Important Differences Research Articles

Ontology of active and passive environmental exposure

Exposure is a central concept of the health and behavioural sciences needed to study the influence of the environment on the health and behaviour of people within a spatial context. While an increasing number of studies measure different forms of exposure, including the influence of air quality, noise, and crime, the influence of land cover on physical activity, or of the urban environment on food intake, we lack a common conceptual model of environmental exposure that captures its main structure across all this variety. Against the background of such a model, it becomes possible not only to systematically compare different methodological approaches but also to better link and align the content of the vast amount of scientific publications on this topic in a systematic way. For example, an important methodical distinction is between studies that model exposure as an exclusive outcome of some activity versus ones where the environment acts as a direct independent cause (active vs. passive exposure). Here, we propose an information ontology design pattern that can be used to define exposure and to model its variants. It is built around causal relations between concepts including persons, activities, concentrations, exposures, environments and health risks. We formally define environmental stressors and variants of exposure using Description Logic (DL), which allows automatic inference from the RDF-encoded content of a paper. Furthermore, concepts can be linked with data models and modelling methods used in a study. To test the pattern, we translated competency questions into SPARQL queries and ran them over RDF-encoded content. Results show how study characteristics can be classified and summarized in a manner that reflects important methodical differences.

Song determined by phylogeny and body mass in two differently constrained groups of birds: manakins and cardinals

The songs of birds are complex signals that may have several functions and vary widely among species. Different ecological, behavioural and morphological factors, as well as phylogeny, have been associated as predictors of the evolution of song structure. However, the importance of differences in development, despite their relevance, has seldom been considered. Here, we analysed the evolution of song in two families of songbirds that differ in song development, manakins (suboscines) and cardinals (oscines), with their phylogeny, morphology, and ecology. Our results show that song characteristics had higher phylogenetic signal in cardinals than in manakins, suggesting higher evolutionary lability in the suboscines. Body mass was the main predictor of song parameters in manakins, and together with habitat type, had a major effect on cardinals’ song structure. Precipitation and altitude were also associated with some song characteristics in cardinals. Our results bring unexpected insights into birdsong evolution, in which non-learners (manakins) revealed greater evolutionary lability than song learners (cardinals).

Hyper IgE Syndromes.

The Hyper IgE Syndromes are rare primary immunodeficiencies characterized by eczema, recurrent skin and respiratory infections and elevated serum IgE levels. Nowadays a geneticmolecular characterization is possible and allows the distinction in various monogenic pathologies, which share some clinical characteristics but also important differences. In addition to long-known STAT3 and DOCK8 gene mutations, in fact, also ZNF341, CARD11, ERBB2IP, IL6R and IL6ST genes mutations can cause the disease. The main clinical manifestations are represented by newborn rash, eczema similar to atopic dermatitis, bacterial and viral skin infections, cold abscesses, respiratory infections with possible pulmonary complications, allergies, gastrointestinal manifestations, malignancies and connective tissue abnormalities. Diagnosis is still a challenge because, especially in the early stages of life, it is difficult to distinguish from other pathologies characterized by eczema and high IgE, such as atopic dermatitis. Several scores and diagnostic pathways have been developed, but it is essential to seek a genetic diagnosis. Treatment is based on prevention and early treatment of infections, meticulous skincare, intravenous immunoglobulins and HSCT, which, in some HIES subtypes, can modify the prognosis. Prognosis is related to the affected gene, but also to early diagnosis, timely treatment of infections and early HSCT.

Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation.

Retrospective review. To assess the impact of Body Mass Index (BMI) on patient-reported outcome measures (PROMs) after cervical disc replacement (CDR). BMI may affect PROMs after spine surgery. Primary CDR recipients for herniated disc(s) with BMI <40 were retrospectively selected from a single-surgeon registry. Cohorts were divided into non-obese (BMI <30) and obese (BMI ≥30). Intercohort in-hospital complication rates were compared through independent samples t tests. Pre/postoperative PROMs were compared between cohorts through multivariable regression accounting for demographic differences. Final follow-up dates between patients averaged 11.8 ± 9.3 months. PROMs assessed included Patient-reported Outcomes Measurement Information System-Physical Function, Neck Disability Index, Visual Analog Scale-Neck, Visual Analog Scale-Arm, and the 9-item Patient Health Questionnaire. Improvements in PROMs were evaluated and compared at each follow-up within cohorts through paired t tests. The magnitude of improvement in PROMs from preoperative baseline at 6-week follow-up (∆PROM-6W) and final follow-up (∆PROM-FF) along with achievement rates of minimum clinically important differences were compared between cohorts through multivariable regression accounting for demographic differences. Of 153 patients, 53 patients were noted as obese. Demographic differences included age, prevalence of hypertension and diabetes, and comorbidity burden scores ( P ≤ 0.011, all). No significant variations in in-hospital complications were found. The non-obese cohort demonstrated improvements in all PROMs at 6 weeks and final follow-up periods ( P ≤ 0.005, all). The obese cohort demonstrated improvements in all postoperative PROMs besides 9-item Patient Health Questionnaire at 6 weeks ( P ≤ 0.015, all). After accounting for age and comorbidity variations, there were no significant intercohort differences in raw PROM scores, ∆PROM-6W, ∆PROM-FF, or minimum clinically important difference achievement rates. Regardless of BMI, patients experience significant improvements in physical function, disability, pain, and mental health after CDR for disc herniation. Patients with obesity do not suffer inferior patient-perceived outcomes after CDR. These findings may help surgeons counsel patients in the preoperative period.

Incorporating immigrant optimism into critical consciousness and civic development models: An integrative review and synthesis of civic action among immigrant youth of color in the United States.

Civic action describes participation in political and prosocial activities aimed at benefiting one's communities. A growing literature rooted in critical consciousness (CC) theory suggests that engaging in critical action, which challenges societal inequities, is important for the positive development of youth of color. Although valuable, existing literatures have yet to consider how psychological processes related to the immigrant experience, such as immigrant optimism (IO), may differentially influence the civic participation of immigrant youth of color. IO is a phenomenon in which immigrant groups hold higher aspirations and more positive views of the host society than their nonimmigrant peers, and this often is associated with positive outcomes. This article reviews and integrates relevant research on the civic development of immigrant youth of color, considering both how IO may be a particularly relevant process in shaping immigrant youths' CC development and how civic action may take different forms among these youth. We define concepts, integrate previously siloed literatures, and make recommendations for future research. We propose expanding existing frameworks to consider IO and forms of action, along with their intended outcome. Incorporating IO into studies of CC or civic development can clarify important differences and enhance our understanding of how best to support immigrant youth. Similarly, examining forms of action and their intended outcome may be advantageous in facilitating young immigrants' development as active and engaged members of society. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Reliability of scapular position and periscapular muscle strength tests in healthy subjects with forward neck and rounded shoulder posture

BACKGROUND: People with forward head posture (FHP) and rounded shoulder posture (RSP) may experience shifts in scapular position and alterations in the strength of the muscles surrounding the scapula. Therefore, a reliable scapula position and scapula muscle strength test are required to identified scapula problem and provided appropriate intervention programs. OBJECTIVE: This study aimed to determine the reliability of scapular position measurements obtained using a modified digital inclinometer and palpation meter, as well as muscle strength using a hand-held dynamometer (HHD) in individuals with FHP and RSP. METHODS: Thirty healthy subjects underwent scapular position tests (upward rotation, anterior tilt, depression, and protraction) and strength tests of periscapular muscles (serratus anterior, upper trapezius, middle trapezius, and lower trapezius) on both the dominant and non-dominant sides. The reliability of the measurements was confirmed by computing the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal clinically important difference (MCID). Test and re-tests were conducted over a period of one week and actual values for each measurement were also obtained and assessed. RESULTS: The ICC ranged from 0.802 to 0.935 for the scapular position tests and from 0.808 to 0.949 for muscle strength tests on the dominant and non-dominant sides. For scapular position tests, SEM values ranged from 0.3 cm to 0.6 cm (protraction and depression), from 1.0∘ to 1.7∘ (upward rotation and anterior tilt) and MCID values ranged from 0.7 cm to 1.6 cm (protraction and depression), from 2.8∘ to 4.7∘ (upward rotation and anterior tilt). Regarding muscle strength tests, SEM and MCID values were in the range 14.4N–27.3N and 39.9N–75.7N, respectively. CONCLUSIONS: Scapular position and periscapular muscle strength can be reproducibly measured in healthy subjects individuals with FHP and RSP. These instruments can hence be recommended for evaluating these functional traits in subjects with FHP and RSP.

Deep Peroneal Neurectomy for Midfoot Arthritis: A Comprehensive Review, Surgical Technique, and Case Series

Patients with painful midfoot arthritis unsuccessfully treated with conservative measures have been historically left with the surgical option of midfoot arthrodesis as a definitive treatment. In recent years, excision of the deep peroneal nerve has been offered as a potential alternative. Existing literature on the outcomes of patients undergoing deep peroneal neurectomy for the treatment of midfoot arthritis is limited and piecemeal. In this comprehensive review, technique guide, and retrospective case series, we consolidate the evidence around deep peroneal neurectomy for midfoot arthritis, review operative technique, and determine the outcomes of 4 patients who underwent deep peroneal neurectomy from February 2021 to December 2022 using Patient-Reported Outcome Measurement Information System Physical Function and Pain Interference scores. Four original articles from National Center for Biotechnology Information Medline, published through May 2023, were included. The outcomes of patients treated with deep peroneal neurectomy for midfoot arthritis are discussed. In our case series, the average amount of time between surgery and final postoperative Patient-Reported Outcome Measurement Information System scores was 289 days. The average preoperative physical function score was 36.8. Three patients showed a minimal clinically important difference in physical function; postoperative average was 41.3. Three patients had a minimally clinical important reduction in pain levels (average preoperative pain interference score was 65.8; average postoperative pain interference score was 59.3). One patient underwent a revision neurectomy for inadequate pain relief, and another sought additional treatment for inadequate pain relief. All patients returned to walking in a shoe within 1 month. The outcomes of our case series are similar to those of previously published case series, which demonstrate satisfactory results and acceptable complication rates. For patients with symptomatic midfoot arthritis, deep peroneal neurectomy can be an effective treatment option to reduce pain and improve physical function while requiring minimal postoperative recovery time.

Acarbose Impairs Gut Bacteroides Growth by Targeting Intracellular GH97 Enzymes.

Acarbose is a type-2 diabetes medicine that inhibits dietary starch breakdown into glucose by inhibiting host amylase and glucosidase enzymes. Numerous gut species in the Bacteroides genus enzymatically break down starch and change in relative abundance within the gut microbiome in acarbose-treated individuals. To mechanistically explain this observation, we used two model starch-degrading Bacteroides, Bacteroides ovatus (Bo) and Bacteroides thetaiotaomicron (Bt). Bt growth is severely impaired by acarbose whereas Bo growth is not. The Bacteroides use a starch utilization system (Sus) to grow on starch. We hypothesized that Bo and Bt Sus enzymes are differentially inhibited by acarbose. Instead, we discovered that although acarbose primarily targets the Sus periplasmic GH97 enzymes in both organisms, the drug affects starch processing at multiple other points. Acarbose competes for transport through the Sus beta-barrel proteins and binds to the Sus transcriptional regulators. Further, Bo expresses a non-Sus GH97 (BoGH97D) when grown in starch with acarbose. The Bt homolog, BtGH97H, is not expressed in the same conditions, nor can overexpression of BoGH97D complement the Bt growth inhibition in the presence of acarbose. This work informs us about unexpected complexities of Sus function and regulation in Bacteroides, including variation between related species. Further, this indicates that the gut microbiome may be a source of variable response to acarbose treatment for diabetes.

A global set of barley varieties shows a high diversity in starch structural properties and related gelatinisation characteristics

The gelatinisation temperature and bimodal granule size distribution of barley starch are important characteristics regarding resource efficiency and product quality in the brewing industry. In this work, the diversity in starch amylose content and granule proportions in a set of modern barley varieties (N = 23) was investigated and correlated with their starch gelatinisation behaviour. Milled barley samples had peak starch gelatinisation temperatures ranging from 60.1 to 66.5 °C. Upon separating the barley starch from the non-starch compounds, sample-dependent decreases in starch gelatinisation temperatures were observed, indicating the importance of differences in barley composition. The peak gelatinisation temperatures of milled barley and isolated barley starches were strongly correlated (r = 0.96), indicating that the behaviour of the starch population is strongly reflected in the measurements performed on milled barley. Therefore, we investigated whether amylose content or starch granule size distribution could predict the gelatinisation behaviour of the starches. Broad ranges in the small starch granule volumes (13.9–32.0 v/v%) and amylose contents (18.2–30.7 w/w%) of the barley starches were observed. For the barley samples collected in the north of the USA (N = 8), the small starch granule volumes correlated positively with the peak gelatinisation temperatures of barley starches (r = 0.90, p < 0.01). The considerable variation in starch properties described in this work highlights that, besides starch content, starch gelatinisation temperature or granule size distribution might provide brewers with useful information to optimise resource efficiency.

Deconstructing Fears of Terrorism: A Comparison between Fear from Domestic and International Terrorist Groups

ABSTRACT Although research on fears of terrorism has been growing, previous studies approached the topic of the fear of terrorism as a monolithic concept without considering the various political aspects of terrorism as a crime. The current research employed a novel approach to studying the fear of terrorism as a polylithic phenomenon by comparing three different types of fears of terrorism among Americans: general fears of terrorism, fears of domestic terrorist groups, and fears of international terrorist groups. Drawing on a nationally representative sample from the Chapman Survey of American Fears, Wave 5 (2018), the results of the analysis indicated that the predictors were differentially associated with the three types of fear with respect to their statistical significance and correlation directions. Thus, this study provides a significant contribution to the literature on the fear of terrorism topic by illustrating the important differences among general fears of terrorism, fears of domestic terrorist groups, and fears of international terrorist groups.

Lecanemab Questions.

The recently published results of the 18-month randomized controlled trial of lecanemab, reporting the efficacy of the drug in slowing the progression of early Alzheimer disease, quickly led to approval by the FDA and widespread acceptance of lecanemab treatment. However, there are a number of matters that deserve further consideration. The success of blinding was not assessed, even as infusion reactions and the cerebral pathology underlying amyloid-related imaging abnormalities could have signaled to many participants that they were on drug, potentially exerting a potent placebo effect. The value of the outcome to participants is not defined in the absolute terms necessary for clinical decision-making, and the difference attributable to lecanemab was between 18% and 46% of estimates of the minimal clinically important difference on the Clinical Dementia Rating Scale Sum of Boxes. The attenuation of change on the Alzheimer's Disease Assessment Scale-Cognitive 14 achieved by lecanemab at 18 months was 50% of that achieved by donepezil at 6 months. Lecanemab treatment imposes a high treatment burden. The fact that the burden commences at the initiation of lecanemab treatment, whereas the benefit accrues years later requires us to take into account value discounting over time, which would significantly reduce the benefit/burden ratio. Finally, treatment with monoclonal antibodies to cerebral amyloid has consistently been associated with progressive cerebral atrophy. At the least, these issues should be raised in treatment discussions with patients. They also suggest a need to very seriously reconsider how we evaluate clinical trial results preparatory to translating them into clinical practice. Some suggestions are provided.

South Cuidrach

A new site in north Skye has revealed evidence of human occupation from the Late Upper Palaeolithic as well as the Early and Late Mesolithic periods, suggesting repeated visits by humans for at least 5,000 years from the Late Glacial Interstadial through the Loch Lomond Readvance and up to the mid-Holocene, a time of dynamic climatic and sea-level change. South Cuidrach is one of several sites in the north of the Isle of Skye and around the Inner Sound with lithic (stone tool) evidence diagnostic of a human presence before the mid-Holocene. These sites currently represent a unique concentration of pre-Late Mesolithic sites in Scotland. The lithic evidence which forms the backbone of the cultural and temporal characterisation of the site at South Cuidrach is outlined here. This includes characteristic points and microliths, burins, cores and other items diagnostic of specific cultural groups. Additionally, it has become evident that Rum bloodstone, a raw material well known from the Late Mesolithic period in the region, may be absent before the Early/Late Mesolithic transition, with baked mudstone from Staffin in North Skye being the primary raw material used before this time. The need for detailed knowledge of the region’s lithic technology and typology is well illustrated here, as small details frequently reflect important chronological differences.

1081 Risk Factors for Long Term Opioid Use After Elective Lumbar Spine Surgery: A MSSIC Study

INTRODUCTION: Long-term opioid use after elective lumbar spine surgery is a significant concern, given the current opioid epidemic and its impact on public health. Identifying risk factors for long-term opioid use after spine surgery is crucial in developing effective interventions to reduce the incidence of opioid dependence in this patient population. METHODS: A retrospective analysis of patient data was conducted using the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Patients who underwent elective lumbar spine surgery between March 2018, and September 2021, were included, resulting in a total of 3599 patients at one year and 966 patients at two years follow-up. Poisson generalized estimating equation models were used for multivariate analyses. RESULTS: A total of 493 (13.7%) and 137 (14.2%) patients were still using opiates at one-year and two-years post-surgery respectively. Discharge morphine milligram equivalents (MMEs), baseline PROMIS PF functional scores, baseline pain scores, age, gender, education level, pre-operative opioid use, and not achieving the minimal clinically important difference (MCID) in PROMIS PF scores at follow-up were significantly associated with long-term opioid use. Specifically, pre-operative opioid use had the strongest association with opioid use at one year (IRR = 2.83, CI: 2.40-3.34, p &lt; 0.001) and two years (IRR = 3.79, CI: 2.53-5.68, p &lt; 0.001). Additionally, not achieving MCID in PROMIS scores at follow-up was strongly associated (IRR = 2.00, CI: 1.72-2.32, p &lt; 0.001 and IRR = 2.18, CI: 1.64-2.91, p &lt; 0.001) with opioid use at both time points (1-year and 2-year respectively). CONCLUSIONS: Pre-operative opioid use and not achieving MCID in PROMIS scores at follow-up were the strongest predictors of long-term opioid use after elective lumbar spine surgery. Identifying these risk factors can help clinicians target interventions to reduce opioid use in at-risk patients and improve postoperative outcomes.

Predicting effects of a digital stress intervention for patients with depressive symptoms: Development and validation of meta-analytic prognostic models using individual participant data.

Digital stress interventions could be helpful as an "indirect" treatment for depression, but it remains unclear for whom this is a viable option. In this study, we developed models predicting individualized benefits of a digital stress intervention on depressive symptoms at 6-month follow-up. Data of N = 1,525 patients with depressive symptoms (Center for Epidemiological Studies' Depression Scale, CES-D ≥ 16) from k = 6 randomized trials (digital stress intervention vs. waitlist) were collected. Prognostic models were developed using multilevel least absolute shrinkage and selection operator and boosting algorithms, and were validated using bootstrap bias correction and internal-external cross-validation. Subsequently, expected effects among those with and without a treatment recommendation were estimated based on clinically derived treatment assignment cut points. Performances ranged from R² = 21.0%-23.4%, decreasing only slightly after model optimism correction (R² = 17.0%-19.6%). Predictions were greatly improved by including an interim assessment of depressive symptoms (optimism-corrected R2 = 32.6%-35.6%). Using a minimally important difference of d = -0.24 as assignment cut point, approximately 84.6%-93.3% of patients are helped by this type of intervention, while the remaining 6.7%-15.4% would experience clinically negligible benefits (δ^ = -0.02 to -0.19). Using reliable change as cut point, a smaller subset (39.3%-46.2%) with substantial expected benefits (δ^ = -0.68) receives a treatment recommendation. Meta-analytic prognostic models applied to individual participant data can be used to predict differential benefits of a digital stress intervention as an indirect treatment for depression. While most patients seem to benefit, the developed models could be helpful as a screening tool to identify those for whom a more intensive depression treatment is needed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Role of Multilevel Intercostal Nerve Block in Local Anesthetic Thoracoscopy.

Intercostal nerve block (ICNB) has long been used in thoracic surgery. Local anesthetic thoracoscopy (LAT) is performed under conscious sedation with local anesthesia at the port insertion site. This alone, however, does not anesthetize the parietal pleura from where biopsies are taken and patients can experience pain. To compare LAT with multilevel ICNB versus standard care to determine whether it reduces pain during and post-LAT, its effect on analgesia use, the hospital length of stay (LOS), and related complications. Prospective analysis of patients undergoing LAT between January and June 2021. In the ICNB group, levobupivacaine/xylocaine is administered at the angle of the rib immediately before LAT (up to 5 rib spaces). Visual Analog Score for pain (0 to 100mm) was measured at 1 and 2 hours post-LAT and daily including analgesia use. Twenty patients (10 ICNB vs. 10 standard care group). The mean age is 68 years with 70% males. Visual Analog Score for pain in the ICNB group reduced by 55mm at 1 and 2 hours post-LAT and 45mm at day 1 ( P <0.05) (minimal clinically important difference >16mm]. Median LOS was reduced by 50% in the ICNB group ( P <0.05). Paracetamol use reduced by 56% ( P <0.05). ICNB not only significantly reduces postprocedure pain but also reduces LOS.

281 Does Smoking Status Affect Achievement of Satisfaction and Minimum Clinically Important Difference in Outcomes in Patients With Cervical Myelopathy at 24 Months? A QOD Study

INTRODUCTION: It is not clear whether smoking impacts patient-reported outcomes (PROs) in patients with cervical spondylotic myelopathy (CSM). METHODS: This was an analysis of the prospective Quality Outcomes Database CSM module. Patients of age = 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction) were collected at baseline and 24 months. RESULTS: Of the 1,141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were non-smokers. Compared to the non-smokers, smokers were younger (56.3 ± 11.3 vs 61.5 ± 11.7, p&lt;0.01) and had lower BMI (29.3 ± 6.8 vs 30.3 ± 6.3, p=0.04). A higher number of smokers had depression, anxiety, and COPD (all p&lt;0.01). At baseline, smokers had worse pain (neck: 6.0 ± 3.2 vs 5.1 ± 3.3; arm: 5.7 ± 3.2 vs 4.7 ± 3.5), disability (NDI: 45.2 ± 20.0 vs 37.1 ± 20.6), myelopathy (mJOA: 11.5 ± 2.9 vs 12.2 ± 2.8), and quality of life (EQ-5D: 0.51 ± 0.23 vs 0.57 ± 0.22) (all p &lt; 0.01). At 24-month follow-up, a higher proportion of smokers achieved MCID in mJOA (69.4% vs 56.6%, p &lt; 0.01) compared to non-smokers. Otherwise, there was no significant difference in the PROs at 24-month follow-up between the two groups (all p &gt; 0.05). The two groups were also similarly satisfied (NASS 1-2: smoker 81.2% vs non-smoker 84.6%, p = 0.29) 24 months after surgery. CONCLUSIONS: Despite smokers having worse baseline characteristics in terms of comorbidities and outcomes of interest, both smokers and non-smokers experienced improvement in all the PROs and achieved similar rates of MCID and satisfaction. Although smoking continues to be an important risk factor for poor surgical outcome, it may not have significant impact on PROs and satisfaction in this patient population.

Diverse learners: learning disabilities and quality of life following mind-body and health education interventions for adults with neurofibromatosis.

Neurofibromatosis (NF) is associated with low quality-of-life (QoL). Learning disabilities are prevalent among those with NF, further worsening QoL and potentially impacting benefits from mind-body and educational interventions, yet research on this population is scarce. Here, we address this gap by comparing NF patients with and without learning disabilities on QoL at baseline and QoL-related gains following two interventions. Secondary analysis of a fully-powered RCT of a mind-body program (Relaxation Response Resiliency Program for NF; 3RP-NF) versus an educational program (Health Enhancement Program for NF; HEP-NF) among 228 adults with NF. Participants reported QoL in four domains (Physical Health, Psychological, Social Relationships, and Environmental). We compare data at baseline, post-treatment, and 12-month follow-up, controlling for intervention type. At baseline, individuals with NF and learning disabilities had lower Psychological (T = -3.0, p = .001) and Environmental (T = -3.8, p < .001) QoL compared to those without learning disabilities. Both programs significantly improved all QoL domains (ps < .0001-0.002) from baseline to post-treatment, regardless of learning disability status. However, those with learning disabilities exceeded the minimal clinically important difference in only one domain (Psychological QoL) compared to three domains in individuals without learning disabilities. Moreover, those with learning disabilities failed to sustain statistically significant gains in Psychological QoL at 12-months, while those without learning disabilities sustained all gains. Adults with NF and learning disabilities have lower Psychological and Environmental QoL. While interventions show promise in improving QoL regardless of learning disabilities, additional measures may bolster clinical benefit and sustainability among those with learning disabilities.

Do policy actors have different views of what constitutes evidence in policymaking?

The role played by evidence in policymaking is hotly disputed and there is no agreement over how evidence is defined. This article examines whether policy actors have different views of what counts as evidence and which factors influence these perceptions (for example, professional background, length of service, organisation setting, cultures of evidence)? In addressing this question, we contribute to the growing research focus on the context of evidence use. Q methodology – a mixed method approach to study people’s attitudes towards a topic – is used in interviewing 67 policy actors and comparing two countries, Scotland and Wales, to find out whether there are different cultures of evidence. In both countries, we identified four distinct profiles of attitudes towards evidence: the evidence-based policymaking (EBPM) Idealist, the Pragmatist, the Inclusive, and the Political. Our research highlights important differences between the two contexts, with a greater leaning towards EBPM views of evidence in Wales, and more pragmatism in defining evidence in Scotland. We illustrate how different cultures of evidence coexist in a same context and highlight their similarities and differences. We also contribute to the understanding of the value of Q methodology research by showing that it can be used to compare two datasets collected in different countries.

Influence of Concomitant Meniscal Allograft Transplantation on Midterm Outcomes After Osteochondral Allograft Transplantation: A Comparative Matched-Pair Analysis.

Osteochondral allograft transplantation (OCAT) is an accepted knee joint-preserving treatment strategy for focal osteochondral lesions that is often conducted in combination with meniscal allograft transplantation (MAT). Despite its frequent and simultaneous utilization, there remains a lack in the literature reporting on outcomes and failure rates after concomitant procedures. To determine (1) the midterm clinical success rate after OCAT+MAT in comparison with a matched-pair cohort undergoing isolated OCAT, (2) whether patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time. Cohort study; Level of evidence, 3. A single-center matched-pair cohort study was conducted investigating outcomes in patients who underwent OCAT of the medial or lateral femoral condyle with and without MAT between 2004 and 2020. Patients were matched 1:1 by age (±5 years), sex (male or female), body mass index (±5), and grouped Kellgren and Lawrence grade (grades 0-1 or 2-4). The minimum follow-up time was 2 years. Radiographic variables (International Cartilage Regeneration & Joint Preservation Society [ICRS] grade and Kellgren and Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery for graft failure or conversion to total knee arthroplasty. Patient-reported, clinical, and radiographic outcomes were compared between groups. In total, 66 patients (33 treated with isolated OCAT, 33 treated with OCAT+MAT; 57.6% male) with a mean age of 26.3 years (range, 18-62 years) were followed for a mean of 5.6 years (minimum, 2 years; range, 24-218 months). The 2 cohorts showed no difference in Kellgren and Lawrence grade postoperatively (P = .59). There was a significantly higher ICRS grade detected at follow-up in the OCAT+MAT group (2.81 ± 1.10) compared with the OCAT group (2.04 ± 0.96) (P < .05). There were no statistically significant differences between the groups regarding reoperation rate (OCAT: n = 6; OCAT+MAT: n = 13; P = .116), time to reoperation (OCAT: 46.67 ± 47.27 months vs OCAT+MAT: 28.08 ± 30.16 months; P = .061), and failure rate (OCAT: n = 4 [12.1%] vs OCAT+MAT: n = 5 [15.2%]; P = .66). In the OCAT+MAT group, an increase of tibial slope by 1° conferred a 1.65-fold increase in the hazard for failure over decreased slope (hazard ratio, 1.65; 95% CI, 1.10-2.50; P < .05). The overall survival rate was 86% at a mean follow-up of 5.6 years. Patient-reported outcome scores were significantly improved at the final follow-up compared with preoperative status. No significant differences were seen between groups with respect to subjective IKDC, Lysholm, Tegner, and KOOS results, except for the KOOS Symptoms subscale score, which was significantly higher in the OCAT+MAT group than in the OCAT group (mean difference, 14.6; P < .05) and did exceed the minimal clinically important difference threshold of 10.7. Midterm results after isolated OCAT and OCAT+MAT show high rates of healing and sustainable subjective improvement of knee function and quality of life. However, it should be noted that the difference in reoperation rate and time to reoperation between the groups is arguably clinically important and that lack of statistical significance may be because of low power. These results imply that isolated OCAT is an efficient joint-preserving treatment that can be combined with MAT in well-selected patients with meniscal insufficiency without negative influence on global clinical outcomes.

Outcome differences by sex in oncology clinical trials

Identifying sex differences in outcomes and toxicity between males and females in oncology clinical trials is important and has also been mandated by National Institutes of Health policies. Here we analyze the Trialtrove database, finding that, strikingly, only 472/89,221 oncology clinical trials (0.5%) had curated post-treatment sex comparisons. Among 288 trials with comparisons of survival, outcome, or response, 16% report males having statistically significant better survival outcome or response, while 42% reported significantly better survival outcome or response for females. The strongest differences are in trials of EGFR inhibitors in lung cancer and rituximab in non-Hodgkin’s lymphoma (both favoring females). Among 44 trials with side effect comparisons, more trials report significantly lesser side effects in males (N = 22) than in females (N = 13). Thus, while statistical comparisons between sexes in oncology trials are rarely reported, important differences in outcome and toxicity exist. These considerable outcome and toxicity differences highlight the need for reporting sex differences more thoroughly going forward.