The Relative Merits of Posterior Surgical Treatments for Multi-Level Degenerative Cervical Myelopathy Remain Uncertain: Findings from a Systematic Review

Objectives: To assess the reporting of study design and characteristics in multi-level degenerative cervical myelopathy (DCM) treated by posterior surgical approaches, and perform a comparison of clinical and radiographic outcomes between different approaches. Methods: A literature search was performed in Embase and MEDLINE between 1995–2019 using a sensitive search string combination. Studies were selected by predefined selection criteria: Full text articles in English, with >10 patients (prospective) or >50 patients (retrospective), reporting outcomes of multi-level DCM treated by posterior surgical approach. Results: A total of 75 studies involving 19,510 patients, conducted worldwide, were identified. Laminoplasty was described in 56 studies (75%), followed by laminectomy with (36%) and without fusion (16%). The majority of studies were conducted in Asia (84%), in the period of 2016–2019 (51%), of which laminoplasty was studied predominantly. Twelve (16%) prospective studies and 63 (84%) retrospective studies were identified. The vast majority of studies were conducted in a single centre (95%) with clear inclusion/exclusion criteria and explicit cause of DCM. Eleven studies (15%) included patients with ossification of the posterior longitudinal ligament exclusively with cohorts of 57 to 252. The clinical and radiographic outcomes were reported with heterogeneity when comparing laminoplasty, laminectomy with and without fusion. Conclusions: Heterogeneity in the reporting of study and sample characteristics exists, as well as in clinical and radiographic outcomes, with a paucity of studies with a higher level of evidence. Future studies are needed to elucidate the clinical effectiveness of posterior surgical treatments.

Exploring the effect of a visual constraint on students’ design cognition

This paper presents the results of a study that explores the effect of a visual constraint on design behaviors of architecture students. To examine this effect, 24 second-year architecture students volunteered to participate. Each of them undertook similar conceptual design briefs in two different conditions, one with and another without a visual constraint. Retrospective reporting was used to collect the verbalization of participants. The FBS ontology was used to model the design cognition of the participants by coding their design protocols. A dynamic analysis was used to study the differences between the two conditions based on the problem–solution index. A further index, the pre-structure–post-structure index, was proposed to measure design behavior differences between the two conditions. The correspondence analysis was used to explore the effect of gender. There were statistically significant differences in the distributions of cognitive effort between the two groups. These differences include in the visual constraint group a decrease in the focus on behavior before structure and in the processes related to it, compared to the non-visual constraint group. The non-visual constraint group changed their focus on problem framing and solving while adding a visual constraint led participants to focus simultaneously on both framing and solving. The visual constraint group had a different attention temporally to pre- and post-structure design processes during designing than the non-visual constraint group. The order of experiencing the two design sessions had only a small effect. The results of correspondence analysis demonstrate that there are categorical gender differences not found using statistical testing.

Learning From Science News via Interactive and Animated Data Visualizations: An Investigation Combining Eye Tracking, Online Survey, and Cued Retrospective Reporting

Relying on a multimethod approach with eye tracking, cued retrospective reporting, and a memory test, this experimental study ( N = 45) shows how individuals engage with static, interactive, and interactive-animated data visualizations embedded in online science news. The results suggest that interactivity and animation engage participants most strongly: The second part of the news article is fixated the longest by participants exposed to the interactive-animated visualization, which translates into higher learning outcomes. However, the dynamic process of news reception requires a nuanced understanding of how users attend to visual and textual parts of a message to make informed statements about their effectiveness.

The illness-death model for family studies

Summary Family studies involve the selection of affected individuals from a disease registry who provide right-truncated ages of disease onset. Coarsened disease histories are then obtained from consenting family members, either through examining medical records, retrospective reporting, or clinical examination. Methods for dealing with such biased sampling schemes are available for continuous, binary, and failure time responses, but methods for more complex life history processes are less developed. We consider a simple joint model for clustered illness-death processes which we formulate to study covariate effects on the marginal intensity for disease onset and to study the within-family dependence in disease onset times. We construct likelihoods and composite likelihoods for family data obtained from biased sampling schemes. In settings where the disease is rare and data are insufficient to fit the model of interest, we show how auxiliary data can augment the composite likelihood to facilitate estimation. We apply the proposed methods to analyze data from a family study of psoriatic arthritis carried out at the University of Toronto Psoriatic Arthritis Registry.

Caregiver Daily Reporting of Symptoms in Autism Spectrum Disorder: Observational Study Using Web and Mobile Apps

Background Currently, no medications are approved to treat core symptoms of autism spectrum disorder (ASD). One barrier to ASD medication development is the lack of validated outcome measures able to detect symptom change. Current ASD interventions are often evaluated using retrospective caregiver reports that describe general clinical presentation but often require recall of specific behaviors weeks after they occur, potentially reducing accuracy of the ratings. My JAKE, a mobile and Web-based mobile health (mHealth) app that is part of the Janssen Autism Knowledge Engine—a dynamically updated clinical research system—was designed to help caregivers of individuals with ASD to continuously log symptoms, record treatments, and track progress, to mitigate difficulties associated with retrospective reporting. Objective My JAKE was deployed in an exploratory, noninterventional clinical trial to evaluate its utility and acceptability to monitor clinical outcomes in ASD. Hypotheses regarding relationships among daily tracking of symptoms, behavior, and retrospective caregiver reports were tested. Methods Caregivers of individuals with ASD aged 6 years to adults (N=144) used the My JAKE app to make daily reports on their child’s sleep quality, affect, and other self-selected specific behaviors across the 8- to 10-week observational study. The results were compared with commonly used paper-and-pencil scales acquired over a concurrent period at regular 4-week intervals. Results Caregiver reporting of behaviors in real time was successfully captured by My JAKE. On average, caregivers made reports 2-3 days per week across the study period. Caregivers were positive about their use of the system, with over 50% indicating that they would like to use My JAKE to track behavior outside of a clinical trial. More positive average daily reporting of overall type of day was correlated with 4 weekly reports of lower caregiver burden made at 4-week intervals (r=–0.27, P=.006, n=88) and with ASD symptoms (r=–0.42, P<.001, n=112). Conclusions My JAKE reporting aligned with retrospective Web-based or paper-and-pencil scales. Use of mHealth apps, such as My JAKE, has the potential to increase the validity and accuracy of caregiver-reported outcomes and could be a useful way of identifying early changes in response to intervention. Such systems may also assist caregivers in tracking symptoms and behavior outside of a clinical trial, help with personalized goal setting, and monitoring of progress, which could collectively improve understanding of and quality of life for individuals with ASD and their families. Trial Registration ClinicalTrials.gov NCT02668991; https://clinicaltrials.gov/ct2/show/NCT02668991

Using life history calendars to improve measurement of lifetime experience with mental disorders

BackgroundRetrospective reports of lifetime experience with mental disorders greatly underestimate the actual experiences of disorder because recall error biases reporting of earlier life symptoms downward. This fundamental obstacle to accurate reporting has many adverse consequences for the study and treatment of mental disorders. Better tools for accurate retrospective reporting of mental disorder symptoms have the potential for broad scientific benefits.MethodsWe designed a life history calendar (LHC) to support this task, and randomized more than 1000 individuals to each arm of a retrospective diagnostic interview with and without the LHC. We also conducted a careful validation with the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition.ResultsResults demonstrate that—just as with frequent measurement longitudinal studies—use of an LHC in retrospective measurement can more than double reports of lifetime experience of some mental disorders.ConclusionsThe LHC significantly improves retrospective reporting of mental disorders. This tool is practical for application in both large cross-sectional surveys of the general population and clinical intake of new patients.

Caregiver Daily Reporting of Symptoms in Autism Spectrum Disorder: Observational Study Using Web and Mobile Apps (Preprint)

BACKGROUND Currently, no medications are approved to treat core symptoms of autism spectrum disorder (ASD). One barrier to ASD medication development is the lack of validated outcome measures able to detect symptom change. Current ASD interventions are often evaluated using retrospective caregiver reports that describe general clinical presentation but often require recall of specific behaviors weeks after they occur, potentially reducing accuracy of the ratings. My JAKE, a mobile and Web-based mobile health (mHealth) app that is part of the Janssen Autism Knowledge Engine—a dynamically updated clinical research system—was designed to help caregivers of individuals with ASD to continuously log symptoms, record treatments, and track progress, to mitigate difficulties associated with retrospective reporting. OBJECTIVE My JAKE was deployed in an exploratory, noninterventional clinical trial to evaluate its utility and acceptability to monitor clinical outcomes in ASD. Hypotheses regarding relationships among daily tracking of symptoms, behavior, and retrospective caregiver reports were tested. METHODS Caregivers of individuals with ASD aged 6 years to adults (N=144) used the My JAKE app to make daily reports on their child’s sleep quality, affect, and other self-selected specific behaviors across the 8- to 10-week observational study. The results were compared with commonly used paper-and-pencil scales acquired over a concurrent period at regular 4-week intervals. RESULTS Caregiver reporting of behaviors in real time was successfully captured by My JAKE. On average, caregivers made reports 2-3 days per week across the study period. Caregivers were positive about their use of the system, with over 50% indicating that they would like to use My JAKE to track behavior outside of a clinical trial. More positive average daily reporting of overall type of day was correlated with 4 weekly reports of lower caregiver burden made at 4-week intervals (r=–0.27, P=.006, n=88) and with ASD symptoms (r=–0.42, P<.001, n=112). CONCLUSIONS My JAKE reporting aligned with retrospective Web-based or paper-and-pencil scales. Use of mHealth apps, such as My JAKE, has the potential to increase the validity and accuracy of caregiver-reported outcomes and could be a useful way of identifying early changes in response to intervention. Such systems may also assist caregivers in tracking symptoms and behavior outside of a clinical trial, help with personalized goal setting, and monitoring of progress, which could collectively improve understanding of and quality of life for individuals with ASD and their families. CLINICALTRIAL ClinicalTrials.gov NCT02668991; https://clinicaltrials.gov/ct2/show/NCT02668991

Retrospective Reporting of First Employment in the Life-courses of U.S. Women

The authors investigate the accuracy of young women’s retrospective reporting on their first substantial employment in three major, nationally representative U.S. surveys, examining hypotheses that longer recall duration, employment histories with lower salience and higher complexity, and an absence of “anchoring” biographical details will adversely affect reporting accuracy. The authors compare retrospective reports to benchmark panel survey estimates for the same cohorts. Sociodemographic groups—notably non-Hispanic white women and women with college-educated mothers—whose early employment histories at these ages are in aggregate more complex (multiple jobs) and lower in salience (more part-time jobs) are more likely to omit the occurrence of their first substantial job or employment and to misreport their first job or employment as occurring at an older age. Also, retrospective reports are skewed toward overreporting longer, therefore more salient, later jobs over shorter, earlier jobs. The relatively small magnitudes of differences, however, indicate that the retrospective questions nevertheless capture these summary indicators of first substantial employment reasonably accurately. Moreover, these differences are especially small for groups of women who are more likely to experience labor-market disadvantage and for women with early births.