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• Temporal correlations exist in the GRACE TWS time series, resulting in the presence of colored noise. • To show the impact of these correlations, we apply autoregressive noise model and variance component estimation model. • Neglecting these correlations leads to underestimation of trend uncertainty, misinterpreting its significance. Temporal correlations are prevalent in most geophysical time series data, leading to what is known as colored noise, which become more apparent in the frequency domain rather than time domain. Neglecting this type of noise in modeling can result in underestimated standard errors for the parameters of the model used to analyze the time series. As a result, statistical tests misinterpret the significance of these parameters, such as the overall trend rate, because the "signal to noise" ratio becomes incorrectly larger than it should be. In this study, we investigate the temporal correlations in the time series data from the Gravity Recovery and Climate Experiment (GRACE) mission. GRACE and its successor mission GRACE Follow-On (GRACE-FO) have been successfully employed to monitor global total water storage anomalies over two decades since its initial launch in 2002. We primarily utilize monthly GRACE mascon (mass concentration) solutions provided by NASA Goddard Space Flight Center (GSFC), examining both regional and global scales. The power spectrum density of the residuals, calculated after applying standard harmonic regression to each mascon time series on Earth's land, reveals an average spectral index of κ = −1. This indicates the predominance of flicker noise, one of the most common forms of colored noise in geodetic time series. Notably, the noise becomes more Brownian (κ < −1) in regions with intense hydrological events, while it tends to be more white noise (κ → 0) in areas with less water circulation compared to other land regions. This observation suggests that unmodelled hydrological events, such as droughts, floods, and ones associated with ice-melting, contribute to the residuals as colored noise in the time series. To account for this noise in our time series modeling, we primarily consider autoregressive (AR) moving average (MA) process, commonly known as ARMA, in addition to the standard variance component estimation for noise amplitudes. We focus on individual mascon blocks in the Türkiye Region and mascon solutions for 24 world's major river basins. Our findings demonstrate that an ARMA(1,1) model is sufficient for describing the noise in these regions. The results underscore the importance of considering colored noise, as it leads to approximately three times larger standard errors for the overall trend rate. This substantially impacts the significance of the trend rates. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria, characterized by a misalignment between one's gender identity and assigned sex, propels individuals towards medical interventions like gender reassignment surgery (GRS) to harmonize their bodies with their gender. This process aims to enhance overall quality of life (QoL), functioning, and body image. Recognizing the importance of cultivating a positive body image for transgender individuals navigating societal norms, this narrative highlights the ongoing debate surrounding QoL post-GRS. In response, our study is outlined, aiming to scrutinize QoL and self-image among transgender men post-GRS, offering valuable insights into societal perceptions and psychological well-being in this context. Method: This cross-sectional survey focused on transgender men aged 15 to 35 who underwent gender reassignment surgery (GRS) in 2018–2022 in Shiraz, Iran. Participants, after passing psychiatric evaluations, completed World Health Organization Quality of Life (WHOQOL-100) questionnaires pre- and at least one-year post-surgery. The scores of the Brief-WHOQOL questionnaire were evaluated in four domains of physical health, psychological health, social relationships, and environmental health. Results: A total of 60 individual who underwent GRS completed our questionnaire. The average age of the patients was 24.1 ± 3.8 years. Following GRS, the most increase was observed in the psychological factor (by 25.6%). The increase in score was statistically significant in all subgroups (P < 0.001) after operation. Urban living location had a significant association with higher increase in physical health (P < 0.010), psychological health (P = 0.005), and environmental health (P = 0.012) after GRS. In regards to physical health, the low socioeconomic group had a significantly less physical score improvement in QoL compared to the moderate group (P = 0.024) following GRS. In regards to environmental health, the high socioeconomic groups had significantly higher improvement in QoL compared to the low (P = 0.006) and moderate (P < 0.001) group after operation. Conclusion: The results demonstrate that GRS brings about improvements across all aspects of QoL. However, this enhancement is less pronounced among patients hailing from low socioeconomic backgrounds and rural areas. [ABSTRACT FROM AUTHOR]

Background: Obesity (body mass index ≥ 30 kg/m2) is a major risk factor for heart failure with preserved ejection fraction (HFpEF) and affects most patients with HFpEF. Patients living with obesity may experience delays in HFpEF diagnosis and management. We aimed to understand the clinical journey of patients with obesity and HFpEF and the role of primary care providers (PCPs) in diagnosing and managing patients with both conditions. Methods: An anonymous, US population-based online survey was conducted in September 2020 among 114 patients with self-reported HFpEF and obesity and 200 healthcare providers, 61 of whom were PCPs who treat patients with HFpEF and obesity. Results: Half of patients (51%) with HFpEF reported waiting an average of 11 months to discuss their symptoms with a PCP; 11% then received their diagnosis from a PCP. PCPs initiated treatment and oversaw the management of HFpEF only 35% of the time, and 44% of PCPs discussed obesity treatment medication options with their patients. Only 20% of PCPs indicated they had received formal obesity management training, and 79% of PCPs indicated they would be interested in obesity management training and support. Conclusion: PCPs could play a valuable role in addressing obesity and referring patients with obesity and signs and symptoms of HFpEF to cardiologists. Increased awareness of HFpEF and its link to obesity may help PCPs more quickly identify and diagnose their patients with these conditions. Plain Language Summary: Heart failure with preserved ejection fraction (HFpEF) is a common form of heart failure. Many patients who have HFpEF also have obesity or excess weight. We wanted to understand the medical experience of patients with HFpEF and obesity and the role that primary care providers (PCPs) play in managing patients with these diseases. We surveyed 114 patients with HFpEF and obesity and 200 healthcare providers who treat patients with HFpEF and obesity, 61 of whom were PCPs. One-quarter of patients had a major heart-related event that led to their HFpEF diagnosis. Half of the patients said they had an initial discussion about HFpEF symptoms with a PCP, but only one in ten were diagnosed by a PCP. Few PCPs said they received obesity management training, but most were interested in receiving more obesity management training and support. PCPs play an important role in organizing care for patients with HFpEF and obesity. However, there is room to improve HFpEF awareness and access to obesity management tools and strategies among PCPs. [ABSTRACT FROM AUTHOR]

The Dunhuang murals, a significant part of Chinese heritage, have suffered deterioration primarily due to environmental and chemical factors, notably salt damage. This study proposes a sophisticated method that synergizes Fractional Order Differentiation (FOD) and Partial Least Squares Regression (PLSR) to accurately invert the phosphate content in the mural plaster of the Dunhuang paintings. The focal points of the research include: (1) To address the issue of information loss and reduced modeling precision caused by integer-order differentiation algorithms, the FOD method is employed for preprocessing spectral data. This approach ensures the fine spectral differences in the phosphate content of the mural plaster are precisely captured, (2) Utilizing PLSR, the study models the spectral bands identified at a significance level of 0.01 with measured conductivity values, thereby enabling the precise prediction of the phosphate content in the murals. The research outcomes reveal: (1) The FOD method can elucidate the nonlinear characteristics and variation patterns of the mural samples in the spectral data. As the order increases from zero to two, the number of spectral bands meeting the 0.01 significance test initially decreases and then increases. The highest absolute value of the positive correlation coefficient is observed at the 1.9 order, corresponding to the 2077 nm band, (2) For predicting the phosphate content in the murals, the model at the 1.9 order is most suitable for inversion. This model, after cross-validation, achieves a maximum R2 value of 0.861. This study created an efficient FOD-based model for estimating phosphate in mural plaster. [ABSTRACT FROM AUTHOR]

Background: Joint range of motion based on the neutral null method, muscle strength based on manual muscle testing, and selective voluntary motor control based on selective control assessment of the lower extremity are standard parameters of a pediatric three-dimensional clinical gait analysis. Lower-limb reference data of children are necessary to identify and quantify abnormalities, but these are limited and when present restricted to specific joints or muscles. Methods: This is the first study that encompasses the aforementioned parameters from a single group of 34 typically developing children aged 5–17 years. Left and right values were averaged for each participant, and then the mean and standard deviation calculated for the entire sample. The data set was tested for statistical significance (p < 0.05). Results: Joint angle reference values are mostly consistent with previously published standards, although there is a large variability in the existing literature. All muscle strength distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 5. The mean number of repetitions of heel-rise test is 12 ± 5. Selective voluntary motor control shows that all distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 2. Conclusion: Since typically developing children do not match expectations and reference values from the available literature and clinical use, this study emphasizes the importance of normative data. Excessively high expectations lead to typically developing children being falsely underestimated and affected children being rated too low. This is of great relevance for therapists and clinicians. Level of evidence: 3. [ABSTRACT FROM AUTHOR]

The increasingly digital and multicultural 21st-century society requires future teachers to be prepared for the changes and challenges they may encounter. Not only language and digital competences, but critical-thinking and problemsolving skills are needed. Moreover, well developed socio-affective abilities, empathy among them, are also key when dealing with others. This is even more relevant when teachers are to work with a non-mainstream population, such as adult migrants with low literacy levels, and to design student-centered curricula or activities. Empathy is a multifaceted process involving, among others, perception, intellection, affect and other sensory aspects of the lived experience. It has been argued that the first-person perspective-taking involved in empathic engagement must necessarily involve rational computation and cognitively mediated processing. Training future teachers in the Pedagogy of Multiliteracies is a means to integrate multimodal digital instruction and aggregate cognitive as well as socio-emotional features to the education of future language teachers. Method: A mixed-method pre-post study was conducted with 48 trainee teachers who participated in stand-alone digital multiliteracy interventions, in which they were encouraged to envisage themselves as future teachers of low-literate migrants. Policy documents such as the reference guide on Literacy and Second Language Learning for the Linguistic Integration of Adult Migrants, journal articles, audiovisual resources as well as examples of existing educational materials aimed at the target audience, were made available to them on an online platform. In two separate studies, trainees were encouraged to collaboratively produce two different multimodal outputs. The Revised Scale of Ethnocultural Empathy was administered before and after the intervention, subjecting the data obtained to quantitative analysis. Qualitative data was also collected to gain a better understanding of the affective and cognitive processes experienced by the participants. Results: Simple statistical analysis coupled with the comparison of means was used to respond to the research questions. Statistical hypothesis testing, including correlations and non-parametric statistics were used to analyze the relationship between each of the factors within the RSEE and the participants, considering the different interventions applied. Non-parametric tests (U-Mann Whitney) were used to compare the differences between the levels of ethnocultural empathy of the participants in the two studies. Significant differences were found in Factor 3 (Empathy) and Factor 5 (Anxiety) between the groups and their postintervention results, with a p value of 0.053 and 0.038, respectively. The effect size r was calculated, obtaining a size effect of 0.625 for Factor 3 (Empathy) and 0.674 for Factor 5 (Anxiety). These results indicate that the significant differences and the size effect between both groups are large. U-Mann Whitney non-parametric analysis also revealed gender differences in Factor 3 (Empathy), showing females higher levels than males. Effect size r analysis showed a large size effect of 0.708 for Factor 3 (Empathy). The findings pertaining to gender-related differences in empathy levels confirm the conclusions drawn by previous studies. When contrasting study 1 and 2, statistical differences were also shown after the intervention for the 'Anxiety and Lack of Multicultural Selfefficacy' factor. The qualitative data analysis was carried out with Atlas.ti v.8, in order to isolate and categorize the broader themes and the most significant explanatory quotes extracted from the participants' records and interviews. The results reveal the learning strategies that each group of learners applied to successfully complete the task at hand, as well as the participants' deployment of their critical thinking skills and the awakening of a sense of awareness of their own professional competence development process. Conclusion: This study set out to compare how effective two digital multiliteracy interventions were in developing future language teachers' ethnocultural empathy and cognitive abilities when appraising the educational needs of lowliteracy migrants. Despite the small sample size, the study certainly adds to our understanding of the impact of multimodal tasks involving critical thinking skills on trainees' cognitive and affective abilities. Besides, it expands the growing body of research that points to the desirability of embedding digitally-based content creation tasks in training curricula for future language teachers. [ABSTRACT FROM AUTHOR]

The identification of anticancer peptides (ACPs) is crucial, especially in the development of peptide-based cancer therapy. The classical models such as Split Amino Acid Composition (SAAC) and Pseudo Amino Acid Composition (PseAAC) lack the incorporation of feature representation. These advancements improve the predictive accuracy and efficiency of ACP identification. Thus, the effort of this research is to propose and develop an advanced framework based on feature extraction. Thus, to achieve this objective herein we propose an Extended Dipeptide Composition (EDPC) framework. The proposed EDPC framework extends the dipeptide composition by considering the local sequence environment information and reforming the CD-HIT framework to remove noise and redundancy. To measure the accuracy, we have performed several experiments. These experiments were employed using four famous machine learning (ML) algorithms named; Support Vector Machine (SVM), Decision Tree (DT), Random Forest (RF), and K Nearest Neighbor (KNN). For comparisons, we have used accuracy, specificity, sensitivity, precision, recall, and F1-Score as evaluation criteria. The reliability of the proposed framework is further evaluated using statistical significance tests. As a result, the proposed EDPC framework exhibited enhanced performance than SAAC and PseAAC, where the SVM model delivered the highest accuracy of 96. 6% and significant enhancements in specificity, sensitivity, precision, and F1-score over multiple datasets. Due to the incorporation of enhanced feature representation and the incorporation of local and global sequence profiles proposed EDPC achieves higher classification performance. The proposed frameworks can deal with noise and also duplicating features. These are accompanied by a wide range of feature representations. Finally, our proposed framework can be used for clinical applications where ACP identification is essential. Future works will include extending to a larger variety of datasets, incorporating tertiary structural information, and using deep learning techniques to improve the proposed EDPC. [ABSTRACT FROM AUTHOR]

A longstanding debate concerns the function of carinated elements in both, the Levantine, and European Aurignacian. The present study aims to contribute to this topic with the evaluation of the carinated assemblage from layer D in Hayonim Cave, Western Galilee, Israel, one of the type sites of the Levantine Aurignacian. An operational chain reconstruction with an attribute analysis is paired with a typological approach to the preparation and maintenance products based on artefacts defined as West European Aurignacian. The results of this study are investigated with multivariate statistics offering a methodological contribution. The data is subjected to a transformation into a distance matrix using the Gower distance and tested with the adonis-algorithm for significance. The results clearly indicate that the carinated items in Hayonim Cave did fully or partially function as cores. They are accompanied by diagnostic preparation- and- maintenance products known from the literature e.g. Thèmes bladelets. The statistical analysis indicates only a minor correlation with stratigraphy yet supports the techno-typological criteria applied for defining artefact categories (cores, debitage, tools), as well as the proposed differentiation of carinated 'core' types. The non-carinated cores in Hayonim Cave are characterised by a high variability in typology and reduction concepts. A curious similarity to the Levallois-concept is observed on some of the flake cores. It is therefore suggested that the frequent recycling of Middle Palaeolithic artefacts in the Levantine Aurignacian might have given the Aurignacian flint-knappers the opportunity to study the Levallois concept and apply an approximation of it in their own core reduction strategies. The notion that Palaeolithic flint-knappers actively observed former technological systems through the discarded artefacts directly opens up a new trajectory for the understanding of lithic reduction concept permanence. The conceptual diversification and variability in Hayonim Cave D indicate a highly dynamic period in the Levantine Upper Palaeolithic which increased the adaptive potential and promoted a rapid cultural change. [ABSTRACT FROM AUTHOR]

Background: A fistula is an unusual communication between the skin and an inward organ or between the organs. The current study aimed to determine the role of magnetic resonance imaging (MRI) in the diagnosis, description, and classification of fistula-in-ano. Additionally, the study aimed to compare the MRI findings with the operative findings, which is considered the gold standard in our study. Methods: The present study is a prospective study and was carried out on a group of 61 patients: 52 males and 9 females with a mean age of 41 years, who were suspected to have perianal fistulae presented clinically with discharge or localized pain or were asymptomatic. A preoperative MRI was conducted for fistula-in-ano evaluation in these patients from October 2019 till the end of October 2021. A surgeon conducted a physical examination of all patients to document the number and location of cutaneous openings following a full medical history. The MRI images were evaluated and interpreted by multiple expert radiologists who had more than 5 years of experience in analyzing MRI. In the cases (in 3 cases, 4.92%) where there were discrepancies in their interpretations, a senior radiologist's evaluation was considered the final result and was confirmed surgically. Subsequently, the MRI findings were correlated with surgical findings to indicate the specificity, sensitivity, and accuracy of such MRI findings. Results: The MRI technique was the routine (i.e., without contrast administration) technique in 36 (59.02%) patients, with contrast administration in 21 (34.43%) patients and with anesthesia/sedation (uncomfortable, anxious, and claustrophobic patients need to minimize their motion artifact to improve the quality and obtain more detailed images) in 4 (6.56%) patients. The MRI pathology of the studied patients revealed normal findings in 1 (1.64%) patient, anal fissure/early developing tract in 6 (9.84%) patients, and established tract (sinus/fistula) in 54 (88.52%) patients. Park's and St. James's University Hospital classifications were utilized to categorize the patients, with the most common fistula types based on the Park's classification: intersphincteric (44.3%) and transsphincteric (29.5%). Based on the St. James's classification, grade 1 (intersphincteric (34.4%)) and grade 4 (transsphincteric with abscess/side branch (16.4%)) were the most prevalent. A substantial consensus was reached between MRI and surgery findings for classifying tracts, side branches, and abscesses formation with sensitivity, specificity, and accuracy of 100%, 85.71%, and 98.36%, respectively. Conclusions: MRI is a valuable tool in managing patients with perianal fistulas due to its ability to detect hidden areas of infection (such as abscesses) and secondary extensions. These factors contribute to the high recurrence rate after surgery. Additionally, MR imaging can define the anatomical relationships between the fistula and anal sphincters, helping to predict the likelihood of fecal incontinence following surgery. [ABSTRACT FROM AUTHOR]

As genomic selection emerges as a promising breeding method for both plants and animals, numerous methods have been introduced and applied to various real and simulated data sets. Research suggests that no single method is universally better than others; rather, performance is highly dependent on the characteristics of the data and the nature of the prediction task. This implies that each method has its strengths and weaknesses. In this study, we exploit this notion and propose a different approach. Rather than comparing multiple methods to determine the best one for a particular study, we advocate combining multiple methods to achieve better performance than each method in isolation. In pursuit of this goal, we introduce and develop a computational method of the stacked generalization within ensemble methods. In this method, the meta-model merges predictions from multiple base models to achieve improved performance. We applied this method to plant and animal data and compared its performance with currently available methods using standard performance metrics. We found that the proposed method yielded a lower or comparable mean squared error in predicting phenotypes compared to the current methods. In addition, the proposed method showed greater resistance to overfitting compared to the current methods. Further analysis included statistical hypothesis testing, which showed that the proposed method outperformed or matched the current methods. In summary, the proposed stacked generalization integrates currently available methods to achieve stable and better performance. In this context, our study provides general recommendations for effective practices in genomic selection. [ABSTRACT FROM AUTHOR]

This study evaluates the effectiveness of deep learning and canonical machine learning models for detecting diseases in crayfish from an imbalanced dataset. In this study, measurements such as weight, size, and gender of healthy and diseased crayfish individuals were taken, and at least five photographs of each individual were used. Deep learning models outperformed canonical models, but combining both approaches proved the most effective. Utilizing the ResNet50 model for automatic feature extraction and subsequent training of the RF algorithm with these extracted features led to a hybrid model, RF-ResNet50, which achieved the highest performance in diseased sample detection. This result underscores the value of integrating canonical machine learning algorithms with deep learning models. Additionally, the ConvNeXt-T model, optimized with AdamW, performed better than those using SGD, although its disease detection sensitivity was 1.3% lower than the hybrid model. McNemar's test confirmed the statistical significance of the performance differences between the hybrid and the ConvNeXt-T model with AdamW. The ResNet50 model's performance was improved by 3.2% when combined with the RF algorithm, demonstrating the potential of hybrid approaches in enhancing disease detection accuracy. Overall, this study highlights the advantages of leveraging both deep learning and canonical machine learning techniques for early and accurate detection of diseases in crayfish populations, which is crucial for maintaining ecosystem balance and preventing population declines. [ABSTRACT FROM AUTHOR]

Objective: To evaluate knowledge about HPV and its vaccine, additionally, to examine the effect of knowledge about HPV and its vaccine on perceived benefits and barriers to HPV vaccination among individuals in the western region of Saudi Arabia. Methods: A cross-sectional design was employed in the western region of Saudi Arabia through a self-administered web-based survey. The survey assessed knowledge, perceived benefits, and perceived barriers to HPV vaccination. Results: A total of 1149 eligible participants completed the survey. Participants exhibited limited knowledge of HPV and its vaccine, with an average total score of 4.76 out of 15. Over 80% of participants were unaware that HPV may not show symptoms, cannot lead to HIV, and is not treatable with antibiotics. Over half were unaware that HPV can cause cervical cancer, oral cancer, or genital warts. Unmarried and graduate-educated participants demonstrated greater knowledge. Perceived benefits were positively associated with knowledge levels, while perceived barriers were negatively associated with knowledge levels after controlling for other variables. Conclusions: This study highlights the need for education and healthcare efforts to raise knowledge about HPV and its vaccine in the western region of Saudi Arabia. Also, this study indicated that enhanced knowledge boosts positive attitudes towards HPV vaccination, while reducing perceived barriers, thereby increasing vaccination rates. [ABSTRACT FROM AUTHOR]

Introduction: People with Parkinson's Disease (PD) often show reduced anticipatory postural adjustments (APAs) before voluntary steps, impacting their stability. The specific subphase within the APA stage contributing significantly to fall risk remains unclear. Methods: We analyzed center of pressure (CoP) trajectory parameters, including duration, length, and velocity, throughout gait initiation. This examination encompassed both the postural phase, referred to as anticipatory postural adjustment (APA) (APA1, APA2a, APA2b), and the subsequent locomotor phases (LOC). Participants were instructed to initiate a step and then stop (initiating a single step). Furthermore, we conducted assessments of clinical disease severity using the Unified Parkinson's Disease Rating Scale (UPDRS) and evaluated fall risk using Tinetti gait and balance scores during off-medication periods. Results: Freezing of gait (FOG) was observed in 18 out of 110 participants during the measurement of CoP trajectories. The Ramer-Douglas-Peucker algorithm successfully identified CoP displacement trajectories in 105 participants (95.5%), while the remaining 5 cases could not be identified due to FOG. Tinetti balance and gait score showed significant associations with levodopa equivalent daily dose, UPDRS total score, disease duration, duration (s) in APA2a (s) and LOC (s), length in APA1 (cm) and APA2b (cm), mediolateral velocity in APA1 (X) (cm/s), APA2a (X) (cm/s), APA2b (X) (cm/s) and LOC (X) (cm/s), and anterior-posterior velocity in APA2a (Z) (cm/s) and APA2b (Z) (cm/s). Multiple linear regression revealed that only duration (s) in APA2a and UPDRS total score was independently associated with Tinetti gait and balance score. Further mediation analysis showed that the duration (s) in APA2a served as a mediator between UPDRS total score and Tinetti balance and gait score (Sobel test, p = 0.047). Conclusion: APA2 subphase duration mediates the link between disease severity and fall risk in PD, suggesting that longer APA2a duration may indicate reduced control during gait initiation, thereby increasing fall risk. [ABSTRACT FROM AUTHOR]

Motivation Gene set enrichment (GSE) analysis allows for an interpretation of gene expression through pre-defined gene set databases and is a critical step in understanding different phenotypes. With the rapid development of single-cell RNA sequencing (scRNA-seq) technology, GSE analysis can be performed on fine-grained gene expression data to gain a nuanced understanding of phenotypes of interest. However, with the cellular heterogeneity in single-cell gene profiles, current statistical GSE analysis methods sometimes fail to identify enriched gene sets. Meanwhile, deep learning has gained traction in applications like clustering and trajectory inference in single-cell studies due to its prowess in capturing complex data patterns. However, its use in GSE analysis remains limited, due to interpretability challenges. Results In this paper, we present DeepGSEA, an explainable deep gene set enrichment analysis approach which leverages the expressiveness of interpretable, prototype-based neural networks to provide an in-depth analysis of GSE. DeepGSEA learns the ability to capture GSE information through our designed classification tasks, and significance tests can be performed on each gene set, enabling the identification of enriched sets. The underlying distribution of a gene set learned by DeepGSEA can be explicitly visualized using the encoded cell and cellular prototype embeddings. We demonstrate the performance of DeepGSEA over commonly used GSE analysis methods by examining their sensitivity and specificity with four simulation studies. In addition, we test our model on three real scRNA-seq datasets and illustrate the interpretability of DeepGSEA by showing how its results can be explained. Availability and implementation https://github.com/Teddy-XiongGZ/DeepGSEA [ABSTRACT FROM AUTHOR]

Motivation In many biomedical applications, we are confronted with paired groups of samples, such as treated versus control. The aim is to detect discriminating features, i.e. biomarkers, based on high-dimensional (omics-) data. This problem can be phrased more generally as a two-sample problem requiring statistical significance testing to establish differences , and interpretations to identify distinguishing features. The multivariate maximum mean discrepancy (MMD) test quantifies group-level differences, whereas statistically significantly associated features are usually found by univariate feature selection. Currently, few general-purpose methods simultaneously perform multivariate feature selection and two-sample testing. Results We introduce a sparse, interpretable, and optimized MMD test (SpInOpt-MMD) that enables two-sample testing and feature selection in the same experiment. SpInOpt-MMD is a versatile method and we demonstrate its application to a variety of synthetic and real-world data types including images, gene expression measurements, and text data. SpInOpt-MMD is effective in identifying relevant features in small sample sizes and outperforms other feature selection methods such as SHapley Additive exPlanations and univariate association analysis in several experiments. Availability and implementation The code and links to our public data are available at https://github.com/BorgwardtLab/spinoptmmd. [ABSTRACT FROM AUTHOR]

Extractive document summary is usually seen as a sequence labeling task, which the summary is formulated by sentences from the original document. However, the selected sentences usually are high redundancy in semantic space, so that the composed summary are high semantic redundancy. To alleviate this problem, we propose a model to reduce the semantic redundancy of summary by introducing the cluster algorithm to select difference sentences in semantic space and we improve the base BERT to score sentences. We evaluate our model and perform significance testing using ROUGE on the CNN/DailyMail datasets compare with six baselines, which include two traditional methods and four state-of-art deep learning model. The results validate the effectiveness of our approach, which leverages K-means algorithm to produce more accurate and less repeat sentences in semantic summaries. [ABSTRACT FROM AUTHOR]

Propelled by rapid economic growth, the southwestern Shandong urban agglomeration (SSUA) in China has become a crucial industrial hub, but this process has somewhat hindered vegetation growth and environmental quality. Leveraging the functionalities of the Google Earth Engine (GEE) platform, we derived the fractional vegetation coverage (FVC) through the Normalized Difference Vegetation Index (NDVI) and assessed the eco-environmental quality using the Remote Sensing Ecological Index (RSEI). To examine the patterns and shifts in the SSUA, we employed the Theil–Sen median slope estimation, which provided robust estimates of linear trends, the Mann–Kendall trend test to determine the statistical significance of these trends, and the Hurst exponent analysis to evaluate the long-term persistence and predict future changes in the vegetation coverage and eco-environmental quality. Furthermore, to explore the interdependencies between vegetation coverage (VC) and environmental quality, we applied an improved coupling coordination degree model (ICCDM). This model allowed us to assess the co-evolution and synergy between these two factors over the study period, providing comprehensive insights for sustainable urban and ecological planning in the region. The VC and eco-environmental quality improved consistently across most of the SSUA from 2000 to 2020. The dominance of VC had transitioned from being predominantly characterized by relatively high VC to being mainly characterized by high VC. A substantial portion of the SSUA is predicted to experience improvements in its VC and environmental quality moving forward. Furthermore, the coupling coordination relationship between VC and environmental conditions in the southwest of Shandong Province generally exhibited a state of orderly coordinated development. With the passage of time, there was a clear tendency toward expansion in the coupled uncoordinated areas distributed in a network within each regional economic center. Our research unveils the dynamics and spatial-temporal patterns of VC and ecological quality in the southwestern Shandong urban agglomeration (SSUA) and elucidates the coupling and coordination mechanism between these two aspects, which provides theoretical support for understanding the healthy development of vegetation and ecology in urban agglomerations in an industrial context. [ABSTRACT FROM AUTHOR]

As enterprises face increasing competitive pressures, financial crises can significantly impact on their capital operations, potentially leading to operational difficulties and, ultimately, market exclusion. Consequently, many enterprises have begun to utilize financial early-warning systems to guide and control risks. Currently, there is neither a universal nor comprehensive enterprise financial risk management model in China, nor a unified classification standard for enterprise financial risk management levels. This article takes financial data on A-share listed companies in 2020 as the data sample, including those with special treatment (represented by ST) or non-ST status. We establish an independent indicator system within the framework of profitability, solvency, operational capability, development potential, shareholders' retained earnings, cash flow, and asset growth. The model is constructed employing the factor–logistic fusion algorithm. The factor part addresses the issue of collinearity among risk indicators, and the logistic part presents the results in probabilistic form, enhancing the interpretability of the model. The prediction accuracy of this model exceeds 89%. Finally, by applying the principles of interval estimation theory to statistical hypothesis testing, we categorize the risk levels into Grade A, representing significant risk; Grade B, representing moderate risk; Grade C, representing minor risk; and Grade D, representing no risk. This article aims to provide a comprehensive definition of a universal financial risk management early-warning model applicable to all enterprises in China. [ABSTRACT FROM AUTHOR]

Previous studies have explored use of smart glasses in telemedicine, but no study has investigated its use in teleradiography. The purpose of this study was to implement a six-month pilot program for Western Australian X-ray operators (XROs) to use smart glasses to obtain assisted reality support in their radiography practice from their supervising radiographers, and evaluate its effectiveness in terms of XROs' competence improvement and equipment usability. Pretest–posttest design with evaluation of the XROs' competence (including their X-ray image quality) and smart glasses usability by XROs in two remote centers and their supervising radiographers from two sites before and after the program using four questionnaire sets and X-ray image quality review was employed in this experimental study. Paired t-test was used for comparing mean values of the pre- and post-intervention pairs of 11-point scale questionnaire and image quality review items to determine any XROs' radiography competence improvements. Content analysis was used to analyze open questions about the equipment usability. Our study's findings based on 13 participants (11 XROs and 2 supervising radiographers) and 2053 X-ray images show that the assisted reality support helped to improve the XROs' radiography competence (specifically X-ray image quality), with mean post-intervention competence values of 6.16–7.39 (out of 10) and statistical significances (p < 0.001–0.05), and the equipment was considered effective for this purpose but not easy to use. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Methods: Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Results: Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. Conclusion: The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises. [ABSTRACT FROM AUTHOR]

Background: To evaluate colour stability in artificial saliva by mechanically simulating brushing between in-house 3D-printed resin brackets (IH3DBs) and commercially available brackets. Methods: The samples consist of four sets of ten aesthetic brackets each supplied by four different manufacturers: clear Damon, Synovate C, Crystal and in-house 3D printed brackets (IH3DBs). The brackets were immersed in a plastic tank containing artificial saliva maintained at a constant temperature of 37 °C with a 65-minute brushing system. Staining changes at T0 (pre-brushing) and T1 (post-brushing) were measured with a spectrophotometer according to the VITA and Master scale and brightness values. Statistical analysis compared the colour changes with the Wilcoxon test and in case of significance, severity was investigated. The significance level considered was p < 0.05. Results: The IH3DBs shows statistically significant differences for both scales and brightness values. The Damon and the Crystal brackets report a statistically significant difference only for brightness. The Synovate C bracket shows no statistically significant differences. Conclusions: The IH3DB produced chromaticity differences for the VITA and Master scale possibly due to the surface roughness created during the printing process. However, the IH3DBs together with Damon Clear improved brightness, due to the mechanical action of brushing. [ABSTRACT FROM AUTHOR]

It is estimated that globally, millions of adolescents experience mental health problems, especially anxiety and depression. Adolescents with high perceptions of stress often encounter mental issues, have negative thoughts or are dissatisfied with daily life events. This study employed a quasi-experimental design with two groups and repeated measures to test an innovative nursing intervention, the Be Aware of Stress Smartphone Application. This application aims to increase positive thinking and reduce perceived stress among at-risk adolescents aged 13 to 16, and we sought to determine their satisfaction with its usability. The study was conducted with 44 junior high school students from an opportunity expansion high school in Eastern Thailand, who were randomly assigned to experimental and comparison groups (22 each). Data were collected between December 2023 and February 2024 using the General Information Questionnaire, Positive Thinking Test, Perceived Stress Questionnaire, and Satisfaction of Application Usability scale. The outcomes were measured at baseline, after completing the program at week 4, and at week 8 after using the application. The chi-square test and repeated measures analysis of variance were used to analyze the data. The results of this study have important implications for future research. They indicate a significant improvement in positive thinking and a reduction in perceived stress within the experimental group, compared to the comparison group, at weeks 4 and 8. Moreover, the experimental group reported high satisfaction with the application's usability. These findings suggest that the Be Aware of Stress application is beneficial for community nurses and others to prevent adolescent stress. The study also highlights the need for future research to enhance the application's functionality and compatibility with various phone operating systems to ensure widespread and effective use. [ABSTRACT FROM AUTHOR]

Background: The pre-season preparatory period is considered key for optimizing the physical fitness levels needed to withstand congested match periods and preventing injuries during the regular soccer season. This study contrasted the effects s of neuromuscular training (NMT) versus an endurance-dominated training (ET) program conducted during the preseason on measures of physical fitness and injury occurrence in female soccer players. Methods: Twenty-four female soccer players aged 17.0 ± 1.3 years from a professional soccer club participated in this study. Players were randomly assigned to NMT (n = 12) or ET (n = 12) groups according to their playing position. The preseason intervention program lasted six weeks, with three weekly sessions with a duration of 45–60 min per session. Exercises in the NMT group included muscle strengthening exercises, plyometrics, agility and dynamic stability exercises, while the ET group practiced a traditional pre-season training program consisting of running and sprinting exercises, fartlek, and high-intensity interval training. The training volumes were similar in the two study groups. Anthropometric measurements, physical fitness tests (i.e., linear and change-of-direction speed, muscle strength and power tests) and the overall injury rate per 1000 h of exposure (training, match) were recorded throughout the season. Results: No between group differences were found at pre (T1). Significant group-by-time interactions were observed for the 5, 10, and 30-m linear sprint speed tests (p < 0.001, 2.16 < d < 2.58), the T-test (p = 0.024, d = 1.03), the squat (p < 0.001, d = 4.04), and the countermovement jump test (p < 0.001, d = 2.21), the Loughborough soccer passing test (LSPT) (p = 0.019, d = 1.08), and the 1-RM back squat test (p < 0.001, d = 2.53). Post-hoc tests indicated that NMT provided larger improvements for SJ, CMJ, 1-RM back squat, the 5-m sprint, 10-m sprint, 30-m sprint, T-test and LSPT compared to ET (1.07 > d > 2.77). The injury rate across the season was significantly lower in the NMT (5.1/1000 h exposure) compared to ET (11.8/1000 h exposure) (p = 0.014). Conclusions: The findings support that six-weeks of preseason NMT versus ET induced larger performance improvements, and significantly reduced injury occurrence in elite female soccer players. Key points: • Our results indicate that the integration of 45 to 60 min of preseason neuromuscular training, three times per week, for 6 weeks, can improve physical fitness and prevent injuries in young female soccer players. • The present study demonstrated that the neuromuscular training program can reduce the incidence injury rate by more than 50% and the burden by more than 65% compared to the endurance-dominated training. • Neuromuscular training is an effective approach during the preseason period to improve diverse measures of physical fitness and to reduce injury occurrence. • Preseason neuromuscular training appears to improve the fitness level of female soccer players and as such could allow them to compete at the high level. [ABSTRACT FROM AUTHOR]

This study explains how the gap between theory and empirical research hinders scientific progress in the area of international political economy. To demonstrate this point, I use Chen's Extended Dependence Theory, which challenges liberal peace theory but fails to provide supporting empirical evidence. Chen contends that it is not trade dependence between two states that fosters peace but a challenger's trade relations with the defense-pact partners of the target. Although Chen criticizes liberal peace proponents whose primary concern is how to deter war, his empirical analysis is confined to how to decrease (fatal) militarized disputes short of war. I argue that for his theory to succeed, it must be validated against the most severe and intense form of conflict. Using statistical tests and substantive significance, I uncover no peace-building effect, with regards to war, attributable to Extended Dependence. It appears that the Extended Dependence variable exhibits a ceiling effect. Future research should explain why economic ties and security institutions fail to work together to lower the risk of the most destructive form of conflict. [ABSTRACT FROM AUTHOR]

Objective: Accurate imaging biomarkers that indicate disease progression at an early stage are highly important to enable timely mitigation of symptoms in progressive lung disease. In this context, reproducible experimental models and readouts are key. Here, we aim to show reproducibility of a lung injury rat model by inducing disease and assessing disease progression by multi-modal non-invasive imaging techniques at two different research sites. Furthermore, we evaluated the potential of fibroblast activating protein (FAP) as an imaging biomarker in the early stage of lung fibrosis. Methods: An initial lung injury rat model was set up at one research site (Lund University, Lund, Sweden) and repeated at a second site (Radboudumc, Nijmegen, The Netherlands). To induce lung injury, Sprague-Dawley rats received intratracheal instillation of bleomycin as one single dose (1,000 iU in 200 µL) or saline as control. Thereafter, longitudinal images were acquired to track inflammation in the lungs, at 1 and 2 weeks after the bleomycin challenge by magnetic resonance imaging (MRI) and [18F]FDG-PET. After the final [18F] FDG-PET scan, rats received an intravenous tracer [89Zr]Zr-DFO-28H1 (anti-FAP antibody) and were imaged at day 15 to track fibrogenesis. Upon termination, bronchoalveolar lavage (BAL) was performed to assess cell and protein concentration. Subsequently, the biodistribution of [89Zr]Zr-DFO-28H1 was measured ex vivo and the spatial distribution in lung tissue was studied by autoradiography. Lung sections were stained and fibrosis assessed using the modified Ashcroft score. Results: Bleomycin-challenged rats showed body weight loss and increased numbers of immune cells and protein concentrations after BAL compared with control animals. The initiation and progression of the disease were reproduced at both research sites. Lung lesions in bleomycin-exposed rats were visualized by MRI and confirmed by histology. [18F]FDG uptake was higher in the lungs of bleomycin-challenged rats compared with the controls, similar to that observed in the Lund study. [89Zr]Zr-DFO-28H1 tracer uptake in the lung was increased in bleomycin-challenged rats compared with control rats (p = 0.03). Conclusion: Here, we demonstrate a reproducible lung injury model and monitored disease progression using conventional imaging biomarkers MRI and [18F]FDG-PET. Furthermore, we showed the first proof-of-concept of FAP imaging. This reproducible and robust animal model and imaging experimental set-up allows for future research on new therapeutics or biomarkers in lung disease. [ABSTRACT FROM AUTHOR]

Background: Advanced Trauma Life Support was originated mainly to train doctors who don't manage trauma on a regular basis, including junior doctors as it prepares them more efficiently and effectively for treating and managing trauma patients. This study was conducted to study knowledge, attitude and practice of advanced trauma life support protocol among house-officers in Khartoum state hospitals, Sudan 2023. Methods: This is a cross-sectional descriptive health facility based study conducted in Bahri Teaching Hospital, Omdurman Teaching Hospital and Ibrahim Malik teaching hospital, Khartoum state, Sudan. Data of 151 House-officers of all nationality working in Khartoum state hospitals was collected using a simple random technique, filling questionnaire that was designed especially for this study. Comparison between different variables by Chi-square test and statistical significance difference at P value < 0.05 was done. Result: A total of 151 house officers were included in the study. 49% aged between 20 and 25 years, females were the majority 56.3%. About 41.1% have took ATLS course before. 55.21% of the study participants didn't take the course because it was not available, while 35.42% because it was expensive and 29.17% referred it to their busy lifestyle. 91% of the study population think that ATLS course should be compulsory and 85% think that the ATLS protocol should be recommended to both junior and senior doctors. 77% of the study participants stated that their seniors teaching skills affect how they apply ATLS. Conclusion: Overall junior doctors at Khartoum state hospitals demonstrated a positive attitude towards ATLS, but they showed poor knowledge regarding the topic. It's advised that an earlier training program is introduced by incorporating ATLS course to be part of all final year medical school's curriculum. [ABSTRACT FROM AUTHOR]

Background: Frequency discrimination underlies more complicated auditory activities like speech comprehension and interpretation. However, intensity differences indicate how far apart noises are. This study aimed to evaluate and compare results of frequency modulation and difference limen for intensity in children with cochlear Implants (CI) as well as normal hearing children. Results: This case–control work was performed on 40 children, aged from 5–18 years, divided into two equal groups: a study group with unilateral CI and a control group with normal peripheral hearing. All patients were subjected to otological examination, audiological evaluation, frequency modulation difference limen (FMDL) and difference limen for intensity (DLI) tests. Patients with CI, as compared to normal hearing (NH) subjects, required significantly higher frequencies to discriminate FMDL and DLI respectively (P value = 0.001). At 2000 and 4000 Hz: FMDL had a significant diagnostic power for patients with CI (AUC = 0.980, 0.998 respectively, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. While, at 4000 Hz: DLI had a significant diagnostic power for patients with CI (AUC = 0.999, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. Conclusion: A statistically substantial variation was observed among CI and NH children in FMDL and DLI at all frequencies tested. Patients with CI required significantly higher frequencies to discriminate as compared to NH subjects. Frequencies at 2000 Hz and 4000 Hz possess the best specificity and sensitivity of FMDL. While frequency 4000 Hz possess the best specificity and sensitivity of DLI. [ABSTRACT FROM AUTHOR]

Background and Design: Hematological parameters have been used as laboratory markers to evaluate the systemic inflammation in several rheumatic disease. The aim of this study is to determine the difference of hematological parameters between the patients who have been just fulfilled the Behçet's disease (BD) criteria and patients with recurrent aphthous stomatitis (RAS). Materials and Methods: Twenty patients with newly diagnosed BD and 47 patients with RAS whose oral ulcerations appeared at least three times a year were enrolled in this cross-sectional study. Demographic and clinical characteristics of patients, complete blood count, C-reactive protein (CRP) and erythrocyte sedimentation rate were recorded. Results: Patients' characteristics including gender, age, duration, and frequency of oral aphthous ulcerations in both study groups were comparable (p>0.05). CRP was significantly higher in newly diagnosed BD group when compared to the RAS group (p=0.001). CRP value higher than 2.7 g/dL, mean platelet volume (MPV) value higher than 7.58 fL and lymphocyte count higher than 2.85 103/μL were found to be the markers for distinguishing patients with BD from patients with RAS [odds ratio (OR): 12.76 (95% confidence interval (CI): 2.86-56.88), OR: 5.61 (95% CI: 1.11-28.42), OR: 15.24 (95% CI: 1.77-131.31), respectively]. Conclusion: The elevated CRP, MPV and lymphocyte count were associated with patients with newly diagnosed BD rather than patients with RAS. Further large prospective studies with the healthy control group are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

This work is motivated by learning the individualized minimal clinically important difference, a vital concept to assess clinical importance in various biomedical studies. We formulate the scientific question into a high-dimensional statistical problem where the parameter of interest lies in an individualized linear threshold. The goal is to develop a hypothesis testing procedure for the significance of a single element in this parameter as well as of a linear combination of this parameter. The difficulty dues to the high-dimensional nuisance in developing such a testing procedure, and also stems from the fact that this high-dimensional threshold model is nonregular and the limiting distribution of the corresponding estimator is nonstandard. To deal with these challenges, we construct a test statistic via a new bias-corrected smoothed decorrelated score approach, and establish its asymptotic distributions under both null and local alternative hypotheses. We propose a double-smoothing approach to select the optimal bandwidth in our test statistic and provide theoretical guarantees for the selected bandwidth. We conduct simulation studies to demonstrate how our proposed procedure can be applied in empirical studies. We apply the proposed method to a clinical trial where the scientific goal is to assess the clinical importance of a surgery procedure. for this article are available online. [ABSTRACT FROM AUTHOR]

We consider the problem of testing the equality of conditional distributions of a response variable given a vector of covariates between two populations. Such a hypothesis testing problem can be motivated from various machine learning and statistical inference scenarios, including transfer learning and causal predictive inference. We develop a nonparametric test procedure inspired from the conformal prediction framework. The construction of our test statistic combines recent developments in conformal prediction with a novel choice of conformity score, resulting in a weighted rank-sum test statistic that is valid and powerful under general settings. To our knowledge, this is the first successful attempt of using conformal prediction for testing statistical hypotheses beyond exchangeability. Our method is suitable for modern machine learning scenarios where the data has high dimensionality and large sample sizes, and can be effectively combined with existing classification algorithms to find good conformity score functions. The performance of the proposed method is demonstrated in various numerical examples. for this article are available online. [ABSTRACT FROM AUTHOR]

In this article, we consider the problem of hypothesis testing in high-dimensional single-index models. First, we study the feasibility of applying the classical F-test to a single-index model when the dimension of covariate vector and sample size are of the same order, and derive its asymptotic null distribution and asymptotic local power function. For the ultrahigh-dimensional single-index model, we construct F-statistics based on lower-dimensional random projections of the data, and establish the asymptotic null distribution and the asymptotic local power function of the proposed test statistics for the hypothesis testing of global and partial parameters. The new proposed test possesses the advantages of having a simple structure as well as being easy to compute. We compare the proposed test with other high-dimensional tests and provide sufficient conditions under which the proposed tests are more efficient. We conduct simulation studies to evaluate the finite-sample performances of the proposed tests and demonstrate that it has higher power than some existing methods in the models we consider. The application of real high-dimensional gene expression data is also provided to illustrate the effectiveness of the method. for this article are available online. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand how the permutation test can be used to test null hypothesis • To appreciate how much easier it is to understand than significance tests based on t statistics • To illustrate how the permutation test requires fewer assumptions than t-tests. Background: Quantitative researchers can use permutation tests to conduct null hypothesis significance testing without resorting to complicated distribution theory. A permutation test can reach conclusions in hypothesis testing that are the same as those of better-known tests such as the t-test but is much easier to understand and implement. Aim: To introduce and explain permutation tests using two real examples of independent and dependent t-tests and their corresponding permutation tests. Discussion: This article traces the history of permutation tests, explains the possible reason for their absence in textbooks and offers a simple example of their implementation. It provides simple code written in the R programming language to generate the null distributions and P-values for the permutation tests. Conclusion: Permutation tests do not require the strict model assumptions of t-tests and can be robust alternatives. Implications for practice: Permutation tests are a useful addition to practitioners’ research repertoire for testing hypotheses. [ABSTRACT FROM AUTHOR]

• Distractions caused by fellow drivers (DFDs) have received little attention. • Associations between DFDs and other latent factors were evaluated using SEM. • DFDs are positively associated with stress among recipient drivers. • Stress is positively associated with anxiety-based performance deficits. • DFDs and stress are positively associated with crash propensity. Introduction: Aggressive behavior of drivers is a source of crashes and high injury severity. Aggressive drivers are part of the driving environment, however, excessive aggressive driving by fellow drivers may take the attention of the recipient drivers away from the road resulting in distracted driving. Such external distractions caused by the aggressive and discourteous behavior of other road users have received limited attention. These distractions caused by fellow drivers (DFDs) may agitate recipient drivers and ultimately increase crash propensity. Aggressive driving behaviors are quite common in South Asia and, thus, it is necessary to determine their contribution to distractions and crash propensity. Method: Our study aimed to evaluate the effects of DFDs using primary data collected through a survey conducted in Lahore, Pakistan. A total of 801 complete responses were obtained. Various hypotheses were defined to explore the associations between the latent factors such as DFDs, anxiety/stress (AS), anxiety-based performance deficits (APD), hostile behavior (HB), acceptability of vehicle-related distractions (AVRD), and crash propensity (CP). Structural Equation Modeling (SEM) was employed as a multivariate statistical technique to test these hypotheses. Results: The results supported the hypothesis that DFDs lead to AS among recipient drivers. DFDs and AS were further found to have positive associations with APDs. Whereas, there was a significant negative association between DFD, AS, and AVRD. As hypothesized, DFD and AS had positive associations with CP, indicating that distractions caused by aggressive behaviors leads to stress and consequently enhances crash propensity. Practical applications: The results of this study provide a statistically sound foundation for further exploration of the distractions caused by the aggressive behaviors of fellow drivers. Further, the results of this study can be utilized by the relevant authorities to alter aggressive driving behaviors and reduce DFDs. [ABSTRACT FROM AUTHOR]

The statistical significance of a clinical trial analysis result is determined by a mathematical calculation and probability based on null hypothesis significance testing. However, statistical significance does not always align with meaningful clinical effects; thus, assigning clinical relevance to statistical significance is unreasonable. A statistical result incorporating a clinically meaningful difference is a better approach to present statistical significance. Thus, the minimal clinically important difference (MCID), which requires integrating minimum clinically relevant changes from the early stages of research design, has been introduced. As a follow-up to the previous statistical round article on P values, confidence intervals, and effect sizes, in this article, we present hands-on examples of MCID and various effect sizes and discuss the terms statistical significance and clinical relevance, including cautions regarding their use. [ABSTRACT FROM AUTHOR]

This study aims to highlight the importance of a systematic approach to process capability assessment and the importance of following a sequence of steps. Statistical process control provides several different ways of assessing process capability. This study evaluates the process capability of crown cap manufacturing through capability indices. In addition to calculating the indices, the evaluation involves extensive data analysis. Before calculating the capability indices, the assumptions for their correct selection and use were also verified. Several statistical tests were used to verify each assumption. The research value of the study lies in pointing out that not all tests led to the same conclusions. It highlights the importance of selecting the appropriate test type for the evaluated process quality characteristics. [ABSTRACT FROM AUTHOR]

Simple Summary: The prognosis of PCa at diagnosis is assessed by classification systems that aim to group homogenous sets of patients. However, great heterogeneity exists within these risk groups, in terms of prognostic factors and treatment options. The aim of this study was to assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer patients treated with robot-assisted radical prostatectomy at a high-volume tertiary referral center. Objectives: To assess the prognostic impact and predictors of adverse tumor grade in very favorable low- and intermediate-risk prostate cancer (PCa) patients treated with robot-assisted radical prostatectomy (RARP). Methods: Data of low- and intermediate PCa risk-class patients were retrieved from a prospectively maintained institutional database. Adverse tumor grade was defined as pathology ISUP grade group > 2. Disease progression was defined as a biochemical recurrence event and/or local recurrence and/or distant metastases. Associations were assessed by Cox's proportional hazards and logistic regression model. Results: Between January 2013 and October 2020, the study evaluated a population of 289 patients, including 178 low-risk cases (61.1%) and 111 intermediate-risk subjects (38.4%); unfavorable tumor grade was detected in 82 cases (28.4%). PCa progression, which occurred in 29 patients (10%), was independently predicted by adverse tumor grade and biopsy ISUP grade group 2, with the former showing stronger associations (hazard ratio, HR = 4.478; 95% CI: 1.840–10.895; p = 0.001) than the latter (HR = 2.336; 95% CI: 1.057–5.164; p = 0.036). Older age and biopsy ISUP grade group 2 were independent clinical predictors of adverse tumor grade, associated with larger tumors that eventually presented non-organ-confined disease. Conclusions: In a very favorable PCa patient population, adverse tumor grade was an unfavorable prognostic factor for disease progression. Active surveillance in very favorable intermediate-risk patients is still a hazard, so molecular and genetic testing of biopsy specimens is needed. [ABSTRACT FROM AUTHOR]

Functional networks often guide our interpretation of spatial maps of brain–phenotype associations. However, methods for assessing enrichment of associations within networks of interest have varied in terms of both scientific rigor and underlying assumptions. While some approaches have relied on subjective interpretations, others have made unrealistic assumptions about spatial properties of imaging data, leading to inflated false positive rates. We seek to address this gap in existing methodology by borrowing insight from a method widely used in genetics research for testing enrichment of associations between a set of genes and a phenotype of interest. We propose network enrichment significance testing (NEST), a flexible framework for testing the specificity of brain–phenotype associations to functional networks or other sub‐regions of the brain. We apply NEST to study enrichment of associations with structural and functional brain imaging data from a large‐scale neurodevelopmental cohort study. [ABSTRACT FROM AUTHOR]

Introduction: Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. Materials and method: A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. Results: There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group (p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group (p < 0.003). Conclusion: All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well. [ABSTRACT FROM AUTHOR]

Tax evasion is considered a fundamental problem for countries and is common in some jobs. The aim of this research is designing the tax break model with an emphasis on manufacturing problems in clothing and clothing industry. The research method is mixed and applied. The statistical population is the qualitative sector of 10 university professors and managers in the garment manufacturing industry and 310 in the quantitative sector of the garment industry. The sampling method is simple. Qualitative data were analyzed using theme analysis and for quantitative phase structural equation method. 5 main and 15 sub-themes of the model were identified in the qualitative phase. The model had good fitness and the combined reliability was 0.781 which was acceptable. After testing the hypotheses, it was all confirmed and according to the results of the interpretive structural modeling, complex and multiple tax laws were placed at the fifth level, which indicates that it has the greatest impact on tax evasion of producers. Thus, the relevant authorities in manufacturing apparel and clothing industry are proposed to consider the most important tax evasion factors including increased inflation rate, and to provide strategies to reduce this factor. [ABSTRACT FROM AUTHOR]

As the diversity and volume of images continue to grow, the demand for efficient fine-grained image retrieval has surged across numerous fields. However, the current deep learning-based approaches to fine-grained image retrieval often concentrate solely on the top-layer features, neglecting the relevant information carried in the middle layer, even though these information contains more fine-grained identification content. Moreover, these methods typically employ a uniform weighting strategy during hash code mapping, risking the loss of critical region mapping—an irreversible detriment to fine-grained retrieval tasks. To address the above problems, we propose a novel method for fine-grained image retrieval that leverage feature fusion and hash mapping techniques. Our approach harnesses a multi-level feature cascade, emphasizing not just top-layer but also intermediate-layer image features, and integrates a feature fusion module at each level to enhance the extraction of discriminative information. In addition, we introduce an agent self-attention architecture, marking its first application in this context, which steers the model to prioritize on long-range features, further avoiding the loss of critical regions of the mapping. Finally, our proposed model significantly outperforms existing state-of-the-art, improving the retrieval accuracy by an average of 40% for the 12-bit dataset, 22% for the 24-bit dataset, 16% for the 32-bit dataset, and 11% for the 48-bit dataset across five publicly available fine-grained datasets. We also validate the generalization ability and performance stability of our proposed method by another five datasets and statistical significance tests. [ABSTRACT FROM AUTHOR]

Women's empowerment and health literacy are essential for fostering community well-being. Empowering women through education and diverse training plays a crucial role in ensuring their prosperity and overall health. This study investigates the satisfaction and experiences of underprivileged rural mothers participating in a functional literacy education program in the Kailali district, Nepal. We assess participants' perceptions of program effectiveness, examining training content, facilities, and trainers while exploring menstrual hygiene practices and maternal health awareness. Through convenience sampling, 141 underprivileged women from five rural villages near Tikapur were selected from literacy centers run by Mahima Group. Utilizing structured questionnaires and statistical analyses, including descriptive analyses, Spearman's rho correlation, and Pearson's chi-square test, we found that 65.2% of participants expressed high satisfaction levels. Moreover, 96.5% found the program highly effective, with 97.9% reporting improved literacy skills and 96.5% demonstrating increased awareness of menstrual hygiene practices. Additionally, 97.2% agreed that the program enhanced maternal and child health knowledge. Significant correlations were observed among the training course, facilities, trainers, and overall training perception. In line with this, significant associations were found between age groups (p = 0.003) and geographical areas (p = 0.023) with satisfaction levels with the literacy program. These results underscore the satisfaction of participants within the literacy program and its impact on their lives, and advocates for its broader implementation to empower marginalized communities for sustainable development. [ABSTRACT FROM AUTHOR]

(1) Background: The surgical procedure to create an arteriovenous fistula (AVF) can be performed in either an ambulatory or in-patient hospital setting, depending on the case's complexity, the anesthesia type used, and the patient's comorbidities. The main scope of this study is to assess the cost-effectiveness and clinical implications of surgically creating an AVF in both ambulatory and in-hospital settings. (2) Methods: We conducted a retrospective observational study, in which we initially enrolled all patients with end-stage kidney disease (ESKD) admitted to the Vascular Surgery Department, Emergency County Hospital of Targu Mures, Romania, to surgically create an AVF for dialysis, between January 2020 and December 2022. The primary endpoint of this study is to assess the cost-effectiveness of surgically creating an AVF in an ambulatory vs. in-hospital setting by comparing the costs required for the two types of admissions. Further, the 116 patients enrolled in this study were divided into two groups based on their preference for hospitalization: out-patients and in-patients. (3) Results: Regarding in-patient comorbidities, there was a higher prevalence of peripheral artery disease (PAD) (p = 0.006), malignancy (p = 0.020), and previous myocardial infarction (p = 0.012). In addition, active smoking (p = 0.006) and obesity (p = 0.018) were more frequent among these patients. Regarding the laboratory data, the in-patients had lower levels of white blood cells (WBC) (p = 0.004), neutrophils count (p = 0.025), lymphocytes (p = 0.034), and monocytes (p = 0.032), but there were no differences between the two groups regarding the systemic inflammatory biomarkers or the AVF type. Additionally, we did not register any difference regarding the outcomes: local complications (p = 0.588), maturation failure (p = 0.267), and primary patency (p = 0.834). In our subsequent analysis, we discovered no significant difference between the hospitalization type chosen by patients regarding AVF primary patency failure (p = 0.195). We found no significant association between the hospitalization type and the recorded outcomes (all ps > 0.05) in both multivariate linear regression and Cox proportional hazard analysis. (4) Conclusions: In conclusion, there are no significant differences in the clinical implications, short-term and long-term complications of AVF for out-patient and in-patient admissions. Additionally, we found no variation in the costs associated with laboratory tests and surgical supplies for an AVF creation. Therefore, it is safe to perform ambulatory AVFs, which can reduce the risk of hospital-acquired infections and provide greater comfort to the patient. [ABSTRACT FROM AUTHOR]

Background: Healthcare professionals appear to play a key role in shaping pregnant women's views and attitudes towards lifestyle issues, such as exercise. The aim of this study is to investigate the views and beliefs of Greek midwives and obstetricians regarding exercise during pregnancy. Methods: This is a cross-sectional study conducted during the period of January 2022–March 2023. For this study, 237 Greek midwives and obstetricians employed in healthcare settings in Attica, Greece completed an anonymous and self-report questionnaire. Four different/independent models of multivariate analyses of variance were conducted. Results: The vast majority of these healthcare professionals (88.6%) believed that exercise during pregnancy is generally beneficial. According to the multivariate analyses, healthcare professionals with postgraduate/doctoral studies were more likely to believe that (a) exercise is generally beneficial (p = 0.03), (b) pregnant women should be informed about it (p = 0.028), (c) informing pregnant women is necessary/useful (p = 0.023), and (d) pregnant women showed interest in it (p = 0.034). Also, freelance midwives were more likely to believe that pregnant women should be informed about exercise (p = 0.006), and that they showed interest in it (p = 0.034). In addition, (a) freelance midwives (p = 0.050), and those who had experience in antenatal counselling (p = 0.037), as well as (b) obstetricians who were largely experienced in monitoring normal pregnancies (p = 0.001), were less likely to associate exercise during pregnancy with the occurrence of placental abruption. Conclusion: Alongside healthcare professionals' educational level, their professional setting and professional experience emerge as key factors and need to be considered when designing innovative interventions to support exercise during pregnancy. [ABSTRACT FROM AUTHOR]

Background: In the wake of the coronavirus disease 19 (COVID-19) pandemic, affecting healthcare systems globally, urgent research is needed to understand its potential repercussions on the diagnosis and management of cardiovascular disorders. This emphasises the importance of detecting coronary artery anomalies (CAAs), rare conditions that can range from benign to potentially life-threatening manifestations. We aimed to retrospectively assess the impact of the COVID-19 pandemic on the detection of various coronary anomalies using Coronary Computed Tomography Angiography (CCTA) within a regional tertiary cardiology unit in north-eastern Romania, focusing on perceived occurrence in the population under study, types, and related demographic and clinical factors. Methods: We analysed CCTA scans and investigated the trends in CAA detection among cardiology patients over a decade. We compared pre-COVID-19 and pandemic-era data to assess the impact of healthcare utilisation, patient behaviour, and diagnostic approaches on anomaly detection. Results: Our analysis revealed a higher detection rate of CAAs during the pandemic (3.9% versus 2.2%), possibly highlighting differences in patient clinical profile and addressability changes presentation compared to the previous period. Origination and course anomalies, often linked to severe symptoms, were significantly higher pre-COVID-19 (64.1% versus 51.3%). Conversely, intrinsic CAAs, typically asymptomatic or manifesting later in life, notably increased during the pandemic (49.0% versus 61.4%; p = 0.020). Conclusions: Our study underscores a significant rise in CAA detection during the COVID-19 era, potentially linked to changes in cardiovascular and respiratory clinical patterns, with advanced imaging modalities like CCTA offering accuracy in identification. [ABSTRACT FROM AUTHOR]

Psychiatric nurses are challenged with high levels of stress, which, in turn, lower their professional quality of life (ProQoL) and job satisfaction and increase their intention to leave jobs in psychiatric settings. An adequate level of ProQoL improves patient care provision. The purpose of this study is to assess the levels, relationships, and predictors of the professional quality of life of Jordanian psychiatric nurses and their job satisfaction and intention to leave their job. A descriptive cross-sectional design was used to collect data using the Professional Quality of Life Scale-5 from a convenience sample. Data were collected from 144 psychiatric nurses working in the largest psychiatric hospitals run by Ministry of Health, military, and university-affiliated hospitals. The results showed that the mean scores for compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) were 35.21, 27.0, and 26.36, respectively. The mean scores for intention to leave and job satisfaction were 2.33 and 3.7, respectively. The income level, educational level, intention to leave, and job satisfaction significantly differed in the CS dimension. Nurses' age, intention to leave, and job satisfaction significantly differed in BO. Nurses' age, years of experience, frequent C-shifts worked, and work affiliation were different in STS. Burnout, STS, and educational level predicted CS. CS, STS, job satisfaction, and level of education predicted BO. BO, CS, and frequently working night C-shifts predicted STS. Due to the presence of nurses reporting low levels of ProQoL, job satisfaction, and intension to leave, more studies are needed to assess the factors that affect ProQoL among psychiatric nurses and to evaluate interventional programs that improve the quality of life of psychiatric nurses. This is important in retaining nurses and increasing their job satisfaction. There is a need for interventions that enhance ProQoL. Also, longitudinal studies that measure ProQoL overtime are recommended. This study was not registered. [ABSTRACT FROM AUTHOR]

We propose Fieller-type methods for inference on generalized entropy inequality indices in the context of the two-sample problem which covers testing the statistical significance of the difference in indices, and the construction of a confidence set for this difference. In addition to irregularities arising from thick distributional tails, standard inference procedures are prone to identification problems because of the ratio transformation that defines the considered indices. Simulation results show that our proposed method outperforms existing counterparts including simulation-based permutation methods and results are robust to different assumptions about the shape of the null distributions. Improvements are most notable for indices that put more weight on the right tail of the distribution and for sample sizes that match macroeconomic type inequality analysis. While irregularities arising from the right tail have long been documented, we find that left tail irregularities are equally important in explaining the failure of standard inference methods. We apply our proposed method to analyze income per-capita inequality across U.S. states and non-OECD countries. Empirical results illustrate how Fieller-based confidence sets can: (i) differ consequentially from available ones leading to conflicts in test decisions, and (ii) reveal prohibitive estimation uncertainty in the form of unbounded outcomes which serve as proper warning against flawed interpretations of statistical tests. [ABSTRACT FROM AUTHOR]

Background: Pediatric colorectal specialists care for patients with a variety of defecation disorders. Anorectal (AR) manometry testing is a valuable tool in the diagnosis and management of these children. This paper provides a summary of AR manometry techniques and applications as well as a review of AR manometry findings in pediatric patients with severe defecation disorders referred to a pediatric colorectal center. This is the first study describing multi-year experience using a portable AR manometry device in pediatric patients. Methods: An electronic medical record review was performed (1/2018 to 12/2023) of pediatric patients with defecation disorders who had AR manometry testing. Demographics, diagnostic findings, and outcomes are described. Key Results: A total of 297 unique patients (56.9% male, n = 169) had AR manometry testing. Of these, 72% (n = 188) had dyssynergic defecation patterns, of which 67.6% (n = 127) had fecal soiling prior to treatment. Pelvic rehabilitation (PR) was administered to 35.4% (n = 105) of all patients. A total of 79.5% (n = 58) of the 73 patients that had fecal soiling at initial presentation and completed PR with physical therapy and a bowel management program were continent after therapy. AR manometry was well tolerated, with no major complications. Conclusions: AR manometry is a simple test that can help guide the management of pediatric colorectal surgical patients with defecation disorders. As a secondary finding, PR is a useful treatment for patients with dyssynergic stooling. [ABSTRACT FROM AUTHOR]

Background: Scholarly literature indicates a slow pace at which maritime ports fully embrace digital transformation (DT). The reasons to this are largely anecdotal and lack solid empirical grounding. This inhibits an overall understanding of DT's tenets and the development of evidence-based policies and targeted actions. Methods: This study deployed a qualitative case study strategy to unpack the challenges of undertaking DT through the lens of principal-agent theory (PAT). Results: Analysis of data collected through 13 semi-structured interviews from a port's value chain stakeholders revealed five thematic challenges that contradict successful implementation of DT. These included interagency constraints and system ownership tussles; system sabotage and prevalent corruption; prevalent human agency in port operations; cultural constraints; and political influence on port governance. Conclusions: To address these challenges, the study proposes a four-stage empirically grounded DT strategy framework that guides both practitioners and policymakers through DT endeavors. The framework includes: (1) the port's value chain mapping, (2) stakeholder engagement, (3) resource mobilization, and (4) effective monitoring. For scholars, we provide an avenue for testing statistical significance of association and causality among the identified challenges. [ABSTRACT FROM AUTHOR]

The game of soccer is complex and unpredictable, demanding multifaceted strategies for success. Performance analysis has evolved, focusing on key performance indicators (KPIs) to determine the factors that most significantly influence a team's success or failure during matches. Traditional performance analysis methods have emphasized quantifiable data like physical exertion and basic play events but often neglected the subtler tactical dimensions that could significantly impact game outcomes. This study aimed to fill the gap in the current literature by creating a comprehensive framework that incorporates tactical situations as KPIs. The objective was to examine whether specific playing styles adopted by teams in various tactical situations and phases of the game could predict the outcome of matches. A dataset comprising all First Division Championship matches from 11 different European countries for the 2021–2022 season was analyzed. Variables representing tactical situations were correlated with match outcomes using a Generalized Estimating Equation framework. The model was specified with a binomial distribution and a logit link function. Statistical significance was determined using Wald χ2 tests with a significance level set at p < 0.05. The study's findings revealed that possession style, counterattacking during offensive transitions, and a balanced aggressive defensive strategy significantly increase a team's chances of victory. It also showed that successful teams tend to focus on central attacks, minimize crossing, and execute strategic plays that lead to final attempts on goal with minimal ball possession. The above findings demonstrate that adopting certain tactical approaches significantly influences soccer match outcomes, highlighting the importance of considering tactical aspects as KPIs. [ABSTRACT FROM AUTHOR]

Although the measurements of the lumbar spine and pelvic flexion have shown that subjects with radiculopathy exhibited greater decreases of motion when compared with subjects with low back pain, there is still a lack of evidence regarding the changes in flexion relaxation ratio in patients with radiculopathy. The aims of this study were to investigate the flexion relaxation ratio and flexion of the lumbar spine and pelvis in subjects with low back pain (LBP) and LBP with radiculopathy (LBPR) in comparison with healthy subjects (CG—control group). A total of 146 participants were divided in three groups: LBP patients (54 males; 21 females); LBPR patients (26 males; 11 females); and CG subjects (16 males; 18 females). The lumbar spine and pelvis flexion was recorded using optoelectronic motion capture system. The electrical activity of the erector spinae muscles was assessed by surface electromyography during flexion-extension movements. Comparisons between groups were made using one-way ANOVA tests and Mann–Whithney U test with the level of statistical significance at 0.05. The lumbar and pelvic flexion and electromyography of the erector spinae muscle showed significant differences between LBP and LBPR patients compared to CG. Patients LBPR showed significantly smaller angles of lumbar and pelvic flexion compared to LBP patients and CG. An increase in the erector spinae muscle activity during flexion was also observed in patients with radiculopathy. The increased muscular activity of the erector spinae is related to the reduced flexion of the lumbar spine in order to protect the lumbar spine structure. Measurements of trunk, lumbar spine and pelvic flexion, and the flexion relaxation ratio may allow us to predict better outcomes or responsiveness to treatment of LBPR patients in the future. [ABSTRACT FROM AUTHOR]