Severity of mountain accidents in Catalonia over the period 2011 to 2021: An ordinal regression analysis.

ObjectivesTo evaluate visual grading characteristics (VGC) and ordinal regression analysis during head CT optimisation as a potential alternative to visual grading assessment (VGA), traditionally employed to score anatomical visualisation.MethodsPatient images (n = 66) were obtained using current and optimised imaging protocols from two CT suites: a 16-slice scanner at the national Maltese centre for trauma and a 64-slice scanner in a private centre. Local resident radiologists (n = 6) performed VGA followed by VGC and ordinal regression analysis.ResultsVGC alone indicated that optimised protocols had similar image quality as current protocols. Ordinal logistic regression analysis provided an in-depth evaluation, criterion by criterion allowing the selective implementation of the protocols. The local radiology review panel supported the implementation of optimised protocols for brain CT examinations (including trauma) in one centre, achieving radiation dose reductions ranging from 24 % to 36 %. In the second centre a 29 % reduction in radiation dose was achieved for follow-up cases.ConclusionsThe combined use of VGC and ordinal logistic regression analysis led to clinical decisions being taken on the implementation of the optimised protocols. This improved method of image quality analysis provided the evidence to support imaging protocol optimisation, resulting in significant radiation dose savings.Main Messages• There is need for scientifically based image quality evaluation during CT optimisation.• VGC and ordinal regression analysis in combination led to better informed clinical decisions.• VGC and ordinal regression analysis led to dose reductions without compromising diagnostic efficacy.

To explore the trajectory of clinical symptoms and biomarkers in the last four weeks of life in terminally ill cancer patients. Observational study. Department of Oncology, Shijingshan hospital, Shijingshan Teaching Hospital of Capital Medical University, Beijing, China, between January 2017 and January 2020. This study evaluated 173 terminally ill cancer patients. Seventeen symptoms and fifteen biomarkers were identified. For sequential analysis, the authors divided the final four weeks of life into four time periods from the date of death. Ordinal multiple logistic regression analysis was used to explore the association between the changes in clinical parameters and the risk of death in a given period. Changes in clinical parameters across different time periods were evaluated using the Wilcoxon signed rank test. Abnormal consciousness; elevated ECOG (Eastern Cooperative Oncology Group) scores, neutrophil-to-lymphocyte ratio (NLR), blood urea nitrogen (BUN) to creatinine ratio, C-reactive protein (CRP)-to-albumin ratio; and decreased platelet (PLT) counts were independent factors (p<0.05) for predicting closer death in the final month of life. All parameters above showed significant changes over time in the last month, although the starting time points for these changes varied. Abnormal consciousness, elevated ECOG scores, NLR, BUN-to-creatinine ratio, CRP-to-albumin ratio, and decreased PLT counts are potentially useful markers for approaching death in terminally ill cancer patients. These findings are valuable for understanding the biology of death in terminally ill cancer patients. And to some extent, they may help clinicians recognise that a patient will die in the near future. Cancer, Ordinal regression analysis, Death, Terminal illness, Biomarkers.

Body Mass Index Evaluating Donor Hepatic Steatosis in Living Donor Liver Transplantation

Increasing users is a challenge for shared micro-mobility services at the university, but it is necessary for achieving their full potential. Students with negative experiences with the campus bus service (termed unhappy campus bus riders) may be attracted to micro-mobility due to its flexibility, convenience, and support for sustainable transport goals. Thus, this study aims to evaluate unhappy bus riders’ willingness to use micro-mobility in different scenarios. An online questionnaire was prepared for data collection, with distinct sections designed to gather both revealed and stated preferences. Revealed preference was used to identify students with negative experiences on campus buses. Then, nine scenarios based on micro-mobility adoption barriers were presented in a stated preference section to gauge unhappy bus riders' willingness to use micro-mobility under hypothetical situations. By applying ordinal logit regression analysis on the survey data collected from 308 respondents living on the main campus of the National University of Malaysia, it is found that four out of seven types of bus experiences significantly affect unhappy bus riders’ willingness to use micro-mobility in three scenarios. The results from regression analyses proposed four separate ordinal logit models, each with a single type of negative experience as a predictor variable to calculate the likelihood of micro-mobility use in the future. We believe that the findings of our study can help the university's mobility department identify a new micro-mobility user segment. Consequently, they can devise specific strategies to promote micromobility options for students travelling short distances on campus.

BackgroundStroke is a leading cause of death worldwide. Infections after stroke occur in 30% of stroke patients and are strongly associated with unfavourable outcome. Preventive antibiotic therapy lowers infection rate in patients after stroke, however, the effect of preventive antibiotic treatment on functional outcome after stroke has not yet been investigated.The Preventive Antibiotics in Stroke Study (PASS) is an ongoing, multicentre, prospective, randomised, open-label, blinded end point trial of preventive antibiotic therapy in acute stroke. Patients are randomly assigned to either ceftriaxone at a dose of 2 g, given every 24 hours intravenously for four-days, in addition to stroke-unit care, or standard stroke-unit care without preventive antibiotic therapy. Aim of the study is to assess whether preventive antibiotic treatment improves functional outcome at three months by preventing infections.ResultsTo date, 2,470 patients have been included in PASS. Median stroke severity of the first 2,133 patients (second interim analysis) is 5 (IQR 3 to 9) on the National Institutes of Health Stroke Scale (NIHSS). Due to the PROBE design, no outcome data are available yet. In the initial trial protocol we proposed a dichotomisation of the mRS as primary analysis of outcome and ordinal regression analysis as secondary analysis of primary outcome, requiring a sample size of 3,200 patients. However, ordinal analysis of outcome data is becoming increasingly more common in acute stroke trials, as it increases statistical power. For PASS, funding is insufficient for inclusion of 3,200 patients with the overall inclusion rate of 15 patients per week. Therefore we change the analysis of our primary outcome from dichotomisation to ordinal regression analysis on the mRS. Power analysis showed that with similar assumptions 2,550 patients are needed using ordinal regression analysis. We expect to complete follow-up in June 2014. A full statistical analysis plan will be submitted for publication before treatment allocation will be unblinded.ConclusionThe data from PASS will establish whether preventive antibiotic therapy in acute stroke improves functional outcome by preventing infection. In this update, we changed our primary outcome analysis from dichotomisation to ordinal regression analysis.Trial registrationCurrent controlled trials; ISRCTN66140176. Date of registration: 6 April 2010.

This paper explicitly integrates entrepreneurial orientation and absorptive capacity constructs to understand their combined impact on the performance of micro enterprises with the aim to identify ‘anchor’ firms. Anchor firms are those firms that have the maximum potential to create ‘high value’ in their operations and serve as examples to other companies in the area to emulate. Using principal component and ordinal regression analysis, 79.3% (Nagelkerke R2) of the variance in the performance can be explained and the model meets the necessary tests of proportional odds. The results show that categorization based on the predicted values is able to identify successfully 72.73% of the potential anchor firms while 94.44% and 88.24% of the low performers and medium performers, respectively, were also correctly identified. More importantly, none of these low or medium performers is misclassified as anchor firms.

Background: Pregnancy-related stress can affect a child’s development for a long time, increasing the likelihood of teenage anxiety. High levels of stress hormone exposure during pregnancy may interfere with the development of the nervous system and stress reactions, making a person more susceptible to anxiety disorders. Objective: The purpose of this study is to determine the degree to which prenatal stress leads to teenage anxiety and to examine the association between maternal stress during pregnancy and teenage anxiety levels. Methods: A cross-sectional design was used, involving 143 mothers with adolescents aged 10–19 years, selected through purposive sampling. The Prenatal Distress Questionnaire (PDQ) was used to measure prenatal stress, while the Generalized Anxiety Disorder-7 (GAD-7) was used to measure anxiety in adolescents. The link between prenatal stress and teenage anxiety was examined using Spearman’s correlation, and the impact of prenatal stress on teenage anxiety was ascertained using ordinal regression. Results: Prenatal stress and teenage anxiety were significantly positively correlated, according to Spearman’s correlation test (r= 0.51; p &lt; 0.0001). Ordinal regression analysis indicated that prenatal stress significantly influenced adolescent anxiety (Chi-Square = 27.9; p &lt; 0.0001), explaining 45.6% of its variability (Nagelkerke R²= 0.46). Conclusion: Maternal stress during pregnancy showed a moderate, significant positive correlation with adolescent anxiety (r= 0.51; p &lt; 0.0001), explaining 45.6% of the variance in anxiety levels. Strengthening psychosocial support for pregnant women and implementing early prenatal stress detection programs are essential strategies to reduce the risk of anxiety disorders in their children. These findings highlight the need for psychological support programs for pregnant women to reduce the risk of anxiety disorders in their children.

The popularity of mountain biking (MTB) in the United States has risen in recent years. We sought to identify the prevalence and distribution of MTB associated head and neck injuries presenting to emergency departments across the U.S. and identify risk factors for hospital admission in this patient population. The National Electronic Injury Surveillance System (NEISS) was queried for MTB related injuries of the head and neck from 2009 to 2018, with analysis for incidence, age, gender, anatomic site, and diagnoses. A total of 486 cases were identified, corresponding to an estimated 18 952 head and neck MTB related ED visits. Patients were predominantly male (80.7%) and white (69.8%) with a median age of 35 years (interquartile range, 21-46 years). A majority (88.4%) of patients were released from the ED, but a significant proportion of patients were admitted (9.2%) or transferred (1.2%). The most common facial fractures were facial/not specified (35%), nasal bone (29%), mandible (15%), orbit (12%), and zygomaxillary complex (9%). The greatest predictors of hospital admission/transfer were injury to the mouth or neck and avulsion-type injury (P < .001). MTB results in a significant number of traumatic head and neck injuries nationwide. Patients are primarily adult, white males. The majority of injuries result in discharge from the ED, however a small amount of these patients experience significant morbidity necessitating hospital admission. Understanding the distribution of MTB head and neck injuries may aid in the clinical evaluation of these patients. 4.

Cerebral collateral circulation has a central role in ischemic stroke pathophysiology, and it is considered to correlate with infarct size, the success of reperfusion therapies, and clinical outcomes. Our aim was to study the factors influencing the development of collaterals in patients with acute ischemic stroke eligible for endovascular treatment. We enrolled patients with acute ischemic stroke and large vessel occlusion of anterior circulation potentially eligible for endovascular treatment. Included patients performed multiphase CT angiography to assess collaterals that were graded by the Menon Grading Score. We investigated the associations between clinical factors and collaterals and tested independent associations with logistic (good vs. poor collaterals) and ordinal (collateral grade grouped, Menon 0-2, 3, 4-5) regression analysis adjusting for age, sex, stroke severity, and onset to CT time (OCTT). We included 520 patients, the mean age was 75 (±13.6) years, 215 (41%) were men, and the median (IQR) NIHSS was 17 (11-22). Good collaterals were present in 323 (62%) patients and were associated with lower NIHSS (median 16 vs. 18; p < 0.001) and left hemisphere involvement (60% vs. 45%; p < 0.001), whereas previous stroke/TIA was more frequent in patients with poor collaterals (17 vs. 26%; p = 0.014). These results were confirmed in both logistic and ordinal regression analyses where good collaterals were associated with lower NIHSS (OR = 0.94; 95% CI = 0.91-0.96; cOR = 0.95; 95% CI = 0.92-0.97, respectively) and left hemisphere stroke (OR = 2.24; 95% CI = 1.52-3.28; cOR = 2.11; 95% CI = 1.46-3.05, respectively), while previous stroke/TIA was associated with poor collaterals (OR = 0.57; 95% CI = 0.36-0.90; cOR = 0.61; 95% CI = 0.40-0.94, respectively). Vascular risk factors, demographics, and pre-stroke treatments did not influence the collateral score. The results of our study suggest that risk factors and demographics do not influence the development of collateral circles, except for a negative relation with previous ischemic events. We confirm an already reported observation of a possible protective effect of collaterals on tissue damage assuming NIHSS as its surrogate. The association between left hemispheric stroke and better collaterals deserves to be further explored. Further efforts are needed to identify the factors that favor the development of collaterals.

The current study examined those factors that challenge the reflective practice of EFL teachers in Gambela region Ethiopia, at the high school level, who teach grades 9-12. Considering both the significance of EFL education in Ethiopia as well as the distinct context of Gambela, which may not be as resource-rich as other areas, the study sought to fill an existing gap in understanding the particular factors that impact teachers’ capabilities to reflectively integrate practices. Employing a quantitative, cross-sectional survey design, data were gathered from 90 EFL teachers on their demographic and attitudinal characteristics and perceptions of barriers to the use of reflective practices. Ordinal logistic regression analyses were conducted to determine the predictors among teacher-related factors of agreement with each of the seven challenges statements. Most teacher demographic variables, but, such as Years of Service, Educational Status, Reflective Practitioner Course, were not found to be significant predictors of the challenges examined. But, Sex (Male=1) was a significant predictor of the mother item regarding the challenge of assessing without a timetable (Q20) indicating that male teachers had higher likelihood of endorsing this item as a challenge. Importantly, a teacher’s Opinion on Effective Teaching (views on teaching being reflective practice) was a strong negative predictor of the time scarcity challenge to finding comments (Q24). This suggests that teachers who had stronger beliefs about the importance of reflective teaching, would be significantly less likely to identify lack of time for feedback as a major limitation. Being confused about how to use reflection (Q23) was low overall and not predicted by the variables of interest. These findings point to particular challenges to reflective practices in the Gambela context, but also reveal the significance of an individual teacher’s sense of the value of reflection as a means to overcome some of these perceived obstacles. The study provides context-specific evidence to inform targeted professional development and policy aimed at enhancing EFL teaching quality by addressing perceived difficulties and fostering positive attitudes towards reflection in the Gambela region.

BackgroundMountain and road bike accidents are particularly common with the increased popularity of the sport. We reviewed the attendances in our emergency department over a 4-year period looking at cycling...

SOT-specialists, COVID-19-specialists, and medical ethicists designed an international survey according to CHERRIES guidelines. Personal opinions about continuing SOTs, safe managing of donors and recipients, as well as equity of resources' allocation were investigated. The survey was sent by e-mail. Multiple approaches were used (corresponding authors from Scopus, websites of scientific societies, COVID-19 webinars). After the descriptive analysis, univariate and multivariate ordinal regression analysis was performed. There were 1819 complete answers from 71 countries. The response rate was 49%. Data were stratified according to region, macrospecialty, and organ of interest. Answers were analyzed using univariate-multivariate ordinal regression analysis and thematic analysis. Overall, 20% of the responders thought SOTs should not stop (continue transplant without restriction); over 70% suggested SOTs should selectively stop, and almost 10% indicated they should completely stop. Furthermore, 82% agreed to shift resources from transplant to COVID-19 temporarily. Briefly, main reason for not stopping was that if the transplant will not proceed, the organ will be wasted. Focusing on SOT from living donors, 61% stated that activity should be restricted only to "urgent" cases. At the multivariate analysis, factors identified in favor of continuing transplant were Italy, ethicist, partially disagreeing on the equity question, a high number of COVID-19-related deaths on the day of the answer, a high IHDI country. Factors predicting to stop SOTs were Europe except-Italy, public university hospital, and strongly agreeing on the equity question. In conclusion, the majority of responders suggested that transplant activity should be continued through the implementation of isolation measures and the adoption of the COVID-19-free pathways. Differences between professional categories are less strong than supposed.

Diagnosis of traumatic axonal injury (TAI) is challenging because of its underestimation by conventional MRI and the technical requirements associated with the processing of diffusion tensor imaging (DTI). Serum biomarkers seem to be able to identify patients with abnormal CT scanning findings, but their potential role to assess TAI has seldomly been explored. Patients with all severities of traumatic brain injury (TBI) were prospectively included in this study between 2016 and 2021. They underwent blood extraction within 24 hours after injury and imaging assessment, including DTI. Serum concentrations of glial fibrillary acidic protein, total microtubule-associated protein (t-Tau), ubiquitin C-terminal hydrolase L1 (UCH-L1), and neurofilament light chain (NfL) were measured using an ultrasensitive Simoa multiplex assay panel, a digital form of enzyme-linked immunosorbent assay. The Glasgow Outcome Scale-Extended score was determined at 6 months after TBI. The relationships between biomarker concentrations, volumetric analysis of corpus callosum (CC) lesions, and fractional anisotropy (FA) were analyzed by nonparametric tests. The prognostic utility of the biomarker was determined by calculating the C-statistic and an ordinal regression analysis. A total of 87 patients were included. Concentrations of all biomarkers were significantly higher for patients compared with controls. Although the concentration of the biomarkers was affected by the presence of mass lesions, FA of the CC was an independent factor influencing levels of UCH-L1 and NfL, which positioned these two biomarkers as better surrogates of TAI. Biomarkers also performed well in determining patients who would have had unfavorable outcome. NfL and the FA of the CC are independent complementary factors related to outcome. UCH-L1 and NfL seem to be the biomarkers more specific to detect TAI. The concentration of NfL combined with the FA of the CC might help predict long-term outcome.

SIXTO OBRADOR SENEC PRIZE 2019: Utility of diffusion tensor imaging as a prognostic tool in moderate to severe traumatic brain injury. Part II: Longitudinal analysis of DTI metrics and its association with patient's outcome

This paper examines the influence of getting on the balcony behavior on digital transformation of insurance firms in Kenya within the framework of adaptive leadership theory. The study acknowledges the pivotal role of adaptive leadership behavior in fostering leader-organization value-congruence, perspective-taking, and self-awareness. A positivist approach and a descriptive research design were employed; targeting a population of 392 supervisors from the 56 registered insurance firms listed by the Insurance Regulatory Authority. Using a stratified random sampling technique, a final sample of 127 respondents was obtained, representing a response rate of 63% from the initial study sample of 198. Getting on the balcony behavior was operationalized through value congruence, perspective taking, and self-awareness dimensions. At the same time, digital transformation was assessed using digital innovation, customer experience, and returns on assets capabilities metrics. Descriptive and inferential statistical analyses, including means, standard deviation, correlation analysis, chi-square test, one-way ANOVA, and ordinal logistic regression, were employed to analyze the research data and to test the study hypothesis. The ordinal logistic regression analysis findings, represented by the Nagelkerke Pseudo R-square coefficient, indicated that getting on the balcony behavior explains 37.2% of the variance in digital transformation (Nagelkerke Pseudo R² = .372). Furthermore, the parameter estimates derived from the ordinal regression analysis revealed that getting on the balcony behavior predicted digital transformation, with a significant beta coefficient of -4.100, p≤.05. In conclusion, this study establishes a substantial connection between "getting on the balcony" behavior, encompassing value congruence, perspective taking, and self-awareness, and the digital transformation of insurance firms in Kenya. Specifically, when leaders actively pursue value congruence through perspective-taking and self-awareness practices, this adaptive leadership behavior significantly and positively influences digital transformation. Consequently, the study recommends insurance leaders to proactively embrace getting on the balcony behavior by implementing policies and practices that promote value congruence, enhance perspective-taking, and establish self-awareness. Further, the adaptive leadership framework should be evaluated in broader financial services sector and other industries and regions.