Chi-square Goodness Of Fit Test Research Articles

Assessing general hospital doctors’ attitudes toward psychiatric care in multicultural settings

ObjectivePsychiatric care in general hospitals depends on collaboration with non-psychiatrist doctors. The Doctors’ Attitudes toward Collaborative Care for Mental Health (DACC-MH) is a two-factor scale designed to address this issue and validated in the UK in 2010. However, its applicability in contemporary, culturally diverse settings is unknown and therefore this study was aimed at determining its validity and consistency using data from our 2021 international study. Confirmatory and exploratory factor analyses were used, comparing results from our 2021 study (n = 889) with those from the 2010 UK study (n = 225).ResultsThe DACC-MH consultation subscale, but not the management subscale, aligned with data from our larger, international study. The 2-factor model failed the Chi-square goodness of fit test (χ2(19) = 53.9, p < 0.001) but had acceptable other fit indices. While the previously identified attitudinal difference between physicians and surgeons was replicated, measurement invariance for this result could not be established. Exploratory factor analysis suggested a 6-factor model, contrasting with the 2-factor model proposed in 2010 for the UK sample. The DACC-MH scale shows significant limitations when applied to a larger, international dataset. Cultural and generational differences in doctors’ attitudes appear relevant and should be considered in assessing barriers to psychiatric care in general hospitals.

The impact of three learning methods on dental students' satisfaction and knowledge acquisition.

Health professionals' education presents unique challenges including clinical application of knowledge and interprofessional collaboration. Additionally, institutions suffer from faculty shortages while class sizes increase. Therefore, educators seek innovative andragogical techniques utilizing minimal resources. Several active learning methods have been introduced as a solution. The aim of this study is to assess the impact of lecture (LBL), case (CBL), and team (TBL) based learning on the students' satisfaction and knowledge attainment. A total of 134 sophomore dental students are taught pediatric dentistry course using LBL, CBL, and TBL techniques. At the end of the course, students are invited to participate in a satisfaction survey. Statistical analysis is conducted using a two-sided chi-square goodness of fit test. Students' comments are used for qualitative analysis. Final exam analysis is administered via Examsoft software. A total of 98% of the students participated in the survey out of which 83% met the inclusion criteria (N=110). Students chose LBL as the method that helped them learn in a comprehensive way, provided the most comfortable environment, and presented the overall highest satisfaction with statistically significant difference (p value=0.001). LBL questions scored the highest point biserial and discrimination index. The percentage of correct answers and difficulty level was highest for TBL. Students preferred LBL over the other learning methods. Final exam psychometrics showed favorable results for LBL and TBL. Students could potentially benefit from combining both techniques. However, more research is needed to assess the effectiveness of various teaching methods on the short- and long-term learning outcomes.

Feasibility and practicality of a simulated placement: an exploratory pilot of a novel training method for postgraduate psychology students in the wake of COVID-19

ABSTRACT Objective In 2020, COVID-19 caused a drastic interruption to face-to-face postgraduate psychology placements in Australia, prompting the development of a simulated placement. This pilot project represents a preliminary evaluation of the program by exploring the feasibility of a simulated placement as a novel training modality for competence development in postgraduate psychology training. Method Students enrolled in a simulated postgraduate psychology placement in 2021 completed an online survey at the end of the placement. Acceptability, perceived competency and experience of the placement were assessed. Chi-square goodness of fit tests were used to evaluate the difference between rates of completion and the length of time it took to complete placement requirements between students enrolled in face-to-face placements in 2019 and 2020, and the simulated placement in 2021. Results The results showed an increase in proportion of students who completed the simulated placement than previous face-to-face placements and that students were able to complete training and meet competence in shorter time frames. Students reported increased psychological competency and confidence to practice at the completion of the simulated placement. Conclusions A simulated psychology placement is a novel teaching modality that may be feasible in the development of perceived psychological competence and confidence in postgraduate psychology students.

Oncotype DX in Breast Cancer Management: Insights and Outcomes From the United Arab Emirates.

Introduction Breast cancer remains the most significant cancer affecting women worldwide, with an increasing incidence, especially in developing regions. The introduction of genomic tests like Oncotype DX has revolutionized personalized treatment, allowing for more tailored approaches to therapy. This study focuses on the United Arab Emirates (UAE), where breast cancer is the leading cause of cancer-related deaths among women, aiming to assess the predictive accuracy of the Oncotype DX test in categorizing patients based on recurrence risk. Materials and methods A retrospective cohort study was conducted on 95 breast cancer patients diagnosed at Tawam Hospital between 2013 and 2017 who underwent Oncotype DX testing. Data on patient demographics, tumor characteristics, treatment details, and Oncotype DX scores were collected. Survival analysis was performed using the Kaplan-Meier method, with the chi-square goodness of fit test assessing the model's adequacy. Results The cohort's age range was 27-71 years, with a mean age of 50, indicating a significant concentration of cases in the early post-menopausal period. The Oncotype DX analysis classified 55 patients (57.9%) as low risk, 29 (30.5%) as medium risk, and 11 (11.6%) as high risk of recurrence. The majority, 73 patients (76.8%), did not receive chemotherapy, highlighting the test's impact on treatment decisions. The survival analysis revealed no statistically significant difference in recurrence rates across the Oncotype DX risk categories (p = 0.268231). Conclusion The Oncotype DX test provides a valuable genomic approach to categorizing breast cancer patients by recurrence risk in the UAE. While the test influences treatment decisions, particularly the use of chemotherapy, this study did not find a significant correlation between Oncotype DX risk categories and actual recurrence events. These findings underscore the need for further research to optimize the use of genomic testing in the UAE's diverse patient population and enhance personalized treatment strategies in breast cancer management.

Knowledge and perceptions regarding pulmonary rehabilitation amongst Ecuadorian physicians following COVID-19 outbreak.

Pulmonary rehabilitation is already an established technique for patients with chronic respiratory disease, aimed at improving breathlessness, exercise capacity, health status, and well-being. The aim of this study was to assess the knowledge and perceptions about pulmonary rehabilitation post-COVID-19 infection among Ecuadorian physicians. We conducted a cross-sectional online survey-based study using a 27-item questionnaire to assess the knowledge about specific topics related to pulmonary rehabilitation. The sample comprised Ecuadorian physicians who were currently enrolled to an active medical practice that included care to COVID-19 patients. Descriptive statistics were applied for demographic variables of interest. A chi-square goodness of fit test was used to determine whether the observed frequencies of each of the answers per query were within or outside of the expected frequencies by chance. In total, 295 participants answered the survey, out of which 57.3% were general practitioners. Most agreed that COVID-19 infected patients must be followed-up with some measurement of respiratory function (81.4%, p=0.000), but only 18.3% (n=54, p=0.000) were aware of specific guidelines related to rehabilitation. 93.6% (n=276, p=0.000) considered that pulmonary rehabilitation provides a benefit, of any kind, to patients with past COVID-19 infection. Most physicians considered pulmonary rehabilitation beneficial following COVID-19. However, there is uncertainty on how to adequately follow up patients, complementary tests, and specific guidelines outlining rehabilitative interventions.

Language impairments in seropositive and seronegative autoimmune encephalitis.

Autoimmune encephalitis (AE) is a rare neuroinflammatory disease affecting the central nervous system. To examine language functions in patients with different subsets of AE consisting of seropositive and seronegative groups. Fifty-two patients were recruited from neurology departments in Melbourne, Australia, who met clinical criteria for possible AE. Language tests include the Naming Test from the Sydney Language Battery (SydBat), the semantic fluency trial from the Controlled Oral Word Association Test (COWAT), and the Vocabulary and Similarities subtests of the Weschler Abbreviated Scale of Intelligence-Second Edition. The results were standardised with normative data. The mean age of our cohort was 52.5years old, with the average time from hospital admission to recruitment being 38.41months. At an aggregate level, none of the mean language test z-scores were below normative data. At the patient level, impairment rates were 18.37% for COWAT (animals), 28.57% for SydBat (naming), 4.65% for Similarities, and 4.55% for Vocabulary. Chi-squared goodness of fit tests indicated that observed performances were significantly below expected performances for the SydBat (naming) test (p < 0.0001) and COWAT (animals) (p = 0.004). While, on average, language functions were within normal limits in patients with AE, but a subgroup exhibited lower performance in semantic fluency and visual confrontation naming, with impairment rates below expected norms. To advance understanding of language in chronic AE patients, exploring the impact of seizure burden, antiseizure medication use, and the relationship of language functions with other cognitive functions is crucial.

Optimizing aeration efficiency and forecasting dissolved oxygen in brackish water aquaculture: Insights from paddle wheel aerator

BackgroundAquaculture relies significantly on effective aeration systems to ensure optimal conditions for aquatic organisms. This 96-day study investigates the dynamic relationship between Oxygen Transfer Rates (OTR) and seasonal variations, with a specific focus on the impact of seasonal dynamics and the placement of paddle wheel aerators. The study recognizes the pivotal role of Total Dissolved Solids (TDS) and Total Suspended Solids (TSS) as key water quality parameters influencing aeration efficiency. MethodologyA series of water circulation experiments were conducted at regular intervals to assess mixing rates, revealing a nuanced trajectory ranging from 27.05 to 14.22 m³/kWh. The study scrutinized the influence of TDS and TSS on these rates. Additionally, water velocity variations, ranging from 0.45 to 1.67 m/s, were examined, highlighting density-dependent changes, particularly evident post four weeks of operation. Oxygen stratification analysis provided insights into deviations in Dissolved Oxygen (DO) concentrations, with particular attention to climatic aberrations. Rigorous statistical analyses, including chi-squared, Pearson correlation, Gaussian distribution checks, and student's t-tests, validated the methodological robustness and data reliability. Significant findingsEmploying a Seasonal Auto Regressive Integrated Moving Average (SARIMA) model, the study achieved a remarkable 97 % accuracy in forecasting DO levels for the subsequent 96 days. Real-time validation, complemented by a Chi-square goodness of fit test, reaffirmed the model's reliability, establishing congruence between observed and forecasted values. This research underscores the critical roles of strategic aerator placement and seasonal considerations in optimizing pond aeration efficiency, providing substantive insights for the sustainable management of aquaculture ecosystems.

Comparing student-centered learning in a video-based app to the grammar-translation method in an EFL class

A number of learning applications have been developed as a result of technological advancement in the active multidisciplinary field of research linguistics, along with education (Shadiev & Liu, 2023). One such app is Soqqle, a learning program created for mobile device-based video coursework that allows for constructivist learning. This study aims to show whether using the Soqqle method improves the English production and comprehension performance of A2 level EFL Spanish students, as this sort of technology is uncommon in EFL Spanish classrooms. A sample of 76 high school students participated in this study in the Catalan region of Spain. The participants were distributed into three groups: a control group and two experimental groups. While the control group only received instruction using the grammar-translation method, both experimental groups were coached on how to use the Soqqle application for video storytelling and content-based learning. The first treatment group used the Soqqle app, and the second experimental group received instruction through the grammar-translation method, and they also used Soqqle. A prequestionnaire, pretest, posttest, and postquestionnaire were used to collect the data, and an analysis of the data was conducted using a repeated measures ANOVA and chi-square goodness of fit tests. The results revealed that all three groups had improved following the instruction period, and the methods of instruction were equally effective contrary to the assumption of the alternative hypothesis. Additionally, the findings have shown that using Soqqle increases motivation at the same rate as the other methods employed in this study due to the dynamics between the teacher and the students, putting an emphasis on the quality of the instructor over the quality of the type of instruction.

Knowledge and Awareness of Various Physical Restraints and Protective Stabilisation Methods: Parent’s Perception towards their Use in Children: A Multimedia Pre- and Post-test Quasi-experimental Study

Introduction: Physical restraints are often a debatable and misunderstood aspect of dental healthcare practice. They are frequently used in dental care settings to immobilise children and reduce the risk of injury during procedures. It is essential to assess parents' knowledge, awareness, and attitudes towards physical restraints and provide accurate information about them. This is important to ensure that they are used appropriately and ethically. Aim: To assess parents’ knowledge, awareness, and attitudes towards physical restraints in dental care settings before and after a multimedia intervention, and to provide precise information about the same. Materials and Methods: The study was conducted at the Department of Paediatric and Preventive Dentistry, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India using a pretest and post-test quasi-experimental study design on 400 parents whose children were between 3 and 16 years of age. The survey was conducted between December 2022 and March 2023. The data collection methods used in the present study consisted of a pre-education questionnaire and a post-education questionnaire administered after a multimedia educational intervention. The collected data were subjected to statistical analysis, including measures such as mean, Standard Deviation (SD), Chi-square goodness of fit test, Wilcoxon's signed-rank test, and Kruskal-Wallis tests. Results: When questioned about various stabilisation methods like direct and indirect methods, 379 (94.8%) of the study parents were unaware of them. However, after education, the majority of parents, 393 (98.3%), became aware that there were two types of stabilisation methods. Initially, 294 (73.5%) of parents refused to provide permission for doctors to treat their children using various stabilisation techniques. However, after being thoroughly educated about the various methods and their benefits, 383 (95.8%) agreed to let the dentist employ different stabilisation techniques when treating their children. This assurance helped alleviate concerns about potential harm to the child caused by using these stabilisation methods. Conclusion: The study suggests that there is a significant knowledge gap among parents. However, the implementation of multimedia educational intervention methods during dental visits by dentists played a crucial role in increasing their knowledge and resulted in a significant improvement in their attitude towards stabilisation methods.

Application of Multivariate Logistic Regression and Decision Trees to Assess Factors Influencing Prevalence of Abortion and Stillbirth in Yankasa sheep

AbstractThis study was carried out to assess factors influencing prevalence of abortion and stillbirth in Yankasa sheep using multivariate logistic regression and decision trees. 191 kidding records of Ewes from a total of 50 traditional Yankasa sheep herders within Nasarawa South agro-ecological zone from the year 2020-2021 were utilized in the study. Sampling was restricted to only farmers that were able to give information on Lamb, Ram and Ewe identification as well as occurrence of abortion, stillbirth (defined as a kid born dead or dying within 24 hours after birth), kidding date or period, parity and number of foetuses. Three seasons of abortion or stillbirth were generated according to the month of the year: rainy season (from May to October), dry season (from February to April) and harmattan season (from November to January). The logit of the probability of an abortion or stillbirth was modelled using logistic regression assuming an asymptotic binomial distribution. The Chi-square goodness of fit test was performed to check if the multivariate logistic model fitted the data well (P&gt;0.05). Chi-square automatic interaction detection (CHAID) algorithm was also employed to model incidence of abortion or stillbirth. The chi-square analysis revealed that parity did not significantly (P&gt;0.05) affect the incidence of abortion. However, season of the year significantly (P&lt;0.05) affected prevalence of abortion, which was higher in the harmattan (38.5%) compared to the rainy (11.5%) and dry season (16.5%), respectively. Parity and season of the year did not affect significantly (P&gt;0.05) the prevalence of stillbirth. The binary logistic regression analysis showed that season affected significantly (P&lt;0.05) the prevalence of abortion, especially in the harmattan period with a high odds ratio (4.539). This was also confirmed by the result of the CHAID analysis. The present information could be exploited in management practices to reduce to the incidence of abortion in order to improve the production level of the sheep farmers.

Bilateral breast cancer and the influence of body mass index in clinicopathological features and overall survival.

Breast cancer (BC) and obesity are two closely associated pathologies with increasing incidence and mortality rates. Bilateral Breast Cancer (BBC) displays a low incidence rate within BC and obesity represents a major risk factor. The aim of this study is to analyzed BBC clinicopathological features distribution and determine the potential influence of obesity in BBC in these same features and overall survival. Clinicopathological information was obtained from 42 cases of women with BBC diagnosed in IPO-Porto. To evaluate the frequency distribution of the clinicopathological data, a chi-square goodness of fit test was performed for BBC cases. A chi-square test of independence was applied for BMI stratification. Cox regression was performed for overall survival. Statistical significance was set at p-value < 0.05. Distribution of BBC clinicopathological features was found to be statistically significant in family history (p-value < 0.001), BBC type (p-value < 0.001), stage (p-value = 0.005), differentiation grade (p-value < 0.001), receptor expression (p-value < 0.001) and histological type (p-value = 0.031). In comparison to the statistical expected results, we observed an increased cases of absence of family history and less cases of metachronous BBC. Histological types between tumours of BBC were mostly concordant. All cases presented concordant receptor expression. Analysis stratified by BMI revealed that obese women were diagnosed later, although without statistical significance. All obese women presented poor differentiation grade (n =6). Overweight patients display a tendency to a better overall survival with lower tumour stages and lower differentiation grades. Our results reveal the same receptor expression between contralateral tumours. Also, most tumours share the same histological type. When stratified by BMI, we observed a tendency for overweight women to have improved overall survival.

A mixed-method approach to examining the experiences of allied health clinicians and managers of the performance, appraisal and development framework in a regional health care service.

Evaluating employee performance is important for organisational success however, limited research exists across the allied health workforce. This study investigated allied health clinician and manager experiences and perceptions of the appropriateness of the performance and development (PAD) framework. A mixed methods design with purposive sampling was conducted in a medium size hospital and health service in regional Queensland to investigate the appropriateness of the PAD framework. A 29 item online survey collected likert scale and open ended responses. Identified respondents also completed a semi-structured interview. Aggregated satisfaction scores identifying PAD alignment, processes, education, resources and perceptions were analysed to identify organisational PAD appropriateness. Themes from interviews provided concurrent experiential data. Eighty-five respondents completed the online survey and 20 interviews were conducted. A Chi-Square Goodness of Fit test revealed a significant (p < 0.05) clinician (n = 75) response of moderate dissatisfaction (36%) for the PAD framework, while managers (n = 10) were neither dissatisfied nor satisfied (50%) or moderately satisfied (40%). Clinician aggregated agreement responses were significantly (p < 0.05) higher for PAD alignment (45%), processes (63%), education (49%) and lower for feedback (33%) and resources (28%). Manager aggregated agreement responses were high for PAD alignment (85%), processes (55%), education (57%), feedback (65%) and perceptions (50%). Interviews (n = 20) revealed three themes: uncertainty around PAD framework; expectations for experienced leadership and importance of discipline specific knowledge. This study draws on both clinician and manager input to assess the overall PAD framework with responses favouring clinician dissatisfaction to the current process. The PAD framework is valuable for staff development when there is positive rapport and discipline alignment between both clinician and manager. Successful staff appraisals require efficient and appropriate documentation that promotes individual development, clinical performance and organisational priorities.

Nonadherence to Immunosuppressants Among Transplant Recipients: Emotional Intelligence as a Predictive Factor During COVID-19 Pandemic.

To evaluate the association between emotional intelligence and fear of COVID-19 on self-reported adherence, based on a cross-sectional design. Transplants recipient of both sexes aged 23-75 years old were evaluated at the Organ Transplant Unit, University Hospital of Catania, Italy. Data were analyzed using frequency, descriptives, Spearman and Pearson correlations, Chi-square goodness of fit test, and linear regression. Self-reported adherence was estimated with the Basel Assessment of Adherence with Immunosuppressive Medication Scale (BAASIS). Emotional intelligence and fear of COVID were, respectively, measured with the Emotional Intelligence Scale (EIS) and Multidimensional Assessment of COVID-19 Related Fears Scale (MAC-RF). This was a cross-sectional study of kidney transplant recipients. In reporting this study the authors followed the STROBE guidelines. A correlation was found between EIS and MAC and between EIS and adherence but there was no correlation between MAC and adherence. A linear regression model was also conducted using a stepwise method, which indicated that EIS was a significant predictor of adherence (p <0.05). This study was found that EIS is a predictor of adherence to treatment in transplant patients. Fear of COVID, while positively correlated to EIS, is not correlated to the adherence's outcome, possibly due to the proper follow-up performed to the patients. Indeed, according to these results, we suggest to provide good follow-ups with recipients, with interviews also based on self-regulation and awareness.

Reporting of Participant Demographics in Clinical Trials Published in General Radiology Journals

The reporting of research participant demographics provides insights into study generalizability. Our study aimed to determine the frequency at which participant age, sex/gender, race/ethnicity, and socioeconomic status (SES) are reported and used for subgroup analyses in radiology randomized controlled trials (RCTs) and their secondary analyses; as well as the study characteristics associated with, and the classification systems used for demographics reporting. RCTs and their secondary analyses published in 8 leading radiology journals between 2013 and 2021 were included. Associations between study characteristics and demographic reporting were tested with the chi-square goodness of fit test for categorical variables, Wilcoxon-Mann-Whitney test for impact factor, and logistic regression for publication year. Among 432 included articles, 89.4% (386) reported age, 90.3% (390) sex/gender, 5.6% (24) race/ethnicity, and 3.0% (13) SES. Among articles that reported these demographics and were not specific to a subgroup, results were analyzed by age in 14.2% (55/386), sex/gender in 19.4% (66/340), race/ethnicity in 13.6% (3/22), and SES in 46.2% (6/13).Journal, impact factor, and last author continent were predictors of race/ethnicity and SES reporting. Funding was associated with race/ethnicity reporting. No study reported sex and gender separately, or documented transgender, nonbinary gender spectrum or intersex participants. A single category for race/ethnicity was used in 37.5% (9/24) of studies, consisting of either "White" or "Caucasian." The reporting of participant demographics in radiology trials is variable and not always representative of the population diversity. Editorial guidelines on the reporting and analysis of participant demographics could help standardize practices.

Obesity represents a persisting health issue in axial spondyloarthritis, particularly affecting socially disadvantaged patients.

Obesity is an important comorbidity in axial spondyloarthritis (axSpA). However, the prevalence of obesity in axSpA compared with the general population and associated socioeconomic factors remain unknown. This repeated cross-sectional study compared BMI groups of patients with axSpA to the Swiss population at three time points (2007, 2012 and 2017). BMI categories were compared by different age, sex, and education categories using the Chi-Squared Goodness of Fit test. Unpaired, one-sided t-tests were used to compare the BMI in axSpA patients between the different time points. Compared to the general population, axSpA patients had a higher proportion of overweight and obese: 18.9% of all axSpA patients were obese, compared to 11.3% of the Swiss population in 2017. Comparison of BMI groups within sex, age and education groups consistently showed a trend towards higher rates of overweight and obesity in axSpA. Furthermore, axSpA patients, especially females, showed a trend of increasing BMI over the studied 10 years. At every time point, overweight and obese patients were significantly more likely to be male, were older and had higher disease activity than patients with normal weight. Obesity was associated with a deprived socioeconomic status as indicated by a higher proportion of patients with manual labor jobs and lower levels of education. The prevalence of obesity was significantly higher among patients with axSpA compared to the Swiss population, with socially disadvantaged individuals being the most affected. There is an urgent need to initiate prevention strategies for obesity in axSpA patients.

Incidence of complications related to shoulder arthroplasties identified on computed tomography.

Determine incidence of shoulder arthroplasty complications identified on computed tomography (CT). Retrospective institutional database review of patients with shoulder arthroplasties who underwent CT between 01/2006-11/2021 at a tertiary academic referral center with subspecialized orthopedic shoulder surgeons. CT reports were reviewed for arthroplasty type and complication. Data were stratified and summarized. Associations between complications and arthroplasty types were determined with Chi-squared goodness of fit test. Eight hundred twelve CTs in 797 unique patients were included (438 (53.9%) females and 374 (46.1%) males; mean age 67 ± 11years). There were 403 total shoulder arthroplasties (TSA), 317 reverse total shoulder arthroplasties (rTSA), and 92 hemiarthroplasties (HA). Complications were present in 527/812 (64.9%) and incidences were: loosening/aseptic osteolysis 36.9%, periprosthetic failure 21.6%, periprosthetic fracture 12.3%, periprosthetic dislocation 6.8%, joint/pseudocapsule effusion 5.9%, prosthetic failure 4.8%, infection 3.8%, and periprosthetic collection 2.1%. Complications per arthroplasty were: 305/403 (75.7%) TSAs, 176/317 (55.5%) rTSAs, and 46/92 (50%) HAs (p < 0.001). Periprosthetic fracture (20.8%), prosthetic dislocation (9.8%), and prosthetic failure (7.9%) were highest in rTSAs (p < 0.001, p < 0.013, p < 0.001, respectively). Loosening/aseptic osteolysis most frequent in TSAs (54.1%) (p < 0.001). Periprosthetic failure most frequent in HA (32.6%) (p < 0.001). Significant associations were identified with joint/pseudocapsule effusion and loosening/aseptic osteolysis (p = 0.04) and prosthetic dislocation (p < .001). In this single tertiary academic referral center cohort, the incidence of shoulder arthroplasty complication identified on CT was 64.9% and the most commonly occurring complication was loosening/aseptic osteolysis (36.9%). TSA had the highest incidence of complication (75.7%).

Effects of road infrastructure development on residential property value and land development shifts in a peri-urban area of Karachi, Pakistan

The introduction of road infrastructure development projects often triggers expectations of shifts in property values. Extensive research has already been conducted regarding the impact of such projects on property values and land development in developed regions. However, there is a research gap when it comes to developing countries like Pakistan. Therefore, this study aimed to investigate the influence of the road infrastructure development project, the M-9 Motorway, on residential property values and land development in a mega residential project in Bahria Town Karachi (BTK), Pakistan. This study employs a mixed-methodology approach, incorporating qualitative methods (interviews) and quantitative analysis (questionnaire surveys and property data analysis). Statistical tools such as Statistical Package for Social Sciences (SPSS), the Pearson correlation coefficient, and the Chi-square goodness of fit test were used for correlation and hypothesis testing. This research reveals that proximity to a major road infrastructure project directly impacts property purchase prices, rents, and land development in BTK, either positively or negatively. The obtained results align with both expectations and the existing literature. Although these findings should not directly apply to other locations and contexts, they can be considered suggestive indicators for planning purposes.

Impact of best practice advisory on genetic counseling referral patterns for patients with endometrial cancer.

5606 Background: The National Comprehensive Cancer Network (NCCN) recommends that patients with endometrial cancer under age 50 undergo germline genetic testing. Despite this recommendation, completion rates are suboptimal for patients with gynecologic malignancies. The reasons for failure to complete testing are unknown, but oncology providers may not refer patients to genetic counselors, who frequently order this testing. Best practice advisories (BPAs) in electronic medical records can alert providers of patients who meet guideline-based treatments and testing criteria. It is unknown how oncology providers interact with a BPA indicating patients with endometrial cancer meet NCCN germline testing criteria. The objective of this study is to evaluate genetic counseling referral patterns after implementing a BPA. Methods: Our team developed a BPA to prompt oncology providers to order genetic counseling referrals for patients diagnosed with endometrial or uterine cancer under age 50. We reviewed all provider-BPA interactions between go-live (January 2022) and January 2023. Patient demographic, histopathologic, and cancer treatment data were collected. Provider actions, including BPA cancellation and order placement, were collected. The Chi-Square goodness of fit test was used to identify differences in referral rates by patient or disease characteristics. Results: The BPA displayed 1121 times for 103 patients. Attending physicians received 535 alerts, fellow physicians – 269, and advanced practice providers (APPs) – 317. The median number of alerts per patient was 7 (range 1-87). Of the 103 patients, 23 were excluded from analysis due to no diagnosis of endometrial cancer, patient declined referral, previously completed, or a lack of provider visits within the study period. Of the 80 eligible patients, 36 (45%) received referrals; 18 were placed by attending physicians, 17 by fellows, and one by an APP. Patients under age 40 versus age 40-49 were more likely to be referred (65% vs. 35%; p = 0.011). Patients with active disease were more likely to be referred than those in surveillance (65% vs. 18%; p &lt; 0.001). There were no differences in referral rates by primary language, race, body mass index ≥40, fertility-sparing versus definitive treatment, stage I versus stage II-IV disease, or grade 1-2 versus three tumors. Conclusions: Despite implementing a BPA, only 45% of eligible patients received indicated referrals. Attending and fellow physicians frequently manage patients with active disease and often order referrals; however, APPs frequently manage patients in surveillance and infrequently place referrals, highlighting an opportunity for education. In addition, patients aged 40-49 are less likely to be referred, suggesting a need for new strategies to improve referral rates. Further research is indicated to identify referral barriers for patients undergoing active treatment.

CDH1 incidental findings in patients with personal or family history of breast cancer.

10524 Background: Pathogenic variants in CDH1 ( CDH1+) are associated with hereditary diffuse gastric cancer (HDGC), with an increased risk for DGC (~40-83%) and lobular breast cancer (BC) (~64%) [1]. The National Cancer Center Network recommends the inclusion of CDH1 in multi-gene panel testing (MGPT) for patients with significant history of BC, given its classification as a high-risk BC gene [2]. Management includes prophylactic gastrectomy or consideration of annual endoscopic biopsies and high-risk breast screening, with consideration of prophylactic mastectomy. Several studies have identified CD H1+ patients who do not meet the International Gastric Linkage Consortium’s diagnostic criteria for HDGC [3.4,5,6]. These studies have brought concerns of CDH1 pathogenic variants in patients with low risk phenotypes, given the potential for total gastrectomy to reduce DGC risk. Our study aims to investigate our cohort of patients with a personal and/or family history of BC to determine if there is a significant number of CDH1+ patients with a non-classical presentation of HDGC. Methods: 17,208 families with a history of BC who underwent MGPT were seen in a Clinical Cancer Genetics (CCG) high-risk breast clinic between August 2013 and July 2022. They were identified using a prospectively maintained MD Anderson Cancer Center CCG database. Families were categorized by their history of GC and CDH1 status. Results: Among the families, 10,202 (59%) had a proband with a personal history of BC, with a mean age of onset of 51 years. 49 families (0.28%) were CDH1+. 21 CDH1+ families (43%) had no personal and/or family history of GC. Overall, 0.12% of families within the cohort were CDH1+ and had no family history of GC. A chi-square goodness of fit test was performed comparing observed (O) versus expected frequencies (E) (O/E) of families that were: 1) CDH1+ and had a history of GC (28/28), 2) CDH1+ and no history of GC (21/21), 3) CDH1 – (benign variant or variant of unknown significance (VUS)) and a history of GC (180/164), and 4) CDH1- and no history of GC (16,979/16,995). O was determined by using a general population risk of GC (0.81%) and estimated risk of DGC for CDH1+ individuals (58.2%). The X2 was determined to be 1.576, with a p-value of 0.66483. Conclusions: In comparison to the expected frequency of incidental CDH1+ families identified via MGPT, we found that there was not a significant difference in expected and observed frequencies of families based on CDH1 status and presence of GC. These results likely reflect the incomplete penetrance and variable expressivity of HDGC, in addition to reported cases of occult signet ring cell carcinomas in biopsy samples or surgical pathology that has been reported in low risk presenting families [7]. We seek to validate these results with cohort of patients in which the diffuse gastric cancer pathology is known and to expand the analysis in patients specifically with a personal history of lobular breast cancer.

Does the Size and Experience Matter? Empirical Research on Selected Barriers to Eco-Innovations in Slovak SMEs

Abstract Enterprises face several challenges when it comes to their innovation activities. Often, they encounter a number of barriers that impede the creation, introduction, use, and diffusion of eco-innovations, particularly for small and medium-sized enterprises (SMEs). SMEs have significant innovation potential, and hence it is crucial to identify, clarify, and reduce the barriers that hinder their innovative activity and the development of eco-innovations. The aim of the article is to assess the barriers that negatively affect the eco-innovation activities of Slovak SMEs, to find out which of them are perceived as the most significant in the SMEs studied, and to identify the relationship between the perception of barriers, the size of the enterprises and their previous involvement in eco-innovations. The empirical data were collected in 2023 from a sample of 487 randomly selected Slovak SMEs. The representativeness of the sample was confirmed by the Chi-square goodness of fit test. The authors of the article formulated three hypotheses, which they tested using non-parametric tests. The first two hypotheses assumed a statistically significant effect of the size of the enterprises and their previous experience in implementing eco-innovation on the intensity of the perception of barriers to eco-innovation. These were not confirmed. The third hypothesis was related to the overall ranking of the importance of the barriers to eco-innovation and confirmed that the cost of eco-innovation is the most important barrier for SMEs in Slovakia.