Fair Correlation Research Articles

The mSQUASH is a feasible and valid measurement tool to uniformly assess daily physical activity in patients with rheumatic diseases

BackgroundThe modified Short QUestionnaire to ASsess Health-enhancing physical activity (mSQUASH) was originally developed and validated in Dutch patients with axial spondyloarthritis (axSpA). To support world-wide distribution, applicability and comparability of...

The use of a novel toe-thumb pressure index for assessing arterial status in the lower limb. A reliability and validity study.

This study explored the reliability, validity and perceived comfort of a novel thumb pressure measure and calculation of a toe-thumb index to identify their suitability as an adjunct or alternatives to ankle-brachial and toe-brachial indices. Repeated manual thumb and toe systolic blood pressures were conducted using two raters, over two time points, on 34 healthy participants. Concurrent automated toe, thumb and brachial systolic blood pressures as well as comfort ratings for these measures (using a 10mm visual analogue scale) were captured once by a research assistant. Automated thumb and brachial measures showed fair correlation (ρ=0.36, p=0.03) and a toe-thumb index and toe-brachial index good correlation (ρ=0.62, p<0.01). Intraclass correlation coefficients (ICC) identified moderate intra-rater reliability for manual thumb pressures for Rater 1 and 2 (ICC 0.57, 95% CI [0.14, 0.79] and ICC 0.74, 95% CI [0.49, 0.87], respectively), while inter-rater reliability was poor (ICC=0.16, 95% CI [-0.85, 0.47]). Concurrent validity comparing manual and automated measures for thumb pressure was also poor (ICC -0.05, 95% CI [-1.06, 0.72] and ICC 0.42, 95% CI [-0.16, 0.72] Rater 1 and 2 respectively). Thumb measures were significantly more comfortable than brachial measures (5mm, p<0.00). Thumb systolic pressures are correlated with brachial systolic pressures, with reasonable intra-rater reliability, however, correlation is only fair and measurement error wider than clinically acceptable. Furthermore, manual measures are poorly correlated with automated units. Consequently, caution is required in applying these techniques. As thumb measures were perceived as significantly more comfortable than brachial measures and have an advantage where brachial pressures cannot, or should not, be obtained, further evaluation is warranted.

Conjunctival and Corneal Endothelium Profile in a Sample of Healthy Electronic Cigarette Smokers

Objective: Though e-cigarette is thought of as a healthy alternative way of smoking, the unknown nicotine concentration level and chemical compounds from the aerosol mist and flavourings are potentially harmful and may exert irritation or damage to the ocular surface. Thus, a cross-sectional study was conducted to identify the conjunctival and corneal endothelium profile among healthy e-cigarette smokers, and the relationship between smoking behaviour with the conjunctival and corneal endothelium profile. Material and Methods: Seventeen healthy e-cigarette smokers and 17 non-smokers were recruited for this study where their palpebral redness, bulbar redness, limbal redness, conjunctival roughness, central corneal thickness, endothelial cell density, and coefficient of variation of endothelium cell area were assessed using slit lamp biomicroscope and specular microscope. Results: There was a non-significant, higher mean rank observed in the total palpebral redness, total bulbar redness, total limbal redness, total conjunctival roughness, central corneal thickness, endothelial cell density, and coefficient of variation of the endothelium cell area in e-cigarette smokers compared to non-smokers (p-value&gt;0.05). Only smoking frequency and total palpebral redness showed a statistically significant, positive, and fair correlation (r=0.349, p-value=0.043), while no other smoking behaviour showed a significant correlation (p-value&lt;0.05). Conclusion: The use of e-cigarettes showed no significant impact on the conjunctival and corneal profile among the users, but further research with comprehensive evaluation is required in a larger sample size of more established e-cigarette smoking profiles.

Satellite Based Composite Weather Insurance Product for assessing mid-term adversary

The present study formulated a satellite-based rainfall insurance product (SRIP) at sub-seasonal scale during 2015–2020 by integrating meteorological, geophysical and vegetation index products e.g. rainfall (CHIRPS:Climate Hazards Group InfraRed Precipitation with Station), soil moisture (SMAP), normalized difference vegetation index (NDVI) and normalized difference water index (NDWI) from moderate resolution imaging spectro-radiometer (MODIS). The SRIP was meticulously designed to integrate both cause (rainfall) and impact (NDVI, NDWI, soil moisture) parameters to enhance the assessment of min-season crop risks, with a particular emphasis on deficit rainfall. The performance evaluation of SRIP was conducted in two distinct agro-climatic zones viz. Deoria district of Uttar Pradesh (Upper Gangetic Plain Region) and Krishna district of Andhra Pradesh (Southern Plateau and Hills Region) spanned from June to October, which aligns with the major crop-growing season corresponding to the Southwest monsoon period in India. Three sets of SRIPs were investigated i.e. SRIP with cause parameter (SRIP1), SRIP with cause-impact parameters with no lag response (SRIP2) and SRIP with cause-impact parameters with one-month lag response (SRIP3). The SRIP was structured to provide a numerical index on a scale ranging from 0 to 1, representing poor to good crop-growing conditions that could effectively identify the rainfall deficit threshold (SRIP≤0.43) corresponding to negative percent deviation in rainfall (PDR≤−20%). This threshold level was recognized for compensation of triggers at the multiple crop growth phases during the crop-growing season. The district average of SRIP and PDR showed fair correlation co-efficient (0.77 ≤ r ≤ 0.88). Good correlation between sub-seasonal (monthly, bi-monthly, tri-monthly) SRIP and normalized MODIS Gross Primary Productivity (0.65 ≤ r ≤ 0.98), and SRIP deviation and yield deviation (0.45 ≤ r ≤ 0.97) reflect sensitivity of SRIP to crop carbon productivity and crop yield. The findings of the present study recommend SRIP not only a multi-phase composite index for assessing mid-season crop risks in terms of rainfall deficit for clusters of insurance units, but it has the potential to be used by insurance agencies to settle the claims by farmers in a transparent and faster manner for crop loss due to large-scale rainfall deficits. However, SRIP needs to be customized in future to make it more adaptable to settle insurance claims due to weather adversaries at individual farm level.

The Gastrointestinal Symptom Rating Scale has a Good Test-Retest Reliability in Well-Trained Athletes With and Without Previously Self-Identified Gastrointestinal Complaints.

Athletes often report gastrointestinal (GI) complaints. Standardized validated tests validated in athletes are lacking. The objective of the current study was to investigate the test-retest reliability of the gastrointestinal symptoms rating scale (GSRS), a disease-specific instrument of 15 items to quantify the severity of various GI symptoms. For this purpose, a 3-week repeated measurements design was used. The mean difference (Wilcoxon signed rank test), associations (Spearman correlations), and systematic difference using Bland-Altman calculations for repeated measurements, as well as its internal consistency (Cronbach's alpha) on testing day 1 and day 2 were analyzed, with significance set at p ≤ 0.05. A total of n = 70 well-trained athletes (26.1 ± 5.4years, of which 40% were female) were included. A high Cronbach's α for GSRS was found on testing day 1 (0.825), and day 2 (0.823), suggesting a good and comparable internal consistency of the questionnaire. When assessing the multilevel temporal stability for total GSRS scores (28.0, IQR 22.0-36.3 vs 26.5, IQR 18.0-35.0), there was a small but significant difference (Z = - 2.489, and p = 0.013), but a fair correlation between day scores (r = 0.68, p < 0.001), and a Bland-Altman reporting difference between questionnaires within 10% of the total GSRS score, without significant reporting bias (p = 0.38). In most cases, except for hunger, burping, and loose stools, the individual GSRS items were reported in line with total scores and similar for sex. In conclusion, the GSRS is reliable when used with athletes, with good internal consistency for most symptoms independently of sex, except for hunger, burping, and loose stools.

Non-Pharmacological Management of Gestational Diabetes Mellitus with a High Fasting Glycemic Parameter: A Hospital-Based Study in Vietnam

Background/Objectives: The prevalence of gestational diabetes mellitus (GDM) is increasing at an alarming rate worldwide. Delayed management can lead to adverse composite outcomes for both mother and her offspring. To our knowledge, the clinical association between glycemic parameters and the results of the non-pharmacological GDM approach remains limited; thus, this study aimed to address this important clinical issue in the literature. Methods: This was a retrospective cross-sectional study of 174 Vietnamese pregnant women with the positive oral glucose tolerance test (OGTT) for a high fasting glycemic parameter at Hung Vuong Hospital from 04/2022 to 07/2022. This study aimed to evaluate the success rate of GDM with an elevated index of fasting glycemic concentration which was managed after 2 weeks of a dietary regimen combined with adequate physical activities and to reveal its related factors. Results: Out of 174 singleton pregnancies that met the inclusion criteria, 103 GDM pregnant women were successfully managed after 2 weeks of monitoring (59.2%; 95% confidence intervals (CI): 51.9–66.5). The study revealed a fair correlation between the corresponding test of blood glucose at OGTT and after 2 weeks of GDM management (r = 0.270–0.290, p &lt; 0.0001). The GDM pregnant women with an elevated fasting glycemic parameter and with any of elevated 1 h or 2 h blood glucose levels and in cases of three elevated glycemic parameters (fasting, 1 h, and 2 h blood glucose at the initial results of OGTT) reduced the success rate of glycemic control to 56.5%, 49.2%, respectively, compared to the group with solely a high fasting index of blood glucose (69.6%). The pregnant women who participated in high-intensity sports activities related to a two-fold increase in success rate compared with the group engaging in light and moderate-intensity physical activity. Conclusions: The success rate of glycemic control in GDM women was highest in the group with solitary fasting hyperglycemia and lower in the contributory groups with two and three high parameters. The application of diet therapy plus physical activities among GDM pregnant women is potentially necessary to improve the effectiveness of treatment, minimize adverse pregnancy outcomes, and reduce substantially the hospitalization rate.

Association of pulmonary function with functional capacity among middle-aged women

INTRODUCTION: Age-related decline in pulmonary function and functional capacity is seen in adults. The menopausal process leads to a decline in pulmonary function and functional capacity which is essential in maintaining independence in daily life. OBJECTIVE: The present study aimed to explore the association of pulmonary function with functional capacity among middle-aged women. METHODS: One hundred and eight female participants aged 40–55 years were included in this cross-sectional study; depending on their menstrual history participants were classified as premenopausal and postmenopausal. After initial screening and assessment, six-minute walk test (6MWT) and pulmonary function (FEV1, FVC, FEV1/FVC) were recorded as per standardised guidelines. The mean and standard deviation for all continuous variables were calculated. Correlations were estimated using Pearson’s coefficient of correlation. A comparison of premenopausal and postmenopausal groups was done by independent t-test. A two-tailed p-value &lt; 0.05 was considered statistically significant. RESULTS: There were significant differences in values of six-minute walk distance (6MWD) and pulmonary function values of pre and postmenopausal women (p &lt; 0.05). The Pearson coefficient of correlation showed t significant association of FEV1, FVC and FEV1/FVC with 6MWD among middle-aged women. There was fair positive correlation of FEV1 (r = 0.391, p = 0.002) and FEV1/FVC (r = 0.395, p = 0.002) with 6MWD among postmenopausal women. CONCLUSION: There exists a fair positive correlation of pulmonary function with 6MWD among middle-aged women particularly postmenopausal women. Early screening of respiratory health and functional capacity should be initiated for middle-aged women as a preventive strategy.

Validity and reliability of the Pain Assessment in Impaired Cognition 15 (PAIC15) observation scale in persons with aphasia

BackgroundThe use of self-report pain scales in persons with aphasia can be challenging due to communication and cognitive problems, while for assessing pain self-report pain is considered the gold standard (Harrison RA, Field TS. Post stroke pain: identification, assessment, and therapy. Cerebrovasc Dis. 2015;39(3–4):190–201.). An observational scale may be used as an alternative. This study examines the validity and reliability of the observational Pain Assessment in Impaired Cognition (PAIC15) scale in persons with aphasia.MethodsPersons with aphasia were observed during rest and transfer by two observers using the PAIC15. The PAIC15 comprises 15 items covering the three domains of facial expressions, body movements, and vocalizations. When able, the participant completed four self-report pain scales after each observation. The observations were repeated within one week. For criterion validity, correlations between the PAIC15 and self-report pain scales were calculated and for construct validity, three hypotheses were tested. Reliability was determined by assessing internal consistency, and intra- and interobserver agreement.ResultsPAIC15 observations were obtained for 71 persons (mean age 75.5 years) with aphasia. Fair positive correlations (rest: 0.35–0.50; transfer: 0.38–0.43) were reported between PAIC15 and almost all self-report pain scales. Results show that significantly more pain was observed in persons with aphasia during transfer than during rest. No differences were found for observed pain between persons with aphasia who use pain medication and those without, or persons who have joint diseases compared to those without. Results showed acceptable internal consistency. Intra- and interobserver agreement was high for most PAIC15 items, particularly for the domains body movements and vocalizations during rest and transfer.ConclusionsRecognition of pain in persons aphasia using the PAIC15 showed mixed yet promising results.

Active Left Atrial Ejection Fraction as a Non-Invasive Marker in Pulmonary Hypertension Secondary to Heart Failure

BackgroundPatients with pulmonary hypertension (PH) secondary to left heart failure (HF) exhibit a complex pathophysiological profile and poor prognosis. Left atrial function is pivotal in the progression of this disease, yet its predictive significance remains exclusive. This study aimed to explore the predictive capability of LA metrics in this population and compare them with other common predictors. MethodsIn this retrospective study, consecutive patients with PH secondary to HF who underwent cardiac magnetic resonance (CMR) imaging between December 2010 and December 2021 were enrolled. The composite endpoint was defined as all-cause death, heart-lung transplantation, or left ventricular assist device implantation. Survival analyses were performed using Kaplan–Meier curves and Cox regression analyses. ResultsA total of 174 patients with PH secondary to HF, with a mean age of 53.2 ± 14.9 years, including 90 men, were included in the final analysis. During a median follow-up of 31.9 months, 58 patients (33.3%) with PH reached the endpoints. There was a fair correlation between active left atrial ejection fraction (LAEF) and pulmonary artery wedge pressure (r = -0.397, p = 0.044). Active LAEF had a strong correlation with oxygen consumption at anaerobic threshold (r = 0.769, p < 0.001) and peak oxygen consumption (r = 0.754, p < 0.001). Active LAEF demonstrated comparable prognostic performance to other variables measured by echocardiography or CMR. After adjusting for clinical variables and left ventricular ejection fraction, active LAEF was still an independent predictor for adverse events (C-statistic: 0.784). Subgroup analysis among HF patients with preserved ejection fraction demonstrated that those with active LAEF ≤ 8.6% had a 7.05-fold higher risk of experiencing the composite endpoint compared to those with active LAEF > 8.6%. ConclusionAlthough active LAEF does not demonstrate statistical improvement in outcome discrimination compared to established metrics, it may still merit consideration for assessing disease severity and prognosis in patients with PH secondary to HF. The integration of active LAEF and HF subtypes may stratify individuals at different levels of risk.

A Comparison of ChatGPT and Expert Consensus Statements on Surgical Site Infection Prevention in High-Risk Paediatric Spine Surgery.

Artificial intelligence (AI) represents and exciting shift for orthopaedic surgery, where its role is rapidly evolving. ChatGPT is an AI language model which is preeminent among those leading the mass consumer uptake of AI. Artamonov and colleagues compared ChatGPT with orthopaedic surgeons when considering the diagnosis and management of anterior shoulder instability; they found a limited correlation between them. This study aims to further explore how reliable ChatGPT is compared with orthopaedic surgeons. Twenty-three statements were extracted from the article "Building Consensus: Development of a Best Practice Guideline (BPG) for Surgical Site Infection (SSI) Prevention in High-risk Pediatric Spine Surgery" by Vitale and colleagues. These included 14 consensus statements and an additional 9 statements that did not reach consensus. ChatGPT was asked to state the extent to which it agreed with each statement. ChatGPT appeared to demonstrate a fair correlation with most expert responses to the 14 consensus statements. It appeared less emphatic than the experts, often stating that it "agreed" with a statement, where the most frequent response from experts was "strongly agree." It reached the opposite conclusion to the majority of experts on a single consensus statement regarding the use of ultraviolet light in the operating theatre; it may have been that ChatGPT was drawing from more up to date literature that was published subsequent to the consensus statement. This study demonstrated a reasonable correlation between ChatGPT and orthopaedic surgeons when providing simple responses. ChatGPT's function may be limited when asked to provide more complex answers. This study adds to a growing body of discussion and evidence exploring AI and whether its function is reliable enough to enter the high-accountability world of health care. This article is of high clinical relevance to orthopaedic surgery given the rapidly emerging applications of AI. This creates a need to understand the level to which AI can function in the clinical setting and the risks that would entail.

Associations of passive muscle stiffness and muscle echo-intensity with muscle strength

Objective: Muscle tissue parameters including composition and stiffness of muscle can have an important effect on muscle strength. In this study, we aimed to investigate the relationships between muscle echo-intensity (EI), tendon stiffness and muscle strength in young men and women. Methods: Ultrasound B-mode images of the Rectus Femoris (RF), Vastus Medialis (VM) and Patellar Tendon (PT) were acquired in fifty-two healthy subjects (mean age; 27.43±5.3 years). RF, VM and PT stiffness were characterized by shear-wave elastography measurements. Quantitative evaluations were performed, including measurement of muscle and tendon thickness and muscle EI. Isometric knee extension muscle strength was measured using hand-held dynamometer. Results: RF stiffness had a good correlation with muscle strength (r=-0.46, p&lt;0.05) and had a fair correlation with EIRF(r=-0.37,p&lt;0.05), VM stiffness had a good correlation with muscle strength (r=0.42, p&lt;0.05) and had a fair correlation with EIVM (r=-0.43,p&lt;0.05) in women. RF stiffness had a good correlation with muscle strength (r=-0.54, p&lt;0.05), had a good correlation with EIRF(r=-0.41,p&lt;0.05) in men.VM stiffness had a good correlation with muscle strength(r=-0.50; p&lt;0.05), and had a good correlation with EIVM(r=-0.60,p&lt;0.05) in men. EIRF and EIVM had a good relation with muscle strength in men and women (For EIRF; r=-0.46; r=-0.54; for EIVM; r=-0.42; r=-0.50 p&lt;0.05, respectively) Conclusions: This study demonstrates that there is a relationship between isometric muscle strength and passive muscle stiffness, muscle EI. Additionally, muscle EI affects muscle stiffness in healthy men and women. Our results should be considered in elite athletes for whom the strengthening program is important.

The relationship between cognitive function and functional capacity, and cognitive reserve and reaction time in patients with multiple sclerosis.

Cognitive dysfunction is frequently seen in multiple sclerosis (MS). However, there are conflicting findings regarding the factors it is associated with. To investigate the relationship between aerobic capacity, strength, disability, depression, fatigue, and cognitive reserve and function. The mobile applications Trail Making Test (TMT A-B), Digit Span Test (DST), Visuospatial Memory Test (VSMT), and Tap Fast were used in the cognitive function evaluation. Functional performance was assessed with the 6-minute walk test (6MWT), 5-Time Sit-to-Sand (5STS) test, and grip strength. Cognitive Reserve Index (CRI), Beck Depression Inventory, Fatigue Severity Scale (FSS), and Nottingham Health Profile were also used. A significant difference was found between the MS and control groups only in the 6MWT, STS-5, grip strength, TMT, VSMT, and Tap Fast. Good correlation was found between the TMT-A and 6MWT and physical mobility. A fair correlation was shown between grip strength, energy, and pain status. A good correlation was found between TMT-B and 6MWT, and a fair relationship with disability, cognitive reserve, and pain. Good correlation was observed between the DST and 6MWT, left grip strength, pain, and energy status; fair correlations were found between right grip strength, cognitive reserve, and physical mobility. Good correlation was found between the VSMT and energy. A fair relationship between disability, cognitive reserve, and pain was demonstrated. Good correlation was observed between the Tap Fast score and disability, 5STS, FSS, energy, and physical mobility. A fair relationship was found between pain and social isolation. It has been shown that cognitive performance in MS is related to disability, functional performance, cognitive reserve, fatigue, and general health. NCT06084182.

A comparison between 3D printed models and standard 2D planning in the use of metal block augments in revision knee arthroplasty.

The study focused on the ability to predict the need and size of femoral and tibial augmentation using standard two-dimensional (2D) templates and models created with three-dimensional (3D) printing in surgical planning. This observational cohort study included 28 consecutive patients (22 females, 6 males; mean age: 71±7.3 years; range, 54 to 82 years) with periprosthetic joint infection recruited between March 2021 and September 2023 undergoing revision total knee arthroplasty revision (TKA). Standard planning was made using calibrated X-ray images. The 3D planning started with computed tomography scans to generate a 3D template of the distal femur and proximal tibia. The model was exported to a 3D printer to produce a patient-specific phantom. The surgery was then simulated on the 3D phantom using revision knee arthroplasty instrumentation to evaluate the appropriate augmentation to use until a correct alignment was obtained. Three-dimensional planning predicted the need for femoral and tibial augments in 22 (78.6%) cases at both the tibial and femoral components, while 2D planning correctly predicted the need for augmentation in 17 (60.7%) for the tibial side and 18 (64.3%) for the femoral side. The Cohen's kappa demonstrated a significant agreement between the 3D planning for the femoral metal block and the intraoperative requirement (kappa=0.553), whereas 2D planning showed only nonsignificant poor agreement (kappa=0.083). In contrast, the agreement between 2D or 3D preoperative planning for tibial augment and the intraoperative requirement was nonsignificant (kappa=0.130 and kappa=0.158, respectively). On the femoral side, 2D planning showed only a fair nonsignificant correlation (r=0.35, p=0.069), whereas 3D planning exhibited substantial agreement with the actual thickness of the implanted augment (r=0.65, p<0.001). On the tibial side, 3D and 2D planning showed substantial agreement with the actual size of implanted augments (3D planning, r=0.73, p<0.001; 2D planning, r=0.69, p<0.001). Prediction based on 3D computed tomography segmentation showed significant agreement with the intraoperative need for augmentations in revision TKA. The results suggest that planning with 3D printed models represents a stronger aid in this kind of surgery rather than standard 2D planning, providing greater accuracy in the prediction of the required augmentation in revision TKA.

Left atrial fractional shortening in cats: a comparison between two echocardiographic views

Introduction/objectivesLeft atrial fractional shortening (LAFS%) is a widely used index of left atrial systolic function in cats that has been shown to predict development of hypertrophic cardiomyopathy (HCM) and cardiac mortality. It can be determined by two methods: from an M-mode right parasternal short-axis view (LAFS%RPSA-MM) or two-dimensional right parasternal long-axis four-chamber view (LAFS%RPLA-2D). We aimed to assess the agreement between LAFS%RPSA-MM and LAFS%RPLA-2D in cats and to evaluate the correlation between LAFS%RPSA-MM and LAFS%RPLA-2D and left ventricular systolic performance. Animals, materials, and methodsOne hundred and seventeen cats were enrolled in the study: 40 control, 41 HCM stage B (asymptomatic), and 36 HCM stage C (symptomatic) cats. This was a retrospective case–control study. Bland–Altman analysis was used to assess agreement between LAFS%RPSA-MM and LAFS%RPLA-2D across the whole cohort and in cats with asymptomatic and symptomatic HCM. Correlation analysis was used to assess associations between LAFS% methods and forward aortic flow, left ventricular fractional shortening, and aortic root motion. ResultsThe LAFS% determined by LAFS%RPSA-MM and LAFS%RPLA-2D was similar (P=0.8), but Bland–Altman analysis showed wide limits of agreement between methods. There was a good correlation between LAFS%RPSA-MM and LAFS%RPLA-2D and aortic root motion (r = 0.78 and r = 0.71, respectively) and a fair correlation with left ventricular fractional shortening (r = 0.31 and r = 0.29, respectively). None of the methods showed a correlation with indices of aortic flow. ConclusionsOur study suggests a poor agreement between LAFS%RPSA-MM and LAFS%RPLA-2D, and thus, these methods should not be used interchangeably. Both echocardiographic methods showed good correlation with aortic root motion.

The Myanmar Version of the Oswestry Disability Questionnaire: A Cross-Cultural Adaptation, Reliability and Validity Study in the Low Back Pain Population

Objective: To translate and cross-culturally adapt the Myanmar version of the Oswestry Disability Questionnaire (M-ODQ), and examine its reliability and validity in the low back pain (LBP) population. Material and Methods: The M-ODQ was cross-culturally adapted in accordance with the ISPOR guidelines for translation. Prefinal testing was done on 20 individuals with LBP, with minor changes. The test-retest reliability, internal consistency, concurrent and construct validity, plus ceiling and floor effects of the M-ODQ were conducted on 101 individuals with LBP, via calculating the intraclass correlation coefficient ICC(2,1), Cronbach’s alpha, and Spearman’s rank correlation coefficient by correlating with the Myanmar version of the Roland-Morris Disability Questionnaire (M-RMDQ), visual analogue scale (VAS), back performance scale (BPS), and the Stark quality of life (QoL) questionnaire. The level of significance was set at p-value&lt;0.05 for all statistical analyses.Results: The test-retest reliability and internal consistency of the M-ODQ showed an ICC(2,1) of 0.91 and a Cronbach’s alpha of 0.703, thus indicating that the M-ODQ had an acceptable level of reliability. A moderate correlation between the M-ODQ and M-RMDQ (rho=0.56); and fair correlation with the VAS (rho=0.253), BPS (rho=0.336), and the physical component of the Stark QoL questionnaire (rho= -0.274) were found. Weak or no correlation was demonstrated with the mental component of the Stark QoL questionnaire (rho= -0.204). No ceiling or floor effects of the M-ODQ occurred in this study. Conclusion: The M-ODQ is a reliable and valid outcome measure for assessing disability among LBP patients in the Myanmar population.

Transformation from hematoxylin-and-eosin staining to Ki-67 immunohistochemistry digital staining images using deep learning: experimental validation on the labeling index.

Endometrial cancer (EC) is one of the most common types of cancer affecting women. While the hematoxylin-and-eosin (H&E) staining remains the standard for histological analysis, the immunohistochemistry (IHC) method provides molecular-level visualizations. Our study proposes a digital staining method to generate the hematoxylin-3,3'-diaminobenzidine (H-DAB) IHC stain of Ki-67 for the whole slide image of the EC tumor from its H&E stain counterpart. We employed a color unmixing technique to yield stain density maps from the optical density (OD) of the stains and utilized the U-Net for end-to-end inference. The effectiveness of the proposed method was evaluated using the Pearson correlation between the digital and physical stain's labeling index (LI), a key metric indicating tumor proliferation. Two different cross-validation schemes were designed in our study: intraslide validation and cross-case validation (CCV). In the widely used intraslide scheme, the training and validation sets might include different regions from the same slide. The rigorous CCV validation scheme strictly prohibited any validation slide from contributing to training. The proposed method yielded a high-resolution digital stain with preserved histological features, indicating a reliable correlation with the physical stain in terms of the Ki-67 LI. In the intraslide scheme, using intraslide patches resulted in a biased accuracy (e.g., ) significantly higher than that of CCV. The CCV scheme retained a fair correlation (e.g., ) between the LIs calculated from the digital stain and its physical IHC counterpart. Inferring the OD of the IHC stain from that of the H&E stain enhanced the correlation metric, outperforming that of the baseline model using the RGB space. Our study revealed that molecule-level insights could be obtained from H&E images using deep learning. Furthermore, the improvement brought via OD inference indicated a possible method for creating more generalizable models for digital staining via per-stain analysis.

Disagreement of Rehabilitation Adherence Perceptions Among Athletic Trainers and Injured Collegiate Athletes

Collegiate athletic trainers continue to report adherence to physical rehabilitation programs to be a problem in collegiate athletics, as rehabilitation adherence among collegiate athletes can range between 40% and 90%. Inconsistent appropriate adherence to these programs may limit patients’ ability to successfully recover from their sports injuries. This study sought to understand if differences in perception of rehabilitation adherence existed between athletic trainers and collegiate athletes. A nonsignificant fair inverse correlation was found between the athletic trainer perceptions and patient self-perceptions of rehabilitation adherence after an examination of 19 separate physical rehabilitation programs led by 5 collegiate athletic trainers (R = −.48, p = .06). Given the found practitioner–patient disconnect, collegiate athletic trainers should consider further encouraging patient involvement within their rehabilitation programs through various tactics such as the use of patient-rated outcomes or conversations that minimize patient distress.

Urban diabetes: analysis of diabetes prevalence in cities of the Lombardy region participating in the cities changing diabetes project.

The urban population increases by about 60 million people/year. Urbanization, unhealthy lifestyle and aging of the population are reflected in a constant growth in the prevalence of diabetes. In 2014, Steno Diabetes Centre in Copenhagen, University College London and Novo Nordisk, launched the Cities Changing Diabetes® program with the aim of creating a unified movement that would stimulate policy-makers to prioritize urban diabetes. The socio-demographic data derive from (1) ISTAT (National Institute of Statistics of Italy), (2) ATS Metropolitan City of Milan, (3) ATS Val Padana-Cremona, (4) ATS Insubria-Varese, (5) The unemployment rates of the various municipalities have been extrapolated from an ISTAT-MEF elaboration published by Sole 24 Orejournal. In the different sanitary districts of the Metropolitan City of Milan, a strong linear correlation was found between the prevalence of diabetes and the prevalence of heart disease (R = 0.695, p < 0.001), as well as between the prevalence of diabetes and of nephropathies (R = 0.316, p < 0.001). The analysis concerning the province of Cremona showed a fair correlation between the prevalence of diabetes and cardiovascular disease (R = 0.658, p < 0.001). Even for the municipalities of Varese, the analysis documented a good correlation between the prevalence of diabetes and heart disease (R = 0.419, p < 0.001), but not between diabetes and nephropathies. Interesting differences in the relationship of diabetes prevalence with several diseases and socio-demographic factors have been found when comparing the metropolitan City of Milan with two smaller size cities as Varese and Cremona. Our present data confirm the hypothesis that urban diabetes will be the challenge for our society during the next decades.

The strength of balance: Strength and dynamic balance in children with and without hypermobility.

Generalized Joint hypermobility (GJH) is predominantly non-symptomatic. In fact, individuals with joint flexibility usually perform better than their non-hypermobile counterparts during physical activities. Notwithstanding, strength and balance are essential to maintain the control of the extra range of motion during activities and to prevent musculoskeletal complications. There are limited and conflicting pieces of evidence in literature regarding the association between strength and balance in children with GJH. The purpose of this study was to examine differences in functional strength, dynamic balance, proprioception, and isometric strength in children with and without joint hypermobility and determine the association between strength outcomes and dynamic balance. A cross-sectional study was conducted among children aged 6 to 11. Hypermobility was determined using the Beighton Score, with scores ≥6 representing hypermobility. Functional strength was assessed with the Functional Strength Measure (FSM), isometric strength was determined with a handheld dynamometer (HHD), the Y-Balance Test (YBT) was used to assess dynamic balance and the Wedges test to measure proprioception. This study included 588 participants (age: 7.97 ± 1.3 years; height: 128±10.1 cm; mass: 27.18 ± 7.98 kg). 402 children were classified as having normal mobility and 186 as being hypermobile. Hypermobile children had better functional strength in the lower extremities than children with normal range mobility but lower reach distance in the YBT. No differences in proprioception, functional strength of the upper extremity or isometric strength in the hands were found. However, isometric lower extremity force was less in hypermobile children than children with normal range mobility. Irrespective of their joint mobility, a fair significant correlation existed between total Y-balance distance and FSM items r = 0.16-0.37, p = 0.01. Correlations between total Y-balance distance and isometric strength of knee and ankle muscles ranged between r = 0.26-0.42, p = 0.001. Hypermobile joints seem to co-occur with lower extremity isometric strength, more functional strength in the lower extremities and less reaching distance in dynamic balance. The opposing direction of the results on functional and isometric strength tests highlights the importance of the type of outcome measures used to describe the association of strength and the range of motion.

Momentum transfer and foam production via breaking waves in hurricane conditions

Generated under hurricane conditions, a slip layer composed of foam, spray, bubble emulsion, etc. determines the behavior of surface drag with wind speed. This study estimates foam's contribution to this behavior. A logarithmic parametrization of surface drag is introduced, where the effective roughness length of the underlying surface is decomposed into three fractional roughness lengths. These correspond to the foam-free area (as determined by open-ocean data at low wind speeds and laboratory data at high wind speeds), which includes the effects of spray, bubble emulsion, etc., and ocean areas covered by whitecaps and streaks, each weighted by their respective coverage coefficients. A key concept of this approach is the use of well-established experimental bubble-size spectra produced by breaking surface waves to obtain the foam-produced effective roughness length. This method provides a fair correlation of the logarithmic parametrization of surface drag against wind speed with a wide class of experimental data. Additionally, this approach estimates the hurricane's potential intensity, demonstrating reasonable agreement with experimental findings.