Important Differences Research Articles

The Promising 2-Year Performance of the Patient-Reported Outcomes Measurement Information System in Primary Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Background: Minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds have been previously defined for the Patient-Reported Outcomes Measurement Information System (PROMIS) at 1-year follow-up in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome; however, the MCID and PASS thresholds are yet to be defined for the PROMIS at 2-year follow-up. Purpose: (1) To establish MCID and PASS thresholds for the PROMIS Pain Interference (PROMIS-PI) and PROMIS Physical Function (PROMIS-PF) at 2-year follow-up and (2) to correlate PROMIS scores with hip-specific patient-reported outcome measure (PROM) scores. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients undergoing primary hip arthroscopy for femoroacetabular impingement syndrome between August and November 2020 with preoperative and minimum 2-year postoperative data were identified. Collected scores included those for the PROMIS-PI, PROMIS-PF, Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), International Hip Outcome Tool–12 (iHOT-12), and visual analog scale (VAS) for pain. MCID thresholds were calculated using the distribution-based method and PASS thresholds using the anchor-based method. Pearson correlation coefficients were used to compare scores between PROMs. Results: A total of 65 patients met the criteria for inclusion (72.3% female; mean age, 36.9 ± 13.5 years; mean body mass index, 26.2 ± 6.0). The mean follow-up was 25.3 ± 3.3 months. Significant preoperative to postoperative improvements were observed for all PROMs (P < .001). MCID thresholds and achievement rates were as follows: HOS-ADL, 10.1 and 75%, respectively; HOS-SS, 13.8 and 79%, respectively; iHOT-12, 14.0 and 67%, respectively; VAS pain, –13.8 and 78%, respectively; PROMIS-PI, –4.7 and 65%, respectively; and PROMIS-PF, 5.8 and 60%, respectively. PASS thresholds and achievement rates were as follows: HOS-ADL, 78.7 and 67%, respectively; HOS-SS, 76.4 and 62%, respectively; iHOT-12, 67.4 and 60%, respectively; VAS pain, 25.5 and 61%, respectively; PROMIS-PI, 57.0 and 65%, respectively; and PROMIS-PF, 45.6 and 58%, respectively. PROMIS-PI scores correlated most strongly with HOS-ADL (r = −0.836), HOS-SS (r = −0.767), and iHOT-12 (r = −0.719) scores and exhibited at least moderate correlations (r≥−0.595) with the other PROM scores. PROMIS-PF demonstrated moderate correlations with all the other PROM scores (r≥−0.586). Strong correlations were seen between the hip-specific PROM scores (r≥−0.745). Conclusion: This study defined 2-year MCID and PASS thresholds for the PROMIS-PI and PROMIS-PF and demonstrated moderate to strong correlations between PROMIS scores and hip-specific PROM scores.

Minimum important difference of the ICIQ-UI SF score after self-management of urinary incontinence

BackgroundThis study aimed to evaluate clinically relevant improvement after conservative self-management of urinary incontinence via a mobile app. It further aimed to establish Minimum Important Differences (MIDs) based on the severity and type of urinary incontinence.MethodsData was collected in a prospective cohort study that evaluated the freely available app Tät®. The app provided pelvic floor muscle training (PFMT) and life-style advice. Non-pregnant, non-postpartum women (≥ 18 years) who downloaded the app to treat urinary incontinence were included, if they completed the Patient Global Impression of Improvement (PGI-I) question at the 3-month follow-up (n = 1,733). Participants answered the International Consultation on Incontinence Questionnaire (ICIQ-UI SF) at baseline and after 3 months. The score change was analysed for correlation (Spearman) with the PGI-I. We then analysed one-way ANOVAs to determine whether there were significant differences between the groups based on the answers to the PGI-I. The MID was set to the mean change of the group that selected the answer “a little better” to the PGI-I question.ResultsThe one-way ANOVA showed significant differences between PGI-I groups (p < 0.001). The MID for the general group was set to 1.46 (95% Confidence Interval [CI] 1.26–1.67). In the sub-group analyses, a MID for the group with slight incontinence could not be determined. For the group with moderate severity the MID was determined to be 1.33 (95% CI 1.10–1.57) and for the severe/very severe group it was 3.58 (95% CI 3.08–4.09). Analysis of different types of incontinence showed no difference in MIDs.ConclusionsThe MID for self-management via a mobile app was lower than previously established MIDs, but differed depending on baseline severity. This study shows that MIDs need adjustment for baseline severity and treatment intensity when interpreting clinical trial results. If using MIDs as exact numbers, the study population and the treatment must be comparable.

People living with HIV display increased anti-apolipoprotein A1 auto-antibodies, inflammation, and kynurenine metabolites: a case-control study.

This study aimed to study the relationship between auto-antibodies against apolipoprotein A1 (anti-apoA1 IgG), human immunodeficiency virus (HIV) infection, anti-retroviral therapy (ART), and the tryptophan pathways in HIV-related cardiovascular disease. This case-control study conducted in South Africa consisted of control volunteers (n = 50), people living with HIV (PLWH) on ART (n = 50), and untreated PLWH (n = 44). Cardiovascular risk scores were determined, vascular measures were performed, and an extensive biochemical characterisation (routine, metabolomic, and inflammatory systemic profiles) was performed. Anti-apoA1 IgG levels were assessed by an in-house ELISA. Inflammatory biomarkers were measured with the Meso Scale Discovery® platform, and kynurenine pathway metabolites were assessed using targeted metabolomic profiling conducted by liquid chromatography-multiple reaction monitoring/mass spectrometry (LC-MRM/MS). Cardiovascular risk scores and vascular measures exhibited similarities across the three groups, while important differences were observed in systemic inflammatory and tryptophan pathways. Anti-apoA1 IgG seropositivity rates were 15%, 40%, and 70% in control volunteers, PLWH ART-treated, and PLWH ART-naïve, respectively. Circulating anti-apoA1 IgG levels were significantly negatively associated with CD4+ cell counts and positively associated with viremia and pro-inflammatory biomarkers (IFNγ, TNFα, MIPα, ICAM-1, VCAM-1). While circulating anti-apoA1 IgG levels were associated with increased levels of kynurenine in both control volunteers and PLWH, the kynurenine/tryptophan ratio was significantly increased in PLWH ART-treated. HIV infection increases the humoral response against apoA1, which is associated with established HIV severity criteria and kynurenine pathway activation.

CP-AFM Molecular Tunnel Junctions with Alkyl Backbones Anchored Using Alkynyl and Thiol Groups: Microscopically Different Despite Phenomenological Similarity.

In this paper, we report results on the electronic structure and transport properties of molecular junctions fabricated via conducting probe atomic force microscopy (CP-AFM) using self-assembled monolayers (SAMs) of n-alkyl chains anchored with acetylene groups (CnA; n = 8, 9, 10, and 12) on Ag, Au, and Pt electrodes. We found that the current-voltage (I-V) characteristics of CnA CP-AFM junctions can be very accurately reproduced by the same off-resonant single-level model (orSLM) successfully utilized previously for many other junctions. We demonstrate that important insight into the energy-level alignment can be gained from experimental data of transport (processed via the orSLM) and ultraviolet photoelectron spectroscopy combined with ab initio quantum chemical information based on the many-body outer valence Green's function method. Measured conductance GAg < GAu < GPt is found to follow the same ordering as the metal work function ΦAu < ΦAu < ΦPt, a fact that points toward a transport mediated by an occupied molecular orbital (MO). Still, careful data analysis surprisingly revealed that transport is not dominated by the ubiquitous HOMO but rather by the HOMO-1. This is an important difference from other molecular tunnel junctions with p-type HOMO-mediated conduction investigated in the past, including the alkyl thiols (CnT) to which we refer in view of some similarities. Furthermore, unlike in CnT and other junctions anchored with thiol groups investigated in the past, the AFM tip causes in CnA an additional MO shift, whose independence of size (n) rules out significant image charge effects. Along with the prevalence of the HOMO-1 over the HOMO, the impact of the "second" (tip) electrode on the energy level alignment is another important finding that makes the CnA and CnT junctions different. What ultimately makes CnA unique at the microscopic level is a salient difference never reported previously, namely, that CnA's alkyne functional group gives rise to two energetically close (HOMO and HOMO-1) orbitals. This distinguishes the present CnA from the CnT, whose HOMO stemming from its thiol group is well separated energetically from the other MOs.

Let's Agree to Disagree on Operative Versus Nonoperative Treatment for Distal Radius Fractures in Older People: Protocol for a Prospective International Multicenter Cohort Study.

Distal radius fractures are the most frequently encountered fractures in Western societies, typically affecting patients aged 50 years and older. Although this is a common injury, the best treatment for these fractures in older patients is still under debate. This prospective study aims to compare the outcome of operatively and nonoperatively treated distal radius fractures in the older population. Only patients with distal radius fractures for which equipoise regarding the optimal treatment exists will be included. This prospective international multicenter observational cohort study will be designed as a natural experiment. Natural experiments are observational studies in which treatment allocation is determined by factors outside the control of the investigators but also (largely) independent of patient characteristics. Patients aged 65 years and older with an acute distal radius fracture will be considered for inclusion. Treatment allocation (operative vs nonoperative) will be based on the local preferences of the treating hospital either in Switzerland or the Netherlands. Hence, the process governing treatment allocation resembles that of randomization. Patients will be identified after treatment has been initiated. Based on the radiographs and baseline information of the patient, an expert panel of 6 certified trauma surgeons from 2 regions will provide their treatment recommendation. Only patients for whom the experts disagree on treatment recommendations will ultimately be included in the study (ie, for whom there is a clinical equipoise). For these patients, both operative and nonoperative treatment of distal radius fractures are viable, and treatment choice is predominantly determined by personal or local preference. The primary outcome will be the Patient-Rated Wrist Evaluation score at 12 weeks. Secondary outcomes will include the Physical Activity Score for the Elderly, the EQ questionnaire, pain, the living situation, range of motion, complications, and radiological outcomes. By including outcomes such as living situation and the Physical Activity Score for the Elderly, which are not relevant for younger cohorts, valuable information to tailor treatment to the needs of the older population can be gained. According to the sample size collection, which was based on the minimal important clinical difference of the Patient-Rated Wrist Evaluation, 92 patients will have to be included, with at least 46 patients in each treatment group. Enrollment began in July 2023 and is expected to continue until summer 2024. The final follow-up will be 2 years after the last patient is included. Although many trials on this topic have previously been published, there remains an ongoing debate regarding the optimal treatment for distal radius fractures in older patients. This observational study, which will use a fairly new methodological study design, will provide further information on treatment outcomes for older patients with distal radius fractures for which to date equipoise exists regarding the optimal treatment. DERR1-10.2196/52917.

Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging

To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging. Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported. One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (P < .001) and ASES (P < .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (P < .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (P= .023). The corresponding figures for ASES were 98% and 71%, respectively (P= .004). In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon. Level III, retrospective cohort study.

Pairing taVNS and CIMT is feasible and may improve upper extremity function in infants.

In this study we combined non-invasive transcutaneous auricular vagal nerve stimulation (taVNS) with 40 h of constraint induced movement therapy (CIMT) in infants. All infants completed the full intervention with no adverse events. Therapists were able to maintain high treatment fidelity and reported high ratings for ease of use and child tolerance. Preliminary results show promising gains on motor outcomes: Mean QUEST increase 19.17 (minimal clinically important difference, MCID 4.89); Mean GMFM increase 13.33 (MCID 1%-3%). Infants also exceeded expectations on Goal Attainment Scores (+1). Early data is promising that taVNS paired with intensive motor CIMT is feasible, reliable, and safe in young infants with hemiplegia, and may help harness activity-dependent plasticity to enhance functional movement.

MECP2-related disorders while gene-based therapies are on the horizon.

The emergence of new genetic tools has led to the discovery of the genetic bases of many intellectual and developmental disabilities. This creates exciting opportunities for research and treatment development, and a few genetic disorders (e.g., spinal muscular atrophy) have recently been treated with gene-based therapies. MECP2 is found on the X chromosome and regulates the transcription of thousands of genes. Loss of MECP2 gene product leads to Rett Syndrome, a disease found primarily in females, and is characterized by developmental regression, motor dysfunction, midline hand stereotypies, autonomic nervous system dysfunction, epilepsy, scoliosis, and autistic-like behavior. Duplication of MECP2 causes MECP2 Duplication Syndrome (MDS). MDS is found mostly in males and presents with developmental delay, hypotonia, autistic features, refractory epilepsy, and recurrent respiratory infections. While these two disorders share several characteristics, their differences (e.g., affected sex, age of onset, genotype/phenotype correlations) are important to distinguish in the light of gene-based therapy because they require opposite solutions. This review explores the clinical features of both disorders and highlights these important clinical differences.

A National Survey on the Relationship of Youth Sport Specialization Behaviors to Self-Reported Anxiety and Depression in Youth Softball Players.

There are little to no data on whether any associations exist between sport specialization and mental health in youth softball athletes. Highly specialized youth softball athletes will have worse self-reported depression and anxiety symptom scores compared with low and moderate specialized athletes. Cross-sectional survey. Level 4. An online cross-sectional survey was distributed in the fall of 2021 to a national sample of female youth softball athletes between the ages of 12 and 18 years. Sport specialization status was determined using a 3-point specialization scale that classifies either low, moderate, or high. The patient health questionnaire-9 (PHQ-9) and the 7-item general anxiety disorder scale (GAD-7) were used to assess self-reported symptoms of depression and anxiety. Comparison also included sports participation and specialization behaviors between specialization groups. A total of 1283 subjects (mean age, 15.1 ± 1.7 years) fully completed the survey. After adjusting for covariates, lower scores were reported on both the PHQ-9 and GAD-7 by highly specialized athletes compared with moderate or low specialization athletes (PHQ-9, high = 8.6 ± 0.4; moderate = 11.2 ± 0.3; low = 10.9 ± 0.5; P < 0.01; GAD-7, high = 6.5 ± 0.4; moderate = 8.6 ± 0.3; low = 8.4 ± 0.4, P < 0.01). Conversely, higher scores were reported on both scales for athletes who received private softball coaching compared with those who did not (PHQ-9, 11.5 ± 0.3 vs 9.0 ± 0.3; P < 0.01; GAD-7, 8.8 ± 0.3 vs 6.9 ± 0.3, P < 0.01). Finally, athletes who reported an arm overuse injury in the previous year reported higher PHQ-9 scores (10.8 ± 0.3 vs 9.8 ± 0.3; P < 0.01). While sport specialization, as measured by the validated 3-point scale, was not associated with increased anxiety and depression symptom scores, other aspects of specialization behavior such as private coaching or overuse injury history were associated with worse scores on these scales, indicating potential concern for anxiety and depression. However, although the differences we observed were statistically significant, they did not exceed the minimal clinically important difference values that have been established for the PHQ-9 (5 points) or GAD-7 (4 points). This project is a first step toward understanding the sport specialization behaviors and their influence on the mental health of youth softball athletes. Focusing on investigating specialization behaviors further may reveal to be a better indicator of risk of developing anxiety and depression symptoms compared with utilizing the 3-point specialization scale.

Problematic overstudying, Big Five personality, and music performance anxiety: associations with well-being and GPA

BackgroundProblematic overstudying is a compulsive and pathological overinvolvement in studying leading to harm and considerable functional impairments. It is conceptualized as “study addiction,” a precursor to work addiction. It has been investigated within the addictive behaviours framework in general populations of students for over a decade. A previous study analysed the problem among young musicians as a particularly vulnerable group. It found some important differences in potential personality risk factors among music academy students compared to general populations of students and showed an im-portant role of social anxiety. The current study aimed to validate these findings in a separate larger sample and extend them by investigating the role of music performance anxiety (MPA).Participants and procedureThe study was conducted among 213 students of music academies. Valid and reliable measures of study addiction, MPA, Big Five personality and well-being were used.ResultsThe results showed that MPA played a similar role as social anxiety in terms of being a predictor, mediator, and moderator of the main replicated effects supporting the hypothesised mechanisms regulating study addiction. However, extraversion was not associated with study addiction in multiple hierarchical regression analysis, but conscientiousness and neuroticism were. Study addiction was associated with indicators of decreased well-being, above and beyond MPA, and personality.ConclusionsThese results show that MPA plays an analogous role to social anxiety and that the role of Big Five personality in study addiction among young musicians requires further investigation due to inconsistent findings.

An overview of nutritional factors in the aetiopathogenesis of myocardial fibrosis in great apes.

The main cause of mortality in great apes in zoological settings is cardiovascular disease (CVD), affecting all four taxa: chimpanzee (Pan troglodytes), bonobo (Pan paniscus), gorilla (Gorilla spp.) and orangutan (Pongo spp.). Myocardial fibrosis, the most typical histological characterisation of CVD in great apes, is non-specific, making it challenging to understand the aetiopathogenesis. A multifactorial origin of disease is assumed whereby many potential causative factors are directly or indirectly related to the diet, which in wild-living great apes mainly consists of high-fibre, low-carbohydrate and very low-sodium components. Diets of great apes housed in zoological settings are often different compared with the situation in the wild. Moreover, low circulating vitamin D levels have recently been recognised in great apes housed in more northern regions. Evaluation of current supplementation guidelines shows that, despite implementation of different dietary strategies, animals stay vitamin D insufficient. Therefore, recent hypotheses designate vitamin D deficiency as a potential underlying factor in the pathogenesis of myocardial fibrosis. The aim of this literature review is to: (i) examine important differences in nutritional factors between zoological and wild great ape populations; (ii) explain the potential detrimental effects of the highlighted dietary discrepancies on cardiovascular function in great apes; and (iii) elucidate specific nutrition-related pathophysiological mechanisms that may underlie the development of myocardial fibrosis. This information may contribute to understanding the aetiopathogenesis of myocardial fibrosis in great apes and pave the way for future clinical studies and a more preventive approach to great ape CVD management.

A Suprapatellar approach, when compared to an Infrapatellar approach, yields less Anterior Knee Pain and better patellofemoral joint Function, for intramedullary nailing of diaphyseal tibial fractures. Results of a Randomised Controlled Trial.

To assess if a suprapatellar (SP) approach, when compared to an infrapatellar (IP) approach, yielded less patient reported anterior knee pain and higher patellofemoral joint function at 6 weeks and 12 months post operatively, when treating tibial fractures with intramedullary nailing. Prospective, parallel group randomized control trial. Tertiary level one trauma care centre, Brisbane, Australia. Skeletally mature patients with an acute diaphyseal tibial fracture (AO/OTA 41A2/3, 42 A1- 43A3) amenable to an IMN were included. Exclusion criteria were peri-prosthetic fractures, nonunions, and presence of a contralateral injury that would restrict weightbearing. Anterior knee pain, through the visual analogue scale (VAS) and patellofemoral function using the Kujala scale at 6-weeks and 12-months were compared between those treated with a SP and IP approach. 95 tibia fractures were included in the randomized trial, with complete follow-up data for 44 and 46 tibia fractures in the SP and IP groups, respectively. The SP cohort exhibited better patella-femoral knee function at both 6 weeks post operatively (Kajula 53.0 for SP vs 43.2 for IP, p<0.01)) and 12 months (Kujala 92.0 for SP vs 81.3 for IP (p<0.01)), and a reduction in anterior knee pain at 12-months post-operatively (VAS 0.7 SP vs 2.9 IP, p<0.01). This randomized trial demonstrated clinically meaningful differences in patellofemoral function, for a suprapatellar versus infrapatellar approach, with a greater than 10 point discrepancy in Kujala score at both 6 weeks and 12 months. Additionally, there was a clinically important difference in VAS knee pain scores for patients at 12 months, but not at 6 weeks, post operatively. These results contribute to the growing body of evidence demonstrating the functional and clinical benefits of the suprapatellar approach.

Real-World Use and Effectiveness Outcomes in Patients with Rheumatoid Arthritis Treated with Upadacitinib: An Analysis from the CorEvitas Registry.

Data assessing longer-term real-world effectiveness and treatment patterns with upadacitinib (UPA), a Janus kinase inhibitor, in rheumatoid arthritis (RA) are lacking. We assessed improvement in clinical and patient-reported outcomes and treatment patterns for up to 12months among adult patients with RA initiating UPA. Data were collected from the CorEvitas® RA Registry (08/2019-04/2022). Eligible patients had moderate to severe RA (Clinical Disease Activity Index [CDAI] > 10) and follow-up visits at 6 or 12months after UPA initiation. Outcomes were mean change from baseline, percentage achieving minimal clinically important differences (MCID) in clinical and patient-reported outcomes, and disease activity at follow-up. We evaluated clinical outcomes and therapy changes among patients with tumor necrosis factor inhibitor (TNFi) experience and among those receiving UPA as first-line therapy, as well as those receiving UPA as monotherapy versus as part of combination therapy. We further evaluated whether outcomes were similar among those that remained on therapy. Patients treated with UPA (6-month cohort, N = 469; 12-month cohort, N = 263) had statistically significant improvements (p < 0.001) in mean CDAI, tender/swollen joint counts, pain, and fatigue at follow-up. At 12months, 46.0% achieved MCID in CDAI and 40.0% achieved low disease activity/remission. Overall, 43.0% discontinued UPA at 12months; of those receiving combination treatment (N = 90) with conventional therapies and UPA, 42.2% (N = 38) discontinued conventional therapy. Findings were similar in the 6-month cohort and among subgroups. Changes from baseline and proportions of patients achieving MCID or clinical outcomes tended to be numerically lower among patients with TNFi experience and numerically higher among those receiving UPA as first-line therapy. UPA initiation was associated with improvements in clinical and patient-reported outcomes, with meaningful clinical improvements regardless of prior TNFi experience, line of therapy, or concomitant use of conventional therapies. Further research is needed to better understand sustained response of UPA over longer treatment periods.

Critical Consciousness is an Individual Difference: A Test of Measurement Equivalence in American, Ukrainian, and Iranian Universities

We live in a world in which we are socially, politically, economically, and environmentally connected with other people. Online communication has facilitated people coming together from different parts of the world. In terms of social justice movements, people have come together to share ideas about how they perceive social inequality and how to address it, which is what academics call critical consciousness. While scholars have explored critical consciousness in the American context, whether it operates on a global scale is under-explored. To address this question, we administered the Critical Consciousness Scale (a validated survey) with students from the United States, Iran, and Ukraine. Our findings demonstrate that critical consciousness maintains its factor structure across the entire sample, meaning that students from these three countries share some notions of critical consciousness. However, when comparing national groups, we find that critical consciousness is defined differently by students in different countries. In a practical sense, these findings mean that some aspects of critical consciousness are shared, but there are important differences in how it is perceived and how its components relate to one another. By attempting to understand critical consciousness internationally, this study serves as a cautionary narrative for international solidarity movements organized around the goal of social justice.

Comparison of statistical methods used to meta-analyse results from interrupted time series studies: an empirical study

BackgroundThe Interrupted Time Series (ITS) is a robust design for evaluating public health and policy interventions or exposures when randomisation may be infeasible. Several statistical methods are available for the analysis and meta-analysis of ITS studies. We sought to empirically compare available methods when applied to real-world ITS data.MethodsWe sourced ITS data from published meta-analyses to create an online data repository. Each dataset was re-analysed using two ITS estimation methods. The level- and slope-change effect estimates (and standard errors) were calculated and combined using fixed-effect and four random-effects meta-analysis methods. We examined differences in meta-analytic level- and slope-change estimates, their 95% confidence intervals, p-values, and estimates of heterogeneity across the statistical methods.ResultsOf 40 eligible meta-analyses, data from 17 meta-analyses including 282 ITS studies were obtained (predominantly investigating the effects of public health interruptions (88%)) and analysed. We found that on average, the meta-analytic effect estimates, their standard errors and between-study variances were not sensitive to meta-analysis method choice, irrespective of the ITS analysis method. However, across ITS analysis methods, for any given meta-analysis, there could be small to moderate differences in meta-analytic effect estimates, and important differences in the meta-analytic standard errors. Furthermore, the confidence interval widths and p-values for the meta-analytic effect estimates varied depending on the choice of confidence interval method and ITS analysis method.ConclusionsOur empirical study showed that meta-analysis effect estimates, their standard errors, confidence interval widths and p-values can be affected by statistical method choice. These differences may importantly impact interpretations and conclusions of a meta-analysis and suggest that the statistical methods are not interchangeable in practice.

Physical function and activity of patients after open abdominal surgery: a prospective cohort study comparing the clinimetric properties of two outcome measures

ObjectivesTo measure and compare the clinimetric properties of the Chelsea Critical Care Physical Assessment (CPAx) and Physical Function in Intensive Care Test-scored (PFIT-s) for assessment of physical function and activity. DesignProspective cohort design using crossover-randomisation of the sequence in which participants were assessed with CPAx and PFIT-s. SettingSurgical and transplant intensive care units (ICU) in an academic hospital. ParticipantsAdults who underwent elective open abdominal surgery. Consecutive sampling was used to enrol 69 participants. InterventionsPhysical function and activity were assessed on ICU days one, three, five and at ICU discharge using the CPAx and PFIT-s in random order. Main outcome measuresResponsiveness to change, minimal clinically important difference (MCID), floor and ceiling effect, and convergent validity. ResultsCPAx demonstrated a large responsiveness (effect size index (ESI)= 0.83) and PFIT-s moderate responsiveness (ESI=0.73) to change in scores. MCID for CPAx was 2.1 (standard error of measurement (SEM) 1.1) and for PFIT-s 0.6 (SEM=0.3). CPAx had no floor effect and a small ceiling effect (9%, n = 6) at ICU discharge compared to 2% (n = 1) floor and 48% (n = 32) ceiling effects of PFIT-s. Moderate convergent validity was found for both tools at ICU admission (n = 67, r = 0.62, p < 0.001) and discharge (n = 67, r = 0.51, p < 0.001). ConclusionCPAx is most responsive to changes in physical function and activity scores, has no floor and limited ceiling effects and moderate convergent validity, and is recommended for similar cohorts. Contribution of the paper•This paper describes clinimetric properties of CPAx compared to PFIT-s for a cohort of middle-aged patients who had elective open abdominal surgery and contributes to the limited existing evidence.•It reports MCID for CPAx and PFIT-s for this elective surgery cohort.

Atypical song of Blackcap Sylvia atricapilla

The song of the Eurasian Blackcap Sylvia atricapilla consists of two distinct parts: an initial chattering of different harsh notes followed by a louder, fluting warble. However, some enigmatic individuals present an atypical version of their song characterised by a remarkable simplification of the traditional rich fluting warble. This study documents the unprecedented observation in the Iberian Peninsula of an atypical singer in Els Ports Natural Park (Catalonia, NE Spain). This bird exhibited distinct behavior including perching high in trees and intense morning singing, in addition to the atypical song marked by the substitution of the rich fluting warble by a monotonous series of approximately 15 similar notes. In a meticulous analysis of atypical Blackcap recordings on the online portal xeno-canto, we identified 12 cases of similar atypical singers distributed across Europe. We compared the vocal patterns of these atypical singers with the well-known Blackcap song variant leiern and concluded that there are important differences. People participating in common bird censuses should be aware of this variability in Eurasian Blackcap songs and the occurrence of atypical singers to avoid misidentification. The description and reporting of such observations will help improve knowledge of the complex subject of bird vocalisations.

Influence of smoking on patient-reported outcome measures (PROMs) in patients undergoing surgery for adult spinal deformity: a propensity score-matched analysis.

The purpose of this study was to determine the isolated influence of smoking in patient-reported outcome measures (PROMs) for adult spinal deformity (ASD) surgery excluding known tobacco-related complications. Retrospective analysis of a prospective multicenter ASD database. Patients operated on ASD with 2year post-operative follow-up were included. Former smokers (non-active smokers) and patients developing mechanical or infectious complications were excluded. Changes of PROMs over time were analyzed using mixed models for repeated measures (MMRM). Propensity score matching (PSM) (1:1 ratio, caliper 0.10) was performed without replacement using optimum algorithm, tolerance ≤ 0.001, and estimated with 95% confidence interval (CI). PROMS in both groups were compared by paired t test or Wilcoxon signed-rank test. 692 out of 1246 surgical patients met our inclusion criteria. 153 smokers were matched with 153 non-smokers according to age, BMI, number of fused levels, and global tilt. After PSM both groups were homogeneous regarding baseline parameters, surgical data, and complications (mechanical complications and infection excluded). Smokers had worse baseline results for SRS-total, SRS-pain COMI-back, and ODI; smokers also showed worse 2-year outcomes for SRS-total, SRS-function, SRS-pain, SRS-self-image, and ODI. However, no differences between the two groups were found in the improvement from baseline to 2-year follow-up or in the timing of this improvement (MMRM). The proportion of patients reaching the minimal clinically important difference (MCID) after surgery was similar in the two groups, but the proportion of patients reaching patient acceptable symptom state (PASS) was significantly lower in smokers for SRS-Subtotal, SRS-function, and SRS-image. Even in the absence of smoking-related complications, smokers had worse PROMs at baseline and 2 years after surgery with less patients achieving PASS, but similar degrees on improvement compared to non-smokers. The proportion achieving MCID was also similar between the two cohorts.

The feasibility of the adapted H-GRASP program for perceived and actual daily-life upper limb activity in the chronic phase post-stroke

(Purpose: Assessing feasibility and initial impact of the Home-Graded Repetitive Arm Supplementary Program combined with in-home accelerometer-based feedback (AH-GRASP) on perceived and actual daily-life upper limb (UL) activity in stroke survivors during the chronic phase with good UL motor function but low perceived daily-life activity. Material and methods: A 4-week intervention program (4 contact hours, 48 h self-practice) encompassing task-oriented training, behavioral techniques, phone-based support, monitoring, and weekly feedback sessions using wrist-worn accelerometery was implemented using a pre-post double baseline repeated measures design. Feasibility, clinical assessments, patient-reported outcomes, and accelerometer data were investigated. Results: Of the 34 individuals approached, nineteen were included (recruitment rate 56%). Two dropped out, one due to increased UL pain (retention rate 89%). Seven (41%) achieved the prescribed exercise target (120 min/day, six days/week). Positive patient experiences and improvements in UL capacity, self-efficacy, and contribution of the affected UL to overall activity (p < 0.05, small to large effect sizes) were observed. Additionally, seven participants (41%) surpassed the minimal clinically important difference in perceived UL activity.Conclusions: A home-based UL exercise program with accelerometer-based feedback holds promise for enhancing perceived and actual daily-life UL activity for our subgroup of chronic stroke survivors.

The Influence of Titanium Dioxide (TiO2) Particle Size and Crystalline Form on the Microstructure and UV Protection Factor of Polyester Substrates.

The inclusion of particles in a polymeric substrate to achieve certain properties is a well-known practice. In the case of textile substrates, this practice may deeply affect the structure of the produced yarns, as even a filament with no textile applications can be obtained. In this manuscript, titanium dioxide (TiO2) particles were incorporated into polyester (PET) chips and the influence of these fillers on the properties of yarn and fabric, and the ultraviolet protection factor (UPF) was assessed. For this purpose, rutile and anatase crystalline forms of TiO2, as well as the size of the particles, were evaluated. Moreover, parameters such as mechanical properties, orientation of the macromolecules and thermal behavior were analyzed to ensure that the textile grade is maintained throughout the production process. The results showed that the inclusion of micro- and nanoparticles of TiO2 decreases the molecular weight and tenacity of PET. Also, although orientation and crystallinity varied during the textile process, the resulting heatset fabrics did not present important differences in those parameters. Finally, the attainment of textile-grade PET-TiO2 fabrics with UPF indexes of 50+ with both rutile and anatase and micro- and nano-sized TiO2 forms was demonstrated.