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Acute ketone monoester (KE) supplementation can alter exercise responses, but the performance effect is unclear. The limited and equivocal data to date are likely related to factors including the KE dose, test conditions, and caliber of athletes studied. We tested the hypothesis that mean power output during a 20-min cycling time trial (TT) would be different after KE ingestion compared to a placebo (PL). A sample size of 22 was estimated to provide 80% power to detect an effect size dz of 0.63 at an alpha level of.05 with a two-tailed paired t test. This determination considered 2.0% as the minimal important difference in performance. Twenty-three trained cyclists (N = 23; peak oxygen uptake: 65 ± 12 ml·kg−1 min−1; M ± SD), who were regularly cycling >5 hr/week, completed a familiarization trial followed by two experimental trials. Participants self-selected and replicated their diet and exercise for ∼24 hr before each trial. Participants ingested either 0.35 g/kg body mass of (R)-3-hydroxybutyl (R)-3-hydroxybutyrate KE or a flavor-matched PL 30 min before exercise in a randomized, triple-blind, crossover manner. Exercise involved a 15-min warm-up followed by the 20-min TT on a cycle ergometer. The only feedback provided was time elapsed. Preexercise venous [β-hydroxybutyrate] was higher after KE versus PL (2.0 ± 0.6 vs. 0.2 ± 0.1 mM, p <.0001). Mean TT power output was 2.4% (0.6% to 4.1%; mean [95% confidence interval]) lower after KE versus PL (255 ± 54 vs. 261 ± 54 W, p <.01; dz = 0.60). The mechanistic basis for the impaired TT performance after KE ingestion under the present study conditions remains to be determined. [ABSTRACT FROM AUTHOR]

To investigate whether the association between hearing difficulties and self-reported memory problems is mediated by physical health and psychosocial wellbeing. A cross-sectional study. Path analyses were used to test potential theoretical models (psychosocial-cascade, common cause) of the association between hearing difficulties and memory problems, adjusting for age. A sample of 479 adults (18–87 years) completed self-reported outcome measures. Half the participants reported clinically significant hearing difficulties and 30% self-reported memory problems. In the direct model, reporting hearing difficulties was associated with a greater likelihood of reporting memory problems (β = 0.17, p = 0.007, 95% Confidence Intervals [CI] = 0.00, 0.01). Hearing difficulties were also associated with poorer physical health, but this did not mediate the association with memory. Psychosocial factors, however, fully mediated the relationship between hearing difficulties and memory problems (β = 0.03, p = 0.019, 95% CI = 0.00, 0.01). Adults with hearing difficulties may be more likely to self-report memory problems, irrespective of age. This study supports the psychosocial-cascade model, as the association between self-reported hearing and memory problems was explained entirely by psychosocial factors. Future studies should investigate these associations using behavioural measures, as well as explore whether interventions can reduce the risk of developing memory problems in this population. [ABSTRACT FROM AUTHOR]

Background: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by extreme preoccupation with non‐existent or minor defects in appearance, disrupting daily functioning. Melasma is a common concern among BDD patients with dermatological conditions. This study aimed to estimate the incidence and characteristics of BDD in patients with melasma, and compare the psychological condition of patients and age‐ and sex‐matched healthy controls. Methods: Patients with melasma and healthy controls were screened using the BDD Questionnaire (BDDQ), Self‐rating Anxiety Scale (SAS), and Self‐rating Depression Scale (SDS). A questionnaire was administered to collect demographic information and clinical characteristics. Standard statistical tests were conducted, such as descriptive analysis, chi‐square, and nonparametric tests. The level of statistical significance for all tests was set at a P < 0.05. Results: Among the 470 patients with melasma included in the study, 53 were positive for BDDQ in the preliminary screening and were associated with a history of treatment, higher Melasma Area and Severity Index (MASI), and Melasma Quality of Life (MELASQoL) scores, and higher SAS and SDS scores. The positive rate of BDDQ ranged from 0.4%, using the most stringent criteria to assess melasma severity, to 11.3%, without using objective criteria. Compared to healthy controls, patients with melasma had a higher positive rate of BDDQ and higher SAS and SDS scores. Conclusion: In patients with melasma who exaggerate the severity of the disease, psychiatric treatment and the patient‐physician relationship have a positive effect. This study assessed the positive rate of BDDQ in melasma and proposed the feasibility of psychiatric treatment for patients with melasma. [ABSTRACT FROM AUTHOR]

Montessori is a highly individualized pedagogy that prioritizes following each child's individual interests over standardized test scores. This quasi-experimental study compares groups of Montessori students (treatment groups, N = 535–710) with control groups of non-Montessori students, matched through the simple matching method, which controls for the effect of background variables on schooling outcomes. The tested hypothesis is that the treatment groups achieve mean scores that are not significantly lower and have a significantly higher standard deviation on standardized tests of mathematics and language. The study encompassed students in Grade 2, 5, 8, and 10 across two separate cohorts. Results indicate that Montessori students attain either comparable or significantly higher scores than non-Montessori students, depending on grade and cohort, with greater score variability observed, particularly at Grade 8 and in mathematics. This finding implies the necessity for future investigations into the effect of Montessori teachers' instructional practices. [ABSTRACT FROM AUTHOR]

The vertical toe position at minimum toe clearance (MTC) in the swing phase is critical for walking safety. Consequently, the joints involved should be strictly controlled and coordinated to stabilize the foot at MTC. The uncontrolled manifold (UCM) hypothesis framework has been used to determine the existence of synergies that stabilize relevant performance variables during walking. However, no study investigated the presence of a multi-joint synergy stabilizing the foot position at MTC and the effects of age and walking speed on this synergy. Is there a multi-joint synergy stabilizing MTC during treadmill walking? Does it depend on the persons' age and walking speed? Kinematic data from 23 young and 15 older adults were analyzed using the UCM approach. The participants walked on a treadmill at three speeds: slow, self-selected, and fast. The sagittal and frontal joint angles from the swing and stance legs and pelvis obliquity were used as motor elements and the vertical toe position at MTC was the performance variable. The variances in the joint space that affected (V ORT , 'bad' variance) and did not affect (V UCM , 'good' variance) the toe position at MTC and the synergy index (ΔV) were computed. The ΔV >0 was revealed for all subjects. Walking speed did not affect ΔV in older adults, whereas ΔV reduced with speed in young adults. ΔV was higher for older than for young adults at self-selected and fast speeds, owing to a lower V ORT in the older group. The vertical toe position at MTC was stabilized by a strong multi-joint synergy. In older adults, this synergy was stronger, as they were better at limiting V ORT than young adults. Reduced V ORT in older adults could be caused by more constrained walking, which may be associated with anxiety due to walking on a treadmill. • A multi-joint synergy (ΔV Z) stabilizes the minimum toe clearance (MTC) in walking. • ΔV Z is higher and variances (V UCM and V ORT) are lower at MTC than in the first half of swing phase. • The ΔV Z and V ORT reduced in young but not in older adults when walking in fast speed. • Older adults showed higher ΔV Z and lower V ORT than young adults. • A reduced V ORT in older adults may be a compensatory strategy adopted to constraint the MTC. [ABSTRACT FROM AUTHOR]

Background: Given students' lack of self‐directed learning skills and the growing concern about implementing massive online open courses (MOOCs) in K12 education, learning strategies are needed to facilitate MOOC learning. Many studies have provided different strategies for effective learning in MOOCs. However, there is still limited research to confirm whether these strategies effectively support MOOC learning when deployed by secondary schools, which are not MOOC developers. Objectives: This mixed‐method study examines the provision of different learning strategies, including a learning guide, an academic mentoring programme, a training workshop, and a reimbursement scheme, and investigates the impact of these strategies on student learning in MOOCs. Methods: The study uses two data sources: (1) surveys with 40 participants and (2) semi‐structured interviews with 12 participants. The quantitative data were analysed with descriptive statistics and Fisher's exact test, and the qualitative data were analysed with thematic analysis. Results and Conclusion: The findings indicate that MOOC learners had positive attitudes towards the overall school support, with mentoring enjoying great popularity amongst the students. In terms of the effectiveness of the school support, the mentoring programme and reimbursement scheme were more effective than the university training and learning guide. The paper discusses the implications for researchers and educators. Lay Description: What is already known about this topic: There are a large number of K12 MOOC implementations, which are (i) STEM‐related and computer science courses, and (ii) from Europe and the USA.Limited studies provided different learning strategies for MOOC learning from the perspective of K12 schools, which are not MOOC developers.There is a need to explore MOOC initiatives encompassing a wide variety of subjects, including computer science MOOCs and non‐computer science MOOCs, in regions beyond Europe and the USA.There is also a need for further scrutiny of the effectiveness of learning strategies provided by the K12 school. What this paper adds: Our study launched the first MOOC implementation in K12, encompassing several subject areas beyond computer science in the region of Asia.Our study provided different learning strategies adopted by the K12 school, and the analysis revealed that MOOC learners took positive attitudes towards overall school support with mentoring enjoying great popularity with these students.Our study examined the effectiveness of school support and identified that mentoring and reimbursement are more effective than university training and the learning guide. Implications for practitioners: The insights gained from the study enable other K12 schools and educators to implement MOOC into existing school infrastructures successfully.These strategies provided in the MOOC implementation program can be helpful in many different online learning contexts. [ABSTRACT FROM AUTHOR]

Objective: Compare the long-term effects of two different individualised physical activity interventions in hip or knee osteoarthritis patients. Design: Randomised, assessor-blinded, controlled trial. Setting: Primary care. Subjects: Patients with clinically verified hip or knee osteoarthritis, <150 min/week with moderate or vigorous physical activity, aged 40–74. Intervention: The advice group (n = 69) received a 1-h information and goalsetting session for individualised physical activity. The prescription group (n = 72) received information, goalsetting, individualised written prescription, self-monitoring, and four follow-ups. Main measures: Physical activity, physical function, pain and quality of life at baseline, 6, 12 and 24 months. Results: There were only minor differences in outcomes between the two groups. For self-reported physical activity, the advice group had improved from a mean of 102 (95% CI 74–130) minutes/week at baseline to 214 (95% CI 183–245) minutes/week at 24 months, while the prescription group had improved from 130 (95% CI 103–157) to 176 (95% CI 145–207) minutes/week (p = 0.01 between groups). Number of steps/day decreased by −514 (95% CI −567–462) steps from baseline to 24 months in the advice group, and the decrease in the prescription group was −852 (95% CI −900–804) steps (p = 0.415 between groups). Pain (HOOS/KOOS) in the advice group had improved by 7.9 points (95% CI 7.5–8.2) and in the prescription group by 14.7 points (95% CI 14.3–15.1) from baseline to 24 months (p = 0.024 between groups). Conclusions: There is no evidence that individualised physical activity on prescription differs from individualised advice in improving long-term effects in patients with hip or knee osteoarthritis. [ABSTRACT FROM AUTHOR]

We study a nonparametric test procedure based on order statistics for testing the null hypothesis of equality of two continuous distributions. The exact null distribution of the proposed test statistic is obtained using an enumeration method and a novel combinatorial argument. A recurrence relation for the probability generating function and a sequential approach for computing the mean and variance of the distribution are given. Critical values and characteristics of the distribution for selected small sample sizes are presented. For the Lehmann alternative family, the exact power function of the new test is derived, and its power performance is examined. We also study the power performance of the proposed test under the location-shift and scale-shift alternatives using Monte Carlo simulations and observe its superior performance when compared to commonly used nonparametric tests under various scenarios. A generalization of the proposed procedure for unequal sample sizes is discussed. An illustrative example and some concluding remarks are provided. [ABSTRACT FROM AUTHOR]

Evidence regarding the impact of empathic communication training on nurse practitioner (NP) students is lacking. Despite increasing emphasis within practice settings in the United States, formal communication training for NP students has been modestly integrated into curriculum, based on limited data supporting its efficacy. As such, we sought to evaluate the impact of empathic communication training on NP students' self-efficacy with empathic communication. This is a quasi-experimental study of a single group of NP students (n = 49) who participated in empathic communication training with pretraining/posttraining measurements using the Self-Efficacy-12 instrument. There were statistically significant improvements in students' comfort and confidence with nine of the 17 items surveyed. Several other domains also showed improvement approaching statistical significance. Based on our results, empathic communication training increases NP students' self-efficacy with empathic communication. [ABSTRACT FROM AUTHOR]

Introduction: More than half of the patients with moderate and severe osteoarthritis (OA) report unsatisfactory pain relief, requiring consideration of intra‐articular (IA) injections as the second‐line management. Ultrasound‐guided IA injection has proven evidence of higher accuracy in administering IA injectates into the joints than landmark‐guided or blind IA injections. However, questions remain about translating higher accuracy rates of ultrasound‐guided injection into better clinical improvements. Therefore, we examined the symptomatic benefits (pain, function and patient satisfaction) of ultrasound‐guided injection in knee, hip and hand OA compared with blind injections by synthesising a systematic review and meta‐analysis of randomised controlled trials (RCT). Methods: PubMed, Medline and Embase databases were searched for eligible studies from their inception to August 28, 2023. Results: Out of 295 records, our meta‐analysis included four RCTs (338 patients with knee OA), demonstrating significant improvement in procedural pain [−0.89 (95% CI −1.25, −0.53)], pain at follow‐up [−0.51 (95% CI −0.98, −0.04)] and function [1.30 (95% CI 0.86, 1.73)], favouring ultrasound guidance. One single study showed higher patient satisfaction with ultrasound guidance. Conclusion: Ultrasound‐guided IA injection provided superior clinical outcomes compared with landmark‐guided IA injection. [ABSTRACT FROM AUTHOR]

The study concentrates on two different genetic programming approaches for determining passenger car equivalent (PCE) values and observing the impact on capacity estimation at urban unsignalized intersections. Considering heterogeneous traffic conditions, a new PCE value is introduced to encompass sustainable modes of public transit vehicles, specifically slow-moving three-wheelers (SM3W), commonly known as E-Rickshaws. Since PCE value is considered an important parameter for capacity calculations, the present study considered 14 unsignalized intersections located in Ranchi city of India. An automatic plate recognition system is employed to have the count of vehicular traffic. The methodologies include age-layered population structure genetic programming (ALPSGP), and the offspring selection genetic programming (OSGP) approach that incorporates static and dynamic variables. Based on the significance test and ranking of the genetic programming (GP) models, the OSGP model is recommended as the most appropriate model for heterogeneous traffic. Sensitivity analysis reported that lagging headway () is the most contributing factor in PCE estimation. The PCE value of SM3W is found to be 0.81 and that could be incorporated as a new classification of vehicles in Indo-HCM. It is observed that evaluated capacity based on PCE values of OSGP performed admirably in both normal and congested traffic situations. [ABSTRACT FROM AUTHOR]

This study concerns the management of operational risk in truck transport using the reliability theory of risks. In this regard, the risk analysis of changes in the vehicle unavailability represents an important topic. In this study, the authors present their own method for analysing the phase changes in risk corresponding to successive sections (phases) of vehicle mileage. The presented risk analysis method is based on an integrated assessment of losses associated with the costs of incidental repairs and losses caused by lost income during vehicle downtime. This includes the following: assessment of differences in average risk and differences in the coefficient of variation in the time series of vehicle mileage phases, indicating the outliers and extremes of phase risk, identifying their physical causes and testing the statistical significance of phase risk differences. The proposed method is described mathematically and verified experimentally based on the operational data concerning trucks from two selected brands (20 trucks from each brand). We show that the method can be used to predict the continuity of transport services in the short term (one-year horizon). The method could also be useful to compare vehicles of different brands in the context of their sensitivity to operational risks. [ABSTRACT FROM AUTHOR]

The material developed focuses on the analysis of energy efficiency trends in Poland, utilising ODEX indicators for the sectors of industry, transport, households and in general, from 2011 to 2021. The objective of the study is to assess the progress made in energy efficiency and to forecast future trends in these sectors. The methods employed are based on statistical modelling of time series, taking into account sector-specific energy consumption dynamics. The following techniques were employed: linear regression, cluster analysis to identify patterns of change, statistical hypothesis testing for energy efficiency and simplified autoregressive models. The results demonstrated significant improvements in energy efficiency in the industrial sector, stability of the ODEX indicator in the transport sector and gradual improvements in households and overall. The prediction indicates an upward trend in the ODEX indicator in the short term, suggesting an increase in energy demand. However, it also predicts a decline in the long term, which may indicate the effectiveness of future energy efficiency strategies and investments. Consequently, the necessity for continued efforts to increase energy efficiency and further research into the factors influencing energy efficiency in different economic sectors is emphasised. [ABSTRACT FROM AUTHOR]

Introduction: Pneumothorax is associated with poor prognosis in patients with acute respiratory distress syndrome (ARDS). We sought to examine the outcomes of patients who are supported on veno-venous extracorporeal membrane oxygenation (VV ECMO) and develop a pneumothorax. Methods: We retrospectively reviewed all adult VV ECMO patients supported for ARDS between 8/2014-7/2020 at our institution, excluding patients with recent lung resection and trauma. Clinical outcomes were compared between patients with a pneumothorax to those without a pneumothorax. Results: Two hundred eighty patients with ARDS on VV ECMO were analyzed. Of those, 213 did not have a pneumothorax and 67 did. Patients with a pneumothorax had a longer duration of ECMO support (30 days [16–55] versus 12 [7–22], p < 0.001) and hospital length of stay (51 days [27–93] versus 29 [18–49], p < 0.001), and lower survival-to-discharge (58.2% versus 77.5%, p = 0.002) compared to patients without a pneumothorax. Controlling for age, BMI, sex, RESP score and pre-ECMO ventilator days, the odds ratio of survival-to-discharge was 0.41 (95% CI 0.22–0.78) in patients with a pneumothorax compared to those without. There was a lower incidence of significant bleeding when chest tubes were placed by proceduralist services (2.4% versus 16.2%, p = 0.03). Removal of the chest tube prior to ECMO decannulation compared to removal after decannulation was associated with need for replacement (14.3% versus 0%, p = 0.01). Conclusion: Patients who develop a pneumothorax and are supported with VV ECMO for ARDS have longer duration on ECMO and decreased survival. Further studies are needed to assess risk factors for development of pneumothorax in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare workforce diversity is essential for increasing access and reducing racial/ethnic health disparities. We examined the growth and trends in physician assistant/associate (PA) workforce demographic composition by initial year of certification. Methods: Drawing on data from the National Commission on Certification of Physician Assistants, we aggregated gender, age (1975-2020), race/ethnicity, and underrepresented in medicine (URiM) (2000-2020). Descriptive statistics of demographics were calculated by the initial certification year and assessed for trends using the Cochran-Armitage test. Results: Analyses revealed an 11.7% annual growth rate in PAs earning initial certification and a change in gender composition (23.9% to 74.2% female) from 1975 to 2020. Between 2000 and 2020, we observed significant increases (all p<0.001) in the proportions of PAs who self-identify as Asian (5.7 percentage points), Hispanic/Latino(a) (3.5 percentage points), and multiracial (2.4 percentage points). However, there was a decline (all p<0.001) in the proportions of PAs who self-identify as Black/African American (1.2 percentage points), American Indian/Alaska Native (0.1 percentage points), Native Hawaiian/Pacific Islander (0.1 percentage points), and other race (1.1 percentage points). Trend analyses revealed that the proportion of PAs identifying as URiM decreased over the past 21 years. Conclusion: Ongoing assessment of the PA workforce demographics is essential to track the progress and effectiveness of diversification initiatives. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Eating Assessment Tool (PEDI‐EAT‐10) is a reliable and valid tool for rapid identification of dysphagia in patients aged 18 months to 18 years. Aims: To translate and adapt the PEDI‐EAT‐10 into the Italian language and evaluate its validity and reliability. Methods & Procedures: The translation and cross‐cultural adaptation of the tool consisted of five stages: initial translation, synthesis of the translations, back translation, expert committee evaluation and test of the prefinal version. The internal consistency of the translated tool was analysed in a clinical group composed of 200 patients with special healthcare needs aged between 18 months and 18 years. They were consecutively enrolled at the Rare Disease Unit, Paediatrics Department, Fondazione Policlinico Agostino Gemelli‐IRCCS, Rome. For test–retest reliability, 50 caregivers filled in the PEDI‐EAT‐10 questionnaire for a second time after a 2‐week period. Construct validity was established by comparing data obtained from patients with data from healthy participants (n = 200). The study was approved by the local ethics committee. Outcomes & Results: Psychometric data obtained from patients (104 M; mean age = 8.08 ± 4.85 years; median age = 7 years) showed satisfactory internal consistency (Cronbach's α = 0.89) and test–retest reliability (Pearson r = 0.99; Spearman r = 0.96). A total of 30% of children were classified as having a high risk of penetration/aspiration. The Italian PEDI‐EAT‐10 mean total score of the clinical group was significantly different from that resulting from healthy participants. Conclusions & Implications: The PEDI‐EAT‐10 was successfully translated into Italian, validated and found to be a reliable one‐page rapid screening tool to identify dysphagia in children and adolescents with special needs. What this paper adds: What is already known on the subject: The PEDI‐EAT‐10 is a valid and reliable quick discriminative paediatric tool for identifying penetration/aspiration risks. What this paper adds to the existing knowledge: In the present study we successfully translated and adapted the PEDI‐EAT‐10 into the Italian language. What are the potential or actual clinical implications of this work?: This translation and adaptation increase access to valid feeding and swallowing assessment for children of Italian‐speaking families. In addition, the I‐PEDI‐EAT‐10 can suggest further assessment of patients' swallowing abilities. [ABSTRACT FROM AUTHOR]

Background: Accurate measurement of polyps size is crucial in predicting malignancy, planning relevant intervention strategies and surveillance schedules. Endoscopists' visual estimations can lack precision. This study builds on our prior research, with the aim to evaluate a recently developed quantitative method to measure the polyp size and location accurately during a simulated endoscopy session. Methods: The quantitative method merges information about endoscopic positions obtained from an electromagnetic tracking sensor, with corresponding points on the images of the segmented polyp border. This yields real-scale 3D coordinates of the border of the polyp. By utilising the sensor, positions of any anatomical landmarks are attainable, enabling the estimation of a polyp's location relative to them. To verify the method's reliability and accuracy, simulated endoscopies were conducted in pig stomachs, where polyps were artificially created and assessed in a test–retest manner. The polyp measurements were subsequently compared against clipper measurements. Results: The average size of the fifteen polyps evaluated was approximately 12 ± 4.3 mm, ranging from 5 to 20 mm. The test–retest reliability, measured by the Intraclass Correlation Coefficient (ICC) for polyp size estimation, demonstrated an absolute agreement of 0.991 (95% CI 0.973–0.997, p < 0.05). Bland & Altman analysis revealed a mean estimation difference of − 0.17 mm (− 2.03%) for polyp size and, a mean difference of − 0.4 mm (− 0.21%) for polyp location. Both differences were statistically non-significant (p > 0.05). When comparing the proposed method with calliper measurements, the Bland & Altman plots showed 95% of size estimation differences between − 1.4 and 1.8 mm (− 13 to 17.4%) which was not significant (p > 0.05). Conclusions: The proposed method of measurements of polyp size and location was found to be highly accurate, offering great potential for clinical implementation to improve polyp assessment. This level of performance represents a notable improvement over visual estimation technique used in clinical practice. [ABSTRACT FROM AUTHOR]

Many segmentation or change‐point detection methods for homogenizing climate time series compare candidate station data with reference data to eliminate common climate signals and more efficiently detect spurious, non‐climatic changes. One drawback is that it is difficult to decide whether the detected change‐point is due to the candidate series or to the reference. A so‐called attribution procedure is typically applied in a post‐processing step for each detected change‐point. This article describes a new statistical method for the attribution of change‐points detected in Global Navigation Satellite System (GNSS) minus reanalysis series of integrated water vapour. It requires at least one nearby station with similar GNSS and reanalysis data. Six series of differences are formed from the four base series (BS) and are tested for a significant jump at the time of the change‐point detected in the candidate station. The six test results are analysed with a statistical predictive rule to attribute the change‐point to one, or several, of the four BS. Original aspects of our method are: (1) the significance test, which is based on a generalized linear regression approach, taking both heteroscedasticity and autocorrelation into account; (2) the predictive rule, which uses a machine learning method and is constructed from the test results obtained with the real data by using a resampling strategy. Four popular machine learning methods have been compared using cross‐validation and the best one was applied to a real data set (49 main stations with 114 change‐points). The results depend on the choice of the test significance level and the aggregation method combining the prediction results when several nearby stations are available. We find that 62% of the change‐points are attributed to GNSS, 19% to the reanalysis, and 10% are due to coincident detections. [ABSTRACT FROM AUTHOR]

The cognitive advantage (CA) hypothesis claims that multilingualism promotes the development of several basic cognitive capacities. A large number of empirical findings support this hypothesis, but recently there have also been numerous contradictory findings and methodological objections. The present paper extends the investigation of possible cognitive advantages from basic cognitive (executive) functions to broader cognitive competencies such as cognitive flexibility. A promising candidate for this is 'flexibility of goal adjustment' (FGA), a capacity of developmental regulation that solves problems through flexible adaptation processes. In a study with N = 119 monolingual and multilingual adults we found the predicted positive correlation between multilingualism and FGA. However, the mediator function of executive capacities entailed in the CA hypothesis operationalised as Stroop and flanker tasks could not be demonstrated. [ABSTRACT FROM AUTHOR]

Hydraulic fracturing (HF) is commonly used to enhance onshore recovery of oil and gas during production. This process involves the use of a variety of chemicals to support the physical extraction of oil and gas, maintain appropriate conditions downhole (e.g., redox conditions, pH), and limit microbial growth. The diversity of chemicals used in HF presents a significant challenge for risk assessment. The objective of the present study is to establish a transparent, reproducible procedure for estimating 5th percentile acute aquatic hazard concentrations (e.g., acute hazard concentration 5th percentiles [HC5s]) for these substances and validating against existing toxicity data. A simplified, grouped target site model (gTSM) was developed using a database (n = 1696) of diverse compounds with known mode of action (MoA) information. Statistical significance testing was employed to reduce model complexity by combining 11 discrete MoAs into three general hazard groups. The new model was trained and validated using an 80:20 allocation of the experimental database. The gTSM predicts toxicity using a combination of target site water partition coefficients and hazard group‐based critical target site concentrations. Model performance was comparable to the original TSM using 40% fewer parameters. Model predictions were judged to be sufficiently reliable and the gTSM was further used to prioritize a subset of reported Permian Basin HF substances for risk evaluation. The gTSM was applied to predict hazard groups, species acute toxicity, and acute HC5s for 186 organic compounds (neutral and ionic). Toxicity predictions and acute HC5 estimates were validated against measured acute toxicity data compiled for HF substances. This case study supports the gTSM as an efficient, cost‐effective computational tool for rapid aquatic hazard assessment of diverse organic chemicals. Environ Toxicol Chem 2024;43:1161–1172. © 2024 ExxonMobil Petroleum and Chemical BV. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. [ABSTRACT FROM AUTHOR]

Air pollution is a growing concern in today's urbanized world, necessitating efficient and accurate methods for air quality monitoring. The proliferation of IoT devices has led to a surge in the generation of time-series data. With its high volume and complexity, this surge in time-series data necessitates cloud-based solutions for handling and analyzing this data effectively. However, existing methods for air quality monitoring face challenges in capturing the complex patterns and dynamics of air pollution, which often exhibit both linear and nonlinear characteristics. Air pollution data often exhibit both linear and nonlinear characteristics. Linearity and nonlinearity refer to the nature of the relationships within the data. Some aspects of air quality, such as pollutant concentrations, may follow linear patterns, while other factors, like the interaction of multiple pollutants and environmental conditions, exhibit nonlinear relationships. This complexity arises from the multifaceted nature of air quality dynamics, which various factors and interactions can influence. To address these challenges, this study introduces a novel hybrid time-series approach that combines the proven strengths of two well-established techniques: traditional time-series autoregressive integrated moving average (ARIMA) and soft computing adaptive neuro-fuzzy inference system (ANFIS). The hybrid model is designed to provide a comprehensive solution that accommodates the diverse characteristics of air quality time-series data. To assess the efficacy of our proposed model, we conducted extensive experiments using real-world air pollution datasets obtained from the Ministry of Environment, Forest and Climate Change of India, covering the period from January 2015 to July 2020. Our evaluation includes a range of performance metrics such as root-mean-square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE), and mean squared logarithmic error (MSLE). Specifically, our model demonstrates exceptional accuracy, with notably low error values for key metrics such as air quality index (AQI) and PM2.5. Furthermore, we subjected our innovative hybrid model to rigorous statistical testing using the Diebold-Mariano test, establishing the significance and superiority of our approach. This research advances our understanding of air quality prediction and offers a valuable solution for mitigating the detrimental effects of air pollution on public health and the environment. [ABSTRACT FROM AUTHOR]

The aim is to pilot a low-touch program for reducing benzodiazepine receptor agonist (BZRA; benzodiazepines, z-drugs) prescriptions among older veterans. Pilot randomized controlled trial consists of 2,009 veterans aged ≥ 65 years who received BZRA prescriptions from a Veterans Health Administration pharmacy (Colorado or Montana) during the prior 18 months. Active: Arm 1 was a mailed brochure about BZRA risks that also included information about a free, online cognitive behavioral therapy for the insomnia (CBTI) program. Arm 2 was a mailed brochure (same as arm 1) and telephone reinforcement call. Control: Arm 3 was a mailed brochure without insomnia treatment information. Active BZRA prescriptions at follow-up (6 and 12 months) were measured. In logistic regression analyses, the odds of BZRA prescription at 6- and 12-month follow-ups were not significantly different for arm 1 or 2 (active) versus arm 3 (control), including models adjusted for demographics and prescription characteristics (p-values >0.36). Although we observed no differences in active BZRA prescriptions, this pilot study provides guidance for conducting a future study, indicating a need for a more potent intervention. A full-scale trial testing an optimized program would provide conclusive results. Mailing information about BZRA risks and CBTI did not affect BZRA prescriptions. [ABSTRACT FROM AUTHOR]

Granger causality is a classical and important technique for measuring predictability from one group of time series to another by incorporating information of the variables described by a full vector autoregressive (VAR) process. However, in some applications economic forecasts need to be made based on information provided merely by a portion of variates (e.g., removal of a listed stock due to halting, suspension or delisting). This requires a new formulation of forecast based on an embedded subprocess of VAR, whose theoretical properties are often difficult to obtain. To avoid the issue of identifying the VAR subprocess, we propose a computation‐based approach so that sophisticated predictions can be made by utilizing a reduced variable information set estimated from sampled data. Such estimated information set allows us to develop a suitable statistical hypothesis testing procedure for characterizing all designated Granger causal relationships, as well as a useful graphical tool for presenting the causal structure over the prediction horizon. Finally, simulated data and a real example from the stock markets are used to illustrate the proposed method. [ABSTRACT FROM AUTHOR]

Because Null Hypothesis Significance Tests (NHST) can be misleading particularly when sample sizes are large, reporting effect sizes is recommended. Effect sizes such as Cohen's d, however, are abstract statistics and not relevant to decision-making. This article introduced an alternative formulation of Cohen's d based on a "minimal important percent difference" (MIPD) between groups that has an intuitive, practical meaning. Cohen's d was calculated based on detecting MIPDs of 5% and 10% differences in means. Power analyses were used to determine the number of responses needed to detect differences in means. Power-probability sample size requirements were examined for an 80% and a 50% chance of accepting a difference of MIPD at p <.05. We proposed a four-step process to show how both effect size and NHST jointly contribute to decision-making. To demonstrate the process, data were obtained for 6 years of annual waterfowl surveys in Illinois (N = 17,265, average response rate = 41%). [ABSTRACT FROM AUTHOR]

The escalating process of urbanization has raised concerns about incidents arising from overcrowding, necessitating a deep understanding of large human crowd behavior and the development of effective crowd management strategies. This study employs computational methods to analyze real-world crowd behaviors, emphasizing self-organizing patterns. Notably, the intersection of two streams of individuals triggers the spontaneous emergence of striped patterns, validated through both simulations and live human experiments. Addressing a gap in computational methods for studying these patterns, previous research utilized the pattern-matching technique, employing the Nelder-Mead Simplex algorithm for fitting a two-dimensional sinusoidal function to pedestrian coordinates. This paper advances the pattern-matching procedure by introducing Simulated Annealing as the optimization algorithm and employing a two-dimensional square wave for data fitting. The amalgamation of Simulated Annealing and the square wave significantly enhances pattern fitting quality, validated through statistical hypothesis tests. The study concludes by outlining potential applications of this method across diverse scenarios. [ABSTRACT FROM AUTHOR]

Background: Misconceptions about male nurses not only exacerbate the gender imbalance in the nursing profession but also negatively impact male nurses embarking on their careers. Currently, no tool exists to measure the gender biases toward males in nursing among nursing students in China. Consequently, the primary objective of this study is to assess the validity and reliability of the Chinese translation of the Gender Misconceptions of Men in Nursing (GEMINI) scale among nursing students. Methods: This cross-sectional study involved 1,102 nursing students from China who participated online. We utilized the Brislin translation technique with a forward-backward approach. To determine the factor structure within the Men in Nursing Gender Misconceptions Scale's Chinese version, both exploratory (EFA) and confirmatory factor analysis (CFA) were applied. The scale's internal consistency was measured through the Cronbach's alpha coefficient, corrected item-total correlation, and a retest reliability assessment. Results: The scale showed a content validity index of 0.938 and a retest reliability of 0.844. EFA indicated a two-factor structure for the translated instrument. CFA revealed a chi-square/degree of freedom of 3.837, an incremental fit index (IFI) of 0.952, a goodness-of-fit index (GFI) of 0.910, a comparative fit index (CFI) of 0.952, and an RMSEA of 0.073, all of which were within acceptable limits. The scale's Cronbach's α was 0.953, and the corrected item-total correlations ranged between 0.539 and 0.838. Gender-based misconceptions about men in nursing among students appeared to be influenced by their gender and whether they considered a nursing program as their first choice when applying for a major. Misconceptions about male nurses are greater among men and those who do not consider nursing programs as their first choice when applying for a major. Conclusions: The Chinese adaptation of the GEMINI scale showcased high reliability and validity. It stands as a potential instrument to gauge gender misconceptions concerning male nurses among Chinese nursing students. [ABSTRACT FROM AUTHOR]

Detecting epistatic drivers of human phenotypes is a considerable challenge. Traditional approaches use regression to sequentially test multiplicative interaction terms involving pairs of genetic variants. For higher-order interactions and genome-wide large-scale data, this strategy is computationally intractable. Moreover, multiplicative terms used in regression modeling may not capture the form of biological interactions. Building on the Predictability, Computability, Stability (PCS) framework, we introduce the epiTree pipeline to extract higher-order interactions from genomic data using tree-based models. The epiTree pipeline first selects a set of variants derived from tissue-specific estimates of gene expression. Next, it uses iterative random forests (iRF) to search training data for candidate Boolean interactions (pairwise and higher-order). We derive significance tests for interactions, based on a stabilized likelihood ratio test, by simulating Boolean tree-structured null (no epistasis) and alternative (epistasis) distributions on hold-out test data. Finally, our pipeline computes PCS epistasis p-values that probabilisticly quantify improvement in prediction accuracy via bootstrap sampling on the test set. We validate the epiTree pipeline in two case studies using data from the UK Biobank: predicting red hair and multiple sclerosis (MS). In the case of predicting red hair, epiTree recovers known epistatic interactions surrounding MC1R and novel interactions, representing non-linearities not captured by logistic regression models. In the case of predicting MS, a more complex phenotype than red hair, epiTree rankings prioritize novel interactions surrounding HLA-DRB1, a variant previously associated with MS in several populations. Taken together, these results highlight the potential for epiTree rankings to help reduce the design space for follow up experiments. [ABSTRACT FROM AUTHOR]

To describe physical functioning after severe COVID-19-infection. An explanatory sequential mixed method design was used. Thirty-nine participants performed tests and answered questionnaires measuring physical functioning six months after hospitalisation due to COVID-19. Thirty of these participants participated in semi-structured interviews with questions regarding how they perceived their physical functioning and recovery from COVID-19 at 12 months post-hospitalisation. At six months, physical functioning measured via chair stand test and hip-worn accelerometers was lower than normal reference values. There was a reduction in breathing muscle strength. Participants estimated their functional status during different activities as lower compared to those before COVID-19-infection, measured with a patient-specific functional scale. At one year after infection, there were descriptions of a rough recovery process and remaining symptoms. Patients recovering from severe COVID-19 seem to have reduced physical functioning and activity levels, and they perceive their recovery to be slow and difficult. They experienced a lack of clinical support and contradictory advice regarding rehabilitation. Coaching in returning to physical functioning after the infection needs to be better co-ordinated and there is a need for guidelines for health professionals to avoid patients receiving contradictory advice. Coronavirus infection disease-19 (COVID-19) can have a great impact on a person's physical functioning. In the early course of the COVID-19 pandemic there were not any clear guidelines regarding rehabilitation for this group of patients. As some people with COVID-19 may have impairments in their physical functioning up to one year after leaving hospital there is a need to provide rehabilitation. [ABSTRACT FROM AUTHOR]

We propose and evaluate an automated pipeline for discovering significant topics from legal decision texts by passing features synthesized with topic models through penalized regressions and post-selection significance tests. The method identifies case topics significantly correlated with outcomes, topic-word distributions which can be manually interpreted to gain insights about significant topics, and case-topic weights which can be used to identify representative cases for each topic. We demonstrate the method on a new dataset of domain name disputes and a canonical dataset of European Court of Human Rights violation cases. Topic models based on latent semantic analysis as well as language model embeddings are evaluated. We show that topics derived by the pipeline are consistent with legal doctrines in both areas and can be useful in other related legal analysis tasks. This article is part of the theme issue 'A complexity science approach to law and governance'. [ABSTRACT FROM AUTHOR]

Objective: Return to work and permanence in employment of women who survive breast cancer are topics that become important as incidence and survival rates increase. Self-efficacy as a modifiable element is of special interest in this process. The objective of this study is to measure the level of self-efficacy in female breast cancer survivors, according to sociodemographic, work and treatment characteristics and their relationship with return to work. Methods: This was a cross-sectional study, based on a survey of breast cancer patients about their demographic and work characteristics, the return to work process, permanence in the same job and the level of work self-efficacy. Differences in the level of self-efficacy with respect to characteristics were evaluated using bivariate analyses and hypothesis statistical testing. A value of p<0.05 was considered statistically significant. Results: One hundred and twenty-four women were included, 87.9% had returned to work, the majority (56.4%) between one and six months after treatment, 67.7% remained in the same job. Higher levels of work self-efficacy were related to a higher probability of returning to work and staying there, and a shorter time to return to work; these differences were statistically significant. Conclusion: Occupational health and risk prevention services must consider and strengthen work self-efficacy and organizational support in breast cancer survivors to achieve a successful return to work [ABSTRACT FROM AUTHOR]

State-of-the-art 1D transport solvers ASTRA and TRANSP are verified, then validated across a large database of semi-randomly selected, time-dependent DIII-D discharges. Various empirical models are provided as baselines to contextualize the validation figures of merit using statistical hypothesis tests. For predicting plasma temperature profiles, no statistically significant advantage is found for the ASTRA and TRANSP simulators over a baseline empirical (two-parameter) model. For predicting stored energy, a significant advantage is found for the simulators over a baseline empirical model based on confinement time scaling. Uncertainty in the results due to diagnostic and profile fitting uncertainties is approximated and determined to be insignificant due in part to the large quantity of discharges employed in the study. Advantages are discussed for validation methodologies like this one that employ (1) large databases and (2) baselines for comparison that are specific to the intended use-case of the model. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession. Methods This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed. Results Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (−16.89%), days to initiate therapy (−13.43%), and episode length (−13.78%). Conclusion Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes. Impact Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care. [ABSTRACT FROM AUTHOR]

Romans 8:20-22 is the prooftext par excellence for the hypothesis that the natural world is fallen. The basis for that hypothesis is challenged as follows: "subjected to futility" refers principally to Gen 1:26-28, not Gen 3:17-18, and must be interpreted as such; "bondage to decay" is best understood through the OT's naturalistic view of environmental phenomena; "groaning in labor pains" is not a periphrasis for animal suffering, but a personification of the creation-sin antipathy. While Paul assumes that sin can have extrinsic effects on creation, Rom 8:20-22 does not imply that creation was vitiated intrinsically by the fall, and thus the passage is fully compatible with the notion that the natural world retains the full extent of its prelapsarian integrity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Behavioral health disorders (BHDs) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes. STUDY DESIGN: Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018 and 2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Postoperative textbook outcomes (ie no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed. RESULTS: Among 694,836 cancer patients, 46,719 (6.7%) patients had at least 1 BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs BHD: 20.3%; p < 0.001). Among surgical patients, individuals with BHD had higher odds of a complication (odds ratio [OR] 1.32 [1.26 to 1.39]), prolonged length of stay (OR 1.36 [1.29 to 1.43]), and 90-day readmission (OR 1.57 [1.50 to 1.65]) independent of social vulnerability or hospital-volume status resulting in lower odds to achieve a TO (OR 0.66 [0.63 to 0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs BHD: $17,432; p < 0.001). Of note, patients with BHD had worse long-term postoperative survival (median, no BHD: 46.6 [45.9 to 46.7] vs BHD: 37.1 [35.6 to 38.7] months) even after controlling for other clinical factors (hazard ratio 1.26 [1.22 to 1.31], p < 0.001). CONCLUSIONS: BHD was associated with lower likelihood to achieve a postoperative textbook outcome, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery. [ABSTRACT FROM AUTHOR]

Introduction: Urolithiasis is one of the most common urological problems worldwide. The fastest treatment modality to achieve stone clearance of ureteral stones is Ureteroscopic Lithotripsy (URSL). However, it is negated by both the cost burden and potential risk to the patient. Medical Expulsive Therapy (MET) is a treatment option for upto 10 mm stones but has failure rates of 40-60% in the literature. Aim: To analyse the various indications for surgery, whether MET was used or not, if used-its details, operative findings at ureteroscopy including the reason for the failure of MET. Materials and Methods: A cross-sectional study consisting of 72 patients with ureteric calculi undergoing URSL was analysed from June 2017 to December 2018 at Mazumdar Shaw Medical Centre, Bangalore, Karnataka, India. Indications were assessed at the time of admission. During ureteroscopy, factors like impaction, distal obstruction, and unusual findings were studied, which could have contributed to the failure of MET. The Chi-square test was used as a test of significance for categorical data. The Analysis of Variance (ANOVA) test was used as a test of significance to identify the mean difference between continuous variables. The p-value of <0.05 was considered statistically significant. Results: The mean age in the study was 41.65±13.4 years (range 20-69 years), and the mean stone size was 10.03±3.34 mm. Large stone was the most common indication (41, 56.9%, p=0.004), followed by failed MET (35, 48.6%). Even though MET could have been continued for four weeks in 17 patients (23.6%), they were taken up for surgery. The impaction rate was 70.8% (51), with 48.6% (35) being large impacted stones and 22.2% (16) being small impacted stones. The overall stone clearance rate was 68 out of 72 (94.4%). Conclusion: Large stone size (=10 mm) and failed MET were the main indications for surgery. One reason for the failure of MET was not waiting for a duration of four weeks. During ureteroscopy, impaction of the stone, irrespective of size, was the most common finding and was the reason for the failure of MET. Ureteric stones on MET should not be neglected as there are reasons for the failure of MET, and they will require URSL after four weeks. [ABSTRACT FROM AUTHOR]

Parkinsonism‐dystonia‐2 PKDYS2 is an autosomal‐recessive disorder, caused by pathogenic biallelic variants in SLC18A2 which encodes the vesicular monoamine transporter (VMAT2) protein. PKDYS2 is a treatable neurotransmitter disease, and the rate of diagnosis of this disorder has increased significantly with the advance of genomic technologies. Our report highlights a novel pathologic variant in one case and a novel finding on MRI Brain, consisting of a normal symmetrical signal intensity in the dorsal brainstem and pons, and it substantiates the significance of genetic testing in the evaluation of children with developmental delays, which influences clinical decisions to enhance patient outcomes. [ABSTRACT FROM AUTHOR]

The present in vitro study aimed to evaluate the influence of various surface treatments on the micro-shear bond strength (μSBS) of calcium silicate–based materials (CSMs) to resin composite. Two hundred and forty cylindrical acrylic molds were filled with Biodentine, NeoMTA Plus, NeoPUTTY MTA, TheraCal LC, and Well-Root PT. The specimens were divided into four groups: control with no surface treatment, acid-etching, tribochemical silica coating (TSC), sandblasting with aluminum oxide (AL). Resin composite was applied and photo-polymerized. The μSBS was measured and surface alterations were evaluated using a SEM. Data were examined using two-way ANOVA and Tukey tests at a significance level of 5%. The lowest bond strength values were detected in the controls. Moreover, the lowest μSBS was demonstrated in the untreated NeoMTA Plus group, whereas the aluminum oxide–treated TheraCal LC group exhibited the highest bond strength (p < 0.05). Cohesive failures were observed dominantly for Biodentine and TheraCal LC, adhesive failures in Well-Root PT, and mixed failures for NeoPUTTY MTA. Surface treatments increased the μSBS values of CSMs and affected the micromorphology of the sample surfaces. The study suggests that surface treatments would be advantageous on CSMs. [ABSTRACT FROM AUTHOR]

Background: Endoscopic submucosal dissection (ESD) was widely used for the removal of esophageal tumors, and post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) was one of the postoperative adverse events. The aim of this research was to develop and validate a model to predict electrocoagulation syndrome after endoscopic submucosal dissection of esophageal tumors. Materials and methods: Patients who underwent esophageal ESD in our hospital were retrospectively included. A predictive nomogram was established based on the results of multivariate logistic regression analysis, and bootstrapping resampling was used for internal validation. Besides, the clinical usefulness of the nomogram was evaluated using decision curve analysis (DCA) and clinical impact curve. Results: A total of 552 patients who underwent esophageal ESD were included in the study, and the incidence of PPECS was 12.5% (69/552). Risk factors associated with PEECS (p < 0.1) were analyzed by multivariate logistic regression analysis, and the final model included four variables, namely gender, diabetes, tumor size and operation time. The predictive nomogram was constructed based on the above four variables, and the area under the ROC curve (AUC) was 0.811 (95% CI 0.767–0.855). The calibration curve of the nomogram presented good agreement between the predicted and actual probabilities. DCA showed that the model improved patient outcomes by helping to assess the risk of PEECS in patients compared to an all-or-no treatment strategy. In addition, the clinical impact curve of the model also indicates that the nomogram has a high clinical net benefit. Conclusion: In conclusion, we have developed a predictive nomogram for PEECS after ESD for esophageal tumors with good predictive accuracy and discrimination. This predictive nomogram can be effectively used to identify high-risk patients with PEECS, which will help clinicians in clinical decision-making and early intervention. [ABSTRACT FROM AUTHOR]

Background: Psychological Clearance level (PCL) for patients undergoing metabolic and bariatric surgery (MBS) is a critical step for successful postoperative outcomes. This study aims to assess the relationship between the level of psychologic fitness and postoperative outcomes in patients undergoing MBS. Methods: We retrospectively analyzed the data of patients who underwent MBS (laparoscopic sleeve gastrectomy [LSG] and laparoscopic Roux-en-Y Gastric Bypass [LRYGB]) and completed two years follow-up, between 2012 and 2019, in a single medical center. The patients were divided into four groups based on PCL, suggesting level of readiness for surgery: Group A (PCL-0: guarded), group B (PCL-1: Fair/reasonable), group C (PCL-2: Good/appropriate), and group D (PCL-3: Strong/excellent). Primary outcome was the percent of total body weight loss (%TWL), and the absolute change in BMI units. Secondary outcomes were missed postoperative visits and patient compliance. Differences between the groups were analyzed using a generalized linear model (GLM), chi-squared and exact Fisher tests, as appropriate. Results: Of 1411 total patients, 607 (43.20%) had complete data at two years follow-up. 512 (84.34%) were females. LSG was performed in 361 (59.5%). No difference was found in %TWL between the four groups (22.14% vs. 28.0% vs. 26.0% vs. 24.8%, p = 0.118). We found a small difference in the mean (SD) of absolute change in BMI between the groups, and on post-hoc analysis it was found between groups B (PCL-1) and D (PCL-3). Overall, no difference between the groups in number of follow-up visits, or compliance issues. However, patients who attended more follow-up visits had less compliance issues (p < 0.001). PCL is inversely correlated with number of psychologic diagnoses (r = − 0.41, p < 0.001) and medical comorbidities (r = − 0.20, p < 0.001). Conclusion: We found no difference in the percent of TWL in patients who underwent MBS based on PCL at two -years follow-up. Medical comorbidities and psychiatric diagnoses impact the PCL. [ABSTRACT FROM AUTHOR]

To longitudinally investigate speech production (consonant proficiency, consonant errors and perceived velopharyngeal competence) in 17 internationally adopted (IA) children with unilateral cleft lip and palate (UCLP) at three time points. Consonant proficiency (percent consonants correct, consonant inventory) and number and type of consonant errors were calculated based on blind phonetic transcriptions of words from the Swedish Test of Articulation and Nasality (SVANTE). Velopharyngeal competence was perceptually rated by three blinded experienced speech-language pathologists at the ages of 3, 5 and 7–8 years. A significant positive development of speech production was found, although most children still scored very low for consonant proficiency at the age of 7–8 compared with normative values: the median for percent consonants correct was 79.7 and many children still had persisting cleft-related and developmental consonant errors. At the age of 7–8, almost half of the children were rated as having a competent velopharyngeal function and only three as having an incompetent velopharyngeal function. Persisting speech difficulties at school age in IA children with UCLP were found in the present study, which is one of the very few longitudinal studies. Our results highlight the need for detailed follow-up of speech production in clinical settings. Speech disorders may have a severe impact on a child's intelligibility and participation with peers, and there is a need for more studies investigating the actual everyday effect of the difficulties found. [ABSTRACT FROM AUTHOR]

Objectives: More than half of women do not achieve appropriate gestational weight gain. Maternal body image may be an important factor associated with gestational weight gain. However, this association has not been thoroughly evaluated. We aimed to elucidate whether body image parameters before and during pregnancy are associated with gestational weight gain in Japanese women. Methods: This prospective cohort study was conducted at a hospital in Osaka, Japan from March 2020 to March 2021. We recruited women with singleton pregnancies in their second and third trimesters. Body image was assessed using the Pregnancy and Weight Gain Attitude Scale and additional questions. Gestational weight gain was classified as insufficient, appropriate, or excessive based on recommended ranges in Japan. One-way analysis of variance, chi-square tests, and multinomial logistic regression analyses were performed to identify factors associated with insufficient or excessive weight gain. Results: Of 266 enrolled women, 47 had insufficient weight gain and 100 had excessive weight gain during pregnancy. Risk factors for excessive gestational weight gain included a history of dietary restriction before pregnancy, negative attitudes toward gestational weight gain, and perception of body shape as fat and body shape dissatisfaction during pregnancy. Perception of body shape as thin during pregnancy was identified as a risk factor for insufficient gestational weight gain. Conclusions: Body image before and during pregnancy may be an important factor in preventing insufficient or excessive gestational weight gain in Japanese women. Healthcare professionals should consider body image when providing health guidance on weight management to pregnant women. Significance: What is Already Known? Body image is a possible factor in gestational weight gain. Compared to women in other countries, Japanese women of reproductive age tend to have a negative body image. What this Study adds? A history of dietary restriction before pregnancy and negative body image during pregnancy were associated with excessive gestational weight gain among Japanese women. Perception of body shape during pregnancy as thin was associated with insufficient gestational weight gain. Thus, even in a Japanese population, characterized by a majority of women with pre-pregnancy underweight or normal body mass index status, associations between negative body image and gestational weight gain were similar to those in other countries. [ABSTRACT FROM AUTHOR]

The objective was to determine reliability of sagittal plane range of motion (ROM) assessment in a healthy population and in people with cervicogenic headache (CGH). Upper cervical flexion/extension ROM was measured using an iPhone magnetometer sensor and retraction/protraction ROM measured by linear displacement. Two independent raters evaluated these movements in 33 subjects with CGH and 33 age and gender matched asymptomatic healthy controls on two occasions. Measurement procedures were standardized; and the order of testing randomized. Reliability, standard error of measurement (SEM) and minimum detectable change (MDC) were calculated. Subjects comprised 30 females and 36 males. The iPhone method demonstrated high reliability (ICC >0.82) with SEM values ranging from 0.62 to 1.0 and MDC values ranging from 1.70 to 4.81 respectively. Evaluation of linear displacement demonstrated moderate reliability (ICC >64). with SEM values ranging from 0.38 to 1.91 and MDC values ranging from 1.05 to 1.63 respectively. Compared to healthy controls, upper cervical flexion, retraction and protraction ROM was significantly less in the CGH group with mean difference of 6.50°, 1.52 cm and 2.34 cm respectively. Upper cervical spine sagittal plane ROM can be measured with moderate to high reliability and was found to be more restricted in people with CGH. [ABSTRACT FROM AUTHOR]

On-farm research (OFR) has become popular as a result of precision agriculture technology simplifying the process and farm software capabilities to summarize results collected through the technology. Different OFR designs exists with strip-trials being a simple approach to evaluate different treatments. Common in OFR is the use of yield monitors to collect crop performance data since yield represents a primary response variable in these type studies. The objective was to investigate the ability of grain yield monitoring technologies to accurately inform strip trials when frequent yield variability exists within an experimental unit. A combination of six sub-plot treatment resolutions (TR) that differed in length of imposed yield variation (7.6, 15.2, 30.5, 61.0, 121.9, and 243.8 m) were harvested at combine ground speeds of 3.2, 6.4, 7.2, and 8.1 kph, depending on study site (three study sites total). Intentional yield differences in maize (Zea mays L.) were created for each sub-plot by alternating the amount nitrogen (N) applied: 0 or 202 kg N/ha. Yield was measured by four commercially available yield monitoring (YM) technologies and a weigh wagon. Comparisons were made between the accumulated mass of the YM technology and weigh wagon through percent differences along with testing the significance of the plotted relationship between YM and weigh wagon. Results indicated that yield monitoring technology can be used to evaluate strip trial performance regardless of yield frequency and variability (error < 3%) within an experimental unit when operating within the calibrated range of the mass flow sensor. Operating outside of the calibrated range of the mass flow sensor resulted in > 15% error in estimating accumulated weight and overestimation of yield by 23%. Finally, no significant differences existed in estimating accumulated weight values between grain yield monitor technologies (all p-values ≥ 0.54). [ABSTRACT FROM AUTHOR]

Human anterior gradient‐2 (AGR2) has been implicated in carcinogenesis of various solid tumours, but the expression data in prostate cancer are contradictory regarding its prognostic value. The objective of this study is to evaluate the expression of AGR2 in a large prostate cancer cohort and to correlate it with clinicopathological data. AGR2 protein expression was analysed immunohistochemically in 1023 well‐characterized prostate cancer samples with a validated antibody. AGR2 expression levels in carcinomas were compared with matched tissue samples of adjacent normal glands. AGR2 expression levels were dichotomized and tested for statistical significance. Increased AGR2 expression was found in 93.5% of prostate cancer cases. AGR2 levels were significantly higher in prostate cancer compared with normal prostate tissue. A gradual loss of AGR2 expression was associated with increasing tumour grade (ISUP), and AGR2 expression is inversely related to patient survival, however, multivariable significance is not achieved. AGR2 is clearly upregulated in the majority of prostate cancer cases, yet a true diagnostic value appears unlikely. In spite of the negative correlation of AGR2 expression with increasing tumour grade, no independent prognostic significance was found in this large‐scale study. [ABSTRACT FROM AUTHOR]

An adequate foot clearance height while stepping over an obstacle is important for safety in daily life. In the present study, we examined whether visual illusions affect foot clearance during a stepping-over action, and whether this is further influenced by gaze behavior. Twelve participants stepped over an obstacle placed four meters away under conditions of three different obstacle characteristics: white, horizontal, or vertical lines. We measured the participants' foot clearances during the step-over action and their gaze behavior during the approaching phase. Participants stepped significantly higher over the obstacles in the vertical lines (illusion) condition. The duration of gaze fixation on the obstacle positively correlated with increased foot clearance in the vertical condition, suggesting that the effect of the visual illusion on foot clearance was enhanced by prolonged gaze fixation. Conversely, prolonged fixation negatively correlated with foot clearance in the white (control) condition, implying that a cautious perception of an obstacle may contribute to efficient stepping-over action. [ABSTRACT FROM AUTHOR]

This paper aims to interpret the connotation of high-quality development of tourism economy (HQTE) from the perspective of the new development concepts of innovation, coordination, green, openness and sharing, and then to evaluate the spatial differentiation of China's HQTE based on provincial panel data from 2009 to 2018. Specifically, we employ the spatial convergence model to explore the absolute and conditional β convergence trends of HQTE in the whole country and the eastern, central and western regions of China. Our empirical results reveal that: 1) within the decade, from 2009 to 2018, regions of China with the highest HQTE index is its eastern region followed by the central region and then the western region, but the fastest growing one is the western region of China followed by the central region and then the eastern region. 2) Whether or not the spatial effect is included, there are absolute and conditional β convergence in HQTE in the whole country and aforementioned three regions. 3) The degree of government attention as well as the level of economic development and location accessibility are the positive driving factors for the convergence of HQTE in the whole country and the three regions. The degree of marketization and human capital have not passed the significance test either in the whole country or in the three regions. The above conclusions could deepen the understanding of the regional imbalance and spatial convergence characteristics of HQTE, clarify the primary development objects, and accomplish the goal of China's HQTE. [ABSTRACT FROM AUTHOR]

This paper focuses on the likelihood ratio test (LRT) statistics for different hypothesis tests. Assuming that a random sample is from a normal population, we make the sample size n and the dimension p close to infinity and satisfy p < n − c for some 1 ≤ c ≤ 4. Based on this assumption, the moderate deviation principle (MDP) for the LRT will be given under the null hypothesis. The corresponding numerical simulation results are shown at the end of the paper. [ABSTRACT FROM AUTHOR]