Level Of Quality Research Articles

Limited evidence to support demineralized bone matrix in foot and ankle surgical procedures: A systematic review

BACKGROUND Demineralized bone matrix (DBM) is a commonly utilized allogenic bone graft substitute to promote osseous union. However, little is known regarding outcomes following DBM utilization in foot and ankle surgical procedures. AIM To evaluate the clinical and radiographic outcomes following DBM as a biological adjunct in foot and ankle surgical procedures. METHODS During May 2023, the PubMed, EMBASE and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following DBM for the management of various foot and ankle pathologies. Data regarding study characteristics, patient demographics, subjective clinical outcomes, radiological outcomes, complications, and failure rates were extracted and analyzed. In addition, the level of evidence (LOE) and quality of evidence (QOE) for each individual study was also assessed. Thirteen studies were included in this review. RESULTS In total, 363 patients (397 ankles and feet) received DBM as part of their surgical procedure at a weighted mean follow-up time of 20.8 ± 9.2 months. The most common procedure performed was ankle arthrodesis in 94 patients (25.9%). Other procedures performed included hindfoot fusion, 1st metatarsophalangeal joint arthrodesis, 5th metatarsal intramedullary screw fixation, hallux valgus correction, osteochondral lesion of the talus repair and unicameral talar cyst resection. The osseous union rate in the ankle and hindfoot arthrodesis cohort, base of the 5th metatarsal cohort, and calcaneal fracture cohort was 85.6%, 100%, and 100%, respectively. The weighted mean visual analog scale in the osteochondral lesions of the talus cohort improved from a pre-operative score of 7.6 ± 0.1 to a post-operative score of 0.4 ± 0.1. The overall complication rate was 27.2%, the most common of which was non-union (8.8%). There were 43 failures (10.8%) all of which warranted a further surgical procedure. CONCLUSION This current systematic review demonstrated that the utilization of DBM in foot and ankle surgical procedures led to satisfactory osseous union rates with favorable wound complication rates. Excellent outcomes were observed in patients undergoing fracture fixation augmented with DBM, with mixed evidence supporting the routine use of DBM in fusion procedures of the ankle and hindfoot. However, the low LOE together with the low QOE and significant heterogeneity between the included studies reinforces the need for randomized control trials to be conducted to identify the optimal role of DBM in the setting of foot and ankle surgical procedures.

Novel Conservative Therapies in Migraine Management: The Impact of Fascia Exercises in a Randomized Controlled Trial

Background/Objectives: Migraine is a complex neurological disorder often associated with autonomic nervous system (ANS) dysfunction. This study aimed to evaluate the effects of fascia exercises on migraine symptoms and explore their potential as a novel conservative treatment approach. Methods: A prospective, randomized controlled trial was conducted with 30 migraine patients who were randomly assigned to a treatment group (fascia exercises) or a control group (conventional physiotherapy). Both groups underwent a six-week intervention consisting of two sessions per week. Pain intensity, migraine-related disability, sleep quality, anxiety, depression, heart rate variability (HRV), and patient satisfaction were assessed before and after the intervention using validated scales. Results: Significant improvements in pain intensity, attack frequency and duration, migraine-related disability, sleep quality, and anxiety levels were observed in both groups (p < 0.05). However, the treatment group demonstrated a more pronounced reduction in depression scores compared to the control group (p < 0.05). While no significant changes in HRV parameters were detected in either group, patient satisfaction was significantly higher in the treatment group (p < 0.05). Conclusions: Fascia exercises represent a promising complementary therapy for migraine management, offering significant improvements in both physical and psychological symptoms. While immediate effects on HRV were not evident, the potential to modulate autonomic balance and address migraine pathophysiology warrants further exploration. These findings highlight the value of fascia exercises as a low-cost, non-invasive approach, emphasizing the need for further research to confirm their long-term clinical benefits and integration into migraine treatment protocols.

Quality of Life in Adults with Atopic Dermatitis in Relation to Disease Severity: Nationwide Data in Japan.

The impact of atopic dermatitis (AD) on daily life and different levels of quality of life (QOL) according to AD severity has not been fully elucidated. This study aimed to assess QOL in relation to the AD severity in Japan. This observational study used anonymized data of health insurance association members and their families registered to a mobile health app. The QOL measures included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensional five-level descriptive system (EQ-5D-5L), Work Productivity and Activity Impairment (WPAI), and sleep disturbance Numerical Rating Scale (NRS). The data were assessed according to AD severity: the Patient-Oriented Eczema Measure (POEM: 0-2, "clear/almost clear"; 3-7, "mild"; 8-16, "moderate"; 17-24, "severe"; 25-28, "very severe"); and itch NRS (0-10). Of 1507 adults with AD symptoms or undergoing treatments, 882 were identified with AD diagnosis records. Of those, 229 (26.0%), 242 (27.4%), 273 (31.0%), and 138 (15.6%) were included in the clear/almost clear, mild, moderate, and severe/very severe POEM groups, with mean ± standard deviation DLQI scores of 2.0 ± 2.7, 3.6 ± 3.3, 6.1 ± 4.4, and 10.4 ± 5.7, respectively. Higher DLQI scores were observed with increasing POEM severity and itch NRS (Spearman's rank correlation coefficient 0.629 and 0.615, respectively). EQ-5D-5L scores slightly lowered with increasing POEM severity, whereas WPAI percentage slightly increased. Sleep disturbance NRS increased with increasing AD severity in terms of POEM and itch NRS. Adults identified with AD diagnosis records (n = 882) yielded higher WPAI percentages than those without (n = 1204) in all four domains (Wilcoxon rank sum test, p < 0.001 for all). This study, using real-world data in Japan, presented valuable data on the relationship between AD severity and various aspects of QOL. The data suggested greater QOL impairment with increasing AD severity; even at lower severity levels, QOL was impacted to some extent. The results highlight the need for careful consideration during clinical practice.

Degraded Forest Evaluation Using Vegetation Indices at Bandealit Resort, Meru Betiri National Park

The forest degradation and deforestation was widely occurred in Indonesia and Meru Betiri National Park is one of the area with illegal loggings threats. Bandealit Resort as one of the resort in Meru Betiri National Park was reported as the area with high activity of illegal loggings specifically in 2020. Based on this information, this research study aims to evaluate the degraded level of the forests using Normalized Difference Vegetation Index and Enhanced Vegetation Index (NDVI and EVI) so it can be managed and evaluated in the future. This research use direct and indirect observation methods in three areas with different damage levels. Direct observation was done by counting the number of species and the stands trees, while the indirect observation was analyzing the Landsat 8 Imagery in 2020, 2021 and 2022. The results showed that the A area had the lowest density with only 45 remaining trees than two others with more than 150 trees. The greenness levels imply the quality level of tree stand density, as higher the tree stand density, the higher the greenness. NDVI and EVI showed that A area had the range from low greenness (sparse density) to high greenness (medium density) than two others area had the higher greenness and densities.

Impact of deep or ovarian endometriosis on pelvic pain and quality of life: prospective cross-sectional ultrasound study.

To assess whether premenopausal women diagnosed with deep or ovarian endometriosis on transvaginal sonography (TVS) were more likely to suffer from dyspareunia and pelvic pain symptoms, and have a lower quality of life, compared to women without sonographically diagnosed deep or ovarian endometriosis. This was a prospective, cross-sectional study carried out between February 2019 and October 2020 at the general gynecology clinic at University College London Hospital, London, UK. All premenopausal women aged 18-50 years, who were examined consecutively by a single experienced examiner and underwent a detailed TVS scan, were eligible for inclusion. Pregnant women and those who had received a previous diagnosis of endometriosis or who had experienced a hysterectomy or unilateral/bilateral oophorectomy were excluded. Sonographic findings consistent with deep or ovarian endometriosis were noted. All women completed the British Society of Gynaecological Endoscopy pelvic pain questionnaire. The primary outcome was to determine whether women with sonographic evidence of endometriosis were more likely to experience moderate-to-severe levels of dyspareunia (score of ≥ 4 on an 11-point numerical rating scale (NRS)). Secondary outcomes included assessing moderate-to-severe levels of other pelvic pain symptoms (NRS score of ≥ 4), bowel symptoms (score of ≥ 2 on a 5-point Likert scale) and quality of life, which was measured using the EuroQol-5D-3L (EQ-5D) questionnaire. The number of women with pain scores ≥ 4 and bowel scores ≥ 2, as well as the mean EQ-5D scores, were compared between the group with and that without sonographic evidence of endometriosis using logistic regression analysis, and multivariable analysis was used to adjust for demographic and clinical variables. A total of 514 women were included in the final study population, of whom 146 (28.4%) were diagnosed with deep or ovarian endometriosis on TVS. On multivariable analysis, the presence of moderate-to-severe dyspareunia was not found to be associated with endometriosis. Moderate-to-severe dyspareunia was significantly associated with lower age (odds ratio (OR), 0.70 (95% CI, 0.56-0.89); P = 0.003) and a history of migraine (OR, 3.52 (95% CI, 1.42-8.77); P = 0.007), and it occurred significantly less frequently in women with non-endometriotic ovarian cysts (OR, 0.47 (95% CI, 0.28-0.78); P = 0.003). There was also a trend towards a positive association between anxiety/depression and moderate-to-severe dyspareunia (OR, 1.94 (95% CI, 0.93-4.03); P = 0.08). Following multivariable analysis, the only symptoms that were significantly more common in women with endometriosis compared to those without were menstrual dyschezia (OR, 2.44 (95% CI, 1.59-3.78); P < 0.001) and difficulty emptying the bladder (OR, 2.56 (95% CI, 1.52-4.31); P < 0.001). Although not reaching statistical significance on multivariable analysis, dysmenorrhea (OR, 1.72 (95% CI, 0.92-3.20); P = 0.09) and lower EQ-5D score (mean ± SD, 0.67 ± 0.33 vs 0.72 ± 0.28; P = 0.06) also occurred more frequently in women with sonographic evidence of endometriosis. The majority of pelvic pain symptoms did not differ significantly between women with and those without sonographic evidence of endometriosis, indicating that endometriosis may not always be the source of pelvic pain, even if present. This highlights the need to rule out other causes of pain in symptomatic endometriosis patients before considering surgical procedures, and to provide appropriate patient counseling. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Influence of Visual Quality and Cultural Background on Consumer Apple Preferences: An Eye-Tracking Study with Chinese and Hungarian Consumers

Using eye-tracking technology, the proposed study investigates how customers visually evaluate apples varieties and apple defects and how these evaluations affect their purchasing decisions. Three aspects were examined in this study: apple variety, defect severity, and cultural background. Idared, Golden Delicious Yellow, and Golden Delicious Green apple varieties with increasing degrees of bruising were shown to Chinese and Hungarian participants. The findings show that apple variety had no significant effect on gaze patterns, whereas cultural background had a considerable impact on visual attention measures. The most important element in grabbing and retaining customer attention was the severity of the defect, which was measured by area. The “Threshold of Rejection”, which characterizes consumer tolerance for Apple defects, is introduced in the study. Furthermore, a polynomial regression model was created to predict the probability of repurchasing an apple depending on its visual quality (level of bruising). These results provide useful information for marketing plans, quality assurance, and comprehending customer behavior in the fresh produce sector.

Transcutaneous vagus nerve stimulation for Parkinson’s disease: a systematic review and meta-analysis

BackgroundTranscutaneous vagus nerve stimulation (tVNS) has emerged as a novel noninvasive adjunct therapy for advanced Parkinson’s disease (PD), yet no quantitative analysis had been conducted to assess its therapeutic effect.ObjectivesThis review aimed to investigate the efficacy of tVNS on motor function, other potential clinical targets and its safety in various treatment conditions.MethodsWe searched six databases for randomized controlled trials (RCTs) that involved treating PD patients with tVNS. Primary outcome was motor functions, including severity of motor signs, functional mobility and balance, and gait parameters. Secondary outcomes were cognition, emotion, sleep related impairments, patient reported non-motor outcomes, and any adverse events. All outcomes were classified and analyzed according to the treatment duration and medication condition of an included study. Risk of bias was evaluated by referencing Cochrane risk of bias tool 1.0. Data was analyzed by Revman 5.4.Results6 RCTs with 176 PD patient were included. Several motor functions and non-motor functions measured during on-medication condition (severity of motor signs −0.48 [95% CI −0.93, −0.04], gait −0.48 [95% CI −0.85, −0.1], patients reported non-motor outcomes −0.4 [95% CI −0.78, −0.03]), improved significantly. However, verbal fluency, sleep-related impairment, and fatigue were negatively impacted by tVNS during on-medication condition. No distinct adverse events were reported.ConclusiontVNS is a relatively safe adjunct treatment for PD. It has small to moderate therapeutic effects on motor functions and may negatively impact on a few other outcomes. Quality level of the evidence is low and further research is warranted.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42024503322 (PROSPERO).

Exploring the associations between street-view green space quantity and quality, and influenza in Guangzhou, China through machine learning and spatial regression: A socio-economic equity perspective

Existing studies have highlighted that green space is associated with non-communicable diseases. However, scant attention has been paid to the association between green space quantity and quality with communicable diseases. Here, we explore the relationships between green space and influenza cases in Guangzhou, China, using street-view green (SVG) space quantity and SVG-quality indicators, which offer a better assessment of urban green space than traditional remote sensing metrics. Influenza cases were collected from hospitalization records, while street-level green space was measured by street-view data and deep neural networks. The neighbourhood deprivation index (NDI) was also used as a proxy for neighbourhood-level socio-economic status. We employed the Random Effects-Eigenvector Spatial Filtering (RE-ESF) regression model because of its usefulness in handling spatial dependence. Findings showed that higher levels of SVG-quantity and quality are associated with a lower number of influenza cases, implying a negative relationship. Specifically, the marginal effects for SVG indicate that influenza may decrease by 145 cases for every unit increase in SVG-quantity, and by 11 cases for every unit increase in SVG-quality. In terms of planning, this could mean that though green quality is essential for the aesthetic part of urban life, quantity is much more critical concerning the containment of influenza. In addition, SVG-quantity and quality moderated the positive association between NDI and influenza cases. In other words, people in more deprived neighbourhoods were more influenced by SVG-quantity and quality compared to people living in less deprived areas. This means that more green space should be added to such neighbourhoods. We also observed that the association between SVG-quality and influenza cases was weaker for females, people aged between 18 and 45, and employed people. Because influenza is the most common pandemic worldwide, green space at the street level should be considered when promoting equitable public health and this study provides quantifiable evidence for the negative effect of green space quantity and quality over influenza cases.

Comparison of Hybrid Rye and Wheat for Grain Yield and Other Agronomic Traits Under Less Favourable Environmental Conditions and Two Input Levels

Agriculture in the European Union is constantly the subject of public debate, particularly concerning reduced mineral fertilisation and reduced chemical plant protection. Hybrid rye could play a special role in this context, as it usually requires less fertiliser and pesticides than winter wheat and has a high yield potential. In Germany, both crops can be grown on most sites. To test whether hybrid rye is competitive with winter wheat, a trial was conducted with 10 hybrid rye and 20 wheat varieties of all quality levels. The trial was grown for three years (2021, 2022, 2023) on three conventionally managed farms with 40–64 soil points (on a scale of 1–100) in south-west Germany. It was conducted with two input levels: I1, fertilisation (100–120 kg N/ha for hybrid rye; 140–180 kg N/ha for winter wheat), and chemical plant protection including growth regulators; I2, no chemical plant protection, and 20% reduced N fertilisation, one to three harrows. In eight out of nine location × year combinations, hybrid rye was significantly (p &lt; 0.001) superior to winter wheat in terms of grain yield under these conditions. On average, hybrid rye yielded 9.1 and 7.8 t ha−1 for I1 and I2, respectively, compared to 8.0 and 6.8 t ha−1 for wheat, respectively. A close correlation of the cultivar’s grain yield between I1 and I2 for both crops showed a missing cultivar × input level interaction. Under these conditions, hybrid rye produced higher grain yields and better baking quality than wheat in both input regimes, contributing to a more sustainable cropping system.

Integrated Risk Framework (IRF)—Interconnection of the Ishikawa Diagram with the Enhanced HACCP System in Risk Assessment for the Sustainable Food Industry

This paper presents a new risk assessment methodology called the Integrated Risk Framework (IRF) through the application of Ishikawa diagrams combined with the enhanced Hazard Analysis and Critical Control Point (HACCP) system. This risk investigation technique aims to ensure a significantly higher level of quality, safety, and sustainability in food products by using improved classical methods with strong intercorrelation capabilities. The methodology proposes expanding the typology of basic physical, chemical, and biological risks outlined by the ISO 22000 Food Safety Management System standard, adding other auxiliary risks such as allergens, fraud/sabotage, Kosher/Halal compliance, Rapid Alert System for Food and Feed notification, or additional specific risks such as irradiation, radioactivity, genetically modified organisms, polycyclic aromatic hydrocarbons, African swine fever, peste of small ruminants, etc. depending on the specific technological process or ingredients. Simultaneously, it identifies causes for each operation in the technological flow based on the 5M diagram: Man, Method, Material, Machine, and Environment. For each identified risk and cause, its impact was determined according to its severity and likelihood of occurrence. The final effect is defined as the risk class, calculated as the arithmetic mean of the impact derived at each process stage based on the identified risks and causes. Within the study, the methodology was applied to the spring water bottling process. This provided a new perspective on analyzing the risk factors during the bottling operations by concurrently using Ishikawa diagrams and HACCP principles throughout the product’s technological flow. The results of the study can form new methodologies aimed at enhancing sustainable food safety management strategy. In risk assessment using these two tools, the possibility of cumulative or synergistic effects is considered, resulting in better control of all factors that may affect the manufacturing process. This new perspective on studying the dynamics of risk factor analysis through the simultaneous use of the fishbone diagram and the classical HACCP system can be extrapolated and applied to any manufacturing process in the food industry and beyond.

Histological prediction and choice of the best resection strategy in front of a colorectal lesion > 2cm: prospective comparison of endoscopic characterization, non-targeted and targeted biopsies.

Accurate endoscopic characterization of colorectal lesions is essential to predict histology and select the best treatment strategy but remains very difficult. Instead of the recommended endoscopic characterization, many gastroenterologists routinely perform biopsies of the lesion to propose endoscopic resection with or without R0 intent. The aim of this study was to determine which of endoscopic characterization or biopsies, either targeted (TB) or non-targeted (NTB), is the most effective to determine the best treatment strategy for colorectal neoplasia > 2cm. We prospectively assessed the best strategy between endoscopic characterization and targeted or non-targeted biopsies, so that the proposed resection technique offered a level of quality of tumor resection adapted to the definitive histology of the lesion on R0-resected specimen. 84 patients with 88 lesions were included. "Adequate treatment" was proposed by endoscopic characterization in 52.3 to 70.5% of cases, "under treatment" in 2.3 to 9.1% and "over treatment" in 20.5 to 45.5%. Two severe events were recorded. "Adequate treatment" was proposed by TB and NTB in respectively 72.7 and 69.3% of cases, "under treatment" in respectively 27.3 and 30.7% and no case of "over treatment" was reported. TB and NTB were ineffective to evaluate the depth of invasion in the submucosa and to differentiate superficial invasive from deep invasive adenocarcinomas. Biopsies-based strategies are unable to predict depth of cancer invasion and could be associated with a risk of under treatment of large colorectal lesions in near a third of the cases compared to only around 5% with endoscopic characterization. Endoscopic characterization could lead to over treatment, but mainly by endoscopic submucosal dissection with low morbidity. Characterization with the CONECCT classification could decrease the risk of under treatment and avoid surgeries for non-malignant colorectal lesions. Other endoscopic criteria should be determined to better characterize colorectal lesions and to improve the best adapted treatment for each lesion.

Do patients with severe acne vulgaris prefer the evening chronotype more? A case-control study.

This study aimed to investigate sleep quality, chronotype preferences, anxiety, and depression levels in patients diagnosed with acne vulgaris and compare them with healthy controls. This cross-sectional case-control study included 92 patients with acne vulgaris and 59 age- and sex-matched healthy controls. Acne severity was assessed using the Global Acne Grading System (GAGS); sleep quality using the Pittsburgh Sleep Quality Index (PSQI); chronotype preferences using the Morningness-Eveningness Questionnaire (MEQ); and anxiety and depression levels using the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). There were no significant differences in the MEQ, BDI, or BAI scores between the two groups. The PSQI score was significantly higher in the patient group than that in the control group. Acne severity was negatively correlated with the MEQ scores and positively correlated with the PSQI scores. When the patient group was divided into three subgroups according to acne severity (mild, moderate, and severe), significant differences in MEQ and BAI scores were observed between the groups. According to the post-hoc analysis, the severe acne group had higher BAI scores, while the mild acne group had higher MEQ scores. It would be more appropriate to be aware of the potential psychiatric comorbidities of acne vulgaris and adopt a multidisciplinary approach to the treatment and management process.

Evaluation of the reality of electronic banking services provided by banks operating in the city of Nasiriya from the users' point of view of these services.

This research aimed to identify the level and reality of electronic banking services provided by banks operating in the city of Nasiriya through a survey of the opinions of users of these services and thus to know the level of their satisfaction with the electronic banking services provided by the branches of banks operating in the city of Nasiriya, which are (Rafidain Bank, Rashid Bank and the Iraqi Trade Bank), as the study community consisted of customers of these banks and those dealing with electronic banking services. The descriptive analytical approach was used to evaluate the quality of electronic banking services provided by the banks surveyed by designing and distributing a questionnaire form to the target sample to measure the degree of quality of services, their type, and the difficulties facing electronic banking work, where the data extracted from the questionnaire form were studied and analyzed using the statistical program (SPSS). After analyzing this data, the research reached a set of results, the most important of which was the poor quality of electronic banking services provided by banks operating in the city of Nasiriya. Thus, they are below the required level compared to the electronic banking services provided by local and international banks and other competing banks. In light of these results, recommendations were made, the most important of which was for the banks in the research sample to work on raising the level of quality of services Electronic banking by developing and improving its websites and enabling customers to deal with them flexibly, as well as working to increase customers' confidence in electronic services and improve them in quantity and quality.

Analytical performance of OncoPrism-HNSCC, an RNA-based assay to inform immune checkpoint inhibitor treatment decisions for recurrent/metastatic head and neck squamous cell carcinoma

BackgroundWhile immune checkpoint inhibitor (ICI) therapies can significantly improve outcomes for patients with recurrent/metastatic head and neck squamous cell carcinoma (RM-HNSCC), only about 15–20% benefit from such treatments. Clinical tests that guide the use of ICIs are therefore critically needed. OncoPrism-HNSCC was developed to address this need. The assay combines next generation RNA sequencing-based immunomodulatory gene expression signatures with machine learning algorithms to generate an OncoPrism score that classifies patients as having low, medium, or high likelihood of disease control in response to ICI treatment. Also, OncoPrism-HNSCC leverages the same FFPE patient tumor RNA used for ICI response prediction to identify rare cases where oncogenic rearrangements in NTRK1/2/3 or ALK genes may occur, and which may indicate the use of potentially highly effective targeted therapies. The clinical performance of OncoPrism-HNSCC has been validated. Here, we report its analytical performance in the presence of potentially confounding sources of variation.MethodsThe assay’s analytical sensitivity was assessed by varying RNA input quantity and quality, observing the effect on ICI response prediction scores. Analytical specificity was tested by spiking increasing percentages of genomic DNA into input RNA. Intra-assay and inter-assay precision were evaluated, and the analytical sensitivity, specificity, and precision of gene fusion detection were assessed. Concordance with orthogonal methods of gene fusion detection was tested on 67 FFPE clinical samples.ResultsVarying RNA inputs as low as four-fold below the nominal input amount had little effect on ICI response prediction scores. RNA quality levels below the test threshold had no significant effect. Genomic DNA spike-ins up to 30% had only a small effect on scores. The pooled standard deviation for multiple operators, reagent lots, batches, and sequencers yielded an overall variance represented by just 0.87% of the score range of the test (0–100). NTRK and ALK gene fusion detection was 100% concordant with orthogonal methods.ConclusionsRobust and reliable analytical performance of the OncoPrism-HNSCC assay supports its clinical use, even in the presence of variation typically encountered in the laboratory setting.

Online Service Quality Assessment in Higher Education: Development, Validation, and Implementation of an e-Tool

In pursuit of quality and excellence in educational institutions, it is increasingly important to identify demands and needs of stakeholders. Service quality has been identified as one such demand. The purpose of the current study was to develop and validate a quality service assessment tool based on SERVQUAL Model to describe the service quality in Higher Education Institution. The sources of data were the head and personnel of the different clusters of CBSUA. The data were treated statistically using weighted mean and rank. The weighted-mean scores for the five SERVQUAL dimensions across the offices of the University President, Research and Innovation, Administration and Finance, Business and External Affairs, and Academic Cluster demonstrates that respondents find all five dimensions to be appropriate for assessing the service quality of each office. The relatively high scores across all dimensions highlight the importance of Tangibility, Assurance, Reliability, Reliability, Responsiveness, and Empathy in shaping stakeholders' perceptions and expectations of service quality within an educational institution. While some dimensions hold greater importance for specific offices due to their unique roles and responsibilities, all dimensions are nonetheless essential for evaluating the overall service quality in each context. The findings align with previous research on the applicability of the SERVQUAL model across various contexts, including higher education institutions. Ultimately, the results underline the significance of maintaining a high level of service quality across all dimensions in each office, as this is crucial for ensuring stakeholder satisfaction and fostering a positive reputation for the university.

Modern Digital Query Analytics of Patient Education Materials on Acanthosis Nigricans: Systematic Search and Content Analysis.

Online digital materials are integral to patient education and health care outcomes in dermatology. Acanthosis nigricans (AN) is a common condition, often associated with underlying diseases such as insulin resistance. Patients frequently search the internet for information related to this cutaneous finding. To our knowledge, the quality of online educational materials for AN has not been systematically examined. The primary objective of this study was to profile the readability and quality of the content of publicly available digital educational materials on AN and identify questions frequently asked by patients. This study analyzed publicly available internet sources to identify the most frequent questions searched by patients regarding AN using the Google Rankbrain algorithm. Furthermore, available articles on AN were evaluated for quality and reading level using metrics such as the Brief DISCERN score, and readability was determined using three specific scales including the Flesch-Kincaid score, Gunning Fog index, and the Coleman-Liau index, based on literature. Patients most frequently accessed facts on AN from government sources, which comprised 30% (n=15) of the analyzed sources. The available articles did not meet quality standards and were at a reading level not appropriate for the general public. The majority of articles (n=29/50, 58%) had substandard Brief DISCERN scores, failing to meet the criteria for good quality. Clinicians should be aware of the paucity of valuable online educational material on AN and educate their patients accordingly.

Physical activities, sedentary behavior, sleep quality, and quality of life among female medical versus nonmedical college students: A cross-sectional study

Despite the numerous health benefits of physical activity (PA), sedentary behavior (SB) and physical inactivity remain major public health concerns. A lack of PA increases the chance of developing some noncommunicable diseases that are on the rise worldwide. Therefore, this study aimed to evaluate the level of PA, SB, sleep quality (SQ), and quality of life (QOL) among Saudi female college students. A cross-sectional study was carried out among female students enrolled in various colleges, both medical and nonmedical, at King Saud University in Riyadh during the academic year 2018 to 2019. Participation posters were sent to colleges’ departments, and survey links were shared through university social media channels. The study utilized the International Physical Activity Questionnaire and the Pittsburgh Sleep Quality Index to evaluate PA and SQ and the World Health Organization Quality of Life Assessment Instrument to evaluate QOL. In order to conduct statistical analyses, frequency counts, means, and standard deviations were calculated for PA, SQ, and QOL scores. In this study, 131 Saudi female college students were conveniently recruited from 223 who met the inclusion criteria, with a mean age of 20.4 ± 1.4. Most participants were from medical colleges (n = 86, 6, 5.6%) and the minority were nonmedical (n = 45, 34.4%). We have found that International Physical Activity Questionnaire indicated that most students had low PA (52% of the participants), about 35% had a moderate PA, and only 17% had high PA. SB was present among 22.9% of participants. Nearly 68.7% of the students scored poorly on the Pittsburgh Sleep Quality Index for SQ. The students had high QOL, with a mean WHOQOL-BREF total score of 90.76 ± 12.77. Medical and nonmedical students showed no significant differences in PA, SB, or QOL. No apparent relationship was found between PA and SQ or QOL. This study shows that a significant proportion of female college students maintain an unfavorable lifestyle characterized by insufficient PA and subpar SQ. Implementing programs that encourage students to be more physically active, reduce sedentary time, and integrate sleep education programs to improve their sleep habits are necessary.

A Couple-Based Intervention for Chinese Older Adults With Type 2 Diabetes

Spousal involvement in diabetes care is recommended theoretically, but effectiveness in clinical settings and among diverse populations is unclear. To test the effect of a couple-based intervention among Chinese older patients with type 2 diabetes and their spouses. This multicenter randomized clinical trial comprised 2 arms: a couple-based intervention arm and an individual-based control. The trial was conducted across 14 community health care centers in Guangzhou, China, between September 1, 2020, and June 30, 2022, and included patients with confirmed type 2 diabetes aged 55 years or older. Eligible partners were married to or cohabitated with the patients. Patients who previously participated in type 2 diabetes education courses were excluded, as were couples who both had diabetes, to make a clear distinction between patients and spouses. The data were analyzed between January 2023 and April 2024. The interventions consisted of 4 weekly group education sessions followed by behavior change booster telephone calls over 2 months that targeted either patients and spouses (ie, intervention arm) or patients alone (ie, control arm). Follow-up assessments were conducted at 6 and 12 months post intervention. The primary outcome was hemoglobin A1c (HbA1c) levels for patients and quality of life for their spouses. Collective efficacy and behaviors were secondary outcomes for both patients and spouses. Group comparisons were conducted using multilevel models based on an intention-to-treat approach, with outcome measures assessed for both patients and their spouses. A total of 207 couples were included in the study, with 106 randomized to the intervention arm and 101 to the control arm. The mean (SD) age of patients was 66.0 (6.5) years, with 105 (50.7%) being men; spouses had similar demographics. Patients' HbA1c levels decreased in both arms over the 12-month follow-up, with no significant between-arm differences (β = -0.08; 95% CI, -0.57 to 0.42). Collective efficacy and collective behavior for patients increased after intervention but with a similar magnitude between arms. None of these measures showed between-arm differences among spouses in either arm. In subgroup analysis, decreases in HbA1c levels were constant and lasting in patients with high baseline HbA1c levels (≥8.0%) with a statistically significant difference. These findings show that the overall treatment effect of the couple-based intervention was weak. However, the couple-based intervention benefited patients with poor glucose control. Patients' glucose levels, spouses' availability to provide support, and couples' collaborative preferences for mutual or individual diabetes management should be considered in tailoring treatment strategies among older adults with type 2 diabetes. Chinese Clinical Trial Registry Identifier: ChiCTR1900027137.

Correlates of Perceived Illness Severity and Terminality in Advanced Lung and Prostate Cancer.

While prognostic awareness has been commonly assessed as perceived illness terminality in patients with advanced cancer, both perceptions of illness severity and terminality may be correlated with symptom burden and quality of life. The present study examined physical and psychological symptoms, quality of life, and smoking status in relation to perceived illness severity and terminality in patients with advanced, inoperable lung and prostate cancer. Patients (N=198) were recruited from hospitals in the midwestern U.S. to complete a one-time survey. Prognostic awareness was assessed in the following categories: "relatively healthy," "seriously ill but not terminally ill," or "seriously and terminally ill." Only 12% reported an accurate prognostic awareness ("seriously and terminally ill") and 66% perceived themselves as "relatively healthy." Higher levels of anxiety, depressive symptoms, fatigue, and pain, and worse quality of life were associated with a higher likelihood of reporting serious illness, irrespective of perceived illness terminality. Smoking status was unrelated to prognostic awareness. For patients with advanced lung cancer, greater breathlessness was associated with a higher likelihood of reporting serious or terminal illness. Our findings suggest that perceiving cancer as serious, not just terminal, is related to symptom burden and quality of life. Results point to the need for interventions to improve prognostic understanding and coping with the disease.

Prevalence, correlates and comorbidity of irritability in adults with major depressive episode in the U.S. population (2012-2013).

Irritability has been documented in major depressive episodes (MDE) in children and adolescents. However, the prevalence of irritability in MDE and its clinical correlates remain unknown in adults. We showed associations between the prevalence of irritability and its sociodemographic characteristics in a representative U.S. sample, along with the associations between irritability and other psychiatric disorders and its relationship with health-related quality of life. This cross-sectional study utilized a large national sample (n=36,309) from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Face-to-face interviews were conducted to collect sociodemographic characteristics, structured diagnoses, and self-reported irritability. The irritable MDE group (n=4988) was compared to the non-irritable MDE group (n=3065). The lifetime prevalence of irritability in MDE was estimated at 61.3%. Participants with irritable MDE were significantly more likely to report a lifetime history of psychiatric disorders (aOR=1.96) than those with non-irritable MDE. Irritable MDE was also positively associated with severe MDE (aOR=2.12). Participants with irritable MDE were more likely to report a lifetime history of suicide attempts (aOR=1.15), substance use disorders (aOR=1.54), mood disorders (aOR=1.93), and anxiety disorders (aOR=1.67). Participants with irritable MDE had lower levels of health-related quality of life than those with non-irritable MDE. The majority of adults with MDE exhibits irritability. Irritability is associated with severe characteristics and comorbidities, leading to a higher burden of depression. This study demonstrates a strong association between irritable MDE and psychiatric comorbidities, as well as a substantial burden of depression and related conditions. As a cross-sectional study using a representative sample of the U.S. population with highly reliable psychiatric diagnoses, our results are generalizable. Practitioners managing MDE should identify and treat these comorbidities.