Minimal important difference, patient acceptable symptom state and longitudinal validity of oxford elbow score and the quickDASH in patients with tennis elbow.

BACKGROUND: The Oxford Elbow Score (OES) and the short version of Disabilities of Arms, Shoulder and Hand (QuickDASH) are common patient-reported outcomes for people with elbow problems. Our primary objective was to define thresholds for the Minimal Important Difference (MID) and Patient-Acceptable Symptom State (PASS) for the OES and QuickDASH. The secondary aim was to compare the longitudinal validity of these outcome measures. METHODS: We recruited 97 patients with clinically-diagnosed tennis elbow for a prospective observational cohort study in a pragmatic clinical setting. Fifty-five participants received no specific intervention, 14 underwent surgery (11 as primary treatment and 4 during follow-up), and 28 received either botulinum toxin injection or platelet rich plasma injection. We collected OES (0 to 100, higher is better) and QuickDASH (0 to 100, higher is worse), and global rating of change (as an external transition anchor question) at six weeks, three months, six months and 12 months. We defined MID and PASS values using three approaches. To assess the longitudinal validity of the measures, we calculated the Spearman's correlation coefficient between the change in the outcome scores and external transition anchor question, and the Area Under the Curve (AUC) from a receiver operating characteristics (ROC) analysis. To assess signal-to-noise ratio, we calculated standardized response means. RESULTS: Depending on the method, MID values ranged from 16 to 21 for OES Pain; 10 to 17 for OES Function; 14 to 28 for OES Social-psychological; 14 to 20 for OES Total score, and - 7 to -9 for QuickDASH. Patient-Acceptable Symptom State (PASS) cut offs were 74 to 84 for OES Pain; 88 to 91 for OES Function; 75 to 78 with OES Social-psychological; 80 to 81 with OES Total score and 19 to 23 with Quick-DASH. OES had stronger correlations with the anchor items, and AUC values suggested superior discrimination (between improved and not improved) compared with QuickDASH. OES also had superior signal-to-noise ratio compared with QuickDASH. CONCLUSION: The study provides MID and PASS values for OES and QuickDASH. Due to better longitudinal validity, OES may be a better choice for clinical trials. TRIAL REGISTRATION: ClinicalTrials.gov NCT02425982 (first registered April 24, 2015).

Cultural Niche Construction as a Framework for Reorienting Human-Environment Relations.

In this paper, we argue that the theory of cultural niche construction provides a cogent and fruitful framework for studying and managing human-environment relationships, including our conceptualizations of them. We first review the development of the ideas of niche construction from evolutionary to social contexts. We then discuss how various human cognitive and affective goals are achieved through our engagement and interaction with the environment, as cognitive and affective niche construction. We extend this analysis to the built environment, as urban niche construction, and provide two examples of urban design for which niche construction provides useful theoretical and practical insights. We also discuss how different urban policy initiatives are related through the lens of cultural niche construction.

Outcomes of AO/OTA C-type fractures of the distal humerus after open reduction and internal fixation with locking plate constructs in patients at least 65 years old.

BACKGROUND: Modern treatment options of distal humerus fractures of active elderly patients are osteosynthesis and total elbow arthroplasty. The evidence of outcomes of ORIF after AO/OTA C-type fractures mostly predates the adoption of locking plates. We evaluated the results of open reduction and internal fixation of these fractures treated exclusively with anatomic locking plates. METHODS: A retrospective cohort of 39 patients aged 65 years or above with ORIF for AO/OTA C-type distal humerus fracture using locking plates was analysed. 23 provided follow-up data and 14 attended a follow-up visit. Primary outcome was the Oxford Elbow Score. Secondary outcomes were Mayo Elbow Performance Score, quickDASH, satisfaction, range of motion, complications and revision surgeries. RESULTS: Mean Oxford Elbow Score pain was 83 (SD 17), Oxford Elbow Score function 83 (17) and Oxford Elbow Score social-psychological 79 (20). Mean total Oxford Elbow Score was 81 (15). Among the 14 patients who attended a follow-up visit, Mayo Elbow Performance Score was 85 (17), qDASH 19 (16), active arc of motion 119 (19) degrees. Mayo Elbow Performance Score and arc of motion were worse than on the healthy side. One patient had a serious deep infection. Eleven patients had at least one revision surgery, of which 6 were implant removals and 2 subsequent total elbow arthroplasties. CONCLUSIONS: Distal AO/OTA C-type distal humerus fractures in older adults can be treated reliably and with good outcomes with ORIF using modern locking plates. The mean qDASH scores are similar to population normal values, but when compared to the healthy arm, single-arm outcomes indicated somewhat impaired function. About 1 in 4 patients had at least one revision surgery.

The Rational Appropriateness of Group-Based Pride.

This article seeks to analyze the conditions in which group-based pride is rationally appropriate. We first distinguish between the shape and size of an emotion. For the appropriate shape of group-based pride, we suggest two criteria: the distinction between group-based pride and group-based hubris, and between we-mode and I-mode sociality. While group-based hubris is inappropriate irrespective of its mode due to the arrogant, contemptuous, and other-derogating character of this emotion, group-based pride in the we-mode is appropriate in terms of shape if it is felt over an achievement to which the group members collectively committed themselves. For the same reason, members of I-mode groups can feel appropriately proud of the achievement of their group if they have collectively contributed to it. Instead, group-based pride by mere private identification with a successful group can be rationally appropriate if it manifests the person's reduced-agency ideal and is also part of a coherent pattern of rationally interconnected emotions focused on the same ideal. Moreover, we suggest that pride in the success of one's family member or a close friend is typically felt over the rise of social status that one group member's success grants to the group. However, social status cannot be valued for its own sake as this undermines the values upon which social status is founded. Instead, direct or indirect causal contribution to the success of one's child, friend, or student can warrant group-based pride, which may be justified on the basis of shared values without causal contribution as well. Finally, regarding the size of group-based pride, members of we-mode groups are warranted to experience and express more intense pride than members of I-mode groups. Moreover, the proper intensity of this emotion depends on the particular other(s) to whom the expression is directed. Finally, criteria of appropriate size don't apply to shared group-based pride as sharing increases the intensity of emotion by default.

Interpersonal and Collective Affective Niche Construction: Empirical and Normative Perspectives on Social Media.

This paper contributes to the interdisciplinary theory of collective affective niche construction, which extends the extended mind (ExM) thesis from cognitive to affective phenomena. Although theoretically innovative, the theory lacks a detailed psychological account of how collective affectivity is scaffolded. It has also been criticized for its uncritical assumption of the subject qua the autonomous user of the affective scaffolding as disposable resources, abstracting away from embedded subjectivity in particular techno-political arrangements. We propose that the social motivation hypothesis, an account grounded in recent empirical and theoretical developments in psychology as well as in the classic theory of moral sentiments, will address the former criticism by explicating the basic mechanisms of human social orientation at work in collective affective niche construction. We also begin to address the latter normative criticism in mobilizing a so-called we-mode approach to collective emotion. To make these theoretical dialectics salient, we study social media as a case of collective affective niches, focusing on the impact on subjective well-being. Finally, we briefly identify promising future directions in building a normative theory of affective niche construction on the collective level.

Scandinavian Olecranon Research in the Elderly (SCORE): protocol for a non-inferiority, randomised, controlled, multicentre trial comparing operative and conservative treatment of olecranon fractures in the elderly.

INTRODUCTION: The incidence of olecranon fractures is growing in the elderly population. The traditional operative approach is giving way among the elderly to conservative treatment, which seems to provide a comparable functional outcome with a lower complication burden. However, there is still a lack of reliable evidence to support this shift.The objective of this trial is to investigate whether conservative treatment of displaced olecranon fractures in patients aged 75 or older yields comparable results to those of operative treatment in terms of pain and daily function. METHODS AND ANALYSIS: Scandinavian Olecranon Research in the Elderly (SCORE) is a randomised, controlled, multicentre, non-inferiority trial. Eligible patients will be randomised to either conservative or operative treatment. The sample size will be 68 patients and allocation done at a 1:1 ratio (34 patients per group). The randomisation is stratified according to the participating hospital and patient's sex. Both groups will receive the same postoperative physiotherapy and pain management. The primary outcome is Disabilities of the Arm, Shoulder and Hand at 1-year follow-up. Secondary outcomes are pain and satisfaction measured on visual analogue scales, Patient Reported Elbow Evaluation, range of motion of the elbow and extension strength of the elbow compared with the unaffected arm. Radiographs will be taken at each follow-up. Primary analysis of the results will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION: The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and will be submitted for approval to the Regional Ethics Committees in Linköping, Sweden and Copenhagen, Denmark. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04401462. PROTOCOL VERSION: This is the second protocol version dated on 16 April 2020.

Emotional and Social Factors influence Poker Decision Making Accuracy.

Poker is a social game, where success depends on both game strategic knowledge and emotion regulation abilities. Thus, poker provides a productive environment for studying the effects of emotional and social factors on micro-economic decision making. Previous research indicates that experiencing negative emotions, such as moral anger, reduces mathematical accuracy in poker decision making. Furthermore, various social aspects of the game­such as losing against "bad players" due to "bad luck"­seem to fuel these emotional states. We designed an Internet-based experiment, where participants' (N = 459) mathematical accuracy in five different poker decision making tasks were assessed. In addition, we manipulated the emotional and social conditions under which the tasks were presented, in a 2 × 2 experimental setup: (1) Anger versus neutral emotional state­participants were primed either with an anger-inducing, or emotionally neutral story, and (2) Social cue versus non-social cue­during the tasks, either an image of a pair of human eyes was "following" the mouse cursor, or an image of a black moving box was presented. The results showed that anger reduced mathematical accuracy of decision making only when participants were "being watched" by a pair of moving eyes. Experienced poker players made mathematically more accurate decisions than inexperienced ones. The results contribute to current understanding on how emotional and social factors influence decision making accuracy in economic games.

Experienced poker players are emotionally stable.

Online poker and poker subcultures have become exceedingly popular. Previous studies assessing experience and skill in poker have revealed that proficiency in emotion regulation is a consequential factor in explaining financial success in the game. We assessed (N=478) the associations between poker players' (recruited from online poker forums) level of poker experience and HEXACO-PI-R personality traits. The results indicate that a predisposition for emotional stability-that is, lower scores on emotionality-is linked to high levels of poker experience. Thus, in order to become a successful and experienced poker player, it helps to be able to "keep cool" under pressure. Further exploratory analyses suggest that players who prefer live play to online play are more likely to be extroverted and open to experiences. The results contribute to the extant literature on individual differences in personality in poker players, and in particular help to fill the interdisciplinary gap between personality and gambling research.

Losing more by losing it: poker experience, sensitivity to losses and tilting severity.

In poker, detrimental decision-making as a result of losing control due to negative emotions is known as tilting. Previous evidence suggests that poker experience is related to better emotion regulation in dealing with poker losses, and possibly to reduced severity of tilting in the game. A correlational on-line study (N = 417) was conducted to operationalize the tilting phenomenon by defining certain experiential characteristics that conceivably protect players from tilting or predispose them to it. These characteristics, as well as a measurement of poker experience, were then used in predicting the severity of tilting. It was hypothesized that (1) players with more poker experience are more likely to perceive having tilted less severely, as a result of accumulating poker experience; (2) players with more poker experience have lower severity of tilting; (3) players with more poker experience report lower emotional sensitivity to losses; and (4) players with a higher emotional sensitivity to losses have higher severity of tilting. Hypotheses 1 and 4 were supported, hypothesis 3 was weakly supported, but contrary to hypothesis 2, poker experience was associated with higher tilting severity. It is argued that these results are sensible if experienced players are less likely to tilt in relative terms, per single hand, but more likely to tilt in the long run.

"Don't worry, it's just poker!"--experience, self-rumination and self-reflection as determinants of decision-making in on-line poker.

On-line poker is a game of chance and skill. The construct of poker playing skill has both a technical (game strategy-related) and an emotional (emotion regulation-related) aspect. A correlational on-line study (N = 354) was conducted to assess differences in technical skills and emotional characteristics related to poker playing style between experienced and inexperienced poker players. Results suggest that, with respect to emotional characteristics, experienced poker players engage in less self-rumination and more self-reflection, as compared to inexperienced players. Experienced poker players are also able to make better decisions, by mathematical standards, in a poker decision-making environment, as assessed by two fictitious on-line poker decision-making scenarios. Furthermore, this study provides supportive evidence that experienced poker players conceptualize the construct of "luck" differently from inexperienced players. A new poker playing experience scale (PES) for accurately measuring poker playing experience is presented in this paper.

Matrilysins-1 and -2 (MMP-7 and -26) and metalloelastase (MMP-12), unlike MMP-19, are up-regulated in necrotizing enterocolitis.

OBJECTIVES: Necrotizing enterocolitis (NEC) is the most common gastrointestinal disease of premature infants characterized histologically by extensive tissue injury and inflammation. Matrix metalloproteinases (MMP) are involved in tissue remodeling and cell migration, both being important aspects of inflammatory disease. The aim of this study was to investigate whether MMPs play a role in the pathogenesis of NEC. METHODS: Expression of MMP-1, -7, -9, -10, -12, -19 and -26 was studied using in situ hybridization/immunohistochemistry in samples intestinal tissue removed from 15 patients with NEC; in 7 of them control samples were obtained at closure of stomas. Six intestinal samples from patients with intestinal atresia and four samples of necrosis were also included in the material examined. Laminin-5 was immunostained to find migrating enterocytes and cytokeratin to delineate mucosal epithelium. RESULTS: MMP-7 protein was upregulated in the epithelium of 12/18 NEC samples. MMP-26 was induced in stromal cells of 12/17 NEC specimens. Stromal expression was found for MMP-1 and -12 mRNAs in 7/18 samples. MMP-1 was also detected in the epithelium of regenerating areas. Both NEC and stoma samples expressed MMP-9 in inflammatory cells. Epithelial MMP-19 was downregulated in NEC. CONCLUSIONS: Our results suggest that several MMPs may be major factors in tissue destruction and remodeling in NEC. Targeted inhibition of matrilysins, using synthetic MMP inhibitors or blockers of their signal transduction pathways, may represent a novel therapeutic option for the treatment of intestinal inflammation associated with NEC.