Individual Differences In Outcomes Research Articles

GLI1 polymorphisms influence remission rate and prognosis of young de novo acute myeloid leukemia patients treated with cytarabine-based chemotherapy.

Acute myeloid leukemia (AML) is a highly heterogeneous hematological malignancy. Cytarabine (Ara-C)-based chemotherapy is the primary treatment for AML, but currently known prognostic risk stratification factors cannot fully explain the individual differences in outcome of patients. In this article, we reported that patients with homozygous GLI1 rs2228224 mutation (AA genotype) had a significantly lower complete remission rate than those with GG wild type (54.17% vs.76.02%, OR = 1.993, 95% CI: 1.062-3.504, P = 0.031). GLI1 rs2229300 T allele carriers had remarkably shorter overall survival (513 vs. 645days, P = 0.004) and disease-free survival (342 vs. 456days, P = 0.033) than rs2229300 GG carriers. Rs2229300 G > T variation increased the transcriptional activity of GLI1. CCND1, CD44 and PROM1 were potential target genes differentially regulated by GLI1 rs2229300. Our results demonstrated for the first time that GLI1 polymorphisms influence chemosensitivity and prognosis of young de novo AML patients treated with Ara-C.

Computer-based intervention for residents of domestic violence shelters with substance use: A randomized pilot study.

Intimate Partner Violence (IPV) is a significant public health problem often associated with serious mental health and physical health implications. Substance use disorders (SUDs) are one of the most common comorbidities among women with IPV, increasing risk of subsequent IPV. The current study examined the feasibility, acceptability, and preliminary effectiveness of a brief computerized intervention to reduce alcohol and drug use among women with IPV. Fifty women with recent IPV and alcohol and drug use risk were recruited from domestic violence shelters and randomized to the experimental computerized intervention or to an attention and time control condition. The primary outcome was percent heavy drinking or drug using days in 3 month increments over the 6 months after leaving the shelter. Receipt of substance use services and IPV severity were evaluated as secondary outcomes. The computerized intervention was feasible and acceptable, with high (n = 20, 80%) completion rates, engagement with the intervention, and satisfaction scores. As expected in this pilot trial, there were no significant differences between conditions in percent heavy drinking/drug using days or receipt of substance use services and large individual differences in outcomes. For example, receipt of substance use services decreased by a mean of 0.05 times/day from the baseline to the 6-month time period in the control condition (range -1.00 to +0.55) and increased by a mean of 0.06 times/day in the intervention condition (range -0.13 to +0.89). There were large decreases in IPV severity over time in both conditions, but directions of differences favored the control condition for IPV severity. A computerized intervention to reduce the risk of alcohol/drug use and subsequent IPV is feasible and acceptable among residents of a domestic violence shelter. A fully powered trial is needed to conclusively evaluate outcomes.

Abstract 15363: Safety of Leadless Pacemakers vs. Transvenous Pacemakers in Patients Older Than 65 Years

Introduction: Leadless pacemakers (LP) are a less invasive option compared to conventional transvenous pacemakers (TVP). They were introduced with the hope of eliminating complications associated with TVP and leads, which are more common among the elderly population. However, evidence supporting their use is uncertain. This study aims to compare the safety of the LP compared to TVP in patients 65 and older. Methods: We retrospectively analyzed consecutive patients, aged 65 and older, who were implanted a LP or TVP between August 2017 and November 2021, in 2 experienced Cardiovascular centers. The primary endpoint was a composite of any procedure-related complication (hematoma, venous thrombosis, infections, hemothorax, device dislodgement, pneumothorax). The secondary endpoint was the need for reinterventions. Results: A total of 313 patients were included; 219 received a TVP and 94 patients received a LP. Of the TVPs implanted, 68% used cephalic access, 21% axillary and 11% subclavian. The mean age was 78.9 + 7.76 for the TVP group and 82.6 +8.83 for the LP group. A total of 23 patients in the TVP group reached the primary end point vs 4 patients in the LP group, with a relative risk reduction of 60% of procedure related complications in LP compared to TVP (risk ratio [RR]:0.4; 95% CI (0.144-1.139); P= 0.043). In addition, 8 patients in the TVP group reached the secondary outcome vs none in the LP group (3.65% vs. 0%; p= <0.00001).. There were no statistically significant differences in individual outcomes between the TVP group and the LP group: incision-site hematomas (11 (5%) vs. 2 (2.1%); p=0.24), venous thrombosis (2 (2%) vs 1 (0.5 %); p=0.9), infections (1 (0.5%) vs 1 (1%) ; p=0.54), hemothorax (1 (0.5%) vs. 0 (0%); p=1), device dislodgement (8 (3.6%) vs 0 (0%); p=0.11), pneumothorax (none in either group). Conclusion: This study demonstrates that LP is a safer option than TVP among patients aged 65 and older. Additional studies are needed to further establish these findings. 1

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre.

Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.

Variability in Quantity and Quality of Early Linguistic Experience in Children With Cochlear Implants: Evidence from Analysis of Natural Auditory Environments.

Understanding how quantity and quality of language input vary across children with cochlear implants (CIs) is important for explaining sources of large individual differences in language outcomes of this at-risk pediatric population. Studies have mostly focused either on intervention-related, device-related, and/or patient-related factors, or relied on data from parental reports and laboratory-based speech corpus to unravel factors explaining individual differences in language outcomes among children with CIs. However, little is known about the extent to which children with CIs differ in quantity and quality of language input they experience in their natural linguistic environments. To address this knowledge gap, the present study analyzed the quantity and quality of language input to early-implanted children (age of implantation <23 mo) during the first year after implantation. Day-long Language ENvironment Analysis (LENA) recordings, derived from home environments of 14 early-implanted children, were analyzed to estimate numbers of words per day, type-token ratio (TTR), and mean length of utterance in morphemes (MLUm) in adults' speech. Properties of language input were analyzed across these three dimensions to examine how input in home environments varied across children with CIs in quantity, defined as number of words, and quality, defined as whether speech was child-directed or overheard. Our per-day estimates demonstrated that children with CIs were highly variable in the number of total words (mean ± SD = 25,134 ± 9,267 words) and high-quality child-directed words (mean ± SD = 10,817 ± 7,187 words) they experienced in a day in their home environments during the first year after implantation. The results also showed that the patterns of variability across children in quantity and quality of language input changes depending on whether the speech was child-directed or overheard. Children also experienced highly different environments in terms of lexical diversity (as measured by TTR) and morphosyntactic complexity (as measured by MLUm) of language input. The results demonstrated that children with CIs varied substantially in the quantity and quality of language input experienced in their home environments. More importantly, individual children experienced highly variable amounts of high-quality, child-directed speech, which may drive variability in language outcomes across children with CIs. Analyzing early language input in natural, linguistic environments of children with CIs showed that the quantity and quality of early linguistic input vary substantially across individual children with CIs. This substantial individual variability suggests that the quantity and quality of early linguistic input are potential sources of individual differences in outcomes of children with CIs and warrant further investigation to determine the effects of this variability on outcomes.

Neuropsychological care guidelines for people with spina bifida.

While the neuropsychological profile for individuals with Spina Bifida (SB) can vary, often certain patterns of strengths and weaknesses are evident across the lifespan. Understanding variability related to neural structure, genetics, ethnicity, and the environment is key to understanding individual differences in outcomes and can be vital in planning interventions and tracking progress. This article outlines the SB Guideline for the Neuropsychological Care of People with Spina Bifida from the 2018 Spina Bifida Association’s Fourth Edition of the Guidelines for the Care of People with Spina Bifida and acknowledges that further research in SB neurocognitive profiles is warranted.

Spinal manipulation and exercise for low back pain in adolescents: a randomized trial.

Low back pain (LBP) is common in adolescence, but there is a paucity of high-quality research to inform care. We conducted a multicenter randomized trial comparing 12 weeks of spinal manipulative therapy (SMT) combined with exercise therapy (ET) to ET alone. Participants were 185 adolescents aged 12 to 18 years with chronic LBP. The primary outcome was LBP severity at 12, 26, and 52 weeks. Secondary outcomes included disability, quality of life, medication use, patient- and caregiver-rated improvement, and satisfaction. Outcomes were analyzed using longitudinal linear mixed effect models. An omnibus test assessing differences in individual outcomes over the entire year controlled for multiplicity. Of the 185 enrolled patients, 179 (97%) provided data at 12 weeks and 174 (94%) at 26 and 52 weeks. Adding SMT to ET resulted in a larger reduction in LBP severity over the course of 1 year (P = 0.007). The group difference in LBP severity (0-10 scale) was small at the end of treatment (mean difference = 0.5; P = 0.08) but was larger at weeks 26 (mean difference = 1.1; P = 0.001) and 52 (mean difference = 0.8; P = 0.009). At 26 weeks, SMT with ET performed better than ET alone for disability (P = 0.04) and improvement (P = 0.02). The SMT with ET group reported significantly greater satisfaction with care at all time points (P ≤ 0.02). There were no serious treatment-related adverse events. For adolescents with chronic LBP, spinal manipulation combined with exercise was more effective than exercise alone over a 1-year period, with the largest differences occurring at 6 months. These findings warrant replication and evaluation of cost effectiveness.

Assessment of releases of translocated and rehabilitated Yucatán black howler monkeys (Alouatta pigra) in Belize to determine factors influencing survivorship.

Rehabilitation and reintroduction have become important to the management and welfare of primates worldwide. However, the suitability and success of these practices must be evaluated to determine their effectiveness as well as to improve programs and methods, as little is known about the factors influencing survival of released individuals. Between 2011 and 2014, 28 howler monkeys, Alouatta pigra, were released at Fireburn Reserve, northern Belize by the Primate Rehabilitation Centre of Belize: Wildtracks. From March to August 2015, field trips were made to determine the number and identity of surviving individuals to assess whether differences in individual outcomes (survived or disappeared) could be associated with specific characteristics or backgrounds of the monkeys. Fourteen of the twenty rehabilitated monkeys and seven of the eight translocated monkeys were found alive. The proportion of surviving individuals was not significantly different between rehabilitants and translocated animals, males and females, former pets and wild animals, short- and long-term rehabilitants, or different ages at release or intake. As mortality was low and none of the general factors analyzed influenced survivorship, it is suggested that chance or individual traits may be important in the outcomes of releases. This study provides an example of successful population reintroduction from both rehabilitation and translocation programs, and the first analyses of characteristics impacting the success of releases of howler monkeys.

Immune-related gene polymorphisms in pulmonary diseases.

Between the DNA sequences of two randomly-selected human genomes, which consist of over 3 billion base pairs and twenty five thousand genes, there exists only 0.1% variation and 99.9% sequence identity. During the last couple of decades, extensive genome-wide studies have investigated the association between single-nucleotide polymorphisms (SNPs), the most common DNA variations, and susceptibility to various diseases. Because the immune system's primary function is to defend against myriad infectious agents and diseases, the large number of people who escape serious infectious diseases underscores the tremendous success of this system at this task. In fact, out of the third of the global human population infected with Mycobacterium tuberculosis during their lifetime, only a few people develop active disease, and a heavy chain smoker may inexplicably escape all symptoms of chronic obstructive pulmonary disease (COPD), lung cancer, and other smoke-associated lung diseases. This may be attributable to the genetic makeup of the individual(s), including their SNPs, which provide some resistance to the disease. Pattern recognition receptors (PRRs), transcription factors, cytokines and chemokines all play critical roles in orchestrating immune responses and their expression/activation is directly linked to human disease tolerance. Moreover, genetic variations present in the immune-response genes of various ethnicities may explain the huge differences in individual outcomes to various diseases and following exposure to infectious agents. The current review focuses on recent advances in our understanding of pulmonary diseases and the relationship of genetic variations in immune response genes to these conditions.

Examination of Individual Differences in Outcomes From a Randomized Controlled Clinical Trial Comparing Formal and Informal Individual Auditory Training Programs

The purpose of this study was to determine if patient characteristics or clinical variables could predict who benefits from individual auditory training. A retrospective series of analyses were performed using a data set from a large, multisite, randomized controlled clinical trial that compared the treatment effects of at-home auditory training programs in bilateral hearing aid users. The treatment arms were (a) use of the 20-day computerized Listening and Communication Enhancement program, (b) use of the 10-day digital versatile disc Listening and Communication Enhancement program, (c) use of a placebo "books-on-tape" training, and (d) educational counseling (active control). Multiple linear regression models using data from 263 participants were conducted to determine if patient and clinical variables predicted short-term improvement on word-recognition-in-noise abilities, self-reported hearing handicap, and self-reported hearing problems. Baseline performance significantly predicted performance on each variable, explaining 11%-17% of the variance in improvement. The treatment arm failed to emerge as a significant predictor with other clinical variables explaining less than 9% of the variance. These results suggest that hearing aid users who have poorer aided word-recognition-in-noise scores and greater residual activity limitations and participation restrictions will show the largest improvement in these areas.

Bilingual children's long-term outcomes in English as a second language: language environment factors shape individual differences in catching up with monolinguals.

Bilingual children experience more variation in their language environment than monolingual children and this impacts their rate of language development with respect to monolinguals. How long it takes for bilingual children learning English as a second language (L2) to display similar abilities to monolingual age-peers has been estimated to be 4-6 years, but conflicting findings suggest that even 6 years in school is not enough. Most studies on long-term L2 development have focused on just one linguistic sub-domain, vocabulary, and have not included multiple individual difference factors. For the present study, Chinese first language-English L2 children were given standardized measures of vocabulary, grammar andglobal comprehension every year from 4 ½ to 6 ½ years of English in school (ages 8½ to 10½); language environment factors were obtained through an extensive parent questionnaire. Children converged on monolingual norms differentially according to the test, with the majority of children reaching monolingual levels of performance on the majority of tests by 5 ½ years of English exposure. Individual differences in outcomes were predicted by length of English exposure, mother's education, mother's English fluency, child's use of English in the home, richness/quality of the English input outside school and age of arrival in Canada. In sum, the timeframe for bilinguals to catch up to monolinguals depends on linguistic sub-domain, task difficulty and on individual children's language environment, making 4-6 years an approximate estimate only. This study also shows that language environment factors shape not only early-stage but also late-stage bilingual development.

Predicting treatment response in posttraumatic stress disorder.

Predicting treatment response in posttraumatic stress disorder.

Age-related Shift in Neural Complexity Related to Task Performance and Physical Activity

The human brain undergoes marked structural changes with age including cortical thinning and reduced connectivity because of the degradation of myelin. Although these changes can compromise cognitive function, the brain is able to functionally reorganize to compensate for some of this structural loss. However, there are interesting individual differences in outcome: When comparing individuals of similar age, those who engage in regular physical activity are less affected by the typical age-related decline in cognitive function. This study used multiscale entropy to reveal a shift in the way the brain processes information in older adults that is related to physical activity. Specifically, older adults who were more physically active engaged in more local neural information processing. Interestingly, this shift toward local information processing was also associated with improved executive function performance in older adults, suggesting that physical activity may help to improve aspects of cognitive function in older adults by biasing the neural system toward local information processing. In the face of age-related structural decline, the neural plasticity that is enhanced through physical activity may help older adults maintain cognitive health longer into their lifespan.

Will My Patient Benefit from Audiologic Rehabilitation? The Role of Individual Differences in Outcomes

Postfitting audiologic rehabilitation (AR) has been a recognized component of the management of hearing-impaired adults since World War II. Despite growing evidence that such interventions as individual auditory training and counseling-based group AR are effective augmentations to amplification, these programs are not commonly implemented in the audiology community. Although research suggests that, on average, patients who engage in AR have improved outcomes compared to those who do not, clinicians have a difficult time determining which of their patients will benefit, if at all, from any particular AR intervention. This article will explore the current literature on auditory training and counseling-based AR in the context of individual variability and those individual factors that are likely to influence postintervention performance. A model of progressive AR, based on patient-identified treatment goals, is proposed to help guide the clinician in making the most appropriate rehabilitative decisions for the patient.

Evaluating the Physical Fit of Receiver-in-the-Ear Hearing Aids in Infants

In spite of early identification and intervention efforts achieved by Early Hearing Detection and Intervention (EHDI) programs, many infants with hearing loss experience delays in early vocabulary development in comparison to peers with normal hearing (Mayne, Yoshinaga-Itano, Sedey, 2000a; Mayne, Yoshinaga-Itano, Sedey, Carey, 2000b; Moeller et al, 2007a, 2007b). One of the several factors that may contribute to individual differences in outcomes is inconsistent hearing aid use in this age group. This may be associated with the physical fit when using traditional behind-the-ear (BTE) hearing aids, since they are relatively large in comparison with the small and soft ear of an infant. Receiver-in-the-ear (RITE) hearing aids may be advantageous for use in pediatric fittings, since they are very tiny and lightweight and therefore sit comfortably on a small soft ear. To evaluate the use of a RITE hearing aid with an instant ear-tip especially developed for infants in terms of physical fit, stability, safety, and security of the device, as well as the use of retention tools (remedies for keeping the hearing aid securely on the ear) with this age group. A longitudinal study with hearing impaired infants fitted with RITE hearing aids was performed. Eighteen infants with mild to moderate/severe hearing loss participated in the study. The age range was 2-36 mo. Sixteen infants had worn hearing aids prior to their participation in the study. Each hearing impaired infant was fitted with the RITE hearing aid and an instant ear-tip, the size of which was chosen by the audiologist. The infants used the device for a period of 2-5 mo. Audiologists and parents completed questionnaires at every visit (5-7 visits in total). Responses were obtained using a category rating scale (Stevens, 1975) from 0 to 10. The data were analyzed using descriptive statistics and nonparametric statistics. Sixteen of the 18 children completed the study. At the end of the study, 11 of the 16 children were using the instant ear-tip, whereas five children were fitted with the receiver mounted in a custom earmold. The audiologists rated the RITE solution to provide a safe, stable, and secure fit. The general trend was that ratings improved over time. At the final follow-up session, all median ratings were between 8 and 10. Based on the positive results obtained in the study, the use of an appropriately designed RITE hearing aid is recommended for infants.

Some observations about cochlear implants: challenges and future directions

At the present time, cochlear implantation is the only available medical intervention for patients with profound hearing loss and is considered the “standard of care” for both prelingually deaf infants and post-lingually deaf adults. It has been suggested recently that cochlear implants are one of the greatest accomplishments of auditory neuroscience. Despite the enormous success of cochlear implantation for the treatment of profound deafness, especially in young prelingually deaf children, several pressing unresolved clinical issues have emerged that are at the forefront of current research efforts in the field. In this commentary we briefly review how a cochlear implant works and then discuss five of the most critical clinical and basic research issues: (1) individual differences in outcome and benefit, (2) speech perception in noise, (3) music perception, (4) neuroplasticity and perceptual learning, and (5) binaural hearing.

The Impact of Positive Psychology on Diabetes Outcomes: A Review

Background: Due to the intensive treatment requirements needed to maintain diabetes control, optimal diabetes outcomes can be difficult to achieve for individuals with type 1 or type 2 diabetes from child- hood through adulthood. While risk factors related to individual differences in outcomes have been studied in depth, there is a growing body of research that has revealed the effects of positive personal and environmental characteristics on diabetes management and glycemic control. The goal of this review is to summarize the existent literature on the role of positive characteristics in diabetes outcomes. Method: Extensive literature searches were conducted using Medline, PsychInfo, and CINAHL to identify studies assessing positive personal and environmental characteristics and diabetes outcomes. Included articles were published between 1989 and 2012. Results: Across the lifespan, positive personal characteristics such as self-efficacy, self-esteem, and adaptive coping were associated with diabetes management and glycemic control. Positive environmental factors such as parental monitoring and support were also important predictors of good outcomes, particularly for adolescents. Conclusions: Positive personal and environmental factors have been shown to be associated with diabetes outcomes and should be addressed in efforts to improve outcomes at all life stages. Clinical research and practice may be enhanced through efforts to evaluate and promote positive personal and environmental factors with the ultimate goal of reducing barriers to optimal diabetes management and control.

What contributes to perceived stress in later life? A recursive partitioning approach.

One possible explanation for the individual differences in outcomes of stress is the diversity of inputs that produce perceptions of being stressed. The current study examines how combinations of contextual features (e.g., social isolation, neighborhood quality, health problems, age discrimination, financial concerns, and recent life events) of later life contribute to overall feelings of stress. Recursive partitioning techniques (regression trees and random forests) were used to examine unique interrelations between predictors of perceived stress in a sample of 282 community-dwelling adults. Trees provided possible examples of equifinality (i.e., subsets of people with similar levels of perceived stress but different predictors) as well as identification both of contextual combinations that separated participants with very high and very low perceived stress. Random forest analyses aggregated across many trees based on permuted versions of the data and predictors; loneliness, financial strain, neighborhood strain, ageism, and to some extent life events emerged as important predictors. Interviews with a subsample of participants provided both thick description of the complex relationships identified in the trees, as well as additional risks not appearing in the survey results. Together, the analyses highlight what may be missed when stress is used as a simple unidimensional construct and can guide differential intervention efforts.

Quality of Life in Montevideo

This paper analyzes various dimensions of the quality of life in Montevideo. The paper finds that satisfaction with various public goods and services at the neighborhood level play a minor role in the overall reported well-being of individuals and in the satisfaction of life domains, such as leisure, social life, family, health, housing, neighborhood economic situation and work. This is in spite of significant disparities in a wide range of indicators among those living in different areas of the city. The results further suggest that differences in overall happiness and in domain satisfaction are mostly due to differences in individual outcomes like education, health, labor situation and housing quality.

A Mathematical Model of HIV Infection: Simulating T4, T8, Macrophages, Antibody, and Virus via Specific Anti-HIV Response in the Presence of Adaptation and Tropism

A mathematical model of the host's immune response to HIV infection is proposed. The model represents the dynamics of 13 subsets of T cells (HIV-specific and nonspecific, healthy and infected, T4 and T8 cells), infected macrophages, neutralizing antibodies, and virus. The results of simulation are in agreement with published data regarding T4 cell concentration and viral load, and exhibit the typical features of HIV infection, i.e. double viral peaks in the acute stage, sero conversion, inverted T cell ratio, establishment of set points, steady state, and decline into AIDS. This result is achieved by taking into account thymic aging, viral and infected cell stimulation of specific immune cells, background nonspecific antigens, infected cell proliferation, viral production by infected macrophages and T cells, tropism, viral, and immune adaptation. Starting from this paradigm, changes in the parameter values simulate observed differences in individual outcomes, and predict different scenarios, which can suggest new directions in therapy. In particular, large parameter changes highlight the potentially critical role of both very vigorous and extremely damped specific immune response, and of the elimination of virus release by macrophages. Finally, the time courses of virus, antibody and T cells production and removal are systematically investigated, and a comparison of T4 and T8 cell dynamics in a healthy and in a HIV infected host is offered.