Effect Size Index Research Articles

Age-Related Differences in Accelerometer-Assessed Physical Activity and Sleep Parameters Among Children and Adolescents With and Without Autism Spectrum Disorder

Physical inactivity and sleep disorders are health-related concerns of youth with autism spectrum disorder (ASD) that can persist from childhood and exacerbate core symptoms. However, evidence on group differences in accelerometer-assessed physical activity and sleep parameters among youth with and without ASD is inconclusive and age-specific effects remain unclear. To synthesize evidence on group differences in accelerometer-assessed physical activity and sleep parameters and examine the moderating effects of age between children and adolescents with and without ASD. American Psychological Association PsychInfo, CINAHL Ultimate, ERIC, MEDLINE, SPORTDiscus with Full Text, and Web of Science from inception to February 2023. Two independent reviewers screened articles for observational research comparing accelerometer-assessed physical activity levels and sleep parameters in children and adolescents with and without ASD. After developing a standardized form, relevant data were extracted. Quality was assessed using the McMaster Critical Review Form and rated based on sample, measurement, and analyses. The Preferring Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. The primary outcomes were actigraphy-measured MVPA, sleep latency, sleep efficiency, total sleep time, and wake after sleep onset. Data were pooled using a random-effects model. Hedges g was used to express the effect size index. Meta-regression on age was also performed to investigate the potential moderating effects. Collectively, 1757 studies were initially identified. Among 104 articles that were assessed, 28 were included, comprising moderate-to-vigorous physical activity (MVPA), 4 sleep parameters, and 73 independent effect sizes. A total of 28 studies were included in analysis, comprising 805 children and adolescents with ASD and 1573 without ASD (age range, 5.1-16.9 years). Compared with peers without ASD, children and adolescents with ASD had a small-to-moderate difference in MVPA (g = -0.450; 95% CI, -0.622 to -0.277), total sleep time (g = -0.332; 95% CI, -0.574 to -0.090), sleep efficiency (g = -0.424; 95% CI, -0.645 to -0.203), and a moderate difference in sleep latency (g = 0.514; 95% CI, 0.351 to 0.677) measured by actigraphy. Children and adolescents with ASD experienced an age-related decline in moderate-to-vigorous physical activity (β = -0.049 [95% CI, -0.097 to -0.001]; P = .045), indicating that younger children with ASD showed a smaller difference in MVPA compared with their peers without ASD. Moderating effects of age on sleep parameters were not significant. The findings of this meta-analysis suggested that children and adolescents with ASD had lower MVPA and worse sleep than peers without ASD, and the difference in MVPA varied with age. These findings reinforce the need for public health initiatives aimed at reducing these group disparities.

Cognitive behavioural therapy to improve social skills in children and adolescents with autism spectrum disorder: A meta-analysis of randomised controlled trials

BackgroundCognitive behavioural therapy (CBT) is effective in treating various neurological and psychiatric diseases. It improves anxiety symptoms in children with autism spectrum disorder, gaining considerable empirical support. However, social skills results are mixed, leading to debate over its effectiveness, highlighting the need for further development. While the Social Responsiveness Scale (SRS) is a secondary indicator to measure anxiety symptoms, it primarily evaluates social skills, which are essential for rehabilitating children with autism. Therefore, evaluating social disorder improvement in children with autism is imperative. Social impairment is a core autism symptom. Therefore, we conducted a systematic review of randomised controlled trials assessing the effects of CBT on social skills in this population. MethodsWe reviewed articles published in several databases through October 2022 and relevant reference lists. We used the standardised mean difference (SMD) as the main effect size indicator and focused on SRS metrics from baseline to endpoint. We analysed subgroups, heterogeneity, bias risk, and publication bias. ResultsOur meta-analysis included 214 children from seven randomised controlled trials with nine datasets. Forest plot analysis shows CBT improved social skills in children with autism compared to controls. Subgroup analysis revealed parents' and teachers' SRS scores for children, SRS scores of CBT versus waitlist controls, and those of CBT versus non-waiting-list controls. LimitationsMost randomised controlled CBT trials for children with autism have explored anxiety symptom improvement. Further, social skill assessment was a secondary outcome or not assessed. Thus, social skills data are insufficient. ConclusionsCBT is effective in improving social impairment in children with autism. RegistrationThis meta-analysis was registered with the International Prospective Register of Systematic Reviews (CRD42022363423).

What is the impact of stress on the onset and anti-thyroid drug therapy in patients with graves’ disease: a systematic review and meta-analysis

BackgroundThe effect of stress on Graves’ disease (GD) is controversial. Our purpose was to quantify the impacts of stress on patients with Graves’ disease.MethodsSystematic searches of PubMed, MEDLINE, Embase, Web of Science, Scopus, Cochrane Library and PsycInfo were conducted from inception to 1 January 2023. Studies comparing the incidence of stressful life events (SLEs) that occurred before diagnosis and during drug therapy in cases diagnosed with GD and controls were included in the final analysis.ResultsNine case-control studies and four cohort studies enrolling 2892 participants (1685 [58%] patients) were included. Meta-analysis revealed a high and significant effect-size index in a random effect model (d = 1.81, P = 0.01), indicating that stress is an important factor in the onset of GD. The relationship between SLEs and GD was stronger in studies with higher proportions of female patients (β = 0.22, P < 0.01) and weaker in studies with older patients with GD (β =−0.62, P < 0.01). However, stress did not significantly affect the outcome of antithyroid drug therapy for GD (d = 0.32, P = 0.09).ConclusionsThe results of this meta-analysis suggest that stress is one of the environmental triggers for the onset of GD. Therefore, we recommend stress management assistance for individuals genetically susceptible to GD, especially for young females.

Meta-Analysis of Tablet-Mediated Interventions to Teach Mathematics for Individuals With Autism Spectrum Disorder and/or Intellectual Disability

Tablet-mediated interventions have shown promise in improving the mathematical skills of individuals with autism spectrum disorder (ASD) and/or intellectual disability (ID). This meta-analysis aims to provide a quantitative synthesis of single-case experimental studies of using tablet-mediated interventions to teach mathematics to individuals with ASD and/or ID. Twenty-seven published studies between 2012 and 2022 were included. The Tau-U effect size index was used to gauge the overall effect size of tablet-mediated interventions. The obtained effect size (Tau-U = 0.98, 95% CI 0.92–1.00) indicated large improvements in mathematics performance after using tablet-mediated interventions. The analysis of potential moderating variables, including participant characteristics, intervention components, and target mathematical skills found no statistically significant moderators. Implications for researchers and practitioners who use tablet-mediated interventions to teach mathematics to individuals with ASD and/or ID are also discussed.

Methods for estimating the sampling variance of the standardized mean difference.

One of the most widely used effect size indices for meta-analysis in psychology is the standardized mean difference (SMD). The most common way to synthesize a set of estimates of the SMD is to weight them by the inverse of their variances. For this, it is necessary to estimate the corresponding sampling variances. Meta-analysts have a formula for obtaining unbiased estimates of sampling variances, but they often use a variety of alternative, simpler methods. The bias and efficiency of five different methods that have been proposed and that are implemented in different computerized calculation tools are compared and assessed. The data from a set of published meta-analyses are also reanalyzed, calculating the combined estimates and their confidence intervals, as well as estimates of the specific, between-studies variance, using the five estimation methods. This test of sensitivity shows that the results of a meta-analysis can change noticeably depending on the method used to estimate the sampling variance of SMD values, especially under a random-effects model. Some practical recommendations are made about how to choose and implement the methods in calculation resources. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

IS THE RACEWALKING BIOMECHANICS SIGNIFICANTLY INFLUENCED BY COACHING?

While there is a significant number of analyses of influence of coaching and training content on performance, detailed analyses linking teaching the technique and biomechanics indicators in literature are rather scarce. The purpose of the study was to determine the differences between two groups of racewalkers in the selected variables describing their gaits. The research method consisted of measuring ground reaction forces as well as kinematics of motion recorded by video cameras and the OptoJumpNext system of 14 athletes from two distinct training groups of athletes walking at individually determined speed. To identify the differences in 9 key variables between the two groups, a two-sample unpaired T-test was performed, which was also controlled by Cohens' effect size indicator. The main finding of the study is that 5 key variables unrelated to walking speed were statistically different between the two groups, with Group A (predominantly "M"-shaped) having a lower ratio of peak ground reaction force (GRF) to GRF at 70% of the contact phase (p=0.0000), lower ratio of total GRF at the end and beginning of the interval 70% - 80% (p=0.0006), greater pelvic rotation (p=0.0056) and a more upright posture with lower forward pelvic tilt (p=0.0001) and lower backward thoracic tilt (p=0.0000). There were no significant differences between the two groups in two variables describing upper body movement i.e. arm-swing angle and thoracic rotation. Another variable (peak GRF) was also statistically different between the two group (p=0.0000), but this variable is related to the walking speed, which was not identical for the two groups. In conclusion, differences in the selected biomechanical indicators, that are trainable according to literature, may have been influenced by apparently different training approaches applied within the two groups of athletes. We suggest that, although the gait in racewalking is rather strictly defined by the rules, the above variables can and should be controlled and influenced by training to develop a smooth racewalking technique with lower peak ground reaction forces.

How big is a big hazard ratio in clinical trials?

Background: The hazard ratio has been widely used as an index of effect size in clinical trials for time-to-event data. The use of the Cox proportional hazards models and other hazard centered models is ubiquitous in clinical trials for time-to-event data. The relativity of effect sizes (small, medium, large) has been widely discussed and accepted when comparing magnitude of association for continuous and categorical data, but not yet for time-to-event outcomes. Methods: We review published hazard ratios, investigate the relationships among HR, relative risk (RR), odds ratio (OR), and Cohen’s d, and calculate the corresponding HRs for given event rate in control group ( ) by adding standard normal deviation with 0.2 (small), 0.5 (medium) and 0.8 (large) to the event rate in the case group ( based on equation . Results: Our results indicate that HRs are from 1.68 to 1.16 when the event rate of control group moves from 1% to 90%, which are equivalent to Cohen’s d = 0.2 (small). HRs are ranged between 3.43 and 1.43 when the event rate of control group moves from 1% to 90%, which are equivalent to Cohen’s d = 0.5 (medium), HRs are valued between 6.52 and 1.73 when the event rate of control group moves from 1% to 90%, which are equivalent to Cohen’s d = 0.8 (large). Conclusions: This study provides general guidelines in interpreting the magnitudes of HRs for time-to-event data in clinical trials.

Diagnostic and prognostic value of stress CMR imaging to evaluate stable chest pain: a twenty-year meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnostic accuracy and prognostic value of stress CMR in patients with stable chest pain syndromes. Methods We performed a prespecified systematic review and meta-analysis of studies published over the last twenty years on the diagnostic and prognostic value of stress CMR (PROSPERO: CRD42022299275). We measured pooled diagnostic indicators, including diagnostic odds ratio (DOR), sensitivity, specificity, area under the curve (AUC), and summary effect size indicators, including odds ratios (ORs) and cumulative annualized event rates (AERs) for all-cause death, cardiovascular death and major adverse cardiac events (MACE). Results We identified 33 diagnostic studies pooling 7,815 individuals (mean age, 62 years, 62% males) and 31 prognostic studies pooling 67,080 patients (mean age, 62 years; 57% males; mean follow-up 3.5 years for a total of 381,357 person-years). Stress CMR yielded a pooled DOR of 26.4 (95%CI:10.6–65.9), a sensitivity of 81% (95%CI:68–89%), a specificity of 86% (95%CI:75–93%), and an AUC of 0.84 (95%CI:0.77–0.89) for the detection of functionally obstructive CAD with fractional flow reserve as the reference test. In subgroup analysis, 3 Tesla imaging yielded higher diagnostic accuracy achieving a DOR of 33.2. Presence of stress-inducible ischemia was associated with higher all-cause mortality (OR:2.0; 95%CI:1.7–2.3), cardiovascular mortality (OR:6.4; 95%CI:4.5–9.1), and increased risk of MACE (OR:5.3; 95%CI:4.0–7.0). AERs for cardiovascular death and MACE were &amp;lt; 1% in patients without stress-inducible ischemia. Conclusion Stress CMR yields high diagnostic accuracy and delivers robust prognostication in patients with stable chest pain and known or suspected CAD, particularly with 3 Tesla imaging. While inducible ischemia portends excess mortality and increased risk of MACE, a negative stress CMR indicates a very low risk of future cardiovascular events, with a warranty period of at least 3.5 years.

Effectiveness of Cognitive-behavioral Therapy on the Positive and Negative Psychotic Symptoms and Emotion Regulation of Patients With Schizophrenia Spectrum Disorders

Objective Schizophrenia is the most debilitating psychiatric disorder with the highest psychiatric ward admission rate. Drug therapy is the first line of treatment. However, it does not result in appropriate therapeutic responses in many patients, and they experience emotional regulation difficulties and psychosis symptoms after initial symptom resolution. Cognitive-behavioral therapy (CBT) is currently an adjuvant treatment besides drug therapy to target the persistent symptoms of psychosis. The present study aims to determine the effectiveness of CBT on the positive and negative symptoms and emotional regulation of those suffering from schizophrenia spectrum disorders. Materials &amp; Methods The research design was single-subject and of the AB type (baseline and intervention) with a follow-up phase. Besides the routine therapy sessions, CBT sessions were held for the study participants. They were patients admitted to Razi Educational and Therapeutic and Research Psychiatric Center in Tehran City, Iran, who were selected based on the inclusion criteria. Thirty patients were selected with convenience sampling, and 5 were randomly placed in the CBT group. They were evaluated with the scales of positive and negative symptoms of Kay, Fiszbein, and Opler (1986) and difficulties in emotional regulation by Gratz and Roemer (2004) in the baseline, intervention, and follow-up phases. The treatment sessions were planned based on the CBT protocol developed by Laura Smith, Paula Nathan, Uta juniper, Patrick Kingsep, and Louella Lim (2003). Non-overlap of all pairs (NAP), percentage of non-overlapping data (PND), percentage of all non-overlapping data (PAND), percentage of data points exceeding the median (PEM), Cohen’s d effect size, and improvement percentages were used to analyze the data, and visual graphs were used for data presentation. Results The outcomes showed that in the intervention phase, compared to the baseline phase, the effect sizes of the positive and negative symptoms in the first to fifth participants were 1.6, 3.1, 3.2, 1.9, and 2.4, respectively. Only the effect sizes of the second and third participants were large. The effect sizes of the emotional regulation factor in the first to fifth participants were 2.8, 1.2, 1.1, 2.2, and 1.9, respectively. The effect size of the second participant was large, and the rest were average. The findings of this study showed that during the post-therapy and follow-up stages, while patients who had received CBT still experienced positive and negative symptoms of psychosis and difficulties in emotional regulation; these symptoms decreased in comparison with the baseline phase. Furthermore, their improvement percentages were not significant. Conclusion Data analysis showed that although CBT is effective in reducing positive and negative psychotic symptoms and improving the emotional regulation of patients, the data obtained from Cohen’s d effect size and recovery indices showed that the results are not clinically significant. In other words, although the patients who received CBT showed a slight improvement in psychotic symptoms and difficulty in emotional regulation, they could not maintain the therapeutic gains in the follow-up phase.

Effects of age, seasonality, and reproductive status on the gut microbiome of Southern White Rhinoceros (Ceratotherium simum simum) at the North Carolina zoo

BackgroundManaged southern white rhinoceros (Ceratotherium simum simum) serve as assurance populations for wild conspecifics threatened by poaching and other anthropocentric effects, though many managed populations experience subfertility and reproductive failure. Gut microbiome and host health are inextricably linked, and reproductive outcomes in managed southern white rhinoceros may be mediated in part by their diet and gut microbial diversity. Thus, understanding microbial dynamics within managed populations may help improve conservation efforts. We characterized the taxonomic composition of the gut microbiome in the managed population of female southern white rhinoceros (n = 8) at the North Carolina Zoo and investigated the effects of seasonality (summer vs. winter) and age classes (juveniles (n = 2; 0–2 years), subadults (n = 2; 3–7 years), and adults (n = 4; >7 years)) on microbial richness and community structure. Collection of a fecal sample was attempted for each individual once per month from July-September 2020 and January-March 2021 resulting in a total of 41 samples analyzed. Microbial DNA was extracted and sequenced using the V3-V4 region of the 16S rRNA bacterial gene. Total operational taxonomic units (OTUs), alpha diversity (species richness, Shannon diversity), and beta diversity (Bray-Curtis dissimilarity, linear discriminant analysis effect size) indices were examined, and differentially enriched taxa were identified.ResultsThere were differences (p < 0.05) in alpha and beta diversity indices across individuals, age groups, and sampling months. Subadult females had higher levels of Shannon diversity (Wilcoxon, p < 0.05) compared to adult females and harbored a community cluster distinct from both juveniles and adults. Samples collected during winter months (January-March 2021) possessed higher species richness and statistically distinct communities compared to summer months (July-September 2020) (PERMANOVA, p < 0.05). Reproductively active (n = 2) and currently nonreproductive adult females (n = 2) harbored differentially enriched taxa, with the gut microbiome of nonreproductive females significantly enriched (p = 0.001) in unclassified members of Mobiluncus, a genus which possesses species associated with poor reproductive outcomes in other animal species when identified in the cervicovaginal microbiome.ConclusionTogether, our results increase the understanding of age and season related microbial variation in southern white rhinoceros at the North Carolina Zoo and have identified a potential microbial biomarker for reproductive concern within managed female southern white rhinoceros.

Child maltreatment and alexithymia: A meta-analytic review.

Alexithymia refers to difficulties identifying and describing one's emotions. Growing evidence suggests that alexithymia is a key transdiagnostic risk factor. Despite its clinical importance, the etiology of alexithymia is largely unknown. The present study employs meta-analytic methods to summarize findings on the role of one hypothesized antecedent of adult alexithymia, namely child maltreatment. We obtained effect size estimates from 99 independent samples reported in 78 unique sources that reported both child maltreatment history and adult levels of alexithymia. These studies involved a total of 36,141 participants. Using correlation coefficients as our effect size index, we found that child maltreatment was positively related to overall adult alexithymia (r = .23 [.19, .27]). Notably, emotional abuse (r = .18 [.13, .23]), emotional neglect (r = .21 [.16, .26]), and physical neglect (r = .18 [.15, .22]) were the strongest predictors. Effects were moderated by gender, affiliation with clinical versus nonclinical samples, and publication status. Overall results were robust to publication bias and the presence of outliers. These findings contribute to a more nuanced understanding of the complex connection between different types of child maltreatment and alexithymia, providing greater insight into the early environmental influences on alexithymia. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Abstract 5327: Automated organoid alignment for clonal response characterization in pancreatic ductal adenocarcinoma

Abstract Background: Therapeutic screening Pancreatic Ductal Adenocarcinoma (PDAC) relies on well-level assessment for high throughput response evaluation. Patient-derived cancer organoids (PCOs) model subclonal populations, however the significance of resistant populations is uncertain when characterized with well-level response. Using a high-throughput screening assay, we present an automated alignment algorithm to characterize populations of organoid growth as compared to validated well-level therapeutic response assays. Methods: High content imaging was performed in low volume (10uL), 96-well angiogenesis plating format (Ibidi, Inc) at 4x objective with 5-frame Z-stack (600um) with brightfield imaging captured at 0h and 72h. Images underwent processing using Gen5 suite (Biotek, Inc) including Z-projection to render organoids into single two-dimensional planes. Baseline objects were defined between 50µm and 750µm, and filtration based on circularity defined as &amp;gt;0.4. Object alignment was performed based on root-mean-square-deviation (RMSD) between all combinations of objects to optimize match determination. This analysis was performed in drug screen of 80 independent agents in early clinical trials in combination with CDK7 inhibitor, SY-5609. Well level viability was performed using standardized 3D CellTiterGlo (CTG, Promega Inc.) (33% v/v). Response was assessed using descriptive statistics, effect size (Glass’s Δ), and Therapeutic Sensitivity Index (TSI) defined as the weighted average between elements with growth from media control versus treated population. Results: Z projection of 600um in Low-volume plating (10µL) of matrix suspension yielded 1.68 organoids per µL relative to the traditional hanging drop design (50µL) 0.75 organoids per µL (p&amp;lt;0.005). Organoid alignment across the continuum of RMSD yielded maximum successful matches at 75µm with 66.1% of objects versus 6.7% based on randomly assigned objects across validation experimental sets (n=1380). An optimal circularity value was determined at 0.4; an increase of circularity by 0.1 yielded a &amp;gt;5% reduction in of matched objects, while a decrease in circularity by 0.1 yielded a &amp;lt;5% reduction in unmatched objects. A poor correlation was seen for the percent of growing organoids within a population and well level normalized viability via CTG (R = 0.37). The normalized CTG value had improved in correlation when compared to effect size relative to control (R = 0.54) and TSI (R = 0.56). Conclusion: We provide a method for high fidelity alignment of PCOs in low-volume format for matrix-based screening applications. These techniques can be adapted to existing staining protocols to characterize subclonal response in the context of both molecular heterogeneity and clinical outcomes. Citation Format: Ethan Samuel Lin, Md Shahadat Hossan, Austin Stram, Eleanor E. Riedl, Luke J. Koeppel, Jaimie M. Warner, Jeremy D. Kratz. Automated organoid alignment for clonal response characterization in pancreatic ductal adenocarcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5327.

Wybrane wskaźniki wielkości efektu w badaniach psychologicznych

Reflecting the changing statistical practice in psychological research, dominated by null hypothesis testing using a decision about the level of significance of the results, the recommendations are indicated for reporting effect sizes in papers. The study presents the concept of the effect size and indicates its place in data analysis regarding to outcome’s significance. The purpose of the work is to describe selected effect size indicators and to point the need of use and their proper presentation and interpretation in social sciences empirical work data analysis reports. Considering statistical analysis approach limits based on significance level only, the study presents the possibility of including in the data analysis an indicator of a more practical use which is the size of the effect. By using the most popular analysis methods, such as, Student t -test, univariate analyses of variance in between- and within-group schemes as well as Wilcoxon test, Mann-Whitney’s U , Kruskal-Wallis H , Friedman’s test and considering analysis for qualitative data, matched to research plans indicators of the effect size were presented. The paper presents the use, calculation and interpretation of the size effect such as: Cohen’s d , Hedges g , delta, Glass’s r g , matched pairs correlation r c , eta-square, omega-square and epsilon-square, Kendall’s W and fi , Cramer’s V as well as odds ratio and relative risk. The presentation of the effect size indicators was contrasted with the corresponding research plans and the type of data collected.

Accurate Confidence and Bayesian Interval Estimation for Non-centrality Parameters and Effect Size Indices

Reporting effect size index estimates with their confidence intervals (CIs) can be an excellent way to simultaneously communicate the strength and precision of the observed evidence. We recently proposed a robust effect size index (RESI) that is advantageous over common indices because it’s widely applicable to different types of data. Here, we use statistical theory and simulations to develop and evaluate RESI estimators and confidence/credible intervals that rely on different covariance estimators. Our results show (1) counter to intuition, the randomness of covariates reduces coverage for Chi-squared and F CIs; (2) when the variance of the estimators is estimated, the non-central Chi-squared and F CIs using the parametric and robust RESI estimators fail to cover the true effect size at the nominal level. Using the robust estimator along with the proposed nonparametric bootstrap or Bayesian (credible) intervals provides valid inference for the RESI, even when model assumptions may be violated. This work forms a unified effect size reporting procedure, such that effect sizes with confidence/credible intervals can be easily reported in an analysis of variance (ANOVA) table format.

1062 DIAGNOSTIC AND PROGNOSTIC VALUE OF STRESS CMR IMAGING TO EVALUATE STABLE CHEST PAIN: A TWENTY-YEAR META-ANALYSIS

Abstract Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnostic accuracy and prognostic value of stress CMR in patients with stable chest pain syndromes. Methods We performed a systematic review and meta-analysis of studies published over the last twenty years on the diagnostic and prognostic value of stress CMR (PROSPERO: CRD42022299275). We measured pooled diagnostic indicators, including diagnostic odds ratio (DOR), sensitivity, specificity, area under the curve (AUC), and summary effect size indicators, including odds ratios (ORs) and cumulative annualized event rates (AERs) for all-cause death, cardiovascular death and major adverse cardiac events (MACE). Results We identified 33 diagnostic studies pooling 7,815 individuals (mean age, 62 years, 62% males) and 31 prognostic studies pooling 67,080 patients (mean age, 62 years; 57% males; mean follow-up 3.5 years for a total of 381,357 person-years). Stress CMR yielded a pooled DOR of 26.4 (95%CI:10.6-65.9), a sensitivity of 81% (95%CI:68-89%), a specificity of 86% (95%CI:75-93%), and an AUC of 0.84 (95%CI:0.77-0.89) for the detection of functionally obstructive CAD with fractional flow reserve as the reference test. In subgroup analysis, 3 Tesla imaging yielded higher diagnostic accuracy achieving a DOR of 33.2. Presence of stress-inducible ischemia was associated with higher all-cause mortality (OR:2.0; 95%CI:1.7-2.3), cardiovascular mortality (OR:6.4; 95%CI:4.5-9.1), and increased risk of MACE (OR:5.3; 95%CI:4.0-7.0). AERs for cardiovascular death and MACE were &amp;lt;1% in patients without stress-inducible ischemia. Conclusions Stress CMR yields high diagnostic accuracy and delivers robust prognostication in patients with stable chest pain and known or suspected CAD, particularly with 3 Tesla imaging. While inducible ischemia portends excess mortality and increased risk of MACE, a negative stress CMR indicates a very low risk of future cardiovascular events, with a warranty period of at least 3.5 years.

Cognitive behavioral therapy for anxiety and depression in cancer survivors: a meta-analysis

This study aimed to investigate the effects of cognitive behavioral therapy (CBT) on anxiety and depression in cancer survivors. The PubMed, Embase, PsycINFO, and Cochrane Library databases were searched. Randomized controlled trials that evaluated the effects of CBT in cancer survivors were included. The standardized mean difference (SMD) was used as an effect size indicator. Fifteen studies were included. For the depression score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, SMD (95% confidence interval [CI]) = 0.88 (0.46, 1.29), P < 0.001; pre-treatment versus 3-month follow-up, 0.83 (0.09, 1.76), P = 0.08; pre-treatment versus 6-month follow-up, 0.92 (0.27, 1.58), P = 0.006; and pre-treatment versus 12-month follow-up, 0.21 (− 0.28, 0.70), P = 0.40. For the anxiety score, the pooled results of the random effects model were as follows: pre-treatment versus post-treatment, 0.97 (0.58, 1.36), P < 0.001; pre-treatment versus 3-month follow-up, 1.45 (− 0.82, 3.72), P = 0.21; and pre-treatment versus 6-month follow-up, 1.00 (0.17, 1.83), P = 0.02). The pooled result of the fixed effects model for the comparison between pre-treatment and the 12-month follow-up was 0.10 (− 0.16, 0.35; P = 0.45). The subgroup analysis revealed that the geographical location, treatment time and treatment form were not sources of significant heterogeneity. CBT significantly improved the depression and anxiety scores of the cancer survivors; such improvement was maintained until the 6-month follow-up. These findings support recommendations for the use of CBT in survivors of cancer.

Association of low-density lipoprotein cholesterol levels with the risk of mortality and cardiovascular events: A meta-analysis of cohort studies with 1,232,694 participants

Lowering elevated low-density lipoprotein cholesterol (LDL-C) is an important strategy to prevent cardiovascular disease (CVD), while some studies report low LDL-C increases all-cause mortality. Our study aimed to explore the appropriate low LDL-C level with the lower CVD risk but with no excess risk for all-cause mortality. PubMed, Embase, Cochrane Library, and Web of Science were searched until April 7, 2021. Twenty cohort studies with 1232,694 adults were obtained. Effect size index was evaluated using pooled relative risk (RR) with 95% confidence interval (CI). Heterogeneity was assessed using the Cochran's Q test and I2 statistic, and heterogeneity sources was investigated using meta-regression. Publication bias was assessed and sensitivity analysis was performed. The risks of all-cause mortality (RR: 1.34, 95%CI: 1.00-1.80), CVD death (RR: 1.79, 95%CI: 1.26-2.54), CHD death (RR: 2.03, 95%CI: 1.36-3.03) were higher in LDL-C ≥ 160 mg/dL than LDL-C of 70-129 mg/dL. Both LDL-C of 130-159 mg/dL and ≥ 160 mg/dL were associated with higher CVD risk than LDL-C of 70-129 mg/dL, with RR of 1.26 (95%CI: 1.08-1.47) and 1.70 (95%CI: 1.35-2.14), respectively. Compared to LDL-C of 70-129 mg/dL, no association was found between LDL < 70 mg/dL and all-cause mortality and CVD events. Our results found LDL-C ≥ 130 mg/dL was associated with the higher risk of all-cause mortality and CVD risk, indicating that adults with high LDL-C should take interventions to regulate the LDL-C level lower than 130 mg/dL.

Local control comparison of early-stage non-melanoma skin Cancer (NMSC) treated by superficial radiotherapy (SRT) and external beam radiotherapy (XRT) with and without dermal image guidance: a meta-analysis

BackgroundVarious treatments exist for non-melanoma skin cancer (NMSC), but the mainstay is surgical removal. Superficial radiotherapy (SRT) is one non-surgical technique that has been used for over a century but fell out of favor due to the advent of Mohs micrographic surgery (MMS). A new technology that combines a 22 megahertz (MHz) dermal ultrasound with SRT (US-SRT) enables tumor visualization before, during, and after treatment, and demonstrates increased cure rates and reduced recurrences.MethodsWe conducted a meta-analysis comparing the local control (LC) of four studies using traditional non-image-guided forms of radiotherapy for NMSC treatment to two seminal studies utilizing high-resolution dermal ultrasound-guided SRT (HRUS-SRT). The four traditional radiotherapy studies were obtained from a comprehensive literature search used in an article published by the American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions. The meta-analysis employed a logit as the effect size indicator with Q-statistic to test the null hypothesis.ResultsLC rates for the 2 US-SRT studies were statistically superior to the 4 traditional therapies individually and collectively. When stratified by histology, statistically superior outcomes for US-SRT were observed in all subtypes with p-values ranging from p < 0.0001 to p = 0.0438. These results validated an earlier analysis using a logistic regression statistical method showing the same results.ConclusionUS-SRT is statistically superior to non-image-guided radiotherapies for NMSC treatment. This modality may represent the future standard of non-surgical treatment for early-stage NMSC.

Response willingness in consecutive travel surveys: an investigation based on the National Household Travel Survey using a sample selection model

Declining survey response rates have increased the costs of travel survey recruitment. Recruiting respondents based on their expressed willingness to participate in future surveys, obtained from a preceding survey, is a potential solution but may exacerbate sample biases. In this study, we analyze the self-selection biases of survey respondents recruited from the 2017 U.S. National Household Travel Survey (NHTS), who had agreed to be contacted again for follow-up surveys. We apply a probit with sample selection (PSS) model to analyze (1) respondents’ willingness to participate in a follow-up survey (the selection model) and (2) their actual response behavior once contacted (the outcome model). Results verify the existence of self-selection biases, which are related to survey burden, sociodemographic characteristics, travel behavior, and item non-response to sensitive variables. We find that age, homeownership, and medical conditions have opposing effects on respondents’ willingness to participate and their actual survey participation. The PSS model is then validated using a hold-out sample and applied to the NHTS samples from various geographic regions to predict follow-up survey participation. Effect size indicators for differences between predicted and actual (population) distributions of select sociodemographic and travel-related variables suggest that the resulting samples may be most biased along age and education dimensions. Further, we summarized six model performance measures based on the PSS model structure. Overall, this study provides insight into self-selection biases in respondents recruited from preceding travel surveys. Model results can help researchers better understand and address such biases, while the nuanced application of various model measures lays a foundation for appropriate comparison across sample selection models.

Episodic memory effects of gamma frequency precuneus transcranial magnetic stimulation in Alzheimer's disease: A randomized multiple baseline study.

Episodic memory decline is the prominent neuropsychological feature of typical Alzheimer's Disease (AD), for which current treatments have a limited clinical response. Recently, gamma entrainment therapy has been used as a non-invasive treatment in AD, providing evidence that it may have the potential to alleviate brain pathology and improve cognitive function in AD patients. At the same time, the precuneus (PC) has been recognized as a key area involved in AD related memory deficits and as a key node of the Default Mode Network. This study aimed to investigate the effectiveness of a 40 Hz Transcranial Magnetic Stimulation (TMS) intervention, delivered bilaterally to the precuneus for 10 days, in improving the patients' episodic memory performance. Secondary outcome variables investigated included general cognitive function, semantic and spatial memory, as well as attention and executive function. A concurrent multiple baseline design across five cases was employed. Four patients completed the study. Visual analysis combined with effect size indices were used to evaluate changes across phases. An increase in the average level of immediate recalled words was observed in three out of four patients. Effect size indices indicated significant improvement of attention skills in two patients. No treatment effect was observed for semantic and visual memory, or for executive function. An immediate treatment effect was observed in all patients' general cognitive function as assessed with the Alzheimer's Disease Assessment Scale (mean reduction of 5 points), which was maintained and improved further three months post-treatment. The neuropsychological evaluations indicated improved performance three months post-treatment in immediate and delayed recall, attention, phonological verbal fluency, anxiety, and neuropsychiatric symptoms. This study provides preliminary evidence for the efficacy of a novel non-pharmacological treatment using gamma-band TMS in addressing cognitive dysfunction in AD.