Holistic Measure Research Articles

Ultra-short-term versus short-term measures of heart rate variability in specialist police units: A pilot reliability study.

Police officers are exposed to high levels of stress. Serving on Special Weapons and Tactics (SWAT) teams is a highly demanding duty that may further increase levels of stress in police personnel. This stress may accumulate, thereby increasing allostatic load. As such, holistic stress measures may be valuable for quantifying multifactorial stress accumulation in SWAT personnel. Heart rate variability (HRV) is one field-deployable measure that may be suitable in this context. However, with logistical challenges present in this population, determining if 30 s; rather than more the typical 5-min ECG data collection, provides sufficient reliability may be beneficial for reducing the logistical barrier to adoption of HRV monitoring in SWAT personnel. This study compared 30-s to 5-min HRV analyses of ECG data obtained from 15 male SWAT personnel. Findings demonstrated good (ICC >0.8) reliability only in the VLF, HF, SD1, and SD2 HRV domains. The VLF and SD2 measures may be erroneous, as 5-min may still insufficiently characterize these measures. However, this study confirms the robust quality of nonlinear HRV analysis, as the SD1 value demonstrated the highest ICC reported here (0.902). Therefore, while 5-min ECGs may still preferable, the 30-s measure may still be viable for organizations considering HRV assessment.

Transformative approaches for clinical trials in ophthalmology: Virtual reality as a metric for functional vision in inherited retinal diseases

Determining the efficacy of therapeutic interventions in ophthalmology requires not only the assessment of retinal structure and visual function but also a comprehensive evaluation of functional vision. Functional vision pertains to the patient's capacity to execute essential, vision‐dependent tasks, thereby maintaining autonomy. Traditional measures like visual acuity, contrast sensitivity, and visual field evaluations can fall short in encapsulating the full spectrum of visual deficits experienced by patients. To address this gap, translational researchers are increasingly focusing on developing performance outcomes (PerfOs) that provide a holistic measure of the therapy's impact on daily life activities.PerfOs are designed to strike a balance between measurement precision, relevance to the patient's daily life, and ecological validity, all while being adaptable for use in multicenter studies. A promising approach to achieving these objectives is the use of virtual reality (VR) for performance assessment. VR offers unparalleled control over experimental conditions, such as lighting, and enables rapid, objective behavioral measurements. Additionally, its reproducibility across various assessment centers and the safety it provides to participants make VR an ideal tool for this context.In this presentation, we introduce two innovative PerfOs developed for inherited retinal diseases, employing VR to enhance clinical endpoint accuracy in ophthalmology. The first is a mobility test, validated extensively in both real‐world and virtual settings. It demonstrates high reproducibility and reliability, effectively differentiates between retinitis pigmentosa patients and healthy controls, and accurately categorizes disease stages. The second is a VR‐based visual search task, specifically designed for the same patient population. These studies collectively affirm the potential of VR in establishing novel, meaningful clinical endpoints, significantly advancing the field of ophthalmology and enhancing patient‐centric care.

Analyzing the Accessibility of Trolley Bus Stops in the City of Salzburg

Public transport promotes sustainable mobility by enhancing connectivity, safety, comfort and health. The location, type, condition and spacing of stops play a pivotal role in determining the accessibility to public transport. Poor accessibility to public transport can lead to increased cost and time of travel, poor mobility, traffic congestion and social exclusion. This study uses Multi Criteria Analysis to provide a holistic measure of accessibility in terms of Transit Accessibility Index (TAI) for all the trolley bus stops in the city of Salzburg. Five quantitative indicators are combined and weighted appropriately to obtain the final accessibility score. An overall accessibility assessment is performed to further classify the bus stops into five performance categories based on their final accessibility score. Ideal Point Method is employed to determine the values of indicators for the ideal bus stop and compare the values with those of the existing stops. The result from the analysis shows that the most accessible trolley bus stops are located in the core region of Salzburg city near the city center and the main train station. This kind of analysis is crucial for sustainable transport planning and thus helps to promote smart mobility and better habitability of the city.

Self-Transcendence as a Risk and Resilience Factor in Individuals at Clinical High Risk for Psychosis.

Self-transcendence is a personality feature and psychological resource that involves feelings of connectedness with the universe, all of humanity, and the individual self. Self-transcendence has been positively associated with both positive psychotic symptoms and clinical high risk for developing psychosis status, but studies reporting these findings focus solely on the connectedness-with-universe aspect of self-transcendence. The broader self-transcendence literature, which also includes connection with humanity and oneself, robustly supports self-transcendence as an indicator of well-being. Given this discrepancy, we sought to understand whether self-transcendence should be considered a risk or resilience factor for youth at clinical high risk. We operationalised self-transcendence using two more holistic measures novel to the clinical high risk population. Clinical high risk participants (n = 42) and healthy controls (n = 44) completed the Adult Self-Transcendence Inventory and participated in narrative life story interviews which were coded for self-transcendence themes. Clinical high risk individuals scored lower than healthy controls on measures of self-transcendence, functioning, and life satisfaction. However, there were no group differences in the relationships between self-transcendence and measures of well-being. Our findings suggest self-transcendence is a part of healthy personality development that may be impacted in clinical high risk individuals yet may still function as a psychological resource for this population, pointing toward new avenues for intervention in clinical high risk and other mental health populations.

The microbiome and the eye: a new era in ophthalmology.

The human microbiome has progressively been recognised for its role in various disease processes. In ophthalmology, complex interactions between the gut and distinct ocular microbiota within each structure and microenvironment of the eye has advanced our knowledge on the multi-directional relationships of these ecosystems. Increasingly, studies have shown that modulation of the microbiome can be achieved through faecal microbiota transplantation and synbiotics producing favourable outcomes for ophthalmic diseases. As ophthalmologists, we are obliged to educate our patients on measures to cultivate a healthy gut microbiome through a range of holistic measures. Further integrative studies combining microbial metagenomics, metatranscriptomics and metabolomics are necessary to fully characterise the human microbiome and enable targeted therapeutic interventions.

Evaluating the Economic Efficiency of Fuel Reduction Treatments in Sagebrush Ecosystems That Vary in Ecological Resilience and Invasion Resistance

The concepts of resilience and resistance (R&R) have been used to improve wildland fuel treatment outcomes by identifying parts of the landscape that are more likely to respond well to treatment. This study examined how the economic benefits and costs of fuel treatments in sagebrush (Artemisia spp.) ecosystems varied with the resilience and resistance properties of the treatment site. Generalized ecological models were developed for the economic analysis of fuel treatments that integrated ecological succession, annual grass invasion, pinyon–juniper expansion, and wildfire to simulate ecosystem dynamics over time. The models incorporated resilience and resistance by varying model parameters related to each plant community’s ability to resist annual grass invasion and recover post-disturbance. Simulations produced estimates of the expected (ex ante) benefit–cost ratio for each treatment. The approach also considered the benefits associated with the system remaining in an ecologically favorable condition, allowing us to report a more holistic measure of the net economic benefits of fuel treatments. The results from the simulations indicated fuel treatment was economically efficient in late-successional sagebrush and early-successional juniper in mountain big sagebrush associations. For sagebrush associations where treatment was economically efficient, higher R&R status sites had higher benefit–cost ratios. The results suggested that treatment costs were more determinative of economic efficiency than treatment benefits.

Validation of a holistic composite outcome measure for the evaluation of chronic pain interventions.

Chronic pain is a personal experience influenced by multiple biopsychosocial factors. Using a pain intensity measure alone to assess the effectiveness of a chronic pain intervention fails to fully evaluate its impact on the multifaceted chronic pain experience. The holistic minimal clinically important difference (MCID) is a composite outcome developed to provide a comprehensive assessment of chronic pain in response to intervention, across 5 outcome domains: pain intensity, health-related quality of life, sleep quality, physical, and emotional function. To focus on domains where the individual need is greatest, the holistic MCID reflects the cumulative MCID averaged over only the domains where subjects were impaired preintervention. To assess the internal and construct validity of the Holistic MCID score to inform its future use as an evidence-based tool. This validation study was undertaken using data from the EVOKE trial with 111 patients up to 24-month follow-up. Internal consistency of the holistic MCID was assessed using Cronbach alpha statistic and dimensional exploration using principal component analysis. The holistic MCID measure demonstrated strong internal consistency with Cronbach alpha >0.7 at all follow-ups. Principal component analysis showed one overarching holistic dimension to be present in the composite. Construct validity was demonstrated by an increase in the holistic MCID score being associated with both increased Patients' Global Impression of Change, EuroQol visual analogue scale score, and each of the outcome domains in a "leave-one-out" analysis (all P < 0.001). The holistic MCID provides a valid measure for the comprehensive, personalized assessment of response after a chronic pain intervention. The validity of the holistic MCID requires further confirmation in other chronic pain populations and with different interventions.

Gender Differences in Self-assessed Measures of Health: How Does the Structure of Self-rated Health Compare Across Transgender and Cisgender Groups?

Self-rated health (SRH) is consistently related to mortality and morbidity. Yet, health ratings are subjective and reflect an individual's social context. Prior work has found differences in the structure of SRH—that is, in how self-assessments relate to underlying health conditions—across social groups, including by gender. However, prior work has not included transgender adults despite evidence that widespread interpersonal and structural stigma uniquely shapes their subjective experience of health. This study draws on information about 12 health conditions for a sample of transgender men, transgender women, nonbinary adults, cisgender men, and cisgender women. It examines whether the probabilities of reporting poor or fair SRH are similar among those with various underlying health problems. Findings reveal differences by gender identity and age group. For more than half of the examined conditions, self-rated health is poorer among nonbinary adults and younger transgender men than among other gender groups. These differences likely reflect distinct self-assessment processes that consider minority stress and structural stigma, as well as underlying differences in severity and comorbidity that stem from such stigma processes. SRH remains a useful, holistic measure of well-being, including for transgender groups.

Response of health-related quality of life following pediatric/congenital cardiac catheterization procedures

BackgroundHealth related quality of life (HRQOL) is a patient-reported metric (PRM) that provides a holistic measure of health that is not addressed in traditional outcome measures. The acute responsiveness of HRQOL after pediatric/congenital cardiac catheterization procedures has not, to our knowledge, been studied. MethodsA single-center prospective cohort study was performed, longitudinally evaluating HRQOL and other PRM in school-age children and adolescents (ages 8-18) undergoing diagnostic and interventional cardiac catheterization procedures prior to their scheduled procedure, and then 1 day, ∼1 month, and ∼3 months after the procedure. Differences between HRQOL at baseline and at 1- and 3-month follow-up were evaluated using paired Student's t-tests. ResultsA total of 70 patient-parent/guardian dyads were studied. The participating patients were 13±3 years old, 51% female, and 74% non-Hispanic white, with 54% undergoing a diagnostic procedure. The trajectory of cardiac-specific HRQOL as measured through Pediatric Cardiac Quality of Life Inventory differed for patients undergoing diagnostic and interventional procedures. Following diagnostic procedures, there was no significant change in cardiac-specific HRQOL (p>0.05). After interventional procedures, patient-reported cardiac-specific HRQOL increased at both 1-month (4.3±11, p=0.04) and 3-months (5.9±11.4, p=0.02), though the same changes were not seen in parent/guardian-reported cardiac-specific HRQOL (p>0.05). PROMIS measures of physical function, psychological symptoms, and social function were associated with baseline cardiac-specific HRQOL (all p<0.05), but no associations were seen between other patient-reported outcomes and baseline HRQOL or change from baseline to 3-month follow-up. ConclusionAcross a range of transcatheter interventional procedures, patient-reported cardiac-specific HRQOL improved in short term follow up, though these changes were not seen in parent/guardian reported measures. Incorporating these patient-centered metrics into evaluation of transcatheter therapies may provide more accurate measures of comparative effectiveness.

Examining the Effectiveness and Feasibility of Lockdown and Social Distancing Measures in Mitigating COVID-19 Transmission: Insights from Windhoek, Namibia

The study explored the impacts and feasibility of lockdown, social distancing, and personal protection measures in Windhoek, Namibia, focusing on informal settlements. We used a nested mixed-method research design to capture people&amp;rsquo;s perceptions of the impacts and adherence to lockdown, social distancing, and personal protection, as well as document the challenges experienced during lockdown. Social distancing and personal protection were challenging to many in informal settlements due to overcrowding and the use of communal facilities. Some could not afford masks and sanitizers; they had to choose between buying a mask or bread. The study found significant economic disproportions; informal settlement residents faced severe food shortages and job losses during the pandemic. Those living in affluent communities mentioned various benefits of the lockdown, such as reduced crime and enhanced family time. Government support, including a once-off stipend and free water, was welcomed but did not benefit all and was not sustainable. Children&amp;rsquo;s education was adversely affected, especially for those without access to technology. The research highlights the need for holistic and sustained support measures to tackle the multidimensional impacts of pandemics. The findings underscore the vulnerabilities exacerbated by the pandemic and the critical need for targeted interventions to support vulnerable communities in future crises. We recommend developing location-specific, need-based solutions unique for each community in future pandemics.

Thromboembolism prophylaxis timing is associated with center mortality in traumatic brain injury: A Trauma Quality Improvement Program retrospective analysis.

Timing of venous thromboembolism chemoprophylaxis (VTEPPx) in traumatic brain injury (TBI) is complex given concerns for potential worsening of hemorrhage. While timing of VTEPPx for TBI patients is known to vary at the patient level, to our knowledge, variation at the hospital level and correlation with quality metrics have not been quantified in a cohort of nonneurosurgical patients. This was a retrospective cohort study of the Trauma Quality Improvement database from 2018 to 2021. The primary outcome was variation in VTEPPx timing. This was ascertained by empirical Bayesian methodology using multilevel mixed-effects logistic regression. Secondary outcomes included the association of risk-adjusted VTEPPx timing and hospital characteristics such as volume and risk-adjusted mortality, which was assessed through Pearson's correlation coefficient (r). Risk-adjusted mortality was similarly calculated using multilevel mixed-effects modeling. Of 132,028 patients included in the current study, 38.7% received care at centers in the earliest quartile of VTEPPx timing, classified as Early (others labeled Delayed). Patients receiving care at Early centers presented with severe TBI at a similar rate to Delayed (17.4% vs. 19.0%; absolute standardized mean difference, 0.04). Early center patients more commonly received unfractionated heparin as opposed to low-molecular-weight heparin compared with Delayed (40.5% vs. 27.6%; absolute standardized mean difference, 0.28). At the center level, 12% of observed variation in VTEPPx was attributable to differential hospital practices. Overall trauma volume (r = -0.22, p < 0.001) and TBI volume (r = -0.19, p < 0.001) were inversely associated with risk-adjusted VTEPPx timing. In addition, centers initiating VTEPPx earlier had lower overall (r = 0.17, p < 0.001) and TBI-related mortality (r = 0.17, p < 0.001). There is significant center-level variation in timing of VTEPPx among TBI patients. Earlier VTEPPx was associated with improved center outcomes overall and among TBI patients, supporting usage of VTEPPx timing as a holistic measure of quality. Prognostic and Epidemiological; Level III.

Multidimensional human wellbeing in periodic octopus closures in Zanzibar

ABSTRACT Our study of periodic octopus closures helps to fill an empirical gap in community-based marine protected area (MPA) research on socially-diverse multidimensional wellbeing impacts. Human wellbeing provides a more meaningful and holistic measure of social impacts than previous economic measures while recognising equity- evidence that ultimately ensures support and enables long-term success in conservation. We trace the flow of benefits, costs and burdens from closures at three sites in Zanzibar and explore how different types of fishers and traders perceive impacts. This is done at a personal, livelihood group and village or community level, as well as in terms of ecosystem effects. Storytelling, photo-elicitation tasks and focused discussions prioritized participants’ emic descriptions and understandings of closures. We iteratively, qualitatively coded data using a three-dimensional (material, relational and subjective) social wellbeing approach. Despite different conditions and histories at the three sites, participants identified similar wellbeing attributes as affected by the closure. Themes included social conflict, non-compliance, income, education, food/nutrition, and communal benefits reflecting recent literature on MPAs and human wellbeing. Perceptions of inequity cross cut all three dimensions and gender was a strong dimension that emphasized procedural and distributional inequity between different types of livelihood groups e.g. small-scale traderwomen and male skindivers. Material wellbeing losses due to poor market environments highlighted how better alignment is needed between periodic closure activities and resulting value chain dynamics. Opening events intensely impacted wellbeing across all dimensions, suggesting that these moments are critical for creating positive perceptions or losing support for closures.

High School Enabling Programs, Learning Journeys, and Transitions: Measuring Effectiveness from the Student Perspective

University enabling programs provide historically underrepresented students with aspirational gateways and the academic skills and knowledges essential for success at university. Measurement of the efficacy of such programs has been typically neoliberal and quantitative in nature. This article argues for a nuanced measurement of success, exploring the efficacy of enabling programs from the students’ perspective to reduce marginalising the lived experience of enabling students. A phenomenologically inspired, qualitative online survey was made available to students enrolled in two high school enabling programs at Murdoch University, TLC Learning for Tomorrow, and FlexiTrack High, and an interpretative phenomenological analysis was performed on the data. The key findings indicate that enabling students feel well equipped for first year transition, but some barriers endure. The qualitative evidence could give rise to the creation of a more holistic measure of student success and encourage universities to develop stronger transition strategies for equity groups.

ID: 320392 From pain intensity to holistic composite measures as marker of success for Spinal Cord Stimulation

ID: 320392 From pain intensity to holistic composite measures as marker of success for Spinal Cord Stimulation

The Walsh Family Resilience Questionnaire: Validity evidence from Portugal

AbstractBackgroundFamily resilience refers to a family's capacity to face and manage adversities, emerging as a stronger and more resourceful unit. A family system approach enlarges the lens to the broad relational network, identifying potential resources for resilience within the immediate and extended family. This approach emphasizes a family's innate ability to adapt in the face of adversities.ObjectiveThis study aims to test the psychometric properties of the Walsh Family Resilience Questionnaire (WFRQ) using a sample of Portuguese caregivers with children aged between 10 and 15 years.MethodA total of 267 caregivers of children aged 10 to 15 years completed a sociodemographic questionnaire and the WFRQ. Analyses were performed to evaluate the WFRQ's validity evidence based on the internal structure (i.e., dimensionality and reliability) and on its relationship to other variables.ResultsThe findings supported a 31‐item version of the WFRQ with one third‐order latent factor, three second‐order factors, and nine first‐order factors for the Portuguese population. The WFRQ exhibited satisfactory validity evidence based on the internal structure and relation to other variables.ConclusionOverall, the results of this study demonstrate the suitability of the WFRQ as a holistic measure to gauge resilience at the family level, going beyond individual assessments.ImplicationsThis instrument holds significant utility in family resilience research and clinical interventions involving families.

Does socioeconomic status modify how individuals perceive or describe their own health? An assessment of reporting heterogeneity in the Health Survey for England

BackgroundSelf-reported health (SRH) is widely used as a proxy for health status; it is a simple, holistic measure of health and has been associated with other health outcomes. However, variation...

Composite Accessibility Index: A Novel and Holistic Measure for Evaluating Transit Accessibility

The accessibility of public transport is a vital factor for the overall success of transit operations. It determines whether people choose to use and rely on public transport by assessing the ease of accessing opportunities. Accessibility, as a measure of the system’s performance, encompasses various travel segments and can be evaluated from different perspectives. Evaluating transit accessibility in data-constrained environments, particularly in developing countries, requires an optimal framework. The present study proposed a framework by modifying available accessibility measurement indices and trying to encompass all affecting variables in a single composite index. The integrated transit system comprising the bus rapid transit system and city bus in Surat city, India, is selected to demonstrate the proposed framework. The results of the ranked-based correlation coefficient test exhibit the comprehensive assessment capabilities of the proposed composite index in evaluating transit performance. Surat city’s transit network shows better coverage based on the gravity model theory, that is, moderate performance in local coverage offered capacity per population. However, it exhibits poor accessibility with respect to reaching destinations, resulting in below-average transit accessibility. Except for the city center and eastern part, 65% of the city area experiences inadequate accessibility of public transport. These findings align with the city’s low transit mode share of 2.5% and stagnant daily ridership of 0.25–0.28 million passengers in the last half decade. The composite index map serves as a planning tool for optimizing the utilization of available resources and guiding future policy implementations.

Deciphering the Role of Total Water Storage Anomalies in Mediating Regional Flooding

AbstractRegional floods result from various flood generation mechanisms. Traditional analyses mainly link flooding to extreme rainfall, with limited input from soil moisture. Total water storage (TWS) is a holistic measure of basin wetness, including additional storage components from surface water, snow, and groundwater. Utilizing a new 5‐day Gravity Recovery and Climate Experiment and its Follow On (GRACE(‐FO)) data set, we investigated the linkage between short‐term TWS anomaly (TWSA) and regional flooding. The 5‐day TWSA solutions revealed flood signals missed by monthly TWSA solutions. Global basins exhibit distinct storage‐discharge co‐evolution patterns, offering new insights into flood mechanisms and propensity. Our bivariate event analyses show the annual maximum river discharges co‐occur more often with the TWSA maxima than with precipitation in many basins. Further analyses revealed TWSA's time‐lagged effect on river discharge, particularly in basins susceptible to floods triggered by saturation‐excess runoff. The 5‐day TWSA provides a new source of information for enhancing global flood preparedness.

The environmental repercussions of financial development and green energy in BRICS economies: From the perspective of new composite indices

This study is significant because it fills the gap in future literature by looking at the panel of 5 Brazil, Russia, India, China, and South Africa (BRICS) economies regarding the important role of financial development (FD) in environmental deterioration under the holistic measures of FD and environmental quality, something that has been largely overlooked in preceding studies. Consequently, this study explores the environmental effects of FD, employing a composite environmental quality proxy (CEQP) and a composite FD proxy (CFDP). In pursuit of this objective, the continuously updated fully modified (Cup-FM) and continuously updated bias corrected (Cup-BC) procedures are applied. These procedures enabled us to comprehensively explore the dynamic interactions between the combined index for FD and CEQP controlling agricultural activities, economic growth, renewable energy consumption, and nonrenewable energy consumption (NREC) in the panel of 5-BRICS economies from 2005 to 2019. The empirical results show that CFDP appeases environmental deterioration and thus improves environmental quality. The agricultural activities intensify environmental deterioration. The analysis also reveals a U-shaped relationship between the CEQP and economic growth (inverted U-type environmental Kuznets curve hypothesis) for the BRICS nations. Additionally, renewable energy improves environmental quality, whereas NREC decreases it. As supported by the results of the study, BRICS policymakers should encourage the financial sector to support green energy initiatives and achieve environmental stability.

The influence of air masses on human mortality in the contiguous United States.

Temperature-related mortality is the leading cause of weather-related deaths in the United States. Herein, we explore the effect of air masses (AMs) - a relatively novel and holistic measure of environmental conditions - on human mortality across 61 cities in the United States. Geographic and seasonal differences in the effects of each AM on deseasonalized and detrended anomalous lagged mortality are examined using simple descriptive statistics, one-way analyses of variance, relative risks of excess mortality, and regression-based artificial neural network (ANN) models. Results show that AMs are significantly related to anomalous mortality in most US cities, and in most seasons. Of note, two of the three cool AMs (Cool and Dry-Cool) each show a strong, but delayed mortality response in all seasons, with peak mortality 2 to 4days after they occur, with the Dry-Cool AM having nearly a 15% increased risk of excess mortality. Humid-Warm (HW) air masses are associated with increases in deaths in all seasons 0 to 1days after they occur. In most seasons, these near-term mortality increases are offset by reduced mortality for 1-2weeks afterwards; however, in summer, no such reduction is noted. The Warm and Dry-Warm AMs show slightly longer periods of increased mortality, albeit slightly less intensely as compared with HW, but with a similar lag structure by season. Meanwhile, the most seasonally consistent results are with transitional weather, whereby passing cold fronts are associated with a significant decrease in mortality 1day after they occur, while warm fronts are associated with significant increases in mortality at that same lag time. Finally, ANN modeling reveals that AM-mortality relationships gleaned from a combined meta-analysis can actually lead to more skillful modeling of these relationships than models trained on some individual cities, especially in the cities where such relationships might be masked due to low average daily mortality.