Kendall's Tau Research Articles

Validation of the Japanese version of the Clinical Frailty Scale.

Among the many screening tools developed to detect frailty and disability in older adults, the Clinical Frailty Scale (CFS) is a valid, reliable, and easy-to-use tool and has been translated into several languages. The aim of this study was to demonstrate the validity of the Japanese version of the CFS (CFS-J). The necessary permissions were obtained from Rockwood and colleagues. The Japanese version was prepared by translation (English to Japanese) and verified by back translation (Japanese to English). Concurrent criterion validity was assessed by evaluating the extent to which CFS relates to the Frailty Index (FI), the Frailty Index based on a Comprehensive Geriatric Assessment (FI-CGA), and Performance Status (PS), using Kendall's tau. In total, 223 patients admitted to the geriatric ward of an acute hospital between June 2021 and March 2023 were analyzed in the validation study. Mean age was 84.9 ± 5.9 years (range, 67-101 years), 128 (57.4%) were women, and the mean body mass index was 20.9 ± 4.0 kg/m2. In a correlation analysis, significantly positive associations were found between the CFS-J and the FI (r = 0.713, P < 0.001), the FI-CGA (r = 0.691, P < 0.001), and PS (r = 0.669, P < 0.001) for numerical variables. Significant positive associations were also found between the CFS-J and the FI (r = 0.567, P < 0.001) and the FI-CGA (r = 0.591, P < 0.001) for categorical valuables. The CFS-J was found to be a valid instrument for identifying frailty in Japanese inpatients. Geriatr Gerontol Int 2025; ••: ••-••.

A psychologically interpretable artificial intelligence framework for the screening of loneliness, depression, and anxiety.

Negative emotions such as loneliness, depression, and anxiety (LDA) are prevalent and pose significant challenges to emotional well-being. Traditional methods of assessing LDA, reliant on questionnaires, often face limitations because of participants' inability or potential bias. This study introduces emoLDAnet, an artificial intelligence (AI)-driven psychological framework that leverages video-recorded conversations to detect negative emotions through the analysis of facial expressions and physiological signals. We recruited 50 participants to undergo questionnaires and interviews, with their responses recorded on video. The emoLDAnet employs a combination of deep learning (e.g., VGG11) and machine learning (e.g., decision trees [DTs]) to identify emotional states. The emoLDAnet incorporates the OCC-PAD-LDA psychological transformation model, enhancing the interpretability of AI decisions by translating facial expressions into psychologically meaningful data. Results indicate that emoLDAnet achieves high detection rates for loneliness, depression, and anxiety, with F1-scores exceeding 80% and Kendall's correlation coefficients above 0.5, demonstrating strong agreement with traditional scales. The study underscores the importance of the OCC-PAD-LDA model in improving screening accuracy and the significant impact of machine learning classifiers on the framework's performance. The emoLDAnet has the potential to support large-scale emotional well-being early screening and contribute to the advancement of mental health care.

Surrogacy between pathological complete response and overall survival: An individual patient data analysis of eight RCTs on neoadjuvant treatment plus surgery for esophageal cancer.

498 Background: Overall survival (OS) is the gold standard endpoint of treatment efficacy but requires an extended follow-up period. This study aimed to determine the validity of pathological complete response (pCR) as a surrogate endpoint for OS. Methods: The individual-level surrogacy between categorical outcome and OS was assessed using Kendall correlation coefficient, τ. Because no method has been reported to estimate τ between categorical variables and OS, we proposed the new method using an inverse probability of censoring weighting (IPCW) estimator adjusted for tied data that occur when applied to categorical outcomes. To evaluate the validity of this new method, we conducted simulations to compare its estimation accuracy with existing methods. A systematic review for all phase III RCTs comparing therapies in perioperative settings for resectable advanced esophageal and gastroesophageal junction cancer was performed and individual patient data (IPD) were requested from all included trials. Finally, surrogacy between pCR and OS was assessed using our proposed method. Results: Across all scenarios with varying τ values, sample sizes, and censoring proportions, the proposed method showed the lowest bias compared to the existing statistical methods. In total, 23 eligible trials were identified and IPD were available from eight RCTs (JCOG1109, JCOG9907, JCOG9204, FFCD9901, FFCD9102, SAKK75/08, CROSS, and KOK), including 1688 patients who received neoadjuvant therapy. For trial-level analysis, pCR showed a strong correlation with a determination of correlation of 0.65 when limited to neoadjuvant chemotherapy (NAC) trials. For individual-level analysis, in patients who received NAC, the hazard ratio (HR) for OS of pCR was 0.25 (95% CI: 0.13 - 0.47), and τ between OS and pCR was 0.225. While in patients who received neoadjuvant chemoradiotherapy (NACRT), the HR was 0.54 (95% CI: 0.45 - 0.66), and τ was 0.189. Additionally, τ between OS and pathological grade (pGrade), OS and tumor regression grade (TRG) was 0.196 and 0.143, respectively. As a reference, hypothetical data showed that in order to achieve a τ of 0.8 between pCR and OS, it is necessary to be able to clearly identify the prognosis to the extent that an HR of 0.09 (95% CI: 0.08 - 0.11) can be obtained. Conclusions: While pCR is sensitive enough to stratify prognosis and exhibit strong trial-level surrogacy, no individual-level surrogacy was demonstrated, making them insufficient to replace OS. It should be noted that there are substantial differences in prognostic stratification and potential use of pCR as primary endpoints in clinical trials.

366. Antibiotic Stewardship Program Improved the Susceptibility of Commonly Seen Gram-negative Bacilli Over 12 Years at Singapore General Hospital

Abstract Background Antibiotic stewardship program (ASP) is advocated in all healthcare institutions to combat rising bacteria resistance. In 2008, ASP was established at Singapore General Hospital, with strategies focused on promoting appropriate use of anti-pseudomonal agents at first and expanding to ceftriaxone in 2015. Strategies include: 1) prospective audit feedback (PAF); 2) antibiotic guidelines; 3) digital solutions (computerized decision support system &amp; mobile application); and 4) physician education [Figure 1]. In this study, we aim to evaluate the susceptibility rates of common gram-negative bacilli (GNB) and appropriate antibiotic use over time with ASP implementation.Figure 1:Antibiotic stewardship strategies implemented at Singapore General Hospital from 2008 to 2023 Methods We conducted an observational study from 2011 to 2023. Kendall’s tau coefficient (τ) was used to correlate the trend of bacteria susceptibility and percentage of appropriate antibiotic use with time. Susceptibility results of E.coli (EC), Klebsiella species (excluding Klebsiella aerogenes), Pseudomonas aeruginosa (PA) and Acinetobacter baumannii (AB) towards ceftriaxone (CRO), co-amoxiclav (AMC), piperacillin-tazobactam (PT), ertapenem (ERT) and meropenem (MEM), where applicable, was established based on breakpoints by Clinical and Laboratory Standards Institute. Percentage of appropriate MEM, ERT and PT use were derived from hospital-wide PAF.Figure 2:Trends of antibiotic susceptibility of E. coli, Klebsiella spp., Ps. aeruginosa and A. baumannii at Singapore General Hospital (2011-2023) Results Susceptibility of EC and Klebsiella spp. towards CRO, AMC, PT, ERT and MEM have significantly increased over time (p &amp;lt; 0.05). Susceptibility of PA and AB towards MEM have also significantly increased (p &amp;lt; 0.05) [Figure 2, 3]. Notably, % of appropriate MEM and ERT use from 2011 to 2023 have significantly improved from 72.7% to 85.9% (τ= 0692, p &amp;lt; 0.05) and 75.9% to 92.0% (τ= 0.72, p &amp;lt; 0.05) respectively [Figure 4]. Percentage of appropriate PT use from 2013 to 2023 increased from 72% to 80.4% (τ= 0.055, p= 0.815).Figure 3:12- year trend of the susceptibility of Gram-negative bacilli towards commonly used broad-spectrum antibiotics from 2011 to 2023 Conclusion ASP is pertinent in promoting appropriate antibiotic use through multi-pronged approaches. Importantly, ASP’s goal of improving susceptibility of common GNB towards several broad-spectrum antibiotics was achieved. With increasing appropriate carbapenem use reaching a saturable stage, ASP must remain adaptable and design innovative strategies to expand its reach to even narrower spectrum antibiotics.Figure 4:Percentage of appropriate use of ertapenem, meropenem, and piperacillin-tazobactam over time Disclosures All Authors: No reported disclosures

Ultrasound Predicts Drug-Induced Sleep Endoscopy Findings Using Machine Learning Models.

Ultrasound is a promising low-risk imaging modality that can provide objective airway measurements that may circumvent limitations of drug-induced sleep endoscopy (DISE). This study was devised to identify ultrasound-derived anatomical measurements that could accurately predict collapse pattern and location based on the VOTE criteria (VOTE: Velum, Oropharynx, Tongue, and Epiglottis). Ultrasonography was performed on 20 adult patients of various airway subsites while awake and sedated with concurrent endoscopy performed during drug-induced sleep. Measurements were obtained from the ultrasonographic images, and percent collapse (Pc) was estimated then graded using a standard VOTE score. Generalized Least Squares regression (GLS) was used to establish models predictive of Pc on a continuous scale, while multiple machine learning (ML) models were trained to predict each VOTE score (binary, >50% collapse) from ultrasound measurements. Measurements of multiple ultrasonographic airway subsites demonstrated associations with endoscopic collapse using Kendall Tau correlation. The GLS models showed moderate to strong correlation between multiple ultrasound features and Pc (R2 adj 0.53-0.82) across all VOTE subsites. ML models accurately predicted binarized VOTE scores from ultrasound measurements in four out of five VOTE subsites (F1 score >0.65), while the VOTE subsite with the most accurately predicted collapse was lateral velum collapse with an F1 score of 0.93 averaged across all models. Ultrasound is a reliable imaging modality and can identify features of airway collapse during drug-induced sleep. Regression (GLS) and ML models show promise in predicting severity of collapse during DISE with analysis of airway ultrasonographic measurements. 3 Laryngoscope, 2025.

The Analysis of Hydrometeorological Characteristics in the Yarlung Tsangpo River Basin

Understanding the hydrometeorological processes of the Yarlung Tsangpo River Basin, located on the “Third Pole” Qinghai–Tibet Plateau, is crucial for effective water resource management and climate change adaptation. This study provides a comprehensive analysis of the basin’s hydrometeorological characteristics using long-term observational data from six representative stations across the upper, middle, and lower reaches. We examined trends, periodicity, variability, and correlations of key elements—precipitation, temperature, evaporation, and discharge—employing methods such as linear regression, Mann–Kendall tests, wavelet analysis, and Kendall rank correlation coefficient tests. The results indicated that precipitation and discharge exhibited non-significant upward trends, with fluctuations across decades, while temperature showed a significant increase of 0.39 °C per decade, surpassing the national and global rates. Evaporation generally decreased with increasing precipitation; however, at Lazi Station, evaporation significantly increased due to low precipitation and rising temperatures causing decreased relative humidity. Periodic analysis revealed cycles at multiple temporal scales, particularly at 2–5 years, 10 years, and over 20 years. Correlation analysis demonstrated a strong positive relationship between precipitation and discharge, and a negative correlation between evaporation and discharge. The hydrometeorological characteristics are significantly influenced by climatic factors, especially precipitation and temperature, with the warming trend potentially affecting water’s availability and distribution. These findings offer valuable insights for water resource management and highlight the need for continuous monitoring to understand hydrological responses to climatic and anthropogenic changes in this critical region.

"Utility of PET/CT with [18F] F-fluorocholine in assessing the response to antiandrogenic therapy in patients with prostate cancer."

To evaluate the correlation between response assessment measured by PET/CT with [18F] F-fluorocholine (Choline PET/CT) and serum levels of PSA in patients with prostate cancer under antiandrogenic treatment. A retrospective study included patients with CRPC and CSPC treated with enzalutamide, abiraterone, or apalutamide between June 2018 and July 2021, who underwent baseline and a follow-up Choline PET/CT. The difference in maximum SUVmax (ΔSUV) between both studies and the PSA value before and at follow-up were recorded. The response to treatment was compared by PSA vs. PET, assessing their association, agreement, and correlation. Thirty patients were included (median age 74 years, range 68-78), 12 with CSPC and 18 with CRPC; 22 had nodal disease, and 15 had active bone disease. The average time between pre-treatment and follow-up PET/CT was 11 months (range 3.5-23). Patients with extra-nodal metastatic disease at the beginning of treatment showed a higher correlation between PSA and ΔSUV (OR 4.375). In patients with bone disease at the start of treatment, 80% were classified as non-responders on PET response assessment, while only 40% were non-responders by PSA. The correlation between PET and PSA was mild (Kendall's tau_b 0.26), and the classification into Responders/Non-responders had only slight agreement (Cohen's kappa 0.30). Choline PET/CT shows low concordance with the PSA values obtained during the follow-up of response to anti-androgen therapy, especially in patients with bone involvement.

Three-dimensional complementary breast ultrasound (3D CBUS): Improving 3D spatial resolution uniformity with orthogonal images.

With increasing evidence supporting three-dimensional (3D) automated breast (AB) ultrasound (US) for supplemental screening of breast cancer in increased-risk populations, including those with dense breasts and in limited-resource settings, there is an interest in developing more robust, cost-effective, and high-resolution 3DUS imaging techniques. Compared with specialized ABUS systems, our previously developed point-of-care 3D ABUS system addresses these needs and is compatible with any conventional US transducer, which offers a cost-effective solution and improved availability in clinical practice. While conventional US transducers have high in-plane resolution (axial and lateral), their out-of-plane resolution is constrained by the poor intrinsic elevational US resolution. Consequently, any oblique view plane in an acquired 3DUS image will contain high in-plane and poor out-of-plane resolution components, diminishing spatial resolution uniformity and overall diagnostic utility. To develop and validate a novel 3D complementary breast ultrasound (CBUS) approach to improve 3DUS spatial resolution uniformity using a conventional US transducer by acquiring and generating orthogonal 3DUS images. We previously developed a cost-effective, portable, dedicated 3D ABUS system consisting of a wearable base, a compression assembly, and a mechanically driven scanner for automated 3DUS image acquisition, compatible with any commercial linear US transducer. For this system, we have proposed 3D CBUS approach which involves acquiring and registering orthogonal 3DUS images ( and ) with an aim of overcoming the poor resolution uniformity in the scanning direction in 3D US images. The voxel intensity values in the 3D CBUS image are computed with a spherical-weighted algorithm from the original orthogonal 3DUS images. Experimental validation was performed with 2DUS frame densities of 2, 4, 6 frames mm-1 using an agar-based phantom with a speed of sound of 1540 ms-1 and an embedded nylon bead. Lateral and axial full-width at half-maximum (FWHMLAT and FWHMAX) values were calculated from cross-sections taken at polar view planes ranging from 0° to 90° for 3DUS and 3D CBUS images of a bead phantom in focal zone and far field regions. Kendall's Tau-b correlation coefficients were calculated between FWHM measurements and cross-section angle for all frame density settings at a significance level of . Volumetric 3D segmentations were performed for 3DUS and 3D CBUS images of an inclusion phantom to confirm volumetric reconstruction accuracy. For statistical analysis, a repeated measures ANOVA with the Greenhouse-Geisser correction was performed at a significance level of . Experimental validation of the orthogonal 3DUS images show complementary trends of increasing and decreasing FWHMLAT from in-plane to out-of-plane (0° and 90° and vice versa) views. This is exemplified with the scan taken at 4 frames mm-1 in the focal zone, where FWHMLAT ranges from 3.51 to 1.10 mm for and 1.02-3.02 mm for , spanning 0°-90°, respectively. When combined in the 3D CBUS image, the FWHMLAT exhibits greater uniformity across view angles by mitigating poor out-of-plane resolution using its complementary in-plane component, with corresponding FWHMLAT values of 1.27 and 1.46 mm. While visual enhancements were seen in the 3D CBUS image, no statistically significant differences were found in volumetric measurements of the spherical inclusions in the 3DUS and 3D CBUS images. The out-of-plane resolution in the orthogonal 3DUS images is improved upon their combination into a single 3D CBUS image. These results demonstrate that the proposed 3D CBUS generation approach can improve 3D spatial resolution uniformity, while employing a commercial US transducer. The proposed 3D CBUS method shows potential utility for improving image resolution uniformity in 3D ABUS images, with the goal of improving point-of-care breast cancer supplemental screening and diagnostic applications, particularly in women with dense breasts and limited resource settings.

Small-area and socially differentiated analyses of the utilization of screening examinations in the city of Hamburg: a secondary data analysis

Social reporting in Hamburg identifies existing inequalities at the urban area level. These social-contextual variations may potentially influence preventive health behaviors. The aim of this article is to examine correlations between the degree of social regional disadvantage of Hamburg's population and the utilization of regular screening examinations for children, adolescents, and adults through small-area analysis. The analyses are based on claims data from 2017 of insured individuals living in Hamburg from three cooperating statutory health insurance funds. A socially contextual indicator (1 = "very low" to 7 = "high") was assigned to the data at urban area level. Based on this, binary correlations between the social indicator and calculated utilization rates (stratified by gender and age) of early detection examinations were examined using Kendall's tau correlation analysis. The study population included N = 433,053 individuals (53.7 % female) from the city of Hamburg. Strong positive associations were found between utilization rates and social contextual index classes for U7 to U9 examinations (r > 0.7; p-values < 0.05) as well as cervical cancer screening (r > 0.9; p-values = 0.002), indicating that utilization increases with the rising social status of the urban area level. Additionally, strong positive correlations can be observed in some subgroups for prostate cancer screening (> 59 years: r = 0.905, p-value = 0.004) and colorectal cancer screening (women aged 50-60 years: r = 0.905, p-value = 0.004). No significant correlations were found for other subgroups, as well as for skin cancer screening, breast cancer screening and the J1 examination (p-value > 0.05). Strong negative associations have only been detected for the general health check-up for individuals aged 35 to 59 (women: r = -0.810, p-value = 0.011; men: r = -0.714, p-value = 0.024). The results indicate inequalities in the use of early detection examinations provided by statutory health insurers for children and adults to the disadvantage of urban areas ranking lower in social status. This socially selective utilization may lead to an accumulation of health problems in urban areas that are already disadvantaged socially, which would result in an exacerbation of existing social and health inequalities. Small-scale and socially differentiated analyses of healthcare provision should be seen as a regular component of regional healthcare provision. They provide starting points for a more needs-oriented further development of the healthcare system and secondary prevention services.

Accuracy of the strengths and difficulties questionnaire in identifying common mental health disorders in children and adolescents: a cross-sectional analytical study

Background and aimThis cross-sectional analytic study, conducted in the Child and Adolescent Mental Health (CAMH) Clinic of Sultan Qaboos University Hospital (SQUH) for 12 months, aimed to evaluate the precision of the Strengths and Difficulties Questionnaire (SDQ) in identifying hyperactivity disorder (ADHD), conduct problems, and emotional difficulties in children and adolescents in an Arab-speaking population.MethodThe study involved 139 participants aged 4 to 17 years drawn from new referrals to CAMH services. SDQ scores were compared with the gold standard clinical diagnosis obtained through diagnostic interviews based on the Diagnostic and Statistical Manual of Mental Disorders criteria. The predictive accuracy of SDQ subscales for attention deficit hyperactivity disorder (ADHD) and emotional difficulties was evaluated using Kendall's tau-b.ResultThe results indicated moderate agreement for emotional problems (Kendall's tau b 0.265; p < 0.001) and between moderate and strong agreement for hyperactivity problems (Kendall's tau b 0.351; p < 0.001). Screening efficiency indices, including sensitivity and positive predictive values, varied between the two disorders (sensitivity: 56–80%; positive predictive values: 40% to 56%).ConclusionThe study underscores the importance of understanding the strengths and limitations of SDQ in clinical settings, providing valuable information for mental health assessments in children and adolescents.

APAKAH BEBAN KERJA MENTAL BERHUBUNGAN DENGAN TINGKAT KECEMASAN PADA KARYAWAN BANDARA?

Anxiety was the anticipation of future danger accompanied by feelings of dysphoria and somatic symptoms. Anxiety often occured in employees within the early adults (ages 26-35). Risk factors of anxiety in employees included genetics, social and family environmental factors, and mental workload. The impact of mental workload on employees could affect mental health, specifically the level of anxiety, that could implicate the job performance. The aim of this study was to assess the relationship between gender, age, and mental workload with the anxiety levels of airport employees. The design of the study was observational analytic cross-sectional approach. A sample size of 125 subjects were obtained through cluster random sampling. Primary data was collected using the HARS and NASA-TLX questionnaires. Data were analyzed with SPSS using the Kolmogorov-Smirnov and Kendall's Tau tests. There were 69 male employees and 53 individuals were in the early adulthood (26-35 years). For mental workload, 51 employees had a slightly high workload and 47 employees had severe anxiety.The bivariate analysis indicated that there was no relationship between gender and anxiety levels (p=0.709) as well as age and anxiety levels (p=0.142). However, there was a relationship between mental workload and anxiety levels (p=0.005). Mental workload is related with anxiety levels in airport workers.

Associations of Essential and Non-Essential Trace Elements' Levels in the Blood, Serum, and Urine in Women with Premature Ovarian Insufficiency.

Premature ovarian insufficiency (POI) is poorly understood, with causes identified in only 25% of cases. Emerging evidence suggests links between trace elements (TEs) and POI. This study is the first to compare concentrations of manganese (Mn), copper (Cu), zinc (Zn), selenium (Se), molybdenum (Mo), arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) across urine, serum, and whole blood in women with POI compared to healthy controls (HC), aiming to explore their distribution and potential associations with POI. This cross-sectional-case-control study enrolled 81 participants (40 POI patients and 41 healthy controls) at the University Medical Centre Ljubljana, Slovenia. Blood and urine samples were collected to quantify basic biochemical parameters using standard clinical chemistry methods and concentrations of Mn, Cu, Zn, Se, Mo, As, Cd, Hg, and Pb using inductively coupled plasma-mass spectrometry (ICP-MS). Participants also completed questionnaires on socio-demographics, medical history, lifestyle, and nutrition. Data was analyzed using the Mann-Whitney U test, Student's t-tests, Fisher exact test, logistic regression models adjusted on body mass index (BMI), age, hematocrit, and Kendall's tau correlation. Women with POI had significantly higher BMI and red blood cell (RBC) indices, including hemoglobin, hematocrit, and red cell distribution width (RDW), compared to controls. A larger proportion of POI patients resided in rural agricultural areas. Liver and kidney function assessments showed no significant differences between the groups. Adjusted models revealed that POI patients had significantly lower urinary levels of Cu, Zn, Se, Mo, Cd, Hg, and Pb than controls, while whole blood Mn levels were higher. Serum Cu levels were significantly elevated in POI patients, whereas Pb, Cd, and Hg were lower. No significant differences were observed for As. Correlation analysis showed several strong to moderate associations among TEs across biofluids, but only weak correlations were found between TEs and demographic or biochemical factors. This study suggests potential associations between TEs and POI in women. Notably, most TEs (Zn, Se, Cu, Mo, Cd, Hg, Pb) were significantly lower in the urine of the POI group, while Cu, Cd, Hg, and Pb showed significant differences in both urine and serum.

Balancing Performance and Health in Elite Hungarian Athletes: The Relationship Among Disordered Eating Risk, Body Composition, and Nutrition Knowledge.

disordered eating (DE) and eating disorders (ED) can negatively impact athletes' health, wellbeing, and athletic performance. this cross-sectional study aims to assess DE risk, body composition, and nutrition knowledge among elite Hungarian athletes. DE risk was assessed using DESA-6H and EAT-26 scales, nutrition knowledge through the Abridged Nutrition for Sport Knowledge Questionnaire (A-NSKQ), and body composition with the OMRON BF511 device. The data were analyzed using Kendall's tau correlations, Mann-Whitney U tests, and ROC analysis. a total of 71 athletes participated (39.4% males, mean age = 24.8 years, SD = 4.8 years and 60.6% females, mean age = 24.3 years, SD = 4.3 years). At-risk scores on the DESA-6H scale were recorded for nine athletes (12.7%), while 32.4% scored in the risk zone on the EAT-26, with female athletes in aesthetic, endurance and weight-dependent sports being most affected. Low BF was observed in four males and four females. Nutrition knowledge (49.1%) was below the acceptable threshold. DESA-6H significantly correlated with EAT-26 scores, BMI, sports nutrition knowledge, and A-NSKQ total scores. A statistically significant difference by gender was found in the EAT-26 total score (p = 0.019, d = 0.65). Risk groups significantly differed in A-NSKQ scores (p = 0.026, d = 0.511) and sport nutrition knowledge, specifically (p = 0.016, d = 0.491). Using EAT-26 to identify at-risk athletes and the DESA-6H recommended cut-off, the ROC analysis showed a sensitivity of 29.1% and a specificity of 95.7%. insufficient nutrition knowledge plays a role in being at-risk for DE and ED. These results underscore the need for early detection, early sport nutrition education across all elite athletes, with particular attention to female athletes in aesthetic, endurance and weight-dependent sports, and for monitoring these athletes to prevent DE. Further work is warranted to optimize screening tools such as EAT-26 and DESA-6H for elite athletes.

Higher anxiety levels negatively correlated with of sleep quality persons with hemodialysis; A cross-sectional study

Haemodialysis is the commonest form of kidney replacement therapy in the world. Physical deterioration and psychological such as anxiety is common problem in this therapy. In addition, quality of sleep is important for this vulnerable population. Nurses have an important role in reduce anxiety and increasing quality of sleep, however there is little known in Indonesian sample. To determine the correlation between anxiety level and sleep quality persons with haemodialysis. Quantitative research-cross-sectional study approach. Two hundred and thirty-four respondents participated in this study. The Pittsburgh Sleep Quality Questionnaire (PSQI) and The Hamilton Anxiety Rating Scale (HARS) Indonesia version questionnaires were administered in this study. Kendall Tau data analysis technique was used in this study. Significant correlation between anxiety and sleep quality in persons with haemodialysis (p=0.001; r=0.640). Higher anxiety levels negatively correlated with of sleep quality persons with haemodialysis. Managing anxiety could potentially improve the sleep quality of persons with haemodialysis. Assessment and, nursing intervention strategy for manage persons with haemodialysis’ anxiety level are needed. Identify the predictor factor of anxiety in this population are recommended for future work.

Sex-related functional outcome after periacetabular osteotomy in mild to severe hip dysplasia.

Periacetabular osteotomy (PAO) is well established for acetabular reorientation and has shown successful improvement in patient-reported outcome measures (PROMs). Nevertheless, studies focusing on postoperative outcomes related to patient individual factors are still underrepresented. Therefore, this study aimed to analyze the functional outcome and activity level in relation to patient sex with a minimum follow-up of two years after PAO for mild to severe hip dysplasia. A single-centre study was conducted, enrolling patients undergoing PAO and completing a preoperative and postoperative radiological and clinical outcome assessment. The PROMs were assessed using the modified Harris Hip Score (mHHS), the Hip disability and Osteoarthritis Outcome Score (HOOS) with the subscales for pain, sport, activities of daily living (ADL), and quality of life (QoL), and the University of California, Los Angeles (UCLA) activity score. Kendall's tau were calculated for correlation analyses. In total, 145 patients (28 male, 117 female) were included. The PROMs improved significantly across males and females at the latest follow-up. Female patients had significantly lower preoperative PROMs: mHHS (47 vs 57.4; p = 0.002); HOOS pain (44.9 vs 60; p = 0.003), sport (47 vs 57.4; p = 0.002), ADL (58.9 vs 69.3; p = 0.032), and QoL (26.8 vs 39.3; p = 0.009); and UCLA (5.6 vs 6.7, p = 0.042) scores. Males showed higher postoperative UCLA scores (7.5 vs 6.7; p = 0.03). Kendall's tau showed significant negative correlation between BMI and UCLA scores in females and males (-0.21 to -0.29; p = 0.002/0.048), while BMI and HOOS sport (-0.16; p = 0.015) and ADL (-0.2; p = 0.003), as well as QoL (-0.14; p = 0.031) and preoperative acetabular inclination (-0.13; p = 0.049) were only significantly negatively correlated in females. Patient sex affects PROMs before and after PAO. Female patients experience higher improvement in hip function and activity level, due to poorer preoperative PROMs than males. Thus, these data are particularly interesting in providing preoperative guidance regarding postoperative outcome expectations.

Correlation between oral health knowledge and awareness and periodontal status in non-syndromic cleft lip and palate patients undergoing orthodontic treatment: a cross-sectional study

Introduction: Children and adolescents with non-syndromic cleft lip and palate (CLP) experience a higher prevalence of caries and periodontal disease compared to those without CLP. This increased prevalence is often attributed to greater plaque accumulation, which can lead to gingival inflammation and periodontal disease. This study aims to analyze the correlation between oral health knowledge and awareness and the periodontal health status of orthodontic patients with cleft lip and palate (CLP).Method: This study used a cross-sectional approach. The study population consisted of orthodontic patients with non-syndromic CLP who met the inclusion criteria. The research was conducted at the UNPAD Dental Teaching Hospital (RSGM Unpad) from March to May 2024. Twenty-seven participants with non-syndromic CLP were included in the study. A non-probability, purposive sampling technique was employed. oral health knowledge and awareness were assessed using questionnaires, while periodontal health examinations were evaluated using the Community Periodontal Index (CPI). Correlation analyses were performed using Kendall's Concordance Correlation (W). Additionally, Spearman Rank Correlation Analysis was conducted to identify the dominant variables. Results: The analysis revealed a Kendall's Concordance Correlation (W) of 0.544, which is statistically significant (p &lt; 0.0001), indicating a 54.4% relationship between the variables. The correlation between knowledge and periodontal health status in orthodontic patients with non-syndromic CLP was 11.16%, with a p-value of 0.0443 (p &lt; 0.05) and an r-value of 0.33. The correlation between awareness of oral health and periodontal health status in these patients was 19.85%, with a p-value of 0.0099 (p&lt;0.05) and an r-value of 0.45. Conclusion: There is a weak correlation between knowledge and awareness of oral health and the periodontal health status in non-syndromic CLP patients undergoing fixed orthodontic treatment.

Midwives' experiences of receiving maternity care and predictors of their overall birth experiences.

Limited research has been conducted on midwives' experiences of receiving maternity care. Midwives may bring a degree of their own personal lives to their work, including their own birthing experience. To explore midwives' experiences of giving birth and receiving maternity care and predictors of overall birth experience. Midwives who, after completing their midwifery education, experienced their first birth within the Australian maternity care system, were female, over the age of 18, and fluent in English. Data from an online national survey were analysed using descriptive statistics, multiple regression analysis, and Kendall's tau correlation studies. In total, 447 midwives' responses were included. Overall, 85 % of midwives reported positive birth experiences, 12.5 % a negative or traumatic birth experience, and 2.5 % neither positive nor negative. Five significant predictors of overall birth experience were: having a normal vaginal birth, maternity care providers who instilled a sense of confidence in their professional competence, receiving the maternity care options of their choice, being able to use professional knowledge to question and negotiate with care providers, and having control over their care. Overall, 27.1 % of midwives reported feeling coerced at any one or more points of time. Satisfaction with postnatal care was most strongly correlated with overall birth experience. Midwives appear to experience birth as an overall positive experience, and this could be due to their high level of agency and autonomy in choosing a known and trusted individual care provider; however, knowledge of possible complications could explain high levels of reported coercion. Midwives may need to invest more in getting good postnatal support in place, as this appeared to have the greatest impact on their overall birth experience.

Patient-Reported Fatigue Associated with Joint Histopathology in Rheumatoid Arthritis.

Fatigue is important for patients with rheumatoid arthritis (RA) but is poorly understood. We sought to study associations of fatigue with clinical features, disease activity, and synovial histology. Patients meeting the American College of Rheumatology/EULAR 1987 and/or 2010 RA criteria were recruited before elective total joint replacement. Demographics, RA characteristics, tender and swollen joints, erythrocyte sedimentation rate (ESR) and C-reactive protein, and patient-reported fatigue, categorized as mild, moderate, or severe, were collected. Hematoxylin and eosin stains of sectioned synovium were systematically scored by a pathologist. Relationships between fatigue and studied variables were evaluated with Kendall's tau. A directed acyclic graph (DAG) was used to illustrate associations of exposures, outcome variables, mediators, and confounders. Multivariable ordered logistic regression was used to further study associations. Of 160 included patients, 85.6% were women, with a median age of 63.5 (55.25-71.40) and mean disease activity scores in 28 joints using ESR (DAS28-ESR) of 3.91 (SD 1.3). There were no differences in comorbidities across fatigue categories. Fatigue correlated with DAS28-ESR, synovial lining hyperplasia (SLH), anxiety, depression, and pain. In the DAG, DAS28-ESR was associated with fatigue, full mediation by pain, partial mediation by depression and anxiety, and confounding by female sex. SLH was independently associated with fatigue but did not confound the relationship between DAS28-ESR and fatigue. SLH was affected by synovial lymphocytic inflammation. In multivariable models, female sex, DAS28-ESR, and SLH were all associated with higher fatigue. Although fatigue is associated with DAS28-ESR, it is also associated with SLH independently of disease activity.

Breaking ICD Codes: Identifying Ambiguous Respiratory Infection Codes via Regional Diagnosis Heterogeneity.

We aimed to analyze regional variations in the assignment of International Classification of Diseases, 10th Revision (ICD-10) codes to acute respiratory infections, seeking to identify notable anomalies that suggest diverse diagnoses of the same condition. We analyzed national weekly diagnosis data for acute respiratory infections (ICD-10 codes J00-J22) in Poland from 2010 to 2019, covering all 380 county-equivalent administrative regions and encompassing 292 million consultations. Data were aggregated into age brackets. We calculated the Kendall tau correlations between shares of particular diagnoses. We found staggering differences across regions in applied diagnoses that persisted even after disaggregating the data into age groups. The differences did not seem to stem from different levels of health care use, as there was no consistent pattern suggesting variability in milder diagnoses. Instead, there were numerous pairs of strongly negatively correlated codes implying classification ambiguity, with the most problematic diagnosis being J06 (acute upper respiratory infections of multiple and unspecified sites), which was used almost interchangeably with a diverse range of others, especially J00 (common cold) and J20 (bronchitis). To the best of our knowledge, this is the first study using observable anomalies to analyze regional coding variability for the same respiratory infection. Although some of these discrepancies may raise concerns about misdiagnosis, the majority of cases involving interchangeably used codes did not seem to substantially impact treatment or prognosis. This suggests that ICD codes may have clinical ambiguities and could face challenges not only in fulfilling their intended purpose of generating internationally comparable health data but also in their use for comprehensive government health planning.

INTRA-ORGANIZATIONAL KNOWLEDGE SHARING AND INNOVATION OF POLISH ENTERPRISES

Knowledge sharing plays a key role in the effectiveness of the knowledge management process and contributes to improving the efficiency and stimulating the innovation of enterprises. Knowledge sharing is an important process that affects the improvement of innovation both at the organizational and individual level. However, the SME sector shows limitations in the intra-organizational knowledge sharing process, which may adversely affect the innovativeness of these entities. The main research objective is to identify the level of intra-organizational knowledge sharing in Polish SME enterprises and to diagnose the impact of knowledge sharing on the innovativeness of these enterprises. For the purposes of achieving the main objective and verifying the research hypotheses, a survey was conducted on a group of 355 micro, small and medium-sized enterprises in the Silesian Voivodeship. Statistical analysis was conducted using descriptive statistics and the Kendall tau correlation coefficient and showed a positive relationship between the level of knowledge sharing and the innovativeness of SMEs. However, it was not possible to confirm the increasing scope of knowledge sharing with the increase in the size of the enterprise.