Search

Background/Objectives: Emergency Medical Response Systems (EMRSs) play a vital role in delivering medical aid during natural and man-made disasters. This quantitative research delves into the analysis of risk and effectiveness within Serbia's Emergency Medical Services (EMS), with a special emphasis on how work organization, resource distribution, and preparedness for mass casualty events contribute to overall disaster preparedness. Methods: The study was conducted using a questionnaire consisting of 7 sections and a total of 88 variables, distributed to and collected from 172 healthcare institutions (Public Health Centers and Hospitals). Statistical methods, including Pearson's correlation, multivariate regression analysis, and chi-square tests, were rigorously applied to analyze and interpret the data. Results: The results from the multivariate regression analysis revealed that the organization of working hours (β = 0.035) and shift work (β = 0.042) were significant predictors of EMS organization, explaining 1.9% of the variance (R2 = 0.019). Furthermore, shift work (β = −0.045) and working hours (β = −0.037) accounted for 2.0% of the variance in the number of EMS points performed (R2 = 0.020). Also, the availability of ambulance vehicles (β = 0.075) and financial resources (β = 0.033) explained 4.1% of the variance in mass casualty preparedness (R2 = 0.041). When it comes to service area coverage, the regression results suggest that none of the predictors were statistically significant. Based on Pearson's correlation results, there is a statistically significant correlation between the EMS organization and several key variables such as the number of EMS doctors (p = 0.000), emergency medicine specialists (p = 0.000), etc. Moreover, the Chi-square test results reveal statistically significant correlations between EMS organization and how EMS activities are conducted (p = 0.001), the number of activity locations (p = 0.005), and the structure of working hours (p = 0.001). Conclusions: Additionally, the results underscore the necessity for increased financial support, standardized protocols, and enhanced intersectoral collaboration to strengthen Serbia's EMRS and improve overall disaster response effectiveness. Based on these findings, a clear roadmap is provided for policymakers, healthcare administrators, and EMS personnel to prioritize strategic interventions and build a robust emergency medical response system. [ABSTRACT FROM AUTHOR]

Background/Objectives: Fibromyalgia (FM) affects up to 5% of the global population and is a leading cause of significant social and economic consequences. Higher health literacy leads to better understanding of treatment plans, improved self-care, and adherence to recommendations, enhancing overall quality of life. This study aims to determine whether different aspects of the disease are influenced by patients' education level and literacy when applying the same therapy and to assess how patients' perceptions of therapy outcomes vary over time based on their educational level. Methods: This study involved 140 fibromyalgia (FM) patients diagnosed using the 2016 ACR criteria, with 128 completing the study. Participants attended three visits over 28 weeks and were stratified into four groups based on educational level: Group 1—secondary school or less; Group 2—high school graduates; Group 3—college graduates; Group 4—university graduates. Patients were assigned to groups (n = 32, 32, 30, and 34, respectively) after the initial evaluation (T0). The treatment was assessed (T1) and followed up three months later (T2) to evaluate changes in functional status and quality of life. All patients underwent the same rehabilitation program, cognitive therapy, and kinesiotherapy. Results: Significant differences in disease impact on the patient's life (FIQ total score) were observed between groups from the initial evaluation (p = 0.000). The overall FIQ score was notably affected by non-pharmacological therapy in patients with higher education. These differences continued to be significant even three months after the treatment ended (p = 0.000). Functional limitations were evident from the start (p = 0.000) and improved significantly post-treatment in patients with higher education (p = 0.000). However, subjective evaluations of disease impact (assessed by the first item of FIQ) did not consistently align with objective findings (hand grip strength). Functional limitations did not significantly differ in subjective evaluations (F1Q1) across educational levels (p = 0.045), and inverse correlations were noted between functional status and SF-12 well-being components. Conclusions: This study underscores that higher education enhances fibromyalgia management and functional outcomes, particularly when combined with non-pharmacological therapies. However, subjective perceptions may not always align with objective improvements, indicating that factors beyond education, such as personal and external influences, also impact disease management. Thus, improving health literacy through educational interventions could further benefit FM patients' quality of life. [ABSTRACT FROM AUTHOR]

This paper attempts to establish the accurate and timely forecasting model for the total output value of agriculture, forestry, animal husbandry, and fishery (TOVAFAF) in various provinces of China using NPP-VIIRS nighttime light (NTL) remote sensing data and machine learning algorithms. It can provide important data references for timely assessment of agricultural economic development level and policy adjustment. Firstly, multiple NTL indices for provincial-level administrative regions of China were constructed based on NTL images from 2013 to 2023 and various statistics. The results of correlation analysis and significance test show that the constructed total nighttime light index (TNLI), luminous pixel quantity index (LPQI), luminous pixel ratio index (LPRI), and nighttime light squared deviation sum index (NLSDSI) are highly correlated with the TOVAFAF. Subsequently, using the relevant data from 2013 to 2020 as the training set, the four NTL indices were separately taken as single independent variable to establish the linear model, exponential model, logarithmic model, power exponential model, and polynomial model. And all the four NTL indices were taken as the input features together to establish the multiple linear regression (MLR), extreme learning machine (ELM), and particle swarm optimization-ELM (PSO-ELM) models. The relevant data from 2021 to 2022 were taken as the validation set for the adjustment and optimization of the model weight parameters and the preliminary evaluation of the modeling effect. Finally, the established models were employed to forecast the TOVAFAF in 2023. The experimental results show that the ELM and PSO-ELM models can better explore and characterize the potential nonlinear relationship between NTL data and the TOVAFAF than all the models established based on single NTL index and the MLR model, and the PSO-ELM model achieves the best forecasting effect in 2023 with the MRE value for 32.20% and the R2 values of the linear relationship between the actual values and the forecasting values for 0.6460. [ABSTRACT FROM AUTHOR]

In this work, a nonparametric method is proposed to jointly test the significance of the regression coefficient estimates in a logistic regression model and identify which explanatory variables are effective in predicting the binary response. The motivating example is related to the factors affecting the propensity of Italian Small Medium Enterprises (SMEs) to innovate. The explanatory variables of the model represent firms' characteristics, such as size and age, and the possible effect of the sector of economic activity is taken into account by including a set of binary variables as control factors. The dependent variable indicates whether a company, in the period under study, introduced at least one product or process innovation. Therefore, it is also dichotomous, and the logistic regression model is appropriate for representing the relationship between explanatory variables and dependent variable. Specifically, the logit transformation of the firm's propensity to innovate, i.e., the probability that a company randomly chosen from the population of Italian SMEs has introduced an innovation or, equivalently, the proportion of innovative companies among the Italian SMEs, is expressed as a linear function of the predictors (explanatory and control variables). The proposed test is based on the permutation approach and satisfies important statistical properties, proved in a simulation study. The test is more flexible and robust than the classic parametric approach, and is preferable to typical stepwise regression procedures for the selection of a parsimonious and effective model. [ABSTRACT FROM AUTHOR]

Introduction: Upper gastrointestinal bleeding (UGIB) is among the most common causes of morbidity and mortality worldwide, accounting for major resource allocation and increasing incidence. This study aimed to evaluate the severity of non-variceal bleeding in patients at risk of bleeding through the use of NSAIDs, oral anticoagulants, and antiplatelet therapy. Material and Method: The study included 296 patients admitted in the Gastroenterology Department of the Municipal County Emergency University Hospital, Timisoara, between 01.01.2018 and 01.04.2020, and diagnosed via gastroscopy with non-variceal gastrointestinal bleeding. The patients were divided among four groups based on their use of different drugs known to induce UGIB, i.e., aspirin and clopidogrel, NOACs, NSAIDs, and anti-vitamin K drugs, respectively. Statistical analyses were performed based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables with pairwise comparisons based on Bonferroni adjusted significance tests. Results: The results showed several parameters having statistical significance among the different groups of patients. Patients on NOACs had statistically significant lower hemoglobin levels, lower hematocrit values, lower erythrocytes, lower RDW and higher fibrinogen levels compared to patients on VKA. Discussion: Surprisingly, the results from our study suggest that the use of NOACs was associated with a higher risk of bleeding when compared to VKA, which differs from the existing literature. Conclusions: One of the important factors causing upper non-variceal bleeding can be iatrogenic, either due to antiplatelet drugs or anticoagulants, to which NSAID treatment is additionally associated for various reasons. In our study, the use of NOACs seemed to have a more severe bleeding spectrum with higher morbidity compared to VKA. [ABSTRACT FROM AUTHOR]

This paper demonstrates the effectiveness and superiority of Empirical Mode Decomposition (EMD) in projecting non-stationary hydrological data. The study focuses on daily Sea Surface Temperature (SST) sequences in the Niño 3.4 region and uses EMD to forecast the probability of El Niño events. Applying the Mann–Kendall test at the 5% significance level reveals a significant increasing trend in SST changes in this region, particularly noticeable after 1980. This trend is associated with the occurrence of El Niño and La Niña events, which have a recurrence interval of approximately 8.4 years and persist for over a year. The modified Oceanic Niño Index (ONI) proposed in this study demonstrates high forecast accuracy, with 97.56% accuracy for El Niño and 89.80% for La Niña events. Additionally, the EMD of SST data results in 13 Intrinsic Mode Functions (IMFs) and a residual component. The oscillation period increases with each IMF level, with IMF7 exhibiting the largest amplitude, fluctuating between ±1 °C. The residual component shows a significant upward trend, with an average annual increase of 0.0107 °C. These findings reveal that the EMD-based data generation method overcomes the limitations of traditional hydrological models in managing non-stationary sequences, representing a notable advancement in data-driven hydrological time series modeling. Practically, the EMD-based 5-year moving process can generate daily sea temperature sequences for the coming year in this region, offering valuable insights for assessing El Niño probabilities and facilitating annual updates. [ABSTRACT FROM AUTHOR]

Background/Objectives: This retrospective study aims to evaluate the safety and functional outcomes of simultaneous bilateral total knee arthroplasty (TKA) compared to two-stage bilateral TKA procedures. Osteoarthritis is the leading cause of knee joint replacement globally, so we sought to determine whether the one-stage approach could be deemed non-inferior to the two-stage method in terms of perioperative complications and postoperative recovery. Methods: We analyzed two cohorts: 43 patients underwent one-stage bilateral TKA, while 66 patients received two-stage TKA. The data collected included demographic details, comorbidities, postoperative complications, and functional outcomes assessed by the Oxford Knee Score (OKS), European Quality of Life, and Visual Analogue Scale scores at preoperative and five years postoperative follow-ups. Results: The results showed statistically significant improvements in quality-of-life measures for both groups, with the one-stage group exhibiting greater enhancement in OKS (p < 0.05). Complication rates were similar across both procedures, with no significant differences in infection rates or other adverse events. Conclusions: This study suggests that the one-stage approach to treat bilateral knee arthritis could reduce subjective stress and healthcare costs, presenting a safe alternative for appropriately selected patients. However, the findings highlight the necessity of considering patients' overall health status when planning surgical interventions. Further research involving larger populations is recommended to validate our conclusions. [ABSTRACT FROM AUTHOR]

Objectives: The LYMQOL is the most frequently translated, validated, objective tool for assessing Health-Related Quality of Life (HRQoL) in individuals with upper limb lymphedema (ULL). There have been adaptations and validations in a number of different countries. While a German version of LYMQOL Leg for lower limb lymphedema is available, a validated translation of LYMQOL Arm to German is lacking. We aimed to perform a cross-cultural adaption and translation according to ISPOR principles. Methods: Patients suffering from ULL from Germany, Austria, and Switzerland (n = 52) were questioned twice using the translated LYMQOL Arm, SF-36, and an evaluation questionnaire. The assessment of the content validity and face validity proved this version of LYMQOL Arm to be acceptable for interviewing German-speaking patients with ULL in Germany. Results: Comparison of LYMQOL Arm and SF-36 demonstrated good construct validity. Test–retest reliability was moderate to good (intraclass correlation coefficients 0.66–0.73). Cronbach's alpha values varied between 0.79 and 0.89 in both interviews, indicating good internal consistency. Factor analysis revealed a cumulative variance of 59.5% for the four domains of the questionnaire. Conclusion: There was no significant association between lymphedema stage and LYMQOL Arm score. This trial tested the appropriateness of the German version of the LYMQOL Arm for measuring HRQoL in German-speaking individuals with ULL. [ABSTRACT FROM AUTHOR]

Over the past few decades, cities have experienced increased floods affecting property and threatening human life as a result of a warming planet. There is still an incomplete understanding of the flood risk patterns in urban communities with different socioeconomic characteristics. In this study, we produced separate flood exposure and vulnerability indices based on relevant factors, then combined them as a risk index for Houston, Texas and Charleston, West Virginia. We applied statistical methods to extract the most significant social vulnerability factors in each study area. Finally, we mapped significant hot spots or clusters of high flood risk and compared results to socioeconomically disadvantaged populations. Based on the results, high-risk or 1%-annual-chance floodplains cover 23% of the Houston and 7% of Charleston study areas. Within these floodplains, 13% of the total developed land in Houston and 9% in Charleston are situated. In the event of a 1%-annual-chance flood, an estimated 5% of the total population in Houston and 6% in Charleston may require evacuation. Statistically significant flood risk clusters could only be identified in Houston. The implications from this work help to provide an analysis framework for larger urban areas while offering suggestions for its improvement in smaller populated areas. [ABSTRACT FROM AUTHOR]

Introduction: The present study aimed to investigate the deformation behavior of three different clear aligner systems, CA® Pro+ Clear Aligner (Scheu Dental, Iserlohn, Germany), Taglus Premium (Taglus Company, Mumbai, India), and Spark Trugen (Ormco Corp., Orange, CA, USA), under compression testing, using the digital image correlation (DIC) technique. Materials and Methods: A total of 15 patients were treated with each of the three aligner systems, resulting in 45 sets of aligners. Each aligner set was fixed on the 3D-printed dental arches and then in an articulator. Then, the samples were subjected to occlusal forces using a purpose-built test stand to allow for controlled force application and precise displacement determination. The DIC technique was used for capturing the deformation behavior, providing detailed strain and displacement fields. Statistical analysis was performed using one-way ANOVA and Bonferroni post hoc tests with a significance of 0.05. Results: The results indicate that the Spark system exhibited the most substantial rigid displacement. Furthermore, the elastic deformation values of the Spark and Taglus systems were significantly higher than those of the CA Pro+ system (p > 0.05). Conclusions: The Spark Trugen clear aligner system demonstrated a lower stability to rigid displacement and elastic deformation under compression testing compared to the Scheu CA® Pro+ Clear Aligner and Taglus Premium. All three tested clear aligner systems showed an increased resistance to elastic displacement and rigid deformation in the mandibular arch. [ABSTRACT FROM AUTHOR]

This study explores burnout among nursing students in Bangalore, India, focusing on Exhaustion and Disengagement scores. A cross-sectional design was applied using the Oldenburg Burnout Inventory modified for nursing students, collecting data using a survey that was conducted between October and December 2023. The sample consisted of 237 female nursing students from the Bachelor of Science in Nursing program at Bangalore College of Nursing, South India. The study integrated the t-distributed Stochastic Neighbor Embedding (t-SNE) procedure for data simplification into three t-SNE components, used in a hierarchical clustering analysis, which identified distinct student profiles: "High-Intensity Study Group" and "Altruistic Aspirants". While burnout scores were generally high, students with high study hours ("High-Intensity Study Group") reported greater Exhaustion, with a mean score of 26.78 (SD = 5.26), compared to those in the "Altruistic Aspirants" group, who reported a mean score of 25.00 (SD = 4.48), demonstrating significant differences (p-value = 0.005). Conversely, those motivated by altruism ("Altruistic Aspirants") showed higher Disengagement, with a mean score of 19.78 (SD = 5.08), in contrast to "High-Intensity Study Group", which reported a lower mean of 17.84 (SD = 4.74) (p-value = 0.002). This segmentation suggests that burnout manifests differently depending on the students' academic load and intrinsic motivations. This study underscores the need for targeted interventions that address specific factors characterizing the clusters and provide information for designing future research and interventions. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: Thirty years ago, the first attempt by Saliba and colleagues was made to reduce the negative effects (hypercarbia) of exogenous surfactant (ES) by slowing its administration. Sixteen years later, we observed the first less invasive surfactant administration (LISA) attempt by Kribs and colleagues. Many studies, since that time, have tried to minimize the invasiveness of ES and subsequent cerebral blood flow perturbations through studies using near-infrared spectroscopy (NIRS). We sought to address this medical challenge by identifying a less problematic modality of ES administration by delivering multiple aliquots of ES instead of a single one, as typically performed. The aim of this study was to test the hypothesis that a different way of administering ES using more aliquots could be a safe alternative that should be assessed in further studies. Methods: Patients between 26 + 0 and 35 + 6 weeks of gestational age (GA) requiring ES administration were enrolled (April 2023–February 2024). Differently fractioned doses were delivered according to an arbitrary standard dosage (0.3 mL per aliquot in babies < 29 weeks; 0.6 mL in babies ≥ 29 weeks), while NIRS and transcutaneous CO2 (tCO2) monitoring were always performed. ES's effectiveness was assessed based on the reduction in the Oxygen Saturation Index (OSI) after administration. Persistent desaturation, bradycardia, and airway obstruction were defined as adverse effects and used to evaluate safety during ES administration, as well as variability in NIRS-rSO2 values and tCO2. Results: Twenty-four patients were enrolled with a median GA of 29 weeks (IQR 4.5) and BW of 1223 ± 560 g. In addition, 50% of the cohort received fewer than three aliquots, whereas the other 50% received more than three. Monitoring was started before the procedure and continued 30′ after the last ES aliquot administration. The variability in NIRS-SpO2 values was significantly higher in the group (p = 0.007) with a lower number of aliquots administered. Similarly, increased NIRS-rSO2 values (p = 0.003) and increased tCO2 levels (p = 0.005) were observed in infants who underwent an ES split after the administration of a low number of aliquots. Conclusions: Our data obtained from the group with > 3 fractionated doses of ES seem to justify the preparation of a more robust study, as the combination of reduced NIRS variability and reduced tCO2 maximum levels is consistent with more stable cerebral blood flow during the challenging time of ES administration. [ABSTRACT FROM AUTHOR]

Myxoid liposarcomas are malignant soft-tissue sarcomas whose treatment represents a challenge, even for the most experienced surgeon. In this study, we report on our experience with the treatment of myxoid liposarcomas of the thigh. Our retrospective analysis included myxoid liposarcomas of the thigh treated with surgical resection between 2016 and 2022. Resection margins, complications, local recurrences, and metastases were recorded. The oncological outcome of each case was evaluated at their latest follow-up. Adjuvant therapies were administered according to the ESMO guidelines. Functionality was assessed with the MSTS score before surgery and at the patients' latest follow-up. Thirty cases (ten high-grade and 20 low-grade) were included. The mean diameter was 11.8 cm. Twenty-four cases had wide margins (80%) and six (20%) were marginal. Five cases (60% marginal) had local recurrences (17%). Marginal resection was associated with a higher risk of local recurrence (p = 0.041). Three cases with high-grade tumors (10%) developed metastases. At the patients' latest follow-up, their mean MSTS score had risen from 22.9 to 27.3. While tumor grade influences the risk of metastases, the quality of resection margins can determine the local recurrence rate. An adequate surgery can lead to good post-operative functional outcomes. [ABSTRACT FROM AUTHOR]

The Jarque–Bera test is commonly used in statistics and econometrics to test the hypothesis that sample elements adhere to a normal distribution with an unknown mean and variance. This paper proposes several modifications to this test, allowing for testing hypotheses that the considered sample comes from: a normal distribution with a known mean (variance unknown); a normal distribution with a known variance (mean unknown); a normal distribution with a known mean and variance. For given significance levels, α = 0.05 and α = 0.01 , we compare the power of our normality test with the most well-known and popular tests using the Monte Carlo method: Kolmogorov–Smirnov (KS), Anderson–Darling (AD), Cramér–von Mises (CVM), Lilliefors (LF), and Shapiro–Wilk (SW) tests. Under the specific distributions, 1000 datasets were generated with the sample sizes n = 25 , 50 , 75 , 100 , 150 , 200 , 250 , 500 , and 1000. The simulation study showed that the suggested tests often have the best power properties. Our study also has a methodological nature, providing detailed proofs accessible to undergraduate students in statistics and probability, unlike the works of Jarque and Bera. [ABSTRACT FROM AUTHOR]

Background: Even if robotic assisted total knee arthroplasty (RATKA) is a widely used technique, there is still a gap of knowledge about whether this technology is effective in improving the patient utility. This measure is of paramount importance for conducting cost effectiveness analysis. The aim of this study was to compare the utility measure derived from self-reported outcomes questionnaires in patients who underwent RATKA compared to patients who underwent the manual surgery. Methods: We compared 72 patients operated with a robotic technique with 70 operated with traditional technique. The utility data were collected with the WOMAC (Western Ontario and McMaster University Osteoarthritis index) self-administrated questionnaire that investigates pain, stiffness and functionality of the patients, an then mapped to a utility value through a validated transforming function. We performed three surveys: the first one before the intervention (t0), the second one 1 year after the surgery (t1) and the third one at the 2 year follow up (t2). Results: we observed higher utility values in both groups. In detail, the mean utility score in the RATKA group increased from 0.37 to 0.71 (t1) and 0.78 (t2), while in the conventional group it increased from 0.41 to 0.78 (t1) and 0.78 (t2). The fixed effect coefficients of t1 and t2 were found to be 0.37 and 0.363 (p < 0.001 for both). The coefficient of the robotic technique, along with its interaction with the t1 and t2 time effect was non-significant. Conclusions: Even if at t1 the utility of patient who underwent RATKA were lower, at longer follow up (t2) we found no significant difference compared to traditional technique, leaving the superiority of robotic assisted technique yet to be proved. Our results may be useful for calculating the gained or lost Quality Adjusted Life Years (QALYs), so that the health care system (or an insurance company) could make an appropriate decision whether to fund the robotic approach or not, after a careful assessment of the incremental costs incurred. [ABSTRACT FROM AUTHOR]

Background: Football, as the most popular sport worldwide, has long been under suspicion of causing varus knee alignment as early as adolescence. However, no causal relationship has yet been found. The first step to do so would be to determine the prevalence of lower leg malalignment among male junior football players depending on age, performance level and the number of active seasons played. Methods: Leg axis alignment in frontal plane was determined in male junior football players of different age levels between 7 and 18 years by measuring the intercondylar/intermalleolar distance (ICD/IMD) in an upright position. In addition to anthropometric data, multiple sport-specific data such as the start of their football career or training time per week were collected by means of questionnaires (clinical trial registration number: DRKS00020446). Results: 207 male junior football players were included in this survey. The mean age was 12.8 years. Within the group of 15 to 18 year olds, the prevalence of varus knee malalignment was highest at just under a third (32.1%). In the subpopulation that played actively for more than ten seasons, 28.9% showed varus leg axis. Regarding performance level, the highest IMD/ICD values and highest prevalence of varus alignment were found among football players who play on a semi-professional level (16.7%), compared to amateur (11.4%) and high-performance levels (2.8%). Conclusions: Further research is necessary to investigate if this high prevalence of varus knee in children of a higher age and higher playing levels is due to the selection bias of football players with varus knee or a real development of varus knee in individuals. [ABSTRACT FROM AUTHOR]

Background/Objectives: The increase in digital tools in early childhood education highlights the need for evidence-based assessments that support cognitive development and align with educational requirements and technological advances. This study contributes to the evaluation of the Bilingual English Language Learner Assessment (BELLA), designed to enhance early learning through curriculum-aligned tasks in preschool-aged children. Methods: Data were collected from 17 schools, including 506 preschool children, using a mixed-model approach to assess BELLA's capacity to appraise early numeracy, literacy, science, and social/emotional development. Analyses included a three-way ANOVA to examine the effects of sex, age, and sub-domain on pass rates and mixed-effects models to evaluate interactions between age and domain. Results: The results indicated a significant effect of age on performance across all domains, with older children demonstrating higher pass rates (p < 0.0001). No significant gender bias was detected. The interaction between age and domain was also significant (p < 0.0001), suggesting domain-specific age-related performance trends, which aligns with internal validity requirements. Conclusion: These findings position BELLA within the growing body of literature on digital media use in early childhood assessment and education, highlighting its potential as a curriculum-compliant digital assessment tool that evaluates and supports cognitive development without a gender bias. This study contributes to the field by providing empirical evidence of BELLA's effectiveness and suggesting future research directions, including the exploration of its bilingual (and potentially multilingual) applications and external validation against existing evidence-based assessments. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In genomic studies, univariate analysis is commonly used to discover susceptible variants. It applies univariate regression for each variant and tests the significance of the regression coefficient or slope parameter. This strategy, however, may miss signals that are jointly detectable with other variants. Multivariate analysis is another popular approach, which tests grouped variants with a predefined group, e.g., based on a gene, pathway, or physical location. However, the power will be diminished if the modeling assumption is not suited to the data. Therefore, data-adaptive testing that relies on fewer modeling assumptions is preferable. Possible approaches include a data-adaptive test proposed by Ueki (2021), which applies to various data-adaptive regression models using a generalization of Yanai's generalized coefficient of determination. While several regression models are possible choices for the data-adaptive test, this paper focuses on the fused lasso that can count for the effect of adjacent variants and investigates its performance through comparison with other existing tests. Simulation studies demonstrate that the test using fused lasso has a high power compared to the existing tests including the univariate regression test, saturated regression test, SKAT (sequence kernel association test), burden test, SKAT-O (optimized sequence kernel association test), and the tests using lasso, ridge, and elastic net when assuming a similar effect of adjacent variants. [ABSTRACT FROM AUTHOR]

The aim was to evaluate the effect of different whitening toothpastes on the enamel surface roughness and color variation. Twenty-four molars were sectioned and divided into eight groups (n = 3) considering the following two factors under study: toothpaste type (Colgate® Total Original, Oral B® 3D White Luxe Perfection, Curaprox® Black is White, and Signal® White Now) and brushing protocol (short- and long-term). Surface roughness was examined by atomic force microscopy (AFM), and color change (ΔE) was measured using the CIE L*a*b* system. Data were statistically analyzed using comparative parametric tests at a 5% significance level. In the short-term protocol, only the Signal® White Now toothpaste increased surface roughness (p = 0.038) compared to the Colgate® Total Original group. No significant differences (p > 0.05) were observed in surface roughness in the long-term protocol. Regarding color variation, no statistically significant differences (p > 0.05) were observed in either protocol. Overall, the whitening toothpastes did not affect enamel surface roughness or color, except for Signal® White Now, which caused increased roughness in the short-term protocol. However, all toothpastes induced a visual change in color. [ABSTRACT FROM AUTHOR]

Spinal disorders are some of the most prevalent health concerns, especially among students. Based on student demographics, this cross-sectional study evaluated the correlation between functional tests (FTs) and spinal range of motion (ROM). This study included 206 students (age = 19.85 ± 1.80 years) from the Vasile Alecsandri University of Bacău. Participants' assessments were conducted using the following tests: (i) Ott, (ii) Schober, (iii) Stibor, (iv) finger-to-floor distance, (v) lateral flexion of the cervical and lumbar spine, and (vi) flexion of the cervical spine. Correlation analyses were evaluated using the Spearman correlation coefficient analysis. The results indicated a very strong relationship between lateral flexion of the lumbar spine on the left (LFLSL) and right (LFLSR) for all departments (r = 0.85 to 0.97, p < 0.05). There was a stronger relationship between FT results and spinal ROM for physical-education-department students compared to students from other departments (n = 17, r = −0.38 to 0.93, p < 0.05). There was no statistically significant correlation between FTs and spinal ROM based on age (p > 0.05). The study results provide evidence of the primary risk factors that predispose students to postural deviations. Practitioners and physiotherapists can utilize these values as a reference for potential therapeutic interventions. [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]

Background: Parents of children suffering from congenital heart disease experience high levels of stress and negative emotions. Therefore, recognition of parents' emotional states and their ways of coping with it is becoming more and more important. Methods: The study group consisted of 154 parents of newborns and infants with cyanotic congenital heart disease, before and after cardiac surgery (partial or full). To assess parental negative emotions, the level of stress, and strategies of coping with it, standardized questionnaires, such as HADS-M, PSS-10, and COPE, were used. Results: Stress levels in parents were high and associated with negative emotions (anxiety, depression, irritability), as well as the choice of non-constructive coping strategies, which was observed especially in younger parents. Conclusions: Assessing parents' stress levels and ways of coping with stress can improve family functioning and provide better development conditions for the child. [ABSTRACT FROM AUTHOR]

Leishmania infantum, a zoonotic vector-born parasite, is endemic in the Mediterranean region, presenting mostly as visceral (VL), but also as cutaneous (CL) and mucosal leishmaniasis (ML). This study aimed to describe the epidemiological and clinical aspects of the CL and ML cases diagnosed in mainland Portugal between 2010 and 2020. Collaboration was requested from every hospital of the Portuguese National Health System. Cases were screened through a search of diagnostic discharge codes or positive laboratory results for Leishmania infection. Simultaneously, a comprehensive literature search was performed. Descriptive statistics and hypothesis testing were performed using IBM® SPSS® Statistics. A total of 43 CL and 7 ML cases were identified, with a predominance of autochthonous cases (86%). In CL, immunosuppressed individuals constituted a significant proportion of patients (48%), and in this group, disseminated CL (22%) and simultaneous VL (54%) were common. In autochthonous cases, lesions, mostly papules/nodules (62%), were frequently observed on the head (48%). The approach to treatment was very heterogeneous. ML cases were all autochthonous, were diagnosed primarily in older immunosuppressed individuals, and were generally treated with liposomal amphotericin B. The findings suggest a need for enhanced surveillance and reporting, clinical awareness, and diagnostic capacity of these forms of leishmaniasis to mitigate underdiagnosis and improve patient outcomes. A holistic One Health approach is advocated to address the multifaceted challenges posed by leishmaniases in Portugal and beyond. [ABSTRACT FROM AUTHOR]

Background: With CAD-CAM, dental models are often fabricated by additive manufacturing (AM) methods. Dental models for implant prostheses involve the manual placement of analogs, which could affect their final fit. Therefore, in this experimental in vitro study, the accuracy of the analogs' position in models printed using AM methods was examined by comparing three different printing orientations. Methods: An STL file was obtained by scanning a master model with an implant placed in the maxillary left central incisor position. Three study groups (n = 10) with varying printing orientation parameters were obtained (0, 45, and 90 degrees). They were digitalized with a laboratory scanner and evaluated with an analysis metrology program. Differences between 3D datasets were measured using the RMS for trueness and SD RMS for precision. The data were statistically analyzed using the ANOVA test at a significance level of p < 0.05, followed by the Bonferroni post hoc test. Results: The 45-degrees group showed the best results. Regarding trueness, statistically significant differences were found between the 45- and 90-degrees groups (p < 0.005). In terms of precision, statistically significant differences appeared between the 45- and 0-degrees groups (p < 0.011) and between the 45- and 90-degrees groups (0.003). Conclusions: The printing angulation parameter affects the accuracy of 3D-printed models. Implant models manufactured at 45 degrees of printing angulation are more accurate than those printed at 0 or 90 degrees. [ABSTRACT FROM AUTHOR]

The Omicron variants BA.1, BA.2, and BA.5 caused several waves of SARS-CoV-2 in Germany in 2022. In this comparative study, public health data on SARS-CoV-2 infections from Mecklenburg-Western Pomerania, Germany, between January and October 2022 were examined retrospectively using Pearson's chi-squared tests and Fisher's exact tests for testing for statistical significance. Compared to BA.5 infections, BA.1 and BA.2 infections affected younger individuals aged up to 19 years significantly more often, whereas BA.5 infections occurred significantly more frequently in patients between 40 and 59 years of age when compared to BA.1 and BA.2. Infections with all three variants predominantly caused flu-like symptoms; nevertheless, there were significant differences between the reported symptoms of BA.1, BA.2, and BA.5 infections. Especially, the symptoms of 'fever', 'severe feeling of sickness', 'loss of taste', and 'loss of smell' were significantly more often present in patients with BA.5 infections compared to BA.1 and BA.2 cases. Additionally, BA.2 and BA.5 cases reported significantly more often the symptoms of 'runny nose' and 'cough' than BA.1-infected cases. Our findings indicate remarkable differences in the clinical presentations among the sub-lineages, especially in BA.5 infections. Furthermore, the study demonstrates a powerful tool to link epidemiological data with genetic data in order to investigate their potential impact on public health. [ABSTRACT FROM AUTHOR]

This study examines the relationships between state-provided paid-leave availability and enrollment in public health and nutrition programs (SNAP, Medicaid, WIC) among single low-income women following a birth in the U.S. We hypothesize that women in paid leave states will be less likely to participate in publicly available health and nutrition programs. Data are from the Survey of Income and Program Participation (SIPP), a nationally representative panel survey data set (N = 1168). Descriptive tests of significance and probit regression models are used to examine the relationship between paid-leave availability and participation in SNAP, Medicaid, and WIC following a birth. A descriptive analysis suggests significantly lower enrollment in SNAP but not Medicaid or WIC for single low-income women in paid-leave states compared to those in non-paid-leave states. The finding of significantly lower post-birth SNAP participation in paid-leave states holds in probit models that include potentially relevant mother, household, and state controls. [ABSTRACT FROM AUTHOR]

Dynamic voltage and frequency scaling (DVFS) is a technique used to optimize energy consumption in ultra-low-power embedded systems. To ensure sufficient computational capacity, the system must scale up its performance settings. The objective is to conserve energy in times of reduced computational demand and/or when battery power is used. Fast Fourier Transform (FFT), Cyclic Redundancy Check 32 (CRC32), Secure Hash Algorithm 256 (SHA256), and Message-Digest Algorithm 5 (MD5) are focused functions that demand computational power to achieve energy-efficient performance. Selected operations are analyzed from the energy consumption perspective. In this manner, the energy required to perform a specific function is observed, thereby mitigating the influence of the instruction set or system architecture. For stable operating voltage scaling, an exponential model for voltage calculation is presented. Statistical significance tests are conducted to validate and support the findings. Results show that the proposed optimization technique reduces energy consumption for ultra-low-power applications from 27.74% to up to 47.74%. [ABSTRACT FROM AUTHOR]

Background: Palliative care (PC) focuses on relieving pain and difficult symptoms rather than treating disease or delaying its progress. Palliative care views death as a natural process and allows patients to live the last phase of their existence in the best possible way, encouraging them to express their opinions and wishes for a good death. Interventions are advocated to control symptoms and distress and promote wellbeing and social functioning. A multidisciplinary approach to support patients receiving palliative care is encouraged. Objective: The aims of this study were to investigate the facilitators and barriers to PC in people with kidney disease from a nursing perspective and to explore predictive factors associated with nurse-perceived facilitators and barriers to PC in people with kidney disease. Design: This study is a survey that adopted a questionnaire created in 2021 with Delphi methology, which included 73 statements divided into 37 facilitators and 36 barriers to PC in patients with kidney disease, to be scored using a Likert scale. Participants and Measurements: Participants were obtained through the membership database of the European Dialysis and Transplant Nurses Association/European Renal Care Association (EDTNA/ERCA) of 2020. Inclusion criteria included being registered as a nurse, an EDTNA/ERCA member and understanding of the English language. The questionnaire was sent via email. Results: Three profiles of respondents were found: the first group was characterized by the highest agreement percentages of facilitators and with an average value of 53.7% in barriers; the second was characterized by a lower endorsement of facilitators and similar agreement to the first group for barriers; the third group had a high probability (>80%) of items endorsing both barriers and facilitators. Predictive variables were significantly associated with "Years in nephrology" and "macro geographic area". Conclusions: This study demonstrates variation in PC practice across Europe. Some professionals identified fewer barriers to PC and appeared more confident when dealing with difficult situations in a patient's care pathway, while others identified more barriers as obstacles to the implementation of adequate treatment. The number of years of nephrology experience and the geographical area of origin predicted how nurses would respond. This study was not registered. [ABSTRACT FROM AUTHOR]

Women are at increased risk of trauma exposure and of experiencing prolonged posttraumatic stress. Maternal trauma exposure and associated impairment may adversely impact mother–infant interaction quality, which may in turn be associated with infant temperament difficulties. More research is needed to identify which maternal trauma predictors are most robustly related to infant temperament outcomes. The present study aimed to address this gap by examining maternal sensitivity as a mediator of relations between maternal trauma and infant temperament in a longitudinal study of a rural cohort of mother–infant dyads. Mediation via maternal sensitivity was not supported in any of the primary analyses. Greater maternal trauma exposure was found to predict greater infant regulation behavior, a finding that was in opposition to expected results and which may be explained by protective factors found within the sample. The present sample was skewed toward married, educated women who reported high social support satisfaction and low trauma-associated impairment. The findings elucidate protective factors that may mitigate adverse outcomes for both mothers and infants. Future research models should include additional maternal trauma variables (e.g., recency, type, revictimization/polyvictimization), in utero maternal cortisol exposure, maternal insensitivity/ambiguous response patterns during caregiver tasks, and analysis of the IBQ-R subscales. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is a common neurodegenerative disorder with a prolonged prodromal phase. Higher urinary bis(monoacylglycerol)phosphate (BMP) levels associate with LRRK2 (leucine-rich repeat kinase 2) and GBA1 (glucocerebrosidase) mutations, and are considered as potential noninvasive biomarkers for predicting those mutations and PD progression. However, their reliability has been questioned, with inadequately investigated genetics, cohorts, and population. In this study, multiple statistical hypothesis tests were employed on urinary BMP levels and sequences of 90 PD-risk single nucleotide polymorphisms (SNPs) from Parkinson's Progression Markers Institution (PPMI) participants. Those SNPs were categorized into four groups based on their impact on BMP levels in various cohorts. Variants rs34637584 G/A and rs34637584 A/A (LRRK2 G2019S) were identified as the most relevant on increasing urinary BMP levels in the PD cohort. Meanwhile, rs76763715 T/T (GBA1) was the primary factor elevating BMP levels in the prodromal cohort compared to its T/C and C/C variants (N370S) and the PD cohort. Proteomics analysis indicated the changed transport pathways may be the reasons for elevated BMP levels in prodromal patients. Our findings demonstrated that higher urinary BMP levels alone were not reliable biomarkers for PD progression or gene mutations but might serve as supplementary indicators for early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Adverse weather conditions at night are very fatal to drivers, causing serious traffic accidents. Road lighting is a facility that can alleviate these dangerous situations. Nevertheless, road lighting has only rarely been studied during adverse weather. The reason is that the current road lighting performance evaluation method is presented based on normal weather. The current road lighting performance evaluation method uses a luminance meter to measure the road surface, which is not suitable due to scattering during adverse weather such as rain and fog. Therefore, this study proposes obstacle recognition distance as a measure of effectiveness to evaluate the performance of road lighting during adverse weather. There is a lack of actual research on whether obstacle recognition distance can be used as a measure of effectiveness for road lighting during adverse weather. Therefore, in this study, 30 subjects were used to measure the subjects' obstacle recognition distance according to changes in weather conditions, road lighting grade, and road lighting color temperature. As a result, it was analyzed that there was a clear trend of change in obstacle recognition distance depending on the change in each condition. It was found that, under the same road lighting performance conditions, there was a difference of up to 72.86% by weather condition; under the same weather conditions, there was a difference of up to 22.75% by road lighting grade; and by color temperature, there was a difference of up to 21.87%. In addition, a statistical significance test was performed to support the existence of a difference, and the results were synthesized to suggest that obstacle recognition distance can be used as a performance measure of effectiveness of road lighting in adverse weather. [ABSTRACT FROM AUTHOR]