Search

Background: Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. Aims: We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. Study design: The first part of this before/after study consisted in assessing the proportion of patients receiving an anti‐diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. Results: Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti‐diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p =.40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p =.35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1–7] vs. 0 day [0–2]; p <.001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p <.001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. Conclusions: The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. Relevance to clinical practice: The use of specific anti‐diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU. [ABSTRACT FROM AUTHOR]

Objective: To investigate gastrointestinal (GI)‐related physician visits and drug dispensations in the 5 years preceding a first recorded demyelinating event or multiple sclerosis (MS) onset. Methods: Using linked administrative and clinical data from British Columbia (1996–2013), Canada, we identified an administrative cohort via a validated algorithm (n = 6863), a clinical cohort diagnosed at a MS clinic (n = 966), and matched controls (administrative cohort: n = 31,865; clinical cohort: n = 4534). In each cohort, the 5 years before a first demyelinating event or MS symptom onset (i.e., index date) were examined. We compared rates of GI‐related physician visits and risk of ≥1 GI‐related dispensation between MS cases and controls using negative binomial and robust Poisson models. Sex differences were tested using interaction terms. Results: The administrative cohort MS cases had higher rates of physician visits related to gastritis and duodenitis (adjusted rate/risk ratio (aRR):1.42, 95% CI: 1.10–1.83) and diseases of the esophagus (aRR: 1.46, 95% CI: 1.06–2.02) prior to the index date. MS cases also had greater risk of at least one dispensation for several drug classes, including constipation‐related (aRR: 1.82, 95% CI: 1.50–2.22), antiemetics/antinauseants (aRR: 1.64, 95% CI: 1.43–1.89), and propulsives (promotility drugs; aRR: 1.62, 95% CI: 1.47–1.79). Men had a disproportionally higher relative risk for propulsives than women (aRR: men = 2.32, 95% CI: 1.79–3.00; women = 1.54, 95% CI: 1.36–1.72). Several findings were similar in the smaller clinical cohort though none reached statistical significance. Interpretation: GI‐related physician visits and drug dispensations were more common in the 5 years before the first demyelinating event versus matched controls. GI symptoms are a measurable feature of the prodromal or early phase of MS, with a sex difference evident. [ABSTRACT FROM AUTHOR]

Background: Omalizumab, an anti‐IgE monoclonal antibody, is an effective treatment in chronic spontaneous urticaria (CSU). Predictors of fast and good response for omalizumab treatment have not yet been identified and characterized. Objective: To evaluate whether soluble FcεRI (sFcεRI), a marker of IgE‐mediated mast cell activation, predicts the time of response to omalizumab in CSU. Methods: Sera of 67 CSU patients were obtained before omalizumab treatment and analysed for sFcεRI levels by ELISA (2 ng/mL was used as cut‐off for elevated sFcɛRI). Treatment response during the first 4 weeks was assessed with the urticaria activity score (UAS7), urticaria control test (UCT) and the rolling UAS7 (rUAS7). Results: Elevated pre‐treatment sFcɛRI levels were detected in more than 70% of patients with completely controlled disease (UCT = 16) and well‐controlled disease (UCT = 12–15) and were significantly associated with disease control (χ2 = 4.94, p < 0.05). More than half of the patients (14/25) with low levels had poor disease control (UCT < 12). Of the patients who achieved complete and marked UAS7 response, respectively, 75% and 63% had elevated baseline sFcɛRI levels. Post‐treatment UAS7 scores were lower in patients with elevated sFcɛRI levels reaching statistical significance at Week 3 (p < 0.05). Patients with elevated baseline sFcɛRI levels achieved rUAS7 ≤ 6 and = 0 earlier than those with lower levels (Days 9 vs. 13 and Days 12 vs. 14, respectively). Conclusion: Elevated sFcεRI serum levels predict early and good response to treatment with omalizumab, which may help to better design treatment options for CSU patients. [ABSTRACT FROM AUTHOR]

Introduction: Academic detailing has been used as a preferential method to increase pharmacists' awareness of naloxone; however, its impact on actual dispensing rates is not well established. Objective: The aim of this pilot study is to determine if a student‐led academic detailing on naloxone use and communication increased the amount of naloxone ordered from independent pharmacies in various geographic settings throughout Northeast Pennsylvania. Methods: Thirty‐nine independent pharmacies which utilized a single wholesaler were randomized to receive an in‐person, student‐led training about naloxone use and communication. Students attended a train‐the‐trainer presentation to ensure a universal training was provided to all pharmacies. Students were provided with intranasal naloxone demonstration devices, handouts on effective communication, and talking points for each pharmacy visit. All academic detailing sessions were held live at each pharmacy during that pharmacy's regular business hours. Topics covered included appropriate naloxone use, what to expect after giving naloxone, and evidence‐based communication methods for engaging with patients about purchasing naloxone. Devices and handouts were left behind for pharmacists to use in daily practice. Naloxone and opioid shipping data for 3 months prior to and 3 months post‐intervention were compared. Results: Naloxone ordered in the pre‐intervention period was 21 vs. 26 (intervention vs. control) (p = 0.59) and 31 vs. 29 post‐intervention (p = 0.25). There was no statistically significant difference in the number of pharmacies which ordered more naloxone pre vs. post‐intervention or in the total amount of opioids ordered pre vs. post‐intervention. Conclusion: While pharmacies which received academic detailing did order more naloxone than pharmacies which did not, the difference did not rise to a level of statistical significance. As the population of this pilot study was small, expanding this approach to academic detailing to a larger population is warranted to possibly see more robust results. [ABSTRACT FROM AUTHOR]

Objective: To report on our first‐in‐human experience using the LithoVue Elite™ ureteroscope (Boston Scientific Corp., Marlborough, MA, USA) to measure intrarenal pressure (IRP) during flexible ureteroscopy. Patients and Methods: A single‐arm retrospective observational analysis was performed in 50 consecutive patients undergoing ureteroscopic lithotripsy using the LithoVue Elite™ system with pressure sensing capability between April 2022 and February 2023 at two centres. A pressure bag set at 150 mmHg or hand irrigation with a 60‐mL syringe was used for irrigation and a ureteric access sheath (UAS) was placed at the physician's discretion. Median and maximum IRPs, and relative cumulative time exceeding 20, 40, 60, 80, 100, 120, 140, 160, and 200 mmHg per total procedure time were analysed. The two‐sample Mann–Whitney U‐test was used, with statistical significance set at P < 0.05. Results: The median (interquartile range [IQR]) patient age and body mass index (BMI) was 62.5 (46.7–68.2) years and 27.6 (23.3–32.1) kg/m2, respectively. During the median (IQR) total procedure time of 31.9 (17.4–44.9) min, the median and maximum IRPs were 28.5 (20.0–47.5) and 174.0 (133.5–266.0) mmHg, respectively. IRP remained at <60 mmHg during 92% of the procedure times. Patients with Asian ethnicity, and those without pre‐stenting or UAS use exhibited longer cumulative/total durations exceeding pre‐defined IRP cut‐off values. The smaller 10/12‐F UAS did not lower pressures as much as the 11/13‐F or 12/14‐F UAS (P < 0.001). Age, diabetes, hypertension, preoperative α‐blockade, stone size, and BMI did not show any statistically significant associations with IRP. Conclusions: The IRP can now be routinely measured during ureteroscopy. Patients had a median IRP of 28.5 mmHg and a maximum of 174 mmHg. Using a smaller UAS (10/12 F), Asian ethnicity, and tight ureters were found to have higher IRPs. [ABSTRACT FROM AUTHOR]

Background: Placenta accreta spectrum disorder is an increasingly prevalent cause of maternal morbidity in developed countries. Aims: This study aimed to review the management and outcomes of cases of placenta accreta spectrum, and compare blood loss and blood transfusion rates, over time after an institutional change in planned primary surgeon from gynaecological oncologists to experienced obstetricians. Methods: This retrospective cohort study included all cases of suspected or confirmed placenta accreta spectrum disorder (PASD) between 1999 and 2021 at Monash Health. Data were collected by reviewing medical records to obtain baseline characteristics, details of surgical planning and management and major maternal morbidity outcomes over a 20‐year period. The primary surgical lead was recorded as either gynaecological oncologist or experienced obstetricians. The primary outcomes were estimated maternal blood loss and number of units of blood transfused. Results: A total of 88 patients were identified: 43 between 1999 and 2015 where gynaecological oncologists were the primary surgeon in 79% of cases and 45 between 2016 and 2021 where experienced obstetricians were the primary surgeon in 73.3% of cases. There was no statistically significant difference in the estimated blood loss between the two time periods (median: 2000 vs 2500 mL, P = 0.669). Hysterectomy rates were significantly reduced in the second time period, from 100 to 73.3%, P < 0.001. Conclusion: Management of cases of PASDs has improved over time with changes in antenatal diagnosis and perioperative management, and management by experienced obstetricians has similar maternal outcomes compared to those whose management includes the presence of gynaecological oncologists. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether a Bayesian interpretation might help prevent misinterpretation of statistical findings and support authors to differentiate evidence of no effect from statistical uncertainty. Design: A Bayesian re‐analysis to determine posterior probabilities of clinically important effects (e.g., a large effect is set at a 4 percentage point difference and a trivial effect to be within a 0.5 percentage point difference). Posterior probabilities greater than 95% are considered as strong statistical evidence, and less than 95% as inconclusive. Sample: 150 major women's health trials with binary outcomes. Main Outcome Measures: Posterior probabilities of large, moderate, small and trivial effects. Results: Under frequentist methods, 48 (32%) were statistically significant (p‐value ≤ 0.05) and 102 (68%) statistically non‐significant. The frequentist and Bayesian point estimates and confidence intervals showed strong concordance. Of the statistically non‐significant trials (n = 102), the Bayesian approach classified the majority (94, 92%) as inconclusive, neither able to confirm or refute effectiveness. A small number of statistically non‐significant findings (8, 8%) were classified as having strong statistical evidence of an effect. Conclusions: Whilst almost all trials report confidence intervals, in practice most statistical findings are interpreted on the basis of statistical significance, mostly concluding evidence of no effect. Findings here suggest the majority are likely uncertain. A Bayesian approach could help differentiate evidence of no effect from statistical uncertainty. [ABSTRACT FROM AUTHOR]

Background: We aimed to assess self‐management skills and adherence behaviors in young people post‐liver transplant and compare these with those of young people with autoimmune liver disease and other forms of chronic liver disease. Method: As part of our specialist multidisciplinary clinic, n = 156 young people (aged 16–25 years) completed the Liver Self‐Management Questionnaire (an adaptation of the Developmentally Based Skills Checklist for adolescents post‐liver transplant and modified for us across liver disease type and within the United Kingdom). Those taking medication (n = 128) also completed a service‐designed questionnaire regarding adherence. The statistical significance of group differences was assessed with non‐parametric analyses. Results: Young people post‐liver transplant were less likely to report managing their condition independently than those with autoimmune liver disease or those with other forms of chronic liver disease. They also reported higher adherence (93%) compared to those with autoimmune liver disease (77%) and those with other forms of chronic liver disease (85%). However, the vast majority of self‐management and adherence behaviors were comparable between young people post‐transplant and those with autoimmune liver disease/other forms of chronic liver disease. Conclusion: Our data are in line with existing data from US samples and also extend these findings to include those with other forms of chronic liver disease. These data highlight the importance of individualized care for young adults, regardless of condition type or healthcare setting, and of clinicians managing their expectations regarding what is considered appropriate condition management in early adulthood. [ABSTRACT FROM AUTHOR]

The optimal surgical intervention for lateral patellar instability remains a topic of controversy despite satisfactory clinical outcomes and low re‐dislocation rates reported in numerous studies following medial patellofemoral ligament reconstruction (MPFLR) with and without tibial tubercle transfer (TTT). The purpose of this systematic review and meta‐analysis is to investigate the hypothesis that combining MPFLR with TTT provides reduced complication rates and improved clinical outcomes to isolated MPFLR in patients with lateral patellar instability. We conducted a comprehensive systematic review and meta‐analysis of comparative trials involving MPFLR with and without TTT, sourcing data from PubMed, the Cochrane Library, Embase, and Web of Science. The primary clinical outcomes analyzed included the Kujala score, the Lysholm score, complication rates, and the Caton–Deschamps index (CDI). Random or fixed effects were used for the meta‐analysis. Postoperatively, there were no significant differences observed in the Kujala and Lysholm scores between MPFLR and MPFLR + TTT (p = 0.053). At the final follow‐up, the CDI had decreased 0.015 (95% CI −0.044, 0.013; p = 0.289) points in the MPFLR group, with no statistical significance. In contrast, the MPFLR + TTT group demonstrated a significant decrease of 0.207 (95% CI −0.240, −0.174; p = 0.000) points in CDI. Notably, the complication rate was higher in the MPFLR + TTT group compared to the MPFLR‐only group (RR = 2.472; 95% CI 1.638, 3.731; p = 0.000). Both MPFLR and MPFLR + TTT procedures yield significant improvements in the Kujala and Lysholm scores. However, the MPFLR + TTT approach results in an apparent improvement in CDI and corrects patellar maltracking, particularly in cases involving high tibial tuberosity‐trochlear groove (TT‐TG) (>20 mm) or patella alta (CDI > 1.2), while MPFLR alone cannot. It is essential to consider the higher complication rate of MPFLR + TTT, which suggests that MPFLR alone may be sufficient for patients without high TT‐TG or patella alta. [ABSTRACT FROM AUTHOR]

The complementary nature of analysis of variance (ANOVA) Simultaneous Component Analysis (ASCA+) and Tucker3 tensor decompositions is demonstrated on designed datasets. We show how ASCA+ can be used to (a) identify statistically sufficient Tucker3 models; (b) identify statistically important triads making their interpretation easier; and (c) eliminate non‐significant triads making visualization and interpretation simpler. For multivariate datasets with an experimental design of at least two factors, the data matrix can be folded into a multi‐way tensor. ASCA+ can be used on the unfolded matrix, and Tucker3 modeling can be used on the folded matrix (tensor). Two novel strategies are reported to determine the statistical significance of Tucker3 models using a previously published dataset. A statistically sufficient model was created by adding factors to the Tucker3 model in a stepwise manner until no ASCA+ detectable structure was observed in the residuals. Bootstrap analysis of the Tucker3 model residuals was used to determine confidence intervals for the loadings and the individual elements of the core matrix and showed that 21 out of 63 core values of the 3 × 7 × 3 model were not significant at the 95% confidence level. Exploiting the mutual orthogonality of the 63 triads of the Tucker3 model, these 21 factors (triads) were removed from the model. An ASCA+ backward elimination strategy is reported to further simplify the Tucker3 3 × 7 × 3 model to 36 core values and associated triads. ASCA+ was also used to identify individual factors (triads) with selective responses on experimental factors A, B, or interactions, A × B, for improved model visualization and interpretation. ANOVA Simultaneous Component Analysis (ASCA+) and Tucker3 tensor decompositions are combined to identify statistically sufficient Tucker3 models, identify statistically important triads and eliminate non‐significant triads, making visualization and interpretation simpler. The new method is illustrated on a previously published dataset. Bootstrap analysis was used to determine confidence intervals and identify statistically significant core values. An ASCA+ backward elimination strategy is reported to further simplify the Tucker3 model and identify individual triads with selective responses on experimental factors. [ABSTRACT FROM AUTHOR]

The appearance of actinic lentigines mainly found on face, back of the hands, upper back and décolleté is associated with chronic sun exposure. However, there is no study looking at the role of long UVA specifically in the development of actinic lentigines. This study was conducted in 20 Japanese adult women exposed on the upper back area three times per week for 6 weeks to incremental sub‐erythemal UVA1 doses (5 J/cm2 at weeks 1 and 2, 10 J/cm2 at weeks 3 and 4 and 15 J/cm2 at weeks 5 and 6). Clinical assessment, performed on day 0 (before any exposure), and on days 14, 28 and 42, included the evaluation of skin pigmentation (pigmented spots), chromametry of the pigmented skin lesions and measurement of dyschromy. The number of pigmented spots and uniformity of the skin's pigmentation were clearly increased in comparison with baseline, statistical significance of the difference (p < 0.05) being reached at D 28 and D 42 in both cases. In conclusion, repeated sub‐erythemal UVA1 exposure induces the development of actinic lentigines. Thus, a suitable protection including long UVA coverage is also needed to prevent from the damages induced by low, sub‐erythemal doses of UV exposure. [ABSTRACT FROM AUTHOR]

This study aimed to compare mobility range, level of pain and sleep quality in patients with venous leg ulcers to age‐ and gender‐matched controls without ulcers. Twenty patients with venous leg ulceration and 20 matched controls each answered a questionnaire, completed the short‐physical performance battery, filled in a subject diary and wore a smartwatch for 1 week. The median daily step counts of the ulcer group (3622 steps/day) and the control group (5133 steps/day) were significantly different (P =.017). Significant correlations between total step count and age, duration of physical outdoor activities and scores in the short‐physical performance battery were observed in the ulcer group. The scores in the short‐physical performance battery were significantly different in both groups (P =.005), indicating weaker physical performance in the ulcer group. The greatest difference in the self‐reported level of pain between the two groups was stated during movement. On average, the ulcer group slept shorter by 1 h 38 min (P =.002) and had 0.7 wake phases per night (P =.019) more than the control group. Assessing mobility in patients with venous leg ulcers can be used to develop preventive and interventional concepts to improve and individualise physical therapies. [ABSTRACT FROM AUTHOR]

Using U.S. post‐war data, we investigate whether the interest rate response to inflation known as the Fisher effect could be asymmetric. The asymmetry considered is that the long‐run change in the interest rate is larger when inflation rises than when it falls. The possibility follows from behavioural hypotheses about the relationship of inflation expectations to actual inflation. Using an asymmetric cointegration approach, we find asymmetric cointegration in the Fisher effect for the post‐war period through 1979, but not subsequently. We then find that starting in 1980, a breakdown developed in the relationship between inflation expectations from surveys and actual recent inflation rates, a breakdown not accounted for by asymmetry. If the survey results approximate true expectations, then econometric testing using actual recent inflation to compute expected inflation will suffer from mismeasurement, which could explain the finding of no cointegrating Fisher effect post‐1979. The paper accounts for breakpoints and uses bootstrapping to conservatively estimate statistical significance. [ABSTRACT FROM AUTHOR]

Following calls for research to increase gender equality, we investigated women's intentions to pursue career opportunities, in the form of career development programs. We built on lack of fit and signaling theory to argue that women's but not men's pursuit of career opportunities would be influenced by recruiter gender and gender‐stereotypical wording in recruitment advertisements. We conducted two studies in Germany. In Study 1 (video‐based experiment with 329 university students), we found that when a male recruiter used stereotypically masculine compared to feminine wording, female students anticipated lower belongingness, expected lower success of an application, and indicated lower application intentions for career opportunities. These differences in female students' evaluations disappeared when the recruiter was female. While Study 2 (experimental vignette study with 545 employees) replicates the negative effects of masculine wording for female employees; the buffering effect of female recruiters was only replicated for younger, but not for older female employees. Women's anticipated belongingness mediated the relationship between advertisement wording and application intentions when the recruiter was male. Recruiter gender and wording had no effects on men. Our work contributes to a better understanding of when and why contextual characteristics in the recruitment process influence women's pursuit of career opportunities. [ABSTRACT FROM AUTHOR]

Acta Obstetricia et Gynecologica Scandinavica (AOGS) has updated its guidelines for authors to report methods and statistical analyses. The guidelines reflect recent advancements in research methodology and address concerns about the misuse of statistical hypothesis testing. The guidelines aim to promote transparency and best practices in scholarly publishing by encouraging consistent and standardized reporting. They also emphasize the interpretation of effect sizes and confidence intervals, rather than relying solely on statistical significance. The guidelines cover various aspects of experimental and observational studies and are aligned with the EQUATOR network's guidelines for health research. AOGS encourages authors to adhere to these guidelines to enhance the credibility and understanding of their research. [Extracted from the article]

Even while attempting to explain the same outcomes, research on leadership and on human resource management (HRM) have largely progressed on parallel trajectories. We extend recent efforts to bring these fields closer together by testing how employee perceptions of a high‐performance work system (HPWS) and transformational leadership (TL), independently and jointly, influence four important employee attitudes. Analyses of 308 subordinates of 76 managers in five multinational companies suggest that a HPWS substitutes for much of the independent influence of TL and constitutes an important boundary condition for some of this influence. Implications for future research on HRM and leadership are discussed. [ABSTRACT FROM AUTHOR]

Purpose: Does the cylindrical shaped bone block allow a stable construct for the arthrodesis of the pubic symphysis compared to a rectangular shaped bone block. The cylindrical shaped bone block stabilized by a 3.5 symphyseal plate is inferior to the stabilization with an internal fixator. Methods: This study analyzed the arthrodesis of the pubic symphysis on 24 synthetic pelvises, using a rectangular shaped bone block (control group) or a cylindrical shaped bone block, stabilized with a symphysis locking plate (n = 8) as the standard clinical procedure. Additionally we analyzed the stability using an internal fixator. Results: This study showed that utilizing a cylindrical shaped synthetic bone graft results in a significant higher contact area and compression force compared to the classical rectangular shaped graft. Furthermore, the stabilization with an internal fixator had the tendency for increases of compression force and contact area, yet without a statistical significance, when compared to the plate fixation. Conclusion: The novel method of cylindrical symphysis resection and cylindrical bone block implantation allowed an increased biomechanical stability compared to using a classical rectangular bone graft, also resulting in higher contact area. Moreover, this technique would also allow a minimally invasive approach for this purpose, which in turn could preserve perisymphyseal ligaments, thereby improving healing in a clinical context. [ABSTRACT FROM AUTHOR]

Aim: Pharmacokinetics have historically been assessed using drug concentration data obtained via blood draws and bench‐top analysis. The cumbersome nature of these typically constrains studies to at most a dozen concentration measurements per dosing event. This, in turn, limits our statistical power in the detection of hours‐scale, time‐varying physiological processes. Given the recent advent of in vivo electrochemical aptamer‐based (EAB) sensors, however, we can now obtain hundreds of concentration measurements per administration. Our aim in this paper was to assess the ability of these time‐dense datasets to describe time‐varying pharmacokinetic models with good statistical significance. Methods: We used seconds‐resolved measurements of plasma tobramycin concentrations in rats to statistically compare traditional one‐ and two‐compartmental pharmacokinetic models to new models in which the proportional relationship between a drug's plasma concentration and its elimination rate varies in response to changing kidney function. Results: We found that a modified one‐compartment model in which the proportionality between the plasma concentration of tobramycin and its elimination rate falls reciprocally with time either meets or is preferred over the standard two‐compartment pharmacokinetic model for half of the datasets characterized. When we reduced the impact of the drug's rapid distribution phase on the model, this one‐compartment, time‐varying model was statistically preferred over the standard one‐compartment model for 80% of our datasets. Conclusions: Our results highlight both the impact that simple physiological changes (such as varying kidney function) can have on drug pharmacokinetics and the ability of high‐time resolution EAB sensor measurements to identify such impacts. [ABSTRACT FROM AUTHOR]

Objective: To compare tear film (TF) osmolarity measured using TearLab® and I‐PEN® osmometers in the same dogs without any ocular surface disease. Animal Studied: Fifty‐two dogs (98 eyes) of different breeds were evaluated. Procedures: Tear film (TF) osmolarity was evaluated at 2‐min intervals. The test was randomly determined, and single measurements were performed using each osmometer. Subsequently, complete ophthalmologic examinations were performed based on Schirmer tear test‐1 (STT‐1) analysis, tear film breakup time (TFBUT), and slit‐lamp biomicroscopy. For each osmometer, the mean ± standard deviation of the TF osmolarity was calculated, and a paired Student's t‐test was used to compare the values obtained. Pearson correlation analysis was performed to assess the association between osmolarity and other values such as STT‐1, TFBUT, and age. Results: Tear film osmolarity determined using TearLab® (340.42 ± 15.87 mOsm/L) and I‐PEN® (321.58 ± 17.39 mOsm/L) were significantly different (p <.001). However, statistical significance could not be confirmed between osmolarity and other values, such as STT‐1, TFBUT, and age. Conclusions: In dogs, the TF osmolarity values obtained using TearLab® tend to be higher than those obtained using I‐PEN®, contrary to that observed in humans. These findings can serve as a reference for establishing normal values for each osmometer for clinical use in measuring TF osmolarity in dogs. [ABSTRACT FROM AUTHOR]

Objectives: To generate a national and zonal pooled estimate of current tobacco usage (CTU) in any form, as well as stratified gender and tobacco type (smokeless and smoke) specific estimates among the Indian population, utilising evidence from 2010 to 2022. Method: PubMed, Scopus, ScienceDirect, CINAHL and Google Scholar databases were searched for articles on tobacco use among Indian adults published between January 2010 and October 2022. The NIH Quality Assessment Tool was used to assess study quality, and a random‐effects inverse‐variance method was used to attain a pooled estimate of usage. Heterogeneity was estimated through I2 statistics and prediction intervals, and further subgroup analysis and meta‐regression were conducted. A leave‐one‐out analysis was done to establish the sensitivity of the pooled estimate. Results: CTU prevalence of any form among the adult Indian population was 35.2% [confidence interval (CI) 25.27–45.92, I2 = 99.7, p < 0.001] between 2010 and 2022 with a wide Prediction interval between 3.19 to 78.74. The regionally drawn estimate for the years 2016–2022 was 44.3% (CI 30.57–58.64, I2 = 99.8, p < 0.01). Highest prevalence was found in the East zone (55.4%) followed by the northeast with 51.8% tobacco consumption. Although residual heterogeneity persisted after subgroup analysis, the variability in estimates showed statistical significance when considering disaggregated estimates across administrative zones and gender‐wise consumption. The estimated CTU among males was 54.1%, whereas in females it was 15%. Leave‐one‐out analysis indicated the findings are reliable and are not dependent on any one study. Conclusion: This review highlights differences in tobacco usage estimates from national‐level surveys and regional studies. More regionally representative surveys of tobacco usage to tailormade prevention efforts alongside increased regional efforts improved community‐level advocacy and more coordinated and stringent tobacco prevention policy implementation at national and state levels are warranted. [ABSTRACT FROM AUTHOR]

Background: Incidental gastrointestinal tract (GIT) uptake is found in up to 6.3% of patients undergoing positron emission tomography (PET). This may be physiologic or pathologic and requires endoscopic assessment. Aim: To determine the diagnostic yield of endoscopy in this setting and characterise PET avidity as a predictor of clinically significant findings. Methods: We retrospectively reviewed all consecutive patients undergoing upper endoscopy or colonoscopy for incidental 18FDG PET positivity in the GIT. Results: A total of 255 patients (62% male, median age 67 years) underwent colonoscopy or sigmoidoscopy for 276 separate areas of PET avidity in the colon. Malignancy was found in 44 cases (16%), and a significant polyp was found in an additional 103 cases (37%). Neoplastic change was found more often in the case of intense compared with non‐intense PET avidity (odds ratio (OR) 3.40, 95% confidence interval (CI) 1.95–5.93, P < 0.001), and in focal compared with diffuse uptake (OR 5.97, 95% CI 2.9–12.2, P < 0.001). Upper GIT endoscopy was performed in 75 patients (46 male, median age 63 years) for 77 isolated areas with PET avidity. Malignancy was found in 16 cases (21%), and all were new primary lesions. Numerically, malignant findings were more common in intense (29.7%) than non‐intense (12.5%) PET avidity (OR 2.96, 95%, CI 0.92–9.57, P = 0.069). Conclusions: Both focal and intense colonic 18FDG uptake correlate strongly with a high‐risk polyp or malignant lesion. Up to 21% of all gastroscopies performed for evaluation of incidental PET uptake diagnosed a new primary malignancy. These referrals need appropriate triaging and timely endoscopic assessment. [ABSTRACT FROM AUTHOR]

Mathematics is a limited component of solutions to real‐world problems, as it expresses only what is expected to be true if all our assumptions are correct, including implicit assumptions that are omnipresent and often incorrect. Statistical methods are rife with implicit assumptions whose violation can be life‐threatening when results from them are used to set policy. Among them are that there is human equipoise or unbiasedness in data generation, management, analysis, and reporting. These assumptions correspond to levels of cooperation, competence, neutrality, and integrity that are absent more often than we would like to believe. Given this harsh reality, we should ask what meaning, if any, we can assign to the P‐values, "statistical significance" declarations, "confidence" intervals, and posterior probabilities that are used to decide what and how to present (or spin) discussions of analyzed data. By themselves, P‐values and CI do not test any hypothesis, nor do they measure the significance of results or the confidence we should have in them. The sense otherwise is an ongoing cultural error perpetuated by large segments of the statistical and research community via misleading terminology. So‐called inferential statistics can only become contextually interpretable when derived explicitly from causal stories about the real data generator (such as randomization), and can only become reliable when those stories are based on valid and public documentation of the physical mechanisms that generated the data. Absent these assurances, traditional interpretations of statistical results become pernicious fictions that need to be replaced by far more circumspect descriptions of data and model relations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the aryl hydrocarbon receptor (AHR)/regulatory T cell (Treg)/T‐helper 17 (Th17) cell pathway on the pathogenesis of migraine. Background: Migraine is a disabling neurovascular disease that imposes an enormous burden on both individuals and society. The pathophysiological mechanisms of migraine remain controversial. Recent studies have suggested that immune dysfunction may be involved in the pathogenesis of migraine. The AHR, a receptor expressed on most immune cells, has been implicated in the occurrence of many autoimmune diseases; however, whether it is involved in the pathogenesis of migraine is unclear. Methods: A chronic migraine rat model was established through repeated intraperitoneal injection of nitroglycerin (NTG). The mechanical and thermal pain thresholds were assessed using von Frey filaments and radiant heat. Next, the protein expression levels of AHR in the trigeminal nucleus caudalis (TNC) region of chronic migraine (CM)‐like rats were quantified and the changes in Treg/Th17‐related transcription factors and inflammatory factors in the TNC were explored. To determine the role of AHR in CM, we examined the effects of the AHR agonist 2‐(1′‐indole‐3′‐carbonyl)‐thiazole‐4‐carboxylic acid methyl ester (ITE), and AHR antagonist CH‐223191 on pain behavior, c‐Fos, calcitonin gene‐related peptide (CGRP), AHR, and Treg/Th17‐related factor expression in CM‐like rats. Results: Repeated administration of NTG significantly enhanced nociceptive hypersensitivity and increased expression of c‐Fos and CGRP in rats, while AHR was significantly decreased in the TNC. In addition, the expression of the transcription factor forkhead box protein P3 and the signal transducer and activator of transcription 5 decreased significantly. In contrast, the expression of the transcription factor retinoic acid receptor‐related orphan receptor γ t and signal transducer and activator of transcription 3 were significantly increased. Moreover, the mRNA level of transforming growth factor beta‐1 was decreased, while that of interleukin (IL)‐10 and IL‐22 was increased in the TNC. The AHR agonist ITE alleviated migraine‐like pain behaviors in rats, activated the AHR signaling pathway, and improved the imbalance of Treg/Th17‐related transcription factors and inflammatory factors. Conversely, the AHR antagonist CH‐223191 did not alleviate migraine‐like pain behaviors in rats; and even exacerbated them. Conclusions: The AHR participates in the development of CM by regulating Treg/Th17‐related homeostasis. Therefore, treatments targeting the AHR/Treg/Th17 signaling pathway could be new effective interventions for CM treatment. [ABSTRACT FROM AUTHOR]

We examined associations between mild or asymptomatic prenatal SARS‐CoV‐2 infection and preterm live birth in a prospective cohort study. During August 2020–October 2021, pregnant persons were followed with systematic surveillance for RT‐PCR or serologically confirmed SARS‐CoV‐2 infection until pregnancy end. The association between prenatal SARS‐CoV‐2 infection and preterm birth was assessed using Cox proportional‐hazards regression. Among 954 pregnant persons with a live birth, 185 (19%) had prenatal SARS‐CoV‐2 infection and 123 (13%) had preterm birth. The adjusted hazard ratio for the association between SARS‐CoV‐2 infection and preterm birth was 1.28 (95% confidence interval 0.82–1.99, p = 0.28), although results did not reach statistical significance. [ABSTRACT FROM AUTHOR]

Background: Since there is currently no conclusion on the efficacy and adverse effects of oxymetazoline, this meta‐analysis attempts to explore its efficacy and adverse events, so as to provide guidance for clinical medication. Methods: We searched PubMed, Embase, and Cochrane Library from the establishment of the database to May 2021. We included studies that patients were randomly assigned to receive oxymetazoline or vehicle, and we excluded duplicate publications, research without full text, incomplete information or inability to conduct data extraction, animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. Results: The pooled results show that the 3 (RR = 1.76, 95% CI: 1.53–2.03), 6 (RR = 1.71, 95% CI: 1.47–2.00), 9 (RR = 1.63, 95% CI: 1.40–1.90), 12 (RR = 1.41, 95% CI: 1.18–1.67) ‐hours CEA success rate and the 3 (RR = 1.65, 95% CI: 1.34–2.03), 6 (RR = 1.75, 95% CI: 1.43–2.14), 9 (RR = 1.63, 95% CI: 1.33–2.00), 12 (RR = 1.78, 95% CI: 1.45–2.18) ‐hours SSA success rate after oxymetazoline treatment for rosacea is significantly higher than that of vehicle. Additionally, the pooled results show that the incidence of TEAEs after treatment with oxymetazoline is significantly higher than that of vehicle (RR = 1.34, 95% CI: 1.10–1.2). However, our analysis of specific adverse events found that the oxymetazoline group was only significantly higher than the vehicle group in the incidence of application‐site dermatitis (RR = 8.91, 95% CI: 1.76–45.23), and there was no statistical significance in the difference in the incidence of other adverse events. Conclusion: Oxymetazoline is effective and can be selected for the treatment of persistent facial erythema of rosacea. Additionally, application‐site dermatitis was the most important one. [ABSTRACT FROM AUTHOR]

Objective: Geriatric patients have more complicated appendicitis, which leads to higher morbidity and mortality rates. Sarcopenia has been shown to have a negative impact on patients undergoing surgery. This study aims to reveal the predictive value of computerized tomography‐assessed (CT‐assessed) sarcopenia for complicated appendicitis in geriatric patients. Methods: One‐hundred fifty‐four patients' with acute appendicitis age, gender, co‐morbidities, appendicitis status, and body mass index (BMI) values were analyzed. The skeletal muscle index (SMI) and related measurements were evaluated. Results: Fifty‐two percent of the patients had complicated, and 48% had uncomplicated appendicitis. There was a statistically significant difference between uncomplicated and complicated cases regarding BMI, SMI, and muscle area values (P < 0.05). The cutoff point by Receiver Operating Characteristic Curve analysis was conducted for SMI and showed 71% sensitivity and 52% specificity (P = 0.042). Multivariate analysis has shown that comorbidities are significantly more associated with complicated appendicitis than sarcopenia. Conclusion: Geriatric patients with lower BMI, decreased muscle area, and CT‐detected sarcopenia have an increased risk of complicated appendicitis. Comorbidities are also important risk factors. Surgeons should be aware of factors leading to complicated appendicitis, which may cause higher morbidity and mortality rates in elderly patients. [ABSTRACT FROM AUTHOR]

Complex or hard‐to‐heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb‐threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer‐reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA‐ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high‐stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed. [ABSTRACT FROM AUTHOR]

Background: A health‐promoting lifestyle is acknowledged as a 'positive ageing' strategy for older people. The inevitable decline in their social networks may lead to loneliness and subsequently damage their health‐promoting lifestyle. Therefore, pet owning has become a popular way for them to alleviate loneliness. However, the attachment resulting from pet ownership may either facilitate or impede older people's ability to counteract the negative effect of loneliness on health‐promoting lifestyles, and this effect may only be observed when pet owners have limited human confidants. Objectives: To identify the role of pet attachment in alleviating the negative impact of loneliness on a health‐promoting lifestyle and its supplementary role in the deficiency of social relationships by analysing the correlation mechanism between pet attachment, loneliness and a health‐promoting lifestyle. Methods: Self‐report questionnaires were sent to 879 older people (aged ≥60) with pets in China by using a multistage stratified random sampling method. Cross‐sectional threshold regression models were established to analyse the nonlinear effects of loneliness on a health‐promoting lifestyle and the different threshold effects among different social relationship levels. Results: A single threshold value (0.444) was drawn to determine the action mode of pet attachment on the negative relationship between loneliness and a health‐promoting lifestyle. When the level of pet attachment exceeded 0.444, the inhibition of loneliness on a health‐promoting lifestyle decreased significantly. Additionally, this threshold effect was evident among older people at different levels of social relationships. Conclusions: The negative effect of loneliness on a health‐promoting lifestyle is alleviated by the single threshold effect of pet attachment. Pet–owner relationships can compensate for a lack of social relationships to some extent and alleviate both an individual's loneliness and its negative effect on a health‐promoting lifestyle. Implications for practice: To alleviate loneliness and promote healthy ageing in older people who lack social relationships, the tailored pet intervention strategies that prioritize 'one health' at the animal‐ecosystem interface that consider their different individual levels of social relationship should be developed. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of irrigating solutions containing 5% boric acid + 1% citric acid or 1% peracetic acid + high concentration hydrogen peroxide on root cleaning and bond strength of cementation systems after 24 h and 6 months of glass fiber post cementation. One hundred and twenty roots were endodontically treated. The specimens were randomized into one of four treatments (n = 10): DW (distilled water); NaOCl2.5% + EDTA17% (2.5% sodium hypochlorite solution + 17% EDTA); PA1% + HP (1% peracetic acid solution + high concentration of hydrogen peroxide); BA5% + CA1% (5% boric acid associated with 1% citric acid). The cleaning efficacy in the cervical, middle, and apical thirds of the post‐space, and the push‐out bond strength at 24 h and 6 months after post cementation were evaluated by Kruskal‐Wallis and two‐way ANOVA tests, respectively. BA5% + CA1% showed statistically significantly superior cleaning efficacy compared to the other solutions. This irrigation protocol also resulted in higher bond strength at 24 h and 6 months, regardless of the root third considered, and this was statistically significantly higher than those seen for DW and PA1% + HP. For BA5% + CA1% irrigation protocol, type 1 adhesive failure was the most prevalent. Post‐space irrigation with BA5% + CA1% provided both higher cleaning efficacy and better bond strength. [ABSTRACT FROM AUTHOR]

Introduction: Among patients with non‐valvular atrial fibrillation (AF) and percutaneous left atrial appendage closure (LAAC) undergoing direct current cardioversion (DCCV), the need for and use of LAA imaging and oral anticoagulation (OAC) is unclear. Objective: The purpose of this study is to evaluate the real‐world use of transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) before DCCV and use of OAC pre‐ and post‐DCCV in patients with AF status post percutaneous LAAC. Methods: This retrospective single center study included all patients who underwent DCCV after percutaneous LAAC from 2016 to 2022. Key measures were completion of TEE or CCTA pre‐DCCV, OAC use pre‐ and post‐DCCV, incidence of left atrial thrombus (LAT) or device‐related thrombus (DRT), incidence of peri‐device leak (PDL), and DCCV‐related complications (stroke, systemic embolism, device embolization, major bleeding, or death) within 30 days. Results: A total of 76 patients with AF and LAAC underwent 122 cases of DCCV. LAAC consisted of 47 (62%), 28 (37%), and 1 (1%) case of Watchman 2.5, Watchman FLX, and Lariat, respectively. Among the 122 DCCV cases, 31 (25%) cases were identified as "non‐guideline based" due to: (1) no OAC for 3 weeks and no LAA imaging within 48 h before DCCV in 12 (10%) cases, (2) no OAC for 4 weeks following DCCV in 16 (13%) cases, or (3) both in 3 (2%) cases. Among the 70 (57%) cases that underwent TEE or CCTA before DCCV, 16 (23%) cases had a PDL with a mean size of 3.0 ± 1.1 mm, and 4 (6%) cases had a LAT/DRT on TEE resulting in cancellation. There were no DCCV‐related complications within 30 days. Discussion: There is a widely varied practice pattern of TEE, CCTA, and OAC use with DCCV after LAAC, with a 6% rate of LAT/DRT. LAA imaging before DCCV appears prudent in all cases, especially within 1 year of LAAC, to assess for device position, PDL, and LAT/DRT. [ABSTRACT FROM AUTHOR]

Paleomagnetic statistical inference is underpinned by a family of parametric null hypothesis tests. In many cases, however, paleomagnetic data do not meet the distributional assumptions of these tests, which can lead to spurious inferences. Earlier studies have proposed the bootstrap as a nonparametric alternative for paleomagnetic analysis, which can be applied even when the distributional form of the data is unknown. Key among these approaches is the bootstrap test for a common mean direction, which relies on assessment of the overlap of estimated confidence regions. In its current form, the bootstrap test for a common mean paleomagnetic direction does not consider a null hypothesis and can yield outcomes that cannot be interpreted in terms of a statistical significance level. To resolve these issues, we use recent advances to place such bootstrap tests within a null hypothesis significance testing framework, and unify them with the existing family of paleomagnetic statistical tests. Furthermore, using numerical experiments we demonstrate the applicability of such a nonparametric approach to moderately sized paleomagnetic data sets typical of modern and legacy studies. Finally, we demonstrate how a confidence region can be estimated for the common mean of two sets of directions and how known directions, such as the expected field produced by a geocentric axial dipole, can be compared to that mean. Plain Language Summary: Statistical inference is the process of using observations to infer the properties of an unobserved population. An example of this process in paleomagnetism (the study of Earth's ancient magnetic field based on information preserved in geological materials) is a test of whether two sets of field directions have a common mean. Traditional statistical methods used to address this question make assumptions about the properties of the observations, which are known to be invalid in many cases. An alternative approach is so‐called bootstrapping, which relaxes assumptions about the observations and can then be applied more widely. In this study, we show how bootstrapping can be applied to paleomagnetic observations within the interpretational structure of existing paleomagnetic statistics, thus, providing a consistent inference framework. Furthermore, using numerical experiments we investigate how many paleomagnetic observations are required for bootstrapping to yield reliable results. Key Points: Advances in bootstrapping directional data are consideredThe number of directions needed for bootstrap‐based inference is assessedA bootstrap common mean direction test (CMDT) for paleomagnetic directions is presented [ABSTRACT FROM AUTHOR]

Background: Endobronchial ultrasound‐guided (EBUS) transbronchial needle aspiration (TBNA) has significantly improved the diagnostic workup for intrathoracic lymphadenopathies. More recently, EBUS intranodal forceps biopsy (IFB) has been developed in an attempt to maximize diagnostic yield by providing additional tissue. In this study, we aimed to assess the improvement of diagnostic yield with EBUS‐TBNA combined with EBUS‐IFB, compared to EBUS‐TBNA alone. Methods: Consecutive patients who had 19‐G EBUS‐TBNA and EBUS‐IFB from August 30, 2018, to September 28, 2021, were included. Four senior pathologists retrospectively analyzed, independently and blindly, first, only the EBUS‐TBNA samples (cell block), then, at least 1 month later, both samples from EBUS‐TBNA and from EBUS‐IFB together. Results: Fifty patients were included in the study and 52 lymph nodes were analyzed. Diagnostic yield was 77% (40/52) for EBUS‐TBNA alone and 94% (49/52) when combined with EBUS‐IFB (p = 0.023). Malignancy was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 25/26 cases (96%), versus 22/26 (85%) with EBUS‐TBNA alone (p = 0.35); and 4/5 (80%) versus 2/5 (40%) for lymphoma specifically. Kappa interobserver agreement was 0.92 for EBUS‐IFB and 0.87 for EBUS‐TBNA alone. Nonmalignant condition was diagnosed with EBUS‐TBNA combined with EBUS‐IFB in 24/26 cases (92%), versus 18/26 (69%) for EBUS‐TBNA alone (p = 0.07). Conclusion: The use of EBUS‐IFB combined with 19‐G EBUS‐TBNA improves the mediastinal lymph node diagnostic yield However the benefit appears to be mainly restricted to nonmalignant histology. [ABSTRACT FROM AUTHOR]

Background: The best choice between first‐line aspiration and stent retriever for acute basilar artery occlusion remains controversial. This study aims to perform a systematic review and meta‐analysis comparing the stent retriever and direct aspiration about reported recanalization rates and periprocedural complications. Method: PubMed, Embase, Web of Science, Cochrane, and Clinical Trials were searched for the studies evaluating the efficacy and safety of first‐line aspiration versus stent retriever for acute basilar artery occlusion. A standard software program (Stata Corporation) was used for end‐point analyses. Statistical significance was defined as a p‐value less than.05. Results: A total of 11 studies were involved in the current study, including 1014 patients. Regarding postoperative recanalization, the pooled analysis identified a significant difference in successful recanalization (odds ratio [OR] = 1.642; 95% confidence interval (95% CI): 1.099–2.453; p =.015) and complete recanalization (OR = 3.525; 95% CI: 1.306–2.872; p =.001) between the two groups in favor of the first‐line aspiration. Concerning the complications, the first‐line aspiration could achieve a lower rate of total complication (OR =.359; 95% CI:.229–.563; p <.001) and hemorrhagic complication (OR =.446, 95% CI:.259–.769; p =.004) than stent retriever. No significant difference was observed in postoperative mortality (OR =.966; p =.880), subarachnoid hematoma (OR =.171; p =.094), and parenchymal hematoma (OR =.799; p =.720). In addition, the pooled results revealed a significant difference in procedure duration between the two groups in favor of aspiration (WMD = −27.630, 95% CI: −50.958 to −4.302; p =.020). However, there was no significant difference in favorable outcome (OR = 1.149; p =.352) and rescue therapy (OR = 1.440; p =.409) between the two groups. Conclusion: Given that the first‐line aspiration was associated with a higher rate of postoperative recanalization, a lower risk of postoperative complication, and a faster duration of the procedure, these findings support the aspiration may be more secure than a stent retriever. [ABSTRACT FROM AUTHOR]

Background: Mental training can be beneficial when learning new motor skills. Objective: To evaluate whether a combination of physical and mental training can replace physical training. Methods: Sixty dental students were randomly divided into six groups, which were assigned different regimens of physical and mental training: A. 75% mental 25% physical; B. 50% mental 50% physical; C. 75% physical 25% mental; D. 100% mental; E. 100% physical; F. control, no practice. The physical training comprised eight different tasks performed on the Purdue Pegboard: four tasks with direct vision (PD) and four tasks with indirect vision (PIND). The mental training involved listening to a recording explaining the actions to be performed. The tests were performed twice: T0, before training; and T1, at 24 h after training. The non‐parametric Mann–Whitney test was used to detect differences between the groups. Changes between T0 and T1 within a group were analysed by Wilcoxon signed‐rank test. Results: There were no significant differences between the groups at T0. At T1, members of Groups A, B, C, and E had improved at five to eight tasks, while Groups D and F had improved at two tasks. Notably, Group D improved in the assembly tasks. Ranking the extent of improvement at T1, indicated that For PD Groups B, E > F, D while for PIND B, C, E > A, F and E > D. Conclusion: Substituting some physical training by mental training can provide similar improvements in fine motor skills, although the optimal combination remains to be determined. Mental training may be more effective for cognitive tasks. [ABSTRACT FROM AUTHOR]

Background: Additional ablation strategies after pulmonary vein isolation (PVI) for patients with nonparoxysmal atrial fibrillation (non‐PAF) lasting ≥2 years have not been fully effective. This is presumably because of insufficient identification of non‐PAF maintenance mechanisms. In this study, we employed a novel online and real‐time phase mapping system, ExTRa Mapping, to identify and modulate rotors as one of the non‐PAF maintenance mechanisms in patients with non‐PAF sustained after PVI. We investigated the relationship between outcomes of ExTRa Mapping‐guided rotor ablation (ExTRa‐ABL) and non‐PAF duration prior to this procedure. Methods: This study consisted of 73 non‐PAF patients (63 ± 8 years, non‐PAF duration 31 ± 37 months) who underwent the first ExTRa‐ABL in patients with non‐PAF sustained after completion of PVI. Results: Freedom from non‐PAF/atrial tachycardia (AT) recurrence at 12 months after ExTRa‐ABL was achieved in 50 (69%) of patients. The non‐PAF duration prior to ExTRa‐ABL was significantly longer in patients with non‐PAF/AT recurrence after ExTRa‐ABL compared with those without (56 ± 50 vs. 19 ± 22 months, p =.001). In patients with non‐PAF duration of ≤60 months prior to ExTRa‐ABL, compared with >60 months, non‐PAF/AT‐free rate was significantly higher (68.9% vs. 23.1%, p <.001), during the follow‐up of 36 ± 18 months. Conclusions: A non‐PAF duration of ≤60 months prior to ExTRa‐ABL was associated with a better outcome. The effect of ExTRa‐ABL was considered to be limited in patients with >60 months of non‐PAF duration. [ABSTRACT FROM AUTHOR]

Pressure ulcers can develop in bedridden or immobile patients which physiotherapists frequently encounter. Although physiotherapists receive training for preventing pressure ulcers, there is limited evidence of physiotherapists' knowledge level. Our study evaluated physiotherapists' pressure ulcer prevention knowledge. The level of knowledge for pressure ulcer prevention was inquired with the Turkish version of the Pressure Ulcer Prevention Knowledge Assessment Instrument (PUPKAI‐T). Two hundred and sixty‐five physiotherapists participated in our study. The median PUPKAI‐T total score ranged from 8 to 21. Only two physiotherapists (0.8%) got good points from the questionnaire. The highest score was Nutrition (Theme 4; 59.2%), and the lowest score belonged to the contact preventive interventions that reduce pressure/shearing (Theme 5; 26.7%). The question with the lowest success rate was the positioning question of Theme 5 (Question 2; 12.5%). In our study, physiotherapists' pressure ulcer prevention knowledge was evaluated with a relatively high number of participants compared to the literature. These results brought to mind that training programs that specifically emphasise techniques to prevent pressure ulcers and positioning manoeuvres to be organised increase the knowledge level of physiotherapists. [ABSTRACT FROM AUTHOR]

Tables and charts have long been seen as effective ways to convey data. Much attention has been focused on improving charts, following ideas of human perception and brain function. Tables can also be viewed as two‐dimensional representations of data; yet, it is only fairly recently that we have begun to apply principles of design that aid the communication of information between the author and reader. In this study, we collated guidelines for the design of data and statistical tables. These guidelines fall under three principles: aiding comparisons, reducing visual clutter, and increasing readability. We surveyed tables published in recent issues of 43 journals in the fields of ecology and evolutionary biology for their adherence to these three principles, as well as author guidelines on journal publisher websites. We found that most of the over 1000 tables we sampled had no heavy grid lines and little visual clutter. They were also easy to read, with clear headers and horizontal orientation. However, most tables did not aid the vertical comparison of numeric data. We suggest that authors could improve their tables by the right‐flush alignment of numeric columns typeset with a tabular font, clearly identify statistical significance, and use clear titles and captions. Journal publishers could easily implement these formatting guidelines when typesetting manuscripts. [ABSTRACT FROM AUTHOR]

Zooarcheological analysis shows that there is an overabundance of seabird wings recovered from Viking Age archeological sites in Iceland, especially when the rest of the body is considered. Cultural choices seem to be driving this differential. By comparing two species of alcids to ptarmigan, primarily recovered from domestic middens, the overabundance of specific bones suggests differences in bird butchery and use strategies. The data come from nine sites: one from Þjórsárdalur, five from Skagafjörður, and three from Mývatnssveit. Alcid wings, particularly proximal bones, are disproportionately recovered, while ptarmigan are generally represented by more legs than expected. By several metrics, the statistical significance of these patterns is dramatic and leads to the conclusion that alcid wings are discarded more frequently than other body parts. The simplest explanation for this pattern is that it is a result of the availability of each of the birds, which ultimately affects the way they are processed. [ABSTRACT FROM AUTHOR]

This work proposes an approach to assess the effects observed in multicolor flow cytometry (MFC) experiments, for all markers and experimental factors simultaneously. It achieves this end by extending ANOVA simultaneous component analysis (ASCA), a multivariate version of ANOVA, to flow cytometry data. It is based on an initial multiset PCA model to describe the main variation patterns of cell marker expression, followed by an ASCA model on the histograms built from these PCA scores. This approach allows for determining the variations in cell phenotype distribution that are related to the experimental design. On a data set from a study of the immune response to prolonged physical exercise, the proposed method computed the effect size and statistical significance of all the experimental factors and their interactions. Most notably, it provided easily interpretable submodels for the overall effect of the walking exercise and for the interaction between exercise and the responsiveness to a bacterial stimulus. The application of a time‐guided sequential clustering algorithm to the ASCA scores revealed a stratification of the studied individuals based on their neutrophil activation dynamics. These effects were not clearly detectable using PCA alone. In comparison with pairwise classification models by DAMACY (a discriminant analysis method for MFC data), ASCA results were less detailed in describing differences between specific samples, but had the advantage of modeling several factors and levels simultaneously. Such characteristics make the proposed implementation of ASCA an effective and complementary addition to the chemometric methodologies for the analysis of MFC data. [ABSTRACT FROM AUTHOR]

Objective: Complex regional pain syndrome (CRPS) can be distinguished as type I without and type II with electrophysiological evidence of major nerve lesion. The pathophysiology of both subgroups is still under investigation. The aim of this research is to demonstrate the nerve morphology and electrophysiology in CRPS type I patients. Materials and Methods: Bilateral median and ulnar nerve cross‐sectional areas were evaluated with ultrasound and also median and ulnar nerve conduction studies of both hands were performed. Cross‐sectional areas of median and ulnar nerves and nerve conduction studies in healthy controls were also obtained and compared with the patients. Results: Twenty‐five male patients and 11 healthy male controls were enrolled in the study. The mean age of the patients was 24.08 ± 5.50 years and controls was 23.18 ± 5.09 (p > 0.05). Compound muscle action potential (CMAP) and sensory nerve action potential (SNAP) amplitudes of the diseased side were found significantly lower than the healthy side (p < 0.05). Both median and ulnar nerve distal motor latency values were significantly higher in the patient group (p < 0.05). There was no significant difference in the median and ulnar nerve cross‐sectional area when compared with the opposite extremity and healthy volunteers. Conclusion: The lower SNAP and CMAP amplitudes of the median and ulnar nerves compared to the healthy side and the prolongation of the affected side median and ulnar nerve distal motor latencies of the affected individuals may indicate axonal involvement in patients with CRPS type 1. Decreased CMAP amplitudes may also indicate muscle atrophy due to a decrease in the number of functional motor units. [ABSTRACT FROM AUTHOR]

Aim: The 'island rule' postulates that on islands large continental animals become smaller, and small continental animals become larger. Its generality has been supported by some studies but contested by others. Bats are cosmopolitan and speciose mammals thus are ideal to test ecogeographic patterns. Based on three functionally distinct measures of body size, I compare mainland and island variation in bats at the order to subspecies level. Location: Globally. Taxon: Chiroptera. Methods: I compiled information from literature on the skull length, forearm length, and body mass of 251 bat species in 840 locations. For conspecific bats from different locations, I calculated size divergences, and categorized them as within‐mainland (M–M), mainland‐to‐island (M–I), or island‐to‐island (I–I). I used a modified size ratio to quantify divergences, analysis of variance, non‐parametric tests, and effect sizes to complement statistical significances. Results: On islands, cranial size increases, wing length becomes more uniform, and body mass decreases more often than not. The first trend would support the island rule, but had a small effect size. Families differ considerably in how they vary geographically. Species are ranked very differently based on functionally distinct size measures. Divergences are uniform across M–M, M–I, and I–I ranges, and large between bats of different subspecies. Main Conclusions: Likely owing to limitations imposed by flight and echolocation, bats do not follow the island rule. The absence of correlation between how bats are ranked based on them indicates that functionally distinct size measures are not necessarily coadaptive. High vagilities may lead to low local differentiation, but interfamilial variation shows this differentiation to also depend on other factors. Body sizes converge to species‐specific optima, not to supraspecific optima as predicted by theoretical studies. Size differences are reflected in taxonomy more often if observed across M–I ranges. [ABSTRACT FROM AUTHOR]

Purpose: The ±2.00 D accommodative facility test presents several limitations, including the lack of objective information and inherent characteristics such as vergence/accommodative conflict, change in apparent size of the image, subjective criteria for judging blur and motor reaction time. By using free‐space viewing conditions and an open‐field autorefractor to monitor the refractive state, we examined the impact of manipulating these factors on the qualitative and quantitative assessment of accommodative facility. Methods: Twenty‐five healthy young adults (24.5 ± 4.5 years) took part in this study. Participants performed three accommodative facility tests (adapted flipper, 4D free‐space viewing and 2.5D free‐space viewing) under both monocular and binocular conditions in random order. A binocular open‐field autorefractor was used to assess the accommodative response continuously, and these data were used to characterise accommodative facility quantitatively and qualitatively. Results: There were statistically significant differences between the three testing methods both quantitatively (p < 0.001) and qualitatively (p = 0.02). For the same accommodative demand, a lower number of cycles was obtained for the adapted flipper condition in comparison with the 4D free‐space viewing test (corrected p‐value < 0.001, Cohen's d = 0.78). However, this comparison did not reach statistical significance for qualitative measures of accommodative facility (corrected p‐value = 0.82, Cohen's d 0.05). Conclusions: These data provide evidence that the qualitative assessment of accommodative facility is not influenced by the inherent limitations of the ±2.00 D flipper test. The use of qualitative outcomes by incorporating an open‐field autorefractor allows examiners to increase the validity of the accommodative facility test in both clinical and research settings. [ABSTRACT FROM AUTHOR]

The conventional phase II trial design paradigm is to make the go/no‐go decision based on the hypothesis testing framework. Statistical significance itself alone, however, may not be sufficient to establish that the drug is clinically effective enough to warrant confirmatory phase III trials. We propose the Bayesian optimal phase II trial design with dual‐criterion decision making (BOP2‐DC), which incorporates both statistical significance and clinical relevance into decision making. Based on the posterior probability that the treatment effect reaches the lower reference value (statistical significance) and the clinically meaningful value (clinical significance), BOP2‐DC allows for go/consider/no‐go decisions, rather than a binary go/no‐go decision. BOP2‐DC is highly flexible and accommodates various types of endpoints, including binary, continuous, time‐to‐event, multiple, and coprimary endpoints, in single‐arm and randomized trials. The decision rule of BOP2‐DC is optimized to maximize the probability of a go decision when the treatment is effective or minimize the expected sample size when the treatment is futile. Simulation studies show that the BOP2‐DC design yields desirable operating characteristics. The software to implement BOP2‐DC is freely available at www.trialdesign.org. [ABSTRACT FROM AUTHOR]

Background and purpose: Recommended loading doses of levetiracetam (LEV) for status epilepticus (SE) treatment have increased over time. However, this was not evidence‐based, and the benefit of the increase remains unclear. The effect of different LEV loading doses on SE prognosis was explored. Methods: This is a retrospective analysis of an SE adult registry (January 2016–December 2021), including patients receiving LEV as a second‐line SE treatment. Patients were stratified according to LEV loading doses (threshold 35 mg/kg). Main outcomes were global mortality, LEV use as last SE treatment, and return to baseline conditions at discharge, exploring LEV as a dichotomized or continuous dose. Results: Among 202 patients, 44 received LEV at ≥35 mg/kg and 158 below it. Global mortality, adjusted for SE severity and potentially fatal aetiology, was more frequent in the high LEV dose group (27.2% vs. 17.1%, odds ratio 3.14, 95% confidence interval 1.23–8.06; p = 0.017), whilst LEV prescription as last treatment and return to baseline conditions were comparable. Considering continuous LEV dosages or mortality in ongoing SE, however, no outcome reached statistical significance. Conclusions: Lower LEV loading doses do not seem to correlate with worse clinical outcome, challenging current guidelines. Further studies, ideally prospective, are needed on this topic. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the mediating effect of workplace social capital on the relationship between authentic leadership and the three dimensions of organizational commitment: affective, normative, and continuance. Methods: In January 2019, anonymous self‐reported questionnaires were distributed to 1220 nurses working in the general wards of two university hospitals in Japan. Structural equation modeling was used to examine the mediating effects of workplace social capital on the relationship between nurse managers' authentic leadership and the three dimensions of organizational commitment. Results: Six hundred and fifty‐nine data points were analyzed (valid response rate = 54.0%). Participants' average age was 28.6 years (standard deviation: 6.6), and 93.3% were female. The mediation indirect effect of workplace social capital between authentic leadership and organizational commitment was statistically significant in the models of affective organizational commitment and normative organizational commitment, but not in the model of continuance organizational commitment. Conclusions: The effects of authentic leadership and workplace social capital had different impacts on each of the three dimensions of organizational commitment. Nurse managers' authentic leadership and workplace social capital can enhance nurses' positive commitment to the organization. [ABSTRACT FROM AUTHOR]

BACKGROUND: The proportionality principle has been broadly used for over 10 years in regulatory assessments of pesticide residues. It allows extrapolation of supervised field trial data conducted at lower or higher application rates compared to the use pattern under evaluation by adjustment of measured concentrations, assuming direct proportionality between the rates applied and the resulting residues. This work revisits the principle idea by using supervised residue trials sets conducted under identical conditions but with deviating application rates. Four different statistical methods were used to investigate the relationship between application rates and residue concentrations and to draw conclusions on the statistical significance of the direct proportionality assumed. RESULTS: Based on over 5000 individual trial results, the assumption of direct proportionality was not confirmed to be statistically significant (P > 0.05) using three models: direct comparison of application rates and residue concentrations ratios and two linear log‐log regression models correlating application rate and residue concentration or only residue concentrations per se. In addition, a fourth model analysed deviations between expected concentrations following direct proportional adjustment and measured residue values from corresponding field trials. In 56% of all cases, the deviation was larger than ±25%, which represents the tolerance usually accepted for the selection of supervised field trials in regulatory assessments. CONCLUSION: Overall, the assumption of direct proportionality between application rates and resulting residue concentrations of pesticides was not statistically significant. Although the proportionality approach is highly pragmatic in regulatory practice, its use should be considered carefully on a case‐by‐case basis. © 2023 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. [ABSTRACT FROM AUTHOR]

Aim: To investigate midwives' (MWs) and public health nurses' (PHNs) clinical practice and knowledge related to nutrition, with a particular focus on iodine in northern parts of Norway. Maternal iodine status prior to and during pregnancy, and the lactating period, is crucial for brain development and growth of the foetus and infant, from conception up until the first two years of life. In Norway, studies have documented mild to moderate iodine deficiency in this group. Design/Methods: MWs (n = 128) and PHNs (n = 154) responded to a survey regarding nutrition and iodine. Descriptive data and non‐parametric tests were used to analyse data. Results: Around half of the participants provided dietary guidance to a great extent. Practice of iodine‐specific recommendations was lower, particularly regarding lactating women. Compared to other nutrients, iodine was not a priority. Conclusion: The study indicates a lack of knowledge and poor clinical practice about iodine among MWs and PHNs. [ABSTRACT FROM AUTHOR]

Purpose: Varian Ethos utilizes novel intelligent‐optimization‐engine (IOE) designed to automate the planning. However, this introduced a black box approach to plan optimization and challenge for planners to improve plan quality. This study aims to evaluate machine‐learning‐guided initial reference plan generation approaches for head & neck (H&N) adaptive radiotherapy (ART). Methods: Twenty previously treated patients treated on C‐arm/Ring‐mounted were retroactively re‐planned in the Ethos planning system using a fixed 18‐beam intensity‐modulated radiotherapy (IMRT) template. Clinical goals for IOE input were generated using (1) in‐house deep‐learning 3D‐dose predictor (AI‐Guided) (2) commercial knowledge‐based planning (KBP) model with universal RTOG‐based population criteria (KBP‐RTOG) and (3) an RTOG‐based constraint template only (RTOG) for in‐depth analysis of IOE sensitivity. Similar training data was utilized for both models. Plans were optimized until their respective criteria were achieved or DVH‐estimation band was satisfied. Plans were normalized such that the highest PTV dose level received 95% coverage. Target coverage, high‐impact organs‐at‐risk (OAR) and plan deliverability was assessed in comparison to clinical (benchmark) plans. Statistical significance was evaluated using a paired two‐tailed student t‐test. Results: AI‐guided plans were superior to both KBP‐RTOG and RTOG‐only plans with respect to clinical benchmark cases. Overall, OAR doses were comparable or improved with AI‐guided plans versus benchmark, while they increased with KBP‐RTOG and RTOG plans. However, all plans generally satisfied the RTOG criteria. Heterogeneity Index (HI) was on average <1.07 for all plans. Average modulation factor was 12.2 ± 1.9 (p = n.s), 13.1 ± 1.4 (p = <0.001), 11.5 ± 1.3 (p = n.s.) and 12.2 ± 1.9 for KBP‐RTOG, AI‐Guided, RTOG and benchmark plans, respectively. Conclusion: AI‐guided plans were the highest quality. Both KBP‐enabled and RTOG‐only plans are feasible approaches as clinics adopt ART workflows. Similar to constrained optimization, the IOE is sensitive to clinical input goals and we recommend comparable input to an institution's planning directive dosimetric criteria. [ABSTRACT FROM AUTHOR]

This article discusses the challenges that ordinary readers face when trying to understand statistics in medical research. The authors advocate for action from journals and medical societies to make statistics more reader-friendly. They reference a study that compared two classification systems in cardiotocographic assessment and highlight the importance of statistical accuracy in medical studies. The authors propose involving statistics specialists in study teams, declaring if statistical analysis has been reviewed, transparently acknowledging statistical weaknesses, and clarifying the impact of alternative statistical approaches. They also mention the difficulty of rigorously checking statistics during the review process. [Extracted from the article]

Introduction: COVID‐19 usually presents with upper respiratory tract infection in varying severity which can lead to sepsis. Early prediction of sepsis may reduce mortality by timely interventions. The intended purpose of this study was to determine whether the advanced parameters like the extended inflammation parameters (EIPs) can predict prognosis and early progression to sepsis as a sequel of COVID‐19 infection and can be used as a screening profile. Also, to evaluate the Intensive Care Infection Score (ICIS) and the COVID‐19 prognostic score and validate the scores for our population. Methods: Prospective observational study of 50 reverse transcription‐ polymerase chain reaction (RT‐PCR) proven admitted COVID‐19 patients. The data assessed included complete blood counts (CBC) with EIP measurements, from Day 1 of admission to Day 10. The following groups were studied: noncritical (NC) and critical illness (CI) in COVID‐19 positive cases, COVID negative sepsis and nonsepsis cases, and healthy volunteers for reference range. Results: The parameters that showed statistically significant higher mean in CI group compared to the NC group are reactive lymphocyte number and percentage (RE‐LYMPH#, RE‐LYMPH%), antibody synthesizing lymphocyte number and percentage (AS‐LYMPH#, AS‐LYMPH%), Reactive monocyte count and percentage (RE‐MONO#, RE‐MONO%/M), ICIS, COVID‐19 prognostic score (p‐value <0.05). The AUC confirmed the diagnostic accuracy of all these parameters. From the multivariate logistic regression, the significant risk factor was RE‐LYMPH# with cut‐off >0.10 (p value: 0.011). Conclusion: The new EIP parameters, RE‐MONO#, RE‐MONO%/M, ICIS score and COVID‐19 prognostic score are useful for early prediction of critical illness. AS‐LYMPH is the most useful predictor of critical illness on multivariate analysis. RE‐MONO# and RE‐MONO%/M parameter are useful in distinguishing critical and noncritical non‐COVID and COVID‐19 patients. [ABSTRACT FROM AUTHOR]