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The purpose of our study was to assess the multiscalar changes in leprosy burden and its associated risk factors over the last three decades. We conducted an in-depth examination of leprosy's spatial–temporal trends at multiple geographical scale (global, regional, and national), utilizing information from Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2019). Incidence and the estimated annual percentage change (EAPC) in age-standardized incidence rate (ASIR) of leprosy were determined, with countries categorized based on leprosy incidence changes. We examined socioeconomic and physical geography influences on leprosy incidence via Spearman correlation analysis, using ternary phase diagrams to reveal the synergetic effects on leprosy occurrence. Globally, incident cases of leprosy decreased by 27.86% from 1990 to 2019, with a reduction in ASIR (EAPC = −2.53), yet trends were not homogeneous across regions. ASIR and EAPC correlated positively with sociodemographic index (SDI), and an ASIR growth appeared in high SDI region (EAPC = 3.07). Leprosy burden was chiefly distributed in Tropical Latin America, Oceania, Central Sub-Saharan Africa, and South Asia. Negative correlations were detected between the incidence of leprosy and factors of SDI, GDP per capita, urban population to total population, and precipitation, whereas the number of refugee population, temperature, and elevation showed opposite positive results. Despite a global decline in leprosy over the past three decades, the disparities of disease occurrence at regional and national scales still persisted. Socioeconomic and physical geographic factors posed an obvious influence on the transmission risk of leprosy. The persistence and regional fluctuations of leprosy incidence necessitate the ongoing dynamic and multilayered control strategies worldwide in combating this ancient disease. [ABSTRACT FROM AUTHOR]

Solar bright points (BPs) are small-scale magnetic features observed on the solar surface. They play a significant role in the transfer of energy and mass between the solar photosphere and the corona. This article presents a comprehensive statistical analysis of BPs in different solar areas: quiet Sun (QS), active regions (AR), and coronal holes (CH). We separate the BPs into two categories: network and internetwork. Our study aims to understand the spatial distribution and properties of BPs in these areas, which can help improve our knowledge of the Sun's magnetic activity and energy transfer processes. Our research highlights the close relationship between the spatial distribution and characteristics of BPs and the solar magnetic field. Using machine learning, we achieved efficient and accurate BP detection, enabling analysis of a larger dataset. The prevalence of network BPs in the QS and internetwork BPs in CH suggests differences in magnetic field concentration. In AR, BPs are evenly distributed between network and internetwork areas, reflecting the complex nature of the magnetic field. [ABSTRACT FROM AUTHOR]

To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck. • Incidence of contralateral nodal relapse (CLNR) is low in lateralised oral cancers. • ≥2 ipsilateral positive lymph nodes are associated with higher risk of CLNR. • Nodal levels IB and II are the most common stations of contralateral relapse. • Contralateral relapse increases with increasing number of positive lymph nodes. • Elective contralateral neck treatment may be considered in case of ≥2 ipsilateral positive lymph nodes. [ABSTRACT FROM AUTHOR]

This short article aims to deliver a basic understanding of the fundamentals of data types and the application of descriptive statistics. Frequency distribution, including the normal (Gaussian) distribution, is covered alongside statistical testing and the basics of correlation and regression. Meta-analysis and systematic review are introduced. [ABSTRACT FROM AUTHOR]

Observer reliability studies for fracture classification systems evaluate agreement using Cohen's κ and absolute agreement as outcome measures. Cohen's κ is a chance-corrected measure of agreement and can range between 0 (no agreement) and 1 (perfect agreement). Absolute agreement is the percentage of times observers agree on the matter they have to rate. Some studies report a high-absolute agreement but a relatively low κ value, which is counterintuitive. This phenomenon is referred to as the Kappa Paradox. The objective of this article was to explain the statistical phenomenon of the Kappa Paradox and to help readers and researchers to recognize and prevent this phenomenon. [ABSTRACT FROM AUTHOR]

Insulin resistance (IR) is a key risk factor for chronic metabolic diseases, but its laboratory diagnosis is still costly; thus, the triglyceride-glucose (TyG) index has been proposed as a surrogate method. Our aim was to provide a detailed analysis of cutoffs and test the hypothesis that the TyG index would present reasonable performance parameters for IR screening. This is a cross-sectional study with baseline data from 12,367 eligible participants of both sexes (aged 35–74 years) from the Brazilian Longitudinal Study of Adult Health. TyG correlation and agreement with the Homeostasis Model Assessment for Insulin Resistance were analyzed. Positive and negative predictive values (PV+, PV–) and likelihood ratio (LR+, LR–) were calculated. A moderate positive correlation between TyG and Homeostasis Model Assessment for Insulin Resistance was observed (Pearson r = 0.419). The area under the receiver operating characteristic curve of TyG for IR diagnosis was 0.742 and the optimal cutoff was 4.665, reaching a kappa agreement value of 0.354. For this cutoff, a PV+ of 59.3% and PV– of 76.0%, as well as an LR+ of 2.07 and LR– of 0.45 were obtained. Alternatively, because high sensitivity is desired for screening tests, selecting a lower cutoff, such as 4.505, increases the PV– to 82.1%, despite decreasing the PV+ to 50.8%. We conclude that TyG has important performance limitations for detecting IR, but that it may still be reasonably useful to help screening for IR in adults because it can be calculated from low-cost routine blood tests. Research on the TyG index's effectiveness in assessing insulin resistance yields varying outcomes. Our extensive study reveals notable limitations in TyG's diagnostic performance, especially in predictive values and likelihood ratios for IR diagnosis. Despite this, TyG remains reasonably useful for IR screening in adults, given its cost-effective calculation from routine blood tests. Combining TyG with other data can enhance insulin resistance screening for clinicians. Abbreviations: AUC, area under the curve; HOMA, Homeostasis Model Assessment for Insulin Resistance; IR, insulin resistance; ROC, receiver operating characteristic; TyG: triglyceride-glucose. [Display omitted] [ABSTRACT FROM AUTHOR]

Nearly half of all state Medicaid agencies in the United States have implemented managed long-term services and supports (MLTSS). Data gaps have inhibited our understanding of MLTSS experiences to date. We draw on a national survey with novel data linkages to develop a profile of older dual-enrollees with significant LTSS needs by MLTSS program presence. Cross-sectional observational study using the 2015 round of the National Health and Aging Trends Study (NHATS), a longitudinal study of a nationally representative sample of Medicare beneficiaries aged 65 years and older. The sample comprised 275 participants who self-reported Medicaid enrollment and met our definition of significant LTSS need as defined by receiving help with 2 or more self-care or mobility activities (eating, bathing, toileting, dressing, bed transfer, indoor mobility). Bivariate analyses were used to comparatively examine differences in demographic, health, and care circumstances by MLTSS, as defined by living in a county with MLTSS program presence. Among approximately 1 million (weighted sample) older dual-enrollees with significant LTSS needs, 56.2% (weighted percentage) lived in counties with MLTSS and 43.7% lived in counties with mandatory MLTSS enrollment in 2015. Those living in areas with MLTSS were much more likely to be of Hispanic or other race and ethnicity (50.5% vs 15.1%, P <.001) yet less likely to live in a rural location (8.7% vs 31.4%, P <.05) or in a residential care facility or nursing home (18.4% vs 34.7%, P <.05). The majority (78.5%) received assistance from 2 or more helpers and received more than 70 hours of care per week. Our findings reinforce the growing reach of MLTSS programs and importance of filling evidence gaps about who these programs are serving. [ABSTRACT FROM AUTHOR]

Previous studies suggest that there is discordance between actual weight status and body-weight perception. This fact has implications when it comes to designing public health interventions. The aim of this study was to estimate the prevalence of the different categories of weight status and body-weight perception and to analyse their concordance in a representative Spanish population sample. Cross-sectional study. Data were sourced from the 2018 Galician Risk Behaviour Data System, with the target population being all persons aged 16 years and above. We collected data on self-perceived body weight and assessed weight status on the basis of body mass index (BMI). BMI was estimated using self-reported measures of weight and height. To estimate concordance, Cohen's kappa coefficient, both unweighted and weighted with Cicchetti weights, was calculated. Data were obtained for 7853 individuals aged 16 years and above, whereas the overall unweighted concordance was 0.393 (95%CI: 0.377–0.409), with an agreement percentage of 61.6%, weighted concordance was 0.503 (0.490–0.517), with an agreement percentage of 86.6%. The highest concordance between self-perceived body weight and weight status was observed in women. By age group, the highest concordance was observed in the youngest group (16–24 years) for the BMI categories of underweight and overweight, and in the 45–64 age group for the category of obesity. The results highlight the existence of differences between self-perceived body weight and weight status, according to sex and age. [ABSTRACT FROM AUTHOR]

The present study aims to explore the effect of COVID-19 infection on pregnant women in plateau regions. Data from 381 pregnant women infected with COVID-19 who underwent prenatal examination or treatment at Women and Children's Hospital of Tibet Autonomous Region between January 2020 and December 2022 and 314 pregnant women not infected with COVID-19 were retrospectively collected. The study participants were divided into an infected and non-infected group according to whether they were infected with COVID-19. Basic information (ethnicity, age, body mass index and gestational age [GA]), vaccination status, intensive care unit (ICU) admission and delivery outcomes were compared. Binary logistic regression was used to analyse the influencing factors of ICU admission. The results revealed significant differences in the GA, vaccination rate, blood pressure, partial pressure of oxygen, white blood cell (WBC) count, ICU admission rate, preeclampsia rate, forearm presentation rate, thrombocytopenia rate, syphilis infection rate and placental abruption rate between the two groups (P < 0.05). A univariate analysis showed that COVID-19 infection, hepatitis B virus infection, the WBC count and hypoproteinaemia were risk factors for ICU admission. The results of the multivariate analysis of the ICU admission of pregnant women showed that COVID-19 infection (odds ratio [OR] = 4.271, 95 % confidence interval [CI]: 3.572–5.820, P < 0.05) was a risk factor for ICU admission and the WBC count (OR = 0.935, 95 % CI: 0.874–0.947, P < 0.05) was a protective factor for ICU admission. Pregnant women are vulnerable to the adverse consequences of COVID-19 infection, and public health measures such as vaccination are needed to protect this population subgroup. [ABSTRACT FROM AUTHOR]

To ensure the quality, safety and efficacy of medicinal products, it is necessary to develop and execute appropriate manufacturing process and product control strategies. Traditionally, product control strategies have focused on testing known quality attributes with limits derived from levels administered in preclinical and clinical studies with an associated statistical analysis to account for variability. However, not all quality attributes have impact to the patient and those with the potential to impact safety and efficacy may not be significant when dosed at patient-centric levels. Therefore, achieving patient-centricity is understanding patient relevance, which is defined as the level of impact that a quality attribute could have on safety and efficacy within the potential exposure range. A patient-centric quality standard (PCQS) is therefore a set of patient relevant attributes and their associated acceptance ranges to which a drug product should conform within the expected patient exposure range. This manuscript describes historical perspectives details the way to create and leverage a PCQS in a variety of pharmaceutical product modalities. [ABSTRACT FROM AUTHOR]

• Proposing a fiducial-based fatigue design model for small-sample test data. • The quantile score considering overestimation and underestimation impacts is employed for fatigue design validation. • The proposed method outperforms the ISO method on small and medium sample data. • The proposed method performs comparably to the ISO method on extensive data. Understanding the correlation between the fatigue life of engineering materials and the applied stress is a crucial aspect of reliability and safety design. However, small data observations frequently occur in fatigue testing due to factors like time and budget limitations, as well as constraints related to the availability of testing materials and resources. In this article, fiducial inference method is employed for modeling P - S - N curves to deal with scenarios with small sample sizes. Fiducial inference can be seen as a procedure that provides a measure within a parameter space while requiring fewer assumptions than Bayesian inference (no prior). The performance of the proposed method is evaluated by comparing it with the ISO method using statistical simulation data and aluminum alloy 2524-T3 data. In scenarios with ample data (no less than 15 observations at each of the four stress levels), the proposed fiducial-based method yields results comparable to those obtained through the ISO method. When dealing with small-sample data (around 2–4 observations for each of the four stress levels) and medium-sample data (about 5–10 observations per stress level), the proposed fiducial-based method consistently outperforms the ISO method in terms of the quantile scores (also known as pinball loss). This shows the advantageous performance of the fiducial method under conditions of limited data availability. Besides, the consistency in performance across varying data size scenarios underscores the reliability and robustness of the fiducial-based approach in estimating probabilistic S - N curves. [ABSTRACT FROM AUTHOR]

• Information about all existing synthesized Mg containing high entropy alloys has been collected, systematized and analyzed. • Mg has a significant influence on the high entropy alloys properties. • Classification of high entropy alloys based on its density was proposed. • Unlocking novel insights in magnesium-inclusive high-entropy alloys. • Advancements in magnesium-enriched high-entropy alloys. This review focuses on thermodynamic and physical parameters, synthesis methods, and reported phases of Magnesium (Mg) containing high-entropy alloys (HEAs). Statistical data of publications concerning Mg-containing HEAs were collected and analyzed. Data on the chemical elements included in Mg-containing HEAs, their theoretical end experimental densities, thermodynamic parameters, physical parameters, fabricated techniques and reported phases were also collected and discussed. On the basis of this information, a new classification for HEAs was proposed. It is also shown that the existing thermodynamic parameters cannot accurately predict the formation of a single phase solid solution for Mg-containing HEAs. The physical parameters of Mg-containing HEAs are within a wide range, and most of the synthesized Mg-containing HEAs have a complex multiphase structure. [ABSTRACT FROM AUTHOR]

The Community Helpers Programme (CHP) is a peer-helping programme providing youth and young adults with tools to support their peers to problem solve and seek mental health and suicide prevention support. This study aims to evaluate the effectiveness of the provincial programme (primary outcomes = knowledge, self-efficacy; secondary outcome = awareness of stigma) and describe the experience of participants, coordinators, and others. The mixed methods evaluation included a longitudinal panel design outcome evaluation along with follow-up interviews. A series of three surveys collecting participant characteristics, knowledge, self-efficacy, and awareness of stigma at pre-training (T0), post-training (T1), and six-months follow-up (T2) were conducted. Mean group scores were calculated for completers (T0 and T1 completers and T0, T1, and T2 completers). Friedman tests were conducted to assess change over time and follow-up Wilcoxon Signed Rank tests determined the significance of changes in scores between each timepoint. Content analysis was conducted on qualitative data. Participants' knowledge of mental health, suicide, and available supports along with self-efficacy increased from T0 to T1, and declined at T2. Awareness of stigma was high at all timepoints. Themes from the qualitative analysis included skill and knowledge development facilitators (e.g., consideration of learner needs, passionate coordinators, engaged learning approaches), sustaining community helper connectedness (e.g., helpers' network, awareness of and communication with local resources), and role and impact of CHP (e.g., addressing stigma, success stories). This evaluation demonstrated that CHP was effective and offered feedback on experiences, including suggestions on CHP strengths and aspects to explore. [ABSTRACT FROM AUTHOR]

Most patients experience stable quality of life (QoL) after stereotactic ablative radiotherapy (SABR) treatment for oligometastases. However, a subset of patients experience clinically relevant declines in QoL on post-treatment follow-up. This study aimed to identify risk factors for QoL decline. The SABR-5 trial was a population-based single-arm phase II study of SABR to up to five sites of oligometastases. Prospective QoL was measured using treatment site-specific tools at pre-treatment baseline and 3, 6, 9, 12, 15, 18, 21, 24, 30 and 36 months after treatment. The time to persistent QoL decline was calculated as the time from SABR to the first decline in QoL score meeting minimum clinically important difference with no improvement to baseline score on subsequent assessments. Univariable and multivariable logistic regression analyses were carried out to determine factors associated with QoL decline. One hundred and thirty-three patients were included with a median follow-up of 32 months (interquartile range 25–43). Thirty-five patients (26%) experienced a persistent decline in QoL. The median time until persistent QoL decline was not reached. The cumulative incidence of QoL decline at 2 and 3 years were 22% (95% confidence interval 14.0–29.6) and 40% (95% confidence interval 28.0–51.2), respectively. In multivariable analysis, disease progression (odds ratio 5.23, 95% confidence interval 1.59–17.47, P = 0.007) and adrenal metastases (odds ratio 9.70, 95% confidence interval 1.41–66.93, P = 0.021) were associated with a higher risk of QoL decline. Grade 3 or higher (odds ratio 3.88, 95% confidence interval 0.92–16.31, P = 0.064) and grade 2 or higher SABR-associated toxicity (odds ratio 2.24, 95% confidence interval 0.85–5.91, P = 0.10) were associated with an increased risk of QoL decline but did not reach statistical significance. Disease progression and adrenal lesion site were associated with persistent QoL decline following SABR. The development of grade 3 or higher toxicities was also associated with an increased risk, albeit not statistically significant. Further studies are needed, focusing on the QoL impact of metastasis-directed therapies. • This is the first study to report risk factors for persistent quality of life (QoL) decline post-SABR for oligometastasis. • In this analysis, disease progression was the dominant risk factor for persistent QoL decline following SABR. • Adrenal sites of oligometastasis were also associated with persistent QoL decline but this finding will require validation in larger studies. • Further studies are needed focusing on the QoL impact of metastasis-directed therapies. [ABSTRACT FROM AUTHOR]

Mobile health applications (mHealth apps) are increasingly being used in weight loss interventions. However, evidence on the effects of such interventions on diet quality and their correlation with weight loss is lacking. The objective of this study was to examine whether changes in the diet quality of adults with prediabetes followed the use of an mHealth-enabled lifestyle intervention, compared with those who did not, and whether these changes correlated with weight loss. A secondary analysis of a 6-month randomized controlled trial Diabetes Lifestyle Intervention using Technology Empowerment (D'LITE) was conducted, with participants recruited from October 2017 to September 2019. Community-dwelling adults (n = 148) in Singapore diagnosed with prediabetes and body mass index (BMI) ≥23 were included in this study. Participants were randomized to receive either a 6-month mHealth-enabled lifestyle intervention program (diet and physical activity) or standard care dietary advice. Dietary data were collected in the form of 2-day food records at baseline, 3, and 6 months. Changes in Alternate Healthy Eating Index-2010 (AHEI-2010) scores and food groups (servings/day), calculated from the dietary data, and correlation between changes in AHEI-2010 and weight loss at 3 and 6 months, were examined. Between-group comparisons of continuous variables and within-participants variation were performed using longitudinal mixed-effect models, intention-to-treat principles. The models included treatment groups, time (baseline, 3 months, and 6 months), and covariates (age, sex, and BMI), as well as the group × time interactions, as fixed variables and within-participant variation in outcome values as random variable. The random intercept for participants accounted for the dependence of repeated measures. A likelihood ratio test was also conducted to test random effect variance. Spearman correlation test was used to examine correlation between changes in AHEI-2010 scores and weight loss. There was a significant improvement in overall diet quality as ascertained by the AHEI-2010, by 6.2 points (95% confidence interval [CI], 3.8–8.7; P < 0.001) in the intervention group as compared with the control. The participants in the intervention group had a significantly greater reduction in intake of sugar-sweetened beverages (SSB) by 0.5 servings/day (95% CI, −0.8, −0.2; P < 0.001) and sodium by 726 mg/day (95% CI, −983, −468; P <.001), compared with those receiving standard care. At 3 and 6 months, a significant decrease in SSB (0.8 servings/day; 0.7 servings/day, respectively) and sodium (297 mg/day; 296 mg/day, respectively) intakes were reported compared with baseline intakes. Small positive correlations (r = 0.2; P < 0.05) were observed between changes in AHEI-2010 scores from baseline and percentage weight loss at 3 and 6 months. For adults with prediabetes in Singapore, diet quality can be improved with an mHealth-enabled lifestyle intervention program. A small positive correlation exists between AHEI-2010 scores and weight loss. [ABSTRACT FROM AUTHOR]

To investigate the association between pre-pregnancy body mass index (BMI) and the early pregnancy loss rate in patients in first hormone replacement therapy-frozen-thawed embryo transfer (HRT-FET) cycles and find the threshold. A retrospective cohort study was conducted using a total of 14030 HRT-FET cycles at the Reproductive Center from January 2017 to December 2021. The association of pre-pregnancy BMI on early pregnancy loss rate in patients in HRT-FET cycles was assessed by performing univariate analysis, multivariable logistic regression, curve fitting and threshold effect analysis. There were 2076 cycles of early pregnancy loss, and the pregnancy loss rate was 14.80%. After adjusting for confounding factors, the early pregnancy loss rate of the obese group was significantly higher than that of the normal weight group (P < 0.05). The threshold effect analysis showed that as the pre-pregnancy BMI ranged from 21.2 to 25.8 kg/m2, the early pregnancy loss rate came to the plateau phase at the low level. In addition, when the BMI was ≥ 25.8 kg/m2, the early pregnancy loss rate increased by 3% (aOR = 1.03, P = 0.01) with each 1 kg/m2 increment of BMI. The early pregnancy loss rate might achieve a low level when the pre-pregnancy BMI was within the range of 21.2- 25.8 kg/m2. The early pregnancy loss rate would increase when pre-pregnancy BMI is more than 25.8 kg/m2. For patients in HRT-FET cycles, adjusting their pre-pregnancy BMI to the optimal level by following a healthy diet and daily exercise may help to reduce the early pregnancy loss. [ABSTRACT FROM AUTHOR]

The goal of asthma guideline therapy is to achieve disease control, by minimizing impairment and decreasing the risk of exacerbations and adverse effects of the disease and its treatment. The primary objective of most clinical trials of biologics for severe asthma is a reduction in exacerbation rate. Recently, studies with patients at the lower guideline steps have also selected exacerbation reduction as a primary objective. These trials in patients with milder disease frequently demonstrate statistically significantly fewer exacerbations, but their power calculations reflect larger sample size and smaller effect size. Exacerbations have a precise consensus definition, although a minimal clinically important difference has not been established. Reduction of exacerbations in severe asthma is commonly 10-fold greater than in mild disease. Further, reduction in exacerbations is not always associated with reduced impairment. If superior control is the objective, both domains should demonstrate consistent and parallel improvement. The disconnect may reflect the need for alternative tools for measurement of impairment or, possibly, different therapeutic mechanisms of action. Determining response to biologics or discussion of disease remission requires assessing symptoms that may occur daily rather than focusing on exacerbations that occur once or twice a year for patients at the highest steps of care according to the guidelines. [ABSTRACT FROM AUTHOR]

The volume of shoulder arthroplasty continues to rise. Computed tomography (CT) is a valuable tool for preoperative planning and has been linked to decreased revision rates in patients undergoing anatomic or reverse total shoulder arthroplasty (TSA). As more patients undergo CT imaging prior to planned arthroplasty, the number of incidental findings (IFs) will likely increase. The purpose of this study was to quantify the frequency of IFs on preoperative shoulder CT scans prior to TSA, describe common IFs, and report the incidence of further medical or imaging evaluation of those findings. A secondary aim was to identify patient characteristics associated with the identification of IFs on preoperative CT imaging prior to TSA. A retrospective, single-center cohort study of 385 patients undergoing planned TSA between 2018 and 2022 was performed. Patients who underwent a preoperative CT were included. Data were extracted from the electronic medical records for each included patient. Patient factors associated with increased IFs on CT were identified using univariate logistic regression model. A total of 385 patients who underwent 416 anatomic or reverse TSA procedures were included in analysis. Overall, 208 (50.0%) patients were found to have IFs on CT. Pulmonary IFs were the most common type of IF (58.2%). A total of 57 IFs (27.9%) were deemed actionable and required further evaluation. The most common action performed was a chest CT scan (47.4%). Three patients (5.3%) required further biopsy of IFs, and 4 patients (7.0%) required surgical intervention. Smoking history was significantly associated with both identification of IFs (P =.017) and with that finding being actionable (P =.037). Male gender was associated with a decreased likelihood of actionable IFs (OR = 0.41, P =.004). IFs on preoperative imaging for TSA are common and may require further evaluation. Most IFs are related to pulmonary pathology, and a concern for lung cancer prompted further work-up in some patients. For high-volume TSA centers, it may be beneficial to establish protocols for care based on common IFs. [ABSTRACT FROM AUTHOR]

Postoperative follow-up is a routine component of the surgical care of a patient undergoing shoulder arthroplasty. Orthopedic journals require a high follow-up percentage in prospective studies to ensure reproducibility, generalizability of the data, and to limit bias. This study's primary aim was to report the true follow-up rates after total shoulder arthroplasty among a multicenter cohort at 1, 2, 5, and 10 years and to explore various demographic factors associated with follow-up rates. A retrospective review of patients undergoing anatomic and reverse total shoulder arthroplasties at five U.S. centers from 2000 to 2020 was performed. The presence or absence of follow-up at 1-, 2-, 5-, and 10-year follow-up intervals was recorded as well as associated patient demographics and history variables. Univariate and multivariable logistic regression models were employed to examine the factors associated with patient follow-up. 4700 shoulder arthroplasties were identified across five centers for review. Eligible follow-up rates were 66% at 1 year, 47% at 2 years, 26% at 5 years, and 9% at 10 years. When compared with the majority baseline groups at 1 year in multivariable analysis, the follow-up rate was significantly less for male patients (odds ratio [OR] = 0.83, P =.004), those over age 80 (OR = 0.66; P <.001), black patients (OR = 0.76, P =.035), Hispanic patients (OR = 0.54, P =.041), self-paying patients (OR = 0.5, P <.001), disabled patients (OR = 0.69, P =.021), those with psychiatric history (OR = 0.76, P <.001), and those with preoperative opioid use (OR = 0.81, P =.016). At 2 years, significantly lower follow-up rates were identified with patients ages 35 to 49.9 years (OR = 0.62, P =.013), over age 80 (OR = 0.67, P <.001), Hispanic (OR = 0.42, P =.010), unemployed (OR = 0.65, P =.014), psychiatric history (OR = 0.82, P =.017), and smoking history (OR = 0.71, P =.010). True clinical follow-up rates following shoulder arthroplasty are much lower than the 80% 2-year follow-up rate expected by most orthopedic journals. Many factors contribute to differences among follow-up rates. Promoting follow-up at all time points would limit bias in orthopedic literature and potentially allow for early intervention of complications, but would need to be balanced with the additional burden and resources needed from patients and providers. [ABSTRACT FROM AUTHOR]

The impact of hypovitaminosis D in patients undergoing shoulder arthroplasty has yet to be fully determined. Our study aims to assess postoperative outcomes in patients undergoing shoulder arthroplasty, and evaluate the association between preoperative vitamin D level and postoperative outcomes. A retrospective review of patients undergoing hemiarthroplasty, anatomic total shoulder arthroplasty, and reverse total shoulder arthroplasty between 2012 and 2022 at a single institution was performed. Outcomes including readmission, reoperation, mortality, and medical complications, as well as preoperative and postoperative range of motion (ROM), pain scores, and functional outcome scores, were examined. Between September 2012 and September 2022, 576 shoulder arthroplasties were performed at our institution, of which 94 patients had preoperative vitamin D levels recorded; 35.11% were deficient with vitamin D levels under 20 mg/mL, 29.79% were insufficient and had vitamin D levels between 20 and 29 mg/mL, and 35.11% had levels considered sufficient. There was no statistically significant association between vitamin D levels and complications on univariable analysis (P >.05). There was also no statistically significant association between preoperative vitamin D levels and use of cemented implants intraoperatively. Pain scores and ROM were not associated with vitamin D level although ROM approached statistical significance. The association between lower vitamin D levels and worse postoperative outcomes or increased rate of short-term complications was not supported by our study. For patients without osteoporosis, a recorded low vitamin D level at the time of surgery was not associated with an increased risk of postoperative complications or poor postoperative outcome. Randomized controlled trials investigating the association between vitamin D and postoperative outcomes are needed. [ABSTRACT FROM AUTHOR]

A lack of comprehensive research on socioeconomic factors affecting total shoulder arthroplasty (TSA) outcomes has demonstrated the need for further study. The purpose of this study is to determine the effects of socioeconomic factors such as ethnicity, income, and insurance status on the outcomes following TSA. All anatomic TSA and reverse TSA cases from the National Inpatient Sample (NIS; N = 128,376) database from 2011 to 2019 as well as the Nationwide Readmission Database (NRD; N = 103,023) from 2010 to 2019 were analyzed. Self-identified ethnicities assessed in NIS included Caucasian (CC), African American (AA), and Hispanic (H), and ethnicities were compared to Caucasians. NRD cases were assessed by insurance status (Medicare, Medicaid, and private) and zip code income Quartiles (Q1-4, with Q1 being the lowest). Insurance types and Q1-3 were compared to private insurance and Q4, respectively. Demographic data, quantitative variables, and binary categorical variables were analyzed using chi-square test of independence, one-way ANOVA with Tukey-Kramer post hoc analyses, and binary logistic regression, respectively. For NIS, AA had the highest percent Q1 and comorbidities of all ethnicities (P <.001), increased lengths of stay and hospital stay extensions (both P <.001). The majority of H were Q1 (P <.001) with increased comorbidities (P <.001), lengths of stay (P <.001), stay extensions (P =.027) and complications (P =.043). For NRD, Medicare patients had a 1.5 times higher mean comorbidity score (P <.001) and increased risk of complication (P =.007), readmission (P <.001), revision (P =.028), hospital stay extension (P <.001), and discharge to a new facility (P <.001). Similarly, Medicaid patients had a 1.6 times increased mean comorbidity score (P <.001), and the highest risk of the following adverse outcomes: length of stay extension (odds ratio [OR]: 1.43, P <.001), complication (OR: 1.24, P =.017), and readmission (OR: 1.18; P =.041). Additionally, they had an increased risk of discharge to a new facility (OR: 1.78, P <.001). Comparing TSA patients in the Q1-3 to Q4, first quartile income was significantly associated with increased risk of hospital stay extension (P =.043), complication (P <.001), and readmission (P <.001). Second and third quartile patients had increased risks of any complication (Q2: P =.003; Q3: P =.016). The socioeconomic factors studied - ethnicity (AA and H), zip code income (Q1, Q2, and Q3), and insurance status (Medicare or Medicaid) - were all shown to have significantly increased risk for adverse outcomes following TSA. Private insurance status, CC, and zip code income Q4 were all predictive of significantly less adverse outcomes. Further study is needed to assess specific social differences associated with these results. [ABSTRACT FROM AUTHOR]

Total shoulder arthroplasty (TSA) is a common orthopedic procedure for which there are anatomic TSA (aTSA) and reverse TSA (rTSA) options. The current study aimed to characterize the 2011-2020 utilization trends of aTSA and rTSA as well as assess and compare perioperative outcomes using a large, national, multi-insurance administrative data set. Data were utilized from the 2011 through 2020 M151 PearlDiver database. Trends in usage of aTSA relative to rTSA were characterized. For the more recent years (2015 through 2020), after 1:1 matching of patients based on age, sex, and Elixhauser Comorbidity Index, perioperative outcomes and surgeon volume were compared for the two procedures with univariable and multivariable analyses. From 2011 through 2020, a total of 148,231 TSAs were identified (aTSA 57,680 [38.9%]; rTSA 90,551 [61.1%]). Over this period, the yearly overall incidence of TSAs being performed increased from 5890 to 23,215 (an increase of 394.1%) and the percent of TSA being performed with rTSA increased from 31.4% to 74.9%. The increased percentage of rTSA was accounted for by increased numbers of rTSA, as opposed to decreased aTHA. When assessing patients from the more recent years (2015-2020), those undergoing rTSA were older, more female, and had a higher Elixhauser Comorbidity Index (P <.0001 for each). After matching for these criteria, 33,582 were available from each of the subcohorts for comparing perioperative outcomes. Of these matched patients, those undergoing rTSA (compared to aTSA) were of independently greater odds for: transfusion (odds ratio [OR] 1.92), wound dehiscence (OR 1.54), any adverse event (OR 1.29), sepsis (OR 1.46), acute kidney infection (OR 1.35), pneumonia (OR 1.30), urinary tract infection (OR 1.28), and severe adverse events (OR 1.16). For surgeon volume, there was a long right-tail where the average ± standard deviation was more than twice the median for both rTSA (average: 40.7 ± 78.9; median: 16 [39]) and aTSA (average: 39.2 ± 56.3; median: 18 [39]). From 2011 to 2020, the number of TSAs performed yearly increased by 394.1%, of which rTSA increased from 31.4% to 74.9%. This shows that rTSA has been a disruptive technology in TSA because it has expanded the TSA patient population. There were increased perioperative adverse events associated with rTSA vs. aTSA, which is not explained by patient demographics or comorbidities. Given the rapid adoption of rTSA and the low average annual volume of this procedure performed per surgeon (<7), the effect of surgeon volume on perioperative outcome following rTSA merits further investigation. [ABSTRACT FROM AUTHOR]

The B2 glenoid poses significant challenges for reconstruction with shoulder arthroplasty. A variety of techniques has been used to quantify the B2 glenoid and is often used for surgical decision-making. The critical B2 glenoid ratio is a novel measure and is defined as the ratio between the paleoglenoid length (original glenoid surface) and the total glenoid length. This study aims to define inter and intrarater reliability of the critical B2 ratio and to compare it to conventional methods of measurement. A convenience sample of patients with Walch B2 glenoid morphology was generated from a prospectively collected multicenter shoulder arthroplasty registry. The axes of preoperative computed tomography (CT) images were reoriented in the scapular plane. Three sports medicine surgeons experienced in arthroplasty measured the critical B2 glenoid ratio in addition to posterior humeral subluxation, version, and glenoid bone loss at 2 timepoints greater than 1 week apart. Inter-rater and intra-rater reliability were calculated for all readers and CT measures with the intraclass correlation coefficient (ICC). The critical B2 glenoid ratio was compared to conventional measurements using Spearman's rank correlation coefficients and receiver operating characteristic (ROC) curves. The critical B2 glenoid ratio demonstrated good inter-rater reliability among the 3 measurers with ICCs of 0.89 and 0.799 for the 1st and 2nd measurement sessions, respectively. The critical B2 glenoid ratio showed excellent intrarater reliability for 2 of the measurers (ICC 0.933 and 0.98) and good intrarater reliability for 1 of the measurers (ICC 0.820). A significant correlation was observed between glenoid bone loss along Friedman's line and the critical B2 ratio (P <.001). ROC curves found a B2 ratio = 0.4 was found to be an inflection point for 15° of neoglenoid (posterior erosion surface) retroversion. ROC curves to assess if humeral head subluxation >70% correlated to a threshold B2 ratio value revealed no significant threshold. The critical B2 glenoid ratio is a novel and reproducible CT-based measure that is defined as the ratio between the paleoglenoid length and the total glenoid length. It has high reproducibility based on inter and intra-rater reliability among a group of shoulder surgeons. A critical B2 ratio of less than or equal to 0.4 correlates with significant neoglenoid retroversion and may be a threshold beyond which to avoid corrective eccentric reaming for anatomic shoulder arthroplasty. [ABSTRACT FROM AUTHOR]

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• In this study, we conducted a statistical analysis of foF2 and TEC data under both ionospheric quiet and disturbed conditions, employing the ionospheric slab thickness model. • The utilization of Kriging with external drift (KED) in generating maps has enhanced their realism. • The inclusion of foF2 data from the map's periphery has resulted in the overall stabilization of the map. • Based on our findings, we can conclude that the correlation distance between ionospheric characteristics should not exceed the range of 120–300 km. The importance of this study lies in its contribution to the field of ionospheric science, particularly in the monitoring and prediction of ionospheric parameters. This study focuses on comparing two techniques for spatio-temporal kriging of critical ionospheric parameters, namely the F2 layer critical frequency (foF2) and Total Electron Content (TEC), under both quiet and disturbed ionospheric conditions. The first technique, Ordinary Kriging (OK), relies solely on foF2 data, while the second technique, Kriging with External Drift (KED), incorporates the dynamic relationship between foF2 and TEC data to improve the interpolation process. This study demonstrates how KED, which utilizes dynamic secondary information, offers advantages over OK. By simultaneously monitoring the ionosphere from a single ionosonde station and collecting data from visible GPS satellites, KED enhances the accuracy of spatial structural analysis, enabling more precise estimations of ionospheric characteristics across interpolation grid nodes. The research highlights that the non-uniform distribution of ionosonde stations, especially in regions with limited foF2 data, can benefit from KED's incorporation of TEC data. Additionally, the study reveals the potential for improving TEC maps by assimilating foF2 data located at the periphery of the observation area. Furthermore, the paper discusses the determination of semivariogram structures for both foF2 and TEC data, emphasizing the spatial correlations between data points. These findings contribute to a better understanding of ionospheric behavior and the potential for enhanced ionospheric modeling. [ABSTRACT FROM AUTHOR]

Hallux valgus is a common condition where the subluxation of the first metatarsophalangeal joint and lateral deviation of the hallux at the interphalangeal joint creates difficulty with footwear fit. Footwear and foot orthoses are commonly prescribed nonsurgical treatments for hallux valgus. Do extra-width footwear and foot orthoses influence peak pressure at the medial aspect of the metatarsophalangeal and interphalangeal joints in women with hallux valgus? Community-dwelling women with symptomatic hallux valgus underwent gait testing when wearing their own shoes and when wearing extra-width footwear fitted with three-quarter length, arch-contouring prefabricated foot orthoses. Peak pressure (kPa) on the medial aspect of the metatarsophalangeal and medial interphalangeal joints and on the plantar surface of the foot (hallux, lesser toes, metatarsophalangeal joint 1, metatarsophalangeal joints 2–5, midfoot and heel) were measured using the novel pedar®-X system with the pedar® pad and pedar® insole, respectively (Novel, GmbH, Munich, Germany). Paired samples t -tests were used to calculate the differences between the two conditions, and the magnitude of observed differences was calculated using Cohen's d. We tested 28 participants (aged 44–80 years, mean 60.7, standard deviation 10.7). Compared to their own footwear, wearing the intervention footwear and orthoses was associated with a statistically significant decrease in pressure on the medial aspect of the metatarsophalangeal joint (58.3 ± 32.8 versus 42.6 ± 32.8, p =0.026, d =0.49), increased pressure under the midfoot (70.7 ± 25.7 versus 78.7 ± 23.6, p =0.029, d =0.33) and decreased pressure underneath the heel (137.3 ± 39.0 versus 121.3 ± 34.8, p =0.019, d =0.45). The intervention footwear and orthoses significantly decreased peak pressure on the medial aspect of the first metatarsophalangeal joint but had no significant effect on the interphalangeal joint. Further studies are required to determine whether these changes are associated with improvements in symptoms associated with hallux valgus. • We investigated peak medial and plantar pressure in women with hallux valgus. • The intervention decreased medial pressure at the first metarsophalangeal joint. • The intervention increased midfoot and decreased heel plantar pressure. • Women with hallux valgus may benefit from extra-width footwear and orthoses. [ABSTRACT FROM AUTHOR]

The development of normal tissue radiation dose-response models for children with cancer has been challenged by many factors, including small sample sizes; the long length of follow-up needed to observe some toxicities; the continuing occurrence of events beyond the time of assessment; the often complex relationship between age at treatment, normal tissue developmental dynamics, and age at assessment; and the need to use retrospective dosimetry. Meta-analyses of published pediatric outcome studies face additional obstacles of incomplete reporting of critical dosimetric, clinical, and statistical information. This report describes general methods used to address some of the pediatric modeling issues. It highlights previous single- and multi-institutional pediatric dose-response studies and summarizes how each PENTEC taskforce addressed the challenges and limitations of the reviewed publications in constructing, when possible, organ-specific dose-effect models. [ABSTRACT FROM AUTHOR]

This letter introduces a Discriminant Analysis-based unimodality Test (DAT) for automatically identifying whether a dataset is unimodal or multimodal, detecting deviations in time series datasets, estimating statistical parameters, and identifying the skewness of the data. DAT is effective in classifying datasets under both unimodal and multimodal conditions and is suitable for bi-classification applications. The performance of DAT was compared to two well-known unimodality tests, namely the dip and folding tests, and is shown to perform better. We then extended DAT to the development of a fault detection technique, which was tested against five different machine learning classifiers using data from the Case Western Reserve University (CWRU) ball bearing database. The results obtained show that the proposed approach is effective, achieving 99.999% accuracy for detecting small ball bearing fault sizes (0.007 inches). Our conclusion indicates a significant potential of the proposed test for improving anomaly detection in industrial and other related fields. • Introduces the Discriminant Analysis-Based Unimodality Test (DAT). • Compares DAT with Dip and Folding tests and proves superiority. • Extension and application of DAT for fault detection with 99.999% accuracy. • Shows immense potential for enhancing anomaly detection. [ABSTRACT FROM AUTHOR]

Evidence shows stereotactic ablative body radiotherapy (SABR) is used as a non-invasive ablative therapy in the treatment of multisite oligometastatic (OM) and oligoprogressive (OP) diseases originating from metastatic breast cancer. This study aims to report the treatment outcomes and to investigate what factors that are prognostic in terms of local control, progression-free survival (PFS) and overall survival (OS) in patients receiving SABR for extracranial OM and OP diseases originating from metastatic breast cancer. A retrospective review on treatment records of patients with OM and OP from metastatic breast cancer who underwent SABR at a single was carried out. SABR was performed with daily image-guided radiotherapy (IGRT) using a dedicated robotic SABR machine. Local control, PFS and OS were calculated using Kaplan-Meier statistics and the post-treatment toxicity data was scored following the CTCAE v4.0 protocol. Univariate and multivariate Cox regression tests were used in the subgroup analysis of prognostic factors on PFS and OS including patients' age, types of follow-up imaging (staging CT only vs whole-body MR/PET), metastases status (OM vs OP), primary breast cancer tumour grade, hormone receptors (ER/PR/HER2) status, change of systemic treatments at SABR, number of metastases, SABR treatment sites and doses. 56 metastatic breast cancer patients (38 patients with OM and 18 patients with OP) were involved in this retrospective review. The median follow-up was 35.6 months (range 4.0–132.9 months). The estimated local control at 1 , 2 and 5 years were 90.9%, 88.7% and 88.7%, respectively. The estimated median PFS was 19.2 months (95%CI 10.3–28.1 months); the PFS at 1, 2 and 5 years were 63.3%, 44.4% and 33.2%. The estimated OS at 1, 2 and 5 years were 98.0%, 91.9% and 74.3%, respectively with the estimated median OS of 105.1 months (95%CI 51.5–158.7 months). The vast majority of patients tolerated the treatment well with the commonest acute side effects as grade 1 fatigue. There were no statistically significant factors found in OS regression analysis. The types of follow-up imaging, metastases status, oestrogen receptor status, and number of metastases for SABR were statistically significant factors (p < 0.05) in the multivariate Cox regression analysis on PFS. There are limited studies published on the efficacy and post-treatment toxicities of metastatic breast cancer OM and OP SABR with adequate length of follow-up. This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer in terms of the acceptable post-treatment toxicities. • This study reported SABR treatment outcomes for multisite OM and OP diseases originating from metastatic breast cancer • It showed modest local control and post-treatment toxicities on the SABR of extracranial OM and OP from metastatic breast cancer. • The types of follow-up imaging, OM vs OP, oestrogen receptor status, and number of metastases for SABR can be used as PFS prognostic factors. [ABSTRACT FROM AUTHOR]

India is the third-largest tobacco manufacturer and its use in India is characterised by a high prevalence of smoking and smokeless (sl) tobacco use. This results in 1 million deaths per year in the country. Given the high burden of tobacco use, this study examines the regional variations and socio-economic correlates of tobacco use in India. National Family Health Survey- 5 (2019–2020) have been analysed for the purpose of the study. A sample of 101,839 males aged 15–54 years was included in this study. Primary outcomes of tobacco use were categorised into smoking, smokeless and dual use of smoking and smokeless tobacco use. Bivariate analysis and decomposition analysis was done to study the socio-economic inequality. The prevalence of tobacco use among males in India is around 41 percent. As indicated by the results of the logistics regression, age is positively related to smoking among males. Males aged 45–54 years are 2.5 (95 % concentration index [CI]:2.30–2.63) times probable to smoke, 1.4 (95% CI: 1.30–1.47) times probable of smokeless tobacco consumption and 2.2 (95% CI: 2.10–2.35) times more prone to using both types of substances compared to the younger age group. Males who are widower use smokeless 1.69 times (95% CI: 1.44–1.99) higher with reference to unmarried males. Males belonging to Scheduled tribes are 1.2 (95% CI: 1.13–1.25) times more likely to smoke, 1.3 (95% CI: 1.24–1.37) times more likely to use smokeless substances and 1.4 (95% CI: 1.33–1.47) times more likely to have dual use of tobacco than other social groups. Manual workers (both skilled are unskilled) are likely to smoke (odds ratio [OR] = 1.1, 95% CI: 1.02–1.11), use smokeless tobacco (OR = 1.3, 95% CI: 1.23–1.34) and have dual use of tobacco (OR = 1.29, 95% CI: 1.24–1.34) more than that of other categories. The decomposition of the concentration index shows a significant contribution from factors like a no education, ST/SC caste and wealth index. Among the states and union territories, the prevalence of tobacco is high in West Bengal, Tripura, Mizoram, Manipur, Meghalaya and Sikkim. This study is useful for informing target-based prevention policies since it helps in highlighting regions, socio-economic and demographic groups especially vulnerable to tobacco addiction. In India, males from poorer and vulnerable socio-economic backgrounds are more likely to use tobacco. State wise, the eastern zone starting from West Bengal to the North-Eastern states have higher tobacco use than the rest of the country. There is an urgent need to frame policies for controlling the use of tobacco especially among high-risk groups. [ABSTRACT FROM AUTHOR]

The objective of this study was to identify Brazil's most critical garbage codes (GCs) reclassified to Chagas disease (ChD) in mortality data and their proportions. We also estimated the potential impact of misclassification on the number of deaths attributed to ChD. Population-based descriptive study. We used the Mortality Information System (SIM; in Portuguese) data before and after routine GC investigation in 2015–2019 to evaluate ChD deaths detected among them. We identified priority GCs, which contributed more than 0.1 % to the percentage of total ChD deaths registered. Spearman's correlation was used to evaluate the association between the reclassification of priority GCs and ChD prevalence. Then, we applied the GC correction factors to estimate the number of deaths attributed to ChD. 22,154 deaths were reported as ChD in the study period. Among them, 1004 deaths originally listed as priority GCs were deaths reclassified to ChD after an investigation in the SIM final database. Unspecific cardiomyopathy (10.2 %), unspecific heart diseases (4.7 %), and heart failure (2.8 %) were GCs with the highest proportions of reclassification to ChD in Brazil. Higher ChD prevalence at the state level was associated with a higher proportion of GC deaths reclassified as ChD. When applying correction factors identified after investigation, we estimated an increase of 26.4 % in registered ChD deaths, mostly in states with higher endemicity. GCs might conceal deaths due to ChD, particularly in Brazil's states with higher endemicity. The approach suggested in this study may offer an alternative method for estimating ChD-related deaths in endemic countries. [ABSTRACT FROM AUTHOR]

Patients with breast cancer who have positive lymph nodes are currently recommended axillary node clearance (ANC) or regional nodal irradiation (RNI). ANC is associated with complications such as lymphoedema, brachial plexopathy and shoulder stiffness. The AMAROS Group showed RNI to be non-inferior to ANC with regards to survival and recurrence, and with a better quality of life. We conducted a large real-world population study to show our centre's experience with the use of RNI and to contribute to the current discussion around the management of node-positive breast cancer. We evaluated patients who received RNI as opposed to ANC between 2006 and 2009 (n = 190). Patients had a range of cancer subtypes/grades. All had positive axillary disease, identified by axillary node sampling or sentinel lymph node biopsy. Systemic therapy was given as per standard protocol. Our data were compared with those of patients who had RNI (n = 681) in AMAROS. Patients were followed up retrospectively and overall survival, breast cancer-specific survival, distant metastasis-free survival, locoregional recurrence and toxicity were recorded, including lymphoedema, brachial plexopathy and shoulder stiffness. Survival analysis was performed on R via the Kaplan–Meier method. Univariate and multivariate analyses were also performed. Toxicity data were reported as percentages. Patients meeting POSNOC trial criteria (one to two positive sentinel lymph nodes, macrometastasis, receiving adjuvant chemotherapy) including if oestrogen receptor-positive (stratified POSNOC) were identified for subgroup analysis in the regression model. Locoregional recurrence was 3.16% versus AMAROS RNI of 1.82%. Overall survival was slightly lower in our population, but cancer-specific survival was higher than AMAROS. Lymphoedema rates were 5.8% versus AMAROS 11% in RNI and 23% in ANC arms, respectively. Brachial plexopathy was 1.6% and arm/shoulder stiffness 7.4%. AMAROS conducted a quality of life survey pertaining to arm/shoulder stiffness, mobility and function, which seemed to affect about 18% in the RNI arm. Univariate analysis revealed POSNOC status, especially if also oestrogen receptor-positive, to be a low risk group with hazard ratio 0.42 (0.20–0.83, P = 0.015). Extracapsular extension of lymph node metastasis was a poor prognostic factor; hazard ratio 4.39 (1.45–14.0, P = 0.009). We support the conclusion of the AMAROS trial with survival and recurrence following RNI being non-inferior to ANC, and with similarly favourable toxicity data. We support the continuing use of RNI as a treatment option for patients with node-positive breast cancer. Further research is required to answer the key questions regarding personalised management for node-positive breast cancer, with regards to de-escalation and also intensification for the patients exhibiting adverse tumour biology. • Real world data from our centre shows similar outcomes with regards to survival and toxicity as the AMAROS Group. • We have found that the POSNOC criteria , when applied to our dataset, are a lower risk group. • We suggest de-escalation of multimodality treatment for low risk node positive breast cancer with personalisation of care. [ABSTRACT FROM AUTHOR]

This study considers one of the partially accelerated life testing models, mainly a constant-stress approach with unified hybrid censored data. The data represents the lifetime of units following the exponentiated gamma distribution (EGD). The estimation techniques for the parameter of EGD and the acceleration factor are discussed, along with the maximum likelihood estimation technique, the Bayesian and E-Bayesian estimation. Utilizing the squared error loss (SEL) and LINEX loss functions, the E-Bayesian and Bayesian estimates are generated. For deriving the estimates of Bayesian and E-Bayesian approaches, we use the MCMC method. Real-world data is also provided for illustration. Furthermore, unified hybrid censoring schemes (HCSs) are examined to determine their effectiveness in the light of the results. In the end, we compare among the proposed methods during their findings. The study's findings demonstrate how well the suggested techniques work when utilizing unified HCS. The study also makes clear how important it is to adopt the CSPALT model, as it yields more failed things in a shorter amount of time than items with typical use situations. In conclusion, it is suggested that this research be used to tasks like industrial product reliability testing. [ABSTRACT FROM AUTHOR]

Missing data are a common issue in medical research. We aim to explain in non-technical language the issues and concepts around missing data, as well as discuss common methods for handling missing data. Specifically, our objectives are to answer the following questions: (1) What are missing data and why should we care about them? (2) What are the missingness mechanisms and how do they impact statistical analysis? (3) How can we explore missing values in our datasets? (4) What are ad-hoc methods for dealing with missing values and are they valid? (5) What is multiple imputation? (6) What should we consider when conducting a multiple imputation analysis? (7) Is multiple imputation always needed? (8) How should we report an analysis with missing data? We illustrate discussions with examples from an orthodontic study. [ABSTRACT FROM AUTHOR]

The introduction of reporting checklists such as CONSORT aimed to enhance the clarity and transparency of the reporting of Randomised Clinical Trials (RCTs). A benefit of clear reporting is to allow healthcare clinicians to assess both the study quality and trial findings and determine its applicability in the treatment of their patients. Despite this global initiative, the reporting of Randomised Clinical Trials (RCTs) undertaken in both dentistry and orthodontics has been reported to sub-optimal in relation to several domains affecting the validity of the trial. Within the literature the adequacy of the statistical analysis undertaken in a trial has been questioned. The aim of this narrative review is to provide clinicians with an overview of the common statistical errors evident in published orthodontic Clinical Trials and to highlight the potential consequences on the interpretation of the trial findings. [ABSTRACT FROM AUTHOR]

Longitudinal growth data with repeated measurements of distances and angles on radiographs are usually collected to study skeletal and dental changes throughout childhood and adolescence. The analysis of longitudinal data usually requires sophisticated statistical methods and modeling techniques because repeated measurements made on the same subject violate the assumption of independence underlying classical statistical tests. Advanced methods, such as multilevel modeling, must be used to account for the correlations between repeated measurements. In this article, we describe four statistical models for the analysis of growth data: linear multilevel model, curvilinear multilevel model, multilevel Preece-Baines model, and super imposition by translation and rotation (SITAR) model. We use data of 42 children on the mandibular length obtained from the archives at the AAOF Craniofacial Growth Legacy Collection for demonstration. Our analyses showed that although the multilevel curvilinear model appears to fit the data well from a statistical perspective, the Preece-Baines model and the SITAR model provide additional insights into mandibular growth. The SITAR model suggests two growth peaks which is consistent with the current understanding of mandibular growth and deserves more attention from orthodontic researchers. [ABSTRACT FROM AUTHOR]

This article presents a useful application of the Manta Ray Foraging Optimization (MRFO) algorithm for solving the adaptive infinite impulse response (IIR) system identification problem. The effectiveness of the proposed technique is validated on four benchmark IIR models for reduced order system identification. The stability of the proposed estimated IIR system is assured by incorporating a pole-finding and initialization routine in the search procedure of the MRFO algorithm and this algorithmic modification contributes to the MRFO algorithm when seeking stable IIR filter solutions. The absence of such a scheme, which is primarily the case with the majority of the recently published literature, may lead to the generation of an unstable IIR filter for unknown real-world instances (particularly when the estimation order increases). Experiments conducted in this study highlight that the proposed technique helps to achieve a stable filter even though large bounds for the design variables are considered. The convergence rate, robustness, and computational speed of MRFO for all the considered problems are investigated. The influence of the control parameters of MRFO on the design performances is evaluated to gain insight into the interaction between the three foraging strategies of the algorithm. Extensive statistical performance analyses employing various non-parametric hypothesis tests concerning the design consistency and convergence are conducted for comparison of the proposed MRFO-based approach with six other metaheuristic search procedures to investigate the efficiency. The results on the mean square error metric also highlight the improved solution quality of the proposed approach compared to the various techniques published in the literature. [ABSTRACT FROM AUTHOR]

The rate coefficients of H + O 2 = O + OH (R1) were reevaluated using the reported shock tube experimental data from Ryu et al. (1995), Yuan et al. (1991), Masten et al. (1991) and Hong et al. (2011) based on our latest kinetic mechanism [Xueliang Yang et al., Journal of Physical Chemistry A, 2021, 125, 10223–10234]. The statistical analysis using weighted average and weighted least-square regression was performed by applying the updates on specific rates and corresponding uncertainties. The chain-termination reaction of H + O 2 (+ M) = HO 2 (+ M) (R2) was reevaluated as well. New rate formulae of R1 and R2 were derived and incorporated back into the mechanism. The validation demonstrates the updated mechanism has good performance against the measurements such as mass burning rate and ignition delay time at broad range of initial conditions. • The reaction rates of H + O 2 were reevaluated based on shock tube experiments. • Uncertainties of reaction rates were assessed for weighted statistical analysis. • The updated mechanism with reevaluated rates was validated against the measurements. [ABSTRACT FROM AUTHOR]

Si le terme de transphobie est aujourd'hui discuté dans les médias comme dans la littérature scientifique à ce sujet, c'est souvent pour renvoyer aux questions de discriminations, de stigmatisations et, plus rarement, d'agressions. En France, notamment, la notion d'« homicide transphobe » est très peu discutée. L'objet de cet article sera d'en définir les contours et d'en proposer un panorama comparatif à travers le monde. If the term transphobia is discussed in the media or in the scientific literature on the subject, it is often in reference to questions of discrimination, stigmatization and, more rarely, aggression. In France, in particular, the notion of "transphobic homicide" is rarely discussed. The purpose of this article is to define this concept and to offer a worldwide comparative overview. [ABSTRACT FROM AUTHOR]

Examine user perceptions of the Mind Your Heart (MYH) program, a mindful eating and nutrition education program delivered via an eHealth system. Sixteen participants (41.5 ± 13.1 years) completed sample MYH lessons over 3 weeks. We examined changes in mindfulness from the State Mindfulness Scale via text messages sent 3 times per week. We assessed MYH user perceptions in a semistructured interview after 3 weeks. Analyses included Spearman's correlation, repeated measures ANOVA, and thematic analysis. State Mindfulness Scale scores were significantly improved (F [1,15] = 5.35, P = 0.01) from week 1 (M = 2.28 ± 0.80) to week 3 (M = 2.75 ± 1.04). Four themes emerged: (1) MYH is supportive of health goals, (2) text messages act as an intervention, (3) facilitators or inhibitors of use, and (4) enhancing engagement. Based on participant feedback, the final version of MYH should include example-based learning to translate abstract concepts like mindful eating into action. [ABSTRACT FROM AUTHOR]

Adenoid cystic carcinoma (ACC) grows slowly and is characterised by potential recurrence and metastasis to distant organs. This study aimed to evaluate the risk factors for locoregional recurrence (LRR) and distant metastasis in patients with ACC of the external auditory canal (EAC). Demographic, pathological, therapeutic and survival data of 143 patients with EAC ACC were reviewed in this study. Univariate and multivariate Cox proportional hazard regression analyses were carried out to determine the risk factors for LRR and distant metastasis. Factors associated with overall survival after LRR and distant metastasis were also analysed. During a median follow-up of 49 months, 31 of 143 patients were observed with LRR and 34 developed distant metastasis. Bone invasion and histological subtype were independent risk factors for locoregional recurrence-free survival. T stage and LRR were independent risk factors for distant metastasis-free survival. Salvage surgery and adjuvant radiotherapy or chemoradiotherapy for LRR resulted in better survival, whereas extrapulmonary metastasis and LRR were associated with a higher risk of poor survival after distant metastasis. Patients with distant metastases, especially those with LRR, are at significant risk of poor prognosis. Our findings emphasise the importance of long-term regular follow-up and recommend surgical intervention with radiotherapy for recurrent EAC ACC. • Largest series of adenoid cystic carcinoma of the external auditory canal from a single centre. • Identify the risk factors influencing survival after the occurrence of locoregional recurrence and distant metastasis. • Emphasise the importance of long-term regular follow-up. • Provide guidance for treating physicians in terms of risk stratification and treatment strategies. [ABSTRACT FROM AUTHOR]

This work presents the application of Neural Networks (NNs) techniques to develop an empirical model for foF2, the critical frequency of the F2 ionospheric layer. Prediction of foF2 parameter is important because of the paucity of data in some areas of the globe (due to uneven distributions of ground- based measuring equipment) and, also, because of the roles it plays in high frequency communications and navigation purposes. Hourly values of foF2 corresponding to the period 1985–2007 and obtained from 105 World-wide distributed ionospheric stations, have been considered in this work. A statistical analysis of the difference between NN model-derived and the corresponding experimental foF2 values was carried out for eleven (11) selected ionospheric stations during periods of very high (year 2000), relatively low (year 2006) and very low (year 2008) solar activity. In particular, the ionospheric behavior during the years 2000 and 2008 appeared to be very challenging to be captured for any empirical model. For comparison purposes, the same kind of statistical analysis was performed with foF2 values as obtained from the International Reference Ionosphere (IRI) model and from NeQuick 2 model. Results of the statistical comparison confirmed that the neural network modelling approach is suitable to describe in a climatological way the main characteristics of the ionosphere F2 layer peak frequency, also over the extended geographic region where the additional sensor stations were located. The results obtained also indicate that the NN predictions and NeQuick 2 algorithm driven by solar flux (F10.7) index have similar performance. [ABSTRACT FROM AUTHOR]

In order to compare the strength results of brittle materials from various testing methods or use the data for design purposes, it is essential to know the effective volume (V eff) or surface (S eff) for every loading scenario. For the Ball-on-Three-Balls-test (B3B), V eff and S eff have to be determined and investigated through Finite-Element-Analysis due to the lack of an accurate analytical description of the stress field. Through this work, the effective volume and surface of the B3B-test are made available as tabulated data for a wide range of specimen geometries and materials, along with the tools to utilize the data. A fitting model for the dependency of V eff and S eff on the Weibull-modulus for any given specimen geometry is provided. The influence of load-dependent non-linear effects on V eff and S eff is discussed. Finally, the necessity of V eff and S eff for statistical strength analysis is demonstrated through a practical example. [ABSTRACT FROM AUTHOR]

The carpal tunnel syndrome instrument (CTSI) is the most widely used patient-reported outcome measure (PROM) in carpal tunnel syndrome (CTS). However, CTSI is an ordinal-type questionnaire and might have caused misinterpretations of the PROM between surgical outcomes of CTS (Camitz and extra/open carpal tunnel release). This study aims to convert the CTSI to an interval scale using Rasch analysis (RA) and evaluate the outcome differences between the original and transformed scales. Prospective control study. Four hundred twenty-four patients with 567 CTSs had been interviewed for CTSI perioperatively and treated with either endoscopic/open carpal tunnel release or Camitz tendon transfer. Each CTSI was analyzed for dimensionality, fit statistics, and a transformation of the ordinal-to-interval scale by RA. We compared the two groups perioperative scores of three CTSI versions (original 11-item, modified 8-item, and transformed 8-item). Based on the RA, the original CTSI was not unidimensional. We identified two dimensions. After removing misfit items, the perioperative course of each score by three versions of each dimension was compared (Repeated 2-factor analysis of variance). The transformed interval scales of CTSI provided different assessments of score changes from the ordinal scale of CTSI analyses. Original CTSI consisted of ordinal scale items that yielded different conclusions than scores converted to interval scale by Rasch analysis. CTSI should convert into an interval scale after reclassifying dimensionality by Latent Factor Analysis and removing misfit items • The original CTSI was not unidimensional. • Carpal tunnel syndrome instrument was transformed from an ordinal scale to interval scale. • The transformed interval scales of CTSI provided different assessments of score changes from the ordinal scale of CTSI analyses. • CTSI should convert into an interval scale after re-classifying dimensionality by Latent Factor Analysis and removing misfit items. [ABSTRACT FROM AUTHOR]

• Both competency-based learning and traditional learning methods were effective methods for teaching statistics. • Students felt competency-based learning allowed more flexibility with repeating course content until it was mastered. • Statistics self-efficacy was comparably improved when students were enrolled in competency-based vs. traditional learning statistics course sections. Interdisciplinary undergraduate students are expected to develop statistical competence to interpret research findings as they advance in their healthcare studies and careers. However, students often report anxiety related to learning statistical course content. This descriptive study examined differences in statistical knowledge and self-efficacy scores of undergraduate students enrolled in online competency-based and traditional learning statistics courses. A sample of 20 nursing and interdisciplinary, undergraduate students from a Midwestern University who were enrolled in introductory statistics courses were recruited for this study. Significant differences between pre-test and post-test statistical knowledge and self-efficacy scores were compared for students receiving online competency-based learning and traditional learning statistical course content. The Current Statistics Self-Efficacy (CSSE) and the Self-Efficacy to Learn Statistics (SELS) measures determined the statistics self-efficacy scores. There was a significant difference in knowledge scores from pre- to post-test in the areas of hypothesis testing (p =.02), measures of central tendency (p =.001), and research design (p =.001), but there was not a significant difference in overall mean scores between competency-based learning and the traditional learning groups (p =.10). The pre-test to post-test Current Statistics Self-Efficacy student scores improved significantly in both the competency-based learning (p <.001) and traditional learning (p <.001) statistics course sections; and the Self Efficacy to Learn Statistics pre-test to post-test scores were also significantly improved in the competency-based (p <.001) and traditional (p =.02) learning groups. Both online competency-based and traditional learning methods improved interdisciplinary undergraduate students' statistical knowledge and self-efficacy scores. Online competency-based learning was described by the students as at least as beneficial as traditional learning for studying statistics while allowing more flexibility to repeat content until it was mastered. This study compared pre- and post-test differences in statistical knowledge and self-efficacy scores of students enrolled in online competency-based learning and traditional learning statistics class sections. [ABSTRACT FROM AUTHOR]

The Swarm satellite mission has been used for numerous studies of the ionosphere. Here we use a global product, based on electron density measurements from Swarm that characterises ionospheric variability. The IPIR (Ionospheric Plasma IRregularities product) provides characteristics of plasma irregularities in terms of their amplitudes, gradients and spatial scales and assigns them to geomagnetic regions. Ionospheric irregularities and fluctuations are often the cause of errors in position, navigation, and timing (PNT) based on the Global Navigation Satellite Systems (GNSS), in which signals pass through the ionosphere. The IPIR dataset also provides an indication, in the form of a numerical value index (IPIR index), of the severity of irregularities affecting the integrity of trans -ionospheric radio signals and hence, the accuracy of GNSS positioning. We analysed datasets from Swarm A and ground-based scintillation receivers. Time intervals (when Swarm A passes over the field of view of the ground-based GPS receiver) are compared to ground-based scintillation data, collecting an azimuthal selection of the GNSS data relevant to the Swarm satellite overpass. We provide validations of the IPIR product against the ground-based measurements from 23 ground-based receivers, focusing on GPS TEC and scintillation data in low-latitude, auroral and polar regions, and in different longitudinal sectors. We have determined the median, mean, maximum and standard deviation of the parameter values for both datasets and each conjunction point. We found a weak correlation of the intensity of both phase and amplitude scintillation with the IPIR index. [ABSTRACT FROM AUTHOR]

Introduction : In pursuit of sustainability goals, many cities are introducing measures to increase the usage of bicycles as a means of transportation. City planners aim to ensure that this increase does not lead to an increase in crashes, but must make corresponding infrastructure decisions with limited information. Sufficient data to perform a statistical analysis of location-specific crash frequencies is rarely available. For example, only approximately 10% of all bicycle crashes are reported to the police (Shinar et al., 2018). Therefore, urban planners often rely on expert opinion, which may lead to suboptimal prioritization and realization of infrastructure improvements. Method: This paper demonstrates how surveys on bicycle crashes can be used to aid urban planners in making infrastructure decisions. In addition to confirming the location and characteristics of reported crashes, surveys can uncover characteristics of crashes that are not reported to the police, situations in which a crash almost occurred, and locations perceived by cyclists to be dangerous. Surveys also allow urban planners to investigate non-infrastructure related causes of crashes, such as the frequency with which individual cyclists use other modes of transportation. Practical Applications: The usefulness of surveys in the determination of urban cycling safety is demonstrated in this paper through analysis of survey results from the city of Zurich in 2018. [ABSTRACT FROM AUTHOR]

Cervical cancer (CC) remains a crucial public health issue in Estonia, with high incidence and late diagnosis. The aim of this study was to examine time trends of stage-specific CC incidence in Estonia and factors associated with advanced-stage diagnosis of CC. This was a nationwide population-based retrospective study. Data on CC cases diagnosed in Estonia in 2007–2018 were obtained from the Estonian Cancer Registry, including tumour, nodes, metastases stage at diagnosis. Sociodemographic data were obtained from the Population Registry. To estimate the risk of advanced-stage diagnosis (stages II–IV vs stage I) associated with sociodemographic factors, Poisson regression with robust variance was used to calculate univariate and multivariate prevalence ratios (PR) with 95% confidence intervals (CIs). Time trends of stage-specific CC incidence for 2005–2019 were examined with joinpoint analysis. Incidence of stage I CC showed a significant decline of 4.9% per year since 2007, whereas no change was seen for other stages. Of the 2046 women diagnosed in 2007–2018, 1137 (55.6%) were diagnosed at an advanced stage; this proportion increased from 51% in 2007–2009 to 58% in 2015–2018 (P = 0.004). Multivariate regression analysis showed that advanced-stage diagnosis was associated with age (PR 2.16, 95% CI 1.87–2.49 for women aged ≥75 years compared with those aged 30–44 years), educational level (PR 1.32, 95% CI 1.15–1.51 for women with basic/primary education compared to university education) and marital status (PR 1.14, 95% CI 1.01–1.29 for single women compared to married/cohabiting women). No associations were observed by region of residence or nationality. To reduce CC mortality, it is crucial to improve prevention and early diagnosis of CC in Estonia through human papillomavirus vaccination and effective and quality-assured screening particularly targeting high-risk groups as well as encouraging symptom awareness and regular check-ups among older women. [ABSTRACT FROM AUTHOR]