An empirical comparison of sleep-specific versus generic quality of life instruments among Australians with sleep disorders.

PURPOSE: In Australian adults diagnosed with a sleep disorder(s), this cross-sectional study compares the empirical relationships between two generic QoL instruments, the EuroQoL 5-dimension 5-level (EQ-5D-5L) and ICEpop CAPability measure for Adults (ICECAP-A), and three sleep-specific metrics, the Epworth Sleepiness Scale (ESS), 10-item Functional Outcomes of Sleep Questionnaire (FOSQ-10), and Pittsburgh Sleep Quality Index (PSQI). METHODS: Convergent and divergent validity between item/dimension scores was examined using Kendall's Tau-B correlation, with correlations below 0.30 considered weak, between 0.30 and 0.50 moderate and those above 0.50 strong (indicating that instruments were measuring similar constructs). Exploratory factor analysis (EFA) was conducted to identify shared underlying constructs. RESULTS: A total of 1509 participants (aged 18-86 years) were included in the analysis. Convergent validity between dimensions/items of different instruments was weak to moderate. A 5-factor EFA solution, representing 'daytime dysfunction', 'fatigue', 'wellbeing', 'physical health', and 'perceived sleep quality', was simplest with close fit and fewest cross-loadings. Each instrument's dimensions/items primarily loaded onto their own factor, except for the EQ-5D-5L and PSQI. Nearly two-thirds of salient loadings were of excellent magnitude (0.72 to 0.91). CONCLUSION: Moderate overlap between the constructs assessed by generic and sleep-specific instruments indicates that neither can fully capture the complexity of QoL alone in general disordered sleep populations. Therefore, both are required within economic evaluations. A combination of the EQ-5D-5L and, depending on context, ESS or PSQI offers the broadest measurement of QoL in evaluating sleep health interventions.

Causal inference approaches reveal both positive and negative unintended effects of agricultural and urban management practices on instream biological condition.

Agricultural and urban management practices (MPs) are primarily designed and implemented to reduce nutrient and sediment concentrations in streams. However, there is growing interest in determining if MPs produce any unintended positive effects, or co-benefits, to instream biological and habitat conditions. Identifying co-benefits is challenging though because of confounding variables (i.e., those that affect both where MPs are applied and stream biota), which can be accounted for in novel causal inference approaches. Here, we used two causal inference approaches, propensity score matching (PSM) and Bayesian network learning (BNL), to identify potential MP co-benefits in the Chesapeake Bay watershed portion of Maryland, USA. Specifically, we examined how MPs may modify instream conditions that impact fish and macroinvertebrate indices of biotic integrity (IBI) and functional and taxonomic endpoints. We found evidence of positive unintended effects of MPs for both benthic macroinvertebrates and fish indicated by higher IBI scores and specific endpoints like the number of scraper macroinvertebrate taxa and lithophilic spawning fish taxa in a subset of regions. However, our results also suggest MPs have negative unintended effects, especially on sensitive benthic macroinvertebrate taxa and key instream habitat and water quality metrics like specific conductivity. Overall, our results suggest MPs offer co-benefits in some regions and catchments with largely degraded conditions but can have negative unintended effects in some regions, especially in catchments with good biological conditions. We suggest the number and types of MPs drove these mixed results and highlight carefully designed MP implementation that incorporates instream biological data at the catchment scale could facilitate co-benefits to instream biological conditions. Our study underscores the need for more research on identifying effects of individual MP types on instream biological and habitat conditions.

Content Comparison of Quality-of-Life Instruments Used in Economic Evaluations of Sleep Disorder Interventions: A Systematic Review.

BACKGROUND: Assessment of quality of life (QoL) in people living with sleep disorders using questionnaires is necessary to compare intervention benefits. Knowledge of the content and concepts covered by specific QoL instruments is essential to determine which instruments are best suited for conducting economic evaluations of sleep-related interventions. OBJECTIVES: This review aims to identify the QoL instruments that have been applied in economic evaluations of sleep disorder interventions and compare their conceptual overlap and content coverage using the framework of the International Classification of Functioning, Disability and Health (ICF). METHODS: A systematic review of full economic evaluations in sleep published in peer-reviewed journals from conception to 30 May, 2023 was conducted. MEDLINE, PsychInfo, ProQuest, Cochrane, Scopus, CINAHL, Web of Science and Emcare were searched for eligible studies. Studies incorporating either generic or sleep-specific QoL instruments as the primary or secondary measures of effectiveness within a full economic evaluation were included. Quality appraisal against the JBI Critical Appraisal Checklist for Economic Evaluations and EURONHEED checklists and mapping of QoL items to ICF categories were performed by two reviewers, with a third helping settle any potential differences. RESULTS: Sixteen instruments were identified as having been used in sleep health economic evaluations. The EQ-5D-3L, Epworth Sleepiness Scale, and Insomnia Severity Index were the most widely used, but the latter two are predominantly diagnostic tools and not specifically designed to guide economic evaluations. Other instruments with broader ICF content coverage have been least used, and these include the Sleep Apnea Quality of Life Index, Functional Outcomes of Sleep Questionnaire, 15 Dimensions, Short-Form 6 Dimensions, 12-item Short Form Survey, 36-item Short Form Survey and the GRID Hamilton Rating Scale for Depression. CONCLUSIONS: This study provides an overview of current QoL instruments used in economic evaluations of sleep with respect to their content coverage. A combination of generic and sleep-specific instruments with broader ICF content coverage is recommended for such evaluations.

Observed and projected functional reorganization of riverine fish assemblages from global change.

Climate and land-use/land-cover change ("global change") are restructuring biodiversity, globally. Broadly, environmental conditions are expected to become warmer, potentially drier (particularly in arid regions), and more anthropogenically developed in the future, with spatiotemporally complex effects on ecological communities. We used functional traits to inform Chesapeake Bay Watershed fish responses to future climate and land-use scenarios (2030, 2060, and 2090). We modeled the future habitat suitability of focal species representative of key trait axes (substrate, flow, temperature, reproduction, and trophic) and used functional and phylogenetic metrics to assess variable assemblage responses across physiographic regions and habitat sizes (headwaters through large rivers). Our focal species analysis projected future habitat suitability gains for carnivorous species with preferences for warm water, pool habitats, and fine or vegetated substrates. At the assemblage level, models projected decreasing habitat suitability for cold-water, rheophilic, and lithophilic individuals but increasing suitability for carnivores in the future across all regions. Projected responses of functional and phylogenetic diversity and redundancy differed among regions. Lowland regions were projected to become less functionally and phylogenetically diverse and more redundant while upland regions (and smaller habitat sizes) were projected to become more diverse and less redundant. Next, we assessed how these model-projected assemblage changes 2005-2030 related to observed time-series trends (1999-2016). Halfway through the initial projecting period (2005-2030), we found observed trends broadly followed modeled patterns of increasing proportions of carnivorous and lithophilic individuals in lowland regions but showed opposing patterns for functional and phylogenetic metrics. Leveraging observed and predicted analyses simultaneously helps elucidate the instances and causes of discrepancies between model predictions and ongoing observed changes. Collectively, results highlight the complexity of global change impacts across broad landscapes that likely relate to differences in assemblages' intrinsic sensitivities and external exposure to stressors.

Drivers of Odonata flight timing revealed by natural history collection data.

Global change may cause widespread phenological shifts. But knowledge of the extent and generality of these shifts is limited by the availability of phenological records with sufficiently large spatiotemporal extents. Using North American odonates (damselflies and dragonflies) as a model system, we show how a combination of natural history museum and community science collections, beginning in 1901 and extending through 2020, can be leveraged to better understand phenology. We begin with an analysis of odonate functional traits. Principal coordinate analysis is used to place odonate genera within a three-dimensional trait ordination. From this, we identify seven distinct functional groups and select a single odonate genus to represent each group. Next, we pair the odonate records with a list of environmental covariates, including air temperature and degree days, photoperiod, precipitation, latitude and elevation. An iterative subsampling process is then used to mitigate spatiotemporal sampling bias within the odonate dataset. Finally, we use path analysis to quantify the direct effects of degree days, photoperiod and precipitation on odonate emergence timing, while accounting for indirect effects of latitude, elevation and year. Path models showed that degree days, photoperiod and precipitation each have a significant influence on odonate emergence timing, but degree days have the largest overall effect. Notably, the effect that each covariate has on emergence timing varied among functional groups, with positive relationships observed for some group representatives and negative relationships observed for others. For instance, Calopteryx sp. emerged earlier as degree days increased, while Sympetrum sp. emerged later. Previous studies have linked odonate emergence timing to temperature, photoperiod or precipitation. By using natural history museum and community science data to simultaneously examine all three influences, we show that systems-level understanding of odonate phenology may now be possible.

Thirty-Day Unplanned Readmissions Following Hospitalisation for Atrial Fibrillation in Australia and New Zealand.

AIMS: Atrial fibrillation (AF) is a leading cause of hospitalisations, yet little is known about 30-day readmissions following discharge despite increasing policy focus on reducing readmissions. We assessed the rate, timing, causes and predictors of 30-day unplanned readmission following an acute and elective AF hospitalisation using population-wide data. METHODS: We studied all patients hospitalised for AF from 2010 to 2015 at all public and most private hospitals in Australia and New Zealand. The main outcome measures were unplanned readmissions within 30 days of discharge, primary diagnosis associated with these readmissions, and their predictors as modelled by logistic regression. RESULTS: Among 301,654 patients hospitalised for AF (mean age 69.2±13.6 yrs, 55.6% female, 65.2% acute presentations), 29,750 (9.9%) experienced an unplanned readmission within 30 days with 62.6% occurring by 14 days. Unplanned readmissions occurred more frequently following an acute versus elective AF hospitalisations (12.5% vs 4.9%, p<0.001). The most common diagnoses associated with readmissions were recurrence of AF (n=9,890, 33.2%), and preventable conditions including heart failure (n=2,683, 9.0%), pneumonia (n=724, 2.4%) and acute myocardial infarction (n=510, 1.7%). A higher risk of 30-day readmission was associated with congenital cardiac/circulatory defect (OR 2.18, CI 1.44-3.30), congestive heart failure (OR 1.34, CI 1.30-1.39), and arrhythmia/conduction disorders (OR 1.25, CI 1.21-1.28). CONCLUSION: Almost 1 in 10 AF hospitalisations resulted in unplanned readmission within 30-days, mostly for AF recurrence. Improved clinical management of AF and transitional care planning are required to reduce unplanned readmissions following AF hospitalisations.

The Figure-of-8 Walk Test used to detect the loss of motor skill in walking among persons with Parkinson's disease.

BACKGROUND: The Figure-of-8 Walk Test (F8W) is a valid measure of walking skill in older adults with a mobility disability. Use of the F8W in assessing walking skill in persons with Parkinson's disease (PWP) is unknown. PURPOSE: We examined the validity of the F8W by associations with mobility, and cognitive and physical function, and determined the ability of the F8W to discriminate the motor skill of walking in PWP from that of older adults (OA). METHODS: Participants, PWP (n = 60) and OA (n = 34) performed the F8W, usual straight path walking, the Montreal Cognitive Assessment (MoCA), and the Late-Life Function and Disability Instrument (LLFDI). RESULTS: Among PWP, F8W time and steps related to: usual gait speed (r = -0.660, -0.650); stride time variability (r = 0.377, 0.438); cognition (r = -0.293, time only); and physical function (r = -0.532, - 0.619), all p < .05. Area under the curve (AUC) analyses demonstrated greater sensitivity and specificity of F8W performance (0.811, 0.790) compared to usual gait speed (0.729) to recognize the motor skill of walking in PWP from that of OA. CONCLUSION: The F8W is a valid indicator of the motor skill of walking in PWP. Use of the F8W may uncover walking difficulties not identified by usual gait speed.

Drivers of species richness and beta diversity of fishes in an Afrotropical intermittent river system.

Tropical freshwater ecosystems are some of the most threatened systems yet remain understudied relative to temperate systems. Here, we look at the drivers of community structure of fishes in a tropical and intermittent system in central Kenya. We conducted monthly samples within the upper Northern Ewaso Ng'iro to assess variation in community composition and abiotic characteristics. We analyzed species richness along the longitudinal gradient, computed beta diversity within the system, relative contributions of each site, and partitioned beta diversity metrics into nestedness and turnover components. We found that, similar to temperate intermittent systems, species richness varied along the longitudinal gradient, nestedness contributions to beta diversity exceeded those of turnover, and environmental and spatial variables determined patterns of beta diversity. Sites at the highest and lowest ends of the species richness gradient showed the highest contributions to beta diversity, suggesting sites important for preservation or restoration initiatives, respectively. With ongoing water extraction and conflict over resources throughout the region, this study highlights the need for further investigations of the effects of multiple stressors on biodiversity patterns and ecosystem functioning in tropical stream communities.

A preference for quality: Australian general public's willingness to pay for home and residential aged care.

In Australia and many other countries internationally, aged care services are provided to older people in their own homes or residential care facilities. The majority of these services are funded by the federal government using taxpayer contributions from the general public. However, the monetary value Australians place on aged care services, and the factors that predict this value, have not been examined. We, therefore, sought to determine the general public's willingness to pay (WTP) for aged care services and examine which factors influence this WTP. A cross-sectional contingent valuation survey was administered to a nationally representative cohort of 10,285 Australians between September and October 2020 from the general population aged 18 years and over. Respondents were asked to indicate their WTP values for satisfactory and high-quality aged care services to be provided in the future. A two-part regression model was used to explain what factors explained variation in WTP. In total, 80% (61%) of respondents were willing to pay to access satisfactory (high) quality home care (counterpart figures for residential care were 64% (45%)). On average, respondents were willing to pay between $126 and $158 ($145 and $237) per week to receive satisfactory-quality (high-quality) home care and between $333 and $520 ($308 and $680) per week for satisfactory-quality (high-quality) residential care. Respondents were willing to pay an additional $120 per week on average to access high-quality aged care. Higher WTP values were generally associated with being younger, male, recent experience with aged care through a close family member accessing aged care and ability to pay. These results suggest general public support for payment of individual co-contributions to access aged care services in the future.

Economic evaluations considering costs and outcomes of diabetic foot ulcer infections: A systematic review.

BACKGROUND: Diabetic foot ulcer (DFU) is a severe complication of diabetes and particularly susceptible to infection. DFU infection intervention efficacy is declining due to antimicrobial resistance and a systematic review of economic evaluations considering their economic feasibility is timely and required. AIM: To obtain and critically appraise all available full economic evaluations jointly considering costs and outcomes of infected DFUs. METHODS: A literature search was conducted across MedLine, CINAHL, Scopus and Cochrane Database seeking evaluations published from inception to 2019 using specific key concepts. Eligibility criteria were defined to guide study selection. Articles were identified by screening of titles and abstracts, followed by a full-text review before inclusion. We identified 352 papers that report economic analysis of the costs and outcomes of interventions aimed at diabetic foot ulcer infections. Key characteristics of eligible economic evaluations were extracted, and their quality assessed against the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS: 542 records were screened and 39 full-texts assessed for eligibility. A total of 19 papers were included in the final analysis. All studies except one identified cost-saving or cost-effective interventions. The evaluations included in the final analysis were so heterogeneous that comparison of them was not possible. All studies were of "excellent", "very good" or "good" quality when assessed against the CHEERS checklist. CONCLUSIONS: Consistent identification of cost-effective and cost-saving interventions may help to reduce the DFU healthcare burden. Future research should involve clinical implementation of interventions with parallel economic evaluation rather than model-based evaluations.

A systematic review protocol for examining 30-day readmission costs for atrial fibrillation patients.

INTRODUCTION: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and readmissions of AF patients place a huge burden on the healthcare system, including economically. With an increasing prevalence, the burden of AF will continue evolving. To illuminate the readmission-specific economic burden, we aim to provide quality evidence on the cost of readmissions within 30 days where AF has been the primary diagnosis at the index admission. METHODS AND ANALYSIS: We will conduct a systematic review of all peer-reviewed articles examining readmission costs for AF patients. We will search MedLine, Cumulative Index to Nursing and Allied Health Literature, Scopus and Cochrane Library for articles written in English, published in peer-reviewed journals from inception to 2019. Reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols checklist. Studies will be included if patients were aged 18 years and over, AF was the primary diagnosis of index admission and costs of readmission within 30 days were reported. Quality assessment of studies will be done using a modified Evers checklist. Study results will be summarised in a Forest plot and heterogeneity tested for using the Cochran's Q and I2 statistic. A random-effects model will be applied for meta-analysis if studies are sufficiently homogeneous. The cost of readmission to hospital within 30 days for AF patients is the main outcome of interest while additional outcomes are 30-day readmission rate, predictors of readmission and predictors of readmission costs. ETHICS AND DISSEMINATION: Formal ethical approval is not required as no patients will be involved. Dissemination of results will be through a peer-reviewed publication. PROSPERO REGISTRATION NUMBER: CRD42019132017.

Modeling the Size Spectrum for Macroinvertebrates and Fishes in Stream Ecosystems.

The size spectrum is an inverse, allometric scaling relationship between average body mass (M) and the density (D) of individuals within an ecological community or food web. Importantly, the size spectrum assumes that individual size, rather than species' behavioral or life history characteristics, is the primary determinant of abundance within an ecosystem. Thus, unlike traditional allometric relationships that focus on species-level data (e.g., mean species' body size vs. population density), size spectra analyses are 'ataxic' - individual specimens are identified only by their size, without consideration of taxonomic identity. Size spectra models are efficient representations of traditional, complex food webs and can be used in descriptive as well as predictive contexts (e.g., predicting responses of large consumers to changes in basal resources). Empirical studies from diverse aquatic ecosystems have also reported moderate to high levels of similarity in size spectra slopes, suggesting that common processes may regulate the abundances of small and large organisms in very different settings. This is a protocol to model the community-level size spectrum in wadable streams. The protocol consists of three main steps. First, collect quantitative benthic fish and invertebrate samples that can be used to estimate local densities. Second, standardize the fish and invertebrate data by converting all individuals to ataxic units (i.e., individuals identified by size, irrespective of taxonomic identity), and summing individuals within log2 size bins. Third, use linear regression to model the relationship between ataxic M and D estimates. Detailed instructions are provided herein to complete each of these steps, including custom software to facilitate D estimation and size spectra modeling.

Spatiotemporal variability underlying skill in curved-path walking.

BACKGROUND: Daily life walking frequently involves curved paths. While mean gait characteristics and orientation of the body during curved path walking have been described, little has been reported about spatiotemporal variability during curved path walking and its relation to the motor skill of walking in older adults. RESEARCH QUESTION: Among community-dwelling older adults, is greater spatiotemporal variability during curved path walking related to better curved path walking ability? METHODS: Community dwelling older adults (n = 34) completed the Figure-of-8 Walk Test (F8W, a measure of curved path walking ability) and usual straight path walking on an instrumented walkway. Standard deviations for step length, stride width and step time (step length variability, SLV, stride width variability, SWV, step time variability, STV) during both conditions were determined, along with time and number of steps to complete F8W. Associations were examined with Pearson r correlation coefficients, regressions determined contributions of variability during curved path walking to F8W performance, and AUC analyses were used to determine the ability of variability during curved path walking to distinguish better vs poorer F8W performance. RESULTS: F8W time and steps were negatively associated with both SLV (r's = -0.37, p < 0.05) and SWV (r's = -0.67 to -0.82, p < 0.001). Both SLV and SWV independently contributed to F8W performance (SLV ßs = -0.26 to -0.29, p < 0.03; SWV ßs = -0.74 to -0.76, p < 0.001). The AUC of the ROC curve for SLV was 0.716, and for SWV was 0.765. SIGNIFICANCE: Greater spatial variability, particularly SWV, was associated with better motor skill of curved path walking. It is important for clinicians to understand the variables that contribute to successful performance of complex walking tasks as these can be targets for rehabilitation. The findings suggest that practice of adjustment of stride width and step length during walking are important.