Large Effect Size Differences Research Articles

Examining evidence of lung cancer stigma among health-care trainees.

Innovations in lung cancer control and care have started to transform the landscape of lung cancer outcomes, but lung cancer stigma and biases have been implicated as a deterrent to realizing the promise of these innovations. Research has documented lung cancer stigma among the general public and lung cancer survivors (self-blame), as well as clinicians across many disciplines. However, studies have not explored lung cancer stigma in health-care trainees. These data seek to address that gap and inform efforts to prevent the emergence or mitigate the presence of lung cancer stigma among future clinicians. Using clinical vignettes and a 2x2 factorial design, this investigation evaluated the impact of a history of smoking (yes vs no) and cancer diagnosis (lung vs colorectal) on perceptions of the described patient among 2 groups of preclinical health-care trainees (medical = 94 and nursing = 138). A charitable giving paradigm also asked participants to donate provided funds to 1 of 2 cancer advocacy organizations: one serving the lung cancer community and one serving the colorectal cancer community. In study 1, results revealed a consistent pattern of statistically significant and medium to large effect size differences regarding stigmatized perceptions (eg, higher stigmatizing behavior, increased pity, greater anger, and less helping) for individuals with a history of smoking but no reliable differences regarding cancer diagnosis. Analysis of data from nursing trainees in study 2 showed a similar pattern of statistically significant and medium to large effects pertaining to stigma behavior and perceptions of individuals who had a history of smoking depicted in the vignettes. The charitable giving paradigm did not identify any reliable difference between the groups in either study. Findings revealed a consistent pattern of health-care trainee perceptions that varied by smoking status but much less evidence that the cancer diagnosis contributed to different perceptions. This suggests that efforts to integrate consideration of stigma and biases in health-care training needs to adopt an approach that seeks to mitigate or eliminate stigmatizing perceptions and behaviors toward individuals with a history of smoking.

Active Direction: A new observational measure of African American parenting

A new observational measure of a culturally salient, supportive African American parenting style, Active Direction, was developed. Ratings were compared to standard qualitative ratings and across two ethnic groups. Active Direction represents the provision of structure to interactions in the form of corrective direction with clear and concise feedback that is assessed for supportiveness rather than simple content or tone. The 7-point rating item was examined in observations of African American (n = 172) and Hispanic American (n = 196) mother-child interactions collected at age 2.5 years in families from low-income households. Ratings were compared and associations to previously reported ratings of the interactions were examined. Active Direction was often observed among the African American mothers (81%) but rarely observed among the Hispanic mothers (16%), with a large effect size difference, supporting the hypothesis that Active Direction may represent a culturally specific approach to parenting for African American parents. Maternal behavior correlations of Active Direction with cognitive stimulation, intrusiveness, scaffolding, and calm authority and with child affiliative obedience and dyadic routines and rituals were significantly higher and detachment significantly lower in the African American compared to the Hispanic sample. The new measure of Active Direction, centered around culturally salient values and differences in both historical and lived experiences, addresses characteristics of parenting in African American families that are supportive of their children’s development and provides a fruitful direction for future research.

Abstract PO1-11-10: Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients

Abstract There is a steep linear increase in patients surviving a cancer diagnosis. Clinical solutions that address the high prevalence of cancer-related treatment effects (CRTE) are urgently needed. A stark example of this need is the dearth of screening and treatment programs for cancer related cognitive impairment (CRCI) (colloquially called “chemo-brain”). Up to 75% of cancer patients report neurocognitive changes that leave patients unable to cope with the expectations of employers, colleagues, families, and friends. The prevalence of neurological disorders is 275% higher among adult cancer patients, when compared to an adult cancer-free population. For many adolescent and young adult cancer patients, the onset of CRCI occurs during "cognitive prime time"; a time when individuals are pursuing education, careers, and raising families. To address a gap in CRTE we have implemented a virtual multi-disciplinary intervention to measure and treat CRCI. Our CRCI intervention follows National Comprehensive Cancer Network and American Society of Clinical Oncology (ASCO) guidelines for CRCI. These guidelines indicate a multi-disciplinary approach with emphasis on increasing physical activity levels, cognitive-behavioral therapy, memory adaptive training, mood management, and sleep optimization. Our approach also follows recent ASCO guidelines for nutrition counseling. Our CRCI program utilizes medical oncologists, physician assistants, mental health therapists, registered dietitians, and occupational therapists. A nationally validated patient reported outcome (PRO) measurement, analysis, and reporting platform informs clinical treatment pathways, monitors patient progress, guides clinical decision making, and improves patient/provider communication. Using health status measures for CRCI, and following American Cancer Society and ASCO guidelines, patients are risk-stratified into three personalized cancer survivor care pathways: 1) low-complexity patients; 2) medium-complexity patients; and 3) high-complexity patients. Low-complexity patients baseline PROs score in the normal range, medium-complexity patients are those who score below the norm (moderate to large effect size difference from normal), and high-complexity patients are those who score well below the norm (greater than larger effect size difference from normal). Low-complexity patients are enrolled into a self-management and continuation of care program. Medium-complexity patients are enrolled into a shared care program. High-complexity patients are enrolled into an acute care program. All three clinical pathways include continued risk-factor vital-sign surveillance. Nearly 100% (99%) of patients who enroll in our primary cancer survivor care program complete our PRO baseline (N=80). From a convenient sample of breast cancer patients (N=42), provisional results of patient-specific segmentation analyses reveal a nearly perfect bell-shaped curve, with 51% of the population classified within the definition of medium-complexity and even split of outliers (high-complexity 24% and low-complexity 24%). Additionally, of all patients in our primary cancer survivor care program who completed at least three measurement time points for health status measures of cognitive impartment (N=38), 92% had a positive experience, 71% had a clinically significant improvement in cognitive health, 21% had a no change in cognitive status, and only 8% had a decline in cognitive health. If these data, and PRO implementation approach hold true, this program could be scaled to national and international cancer survivor population suffering from CRCI. Citation Format: John Librett, Mark Kosinski, Gregory Litton. Use of a standardized tool for the evaluation and treatment of cancer related cognitive impairment (chemo-brain) among breast cancer patients [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-11-10.

50 Neuropsychological Functioning in Depression, Borderline Personality Disorder, and Suicidality

Objective:Depression and borderline personality disorder (BPD) are frequently comorbid psychiatric disorders that reliably share deficits in executive functioning (EF). In addition to EF, meta-analytic evidence indicates that processing speed and verbal memory are also affected in depression and BPD, but the impact of BPD further spans the domains of attention, nonverbal memory, and visuospatial abilities. Suicidality is a notable phenotypic commonality in depression and BPD. Neuropsychologically, there are consistent discrepancies between individuals who have and have not thought about suicide in global cognitive functioning, as well as between those who have attempted suicide and those who have just thought about suicide in EF. This study aims to replicate the effect size differences between these groups and explore whether neuropsychological functioning relates to dimensional measures of psychopathology.Participants and Methods:Right-handed women between the ages of 18 and 55 were recruited into one of three diagnostic groups: a) current major depressive episode (MDD; n=22); b) current major depressive episode with comorbid BPD (MDD+BPD; n=19); and c) absence of current major depressive episode and BPD (controls; n=20). Groups were also classified based on historical suicide attempt and on the presence or absence of historical suicidal ideation. Exclusions included bipolar disorder, neurodevelopmental disorder, moderate/severe brain injury, neurological illness, serious physical illness, eating disorder, and moderate/severe alcohol/substance use disorder. Participants were administered the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), Beck Depression Inventory (BDI-II), Interpersonal Needs Questionnaire (INQ), UPPS-P Impulsive Behavior Scale, Everyday Memory Questionnaire, Brief Visuospatial Memory Test (BVMT), California Verbal Learning Test (CVLT), Delis-Kaplan Executive Function System (D-KEFS) Color-Word Interference Test, D-KEFS Trail Making Test, D-KEFS Verbal Fluency, Wechsler Adult Intelligence Scale-IV Coding and Digit Span subtests, Wechsler Memory Scale-IV Logical Memory, and Wechsler Test of Adult Reading.Results:With one exception, analyses of raw scores indicated there were no significant neuropsychological differences between groups based on diagnosis, historical suicidal ideation, and suicide attempt (p>.05). However, individuals with MDD+BPD, historical suicidal ideation, or suicide attempt endorsed more memory complaints than the other groups with large effect size differences. Differences in self-reported impulsivity indicated large effects between controls and MDD+BPD, moderate to large effects when comparing controls to MDD and MDD to MDD+BPD, and moderate effects among the suicidal ideation and suicide attempt groups. Impulsivity was rated highest in those with MDD+BPD, historical suicidal ideation, or suicide attempt. These analyses applied false-discovery rate correction and adjusted for age. Using ridge regressions to separately predict depressive symptoms, BPD symptoms, and suicide risk factors, neuropsychological indices were most associated with suicide risk factors and explained 22.8% of INQ variance. Conversely, these indices explained 9.6% of ZAN-BPD variance and 0.6% of BDI-II variance.Conclusions:The neuropsychological literature on BPD describes moderate crosscutting neuropsychological dysfunction, and clarifying the distinct cognitive alterations associated with comorbid psychiatric disorders and suicide phenomena offers novel avenues of research for investigating their mechanisms. While neuropsychological functioning may not strongly relate to psychiatric symptomatology, it may contribute to meaningful algorithms of suicide risk in individuals with depression and BPD.

Preservice teachers’ health literacy levels and perceptions of teaching capabilities: an Australian case study

ABSTRACT Research studies focusing on schools and teachers’ capabilities to teach and develop students’ health literacy (HL) are few. Of the research that currently exists, teachers face difficulties when teaching health education to enhance students’ critical HL levels, with only one study examining preservice teachers (PSTs). The aim of this study is to explore one Australian University and two of its undergraduate initial teacher education (ITE) programs and the role that it plays in developing PSTs’ HL levels and capabilities to plan for promoting students’ HL. Twenty-three final year Health and Physical Education (HPE) and thirty-four final year Primary Education participants completed a Health Literacy Questionnaire. Five PSTs from each ITE program consented and were involved in focus group and individual interviews. Current HL levels were found to be higher across all nine sections for HPE PSTs when compared with Primary PSTs, showing medium to very large effect size differences, with all but one section reporting statistical significance. Interviews emphasised the need for ITE programs to focus on developing PSTs’ HL levels and to implement authentic opportunities to practice enhancing students’ HL. Findings provide insight into the role ITE programs in promoting PSTs’ HL before becoming graduate teachers in schools.

Impact of Family Caregiver and Patient Related Factors on Quality of Life in Head Neck Cancer Patients

To study an impact of family caregiver and patient related factors on quality of life in head- neck squamous cell carcinoma (HNC) patients. A descriptive cross-sectional study was conducted in department of radiation oncology at a rural tertiary cancer center from August 2019 to January 2022. Marathi speaking, newly diagnosed, non-metastatic, histopathology proven HNC patients who consented for study were included. Marathi version of an updated head neck specific European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-H&N43) was used. Indigenously prepared and validated interviewer administered questionnaire (IAQ) for patients and respective family caregiver (FCG) were used to understand attitude towards HNC(ATHNC) and FCG's attitude as a caregiver (ATC). Total score was directly proportional to ATHNC and inversely proportional to ATC. Graph-Pad, Instat-3 (California Inc) was used for statistical analysis. A total of 210 patients and respective FCG were interviewed. Subgroup analysis of QOL was done for 201 radically treated patients (RTP) with respect to age, sex, education, socioeconomic status, place of residence, duration of symptoms, stage and disease sub-site. QOL of palliative treatment group (N = 9) was compared with RTP. All these parameters had impact on QOL with medium to large effect size difference and minimum important difference/change. ATHNC was significantly better for young (p = 0.022), literate (p = 0.004) and upper socioeconomic class (USC) (p = 0.043) FCGs. It was significantly better for male (p = 0.003), literate (p = 0.001), USC (p = 0.004) patients presenting in early stage of disease (p = 0.013). Though it was not significant on multivariate analysis. ATHNC score of FCGs had significant effect on QOL of patients with respect to role function (RF) (p = 0.032), financial difficulties (FI) (p = 0.017) and sexuality (SX) (p = 0.048). Patients with higher ATHNC score had significantly better QOL with respect to social function (SF) (p = 0.0004), FI (p = 0.0002), body image (BI) (p = 0.0033) and social contact (SC) (p = 0.0057). QOL of patients having FCGs with lower ATC score was significantly better. QOL of patients with younger FCGs was significantly better with respect to FI (p = 0.0244) while it was significantly better for pain (PA) (p = 0.0462) and emotional function (EF) (p = 0.0144) if FCG was male. Suboptimal literacy and accountability level were few short comings of this study. Informer bias cannot be ruled out CONCLUSION: Age, sex, place of residence, educational level, socioeconomic status, duration of symptoms, stage, and site of lesion affects different QOL parameters differently and hence an individual QOL needs to be addressed. FCGs parameters affect QOL of patients. Understanding the determinants and its pattern of effect on QOL of patients will guide us to offer timely care and interventions in a pragmatic mode.

EFFECT OF UTILIZING INTERACTIVE VIRTUAL LAB ON STUDENTS PERFORMANCE IN PHYSICS

CLINT ERVEN H. MOSQUEDA. 2023. Effect of Utilizing Interactive Virtual Lab on Students Performance in Physics, MSTP Thesis. Graduate School, University of Southern Mindanao, Kabacan, Cotabato. 80pp.Major Adviser: JEAN R. MAGANAKA, MSTPThis research investigated the effect of utilizing interactive virtual lab (Labster) on students performance in physics among the grade 10 of Dungoan High School. It is a quasi-experimental research that uses the Randomized Pretest-Posttest Control Group Design, Using Matched Subjects. Differences in the performances of students who used Labster (experimental group) and with those who did not utilize it (control group) were tested in terms of the result in the posttest. Students performances were measured using a 40-item test that undergone pilot testing and content validation.Results revealed that the significant increase of students performance in the experimental group provides positive effect as (computed U = 2.000, p < 0.001). It wasfound that the use of Labster contribute on enhancing students learning in physics.Results in the rank gain scores with a significant difference in two groups (computed U = 5.500, p < 0.001) revealed that Labster also developed positive attitude towards learning physics with large Cliffs effect size difference of d = 0.71. Thus, there was a significant difference between the experimental and control group. The qualitative part of this research revealed that students perception in utilization of Labster was a great technological integration in terms of learning contents, interface design, and learning experiences with a weighted mean of 4.08, 4.34, and 4.72 respectively. Moreover, the experimental group experienced difficulties while using Labster such as (1) program incompatibility with lower processor (2) incapability to perform tasks with more than two activities at a time and (3) insufficient computer literacy.

0158 Preliminary Study of the Links Between Adverse Childhood Experiences and Actigraphy-Measured Sleep Characteristics in Young Adults

Abstract Introduction Adverse Childhood Experiences (ACEs) are highly stressful events during the first 18 years of life that have been linked with adverse adult health outcomes. Sleep is an important behavioral risk factor for a myriad of health outcomes that have been linked to ACE exposure. A growing body of evidence indicates that ACEs are associated with low self-reported sleep durations, but these findings should be verified using objectively measured sleep characteristics. The purpose of this study was to examine associations of ACE exposure with actigraphy-measured sleep duration, timing, and variability. Methods Methods: In twenty-four young adults (20F/4M; mean±SD, age=24±5 y), we assessed ACE exposure using the 10-item ACE scale and measured sleep characteristics over a ≥6 day period using a wrist-worn actigraphy device. Participants with 0–1 ACEs were characterized as low-ACE (ACE-low, n=10) and participants with 2+ ACEs were characterized as moderate-high-ACE exposure (ACE-mh, n=14). Independent samples t-tests and Hedges’ g effect sizes were used to compare total sleep duration, bed-time, get-up time, time-in-bed, sleep onset latency and the standard deviation of bed time and total sleep duration between groups. Results Time-in-bed was greater in ACE-mh than in ACE-low (mean±SE difference=-60±25 min; p=0.027; g=-0.95), yet there was no difference in total sleep duration (-9±10 min; p=0.46; g=-0.37). This discrepancy was accompanied by a non-significant, but large-effect size difference between ACE-mh and ACE-low (-15±7 min; p=0.051; g=-0.83) in sleep onset latency. There were no differences between groups in either bed-time (p=0.34; g=0.39) or get-up time (p=0.35; g=-1.2), nor in either bed-time (p=0.84; g=-0.08) or total sleep duration (p=0.36; g=-0.37) variability. Conclusion In contrast to prior evidence based on self-report, our initial evidence indicates that ACE exposure is not linked with shorter sleep durations or higher sleep variability when measured using actigraphy. Instead, ACE exposure is linked to greater time in bed and greater sleep onset latencies, suggesting that individuals exposed to ACEs may have less efficient sleep. Support (if any) Support: Research reported in this publication was supported in part by the NCATS of the NIH (UL1TR002537) and by the Injury Prevention Research Center through the CDC (R49 CE003095).

Modulating heart rate oscillation affects plasma amyloid beta and tau levels in younger and older adults

Slow paced breathing via heart rate variability (HRV) biofeedback stimulates vagus-nerve pathways that counter noradrenergic stress and arousal pathways that can influence production and clearance of Alzheimer's disease (AD)-related proteins. Thus, we examined whether HRV biofeedback intervention affects plasma Αβ40, Αβ42, total tau (tTau), and phosphorylated tau-181 (pTau-181) levels. We randomized healthy adults (N = 108) to use slow-paced breathing with HRV biofeedback to increase heart rate oscillations (Osc+) or to use personalized strategies with HRV biofeedback to decrease heart rate oscillations (Osc−). They practiced 20–40 min daily. Four weeks of practicing the Osc+ and Osc− conditions produced large effect size differences in change in plasma Aβ40 and Aβ42 levels. The Osc+ condition decreased plasma Αβ while the Osc− condition increased Αβ. Decreases in Αβ were associated with decreases in gene transcription indicators of β-adrenergic signaling, linking effects to the noradrenergic system. There were also opposing effects of the Osc+ and Osc− interventions on tTau for younger adults and pTau-181 for older adults. These results provide novel data supporting a causal role of autonomic activity in modulating plasma AD-related biomarkers.Trial registration: NCT03458910 (ClinicalTrials.gov); first posted on 03/08/2018.

Collegiate Outdoor Orientation Programming as a High-Impact Practice

Outdoor orientation programs (OOPs) use wilderness or adventure experiences as a transition of incoming first-year students to college and university settings. We explored resilience and flourishing outcomes from two OOP trips in Virginia and North Carolina using the Brief Resilience Scale, the Mental Health Continuum Short Form, and a thematic analysis of participant responses to open-ended survey items. Results illustrate a statistically significant, large effect size difference in flourishing between pre- and post-trip responses (d = .89), and the thematic analysis of open-ended post-trip questionnaire items illustrated the attainment of each of the program's OOP objectives. These results mirror previous findings evidencing the continued importance of this form of experiential learning to engender student success in higher education settings and further justify OOPs' inclusion within a high-impact practices framework.

Quantitative analyses of cytokine profiles reveal hormone-mediated modulation of cytokine profiles in recurrent spontaneous miscarriage

PurposeCytokines play important roles in pregnancy complications. Some hormones such as estrogen, progesterone, and dydrogesterone have been shown to alter cytokine profiles. Understanding how cytokine profiles are affected by these hormones is therefore an important step towards immunomodulatory therapies for pregnancy complications. We analyse previously published data on the effects of estrogen, progesterone, and dydrogesterone on cytokine balances in women having recurrent spontaneous miscarriages. Materials and methodsLevels of eight cytokines (IFN-γ, IL-2, IL-6, IL-10, IL-13, IL-17, IL-23, TNF-α) from n = 22 women presenting unexplained recurrent spontaneous miscarriages were studied. Cytokine values were recorded after in vitro exposure of peripheral blood cells to estrogen, progesterone, and dydrogesterone. We expand on earlier analysis of the dataset by employing different statistical techniques including effect sizes for individual cytokine values, a more powerful statistical test, and adjusting p-values for multiple comparisons. We employ multivariate analysis methods, including to determine the relative magnitude of the effects of the hormone therapies on cytokines. A new statistical method is introduced based on pairwise distances able to accommodate complex relations in cytokine profiles. ResultsWe report several statistically significant differences in individual cytokine values between the control group and each hormone treated group, with estrogen affecting the fewest cytokines, and progesterone and dydrogesterone both affecting seven out of eight cytokines. Exposure to estrogen produces no large effects sizes however, while IFN-γ and IL-17 show large effect sizes for both progesterone and dydrogesterone, among other cytokines. Our new method for identifying which collections (i.e. subsets) of cytokines best distinguish contrasting groups identifies IFN-γ, IL-10 and IL-23 as especially noteworthy for both progesterone and dydrogesterone treatments. ConclusionsWhile some statistically significant differences in cytokine levels after exposure to estrogen are found, these have small effect sizes and are unlikely to be clinically relevant. Progesterone and dydrogesterone both induce statistically significant and large effect-size differences in cytokine levels, hence therapy with these two progestogens is more likely to be clinically relevant. Univariate and multivariate methods for identifying cytokine importances provide insight into which groups of cytokines are most affected and in what ways by therapies.

Predominant polarity as a neurobiological specifier in bipolar disorder: Evidence from a multimodal neuroimaging study

BackgroundWhile predominant (PP) and onset polarity (OP) have considerable clinical and treatment implications in bipolar disorder (BD), the neurobiological underpinnings of PP and OP from a radiological perspective remain largely unknown. The main objective of this study is to investigate the neuroanatomical profile of polarity subphenotypes (PP and OP) in euthymic BD patients, using a standardized multimodal neuroimaging protocol to evaluate regional gray matter (GM) volumes, cortical thickness, as well as white matter (WM) integrity of major projection, commissural and association tracts. MethodsForty-two euthymic BD patients stratified for PP and OP and 42 healthy controls (HC) were included in this computational neuroimaging study to comprehensively characterize gray and white matter alterations. Univariate analyses of covariance (ANCOVAs) were conducted with Bonferroni corrections for each MRI modality and Cohen's d effect sizes were calculated for group comparisons. ResultsPhenotype-associated cortical thickness abnormalities and volumetric alterations were identified, but no WM changes ascertained. Specifically, we found a main effect of OP on GM volume of left middle frontal gyrus and of OP and PP (either or both) on cortical thickness of various regions previously implicated in BD, i.e. inferior frontal gyrus-pars opercularis (left) and pars orbitalis (bilateral), left lateral orbitofrontal gyrus, bilateral medial segment of the superior frontal gyrus, left planum polare, right anterior cingulate gyrus, left anterior and posterior insula, bilateral frontal operculum (both OP and PP); left anterior and posterior orbitofrontal gyrus, left transverse temporal gyrus, right posterior insula (only OP); and right medial frontal cortex (only PP). Based on the magnitude of differences on pairwise comparisons, we found a large effect of OP on cortical thickness in a single region (left anterior orbitofrontal gyrus) (OP-M > OP-D), while PP subgroups showed large or medium effect size differences in cortical thickness (PP-M > PP-D) in a wider array of regions (right medial frontal cortex, left frontal operculum, left inferior frontal gyrus-pars opercularis, bilateral medial segment of the superior frontal gyrus). For most regions, PP-D patients showed the greatest decreases in cortical thickness compared to HC while PP-M showed the smallest, with PP-U showing an “unspecified” pattern mostly lying in-between PP-D and PP-M. ConclusionsOur multimodal imaging findings suggest specific polarity BD subgroups with compromised cortical thickness; we recorded a greater impact of PP on brain structure compared to OP, which provides additional evidence that PP can be considered as a neurobiological specifier in BD.

Association of a Multimodal Intervention With Decreased Opioid Prescribing After Neck Dissection for Malignant Thyroid Disease With Short Hospital Stay

ImportancePrescribing practices for opioid medication after thyroid surgery have been well-studied and established; however, the need for pain management with opioid medication following lateral neck dissection for malignant thyroid disease with a short hospital stay has not been established.ObjectiveTo evaluate a multimodal opioid reduction intervention and its association with a decrease in prescribing of opioid medication at hospital discharge for patients after a lateral neck dissection for thyroid cancer.Design, Setting, and ParticipantsThis was a retrospective cohort study of patients treated from 2011 to 2021 by a tertiary academic institution that performs a high volume of thyroid cancer surgeries annually. We evaluated the electronic health records of 417 patients who had undergone lateral neck dissection for malignant thyroid disease from June 1, 2011, to June 30, 2021, and had a short hospital stay (≤3 days). Patients with longer stays (>3 days) or additional surgical procedures were excluded. Group 1 comprised patients who underwent a neck dissection before the intervention; and group 2, those who underwent the procedure after implementation of the intervention.InterventionA multimodal intervention composed of 3 components to reduce opioid prescribing at hospital discharge home after neck dissection for malignant thyroid disease with a short hospital stay.Main Outcomes and MeasuresThe primary outcome was the quantity of opioid medication prescribed in the postoperative period, measured as oral morphine milliequivalents (MME). The eta-squared effect size (η2ES) metric was used to determine the association of the intervention with a reduction in the MME quantities of opioid medication administered to inpatients and prescribed at discharge. An estimated need for opioids was established for the average patient undergoing lateral neck dissection for thyroid cancer based on the upper range of prescribing after intervention. The data were analyzed from January to March 2022.ResultsThe total study population was 417 patients: group 1 with 171 patients (mean [SD] age , 47.1 [15.6] years; 104 [61%] women; 144 [84%] non-Hispanic White) and group 2 with 246 patients (mean [SD] age , 46.2 [17.4] years; 146 [60%] women; 206 [83.7%] non-Hispanic White). The median MME prescribed at discharge for group 1 per patient was 225 MME compared with 0 MME for group 2, a large effect-size difference. There was a moderate association between the dose amount administered to an inpatient and the prescription dose they received at discharge (r, 0.33). Multiple linear regression analysis of sex, age, race and ethnicity, extent of surgery, and opioid reduction intervention showed that the intervention had a large clinically meaningful association with decreasing opioid prescriptions and dosage amounts at discharge (η2ES, 0.26; 95% CI, 0.19-0.33).Conclusions and RelevanceThe findings of this retrospective cohort study suggest that patients undergoing lateral neck dissections for thyroid cancer with short hospitalization needed very small amounts, if any, postoperative opioid medication for pain management. Adequate postoperative pain control was achieved using nonopioid interventions. Implementing an intervention to decrease the quantity of unnecessarily prescribed opioid medications during hospital discharge may help to reduce the risk of opioid addiction and overdose in patients after surgery.

Quantitative Assessment of Prewriting Skills in Children: The Development and Validation of a Tablet Assessment Tool

Our purpose in this study was to determine the feasibility of assessing children's prewriting with a new tablet tool, the Quantitative Assessment of Prewriting Skills (QAPS), while determining the validity of the QAPS for identifying visual motor skill differences. We recruited 10 children who were receiving occupational therapy (OT) services for visual motor deficits from a local OT clinic and 10 age-matched typically developing (TD) children from the local community. The QAPS assesses the accuracy of copying patterns on a tablet that records the child's finger position on the tablet, and the data are then analyzed for different dimensions of pattern copying. We found a large effect size difference in the QAPS total score between our two participant groups, with the OT group showing poorer performance than TD children; and, among nine assessment dimensions, roundness of a drawn circle showed the largest effect size difference between groups. The QAPS appears to be a promising tool for assessing visual motor skills, and it warrants additional testing in larger participant samples.

Comparison of Sprint Timing Methods on Performance, and Displacement and Velocity at Timing Initiation.

Weakley, J, McCosker, C, Chalkley, D, Johnston, R, Munteanu, G, and Morrison, M. Comparison of sprint timing methods on performance, and displacement and velocity at timing initiation. J Strength Cond Res 37(1): 234-238, 2023-Sprint testing is commonly used to assess speed and acceleration in athletes. However, vastly different outcomes have been reported throughout the literature. These differences are likely due to the sprint timing method rather than differences in athlete ability. Consequently, this study compared different sprint starting methods on sprint time and quantified the velocity and displacement of the athlete at the moment timing is initiated. Starting in a staggered 2-point stance, 12 team sport athletes were required to accelerate 10 meters for 10 repetitions. During each repetition, 5 independent timing methods were triggered. The methods were (a) triggering a Move sensor; (b) starting 50 cm behind the line; (c) triggering a front-foot switch; (d) triggering a rear-foot switch; and (e) starting with the front foot on the line. Timing for each method was initiated at different points during the acceleration phase, and the displacement and velocity of the centroid of the pelvis at the point of timing initiation was assessed under high-speed motion capture. The Move sensor had the smallest displacement and lowest velocity at the point of timing initiation, whereas the front-foot trigger demonstrated the largest displacement and highest velocities. Trivial to very large effect size differences were observed between all methods in displacement and velocity at the point of timing initiation. Furthermore, small to very large differences in time to 5 m were found. These findings emphasize that sprint outcomes should not be compared, unless starting methods are identical. In addition, to detect real change in performance, consistent standardized protocols should be implemented.

Handgrip as a measure of muscle strength and its physiological dependence on therapeutic variables: A randomized case

Clinical and medical data findings have traditionally been more representative of male than female subjects, and when combined, have not clearly differentiated between the groups. In this study there were no research questions initially contemplated, as the data were obtained from an educational setting, where participants completed tasks as part of a pedagogical program of preparation. The nature of the post-hoc analysis renders the study as a hypothesis-generating type rather than a hypothesis-testing one. It began as a cross-sectional quantitative analysis of performance on a task to explore the relationship between hand grip and three independent physiological variables. The data collected from all subjects were randomized since the total group of participants contained a disproportionate number of females as compared to males, this being a result of a demographic predominance of female students in a program of teacher preparation. Graphical analysis with the slope taken as a measure of hand grip dependence on three independent variables, and the correlation value used as a measure of association between variables yielded discernible differences. The grip strength dependence on the hand size as well as the wrist thickness show consistently significant differences for females only, with t-test of significance (p < .001), and large effect size differences based on Cohen’s d values of 3.08 and 1.92, respectively. The significance of the finding that female grip strength depends the most on wrist thickness has implications for rehabilitative and therapeutic settings.

Testosterone and Dihydrotestosterone Changes in Male and Female Athletes Relative to Training Status.

To establish if training volume was associated with androgen baselines and androgen responsiveness to acute exercise. During a "high-volume" training phase, 28 cyclists (14 men and 14 women) undertook oxygen-uptake and maximal-work-capacity testing. Two days later, they completed a repeat-sprint protocol, which was repeated 3 weeks later during a "low-volume" phase. Blood and saliva samples were collected before and after (+5 and +60min) the repeat-sprint protocol. Blood was assayed for total testosterone (TT), free testosterone (FT), and dihydrotestosterone (DHT) and saliva, for testosterone and DHT. Pretrial TT, FT, and DHT concentration was greater for males (P < .001, large effect size differences), and in both genders TT, DHT, and saliva for DHT was higher during high-volume loading (moderate to large effect size). Area-under-the-curve analysis revealed larger TT, FT, and DHT responses to the repeat-sprint protocol among females, and high-volume training was linked to larger TT, DHT, and saliva for DHT responses (moderate to large effect size). Baseline TT and FT correlated with oxygen uptake and work capacity in both genders (P < .05). DHT showed no acute performance correlation but was responsive to volume of training, particularly in females. This work informs on timelines and relationships of androgenic biomarkers in males and females across different training loads, adding to the complexity that should be considered in interpretation thereof. The authors speculate that testosterone may impact acute performance via behavioral mechanisms of motivation and attention; DHT, via training volume-induced androgenic promotion, may facilitate long-term adaptive changes, especially for females.

Predicting response to cognitive training for schizophrenia using results from two studies with different outcomes

BackgroundCollaborative data sharing between research groups provides an opportunity to explore the basis for the heterogeneity in cognitive training outcomes reported in the schizophrenia literature. The current analyses focused on the contribution of site and participant characteristics to these heterogeneous outcomes. MethodsData from two independent studies, from New York (NY) and Los Angeles (LA), were combined to yield a sample of 132 outpatient adults with schizophrenia/schizoaffective disorder. While similar treatment doses, cognitive exercises and outcome measures were used, sites differed in use of coaching, group discussion and compensation. Between-site differences in participant demographic and baseline clinical characteristics were tested. Regression examined predictors of change in cognition (MCCB) and functional capacity (UPSA) which could explain site differences in treatment effects. ResultsMedium to large treatment effect size differences in MCCB and UPSA favored the NY site over LA. When the studies were combined, the effect of site was significant for both outcomes with a medium effect size difference. After controlling for background characteristics, the effect of site was reduced for both outcomes, but remained significant for cognition. Improvement in UPSA was associated with better baseline MCCB (p < 0.001), lower baseline UPSA (p < 0.001) and younger age (p = 0.019). The overall model with site, baseline scores, and participant background characteristics explained about 30% to 40% of the variance in outcomes. DiscussionParticipant and treatment characteristics are both predictive of outcomes, but treatment characteristics may be more consequential to cognitive gain, while participant characteristics may be more consequential to change in functional capacity.

Tense Marking in the Kindergarten Population: Testing the Bimodal Distribution Hypothesis.

Purpose The purpose of this study was to explore whether evidence for a bimodal distribution of tense marking, previously documented in clinically referred samples, exists in a population-based sample of kindergarten children from a rural county in Tennessee. Method A measure of tense marking, the Test of Early Grammatical Impairment (TEGI) Screening Test, was individually administered to consented kindergarten students (N = 153) across three elementary schools in a single school district. The consented children constituted 73% of kindergartners in the district. Cluster analysis was used to evaluate the number and composition of latent classes that best fit the distribution of the TEGI Screening Test scores. Results Analysis of the scores revealed a distribution that deviated significantly from normality. Cluster analyses (Ward's, k-means, single linkage) revealed a two-cluster solution as the best fitting model. The very large effect-size difference in mean TEGI Screening Test score between the two clusters (d = 4.77) provides validation of an identifiable boundary delineating typical from atypical tense marking in this sample of kindergartners. The difference in tense marking across the two clusters was not attributable to child chronological age. The percentage of the sample comprising the low-performing cluster aligns with specific language impairment and developmental language disorder prevalence estimates. Conclusion Additional demonstrations of a bimodal distribution of tense marking in future studies with carefully defined samples could strengthen the clinical marker evidence and utility of this linguistic feature.

Menstrual variation in the acute testosterone and cortisol response to laboratory stressors correlate with baseline testosterone fluctuations at a within- and between-person level

Studies have compared HPA and HPG stress reactivity across the follicular and luteal phases to assess the menstrual impact of estradiol and progesterone fluctuations. Ovulatory shifts in baseline and stressor-induced testosterone among athletic women offer a new framework to explore these responses. Here we investigated menstrual variation in baseline testosterone as a predictor of the acute testosterone and cortisol response to laboratory stressors in female athletes. Using a semi-randomized crossover design, thirty athletic women completed a physical (4 × 6-s bike sprints) and psychological (5 × 2-min cognitive tests with social evaluation) stressor on day seven (D7), 14 (D14), and 21 (D21) of a menstrual cycle. Baseline fluctuations and acute changes in salivary testosterone and cortisol were measured. The D14 testosterone response to both stressors (13.7%) exceeded D7 (7.3%) and D21 (7.0%), whereas cortisol was less responsive on D14 (9.8%) than D7 (13.0%) and D21 (12.0%); all moderate to large effect size differences (p < 0.01). Baseline testosterone, which presented large individual and menstrual variation with a D14 peak, was significantly related (moderate correlations) to testosterone and cortisol stress reactivity on a between-person level. Both outcomes were related (weak correlations) to within-person fluctuations in baseline testosterone, but these effects were mediated by testing day. In conclusion, menstrual variation in baseline testosterone concentration correlated with testosterone and cortisol reactivity to a physical and psychological stressor. Thus, gradients of stressor-induced hormonal change showed some dependency to endogenous testosterone, both individual differences and fluctuations over time, among naturally cycling athletic women. Lay summary The female menstrual cycle is accompanied by dramatic shifts in estradiol and progesterone concentration, but less is known about testosterone variability and its role in stress regulation. In this study, menstrual fluctuations in baseline testosterone concentration correlated with acute testosterone and cortisol reactivity to laboratory stressors.