Objective Measures Research Articles

Inter-rater reliability and clinical relevance of subjective and objective interpretation of videofluoroscopy findings.

Dysphagia is commonly evaluated using videofluoroscopy (VFS). As its ratings are usually subjective normal-abnormal ratings, objective measurements have been developed. We compared the inter-rater reliability of the usual VFS ratings to the objective measurement VFS ratings and evaluated their clinical relevance. Two blinded raters analyzed the subjective normal-abnormal ratings of 77 patients' VFS. Two other blinded raters analyzed the objective measurements of pharyngeal aerated area with bolus held in the oral cavity (PAhold), the pharyngeal area of residual bolus during swallowing (PAmax), the pharyngeal constriction ratio (PCR), the maximum pharyngoesophageal segment opening (PESmax), pharyngoesophageal segment opening duration (POD), airway closure duration (ACD), and total pharyngeal transit time (TPT). We evaluated the inter-rater agreement in the subjective ratings and the objective measurements. Clinical utility analysis compared the measurements with the VFS findings of pharyngeal phase abnormality, penetration/aspiration, and cricopharyngeal relaxation. In the pharyngeal findings, the subjective analysis inter-rater agreement was mainly moderate to strong. The strongest agreements were on the pharyngeal residues and penetration/aspiration findings. The objective measurements had fair to good inter-rater agreement. Clinical utility analysis found statistically significant connections between TPT and pharyngeal phase abnormality, normal PCR and lack of penetration/aspiration, and normal PESmax and normal cricopharyngeal relaxation. The subjective analysis had moderate to strong inter-rater agreement in the pharyngeal VFS findings, especially concerning pharyngeal residues and penetration/aspiration detection, reflecting the efficacy and safety of swallowing. The objective measurements had fair to good inter-observer reproducibility and could thus improve the reliability of VFS diagnostics. 4.

Hospice Administrators' and Providers' Perspectives on Providing Upstream Palliative Care: Facilitators, Barriers, and Policy Prescriptions.

Background: Among patients with serious illness, palliative care before hospice enrollment is associated with improved quality of life, reduced symptom burden, and earlier transitions to hospice. However, fewer than half of eligible patients receive specialty palliative care referrals. As most hospice clinicians and administrators have experience in specialty palliative care, several emerging programs propose engaging hospice clinicians to provide early palliative care. Objective: We sought to identify barriers and facilitators to upstream palliative care. Design: We conducted a key informant qualitative study among hospice administrators and clinicians. Setting/Subjects: We conducted semi-structured interviews with 23 hospice administrators and clinicians in eight states from March to August 2022. We identified participants using snowball and purposive sampling using states that participate in Medicare Advantage's value-based insurance design Model. Results: Respondents indicated that barriers to early palliative care included inadequate staffing and reimbursement. Hospice clinicians providing community-based palliative care can address access barriers and improve transitions to hospice. Respondents expressed desire for payer guidance in identifying eligible patients but were cautious about payers acting as direct palliative care providers. However, payers could facilitate uptake by broadening and specifying coverage of services to include goals of care conversations and symptom management. Routine referrals initiated by objective measures could potentially increase access. Conclusions: Utilizing hospice providers to provide upstream palliative care can increase access, improve outcomes, and ease the transition to hospice.

Serum Biomarkers in Bullous Pemphigoid: A Systematic Review.

Bullous pemphigoid (BP) is the most common type of subepidermal blistering disease, usually observed in the elderly population, with a mean age of presentation between 66 and 83 years. BP is a psychosocially ladened disease, with many patients experiencing negative body image, social isolation, and depression. The identification and validation of biomarkers in BP may further the understanding of disease pathogenesis, provide objective measures in assessing efficacy in clinical trials, and identify new targets for targeted therapy. Two databases (Medline and Embase) were searched from database inception to September 2023. All published articles reporting on biomarker levels of BP patients in serum compared to healthy controls were included. A total of 877 unique articles were identified, resulting in the inclusion of 62 case-control studies reporting on a total of 1837 patients and 140 unique biomarkers. Biomarkers were categorized into T-cell mediated, B-cell mediated, innate immune system, and coagulation cascade pathway. The most notable biomarkers identified include increases in anti-BP180/230 immunoglobulin (Ig)G/E, total IgE, TNF-α, B-cell activating factor, interleukin-31, eosinophil cationic protein, MMP-9, and coagulation cascade biomarker levels. The results of this review provide the greatest support for a role of anti-BP180/230 autoantibodies, Th2 cells, eosinophils, and the coagulation cascade in the pathogenesis of BP. The pathogenesis of BP has an underlying autoimmune etiology centred around the production of autoantibodies against BP180/230, but increased Th2, eosinophil and coagulation cascade activity may be contributory.

Evaluation of the facial profile of skeletal Class III patients undergoing camouflage orthodontic treatment: a retrospective study.

To identify objective metrics for evaluating the esthetics of facial profiles in skeletal Class III patients undergoing camouflage orthodontic treatment. Eighty Asian-Chinese patients classified as skeletal Class III were included. Thirty cephalometric measurements of pre- and posttreatment cephalograms were analyzed. Ten orthodontists assigned visual analog scale (VAS) scores to the pre- and posttreatment profiles based on standardized lateral photographs. Correlations between subjective VAS scores and objective measurements were assessed using Pearson correlation and stepwise multiple linear regression analysis. Lower incisor (L1) protrusion, nasolabial angle, lower lip-E line distance, SNB angle, and L1 to AP plane were significantly correlated with VAS scores of pretreatment profiles of skeletal Class III patients. Factors such as retraction of the lower incisor, increased interincisal angle and overjet, reduction of lower lip-E line distance, as well as augmentation of the Z angle and nasolabial angle were significantly correlated with the changes in VAS scores post-camouflage orthodontic treatment. Stepwise multiple linear regression analysis revealed that pretreatment nasolabial angle, changes in the lower lip-E line distance, and pretreatment Pog-NB distance were the key factors influencing the posttreatment facial profile esthetics of skeletal Class III patients with camouflage orthodontic treatment. Several cephalometric measurements correlate with subjective facial esthetic evaluations of skeletal Class III patients. Changes in lower lip prominence, the pretreatment nasolabial angle, and Pog-NB distance are the main factors related to facial esthetics in skeletal Class III patients after camouflage orthodontic treatment.

Validation of IGA*BSA in Assessing Disease Severity and Response in Patients with Atopic Dermatitis: A Retrospective Cohort Study in China.

Background: Accurate evaluation of atopic dermatitis (AD) severity is crucial to determine and adjust treatment options. Previous studies have found the product of Investigator's Global Assessment (IGA) and affected body surface area (BSA) to be a simple tool, which requires further verification. Objective: To determine the validity of IGA*BSA in assessing the severity of AD across all age, sex, BMI and disease severity groups. Method: We performed a retrospective study of AD using data from a national cohort (China Type II Inflammatory Skin Disease Clinical Research and Standardized Diagnosis and Treatment Project). Results: Overall, 3051 participants were included in the final analysis. IGA*BSA correlated better with objective measures than with subjective measures. IGA*BSA significantly correlated with Eczema Area and Severity Index (EASI) (r = 0.81), which was stronger than either IGA or BSA alone with EASI, regardless of age, sex, Body Mass Index (BMI), and disease severity groups. Besides, IGA*BSA mild, moderate, and severe groups were associated with significantly higher scores of other assessments and had moderate to fair concordance with other assessments severity strata. At follow-up, the concordance of improvement between IGA*BSA 50/75/90 and EASI 50/75/90 was observed (ĸ = 0.65, 0.62, 0.58, respectively). Conclusion: IGA*BSA appears to be a valid objective assessment of AD severity and improvement over time across all age, sex, BMI, and disease severity subgroups in the clinical practice.

Evaluating Changes in Adult Cochlear Implant Users' Brain and Behavior Following Auditory Training.

To describe the effects of two types of auditory training on both behavioral and physiological measures of auditory function in cochlear implant (CI) users, and to examine whether a relationship exists between the behavioral and objective outcome measures. This study involved two experiments, both of which used a within-subject design. Outcome measures included behavioral and cortical electrophysiological measures of auditory processing. In Experiment I, 8 CI users participated in a music-based auditory training. The training program included both short training sessions completed in the laboratory as well as a set of 12 training sessions that participants completed at home over the course of a month. As part of the training program, study participants listened to a range of different musical stimuli and were asked to discriminate stimuli that differed in pitch or timbre and to identify melodic changes. Performance was assessed before training and at three intervals during and after training was completed. In Experiment II, 20 CI users participated in a more focused auditory training task: the detection of spectral ripple modulation depth. Training consisted of a single 40-minute session that took place in the laboratory under the supervision of the investigators. Behavioral and physiologic measures of spectral ripple modulation depth detection were obtained immediately pre- and post-training. Data from both experiments were analyzed using mixed linear regressions, paired t tests, correlations, and descriptive statistics. In Experiment I, there was a significant improvement in behavioral measures of pitch discrimination after the study participants completed the laboratory and home-based training sessions. There was no significant effect of training on electrophysiologic measures of the auditory N1-P2 onset response and acoustic change complex (ACC). There were no significant relationships between electrophysiologic measures and behavioral outcomes after the month-long training. In Experiment II, there was no significant effect of training on the ACC, although there was a small but significant improvement in behavioral spectral ripple modulation depth thresholds after the short-term training. This study demonstrates that auditory training improves spectral cue perception in CI users, with significant perceptual gains observed despite cortical electrophysiological responses like the ACC not reliably predicting training benefits across short- and long-term interventions. Future research should further explore individual factors that may lead to greater benefit from auditory training, in addition to optimization of training protocols and outcome measures, as well as demonstrate the generalizability of these findings.

Altered Abdominal Muscle Recruitment and Declined Physical Function in Postpartum Individuals With Pregnancy-Related Pelvic Girdle Pain: A Matched Case-Control Study.

The influence of pregnancy-related pelvic girdle pain (PPGP) on lumbopelvic muscles has not been comprehensively examined in postpartum individuals. Previous research also presented self-reported activity limitations without objective measures. Thirty postpartum individuals with PPGP (PPGP group) and 30 age-, parity-, and postpartum duration-matched asymptomatic individuals (healthy group) were recruited. Transabdominal ultrasonography was used to measure muscle thickness or activation changes of the external oblique (EO), internal oblique (IO), transverse abdominals, lumbar multifidus, and pelvic floor muscles (PFMs) during rest and while performing the active straight leg raise (ASLR). Muscle changes were compared separately in the painful and nonpainful sides between the PPGP and health control group. Physical function was assessed using the ASLR fatigue (ASLRF), timed up-and-go, and 6-m walking (6MW) tests. The PPGP group had greater thickening changes in the bilateral IO during ASLR compared with the healthy group (nonpainful side, 16.34 vs 3.52 mm; P =.010; painful side, 18.83 vs 6.60 mm; P =.02) but became thinner in the EO (nonpainful side, -2.19 vs 19.97 mm; P <.001; painful side, -5.97 vs 21.43 mm; P <.001). Thicker IO and EO on the nonpainful side (IO, 6.60 vs 5.78 mm; P =.004; EO, 5.37 vs 4.54 mm; P =.011) and a lower bladder base (indication of PFMs) (91.87 vs 78.61 mm; P =.002) during rest were also observed in the PPGP group. Furthermore, the performance of the ASLRF and 6MW tests was poorer in the PPGP than in the healthy group (ASLRF nonpainful side, 82.36 vs 59.09 sec; P =.01; painful side, 75.73 vs 59.26 sec; P =.04; 6MW, 3.48 vs 3.17 sec; P =.02). Postpartum individuals with PPGP demonstrated altered abdominal muscle recruitment strategies during loading tasks, with objectively impaired physical functions. These findings are critical for developing effective muscle training interventions for PPGP.

Esophageal impedance planimetry during per-oral endoscopic myotomy guides myotomy extent.

Peroral endoscopic myotomy (POEM) is the standard treatment for achalasia. Functional luminal imaging probe (FLIP) technology enables objective measurement of lower esophageal sphincter (LES) geometry, with literature linking specific values to improved post-POEM outcomes. Our study assesses FLIP's intraoperative use in evaluating myotomy extent in real-time. Retrospective data from all patients undergoing POEM with intraoperative FLIP measurements were extracted from June 2020 to January 2023. The primary endpoint was intraoperative FLIP measurements, management changes, and symptom improvement (Eckardt score). Fourteen patients (age 56 ± 14years, BMI 28 ± 7kg/m2) were identified. Most patients were female (64%). Predominantly, patients presented with type II achalasia (50%). FLIP measurements were taken before and after myotomy, demonstrating increases in mean distensibility index (DI) 1.6 ± 1. 4 to 5.4 ± 2.1 mm2/mmHg (p < 0.05) and mean diameter (Dmin) 6 ± 1.8 to 10.9 ± 2.3mm (p < 0.05) at 50ml balloon fill. Additional myotomy was performed in one patient when an inadequate increase in FLIP values were noted. Mean operative time was 98 ± 28min, and there were no intraoperative complications. At the30-day follow-up, median Eckardt score decreased from mean apreoperative score of 7 ± 2 to apost-operative mean of 2 ± 3, with 10 patients (78%) having a score ≤ 2. In total, four patients experienced symptom recurrence, with repeat FLIP values revealing a significant decrease in DI from 7 ± 2.2 post-POEM to 2.5 ± 1.5 at recurrence. FLIP technology identified LES pathology in 3 out of 4 (75%) patients, facilitating referral to LES-directed therapy. Our study adds to the literature supporting the use of FLIP technology during thePOEM procedure, with most patients achieving ideal values after a standard-length myotomy. This suggests thepotential benefits of shorter myotomies guided by FLIP to achieve comparable outcomes and reduce postoperative GERD risk. Collaborative standardization of study designs and outcome measures is crucial for facilitating prospective trials and cross-setting outcome comparisons.

Understanding the differences in the use of graphic tool and planning during graphic execution between individuals with autism and typically developing individuals

Individuals with autism (ASD) often face difficulty in executing graphic tasks. This can be related to how one uses a graphic tool (e.g., pen) and plans ahead the graphic execution. Use of graphic tool can be captured using attributes, e.g., pen-tip pressure, number of pen lifts, etc. One’s ability to plan a graphic execution can be quantified using the total duration of pen lifts (i.e., air time). Though pen-and-paper-based Trail Making Test-Part A (TMT-A) can estimate planning of graphic execution, yet it cannot capture other attributes, e.g., pen-tip pressure, pen lift, etc. This can be possible if TMT-A is administered on a pressure-sensitive tablet as seen from existing studies with typically developing (TD) individuals. However, quantification of such attributes using TMT-A administered on a pressure-sensitive tablet remains unexplored for individuals with ASD. In addition, such objective measures can help to understand variations in the use of graphic tool and ability to plan graphic execution even outside the TMT-A task, e.g., while drawing shapes which is important to the development of children’s graphic skills. Here, we conducted a study with 12 pairs of TD children and those with ASD who executed TMT-A (in Phase-I) and shape drawing (in Phase-II) on a pressure-sensitive tablet. Results of our study show differences in the use of graphic tool and planning ahead the graphic execution between two participant groups in both the Phases. Such insights can offer clinical inputs that can be helpful in designing individualized intervention paradigms for children facing difficulties in graphic execution.

Effects of Kinesio Taping on Neck Pain: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.

Neck pain constitutes a prevalent and burdensome health issue, substantially impairing patients' quality of life and functional capabilities. Kinesio taping (KT), a commonly employed intervention within physical therapy, holds promise for mitigating such symptoms; however, a comprehensive evaluation of its efficacy and evidence base is lacking. Therefore, this study endeavors to systematically investigate the therapeutic effects of KT on both subjective neck pain intensity and objective measures of physical activity limitations through a rigorous meta-analytic approach. By synthesizing existing literature and scrutinizing methodological nuances, we aim to furnish healthcare practitioners with evidence-informed insights, facilitating more judicious clinical decision-making and optimizing patient outcomes. According to the PRISMA guidelines, we conducted searches on PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) investigating the efficacy of KT in treating neck pain. Screening was performed based on predefined inclusion and exclusion criteria. Characteristics of the included RCTs were extracted. Trial heterogeneity was assessed using the I2 statistic. Meta-analysis was conducted using Stata 17 software. Risk of bias and methodological quality were evaluated using the Cochrane Risk of Bias 2 tool and the PEDro scale, respectively. In our analysis of 10 RCTs involving 620 patients meeting our inclusion criteria, KT demonstrated significant beneficial effects on neck pain, notably surpassing conventional treatment (weighted mean difference = -0.897, 95% CI -1.30 to -0.49, P < 0.001). Subgroup analysis further revealed that KT exhibited particularly pronounced efficacy in the treatment of nonspecific neck pain and mechanical neck pain, with a more substantial effect observed after 4 weeks of KT intervention compared to 1 week. Moreover, KT demonstrated superior efficacy in alleviating pain symptoms compared to both conventional treatment and sham interventions. KT has demonstrated efficacy in reducing neck pain and improving cervical dysfunction among patients. Prolonged KT treatment or its combination with other therapeutic modalities may potentially enhance therapeutic outcomes. PROSPERO CRD42024524685.

Association between objective measures of oral health and salivary gland irradiation with patient-reported outcomes following head and neck radiation therapy.

To determine whether objective measures of oral health and salivary gland irradiation correlates with subjective measures of eating, drinking, and salivation in patients following head and neck radiation therapy (HNRT). This cross-sectional study included 112 patients following HNRT with a completed patient-reported outcome (PRO) scale. Objective measures at post-HNRT visit included decayed-missing-filled teeth (DMFT) scores, periodontal disease condition, oral hygiene status, dental prosthesis use, and prescribed radiation dose to salivary glands. Data were collected and statistical analysis was performed. There was no significant association between PRO scales and dental prosthesis use, periodontal disease, and oral hygiene. Although some significant findings were seen with DMFT and prescribed radiation dose to salivary glands, this explained only very small amounts of the variation in eating, drinking, and salivation measures in these patients. PRO measures should be integrated in the routine care of patients with head and neck cancer.

Overarm Training Tolerance: A Pilot Study on the Use of Muscle Oxygen Saturation as a Biomarker.

Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention.

Efficacy assessments of public artworks intervening in rural built environments for tourism developments: a comparative study of two tourism villages in Hangzhou

ABSTRACT Interventions through rural tourism programs and rural art projects have played a significant role in rural revitalization initiatives in China, wherein public artworks have been deliberately integrated into rural built environments. This study combined both objective and subjective measurements, in two representative tourism villages in Hangzhou that underwent revitalizations. These artworks were strategically placed in the public domains of the villages in two distinct phases, enabling the calculation of their Visual Exposure Rates (VERs). Objective evaluations were gathered on-site via the Comprehensive Assessment of Artworks and Surroundings (CAAS) survey, and the data were subjected to quantitative analysis using the Analytic Hierarchy Process (AHP) method. The study reveals differential changes in VERs across the two villages, concurrently observing variations in the CAAS scores. Findings indicate the efficient promotion of fusion design to support sustainable rural tourism in three dimensions: spatial layout characteristics, cultural and aesthetic values, and tourism management practices. It suggested that sustainable rural tourism development should not hinge solely on increasing the quantity of public artworks but rather on the holistic improvement of sustainable spatial design and management to enhance the rural value chain, ensuring a more comprehensive and sustainable tourism experience

Occupational noise-induced hearing loss among dental personnel: a scoping review.

Introduction Dental personnel are being exposed to noisy equipment on a daily basis and there are indications that dental professionals are at a higher risk of developing occupational noise-induced hearing loss (NIHL). Therefore, this study aims to assess the available research on NIHL among dental professionals.Methods A total of 452 publications were identified through searches on PubMed and Web of Science. These studies were screened on title and abstract for studies that investigated NIHL among dental professionals using objective or subjective parameters for hearing loss. The remaining publications were then searched for relevant data, such as research type, parameters used for measuring hearing loss and authors' conclusions.Results In total, 28 publications were finally included in the selection. Of this selection, 23 used objective criteria for NIHL, three used subjective criteria and two used both. From the 12 studies with objective measurements that also included a control group in their studies, eight reported a significant higher hearing loss among dental personnel than in the control groups. From the 13 studies with objective measurement without a control group, seven reported significant hearing loss among dental personnel. All five studies with subjective measurements reported significant hearing loss in dental personnel.Conclusions Hearing loss seems to be more prevalent among dental personnel than in most control groups.

Exploring Biomechanical Correlates in Voice Analysis of Multiple Sclerosis Patients.

The predominant alterations in voice of patients with Multiple Sclerosis (MS) are phonatory instability, vocal asthenia and roughness, shortness of breath, hypophonia and hypernasality. However, research on alterations of acoustic parameters has few studies and disparate results. To investigate voice disturbances in patients with MS; both with objective measures (analysis of biomechanical) and subjective measures (scales and questionnaires). Experimental study with a total of 20 participants with MS. Voice samples were collected, and biomechanical correlates were analyzed through the Clinical Voice Systems program, Online Lab APP. The VHI-30 (Voice Handicap Index) questionnaire, the GRBAS (grade, roughness, breathiness, asthenia, strain) scale and the Hospital Anxiety and Depression Scale were used as subjective measures. 95% of participants feel and describe dysphonic difficulties. Self-perception of vocal disability correlated with auditory vocal perceptual analysis in the sample of women. The biomechanical parameters showed alterations in the strength of the glottic closure, in the efficiency index and in the structural imbalance index.

Development of a measuring app for systemic sclerosis-related digital ulceration (SALVE: Scleroderma App for Lesion VErification).

To test the hypothesis that photographs (in addition to self-reported data) can be collected daily by patients with systemic sclerosis (SSc) using a smartphone app designed specifically for digital lesions, and could provide an objective outcome measure for use in clinical trials. An app was developed to collect images and patient reported outcome measures (PROMS) including Pain score and the Hand Disability in Systemic Sclerosis-Digital Ulcers (HDISS-DU) questionnaire. Participants photographed their lesion(s) each day for 30 days and uploaded images to a secure repository. Lesions were analysed both manually and automatically, using a machine learning approach. 25 patients with SSc-related digital lesions consented of whom 19 completed the 30-day study, with evaluable data from 27 lesions. Mean (standard deviation [SD]) baseline Pain score was 5.7 (2.4) and HDISS-DU 2.2 (0.9), indicating high lesion and disease-related morbidity. 506 images were used in the analysis (mean number of used images per lesion 18.7, SD 8.3). Mean (SD) manual and automated lesion areas at day 1 were 11.6 (16.0) and 13.9 (16.7) mm2 respectively. Manual area decreased by 0.08mm2 per day (2.4mm2 over 30 days) and automated area by 0.1mm2 (3.0mm2 over 30 days). Average gradients of manual and automated measurements over 30 days correlated strongly (r = 0.81). Manual measurements were on average 40% lower than automated, with wide limits of agreement. Even patients with significant hand disability were able to use the app. Automated measurement of finger lesions could be valuable as an outcome measure in clinical trials.

The urban desirability paradox: U.K. urban-rural differences in well-being, social satisfaction, and economic satisfaction.

As the majority of the global population resides in cities, it is imperative to understand urban well-being. While cities offer concentrated social and economic opportunities, the question arises whether these benefits translate to equitable levels of satisfaction in these domains. Using a robust and objective measure of urbanicity on a sample of 156,000 U.K. residents aged 40 and up, we find that urban living is associated with lower scores across seven dimensions of well-being, social satisfaction, and economic satisfaction. In addition, these scores exhibit greater variability within urban areas, revealing increased inequality. Last, we identify optimal distances in the hinterlands of cities with the highest satisfaction and the least variation. Our findings raise concern for the psychological well-being of urban residents and show the importance of nonlinear methods in urban research.

Assessment of imaging risks for recurrence after stereotactic radiosurgery for brain metastases (IRRaS-BM)

BackgroundThe identification of viable tumors and radiation necrosis after stereotactic radiosurgery (SRS) is crucial for patient management. Tumor habitat analysis involving the grouping of similar voxels can identify subregions that share common biology and enable the depiction of areas of tumor recurrence and treatment-induced change. This study aims to validate an imaging biomarker for tumor recurrence after SRS for brain metastasis by conducting tumor habitat analysis using multi-parametric MRI.MethodsIn this prospective study (NCT05868928), patients with brain metastases will undergo multi-parametric MRI before SRS, and then follow-up MRIs will be conducted every 3 months until 24 months after SRS. The multi-parametric MRI protocol will include T2-weighted and contrast-enhanced T1-weighted imaging, diffusion-weighted imaging, and dynamic susceptibility contrast imaging. Using k-means voxel-wise clustering, this study will define three structural MRI habitats (enhancing, solid low-enhancing, and nonviable) on T1- and T2-weighted images and three physiologic MRI habitats (hypervascular cellular, hypovascular cellular, and nonviable) on apparent diffusion coefficient maps and cerebral blood volume maps. Using RANO-BM criteria as the reference standard, via Cox proportional hazards analysis, the study will prospectively evaluate associations between parameters of the tumor habitats and the time to recurrence. The DICE similarity coefficients between the recurrence site and tumor habitats will be calculated.DiscussionThe tumor habitat analysis will provide an objective and reliable measure for assessing tumor recurrence from brain metastasis following SRS. By identifying subregions for local recurrence, our study could guide the next therapeutic targets for patients after SRS.Trial registrationThis study is registered at ClinicalTrials.gov (NCT05868928).

Environmental Support Moderates the association of Socioeconomic Distress and Delay Discounting across Adolescence.

Early exposure to socioeconomic distress is hypothesized to reinforce decision making that prioritizes immediate, relative to delayed, rewards (i.e., delay discounting); yet these relations have not been examined longitudinal across the vulnerable adolescent period. This study is one of the first to utilize objective and subjective measures to evaluate the relative effects of environmental disadvantage and the potential protective effects of perceived environmental support on delay discounting. A diverse (48.4% White; 46.7% female) sample of participants (N = 246) reported on their home addresses at baseline when they were, on average, 11.96 years old (SDage = 0.88); Youth then reported perceived environmental supports at baseline and delay discounting annually from ages 13 to 18. A socioeconomic distress index was derived from census tract rates of unemployment, income, educational attainment, and lone parenthood. Greater socioeconomic distress was associated with a greater propensity to discount delayed rewards at baseline. Findings also suggest greater perceived higher environmental support was associated with decreasing rates of delay discounting across adolescence for youth from highly socioeconomically distressed areas. These results highlight potential future avenues for preventative and intervention efforts to improve positive youth outcomes.

Pacific accounting review in 2013–2023: a bibliometric analysis

Purpose This literature review aims to portray the thematic landscape of the Pacific Accounting Review (PAR) from 2013 to 2023. This paper also synthesises the special issues in PAR and identifies the main research streams that facilitate contemplating the dialogic interactions between PAR and real-world challenges. Furthermore, this paper aligns these streams with the emerging concerns in Sustainable Development Goals (SDGs) and technological disruptions to propose impactful future directions for publications in PAR. Design/methodology/approach This review adopts bibliometric analysis to establish the main research streams and objective measures for directing future publications. This paper acquires the data of 310 PAR articles from the Web of Science and ensure the data integrity before the analysis. Based on this technique, this paper also analyses PAR’s productivity, authorship and local and global impacts. Findings Our bibliometric analysis reveals three key research streams: (1) ESG practices and disclosures, (2) informal institutions in accounting and (3) accounting in transition. This finding affirms PAR’s relevance to real-world accounting challenges. Using a thematic map, this paper portrays the current state of PAR’s topics to identify potential directions for future publications. Further, this paper proposes three future paths for PAR: (1) the research agenda for non-financial reporting, (2) research relating to and from diverse countries considering both formal and informal contemporary contextual factors and (3) the future of the evolving accounting profession. Originality/value This study adds value to the existing PAR reviews by extending our knowledge with the latest publications, demonstrating an objective and replicable approach, and offering future directions for PAR publications.