Assessment Score Research Articles

Unlocking the potential: Evaluating the impact of online gamified and non-gamified assessment tools on academic performance, motivation, engagement and satisfaction in undergraduate medical education

ABSTRACT With the advent of technology-enhanced learning, gamification has emerged as a promising strategy to augment student engagement and motivation for formative assessments. This study investigates the effects of online gamified versus non-gamified formative assessment tools on undergraduate medical students’ academic performance, motivation, engagement and satisfaction. Utilising a comparative experimental design, this research involved 222 undergraduate medical students who were randomly assigned to two groups for the end-module assessments. Academic performance was measured through end-module assessment scores, and a questionnaire assessed the motivation, engagement and satisfaction levels of the students with these platforms. Students exposed to gamified assessments showed a significant improvement in academic performance and motivation compared to their non-gamified counterparts. The findings of this study highlight the beneficial impact of gamified formative assessments in medical education, particularly in terms of improving academic performance and student motivation.

A Guidebook for Assessing Mathematical Logic Intelligence in Kindergarten

Many children still need help understanding numbers; children also cannot differentiate between round, triangular, and square shapes. Apart from that, teachers only carry out assessments at the end of the learning semester and do not use assessment guides, especially on aspects of children's mathematical logic intelligence in their daily activities at school. Based on this, this research aims to develop a guidebook for assessing mathematical logic intelligence in kindergarten. This type of research is development research. This research uses the ADDIE model. The research subjects are learning media experts and learning material experts. The test subjects were fifteen teachers. The methods used to collect data are interviews, documentation, and questionnaires. The data collection instrument uses a questionnaire sheet. The data analysis technique used is quantitative descriptive statistical analysis. The research results are the results of material media validation tests with a test percentage value of 96.3% and the eligibility criteria being "very valid." The assessment from media experts was 98.7%, with the eligibility criteria being "very valid." The assessment score from the effectiveness instrument expert has a test percentage value of 97%, with the eligibility criteria being "very valid." The effectiveness test of individual trials were 95.69% "very effective" and small group 91.67% "very effective". It was concluded that the mathematical logic intelligence assessment guidebook is very suitable and adequate for teachers in kindergarten. The research implication is that the developed mathematical logic intelligence assessment guidebook can be used in learning activities.

Multiparametric Chemical Exchange Saturation Transfer MRI Detects Metabolic Changes in Mild Cognitive Impairment Cases at 3.0 Tesla.

This study aimed to assess the potential of multiparametric chemical exchange saturation transfer magnetic resonance imaging (CEST MRI) for MCI detection. Twenty-eight patients with MCI and 31 age- and gender-matched normal controls (NCs) were enrolled. CEST MRI was performed with a gradient and spin-echo sequence on a 3T scanner. Multi-parametric CEST parameters were analyzed, such as amide CEST, amine CEST, amine and amide concentration independent assay (AACID), magnetization transfer ratio yielding rex (MTRrex-amide), and downfield rNOE suppressed apparent exchange-dependent relaxation amide proton (DNS-AREX-amide). Statistical analyses of CEST parameters were performed to evaluate group differences, their correlations with Montreal cognitive assessment (MoCA) score, and diagnostic performance for MCI. Compared with NC group, amide CEST as well as MTRrex-amide decreased in the left hippocampus and amine CEST as well as AACID increased in the right hippocampus in the MCI group; In both hippocampi, the DNS-AREX-amide were significantly lower in the MCI group versus the NC group (all P < 0.05). Amine CEST in the right hippocampus was negatively correlated with MoCA score (r = - 0.457, p = 0.017); DNS-AREX-amide in the bilateral hippocampus was positively correlated with MoCA score (left: r = 0.449, P = 0.019; right: AUC = 0.529, P = 0.05). DNS-AREX-amide in the bilateral hippocampus have a good ability to identify MCI (left: AUC = 0.756, P < 0.01; right: AUC = 0.762, P < 0.01). CEST MRI provides a potential imaging diagnostic strategy for MCI, which may promote early detection of MCI and provide novel insights into the pathological progress toward AD.

Association of LVV-Hemorphin-7 with Sepsis and Shock: Roles of Cathepsin D and G in Hemoglobin Metabolism in a Prospective ICU Cohort Study

Background: Sepsis is a leading cause of mortality in intensive care units (ICUs). Cell-free hemoglobin (CFH) released during sepsis interacts with lysosomal enzymes from neutrophils and macrophages. This study aims to examine the association of LVV-hemorphin-7 (LVV-H7), cathepsin D, and cathepsin G with sepsis and shock in ICU patients. Methods: A prospective observational cohort study was conducted in the medical ICU of a tertiary referral hospital in Taiwan. The patients with an acute increasing sequential organ failure assessment (SOFA) score ≥ 2 between 2022 and 2023. Blood samples from 40 healthy controls were obtained from the hospital biobank. CFH metabolites, including LVV-H7 and lysosomal enzyme cathepsin D and cathepsin G, were compared between the sepsis (definite and probable) and non-sepsis (possible sepsis) groups. Multivariate logistic regression analyzed factors associated with sepsis and shock. Results: Among 120 patients, 75 were classified as septic and 45 as non-septic. Significant differences were observed in CFH, cathepsin D, cathepsin G, and LVV-H7 levels between sepsis and non-sepsis groups. LVV-H7 was a significant predictor for sepsis (adjusted OR [aOR] 1.009, 95% CI 1.005–1.013; p &lt; 0.001) and shock (aOR 1.005, 95% CI 1.002–1.008; p &lt; 0.05). Cathepsin G predicted non-shock (aOR 0.917, 95% CI 0.848–0.991; p &lt; 0.05), while cathepsin D predicted septic shock (aOR 1.001, 95% CI 1.000–1.002; p &lt; 0.05). Conclusions: LVV-H7, cathepsin D, and cathepsin G are associated with the classification of sepsis and shock episodes in critically ill patients with elevated SOFA scores.

The impact of surgery with general anesthesia on cognitive function and putamen volume: a cross-sectional study among older adults

BackgroundPrevious studies have shown that surgery under general anesthesia may diminish cognitive function; however, the proposed mechanisms need further elucidation. The purpose of the current study was twofold: (1) to compare overall and domain-specific differences in cognitive function between the surgery under general anesthesia group and the control group, and (2) to investigate the possible mechanisms of surgery under general anesthesia affecting cognitive function, using T1-structural magnetic resonance imaging.MethodsA total of 194 older adults were included in this study. Patients were divided into a surgery under general anesthesia group (n = 92) and a control group (n = 104). The two groups were matched for age, sex, and educational level. All participants underwent clinical evaluation, neuropsychological testing, blood biochemistry analysis, and T1 phase structural magnetic resonance imaging.ResultsWe found that older adults with a history of surgery under general anesthesia had lower Montreal Cognitive Assessment (MoCA) scores and smaller right putamen volumes (p &amp;lt; 0.05). Linear regression analysis (mediation model) indicated that surgery under general anesthesia affected MoCA scores by diminishing the volume of the right putamen (B = 1.360, p = 0.030).ConclusionWe found evidence that older adults who underwent surgery under general anesthesia had poorer cognitive function, which may have been caused by an apoptotic or otherwise toxic effect of anesthetic drugs on the volume of the right putamen.

Outcomes of adults hospitalized with COVID-19 at the University Teaching Hospital of Butare in Rwanda and validation of the Universal Vital Assessment (UVA) mortality risk score.

There are few data regarding clinical outcomes from COVD-19 from low-income countries (LICs) including Rwanda. Accordingly, we aimed to determine 1) outcomes of patients admitted to hospital with COVID-19 in Rwanda, and 2) the ability of the Universal Vital Assessment (UVA) score to predict mortality in patients with COVID-19 compared to sequential organ failure assessment (SOFA) and quick (qSOFA) scores. We conducted a retrospective study of patients aged ≥18 years hospitalized with laboratory-confirmed COVID-19 at the University Teaching Hospital of Butare (CHUB), Rwanda, April 2021-January 2022. For each participant, we calculated UVA, SOFA, and qSOFA risk scores and determined their area under the receive operating characteristic curve (AUC). We used logistic regression to determine predictors of mortality. Of the 150 patients included, 83 (55%) were female and the median (IQR) age was 61 (43-73) years. The median (IQR) length of hospital stay was 6 (3-10) days. Respiratory failure occurred in 69 (46%) including 34 (23%) who had ARDS. The case fatality rate was 44%. Factors independently associated with mortality included acute kidney injury (adjusted odds ratio [aOR] 7.99, 95% confidence interval [CI] 1.47-43.22, p = 0.016), severe COVID-19 (aOR 3.42, 95% CI 1.06-11.01, p = 0.039), and a UVA score >4 (aOR 7.15, 95% CI 1.56-32.79, p = 0.011). The AUCs for UVA, qSOFA, and SOFA scores were 0.86 (95% CI 0.79-0.92), 0.81 (95% CI 0.74-0.88), and 0.84 (95% CI 0.78-0.91), respectively, which were not statistically significantly different from each other. At a UVA score cut-off of 4, the sensitivity, specificity, positive predictive value, and negative predictive value for mortality were 0.58, 0.93, 0.86, and 0.74, respectively. Patients hospitalized with COVID-19 in CHUB had high mortality, which was accurately predicted by the UVA score. Calculation of the UVA score in patients with COVID-19 in LICs may assist clinicians with triage and other management decisions.

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment

Sleep and Depressive Symptoms in Sedentary Community-Dwelling Older Adults With Sleep Complaints: Findings From Ambulatory Sleep EEG.

There is limited and inconsistent evidence on the association between electroencephalography (EEG) measured sleep and depressive symptoms among community-dwelling older adults. This study aimed to investigate the cross-sectional association between EEG-measured sleep and depressive symptoms. Using baseline data from a randomized clinical trial, we included 66 sedentary community-dwelling older adults with sleep complaints (≥ 1 self-reported insomnia symptom). Sleep was measured using an in-home sleep EEG (Sleep Profiler™) for 2 nights and the Geriatric Depression Scale (GDS-15) was used to measure depressive symptoms. Multiple linear regression analyses were conducted with each sleep parameter as the primary predictor and GDS score as the outcome, adjusting for age, sex, race, education, marital status, chronic conditions, and Montreal Cognitive Assessment (MoCA) score. Several sleep variables were associated with depressive symptoms (GDS score), including a higher percentage of sleep stage N1 (B = 0.11, 95% confidence interval [CI]: 0.02 - 0.20) and N2 (B = 0.04, 95% CI: 0.00 - 0.08), a lower percentage of N3 sleep (B = -0.04, 95% CI: -0.08 to -0.01), greater wake after sleep onset (B = 0.01, 95% CI: 0.00 - 0.02), and a greater number of awakenings ≥90s/hour (B = 0.87, 95% CI: 0.21-1.53). Our study reveals that among sedentary community-dwelling older adults with sleep complaints, more lighter sleep (stage N1, N2), less deep (N3) sleep, and increased awakenings are associated with more depressive symptoms. Sleep interventions aimed at enhancing sleep architecture may also help alleviate depressive symptoms in this population.

A Comparative Study on Traditional and Case Based Teaching Learning Methods and Its Impact on Academic Performance Among First Year Medical Students

Background: The goal of medical education is to develop skilled practitioners who are attuned to the health issues faced by the community. Although lectures are commonly employed to impart new information, a drawback is that the audience tends to be passive and may thus become disengaged. Learning is made up of various interconnected components and involves complex mental processes like problem-solving and analytical thinking. The goal of using structured methods and organized resources is to equip students with effective learning tools. This enables them to gain a deep understanding of cognitive processes and develop the relevant skills needed for their careers. Case-Based Learning (CBL) involves examining a health issue presented by a patient, analysing and understanding pertinent details from past cases, systematically exploring and evaluating the situation, and planning the appropriate management for the patient. Materials and methods: The present study was cross sectional case control study conducted in the department of anatomy, Sri Siddhartha Medical College, Tumkur, Karnataka, India. Results: A total of 192 first year MBBS students participated in the first session of the study and 172 first year MBBS students participated in the second session of the study. The pre-test and post-test total scores of first and second session shows that students have performed better in CBL group when compared to the traditional lecture method of teaching. In the Critical Thinking Exercise scores of session -1 and 2, CBL group was found to be higher when compared to the traditional lecture group which was statistically significant. Comparison of means of internal assessments scores of CBL and Traditional lecture groups showed that the mean internal assessments score of CBL group was higher compared to Traditional lecture group which was statistically significant. Conclusion: Incorporating case-based learning (CBL) into our medical curriculum as a regular teaching method for large group settings should be considered. The integration of didactic lectures with CBL proves to be an effective educational approach. Positive feedback from both students and faculty suggests that CBL has been successfully introduced in departments like anatomy. However, further research is needed to evaluate how well students learn, understand, and retain the course content to fully support the implementation of this method in large undergraduate classes. KEY WORDS: Case-based learning, Traditional teaching learning methods, Critical thinking.

Characteristics of a revised quick sequential organ failure assessment score (RqSOFA) to predict in-hospital mortality of patients visiting the emergency department via ambulance: an observational cohort study.

The National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (qSOFA), and modified qSOFA (MqSOFA) are scoring systems that rely on vital signs. However, NEWS is time-consuming, qSOFA has low sensitivity, and MqSOFA includes a difficult calculation. To address these issues, we developed the Revised qSOFA score (RqSOFA) that consists of percutaneous oxygen saturation, oxygen usage, Simple Shock Index, and the parameters of qSOFA. The predictability of RqSOFA was examined for in-hospital mortality among patients who were transported by ambulance. This observational cohort study included all patients transported via ambulance to an Emergency Department between 2019 and 2021. Patients who had prehospital cardiopulmonary arrest, were pregnant, were younger than 15years old, arrived from another hospital, and had missing data were excluded. The Area Under the Receiver Operating Characteristic curve (AUROC) of RqSOFA, as well as its sensitivity and specificity at the optimal cut-off point, were determined and compared to those of qSOFA, NEWS and MqSOFA. Among 1849 included patients, 53 died in the hospital. The AUROC for RqSOFA was 0.867 and the optimal cut-off point was 2. The sensitivity and specificity were 0.849 and 0.802, respectively. The AUROC of RqSOFA was larger than qSOFA but had no significance with NEWS and MqSOFA. RqSOFA exhibited the same sensitivity and better specificity compared to NEWS. There were no differences in sensitivity and specificity between RqSOFA and MqSOFA. In conclusion, RqSOFA exhibited superior predictability for in-hospital mortality to qSOFA and NEWS, while offering similar predictability to MqSOFA despite relying only on simple measurements.

Efficacy of a 3-Month Oral Function Management Protocol Incorporating Provision of Dietary Advice for Older Outpatients: A Randomised Controlled Trial.

This study aimed to examine the effects of an oral hypofunction management protocol incorporating oral function training and provision of dietary advice for 3 months on the nutritional status and oral function of older patients diagnosed with oral hypofunction. Oral hypofunction is associated with poor nutritional status, emphasising the need for management protocols incorporating provision of nutritional guidance and dietary advice. However, the efficacy of such protocols remains unclear. This quasi-randomised controlled clinical trial included 80 patients (age ≥ 65 years) diagnosed with oral hypofunction who were divided into two groups (intervention and control). The intervention group was provided with dietary advice and instructed to perform daily oral function training. The patients' nutritional status and oral function were evaluated every 1.5 months. Intergroup and intragroup comparisons were made. The intervention group exhibited a significant increase in the mean Mini Nutritional Assessment score over the study period (baseline: 25.4 ± 3.2; after 3 months: 26.3 ± 3.0), whereas no significant difference was observed in the control group (baseline: 26.4 ± 2.4; after 3 months: 26.4 ± 2.7). The mean number of symptoms of poor oral function was 4.0 ± 1.0 and 3.9 ± 0.9 at baseline and 2.8 ± 1.3 and 3.0 ± 1.3 after 3 months in the intervention and control groups, respectively, with a significant difference within the groups. Management protocols incorporating provision of nutritional advice effectively improved the oral function and nutritional status of older patients with oral hypofunction.

Mastering the Sequential Organ Failure Assessment Score: Critical Choices of Score Statistic, Timing, Imputations, and Competing Risk Handling in Major Trials-A Systematic Review.

The Sequential Organ Failure Assessment (SOFA) score originated as a tool for assessing organ dysfunction in critical illness but has expanded to become an outcome measure in clinical trials. We aimed to assess how the SOFA score was used as the primary or secondary endpoint of major randomized controlled trials (RCTs). Independent reviewers searched MEDLINE/PubMed, Scopus, and Embase databases. Articles were selected when they fulfilled: 1) RCT; 2) SOFA score was primary or secondary endpoint; and 3) published in the Lancet, New England Journal of Medicine, or Journal of the American Medical Association. Data collection included study details, outcomes, statistical differences in SOFA score, choice of score statistics, timepoints of SOFA reporting, and how missing data and competing risks analysis were managed. Twenty-three RCTs had SOFA score as outcome measure, eight used it as primary endpoint. Daily maximum SOFA was the key statistic in 11 RCTs, delta SOFA was used in eight, and mean SOFA in four. Mean SOFA was most frequently chosen as primary endpoint (4/8, 50%). There were 18 different outcome assessment timepoints, ranging from 1 to 28 days. Three RCTs reported statistically significant difference in SOFA between groups. Handling of missing SOFA scores was not described in ten of 23 RCTs. When described, it varied from study to study with variable imputation methods and variable accounting for the competing risk of mortality and ICU discharge. There is major variability in the choice of summary statistic for SOFA score analysis and assessment timepoints, when using it as outcome measure in RCTs. There was either no information or great variability in the handling of missing values, use of imputation, and accounting for competing risk. The current use of SOFA scores in RCTs lacks sufficient reproducibility and statistical and methodological robustness.

MRI-PDFF Assessment of Intrahepatic Fat Changes Post-Bariatric Surgery: A Systematic Literature Review

Background and Objectives: Non-alcoholic fatty liver disease (NAFLD) is prevalent among obese individuals and can progress to non-alcoholic steatohepatitis (NASH). Bariatric surgery is known to induce significant weight loss and may improve NAFLD. This systematic review uniquely synthesizes current evidence on the effects of bariatric surgery on intrahepatic fat content, measured by magnetic resonance imaging proton density fat fraction (MRI-PDFF), and assesses study quality using the Newcastle–Ottawa Scale (NOS). Materials and Methods: The literature search was conducted across the PubMed, Scopus, and Web of Science databases up to October 2024, identifying 12 prospective cohort studies involving 613 patients who underwent bariatric surgery. Inclusion criteria included adult patients with NAFLD undergoing bariatric surgery, assessment of liver fat changes using MRI-PDFF before and after surgery, and studies reporting quantitative data on liver fat fraction and relevant clinical parameters. Data extraction focused on patient demographics, surgical procedures, specific weight loss outcomes (delta BMI), changes in intrahepatic fat content (delta MRI-PDFF), and quality assessment scores based on the NOS. Results: Significant reductions in intrahepatic fat content were observed across all studies, with delta MRI-PDFF reductions ranging from 6.9% to 14%. Weight loss outcomes varied, with excess weight loss percentages up to 81.3% and BMI reductions up to 12 kg/m². The quality assessment scores ranged from six to nine out of nine, indicating generally high-quality studies. Correlations were noted between the degree of weight loss and reduction in liver fat content. Several studies reported high rates of resolution of steatosis and NASH post-operatively. Conclusions: Bariatric surgery leads to significant reductions in intrahepatic fat content and improvements in NAFLD among obese patients. The degree of weight loss correlates with the reduction in liver fat. These findings underscore the clinical utility of bariatric surgery as a strategic intervention for managing NAFLD in obese individuals, potentially influencing clinical practice guidelines by integrating bariatric surgery as a viable treatment option for NAFLD-related hepatic conditions.

Capacity building in obstetric ultrasound: Impact of simulation based clinical teaching on resident training at a health facility in India.

Current postgraduate curriculum in India lacks practical training in ultrasound for residents in obstetrics and gynecology. The objective of this study was to develop and assess impact of a capacity building program utilizing clinical teaching and simulation to enhance knowledge and skills of residents at a healthcare facility in India. A training program comprising of 14 modules on basic obstetric ultrasounds was created over 3 months. These modules, validated by fetal medicine experts, underwent a pilot study for face validity. A total of 18 newly enrolled junior residents without prior ultrasound experience were recruited. A two-day workshop included interactive module sessions and 6 h and 30 min of hands-on training using an obstetric simulator. Pre- and post-tests consisting of 50 multiple-choice questions (MCQs) assessed knowledge. Follow-up assessments were carried out at 1 and 3 months. Skill assessment at the third month was conducted using an objective structured practical examination (OSPE), alongside image submission by residents. There was significant improvement in marks over time, with a mean pretest score of 24 ± 2.7 out of 50 marks, post-test score of 36.81 ± 2.86 and stable scores (34.6 ± 3.21, 34.4 ± 2.96) during follow-up reviews. OSPE scores at third month averaged at 21.47 ± 2.3 (maximum marks 30); image assessment scores averaged at 83 ± 8.62 (maximum marks 100). Participant feedback indicated a positive response to all program aspects (practicality, content and structured training). Confidence levels in performing clinical ultrasound improved significantly after attending the module (P < 0.0001). Simulation with clinical teaching effectively enhanced knowledge and skills of residents, fostering confidence in performing basic obstetric ultrasounds early on in their residency. Integrating similar capacity building initiatives into residency training programs can improve healthcare delivery by ensuring a well prepared cadre of doctors skilled in obstetric ultrasounds.

Association between Pregnancy and Musculoskeletal Conditions in Active-Duty Military Service Members.

Non-combat musculoskeletal conditions are endemic among service members and disproportionately affect females. Pregnancy and childbirth contribute to lower physical fitness assessment scores and higher body mass index, both risk factors for musculoskeletal conditions, for up to one-year post-pregnancy. However, there is a paucity of information regarding the impact of pregnancy on musculoskeletal conditions. To explore the association between the post-pregnancy period and incident musculoskeletal conditions (MSK). Retrospective, longitudinal cohort study. Medical and administrative data from the Medical Assessment and Readiness System. Female military service members with and without a pregnancy. Months since pregnancy end, health history, and demographic and military service data were abstracted for each subject. Subsequent MSKs were identified with relevant ICD-10 codes. A multivariable logistic regression model assessed the association between the time since pregnancy end and MSK incidence. A total of 298,607 female service members were identified, of which 19,980 had a pregnancy. A larger percentage of post-pregnancy service members (65.8%) had a MSK diagnosis as compared to the non-pregnant cohort (60.3%). Adjusting for covariates, the model suggests a temporal influence on post-pregnancy MSK incidence, such that service members 3- to 4-months and 5- to 6-months post-pregnancy were more likely to be diagnosed with a MSK as compared to the non-pregnant cohort. However, service members <2 months post-pregnancy were less likely to be diagnosed with an MSK, and the odds of an MSK beyond 6-months decreased out to 24-months post-pregnancy. Pregnancy may increase a service member's odds of sustaining an MSK 3- to 6- months post-pregnancy. Understanding the relationships between pregnancy and MSK risks may lead to changes in postpartum return-to-duty/activity policies, better enabling service members to care for themselves and their families.

Outcomes Following Transtibial Amputation with and without a Tibiofibular Synostosis Procedure

Background: This study compared outcomes at 18 months between patients who underwent transtibial amputation with and without a tibiofibular synostosis procedure. We hypothesized that complication rates would be lower in patients who did not receive a synostosis procedure compared with those who did receive a synostosis procedure, but the synostosis group would report better function. Methods: This multicenter randomized clinical trial (RCT) included patients aged 18 to 60 years who were treated without (n = 52) or with synostosis (n = 54) during transtibial amputation. Patients who refused randomization were enrolled in an observational (OBS) study (n = 93; 31 synostosis, 62 non-synostosis). There were 2 primary outcomes: operative treatment for a complication within 18 months of amputation and Short Musculoskeletal Function Assessment (SMFA) scores. The primary analyses were based on the RCT participants, and the secondary analyses were based on the treatment received by the combined RCT + OBS participants. Results: In the primary RCT analysis, the probability of ≥1 operatively treated complication was higher for the synostosis group (42%; 95% confidence interval [CI]: 29.8% to 56.2%) than the non-synostosis group (24%; 95% CI: 14.2% to 37.9%), with an absolute risk difference of 18% (95% CI: 0.31% to 36%). There were no appreciable differences in mean SMFA scores. In the secondary combined analysis, the probability of an operatively treatment complication was larger in patients who did versus did not receive a synostosis procedure (absolute risk difference: 26.1%; 95% CI: 12.0% to 40.3%). Differences in SMFA scores favored synostosis, although there were no differences in pain, prosthetic use, and satisfaction. Conclusions: The results of the primary RCT analysis supported our hypothesis of fewer complications in patients who do not undergo a synostosis procedure compared with those who undergo a synostosis procedure, but we found insufficient evidence to conclude that those in the synostosis group have better function. The trial did not reach target enrollment. The secondary combined analysis supported the primary analysis in terms of complications. In the secondary analysis, while pain, prosthetic use, and satisfaction remained similar, the SMFA scores were better for the patients who received a synostosis procedure, although the differences are of uncertain clinical importance. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

A Social-Network-Based Crowd Selection Approach for Crowdsourcing Mobile Apps Requirements Engineering Tasks

Mobile apps have revolutionized almost every aspect of our daily lives, shaping the way we shop, learn and work. The transformative and unprecedented impact they have made on our lifestyle and the convenience they have offered have increased their adoption in diverse domains. Therefore, it is of paramount importance to hear from the interested audience about their desires and requirements in mobile apps. This has stressed the need to employ crowdsourcing in requirements engineering (RE) activities to harness the scattered talent in the crowd. RE tasks require certain software domain knowledge, hence, selecting a suitable subset of the crowd is crucial to obtain high-quality contributions. For that, we propose a crowd selection approach for crowdsourcing mobile app requirements engineering tasks which leverages the untapped crowd available on the social network Twitter (recently changed to X). This article is an extension of our previous work, where we present the proposed social-network-based crowd selection approach design, continue to work on the remaining component of the approach and evaluate the approach through a controlled experiment. For evaluation, the approach was utilized to select a real crowd that were invited to contribute to crowdsourcing requirements elicitation tasks for a fitness mobile app. The quality of the crowdsourced requirements was assessed by experts and the results have provided encouraging and compelling insights about the effectiveness of the proposed approach. The obtained assessment scores for the five quality factors clarity, creativity, relatedness, feasibility and diversity were respectively 4.36, 4.01, 4.29, 4.45 and 4.43 out of 5. Overall, we believe that the proposed social-network-based crowd selection approach could help in eliciting mobile app requirements and features that could cater to the needs of a large audience.

Cognitive outcomes of the at-home brain balance program

Accessibility to developmental interventions for children and adolescents could be increased through virtual, at-home delivery of training programs. Virtual childhood training programs and their effects on cognitive outcomes have not been well studied. To that end, this study examined the effects of the at-home Brain Balance® (BB) program on the cognitive task performance of children and adolescents with baseline developmental and attentional difficulties. The study included students with reported diagnosis of ADHD, autism, anxiety, sensory processing disorder, or dyslexia, and students with no reported diagnosis (aged 4–17 years). The at-home BB program is delivered through (1) a computer-based format utilizing multimodal program activities previously studied in-center (multisensory stimulation, gross motor, coordination, balance, and nutritional recommendations); and (2) the BB app (visual motor, auditory and visual processing, and rhythm and timing training) — creating a comprehensive program experience delivered remotely. Cognitive performance was measured by six cognitive tasks from Creyos Health before and after 3 months of participation in the at-home BB program (N = 316) or in-center BB program (N = 4,232), compared to controls. Results showed that overall cognitive assessment scores (including attention, response inhibition, and working memory) improved after participation in either the at-home or the in-center program, compared to controls. Importantly, significant improvements over the controls were observed for two tasks involving attention and inhibitory control, in both programs. Further, two analyses support that the effects on cognitive performance from either delivery format, in-center or at home, are comparable in magnitude. This research: (1) presents new findings demonstrating improved cognitive performance after completing the at-home BB program; (2) replicates previous findings of cognitive improvements after completing the BB program; and (3) suggests that the cognitive effects of virtual at-home BB training are similar to those observed for in-center BB training. Overall, the results demonstrate the effectiveness of the at-home BB program in improving cognitive functioning in pediatric populations with preexisting developmental and attentional difficulties. Virtual delivery and ease of use, provide at-home programs the potential to reduce barriers of access to much-needed developmental and cognitive support, for individuals who may otherwise lack access to high-quality, evidence-based developmental programs.

Combination of rs-fMRI, QSM, and ASL Reveals the Cerebral Neurovascular Coupling Dysfunction Is Associated With Cognitive Decline in Patients With Chronic Kidney Disease.

Neurovascular coupling (NVC) reflects the close connection between neural activity and cerebral blood flow (CBF) responses, providing new insights to explore the neuropathological mechanisms of various diseases. Non-dialysis patients with chronic kidney disease (CKD) exhibit cognitive decline, but the underlying pathological mechanisms are unclear. The prospective study involved 53 patients with stage 1-3a CKD (CKD1-3a), 78 patients with stage 3b-5 CKD (CKD3b-5), and 52 healthy controls (HC). Our investigation involved voxel-based assessments of both global and regional BOLD signal characteristics. Additionally, we explored the correlations between neuroimaging indices, Montreal Cognitive Assessment (MoCA) scores, and clinical laboratory findings. Compared to HC, the CKD3b-5 and CKD1-3a groups exhibited lower ALLF and ReHo in the default mode network (DMN), higher CBF in bilateral hippocampus (HIP), higher susceptibility values in bilateral caudate nucleus (CAU) and putamen (PUT), and lower susceptibility values in bilateral HIP. At the global level, the coupling coefficients were lower in CKD1-3a and CKD3b-5 groups than in HC. At the ROI level, the CBF-ALFF and CBF-ReHo coupling in HIP and basal ganglia regions were lower in CKD3b-5 groups than in the CKD1-3a group. Most importantly, susceptibility-ALFF in ANG.R may mediate the effects of phosphorus on cognitive decompensation in patients with CKD1-3a. Non-dialysis patients with CKD exhibit abnormal NCV, which is associated with the cognitive decline. Specifically, the susceptibility-ALFF may serve as a valuable biomarker for early assessment of cognitive decline in CKD, offering insights into the pathogenesis of cognitive decline in CKD.

Direct Comparison of Treatment Outcome Between the Botulinum Toxin and Calcitonin Gene-Related Peptide Monoclonal Antibody in Migraine Patients.

Migraine is a genetic disorder characterized by recurrent episodes of headache that are throbbing in nature. The objective of this study was to directly compare the efficacy and safety of anti-calcitonin gene-related peptide (anti-CGRP) and botulinum neurotoxin (BoNT) for the preventive treatment of chronic migraine. This quasi-experimental comparative study was conducted on 80 "chronic migraine patients" at King Fahad University Hospital, Dammam, KSA. Chronic migraineurs were divided into two groups (40 patients/group) and were treated with the standard doses of BoNT (group I) and anti-CGRP (group II). All the patients filled out the migraine pain scale, migraine disability assessment score, headache impact test (HIT-6), and adverse drug event questionnaire before the start and at the end of 9 months of treatment. Most of the patients were females (76.3% vs. 23.8%) and were suffering from migraine for more than 24 months (66%). The mean age of the participants was 39.07 ± 10.01 years. Both BoNT and anti-CGRP groups showed a statistically significant decrease in mean HIT-6 and pain scores after 9 months of intervention. A direct comparison between the two treatment groups showed that the anti-CGRP drug caused a higher decrease in HIT-6 and pain scores as compared to the botulinum drug, but the difference was not statistically significant (P = 0.075 and 0.07, respectively). The most common adverse effect was "headache", reported by 45% and 40% of patients, followed by "pain at the site of injection" reported by 27.5% and 32.5% of BoNT and anti-CGRP groups, respectively. The two groups did not differ significantly in the frequency of adverse effects such as nausea, vomiting, visual problems, etc., except "joint stiffness". A significantly higher number of anti-CGRP patients experienced joint stiffness as compared to the BoNT group (17.5% vs. 0%, P = 0.006). A direct comparison between the two treatments indicated that neither of the two interventions is statistically superior to the other in terms of efficacy and both are equally effective in the management of migraine. However, BoNT can be preferred over anti-CGRP because of its cost-effectiveness.