Kruskal-Wallis Research Articles

Closing the distance gap: Evaluating patient travel distances in a community oncology practice.

157 Background: Patient travel distance is an important factor influencing healthcare access, health equity and outcomes. The Rural-Urban Commuting Area (RUCA) classification system categorizes geographic areas based on urbanization and commuting patterns to measure accessibility to healthcare. We study the relationship between RUCA and patient travel distance for a multi-site community-based, medical oncology practice in north-west Chicagoland area. Methods: Using patient ZIP code data and practice locations (clinics) from April 2023 to March 2024, we calculated and compared the straight-line, one-way, patient-clinic travel distance (travel distance) for about 20,000 patients at 5 clinics, using geospatial analysis techniques. We grouped clinics based on location and population characteristics, applied the RUCA classification to patient ZIP codes, and compared travel distances by RUCA categories. Results: The median travel distance for patients was 5.0 miles, with 82% of patients traveling 10 miles or less, and 89% traveling 15 miles or less. Table 1 shows % of patients traveling and travel distance by RUCA categories. Median travel distances for urban metro, suburban metro, and suburban small-town clinics were 4.8mi, 10.8mi and 20.6mi (Kruskal Wallis H-test, p <0.001). Within 50 miles of each clinic, median travel distance for patients from urban ZIP codes (4.8 mi) was lower compared to metropolitan, micropolitan, small town and all other RUCA categories. Conclusions: Preliminary findings indicate a significant association between RUCA and travel distance, with longer travel distances for patients in non-urban locales. Proximity of cancer care sites to the patient’s home reduces distance traveled, minimizing the burden on the patients and their families. Interventions addressing transportation needs (such as improving infrastructure, increasing transportation options, subsidizing healthcare travel, etc.) can be augmented with efforts to strengthen access to community-based sites (expansion of telehealth, incentivizing providers serving non-urban areas, etc.) to reduce patient and caregiver burden. Clinic Site Category % of patients traveling <5 mi <10mi <15mi <50mi >50mi A Suburban Metro 53.8% 30.7% 5.2% 9.1% 0.9% B Suburban Small Town 24.1% 40.6% 21.9% 12.3% 0.4% C Suburban Metro 45.7% 34.3% 5.01% 13.8% 1.0% D Suburban Metro 60.1% 23.9% 6.8% 7.9% 1.2% E Urban Metro 80.3% 9.7% 3.5% 5.2% 1.0% ALL SITES 54.7% 27.1% 7.2% 9.8% 0.9% Clinic Median travel distance in miles (% of patients) by patient RUCA within 50 miles of clinics Urban Metropolitan – High Commute Micropolitan – Flow to Large Urban Cluster Small Town – Flow to Small Urban Cluster All Other A 4.8 (98.2%) 27.5 (1.7%) 48.7 49.4 B 4.0 (42.3%) 8.6 (54.2%) 25.0 20.6 (3.2%) C 5.9 (95.2%) 17.7 (4.5%) 36.7 27.7 D 4.8 (97.1%) 23.7 (2.8%) 48.4 40.1 E 2.7 (98.9%) 32.3 (1.0%) 4.5 ALL 4.8 (91.2%) 10.8 (8.3%) 36.7 (0.1%) 20.6 (0.4%) 4.5

Journey towards equity: Unveiling the relationship between patient travel distance and social vulnerability among patients with cancer.

158 Background: Patient travel distance is a significant barrier to accessing high-quality cancer care, impacting patient outcomes. Factors such as geographic location, transportation infrastructure, and socio-economic status contribute to variations in patient travel distance. The relationship between patient travel distance and the area deprivation index (ADI), a measure of socioeconomic disadvantage (based on income, education, employment, and housing quality) and social vulnerability of neighborhoods developed by the Health Resources & Services Administration (HRSA), remains largely unexplored. This abstract seeks to unveil the intricate relationship between patient travel distance and ADI, shedding light on the impact of social vulnerability on cancer care access. Methods: Using patient ZIP code data and practice location data from April 2023 to March 2024, we calculated the straight-line, one-way, patient-clinic travel distance (travel distance). We then derived the ADI for patient ZIP codes using geospatial mapping techniques and compared travel distances by area deprivation vulnerability categories. Results: While analyzing geographic data for 20,000 patients at 5 locations, we observed that 89% of patients traveled 15 miles or less one-way to reach the practice location, with a median travel distance of 5 miles. Median travel distance in miles for patients within 15 miles of each practice location by ADI vulnerability category is provided (Table). Median travel distances between ADI categories were statistically significant (Kruskal Wallis H-test, p <0.001). Patients from the most disadvantaged neighborhoods generally travel longer distances to access cancer care. Conclusions: Patients in socially vulnerable locales generally travel longer distances to access cancer care. By considering the ADI alongside patient travel distance, healthcare providers and policymakers can understand barriers faced by disadvantaged populations and allocate resources to reduce disparities in access to care. Targeted interventions and policies, like improving transportation services/infrastructure, empowering community-based care locations, and expanding telehealth, are necessary to address travel distance disparities for vulnerable populations. The effects of increased travel distance on timely access to care, treatment adherence, health outcomes, finances, caregivers, and patient satisfaction warrant further investigation. Location Site Category Within 15 miles of the practice location % of patients Median travel distance (in miles) by overall ADI vulnerability Highest (8, 9, 10 ADI Rank) Mid High (5, 6, 7 ADI Rank) Low (1, 2, 3, 4 ADI Rank) A Suburban Metro 89.8% 13.5 2.2 4.7 B Suburban Small Town 86.7% 12.5 13.03 8.5 C Suburban Metro 85.1% 14.9 9.4 5.9 D Suburban Metro 90.9% 12.9 9.6 4.7 E Urban Metro 93.6% 12.9 4.8 2.7 ALL 89% 12.5 6.3 5.0

Maxillary intaglio surface of CNC milled versus 3D printed complete denture bases – an in vitro investigation of the accuracy of seven systems.

The accuracy of the intaglio surface of maxillary complete dentures produced with a variety of digital manufacturing systems have been comprehensively investigated, however, not for multiple systems in the same study. This in vitro study endeavors to measure and compare the accuracy of the intaglio surface of maxillary complete denture bases constructed with different photopolymerization-based 3D printing and CNC milling systems. Two subtractive manufacturing machines and five additive manufacturing machines were used to manufacture a maxillary denture bases (n=10) for analysis. The samples were stored in artificial saliva at 37°C for 7 days to mimic intraoral use before they were air dried for 5 min, and then scanned with an E3 dental laboratory scanner to generate STL files. A 3D metrology software program was used to analyze the data against the original CAD design. Statistical differences were determined with 1-way analysis of variance (ANOVA) and the Kruskal Wallis test (α=.05). Color deviation heat maps were used to interpret areas of clinical significance. The results indicated that the subtractive manufacturing method delivers the truest and most precise intaglio surface of maxillary complete denture bases. The additive manufacturing technique delivers less true and less precise results with inconsistency observed between the different systems as opposed to the subtractive manufacturing groups which showed no significant differences. When manufacturing a complete maxillary denture base subtractive manufacturing will deliver the most consistent and true results.

Quantitative analysis of antibacterial efficacy of herbal irrigants against endodontic microflora – A clinical study

Abstract Aims: The study aimed to assess the antimicrobial effectiveness of green tea and neem extract compared to sodium hypochlorite (NaOCl) against various root canal microorganisms. Materials and Methods: Thirty patients with pulpal necrosis were selected, providing 60 samples before and after irrigation. Groups were assigned as follows: Group A: 3% NaOCl (control), Group B: green tea, and Group C: neem extract. Samples were collected before and after irrigation in two phases. Samples were collected maintaining a strict sterile condition and stored in buffer solution at −80°C for bacterial-load measurement through real-time Polymerase chain reaction (PCR). Statistical analysis included within-group comparisons using Wilcoxon’s test and the paired t-test and inter-group comparisons using the Kruskal–Wallis test with post hoc Dunn’s test and one-way analysis of variance with post hoc Tukey’s honestly significant difference test (P ≤ 0.05). Results: While no irrigant achieved complete bacterial eradication, all solutions exhibited significant antimicrobial activity postirrigation. NaOCl yielded the most effective results, with green tea nearly comparable, and neem extract demonstrating the lowest efficacy. Conclusions: Herbal irrigants, particularly green tea, can serve as effective alternatives to chemical solutions. However, neem extract proved less effective than both green tea and NaOCl, indicating its inferiority in root canal disinfection.

Accelerating access: The power of gold carding in reducing treatment delays.

114 Background: Delays in time to treatment initiation (TTI) for cancer patients have been shown to impact survival/mortality/outcomes, and cause patient distress. The process of obtaining prior authorizations (PA) often leads to significant treatment delays, affecting patient outcomes and posing administrative challenges for healthcare providers. PAs have become a ubiquitous part of modern healthcare, aimed at ensuring appropriate utilization of medical treatments and reducing costs. In recent years, the concept of gold carding (GC), a practice where payers waive PA on services and prescription drugs ordered by providers with a proven track record of PA approvals based on guideline concordance or pathway adherence, has gained attention as a potential solution to provide administrative relief to all stakeholders affected by the PA process. This abstract seeks to explore the impact of GC on TTI for a large multi-site community-based oncology practice in The US Oncology Network having a GC contract with a regional payer. Methods: Using administrative claims data from 2021 to 2023, we derived a population of cancer patients who initiated chemotherapy as their first treatment, calculated the TTI (time from the date of first consultation to the date of treatment initiation), and compared TTI between GC and non-GC patients. Results: The average TTI for 4,836 patients that met the inclusion criteria was 26.3 days. Patients initiating therapy under a GC eligible payer coverage started therapy 4.5 days earlier (22.13 days vs 26.68 days, p<0.00001, Kruskal–Wallis test). 80% of GC eligible patients started their treatment within 30 days of their initial consultation. Conclusions: The findings indicate that gold carding has the potential to expedite the time to treatment initiation for cancer patients. Further research is needed to quantify the cost savings, patient and provider satisfaction, and other intangible benefits from GC. Gold carding offers a viable approach to balance guideline concordant care with lowering administrative burden. We enthusiastically support legislative reforms that encourage gold carding and selectively implement prior authorization requirements based on stratification of health care providers’ performance and adherence to evidence-based medicine. Patient Count Average TTI (days) GC 401 22.13 Commercial 217 21.13 Managed Medicare 184 23.32 Non-GC 4435 26.68 Commercial 1610 25.41 Managed Medicare 1405 27.37 Medicare 959 26.48 Managed Medicaid 254 29.06 Medicaid 112 29.54 All Other 95 30.15

Antibacterial efficacy of carnosic acid as an intracanal medicament against Enterococcus faecalis: Quantitative polymerase chain reaction study

Abstract Aim: The aim of this study was to quantitatively assess the antibacterial effectiveness of carnosic acid, propolis, and calcium hydroxide when used as intracanal medications against Enterococcus faecalis. Methodology: Forty-six human mandibular single-rooted premolar root lengths were standardized to 12 mm after decoronation. Cleaning and shaping were performed. The specimens were placed in Eppendorf Tubes and autoclaved. E. faecalis was inoculated into the canals and incubated for 21 days. The teeth were categorized into four groups: I - carnosic acid, II - propolis, III - calcium hydroxide, and IV - nonmedicated group. The medicaments were applied to the root canals and incubated for 14 days. The DNA extraction of E. faecalis was obtained from dentinal shavings harvested at 400-μm depth and a real-time quantitative polymerase chain reaction was performed. Statistical Analysis: Data were analyzed using the Kruskal–Wallis test and Dunn’s intergroup comparison test in SPSS software. Results: E. faecalis present were 4.14, 6.98, 3.80, and 56.84 mean copies/μl in groups I, III, III, and IV, respectively. A significant difference in antibacterial efficacy was observed between medicated and untreated control groups. However, no statistically significant differences were observed among the groups treated with different medicaments. Conclusion: Carnosic acid has promising antibacterial activity against E. faecalis when used as an intracanal medicament.

Multi-center study on sellar reconstruction after endoscopic transsphenoidal pituitary surgery.

Surgical techniques for sellar reconstruction include no reconstruction, use of synthetic materials, autologous grafts, and/or vascularized flaps. The aim of this study was to conduct a multi-center study comparing the efficacy and postoperative morbidity associated with different sellar reconstruction techniques. A retrospective chart review of patients who underwent endoscopic transsphenoidal surgery for pituitary tumors from five participating sites between January 2021 and March 2023 was performed. The variables included demographics, tumor characteristics, reconstruction technique, postoperative cerebrospinal fluid leak (CSF) leak, and 22-item Sino-Nasal Outcome Test (SNOT-22) scores. Comparisons of postoperative complications, SNOT-22 scores, and duration of surgery by type of onlay reconstruction were evaluated using Fisher's exact test, analysis of variance, and Kruskal‒Wallis test. Five hundred and one patients were identified. The median tumor size was 2.1cm, and 64% were non-functioning. Intraoperative CSF leak was identified in 38% of patients. A total of 89% of patients underwent onlay reconstruction: 49% were reconstructed with mucosal grafts, 35% with nasoseptal flaps, and 5% with other onlay techniques. Nasoseptal flaps were utilized more frequently in the setting of giant pituitary adenomas (>3cm), medial cavernous sinus wall resection, and high-flow intraoperative CSF leaks. Cases who utilized mucosal grafts had an overall shorter operating time (median: 183 min vs. 240 min; p<0.001). Five postoperative CSF leaks were identified, and therefore, statistical analysis could not be performed for this complication. The effectiveness and morbidity of different sellar reconstruction techniques are comparable. Vascularized flaps were utilized more frequently in the setting of larger tumors and high-flow intraoperative CSF leaks.

Role of interleukin 6 polymorphism and inflammatory markers in outcome of pediatric Covid- 19 patients

BackgroundIL-6 polymorphisms were associated to viral infection outcomes through affection of IL-6 production and it is an early indicator of tissue injury and systemic inflammatory response. The study aimed to determine whether genetic IL-6 polymorphisms, serum interleukin-6 level and inflammatory markers (Presepsin, CXCL-10, C3, and C4) are associated with the prediction of disease severity in pediatric COVID-19 patients and its possible use as a prognostic tool in pediatric patients admitted to hospital.MethodsThis prospective cohort study was conducted on 150 children with COVID-19. Patients were divided according to the severity of infection into four groups: group I (mild) 67 cases; group II (moderate) 53 cases, group III (severe) 17 cases and group IV (critical) 14 cases. Serum Interleukin 6, CXCL-10, Presepsin, renal and liver functions, electrolytes, C3, C4, ferritin, and D dimer serum levels were assessed in all patients. The Kruskal Wallis test used to compare parametric quantitative data between studied groups and Mann Whitney test for each pair of groups. Non-parametric quantitative data was compared between studied groups using a one-way ANOVA test and post-hoc Bonferroni analysis for each pair of groups.ResultsGroup I: 35 males and 32 females with a median age of 16 months. Group II: 17 males and 35 females with a median age of 13 months. Group III: 6 males and 11 females with a median age of 12 months and group IV: 3 males and 11 females with a median age of 12 months. There was no statistical difference between the studied groups regarding gender and age. Serum levels of IL- 6, serum ferritin; D-dimer, Presepsin and CXCL 10 were significantly higher in both severe and critical groups than the other 2 groups (mild and moderate). ROC curve analysis showed that interleukin-6 and Presepsin were good markers for prediction of severity of COVID-19 among the diseased children. For severe cases, the sensitivity of interleukin-6 was 76.47% and specificity was 92.31%. For critical cases, the sensitivity of interleukin-6 was 71.43% and specificity was 82.35%. The sensitivity of Presepsin was 76.47% and specificity was 88.46% in severe cases. For critical cases, the sensitivity of Presepsin was 78.57% and specificity of 91.2%. There was significant difference in IL-6 572 allelic among moderate cases with the most frequent 42.3% for genotype (GC) and allelic among severe cases with the most frequent 47.1% for genotype (GC). Significant difference in IL-6 174 allelic among critical cases with the most frequent 78.6% for genotype (CC).ConclusionsChildren whom expressed GC genotypes of IL6 (-572G > C) polymorphism are at a considerably higher risk of developing a severe disease. This risk is significantly larger in the severe group of children than in children in critical condition who have GC genotypes of IL6 (-174 G > C) polymorphism. While IL6 (-597G > A) polymorphism has no role in COVID 19 severity in children.

Dynamic water‐quality responses to wildfire in Colorado

AbstractIn 2020, Colorado experienced the most severe wildfire season in recorded history, with wildfires burning 625 357 acres across the state. Two of the largest fires burned parts of Rocky Mountain National Park (RMNP), and a study was initiated to address concerns about potential effects on drinking water quality from mobilization of ash and sediment. The study took advantage of a wealth of pre‐fire data from adjacent burned and unburned basins in western RMNP. Pre‐ and post‐fire data collection included discrete sample collection and high‐frequency water‐quality measurements using in‐stream sensors. Kruskal–Wallis tests on discrete data indicated that specific conductance, base cations, sulphate, chloride, nitrate, and total dissolved nitrogen concentrations increased post‐fire, whereas silica and dissolved organic carbon (DOC) did not (p ≤ 0.05). In‐stream sensors captured large spikes in concentrations of nutrients, turbidity, and DOC in the burned basin that were missed by discrete sampling. Sensor data indicated nitrate and turbidity increased by up to one and two orders of magnitude, respectively, from pre‐event concentrations during storms, and DOC increased up to 3.5×. Empirical regression equations were developed using pre‐fire data and applied to the post‐fire period to estimate expected stream chemistry in the absence of fire (a ‘no‐fire’ scenario). Overlays of actual post‐fire chemistry showed the timing and magnitude of differences between observed and ‘estimated’ chemistry. For most solutes, observed post‐fire concentrations were notably greater than expected under the ‘no‐fire’ scenario, and differences were greatest during storm events. Comparison of data from the burned and unburned basins indicated DOC concentrations were affected by climate as well as fire. Results from this study demonstrate the importance of both pre‐fire data and high‐frequency data for characterizing dynamic hydrochemical responses in wildfire‐affected areas.

Application of HPLC Coupled with a Charged Aerosol Detector to the Evaluation of Fructose, Glucose, Sucrose, and Inositol Levels in Fruit Juices, Energy Drinks, Sports Drinks, and Soft Drinks

The study aimed to estimate the levels of fructose, glucose, sucrose, and inositol levels in sweetened beverages with a newly developed method using HPLC coupled with a charged aerosol detector (CAD). In total, 85 commercially available non-alcoholic beverages, including 18 energy drinks, 8 sports drinks, 15 soft drinks, 14 fruit drinks, 7 fruit nectars, and 22 fruit juices were analyzed by HPLC-CAD. The method was validated, and it was characterized by a wide concentration range (1–150 µg/mL), sensitivity, and good accuracy (94.9–103%). The results showed significant variation in fructose, glucose, and sucrose concentrations in energy drinks, sports drinks, soft drinks, fruit drinks, fruit nectars, and juice. The highest total sugar contents (fructose, glucose, sucrose, and inositol) were found in energy drinks (14.2 g/100 mL), followed by fruit nectars (13.7 g/100 mL) and soft drinks (12.7 g/100 mL). Statistical analysis (Spearman correlation test, Kruskal–Wallis test) of the data showed significant relationships between particular sugars in the analyzed products.

Evaluation of Quality of Life, Health Belief Model and Insomnia in Obese and Overweight Individuals: A Cross- Sectional Study

Purpose: This study was conducted to evaluate the quality of life, insomnia severity and approaches according to the health belief model of obese and overweight individuals who applied to the dietician polyclinic of the district health directorate in a district of Istanbul. Methods: This cross-sectional study was conducted between September 2022 and March 2023 among 300 obese and overweight individuals aged above 18 who applied to the dietician polyclinic of the district health directorate in a district of Istanbul. In the survey, insomnia severity index, quality of life short form and health belief model scale were used. To compare variables, Chi-Square test, Mann Whitney U and Kruskal Wallis tests were used for statistical analysis of the data. p

Improving the quality and guideline concordance of multidisciplinary gastric cancer care in a safety net hospital.

314 Background: Gastric cancer is a leading cause of cancer death worldwide and disproportionally affects people of East Asian and Latin American ethnicities. This study aimed to implement and evaluate an intervention to improve the quality and guideline concordance of multidisciplinary gastric cancer care at a public safety net hospital, Zuckerberg San Francisco General Hospital (ZSFG). Methods: A quality improvement (QI) intervention was developed and evaluated by pre-post comparison of clinical data. (1) An in-depth chart review of all patients with gastric adenocarcinoma in 2017-2019 (n=17) evaluated concordance with evidence-based guidelines and quality metrics. (2) Multidisciplinary meetings identified barriers to high quality care and established targets for improvement. (3) A clinical algorithm tailored for ZSFG was disseminated to standardize gastric cancer management. (4) A post-intervention chart review was conducted of all patients from 2021-2022 (n=22). (5) Descriptive statistics and pre-post comparison of QI metrics with Chi square and Kruskal Wallis tests were performed. Results: Pre-intervention clinical data and multidisciplinary input identified gaps in care: variation in provider knowledge and practices, rapidly evolving guidelines, limited access to advanced diagnostic modalities, and non-standardized surgical documentation. After implementation of a standardized approach to address these gaps, pre-post improvement was seen in rates of tumor board presentation (36.3% vs. 85.7%, P= 0.033), use of endoscopic ultrasound (9.09% vs. 64.2%, P= 0.017), pre-treatment nodal staging (27.2% vs. 78.5%, P= 0.030), receipt of neoadjuvant chemotherapy (20% vs. 80%, P=0.007 ), documentation of lymphadenectomy type (25% vs. 100%, P= 0.015), and a trend toward reduced time to PET/CT scan (median, 8.5 weeks pre vs 7.1 weeks post, P= 0.268). Conclusions: A QI intervention was successfully implemented to standardize gastric cancer care at ZSFG. Significant improvements were seen in all targeted metrics except time to outside PET scan. Potential confounders affecting pre-post care quality included personnel changes in a small workforce and the COVID-19 pandemic. Nevertheless, our intervention led to sustained improvements in practice patterns. We aim to replicate this success with other malignancies. Category Pre-Intervention Target Post-Intervention P value* Tumor Board% cM0 cases presented 36% (n=11) &gt;90% 86% (n=14) 0.033 Endoscopic ultrasound (EUS)% cM0 cases referred for clinical staging 9% (n=11) &gt;90% 64% (n=14) 0.017 Nodal staging (with EUS or PET) 27% (n=11) N/A 79% (n=14) 0.030 Receipt of neoadjuvant chemotherapy% eligible patients 20% (n=10) &gt;80% 80% (n=10) 0.007 Surgery documentationLymphadenectomy type (i.e., D1 or D2) 25% (n=8) 100% 100% (n=7) 0.015 Time from diagnosis to PET/CT (median) 8.5 wks &lt;5 wks 7.1 wks 0.268 *Chi square test, Kruskal-Wallis test.

Using CT features of cystic airspace to predict lung adenocarcinoma invasiveness.

Lung adenocarcinoma associated with cystic airspace (LACA) was once considered an uncommon manifestation of lung adenocarcinoma (LUAD), and understandings of it are limited; however, it is being observed more frequently in clinical practice. This study sought to assess the prevalence of LACA, and compare the high-resolution computed tomography (HRCT) features of LACA in patients with varying degrees of invasiveness. This study retrospectively reviewed the HRCT scans of 1,525 patients with LUAD ≤3 cm in diameter at the Shanghai Chest Hospital between January 2016 and May 2016. Each nodule was examined to detect the presence of cystic airspace. Additionally, we analyzed the qualitative HRCT findings of the cystic airspaces, including the pattern, number, wall component density, distribution, inner surface, mural nodules, septa, and vessels passing through the cystic airspace using the Pearson χ2 test or Fisher's exact test as appropriate. We also analyzed the quantitative measurements, such as the cystic airspace diameter, wall thickness, and thin-wall proportion, using a one-way analysis of variance or the Kruskal-Wallis rank-sum test as appropriate. LACAs were observed on HRCT in 11.5% (176/1,525) of the patients, of whom 7.1% (36/505) had pure ground-glass nodules, 13.5% (112/830) had mixed ground-glass nodules, and 14.7% (28/190) had solid nodules (P=0.001). The surgical procedures for LACAs varied (P=0.012). The incidence of LACAs increased as nodule diameter and invasiveness increased (both P<0.001). Statistically significant differences were observed in the wall component density, distribution, septa, vessels passing through the cystic airspace, cystic airspace diameter, wall thickness, and thin-wall proportion among the preinvasive lesion (PL), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) groups (P<0.001, P=0.024, P=0.001, P=0.025, P=0.001, P<0.001, and P<0.001, respectively). Wall component density increased as invasiveness increased (P<0.001). Unlike those in the MIAs and IACs, cystic airspaces in PLs typically lacked septa (P=0.001, and P<0.001, respectively). The IACs had larger cystic airspace diameters than the PLs (6.5 vs. 3.7 mm) (P<0.001). The IACs also had thicker wall thickness (11.8 vs. 6.8 mm, 11.8 vs. 8.3 mm) (P<0.001, and P<0.001, respectively) and smaller thin-wall proportions (181.5° vs. 264.8°, 181.5° vs. 223.8°) (P<0.001, and P=0.039, respectively) than the PLs and MIAs. The prevalence and characteristics of cystic airspaces on HRCT can be used to predict invasiveness in patients with LUADs ≤3 cm in diameter.

A Picture Paints a Thousand Words: Perspectives of the Use of Images and Videos of Physical Findings in Virtual OSCE Teaching Sessions.

The COVID-19 pandemic has resulted in medical students' education being disrupted and a new direction of learning towards the online classroom, with students frequently learning to identify clinical signs via online conferencing platforms. Given this shift in student study techniques in the pandemic and post-pandemic era, we set out to analyse the confidence levels of students recognizing clinical signs in patients and the opinions and patterns of resources students would use to build up the knowledge and confidence for their future clinical practice. OSCEazy, a student-led medical education organisation, delivered an online teaching session and disseminated a questionnaire containing ten-point Likert scales, multiple-choice questions and free text options. The majority (over 75%) of respondents reported using digital resources to learn physical examinations. Most respondents were somewhat confident with recognising clinical signs during physical examinations (Median 7, IQR 6-8). Kruskal-Wallis H-test on students' impression of the quality of current OSCE materials showed a statistically significant difference between cohorts (X2(2) = 14.209, p = 0.014). A large proportion of students (98.41%) agreed that an online resources bank would be beneficial for their learning. Wilcoxon rank test showed a statistically significant preference for learning physical examinations using clinical images rather than videos (p = 0.014). A 29% of respondents mentioned the use of physical textbooks as a resource, while online platforms such as OSCE revision websites, YouTube and Google Images had become the mainstream platforms. The findings reported here suggest that there needs to be a greater emphasis on providing online image-based resources to support medical students in learning clinical signs. A resource containing these clinical signs would prove to be of benefit for students to access high-quality self-directed learning to identify and verify clinical signs.

Developing some models to predict the uniaxial compressive strength of various sedimentary rocks (Case studies: Large dam site and mine in Southeast China)

Direct determination of uniaxial compressive strength (UCS) is time-consuming, expensive, and challenging. Therefore, this study aims to indirectly predict UCS using statistical and machine learning methods. First, laboratory measurements were conducted to determine carbonate percentage, water absorption percentage, moisture content, porosity percentage, P-wave velocity, and UCS of sandstone, dolomite, dolomitic limestone, marl limestone, and limestone samples. Subsequently, various models were established to predict UCS using multivariate linear regression (MVLR), random forest regression (RFR), Gaussian process regression (GPR) based on squared exponential kernel function, and adaptive neuro-fuzzy inference system (ANFIS). The influence of Jurassic limestone texture on physical and mechanical properties in stable and unstable slopes in the Three Gorges Dam site and reservoir (TGDSR) showed that the percentage of mudstone texture in unstable slopes is higher than in stable slopes. The UCS, density, compressional wave velocity, and percentage of carbonate in unstable slopes is less than stable slopes. The results indicated that the average measured UCS is 60.60 MPa. Moreover, the average predicted UCS based on the three intelligent methods was 60.55 MPa. The percentage difference between the measured and predicted UCS was −0.09 %, demonstrating that the average error of the three employed methods is less than one percent, highlighting the high accuracy of these methods in estimating rock UCS. Notably, based on error level, Taylor diagram, Wilmot agreement index (WAI), A10 and A20 indices, Nash-Sutcliffe efficiency (NSE), and PM (performance metric) criteria the RFR exhibited superior precision (R2=99 %, and RMSE= 0.06 MPa) compared to the other used methods. The Kruskal-Wallis test (KWT) results showed that there is no significant difference between the measured and predicted values.

The Robison D. Harley, MD Childhood Glaucoma Research Network International Pediatric Glaucoma Registry: The First 872 Cases

PurposeTo report on epidemiologic data from an international, centralized pediatric glaucoma database of 872 patients, focusing on genetic and clinically significant factors. DesignDatabase study utilizing retrospective analysis. Subjects872 children, both female and male, were included in the database. After accounting for database coding errors, data from 865 patients with pediatric glaucoma were analyzed. Number of eyes analyzed fluctuated for each variable. MethodsThe registry is an open access, no charge, REDCap database. Participating clinical centers input data with local Institutional Review Board approval and subsequently have access for research purposes. We retrospectively reviewed 872 patients, comparing demographics, family history, country, disease presentation, and CGRN diagnoses. Analyses for each variable were conducted in SPSS Software v.28.0. Chi-square analyses were performed for nominal data, and ordinal and continuous data were analyzed using Mann-Whitney test, analysis of variance or Kruskal-Wallis tests with multiple comparisons. Main Outcome MeasuresCGRN glaucoma type and markers of clinical severity by country (laterality, cup-to-disc ratio (CTD), corneal diameter, opacification, edema; visual acuity (VA), intraocular pressure (IOP), Haab striae, axial length). Results20 clinical sites from 10 countries entered data. Centers in the USA, India, and Iran input the most data. In the USA, open angle glaucoma following cataract surgery was most common, while in India and Iran it was primary congenital glaucoma neonatal onset. Bilateral disease was more frequent in India and Iran compared to the USA (X2 = 50.6, p<0.001). Clinical measures of severity were typically worse in India compared to the USA. This included increased CTD (X2 = 24.0, p = 0.002), increased corneal diameter (X2 = 8.9, p = 0.01), presence of corneal opacification (X2 = 10.7, p = 0.001), presence of corneal edema (X2 = 11.7, p<0.001), and worse VA (U = 873.5, p<0.001). IOP and presence of Haab striae were not associated with country (p>0.05), while axial length was increased in the USA by an average of 1.04mm (U = 5787, p = 0.002). ConclusionsThis registry has potential to advance our understanding of pediatric glaucoma. Differences in family history, disease presentation, and glaucoma type suggest unique country phenotypes. Registry expansion may allow for insight into best practices for pediatric glaucoma.

Race and ethnicity representation in phase 2/3 oncology clinical trial publications in the United States: A systematic review.

20 Background: The five 1997 Office of Management and Budget (OMB) races in the US include American Indian or Alaskan Native (AI/AN), Asian, Black or African American, Native Hawaiian or Other Pacific Islander (NHPI), and White, with Hispanic ethnicity. Despite the Affordable Care Act (ACA) mandating OMB-based collecting/reporting standards, race and ethnicity publishing in medical journals is inconsistent, despite being necessary to achieve health equity. We aimed to quantify race and ethnicity reporting rates and calculate representation quotients (RQs) in published oncology clinical trials. Methods: In this systematic review, PubMed/Embase were queried for phase 2/3 clinical trials of the 6 most common noncutaneous solid malignancies, published between 2012-2022, in 4 high-impact journals. Trial characteristics were recorded. The RQs for each race and ethnicity were calculated by dividing the percent of representation in clinical trial publications by the percent of year-matched, site-specific incident cancers in the US, compared with Kruskal-Wallis tests with Bonferroni Correction (BC). Reporting was compared between journal publications and ClinicalTrials.gov. Results: Among 1,202 publications evaluated, 364 met inclusion criteria: 16 JAMA , 241 JCO , 19 Lancet , and 88 NEJM . Publications included 268,209 patients (171,132 women [64%]), with a median of 356 (IQR, 131-800) patients per publication. Reported race and ethnicity included AI/AN in 52 (14%) publications, Asian in 196 (54%), Black or African American in 215 (59%), Hispanic in 67 (18%), NHPI in 28 (8%), and White in 254 (70%). Median RQ varied across race (P &lt; .001 BC) with 1.04 (IQR, 0.09-4.77) for Asian, 0.98 (IQR, 0.86-1.06) for White, 0.42 (IQR, 0.12-0.75) for Black or African American, and 0.00 (IQR, 0.00-0.00) for both AI/AN and NHPI patients. Sensitivity analyses showed similar findings upon subset analysis for US-only clinical trials. There was significantly less race and ethnicity reporting in the clinical trial publications compared with ClinicalTrials.gov documentation for AI/AN (14% vs 45%, P &lt; .001 per McNemar χ 2 with continuity correction [MC]) and NHPI (7.7% vs 43%; P &lt; .001 MC). Conclusions: While most phase 2/3 oncology clinical trials published in high-impact journals report race and ethnicity, most did not report AI/AN and NHPI racial categories. Our findings support a call to action for consistent journal policies and transparent race and ethnicity reporting, in alignment with ACA-concordant race and ethnicity federal reporting requirements.

Assessment of anxiety in parents of children undergoing tonsillectomy under general anaesthesia: A cross-sectional study.

Surgery in the pediatric age group entails a significant amount of anxiety for parents. Due to anxiety, parents are unable to take care of their children, which could affect the child's well-being and contributes to poor outcomes. The primary objective of this study is to determine the frequency of preoperative anxiety in parents before the surgery of their children. It is a cross-sectional descriptive study that included either parent of 147 children of American Society of Anaesthesiology (ASA) I & II, aged 1-12 years undergoing tonsillectomy over the period of 1 year. Each parent's demographic data were recorded and requested to answer a proforma containing the Amsterdam Preoperative Anxiety Information Scale (APAIS) for assessing anxiety on a 5-point Likert scale. Median interquartile range (IQR), and frequency (%) were used to report the normal, skewed, and categorical variables. APAIS anxiety and information scores were compared by using either the Mann-Whitney U-test or the Kruskal-Wallis test. Furthermore, anxiety scores were grouped (present/absent) with a cut-off score of 11 for the presence of anxiety, and multivariate logistic regression was performed to explore the relationship between potential risk factors and the parent's anxiety. Overall, anxiety was present in 59 (40.1%) respondents with 20 (33.9%) being fathers and 39 (66.1%) mothers. The median (IQR) for APAIS anxiety and information score were 9 ± 5 and 5 ± 2, respectively. Higher median anxiety scores were observed statistically significant in children under 5 years old, mother respondents, mothers aged 35 or younger, fathers under 40, and mothers with graduate or higher education (p < 0.05). Father respondents (AOR = 0.3, 95% CI = 0.1-0.8, p = 0.01), and mother's education less than graduation (AOR = 0.2, 95% CI = 0.1-0.6, p = 0.006) were also found to be statistically significant predictors. There is a significant prevalence of anxiety in parents of children who underwent surgery under general anaesthesia, and mothers have showed significantly higher anxiety levels than fathers.

Four-dimensional automated quantitative echocardiography assessment of right heart remodeling in patients with functional tricuspid regurgitation.

Functional tricuspid regurgitation (FTR) has a pathophysiological connection with right heart remodeling. Given the increasing focus on right atrial remodeling in recent years, a comprehensive study of all aspects of right heart remodeling is crucial for understanding the progression and treatment of FTR. In the scientific literature, there is a lack of comprehensive exploration of right atrial remodeling in patients with FTR, and no reports on the potential correlation between the degree of this remodeling and the severity of tricuspid regurgitation (TR) have been published. This study aimed to evaluate the relationship between right heart parameters measured by four-dimensional (4D) automated quantitative echocardiography and the severity of TR in patients with FTR. In this prospective case-control study, 100 patients diagnosed with FTR by echocardiography at The First Affiliated Hospital of Guangxi Medical University from February 2022 to March 2023 were prospectively and consecutively selected as the case group, comprising 50 patients with mild FTR and 50 patients with moderate or severe FTR. Additionally, 30 healthy participants served as the control group. Routine echocardiography was employed to obtain two-dimensional (2D) and three-dimensional (3D) images, which was followed by 4D automated quantitative echocardiograph assessment. Analysis of variance (ANOVA) or Kruskal-Wallis tests were used to compare differences between groups, Pearson correlation coefficient analysis was used to discern the relationship between parameters and TR volume, multivariate linear regression was used to identify factors associated with TR volume, and logistic regression was employed to predict the severity of FTR. The case group consisted of 50 patients with mild FTR (26 males, 52%; age range, 31-78 years; mean age ± SD: 58±11.4 years) and 50 patients with moderate-to-severe FTR (21 males, 42%; age range, 29-87 years; mean age ± SD: 60±13.0 years). Additionally, 30 healthy participants (13 males, 43%; age range, 19-81 years; mean age ± SD: 58±13.3 years) constituted the control group. Patients with moderate-to-severe FTR had significant right heart dilatation and functional decline. The TR volume was highly correlated with right atrium minimum volume (RAVmin; r=0.864; P<0.001), and linear regression showed that the RAVmin was independently correlated with the severity of TR in patients (β=0.820; P<0.001). There were several predictive variables that were significantly associated with increased FTR severity, including right atrial reservoir strain [RASr; odds ratio (OR) =0.702; 95% confidence interval (CI): 0.575-0.857; P=0.001], right atrial conduit strain (RAScd; OR =1.308; 95% CI: 1.098-1.558; P=0.003), and right atrial reservoir circumferential strain (RASr-c; OR =0.823; 95% CI: 0.684-0.990; P=0.04). 4D automated quantitative echocardiography allows for the dynamic assessment of right heart volume and function. To determine the development of FTR, RA dilation appears to be more significant than right ventricular dilation. The RASr, RAScd, and RASr-c are directly correlated with FTR severity.

Red cell distribution width and outcome in acute ischemic stroke patients

IntroductionSeveral biomarkers have proven prognostic value for acute ischemic stroke (AIS) patients. Red cell distribution width (RDW) has been associated with several diseases and all-cause mortality and suggested as an independent predictor of Ischemic Stroke severity and outcome. This study aimed to investigate RDW as an independent predictor of functional outcome and death in the 3 months following AIS. MethodsPatients with AIS were divided in four groups according to the quartile of the RDW value at admission. Baseline characteristics of patients in each RDW quartile were compared by Chi-square or Kruskal-Wallis tests, as applicable. We prospectively analyzed the patients for functional outcome in the 3 months following the event. Functional outcome (dichotomized as independent [0-2] or dependent [>2] according to the modified Rankin Scale score) and 90-day mortality was compared between the 4 groups. To conduct this evaluation, univariable and multivariable binary logistic regression analysis for functional independence and mortality at 3 months was conducted, considering the variables previously identified as potential confounders. ResultsThe study's final population was of 416 patients. The patients in higher RDW quartiles were older (p<0.001), had lower blood hemoglobin (p<0.001), higher C reactive protein levels (p=0.017), higher BNP values (p<0.001) and more frequently suffered from atrial fibrillation (p=0.015) and heart failure (p=0.004). Univariate analysis showed a negative association between RDW-Q4 and independence at 3 months (p=0.024), which wasn't verified in the multivariate analysis (p=0.871). Univariate analysis also identified a positive association between RDW-Q4 and 90-day mortality (p=0.049), which was not confirmed in the multivariate analysis (p=0.289). ConclusionsWhen adjusted to potential confounders, RDW does not predict functional outcome or death in the 90 days after acute ischemic stroke.