Greater Effect Size Research Articles

Consolidating the evidence on the effectiveness of strategies to promote vegetable intake in priority settings: An overview of systematic reviews.

Effective interventions to increase vegetable intake are urgently needed. This systematic rapid review aimed to summarise the effectiveness of interventions targeting increased vegetable intakes across diverse settings. The review was guided by the conduct of rapid reviews from the Cochrane Handbook. The literature was searched in February 2024 across PubMed, Web of Science and Cochrane Central for systematic review articles published since 2014. The Risk of Bias In Systematic Reviews tool was used and characteristics of reviews synthesised narratively with intervention effectiveness results were summarised. A total of 20 systematic reviews met the eligibility criteria. Most targeted school-based settings (n = 7) or community/home-based settings (n = 4). Early childhood education and workplaces had one review each, with none in retail, secondary or tertiary education, food service, food relief or aged care. The mean change in vegetable consumption was +0.12 serves per day, with increases of up to +0.42 serves reported (range -0.09 to +0.42). By setting, the largest increases were reported for interventions in school settings (+0.42 serves/day), followed by home (+0.38 serves/day). Almost half the studies reporting effect sizes suggested no effect on intake (46%), 41% suggested a small effect and 13% suggested a medium effect. Greater effect sizes were achieved in interventions implemented across multiple settings. Review findings indicate that the average increase in vegetable intake following interventions is about one-eighth of a serve but up to almost half a serve in some settings. An increase of this magnitude could have a substantial population impact, particularly in population groups with persistently low intakes.

In utero exposure to per - and polyfluoroalkyl substances (PFAS) associates with altered human infant T helper cell development.

Environmental exposures to chemical toxicants during gestation and infancy can dysregulate multiple developmental processes, causing lifelong effects. There is compelling evidence of PFAS-associated immunotoxicity in adults and children. However, the effect of developmental PFAS exposure on infant T-cell immunity is unreported, and, if present, could be implicated in immune-related health outcomes. We seek to model longitudinal changes in CD4+ T-cell subpopulations from birth through 12 months and their association with in-utero PFAS exposure and postnatal CD4+ T-cell frequencies and functions. Maternal-infant dyads were recruited as part of the UPSIDE-ECHO cohort during the first trimester between 2015 and 2019 in Rochester, New York; dyads were followed through the infant's first birthday. Maternal PFAS concentrations (PFOS, PFOA, PFNA, and PFHXS) were quantified in serum during the second trimester using high-performance liquid chromatography and tandem mass spectrometry. Infant lymphocyte frequencies were assessed at birth, 6- and 12-months using mass cytometry and high-dimensional clustering methods. Linear mixed-effects models were employed to analyze the relationship between maternal PFAS concentrations and CD4+ T-cell subpopulations (n=200). All models included a PFAS and age interaction and were adjusted for parity, infant sex, and pre-pregnancy body mass index. In-utero PFAS exposure correlated with multiple CD4+ T-cell subpopulations in infants. The greatest effect sizes were seen in T-follicular helper (Tfh) and T-helper 2 (Th2) cells at 12 months. A log 2 -unit increase in PFOS was associated with lower Tfh [0.17% (95%CI: -0.30, -0.40)] and greater Th2 [0.27% (95%CI: 0.18, 0.35)] cell percentages at 12 months. Similar trends were observed for PFOA, PFNA, and PFHXS. Maternal PFAS exposures correlate with cell-specific changes in the infant T-cell compartment, including key CD4+ T-cell subpopulations that play central roles in coordinating well-regulated, protective immunity. Future studies into the role of PFAS-associated T-cell distribution and risk of adverse immune-related health outcomes in children are warranted.

TM6SF2-rs58542926 genotype has opposing effects on incidence of hepatic and cardiac events in a community cohort: TM6SF2 effects on liver and cardiac outcomes.

TM6SF2-rs58542926-T is associated with increased cirrhosis and modestly decreased coronary artery disease prevalence. However, relative effects of TM6SF2 genotype on major adverse cardiovascular events (MACE) vs. liver-related events (LRE) is not known. We utilized the UK Biobank, a prospective cohort with genetic and inpatient diagnosis data. The primary predictor was TM6SF2-rs58542926 genotype and the primary outcomes were MACE and LRE. Effects were reported as subhazard ratios (sHR) and 10-year cumulative incidence by Fine-Gray competing risk analyses. >430,000 individuals met inclusion criteria. TM6SF2-rs58542926-TT genotype (vs. CC) was associated with higher incidence of LRE (adjusted sHR 3.16, 95% confidence interval [CI] 1.86-5.37) and lower incidence of MACE (adjusted sHR for TT vs. CC genotype 0.76, 95% CI 0.63-0.91 ). In individuals with Fibrosis-4 (FIB4) <1.3, 1.3-2.67, and >2.67, 10-year LRE incidence in TM6SF2-rs58542926-TT vs. CC individuals was 0.08% vs. 0.06% (p>0.05), 0.81% vs. 0.20% (p<0.0001), and 10.5% vs. 3.4% (p=0.00094), respectively. The corresponding values for MACE were 3.8% vs. 5.1% (p=0.032), 6.4% vs. 8.2% (p=0.040), and 17.1% vs. 12.4% (p>0.05). The absolute decrease in MACE with rs58542926-TT (vs. CC) genotype exceeded the absolute increase in LRE in all groups but FIB4>2.67. Associations of TM6SF2 genotype with LRE/MACE were significant in men but not women. TM6SF2-rs58542926-T allele was also associated with increased hepatic steatosis and corrected T1 time by magnetic resonance imaging, with greater effect sizes in men than women. TM6SF2 genotype has opposite effects on LRE vs. MACE incidence, and absolute effects on MACE were greater except in those with highest FIB4 scores. Effects were strongest in men. These findings clarify implications of TM6SF2 genotype based on personalized clinical risk.

Personalized cardiac rehabilitation in older geriatric patients: an analysis of age, heart failure subtypes, and physical metrics

Abstract Background While cardiac rehabilitation (CR) is recognized for enhancing physical fitness, psychological well-being, and overall quality of life in cardiac patients, its universal application often overlooks the heterogeneity within the geriatric population. This study delves into the effectiveness of CR among older geriatric patients, aiming to uncover the disparities in response across various demographics, heart failure subtypes, and angina classifications, thereby underscoring the imperative for personalized CR programs. Methods We retrospectively analyzed 438 CR participants from December 2020 to December 2023, stratifying them by age (median: 65.14 years, IQR: 57.23-72.64), sex (23.74% female), heart failure subtype, and CCS angina class to identify distinct response patterns to CR. The analysis included a comprehensive assessment of physical metrics pre- and post-12-week CR program following cardiac surgeries, transcatheter procedures, coronary events, and/or interventions. We employed the Wilcoxon Rank Sum test for statistical analysis, focusing on identifying non-responders and quantifying effect sizes (r) to determine the magnitude of change across various physical metrics. Results Notable improvements were observed in metabolic equivalents (METs) (+1.82), oxygen uptake (VO2 peak) (+6.36 mL/kg/min), Duke Activity Status Index (DASI) score (+14.79), moderate to vigorous physical activity (MVPA) (+131.28 minutes/week), sitting time (-1.21 hours/day), total activity (+145.65 minutes/week) and sit-to-stand repetitions (+2.65). The greatest effect sizes were observed in DASI score (r=0.750) and sit-to-stand (r=SIS) repetitions (r=0.610), consistent across demographics, heart failure, and CCS categories. Other metrics noted variable changes, with handgrip strength showing no consistent trend. Sensitivity analyses revealed that older geriatric patients (≥ 80 years) with HFpEF experienced significant improvements in DASI score (r=0.638), MVPA (r=0.636), and SIS (r=0.504), while those with HFrEF and HFmrEF showed no significant improvements in any physical metrics. CCS angina classification, common comorbidities, and initial referral events did not significantly influence outcomes. Conclusion This study reaffirms the efficacy of CR but crucially identifies the gaps in its universal application, particularly among older geriatric patients with diverse heart failure subtypes. Our analysis advocates for developing personalized CR programs tailored to patients' individual profiles to enhance effectiveness of rehabilitation. By addressing these specific needs, we can ensure more inclusive and optimized patient care, ultimately supporting the expansion of CR indications to foster a more holistic approach to cardiac health in the geriatric population.

Can sheep help to improve positive emotions, mindfulness, and self-efficacy expectancy? A pilot study of animal-assisted intervention as an enhanced CBT-based therapy for substance use disorders.

Substance use disorders (SUDs) are common, and there is evidence of clinically significant benefit of cognitive behavioral therapy (CBT). The efficacy of CBT in SUDs has been confirmed, although relapse rates of 40%-60% have been reported. An enhancement of CBT-based therapy through an animal-assisted intervention (AAI) with sheep to normalize the occurrence of negative emotions and improve positive emotions as well as mindfulness and self-efficacy expectancy was investigated. A single-session AAI with sheep in a group setting was investigated against treatment as usual over time. N = 36 psychiatric inpatients with SUDs were examined by questionnaires before and 1 week after the intervention and additionally immediately after the intervention. Positive emotions improved significantly in the AAI group 1 week after the intervention with a medium effect size, but not in the control group. Similarly, mindfulness and self-efficacy expectancy improved over time in the AAI group. When exploratory results were evaluated immediately after the intervention while still on the farm, the effects in favor of AAI were even larger. AAI can thus be considered effective in improving positive emotions, mindfulness, and self-efficacy expectancy. The impressive effect sizes immediately after the intervention encourage us to consider what can be done to maintain these even greater effect sizes over time. https://drks.de/search/de/trial/DRKS00027539, identifier DRKS 00027539.

Comparing Deprivation vs Vulnerability Index Performance Using Medicare Beneficiary Surgical Outcomes

Health care researchers, professionals, payers, and policymakers are increasingly relying on publicly available composite indices of area-level socioeconomic deprivation to address health equity. Implications of index selection, however, are not well understood. To compare the performance of 2 frequently used deprivation indices using policy-relevant outcomes among Medicare beneficiaries undergoing 3 common surgical procedures. This cross-sectional study examined outcomes among Medicare beneficiaries (65 to 99 years old) undergoing 1 of 3 common surgical procedures (hip replacement, knee replacement, or coronary artery bypass grafting) between 2016 and 2019. Index discriminative performance was compared for beneficiaries residing in tracts with high- and low-deprivation levels (deciles) according to each index. Analyses were conducted between December 2022 and August 2023. Tract-level deprivation was operationalized using 2020 releases of the area deprivation index (ADI) and the social vulnerability index (SVI). Binary outcomes were unplanned surgery, 30-day readmissions, and 30-day mortality. Multivariable logistic regression models, stratified by each index, accounted for beneficiary and hospital characteristics. A total of 2 433 603 Medicare beneficiaries (mean [SD] age, 73.8 [6.1] years; 1 412 968 female beneficiaries [58.1%]; 24 165 Asian [1.0%], 158 582 Black [6.5%], and 2 182 052 White [89.7%]) were included in analyses. According to both indices, beneficiaries residing in high-deprivation tracts had significantly greater adjusted odds of all outcomes for all procedures when compared with beneficiaries living in low-deprivation tracts. However, compared to ADI, SVI resulted in higher adjusted odds ratios (adjusted odds ratios, 1.17-1.31 for SVI vs 1.09-1.23 for ADI), significantly larger outcome rate differences (outcome rate difference, 0.07%-5.17% for SVI vs outcome rate difference, 0.05%-2.44% for ADI; 95% CIs excluded 0), and greater effect sizes (Cohen d, 0.076-0.546 for SVI vs 0.044-0.304 for ADI) for beneficiaries residing in high- vs low-deprivation tracts. In this cross-sectional study of Medicare beneficiaries, SVI had significantly better discriminative performance-stratifying surgical outcomes over a wider range-than ADI for identifying and distinguishing between high- and low-deprivation tracts, as indexed by outcomes for common surgical procedures. Index selection requires careful consideration of index differences, index performance, and contextual factors surrounding use, especially when informing resource allocation and health care payment adjustment models to address health equity.

Effects of amphibian genetic diversity on ecological communities.

The amount of genetic diversity within a population can affect ecological processes at population, community, and ecosystem levels. However, the magnitude, consistency, and scope of these effects are largely unknown. To investigate these issues, we conducted two experiments manipulating the amount of genetic diversity and environmental factors in larval amphibians. The first experiment manipulated wood frog genetic diversity, the presence or absence of caged predators, and competition from leopard frogs to test whether these factors affected survival, growth, and morphology of wood frogs and leopard frogs. The second experiment manipulated wood frog genetic diversity, the presence or absence of uncaged predators, and resource abundance to test whether these factors affected wood frog traits (survival, morphology, growth, development, and behavior) and other components of the ecological community (zooplankton abundance, phytoplankton, periphyton, and bacterial community structure). Genetic diversity did not affect wood frog survival, growth, and development in either experiment. However, genetic diversity did affect the mean morphology of wood frog tadpoles in the first experiment and the abundance and distribution of zooplankton in the second experiment. It did not affect phytoplankton abundance, periphyton abundance, or bacterial community structure. While effect sizes (Cohen's d) of genetic diversity were approximately half those of environment treatments, the greatest effect sizes were for interaction effects between genetic diversity and environment. Our results indicate that genetic diversity can have a large effect on ecological processes, but the direction of those effects is highly dependent upon environmental conditions, and not easily predicted from simple measures of traits.

Infarct density defined by ADC threshold is associated with long-term functional outcome after endovascular thrombectomy

ObjectivesEndovascular thrombectomy (EVT) dramatically improves clinical outcomes, but the reduction in final infarct volume only accounts for 10–15 % of the treatment benefit. We aimed to develop a novel MRI-ADC-based metric that quantify the degree of tissue injury to test the hypothesis that it outperforms infarct volume in predicting long-term outcome. Materials and methodsA single-center cohort consisted of consecutive acute stroke patients with anterior circulation large vessel occlusion, successful recanalization via EVT (mTICI ≥2b), and MRI of the brain between 12 h and 7 days post-EVT. Imaging was processed via RAPID software. Final infarct volume was based on the traditional ADC <620 threshold. Logistic regression quantified the association of lesion volumes and good outcome (90-day modified Rankin Scale ≤2) at a range of lower ADC thresholds (<570, <520, and <470). Infarct density was calculated as the percentage of the final infarct volume below the ADC threshold with the greatest effect size. Univariate and multivariate logistic regression quantified the association between imaging/clinical metrics and functional outcome. Results120 patients underwent MRI after successful EVT. Lesion volume based on the ADC threshold <470 had the strongest association with good outcome (OR: 0.81 per 10 mL; 95 % CI: 0.66–0.99). In a multivariate model, infarct density (<470/<620 * 100) was independently associated with good outcome (aOR 0.68 per 10 %; 95 % CI: 0.49–0.95), but final infarct volume was not (aOR 0.98 per 10 mL; 95 % CI: 0.85–1.14). ConclusionsInfarct density after EVT is more strongly associated with long-term clinical outcome than infarct volume.

Biomarker Identification for Preterm Birth Susceptibility: Vaginal Microbiome Meta-Analysis Using Systems Biology and Machine Learning Approaches.

The vaginal microbiome has a substantial role in the occurrence of preterm birth (PTB), which contributes substantially to neonatal mortality worldwide. However, current bioinformatics approaches mostly concentrate on the taxonomic classification and functional profiling of the microbiome, limiting their abilities to elucidate the complex factors that contribute to PTB. A total of 3757 vaginal microbiome 16S rRNA samples were obtained from five publicly available datasets. The sampleswere divided into two categories based on pregnancy outcome: preterm birth (PTB) (N = 966) and term birth (N = 2791). Additionally, the samples were further categorized based on the participants' race and trimester. The 16S rRNA reads were subjected to taxonomic classification and functional profiling using the Parallel-META 3 software in Ubuntu environment. The obtained abundances were analyzed using an integrated systems biology and machine learning approach to determine the key microbes, pathways, and genes that contribute to PTB. The resulting features were further subjected tostatistical analysis to identify the top nine features with the greatest effect sizes. We identified nine significant features, namely Shuttleworthia, Megasphaera, Sneathia, proximal tubule bicarbonate reclamation pathway, systemic lupus erythematosus pathway, transcription machinery pathway, lepA gene, pepX gene, and rpoD gene. Their abundance variations were observed through the trimesters. Vaginal infections caused by Shuttleworthia, Megasphaera, and Sneathia and altered small metabolite biosynthesis pathways such as lipopolysaccharide folate and retinal may increase the susceptibility to PTB. The identified organisms, genes, pathways, and their networks may be specifically targeted for thetreatment of bacterial infections that increasePTB risk.

Aerobic exercise improves verbal working memory sub-processes in adolescents: behavioral evidence from an N-back task.

Studies on the effects of aerobic exercise on working memory (WM) have mainly concentrated on the overall effects, yet there is little knowledge on how moderate intensity aerobic exercise impacts the sub-processes of verbal WM (VWM) in adolescents. To address this gap, two experiments were conducted to explore the influence of aerobic exercise on the maintenance and updating sub-processes of VWM. In Experiment 1, a mixed experimental design of 2 (exercise habit: high vs. low) × 3 (memory load: 0-back vs. 1-back vs. 2-back) was used to compare VWM and its sub-processes in 40 adolescents. In Experiment 2, a 2 (group: intervention vs. control) × 3 (time point: pretest vs. 1st post-test vs. 18th post-test) × 3 (memory load: 0-back vs. 1-back vs. 2-back) mixed experimental design was used to investigate the acute and long-term effects of moderate intensity aerobic exercise on VWM and its sub-processes in 24 adolescents with low exercise habits. The results of Experiment 1 showed that VWM performance and its sub-processes in the high exercise habit group were better than those in the low exercise habit group. The results of Experiment 2 showed that the effects of the long-term exercise intervention were superior to those of the acute exercise intervention, and both were superior to the pretest. Meanwhile, it was found that aerobic exercise intervention had a greater effect size on the updating sub-process of VWM. In conclusion, the results indicated that moderate intensity aerobic exercise could enhance the performance of VWM and its sub-processes in adolescents, and long-term intervention showed greater improvement effects compared to acute intervention, especially in the updating sub-process of VWM.

Prolonged drought moderates flood effects on soil nutrient pools across a rainfall gradient

Climate change is manifesting through increased intensity and frequency of extreme events such as droughts and floods. Drought causes significant stress by limiting water availability, resulting in reduced plant growth and belowground carbon (C) inputs as well as plant nutrient uptake and microbial activity, thus impacting C and nutrient cycling. Severe floods can increase leaching of nutrients, which affect nutrient availability for plants and microorganisms potentially compounding drought-induced effects on C and nutrient cycles. However, few studies have assessed the interactions between drought and floods, constraining our ability to predict ecosystem-level effects of projected climate shifts toward fewer but larger rainfall events with longer dry spells between events. We conducted a study to assess how long-term drought moderates the effect of flooding on soil C, nitrogen (N) and phosphorus (P) pools across a rainfall gradient in south-eastern Australia. We collected soil monoliths from field rainfall manipulation facilities with a 5–7 years history of simulated reduced rainfall at three sites representing a rainfall gradient (∼200–800 mm) and exposed them to a 1-in-100-year flood event under laboratory conditions. We assessed nutrients and C in soil and microbial pools before and after the flood and in flood-induced leachates. The results showed that flooding caused significantly greater losses of N in leachates, with greater effect sizes in the drought treatments compared to ambient rainfall. This response was particularly pronounced for nitrate (152 % increase on average), especially at the site with the highest mean annual precipitation (>25-fold increase). This suggest that drought may significantly reduce the capacity of ecosystems to retain N following flood events, particularly in mesic ecosystems where C and nutrient pools are greater.

Adverse pregnancy outcomes in pregnant women with chronic kidney disease: A systematic review and meta-analysis.

Chronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes, but the risk at different stages of CKD (defined by estimated glomerular filtration rate, eGFR) compared with women without CKD has not been quantified in large cohorts. To quantify the association between CKD and adverse pregnancy outcomes according to CKD definition, CKD stage and presence or absence of diabetes. A systematic search of EMBASE and MEDLINE from inception to 5 January 2023. English-language randomised controlled trials as well as cohort and case-control studies investigating adverse pregnancy outcomes in pregnant women with CKD. Two reviewers conducted independent data extractions. A random-effects model was used to estimate risk. We included 19 studies with 3 251 902 women. Defining CKD using eGFR or serum creatinine produced results with greater effect size but wider confidence intervals. Compared with CKD stages 1-2, women with CKD stages 3-5 have a greater risk, but also greater imprecision in the risk estimate, of the following outcomes: pre-eclampsia (OR 55.18, 95% CI 2.63-1157.68, vs OR 24.74, 95% CI 1.75-348.70), preterm birth (OR 20.24, 95% CI 2.85-143.75, vs OR 8.18, 95% CI 1.54-43.46) and neonatal intensive care unit admission (OR 19.32, 95% CI 3.07-121.68, vs OR 9.77, 95% CI 2.49-38.39). Women with diabetic kidney disease, compared with women without diabetic kidney disease, have higher risks of maternal mortality, small-for-gestational-age neonates, pre-eclampsia and gestational hypertension. There is heterogeneity in the definition of CKD in pregnancy. Future studies should consider ways to standardise its definition and measurement in pregnancy.

Organize and mobilize for implementation effectiveness to improve overdose education and naloxone distribution from syringe services programs: a randomized controlled trial

BackgroundThe United States (US) continues to face decades-long increases in opioid overdose fatalities. As an opioid overdose reversal medication, naloxone can dramatically reduce opioid overdose mortality rates when distributed to people likely to experience or witness an opioid overdose and packaged with education on its use, known as overdose education and naloxone distribution (OEND). Syringe services programs (SSPs) are ideal venues for OEND with staff who are culturally competent in providing services for people who are at risk of experiencing or observing an opioid overdose. We carried out a randomized controlled trial of SSPs to understand the effectiveness of the organize and mobilize for implementation effectiveness (OMIE) approach at improving OEND implementation effectiveness within SSPs.MethodsUsing simple randomization, 105 SSPs were enrolled into the trial and assigned to one of two study arms — (1) dissemination of OEND best practice recommendations (Control SSPs) or the OMIE approach along with dissemination of the OEND best practice recommendations (i.e., OMIE SSPs). OMIE SSPs could participate in 60-min OMIE sessions once a month for up to 12 months. At 12-month post-baseline, 102 of 105 SSPs (97%) responded to the follow-up survey.ResultsThe median number of sessions completed by OMIE SSPs was 10. Comparing OMIE SSPs to control SSPs, we observed significant increases in the number of participants receiving naloxone (incidence rate ratio: 2.15; 95% CI: 1.42, 3.25; p < 0.01) and the rate of naloxone doses distributed per SSP participant (adjusted incidence rate ratio: 1.97; 95% CI: 1.18, 3.30; p = 0.01). We observed no statistically significant difference in the number of adopted best practices between conditions (difference in means 0.2, 95% CI: − 0.7, 1.0; p = 0.68). We also observed a threshold effect where SSPs receiving a higher OMIE dose had greater effect sizes with regard to the number of people given naloxone and the number of naloxone doses distributed.ConclusionsIn conclusion, the multifaceted OMIE approach was effective at increasing naloxone distribution from SSPs, despite substantial external shocks during the trial. These findings have major implications for addressing the overdose crisis, which has continued unabated for decades.Trial registrationClinicalTrials.gov, NCT03924505. Registered 19 April 2019.

Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis.

Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060.

Abstract HUP14: Racial And Ethnic Disparities In Neighborhood Socioeconomic Status Associated With Cardiovascular Disease And Stroke: The Women’s Health Initiative

Introduction: The role of socioeconomic status (SES) across cardiovascular diseases (CVD) is well researched at the individual-level but fails to explain the greater CVD rates among Black and American Indian and Alaska Native (AIAN) groups at every level of SES. This research evaluated whether lower Neighborhood SES (NSES), a structural determinant of health, was associated with racial and ethnic disparities in CVD or stroke among aging women. Methods: The data came from the Women’s Health Initiative (WHI) cohort, consisting of 161,808 postmenopausal women with 30 years of data on stroke and CVD incidence. The NSES data were obtained from the US Census based on participant’s census tract of residence. We evaluated racial and ethnic disparities in the exposure and outcome prevalence using ANOVA. Associations between NSES and time to stroke and CVD were evaluated using multivariate adjusted Cox Regression models, and models were stratified by race and ethnicity to evaluate disparities. Results: NSES differed by race and ethnicity. Black, AIAN, and Latina groups were significantly (P&lt;0.01) more likely to live in neighborhoods with NSES Z-scores below the population mean (Z-score=0) compared with White and Asian groups. The mean NSES Z-score among Black participants was -5.21 standard deviations below the population mean. Thirty-year CVD and stroke incidence followed the same trajectory of racial disparities. Preliminary analysis suggests results from Cox regression models will identify lower NSES to be longitudinally associated with greater stroke and CVD incidence overall, and greater effect sizes among groups experiencing structural racism. Conclusion: This research evaluates racial disparities in NSES as a structural determinant of stroke and CVD. These findings provide evidence emphasizing the need for neighborhood-level interventions to improve CVD disparities that coalesce in marginalized communities.

Responsiveness of Patient-Reported Outcome Measures After Large Knee Articular Cartilage Transplantation: A Systematic Review and Meta-analysis

Background: Cartilage transplantation is commonly used to treat large (>4 cm2) articular cartilage defects of the knee. The 2 most common transplants are osteochondral allograft transplantation and autologous chondrocyte implantation. Several patient-reported outcome measures (PROMs) have been used to determine the efficacy of treatment, but it is unknown which measures are the most effective. Purpose: To report the multiple PROMs used after large knee articular cartilage transplantation surgery and to compare the responsiveness between them. Study Design: Meta-analysis; Level of evidence, 4. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search of the PubMed/MEDLINE and Web of Science databases was performed. A total of 181 articles met inclusion criteria. Patient and study characteristics were extracted, including pre- and postoperative means for PROMs. From the articles that met inclusion criteria for responsiveness analysis (2+ PROMs reported, 1-year minimum follow-up, reported pre- and postoperative means and standard deviations; n = 131), the authors compared the responsiveness between PROM instruments using effect size and relative efficiency (RE) if a PROM could be compared with another in ≥10 articles. Results: A total of 10,015 patients (10,093 knees; mean age, 34.8 years; mean body mass index, 26.1) were included in this study. The mean follow-up time was 58.3 months (range, 1.5-247.2 months), imaging findings were reported in 80 articles (44.2%), patient satisfaction was reported in 39 articles (21.5%), and range of motion was reported in 10 articles (5.5%). There were 58 unique PROM instruments identified, with the most used being the International Knee Documentation Committee (IKDC) score (n = 118; 65.2%), followed by Knee injury and Osteoarthritis Outcome Score (KOOS) Pain (n = 58; 32.0%), KOOS Sport and Recreation (n = 58; 32.0%), KOOS Quality of Life (n = 57; 31.5%), KOOS Activities of Daily Living (n = 57; 31.5%), and KOOS Symptoms (n = 57; 31.5%). Overall, IKDC was found to have the greatest effect size (1.68) and the best responsiveness of the other PROMs, which include KOOS Pain (RE, 1.38), KOOS Symptoms (RE, 3.06), KOOS Activities of Daily Living (RE, 1.65), KOOS Sport and Recreation (RE, 1.44), Lysholm (RE, 1.76), and Tegner (RE, 1.56). Conclusion: The IKDC is the most responsive PROM after large knee articular cartilage transplantation surgery. The IKDC score is recommended for assessing outcomes after cartilage transplantation surgery.

Comparing the Effectiveness of Two Kinds of Reading Interventions on Reading Outcomes in Third to Fifth Grade Farsi Speaker Students with Dyslexia: An Exploratory Study.

This research marks the exploration into comparing the effectiveness of two reading interventions in improving reading outcomes for third to fifth-grade Farsi-speaking students with dyslexia. In this randomized control trial study, twenty students in Tehran were randomly assigned to a multi-component group and a comprehension-based intervention group, each receiving 36 sessions of 45 minutes. The effectiveness of the interventions was evaluated using adjusted mean differences with a one-way ANCOVA. The results revealed the comprehension-based intervention's superior effect size across most outcomes, except for the letters string. The effect size was large for word reading 0.93 (CI -0.002 to 1.85), medium for phoneme deletion 0.67 (CI -0.23 to 1.5), small for text comprehension 0.25 (CI -0.62 to 1.13), and trivial for both rhyme identification 0.1 (-0.77 to 0.98) and non-word reading 0.11 (CI -0.76 to 0.98). The multi-component intervention had a greater effect size on letters string than the other intervention, although it was small -0.21 (CI -1.09 to 0.66). The study concluded that comprehension-based intervention was more effective for Farsi-speaking students with dyslexia in grades 3-5, emphasizing the need for diverse intervention approaches to address their specific needs.

Multi‐Ancestry Genetics for Alzheimer’s Disease: Alzheimer’s Disease Genetics Consortium

AbstractBackgroundAlzheimer’s disease (AD) affects individuals of all races and ethnicities, yet large‐scale genetic research to compare genetic makeups for risk or protection of AD between multi‐ancestry datasets is limited. The Alzheimer’s Disease Genetics Consortium (ADGC) assembled the largest multi‐ancestry dataset including 56,241 subjects from non‐Hispanic Whites (NHW), African Americans (AA), Hispanics (HI), and East Asians (EAS) to understand ancestral similarities and differences in genetic risk and protective variants for AD.MethodWe established a Steering Committee with 5 members, 4 main Workgroups including Primary Meta‐Analysis, Follow‐Up Analysis, Secondary Analysis, and Method Evaluation, and 3 affiliated Workgroups consisting of Phenotype Harmonization, Imputation Development, and genome‐wide association study (GWAS)/whole genome sequencing (WGS) Integration. A new computing infrastructure was developed for shared analytic space on Amazon Web Services (AWS), where all members from different institutes accessed to genetic and phenotypic data and conducted analysis under the master analysis plan with centrally developed pipelines and scripts. We conducted ancestry‐specific GWAS using single nucleotide polymorphisms (SNPs) for AD, cross‐ancestry meta‐analysis of 4 ancestry GWASs, fine‐mapping for allelic heterogeneity in known and novel loci for AD, and pathway analysis.ResultWe confirmed 12 known including APOE ɛ4 and ɛ2 variants and identified 2 novel loci for AD in cross‐ancestry meta‐analysis with P&lt;5.4×10−8. African and Asian ancestry subjects displayed greater heterogeneity in effect sizes and significant levels with the previously known AD loci for AD. Ancestry‐specific fine‐mapping indicated presence of potential distinct causal variants across different ancestry groups from multiple known AD loci. Two APOE alleles had greatest effect sizes among East Asians compared to others (EAS&gt;NHW&gt;AA&gt;HI), while we failed to observe significant association signals with AD in SHARPIN and TREM2 regions from African Americans. Of two novel loci, the association signal in the LRRC4C‐API5 region was contributed from all four ancestry groups; in contrast, the signal in the LHX5‐AS1‐RBM19 region was predominantly from Hispanics.ConclusionGenetic risk profiling in multi‐ancestry datasets provided unique opportunity to understand ancestry‐specific and cross‐ancestry genetic risk factors for AD. Further evaluation of these established and novel loci for AD by integrating GWAS and WGS data from ADSP is underway

Low-Grade systemic inflammation is associated with domain-specific cognitive performance and cognitive decline in older adults: Data from the TUDA study

Studies examining the relationships between chronic inflammation, cognitive function and cognitive decline in older adults have yielded conflicting results. In a large cohort of older adults free from established dementia (n = 3270; 73.1 ± 7.9 years; 68.4% female), we evaluated the cross-sectional and longitudinal relationships between serum cytokines (IL-6, IL-10, TNF-α) and both global and domain-specific cognitive performance (Repeatable Battery for Assessment of Neuropsychological Status [RBANS]). Higher IL-6 (OR: 1.33; 1.06, 1.66, p = 0.01), TNF-α (OR: 1.35; 1.09, 1.67, p = 0.01) and IL-6:IL-10 Ratio (OR: 1.43; 1.17, 1.74, p = 0.001) were cross-sectionally associated with impaired global RBANS performance. For specific cognitive domains, greatest effect sizes were observed between higher TNF-α levels and poorer visual-spatial and attention performance. In a subset of participants (n = 725; 69.8 ± 5.5 years; 67.0% female) with repeat assessment performed at a median of 5.4 years, only higher baseline IL-6:IL-10 ratio was associated with impaired incident overall, immediate memory and visual-spatial performance. Associations were stronger in females, but not modified by age or APOE genotype.

Regional Vulnerability Indices in Youth With Persistent and Distressing Psychoticlike Experiences

Distressing and persistent psychoticlike experiences (PLEs) in youth are associated with greater odds of developing psychiatric conditions in adulthood. Despite this risk, it is unclear whether early PLEs show similar brain patterns compared with adults with psychiatric and neurologic conditions. To examine the degree to which persistent and distressing PLEs exhibit neural metrics that show similarity to adults with chronic psychiatric and neurologic conditions. This cohort study used Adolescent Brain Cognitive Development (ABCD) Study examining the persistence and distress associated with PLEs across the first 3 waves of data with baseline structural magnetic resonance imaging data. Analyzed data were collected between September 1, 2016, and September 27, 2021. Children were recruited from 21 research sites across the US. Psychoticlike experiences were assessed using the Prodromal Questionnaire-Brief Child Version, and participants were categorized into groups based on the persistence and distress associated with PLEs. Cortical and subcortical regional vulnerability indices (RVIs) were created by quantifying the similarity of participants' baseline neuroimaging measures to the expected patterns found in adult neuropsychiatric samples. The PLE groups were compared on the following RVI cortical and subcortical metrics: schizophrenia spectrum disorders, bipolar disorder, major depressive disorder, Parkinson disease, Alzheimer disease, and metabolic diseases. Analyses examined PLE groups created from 8242 children in the ABCD sample (52.5% male; mean [SD] age, 9.93 [0.63] years; and 56.3% White), including persistent distressing PLEs (n = 329), transient distressing PLEs (n = 396), persistent nondistressing PLEs (n = 234), transient nondistressing PLEs (n = 390), and low distressing PLEs (n = 6893) groups. Participants with persistent or transient distressing PLEs broadly showed increased subcortical RVI scores across most RVI metrics, with persistent distressing PLEs additionally showing increased scores for cortical RVI metrics. The greatest effect sizes were found for persistent distressing PLEs with cortical RVI-schizophrenia spectrum disorders (β estimate, 1.055; 95% CI, 0.326-1.786) and RVI-Alzheimer disease (β estimate, 2.473; 95% CI, 0.930-4.018). In this cohort study of ABCD participants, the findings suggest that especially the persistent distressing PLEs in children were associated with neural metrics resembling those observed in adults with severe psychiatric and neurologic conditions. These findings support the potential use of brain-based risk scores for early identification and precision medicine approaches in the assessment of PLEs.