Likelihood Ratio Chi-square Research Articles

Factors influencing utilization of physiotherapy services by health care providers at Busia County Referral Hospital in Kenya

BackgroundThe surging trend of noncommunicable diseases complicated by trauma and infectious diseases has left many with marked physical limitations. Physiotherapy component of primary health care could be utilized for management of both communicable and noncommunicable diseases to restore physical functions.ObjectivesTo establish the health care providers’ level of knowledge and factors that influence the utilization of physiotherapy services among community members of Busia County in Kenya. The association between level of knowledge and demographic profile of health care providers at BCRH was also established.MethodDescriptive cross-sectional quantitative study involved 192 participants (nurses, doctors, and clinical officers) who were purposively selected. They completed self-administered questionnaire between August and November 2019. They were both sexes above 18 years of age, drawn from Busia County Referral Hospital. Data was analysed by Microsoft Excel and SPSS version 25.ResultsThe majority (92%) of the health care service providers had adequate knowledge about physiotherapy from their training to working with likelihood ratio chi-square of 7.714 with p-value at 0.01 at 5% level of significant. They had excellent communication (86.03%) with physiotherapists and helped to refer patients at BCRH for physiotherapy (χ2 = 52.02 and p-value = 0.01) at 5% level of significant. They had trust (91.56%) that physiotherapists were knowledgeable enough to handle patients on their own.ConclusionThe health care service providers are knowledgeable about the importance of physiotherapy and have supported its utilization. However, there is need to integrate physiotherapy service at all levels of training and practice of the components of primary health care. This will lead to a holistic patient’s care in terms of preventive, curative, and rehabilitative. Quality of life for the community members will be enhanced for appropriate functionality to meet the population needs. Lower utilization of physiotherapy services in Busia County could be due to factors associated with dynamics within the community and the health care service providers.

Model of dimensions and variables of corporate social responsibility updated through structural equations.

Corporate social responsibility (CSR) is a constantly evolving concept that reflects changes in society and the expectations of stakeholders in a process that leads companies to adapt to respond to new challenges and demands. Similarly, the theory and practice of CSR have moved from regulatory compliance to a more holistic approach that requires more sophisticated models that allow for a deeper understanding. Following the fact that companies now have access to a greater amount of information related to their social and environmental performance, as well as comparative data from other organizations, which is why it is necessary to have a management tool that allows collecting, process, and generating more accurate and meaningful metrics that more effectively reflect a company's impact on society. Consequently, the present work aims to identify a system of variables and dimensions representative of the management of organizations that allows the validation of a generic model of corporate social responsibility determined through factorial and structural modeling capable of reflecting more accurate and up-to-date dimensions and metrics of model variables and dimensions. To carry out the study, a sample of 667 middle and senior managers from medium and large companies in Guayas, Ecuador, were randomly contacted in their respective business contexts by trained interviewers. The data processing was carried out in stages. First, the exploratory factorial analysis method of the items was applied to form relevant factors. Then, the dimensions' structural modeling was formulated and ratified through the pertinent goodness-of-fit indices. The results determined a system of correlated factors whose items present estimators of commonality and high and significant factorial loads, excluding variables that did not exceed the sensitization criteria applied. Finally, a model made up of 15 factors and 66 variables ratified using the comparative adjustment indices, the chi-square likelihood ratio, and the mean square error of approximation is introduced, confirming the proposed corporate social responsibility model.

Real-world safety and discontinuation rates of fam-trastuzumab deruxtecan in advanced HER2-positive and HER2-low cancer.

e12518 Background: Fam-trastuzumab deruxtecan’s (Enhertu) 2022 approval for HER2-low breast cancer spurred widespread adoption of its utilization. DESTINY-Breast04 trial reported 9.9 months median progression-free survival (PFS); however, 16.2% experienced adverse events leading to treatment discontinuation. Our study evaluates real-world adverse event rates causing treatment discontinuation, to assess Enhertu's safety in patients with advanced metastatic cancer. Methods: A retrospective analysis was conducted at a community-based practice in Kansas, USA from 2020 to 2024. 99 patients with HER2-positive and HER2-low cancer, treated with Enhertu, with ECOG performance status of 0 and 1 were identified. Absolute values and proportions were used to represent categorical and nominal variables. Proportions between groups were analyzed using the likelihood ratio chi-square, Fisher's test, and the z-test. Statistical analyses were performed using SAS 9.4. The primary objective was to determine treatment discontinuation rates due to adverse events, while secondary objectives included assessing discontinuation rates due to disease progression, mortality rates, as well as progression-free survival, and dose interruption rates. Results: The average age of patients was 62 years, with 92% being females. The most common cancer types treated were Stage IV metastatic Breast Cancer (87%) and Gastric/Gastroesophageal Junction Cancer (9.1%). Of these cases, 44% were HER2-positive, while the rest were HER2-low. A total of 74% of patients discontinued treatment, with a mean duration of 5.4 months (95% Confidence Interval [CI] 4.2-6.7). Adverse events accounted for 9% of discontinuations, including interstitial lung disease/pneumonitis (33%), thrombocytopenia (11%), diarrhea (11%), nausea (22%), and dysgeusia (11%). 77% experienced grade 2 and 3 adverse events. Disease progression and death resulted in 49.4% and 11% of Enhertu discontinuation respectively. Among patients still on Enhertu (26%), the mean treatment duration was 13.5 months (95% CI 9.5-17.5). The mean PFS was 9.3 months (95% CI 6.2-9.4). Dose interruptions due to adverse events with subsequent resumption occurred in 18% of patients. Conclusions: In our community-based observational study on Enhertu discontinuation rates due to treatment-emergent adverse events (TEAEs), we found a 9% discontinuation rate—significantly lower than the 16.2% reported in the Breast04 trial, (P=0.045). The incidence of interstitial lung disease was 3%, considerably less than the 12% reported in Breast04. Importantly, no deaths related to TEAEs were observed, suggesting a lower occurrence of serious adverse events in clinical practice compared to clinical trials. These results underscore Enhertu's safety profile in advanced metastatic HER2-positive and low cancer.

Outcomes of rituximab as treatment for immune thrombocytopenic purpura in patients who have failed steroids or IVIG: A retrospective study in a community practice.

e23256 Background: Immune thrombocytopenic purpura (ITP) is a challenging disorder with multiple treatment options. The 2019 American Society of Hematology guidelines outline treatment recommendations for ITP which include intravenous immunoglobulin (IVIG) and steroids as first-line, with Thrombopoietin receptor agonists (TPO-RAs) and Rituximab as second-line agents. They favor TPO-RAs over Rituximab but suggest that the choice should be individualized. In this study, we explore the rate and duration of response to Rituximab as a second-line agent for ITP. We also analyze relapse rates and response to sequential TPO-RAs. Methods: A retrospective study of patients with ITP managed in a community practice from 2018 to 2022. The practice’s electronic medical records were searched for the keywords “ITP” and “Rituximab”. 87 patients fit the search terms. We included patients above age 18 treated with Rituximab for ITP after failing steroids or IVIG. We excluded duplicates, incomplete medical records, patients given Rituximab for reasons other than ITP, patients treated with medications other than steroids or IVIG prior to Rituximab, and patients given less than 4 doses of Rituximab. 60 out of 87 patients were eligible. The primary outcome was response to Rituximab defined as platelets above 30,000 per microliter of blood after 12 weeks of its initiation. Secondary outcomes include relapse rate, duration of response, and subsequent response to TPO-RAs. Secondary outcomes were determined by chart-reviewing physician documentation. Results: SAS 9.4 (SAS/STAT Inst., Carry NC) was used for all data. Categorical variables were quoted as absolute numbers and relative frequencies. A test result was considered statistically significant if p < 0.05. For categorical variables, likelihood ratio chi-square, and Fisher’s exact tests were conducted for 2*2 and r*c contingency tables to test associations. 96.7% of eligible patients responded to Rituximab (P < 0.0001), however 46.7% relapsed. 42.9% of relapses happened in less than 1 year, 14.3% in 1 year, 21.4% in 2 years, 7.1% in 3 years, 10.7% in 4 years, and 3.6% in 5 or more years (P = 0.0043). The response rate to TPO-RAs after Rituximab failure was 88%. No significant toxicity from Rituximab was noted beyond previously reported minor side effects, and there was no treatment-related death. Conclusions: The response rate to Rituximab was 96.7% (P < 0.0001) which was sustained in 53.3% of patients. Most relapsed patients responded well to TPO-RAs. These numbers are very comparable to previously reported response to Rituximab. Therefore, we believe that the strategy of using Rituximab as second-line and reserving TPO-RAs for non-responders is clinically-effective and certainly cost-effective given the fact that Rituximab is administered over four weeks as compared to the often lifetime treatment with TPO-RAs.

Attitudes of high school students towards visualization of mathematical content

Teaching is a process for which its plan should contain reflection onto previous experience. With that in mind, teaching situations should be continuously researched and improved in accordance with the research results. Led by this thought and the fact that students are uncritically using visualization to solve mathematical problems, we defined the aim of this research–determine the attitude of students about the visualization of mathematical content (VMC). The subject of this research are the attitudes of students towards VMC. By analyzing our research subject, we have discovered the research problem–students use visual aid to solve problems uncritically. Based on this problem, we have set the aim of our research. Our aim was to determine the students’ attitudes (and their opinions) about VMC. Based on the aim of our research, we have set four research tasks. Based on these research tasks, we have established the main (leading) research question–What is the attitude of high school students towards the application of VMC? We divided the main research question into five questions: Do high school students consider that they understand the term ‘VMC’? Who considers they use more methods of solving mathematical problems using visual aid–high school male students or female students? Students of which grades consider that they use solving problems using visual aid more? What is the attitude of high school students about the relationship between the substantiality of the picture (the amount of data it encompasses) and the difficulty of solving the problem? What is the attitude of students about the use of software to solve mathematical problems? The research has been conducted with 1,240 high school students from Sarajevo, Bosnia & Herzegovina. For the purposes of this article, we employed a survey, questionnaire-based research. The research was created as part of a larger study conducted in the context of preparing a doctoral dissertation related to VMC. It is one fundamental research. An essential aspect of this research involves students’ attitudes toward VMC. After obtaining all necessary approvals from relevant institutions and parents, students proceeded to testing and surveying in their school classrooms, under the supervision of designated individuals who facilitated the conduct of the research. The distribution of the data was not normal, so we used the Pearson Chi-square, likelihood ratio Chi-square, and linear-by-linear association test to examine the association between student attitudes and categorical variables (gender and grade). In addition, we used frequencies and percentages. It has been concluded that the students are mostly positive towards applying visualization in their process of solving mathematical problems and these should be used in the direction of improving the students’ success, their confidence and their level of contentment in their mathematics class, as well as in other life situations that encompass mathematical content. In future research, it could be examined why students expressed such attitudes about the presented situations. Additionally, it would be significant to explore why students do not consider themselves successful in applying VMC, despite claiming to understand the term. The analysis could extend to the content presented in textbooks or instructional materials students use–how visualized the content is or whether students are required to visualize it themselves. It would also be worthwhile to investigate the extent to which teachers encourage students to visualize specific tasks or do so on their behalf. Given the fluctuation in results (we observe affirmative answers–partially or completely) observed across grades–initial decrease, subsequent increase, followed by another decrease–it might be explored whether this is related to the curriculum taught in each grade (such as content, volume, number of class hours, etc.). Regarding images leading to incorrect conclusions, it would be interesting to investigate the types of images students have in mind, how frequently they encounter such situations, where they use these images, who creates them, and similar aspects. These are just some questions for future research.

Disclosure orthodontic and TMD-new study.

Cooperative analysis of participants and controls. Wiley Online Library, National Institute of Health, ResearchGate, ScienceDirect, Google Scholar. Human clinical trials age 18-30 years old, a case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality. Medical and/or dental emergencies, subjects with a history of drug, alcohol or medication abuse, fibromyalgia, being pregnant or lactating, having a coexisting mental, psychiatric, or physical disability, cancerous or significant medical problems and the consumption of drugs and/or medications that affect the nervous system including narcotics, TCA (tricyclic antidepressants), anticonvulsant, muscle relaxants and medication overuse headache. To identify differences between groups, categorical independent variables were analysed using the chi-square test or likelihood ratio, while numeric independent variables were analysed using independent t-tests and analysis of variance (ANOVA). A two-tailed level of statistical significance (α) was established at 0.05. Analysis of multicollinearity was performed following the univariate analyses to examine the collinearity among the independent variables and select independent variables with minimal correlation. Among the highly correlated variables, only one was selected for inclusion in the multivariate model, with the specific variable chosen based on contextual considerations. The research comprised a total of 291 individuals, consisting of two distinct groups: the TMD group (192 participants, 66%) and the control group (99 participants, 34%). Within the TMD group, further subcategorization was conducted, including MMP (masticatory muscle pain) with 44 individuals (15%); TMJD with 26 individuals (9%); and TMP (both MMP and TMJ) with 122 individuals (42%). Using a "holistic" and a "collinearity statistical approach and the utilization of a multivariate model" the conclusion is that TMD is not associated with orthodontics.

An assessment on adoption of Bordeaux paste and mixture by apple growers in Jumla district, Nepal

Apple production largely depend upon the orchard management. High hill of Nepal has great potentiality for apple production. Quality products are pre-requisite of today’s market. Quality product is only maintained through proper orchard management by adopting modern technology. This study focused on the determinants of adoption of Bordeaux paste and mixture by apple growers. A census survey was conducted to total 1500 apple growing farmers of Chandannath Municipality (1-10), Jumla in 2021 and interviewed individually with pre-tested structured interview schedules. Chandannath Municipality being the command area of Apple Super-Zone, Prime-minister Agriculture Modernization Project (PMAMP) having potential producing center was selected for study. The collected information was coded and analyzed by using STATA. The data were analyzed by using descriptive statistics and Probit Model of regression. Good explanatory power of probit model was revealed through likelihood ratio chi-square (LR chi2) was statistically significance at 1% level and pseudo R2 value was 0.6618. Variables such as gender, economic status of farmers, training received, experienced of farmers and availability of plant protection equipment were found statistically significant and are positively related to adoption. Others factors such as age of farmers and education status of farmers were positively correlated with adoption whereas factors such as active members of family, access to credit, farm size, family type and distance form extension services were found negatively related with the adoption of Bordeaux paste and mixture and statistically not significant. Providing subsidies to marginalized farmers, provision of training and extension service to rural farmers would increase adoption of Bordeaux paste and mixture for healthy apple production.

Abstract C077: Effects of treatment delays on colorectal cancer survival

Abstract Introduction: Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide. Understanding the influence of patient characteristics and treatment modalities on delays in care and related outcomes is crucial for optimizing treatment strategies and improving patient survival. Methods: A retrospective analysis of 2,359 CRC patients from the PLCO trial was conducted to assess the relationships between treatment initiation delays and survival outcomes. Descriptive statistics, Spearman's correlation coefficients, and Cox proportional hazards regression analyses were employed to analyze the data. Results: Among other factors, patients with disabilities and those using ibuprofen exhibited a higher hazard ratio and a lower hazard ratio, respectively, indicating the influence of these factors on patient outcomes. Despite examining multiple waiting time predictors, no significant associations were found between these predictors and mortality risk. The model's non-significant likelihood ratio chi-square and log-likelihood value suggested that it did not provide an adequate fit to the data. Discussion: This study highlights the importance of understanding the relationships between patient characteristics, treatment modalities, and their impact on patient outcomes in CRC patients. While curative resection was significantly associated with improved survival, neoadjuvant chemotherapy did not demonstrate a significant effect on mortality. The lack of association between waiting time predictors and mortality risk suggests the need to explore additional factors influencing patient outcomes. Conclusion: In conclusion, the study provides valuable insights into the relationships between patient characteristics, treatment modalities, and their impact on patient outcomes in CRC patients. Further research is needed to identify additional factors that may influence mortality risk and to optimize treatment strategies for this patient population. Citation Format: Percy Guzman Montero. Effects of treatment delays on colorectal cancer survival [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C077.

Relationship between the COVID-19 pandemic and structural inequalities within the pediatric trauma population

BackgroundThe COVID-19 pandemic disrupted social, political, and economic life across the world, shining a light on the vulnerability of many communities. The objective of this study was to assess injury patterns before and after implementation of stay-at-home orders (SHOs) between White children and children of color and across varying levels of vulnerability based upon children’s home residence.MethodsA multi-institutional retrospective study was conducted evaluating patients < 18 years with traumatic injuries. A “Control” cohort from an averaged March-September 2016–2019 time period was compared to patients injured after SHO initiation-September 2020 (“COVID” cohort). Interactions between race/ethnicity or social vulnerability index (SVI), a marker of neighborhood vulnerability and socioeconomic status, and the COVID-19 timeframe with regard to the outcomes of interest were assessed using likelihood ratio Chi-square tests. Differences in injury intent, type, and mechanism were then stratified and explored by race/ethnicity and SVI separately.ResultsA total of 47,385 patients met study inclusion. Significant interactions existed between race/ethnicity and the COVID-19 SHO period for intent (p < 0.001) and mechanism of injury (p < 0.001). There was also significant interaction between SVI and the COVID-19 SHO period for mechanism of injury (p = 0.01). Children of color experienced a significant increase in intentional (COVID 16.4% vs. Control 13.7%, p = 0.03) and firearm (COVID 9.0% vs. Control 5.2%, p < 0.001) injuries, but no change was seen among White children. Children from the most vulnerable neighborhoods suffered an increase in firearm injuries (COVID 11.1% vs. Control 6.1%, p = 0.001) with children from the least vulnerable neighborhoods having no change. All-terrain vehicle (ATV) and bicycle crashes increased for children of color (COVID 2.0% vs. Control 1.1%, p = 0.04 for ATV; COVID 6.7% vs. Control 4.8%, p = 0.02 for bicycle) and White children (COVID 9.6% vs. Control 6.2%, p < 0.001 for ATV; COVID 8.8% vs. Control 5.8%, p < 0.001 for bicycle).ConclusionsIn contrast to White children and children from neighborhoods of lower vulnerability, children of color and children living in higher vulnerability neighborhoods experienced an increase in intentional and firearm-related injuries during the COVID-19 pandemic. Understanding inequities in trauma burden during times of stress is critical to directing resources and targeting intervention strategies.

Antibiotic Consumption Behaviour of Dental Patients Attending in Tertiary Hospital

Background: The consumption of antibiotics is increasing globally and in dentistry, it is increasing day by day at an alarming rate. The irrational consumption of antibiotics results not only in the emergence of antibiotic resistance but also in various adverse reactions and imposes financial burden on health system. Objective: The aim of the study was to assess the antibiotic consumption behaviour of dental patients attending in tertiary hospital. Methods: This cross-sectional study was conducted at Dhaka Dental College Hospital from July 2020 to June 2021 among 195 dental patients. After obtaining informed written consent, data were collected by face to face interview using a pretested semi-structured questionnaire and checklist. Data were analyzed using SPSS 26 version. Pearson’s Chi-square test and Likelihood Ratio were done to assess the association with 5% level of significance. Results: In this study, mean (±SD) age of the dental patients was 41.11 (±14.09) years. Majority of the patients were male (52.8%). More than half (52.8%) of the patients’ monthly family income was ≤20000 BDT with predominant urban dwellers (72.8%). Mean (±SD) antibiotic consumption behaviour score of the patients were 10.96 (±3.879) and behaviour categories were good behaviour (35.9%), average behaviour (32.8%) and poor behaviour (31.8%) respectively. More than half of the patients (56.4%) sometimes forgot or missed any of their antibiotics and about one-fourth (26.7%) of the patients were not aware that they were prescribed antibiotics for their dental conditions. Antibiotic consumption behaviour showed significant association with educational status (p&lt;0.001), occupation (p&lt;0.010), residence (p&lt;0.002), family income (p&lt;0.001) and awareness about antibiotics (p&lt;0.001). Conclusion: This study revealed improper antibiotic consumption behaviour among a large number of dental patients. Behaviour change communication measures focusing on both prescribers and dental patients is recommended to reduce inappropriate consumption of antibiotics and to promote rational usage. Bangladesh Medical Res Counc Bull 2023; 49(2): 91-97

Mindfulness-Based Group Therapy for Chronic Pain Management in Older Adults

ABSTRACT Objectives There were two quality improvement goals for this project: (1) to evaluate the outcomes of an 8-week geriatric-focused mindfulness-based group therapy program for chronic pain management called “Mindfulness-based Chronic Pain Care” offered at a senior community center affiliated with a geriatric primary care clinic, and (2) to obtain feedback from participants to make relevant modifications for future groups. Methods The program consisted of eight 150-minute weekly sessions. Thirteen community-dwelling older adults aged 60 and older participated in the program. The study utilized a non-randomized control-group pretest-posttest design. Participants completed pre- and post-program evaluations measuring pain and related psychosocial outcomes and were also asked to evaluate the importance of the group. Intervention and control groups were compared by t-test, chi-square likelihood ratio, Fischer’s exact test, and multivariate analysis of variance with repeated measures. Results There were statistically significant improvements in three areas: 1) increased activity level, 2) increased “pain willingness,” and 3) decreased generalized anxiety symptoms. Qualitative analysis highlighted how this intervention was important to participants. Conclusions The results of this pilot program indicate promising outcomes for older adults suffering from chronic pain. Clinical Implications The Mindfulness-based Chronic Pain Care program was a practical, feasible, and acceptable approach for pain management among program participants.

Analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in 3172 second-instance and retrial cases in China

BackgroundMedical disputes remain a global public health problem. However, an analysis of the characteristics and risk factors affecting the judgment results of medical damage liability disputes in second-instance and retrial cases in China has yet to be conducted.MethodsWe conducted a systematic search and evaluation of second-instance and retrial cases among all medical damage liability disputes in China Judgments Online; SPSS 22.0 was used for the statistical analysis. A χ2 test or likelihood ratio Chi-square test was used to compare differences between groups, and multivariate logistic regression analysis was performed to determine independent risk factors that could affect the judgment results of medical disputes.ResultsWe included 3172 second-instance and retrial cases among all medical damage liability disputes in the analysis. The results showed that 48.04% of cases were unilateral appeals by the patient, and medical institutions were responsible for providing compensation in 80.64% of these cases. Cases involving compensation ranged from Chinese Yuan (CNY) 100 000 to 500 000 ranked first (40.95%); 21.66% were non-compensation cases. Cases involving mental damage compensation of less than CNY 20 000 accounted for 39.03%. Violations of medical treatment and nursing routines accounted for 64.25% of all cases. In addition, re-identification in 54.59% of cases changed the initial appraisal opinion. Independent risk factors for medical personnel to lose a lawsuit in a multivariate logistic regression model included appeal originator [patient side: OR = 18.809 (95% CI 11.854–29.845); both sides: OR = 22.168 (95% CI 12.249–40.117)], change of the original verdict (OR = 5.936, 95% CI 3.875–9.095), judicial identification (OR = 6.395, 95% CI 4.818–8.487), violations of medical treatment and nursing routines (OR = 8.783, 95% CI 6.658–11.588), and non-standard medical document writing (OR = 8.500, 95% CI 4.805–15.037).ConclusionOur study clarifies the characteristics of second-instance and retrial cases among all medical damage liability disputes in China from multiple perspectives and identifies the independent risk factors for medical personnel losing a lawsuit. This study could help medical institutions prevent and reduce medical disputes, at the same time, it could be helpful for medical institutions to provide better medical treatment and nursing services for patients.

Factors Associated with Juvenile Delinquency: A Case of Arusha Juvenile Remand Home in Arusha City-Tanzania

The assessment of factors related to juvenile delinquency was conducted at Arusha Remand Home in Arusha City. This study adopted a cross-sectional design and gathered both quantitative and qualitative data from various primary and secondary sources. A sample of 103 respondents was selected using a simple random sampling technique. Structured interviews using researcher-administered questionnaires were employed to collect primary data from the participants. In-depth interviews were conducted with selected juveniles to obtain insights into the delinquency in the city. Descriptive statistics and the Likelihood Ratio Chi-Square test were employed for quantitative data analysis, utilising IBM SPSS Statistics version 20. The findings indicated that theft offences accounted for a significant proportion of juvenile delinquency (45.6%), followed by abuse (29.1%) and vandalism (25.2%). The primary causes of delinquent behaviours were identified as poverty (67%), peer influence (28.2%), and family dysfunction (4.9%). Additionally, the study identified gender, household size, parenting style, and the causes of committing crimes as factors associated with juvenile delinquency. Based on these findings, it is recommended that the Arusha City Council, in collaboration with other stakeholders, develop targeted interventions and initiatives to address the specific challenges faced by juveniles. Government welfare officers in Arusha City should design educational programmes aimed at equipping families with the necessary knowledge and skills to create a nurturing environment for their children, thereby guiding juveniles onto a positive path. Implementing these recommendations aims to prevent and reduce juvenile delinquency and promote the overall well-being and positive development of young individuals in Arusha City

Evaluating the Performance of ChatGPT in Ophthalmology: An Analysis of Its Successes and Shortcomings

Foundation models are a novel type of artificial intelligence algorithms, in which models are pretrained at scale on unannotated data and fine-tuned for a myriad of downstream tasks, such as generating text. This study assessed the accuracy of ChatGPT, a large language model (LLM), in the ophthalmology question-answering space. Evaluation of diagnostic test or technology. ChatGPT is a publicly available LLM. We tested 2 versions of ChatGPT (January 9 "legacy" and ChatGPT Plus) on 2 popular multiple choice question banks commonly used to prepare for the high-stakes Ophthalmic Knowledge Assessment Program (OKAP) examination. We generated two 260-question simulated exams from the Basic and Clinical Science Course (BCSC) Self-Assessment Program and the OphthoQuestions online question bank. We carried out logistic regression to determine the effect of the examination section, cognitive level, and difficulty index on answer accuracy. We also performed a post hoc analysis using Tukey's test to decide if there were meaningful differences between the tested subspecialties. We reported the accuracy of ChatGPT for each examination section in percentage correct by comparing ChatGPT's outputs with the answer key provided by the question banks. We presented logistic regression results with a likelihood ratio (LR) chi-square. We considered differences between examination sections statistically significant at a P value of < 0.05. The legacy model achieved 55.8% accuracy on the BCSC set and 42.7% on the OphthoQuestions set. With ChatGPT Plus, accuracy increased to 59.4% ± 0.6% and 49.2% ± 1.0%, respectively. Accuracy improved with easier questions when controlling for the examination section and cognitive level. Logistic regression analysis of the legacy model showed that the examination section (LR, 27.57; P= 0.006) followed by question difficulty (LR, 24.05; P < 0.001) were most predictive of ChatGPT's answer accuracy. Although the legacy model performed best in general medicine and worst in neuro-ophthalmology (P < 0.001) and ocular pathology (P= 0.029), similar post hoc findings were not seen with ChatGPT Plus, suggesting more consistent results across examination sections. ChatGPT has encouraging performance on a simulated OKAP examination. Specializing LLMs through domain-specific pretraining may be necessary to improve their performance in ophthalmic subspecialties. Proprietary or commercial disclosure may be found after the references.

E085 Investigating the relationship between daily disease impact scores and mood in patients with psoriatic arthritis using a smartphone application: a novel use of the PsAID-9 questionnaire

Abstract Background/Aims Psoriatic arthritis (PsA) is a form of inflammatory arthritis affecting up to 30% of those with psoriasis. It has a considerable impact on patients’ functional capacity and quality of life. Studies have shown an increased prevalence of depression in patients with PsA which can contribute to reduced likelihood of disease remission. Smartphone applications have been developed to monitor symptoms in patients with rheumatic diseases. We used experience sampling to assess the relationship between daily PsA symptom burden using the PsAID-9 questionnaire and mood components utilising the validated Mood Zoom (MZ) questionnaire. Methods Participants (n = 25) with PsA aged ≥18 and &amp;lt;80 years, meeting the CASPAR criteria were recruited from rheumatology clinics at a single centre. At baseline, disease impact was assessed using the Psoriatic Arthritis Impact of Disease-9 (PsAID-9) questionnaire. Participants used the Mezurio smartphone application daily for 28 days to collect data on the PsAID-9 and Mood Zoom questionnaires. MZ comprises 10-items assessing mood symptoms on a 5-point Likert scale. The relationship between daily fluctuations in PsA symptoms and each mood component was assessed using linear mixed-effect (LMER) models. Likelihood ratio testing and Chi-square tests were used to identify statistical significance. Each model controlled for gender and PsAID-9 remission at baseline. Results Mean (SD) age was 49.6 (12.05) years. Sixteen had co-morbid psoriasis. Mean (SD) PsAID-9 scores were 3.28 (1.92). There was a bi-directional association between the mood components of MZ and total PsAID-9 score for each day, as shown in Table 1. Conclusion This study has demonstrated a relationship between daily fluctuations in disease burden and mood. This is the first study to pilot a daily assessment of disease impact versus traditional longer interval collections. Whilst these data demonstrate an association between mood and disease symptoms, they do not allow us to make inferences on the causal effect of mood on symptoms and vice versa. Further research into the relationship between mood and disease burden in PsA are warranted. Disclosure D. McGagh: None. N. McGowan: None. Y. Wu: None. C. Hinds: None. K.E.A. Saunders: None. L.C. Coates: None.

Determinants on the Choice of the Main Source of Cooking Energy by Households in Urban Areas of Tanzania: A Case of Kiwanja Cha Ndege Ward in Morogoro Municipality

The study was carried out at Kiwanja cha Ndege ward in Morogoro Municipality by assessing determinants on the choice of the main source of cooking energy by households. This study employed cross–sectional design and collected quantitative data from primary and secondary sources. A total of 150 respondents were selected using a simple random sampling technique. Primary data were collected from respondents through a structured interview method executed through researcher-administered questionnaires. The study used descriptive statistics, the likelihood ratio Chi-Square test, and binary logistic regression analysis using IBM SPSS statistics version 20 and Stata version 11. The results revealed that a large proportion of households used charcoal (84%), followed by gas (11.3%) as the main source of cooking energy. This information implies that households in urban areas prefer mostly using charcoal for cooking. Furthermore, the results revealed that education level, marital status, and main economic activity were the factors that determine the choice of charcoal as the household's main source of cooking energy. The study recommended that the central government, through the Ministry of Energy in collaboration with local government authorities, should create awareness in society on the importance of using clean cooking fuels and technologies. Also, the government of Tanzania should enhance and promote the use of electrical energy as an alternative source of cooking energy in order to protect plant species that are more objects of wood–charcoal use.

Factors influencing contraceptive use among women of reproductive age in plantation farming communities in South-South Nigeria.

The use of contraceptives by women of reproductive age remains one of the cost-effective ways of reducing maternal, infant, and child mortality and achieving a decline in the high fertility rate in the country. This was a descriptive cross-sectional study aimed to assess the association between the location of residence, occupation, and education level and the current use of contraceptives among women of reproductive age resident in plantation farming communities in South-south Nigeria. The test of associations between the dependent and independent variables and covariates was conducted using the Likelihood ratio Chi-square as appropriate. Multiple logistic regressions using the best-fit option of covariate selection were done with the use of contraceptives as the dependent variable. Of the 609 participants recruited, 189 (31.03%) were currently using a contraceptive. Women with secondary education were less likely to use contraceptives compared to the none educated [AOR=0.07; CL: 0.013-0.39]. Location and age were also significant predictors of the use of contraceptives by women in plantation farming communities in Nigeria. Deliberate and purposeful targeting of women and girls of reproductive age in plantation farming communities should be prioritized in the universal access to contraceptive use.

Volume-Weighted Unipolar Voltage Predicts Heart Failure Mortality in Patients With Dilated Cardiomyopathy and Ventricular Arrhythmias

BackgroundPatients with dilated cardiomyopathy (DCM) who are undergoing catheter ablation of ventricular arrhythmias (VAs) are at risk of rapidly progressive heart failure (HF). Endocardial voltages decrease with loss of viable myocardium. Global left ventricular (LV) voltage as a surrogate for the amount of remaining viable myocardium may predict prognosis. ObjectivesThis study evaluated whether the newly proposed parameter volume-weighted (vw) unipolar voltage (UV) can predict HF-related adverse outcomes (HFOs), including death, heart transplantation, or ventricular assist device implantation, in DCM. MethodsIn consecutive patients with DCM referred for VA ablation, vwUV was calculated by mathematically integrating UV over the left ventricle, divided by the endocardial LV surface area and wall thickness. Patients were followed for HFOs. ResultsA total of 103 patients (57 ± 14 years of age; left ventricular ejection fraction [LVEF], 39% ± 13%) were included. Median vwUV was 9.75 (IQR: 7.27-12.29). During a median follow-up of 24 months (IQR: 8-47 months), 25 patients (24%) died, and 16 had HFOs 7 months (IQR: 1-18 months) after ablation. Patients with HFOs had significantly lower LVEF (29% ± 10% vs 41% ± 12%), vw bipolar voltage (BV) (3.00 [IQR: 2.47-3.53] vs 5.00 [IQR: 4.12-5.73]), and vwUV (5.94 [IQR: 5.28-6.55] vs 10.37 [IQR: 8.82-12.81]; all P < 0.001), than patients without HFOs. In Cox regression analysis and goodness-of-fit tests, vwUV was the strongest and independent predictor for HFOs (HR: 3.68; CI: 2.09-6.45; likelihood ratio chi-square, 33.05; P < 0.001). ConclusionsThe novel parameter vwUV, as a surrogate for the amount of viable myocardium, identifies patients with DCM with VA who are at high risk for HF progression and mortality.

The effect of Reiki on fatigue and comfort in hemodialysis patients

ObjectiveThis prospective, single-blind, randomized parallel controlled study was conducted to determine the effects of distant Reiki on the fatigue and comfort levels of patients undergoing hemodialysis (HD) treatment. MethodsThe study was conducted in a private dialysis center located in one of the metropolises of Turkey between October 2020 and September 2021. Sixty-two patients receiving HD treatment were randomly allocated to intervention (n = 31) and control (n = 31) groups. Distant Reiki was administered to the patients in the intervention group three times a week for four weeks. Distant Reiki sessions were held the night before the patient's hemodialysis day and lasted approximately 36–40 min. The patients in the control group were administered routine treatment under the institutional policy without any further intervention. Data were collected using the Fatigue Severity Scale (FSS) and General Comfort Questionnaire (GCQ). Measurements were performed before Reiki was applied, after Reiki was applied (the first day after the 12th session), and four weeks after the last measurement in order to assess whether Reiki has a long-term effect. The data obtained were assessed using Shapiro Wilk, Repeated Measures, Student's t, Pearson chi-square, Likelihood Ratio chi-square, and Fisher Exact chi-square tests. ResultsThe patients in the intervention and control groups were statistically similar in terms of their descriptive characteristics (p>0.05). The intervention group's fatigue score decreased from 5.42 (SD=1.20) to 3.44 (SD=1.00) immediately after the intervention and 3.21 (SD=0.86) four weeks after the intervention. In the control group, these values were 4.50 (SD=1.29), 4.70 (SD=1.22), and 4.65 (SD=1.02), respectively (p<0.05).The general comfort total score of the intervention group increased from 2.86 (SD=0.30) to 3.03 (SD=0.20) immediately after the intervention and 2.98 (SD=0.22) four weeks after the intervention. In the control group, these values were 2.71 (SD=0.33), 2.63 (SD=0.23), and 2.59 (SD=0.30), respectively (p<0.05). ConclusionThis research has shown that distant Reiki, as one of the non-pharmacological methods, positively affects the fatigue severity and comfort level of patients receiving HD treatment.

A Neural Learning Approach for a Data-Driven Nonlinear Error Correction Model.

A nonlinear error correction model (ECM) is developed to fit nonlinear relationships between the nonstationary time series in a cointegration relationship. Different from the previous parametric methods, this paper constructs a hybrid neural network to learn the nonlinear error correction model by combining a linear recurrent neural network with a multilayer BP network. The network learning algorithm is given by using the gradient descent method and error back propagation. Based on the principle of data-driven, all network parameters can be obtained through the network learning and training. The daily data of gold price and the US dollar index in 2021 were used to verify this proposed nonlinear ECM neural learning method and the results were compared by the likelihood ratio Chi-square test. Simulation results show that the proposed data-driven nonlinear error correction neural learning method can improve goodness of fit statistical significantly of complex nonlinear relationship between time series.