OSA, PAP utilization was associated with lower all-cause mortality and MACE incidence. Results might inform trials assessing the importance of OSA therapy toward minimizing cardiovascular risk and mortality in older adults.

The efficacy of cognitive behavioural therapy for depression and anxiety in multiple sclerosis: A systematic review and meta-analysis

Background: Adults with multiple sclerosis (MS) frequently experience symptoms of depression and anxiety, which pose significant challenges. However, psychological support for these symptoms remains a major unmet healthcare need.Objectives: To inform the evidence base for the psychological management of adults with MS, this study examined the efficacy of cognitive behavioural therapy (CBT) interventions for improving symptoms of depression and anxiety. CBT interventions teach skills for improving the relationships between an individual's thoughts, feelings, and/or behaviours. The study also examined the role of intervention and study characteristics as moderators of treatment effects.Methods: Medline, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials were searched up to August 2024 for randomised control trials.Results: A meta-analysis of 15 clinical trials (1508 participants) was conducted, which found a medium significant treatment effect size for depression symptoms (g = 0.59, 95 % Confidence Interval [CI] [0.38, 0.80]) and a small significant treatment effect size for anxiety symptoms (g = 0.38 95 % CI [0.19, 0.57]). Moderator analyses revealed treatment effects for anxiety, but not depression, were significantly larger for studies conducted in non-Western countries compared to Western countries, and for those with smaller sample sizes.Conclusions: CBT-based interventions appear efficacious for the management of depression and anxiety symptoms in adults with MS. However, future clinical trials with larger samples and more rigorous methodology are warranted. Further examination of intervention characteristics, including ways in which CBT is tailored and how this relates to outcomes, may help to refine interventions for people with MS.