Search

Background: The stress‐sensitive maternal hypothalamic–pituitary–adrenal (HPA) axis through the end‐product cortisol, represents a primary pathway through which maternal experience shapes fetal development with long‐term consequences for child neurodevelopment. However, there is another HPA axis end‐product that has been widely ignored in the study of human pregnancy. The synthesis and release of dehydroepiandosterone (DHEA) is similar to cortisol, so it is a plausible, but neglected, biological signal that may influence fetal neurodevelopment. DHEA also may interact with cortisol to determine developmental outcomes. Surprisingly, there is virtually nothing known about human fetal exposure to prenatal maternal DHEA and offspring neurodevelopment. The current study examined, for the first time, the joint impact of fetal exposure to prenatal maternal DHEA and cortisol on infant emotional reactivity. Methods: Participants were 124 mother–infant dyads. DHEA and cortisol were measured from maternal hair at 15 weeks (early gestation) and 35 weeks (late gestation). Observational assessments of positive and negative emotional reactivity were obtained in the laboratory when the infants were 6 months old. Pearson correlations were used to examine the associations between prenatal maternal cortisol, prenatal maternal DHEA, and infant positive and negative emotional reactivity. Moderation analyses were conducted to investigate whether DHEA might modify the association between cortisol and emotional reactivity. Results: Higher levels of both early and late gestation maternal DHEA were linked to greater infant positive emotional reactivity. Elevated late gestation maternal cortisol was associated with greater negative emotional reactivity. Finally, the association between fetal cortisol exposure and infant emotional reactivity was only observed when DHEA was low. Conclusions: These new observations indicate that DHEA is a potential maternal biological signal involved in prenatal programming. It appears to act both independently and jointly with cortisol to determine a child's emotional reactivity. Its role as a primary end‐product of the HPA axis, coupled with the newly documented associations with prenatal development shown here, strongly calls for the inclusion of DHEA in future investigations of fetal programming. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis, based on subjective disease state assessment by the treating pediatric rheumatologist. Methods: The cutoff definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, six methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, the Youden index, 90% specificity, maximum agreement, and receiver operating characteristic curve analysis. Sixty percent of the patients were assigned to the definition cohort, and 40% were assigned to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. Results: The sJADAS10 cutoffs that separated ID from MDA, MDA from MoDA, and MoDA from HDA were ≤2.9, ≤10, and >20.6, respectively. The cutoffs discriminated strongly among different levels of pain, between patients with and without morning stiffness, and among patients whose parents judged their disease status as remission or persistent activity or flare or were satisfied or not satisfied with current illness outcome. Conclusion: The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts and are therefore suitable for use in clinical trials and routine practice. [ABSTRACT FROM AUTHOR]

Objective: Relapses of antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis are important events that can cause organ dysfunction and reduce quality of life. Understanding the effects of the initial treatments for ANCA‐associated vasculitis on the subsequent risk of relapse may help guide monitoring and treatment. Methods: We performed a post hoc analysis of participants with severe ANCA‐associated vasculitis enrolled in an international two‐by‐two factorial randomized controlled trial comparing the effects of plasma exchange (PLEX) to no PLEX and a regimen of reduced glucocorticoid exposure to a standard regimen. We estimated the effects of treatments on relapses of any severity using three competing risk time‐to‐event models adjusted for patient and disease characteristics and other treatments. Each model was adjusted for disease manifestations in different ways. Results: Of 704 participants, 649 (92.2%) achieved remission and 147 (22.7%) experienced 204 relapses. The relapse rate was 10.3 (95% confidence interval [CI] 8.4–12.1) relapses per 100 patient‐years. Neither the use of PLEX (subhazard ratio 0.91–0.94; 95% CIs range from 0.66 to 1.31) nor a glucocorticoid regimen (subhazard ratio 0.93–0.94; 95% CIs range from 0.67 to 1.35) appreciably changed the risk of relapse. Proteinase 3–ANCA and the presence of nonhemorrhagic respiratory manifestations of the disease at trial entry were associated with increased risks of relapse. Receiving dialysis at baseline and administration of oral cyclophosphamide as induction therapy were associated with lower risks of relapse. Conclusion: In patients with severe ANCA‐associated vasculitis, relapses remain common; neither the use of PLEX nor an initial glucocorticoid tapering regimen impacted relapse risk. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QOL) among older adults is a crucial aspect of geriatric care, particularly in the context of global demographic shifts toward ageing societies. Understanding the determinants of QOL in older adults is essential for developing effective interventions to promote well‐being in this population. Methods: This cross‐sectional study conducted in Greece aimed to investigate the complex relationship between depression, frailty, nutritional status, and QOL on 90 older adults (aged ≤65). Assessment instruments including the World Health Organization Quality of Life (WHOQoL)‐BREF questionnaire, Geriatric Depression Scale (GDS), Clinical Frailty Scale (CFS), and Mini Nutritional Assessment (MNA) were utilised to evaluate various dimensions of QOL, depressive symptoms, frailty, and nutritional status. Results: The study revealed significant negative correlations between depression and frailty with all domains of QOL (P < 0.05), indicating that higher levels of depressive symptoms and frailty were associated with lower QOL across physical, psychological, social, and environmental dimensions. Conversely, positive correlations were found between nutritional status and all QOL domains (P < 0.05), suggesting that better nutritional status was linked to higher QOL. Multivariate logistic regression analysis further demonstrated associations between nutritional status and participant characteristics, with females being more likely to be malnourished (odds ratio (OR) = 6.56, P = 0.013), while better health status (OR = 0.34, P = 0.486) and marital status (OR = 0.02, P = 0.019) were protective against malnutrition. Conclusion: These findings underscore the interconnectedness of depression, frailty, and nutritional status in shaping QOL among individuals. Holistic interventions targeting mental health, physical vulnerability, and nutritional well‐being are essential for promoting overall well‐being and functional outcomes in this population. [ABSTRACT FROM AUTHOR]

Summary: Objective: This study identified metabolite modules associated with adiposity and body fat distribution in childhood using gold‐standard measurements. Methods: We used cross‐sectional data from 329 children at mid‐childhood (age 5.3 ± 0.3 years; BMI 15.7 ± 1.5 kg/m2) from the Genetics of Glucose regulation in Gestation and Growth (Gen3G), a prospective pre‐birth cohort. We quantified 1038 plasma metabolites and measured body composition using the gold‐standard dual‐energy x‐ray absorptiometry (DXA), in addition to skinfold, waist circumference, and BMI. We applied weighted‐correlation network analysis to identify a network of highly correlated metabolite modules. Spearman's partial correlations were applied to determine the associations of adiposity with metabolite modules and individual metabolites with false discovery rate (FDR) correction. Results: We identified a 'green' module of 120 metabolites, primarily comprised of lipids (mostly sphingomyelins and phosphatidylcholine), that showed positive correlations (all FDR p < 0.05) with DXA estimates of total and truncal fat (ρadjusted = 0.11–0.19), skinfold measures (ρadjusted = 0.09–0.26), and BMI and waist circumference (ρadjusted = 0.15 and 0.18, respectively). These correlations were similar when stratified by sex. Within this module, sphingomyelin (d18:2/14:0, d18:1/14:1)*, a sphingomyelin sub‐specie that is an important component of cell membranes, showed the strongest associations. Conclusions: A module of metabolites was associated with adiposity measures in childhood. [ABSTRACT FROM AUTHOR]

Objective: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at‐home bleaching applied on the buccal surface only or the buccal and lingual surfaces. Materials and Methods: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at‐home bleaching on the buccal‐only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0–10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t‐test, McNemar's, and Wilcoxon signed‐rank test were used for data analysis (α = 5%). Results: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). Conclusion: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. Clinical Significance: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal‐only technique is sufficient to achieve the desired efficacy. [ABSTRACT FROM AUTHOR]

In our mobile working world, boundaries between work and non‐work domains are more and more blurred, which can impair professionals' recovery and well‐being. Consequently, managing work–non‐work boundaries represents an important challenge for professionals. Research suggests that boundary work tactics conveyed in boundary management interventions may promote recovery and well‐being. However, the efficacy of boundary work tactics is largely unknown, as well as theoretical mechanisms that may explain the effectiveness of boundary management interventions in regard of both training design and training transfer. Building on the social cognitive theory of self‐regulation, we develop a web‐based boundary management training. Based on the integrated training transfer and effectiveness model, we evaluate its effects on the three levels of training effectiveness: (1) perceived learning, (2) cognitions and behaviours, with boundary control and boundary creation as indicators, and (3) recovery and well‐being. Results of our randomized controlled intervention study show several expected changes in boundary creation, suggesting that drawing on the social cognitive theory of self‐regulation for training design can result in effective behaviour change. Intervention effects on recovery and well‐being are more ambiguous, hinting at the power but likewise potential limitations of boundary creation. [ABSTRACT FROM AUTHOR]

We examined how potential job candidates react to a hiring organization that requests diversity, equity and inclusion (DEI) statements, which conservatives in the United States and elsewhere have criticized as being unrelated to job function and inappropriately political or ideological. Across three studies (two of which were pre‐registered), we compared reactions to requests for DEI (vs. teamwork or conservative values) statements as a function of race (Black vs. White), political conservatism and symbolic racism (Total N = 1108). When a DEI (vs. teamwork or politically conservative values) statement was requested, participants who were more (vs. less) conservative perceived the organization as less just, expressed less interest in the job, and expected poorer person‐organization fit, even when a job‐related rationale was provided. Further, participants who were more (vs. less) conservative evaluated a request for a statement consistent with conservative values more favourably. Thus, criticisms that DEI statements are overly political are not applied to other statements that might elicit similar concerns. Moreover, an internal meta‐analysis suggested that the relationships of conservatism to justice and interest (but not person‐organization fit) in response to requests for DEI (vs. teamwork) statements were not independent of racism. Findings were consistent with social dominance theory; racism may underlie seemingly race‐neutral backlash to DEI statements. [ABSTRACT FROM AUTHOR]

Background: Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post‐traumatic stress disorder (PTSD). Aim: To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800‐bed secondary medical centre. Study Design: This retrospective study included 647 patients admitted to a general ICU in an 800‐bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28‐day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti‐psychotics. Results: Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti‐psychotics. Patients who were restrained had longer duration of ventilation (5.9 ± 8.2 vs. 0.36 ± 1.4 days; p <.001) and higher 28‐day mortality (0.26 ± 0.45 vs. 0.07 ± 0.25, Z = 6.86, p <.001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; p =.019), as well as the use of anti‐psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; p =.034) and anti‐depressants (55 [21.2%] vs. 59 [14.8%], respectively; p =.042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; p <.001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; p <.001); higher frequency of in‐hospital anti‐psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; p <.001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7 ± 4.0 vs. 0.04 ± 0.27, respectively; p <.001] and maximum RASS score [0.19 ± 1.6 vs. 0.01 ± 0.54, respectively; p <.001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28‐day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk. Conclusions: Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in‐hospital anti‐psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU. Relevance to Clinical Practice: Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU. Clinical trial registration: NCT04771793. [ABSTRACT FROM AUTHOR]

Background: Preoperative nursing care affects many factors such as reducing the length of hospital stay of the patients in the perioperative period, the rate of postoperative complications, the duration of the operation, decrease of postoperative pain level and early mobilization. Aim: We aimed to determine the effect of preoperative evidence‐based care education that given to cardiac surgery clinical nurses on the postoperative recovery of patients. Study Design: The research was planned as quasi‐experimental. Eighty‐six patients who underwent cardiovascular surgery were divided into control and intervention groups. First, the ongoing preoperative care practices and patient recovery outcomes of the clinic were recorded for the control group data. Second, education was provided for the clinical nurses about the preoperative evidence‐based care list, and a pilot application was implemented. Finally, the evidence‐based care list was applied by the nurses to the intervention group, and its effects on patient outcomes were evaluated. The data were collected using the preoperative evidence‐based care list, descriptive information form, intraoperative information form and postoperative patient evaluation form. Results: The evidence‐based care list was applied to the patients in the intervention group, with 100% adherence by the nurses. All pain level measurements in the intervention group were significantly lower in all measurements (p =.00). The body temperature measurements (two measurements) of the intervention group were higher (p =.00). The postoperative hospital stays of the control group and the intervention group were 11.21 ± 8.41 and 9.50 ± 3.61 days. Conclusion: The presented preoperative evidence‐based care list can be used safely in nursing practices for patients. It provides effective normothermia, reduces the level of pain, shortens the hospital stay and reduces the number of postoperative complications. Relevance to Clinical Practice: By applying a preoperative evidence‐based care to patients undergoing cardiac surgery, pain levels, hospital stays and the number of complications decrease, and it is possible to maintain normothermia. An evidence‐based care can be used to ensure rapid postoperative recovery for patients undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Pneumonia has a high incidence in traumatic brain injury (TBI) patients and lacks effective treatments. Early mobilization (EM) may be a potentially effective treatment. Aim: To explore the impact of EM on TBI‐related pneumonia in the neurosurgical intensive care unit (NICU). Study Design: This study was a historical control study. 100 TBI patients who received EM intervention were prospectively included as the experimental group (EM cohort), and 250 TBI patients were retrospectively included as the control group. The propensity score matching (PSM) method was employed to balance baseline and minimize potential bias. The relationship between EM and TBI‐related pneumonia was investigated by univariate and multivariate logistic regression, then further determined by subgroup analysis. The influence of other variables was excluded by interaction analyses. Finally, the effect of EM on the prognosis of TBI patients was analysed by comparing the Glasgow Coma Scale (GCS) and the hospital stay. Results: After screening, 86 patients were included in the EM cohort and 199 patients were included in the control cohort. There were obvious differences between the two cohorts at baseline, and these differences were eliminated after PSM, when the incidence of pneumonia was significantly lower in the EM cohort than in the control cohort (35.0% vs. 61.9%, p <.001). Multivariate logistic regression showed that EM was an independent risk factor for TBI‐related pneumonia and was significantly associated with a decreased incidence of pneumonia. This correlation was present in most subgroups and was not affected by other variables (p for interaction >.05). Patients in the EM cohort had shorter length of ICU stay (6 vs. 7 days, p =.017) and higher GCS at discharge (12 vs. 11, p =.010). Conclusion: EM is a safe and effective treatment for TBI patients in NICU, which can reduce the incidence of pneumonia, help to improve prognosis and shorten the length of ICU stay. Relevance to Clinical Practice: Although the utilization rate of EM is low in TBI patients for various reasons, EM is still an effective method to prevent complications. Our study confirms that a scientific and detailed EM strategy can effectively reduce the incidence of pneumonia while ensuring the safety of TBI patients, which is worthy of further research and clinical application. [ABSTRACT FROM AUTHOR]

Background: Delirium commonly occurs in paediatric patients with acute critical illness and negatively affects clinical outcomes. Variations in delirium knowledge levels and its management have been noted among nurses. Aims: This study investigated nurses' experiences and knowledge levels regarding paediatric delirium. Additionally, we aimed to assess the gap between knowledge levels and practical experiences with paediatric delirium. Study Design: This cross‐sectional descriptive study conveniently sampled paediatric nurses from a university hospital in South Korea between September 2022 and March 2023. Nursing experiences with paediatric delirium and delirium knowledge levels were measured using structured survey questionnaires. Delirium knowledge was scored 0 to 47, and higher scores indicated higher levels of delirium‐related knowledge. Data were analysed using descriptive statistics and presented as mean, standard deviation, frequency and percentage. Results: A total of 127 paediatric nurses participated in this study; 40.2% had experience with 1–5 delirium cases in the previous year, and 86.6% (n = 110) had never used assessment tools for paediatric delirium assessment. The mean total delirium knowledge score was 34.45 ± 5.4; the mean scores of knowledge regarding aetiology, signs and symptoms and nursing management of delirium were 8.93 ± 1.31, 13.24 ± 2.81 and 12.3 ± 2.7, respectively. Interventions associated with a lower level of delirium‐related knowledge and a lower performance rate included avoiding restraint use and maintaining hydration and electrolyte levels. Interventions associated with a higher level of delirium‐related knowledge but a lower rate of performance comprised providing orientation, offering emotional support, allowing participants to stay with family members and administering medications to manage delirium. Conclusions: Although nurses working in paediatric units exhibited high rate of delirium nursing care, there was the gap between their delirium‐related knowledge and practice. Nurses need to be aware of the insufficient part of delirium care, and paediatric delirium education should be reinforced. Relevance to Clinical Practice: Preventing, assessing and systematically managing paediatric delirium is crucial, and considering the study results, delirium education among nurses is needed. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is applied in pediatric intensive care units to carry out certain painful procedures and to ensure the maintenance and continuity of life support devices. There is a need to analyse the factors that influence the behaviour or intention to use physical restraint. Aim: To create and test psychometrically a paediatric version of the Physical Restraint‐Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. Study Design: A psychometric study. Five medical‐surgical Paeditric Intensive care Units from five hospitals in Spain. The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. Results: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. Conclusions: The Paediatric Physical Restraint‐Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. Relevance for Clinical Practice: Having this instrument will help health centres move towards restraint‐free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs. [ABSTRACT FROM AUTHOR]

Background: Electrocardiographic (ECG) monitoring and recording are seen as the most commonly used non‐invasive diagnostic tool to identify cardiac arrhythmia and myocardial damage in the clinical setting. There is an expectation that critical care nurses are ideally trained to interpret abnormalities and morphology in the ECG more proficiently than nurses from general ward areas. However, the ability to interpret and recognise ECG abnormalities is dependent on which critical care area nurses are currently working in and their level of experience. Aim: The aim of this study was to investigate registered nurses' knowledge in being able to identify and interpret select electrocardiographic rhythms. Study Design: This was a cross‐sectional study that evaluated registered nurses' knowledge of electrocardiogram rhythm identification and interpretation. A convenience sample of 105 registered nurses currently enrolled in a 2‐year Master's programme leading to critical care specialism and advanced practice nurse award were recruited. A 20‐item multiple choice questionnaire that provided examples of electrocardiogram rhythm (n=14) abnormalities and rhythm abnormalities caused by electrolyte disturbances (n=6) Results: The study included registered nurses from critical care and general ward areas. The overall results were poor with only 55% of questions answered correctly. Coronary care nurses scored the highest in identifying ECG rhythms (12/20 ± 1.58; p <.001). When ECG abnormalities associated with electrolyte imbalances were analysed, both groups were unable to identify the effects of hypokalaemia and hypomagnesaemia effectively (p =.748). Length of time as a registered nurse (r = −0.304, p =.002) and length of time in current work environment were weakly correlated (r = −0.328, p =.001). Having a critical care background showed a positive relationship with nursing knowledge of ECG rhythm identification (r = 0.614, p <.001). Conclusion: The results of this study demonstrate that nurses have a poor knowledge of ECG rhythm identification and interpretation, a consistent finding from other work. A possible solution is a revamp of education and training associated with ECG recognition and morphology. Relevance to Clinical Practice: Monitoring and assessing ECG morphology provide important details about cardio‐electroconductive stability, especially with fluctuations in serum electrolyte levels seen in critical illness or trauma. For this, critical nurses must improve their proficiency through education/training or internal quality improvement activities in detecting abnormalities associated with ECG changes beyond those most easily recognizable rhythms such as atrial fibrillation or ventricular tachycardia. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is frequently used in intensive care units to prevent patients' life‐threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool. Aims: Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use. Study Design: A large observational, multicentre study with a repeated one‐day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect. Results: During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%–31.4%) and 25% (95% CI: 21.5%–29.1%) respectively (χ2 = 1.35; p =.24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p =.14). The patient‐to‐nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p <.001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5–10.2]). Conclusion: The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial. Relevance to Clinical Practice: The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint. [ABSTRACT FROM AUTHOR]

Background: The pulse oximeter is a simple, cost‐effective and reliable device for estimating arterial blood oxygen saturation. Nurses are required to be knowledgeable in pulse oximeter use. Little is known about nurses' knowledge of pulse oximetry in the Middle East region. Aim: To assess nurses' knowledge of pulse oximetry among emergency and critical care nurses and to explore predictors of nurses' knowledge of pulse oximetry. Study Design: This is the second part of data analysis that was first presented in the 'proficiency in ECG' study conducted in Jordan. The original data used for both parts of analysis included a questionnaire with two tests; a knowledge of pulse oximeter test and an ECG proficiency test. Participants were asked to take, alone without receiving assistance, both tests. In this study, the second part of analysis, the focus is on the pulse oximeter test. The test consisted of 21 items that emphasize knowledge of basic physiological principles as well as device limitations; whether technical or interpretation. The test administration procedure also included asking participants to provide socio‐demographic variables. In the original data collected in both parts of analysis, nurses working in the emergency department, cardiac care units or intensive care units from nine different hospitals (1 governmental, 6 private and 2 educational) and holding a bachelor degree or higher were asked to participate. Results: The total number of participating nurses was 210; out of 247 approached (response rate, 85%). The mean score in the nurses' knowledge of pulse oximetry test was 12.33 out of 21, corresponding to 58.7%. The clinical area currently working in predicted the knowledge of pulse oximetry test score after controlling for all other variables. Emergency department and intensive care unit nurses scored higher than cardiac care unit nurses by 1.86 and 1.63 points respectively (58.2% and 60% respectively). Conclusion: Nurses consistently report inadequate education and training concerning pulse oximeter use and interpretation. A revision to hospital in‐service education seminars and undergraduate nurses' curriculum to assure adequate preparation is needed. Relevance to Clinical Practice: Knowledge of pulse oximetry among emergency and critical care nurses is modest. This is a challenge worldwide. Predictors of nurses' knowledge of pulse oximetery are the clinical area currently working in (ICU and ED nurses are more knowledgeable than CCU nurses), proficiency in electrocardiography and taking an advanced cardiac life support course. [ABSTRACT FROM AUTHOR]

The prevalence of mental health issues among UK undergraduate students is growing, and poor diet quality appears to be a risk factor for poor mental health although with limited research in this area. Therefore, the objective of this study was to examine the cross‐sectional associations between diet quality and common mental disorders (CMD) such as depression and anxiety in UK undergraduate students. A cross‐sectional survey consisting of demographic information and validated questionnaires (the Short‐Form Food Frequency Questionnaire [SFFFQ] and the Hospital Anxiety and Depression Scale [HADS]) was conducted to measure diet quality and anxiety and depression in young adults in 44 UK‐based universities. Multiple regression analysis adjusting for confounding factors was used to assess the associations between them. Undergraduate university students (n = 202, 67% female) with a mean age of 20.9 ± 3.6 years and a mean body mass index (n = 170) of 22.6 ± 3.2 kg/m2 took part in the study. Prevalence of anxiety was high, with 40% of the sample having an anxiety score in the severe range (≥12 points) while the prevalence of depression was lower, with 6% of the population having a depression score in the severe range (≥12 points). Diet quality was significantly higher for females than males (p = 0.034) and was poor for 38% of the sample, being more common in males compared to females, although not significantly so (43% and 36%, respectively). Diet quality was inversely associated with anxiety (β = −0.427; p = 0.029) and was more likely to be associated with anxiety in females than males (β = 0.743; p = 0.043). No significant relationship between diet quality and depression was found. Better self‐reported health, father's qualification and smoking status were also associated with less anxiety and depression. This research supports other research suggesting that UK universities should explore whether the implementation of dietary interventions and improving the food environment would be a cost‐effective option to reduce the high prevalence of anxiety among students. [ABSTRACT FROM AUTHOR]

While there are data regarding the glycaemic index (GI) and glycaemic load (GL) of many foods in the literature, the values for packaged vegan analogue foods have not been previously published, although processed vegan foods usually contain more carbohydrates than their animal‐based counterparts. This study was carried out to determine the GI and GL values of a selection of packaged vegan foods popular in Türkiye. To determine the GI and GL of test foods, 12 healthy volunteer females participated in the study. Participants randomly consumed test and reference foods (glucose and white bread) on each trial day, and capillary blood glucose was measured at baseline, 15, 30, 45, 60, 90 and 120 mins in duplicate. The GIs of vegan schnitzel, vegan chickpea burger, vegan mince pita, vegan chocolate, vegan snack bar and vegan cheese were 26.1 ± 19.61 (low), 27.1 ± 17.21 (low), 65.1 ± 28.60 (moderate), 42.7 ± 22.32 (low), 63.6 ± 45.86 (moderate), 36.4 ± 16.85 (low), respectively, according to the glucose reference, and were 28.2 ± 16.17 (low), 34.7 ± 18.26 (low), 81.2 ± 31.96 (high), 48.8 ± 12.87 (low), 82.0 ± 54.05 (high), 46.7 ± 28.66 (low), respectively, according to the white bread reference. GLs were 3.5 ± 2.66 (low), 8.6 ± 5.46 (low), 26.6 ± 11.67 (high), 6.1 ± 3.19 (low), 14.2 ± 10.28 (moderate), 5.7 ± 2.63 (low), respectively, according to the glucose reference, and were 3.8 ± 2.19 (low), 11.0 ± 5.80 (moderate), 33.1 ± 13.04 (high), 7.0 ± 1.84 (low), 18.4 ± 12.12 (moderate), 7.3 ± 4.47 (low), respectively, according to the white bread reference. The data from this study provide preliminary data for the GIs and GLs of packaged and processed vegan foods and show that the GIs and GLs of meat and cheese vegan analogues, while still low or moderate, tend to be higher than their animal‐based counterparts which have lower or no glycaemic responses. Further research on the GIs and GLs of more vegan foods is needed. [ABSTRACT FROM AUTHOR]

Professor (now emeritus) Nils Lid Hjort has through more than four decades been one of the most original and productive statisticians in Norway, contributing to a wide range of topics such as survival analysis, Bayesian nonparametrics, empirical likelihood, density estimation, focused inference, model selection, and confidence distributions. This conversation, which took place at the University of Oslo in December 2023, sheds light on how Nils Hjort's curious and open mind, coupled with a deep understanding, has enabled him to seamlessly navigate between different fields of statistics and its applications. Our aim is to encourage the statistics community to always be on the lookout for unexpected connections in statistical science and to embrace unexpected encounters with fellow statisticians from around the world. [ABSTRACT FROM AUTHOR]

Objective: Fasting for weight control is an under‐studied behaviour implicated in eating disorders. However, little is known about what factors account for its onset and persistence. Method: This study sought to identify risk and maintenance factors for fasting among 1025 women recruited through an eating disorder self‐help platform who completed study measures at baseline and 6 month follow‐up. Univariate and multivariate logistic regressions were performed to test which variables at baseline predicted the onset (vs. stably asymptomatic) and persistence (vs. remission) of fasting at follow‐up. Results: Univariate models showed that higher baseline overvaluation, dissatisfaction, fear of weight gain, generalised and social anxiety, depression, self‐esteem deficits and eating disorder symptoms (inflexible eating rules, driven exercise) predicted greater likelihood of fasting onset. Only fear of weight gain and depressive symptoms remained significant in the multivariate model. Higher baseline overvaluation, fear of weight gain, driven exercise, inflexible eating rules, and depression predicted greater likelihood of fasting persistence in univariate models. An adherence to inflexible eating rules and overvaluation remained significant in the multivariate model. Conclusion: Findings shed new light on factors that may account for the development and maintenance of fasting, which have implications for guiding effective interventions targeting this behaviour. Highlights: Fear of weight gain and depressive symptoms predicted the onset of fasting for weight control at 6 months follow‐up among women who did not report fasting behaviours at baseline.Adherence to inflexible eating rules and overvaluation with weight and shape predicted the persistence of fasting for weight control at follow‐up among women who endorsed fasting at baseline.Findings have clear implications for intervention targets among programs designed to address fasting behaviour. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders (ED) have recently been studied from a network approach, conceptualising them as a complex system of interconnected variables, while highlighting the role of non‐ED symptoms and personality dimensions. This study aims to explore the connections between personality and ED symptoms, identify central nodes, and compare the EDs network to a healthy control network. Methods: We employed network analysis to examine the personality‐ED symptom connections in 329 individuals with an ED diagnosis and 192 healthy controls. We estimated a regularised partial correlation network and the indices of centrality and bridge centrality to identify the most influential nodes for each group. Network differences between groups were also examined. Results: Low Self‐Directedness and high Harm avoidance emerged as central bridge nodes, displaying the strongest relationship with ED symptoms. Both networks differed in their global connectivity and structure, although no differences were found in bridge centrality and centrality indices. Conclusions: These findings shed light on the role of personality dimensions, such as Self‐Directedness and Harm Avoidance in the maintenance of ED psychopathology, supporting the transdiagnostic conceptualisation of ED. This study advances a deeper understanding of the complex interplay between personality dimensions and ED symptoms, offering potential directions for clinical interventions. Highlights: This study used a network approach to further our understanding of eating disorders (ED), viewing them as complex systems of interconnected variables. Our goal was to explore the relevance of different personality dimensions in ED symptomatology and examine differences in this network compared to a control group.The network comparison revealed significant differences in both the quantitative and qualitative aspects of the EDs network. Higher connectivity and a distinct structure in the EDs network suggested variations in the interplay between personality dimensions and ED symptoms in individuals with ED, proposing potential avenues for clinical interventions.Self‐Directedness and Harm Avoidance were identified as central bridge nodes in the network, displaying the strongest relationships with ED symptoms. Significant attention should be placed on personality dimensions in the conceptualisation and treatment of EDs. [ABSTRACT FROM AUTHOR]

This Committee Report provides methodological, interpretive, and reporting guidance for researchers who use measures of heart rate (HR) and heart rate variability (HRV) in psychophysiological research. We provide brief summaries of best practices in measuring HR and HRV via electrocardiographic and photoplethysmographic signals in laboratory, field (ambulatory), and brain‐imaging contexts to address research questions incorporating measures of HR and HRV. The Report emphasizes evidence for the strengths and weaknesses of different recording and derivation methods for measures of HR and HRV. Along with this guidance, the Report reviews what is known about the origin of the heartbeat and its neural control, including factors that produce and influence HRV metrics. The Report concludes with checklists to guide authors in study design and analysis considerations, as well as guidance on the reporting of key methodological details and characteristics of the samples under study. It is expected that rigorous and transparent recording and reporting of HR and HRV measures will strengthen inferences across the many applications of these metrics in psychophysiology. The prior Committee Reports on HR and HRV are several decades old. Since their appearance, technologies for human cardiac and vascular monitoring in laboratory and daily life (i.e., ambulatory) contexts have greatly expanded. This Committee Report was prepared for the Society for Psychophysiological Research to provide updated methodological and interpretive guidance, as well as to summarize best practices for reporting HR and HRV studies in humans. [ABSTRACT FROM AUTHOR]

Central limit theorems (CLTs) for frequency‐domain statistics are fundamental tools in frequency‐domain analysis. However, for irregularly spaced data, they are still limited. In both the pure increasing domain and the mixed increasing domain asymptotic frameworks, three CLTs of frequency‐domain statistics are established for the observations at uniformly distributed sampling locations over a rectangular sampling region. One is for discrete Fourier transforms (DFTs), while the other two pertain to generalized spectral means (GSMs). The asymptotic joint normality and independence of the DFT at any finite number of standard frequencies are derived. Additionally, the asymptotic normalities of two GSMs are set up, with asymptotic variances given in different forms, according to the Gaussian or non‐Gaussian model assumption. Three established CLTs are very useful in investigating the sampling properties of many important frequency‐domain statistics, such as periodogram, non‐negative definite auto‐covariance estimator, spectral density estimator, and Whittle likelihood estimator as well. [ABSTRACT FROM AUTHOR]

Summary: In this article, the problem of intermittent fault (IF) detection is investigated for nonstationary processes in the multivariate statistics framework. By combining the moving window technique with maximum likelihood estimation (MLE), the moving window Wald‐based control chart is proposed to realize the detection of IFs in nonstationary processes. The computational efficiency and the convergence properties are discussed for the designed iterative algorithm of MLE. Then, necessary and sufficient conditions are presented to guarantee the detectability of IFs with the consideration of window lengths. Moreover, the alarm delays are analyzed for the appearance and disappearance of IFs. In virtue of the above analysis, the optimal window length is derived by minimizing the supremum of alarm delays. In order to estimate the time of IFs' appearance and disappearance, an algorithm is designed with the inspiration of simulated annealing strategy. Finally, a simulation on rotary steerable drilling tool system is provided to verify the effectiveness of the proposed method. [ABSTRACT FROM AUTHOR]

Aim: To investigate the effects of high‐intensity interval training (HIIT) on periodontitis (PD) progression and behavioural outcomes. Materials and Methods: Forty‐eight Wistar rats were divided into four groups: non‐trained (NT); non‐trained with PD; HIIT with PD; and HIIT. The HIIT protocol, involving daily treadmill sessions, spanned 8 weeks, with PD induced by ligature after the 6th week. Behavioural tests were conducted to assess anxiety and memory. Post euthanasia, we evaluated the systemic inflammatory profile and oxidative stress markers in the hippocampus and amygdala. A morphological evaluation and elemental composition analysis of the mandibular alveolar bone were performed. Results: PD exacerbated alveolar bone level, bone surface damage and alterations in calcium and phosphorus percentages on the bone surface (p <.05), while HIIT attenuated these changes (p <.05). HIIT improved systemic inflammatory markers altered by PD (tumour necrosis factor [TNF]‐α, interleukin [IL]‐10, TNF‐α/IL‐10 and IL‐1β/IL‐10 ratios, p <.05). PD animals exhibited lower total antioxidant capacity and levels of thiobarbituric acid reactive substances in the amygdala and hippocampus, respectively (p <.05). HIIT maintained these parameters at levels similar to those in NT animals. HIIT improved anxiety and memory outcomes altered by PD (p <.05). Conclusions: HIIT attenuates systemic inflammation, anxiety and memory outcomes promoted by PD. [ABSTRACT FROM AUTHOR]

Aim: Radiotherapy is associated with cell depletion and loss of blood supply, which are linked to compromised bone healing. However, the molecular events underlying these effects at the tissue–implant interface have not been fully elucidated. This study aimed to determine the major molecular mediators associated with compromised osseointegration due to previous exposure to radiation. Materials and Methods: Titanium implants were placed in rat tibiae with or without pre‐exposure to 20 Gy irradiation. Histomorphometric, biomechanical, quantitative polymerase chain reaction (qPCR) and enzyme‐linked immunosorbent assay analyses were performed at 1 and 4 weeks after implantation. Results: The detrimental effects of irradiation were characterized by reduced bone–implant contact and removal torque. Furthermore, pre‐exposure to radiation induced different molecular dysfunctions such as (i) increased expression of pro‐inflammatory (Tnf) and osteoclastic (Ctsk) genes and decreased expression of the bone formation (Alpl) gene in implant‐adherent cells; (ii) increased expression of bone formation (Alpl and Bglap) genes in peri‐implant bone; and (iii) increased expression of pro‐inflammatory (Tnf) and pro‐fibrotic (Tgfb1) genes in peri‐implant soft tissue. The serum levels of pro‐inflammatory, bone formation and bone resorption proteins were greater in the irradiated rats. Conclusions: Irradiation causes the dysregulation of multiple biological activities, among which perturbed inflammation seems to play a common role in hindering osseointegration. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to identify the risk factors for gingival invagination during orthodontic treatment after premolar extraction. Materials and Methods: The medical records of 135 patients who had undergone interdental space closure after premolar extraction were collected, and cone beam computed tomography was performed to determine the presence of gingival invagination. The risk factors were examined using mixed‐effects models and generalized propensity score weighting (GPSW) to develop a predictive model. Results: Univariate analysis revealed that the extraction site, buccal bone thickness 4 mm apical to the cemento‐enamel junction (MB1), mid‐root buccal bone thickness (MB2) and vertical skeletal relationships were related to gingival invagination (p <.05). Furthermore, a subsequent multivariable mixed‐effects model analysis indicated a significantly increased risk of gingival invagination at MB1 < 1 mm (p <.001; odds ratio [ORMB1≤0.5mm] = 29.304; 95% confidence interval [CI]: 8.986–93.807; OR0.5

Data collected over time are common in applications and may contain censored or missing observations, making it difficult to use standard statistical procedures. This article proposes an algorithm to estimate the parameters of a censored linear regression model with errors serially correlated and innovations following a Student‐t distribution. This distribution is widely used in the statistical modelling of data containing outliers because its longer‐than‐normal tails provide a robust approach to handling such data. The maximum likelihood estimates of the proposed model are obtained through a stochastic approximation of the EM algorithm. The methods are applied to an environmental dataset regarding ammonia‐nitrogen concentration, which is subject to a limit of detection (left censoring) and contains missing observations. Additionally, two simulation studies are conducted to examine the asymptotic properties of the estimates and the robustness of the model. The proposed algorithm and methods are implemented in the R package ARCensReg. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to examine the effect of professional and individual characteristics, practice environments and psychological empowerment perceptions of nurses on their care behaviours. Design: The study used a cross‐sectional research design following the STROBE guidelines. Methods: The sample of this descriptive and correlational study consisted of 584 nurses working in a university hospital in Turkey. The data were collected between January and June 2023 using the Nursing Information Form, the Practice Environment Scale of the Nursing Work Index (PES‐NWI), the Psychological Empowerment Scale (PES), and the Caring Behaviours Scale‐30, and analysed using descriptive statistics, Spearman's correlation and multiple linear regression. Results: It was determined that PES‐NWI, PES and Caring Behaviours Scale (CBI‐30) scores of nurses were higher than the average. The study revealed that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on their care behaviours. Conclusion: The results of the study showed that nurses' PES‐NWI, PES and CBI‐30 scores were higher than the average, and that certain professional and individual characteristics of nurses, practice environments and psychological empowerment perceptions had an effect on care behaviours. Nursing service managers, in particular, are required to understand the importance of this relationship and create appropriate working conditions which are integrated with psychological empowerment to improve caring behaviours of nurses. [ABSTRACT FROM AUTHOR]

Background: Autogenic training (AT) is a structured meditative‐style practice, consisting of a sequence of simple mental exercises intended to induce a relaxed state in patients. There is some emerging evidence to suggest that AT can be effective in treating certain chronic conditions, however, further evidence is required. A service evaluation of AT services at the Royal London Hospital for Integrated Medicine was conducted to evaluate the impact of AT on patients with chronic conditions. Methods: The service evaluation consisted of the completion of validated quantitative outcome measures pre and posttreatment to explore the impact of AT. AT patients were asked to complete the Measure Yourself Medical Outcomes Profile (MYMOP) and Perceived Stress Scale (PSS) at their first hospital appointment (baseline) and then again 8 weeks later following completion of their AT sessions. Pre‐ and posttreatment scores for each outcome measure were analysed in SPSS using the Wilcoxon signed‐rank test. Results: One hundred ninety‐nine patients completed both initial and follow‐up MYMOP forms and were included in the evaluation. The most common presenting complaints for MYMOP symptom 1 were prolonged anxiety/stress and depression (n = 70, 35.2%), chronic pain and migraine headache (n = 44, 22.1%), chronic insomnia and sleep problems (n = 42, 21.1%) and, long‐term exhaustion and fatigue (n = 18, 9%). The change in median score pre‐ and posttreatment for all MYMOP categories (symptoms, activity and well‐being) were statistically highly significant p < 0.001. Anxiety, stress, depression, pain and insomnia were the symptoms that had the largest statistically significant difference between the median score pre‐ and posttreatment. Fifty‐five patients completed the PSS questionnaire at two time points (pre‐ and posttreatment). It showed a highly statistically significant change in PSS median score in patients experiencing stress (p < 0.001). Discussion: The findings of the evaluation indicate that 8 weeks of AT appears to be effective in improving symptoms of concern to patients and enhancing patients' overall well‐being. In particular, AT was found to be beneficial for patients with symptoms of anxiety, stress, depression, pain and insomnia. [ABSTRACT FROM AUTHOR]

Introduction: Lifestyle, defined as a way of living resulting from an individual's deliberate choices, is a crucial factor in improving and maintaining health. Consequently, the measurement and analysis of lifestyle are of significant importance. This study aims to validate the validity and reliability of the Yonsei Lifestyle Profile‐Active, Balance, Connection, Diversity (YLP‐ABCD) in measuring health‐related lifestyles. Methods: Data were collected from 300 participants aged 55 and older using the YLP‐ABCD. To analyse the validity and reliability of the YLP‐ABCD, analysed using frequency, descriptive statistics, confirmatory factor analysis, and Rasch model analysis. Results: The results indicate that the YLP‐ABCD, which consists of 35 items, demonstrates unidimensionality and local independence. The Rasch model confirmed the suitability of the 5‐point Likert scale for the factors, excluding subfactors Balanced and Unbalanced. The item fit criteria (0.5 < MNSQ < 1.5) were met for all items. The distribution of the respondents' abilities suggests the need for additional items to measure their ability levels. Both the item and respondent separation indices and their reliabilities were satisfactory. Conclusion: This study confirmed the utility of the YLP‐ABCD as a valuable tool for measuring and understanding the multifaceted diversity of lifestyles. Therefore, by utilising YLP‐ABCD to quantitatively measure health lifestyles, we anticipate contributing to improvements in human health and quality of life. [ABSTRACT FROM AUTHOR]

Objectives: Noncarious cervical lesions (NCCLs) are multifactorial and can be caused by the anatomical structure of the teeth, erosion, abrasion and abnormal occlusion. The aim of this case–control study was to explore the risk factors for NCCLs. Methods: Cone‐beam computed tomography was used to determine whether a wedge‐shaped defect existed at the cementoenamel junction. We compared 63 participants with NCCLs with 63 controls without NCCLs, matched for sex, age (±1 year) and toothbrushing‐related factors (e.g., type of bristle and brushing patterns, frequency and strength). All participants were asked to complete a questionnaire about self‐administered daily diet habits and health condition. Univariate and multivariate logistic regression analyses were conducted to determine the risk factors for NCCLs. Results: Significant variables in the univariate analysis (i.e., p <.2) included frequency of carbonated beverage consumption, sella‐nasion‐point B angle (SNB) and Frankfort‐mandibular plane angle (FMA). Multivariate logistic regression demonstrated that the consumption frequency of carbonated beverages (odds ratio [OR] = 3.147; 95% confidence interval [CI], 1.039–9.532), FMA (OR = 1.100; 95% CI, 1.004–1.204) and SNB (OR = 0.896; 95% CI, 0.813–0.988) was independent influencing factors. The area under the receiver operating characteristic curve (AUC) value of regression Model 1 (established with the frequency of carbonated beverage consumption, FMA, SNB and sleep bruxism) was 0.700 (95% CI, 0.607–0.792; p <.001), and that of regression Model 2 (established using the frequency of carbonated beverage consumption, FMA and SNB) was 0.704 (95% CI, 0.612–0.796; p <.001). Conclusions: The consumption frequency of carbonated beverages and FMA was risk factors for NCCLs; the higher the frequency of carbonated beverage consumption and FMA, the higher was the probability of NCCLs. SNB was a protective factor for NCCL occurrence; the larger the SNB, the lower was the probability of NCCL occurrence. These findings have further clarified the aetiology of NCCLs and provided clinicians with valuable insights into strategies for preventing the loss of dental tissue. [ABSTRACT FROM AUTHOR]

Background: Natural head position (NHP), pharyngeal airway and maxillofacial growth pattern are correlated. The author's previous studies proved that following surgical correction of Skeletal Class II malocclusion, the over‐extended NHP returned upright, and the pharyngeal airway space (PAS) dimension expanded. Objective: The present study compares the post‐operative change in NHP and PAS after orthognathic surgery in Skeletal Class II and III malocclusion patients. Methods: Patients receiving orthognathic procedures to correct Skeletal Class II or III malocclusions were reviewed in this retrospective study. Pre‐operative and 6‐week post‐operative cone‐beam computed tomography datasets were collected. Variables representing the craniofacial pattern, the NHP and the PAS were measured three‐dimensionally. Post‐operative variables were compared with their pre‐operative counterparts using either repeat‐measure 2‐way analysis of variance or Wilcoxon matched‐pairs signed rank test. Results: Thirty cases of Skeletal Class II malocclusion and 13 cases of Skeletal Class III malocclusion were collected. Preoperatively, the inter‐group differences were significant in craniofacial pattern (68.14 ± 3.552 degree vs. 79.63 ± 2.497 degree, p <.0001) and the NHP (68.77 ± 11.02 degree vs. 82.83 ± 7.738 degree, p =.0002) while not significant in PAS; after surgery, the intergroup differences in craniofacial pattern and the NHP between groups decreased, and the PAS increased in both groups. Conclusion: Orthognathic surgery may improve compromised NHP and increase PAS in Skeletal Class II and III malocclusion patients. [ABSTRACT FROM AUTHOR]

Background: Low‐intensity continuous inspiratory muscle training improves its strength. The abdominal muscles are the main expiratory muscles, and their training may improve expiratory muscle strength. Respiratory muscle strength regulates coughing effectiveness, which is critical for pneumonia management. In older people, risk factors for the development of pneumonia were respiratory muscle weakness and swallowing impairment. Currently, the impact of high‐intensity intermittent inspiratory and abdominal muscle combined training on the respiratory, swallowing, and systemic muscles is unclear. Objective: We aimed to explore the effects of high‐intensity inspiratory muscle training combined with or without abdominal muscle training on respiratory muscle strength as well as the strength, mass, and performance of swallowing and systemic muscles. Methods: Twenty‐eight healthy adults were divided into two groups. Participants performed high‐intensity intermittent inspiratory muscle single or its combination with abdominal muscle training for 4 weeks. Respiratory muscle strength, swallowing muscle strength and mass, systemic muscle strength, mass and performance were measured at baseline, Week 2 and Week 4. Results: Both groups showed greater maximal respiratory pressures at Week 2 and Week 4 than baseline. Both groups showed improved tongue pressure and geniohyoid muscle thickness at Week 4. In addition, the combined training group improved body trunk muscle mass, handgrip strength and five‐time chair stand test, whereas the single training group did not. Conclusion: This study revealed that high‐intensity inspiratory muscle training improved inspiratory muscle strength and swallowing muscle strength and mass. Moreover, inspiratory and abdominal muscle combined training showed an additional benefit of improving systemic muscle strength, mass and performance. Clinical Trial Registration Number: UMIN000046724; https://upload.umin.ac.jp/cgi‐open‐bin/ctr/index.cgi?ctrno=UMIN000046724. [ABSTRACT FROM AUTHOR]

Background: Mandibular malpositioning may result in an abnormal concentration of stresses within the temporomandibular joint (TMJ) in adult rats, which may further lead to a series of pathological changes, such as articular cartilage wear, subchondral bone sclerosis and osteophyte formation. However, the pathological and adaptive changes in condylar cartilage caused by different stress distributions are still controversial. Objective: The aim of this study was to observe the effect of sagittal changes in mandibular position on condylar cartilage by changing the occlusal vertical dimension (OVD) in adult rats. Methods: Fifteen‐week‐old female rats were divided into three groups: control (CON), increased OVD (iOVD) and loss of occlusion (LO) groups. An occlusal plate and tooth extraction were used to establish the animal model. TMJ samples of the experimental and CON groups were observed and investigated by bone morphological, histomorphological and immunohistochemical staining analyses at 3 days, 1 week, 2 weeks, 4 weeks and 8 weeks. Weight curves were plotted. Results: Micro‐computed tomography showed that, compared with the CON group, cartilage destruction followed by repair occurred in both experimental groups, which was similar to the trend observed in haematoxylin‐eosin staining. All experimental results for the iOVD group showed an approximately similar time trend. Compared with the iOVD group, the toluidine blue and immunohistochemical staining results in the LO group showed no obvious change trend over time. Conclusion: Compared with occlusal loss, an increase in OVD caused faster and more severe damage to condylar cartilage, and subchondral bone repair occurred later. [ABSTRACT FROM AUTHOR]

Background: The temporal tendon is a structure often compromised in patients suffering from temporomandibular disorders (TMD), yet its intraoral location makes a standardised assessment difficult. Objectives: To evaluate the variability and accuracy to target force of a newly designed intraoral extension for a palpometer device (Palpeter, Sunstar Suisse) when compared to manual palpation, in addition to clinically assessing the mechanical sensitivity and referred sensations of the temporal tendon in healthy individuals. Methods: Experiment 1: 12 individuals were asked to target on a scale 0.5, 1 and 2 kg, for 2 and 5 s by using five different methods (Palpeter, Palpeter with three different extension shapes and manual palpation). Experiment 2: 10 healthy participants were recruited for a randomised double‐blinded assessment by applying pressure of 0.5, 1 and 2 kg to the right temporal tendon with the three extensions and manual palpation. Participants rated the intensity of their sensation/pain on a 0–50–100 numeric rating scale (NRS), unpleasantness on a 0–100 NRS, and if present, they rated and drew the location of referred sensations. Repeated measures analysis of variance (ANOVA) was used in both experiments to compare differences between palpation methods. Tukey's HSD tests were used for the post hoc comparisons, and p values below.05 were considered significant. Results: Experiment 1: The extensions showed no significant differences between them regarding reliability and accuracy for all forces and durations (p >.05). The manual method was significantly less reliable and accurate when compared to the other methods (p <.05). Experiment 2: There were no significant differences between the Palpeter extensions regarding pain intensity or unpleasantness NRS scores (p >.05), but all the extensions had significantly increased pain intensity and unpleasantness when compared to manual palpation (p <.05). Similarly, the frequency of referred sensations was similar between extensions but increased when compared to manual palpation. Conclusions: The new Palpeter extensions proved to be significantly more accurate and have lower test–retest variability than the manual method in a non‐clinical setting. Clinically, they showed no significant differences in NRS scores for pain intensity nor unpleasantness, with no major differences in referred sensations, making any of the extensions suitable for clinical testing of the temporal tendon in future studies. [ABSTRACT FROM AUTHOR]

Background: Class II subdivision is a malocclusion characterized by dental and functional asymmetry that is difficult to manage. Impaired muscle function can result in asymmetrical growth, leading to occlusal instability. Objective(s): The study aimed to assess occlusal force in patients with Class II subdivision malocclusion using Innobyte. Additionally, the discrepancies of force generated at the position of maximum intercuspidation between the left and right sides of the arches were evaluated. Methods: The occlusal force of 66 patients with Class II subdivision malocclusion (group S) was measured and compared with that of 66 patients with Class I (group I) and 66 patients with Class II malocclusion (group II). The S group patients had a Class I molar on the right side and a Class II molar on the left side. ANOVA test, followed by the Games‐Howell post hoc test, was performed to compare the mean of the total force among the groups. To assess the difference in force between the right and left arches, one‐way ANOVA test followed by Tukey's post hoc comparison was performed. Finally, a boxplot was created to show the trend of occlusal force recorded in the three groups of patients. Results: The occlusal force differed significantly among the groups (p <.001). Post hoc Games‐Howell analysis showed significant differences as follows: the total force in group S was 165.24 N greater than in group II and in group I was 218.06 N greater than in group II. The difference (right–left) in total force between the groups was statistically significant (p <.001). Tukey's post hoc test showed following significant correlation: in group S was 53.51 N greater than in group II and 63.12 N greater than in group I. Conclusions: Among the analysed groups, patients with Class II malocclusion exhibited the lowest value of occlusal force. In patients with Class II subdivision malocclusion, force asymmetry, characterised by a higher value on the Class I side and a lower value on the Class II side was observed. [ABSTRACT FROM AUTHOR]

This study examined the development of social power perceptions among Chinese children aged 3–5 years (N = 105). After watching videos about various social power cues, such as resource possession, resource control, goal achievement, permission, giving orders, setting norms and popularity, the children were asked to identify the powerful agents (whom do you believe is the more powerful person?) in the videos and provide explanations (why do you think he (she) is a powerful person?). Three‐year‐olds can recognize powerful agents who can grant 'permission' to other agents. By the age of 4, children begin to associate 'popularity', 'resource possession' and 'goal achievement' with social power. Five‐year olds demonstrated the ability to recognize agents who control resources as being more powerful. Analysis of the reasons the children provided for their judgements revealed that for almost every cue (except giving orders), more than 14% of the responses highlighted 'possession of material resources' as an indicator of power. For children aged 3–5 years, 'resource possession' cues may be their preferred basis for inferring and explaining power differences. These results would facilitate researchers to further unravel the mechanisms underlying the development of children's social power perceptions. [ABSTRACT FROM AUTHOR]

There is minimal research investigating the influence of advice on decision‐making in older age. The present study investigated the effect of different types of bad advice, relative to no advice, on young and older adults' decision‐making in the Iowa Gambling Task (IGT). Fifty‐four older adults and 59 young adults completed the IGT after receiving no advice, or advice to select from disadvantageous deck A (small, high‐frequency losses), or disadvantageous deck B (larger, low‐frequency losses). Corrugator EMG, memory and fluid intelligence were assessed. Averaged across advice conditions, older adults made more disadvantageous selections than young adults. There were no age‐related differences in responding to bad advice, nor in corrugator activity in response to losses (i.e. frowning), or in learning to avoid deck A faster than deck B. Selecting from deck B was associated with reduced education among older adults, and reduced fluid intelligence among young adults. The data suggest that older adults make more disadvantageous decisions than young adults, and this is not exacerbated by bad advice. Both young and older adults are slower at learning to avoid choices resulting in low frequency relative to high‐frequency losses, and this may be associated with individual differences in cognitive processing. [ABSTRACT FROM AUTHOR]

Objectives: Clinical associate psychologists (CAPs) train under the auspices of the apprenticeship programme and are a new addition to the psychological workforce. This project sought to evaluate whether a "personal reformulation" (PR) was helpful in terms of personal and professional development during the apprenticeship. Methods: A mixed methods evaluation containing a longitudinal quantitative element and a "Big Q" qualitative element with a single cohort of N = 18 CAPs. A PR consists of a 2‐hr one‐to‐one session and a follow‐up session with a cognitive analytic psychotherapist. During a PR, a sequential diagrammatic reformulation is produced to aid recognition and revision of potentially problematic relationship patterns at work. Two outcome measures concerning reflective capacity and professional quality of life were completed at the start of the apprenticeship, pre‐PR and at 3‐month PR follow‐up. The semi‐structured interviews (n = 11) conducted at the follow‐up were analysed using reflexive thematic analysis. Results: Quantitative changes were limited to significant increases to general confidence and 8/12 apprentices had a reliable increase in confidence in communication. Qualitatively, five overarching themes were found: (1) gaining insight, (2) wellbeing, (3) nature of the space, (4) being an apprentice, and (5) moving forward. Conclusions: PRs were generally found to be emotionally challenging, but relatively large amounts of insight are possible from a very brief intervention that can contribute to personal and professional development during clinical training. More controlled research needs to be conducted and wider applications and evaluations of PRs in different professions would be welcome. [ABSTRACT FROM AUTHOR]

This study aimed to identify the best conditions for ultrasonic‐assisted extraction (UAE) of DPPH and phenolic compounds from cold brew coffee using Box‐Behnken Design (BBD) and Response Surface Methodology (RSM). It explored the effects of solid‐liquid ratio (5%–15%), extraction time (40–50 min), and ultrasonic power (70%–80%) on these compounds, finding that all factors significantly influenced the outcomes. Statistical analysis showed the data fit a quadratic polynomial model well, with R2 values of 0.9981 for phenolic compounds and 0.9799 for DPPH radicals. Using 3D surface and contour plots from these models, the optimal extraction conditions for these compounds from cold brew coffee were determined. The highest yields of total phenolic compounds and DPPH radical were obtained when samples were extracted at a 10% solid–liquid ratio, 45 min extraction time, and 75% ultrasonic power. Under these optimal conditions, total phenolic compounds and DPPH radical were 64.10 ± 0.31 gGAE/mL and 61.90 ± 0.14%, respectively, with a maximum caffeine content of 213.13 ± 0.23 mg/L. Gamma irradiation at kGy also reduced cold brew coffee's microbial content. This research may be a new alternative for producing cold brew coffee that will save time and help extend the shelf life. [ABSTRACT FROM AUTHOR]

The longan fruit, widely grown and consumed in Southeast Asia, contains an abundance of essential natural chemicals present in its flesh and seeds. The microwave‐assisted approach is used to extract these components, which include total phenolic compound and corilagin. The optimization of the extraction process included factors such as the sample ratio (0.5–1.5 g/30 mL), time (10–20 min), and microwave power (600–700 W). These variables were examined using the response surface approach. The statistical analysis revealed that the data was most accurately represented by a quadratic polynomial equation. The decision coefficients for total phenolic compounds and corilagin were found to be 0.9956 and 0.9485, respectively, indicating a high level of accuracy. The result was that the optimal conditions to obtain the highest total phenolic compound and corilagin from longan extract are 22.214 mgGAE/gDW and 55.137 mg/gDW, respectively. The sample was extracted under a ratio of 0.97 g/30 mL set at microwave power at 695.74 W, with an extraction time of 15 min. This study suggests that microwave‐assisted, water‐based extraction can produce healthful, eco‐friendly concentrated longan extracts, yielding high levels of corilagin and phenolic compounds. [ABSTRACT FROM AUTHOR]

Background: No studies have evaluated the unique potential of nurse‐led silver diamine fluoride (SDF) application for children to bridge the gap in interprofessional collaboration. Aim: To investigate the attitudes, beliefs and perceptions of nurses regarding nurse‐led SDF application at the well‐child visit and identify possible barriers and make recommendations. Design: Mixed methods design involving a questionnaire and semi‐structured individual interviews were conducted. Results: All eligible nurses (n = 110) completed the questionnaire, and 16 were interviewed. Questionnaire responses highlighted that nurses were not confident in providing oral health services (score: <3 of 5) beyond oral hygiene advice (score: ≥3.9 of 5) but believed that they should be providing these services for individuals with difficulty accessing care. Interviews reflected that most nurses viewed oral health care as an important part of paediatric health but were limited by knowledge, time and manpower. Most were willing to expand their job scope to include SDF application with formal education and training, competency assessments and approaches to counter time limitations. Conclusion: Where nurses are already providing basic oral healthcare, nurse‐led SDF application could be the next step. Findings suggest that systemic changes should include strategies to empower and motivate nurses to apply SDF at the well‐child visit. [ABSTRACT FROM AUTHOR]

Background: Dental caries is the most common chronic childhood disease. The recommended age for the first dental visit (FDV) is 1 year, yet a minority of children visit before the age of 3 years. Aim: The aim of the study was to estimate the patterns of and predictors for dental visits among a sample of children. Design: Parents of children between the ages of 6 months and 18 years, who attended the paediatric dentistry clinics and the well‐baby clinics, were recruited. A validated questionnaire was used to collect data. Logistic regression was utilized to assess the predictors of ever visiting a dentist. Results: The mean age at FDV was 5.8 ± 2.1 years. Parents' belief of not needing to see a dentist was the most common barrier to visiting a dentist (33%). Among the reasons for FDV, caries and pain were the most common (45% and 20%, respectively). Predictors of ever visiting a dentist were children who are not an only child and children of parents who visited a dentist themselves. Conclusion: Children visited the dentist at an age older than that recommended, and the reasons for FDV were mainly caries and its consequences. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance To assess whether children with febrile seizures and/or epilepsy were at increased risk of experiencing internalizing symptoms or psychotic‐like experiences at age 11 years.This cohort study includes 44 819 children from the 11‐year follow up of the Danish National Birth Cohort. Information on childhood seizures was retrieved from the Danish National Patient Registry, whereas child psychiatric symptoms were assessed in a web‐based questionnaire using the Adolescent Psychotic‐like Symptom Screener and the Strength and Difficulties Questionnaire. Adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs) for the association between childhood seizures and internalizing symptoms (symptom score ≥8) and psychotic‐like experiences (≥2 definite experiences) were obtained using logistic regression models.A total of 1620 children with febrile seizures (3.6%), and 311 children with epilepsy (0.7%) were identified. When adjusted for potential confounders, no association between febrile seizures and psychiatric symptoms was observed, and no association was observed between epilepsy and psychotic‐like experiences. However, the OR for internalizing symptoms was 1.76 (95% CI: 1.20–2.58) in children with epilepsy compared to children without. This higher risk was evident mainly in boys (OR 2.30, 95% CI 1.37–3.85), children with ≥2 epilepsy‐related hospital admissions (OR 2.79, 95% CI 1.81–4.32), and children whose age at first epilepsy‐related hospital admission was 0–3 years (OR 2.47, 95% CI 1.45–4.19).No association was found between febrile seizures and psychiatric symptoms or epilepsy and psychotic‐like experiences at age 11. However, boys with epilepsy were at higher risk of experiencing internalizing symptoms. [ABSTRACT FROM AUTHOR]

In this article, statistical tests concerning the trend coefficient in cointegrating regressions are addressed for the case when the stochastic regressors have deterministic linear trends. The self‐normalization (SN) approach is adopted for developing inferential methods in the integrated and modified ordinary least squares (IMOLS) estimation framework. Two different self‐normalizers are used to construct the SN test statistics: a functional of the recursive IMOLS estimators and a functional of the IMOLS residuals. These two self‐normalizers produce two SN tests, denoted by TSNϵ and τδ1η^T⊥ respectively. Neither test requires studentization with a heteroskedasticity and autocorrelation consistent (HAC) estimator. A trimming parameter ϵ must be chosen to implement the TSNϵ test, whereas the τδ1η^T⊥ test does not require any tuning parameter. In the simulation, the QSNϵ≡TSNϵ2 test exhibits the smallest size distortion among the inferential methods examined in this article. However, this may come with some loss of power, particularly in small samples. [ABSTRACT FROM AUTHOR]

ABSTRACT For topical, dermatological drug products, an in vitro option to determine bioequivalence (BE) between test and reference products is recommended. In particular, in vitro permeation test (IVPT) data analysis uses a reference‐scaled approach for two primary endpoints, cumulative penetration amount (AMT) and maximum flux (Jmax), which takes the within donor variability into consideration. In 2022, the Food and Drug Administration (FDA) published a draft IVPT guidance that includes statistical analysis methods for both balanced and unbalanced cases of IVPT study data. This work presents a comprehensive evaluation of various methodologies used to estimate critical parameters essential in assessing BE. Specifically, we investigate the performance of the FDA draft IVPT guidance approach alongside alternative empirical and model‐based methods utilizing mixed‐effects models. Our analyses include both simulated scenarios and real‐world studies. In simulated scenarios, empirical formulas consistently demonstrate robustness in approximating the true model, particularly in effectively addressing treatment–donor interactions. Conversely, the effectiveness of model‐based approaches heavily relies on precise model selection, which significantly influences their results. The research emphasizes the importance of accurate model selection in model‐based BE assessment methodologies. It sheds light on the advantages of empirical formulas, highlighting their reliability compared to model‐based approaches and offers valuable implications for BE assessments. Our findings underscore the significance of robust methodologies and provide essential insights to advance their understanding and application in the assessment of BE, employed in IVPT data analysis. [ABSTRACT FROM AUTHOR]

Background: Organophosphate flame retardants (OPFRs) are extensively distributed in our environment, prompting concerns about potential health hazards, including lung injuries resulting from OPFR exposure. Methods: The present study recruited 125 lung cancer patients, assessing their exposure to 10 OPFR compounds through urine samples. The final analysis comprised 108 participants after excluding those lacking epidermal growth factor receptor (EGFR) status and those with chronic kidney disease. Demographic and clinical characteristics, as well as urinary OPFR concentrations, were compared based on OPFR detection. Spearman correlation was conducted to explore the relationship between OPFR compounds, while logistic regression was used to identify OPFR compounds associated with EGFR mutation. Results: The study revealed widespread OPFR exposure among lung cancer patients, with an overall detection frequency of 99.07%. Tris(2‐butoxyethyl) phosphate (TBEP) exhibited a strong correlation to its metabolite bis(2‐butoxyethyl) phosphate (r = 0.88, p < 0.01). Patients with TBEP in their urine had higher percentage of wild‐type EGFR and the detection of TBEP was associated with a reduced likelihood of mutant EGFR expression. Conclusions: OPFR exposure was prevalent in lung cancer patients, with TBEP detection identified as a factor with lower EGFR mutation expression. This study contributes to the understanding of OPFR exposure in lung cancer patients and underscores the significance of TBEP in evaluating EGFR mutation in this population. [ABSTRACT FROM AUTHOR]

Background: The goal of the research was to examine the value of peripheral blood indicators in forecasting survival and recurrence among people suffering central‐type non‐small cell lung cancer (NSCLC) undergoing sleeve lobectomy (SL). Methods: Clinical information was gathered from 146 individuals suffering from NSCLC who had SL at our facility between January 2014 and May 2023. Peripheral blood neutrophil lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet lymphocyte ratio (PLR) levels were determined by receiver operating characteristic (ROC) curve to establish the threshold points. Kaplan–Meier survival analysis was employed to evaluate the prognostic value of different groupings, and both univariate and multivariate Cox proportional hazards model (referred to as COX) were performed. Results: The disease‐free survival (DFS) and overall survival (OS) cutoff values were carried out via ROC analysis. Kaplan–Meier survival analysis revealed notable differences in OS for NLR (≥2.196 vs. <2.196, p = 0.0009), MLR (≥0.2763 vs. <0.2763, p = 0.0018), and PLR (≥126.11 vs. <126.11, p = 0.0354). Similarly, significant differences in DFS were observed for NLR (≥3.010 vs. <3.010, p = 0.0005), MLR (≥0.2708 vs. <0.2708, p = 0.0046), and PLR (≥126.11 vs. <126.11, p = 0.0028). Univariate Cox analysis showed that NLR (hazard ratio [HR]: 2.469; 95% confidence interval [CI]: 1.416–4.306, p < 0.001), MLR (HR: 2.192, 95% CI: 1.319–3.643, p = 0.002) and PLR (HR: 1.696, 95% CI: 1.029–2.795, p = 0.038) were correlated alongside OS. Multivariate Cox analysis showed that NLR (HR: 2.036, 95% CI: 1.072–3.864, p = 0.030) was a separate OS risk variable. Additionally, the pN stage (HR: 3.163, 95% CI: 1.660–6.027, p < 0.001), NLR (HR: 2.530, 95% CI: 1.468–4.360, p < 0.001), MLR (HR: 2.229, 95% CI: 1.260–3.944, p = 0.006) and PLR (HR: 2.249, 95% CI: 1.300–3.889, p = 0.004) were connected to DFS. Multivariate Cox analysis showed that pN stage (HR: 3.098, 95% CI: 1.619–5.928, p < 0.001) was a separate DFS risk variable. Conclusion: The study demonstrates that NLR, MLR, and PLR play a convenient and cost‐effective role in predicting survival and recurrence among individuals alongside central‐type NSCLC having SL. [ABSTRACT FROM AUTHOR]

Background: Primary thymic adenocarcinoma (PTAC) is an extremely rare disease with a poor prognosis. In the present study, we sought to analyze the clinical characteristics and prognostic factors of patients with PTAC. Methods: A total of 14 patients with PTAC treated at our center from January 2000 to January 2019 were included in this study. We retrospectively collected information on sex, age, history of smoking, family history of cancer, comorbidities, symptoms, imaging tests, serum tumor marker levels, tumor, node, metastasis (TNM) staging, and treatment records. Follow‐up information was obtained by telephone interviews or outpatient clinic visit. Univariate and multivariate Cox regression analyses were performed to investigate the clinicopathological factors associated with survival. Results: Among 14 patients with PTAC, there were five males and nine females, with an average age of 48.7 ± 9.3 years. A total of 23.1% of the patients had a history of smoking. The clinical symptoms of the patients were nonspecific and seven patients had elevated levels of serum tumor markers. Surgery was performed for nine patients, among which only four received R0 resection. The median survival time of the 14 patients was 16.0 months, and the 1‐, 3‐ and 5‐year survival rates were 57.1%, 35.7% and 21.4%, respectively. TNM stage was identified as an independent prognostic factor for PTAC patients (the median survival time of stage I–IIIA vs. stage IV was 44.0 months vs. 9.0 months, p = 0.002). Conclusions: PTAC is highly aggressive malignancy with poor prognosis. Surgical treatment is feasible, but R0 resection is challenging. TNM staging is significantly associated with patient survival. [ABSTRACT FROM AUTHOR]