Multiple Outcome Measures Research Articles

Comparative efficacy of interpersonal psychotherapy and antidepressant medication for adult depression: a systematic review and individual participant data meta-analysis.

Interpersonal psychotherapy (IPT) and antidepressant medications are both first-line interventions for adult depression, but their relative efficacy in the long term and on outcome measures other than depressive symptomatology is unknown. Individual participant data (IPD) meta-analyses can provide more precise effect estimates than conventional meta-analyses. This IPD meta-analysis compared the efficacy of IPT and antidepressants on various outcomes at post-treatment and follow-up (PROSPERO: CRD42020219891). A systematic literature search conducted May 1st, 2023 identified randomized trials comparing IPT and antidepressants in acute-phase treatment of adults with depression. Anonymized IPD were requested and analyzed using mixed-effects models. The prespecified primary outcome was post-treatment depression symptom severity. Secondary outcomes were all post-treatment and follow-up measures assessed in at least two studies. IPD were obtained from 9 of 15 studies identified (N = 1536/1948, 78.9%). No significant comparative treatment effects were found on post-treatment measures of depression (d = 0.088, p = 0.103, N = 1530) and social functioning (d = 0.026, p = 0.624, N = 1213). In smaller samples, antidepressants performed slightly better than IPT on post-treatment measures of general psychopathology (d = 0.276, p = 0.023, N = 307) and dysfunctional attitudes (d = 0.249, p = 0.029, N = 231), but not on any other secondary outcomes, nor at follow-up. This IPD meta-analysis is the first to examine the acute and longer-term efficacy of IPT v. antidepressants on a broad range of outcomes. Depression treatment trials should routinely include multiple outcome measures and follow-up assessments.

Collection of Multiple Patient-Reported Outcome Measures (CRAM-PROMs) in orthopaedic trauma: a randomized trial to assess the impact of quantity on quality

BackgroundWe rely on sound clinical research to ensure the safety and effectiveness of medical interventions. We are nowadays experiencing an increased utilization of Patient Reported Outcome Measures (PROMs) in research, for which there is good evidence on validity and reliability. However, these measures are often validated in isolation and not in a real-life setting where they are used in conjunction with other questionnaires and measures. Our study objective was to determine if the number of PROMs questionnaires completed by fracture patients affected their reliability; more specifically, the internal consistency of the EuroQuol Five Dimension-Five Level (EQ-5D-5 L) questionnaire. HypothesisOur hypothesis was that there is a progressive decline in reliability as we increase the number of questionnaires given to participants. Patients and methodThis is a randomized study carried out in a single Level I academic trauma center. Patients presenting to the fracture clinic for follow-up were screened. Participants were randomly assigned to 4 groups: group 1 only answered the EuroQol Five Dimension–Five Level (EQ-5D-5 L) questionnaire, group 2 answered one additional questionnaire before the EQ-5D-5 L, group 3 answered two and group 4 answered three additional questionnaires before the EQ-5D-5 L. The primary outcome measured was the internal consistency of the EQ-5D-5 L as a measure of reliability. ResultsEnrolment was 115 participants. Twenty-eight participants were randomized to Group 1, 29 to Group 2, 29 to Group 3, and 29 to Group 4. There was a progressive decline of reliability as number of questionnaires increased except for a sudden rise in group 4. (Group 1: 0.83, 95% Confidence Interval (CI) 0.70 to 0.91; Group 2: 0.74, 95% CI 0.56 to 0.87; Group 3: 0.68, 95% CI 0.44 to 0.83; Group 4: 0.81, 95% CI 0.68 to 0.90). Completeness was 100% for Group 1, 98.5% for Group 2, 100% for Group 3, and 92% for Group 4. DiscussionThese results cannot strongly support our initial hypothesis. Although there is an initial decrease in Cochran’s alpha for Groups 2 and 3 consecutively, the sudden rise in group 4 limits the validity our results. Notwithstanding, researchers should consider these findings when designing their research trials to avoid potential misleading results. Hence, the number of given questionnaires in research should be limited in order for these to maintain their reliability. Level of evidenceII.

Evaluating Age-Related Differences in Wayfinding in a Real-World Indoor Setting

Wayfinding is an important skill that is used in many essential daily activities. While some studies have found older adults to have reduced visuospatial functioning and wayfinding performance, the majority of this research has been conducted in laboratory settings and may suffer from threats to external validity. In the current article, we report an empirical study in which 33 participants, grouped into younger adults versus older adults, were asked to find multiple destinations within a complex real-world building. Multiple outcome measures were collected, including wayfinding performance, spatial learning, self-reported uncertainty, and information-seeking behavior. The results indicated that the older adult participants spent longer amounts of time and traveled longer distances to reach the destinations compared to younger adults, with medium-large effect sizes. Older adults also tended to check signs more frequently and to spend more time examining them, with large to very large effect sizes. Spatial learning outcomes and self-reported uncertainty levels in older and younger groups were not significantly different. We discuss recommendations for future studies in this area regarding experimental design, measurement, and interpretation.

Machine learning-based personalized composite score dissects risk and protective factors for cognitive and motor function in older participants.

With age, sensory, cognitive, and motor abilities decline, and the risk for neurodegenerative disorders increases. These impairments influence the quality of life and increase the need for care, thus putting a high burden on society, the economy, and the healthcare system. Therefore, it is important to identify factors that influence healthy aging, particularly ones that are potentially modifiable through lifestyle choices. However, large-scale studies investigating the influence of multi-modal factors on a global description of healthy aging measured by multiple clinical assessments are sparse. We propose a machine learning model that simultaneously predicts multiple cognitive and motor outcome measurements on a personalized level recorded from one learned composite score. This personalized composite score is derived from a large set of multi-modal components from the TREND cohort, including genetic, biofluid, clinical, demographic, and lifestyle factors. We found that a model based on a single composite score was able to predict cognitive and motor abilities almost as well as a classical flexible regression model specifically trained for each single clinical score. In contrast to the flexible regression model, our composite score model is able to identify factors that globally influence cognitive and motoric abilities as measured by multiple clinical scores. The model identified several risk and protective factors for healthy aging and recovered physical exercise as a major, modifiable, protective factor. We conclude that our low parametric modeling approach successfully recovered known risk and protective factors of healthy aging on a personalized level while providing an interpretable composite score. We suggest validating this modeling approach in other cohorts.

Comparison of patient-reported outcomes between alternative care provider-led and physician-led care for severe sleep disordered breathing: secondary analysis of a randomized clinical trial

BackgroundPrevious research has suggested that alternative (respiratory) care providers (ACP) may provide affordable, accessible care for sleep-disordered breathing (SDB) that decreases wait-times and improves clinical outcomes. The objective of this study was to compare ACP-led and sleep physician-led care for SDB on patient reported outcome and experiences, with a focus on general and health-related quality of life, sleepiness, and patient satisfaction.MethodsWe conducted a secondary analysis of a randomized trial in which participants with severe SDB were assigned to either ACP-led or physician-led management. We created longitudinal linear mixed models to assess the impacts of treatment arm and timepoint on total and domain-level scores of multiple patient-reported outcome measures and patient-reported experience measures.ResultsPatients in both treatment arms (ACP-led n = 81; sleep-physician = 75) reported improved outcomes on the Sleep Apnea Quality of Life Index, Health Utilities Index, and Epworth Sleepiness Scale. Patients in each group had similar and clinically meaningful improvements on domains assessing cognition, emotion, and social functioning. The linear mixed models suggested no significant difference between treatment arms on the patient-reported outcomes. However, scores significantly improved over time.ConclusionsManagement of SDB using ACPs was comparable to physician-led care, as measured bypatient-reported outcome and experience measures. While loss to follow-up limits our findings, these results provide some support for the use of this novel health service delivery model to improve access to high quality SDB care.Clinical trial registrationThis is analysis of data from the study registered Clinicaltrials.gov (NCT02191085).

Non-pharmacological interventions to treat mood disturbances post-stroke: a systematic review

ABSTRACT Background Stroke survivors face high rates of depression, anxiety, and pseudobulbar affect. Clinicians report lack of clarity on effective non-pharmacological interventions due to uncertainty about treatment options as barriers to evidence-based treatment. No systematic review has investigated the effectiveness of non-pharmacological interventions on the conditions of depression, anxiety, and pseudo-bulbar affect. Objectives The aim of this study was to evaluate the effectiveness of non-pharmacological interventions on the outcomes of depression, anxiety, and pseudobulbar affect in post-stroke individuals. Methods Following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched databases Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO for randomized controlled trials in English, within 2012–2023, evaluating the effect of a non-pharmacological intervention on depression, anxiety, and/or pseudobulbar affect. Two researchers screened titles, abstracts, and full texts. One researcher extracted data and assessed risk of bias. Data were synthesized narratively. Results Forty-two studies were included. Intervention types included education (n = 9), psychological therapy (n = 8), and physical exercise (n = 8). Intervention types reporting positive outcomes for depression were psychological therapy (n = 6), physical exercise (n = 3) and robot-assisted therapy (n = 3). Intervention types effective in improving anxiety were physical exercise (n = 2), psychological therapy (n = 3) and multi-modal therapy approaches (n = 2). No studies explored the impact on pseudobulbar affect. Conclusion Non-pharmacological interventions may be effective in improving mood in stroke survivors. Robot-assisted therapy and physical exercise were seen to improve multiple outcome measures. Patient education should be delivered alongside rehabilitation and directed to both stroke-survivor and caregiver.

CABG Case Volume and Patient Outcomes at the Veterans Healthcare Administration: On-Pump versus Off-Pump

Objective: To evaluate use trends and perioperative outcomes of on- and off-pump coronary artery bypass graft (CABG) in US Veterans. Methods: We retrospectively reviewed 44,960 Veteran Health Administration (VHA) patients who underwent isolated CABG between 2008–2021. Multivariable logistic regression was used to analyze associations between surgical technique and outcomes. Adjusted hazard ratios (aHR) are reported. p < 0.05 using two sided tests was considered significant. Results: 6169/44,960 (13.7%) patients underwent isolated off-pump CABG and 38,791/44,960 (86.3%) patients underwent on-pump CABG. Between 2008 and 2021, the proportion of off-pump procedures decreased: 18.8% between 2008–2012, 11.6% between 2013–2017, and 8.6% between 2018–2021 (χ2 = 712.78, df = 2, p < 0.001). Groups were found to be well balanced with respect to age, history of chronic obstructive pulmonary disease (COPD), history of diabetes, history of prior cardiac surgery, as well as left ventricular ejection fraction and history of smoking, and thus an analysis was conducted using the entire cohort. After covariate adjustment, group status was found to not be a predictor of death (aHR = 0.92, 95% confidence interval (95% CI) = 0.66–1.28, p = 0.62), stroke (aHR = 1.33, 95% CI = 0.83–2.12, p = 0.23), myocardial infarction (MI) (aHR = 0.86, 95% CI = 0.51–1.46, p = 0.58). However, given the large imbalance between group size, the groups were then propensity matched on age, history of chronic obstructive pulmonary disease (COPD), diabetes hypertension, smoking, prior cardiac surgery, and left ventricular ejection fraction, resulting in a smaller cohort of 12,130 patients: 5961 (49.1%) on pump and 6169 (50.9%) off pump. After covariate adjustment, the on-pump group in the matched cohort had increased risk of the following within 30 days: death (aHR = 2.60, 95% CI = 1.50–4.51, p < 0.001), stroke (aHR = 1.61, 95% CI = 1.09–2.38, p = 0.016), acute renal failure (aHR = 2.31, 95% CI = 1.46–3.66, p < 0.001), atrial fibrillation (aHR = 1.39, 95% CI = 1.23–1.57, p < 0.001), intraoperative death (aHR = 1.67, 95% CI = 1.07–2.59, p = 0.023), and prolonged intubation (aHR = 1.53, 95% CI = 1.27–1.85, p < 0.001). They also experienced increased length of stay (Beta = 0.05, p < 0.001). Group did not predict risk of reintubation, perioperative myocardial infarction, or postoperative cardiac arrest requiring cardiopulmonary resuscitation (CPR). Conclusions: In a propensity matched cohort of veterans undergoing isolated CABG, off-pump technique was associated with decreased risk of multiple perioperative outcomes measures. However, the proportion of off-pump procedures within the VHA decreased between 2008–2021. This may be secondary to more selective use as overall volume has decreased, though additional study is needed to evaluate these trends.

Medial opening wedge high tibial osteotomy performs similarly irrespective of body mass index.

This study investigates the effect of the body mass index (BMI) on the early (2 years) to midterm (5 years) results of medial opening wedge high tibial osteotomy (MOWHTO). A prospectively maintained single-centre database of 1138 knee osteotomies, between 2002 and2022, was retrospectively reviewed. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee osteoarthritis (OA), with varus knee malalignment, having failed conservative management, were included. Patients were categorized into threegroups according to their BMI as per the classification from the National Institute for Health and Care Excellence (NICE): the healthy weight (HW) group (BMI of 18.5-24.9 kg/m2), the overweight (OW) (BMI of 25-29.9 kg/m2), and the obesity (OB) group (BMI ≥ 30 kg/m2). Multiple patient-reported outcome measures (n = 6) were recorded preoperatively and at 2 and 5 years postoperatively. Deformity analysis was undertaken preoperatively and postoperatively. The relative risk (RR) of the complications between the HW, OWand OB groups was calculated. The rate of conversion to arthroplasty, and 5and 10 years survivorship were recorded, as well as the hazard ratio (HR) of BMI on survivorship. A total of 574 cases were included in the study: the HW group (n = 96), the OW group (n = 233)and the OB group (n = 245), with a mean BMI of 23 ± 1.5 kg/m2, 27.4 ± 1.4 kg/m2 and 34.4 ± 3.8 kg/m2, respectively. The mean follow-up was 13.3 years (4.8-20.3). The mean mechanical tibiofemoral angle corrections were in the HW group: 7.1 ± 3°, OW group: 6.6 ± 3.5°and OB group: 7.1 ± 3.8°, with no intergroup significant difference (p = n.s.). Clinically, despite lower preoperative scores in the OW and OB groups, no difference was observed postoperatively amongst the three groups. The overall complication rate was 12.5% in the HW group, 6.8% in the OW group, and 9.8% in the OB group. There was no significant difference in the RR of complications between the HW and OW groups (RR = 0.6, 95% confidence interval [CI] = 0.3-1.3)(p = 0.2), and the HW and OB groups (RR = 0.8; 95% CI = 0.3-2.2)(p = 0.7). There was no overall significant difference in survival outcomes based on the BMI between the threegroups (p = 0.4). The HR of conversion to arthroplasty between the HW and OW groups was 1.4 [95% CI = 0.6-3.5](p = 0.5)and between the HW and OB groups was 1.8 [95% CI = 0.8-4.4] (p = 0.2). BMI has no significant effect on either the radiological corrections, clinical outcomes, complicationsor survivorship of MOWHTO at short- to medium-term follow-up. No specific cutoff point for BMI can be recommended as a contraindication to MOWHTO. Level IV, Retrospective cohort study.

Quantifying Vagus Nerve Stimulation Outcomes in Multifocal Refractory Epilepsy: A Model Across Multiple Surgeries.

Objective This study aims to develop a quantifiable model for evaluating the outcomes of vagus nerve stimulation (VNS) in patients with multifocal refractory epilepsy, particularly focusing on those who have undergone multiple surgeries. By adopting a patient-centered approach, the study seeks to provide a robust framework for assessing VNS efficacy across various patient demographics, including both adult and pediatric patients, and those with impaired cognitive and communicative abilities. Methods We conducted a retrospective analysis of 49 patients with multifocal refractory epilepsy who underwent at least one VNS surgery. The cohort was divided into two groups: adults (≥16 years) and a combined pediatric group that included patients under 16 years of age and patients with impaired cognitive and communicative skills. The Liverpool Seizure Severity Scale (LSSS) was used for adults, while the Hague Seizure Severity Scale (HASS) was employed for the pediatric group. Key outcome measures, including changes in seizure frequency, quality of life (QoL), number of hospitalizations, and other clinical metrics, were quantified using our proposed model. The iterative use of the mentioned scales was also assessed for validity by comparison with the Engel Outcome Scale (EOS). A total of 96 procedures were assessed. Results The results indicated a significant reduction in seizure severity post-surgery across both groups, as quantified by the LSSS for adults and HASS for pediatric and cognitively impaired patients. The model also demonstrated a consistent decrease in seizure frequency and an improvement in QoL metrics over successive surgeries. Minimal major side effects were reported, supporting the effectiveness of our quantification approach in capturing VNS outcomes. Conclusions This study introduces a novel, quantifiable model for evaluating VNS outcomes, providing a comprehensive tool for clinicians to assess the effectiveness of VNS in managing multifocal refractory epilepsy. By integrating multiple outcome measures into a cohesive framework, our model can aid in better understanding VNS therapy's impact and contribute to more informed clinical practice.

Targeted Screening for Cancer: Learnings and Applicability to Melanoma: A Scoping Review.

This scoping review aims to systematically gather evidence from personalized cancer-screening studies across various cancers, summarize key components and outcomes, and provide implications for a future personalized melanoma-screening strategy. Peer-reviewed articles and clinical trial databases were searched for, with restrictions on language and publication date. Sixteen distinct studies were identified and included in this review. The studies' results were synthesized according to key components, including risk assessment, risk thresholds, screening pathways, and primary outcomes of interest. Studies most frequently reported about breast cancers (n = 7), followed by colorectal (n = 5), prostate (n = 2), lung (n = 1), and ovarian cancers (n = 1). The identified screening programs were evaluated predominately in Europe (n = 6) and North America (n = 4). The studies employed multiple different risk assessment tools, screening schedules, and outcome measurements, with few consistent approaches identified across the studies. The benefit-harm assessment of each proposed personalized screening program indicated that the majority were feasible and effective. The establishment of a personalized screening program is complex, but results of the reviewed studies indicate that it is feasible, can improve participation rates, and screening outcomes. While the review primarily examines screening programs for cancers other than melanoma, the insights can be used to inform the development of a personalized melanoma screening strategy.

Poster 263: Revision and Primary Osteochondral Allograft Transplantation Provide Clinical Benefit at Midterm Follow-up: A Matched Cohort Analysis of Patient-Reported Outcomes, Reoperations, and Failures

Objectives: Prior studies have observed promising short-term outcomes following revision osteochondral allograft (OCA) transplantation, resulting in significant improvement in pain relief, functional outcomes, and quality of life. However, few studies have examined midterm (minimum 5-year) outcomes following revision OCA transplantation. The purpose of this study is to examine midterm outcomes following revision OCA transplantation to the femoral condyle, as well as evaluating reoperation and survivorship, compared to a matched cohort undergoing primary OCA transplantation. Methods: A retrospective review of prospectively collected data was performed to identify patients undergoing revision OCA transplantation to the femoral condyle between 1999-2018 with a minimum of 5-year follow-up. A 1:2 cohort of revision: primary OCA patients, matched based on defect size, age, and body mass index (BMI) were identified. Lysholm, International Knee Documentation Committee (IKDC) subjective form, and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales were collected, as well as the incidence of reoperations or graft failures. Reoperation was defined as any subsequent surgery in the index compartment. Failure was defined as subsequent arthroplasty or revision cartilage procedure. Previously determined thresholds for achievement of clinically significant outcomes were utilized. Results: A total 15 patients undergoing revision OCAs were successfully matched to 30 patients undergoing primary OCA. Mean follow-up following revision OCA was 9.3 ± 3.0 years (range: 5.1 - 14.7). Mean age in patients undergoing revision OCA was 31.1 ± 9.7 years (range: 19.9 - 52.7) with a mean BMI of 25.9 ± 3.4 kg/m2 (range: 20.8 - 30.4). Revision OCA was performed to the lateral condyle in 53% of cases (n = 8/15), with 73%; (n = 11/15) of patients undergoing a concomitant procedure. The mean time between initial and revision OCA was 2.9 ± 1.4 years (range: 1.2 - 6.2). Reoperations were performed in 60% (n = 9/15) of revision OCA patients at a mean time of 4.7 ± 4.2 years (range: 0.6 - 11.2). Failures were observed in 13% (n = 2/15) of revision OCA patients, with total knee arthroplasty performed at a mean of 4.9 ± 3.4 years (range: 2.9 - 8.9). Graft survivorship free from reoperation (p = .568) and failure (p = .753) were not significantly different between revision and primary groups. Patient acceptable symptomatic state (PASS) was achieved following revision OCA patients for IKDC (70%), Lysholm (83%), and KOOS subset questionnaires (Symptoms [70%], Pain [100%], Activities of Daily Living [80%], Sport [90%], and Quality of Life [80%]). Conclusions: At a mean of 9.3 years following revision OCA, 67% of patients required reoperation, with 13% undergoing arthroplasty. No significant difference in graft survivorship free from failure or reoperation was appreciated between revision versus primary OCA groups. Achievement of PASS was observed for multiple outcome measures following revision OCA.

Update on using buccal myomucosal flaps for patients with cleft palate and velopharyngeal insufficiency: primary and secondary interventions.

This review aims to examine the indications and anatomical circumstances for when to optimally incorporate buccal myomucosal flaps (BMFs) into palatal surgical reconstruction. Studies examining outcomes following primary cleft palate repair with incorporation of BMF have demonstrated excellent speech outcomes and low rates of fistula. Furthermore, some reports cite an association of buccal flap use with reduced midface hypoplasia and the need for later orthognathic surgery. When used for secondary speech surgery, BMFs have been shown to lead to speech improvements across multiple outcome measures. Advantages of BMF techniques over conventionally described pharyngeal flap and pharyngoplasty procedures include significant lengthening of the velum, favorable repositioning of the levator muscular sling, and lower rates of obstructive sleep apnea. Although the published data demonstrate excellent outcomes with use of BMFs for primary and secondary palatal surgery, there are limited data to conclude superiority over the traditional, more extensively investigated surgical techniques. The authors of this review agree with the evidence that BMF techniques can be useful in primary palatoplasty for congenitally wide clefts, secondary speech surgery for large velopharyngeal gaps, and/or in individuals with a predisposition for airway obstruction from traditional approaches.

Ceramic-on-Ceramic Total Hip Arthroplasty Using a Double Tapered, Proximally Coated Stem: 15 to 24-year Clinical and Radiologic Follow-Up

BackgroundTotal hip arthroplasty implant choice profoundly affects survivorship, complications, and failure modes. This study evaluates the long-term (average 18 year) outcomes of ceramic-on-ceramic hip arthroplasty using uncemented shells and stems. Despite an impressive 20-year cumulative percent revision of 5.9%, the hydroxyapatite proximally coated femoral components evaluated in this study have seen declining use since 2003. MethodsA review of 349 consecutive total hip arthroplasties from 1999 to 2007 was matched to 272 cases with registry data. A survivorship analysis included 274 hips (Group A) after excluding patients lost to follow-up and navigated cases. Group B comprised 135 patients who had complete datasets spanning a minimum of 15 years. ResultsKaplan-Meier analysis identified a 95.6% survivorship plateau at 16 to 24 years, with no significant impact from age, sex, component size, or original pathology. In Group B, EuroQol-5 Dimensions-5 Levels (EQ5D5L) scores indicated favorable outcomes in mobility, self-care, activities, pain/discomfort, and anxiety/depression, with an EQ5D visual analog score mean of 79.24. Functional scores, including the Harris Hip Score, Oxford Hip Score, and Forgotten Joint Score, showed positive outcomes. Radiologic assessments revealed no osteolysis or loose components, with a mean Engh score of 21.69. Dorr classification identified bone quality variations. Better Engh scores corresponded to higher levels of patient satisfaction. Age at surgery was correlated with better functional scores, while sex influenced various outcomes. ConclusionsThis comprehensive study, spanning an average of 18.23 years, combined multiple patient-reported outcome measures with extensive clinical and radiologic follow-up. It reported a notably high survivorship rate for this implant combination but highlighted the declining use of the hydroxyapatite proximally coated femoral stem used in this study, potentially facing withdrawal risks in Australia. Level of evidenceTherapeutic Level IV.

The role of awareness in implicit and explicit knowledge

Abstract This study investigates the initial incidental acquisition of two L2 morphosyntactic rules and their immediate usage in production. Using a miniature artificial language paradigm, multiple exposure sessions, realistic exposure, non-salient linguistic features, as well as multiple outcome measures, we demonstrate that adult learners can learn animacy with low levels of awareness, but not case. Forty adult native speakers of English participated in the experiment. Participants were exposed to audio sentences in the artificial language paired with pictures on the computer screen for three sessions. Knowledge of animacy and case was measured with production and grammaticality judgment tests. Results demonstrated that concrete, contiguous and easily trackable L2 properties that lend themselves to distributional learning, such as animacy marking, can benefit from incidental exposure. However, more abstract L2 properties, like the morphological paradigm of case, seem not to be learnable by incidental means, and opportunities for explicit learning must be provided.

Effects of Trauma Center Consolidation on Adult Trauma at a Rural Level 1 Trauma Center.

The aim was to determine the impact of consolidation of two rural level 1 trauma centers on adult trauma patients presenting to the remaining level 1 trauma center. To our knowledge, a study assessing the impact of trauma center consolidation on adult trauma patients had yet to be performed. A single institution, retrospective study was conducted at a rural level 1 trauma center. Adult trauma patients who presented to our center from January 2017 to January 2022 were included. The cohorts spanned 33 months pre- and post-consolidation. Multiple demographic and outcome measures were gathered. Data were analyzed using the student's t-test and Chi-squared testing. There was a 33% increase in overall trauma activations and 9% increase in transfers from outside facilities post-consolidation. The post-consolidation group was significantly older, had higher mean injury severity score, and decreased hospital-free days. The post-consolidation group also saw an increase in ICU admission and surgical intervention. While there were no significant differences in ICU-free days or ventilator days, patients in the post-consolidation group with the highest level of activation who required both surgical intervention and ICU admission experienced decreased mortality. The consolidation of trauma services to a single level 1 trauma center in a rural Appalachian health system led to higher trauma volume and acuity, but most importantly decreased mortality for the most severely injured trauma patients.

Determinants of the operational performance of community-managed handpumps in rural Mozambique: An analysis of five years of cross-sectional sustainability assessments

Improving rural water supply sustainability in sub-Saharan Africa remains a major challenge. This study analysed five-years of cross-sectional sustainability check data collected annually between 2011 and 2016 (except 2015) to investigate factors influencing the operational performance of community-managed handpumps in rural Mozambique. Logistic and negative binomial regression was performed using multiple outcome measures of functionality, reliability and continuity. Average marginal effects (AMEs) were estimated to assess the effects of the predictors and mediation analysis was conducted to examine the role of women's participation.Higher levels of handpump performance were associated with financial records quality and update frequency, water committees with spare parts in stock, and committee annual revenue. The AME of high quality or recently updated financial records for non-functionality was estimated to be −0.40 (95% confidence interval [CI], −0.56 to −0.25), which is interpreted as a 40% lower probability of a water point being non-functional compared to the reference group. Water committees with a spare part stock exhibited a preventive effect on both non-functionality and breakdowns in the past 12 months, reducing their probability by 10% (AME, 95% CI, −0.17 to −0.03) and by 18% (AME, 95% CI, −0.30 to −0.05), respectively. Annual committee revenue up to 2,000 MZN (57 USD) reduced the probability of breakdowns by 25% (AME, 95% CI, −0.45 to 0.05). Handpumps were 10% (AME, 95% CI, 0.03 to 0.17) more likely to be non-functional when women were in the committee management positions. Conversely, female maintenance group members were associated with reduced breakdowns in the multivariate regression analysis (odds ratio, 0.48; 95% CI, 0.24 to 0.95).Increasing outreach of post-construction support on capacity building for water committees, particularly on user fee collection, maintaining financial records, replenishing spare parts, and increased participation of women in the maintenance group, may contribute to greater sustainability of rural water points.

Impact of early rehabilitation therapy on functional outcomes in patients post distal radius fracture surgery: a systematic review and meta-analysis

BackgroundThis meta-analysis aims to investigate the efficacy of early rehabilitation on patients who have undergone surgery for distal radius fractures (DRFs) with palmar plating, focusing on multiple outcome measures including upper limb function, wrist function, back extension mobility, pain levels, and complications.MethodsA rigorous search strategy adhering to the PRISMA guidelines was employed across four major databases, including PubMed, Embase, Web of Science, and the Cochrane Library. Studies were included based on stringent criteria, and data extraction was performed independently by two reviewers. Meta-analysis was conducted employing both fixed-effect and random-effects models as dictated by heterogeneity, assessed by the I2 statistic and chi-square tests. A total of 7 studies, encompassing diverse demographic groups and timelines, were included for the final analysis.ResultsThe meta-analysis disclosed that early rehabilitation yielded a statistically significant improvement in upper limb function (SMD -0.27; 95% CI -0.48 to -0.07; P < 0.0001) and back extension mobility (SMD 0.26; 95% CI 0.04 to 0.48; P = 0.021). A notable reduction in pain levels was observed in the early rehabilitation group (SMD -0.28; 95% CI -0.53 to -0.02; P = 0.03). However, there were no significant differences in wrist function (SMD -0.13; 95% CI -0.38 to 0.12; P = 0.36) and complications (OR 0.99; 95% CI 0.61 to 1.61; P = 0.96).ConclusionsEarly rehabilitation post-DRF surgery with palmar plating has been found to be beneficial in enhancing upper limb functionality and back extension mobility, and in reducing pain levels. Nevertheless, no significant impact was observed regarding wrist function and complications.

High survivorship and low complication rate in a single-centre series of 651 medial opening wedge high tibial osteotomy cases with a mean follow-up of 13 years.

This study aimed to report the early to midterm results of medial opening wedge high tibial osteotomy (MOWHTO) from the largest single-centre osteotomy database. The primary outcomes were reporting the radiological corrections and the functional outcomes represented by multiple patient-reported outcome measures (PROMs). The secondary outcomes were to report the complications, revisionsand survivorship up to 10 years postoperatively. A prospectively maintained single-centre database of 1138 knee osteotomies was retrospectively reviewed. Patients who underwent MOWHTO and met the inclusion criteria were included. Those inclusion criteria were moderate to severe knee pain that failed conservative management;varus knee malalignment; and isolated medial osteoarthritis of the knee. A total of 651 cases, with a mean age of 46.7 ± 9 years and a mean body mass indexof 29.6 ± 5.2 kg/m2 , were included. This comprised 71% males (n = 462) and 29% females (n = 189). The mean follow-up was 158.1 ± 45.4 months. Multiple PROMs were recorded preoperatively and serially postoperatively. This included the Knee injury andOsteoarthritisOutcome Scores, the Oxford Knee Score, the Oxford Knee Score-Activity and Participation Questionnaire, the Western Ontario and McMaster University Scores, the Visual Analogue Scale for health and pain, and the EQ-5D, which is a standardised measure of health-related quality of life. All lower limb alignment measurements were recorded pre- and postoperatively. The rates of osteotomy revision, conversion to arthroplasty, complications, and 5- and 10-year survivorship were recorded. A total of 651 cases were followed up to a mean of 158.1 ± 45.4 months. The mean planned correction angle was 7.6° ± 2.9°. The mean planned opening wedge distance was 8.1 ± 3.1 mm. The mean intraoperative anterior and posterior osteotomy gaps opening were 7.7 ± 3.4and 8.9 ± 3.8 mm, respectively. Postoperatively, the mean mechanical tibiofemoral angle improved from -5.7° ± 2.9° varus to 1.3° ± 2.5° valgus, the mean medial proximal tibial angle improved from preoperative 85.5° ± 2.3° to postoperative 91.6° ± 2.7°and the mean Mikulicz point improved from 21.7 ± 12.6% to 54.8 ± 11% (all p values < 0.001). All PROMs significantly improved at 24 months follow-up (all p values < 0.001). The rate of osteotomy revision was 1.1% at a mean of 2 ± 2.5 years postoperatively. The overall rate of arthroplasty conversion was 9.1%. This comprised 5.8% total knee arthroplasty conversion at a mean of 6.9 ± 3.5 years postoperatively and 3.2% unicompartmental knee arthroplasty conversion at a mean of 5.7 ± 2.5 years postoperatively. An overall 10.3% complication rate was recorded. The 5 and 10-year survivorship was 97.2%and 91.9%, respectively. MOWHTOis a radiologically and clinically rewarding procedure with a high survival rate at 5 and 10 years and a low complication rate in experienced hands. MOWHTO should be considered in patients presenting with medial unicompartmental knee pain with an evidence of overload and a varus mechanical coronal plane axis. Level IV, retrospective cohort study.

Combining discrete and continuous information for multi-criteria optimization problems

In multi-criteria optimization problems that originate from real-world decision making tasks, we often find the following structure: There is an underlying continuous, possibly even convex model for the multiple outcome measures depending on the design variables, but these outcomes are additionally assigned to discrete categories according to their desirability for the decision maker. Multi-criteria deliberations may then take place at the level of these discrete labels, while the calculation of a specific design remains a continuous problem. In this work, we analyze this type of problem and provide theoretical results about its solution set. We prove that the discrete decision problem can be tackled by solving scalarizations of the underlying continuous model. Based on our analysis we propose multiple algorithmic approaches that are specifically suited to handle these problems. We compare the algorithms based on a set of test problems. Furthermore, we apply our methods to a real-world radiotherapy planning example.

The being safe, health and positively empowered pilot randomized controlled trial: A digital multicomponent intervention for immigrant women with cumulative exposures to violence.

Pre- and postmigration exposures to violence are significant social determinants of immigrant women's health, safety, and well-being, with Black immigrant women being at high risk because of many coming from conflict-zone countries. The existing literature does not report the development and testing of a multicomponent digital intervention to address safety and health issues among immigrant women with cumulative exposures to violence. This pilot randomized controlled trial evaluated preliminary efficacy of a multicomponent digital intervention (BSHAPE) to improve health and safety outcomes for immigrant women with cumulative violence exposures, posttraumatic stress disorder and/or depression symptoms, and human immune deficiency virus (HIV) risk behaviors. The intervention was developed based on formative qualitative work and input from women. In the randomized controlled trial, 144 Black immigrant women, average age being 33.6 years, were randomly assigned to either the BSHAPE arm (n = 72) or a control arm (n = 72). Data were collected at four time points over 12 months. A generalized estimating equation analysis was performed to examine group differences in change in outcomes over time. Compared to the control arm, participants in BSHAPE showed significant improvement in multiple outcome measures (e.g., HIV/STI risk). This pilot trial of BSHAPE showed promising results for immigrant women with lifetime exposures to violence, poor mental health, and HIV risk. The study also provided useful information to further improve BSHAPE for a full-scale efficacy trial. The digital BSHAPE can be especially advantageous for violence-affected immigrant women who face numerous barriers to accessing in-person care for their safety and health needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).