High Effect Sizes Research Articles

Prosocial Behavior and Life Satisfaction: Exploring Age and Gender Differences Among Higher Education Students

This study assessed the relationship between prosocial behavior and life satisfaction. Furthermore, it also explored age and gender differences. Convenient sampling method was used to collect the data. Data was collected through structured questionnaires from 200 participants of three higher education institutes of Balochistan. The results revealed prosocial behavior was positively associated with life satisfaction of the higher education students. The results further showed significant differences in prosocial behavior for different age groups. However, there weren’t any significant differences found in life satisfaction of different age groups. Moreover, prosocial behavior and life satisfaction had no significant differences between men and women. Finally, results observed that though the correlation between prosocial behavior and life satisfaction was stronger for females than males, the differences were only marginal, and both correlations were in high effect size range.

Qualification of prospective PE teachers for inclusive PE: development and evaluation of a PETE concept

ABSTRACT Purpose The qualification of teachers for inclusive physical education (PE) is a central challenge for sports research and university teaching. Nevertheless, a concept of physical education teacher education (PETE) focusing on situation-specific skills and based on typical requirement situations of inclusive PE has not yet been developed. The Qualification of Prospective PE Teachers for Inclusive PE project (QiPE) aimed to design, implement, and evaluate such a PETE concept based on typical requirement situations of inclusive PE for preservice teachers. Method In the project, requirement situations that teachers had to cope with in inclusive PE were identified on the basis of video recordings (104 PE lessons), and the necessary courses of action, situation-specific skills, and dispositions were determined. Based on this, competence profiles were constructed and a teaching sequence was developed. Three test scales for Recognition, Individual Support, and Participation were developed, and the effectiveness of the first seminar of the developed PETE concept was tested using a pretest-posttest design. Results There were statistically highly significant relations between the developed seminar and the situation-specific skills tested, associated with a large effect size for the Recognition scale ( = .33 or .28), a medium to high effect size for the Individual Support scale ( = .34 or .13), and a medium effect size for the Participation scale for a part of the sample ( = .07), while for the other part of the sample the effect was not significant. Conclusion The developed requirement situation-oriented and casework-based seminar is highly effective in promoting situation-specific skills in preservice teachers with relation to the central demands of inclusive PE: recognition, individual support, and participation. Nevertheless, further research on requirement situations in PE and casework in PETE is needed.

The Development and Assessment of Critical Listening Skills in the Speech Program

Critical listening is comparing what is heard to some standard or cognitive evidence. The creative listener analyses the statements and facts throughout this process to generate critical judgments. This highly intentional endeavor requires a questioning and analytical mentality to conclude or act on the judgments formed through creative listening. The capacity to make knowledgeable judgments while hearing analytically to discern both qualities and faults is the goal of critical listening. The main goal is pedagogical and concerns designing and testing a tool that could measure students’ critical listening skill improvement during a speech course program. A total number of N = 170 learners participated in qualitative-experimental studies in which we developed a t-test and program to develop and assess critical listening skills. Results show that students’ listening skills improved in specific aspects of critical listening at both times. Effects were more significant in the second round due to adjustments to the program curriculum and the assessment tool. Results support the impact of the intervention by modest to high effect sizes and the construct validity of the assessment tool. We consider the improvement found in the current study a vital beginning and recommend that listening skills become an integral part of the curriculum at the undergraduate level. It would be essential to do a follow-up measurement to verify if the learners retain the critical listening skills beyond the current course and use their spontaneously inappropriate real-life situations.

A computational musculoskeletal arm model for assessing muscle dysfunction in chronic obstructive pulmonary disease.

Computational models have been used extensively to assess diseases and disabilities effects on musculoskeletal system dysfunction. In the current study, we developed a two degree-of-freedom subject-specific second-order task-specific arm model for characterizing upper-extremity function (UEF) to assess muscle dysfunction due to chronic obstructive pulmonary disease (COPD). Older adults (65years or older) with and without COPD and healthy young control participants (18 to 30years) were recruited. First, we evaluated the musculoskeletal arm model using electromyography (EMG) data. Second, we compared the computational musculoskeletal arm model parameters along with EMG-based time lag and kinematics parameters (such as elbow angular velocity) between participants. The developed model showed strong cross-correlation with EMG data for biceps (0.905, 0.915) and moderate cross-correlation for triceps (0.717, 0.672) within both fast and normal pace tasks among older adults with COPD. We also showed that parameters obtained from the musculoskeletal model were significantly different between COPD and healthy participants. On average, higher effect sizes were achieved for parameters obtained from the musculoskeletal model, especially for co-contraction measures (effect size = 1.650 ± 0.606, p < 0.001), which was the only parameter that showed significant differences between all pairwise comparisons across the three groups. These findings suggest that studying the muscle performance and co-contraction, may provide better information regarding neuromuscular deficiencies compared to kinematics data. The presented model has potential for assessing functional capacity and studying longitudinal outcomes in COPD.

Association between food control inspection grades and regional incidence of infectious foodborne diseases in Finland

ABSTRACT We studied regional food control inspection grades and their relation to regional incidence of domestically acquired foodborne diseases (caused by Campylobacter spp. Salmonella spp. enterohemorrhagic Escherichia coli (EHEC), and Listeria monocytogenes) using food control inspection data of local food business operators and infectious disease data from 2014 to 2019 from Finland. We observed that inferior overall inspection grades were associated with increased incidence of Salmonella infections (p=0.02). Specifically, inferior grades on cleanliness of facilities, surfaces, and equipment were associated with increased incidence of Salmonella infections (p=0.04). For this topical inspection area, a high effect size was also seen for Campylobacter infections (p=0.06). Of the individual inspection items, an association between increased incidence of Campylobacter infections and inferior grades on storage of foodstuffs (p=0.01) and verification of hygiene proficiency (p=0.03) was observed. These results suggest that food control recognizes non-compliances that may predispose to foodborne diseases.

Knowledge Management and Academic Service Quality on Organization Performance

Knowledge management (KM) in education is considered an approach that enables people to collect information, share and use knowledge to improve organizational performance through educational programs, student outcomes, and effective decision-making of work processes. Organizational performance in the university includes student satisfaction, research productivity, curriculum, academic staff responsiveness, and research rankings. KM through the adoption of advanced technology enables organizations to implement better processes, strong and good collaborative structures, knowledge and information sharing, and problem-solving tools. However, limited studies examine the determinants of the KM process and their relationship to university performance through academic service quality from an educator's perspective. In this study, we proposed a theoretical research model to investigate the determinants of the KM process and examine its relationship to university performance through academic service quality. Data collected from 71 academic staff in universities were used to test the hypotheses with structural equation modelling – Partial Least Square. The results showed information technology and culture have a positive impact on the KM process. Quality of academic services partially mediates knowledge management and university performance. KM process and quality of academic services determine and influence organizational performance substantially (f-square=77.6 %). Finally, among the KM processes, knowledge discovery was found to have the highest effect size on organizational performance. However, KM enablers consisting of rewards &amp; incentives, and organizational support were not proven to influence the KM process. Both culture and IT capabilities must be considered by universities in supporting the KM process and building a culture that supports sharing and utilizing knowledge in every task. Additionally, this capability can help improve the quality of academic services which leads to increased organizational performance.

Microbial Properties Depending on Fertilization Regime in Agricultural Soils with Different Texture and Climate Conditions: A Meta-Analysis

Over-fertilization has a significant impact on soil microbial properties and its ecological environment. However, the effects of long-term fertilization on microbial properties on a large scale are still vague. This meta-analysis collected 6211 data points from 109 long-term experimental sites in China to evaluate the effects of fertilizer type and fertilization duration, as well as soil and climate conditions, on the effect sizes on various microbial properties and indices. The organic fertilizers combined with straw (NPKS) and manure (NPKM) had the highest effect sizes, while the chemical fertilizers N (sole N fertilizer) and NPK (NPK fertilizer) had the lowest. When compared with the control, NPKM treatment had the highest effect size, while N treatment had the lowest effect size on MBN (111% vs. 19%), PLFA (110% vs. −7%), fungi (88% vs. 43%), Actinomycetes (97% vs. 44%), urease (77% vs. 25%), catalase (15% vs. −11%), and phosphatase (58% vs. 4%). NPKM treatment had the highest while NPK treatment had the lowest effect size on bacteria (123% vs. 33%). NPKS treatment had the highest while N treatment had the lowest effect sizes on MBC (77% vs. 8%) and invertase (59% vs. 0.2%). NPKS treatment had the highest while NPK treatment had the lowest effect size on the Shannon index (5% vs. 1%). The effect sizes of NPKM treatment were the highest predominantly in arid regions because of the naturally low organic carbon in soils of these regions. The effect sizes on various microbial properties were also highly dependent on soil texture. In coarse-textured soils the effect sizes on MBC and MBN peaked sooner compared with those of clayey or silty soils, although various enzymes were most active in silty soils during the first 10 years of fertilization. Effect sizes on microbial properties were generally higher under NPKM and NPKS treatments than under NPK or N treatments, with considerable effects due to climate conditions. The optimal field fertilizer regime could be determined based on the effects of fertilizer type on soil microorganisms under various climate conditions and soil textures. This will contribute to the microbial biodiversity and soil health of agricultural land. Such controls should be used for adaptation of fertilization strategies to global changes.

Geometry-derived statistical significance: A probabilistic framework for detecting true positive findings in MRI data.

The false discovery rate (FDR) procedure does not incorporate the geometry of the random field and requires high statistical power at each voxel, a requirement not satisfied by the limited number of participants in imaging studies. Topological FDR, threshold free cluster enhancement (TFCE), and probabilistic TFCE improve statistical power by incorporating local geometry. However, topological FDR requires specifying a cluster defining threshold and TFCE requires specifying transformation weights. Geometry-derived statistical significance (GDSS) procedure overcomes these limitations by combining voxelwise p-values for the test statistic with the probabilities computed from the local geometry for the random field, thereby providing substantially greater statistical power than the procedures currently used to control for multiple comparisons. We use synthetic data and real-world data to compare its performance against the performance of these other, previously developed procedures. GDSS provided substantially greater statistical power relative to the comparator procedures, which was less variable to the number of participants. GDSS was more conservative than TFCE: that is, it rejected null hypotheses at voxels with much higher effect sizes than TFCE. Our experiments also showed that the Cohen's D effect size decreases as the number of participants increases. Therefore, sample size calculations from small studies may underestimate the participants required in larger studies. Our findings also suggest effect size maps should be presented along with p-value maps for correct interpretation of findings. GDSS compared with the other procedures provides considerably greater statistical power for detecting true positives while limiting false positives, especially in small sized (<40 participants) imaging cohorts.

Regionally decreased cortical gyrification in patients with major depressive disorder

IntroductionEarly neurodevelopmental deviations, such as abnormal cortical folding patterns, are a candidate biomarker for major depressive disorder (MDD). Previous studies on patterns of abnormal cortical gyrification in MDD have provided valuable insights; however, the findings on cortical folding are controversial.ObjectivesWe aimed to investigate the association of MDD with the local gyrification index (LGI) in each cortical region at the whole-brain level and the association of the LGI with clinical characteristics of MDD, including recurrence, remission status, illness duration, severity of depression, and medication status of patients with MDD.MethodsWe obtained T1-weighted images of 234 patients with MDD and 215 healthy controls (HCs). LGI values were automatically calculated using the FreeSurfer software according to the Desikan–Killiany atlas. LGI values from 66 cortical regions in the bilateral hemispheres were analyzed. We compared the LGI values between the MDD and HC groups using the analysis of covariance, including patients’ age, sex, and years of education as covariates. The association between clinical characteristics and LGI values was investigated in the MDD group.ResultsCompared with HCs, patients with MDD showed significantly decreased LGI values in the cortical regions, including the bilateral ventrolateral and dorsolateral prefrontal cortices, medial and lateral orbitofrontal cortices, insula, right rostral anterior cingulate cortex, and several temporal and parietal regions, with the highest effect size in the left pars triangularis (Cohen’s f = 0.361; P = 1.78 × 10-13). As for the association of clinical characteristics with LGIs within the MDD group, recurrence and longer illness duration of MDD were associated with increased gyrification in several occipital and temporal regions, which showed no significant difference in LGIs between MDD and HC groups.ConclusionsConsidering that the aforementioned cortical regions are involved in emotion regulation, abnormal cortical folding patterns in such regions may be associated with the dysfunction of emotion regulation-related neural circuits, which may lead to MDD. These findings suggest that LGI may be a relatively stable neuroimaging marker associated with the trait of MDD predisposition.Disclosure of InterestNone Declared

Effects of exercise on bone mineral content in children and adolescents at different growth stages: a Meta-analysis

To evaluate the effect of exercise on bone mineral content(BMC) in children and adolescents at different growth stages. EMBASE, PubMed, Web of Science, CNKI, VIP database and Wanfang database were searched. The randomized controlled trials(RCTS) published in Chinese and English on the effects of exercise on BMC in children and adolescents were collected using exercise, children, adolescents and BMC as search terms. Cochrane collaboration tool was used to evaluate the quality of the included studies, and RevMan5.4 software was used for Meta-analysis. The search time limit is from the establishment of the database to July 20, 2022. A total of 18 articles(22 RCTS) involving 1305 children and adolescents were included. The result of the Meta-analysis showed that: Compared with the control group, (1) exercise significantly improved spinal BMC(SMD=0.28, 95%CI 0.17-0.40, P&lt;0.01) and femoral neck BMC(SMD=0.40, 95%CI 0.20-0.61, P&lt;0.01), but not for systemic BMC(SMD=0.08, 95%CI-0.04-0.21, P=0.19). (2) Subgroup analysis showed that exercise significantly improved spinal BMC in the following stages: prepubertal(SMD=0.48, 95%CI 0.27-0.69, P&lt;0.01)and early pubertal(SMD=0.22, 95%CI 0.05-0.39, P=0.01). The stages in which exercise significantly improved femoral neck BMC were as follows: prepubertal(SMD=0.60, 95%CI 0.05-1.16, P=0.03), early pubertal(SMD=0.22, 95%CI 0.01-0.43, P=0.04), middle and late pubertal(SMD=0.43, 95%CI 0.13-0.72, P&lt;0.01). Exercise significantly enhanced spinal BMC during preadolescence and early adolescence as well as femoral neck BMC throughout childhood and adolescence, especially with higher effect sizes during preadolescence.

Effect of inclusive practices on attitudes: A meta-analysis study

With the study reported on here we aimed to synthesise recent quantitative research to specify the effect of inclusive practices on attitudes via meta-analysis. Since attitudes have an integral role in the performance of inclusion programmes, within the scope of the study, the cumulative findings of experimental studies conducted on attitudes towards inclusive practices were reinterpreted. To this end, studies with a pretest-posttest control group carried out in 2000 and 2021 were scanned from databases according to the inclusion criteria. After the search process, 23 studies that met the inclusion criteria were selected from 54 studies. The overall sample size of the studies included 2,016 participants. The mean effect size calculations, heterogeneity test, moderator analyses and publication bias analyses were conducted through a comprehensive meta-analysis programme (CMA 3.0). The findings that were discussed in accordance with the random effects model (REM) suggest that inclusive practices have a positive effect on attitudes and this effect is at a large level (g = 1.328) with respect to Cohen’s classification. This result indicates that inclusive practices have been strongly influenced by positive attitudes to yield favourable results. According to the moderator analyses, the highest effect sizes were found in the teachers’ group (g = 1,880) according to group level and in primary education (g = 1,374) according to school grades. The attitudes towards inclusion have been strongly influenced by teachers’ beliefs about the power of their teaching. More empirical studies on inclusive practices are recommended.

Effectiveness of a cognitive-behavioral group therapy for complicated grief in relatives of patients with cancer: A randomized clinical trial.

Complicated grief can affect a large number of individuals who have lost a relative due to cancer. To assess the efficacy of a cognitive-behavioral grief therapy (CBGT) group for complicated grief (CG) in those who have lost a relative due to cancer in comparison with a psychoeducational and emotional expression intervention group (PSDEEI). A randomized clinical trial was used, in which 249 relatives of deceased cancer patients with CG were randomly assigned to CBGT or PSDEEI. Complicated grief (Inventory of Complicated Grief [ICG]), depression (Beck Depression Inventory [BDI-II]), hopelessness (Beck Hopelessness Scale [BHS]), anxiety (Beck Anxiety Inventory [BAI]) symptoms, and general health (Goldberg's General Health Questionnaire [GHQ28]) were assessed at pretreatment, posttreatment, and follow-up at 6 and 12months. The CBGT group improved significantly (p<0.001), with the scores in ICG, BDI-II, BAI, BHS, and GHQ28 (p<0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2=0.16), BDI (η2=0.10), BAI (η2=0.06), BHS (η2=0.21), and GHQ28 (η2=0.21). At the 12-month follow-up, the number of cases of CG decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group. The CBGT treatment was effective for CG, depression, anxiety, and hopelessness symptoms and for mental health and was superior to the PSDEEI treatment.

Effects of goal orientation on online learning: A meta-analysis of differences in Korea and US.

This meta-analysis examines the correlation between goal orientation and related variables in online learning to examine the influence of individual goal orientation on online learning as well as the differences arising from diverse cultural backgrounds. The study analyzed 27 papers from 2000 to 2022, comprising 8 US and 19 Korean studies. The average effect size of goal orientation and related variables, such as learning satisfaction, self-efficacy, and task value, were also analyzed. In addition, moderating effect according to the country and type of goal orientation was examined to evaluate differences arising from cultures. It was found that learning immersion, learning participation, and intention to continue learning, showed a high average effect size with goal orientation, with the other related variables also demonstrating a significant average effect size. There was no moderating effect of the state in the relationship between goal orientation and academic achievement, although a moderating effect existed according to the type of goal orientation. Based on the results of this study, we analyzed the variables that can reinforce learning along with goal orientation in online learning situations. Therefore, our findings will help formulate various educational support directions that can lead students to successfully gain knowledge through online learning, which has been growing expeditiously in the wake of the COVID-19 pandemic.

A Mixed Methods Study of Graduate Students' Achievement Motivation and Perceptions of Implementing Asynchronous Online Discussions

This study used sequential explanatory mixed methods to examine higher education female students’ achievement motivation, and explored their perceptions towards the implementation of asynchronous online discussions in the Learning Management course for masters' students at a Western district university of Saudi Arabia. Quantitative data were collected using a one-group pretest-posttest design, and an achievement motivation's scale was administered before and after the treatment. The sample for this phase were a purposeful sample consisted of (n=10).&nbsp; Qualitative data were collected by a focus group discussion for (n=8) who completed the quantitative phase and volunteered to participate in this phase. Due to the small size of the study sample at the quantitative phase, the Wilcoxon Signed Ranks test was used to identify statistically significant differences between the scores of the experimental group in the pre and post applications of the scale, and Cohen's equation (r) to measure the effect size of asynchronous online discussions on the development of students' achievement motivation. This result indicates that there is a positive effect of using asynchronous online discussions on graduated students’ achievement motivation with a high effect size, at three dimensions (Perseverance, Level of Ambition, and Perceived Efficiency) and total scale, while there was no positive effect of using asynchronous online discussions on graduated students’ achievement motivation at the (Goal Setting) dimension. The qualitative results revealed that students had positive perceptions towards asynchronous online discussions. Benefits and strategies that instructors could try to improve the online discussions' implementation arose. Finally, implications and recommendations for future studies regarding the usage of asynchronous online discussions are discussed.

The effect of professional portfolio learning on nursing students’ professional self-concepts in geriatric adult internship: a- quasi-experimental study

BackgroundProfessional self-concept is one of the important outcomes of nursing professionalism. There is a lack of adequately planned curriculum may limit nursing students’ practical knowledge, skills and professional self-concept in providing comprehensive geriatric-adult care and promoting nursing professionalism. Professional portfolio learning strategy has allowed nursing students to continue professional development and enhance nursing professionalism in professional clinical practice. However, there is little empirical evidence in nursing education to support the use of professional portfolios in blended learning modality among internship nursing students. Therefore, this study aims to examine the effect of the blended professional portfolio learning on professional self-concept among undergraduate nursing students during Geriatric-Adult internship.MethodsA quasi-experimental study two-group pre-test post-test design. A total of 153 eligible senior undergraduate students completed the study (76 in the intervention group and 77 in the control group). They were recruited from two Bachelor of Sciences in Nursing (BSN) cohorts from nursing schools at Mashhad University of Medical Sciences (MUMS), in Iran, in January 2020. Randomization was undertaken at the level of school via a simple lottery method. The intervention group received the professional portfolio learning program as a holistic blended learning modality, though the control group received conventional learning during professional clinical practice. A demographic questionnaire and the Nurse Professional Self-concept questionnaire were used for data collection.ResultsThe findings imply the effectiveness of the blended PPL program. Results of Generalized Estimating Equation (GEE) analysis was indicated significantly improved professional self-concept development and its dimensions (self-esteem, caring, staff relation, communication, knowledge, leadership) with high effect size. The results of the between-group comparison for professional self-concept and its dimensions at different time points (pre, post and follow up test) showed a significant difference between groups at post-test and follow up test (p < 0.05),while at pre-test there was no important dissimilarity between two groups (p > 0.05).The results of within-group comparison for both control and intervention showed that there were significant differences in professional self-concept and for all its dimensions across the time from pre-test to post-test and follow-up (p < 0.05), and also from post-test to follow-up it was significant (p < 0.05) for both groups.ConclusionThis professional portfolio learning program demonstrates as an innovative and holistic blended teaching-learning approach to improve professional self-concept during professional clinical practice among undergraduate nursing students. It appears that the use of a blended designed of professional portfolio can promote a link between theory and the advancement of geriatric adult nursing internship practice. The data obtained from the present study can be useful for nursing education to evaluate and redesign a curriculum for development of nursing professionalism as a quality improvement process and groundwork to develop new models of teaching-learning and assessment.

Development of a generative voluntary safety reporting culture (GVSRC) model for the Gulf of Mexico (GOM) oil and gas (O & G) sector using attributes of the aviation safety action program (ASAP)

Generative voluntary safety reporting culture (GVSRC) fosters proactive reporting of hazards, near-misses, potential violations, and operational errors that are precursors of accidents. The Aviation Safety Action Program (ASAP) has been effective in sustaining a GVSRC in the U.S commercial airline industry. To assess the potential cross-disciplinary application of an ASAP-style initiative in the Gulf of Mexico (GOM) oil and gas (O&G) sector, a GVSRC model was developed from employee perceptions of ASAP attributes using structural equation modeling. Hypothesized underlying factors of GVSRC: safety reporting policy fundamentals (SRPF), organizational support, personnel engagements in voluntary safety reporting processes (OSPE), and safety reporting benefits (SRB) were validated. The GVSRC model had a good fit index (RMSEA = 0.031). All underlying factors had significant predictive relationships with GVSRC, with high effect sizes. The GVSRC model has utility in gauging the levels of understanding and acceptance of ASAP attributes in the O&G sector. There were significant linear relationships between the factors and OSPE significantly mediated the relationship between SRPF and SRB. Results suggest that top management support for voluntary safety reporting programs through resource provision can motivate personnel to engage in safety reporting processes. In terms of voluntary reporting propensity, younger respondents significantly underreported safety issues than older personnel, highlighting the need for better hazard identification, safety risk management training, and effective mentoring for younger personnel. Implication for policy is that despite different operating environments and processes, an ASAP-styled initiative has positive value for safety management and engendering a proactive safety reporting culture in the O&G sector.

The Berlin Bimanual Test for Tetraplegia (BeBiTT): development, psychometric properties, and sensitivity to change in assistive hand exoskeleton application

BackgroundAssistive hand exoskeletons are promising tools to restore hand function after cervical spinal cord injury (SCI) but assessing their specific impact on bimanual hand and arm function is limited due to lack of reliable and valid clinical tests. Here, we introduce the Berlin Bimanual Test for Tetraplegia (BeBiTT) and demonstrate its psychometric properties and sensitivity to assistive hand exoskeleton-related improvements in bimanual task performance.MethodsFourteen study participants with subacute cervical SCI performed the BeBiTT unassisted (baseline). Thereafter, participants repeated the BeBiTT while wearing a brain/neural hand exoskeleton (B/NHE) (intervention). Online control of the B/NHE was established via a hybrid sensorimotor rhythm-based brain-computer interface (BCI) translating electroencephalographic (EEG) and electrooculographic (EOG) signals into open/close commands. For reliability assessment, BeBiTT scores were obtained by four independent observers. Besides internal consistency analysis, construct validity was assessed by correlating baseline BeBiTT scores with the Spinal Cord Independence Measure III (SCIM III) and Quadriplegia Index of Function (QIF). Sensitivity to differences in bimanual task performance was assessed with a bootstrapped paired t-test.ResultsThe BeBiTT showed excellent interrater reliability (intraclass correlation coefficients > 0.9) and internal consistency (α = 0.91). Validity of the BeBiTT was evidenced by strong correlations between BeBiTT scores and SCIM III as well as QIF. Wearing a B/NHE (intervention) improved the BeBiTT score significantly (p < 0.05) with high effect size (d = 1.063), documenting high sensitivity to intervention-related differences in bimanual task performance.ConclusionThe BeBiTT is a reliable and valid test for evaluating bimanual task performance in persons with tetraplegia, suitable to assess the impact of assistive hand exoskeletons on bimanual function.

Orphan drugs' clinical uncertainty and prices: Addressing allocative and technical inefficiencies in orphan drug reimbursement.

Legislations incentivising orphan drug development and scientific advances have made orphan drugs pharma's high-end favourite for the past two decades. Currently, around 50% of new marketing authorizations are for orphan drugs. For third-party healthcare payers ("payers") the rise of orphan drugs presents new challenges, including a high degree of uncertainty around clinical benefits and harms, a moderate effect size (for many orphan drugs), and a high price tag. The association of high clinical uncertainty and moderate effect sizes is not surprising in small target populations but in combination with high prices creates the risk of allocative and technical inefficiencies for payers. We here discuss and illustrate these risks. A combination of policies is needed for mitigation of allocative inefficiency: while there may be a rationale for higher prices for orphan than non-orphan drugs, a focus of pricing and reimbursement negotiations should include considerations of product profitability and of the consequences of orphan drug costs on the distribution inequality of medication costs for individual insured persons, coupled to knowledge generation from reimbursement contracts covering high-price orphan drugs that would benefit the wider patient community. Performance-based managed entry agreements could help to de-risk the economic consequences of clinical uncertainty and to mitigate technical inefficiency.

Bioenergy Treatment for Improving Well-Being: A Meta-Analysis

Background: Bioenergy treatment devices for self-treatment with the aim to improve well-being are widely available, have become popular, and are used by a rather large number of persons. Yet, a systematic analysis of the assumed effect of these devices has not yet been conducted. We meta-analyzed eight very similar studies of the Healy device to assess the joint effect size. Method: Eight studies with similar designs, some active controlled and some wait-list controlled, testing the Healy bioenergy device, were meta-analyzed. They were conducted by the producer of the device for quality assurance and further development of the application. An additional literature search revealed no additional, independent studies. Result: The overall effect size across studies, combining all active arms and averaging outcome measures, is Hedge’s g = 0.757 (random effects model, I² = 85.8; z = 6.57; p < 0.0001). The stronger active intervention against control yields a heterogeneous g = 0.825 (random effects, I² = 82.5; z = 7.77; p < 0.0001). Active treatments against each other result in a significant g = 0.29 (fixed effects, I² = 0.0; z = 8.34; p < 0.0001). Discussion: The highest effect sizes are produced by a measure of coherence, followed by the WHO5 well-being questionnaire, the Perceived Stress Scale, with the Measure Your Own Medical Outcome Profile, resulting in the smallest effect size. Heterogeneity can be partially explained by the type of control, with active control producing smaller and wait-list control producing larger outcomes. Another source of heterogeneity is the sequencing of studies. Effect sizes grew for three studies, which were similar, and then fell and remained very similar for the rest of the studies. A limitation of this analysis is the fact that all studies were conducted by the R and D Department of the producer of the device. Conclusion: In this meta-analysis, the Healy device showed considerable effects, improving general well-being in healthy individuals. Nonetheless, an independent confirmation of these findings would be desirable. Moreover, the potential mechanisms of effect of the bioenergy device remain unclear, and further studies addressing this research question are warranted.

Nurturing by nutrition: On the future of gut microbiota management strategies for autoimmune disease.

The incidence of autoimmune disease continues to rise, which urges for new prevention and treatment modalities. The composition of the gut microbiota is associated with both susceptibility and progression of disease. Nutrition significantly shapes the gut microbial composition, and poses as such a modality for both prevention and treatment/adjuvant therapy. At very young age, nutritional intervention targeting the gut microbiota is still possible within a one-size-fits all regime, accompanied by a relatively high effect size. As ageing results in higher interindividual variation induced by cumulative exposome factors, a more personalized approach is needed, having a higher effect size than that of current nutritional intervention. As such, supplementation of microbial consortia consisting of keystone taxa and microbial guilds that are involved in the pathophysiology seem a promising direction to lower the burden of autoimmune disease.