Standardized Effect Size Research Articles

The effectiveness of abstinence-based and harm reduction-based interventions in reducing problematic substance use in adults who are experiencing homelessness in high income countries: A systematic review and meta-analysis: A systematic review.

The effectiveness of abstinence-based and harm reduction-based interventions in reducing problematic substance use in adults who are experiencing homelessness in high income countries: A systematic review and meta-analysis: A systematic review.

Placebo Control and Blinding in Randomized Trials of Procedural Interventions

Unlike medications, procedural interventions are rarely trialed against placebo prior to becoming accepted in clinical practice. When placebo-controlled trials are eventually conducted, procedural interventions may be less effective than previously believed. To investigate the importance of including a placebo arm in trials of surgical and interventional procedures by comparing effect sizes from trials of the same procedure that do and do not include a placebo arm. Searches of MEDLINE and Embase identified all placebo-controlled trials for procedural interventions in any specialty of medicine and surgery from inception to March 31, 2019. A secondary search identified randomized clinical trials assessing the same intervention, condition, and end point but without a placebo arm for paired comparison. Placebo-controlled trials of anatomically site-specific procedures requiring skin incision or endoscopic techniques were eligible for inclusion; these were then matched to trials without placebo control that fell within prespecified limits of heterogeneity. Random-effects meta-regression, with placebo and blinding as a fixed effect and intervention and end point grouping as random effects, was used to calculate the impact of placebo control for each end point. Data were analyzed from March 2019 to March 2020. End points were examined in prespecified subgroups: patient-reported or health care professional-assessed outcomes, quality of life, pain, blood pressure, exercise-related outcomes, recurrent bleeding, and all-cause mortality. Ninety-seven end points were matched from 72 blinded, placebo-controlled trials (hereafter, blinded) and 55 unblinded trials without placebo control (hereafter, unblinded), including 111 500 individual patient end points. Unblinded trials had larger standardized effect sizes than blinded trials for exercise-related outcomes (standardized mean difference [SMD], 0.59; 95% CI, 0.29 to 0.89; P < .001) and quality-of-life (SMD, 0.32; 95% CI, 0.11 to 0.53; P = .003) and health care professional-assessed end points (SMD, 0.40; 95% CI, 0.18 to 0.61; P < .001). The placebo effect accounted for 88.1%, 55.2%, and 61.3% of the observed unblinded effect size for these end points, respectively. There was no significant difference between unblinded and blinded trials for patient-reported end points (SMD, 0.31; 95% CI, -0.02 to 0.64; P = .07), blood pressure (SMD, 0.26; 95% CI, -0.10 to 0.62; P = .15), all-cause mortality (odds ratio [OR], 0.23; 95% CI, -0.26 to 0.72; P = .36), pain (SMD, 0.03; 95% CI, -0.52 to 0.57; P = .91), or recurrent bleeding events (OR, -0.12; 95% CI, -1.11 to 0.88; P = .88). The magnitude of the placebo effect found in this systematic review and meta-regression was dependent on the end point. Placebo control in trials of procedural interventions had the greatest impact on exercise-related, quality-of-life, and health care professional-assessed end points. Randomized clinical trials of procedural interventions may consider placebo control accordingly.

Beta spending function based on conditional power in group sequential design.

Conditional power (CP) serves as a widely utilized approach for futility monitoring in group sequential designs. However, adopting the CP methods may lead to inadequate control of the type II error rate at the desired level. In this study, we introduce a flexible beta spending function tailored to regulate the type II error rate while employing CP based on a predetermined standardized effect size for futility monitoring (a so-called CP-beta spending function). This function delineates the expenditure of type II error rate across the entirety of the trial. Unlike other existing beta spending functions, the CP-beta spending function seamlessly incorporates beta spending concept into the CP framework, facilitating precise stagewise control of the type II error rate during futility monitoring. In addition, the stopping boundaries derived from the CP-beta spending function can be calculated via integration akin to other traditional beta spending function methods. Furthermore, the proposed CP-beta spending function accommodates various thresholds on the CP-scale at different stages of the trial, ensuring its adaptability across different information time scenarios. These attributes render the CP-beta spending function competitive among other forms of beta spending functions, making it applicable to any trials in group sequential designs with straightforward implementation. Both simulation study and example from an acute ischemic stroke trial demonstrate that the proposed method accurately captures expected power, even when the initially determined sample size does not consider futility stopping, and exhibits a good performance in maintaining overall type I error rates for evidentfutility.

Livestream, group movement program for people living with cognitive impairment and care partners: A randomized clinical trial.

There are few widely-available, evidence-based options to support quality of life (QOL) for people living with Alzheimer's disease and related dementias. We performed a randomized, controlled trial with a Waitlist control group to determine whether an online, livestream, mind-body, group movement program (Moving Together, 1 hour, 2 days/week, 12 weeks) improves QOL in people with cognitive impairment (PWCI) or care partners (CPs) and explore mechanisms of action. The primary outcome for both participants was self-reported QOL. Secondary outcomes and potential mediators included mobility, isolation, well-being, cognitive function, and sleep in PWCI and burden, positive emotions, caregiver self-efficacy, stress management, and sleep in CPs. Blinded assessors collected outcome data at baseline, 12, and 24 weeks. We assessed adverse events including falls through monthly check-in surveys and collected qualitative data through evaluation surveys. Intention-to-treat analyses used linear mixed models to compare mean change over time between groups and calculated standardized effect sizes (ESs). Ninety-seven dyads enrolled (PWCI: age 76 ± 11 years, 43% female, 80% non-Hispanic White; CPs: age 66 ± 12 years, 78% female, 71% non-Hispanic White); 15% withdrew before 12 weeks and 22% before 24 weeks. PWCI self-reported significantly better QOL from baseline to 12 weeks in the Moving Together group compared to the Waitlist group (ES = 0.474, p = 0.048) and CPs self-reported improved ability to manage stress (ES = 0.484, p = 0.021). Improvements in participant self-reported QOL were mediated by improvements in their self-reported well-being and CP-reported ability to manage stress. Results were similar when the Waitlist group participated in the program (QOL ES = 0.663, p = 0.006; stress management ES = 0.742, p = 0.002) and were supported by qualitative data. Exploratory analyses suggested possible fall reduction in PWCI. There were no study-related serious adverse events. Online programs such as Moving Together offer a scalable strategy for supporting high QOL for PWCI and helping CPs manage stress. ClinicalTrials.gov NCT04621448. The approval of new medications that slow cognitive decline in people living with Alzheimer's disease and related disorders (ADRD) has raised hope and excitement. However, these medications do not appear to impact quality of life, which is often considered by patients and care partners to be the most important outcome.In this randomized clinical trial, we found that an evidence-based, online, livestream, mind-body, group movement program significantly and meaningfully improves self-rated quality of life in people with ADRD and helps care partners manage stress. Mediation analyses revealed that the key drivers of improvements in participants' quality of life were improvements in their feelings of well-being and care partners' ability to manage stress. Exploratory analyses also suggested a 30% reduction in falls.These results are important because they suggest that an online program, which is available now and can be performed by people from the comfort of home or other location of choice, could be recommended as a complement or alternative to new therapies to help maximize quality of life for people living with ADRD and their care partners.

Efficient alternatives for Bayesian hypothesis tests in psychology.

Bayesian hypothesis testing procedures have gained increased acceptance in recent years. A key advantage that Bayesian tests have over classical testing procedures is their potential to quantify information in support of true null hypotheses. Ironically, default implementations of Bayesian tests prevent the accumulation of strong evidence in favor of true null hypotheses because associated default alternative hypotheses assign a high probability to data that are most consistent with a null effect. We propose the use of "nonlocal" alternative hypotheses to resolve this paradox. The resulting class of Bayesian hypothesis tests permits more rapid accumulation of evidence in favor of both true null hypotheses and alternative hypotheses that are compatible with standardized effect sizes of most interest in psychology. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Structural equation modeling for identifying the drivers of health-related quality of life improvement experienced by patients with migraine receiving eptinezumab

BackgroundAs new migraine therapies emerge, it is crucial for measures to capture the complexities of health-related quality of life (HRQoL) improvement beyond improvements in monthly migraine day (MMD) reduction. Investigations into the correlations between MMD reduction, symptom management, and HRQoL are lacking, particularly those that focus on improvements in canonical symptoms and improvement in patient-identified most-bothersome symptoms (PI-MBS), in patients treated with eptinezumab. This exploratory analysis identified efficacy measures mediating the effect of eptinezumab on HRQoL improvements in patients with migraine.MethodsData from the DELIVER study of patients with 2–4 prior preventive migraine treatment failures (NCT04418765) were inputted to two structural equation models describing sources of HRQoL improvement via Migraine-Specific Quality-of-Life Questionnaire (MSQ) scores. A single latent variable was defined to represent HRQoL and describe the sources of HRQoL in DELIVER. One model included all migraine symptoms while the second model included the PI-MBS as the only migraine symptom. Mediating variables capturing different aspects of efficacy included MMDs, other canonical symptoms, and PI-MBS.ResultsIn the first model, reductions in MMDs and other canonical symptoms accounted for 35% (standardized effect size [SES] − 0.11) and 25% (SES − 0.08) of HRQoL improvement, respectively, with 41% (SES − 0.13) of improvement comprising “direct treatment effect,” i.e., unexplained by mediators. In the second model, substantial HRQoL improvement with eptinezumab (86%; SES − 0.26) is due to MMD reduction (17%; SES − 0.05) and change in PI-MBS (69%; SES − 0.21).ConclusionsImprovements in HRQoL experienced by patients treated with eptinezumab can be substantially explained by its effect on migraine frequency and PI-MBS. Therefore, in addition to MMD reduction, healthcare providers should discuss PI-MBS improvements, since this may impact HRQoL. Health technology policymakers should consider implications of these findings in economic evaluation, as they point to alternative measurement of quality-adjusted life years to capture fully treatment benefits in cost-utility analyses.Trial registration ClinicalTrials.gov (Identifier: NCT04418765; EudraCT (Identifier: 2019–004497-25; URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004497-25).Graphical

The Effectiveness of Concept Maps on Students’ Achievement in Science: A Meta-Analysis

This study aims to evaluate the effectiveness of concept maps on science achievement among elementary and secondary education students, including low-achieving students. A systematic search located 55 studies about concept mapping in science achievement published in peer-reviewed journals and dissertations between 1980 and 2020. We extracted 58 independent standardized mean difference effect sizes from 55 eligible studies involving 5,364 students from Grade 3 to Grade 12 who used concept maps for learning in physics/earth science, chemistry, and biology that met the specified design criteria. A random-effects model meta-analysis revealed that the mean effect size was moderate for overall science (g = 0.776). The mean effect sizes varied from moderate to large based on the subject area (g = 0.671 for biology; g = 0.590 for chemistry; g = 1.040 for physics and earth science); these differences between groups were not statistically significant (p = 0.220). Concept maps were generally associated with increased science learning across several learning and teaching conditions, and methodological features (low-achieving students, higher teaching guidance, intermediate grades, low- or middle-income countries, journal publications, and late year of publication). However, we found significant heterogeneity in most subsets. Implications for future research and practice recommendations are discussed.

Using Smartphone Technology to Track Real-Time Changes in Anxiety/Depression Symptomatology Among Florida Cannabis Users.

Recent scientific attention has focused on the therapeutic effectiveness of cannabis use on a variety of physical and mental ailments. The present study uses smartphone technology to assess self-reported experiences of Florida cannabis users to understand how cannabis may impact anxiety and depression symptomatology. Several hundred Releaf App™ users from the state of Florida provided anonymous, real-time reports of their symptoms of anxiety and/or depression immediately before and after cannabis use sessions. Linear mixed-effects modeling was used to analyze the data at the symptom and user level. Results showed that for the majority of users, cannabis use was associated with a significant decrease in depression and anxiety symptomatology. While symptom type, doses per session, consumption method, and CBD levels were significant predictors of relief change, their effect sizes were small and should be interpreted with caution. At the user level, those who had positive relief outcomes in anxiety reported more doses and sessions, and those in the depression group reported more sessions. Our results generally support the therapeutic effectiveness of cannabis against depression/anxiety symptomatology. Future work should include standardized statistics and effect size estimates for a better understanding of each variable's practical contribution to this area of study.

Evolutionary causes of global patterns of species richness in regional fern floras across the world

AbstractAimGlobally, biodiversity is unevenly distributed, as a result of varying environmental conditions and regionally different historical processes. The influence of the latter on current diversity patterns is poorly understood. We explore geographic patterns of matches and mismatches between phylogenetic relatedness metrics measuring different depths of evolutionary history and investigate the effects of evolutionary legacy at different evolutionary depths on species density of ferns.MethodsWe divided the globe into 392 geographic regions on land, and collated species lists of ferns for each geographic region. We related species richness to phylogenetic metrics reflecting different depths of evolutionary history (standardized effect sizes of mean nearest taxon distance and mean pairwise distance, MNTDses and MPDses, respectively) for ferns in regional floras across the world.LocationGlobal.Time PeriodCurrent.TaxonFerns.ResultsWe show that different centers of fern diversity have strikingly different phylogenetic composition. We find that overall fern species diversity is negatively correlated with both MNTDses and MPDses, so that regions with high species diversity tend to have clustered species assemblages, whereas species‐poor regions tend to have overdispersed species assemblages. At the global extent, MNTDses and MPDses together explained 62.2%, 19.3%, and 65.7% of the variation in species diversity for all ferns as a whole, non‐polypod ferns, and polypods, respectively.Main ConclusionsOur study suggests that current geographic patterns of fern species richness are driven, at least in part, by evolutionary history of ferns, which varies among biogeographic regions.

Psychometric properties of the Persian version of the stuttering generalization self-measure tool in adults who stutter

PurposeOur study aimed to translate the Stuttering Generalization Self-Measure (SGSM) into Persian and investigate its validity, reliability, and internal responsiveness in the Iranian population. MethodThis study was conducted on 30 adults who stutter (AWS) and 30 adults who do not stutter (AWNS). The International Quality of Life Assessment protocol (IQOLA) was applied to translate SGSM into Persian. The face and content validity were determined. Also, the discriminant validity was evaluated by comparing the scores of two groups. In addition, the internal consistency test-retest, and inter-judge reliability were assessed with Cronbach’s alpha and intra-class correlation coefficients (ICC). Moreover, the mean standardized response (MSR) and the standardized effect size were measured to determine the internal responsiveness using pre- and post-treatment data. ResultsAll the items were comprehensible and clear. The content validity ratio (CVR) and content validity index (CVI) for all nine questions were obtained higher than.62 and.9, respectively. The internal consistency value was high (Cronbach’s alpha =.98). For the test-retest reliability, ICC values were excellent, ranging from.93 to.99. The discriminant validity results revealed a significant difference between AWS and AWNS (p < .001). Pre- and post-treatment results indicated high internal responsiveness to changes for percentage of syllable stuttered (SS%) (MSR = 1.09). ConclusionThe Persian version of SGSM (P-SGSM) benefits from the high values for validity and reliability. Furthermore, it distinguishes the AWS and AWNS and reflects the treatment changes significantly.

Sample size calculation for comparing two ROC curves.

Biomarkers are key components of personalized medicine. In this paper, we consider biomarkers taking continuous values that are associated with disease status, called case and control. The performance of such a biomarker is evaluated by the area under the curve (AUC) of its receiver operating characteristic curve. Oftentimes, two biomarkers are collected from each subject to test if one has a larger AUC than the other. We propose a simple non-parametric statistical test for comparing the performance of two biomarkers. We also present a simple sample size calculation method for this test statistic. Our sample size formula requires specification of AUC values (or the standardized effect size of each biomarker between cases and controls together with the correlation coefficient between two biomarkers), prevalence of cases in the study population, type I error rate, and power. Through simulations, we show that the testing on two biomarkers controls type I error rate accurately and the proposed sample size closely maintains specified statistical power.

Validity and responsiveness of EQ-5D-Y in children with haematological malignancies and their caregivers.

The psychometric properties of the EQ-5D-Y have not been widely tested in severely ill children. The aim of this study was to assess and compare the validity and responsiveness of the EQ-5D-Y-3L and EQ-5D-Y-5L in paediatric inpatients with haematological malignancies and caregivers. Respondents completed the interviewer-administered self-complete or proxy version of the EQ-5D-Y-3L and EQ-5D-Y-5L and an overall health assessment twice on different days. Known-groups validity was assessed by comparing patients who differed in overall health and Eastern Cooperative Oncology Group (ECOG) performance. Responsiveness to worsened health was assessed using standardised effect size (SES) for patients with worsened ECOG grade, self-reported rating, or chemotherapy initiation. Ninety-six dyads completed the baseline questionnaires. A smaller proportion of patients reported "no problems" on the EQ-5D-Y-5L compared to EQ-5D-Y-3L for most of the five dimensions. Patients in poor health reported more problems in all dimensions and had higher EQ-5D-Y-5L level sum score, lower EQ VAS and EQ-5D-Y-3L index scores (Cohen's d ES: 0.32-1.38 for patients; 0.50-2.05 for caregivers). There was a mild to good responsiveness to worsened health condition based on ECOG (SES: 0.14-0.61 for patients; 0.40-0.96 for caregivers), suggesting the proxy version was slightly responsive than the self-complete version of both instruments. The results demonstrated validity and responsiveness for both the self-complete and proxy versions of the EQ-5D-Y-3L and EQ-5D-Y-5L. The proxy and 5-level versions of the instrument were more sensitive than the self-complete and 3-level versions in this patient group.

Habitat simplification affects functional group structure along with taxonomic and phylogenetic diversity of temperate‐zone ant assemblages over a ten‐year period

Biodiversity is declining at various scales due to habitat simplification. Nevertheless, there is scarce information on how the biotic and abiotic changes linked to simplification affect several diversity dimensions, such as taxonomic, functional, and phylogenetic diversities. This study investigated whether transforming natural oak forests into induced grasslands affected species diversity, functional group structure, and phylogenetic diversity of ant assemblages inhabiting a temperate forest in central Mexico. We placed over 1000 pitfall traps in five sampling events covering a ten‐year period. We used Hill numbers to evaluate species diversity differences between vegetation types and patterns over time. Ant species were classified into stress‐related functional groups, which were analyzed for their association with vegetation types and changes to their proportional abundance over time. We calculated the standardized effect size of the mean nearest taxon distance to quantify the evolutionary history and test for non‐random patterns within vegetation types and sampling years. Species richness did not differ between vegetation types, yet grasslands showed greater diversity for the q = 1 and q = 2 orders. , We also found three ant species as bioindicators for each type of vegetation. Regarding functional structure, cold climate specialists were associated with oak forests. In contrast, generalist species were predominant in induced grasslands. Higher phylogenetic diversity with an overdispersed structure was associated with oak forest, whereas lower phylogenetic diversity and a clustered pattern were found in induced grassland. These results indicate that habitat simplification may not affect the number of ant species, but rather increases their relative abundance and reorganizes the functional and phylogenetic structure in the ecosystem, particularly shifting towards the dominance of evolutionary closely related species and broad‐stress‐tolerant groups. These results highlight the importance of integrating further dimensions of diversity to properly evaluate the reassembly dynamics after habitat simplification, and understand the mechanisms driving this biodiversity loss.

MetaWin 3: open-source software for meta-analysis.

The rise of research synthesis and systematic reviews over the last 25years has been aided by a series of software packages providing simple and accessible GUI interfaces which are intuitively easy to use by novice analysts and users. Development of many of these packages has been abandoned over time due to a variety of factors, leaving a gap in the software infrastructure available for meta-analysis. To fulfill the continued demand for a GUI-based meta-analytic system, we have now released MetaWin 3 as free, open-source, multi-platform software. MetaWin3 is written in Python and developed from scratch relative to earlier versions. The codebase is available on Github, with pre-compiled executables for both Windows and macOS available from the MetaWin website. MetaWin includes standardized effect size calculations, exploratory and publication bias analyses, and allows for both simple and complex explanatory models of variation within a meta-analytic framework, including meta-regression, using traditional least-squares/moments estimation.

Assessment of immunoprecipitation with subsequent immunoassays for the blood-based diagnosis of Alzheimer's disease.

The Aβ42/40 ratio and the concentration of phosphorylated Tau181 in blood plasma represent attractive biomarkers for Alzheimer's disease. As a means for reducing potential matrix effects, which may interfere with plasma immunoassays, we have previously developed a pre-analytical sample workup by semi-automated immunoprecipitation. Here we test the compatibility of pre-analytical immunoprecipitations with automated Aβ1-40, Aβ1-42 and phosphorylated Tau181 immunoassays on the Lumipulse platform and compare the diagnostic performance of the respective immunoprecipitation immunoassay approaches with direct plasma measurements. 71 participants were dichotomized according to their Aβ42/40 ratios in cerebrospinal fluid into the diagnostic groups amyloid-positive (n = 32) and amyloid-negative (n = 39). The plasma Aβ1-42/1-40 ratio and phosphorylated Tau181 levels were determined on the Lumipulse G600II platform (Fujirebio) by direct measurements in EDTA-plasma or after Aβ- or Tau-immunoprecipitation, respectively. Pre-analytical immunoprecipitation of Aβ turned out to be compatible with the Lumipulse Aβ assays and resulted in a numerical, yet statistically not significant increase in the area under the ROC curve for plasma Aβ1-42/1-40. Additionally, we observed a significant increase in the standardised effect size (Cohen's D). Pre-analytical immunoprecipitation of Tau resulted in increased differences between the diagnostic groups in terms of median and mean phosphorylated Tau 181 levels. Furthermore, we observed a greater Cohen's d (p < 0.001) and a larger area under the ROC curve (p = 0.038) after Tau-IP. Our preliminary findings in a small, preselected sample indicate that pre-analytical immunoprecipitation may have the potential to improve the diagnostic performance of plasma biomarker immunoassays for Aβ1-42/1-40 and phosphorylated Tau181 to predict brain amyloid deposition.

Emotion coaching skills as an augmentation to family-based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion.

To examine the feasibility and acceptability of augmenting family-based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion. In this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation). Forty-one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non-Hispanic, 1% White: Hispanic, 1% Bi-racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was "beneficial"-"very beneficial." The FBT + EC group demonstrated higher parental warmth scores at post-treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3-month follow-up. Finally, at post-treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3-month follow-up. Augmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness. Family based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well-liked by families.

Abstract WP224: Association of Quality-of-Life Domains and Clinical Symptoms in Pediatric Cerebral Cavernous Malformation Patients

Introduction: Cerebral cavernous malformations (CCMs) in children are associated with focal seizures, intracranial hemorrhage, and neurologic deficits, impacting quality of life (QoL). However, previous studies have not evaluated the impact of CCMs on QoL domains in pediatric populations. Methods: Completed self-reports (n=16) or parent-proxy reports (n=32) measuring patient outcomes in physical, mental and social health domains were collected from 48 pediatric familial CCM patients (5-17 years) enrolled in the Brain Vascular Malformation Consortium (BVMC) CCM study between 2019-2022. Survey responses were converted into domain T-scores and standardized against a reference population (mean ( M )=50, SD=10). Scores were oriented for higher scores to reflect worse outcomes. One-sample t-tests analyzed whether mean T scores for each domain differed significantly from 50 (p&lt;0.05). Multivariable linear regression tested whether PROMIS domain T scores were associated with (a) prior hemorrhage, (b) history of seizures, and (c) history of headaches, adjusting for age and sex. Standardized effect sizes were reported. Results: Compared to the reference population, pediatric CCM patients reported significantly better levels of mobility ( M= -2.47, 95% CI=-4.25 to -0.08; p=0.042), anxiety ( M =-4.66, 95% CI=-8.37 to -0.04, p=0.02), depression ( M= -6.13, 95% CI=-8.79 to -3.47, p&lt;0.01), fatigue ( M = -7.40, 95% CI=-10.64 to -4.16, p&lt;0.01), and pain (M =-6.71, 95% CI=-9.79 to -3.63, p&lt;0.01). Multivariable linear regression showed that CCM patients with a history of headaches had impacted peer relationships compared to those without headaches, with an effect size of 7.86 (95% CI=0.162 to 15.55, p=0.05). Patients with a history of seizures reported higher pain scores compared to those without seizures, with an effect size of 5.58 (95% CI=-0.603 to 11.77, p=0.08). Conclusion: Psychological and social functioning domains, particularly experiences in pain and relationships, were impacted in the pediatric CCM population. Further studies conducted with larger sample sizes could determine if the PROMIS questionnaire can reliably assess patient or proxy-reported outcomes in the pediatric CCM population and evaluate within-person changes over time.

Effectiveness of Ketamine for the Treatment of Post-Traumatic Stress Disorder - A Systematic Review and Meta-Analysis.

Post-traumatic stress disorder (PTSD) is an enduring condition characterized by a chronic course and impairments across several areas. Despite its significance, treatment options remain limited, and remission rates are often low. Ketamine has demonstrated antidepressant properties and appears to be a promising agent in the management of PTSD. A systematic review was conducted in PubMed/MEDLINE, Cochrane Library, Clinicaltrials.gov, Lilacs, Scopus, and Embase, covering studies published between 2012 and December 2022 to assess the effectiveness of ketamine in the treatment of PTSD. Ten studies, consisting of five RCTs, two crossover trials, and three non-randomized trials, were included in the meta-analysis. Ketamine demonstrated significant improvements in PCL-5 scores, both 24 hours after the initial infusion and at the endpoint of the treatment course, which varied between 1 to 4 weeks in each study. Notably, the significance of these differences was assessed using the Two Sample T-test with pooled variance and the Two Sample Welch's T-test, revealing a statistically significant effect for ketamine solely at the endpoint of the treatment course (standardized effect size= 0.25; test power 0.9916; 95% CI = 0.57 to 17.02, p=0.0363). It is important to note that high heterogeneity was observed across all analyses. Our findings suggest that ketamine holds promise as an effective treatment option for PTSD. However, further trials are imperative to establish robust data for this intervention.

Effect of Needle Gauge Size on Pain During Intravitreal Anti-VEGF Injection: A Systematic Review and Network Meta-Analysis.

Concerns related to pain from intravitreal injections are one of the key factors mentioned by patients when asked about therapy. In this systematic review and network meta-analysis, we evaluate the literature of comparative clinical trials on the relationship between needle gauge size and pain experience during intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. We searched 12 literature databases on 14 October 2023 for comparative studies of gauge sizes for intravitreal anti-VEGF injections. The primary outcome of interest was the reported pain experience immediately after the injection. All outcomes of pain were transformed into standardized effect sizes using Cohen's d. Using a network meta-analysis approach, we were able to compare all gauge sizes and rank them according to the reported pain experience. We identified nine eligible studies with data on a total of 998 patients and 1004 eyes. Needle sizes studied were 26-gauge, 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge. A complete network was present, which allowed for a network meta-analysis. We used the thickest (26-gauge) needle as the reference group and observed a clear trend of lower pain experience with thinner gauge sizes (d: -0.4, d: -2.7, d: -3.8, d: -4.8, d: -4.5, and d: -5.3; respectively, for 27-gauge, 29-gauge, 30-gauge, 32-gauge, 33-gauge, and 34-gauge). A gauge size of 30 or thinner may minimize patient discomfort related to intravitreal anti-VEGF therapy.

Examining the Efficacy of Culturally Responsive Interventions for Autistic Children and Their Families: A Meta-Analysis.

Culturally responsive interventions for autistic children and their families have been developed and implemented to address issues related to limited representation, inequities, and disparities in access to care of minoritized families in research. Currently available reviews are relatively limited in scope or do not synthesize interventions specifically. Therefore, we conducted a meta-analysis to synthesize autism intervention literature that specifically targeted autistic individuals and their family members from minoritized backgrounds, such as immigrant families. We used four databases to identify studies that used culturally responsive interventions with minoritized autistic children and their families. An article was included if it included empirical intervention data using an experimental design. A total of 354 studies were initially screened, and 24 studies were included. Effect sizes of these studies were extracted across two levels (i.e., child and family levels). Data from group design studies were extracted manually, and data from single-case design studies were extracted using a web-based tool. We used design-comparable standardized effect sizes to compare across both designs. The analysis revealed a large, positive, and significant overall effect size across culturally responsive interventions. Specifically, social-communication and mental health outcomes yielded significant effects at the child level. Additionally, parents' mental health and fidelity of strategy implementation also yielded significant results. Our results suggest that culturally responsive interventions yield comparable outcomes to unadapted, original interventions. Future research should examine the distinction between the effect of cultural adaptation and the efficacy of the intervention itself.