Mean Raw Scores Research Articles

Concurrent validity of the Single Assessment Numerical Evaluation and hip-specific patient-reported outcome measures.

The Single Assessment Numerical Evalution (SANE) score is a pragmatic alternative to longer patient-reported outcome measures (PROMs). The purpose of this study was to investigate the concurrent validity of the SANE and hip-specific PROMs in a generalized population of patients with hip pain at a single timepoint upon initial visit with an orthopaedic surgeon who is a hip preservation specialist. We hypothesized that SANE would have a strong correlation with the 12-question International Hip Outcome Tool (iHOT)-12, the Hip Outcome Score (HOS), and the Hip disability and Osteoarthritis Outcome Score (HOOS), providing evidence for concurrent validity of the SANE and hip-specific outcome measures in patients with hip pain. This study was a cross-sectional retrospective database analysis at a single timepoint. Data were collected from 2,782 patients at initial evaluation with a hip preservation specialist using the iHOT-12, HOS, HOOS, and SANE. Outcome scores were retrospectively analyzed using Pearson correlation coefficients. Mean raw scores were iHOT-12 67.01 (SD 29.52), HOS 58.42 (SD 26.26), HOOS 86.85 (SD 32.94), and SANE 49.60 (SD 27.92). SANE was moderately correlated with the iHOT-12 (r = -0.4; 95% CI -0.35 to -0.44; p < 0.001), HOS (r = 0.57; 95% CI 0.53 to 0.60; p < 0.001), and HOOS (r = -0.55; 95% CI -0.51 to -0.58; p < 0.001). The iHOT-12 and HOOS were recorded as a lower score, indicating better function, which accounts for the negative r values. This study was the first to investigate the relationship between the SANE and the iHOT-12, HOS, and HOOS in a population of patients with hip pain at the initial evaluation with an orthopaedic surgeon, and found moderate correlation between SANE and the iHOT-12, HOS, and HOOS. The SANE may be a pragmatic alternative for clinical benchmarking in a general population of patients with hip pain. The construct validity of the SANE should be questioned compared to legacy measures whose content validity has been more rigorously investigated.

Performance of the Social Responsiveness Scale-2 for the Assessment of Autistic Behaviors in a Sample of Canadian Preschool-Aged Children.

Behavioral traits of autism spectrum disorder (ASD) typically present in early childhood, underscoring the importance of screening tools for the early identification of ASD. The current study compared scores on the Social Responsiveness Scale-Second Edition (SRS-2) Preschool Form between the US standardization sample (n = 247) and a Canadian cohort of preschool-aged children (n = 595) recruited from the Maternal-Infant Research on Environmental Chemicals (MIREC) study. In the MIREC sample, we examined whether ASD-like traits are correlated with sociodemographic characteristics and child intellectual abilities, and how maternal ratings of social skills assessed by the SRS-2 are associated with maternal ratings of general problem behaviors. Mean total SRS-2 raw score was significantly lower in the MIREC sample (mean = 29.7, SD = 15.8) compared to the US standardization sample (mean = 41.9, SD = 26.0). Total raw score in the US standardization sample did not significantly differ between males (mean = 40.6, SD = 23.1) and females (mean = 42.8, SD = 28.7), whereas in the MIREC sample the total raw score was significantly higher among males (mean = 33.0, SD = 17.1) than females (mean = 26.6, SD = 13.9). A significantly larger proportion of the MIREC sample was White, younger in age, and had more educated parents compared to the US standardization sample. ASD-like traits were correlated with lower intellectual abilities, a less enriched home environment, more behavioral problems, and poorer adaptive skills. SRS-2 Preschool Form scores were significantly lower in the Canadian sample compared to the US standardization sample, which may reflect demographic differences between the two groups. Girls may be under-identified when SRS-2 Preschool Form norms are used for screening ASD.

Prevalence of anxiety and depression among cancer patients attending tertiary care hospital in Puducherry – A cross-sectional study

Objectives: Palliative care interventions for cancer patients are usually more effective when they provide them with cues for using the knowledge related to their disease, which helps them adjust and live through the different phases of the illness. The objective of the study is to find the prevalence of anxiety and depression among cancer patients and to assess their quality of life (QOL). Material and Methods: Hospital-based cross-sectional study was conducted among 226 oncology patients attending tertiary care hospitals. After obtaining consent, one-to-one interviews were conducted with cancer patients using a standard questionnaire. Depression anxiety stress scale 21 scale and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) scale were used. Ethical principles were adhered throughout the study. Data were analyzed using the Statistical Package for the Social Sciences software. Results: Out of 226 cancer patients, majority of them 151 (66.8%) were in the age group of 30–59 years and 148 (66.5%) were female. It was found that 62 (27.4%) had stress, 178 (78.8%) had anxiety and 154 (68.1%) were in depression. The mean raw score in overall QOL is 3.27 ± 0.94 standard deviation (SD) and in general health is 3.46 ± 0.81) (SD). Marital status (P = 0.001) and duration since the diagnosis of cancer (P = 0.005) had significant association with the environmental domain of the QOL of patients. Conclusion: This study emphasizes the need for palliative care for psychosocial support to cancer patient to improve their QOL. Comprehensive management for cancer patients by providing family support and a patient-friendly environment is needed.

USING HOSPITAL ELECTRONIC HEALTH RECORDS TO DETERMINE FRAILTY WITH THE PICTORIAL FIT-FRAIL SCALE

Abstract Hip fractures are common in older adults, particularly those that are frail. There is no “gold standard” tool to measure frailty retrospectively from hospital Electronic Health Records (EHRs). The aim of this research was to explore the utility of the Pictorial Fit-Frail Scale (PFFS) in determining frailty retrospectively in older adults admitted to hospital with a hip fracture. A random sample of 200 patients who had a hip fracture was extracted from a larger sample of 682 hip fractures that occurred in older adults (65 years and older) admitted to a Level 1 Trauma Center (April 2015-March 2019). Each EHR was reviewed to determine the availability of data and the score for each of the 14 PFFS domains. The majority, 189 (94.5%) of the EHRs, had data to complete 11-14 of the domains. Patient information was often unavailable to complete the domains of daytime tiredness and pain. The average age was 83.2 (SD 8.2), and 73.0% were female. The mean Raw PFFS score prior to admission was 9.7 (SD 6.6), and 45.5% of patients were classified as moderately or severely frail. Using the Standardized PFFS score (adjusted for up to three missing domains), the mean score was 11.8 (SD 7.9), and 58.2% of patients were classified as moderately or severely frail. The hospital EHR can be used to complete the PFFS. This finding provides researchers and healthcare professionals with a way to stratify older hospitalized patients by frailty, which may be a useful tool for evaluating health outcomes.

Cognitive performance and normative data between Hispanic and non‐Hispanic cohorts: Results from the South Texas Alzheimer’s Disease Research Center (ADRC)

AbstractBackgroundThe prevalence of Alzheimer’s disease and related dementias (ADRD) in the United States was estimated as 6.5 million people in 2022, with a five‐fold increase for the Hispanic/Latinx population expected by 2060. The South Texas Alzheimer’s Disease Center (STAC) was designated as a new ADRC in 2021 by the National Institute on Aging (NIA) with a specific aim to serve the growing needs of the local underrepresented Hispanic population. As cultural and linguistic factors can impact performance on cognitive tests, the goal of the study was to compare UDS‐3 cognitive test raw scores and normative data in Hispanic and non‐Hispanic adults without cognitive impairment residing in South Texas.MethodParticipants from the STAC cohort completed the Uniform Data Set (UDS), V.3.0, which includes demographics and neuropsychological battery. All batteries were administered in the participants’ preferred language, English. Normative data was calculated using Weintraub et al. (2018)’s age, sex, and education adjusted regression models for UDSNB 3.0. Mean differences between baseline visit raw scores and normative data were compared using independent sample t‐tests among Hispanic and non‐Hispanic participants.ResultThirty‐four Hispanic (mean age = 70.4, 67.6% female) and thirty‐eight non‐Hispanic (mean age = 71.9, 57.9% female) participants were included. Hispanic participants had fewer years of education relative to non‐Hispanic participants [M(SD)] = [14.7(2.5)] to [16.5(2.5)], respectively; (t(70.1) = 3.0, p = 0.004); although, the groups did not differ in age or sex distribution (p&gt;0.05). Hispanic and non‐Hispanic participants generally performed equivalently on the neuropsychological battery. However, Hispanics had lower mean raw scores on the Montreal Cognitive Assessment (MoCA) (t(70.8) = 3.6, p&lt;0.001) and the Multilingual Naming Test (MINT) (t(71) = 4.0, p&lt;0.001) relative to non‐Hispanic participants, which persisted when normative data was applied (MoCA: t(71) = 2.3, p = 0.024, MINT: t(71) = 2.8, p = 0.006).ConclusionOverall, Hispanic and non‐Hispanic participants performed similarly on the UDS‐3 neuropsychological battery. However, Hispanics had lower mean raw and normative scores on the MINT, as well as the MoCA which also includes language measures. Our findings highlight the importance of future research validating the sensitivity and specificity of normative data used in underrepresented populations, especially those at higher risk for ADRD.

Cognitive trajectories in relapsing-remitting multiple sclerosis: Evidence of multiple evolutionary trends.

Cognitive impairment (CI) frequently occurs in multiple sclerosis (MS) and is assumed to increase over time. However, recent studies have suggested that the evolution of cognitive status in patients with MS may be more heterogeneous than expected. Predicting CI remains also challenging, and longitudinal studies exploring the baseline determinants of cognitive performances are limited. No studies have explored the predictive value of patient-reported outcome measures (PROMs) regarding future CI. To explore the evolutionary patterns of cognitive status in a cohort of RRMS patients initiating a new disease modifying treatment (DMT), and to determine whether PROMs may have a predictive value for future CI. The present prospective study is a 12-month follow-up of a cohort of 59 RRMS patients who underwent yearly a comprehensive, multiparametric assessment combining clinical (with EDSS assessment), neuropsychological (BVMT-R, SDMT, CVLT-II), MRI-derived metrics and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A longitudinal logistic regression analysis was performed to find baseline correlates of CI at 12 months (T1). A total of 33 patients (56%) were defined as cognitively impaired at baseline, and 20 (38%) were defined as impaired at follow-up after 12 months. The mean raw scores and Z-scores of all the cognitive tests were significantly improved at T1 (p<0.05). There was a statistically significant improvement in most PROM scores at T1 (p<0.05) in comparison with baseline scores. Among the variables assessed, lower education and physical disability level at baseline correlated with impaired SDMT (OR: 1.68, p=0.01; OR: 3.10, p=0.02, respectively) and impaired BVMT-R (OR: 4.08, p=<0.001; OR: 4.82, p=0.001, respectively) at T1. Neither baseline PROMs nor MRI volumetric parameters were predictive of cognitive performances at T1. These findings provide additional evidence that evolution of CI in MS may be a dynamic phenomenon and will not usually follow an inevitable, declining trajectory, and do not support the utility of PROMs in predicting CI in RRMS. The present study is still ongoing to determine whether our findings are confirmed at 2 and 3 years of follow-up.

Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture.

The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient's frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture. A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%. The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.

Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage - A pilot observational study.

Headache after aneurysmal subarachnoid hemorrhage (HASH) is common, severe, and often refractory to conventional treatments. Current treatment standards include medications including opioids, until the pain is mitigated. Peripheral nerve blocks (PNBs) may be an effective therapeutic option for HASH. We conducted a small before-and-after study of PNBs to determine safety, feasibility, and efficacy in treatment of HASH. We conducted a pilot before-and-after observational study and collected data for 5 patients in a retrospective control group and 5 patients in a prospective intervention PNB group over a 12-month period. All patients received a standard treatment of medications including acetaminophen, magnesium, gabapentin, dexamethasone and anti-spasmodics or anti-emetics as needed. Patients in the intervention group received bilateral greater occipital, lesser occipital, and supraorbital PNBs in addition to medications. The primary outcome was pain severity, measured by Numeric pain rating scale (NPRS). All patients were followed for 1 week following enrollment. The mean ages in the PNB group and control group were 58.6 and 57.4, respectively. One patient in the control group developed radiographic vasospasm. Three patients in both groups had radiographic hydrocephalus and IVH, requiring external ventricular drain (EVD) placement. The PNB group had an average reduction in mean raw pain score of 2.76 (4.68, 1.92 p = 0.024), and relative pain score by 0.26 (0.48, 0.22 p = 0.026), compared to the control group. The reduction occurred immediately after PNB administration. PNB can be a safe, feasible and effective treatment modality for HASH. Further investigations with a larger sample size are warranted.

Use of Multiple-Select Multiple-Choice Items in a Dental Undergraduate Curriculum: Retrospective Study Involving the Application of Different Scoring Methods.

Scoring and awarding credit are more complex for multiple-select items than for single-choice items. Forty-one different scoring methods were retrospectively applied to 2 multiple-select multiple-choice item types (Pick-N and Multiple-True-False [MTF]) from existing examination data. This study aimed to calculate and compare the mean scores for both item types by applying different scoring methods, and to investigate the effect of item quality on mean raw scores and the likelihood of resulting scores at or above the pass level (≥0.6). Items and responses from examinees (ie, marking events) were retrieved from previous examinations. Different scoring methods were retrospectively applied to the existing examination data to calculate corresponding examination scores. In addition, item quality was assessed using a validated checklist. Statistical analysis was performed using the Kruskal-Wallis test, Wilcoxon rank-sum test, and multiple logistic regression analysis (P<.05). We analyzed 1931 marking events of 48 Pick-N items and 828 marking events of 18 MTF items. For both item types, scoring results widely differed between scoring methods (minimum: 0.02, maximum: 0.98; P<.001). Both the use of an inappropriate item type (34 items) and the presence of cues (30 items) impacted the scoring results. Inappropriately used Pick-N items resulted in lower mean raw scores (0.88 vs 0.93; P<.001), while inappropriately used MTF items resulted in higher mean raw scores (0.88 vs 0.85; P=.001). Mean raw scores were higher for MTF items with cues than for those without cues (0.91 vs 0.8; P<.001), while mean raw scores for Pick-N items with and without cues did not differ (0.89 vs 0.90; P=.09). Item quality also impacted the likelihood of resulting scores at or above the pass level (odds ratio ≤6.977). Educators should pay attention when using multiple-select multiple-choice items and select the most appropriate item type. Different item types, different scoring methods, and presence of cues are likely to impact examinees' scores and overall examination results.

Short term results of anatomic stemless shoulder replacement with peripheral neck fixation

Most of the current stemless implants are using a central neck fixation design. Easytech Stemless replacements (FX Solutions®, Viriat, France) were developed promoting the idea of peripheral fixation of the stemless implant. The aim of this study was to analyze clinical and radiological results of this stemless TSA implanted for osteoarthritis (OA). A retrospective study of patients who received TSA with the Easytech® Anatomical Shoulder System (FX Solutions®, Viriat, France) for OA was completed at five clinical sites. Preoperative and minimum 2 year follow-up Constant Scores and X-rays were evaluated. Two independent orthopedic surgeons analyzed X-rays to assess anatomy reconstruction and component migration. Revisions and serious adverse effects were reviewed. 129 patients were analyzed with an average follow-up of 37.47 months (24-54). Seven patients had a revision surgery and one of these resulted in the removal of the Anchor Base. The postoperative Constant Scores showed significant improvement with a mean raw Constant Score of 73.78 (38.0-100.0, mean increase 40.96, P<.0001) and mean adjusted Constant Score of 99.14 (42.20-133.30, mean increase 55.68, P<.0001). Radiographic review demonstrated that no modification of the center of rotation (COR) at minimum 24 months was greater than 3 mm and in comparison to preoperative radiographs, restoration of COR was lateralized in 25% of the cases, medialized in 61.5% and 13.5% had no change in COR. The mean value of the cervico-diaphyseal angle was 130.2° (114; 149) at 3 weeks and 129.9° (113.5; 144.0) at 2 years, demonstrating no significant difference (P=.16). 36 patients (35%) had calcar remodeling. Univariate and multivariate logistic regression found no significant factor, which was associated with the variation of the cervico-diaphyseal angle over time, center of rotation, calcar remodeling, or final Constant Score. The Walch B2 and C glenoid subset of patients (n=13) had overall survival rate of 90.9% [95% CI 75.4-100.0] vs. 98.0% [95% CI 95.3-100.0] in other glenoid types (P<.01). Walch B2/C patients were 4.44 [95% CI 1.13, 17.6] times more likely to have a Constant Score <85 (P=.03). The peripheral fixation of the Easytech® Anatomical Shoulder System for OA provides excellent clinical results and imaging stability at minimum two year follow-up. Elderly age, gender and BMI do not affect the stability.

Life Satisfaction of Nurses during the COVID-19 Pandemic in Poland

Health care practitioners are at highest risk of COVID-19 disease. They experience an enormous overload of work and time pressures. The objective of the study was to assess nurses' life satisfaction. The study included professionally active nurses. The research method was an author's questionnaire and a standardized questionnaire, the Satisfaction with Life Scale (SWLS). The study group included 361 working nurses. The mean raw score and the sten score of the nurses' responses to the statements on the SWLS questionnaire were 21.0 (SD ± 5.6, range = 5-35) and 5.73 (SD ± 1.94, range = 1-10), respectively. It was shown that lower life satisfaction was experienced by nurses aged 51 to 60 (raw score: p = 0.003, sten score: p = 0.005), as well as nurses with secondary and undergraduate nursing education (raw score: p = 0.061, sten score: p = 0.043). Nurses who had a higher self-evaluation of the level of knowledge about SARS-CoV-2 infection experienced greater life satisfaction (raw score: p = 0.008, sten score: p = 0.022). The majority of Polish nurses surveyed during the COVID-19 pandemic had a low or medium level of life satisfaction. The low response rate to the survey was most likely due to work overloads during the pandemic. Working in a public service profession, a nurse is exposed to stressful conditions related to protecting human health. Constant difficult and stressful situations and total fatigue experienced by nursing professionals can be the cause of a lack of motivation, occupational burnout, listlessness and mental and physical disease. Further research is necessary to assess the factors positively influencing the level of life satisfaction.

Outcomes and predictors of functioning, mental health, and health-related quality of life in adults born with very low birth weight: a prospective longitudinal cohort study

BackgroundVery low birth weight (VLBW: ≤1500 g) is associated with multiple short and long-term complications. This study aimed to examine outcomes and predictors of functioning, mental health, and health-related quality of life in adults born with VLBW.MethodsIn this prospective longitudinal cohort study, 67 VLBW and 102 control participants were assessed using the Adult Self-Report of the Achenbach System of Empirically Based Assessment and Global Assessment of Functioning at 26 years, and the Hospital Anxiety and Depression Scale and Short Form-36 at 28 years of age. Associations between perinatal and childhood predictors and adult functioning were assessed using linear regression.ResultsCompared with controls, the VLBW group had lower mean raw scores on the Function and Symptom subscales of the Global Assessment of Functioning at 26 years, a higher sum score of symptoms of anxiety and depression due to more depressive symptoms, and poorer mental health-related quality of life at 28 years. The mean group differences ranged from 0.42 to 0.99 SD. Within the VLBW group, lower birth weight and gestational age, a higher number of days with respiratory support and poorer motor function at 14 years were associated with a higher sum score of symptoms of anxiety and depression at 28 years. Days with respiratory support and motor function at 14 years were also predictive of Global Assessment of Functioning scores at 26 years, and mental health-related quality of life at 28 years. Poorer motor and cognitive function at five years were associated with poorer physical health-related quality of life at 28 years. Parental socioeconomic status was related to mental and physical health-related quality of life.ConclusionIn this study, VLBW adults reported poorer functioning and mental health-related quality of life, and more depressive symptoms than their term born peers. Days with respiratory support and adolescent motor function predicted most of the adult outcomes. This study explicates perinatal and developmental markers during childhood and adolescence which can be target points for interventions.

The 50 Most Cited Articles in Knee Medial Collateral Ligament Injury Research.

Background:Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome.Purpose:To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research.Study Design:Cross-sectional study.Methods:We performed a keyword search of the Institute for Scientific Information’s Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence.Results:The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%).Conclusion:This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.

Cerebellar cognitive affective syndrome after acute cerebellar stroke.

IntroductionThe cerebellum modulates both motor and cognitive behaviors, and a cerebellar cognitive affective syndrome (CCAS) was described after a cerebellar stroke in 1998. Yet, a CCAS is seldom sought for, due to a lack of practical screening scales. Therefore, we aimed at assessing both the prevalence of CCAS after cerebellar acute vascular lesion and the yield of the CCAS-Scale (CCAS-S) in an acute stroke setting.Materials and methodsAll patients admitted between January 2020 and January 2022 with acute onset of a cerebellar ischemic or haemorrhagic first stroke at the CUB-Hôpital Erasme and who could be evaluated by the CCAS-S within a week of symptom onset were included.ResultsCerebellar acute vascular lesion occurred in 25/1,580 patients. All patients could complete the CCAS-S. A definite CCAS was evidenced in 21/25 patients. Patients failed 5.2 ± 2.12 items out of 8 and had a mean raw score of 68.2 ± 21.3 (normal values 82–120). Most failed items of the CCAS-S were related to verbal fluency, attention, and working memory.ConclusionA definite CCAS is present in almost all patients with acute cerebellar vascular lesions. CCAS is efficiently assessed by CCAS-S at bedside tests in acute stroke settings. The magnitude of CCAS likely reflects a cerebello-cortical diaschisis.

Use of a locking stem for reverse shoulder arthroplasty is a rare but reliable option.

RSA is widely used in the treatment of complex trauma or degenerative changes of the shoulder. Strong primary fixation of the stem is necessary to prevent any loosening of the stem and subsequent revision. Presently, cement fixation or press-fit fixation are two options for humeral fixation, though each has its own limitations and risks. The aim of the current study is to evaluate the effectiveness of an alternative option involving a distal screw interlocking system for fixation of the humeral stem from initial implantation. We performed a retrospective multicenter study of patients implanted with the Humelock Reversed® stem RSA that can be locked with distal humeral screws in cases of operative poor press fit or to modulate the lengthening of the arm via prosthetic humeral height. Seventy-two patients with a minimum two year follow-up were included, 13 for acute trauma, 42 for degenerative changes, and 17 for revision surgery. No difference was seen in radiological or clinical results for patients with or without interlocking screw primary stabilization. For non-trauma patients, the mean raw Constant score improved significantly from 31 (± 12) to 71 (± 12). For trauma patients, the mean raw Constant score for trauma (63.4) was significantly lower than for non-trauma cases (72.1) (p < 0.001). Analysis of the filling ratio demonstrated that interlocking screws were not used for lower filling ratios and that midterm fixation of the stem is not negatively impacted by distal interlocking screw fixation. Even if use of a distal interlocking screw fixation system is rare, it can be useful for patients with poor quality fixation of stemmed RSA. Use of an interlocking screw system to stabilize the stem in RSA provides good immediate and midterm stability of the implant allowing for clinical and radiological outcomes comparable to those obtained with press-fit fixation alone.

Odor identification impairment in autism spectrum disorder might be associated with mitochondrial dysfunction.

Deficits in olfactory function in autism spectrum disorder (ASD) have already been reported. However, the results of previous studies are not consistent, and the pathophysiological mechanisms of olfactory dysfunction in ASD are not clear. Fifty-three male ASD children or teenagers aged 9-16 years were recruited for the study. The identification and discrimination portion of the Sniffin' Sticks test (SST) was used to assess the olfactory function of the enrolled subjects. The severity of ASD core symptoms and the intelligence quotient (IQ) of participants were assessed. In addition, to explore the potential mechanism underlying olfactory dysfunction, a series of plasma biochemical indicators of oxidative stress, mitochondrial function and inflammation were measured. The mean raw scores on the SST identification and discrimination test of the study subjects were significantly lower than those of typically developing subjects reported in normative data studies. After adjusting for IQ, the odor identification score was not significantly associated with any ASD symptoms. Odor identification was found to be significantly associated with the ratio of L-lactate (L)/pyruvate (P) but not with other measured indicators. The current study validates the impairment of odor identification and discrimination in Chinese ASD children. Odor identification dysfunction may be an independent clinical symptom of ASD. The plasma L/P ratio was found to be significantly associated with odor identification performance, which suggests that mitochondrial dysfunction may be a potential mechanism underlying odor identification impairment in ASD.

Quality of Life of Parents of Children with Cancer—Single-Center, Prospective Cross-Sectional Study from South India

Abstract Introduction Holistic care for children with chronic diseases including cancer should include psychological support for children and their families. The impact of pediatric malignancies in regard to quality of life (QOL) of parents is poorly described. Objectives We aim to study the QOL of parents of children diagnosed with cancer in physical, psychosocial, environmental, and social domains. Materials and Methods A prospective, cross-sectional study was conducted with 162 parents of children diagnosed with malignancy for 3 months or more. Assessment was done by World Health Organization quality of life (WHOQOL-BREF) questionnaire that includes four domains with a total of 26 questions. Data analysis was done by using Statistical Package for Social Sciences (SPSS) version 20.0; p-value less than 0.05 was considered significant. Results on continuous measurements were presented as “Mean ± SD” and categorical measurements were presented as percentages (%). Differences in the quantitative variables between groups were assessed by unpaired-t-test; comparison between groups by nonparametric Mann–Whitney U test and chi-squared test was used to analyze categorical variables with p-value of &lt; 0.05 using a two-tailed taken as statistically significant. Results Mean raw scores of QOL in physical health, psychological, social, and environmental domains were 20.10, 15.28, 8.10, and 25.24, respectively, with social relationships being the lowest; inadequate or low QOL was noted in 50% study population and it was maximally affected by increased duration of treatment, multimodality treatment, socioeconomic status, rural population, education and occupation status of the parents, and increased cost of care. Type of family or place of residence, family history of psychiatric illness, or malignancy did not influence the QOL of parents of children with cancer. Conclusion Psychological support from the beginning of the treatment along with financial, social support should be offered through a comprehensive care program to improve the QOL.

Standardization of the Bayley Scales of Infant and Toddler Development for Persian Children

Objective: The first years of life are particularly important because vital developments occur in all development domains including motor, cognition, communication, and social-emotional. Early detection of developmental delays is essential in planning for early intervention. This study aims to standardize the score of bayley scales of infants and toddlers development-third edition (Bayley-III) for Iranian samples aged 1-42 months. Materials &amp; Methods: Participants included 1700 children divided into 17 age groups of 100 children. The normative information was based on a national sample representative of Iran’s population for infants aged 1-42 months based on the 2011 national population and housing census. For each age group, the total raw scores of each Bayley-III subscale (cognition, receptive communication, expressive communication, fine motor, and gross motor) were converted to scaled scores with a Mean±SD of 10±3. The composite scores (cognition, language and motor domains) were obtained by summing up the scaled scores. The composite scores were scaled to a metric with Mean±SD of 100±15 ranged 40-160. Growth scores (ranged 200-800, with a Mean±SD 500±100), percentile ranks (ranged from 1-99, with 50 as the mean and median), and developmental age equivalent were also determined. Confidence intervals for all five subscales were also determined. To compare the development level of the US children (norm samples) and Iranian children, their mean raw scores in five subscales were compared for finding the difference in scores. Results: The Bayley-III was performed on 1744 children aged 0-42 months, including 908 (52.1%) girls and 836 (47.9%) boys. In comparing the development level of Iranian and US children, it was found that the mean scores were significantly different in 28 age groups (P&lt;0.05). In seven age groups, the US children’s scores were higher (age groups &lt;6 months), and in 21 age groups, the scores of Iranian children were higher ( age groups &gt;6 months). Conclusion: For early detection and intervention of children with developmental delays, a test with a normalized score should be used in Iran. Using the US norm-based scores in Iranian children leads to inaccuracy in the early detection of children with developmental delays.

Prenatal exposure to pesticide residues in the diet in association with child autism-related traits: Results from the EARLI study.

Prior work has suggested associations between prenatal exposure to several classes of pesticides and child autism spectrum disorder (ASD). We examined a previously developed pesticide residue burden score (PRBS) and intake of high pesticide residue foods in association with ASD‐related traits. Participants were drawn from the Early Autism Risk Longitudinal Investigation (EARLI) (n = 256), a cohort following mothers who previously had a child with ASD through a subsequent pregnancy and that child's development. ASD‐related traits were captured according to total Social Responsiveness Scale (SRS) scores at age 3 (mean raw total SRS score = 35.8). Dietary intake was assessed through a food frequency questionnaire collected during pregnancy. We also incorporated organic intake and fatty foods in modified versions of the PRBS. Associations between high‐residue fruit and vegetable intake, the overall PRBS and modified versions of it, and SRS scores were assessed using multivariable linear regression. Overall, we did not observe associations between pesticide residues in foods and ASD‐related outcomes, and modified versions of the PRBS yielded similar findings. However, reductions in ASD‐related traits were observed with higher overall fruit and vegetable intake (adjusted estimates for Q4 vs. Q1: β −12.76, 95%CI −27.8, 2.3). Thus, findings from this high familial probability cohort did not suggest relationships between pesticide residues in the diet according to the PRBS and ASD‐related traits. Beneficial effects of fruit and vegetable intake may influence these relationships. Future work should consider fruit and vegetable intake in association with ASD‐related outcomes.Lay SummaryDiet is the main source of exposure to most pesticides in use today. In this study, we examined the relationship between pesticide exposure from residues in the diet during pregnancy and child autism‐related traits. We found that these pesticide residues from the diet were not related to child autism‐related outcomes at age three. However, higher prenatal fruit and vegetable intake was associated with reductions in child autism‐related traits.

Reading and Listening Comprehension in Individuals With Down Syndrome and Word Reading-Matched Typically Developing Children.

The purpose of this study was to explore the reading comprehension and listening comprehension performance of English-speaking children with Down syndrome (DS) compared with word reading-matched typically developing (TD) children. Participants included 19 individuals with DS (M age = 17;2 [years;months], range: 11;1-22;9) and 19 word reading-matched TD children (M age = 7;2, range: 6;6-8;1). Participants completed three norm-referenced measures of reading comprehension and three norm-referenced measures of listening comprehension. Dependent variables were raw scores on each measure, with the exception of scaled scores on one reading comprehension measure. Independent-samples t tests with Bonferroni-adjusted alpha levels of .008 revealed a significant between-groups difference for two of three reading comprehension measures. The mean raw scores were lower for the DS group than the TD group, with large effect sizes. Independent-samples t tests with Bonferroni-adjusted alpha levels of .008 revealed a significant between-groups difference for three of three listening comprehension measures. The mean raw scores on the three measures were lower for the DS group than the TD group, with large effect sizes. The DS group, despite being matched on word reading to the TD group, demonstrated reduced reading comprehension skills as compared with the TD group. Thus, as individuals with DS acquire word reading skills, it appears that they are unable to translate word reading success to achieve reading comprehension at the expected level (i.e., as indexed by typical readers). The between-groups differences in listening comprehension suggest that deficits in listening comprehension likely are a barrier to reading comprehension proficiency for children with DS. Listening comprehension may be a malleable factor that can be targeted to improve reading comprehension outcomes for individuals with DS.