Difference In Mean Rank Research Articles

Prevalence and intensity of Schistosoma mansoni infection, and contributing factors in Alamata district of Tigray Region, Northern Ethiopia.

Intestinal schistosomiasis caused by Schistosoma mansoni continues to be a significant public health problem in Ethiopia. This study investigated the prevalence and intensity of S.mansoni infection, and contributing factors in Alamata district of Tigray Region, Northern Ethiopia. A community-based cross-sectional study was conducted and 1762 participants were enrolled from five clusters in Alamata district. A questionnaire was used to collect socio-demographic data and risk factors. Stool samples were examined using Kato-katz technique to determine the prevalence and intensity of infection. The data were analyzed using SPSS version 25. Median, inter quartile range (IQR), mean, frequency, and percentage were used to descriptively summarize data. The Wilcoxon Mann-Whitney and Kruskal-Wallis tests were used to compare the differences in mean rank of egg load between different groups. Bivariate and multivariable logistic regression models were used to investigate the association between the odds of being infected with S.mansoni and the different socio-demographic and other factors. The strength of these associations was reported using odds ratio with corresponding 95% confidence intervals, and a P-value below 5% was used to report statistical significance. Out of 1762 residents included in the study 941 (53.4%) were females. The age varied from 5-80 years, with a median age of 25 years (IQR = 27), the overall prevalence of S.mansoni was 21.5% with males accounting for 26% (204/821) of the infections. The proportion of infection was higher among the age groups of 15-19 and 20-29 years at 32.7% and 33.1%, respectively. The mean egg count among the infected study participants was 146.82 eggs per gram of feces (epg) ± (243.17 SD). Factors significantly associated with increased odds of infection were living in Waja cluster (AOR:8.9; 95% CI, 3.5-23.2; P< 0.001); being in the age groups 10-14 (AOR:6.0, 95% CI: 3.1-11.7, P<0.001), 15-19 (AOR:5.8, 95% CI:2.8-12.2, P<0.001), and 20-29 (AOR:3.5, 95% CI:1.8-6.8; P<0.001) years; having direct contact with water while crossing river (AOR: 2.4, 95% CI: 1.5-3.8, P<0.001); and swimming (AOR: 1.4, 95% CI: 1.01-2.0, P = 0.035). The study indicates a notable S.mansoni burden in the area, driven by various risk factors. To effectively address this, enhancing diagnostics, implementing targeted mass drug administration, and conducting comprehensive health education campaigns on disease transmission routes are imperative.

Cultivating Patient Preferences in ALS Clinical Trials: Reliability and Prognostic Value of the Patient-Ranked Order of Function.

The Patient-Ranked Order of Function (PROOF) is a novel approach to account for patient-reported preferences in the evaluation of treatments of amyotrophic lateral sclerosis (ALS). In this study, we assess the reliability and prognostic value of different sets of patient-reported preferences that can be used for the PROOF end point. Data were obtained through online surveys over the course of 12 months using the population-based registry of the Netherlands. Patients were asked to score functional domains of the ALS Functional Rating Scale (ALSFRS-R) and rank the order of importance of each domain. Two weeks after the initial invite, the questionnaire was repeated to evaluate test-retest reliability. Vital status was extracted from the municipal population register. In total, 611 patients with ALS were followed up for survival and 382 patients were included in the test-retest reliability study. All versions of PROOF, using different sets of preferences, resulted in excellent reliability (intraclass correlation coefficients ranged from 0.89 [95% CI 0.87-0.91] to 0.97 [95% CI 0.97-0.98], all p < 0.001), without systematic differences between baseline and week 2 (mean rank difference range -1 to -3 [95% CI range -8 to 2], all p > 0.20). Preferences about future events were more variable than preferences about current symptoms. All versions of PROOF strongly predicted overall survival (hazard ratios per 10th rank percentile ranged from 0.80 to 0.83 [95% CI range 0.76-0.87], all p < 0.001) and had a more even separation of survival curves between rank-stratified subgroups compared with the ALSFRS-R total score. In a large cohort of patients, we show how patient-reported preferences can be measured and integrated reliably with the ALSFRS-R without leading to systematic bias. Patient preferences may provide unique prognostic information in addition to what is already measured conventionally. This could provide a more comprehensive understanding of how medical interventions effectively address the patient's concerns and improve what matters most to them.

Efficiency and intrinsic quality in healthcare: blending radial and non-radial measures of efficiency with a flashpoint of long-term health policy

PurposeEfficiency and quality are primary factors for the survival of health systems. The evaluation of the efficiency of the healthcare system is a crucial component of promoting long-term health policy actions. Healthcare capacity indicators provide a basis for evaluating and comparing the performance of different healthcare organizations. Intrinsic quality indicators are Donabedian (1980)’s structural and process elements of quality of healthcare. This study aims to integrate capacity and intrinsic quality indicators of healthcare while measuring the efficiency of provinces by using radial and non-radial efficiency measurement techniques.Design/methodology/approachEfficiency analysis performed in Turkey from 2015 to 2020 by performing input-oriented radial, nonradial, and super-efficiency estimates for 81 provinces of Turkey by incorporating capacity and intrinsic quality indicators into the different model specifications.FindingsRadial and nonradial efficiency results have an increasing trend over the study years obtained from the efficiency models showing high average scores obtained from the models that include intrinsic quality of care indicators. Statistically significant mean rank differences are observed between different radial efficiency models for all study years (p < 0.001). Negative and moderate level correlations were observed between radial efficiency results and quality of care indicators (r < 0.70).Originality/valueUnder long-term centralized health policies, increases in efficiency result in decreased intrinsic quality of care indicators. A better synthesis of health system capacity and intrinsic healthcare quality indicators is necessary to generate evidence-based health systems.

An evaluation of a simulation-based training programme to support final-year medical students in their preparation for foundation-year prescribing practice

Abstract Introduction Prescribing is a high-risk and error prone activity with doctors reporting a lack of preparedness for prescribing practice,[1] with potential for simulation-based training (SBT) to enhance prescribing skill development.[2] To support preparation for prescribing practice, a team-based SBT programme was developed for final-year medical students. Aim To determine the impact of the SBT on prescribing knowledge and student perceptions of SBT in supporting their prescribing practice. Methods An SBT event was designed to include three complex multi-morbid scenarios reflecting foundation practice. The scenarios were co-produced by a multidisciplinary team, with sessions facilitated by clinical pharmacists. Sessions focused on practical prescribing and authentic decision-making with a convenience sample of final-year medical students. Students worked in small groups to manage conditions including heart failure, atrial fibrillation, diabetic keto-acidosis and chronic obstructive pulmonary disease, all followed by a facilitated debrief. Effectiveness of the SBT on understanding of the treatment of the topics was measured anonymously using ten multiple choice questions (MCQs). A 28-item survey was self-administered to students pre and post session, including demographic questions and prescribing confidence agreement statements using a 5-point Likert-scale (strongly disagreed to strongly agreed), with further open-ended questions used to evaluate views of the SBT, and the perceived impact on prescribing confidence. Data were entered into a database and analysed using SPSS v29. Mann-Whitney U-tests were used to determine differences in unpaired agreement scores with independent t-tests used to explore change in unpaired MCQ test-scores. Results Thirty-seven students attended the SBT with 34 students completing post session surveys. Pre session, mean test scores were 4.5±2.0, and post session, mean test scores were 7.7±1.5, an improvement of 3.2 (CI 2.4 to 4.1) t(69)= 7.5, p&amp;lt;0.0001 (d=1.8 large effect). Self-rated prescribing confidence scores significantly increased post-teaching for ability to identify drug interactions (pre-median: 3 [neutral], post-median: 4 [agreed], p=0.019), monitoring of medications (pre-median: 3, post-median: 4, p&amp;lt;0.001) and ordering of appropriate investigations (pre-median: 3, post-median: 4, p&amp;lt;0.001), with significant differences in mean rank reported for all other self-rated confidence scores, except for completion of drug histories, and accessing of information resources. The majority of participants strongly agreed/agreed that the training was valuable (99.1%), interactive (94.1%), practical and relevant (97.1%), contextualised prescribing (94.1 %), and helped preparation for practice (94.1%). Students also strongly agreed/agreed that they were more confident with their prescribing (82.3%), and that pharmacists were appropriate subject teachers (97.1%). Open-ended responses suggested that students found the session challenging and tiring, but realistic, focusing on common prescribing scenarios they would likely encounter. The debrief and personalised feedback was valued, whilst students reported that more SBT was needed throughout their training for other topics including fluids and insulin prescribing. Conclusion Deficits were identified for self-rated prescribing confidence and knowledge-based competence on final-year medical students. A contextualised prescribing SBT programme is acceptable and valued by final-year medical students to prepare them for practice. Whilst it can improve medical student prescribing knowledge and confidence, impact on prescribing competence is unknown and further work is required to explore this educational modality on prescribing quality.

Examining How Work Environment Effects the Work Engagement of Instructional Designers and the Moderating Role of Psychological Capital

The primary purpose of this study was to determine if and to what extent there is a difference in the overall work engagement of instructional designers who are either working predominantly at home or predominantly in the office in the United States and the secondary purpose of this study was to examine the moderating effect of psychological capital on the predictive relationship between work environment and work engagement. Based on a sample size of 345, the results illustrate that the work engagement scores for those who work predominantly in the office (mean rank = 221.89) were statistically significantly higher than those who work predominantly at home (mean rank = 122.67), U = 23431.50, z = 9.25, p &lt; .001, but did not indicate that the interaction effect between types of work environment and psychological capital on work engagement was statistically significant (B = -0.04, se(HC3) = 0.07, p = 0.58. The results extend research on work engagement by providing evidence that there is a statistically significant difference in mean ranks of work engagement scores between those who worked predominantly at home and those who worked predominantly in the office.

Exploring M-Commerce in Odisha: A Multigenerational Analysis of Acceptance

Exploring M-Commerce in Odisha: A Multigenerational Analysis of Acceptance conducts an in-depth examination of mobile commerce (M-Commerce) adoption in the culturally diverse state of Odisha, India. This research paper delves into the multifaceted landscape of M-Commerce adoption, with a specific focus on understanding how various demographic factors shape individuals' perceptions and preferences. Through a comprehensive investigation, the study aims to uncover gender-based differences, age-related variances, educational qualification-related disparities, occupational-based variations, income-related differences, and regional disparities in factors influencing M-Commerce. The hypotheses put forth explore the absence of significant differences in mean ranks among different demographic categories, providing a rigorous examination of the nuanced dynamics that influence the acceptance and utilization of M-Commerce services. This research contributes valuable insights to both academia and industry, paving the way for targeted strategies to enhance M-Commerce adoption across diverse demographic groups. The practical implications of this research extend to businesses, policymakers, and technology developers operating in the Odisha region. Understanding the multigenerational dynamics of M-Commerce acceptance is imperative for tailoring strategies that resonate with the diverse consumer base in Odisha.

Health-related quality of life, psychological issues and concerns among sarcoma survivors: a mixed method study.

We aimed to explore the health-related quality of life (HRQoL), psychological issues and concerns among sarcoma survivors in India and assess their satisfaction with nursing care. This study employed a sequential mixed-methods design, enrolling 100 sarcoma survivors from July to December 2021, with data collected using standardised questionnaires for HRQoL, depression, anxiety, stress, cognitive impairment and self-structured satisfaction with nursing care. Qualitative data were gathered through focused group discussions. The mean global health score among sarcoma survivors was 79.48 ± 16.26. A significant number of survivors had symptoms of mild-to-moderate depression (30%), severe anxiety (12%), stress (16%) and mild cognitive impairment (5%). Significant mean rank differences were observed between anxiety and financial difficulty (p < 0.05), emotional functioning (p < 0.001), cognitive functioning (p < 0.001), pain (<0.05), insomnia (p < 0.001), fatigue (p < 0.001), anorexia (p < 0.05) and nausea/vomiting (p < 0.001). Educational qualification had a significant association with depression and anxiety while family history of cancer emerged as a significant factor associated with anxiety and stress among survivors. Qualitative analysis revealed themes related to body image, societal discrimination, socio-economic impact, marriage concerns and fertility issues. Survivor satisfaction with nursing care was good. A substantial number of sarcoma survivors had an average HRQoL and experienced depression, anxiety and stress. Our study emphasizes the importance of holistic survivorship care, involving nurses in post-treatment support, and addressing societal discrimination and psychosocial concerns to enhance their quality of life. Our study calls for a holistic approach to sarcoma survivor care and emphasizes the importance of personalised survivorship care plans led by nurses to address the diverse needs of sarcoma survivors in India. Such plans should encompass strategies for managing depression, anxiety and stress, along with addressing body image concerns and social support.

Pulsed low dose rate radiation to mitigate tumor-permissive responses in pancreatic cancer-associated fibroblasts: Introducing the HOST-factor.

682 Background: Pancreatic ductal adenocarcinoma (PDAC) features a distinctive tumor microenvironment comprising cancer-associated fibroblasts (CAFs) and their self-produced extracellular matrix (ECM), forming functional CAF units (CAF u). The current total neoadjuvant therapy (TNT), involving conventional chemoradiotherapy (CRT), yields suboptimal responses while promoting a tumor-permissive CAF u state. To address this, we explored pulsed low dose rate radiation (PLDR)-based TNT, as an alternative to CRT, to treat three-dimensional in vivo-like human PDAC CAF u cultures. We assessed gemcitabine combined with PLDR versus CRT using theHOST Factor, a “harmonized output of stroma traits” factor, comprising several established CAF u functional indicators, which inform on the functional status of the PDAC microenvironment. Methods: The unique CAF u functional values used corresponded to: i) ECM anisotropy; ii) persistent cell-ECM signaling; iii) sustained cytokine-induced activation; iv) cytoskeletal bundling; and v) systemic features of fibroblastic activation. The validity of the resultant HOST factor was assessed using the unit’s ECM ability to elicit fibroblastic activation, indicated by a high αSMA/F-actin ratio value. Results: Ex-vivo CRT led to a HOST factor that was 2-fold greater than chemotherapy alone (p=0.6), which was functionally gauged as a tumor-permissive CAF u. In contrast, PLDR averted CRT-induced tumor-permissive response and established a 6-fold lower HOST factor, suggestive of a “normalized” CAF u, when compared to the HOST factor value established when using conventional TNT (P=0.0016 vs. CRT, and P= 0.0086 vs. gemcitabine alone). The multi-parameter HOST factor validity was confirmed as CRT treated CAF u’s ECM activated human pancreatic fibroblasts (αSMA/F-actin = 70% ± 29) while PLDR-treated CAF u's ECM failed to do so (αSMA/F-actin = 32% ± 26), reaching a 30% mean rank difference (P &lt;0.0001). Conclusions: PLDR mitigates conventional CRT-based TNT-induced tumor-permissive responses, restoring the fibroblastic units' tumor-suppressive function. These results lend support to a phase 1 trial designed to evaluate whether radiation with PLDR-based TNT, constitutes a safe and more effective treatment for PDAC patients. The novel HOST factor is being used to appraise specimens from NCT04452357.

Cough Correlates of Functional Swallow Outcomes in Atypical Parkinsonism.

Swallow and cough impairments lead to aspiration and reduced clearance of aspirate material. Both behaviors are impaired in Parkinson's disease, but it is unknown whether a similar relationship of dysfunction exists in forms of atypical Parkinsonism (APD). Elucidating this association in APD may lead to early, comprehensive airway protection treatment. We tested the hypotheses that swallow deficits in APD are associated with impaired cough and that airway protective dysfunction is associated with longer disease duration. Swallowing difficulty was described by 11 participants with APD. Penetration-Aspiration Scale (PAS) and DIGEST scores for thin liquid trials were extracted from medical records of videofluoroscopic swallow study reports. Voluntary and capsaicin induced-reflex cough measures of flow, volume, and timing were analyzed. While most participants did not have post-swallow residue, ~80% received abnormal PAS scores and reported swallowing difficulty. Those with abnormal PAS scores had lower voluntary cough expired volume (P = 0.037; mean rank difference = 5.0); lower reflex inspiratory flow rate (P = 0.034; mean rank difference = 5.5); and longer reflex expiratory flow rise time (P = 0.034; mean rank difference = 5.5). Higher PAS scores and reduced reflex cough volume acceleration were significantly correlated (r = -0.63; P = 0.04) and longer disease duration predicted larger voluntary cough expired volume (R2 = 0.72) and longer flow rise times (R2 = 0.47). As swallow safety worsens, so might the ability to clear the airways with effective cough in in APD; particularly with longer disease duration. Assessing cough in conjunction with swallowing is important for informing airway protection treatment plans in APD.

Emergency medical services experience in King Saud University Medical City

Objective: This study aimed to assess the response time of the emergency medical services (EMS) at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted at KSUMC emergency department. The study included all records of emergency calls that required ambulance dispatch during the study period. Data on the times they received the call, dispatched the ambulance, arrived at the scene, left the scene, and arrived at the hospital were collected. Each call was examined to assess if it took place during normal working hours (08:00-16:00) or within 30 minutes of shift changes (08:00, 16:00, and 00:00). Results: Of all the calls received, 288 (61.7%) were made during regular working hours (08:00-16:00), while 47 (10.1%) were made during the turning shifts (30 minutes before or after the shift). The median time from receiving the call to dispatch, from receiving the call to arrival at the scene, from dispatch to hospital arrival, and the scene time was 1 minute, 7 minutes, 24 minutes, and 10 minutes, respectively. The response and transportation times for emergency responders were consistent whether the calls were received during shift changes or at other times. The differences in mean rank were not statistically significant (P-values = 0.404 and 0.262, respectively). Conclusion: The EMS team at KSUMC in Riyadh, Saudi Arabia, responded quickly. The median times between receiving a call and arriving at the scene, as well as the median scene time, were found to be adequate.

Abstract 15199: Pyridoxamine Limits Mitochondria-Dependent Ferroptosis in a Rat Model of Doxorubicin-Induced Cardiotoxicity

Background: The use of doxorubicin (DOX) chemotherapy is limited by cardiotoxicity characterized by mitochondrial iron accumulation and ferroptosis, both interesting targets for cardioprotection. We found that pyridoxamine (PM) protects against DOX cardiotoxicity in rats. In this study, we hypothesized that PM is cardioprotective by restoring iron regulation and limiting mitochondria-dependent ferroptosis. Methods: Female Sprague Dawley rats of six weeks old were divided into a DOX group (2 mg/kg/week, 8 weeks, IV, N=7) or control group (CTRL, saline, N=7). Others were treated with PM via drinking water (1 g/L) while receiving DOX or saline (DOX+PM, N=9 and CTRL+PM, N=8). Iron regulation, lipid peroxidation and mitochondrial damage in cardiac tissue were evaluated by qPCR, 4-hydroxynonenal (4-HNE) staining and transmission electron microscopy. Data were compared by 1-way ANOVA or Kruskal-Wallis test with posthoc tests. P values are presented with a mean difference (MD) and [95% CI] or mean rank difference (MRD). Results: DOX significantly increased ZIP14 (P=0.049 vs CTRL, 11.20 MRD) and mitoferrin-1 expression (P=0.0002 vs CTRL, 1.49 MD [0.71, 2.28]), indicating increased cytosolic and mitochondrial iron import. The DOX group showed features of ferroptosis including swollen mitochondria with disrupted cristae (Fig. 1), decreased mitochondrial density (P=0.085 vs CTRL, –0.12 MD [–0.24, 0.01]) and increased 4-HNE levels (P=0.029 vs CTRL, 6.90 MD [0.56, 13.24]). PM treatment significantly decreased ZIP14 (P=0.0055 vs DOX, –12.90 MRD) and mitoferrin-1 expression (P=0.0008 vs DOX, –1.17 MD, [–1.88, –0.46]), indicating restored iron regulation. PM also significantly increased mitochondrial density (P=0.0028 vs DOX, 0.22 MD [0.06, 0.37]) and limited mitochondrial damage (Fig. 1). Conclusion: In conclusion, we show that PM limits DOX-induced mitochondria-dependent ferroptosis, and could be a promising cardioprotective strategy for cancer patients.

The Effect of Health Education on Knowledge and Attitudes of Hand Washing in Children at TKA-TPA Al Muhajirin Kampung Parang

Health problems in children are related to the habit of not keeping their hands clean. The lack of hand washing behavior in school age children is caused by low knowledge about hand washing. Health education is an effort to modify behavior through increasing knowledge and skills to improve healthier lifestyles. The purpose of this study was to identify the effect of health education on the level of knowledge and attitudes towards hand washing in children. This type of quantitative research with a Quasi Experiment approach. Research design one group prepost test design. The sample of this study were 20 children out of a total of 20 children at TKA-TPA Al Muhajirin Kampung Parang. The research instrument used a research questionnaire on the level of knowledge and hand washing attitudes. Statistical test using paired t test. The research results showed that the level of knowledge before the intervention was 18 and increased to 19.45 after the intervention. There was a difference in the average level of knowledge between before and after the intervention with an average difference of 1.45 and a p value = 0.000. Variable hand washing attitude, the table shows that the average hand washing attitude indicator of action before the intervention was 18 and increased to 19 after the intervention. There is a difference in the average action between before and after the intervention with a mean rank difference of 1 and a value of p = 0.001. This means that providing health education about hand washing attitudes is effective in increasing hand washing attitudes in children, where there is a significant increase

COMPARISON BETWEEN 2 ELEMENTARY SCHOOLS ABOUT BARRIERS IN ONLINE LEARNING FOR TEACHERS DURING PANDEMIC COVID-19 IN KEMILING DISTRICT BANDAR LAMPUNG CITY 2023

Background. There are still many teachers who have learning barriers during the pandemic. Teachers from Elementary School 2 Beringin Raya and teachers from Elementary School 2 Sumberejo who had learning obstacles with students such as network constraints, learning applications, parental conditions, limited student learning devices because mobile phones were brought by working parents and lack of supervision. Research Purpose. To find out the comparison of online learning barriers for elementary school teachers during the Covid-19 pandemic at Elementary School 2 Beringin Raya and Elementary School 2 Sumberejo in Kemiling District, Bandar Lampung City. Research Method. Quantitative research with Cross-Sectional approach. The study was conducted on 73 respondents using total sampling technique. Sampling technique using online learning barriers questionnaire during the Covid-19 pandemic. Findings. The hampered at Elementary School 2 Sumberejo is that the average score of 76.86 is higher (bad) than the average score at Elementary School 2 Beringin Raya is 71.16 lower (good). When compared using the statistical test Mann-Whitney test, there is also a difference in Mean Rank between Elementary School 2 Sumberejo 42.49 and Elementary School 2 Beringin Raya 31.66. There is a significant difference in value between Elementary School 2 Sumberejo and Elementary School 2 Beringin Raya with a p-value of 0.001. Conclusion. There is a difference in online learning barriers between the two elementary schools in Kemiling District, Bandar Lampung City in 2023. The teacher who was most hampered by learning during the Covid-19 pandemic was Elementary School 2 Sumberejo.

ANALYSIS OF STOCK PORTFOLIO PERFORMANCE USING THE SHARPE, TREYNOR AND JENSEN METHODS

This study aims to find out whether using the single index method will produce an optimal portfolio of Jakarta Islamic Index 70 (JII70) stocks listed on the IDX for the 2019-2022 period and continue to assess its performance using the Sharpe Ratio, Treynor and Jensen methods to find out the best method in assessing the performance of stock portfolios formed in a period. The selection of this research sample was used based on purposive random sampling technique. This study used the One Way of Variance by Rank Kruskal-Wallis different test. In this study, the Sharpe, Treynor, and Jensen values were standardized through the Z-score transformation (standardized) followed by the Mean Rank difference test between treatments. The test results using the Kruskal-Wallis test were obtained with a probability of 0.000. It is known that the probability of testing ≤ 0.05. These results indicate that there are significant differences between the tests with the Sharpe, Treynor, and Jensen methods. Thus, the null hypothesis H0 in this study was rejected. The test results between the three treatment differences in mean rank, showed no significant difference between each treatment because Jensen had the lowest difference in mean rank to Sharpe and Treynor. Jensen's method has a mean difference the lowest rank against Sharpe and Treynor, meaning that Jensen is the most consistent with indifference. Based on the results of the issuer's Jensen method analysis.

Screening Amazon rainforest plant extracts for antimicrobial activity: a 15-year commitment to the Brazilian biodiversity

IntroductionThe need for new tools to treat infections is constantly growing due to the possibilities of emerging diseases related to environmental changes, climatic catastrophes, microorganism resistance, and human and animal aging, leading to an evident unbalance in the planet’s health. Brazil contains the most significant portion of world biodiversity, a potential source of new antimicrobial natural products. Nonetheless, its environment, particularly its forests, and rainforests, is under threat, meaning that rapidly conducted, comprehensive research into the potential of antimicrobial activity to address this threat is urgently needed.MethodsIn this study, plants from the Amazon rainforest and the Atlantic forests were collected and tested against several pathogenic microbes relevant to humans, animals, and the environment, and subjected to large-scale susceptibility assays, bioautography, and Artemia salina toxicity assays. From the plants, 2,280 organic and aqueous extracts were obtained from different organs, namely leaves, barks, flowers, fruits, and seeds, and subjected to a large-scale susceptibility screening assay against Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus mutans, Streptococcus sanguinis, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Malassezia pachydermatis, Malassezia furfur, and Listeria monocytogenes. Results and discussionThe selected extracts were subjected to antimicrobial susceptibility tests to determine their inhibition zone diameters and minimum bactericidal concentrations, to bioautography, and to an Artemia salina toxicity assay, which resulted in 154 active extracts. Moreover, 111 out of 154 extracts were ranked based on scores established by the p-values and the mean rank differences in each set of test results. The final ranking identified which extracts should be studied in further phytochemical research using thin-layer chromatography techniques as a priority. The extracts obtained from plants belonging to Combretaceae, Connaraceae, Convolvulaceae, Fabaceae, Malpighiaceae, Moraceae, Piperaceae, Polygonaceae, and Salicaceae were selected as the most promising ones and used to support the identification of plant-based antimicrobial active compounds from the immense biodiversity of Brazilian forests.

CtDNA detection in patients with brain metastases arising from solid tumors.

2027 Background: While circulating tumor DNA (ctDNA) is a routine tool for therapeutics in metastatic solid tumors, data in those with stable and active brain metastases (BrMs) is limited. We assessed genomic alterations in ctDNA from patients (pts) with solid tumor BrMs in three groups: isolated BrMs/stable extracranial disease (iCNS), concurrent brain and extracranial progression (cCNS), and extracranial progression with no active BrMs at ctDNA draw (eCNS). We also compared ctDNA alterations between pts with and without BrMs. Methods: Pts with BrMs and a Guardant 360 profile (n=253) from the Duke Molecular Registry of Tumors between 01/2014 – 12/2020 were identified. Intracranial and extracranial disease status were determined via investigator assessment (RECIST and RANO-BM criteria) within 30 days of ctDNA test. Mutant allele fraction (MAF) was defined as the % of mutant alleles divided by total alleles at a given loci. Differences in mean ranks of the MAF % maximum were compared using the Kruskal-Wallis test and pairwise comparisons with the Dwass, Steel, Critchlow-Fligner multiple comparisons post-hoc procedure. We compared differences in MAF &gt;1% using the chi-square test. Results: Among the 253 pts with BrMs: 29 (12%) had iCNS, 160 (63%) cCNS, and 64 (25%) eCNS. The two most common tumor types were breast (BC, 12.0%) and non-small cell lung cancer (NSCLC, 76.4%). Median MAF was lower in the iCNS group (1.6%) vs cCNS (4.8%) p=0.002, but eCNS did not differ (2.6%). In pts with BC BrMs, ESR1 mutations were most frequent in the iCNS group (67%), followed cCNS (54%) then eCNS (18%) (p = 0.09) as were PIK3CA mutations, iCNS(50%), cCNS (46%), and eCNS (27%), p = 0.55. In pts with NSCLC BrMs, EGFR mutations were most frequent in the iCNS followed by cCNS then eCNS (67%, 40% and 37%, p = 0.08). KRAS mutations were more frequent in cCNS followed by eCNS and iCNS (30%, 17% and 6% p = 0.031). Patients with no BrMs (n=449) included 24% breast and 76% NSCLC. In the ctDNA, ESR1 and BRCA2 mutations were more frequent in pts with BC BrMs than those without (60% vs 25%, p&lt; 0.001) and (17% vs 5%, p=0.022), respectively. Mutations in EGFR were more frequent in pts with BrMs vs without (36% vs 17%, p&lt;0.001). Sequencing from both BrMs tissue and ctDNA were available for 8 pts (4cCNS and 4 iCNS). 7 of these (87.5%) had identical mutations in tumor and ctDNA. Conclusions: This study illustrates the feasibility of detecting actionable mutations from ctDNA among pts with BrMs, with and without extracranial disease. A higher frequency of actionable mutations in several targetable genes was observed in ctDNA when comparing pts with and without BrMs, thus providing therapeutic opportunities. Additional studies comparing ctDNA and alterations in BrMs tissue are needed to determine if ctDNA can be considered a surrogate to support treatment decisions.

O036 Postoperative complications are predicted by surgery duration in the unilateral deep inferior epigastric perforator (DIEP) flap reconstruction: a retrospective cohort study

Abstract Introduction Currently, one published study documented operative time (OT) as a predictor for postoperative outcomes in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstructions. No literature has investigated this in unilateral DIEP flaps. We aimed to determine the relationship between unilateral OT, postoperative complications and length-of-stay (LOS). Methods Electronic hospital data of adult women that underwent elective immediate or delayed unilateral DIEP reconstruction at a tertiary centre in London, between 2021 to 2022, was retrospectively analysed. Patients were divided into four groups depending on OT quartiles to define a critical cut-off period. Data on extensive potential confounders was recorded and used in univariable and multivariable regression models. Further statistical analyses were performed where appropriate. Results The final cohort contained 66 patients. Through quartiles, the risk-adjusted cut-off OT was defined as 515 minutes. After risk-adjustment, operations &amp;gt;515 minutes had a significantly higher overall complication rate than ≤515 minutes (HR: 2.16, p=0.032, 95% CI: 1.067, 4.38). No significant difference in mean ranks of LOS (p=0.16) was noted above the cut-off period. In patients that developed at least one complication type, no significant difference was observed in the unadjusted return-to-theatre rate between the two groups (HR: 0.86, p=0.82, 95% CI: 0.23, 3.24). Conclusion We confirmed OT was an independent predictor for postoperative complications in the DIEP flap and demonstrated this in unilateral reconstructions. Larger multicentre prospective studies are required to ascertain the significance of the OT effects, and to deduce the minimum OT threshold below which detriment to patient outcomes arises.

A Comparative Evaluation of Drug Information Leaflets of Over-the-Counter Medicines in Palestine

Our study aims to conduct an evaluation and comparison between the leaflets of local and imported oral solid over-the-counter medications (OTC) found in the Palestinian markets. Forty-nine leaflets were evaluated using a scoring method and depending on the appearance of 31 headings, along with the use of manual word counting to assess the amount of information within 23 topics of all 31. None of the evaluated PIs, local or imported, completed all 31 criteria. Remarkably, the imported product leaflets achieved higher scores than their local leaflets in 19 out of 31 topics, whereas the local products achieved better scores than the imported agents in only 2 items, and 10 criteria were equally scored between them. None of the PIs mentioned pharmacokinetic information, instructions for converting tablets or capsules into liquid forms, or shelf life. In general, imported leaflets give more detailed information than their local counterparts. The lowest value of the fold difference in mean rank was 0.85 times for the direction of use, and the highest value was 2.43-fold for adverse drug reactions. The results showed a deficiency in the information provided in the local package inserts compared to the imported versions of oral solid OTC medications available in Palestine. These findings encourage the Palestinian Ministry of Health to provide full criteria for pharmaceutical companies to ensure that the leaflets contain sufficient and updated information and ensure that the patients use their drugs safely and effectively.

Comparison of the Structured Consent Process Using Modified Delphi Technique with the Standard Process in Obtaining Informed Consent for Procedures in ENT by PHASE III MBBS Students.

Communication skill is a core competency and the training must begin in the undergraduate period itself. The Phase III MBBS students during their ENT posting are required to obtain informed consent for procedures and surgeries in ENT which forms the basis for efficient communication skills in house-surgency (internship) and residency. Informed consent taking is an important aspect and in the clinical postings, the teaching of communication skills along with history taking and physical examination can go a long way in making a strong foundation to good doctor patient relationships. This study aimed to compare the structured consent process using modified Delphi technique with the standard process in obtaining informed consent for procedures in ENT by PHASE III MBBS students. The need to sensitise the MBBS students on appropriate consent taking procedures with familiarisation of the essential elements of the Kalamazoo consensus statement were raised, accepted and final OSCE assessment attributes decided by the modified Delphi technique. The Modified Delphi technique is a unique means to obtain opinions of experts across the field in various spheres so as to identify lacunae if any in the existing teaching with means to reach a valid and reliable consensus. Our study included Phase III MBBS students posted to the Department of ENT, Govt Medical College Kozhikode during Jan-Feb 2022 wherein one batch of 30 students were taught with 2 classes on informed consent taking by the structured process obtained after Modified Delphi technique and included as; "MD" group and another batch of 30 students from the entire batch taught by the standard process was included as; "T" group respectively. After completion of the clinical postings an assessment was carried out with OSCE stations in Mar 2022; wherein 10 students were evaluated for each of the 6 common ENT procedures, 5 students from "T" group and 5 students from "MD" group respectively. Median total score of MD group was 6.5 (3.25-8) and median score of T group was 4.5 (2.25-6.75). The difference in mean ranks of these scores was statistically significant, p < 0.0001. The feedback assessment using the questionnaire with Likert scale had all 30(100%) students recommend this method of structured consent taking for enhancement of communications skills. However 20% of the students were not satisfied with the teaching learning method expressing the need for more time allocation and demonstrations. Informed consent taking requires the appropriate training in the undergraduate period itself as seen by the improved OSCE scores on assessment after teaching by the structured consent taking process as well as from the feedback of the students.

Influence of Aerobic Exercise on Appetite-Regulating Hormones, Ghrelin-o-Acyltransferase and Perceived Hunger in Normal Weight and Obese Adults

Background: Obesity is a major public health issue in the United States (U.S.), affecting an estimated 78 million US adults. Aerobic exercise (AE) is recommended by the American College of Sports Medicine to prevent and treat obesity, yet the effects of AE on circulating hunger hormones including acylated ghrelin and its biological catalyst, ghrelin o-acyltransferase (GOAT) are less known. Objectives: We investigated the effects of AE on circulating concentrations of appetite regulating hormones and GOAT in a pilot sample of adults classified with normal weight (NW) and obese (OB) body weight status. Methods: Using a quasi-experimental design, nine adults with NW (n=4, body mass index [BMI] = 21.3±1.2 kg/m2) and OB (n=5, BMI = 38.9±6.2 kg/m2) body weight status completed a preliminary health/fitness assessment. Participants returned to the laboratory on three separate occasions, separated by ≥ 48 hours to perform cycle exercise at 30% and 60% oxygen uptake reserve (VO2R) or a seated control session with no exercise for 40 min. Fifteen mL of blood was taken pre-and-post exercise and control and were assayed in duplicate. Nonparametric procedures determined whether mean rank differences existed between NW and OB for acylated ghrelin, leptin, insulin, and GOAT in response to exercise and control. Alpha levels were set a priori to p 0.05. Results: Significant mean rank reductions were found in GOAT after compared to before AE and control for NW and OB (p.05). Significant mean rank differences were found in acylated ghrelin after compared to before performing AE at 60% VO2R in NW and OB (p.05); however, differences were not observed between NW and OB (p.05). Conclusions: Our findings reveal the first available data regarding the effects of AE on GOAT, with NW and OB experiencing equivocal changes pre-to-post AE at 60% VO2R, and in response to a seated control session.