Multidimensional Outcome Research Articles

Social Aspects in Land Consolidation Processes

Land consolidation is an instrument that readjusts land parcel shapes and reallocates land rights in order to minimize farmland fragmentation, optimize agricultural output, and generate optimal living and working conditions in rural areas. The optimization and reallocation algorithms typically rely on monetarized values of land parcels, soil quality, and compensation amounts. Yet, land management interventions also need instruments for socio-spatial optimization, which may be in conflict with the monetary ones. Many non-monetary values are qualitative in nature. Hence, there is a research gap in how such values can be detected and incorporated, such that they can create a multi-dimensional land consolidation outcome. This study applies a situational analytical approach to investigate how, where, and when social values and belief systems play a role in land consolidation cases in three different study areas. This process enables the qualitative detection of which types of social values are central during land consolidations and which ones are most essential when evaluating outcomes of land consolidation. The synthesis derives that the incorporation of aims—such as addressing socio-spatial affinity, need for equity and fairness, human recognition, and good neighborship—is possible through an innovation in land consolidation practices, social valuation methods, and/or socially responsive land consolidation laws.

Sarcopenia for outcomes in patients undergoing spinal surgery: A protocol for a systematic review and pooled analysis of observational studies.

BackgroundSarcopenia is a progressive age-related skeletal muscle disorder characterized by decreased muscle mass and loss of muscle function. Recent studies have shown that sarcopenia is able to predict a variety of clinical outcomes after spinal surgery. Controversy still exists among previous reports in terms of the definition and measurement of sarcopenia, these findings are heterogeneous so far. Therefore, the aim of the current study is to assess the up-to-date evidence of sarcopenia for postoperative outcomes among people undergoing spinal surgery.Methods and analysisThis protocol was carried out based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. It has been pre-registered in PROSPERO with the registration number of CRD42021260459. Three databases (including Pubmed, EMBASE, and Cochrane Library) will be searched from inception through May 10, 2021 to determine related cohort studies examining sarcopenia on multidimensional outcomes in patients undergoing spinal surgery. Major outcomes will be involved including mortality, morbidity, length of stay, postoperative complications or adverse events. DerSimonian & Laird random-effects meta-analysis will be used to calculate pooled odds ratio (OR) for binary data and pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) for continuous data. The Newcastle-Ottawa Scale (NOS) will be used to assess the risk of bias of included studies. Narrative synthesis will be carried out if a pooled analysis is not possible.Ethics and disseminationEthical approval is not required for this study as the data involved are from the published literatures. We intend to disseminate or share the results of the study in a peer-reviewed journal or at relevant conferences.PROSPERO registration numberCRD42021260459.

Multidimensional Family-Centred Early Intervention in Children with Hearing Loss: A Conceptual Model.

At least two per thousand newborns are affected by hearing loss, with up to 40% with an additional disability. Early identification by universal newborn hearing screening and early intervention services are available in many countries around the world, with limited data on their effectiveness and a lack of knowledge about specific intervention-related determinants of child and family outcomes. This concept paper aimed to better understand the mechanisms by which multi-dimensional family-centred early intervention influences child outcomes, through parent behaviour, targeted by intervention by a review of the literature, primarily in the field of childhood hearing loss, supplemented by research findings on physiological and atypical child development. We present a conceptual model of influences of multi-disciplinary family-centred early intervention on family coping/functioning and parent–child interaction, with effects on child psycho-social and cognitive outcomes. Social communication and language skills are postulated as mediators between parent–child interaction and non-verbal child outcomes. Multi-disciplinary networks of professionals trained in family-centred practice and the evaluation of existing services, with respect to best practice guidelines for family-centred early intervention, are recommended. There is a need for longitudinal epidemiological studies, including specific intervention measures, family behaviours and multidimensional child outcomes.

Spaulding REhabilitation and COVid Recovery study (RECOVR): Preliminary Findings at 6 Months

Research ObjectivesTo identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes at 6 months post-hospitalization.DesignProspective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings.SettingAcute care and post-acute telephone follow-up.ParticipantsSpanish- and English-speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient hospitalization for acute COVID-19 related illness (N = 52).InterventionsN/A.Main Outcome MeasuresPhysical, cognitive, and psychological symptoms; Self-reported employment status and assistance with ADLs.ResultsMedian age was 60.96 (IQR = 20.89), with race/ethnicity representative of the US adult population (71% White; 13% Black; 27% Hispanic). Compared to premorbid status, 33% of individuals were no longer employed full-time and 23% were no longer independent in basic ADLs. Latent profile analysis identified distinct subgroups within physical, cognitive, and emotional domains of functioning. Approximately 31% were in either the moderately or most symptomatic groups for both cognitive and emotional functioning, with 88% of these also falling into the most symptomatic group for physical functioning. There were 29% in the least symptomatic group across all domains.ConclusionsPersons with severe COVID-19 illness experience persistent functional limitations that interfere with employment and ADLs up to 6 months post-hospitalization. Although symptom variability is high at 6 months, we identified distinct subgroups, including those with co-occurring emotional and cognitive symptoms, that suggest the need for comprehensive assessment and tailored treatment for physical, emotional, and cognitive symptoms.Author(s) DisclosuresThe author's declare no relevant conflict of interests.

The state of the art-psoriatic arthritis outcome assessment in clinical trials and daily practice.

Psoriatic arthritis is a heterogeneous condition with substantial challenges in optimising outcome measures for both clinical trials and daily practice. As with other inflammatory arthritides, there is no gold standard instrument for measuring disease activity or impact, both of which are key to evaluate therapeutic approaches in trials and monitor disease in daily practice. A wide range of domains have been highlighted in the Outcome Measures in Rheumatology (OMERACT) core domain set for psoriatic arthritis; reflecting the disease involvement in multiple tissues (joints, tendons, skin, and spine) and the heterogenous impact of the disease on individuals. This Review summarises the current evidence around outcome measure selection, considering factors such as unidimensional versus multidimensional outcomes, continuous versus binary measures, and the feasibility of these approaches in trials compared with clinical practice.

Development of a Pediatric Epilepsy Program: Analysis of Early Multidimensional Outcomes

Abstract Background A Pediatric Epilepsy Program was instituted in Manitoba in 2016. This report seeks to describe changes in the management of pediatric epilepsy patients in Manitoba since the inception of this Program, to provide an early analysis of local outcomes, and to present a framework for further program development. Methods Data was collected for patients treated both before and after inception of the Program. Caregivers completed questionnaires on quality of life and program satisfaction. An online database was created to capture demographic information, seizure and quality of life outcomes, and caregiver satisfaction ratings. Descriptive statistics were used to summarize the results. Results Prior to commencement of the Program, 16 patients underwent vagal nerve stimulator (VNS) insertion. At last follow-up, 6.25% of patients achieved Engel class I outcome, 75% achieved class III outcome, and 18.75% were classified as class IV. Following inception of the Program, 11 patients underwent resective procedures and 3 underwent VNS insertions. At last follow-up, 78.6% of patients achieved Engel class I outcome, 14.3% achieved class III outcome, and 7.1% were classified as class IV. Since inception of the Program, the average Quality of Life in Childhood Epilepsy Questionnaire-55 score measuring patient quality of life was (59.7 ± 23.2)/100. The average Care-Related Quality of Life-7D score measuring caregiver quality of life was (78.3 ± 18.6)/100. Caregiver satisfaction had an average rating of (9.4 ± 0.8)/10. Conclusion Access to epilepsy surgery has significantly improved for children in Manitoba and has led to favorable, early multidimensional outcomes. Structural organization, funding, and multidisciplinary engagement are necessary for program sustainability and growth.

Cross-cultural Adaptation and Reliability of the Multidimensional Outcome Expectations for Exercise Scale (MOEES) in Filipino Older Adults: A Study Protocol

Cross-cultural Adaptation and Reliability of the Multidimensional Outcome Expectations for Exercise Scale (MOEES) in Filipino Older Adults: A Study Protocol

Linear projections of joint symmetry and independence applied to exact testing treatment effects based on multidimensional outcomes

The growing need for analyzing multivariate aspects of joint data distributions is reinforced by a diversity of experiments based on dependent outcomes. In this sense, different contexts of joint symmetry of data distributions have been dealt with extensively in both theory and practice. Univariate characterizations of properties of multivariate distributions can allow the reduction of the original problem to a substantially simpler one. We focus on research scenarios when vectors x and Ax are identically distributed, where A is a diagonal matrix and absolute values of A’s elements equal to one. It is shown that these scenarios are attractive in new characterizations of joint or mutual independence between random variables. We establish projections of the joint symmetry and independence via the one-dimensional symmetry of linear combinations of x’s components and their interactions. These projections are the most revealing of the multivariate data distribution. The usefulness of the linear projections is exemplified by constructing an efficient nonparametric exact test for joint treatment effects. In this framework, an algorithm for implementing linear projection-based tests is proven. Numerical studies based on generated vectors and a real dataset show that the proposed test can exhibit high and stable power characteristics. The present method can be also used for testing independence between symmetric random vectors.

Social cognitive measures related to exercise behaviour: Validation in Indonesian middle-aged and older adults

IntroductionEvidence shows that exercise adoption and maintenance are influenced by social-cognitive processes. Instruments have been developed to measure these processes, but none have been validated for use in the Indonesian context. This study aimed to validate scales measuring social cognitive constructs related to exercise in Indonesian middle-aged and older population. MethodsThe Self-Efficacy for Exercise, the Exercise Self-Efficacy, the Multidimensional Outcome Expectations for Exercise, the Exercise Goal-Setting, the Exercise Planning and Scheduling, and the Social Support for Exercise Behavior scales underwent forward-backward translation, readability, and content validity assessments with middle-aged and older Indonesian adults (n = 126; age = 61.2 ± 8.2 years, 72% female). Psychometric testing included assessments of internal consistency and 1-week test-retest reliability, convergent validity, known-group validity with self-reported moderate to vigorous physical activity (MVPA), and construct validity using confirmatory factor analyses (CFA). ResultsThe scales were found to be readable and content valid. Internal consistencies were acceptable to excellent (Cronbach's α = 0.76–0.93). Moderate to good repeatability estimates were demonstrated (ICC = 0.72–0.88). Convergent validity was supported by moderate correlations between scale scores and MVPA (r = 0.42–0.72). Participants with sufficient MVPA levels consistently scored higher on scales than those with insufficient PA levels. The CFA showed a moderate fit for all scales except the Social Support for Exercise Behavior scale. ConclusionAlthough the factor structure of the Social Support scale warrants further investigation, the evidence supports the use of the six scales in Indonesian middle and older adults, including for evaluating the impact of theory-based physical activity interventions in this population.

A Multifidelity Function-on-Function Model Applied to an Abdominal Aortic Aneurysm

In this work, we predict the outcomes of high fidelity multivariate computer simulations from low fidelity counterparts using function-to-function regression. The high fidelity simulation takes place on a high definition mesh, while its low fidelity counterpart takes place on a coarsened and truncated mesh. We showcase our approach by applying it to a complex finite element simulation of an abdominal aortic aneurysm which provides the displacement field of a blood vessel under pressure. In order to link the two multidimensional outcomes we compress them and then fit a function-to-function regression model. The data are high dimensional but of low sample size, meaning that only a few simulations are available, while the output of both low and high fidelity simulations is in the order of several thousands. To match this specific condition our compression method assumes a Gaussian Markov random field that takes the finite element geometry into account and only needs little data. In order to solve the function-to-function regression model we construct an appropriate prior with a shrinkage parameter which follows naturally from a Bayesian view of the Karhunen–Loève decomposition. Our model enables real multivariate predictions on the complete grid instead of resorting to the outcome of specific points.

Does Sustainable Transport Deliver Societal Value? Exploring Concepts, Methods, and Impacts with Case Studies

Transportation is one of the main enablers of development. It connects communities, allows the trade of goods among territories, and provides equitable access to public services. However, it is also one of the main causes of climate change, impacting directly and indirectly on human health. This raises the need for transportation infrastructure to be more sustainable so that it can enable more sustainable development. This paper investigates how sustainability in the transport sector can be conceptualized, assessed, and implemented. Definitions are proposed, indicators identified, existing methods reviewed, and three case studies presented. The Sustainable Asset Valuation (SAVi) method and resulting integrated simulation models are used to assess the multidimensional outcomes of conventional and sustainable transport investments. The cases of roads, public bicycle-sharing and bus rapid transport systems are discussed. These investments are assessed using an integrated cost–benefit analysis that goes beyond traditional assessments, considering the benefits and avoided costs of the externalities of a project in the social, environmental, and economic dimensions. The use of the method led to the conclusion that including externalities in a cost–benefit analysis is meaningful and can be relevant for assessing the economic viability of transport infrastructure projects.

Compound Caregiving: Toward a Research Agenda.

Aging family caregivers of adults with intellectual and developmental disabilities (IDD) have unique circumstances setting them apart from the general caregiving population. Such differences include the extensive duration of the caregiving, and health concerns that manifest in the caregiver and individuals with IDD over time. Because of increasing longevity, family caregivers are likely to become compound caregivers (i.e., individuals caregiving for multiple people). Almost 70% of family caregivers of individuals with IDD experience compound caregiving, yet we know very little about compound caregiving. In this article, we highlight the importance of supporting compound caregivers by identifying research issues that address current challenges and future directions. Implications for research are noted, including the need for multidimensional outcome measures and longitudinal studies.

Long-term outcome after severe traumatic brain injury: a systematic literature review.

Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.

Advancing the intersection of soil and well-being systems science

Innovation for soil research can advance multidimensional outcomes for production and environmental quality through consideration of human well-being components. Integrating components from social and soil sciences builds the capacity to foster research and innovations that promote human well-being in conjunction with soil health. We propose The Integrated Soil Well-being Framework to understand the linkages between individual and social well-being related to soil science research and innovation. To facilitate transformative research, we present lines of inquiry of human dimensions research that may support well-being outcomes of soil research and innovation. We then present opportunities in the area of human dimensions of soil science to innovate ways of transformative research that can integrate well-being and soil health: recognizing and fostering a universe of soil knowledge, enabling soil connectivity to increase well-being, and evaluating capability. Finally, we propose three steps to promote soil and well-being integration: multi-disciplinary soil science training, a normative change in the identity of a soil scientist, and diverse methodologies. We aim to create a broader dialogue and open the conversation between scholars from various disciplines and methods studying soils to formulate research agendas with the advancement of human well-being for soil security.

Cognitive Reserve in Early Manifest Huntington Disease Patients: Leisure Time Is Associated with Lower Cognitive and Functional Impairment.

We focused on Cognitive Reserve (CR) in patients with early Huntington Disease (HD) and investigated whether clinical outcomes might be influenced by lifetime intellectual enrichment over time. CR was evaluated by means of the Cognitive Reserve Index questionnaire (CRIq), an internationally validated scale which includes three sections: education, working activity, and leisure time. The clinical HD variables were quantified at three different time points (baseline-t0, 1 year follow up-t1 and 2 years follow up-t2) as per the Unified Huntington’s Disease Rating Scale (UHDRS), an internationally standardized and validated scale including motor, cognitive, functional and behavioral assays. Our sample consisted of 75 early manifest patients, withclinical stage scored according to the Total Functional Capacity (TFC) scale. Our correlational analysis highlighted a significant inverse association between CRIq leisure time (CRIq_LA) and longitudinal functional impairment (namely, the differential TFC score between t2 and t0 or ΔTFC) (p < 0.05), and the multidimensional progression of HD as measured by the composite UHDRS (cUHDRS, p < 0.01). CRIq_LA was significantly and positively associated with better cognitive performances at all time points (p < 0.05). Our results suggest that higher is the CRIq_LA, milder is the progression of HD in terms of functional, multidimensional and cognitive outcome.

Design Devices for Human Development: A Capabilities Approach in Kenya and Uganda

Despite progress in recent decades, many crucial challenges to the eradication of extreme poverty remain intractable. Development interventions often fail to deliver sustained, transformational outcomes to households and communities. The field of design has demonstrated its capacity to deliver designed artifacts that enhance the livelihoods and well-being of people living in resource poor communities, but it remains unclear how its tools can contribute to interventions seeking multidimensional and transformational development outcomes. We present insights from two case studies, conducted in Kenya and Uganda, where a service design approach was applied to the design of two development interventions: a clean cookstove and fuel system, and an innovative insurance product to help farmers cope with climate variability. In both cases, experience mapping, archetype construction, and prototyping served to reveal individual needs, capacities, and values, and enabled the translation of this information into design features for the interventions. Using Amartya Sen’s capabilities approach as an ex post analytical frame, we show how these devices could guide designers seeking to deliver transformational development outcomes when co-designing services that aim for environmental sustainability and social well-being among low-income communities.

Data Integration for the Study of Outstanding Productivity in Biomedical Research

Our goal is to analyze improvement of scientific performance in a multidimensional outcome space, with a focus on US-based biomedical research. With the growing diversity of research databases, limiting assessment of scientific productivity to bibliometric measures such as number of publications, impact factor of journals and number of citations, is increasingly challenged. Using a wider range of outcomes, from publications through practice improvements to entrepreneurial outcomes, overcomes many current limitations in the study of research growth. However, combining such heterogeneous datasets raise three challenges: 1. gathering in one common place a variety of data shared as csv, xml or xls files, 2. merging and linking this data, that sometimes overlap, 3. assessing the impact of research production and inclusive practices in a multidimensional space, that are often missing from the datasets. We would like to present our solution for the first of those challenges, and discuss our leads for the second and third challenges.

The impact of COVID-19 threats, and preventive chain of action: molecule to medicine

The emergence of the novel coronavirus (SARS-CoV-2) had affected us significantly from the individual level, to nationwide and global with a big loss of finances, and the freezing of various factories, schools, and transportation in communities The pandemic started with anxiety and a loss of health guidance and policies due to the unknown causes of viral transmission to human features as well as a high infection rate with low mortality It remains the original source of Covid-19 where it comes from and what is the reality of real viral entities and its origin such as natural born and recombinant viral variants in the case of COVID-19 pandemic. This sentence is unclear. In this short perspective article, we address some issues of risk assessment and management issues using molecular-based decision tools which may benefit or provide future drills to counteract health and clinic safety against a viral pandemic. Every pandemic gives us life threatening lessons on previous and disconnected human networks due to uncertainty of viral infection, which we learned from this COVID-19 pandemic case as well. It gives us some insight on how to rebuild our community regarding the strength of public health and the integration of science tools into the early phase of medical application, such as the role of molecular diagnostics through educational engagement. To promote the value of awareness with solid knowledge-based communication and to develop resilient preventive solutions for supply chains or prevention, the systematic practice of connectivity through visual format using multidimensional data outcomes could help reconsider the leverage of molecules as a bridge for the improvement and application of updated scientific tools of prediction precisely to identify unknown pathogens encompass rigor community-based activity likelihood sensitivity and resistance to pathogen infiltrated society in the future.

Early Transthyrohyoid Injection Laryngoplasty Under Local Anaesthesia in a Single Tertiary Center of Southeast Asia: Multidimensional Voice Outcomes.

Objective:To study the effectiveness of early percutaneous transthyrohyoid injection laryngoplasty under local anesthesia in improving voice quality in unilateral vocal fold paralysis (UVFP) patients.Methods:Longitudinal data of 29 UVFP patients who underwent injection laryngoplasty within six months from the onset of the symptoms were studied. The injectate (0.5–1 mL) was hyaluronic acid-based material (Juvéderm ULTRA XC; Allergan Industrie, France) that was delivered under local anesthesia with transthyrohyoid approach using a double-bend 21G needle. Multidimensional voice outcomes employing: 1) Malay-Voice-Handicap Index-10 (mVHI-10); 2) maximum phonation time (MPT); and 3) acoustic analysis [jitter%, shimmer% and noise-harmonic ratio (NHR)] were used to assess the treatment progress. The voice parameters were measured at baseline (2 weeks pre-injection), and at the first and third months post-injection.Results:The mean age of the 29 patients was 44.69 years, with a female-to-male ratio of 3.14:1. The voice outcomes measured at different time points were evaluated with repeated measures ANOVA. Significant improvement was observed from baseline to three months post injection laryngoplasty for mVHI-10, jitter, and NHR (p<0.001), shimmer (p=0.005) and MPT (p=0.018). Following the procedure, none of the patients developed any major complications.Conclusion:Office setting early transthyrohyoid injection laryngoplasty using a double-bend needle is a safe and effective procedure in patients with UVFP with evidence of significant improvement in voice and life quality.

Physical activity dimensions after stroke: patterns and relation with lower limb motor function

BackgroundStroke survivors show deteriorated physical functioning and physical activity levels. Physical activity levels of stroke survivors are generally low. It is increasingly recognized that physical activity is a multidimensional construct that cannot be captured in a single outcome. In-depth insight into multidimensional physical activity patterns may guide the development and timing of targeted rehabilitation interventions. This longitudinal cohort study explored how multidimensional physical activity outcomes develop during recovery in the subacute phase after stroke and if changes in physical activity were correlated to recovery of lower limb motor function.MethodsPatients were recruited during inpatient rehabilitation. At 3, 12, and 26 weeks post-onset, motor function was measured by the Fugl-Meyer Lower Extremity Assessment (FMA-LE). Physical activity was measured with the Activ8 accelerometer in multiple outcomes: counts per minute during walking (CPMwalking; a measure of Intensity), number of active bouts (Frequency), mean length of active bouts (Distribution) and % of waking time in upright positions (Duration). Generalized estimating equations (GEE) were used to study changes in physical activity over time and the relation with the change in lower limb motor recovery.ResultsThirty-nine patients (age 56 ± 9, 77% male, 89% ischemic stroke) were included. GEE models showed a significant main effect of time for PA Intensity (+ 13%, p = 0.007) and Duration (+ 64%, p = 0.012) between 3 and 12 weeks. Motor function did not show a significant effect in all PA models across the 3 timepoints (p > 0.020). A significant interaction effect of time × motor function was observed (p < 0.001).ConclusionsPatterns of PA recovery depend on the PA dimensions: PA Intensity and Duration increased mostly between 3 and 12 weeks post-stroke, whereas Frequency and Distribution did not show substantial changes. Further, no strong associations with motor recovery and high inter-individual variability were documented, which underlies the need to consider factors specific to the disease, the individual patient and the context.