Higher Severity Levels Research Articles

Characterizing mood disorders in the AFFECT study: a large, longitudinal, and phenotypically rich genetic cohort in the US

There has recently been marked progress in identifying genetic risk factors for major depression (MD) and bipolar disorder (BD); however, few systematic efforts have been made to elucidate heterogeneity that exists within and across these diagnostic taxa. The Affective disorders, Environment, and Cognitive Trait (AFFECT) study presents an opportunity to identify and associate the structure of cognition and symptom-level domains across the mood disorder spectrum in a prospective study from a diverse US population.Participants were recruited from the 23andMe, Inc research participant database and through social media; self-reported diagnosis of MD or BD by a medical professional and medication status data were used to enrich for mood-disorder cases. Remote assessments were used to acquire an extensive range of phenotypes, including mood state, transdiagnostic symptom severity, task-based measures of cognition, environmental exposures, personality traits. In this paper we describe the study design, and the demographic and clinical characteristics of the cohort. In addition we report genetic ancestry, SNP heritability, and genetic correlations with other large cohorts of mood disorders.A total of 48,467 participants were enrolled: 14,768 with MD, 9864 with BD, and 23,835 controls. Upon enrollment, 47% of participants with MD and 27% with BD indicated being in an active mood episode. Cases reported early ages of onset (mean = 13.2 and 14.3 years for MD and BD, respectively), and high levels of recurrence (78.6% and 84.9% with >5 episodes), psychotherapy, and psychotropic medication use. SNP heritability on the liability scale for the ascertained MD participants (0.19–0.21) was consistent with the high level of disease severity in this cohort, while BD heritability estimates (0.16–0.22) were comparable to reports in other large scale genomic studies of mood disorders. Genetic correlations between the AFFECT cohort and other large-scale cohorts were high for MD but not for BD. By incorporating transdiagnostic symptom assessments, repeated measures, and genomic data, the AFFECT study represents a unique resource for dissecting the structure of mood disorders across multiple levels of analysis. In addition, the fully remote nature of the study provides valuable insights for future virtual and decentralized clinical trials within mood disorders.

Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication.

Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N=271 children in mental health care, 8-18years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI=0.91; TLI=0.89; BIC=357.17; RMSEA=0.06; SRMR=0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.

DR-LL Gan: Diabetic Retinopathy Lesions Synthesis using Generative Adversarial Network

— Diabetic Retinopathy (DR) is a serious consequence of diabetes that seriously impact on the eyes and is a leading cause of blindness. If the lesions in DR arise in the central portion of the fundus, they may result in significant vision loss, which we refer to as Diabetic Macular Edema (DME). Deep learning (DL) techniques are commonly used utilized in ophthalmology for discriminative tasks such as diabetic retinopathy or age-related macular degeneration (AMD) diagnosis. Deep learning techniques typically need huge picture data sets for deep convolutional neural networks (DCNNs) training, it should be graded by human specialists. According to international protocol, it is classified into five severity categories. However, improving a grading model for high generality needs a significant quantity of balanced training data, which is challenging to obtain, especially at high levels of severity. Typical techniques for data augmentation, in many applications of deep learning in the retinal image processing domain, the difficulty of access to huge annotated datasets and legal concerns about patient privacy are limiting issues. As a result, the concept of creating synthetic retinal pictures that are indistinguishable from actual data has garnered more attention. GANs have been certain to be an effective framework for creating synthetic databases of anatomically accurate retinal fundus pictures. GANs, in particular, have garnered increasing attention in ophthalmology. in this article, we present a loss-less generative adversarial network (DR-LL GAN) to generate good resolution fundus pictures that May be adjusted to include random grading and information about the lesion. As a result, large-scale generated data may be used to train a DR grading and lesion segmentation model with more appropriate augmentation. Our model experiments evaluated on IDRID and MESSIDOR datasets, it's obtained a discrimination loss of 0.69374 and a generation loss of 1.10438, as well as a segmentation accuracy of 0.9840 in our tests. This might support in the optimization techniques of the neural network design and in computer-aided screening of medical picture, thus increasing diagnostic reliability for clinical assessment in the future of sophisticated technological healthcare.

Factors Affected Recovery Time Of Residents With Covid-19

Background: The massive spread of Covid-19 and made it a pandemic causing a lot of fear and anxiety among people around the world. Covid-19 has been a global disaster which has a high level of spread and severity since it is a contagious disease. The severity of this disease ranges from asymptomatic to severe with general symptoms of fever and cough and causing acute respiratory distress syndrome, especially in the elderly and people with comorbidity. Family support helps patients to meet their basic needs and can help to increase the spirit to recover which is one of the factors that accelerate the patient’s recovery process. 
 Methods: Population in this study consisted 660 residents who had confirmed Covid-19 and 109 samples were taken with purposive sampling technique appropriately to inclusion criteria. Independents variables in this study consisted of history of co-morbidities, knowledge, family support and motivation to recover. While the dependent variable is the healing time of Covid-19. The instrument of this study used a questionnaire sheet. This is a correlational study with cross sectional quantitative analytic. 
 Results: Bivariate analytic show that only family support variable has significant results with p value <0,05. Family support is the determinant factors with p value of 0,0017 compared with other factors such as comorbid, knowledge and motivation. 
 Conclusion: It can be conclude that family support is the determinant of recovery time of people affected by Covid-19. The most needed support for healing in the form of being sufficient and meeting the needs during ilness, both physically and psychologically.

A Novel Deep Learning Model for Detection of Severity Level of the Disease in Citrus Fruits

Citrus fruit diseases have an egregious impact on both the quality and quantity of the citrus fruit production and market. Automatic detection of severity is essential for the high-quality production of fruit. In the current work, a citrus fruit dataset is preprocessed by rescaling and establishing bounding boxes with labeled image software. Then, a selective search, which combines the capabilities of both an extensive search and graph-based segmentation, is applied. The proposed deep neural network (DNN) model is trained to detect targeted areas of the disease with its severity level using citrus fruits that have been labeled with the help of a domain expert with four severity levels (high, medium, low and healthy) as ground truth. Transfer learning using VGGNet is applied to implement a multi-classification framework for each class of severity. The model predicts the low severity level with 99% accuracy, and the high severity level with 98% accuracy. The model demonstrates 96% accuracy in detecting healthy conditions and 97% accuracy in detecting medium severity levels. The result of the work shows that the proposed approach is valid, and it is efficient for detecting citrus fruit disease at four levels of severity.

Responsiveness and other psychometric properties of the Yale-Brown Obsessive-Compulsive Scale Severity Scale-Second Edition in a Dutch clinical sample.

The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used clinician-rated interview to assess the presence and severity of obsessive-compulsive disorder (OCD). The scale is revised (Y-BOCS-II) to overcome several psychometric limitations, for example by extending the scoring for better discrimination within higher severity levels. The aim of the present study was to examine the responsiveness and other psychometric properties of the Y-BOCS-II Severity Scale in a Dutch clinical sample. The Y-BOCS-II is translated into Dutch and administered to 110 patients seeking therapy for OCD. This was done twice, before and after treatment. The original Y-BOCS was simultaneously rated. Self-report measures regarding depression, symptom severity and OCD symptoms were assessed. The Y-BOCS-II has a good internal consistency (Cronbach's α = 0.84), test-retest (intraclass correlation coefficient [ICC] = 0.89) and interrater reliability (ICC = 0.98). The construct validity proved to be modest to good. The responsiveness over time was in favour of the Y-BOCS-II, compared with the Y-BOCS-I, particularly in the moderate-severely affected OCD patients. The Y-BOCS-II Severity Scale is a reliable and valid instrument for accurately assessing the severity of OCD symptoms and for measuring treatment-induced change. This second version also has clinical and psychometric advantages over the Y-BOCS-I. When these findings are sufficiently replicated, use of the Y-BOCS-II as the new common standard seems recommendable.

Вплив організації дистанційного навчання на здоров’я вчителів

Objective: We studied the features of mental and somatic health of teachers in grades 1-11 during distance training, depending on the working load. Materials and methods: We analysed the results of the survey of 330 teachers (average age - 45.4 ± 0.6 years) at the implementation of distance training in connection with the COVID-19 pandemic in spring 2021.The questionnaire contained information on demographic and anthropometric data, features of education and direction of work, as well as data on self-assessment of health status on a scale from 1 to 5. To assess mental health, we used GAD-2 and PHQ-2 screening questionnaires. Results: During the distance training period, 88.5 ± 1.8% of the teachers conducted an average of 18.6 ± 0.4 online lessons a week. A working day of more than 8 hours was disclosed in 50.3 ± 2.8% of the teachers. 80.9 ± 22.2% of the respondents indicated that it was more difficult to check homework during distance training than during the regular training process. The proportion of the teachers who consider their health very bad and bad is by 7.5% higher (p <0.001) than the general population one, and the share of the teachers who consider their health good and very good, on the contrary, is significantly lower by 6, 7% (p < 0.05). The proportion of the people with depressive disorders was 28.2 ± 2.5%, with anxiety disorders - 30.6 ± 2.5%. An increase in the chances of developing depression among teachers is observed at a working day of more than 8 hours (OR = 1.65; CI 1.11-2.45), with more than 20 online lessons a week (OR = 1.06; CI 1.01 -1.12), with a high level of severity of the homework check (OR = 1.82; CI 1.11-3.00), when the working place is located at school, and not at home (OR = 2.60; CI 1, 16-5.84). The chances of anxiety disorders are increased with a working day duration of more than 8 hours (OR = 1.68; CI 1.14-2.47) and each additional lesson over 20 hours a week increases the chances by 8% (OR = 1.08; CI 1.02–1.13). Conclusions: Considering the above, it is necessary to optimize the distance training process, taking into account its health-preserving component for all participants in the educational process - teachers, students, and their parents.

A comparison of technicques to disimpact the fetal head on a second stage caesearean simulator

BackgroundThe rate of second stage caesarean section (CS) is rising with associated increases in maternal and neonatal morbidity, which may be related to impaction of the fetal head in the maternal pelvis. In the last 10 years, two devices have been developed to aid disimpaction and reduce these risks: the Fetal Pillow (FP) and the Tydeman Tube (TT). The aim of this study was to determine the distance of upward fetal head elevation achieved on a simulator for second stage CS using these two devices, compared to the established technique of per vaginum digital disimpaction by an assistant.MethodsWe measured elevation of the fetal head achieved with the two devices (TT and FP), compared to digital elevation, on a second stage Caesearean simulator (Desperate Debra ™ set at three levels of severity. Elevation was measured by both a single operator experienced with use of the TT and FP and also multiple assistants with no previous experience of using either device. All measurements were blindedResultsThe trained user achieved greater elevation of the fetal head at both moderate and high levels of severity with the TT (moderate: 30mm vs 12.5mm p<0.001; most severe: 25mm vs 10mm p<0.001) compared to digital elevation. The FP provided comparable elevation to digital at both settings (moderate: 10 vs 12.5mm p=0.149; severe 10 vs 10mm p=0.44).With untrained users, elevation was also significantly greater with the TT compared to digital elevation (20mm vs 10mm p<0.01). However digital disimpaction was significantly greater than the FP (10mm vs 0mm p<0.0001).ConclusionOn a simulator, with trained operators, the TT provided greater fetal head elevation than digital elevation and the FP. The FP achieved similar elevation to the digital technique, especially when the user was trained in the procedure.

Impacto de la salud oral en la calidad de vida de adultos paraguayos

Introduction: Alterations in the oral cavity can affect people’s quality of life, hence it is important to determine how the individual perceives their own health. Objective: To determine the oral health-related quality of life in adults who received dental care at establishments managed by the Ministry of Public Health and Social Welfare of Paraguay, the School of Dentistry of Universidad Nacional de Asunción, and the “Chacarita” Community Center, in Paraguay, in the first quarter of 2017. Material and Methods: A cross-sectional study was carried out. The Paraguayan version of the Oral Health Impact Profile (OHIP-14Py) was used. Spearman's correlation, Kruskal-Wallis, and Mann-Whitney tests were used to relate the impact of oral health with demographic, labor, educational, and clinical variables. Results: 333 subjects participated in the study. The most affected domains were physical pain, psychological distress, and psychological disability. The correlation between OHIP-14Py and DMF-T was positive but poor (r=0.236; p=&lt;0.001). The oral health-related quality of life was significantly lower in subjects with abnormal oral mucosa (p=0.020), presence of TMJ symptoms (p=0.026), need for prostheses (p&lt;0.001), higher level of severity of DMF-T (p&lt;0.001), use of upper (p=0.004) and lower (p&lt;0.001) prostheses, and absence of functional dentition (p&lt;0.001). Conclusion: Primary and secondary preventive measures should be promoted since oral health status can negatively influence people’s quality of life and may even cause total inability to carry out daily activities.

Frequency of dental caries in 1-5 years aged children and its impact on their quality of life

Oral diseases can vastly depreciate the individual’s quality of life. It has also been considered as the most important oral health burden worldwide. It can also have significant implications on the functional, mental, and social well-being of the individual. This has been found as a preventable dental and oral health issue which have also been amongst the most prevalent chronic disease. Objectives: To estimate the frequency of dental caries and its impact on the quality of children’s life in Hafiz- Abad, Pakistan. Methods: It was a cross sectional analytics based study spanning around nine months. Three hundred and seventy children (aged between 1-5 years) were included as subjects, who visited the District Headquarter (DHQ) hospital, Hafiz Abad, Lahore, Pakistan. Dental caries were measured by using decayed missing filled (DMF) index. Data was collected and analyzed by using SPSS version 23.0. Results: A high prevalence frequency of 243 (65.7%) were found suffering from dental caries. High prevalence of dental caries (70%) in children of low literate parents has been found statistically significant (p=0.035). As far as brushing frequency is concerned 93.8% children were not found brushing their teeth prior to breakfast. Theassociation between brushing frequency prior to breakfast and formation of dental caries was found statistically significant (p&lt;0.001). Conclusion:High prevalence of dental caries coupled with high severity level was found associated with the worse dental and oral hygiene awareness levels amongst the preschool children and their parents

Impact of early childhood caries severity on oral health-related quality of life among preschool children in Mexico: A cross-sectional study.

Information is scarce on Early Childhood Caries (ECC) in Mexican preschool children and its impact on quality of life. To evaluate the ECC prevalence and its impact on OHRQoL in 3-5years-old Mexican children according to disease severity. Caries was determined at two thresholds: (1) children with at least one caries lesion (ICDAS-1-6) and (2) children with at least one lesion in dentin (ICDAS-3-6). OHRQoL was assessed through the Mexican Early Childhood Oral Health Impact Scale (M-ECOHIS). Associations among caries severity, M-ECOHIS, and other variables were assessed by ordinal logistic regression. A total of 409 children participated (53.8% girls, 46.2% boys). Caries prevalence was 82.2% considering all lesions, and 45.0% for dentinal lesions. Significant linear trends (p<.05) among caries levels and categories of exposure were found for socioeconomic variables, dietary habits, and toothbrushing habits. Attending rural private schools (OR=1.39, 95%CI=1.11-1.72; p<.01), two main meals/day (OR=2.75, 95%CI=1.26-6.03; p=.01) and unsupervised toothbrushing (OR=3.20, 95%CI=1.96-5.24; p<.01) increased the risk to have high caries severity levels. M-ECOHIS scores were statistically significant associated with caries levels (χ2 (4) =175.85, p<.01; trend across groups z= 12.63 Prob > |z| < 0.01). M-ECOHIS was significantly associated with caries severity. Type of school, age groups, parents' educational level, family income, and living conditions were correlated with caries, showing how distinctive risk indicators were associated with different caries stages.

How the hospitality industry reacts to COVID-19: structural, managerial and tactical factors

This paper investigates hoteliers’ short-term recovery strategies during the pandemic. Stemming from management crisis theory and the resource-based view of the firm, this article focuses on two environments differently hit by COVID-19, i.e. London and Munich. The findings show that hotels with a more managerial approach have more proactively applied dynamic pricing strategies. When dealing with high severity levels of the pandemic, hoteliers make use of a more streamlined booking portfolio to cope with the crisis. We provide theoretical implications and actionable managerial levers for hoteliers and the wider pricing community on how to maximize revenues during the pandemic.

Relationships between Demographic Factors and Chronic Conditions with Disease Severities.

Disease severities are the outcomes of an inpatient visit classification that assigns a diagnostic related group, including risk of mortality and severity of illness. Although widely used in healthcare, the analysis of factors affecting disease severities has not been adequately studied. In this study, we analyze the relationships between demographics and chronic conditions and specify their influence on disease severities. Descriptive statistics are used to investigate the relationships and the prevalence of chronic conditions. To evaluate the influence of demographic factors and chronic conditions on disease severities, several multinomial logistic regression models are performed and prediction models for disease severities are conducted based on National Inpatient Sample data for 2016 provided by the Healthcare Cost and Utilization Project database in the United States. The rate of patients with a chronic illness is 88.9% and the rate of patients with more than two chronic conditions is 67.6%; further, the rate is 62.7% for females, 73.9% for males, and 90% for the elderly. A high level of disease severity commonly appears in patients with more than two chronic conditions, especially in the elderly. For patients without chronic conditions, disease severities show a lower or safe level, even in the elderly.

Soil Mesofauna Responses to Fire Severity in a Sclerophyllous Forest in Central Chile

Forest fires may have severe impacts on the aboveground biodiversity and soil chemical and biological properties. Edaphic organisms are highly sensitive to disturbances and are typically used to measure the magnitude of these events. Overall, little is known about the responses of these organisms to fires differing in their severity levels. This study aimed to assess the effect of fire severity on the soil mesofauna community diversity and structure in a site located in a Mediterranean zone of central Chile. In postfire conditions, we use spectral indexes from satellite images to map fire severity at four levels (non-damage (ND), low damage (L), medium damage (M), high damage (H)). Soil samples were collected at each severity level, and the mesofauna abundance was quantified. Although the metrics describing species diversity and dominance were similar among fire severity levels, the abundance and composition of the mesofauna were specifically altered at the high severity level. The edaphic mesofauna can be considered suitable bioindicators to evaluate the postfire ecosystem recovery, especially in the areas highly damaged by fire.

Impact of Covid-19 on incident reporting

BackgroundIncident reporting (IR) is a system of spontaneous and voluntary reporting of events, important for assessing safety risks and for improving safety and quality of care. Since Covid-19 pandemic led to a change on the hospital organization, related to an overload of work and an increase of pressure in the wards, this study aims to evaluate the impact of Covid-19 on IR and on safety culture.MethodsThis retrospective study analyzed the data of IR in 2019 and 2020 in the academic hospital of Udine. Number of IR, severity of the events (near miss, events with no harm and events with harm) and IR'S topic were compared. Inappropriate IR were excluded from severity analysis. The chi-square test was used for statistical significance.ResultsIR in 2020 showed a reduction of 17.7% compared to 2019 (1097 vs 1334, p < 0,05). Furthermore, we observed a reduction in near misses (276 vs 390, - 4,81%, p < 0,05) and an increase in events with harm (226 vs. 219, + 4,52%, p < 0,05). Events with no harm showed no significant increase. The analysis of topics revealed an increase in 2020 of problems concerning assessment of patient (+ 4.47%), especially swab's results delays, organizational aspects (+ 4.88%), due to staff reassignment and ward reorganization, and infection prevention and control (+ 4.65%). This increase is significantly associated with Covid-related IR (p < 0,05).ConclusionsIn 2020 were collected fewer IR than 2019 and with an higher level of severity. This change may be associated to the increased workload of the staff who had less time to report incidents. Nevertheless 2020 showed an increase in reporting Covid-19 related issues concerning delay of diagnostic test, new work condition and infection prevention and control measures. This analysis suggests that the decreased number of IRs and near miss during the first year of the pandemic could represent a reduction in safety culture. Additional data are needed.Key messages Covid-19 disease influenced the safety culture by reducing the number of IR and near misses reported.New Covid-related issues emerged as critical during the pandemic.

Depression and anxiety symptoms among Slovenian tertiary students during COVID-19 pandemic

BackgroundThe COVID-19 pandemic and the preventive measures associated with it radically affected educational processes in Slovenia. Schools were suspended and teaching was shifted to home-based distance learning models, with higher education institutions carrying this out for the longest period of time. The pandemic has also had an impact on mental health, and tertiary students seem to be particularly vulnerable.MethodsA cross-sectional internet survey was conducted in February and March 2021. The final sample consisted of 5999 respondents. The prevalence of depression and anxiety symptoms among Slovenian tertiary students was assessed using the Patient health questionnaire (PHQ-9) and the Generalized anxiety disorder questionnaire (GAD-7). Participants with and without more pronounced depressive and anxiety symptoms were dichotomized using a cut-off value of 10 points, with higher scores indicating higher presence of symptoms and categorized into 5 severity levels according to total scale scores. Suicidal ideation was examined using 9th item of the PHQ-9.ResultsData show that 55% of respondents reported having more pronounced depressive symptoms (PHQ-9≥10), with 16% reporting severe depressive symptoms. 5.1% of respondents reported having suicidal ideation more than half of the days and 5% reported having them almost every day. 51.3% of respondents reported having more pronounced anxiety symptoms (GAD -7≥10), with 30.7% reporting severe anxiety symptoms. Females reported more depressive and anxiety symptoms than males.ConclusionsThe results of the present study are to some extent consistent with the findings of comparable studies, but show higher proportions of depressive and anxiety symptoms with the highest severity levels. The data suggest that there is a case for tailored public health interventions that respond to the identified mental health needs of tertiary students in Slovenia.Key messages 55% of respondents reported having depressive symptoms (PHQ-9≥10), with 16% reporting severe depressive symptoms, and 10.1% reported frequent suicidal ideation.51.3% of the respondents reported having more pronounced anxiety symptoms (GAD -7≥10), with 30.7% reporting severe anxiety symptoms.

Does coronary calcium score add value to European SCORE in an asymptomatic population?

Abstract Background Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction in the asymptomatic population. Adding CAC score to European SCORE (Systematic Coronary Risk Evaluation) may improve the prediction of MACE (Major Adverse Cardiovascular Events), providing better cardiovascular risk stratification. Purpose Our study aims to evaluate the impact of CAC severity in MACE prediction compared with SCORE and estimate the additional value of CAC score in cardiovascular risk stratification in a low- risk region and asymptomatic population. Methods and results The study consisted of a prospective registry of 1110 asymptomatic individuals free of known coronary heart disease, enrolled from the GENEMACOR study and referred for computed tomography for the CAC scoring assessment. The mean age was 51.6±8.2 years, and 74.1% were male. This population was followed for a mean of 5.2±3.3 years for the primary endpoint of all-cause of cardiovascular events. The extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done using Hoff's nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC&amp;lt;100 and P&amp;lt;50); moderate CAC (100≤CAC&amp;lt;400 or P50–75) and high CAC (CAC≥400 or P&amp;gt;75). Through a Cox regression for MACE occurrence, SCORE does not remain in the equation, and the higher severity level of CAC presented a significant risk of MACE occurrence with an HR of 7.943 (95% CI 2.948 – 21.401; p&amp;lt;0.0001). Using the C-index, CAC was superior to SCORE (0.729 vs 0.615; p&amp;lt;0.0001). Adding CAC score to SCORE increased MACE prediction compared to SCORE alone (AUC 0.77 vs 0.615; p=0.003). Conclusion Our results point to the importance of the CAC score inclusion in primary prevention to improve cardiovascular risk stratification. CAC score in clinical practice could have a prognostic impact on MACE prediction. Larger prospective multicenter cohorts with longer follow-up should reproduce and validate these findings. Funding Acknowledgement Type of funding sources: None. Table 1

Is tank mixing site-specific premixes and multi-site fungicides effective and economic for managing soybean rust? a meta-analysis

Soybean rust (SBR), caused by Phakopsora pachyrhizi, is controlled with sequential applications of commercial premixes containing two and, more recently, three site-specific fungicides. However, their efficacy has been reduced due to the development of fungicide resistance in the fungal population; hence the use of multi-site fungicides in tank mixing has been encouraged. In this work we used data from 45 uniform fungicide trials conducted across eight Brazilian states during three crop seasons (2014/15, 2015/16, and 2017/18) to identify scenarios when the practice of adding multi-site fungicides in commercial premixes was both technical- and cost-effective. Premixes of quinone outside inhibitor (QoI) + demethylation inhibitors (DMI) or succinate dehydrogenase inhibitors (SDHI) were applied alone, or tank mixed with multi-site fungicides. Three premixes (PICOxystrobin + CYPRoconazole, PYRAclostrobin + FLUXapyroxad and AZOXystrobin + BENZovindiflupyr) were tank mixed with one of three multi-site fungicides (+MANCozeb, +COPpeR oxychloride, and +ChLORothalonil). The benefits from tank mixing a multi-site tended to be highest for the least effective premix. Improvements in control efficacy (C‾, percent point; p.p.) and yield response (D‾, kg/ha) ranged from 3 to 15 p.p. and 58–240 kg/ha, respectively. The improvements in C‾ and D‾ were affected by severity in the non-treated check; significantly higher improvements in D‾ were determined in trials experiencing high SBR severity levels (>80%). The economic analysis for scenarios of soybean price and multi-site costs showed that the addition of +MANC, given its lower price, was more likely to be profitable compared with +CLOR and +COPR, particularly when tank mixed with the least effective commercial premix.

Perbandingan Metode Evaluasi Usability Antara Heuristic Evaluation dan Cognitive Walkthrough

Usability evaluation is needed to identify and analyze usability problems in an application. This study will compare the results of usability evaluation with Heuristic Evaluation and Cognitive Walkthrough methods on the SIMRS Del Egov Center web from the aspects of usability problems found, the level of usability problems, and end user responses that will be evaluated using usability testing to find a more effective method of finding usability problems. Heuristic Evaluation will refer to the 10 heuristic principles proposed by Jacob Nielsen, while Cognitive Walkthrough, the expert will follow the task provided by the researcher. The results showed that the results of the evaluation conducted by Heuristic Evaluation found more usability problems in aspects: efficiency, memorability and satisfaction, while Cognitive Walktrough found more usability problems in aspects: learnability and error. In the severity rating aspect, Cognitive Walktrough is more effective in finding usability problems with a higher severity level, with an average of 3, while heuristic evaluation with an average of 2. In the aspect of end user responses to websites based on usability testing, Heuristic Evaluation has a SUS score which is higher at 57, while Cognitive Walktrough has an SUS score of 54.5. This shows that based on these three aspects, the Heuristic Evaluation method is better at finding usability problems in the SIMRS Del Egov Center application study object.&#x0D;

Health Beliefs in Association with Behaviors in Compliance with COVID-19 Public Health Guidelines: A Cross-sectional Study

ABSTRACT This study investigated the preventive health behaviors against the COVID-19 outbreak in Turkey according to the health belief model. The relationships between perceived susceptibility, severity, benefits, barriers, and preventive health behaviors were examined. 1401 participants consisting of 992 (70.8%) females and 409 (29.3%) males participated in an online survey. Independent groups t-test, hierarchical regression analysis and Process Macro were used for analyses. The findings showed that women perceived higher levels of severity of the disease and the benefits of preventive health behaviors than men. Men perceived more barriers to preventive health behaviors. The levels of anxiety and preventive health behaviors of women were higher than men. In regression analysis, male gender and perceived barriers were found as risk factors for preventive health behaviors. However, female gender, perceived severity, and benefits were protective factors for preventive health behaviors. People with low and moderate anxiety levels were more likely to comply with preventive health behaviors.