High Effect Sizes Research Articles

Executive functions and processing speed in covert cerebral small vessel disease.

Executive dysfunction and slowed processing speed are central cognitive impairments in cerebral small vessel disease (cSVD). It is unclear whether the subcomponents of executive functions become equally affected and whether computerized tests are more sensitive in detecting early cognitive changes over traditional tests. The associations of specific executive abilities (cognitive flexibility, inhibitory control, working memory) and processing speed with white matter hyperintensities (WMHs) and Instrumental Activities of Daily Living (IADL) were examined. In the Helsinki Small Vessel Disease Study, 152 older individuals without stroke or dementia were assessed with brain magnetic resonance imaging and comprehensive neuropsychological evaluation. WMH volumes were obtained with automated segmentation. Executive functions and processing speed measures included established paper-and-pencil tests and the computer-based Flexible Attention Test (FAT), Simon task and Sustained Attention to Response Task. White matter hyperintensity volume and IADL were associated with multiple cognitive measures across subdomains independently of demographic factors. The highest effect sizes were observed for FAT numbers and number-letter tasks (tablet modifications from the Trail Making Test), FAT visuospatial span, Simon task and semantic verbal fluency. Some of the widely used tests such as Stroop inhibition, phonemic fluency and digit span were not significantly associated with either WMHs or IADL. Processing speed and executive function subcomponents are broadly related to functional abilities and WMH severity in covert cSVD, but the strength of associations within subdomains is heavily dependent on the assessment method. Digital tests providing precise measures of reaction times and response accuracy seem to outperform many of the conventional paper-and-pencil tests.

At-home wearable-based monitoring predicts clinical measures and biological biomarkers of disease severity in Friedreich’s Ataxia

BackgroundFriedreich ataxia (FRDA) results in progressive impairment in gait, upper extremity coordination, and speech. Currently, these symptoms are assessed through expert examination at clinical visits. Such in-clinic assessments are time-consuming, subjective, of limited sensitivity, and provide only a limited perspective of the daily disability of patients.MethodsIn this study, we recruited 39 FRDA patients and remotely monitored their physical activity and upper extremity function using a set of wearable sensors for 7 consecutive days. We compared the sensor-derived metrics of lower and upper extremity function as measured during activities of daily living with FRDA clinical measures (e.g., mFARS and FA-ADL) and biological biomarkers of disease severity (guanine-adenine-adenine (GAA) and frataxin (FXN) levels), using Spearman correlation analyses.ResultsThe results show significant correlations with moderate to high effect sizes between multiple sensor-derived metrics and the FRDA clinical and biological outcomes. In addition, we develop multiple machine learning-based models to predict disease severity in FRDA using demographic, biological, and sensor-derived metrics. When sensor-derived metrics are included, the model performance enhances 1.5-fold and 2-fold in terms of explained variance, R², for predicting FRDA clinical measures and biological biomarkers of disease severity, respectively.ConclusionsOur results establish the initial clinical validity of using wearable sensors in assessing disease severity and monitoring motor dysfunction in FRDA.

Increased risk of cardiovascular events in the weeks following hospitalised COPD exacerbations: the EXACOS-CV French nationwide case-crossover study

Abstract Introduction Previous studies indicate that in people living with chronic obstructive pulmonary disease (COPD), the risk of myocardial infarction (MI), heart failure (HF) decompensation, arrhythmias and ischemic stroke increases following a COPD exacerbation. This association has not been explored for detailed types of cardiovascular events (CVE), namely for different types of myocardial infarction. Objective To quantify the risk of CVE following a COPD exacerbation overall, and by detailed type of CVE. Methods A case-crossover study was conducted using the French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI). Case-patients: (i) were aged≥40 years with a COPD diagnosis; (ii) hospitalised in 2018-2019 for CVE; (iii) experienced the CVE within 24 weeks of a hospitalised exacerbation of COPD. Hospitalisation date for CVE was index date. Conditional logistic regression models estimated the association between a hospitalised exacerbation and CVE (overall and by type of CVE) – expressed as odds ratios (OR) – comparing the odds of a hospitalised COPD exacerbation during the risk period (4 weeks prior to index date) versus control periods (9-24 weeks prior to index date). Results Among 122,172 patients with COPD hospitalised for a severe CVE in 2018-2019, 9,840 (8%) had a hospitalised exacerbation of COPD in the prior 24 weeks and qualified as case-patients. Mean age was 76.8 years (SD 10.7); 6,496 (66%) were male. The most frequent CVE were decompensated heart failure (n=5,888, 60%) and acute coronary syndrome (n=1,070, 11%); in-hospital death in the 24 weeks following an exacerbation of COPD occurred in 950 (10%) patients. Median time elapsed between hospitalised exacerbation and CVE (any type) was 43 days (Figure 1); the shortest delays were observed for non-STEMI (24 days) and resuscitated cardiac arrest (28 days). Risk of CVE in the 4 weeks following a hospitalised COPD exacerbation was 3-times the risk in the 9-24 weeks post-exacerbation (OR 3.0; 95%CI 2.9-3.2 – Figure 2). This increase in risk was observed for each individual type of CVE. The highest effect size was observed for non-STEMI (OR 5.3; 95%CI 4.5-6.3). Conclusion The risk of CVE substantially increases following a hospitalised exacerbation of COPD overall and for all types of CVE (acute ischemic events, arrhythmias, and heart failure decompensation). The first month following a hospitalised exacerbation is a period of vulnerability for people living with COPD, with some variability in the magnitude and temporality of risk increase according to the type of CVE. These results stress the need for immediate and sustained monitoring of exacerbating COPD patients to prevent a subsequent severe cardiac event. In addition, exacerbations prevention is an essential target of COPD treatment.

Psilocybin-assisted neurofeedback for the improvement of executive functions: a randomized semi-naturalistic-lab feasibility study.

Executive function deficits, common in psychiatric disorders, hinder daily activities and may be linked to diminished neural plasticity, affecting treatment and training responsiveness. In this pioneering study, we evaluated the feasibility and preliminary efficacy of psilocybin-assisted frontal-midline theta neurofeedback (NF), a neuromodulation technique leveraging neuroplasticity, to improve executive functions (EFs). Thirty-seven eligible participants were randomized into an experimental group (n = 18) and a passive control group (n = 19). The experimental group underwent three microdose sessions and then three psilocybin-assisted NF sessions, without requiring psychological support, demonstrating the approach's feasibility. NF learning showed a statistical trend for increases in frontal-midline theta from session to session with a large effect size and non-significant but medium effect size dynamical changes within sessions. Placebo effects were consistent across groups, with no tasks-based EF improvements, but significant self-reported gains in daily EFs-working memory, shifting, monitoring and inhibition-showing medium and high effect sizes. The experimental group's significant gains in their key training goals underscored the approach's external relevance. A thorough study with regular sessions and an active control group is crucial to evaluate EFs improvement and their specificity in future. Psilocybin-enhanced NF could offer significant, lasting benefits across diagnoses, improving daily functioning. This article is part of the theme issue 'Neurofeedback: new territories and neurocognitive mechanisms of endogenous neuromodulation'.

Video-blogs (Vlogs)-based Project: A Meta Analysis

This study aims to analyze the relationship between using video-blogs (vlogs)-based projects on student academic achievement through project-based learning. This study applied a meta-analysis through comprehensive sources, either from the international or the Indonesian index by considering certain criteria. The data sources in this research were obtained from twenty-seven studies that had met the inclusion criteria. The inclusion criteria used are 1) research published in 2020-2024; 2) research must be obtained from the Google Scholar database; ScienceDirect; ERIC; Wiley and IEEE; 3) Publications indexed by SINTA, Scopus, and Web of Science; 4) publications must be related to Vlog-based project; 5) the research has a value (R); (t) or (f) and 6) sample size (N) ≥ 30 students. The study showed that the Vlog-based project significantly influenced students' academic achievement (z = 8,042; p < 0.001; CI 95 % [ 0.526; 0.962]. The effect size in this study is a high effect size category (rRE = 1,024). In this meta-analysis, the data presented is accurate, valid, and representative, free from publication bias. This finding explains that V-logs-based project-based learning positively affects students' academic achievement. This study shows that using Vlogs-based projects has a positive impact on students' academic achievement, and it encourages teachers to enhance students' academic performance. Furthermore, the Vlogs-based project motivates students to engage more actively and creatively with the learning materials.

Factors Associated with Sexually Explicit Internet Material Use among Adolescents: A Systematic Review.

The advent of the Internet has made pornography more accessible to many people, including teenagers. This systematic review aimed to synthesize data on factors associated with the consumption of sexually explicit internet materials (SEIM) among adolescents. A total of 753 records in Scopus, Embase, MEDLINE/PubMed, and PsycINFO databases were sorted. Forty-eight quantitative survey studies that presented original empirical results and addressed SEIM use among adolescents were included for data extraction, quality analysis, and synthesis. The prevalence of SEIM use varied substantially between studies due to inconsistencies between the operationalization methods used to assess the theoretical construct of SEIM, the period of use (days, months, years), and the age of the participants. SEIM use was highly related to being a boy and having an independent relational style. It was moderately associated with more sexual agency and hyperfemininity for girls and associated with small-to-moderate effect size, with more willingness to engage in casual sex. Sexual performance orientation, sexual permissiveness, bullying behavior, and Internet addiction might be associated with SEIM consumption, although the effect size of these associations was not calculated. Among developmental predictors with high and medium effect sizes, greater use of SEIM in adolescents was associated with being older or reaching puberty. Peer pressure or striving for peer popularity can account for boys' greater exposure to SEIM. The results described show the importance of standardizing the evaluation of SEIM use. Literacy in the use of pornography among teenagers is essential to prevent the possible negative impacts of SEIM consumption.

The effectiveness of enhanced reality simulation on postmastectomy patient care management provided by nursing students: a quasi-experimental study

AimThe aim of this study was to evaluate the effect of enhanced reality simulation on nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. BackgroundBreast cancer is a common disease with increasing incidence and mastectomy is the treatment of choice. Postmastectomy patient care is a multidimensional and complex process. For various reasons, nursing students today graduate with inadequate clinical skills and do not have experience with many cases. DesignThis quasi-experimental study was conducted using a pretest–posttest design with a nonequivalent control group. MethodsThis study was conducted with fourth-year nursing students (78 students). Students were allocated to each group through a simple random allocation using IBM SPSS Statistics version 24. Research data were collected at the Clinical Simulation Training Center of the university in 2020–2021 academic year. The study group (n=39) learned using a scenario-based learning approach with moulage in a real clinical setting using enhanced reality simulation, while the control group (n=39) learned using the same scenario-based approach with the routine practice adult standard patient care model. The data were collected through the “Student Sociodemographic and Descriptive Characteristics Data Collection Form”, the “Student Satisfaction and Self-Confidence in Learning Scale”, the “Postmastectomy Patient Care Skills Checklist” and the “Pre–Post Knowledge Test on Postmastectomy Patient Care Management”. ResultsAll 78 participants completed the training course. The training significantly increased the Student Satisfaction and Self-Confidence in Learning Scale subdimension scores of both groups (p<0.05). The Postmastectomy Patient Care Management scores of the study group students who received enhanced reality simulation training significantly increased (p<0.05), while there was no significant effect on the scores of the control group students (p>0.05). While most the students in the study group increased their rates of correct answers to Postmastectomy Patient Care Management questions significantly (p<0.05) after the enhanced reality simulation training, the students in the control group showed no significant improvement (p>0.05). The training significantly (p<0.001) increased the mean postmastectomy patient care skills control scores. This increase had a high effect size on the study group. ConclusionEnhanced reality simulation is a learning method that increases nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care. Learning with enhanced reality simulation is an effective approach for nursing education that improves nursing students' learning satisfaction and self-confidence and patient care management knowledge and skills regarding postmastectomy care.

Recovery of Comfort and Capability After Upper Extremity Fracture Is Predominantly Associated With Mindset: A Longitudinal Cohort From the United Kingdom

OBJECTIVES: To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures. METHODS: Design: Secondary use of longitudinal data. Setting: Single Level-1 trauma center in Oxford, United Kingdom. Patient selection: English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded. Outcome measures and comparisons: Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2–4 weeks, and 6–9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects. RESULTS: Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P &lt; 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P &lt; 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P &lt; 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P &lt; 0.02). CONCLUSIONS: Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Development of a metabolomic risk score for exposure to traffic-related air pollution: A multi-cohort study

To synthesize vast amounts of high-throughput biological information, omics-fields like epigenetics have applied risk scores to develop biomarkers for environmental exposures. Extending the risk score analytic tool to the metabolomic data would be highly beneficial. This research aimed to develop and evaluate metabolomic risk score (metRS) approaches reflecting the biological response to traffic-related air pollution (TRAP) exposure (fine particulate matter, black carbon, and nitrogen dioxide). A simulation study compared three metRS methodologies: elastic net regression, which uses penalized regression to select metabolites, and two variations of thresholding, where a p-value cutoff is used to select metabolites. The methods performance was compared to assess 1) ability to correctly select metabolites associated with daily TRAP and 2) ability of the risk score to predict daily TRAP exposure. Power calculations and false discovery rates (FDR) were calculated for each approach. This metRS was applied to two real cohorts, the Center for Health Discovery and Wellbeing (CHDWB, n = 180) and Environment and Reproductive Health (EARTH, n = 200). In simulations, elastic net regression consistently presented inflated FDR for both high and low effect sizes and across all three sample sizes (n = 200; 500; 1000). Power to detect correct metabolites exceeded 0.8 for all three sample sizes in all three methods. In the real data application assessing associations of metabolomics risk scores and TRAP, associations were largely null. While we did not identify strong associations between the risk scores and TRAP in the real data application, metabolites selected by the risk score approaches were enriched in pathways that are well-known for their association with TRAP. These results demonstrate that certain methodologies to construct metabolomics risk scores are statistically robust and valid; however, standardized metabolic profiling and large sample sizes are required.

Escape Rooms for Education: A Meta-analysis

This meta-analysis aims to investigate the effectiveness of educational escape rooms in improving learning outcomes and fostering positive attitudes. Specifically, it seeks to examine their impact on the acquisition of content knowledge and the development of attitudes. Additionally, the study conduct a moderator analysis to explore how variables such as subject matter, types of escape rooms, and participants' age may influence these effects. After systematically screening the literature, 22 studies were deemed eligible for inclusion in the meta-analysis. The findings demonstrated a high effect size in knowledge gains and moderate effect size in attitude change, with 0.86 and 0.63, respectively. Interestingly, the moderator analysis did not uncover any statistically significant distinctions in effect sizes based on the three aforementioned moderators. In conclusion, this study affirms the effectiveness of educational escape rooms across a variety of academic disciplines and offers valuable insights for educators and practitioners interested in employing escape rooms as a means of educational innovation.

Evaluating the Effectiveness of Fiber Reinforced Polymer (FRP) in Structural Strengthening: A Meta-analysis

This study aims to evaluate the effectiveness of Fiber Reinforced Polymer in strengthening structures. This research is a type of meta-analysis research. The data source comes from 9 studies sourced from google scholar, DOAJ, ProQuest and Fronteins published in 2023-2024. Data selection techniques through the PRISMA method in 2020. The data analysis in this study is to calculate the effect size value with the help of the STATA application. The results of this study concluded that the application of Fiber Reinforced Polymer had a positive effect on the strengthening of the structure with an effect size value = 0.813 with a high effect size category. This finding explains that the application of fiber reinforced polymer is effective in strengthening concrete structures in civil engineering.

Outcomes of integrating livelihood into mental health and psychosocial support program among survivors of torture: A mixed-method study from western Nepal.

From 1996 to 2006, Nepal experienced a decade-long armed conflict that adversely impacted survivors of torture. The conflict posed threats to various facets of their lives, such as men-tal health, socio-economic status, human rights, and the process of reintegration into their original communities. This study was done with the survivors of torture from the armed conflict. This study aims to generate evidence on the impact of livelihood support (supporting individuals with earning their livelihood through business development, farming/animal husbandry and mi-cro-entrepreneurship) upon mental health and psychosocial wellbeing as well as social empower-ment of survivors of torture. In total, 44 out of 46 torture survivors reported improvement in their mental health and psychosocial well-being after the livelihood intervention was instituted. Significant reduction in the severity of symptoms of depression (21.7% to 2.3%), anxiety (15.2% to 6.8%), and post-traumatic stress disorder (44.4% to 4.5%) was observed with medium to high effect size. Similarly, improvement in social relationship, economic status, and autonomy (increase in self-confidence and motivation) were noticed post-intervention. Our study concludes that the livelihood intervention has significantly contributed to economic uplift, improved mental health, psychosocial well-being, social empowerment and quality of life among the survivors of torture. The data provide preliminary evidence of positive outcomes from integrating a livelihood program into an MHPSS (Mental Health and Psychosocial Support) program. Although the lack of a control group prevents us from isolating the specific impacts of the livelihood program, our qualitative data indicate that the intervention is well-received, culturally rel-evant, and promising. The study has yielded certain recommendations for further research.

Which ERP components are effective in measuring cognitive load in multimedia learning? A meta-analysis based on relevant studies.

The open and generative nature of multimedia learning environments tends to cause cognitive overload in learners, and cognitive load is difficult for researchers to observe objectively because of its implicit and complex nature. Event-related potentials (ERP), a method of studying potential changes associated with specific events or stimuli by recording the electroencephalogram (EEG), has become an important method of measuring cognitive load in cognitive psychology. Although many studies have relied on ERP output measurements to compare different levels of cognitive load in multimedia learning, the results of the effect of cognitive load on ERP have been inconsistent. In this study, we used a meta-analysis of evidence-based research to quantitatively analyze 17 experimental studies to quantitatively evaluate which ERP component (amplitude) is most sensitive to cognitive load. Forty five effect sizes from 26 studies involving 360 participants were calculated. (1) The results of the studies analyzed in subgroups indicated high level effect sizes for P300 and P200 (2) Analyses of moderating variables for signal acquisition did not find that different methods of signal acquisition had a significant effect on the measurement of cognitive load (3) Analyses of moderating variables for task design found that a task system with feedback was more convenient for the measurement of cognitive load, and that designing for 3 levels of cognitive load was more convenient for the measurement of cognitive load than for 2 levels of cognitive load. (4) Analyses of continuous moderating variables for subject characteristics did not find significant effects of age, gender, or sample size on the results.

Children's Educational Attainment and Older Parents' Food Insecurity: Evidence From India.

Objectives: To examine the relationship between children's educational attainment and the risk of food insecurity among older parents and to determine if this relationship varies by the sex and residence of the children. Methods: This study utilized data from the Longitudinal Ageing Survey in India (LASI, 2017-18), comprising 25,914 individuals aged 60+ with at least one living child. Logistic regression, interaction analysis, and propensity score matching were employed to achieve the study's objectives. Results: Having a child with higher education (undergraduate or above) was associated with a 35% reduction in the odds of parents experiencing food insecurity. This negative relationship was significant for both sons' and daughters' education, with daughters' education having higher effect size. Conclusion: In a country like India, characterized by a weak welfare system but a strong collectivist family culture, children's education may play an important role in ensuring older parents' food security.

Exploring vortioxetine combination with intranasal esketamine: A feasible alternative to SSRI/SNRI? - Insights from the REAL-ESK study

BackgroundTreatment-Resistant Depression (TRD) affects almost 30 % of patients with Major Depressive Disorder (MDD). Esketamine Nasal Spray (ESK-NS) has recently been approved for TRD in combination with a Serotonin Specific Reuptake Inhibitor/SSRI or a Serotonin-Norepinephrine Reuptake Inhibitor/SNRI. There is a lack of studies investigating the effectiveness and safety of ESK-NS in combination with other oral antidepressants. AimTo assess the efficacy of Vortioxetine plus ESK-NS in mitigating depressive symptoms and emotional blunting, as well as its tolerability in TRD subjects, compared to the standard-of-care of SSRI/SNRI plus ESK-NS. MethodsWe conducted a post-hoc analysis of the REAL-ESK study. The study included twenty TRD patients, ten subjects taking Vortioxetine as the main oral antidepressant with ESK-NS, and ten subjects taking SSRI or SNRI with ESK-NS. Psychometric assessments (Montgomery-Åsberg Depression Rating Scale/MADRS, Brief Psychiatric Rating Scale/BPRS) were conducted at baseline(T0), one month(T1), and three months after the treatment initiation(T2). ResultsThe combination of Vortioxetine and ESK-NS was as effective as the standard-of-care in reducing depressive symptoms, with a higher effect size in reducing emotional blunting at T2. The safety and tolerability profile of the Vortioxetine+ESK-NS combination appeared to be better, with a lower rate of treatment-emergent adverse events. ConclusionThe combination of Vortioxetine and ESK-NS may be a valuable alternative to the standard-of-care SSRI/SNRI plus ESK-NS in TRD patients, particularly regarding the reduction of emotional blunting and potentially a better safety and tolerability profile. Further randomized controlled trials with larger sample sizes and prospective designs are needed to confirm these findings.

P182 AORTIC VASCULAR BIOMARKERS FOR THE EARLY DETECTION OF PLACENTAL SYNDROMES DURING PREGNANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Placental syndromes (PS) cause over 14 million complications and the death of more than 350,000 women each year. Women with preeclampsia (PE) or gestational hypertension (GH) typically exhibit late gestational acute brachial hypertension, making early intervention difficult. Non-invasive aortic waveform assessments provide nuanced insight to global cardiovascular function. Our objective is to delineate cardiovascular differences between complicated and normotensive pregnancies (NP), to identify early vascular markers of at-risk women. Methods: A systematic search (March 2024) for studies reporting both NP and PS pregnancies was performed across five databases: PubMed; Medline; CINAHL Complete; Web of Science; and Scopus. Inclusion criteria required reporting before, during (trimester: T1; T2; T3), or after pregnancy (&lt; 1 year post-delivery) of at least one of the following vascular biomarkers from aortic pulse pressure waveform: aortic systolic blood pressure (aSBP); aortic pulse pressure (aPP); augmentation index normalised to a heart rate of 75 bpm (AIx@75); or arterial stiffness measured by carotid femoral pulse wave velocity (cfPWV). A meta-analysis of continuous random-effects model calculated Hedges’ g with 95% confidence intervals. Results: The systematic search yielded 19 studies. Analysis depicted PS having significantly higher aggregated measures than NP throughout pregnancy (p &lt;0.001) and a stronger effect size of AIx@75, aSBP, cfPWV in each trimester [T1, Hedges g 1.4(CI .64 - 2.0); T2, 1.1(CI .64 - 1.5); T3, 3.4(CI 2.1 – 4.6) p&lt;0.001]. Overall, cfPWV had the highest effect size particularly during T1 and T3 [T1, 2.8(CI 2.5 – 3.1); T2, 1.7(CI 1.2 – 2.1); T3, 5.3(CI 4.6 – 5.9)]. Low aPP reporting allowed only analysis of T3 which showed similar effect sizes to other markers [3.14(CI 1.23 – 5.05)]. Conclusions: Early indication of PS was quantifiable from vascular biomarkers, along with each trimester of pregnancy being elevated compared to NP. Pulse wave analysis and arterial stiffness assessment could enhance risk assessment from as early as the first trimester, improving and informing prenatal care.

Associations between Aircraft Noise, Sleep, and Sleep-Wake Cycle: Actimetric Data from the UK Biobank Cohort near Four Major Airports.

Nighttime aircraft noise may affect people's sleep, yet large-scale evidence using objective and subjective measures remains limited. Our aim was to investigate associations between nighttime aircraft noise exposure and objectively measured sleep disturbance using a large UK cohort. We used data from 105,770 UK Biobank cohort participants exposed and unexposed to aircraft noise who lived in 44 local authority districts near 4 international airports in England. We used a generalized linear regression model to examine cross-sectional associations between aircraft noise (23:00 hours-07:00 hours) and 7-d actimetric measures collected 2013-2015 (). We also used Logit and generalized estimating equations models to examine associations between and self-reported sleep measures at enrollment (2006-2010) and follow-up (2012-2013). This approach allowed us to compare and contrast the results and support potential future meta-analyses on noise-related sleep disturbance. Cross-sectional analyses of actimetric data suggested sleep disturbance associated with , showing higher level of movements during the least active continuous 8-h time period [: 0.12 milligravitational units; 95% confidence interval (CI): 0.013, 0.23]. We also saw disrupted sleep-wake cycles as indicated by index scores of lower relative amplitude (: ; 95% CI: , ), poorer interdaily stability (: ; 95% CI: , ), and greater intradaily variability (: 0.021; 95% CI: 0.019, 0.023), comparing dB with dB. Repeated cross-sectional analyses found a 52% higher odds of more frequent daytime dozing [odds ratio (OR) ; 95% CI: 1.32, 1.75] for dB in comparison with dB, whereas the likelihood for more frequent sleeplessness was more uncertain (; 95% CI: 0.92, 1.39). Higher effect sizes were seen in preidentified vulnerable groups, including individuals of age and those with diabetes or dementia. Individuals exposed to higher levels of aircraft noise experienced objectively higher levels of sleep disturbance and changes in sleep-wake cycle. https://doi.org/10.1289/EHP14156.

Effectiveness of using Balanced Scorecard in Management Accounting: Meta-analysis

This study aims to evaluate the effectiveness of the use of Balanced Scorecard (BSC) in management accounting through a meta-analysis approach. The Balanced Scorecard is a strategic tool used to measure a company's performance from various perspectives, including finance, customers, internal business processes, and learning and growth. This meta-analysis integrates the results of previous research to provide a comprehensive picture of how BSC affects managerial and organizational performance. The results show that the implementation of BSC significantly contributes to increasing management effectiveness, especially in aligning the company's strategy with operational goals, improving the quality of decision-making, and strengthening managerial accountability with an effect size value of 1,042 (high effect size category). Nonetheless, this study also identifies several factors that can affect the successful implementation of BSC, such as organizational culture, management commitment, and information system quality. These findings have important implications for practitioners and academics in evaluating the benefits and challenges of BSC in the context of management accounting.

The Effectiveness of Overground Robot Exoskeleton Gait Training on Gait Outcomes, Balance, and Motor Function in Patients with Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

This study aimed to investigate the effects of overground robot exoskeleton gait training on gait outcomes, balance, and motor function in patients with stroke. Following the PRISMA guidelines, literature searches were performed in the PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, Ovid-LWW, and RISS databases. A total of 504 articles were identified, of which 19 were included for analysis after application of the inclusion and exclusion criteria. The included literature was qualitatively evaluated using the PEDro scale, while the Egger's regression, funnel plot, and trim-and-fill methods were applied to assess and adjust for publication bias. The averaged PEDro score was 6.21 points, indicating a high level of methodological quality. In the analysis based on dependent variables, higher effect sizes were observed in the following ascending order: gait speed (g = 0.26), motor function (g = 0.21), gait ability (g = 0.18), Timed Up and Go Test (g = -0.15), gait endurance (g = 0.11), and Berg Balance Scale (g = 0.05). Subgroup analyses further revealed significant differences in Asian populations (g = 0.26), sessions lasting longer than 30 min (g = 0.37), training frequency of three times per week or less (g = 0.38), and training duration of four weeks or less (g = 0.25). Overall, the results of this study indicate that overground robot exoskeleton gait training is effective at improving gait speed in patients with stroke, particularly when the sessions exceed 30 min, are conducted three times or less per week, and last for four weeks or less. our results suggest that training is an effective intervention for patients with stroke, provided that appropriate goal-setting and intensity and overground robot exoskeleton gait are applied.

Data-driven risk/benefit estimator for multiple sclerosis therapies.

Multiple sclerosis (MS) disease-modifying treatments (DMTs) are tested in patients pre-selected for favorable risk/benefits ratios but prescribed broadly in clinical practice. We aimed to establish data-driven computations of individualized risk/benefit ratios to optimize MS care. We derived determinants of DMTs efficacy on disability progression from re-analysis and integration of 61 randomized, blinded Phase 2b/3 clinical trials that studied 46,611 patients for 91,787 patient-years. From each arm we extracted 80 and computed 30 features to identify and adjust for biases, and to use in multiple regression models. DMTs mortality risks were estimated from age mortality tables modified by published hazard ratios. Baseline characteristics of the recruited patients determine disability progression rates and DMTs efficacies with high effect sizes. DMTs efficacies increase with MS lesional activity (LA) measured by relapses or contrast-enhancing lesions and decrease with increasing age, disease duration and disability. Unexpectedly, as placebo arms' relapse rate rapidly declines with trial duration, efficacy of MS DMTs likewise decreases quickly with treatment duration. Conversely, DMTs morbidity/mortality risks increase with age, advanced disability, and comorbidities. We integrated these results into an interactive personalized web based DMTs risk/benefit estimator. Results predict that prescribing DMTs to patients traditionally excluded from MS clinical trials causes more harm than benefit. Treatment with high efficacy drugs at MS onset followed by de-escalation to DMTs that do not increase infectious risks would optimize risk/benefit. DMTs targeting mechanisms of progression independent of LA are greatly needed as current DMTs inhibit disability caused by LA only.