Low Category Research Articles

Increased Body Mass Index is Independently Associated with Chronic Kidney Disease among People with Type 2 Diabetes

Background The alarming increase in the prevalence of obesity has implications for chronic kidney disease (CKD) progression in type 2 diabetes (T2D). This study aimed to assess if increased body mass index (BMI) can be an independent risk factor for CKD and T2D in the Indian context. Materials and Methods In this cross-sectional study, 602 (M:F = 378:224) participants were screened using Kidney Disease Improving Global Outcomes (KDIGO) from January to October 2023 in Chennai. Demographic, anthropometric, biochemical, clinical details, and comorbidities were recorded. T2D with CKD low risk was taken as control group, and CKD moderate and high risks were the study groups. BMI was classified based on the Asian criteria into normal (18.5–22.9), overweight (23–24.9), and obese (≥25 kg/m2). Results Majority of participants in moderate and high risk categories were obese compared to the low risk category (60.5% and 66.4% vs. 39.1%; p < 0.001). A higher proportion of participants was on antihypertensive drugs in the high risk group and in the obese category (p < 0.001). Comorbidities and diabetic complications were higher in the high risk group (p < 0.001). Multivariate logistic regression revealed that age of ≥ 60 years [OR(95% CI); 6.3(2.2–18); p = 0.009]; increased BMI as overweight [3.6(2.1–6.3); p < 0.001] and obese [5.2(3.3–8.3); p < 0.001]; smoking [4.2(1.7–10.2); p = 0.002]; increased duration of diabetes of 5–15 years [2.3(1.2–4.5); p = 0.013], 16–25 years [4.8(2.2–10.4); p < 0.001], and >25 years [4.2(1.4–13); p = 0.011]; systolic blood pressure [1.01(1.0–1.03); p = 0.02]; and hemoglobin A1c [1.2(1.1–1.3); p < 0.001] were independent risk factors for the progression of CKD. Conclusion Increased BMI was independently associated with CKD in T2D. Overweight and obese individuals are four to five times at risk for CKD progression. Early identification, lifestyle intervention, and weight-lowering drugs may reduce the complications of obesity in T2D and CKD.

The Differences of Students’ Learning Outcomes Using the Discovery Learning Model and Problem Based Learning in Science Learning at Primary Schools

The paper aims to compare the effectiveness of two learning models, namely Discovery Learning (DL) and Problem Based Learning (PBL), in improving student learning outcomes in science subjects. This type of research is experimental research. The population in this study were all class IV students at SDN 002 SK (Samarinda City), totaling three classes. The calculation results show that the average pretest score in experimental class I is 45.12, which is higher compared to 35.60 in experimental class II. After treatment, the average posttest score in experimental class I increased to 85.80, while in experimental class II it reached 82.11. The average N-Gain for both classes was 0.74, indicating a significant increase in learning outcomes in both classes, although experimental class I showed slightly better results. More in-depth analysis based on high and low learning outcome categories shows consistent differences in the effectiveness of learning models. Hypothesis testing using the T Test, which is applied because the data distribution is normal and the variance is homogeneous, shows a calculated t-value of 8.60 which far exceeds the t_table of 2.070. This causes rejection of H_0 and acceptance of H_1, indicating that the Discovery Learning (DL) model in experimental class I provides better learning results than the Problem Based Learning (PBL) model in experimental class II.

09 Penicillin allergy de-labeling: Adaptation of risk stratification tool for patients and families

Abstract Background Penicillin allergy is reported in 10% of the population, however, over 90% of patients are deemed non-allergic upon allergist assessment. A validated mobile penicillin allergy risk assessment tool was previously developed to help healthcare providers identify patients at low risk of penicillin allergy and de-label them. Objectives The goal of this quality improvement project is to validate a patient-driven version of the assessment tool. Design/Methods Patients 6 months to 18 years old and pregnant women referred to the institution’s allergy clinics for penicillin allergy assessment were invited to use the patient tool to complete a self-assessment prior to their appointment, resulting in the assignment of a risk category: allergic, high risk, low risk, or not allergic. At their appointment, the allergist conducted an assessment with the standardized validated tool. The risk categories determined using the patient tool were compared against the allergist assessment. Patients were provided satisfaction surveys. Results The allergist assessment and patient tool demonstrated agreement in 57/84 (67.9%, 95% CI [56.7%,77.4%]) assessments, intra-class correlation (ICC) = 0.618, p<0.001. Of these, 45/57 (78.9%) patients were stratified as low risk or not allergic. In 22/84 (26.2%) assessments, the patient tool determined a higher risk category than the allergist, primarily due to differences in patients’ perceived timing and description of symptoms. Only 5/84 (6.0%) patients were placed in a lower risk category using the patient tool compared to the validated tool. Of these, one patient responded to the self-assessment accounting for a mild reaction, whereas the allergist assessment accounted for a second, more severe reaction. The other 4/5 patients mistakenly answered that they had never taken penicillin so were stratified as not allergic on the patient tool; however, they had previously taken penicillin and were found at risk of possible allergy by the allergist. Of those who responded to the satisfaction survey, 53/62 (85.5%) agreed that the patient tool was easy to use. Conclusion The patient tool demonstrates good agreement in determining penicillin allergy risk, generally aligning with the validated tool and offering potential as a method of empowering patients to assess their risk and advocate for their care. For a small minority of patients, the patient tool determined a lower risk category than the allergist assessment. To improve safety, agreement, and accessibility, iterative cycles of assessment and changes to the patient tool structure will be applied. Potential competing interests Funding was obtained from Valeo, Polaris Health, CeraVe, ALK, Astra Zeneca, Medexus, Novartis, Sanofi, Pfizer

Kajian Beberapa Status Hara Pada Areal Replanting Tanaman Karet (Hevea brasiliensis) di Kebun Aek Nabara Utara Kecamatan Bilah Hulu

Rubber plants (Hevea brasiliensis) will experience a decrease in production as plants age and the nutrient content in the soil decreases. This study aims to find out the chemical properties of soil on plantations of rubber crops that are converted into palm and coconut crops. The research was conducted from Februari 2023 to Agustus 2024 at the palm coconut plantation of PTPN III Aek Nabara North Garden in Labuhanbatu district and analyzed in the Land Laboratory of the Faculty of Agriculture of the University of Northern Sumatra. The methods used are observation methods, field sampling, and analysis in the laboratory to obtain quantitative data. Observation parameters include soil pH, C-organic, Total Nitrogen, Available P, Cation Interchange Capacity, and Base Fulness. The results of the survey showed that the level of soil fertility at the site of the research was included in the low category. The main limiting factor that causes the low fertility of the soil is the low content of organic material in the soil. In order to improve the fertility status of the ground at the research site for further planting, it is necessary to make efforts such as irrigation and fertilization, as well as the addition of organic materials, to make the availability of nutrients for plants more affordable. Keywords: replanting area, rubber plants, conversion, soil fertility, quantitative data

A review of intracranial aneurysm imaging modalities, from CT to state-of-the-art MR.

Traditional guidance for intracranial aneurysm (IA) management is dichotomized by rupture status. Fundamental to ruptured aneurysm management is the detection and treatment of subarachnoid hemorrhage, along with securing the aneurysm by the safest technique. On the other hand, unruptured aneurysms first require a careful assessment of natural history versus treatment risk, including an imaging assessment of aneurysm size, location, and morphology, along with additional evidence-based risk factors such as smoking, hypertension, and family history. Unfortunately, a large proportion of ruptured aneurysms are in the lower risk size category (<7mm), putting a premium on discovering a more refined non-invasive biomarker to detect and stratify aneurysm instability prior to rupture. In this review of aneurysm work-up, we cover the gamut of established imaging modalities (e.g., CT, CTA, DSA, FLAIR, 3D-TOF-MRA, CE-MRA) as well as more novel MR techniques (MR-VWI, DCE-MRI, CFD). Additionally, we evaluate the current landscape of AI software and their integration into diagnostic and risk stratification pipelines for IAs. These advanced MR techniques, increasingly complemented with AI models, offer a paradigm shift by evaluating factors beyond size and morphology, including vessel wall inflammation, permeability, and hemodynamics. Additionally, we provide our institution's scan parameters for many of these modalities as reference. Ultimately, this review provides an organized, up-to-date summary on the array of available modalities/sequences for IA imaging to help build protocols focused on IA characterization.ABBREVIATIONS: IA = intracranial aneurysm; LP = lumbar puncture; UIA = unruptured intracranial aneurysm; VWI = vessel wall imaging; 3DRA = 3D Rotational Angiography.

A Nationwide, Population-based Study of Intelligence and Hearing Loss Among 3,104,851 Adolescents.

Epidemiological studies have demonstrated a relationship between general intelligence (GI) in youth and hearing loss (HL). However, no large-scale study assessed the relations of GI in late adolescence with conductive HL and sensorineural HL, stratified by severity. This study examined the connection between HL and GI in late adolescence. Cross-sectional study on mandatory pre-military recruitment data recorded during 1967-2019 of patients aged 17-19. We compared GI between sensorineural HL, conductive HL, and those with normal hearing. In addition, we used logistic regression to measure the associations between HL and GI after adjuring for age, sex, education, and socioeconomic status. Among 3,104,851 adolescents assessed, 20,075 (0.6%) exhibited hearing loss (HL). We categorized general intelligence (GI) into three levels for analysis: low (lowest category), medium, and high (reference category). Adjusted odds ratios (ORs) revealed that sensorineural HL (SNHL) was associated with lower GI levels, with ORs ranging from 1.3 [95% CI 1.4-1.2] for the lowest GI category to 1.1 [95% CI 1.15-0.04] for the medium category. Conductive HL (CHL) also demonstrated significant associations, with ORs from 1.8 [95% CI 1.9-1.6] for the lowest GI level to 1.1 [95% CI 1.2-0.9] for medium. Further analysis revealed a statistically significant, severity-dependent relationship between SNHL and the odds of being in the lowest GI quartile (Q1). Specifically, the odds ratios for SNHL ranged from 1.2 [95% CI 1.1-1.3] to 1.3 [95% CI 1.1-1.5] as severity increased, indicating a strong link between greater SNHL severity and reduced cognitive performance. In contrast, CHL did not show a consistent correlation between its severity and GI outcomes, with an OR of 1.6 [95% CI 1.2-2.3] across severity levels. We report a strong relationship between HL and GI in late adolescence. Sensorineural HL, but not conductive HL, demonstrated a severity-based decline in GI. The results highlight the value of early, specifically targeted therapies for HL that consider its etiology and degree.

Pengaruh Model Problem Based Learning Berbantuan Media Assemblr Edu terhadap Kemampuan Pemecahan Masalah Siswa Kelas V

Problem-solving skills are essential competencies that need to be developed in elementary school students. The application of innovative learning models, such as Problem-Based Learning supported by interactive technology media like Assemblr Edu, can be an effective solution for enhancing these skills. This study aims to analyze the impact of the Problem-Based Learning (PBL) model supported by Assemblr Edu media on the problem-solving abilities of fifth-grade students. The research method used is an experimental method with a Pre-test Post-test Non-Equivalent Control Group Design. The results of the study showed that the use of the PBL model supported by Assemblr Edu significantly improved students' problem-solving abilities compared to conventional learning methods. This can be seen from the significant difference in the N-Gain scores, with the experimental class reaching 0.7 (moderate category) and the control class only 0.2 (low category). These findings suggest that interactive technology media like Assemblr Edu can be an effective tool in enhancing students' critical and analytical thinking skills.

Clinical Correlates and Prognostic Impact of Cognitive Dysfunction in Patients With Heart Failure and Preserved Ejection Fraction: Insights From PARAGON-HF.

Cognitive impairment is common in patients with heart failure and preserved ejection fraction but its clinical correlates and prognostic associations are poorly understood. We analyzed cognitive function, using the Mini-Mental State Examination (MMSE), in patients with heart failure and preserved ejection fraction enrolled in a prespecified substudy of the PARAGON-HF trial (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Global Outcomes in Heart Failure With Preserved Ejection Fraction). Logistic regression analyses were performed to determine the variables associated with lower MMSE scores at baseline and postbaseline decline in MMSE scores at 48 weeks. Cox proportional hazards regression and semiparametric proportional rates models were used to examine the risk of clinical outcomes related to baseline MMSE scores, and decline in MMSE scores during follow-up, adjusted for prognostic variables including NT-proBNP (N-terminal pro-B-type natriuretic peptide). At baseline, cognitive function was normal (MMSE score 28-30) in 1809 of 2895 patients (62.5%), borderline (score 24-27) in 794 (27.4%), and impaired (score <24) in 292 (10.1%). Variables associated with both a lower MMSE score at baseline and a decline in score from baseline included older age, a history of stroke or transient ischemia attack, and lower serum albumin. Compared with those with baseline MMSE scores of 28 to 30, patients in the lower MMSE score categories had a stepwise increase in the risk of the composite of time to first HF hospitalization or cardiovascular death, with an adjusted hazard ratio of 1.27 (95% CI, 1.06-1.53) for those with scores of 24 to 27 and 1.58 (95% CI, 1.21-2.06) for those with scores <24, respectively. These associations were also found for the individual components of the composite and all-cause death. Likewise, cognitive impairment was associated with a 50% higher risk of total (first and repeat) heart failure hospitalizations and cardiovascular deaths. Examining the change in MMSE score from baseline, a decrease in MMSE score during follow-up was associated with a higher risk of death. In patients with heart failure and preserved ejection fraction, even modest baseline impairment of cognitive function was associated with worse outcomes, including death. A decline in MMSE score during follow-up was a strong predictor of mortality, independent of other prognostic variables.

Analysis of critical thinking ability of class X senior high school students

Students' critical thinking abilities influence the development of cognitive, affective and psychomotor abilities. Students who have critical thinking ability are able to analyze a problem so they can make decisions. The aim of the research is to determine and describe the initial critical thinking abilities of class X students at MA Nurul Huda, Central Java. This research is quantitative research based on critical thinking ability tests. The instrument used is a test sheet in the form of multiple-choice questions which contains indicators of critical thinking abilities. The results of the research are critical thinking abilities which are categorized into five, namely very good, good, sufficient, low, and very low. Based on data analysis, it is known that the initial critical thinking ability of grade X MA Nurul Huda Central Java students for very good, good, sufficient, low, and very low categories is 0%, 4,54%, 31,82%, 50%, and 13,64%. Therefore, it can be concluded that the critical thinking ability of class X students at MA Nurul Huda, Central Java, is low and needs to be improved.

Analysis of the relationship among technical efficiency, competitive strategy, and export performance in the cocoa agroindustry in Indonesia

The goals of the current study are to analyze the technical efficiency of the Decision Making Unit (DMU) of the cocoa agroindustry and the relationship among technical efficiency, export performance, and competitive strategy in the cocoa agroindustry in Indonesia. Respondents in this study are production and marketing managers at 42 active DMUs. The results show that the average DMU technical efficiency value is 0.963 and 0.985 based on the models of Constant Returns to Scale (CRS) and Variable Returns to Scale (VRS), with the distribution of the full technical efficiency category of 80.95%, the high category of 16.67%, the medium category of 2.38%, and the low category of 0%. This study finds a model for increasing the export performance of the cocoa agroindustry, in which the technical efficiency variable has a significant positive effect on the export performance variable with competitive strategy variables as an intervening variable.

Influence of Common Gene Variants on Lipid Levels and Risk of Coronary Heart Disease in Afro-Caribbeans.

A lower mortality rate from coronary artery disease (CAD) and a more favourable lipid profile have been reported in Afro-Caribbeans compared with people of European ancestry. The aim of this study was to determine whether common lipid variants identified in other populations are associated with lipid levels and CAD in Afro-Caribbeans. We studied 705 Afro-Caribbeans (192 with CAD) who were genotyped for 13 lipid-associated variants. We calculated three polygenic risk scores (PRSs) for elevated LDL (LDL-PRS), decreased HDL (HDL-PRS), and elevated triglycerides (TG-PRS). LDL-PRS, HDL-PRS, and TG-PRS were associated with LDL, HDL, and TG levels, respectively. The LDL-PRS was positively associated with LDL > 2.6 mmol/L and with LDL > 3.0 mmol/L with ORs (odds ratios) of 1.33 (95% confidence interval (CI) = 1.14-1.56) and 1.40 (CI = 1.21-1.62), respectively. The HDL-PRS was associated with a low HDL category (HDL < 1.03 mmol/L) with an OR of 1.3 (CI = 1.04-1.63) and inversely associated with a high HDL category (HDL > 1.55 mmol/L) with an OR of 0.79 (CI = 0.65-0.96). The LDL-PRS was positively associated with CAD after adjustment for age, gender, hypertension, diabetes, and smoking with an OR of 1.27 (CI = 1.06-1.51) but not the HDL-PRS nor the TG-PRS. Results of the present study indicate that common lipid variants are associated with lipid levels and prevalent CAD in Afro-Caribbeans.

The impact of physical activity on progression-free and overall survival in metastatic breast cancer based on molecular subtype

BackgroundAlthough adequate physical activity has been shown to be beneficial in early breast cancer, evidence in metastatic breast cancer is sparse and contradictory, which could be related to distinct effects of physical activity on the different molecular cancer subtypes. Therefore, we here evaluated the effect of physical activity on progression-free and overall survival (PFS, OS) in metastatic breast cancer, specifically looking at molecular subtypes.MethodsInternational Physical Activity Questionnaire (IPAQ) questionnaires, filled out by patients enrolled in the prospective PRAEGNANT registry (NCT02338167; n = 1,270) were used to calculate metabolic equivalent task (MET) minutes, which were subsequently categorized into low (n = 138), moderate (n = 995) or high IPAQ categories (n = 137). Cox regression analyses were used to evaluate the impact of IPAQ categories and its interaction with molecular subtypes on PFS and OS.ResultsPatient and tumor characteristics were equally distributed across IPAQ categories. HER2pos, HRpos and TNBC were present in 23.1%, 65.7% and 11.2% of patients, respectively. IPAQ scores did not have an impact on PFS and OS in addition to established prognostic factors, either overall or in particular molecular subtypes (PFS: p = 0.33 and OS: p = 0.08, likelihood ratio test). Exploratory analyses showed higher overall survival rates for high IPAQ categories compared to low/moderate IPAQ categories in luminal B-like breast cancer.ConclusionsSelf-reported physical activity using the IPAQ questionnaire did not significantly affect PFS or OS in patients suffering from metastatic breast cancer. Nevertheless, some hypothesis-generating differences between molecular subtypes could be observed, which may be interesting to evaluate further.

Developing Interactive Learning Media Using Powtoon to Improve Students' Interest and Learning Outcomes in Global Warming Material

The purpose of this study was to explain how well Powtoon Instructional Materials can help teachers carry out learning activities that can improve students' interest and learning outcomes on the topic of global warming. To explain how well Powtoon Instructional Materials can improve students' interest and learning outcomes. This study uses a type of development research commonly called Research and Development (R&amp;D) with the ADDIE model (Analysis, Design, Development or Production, Implementation or Distribution, and Evaluation). 3 validators conducted validation to produce a feasible product, and the result was 87.6%, which indicates a very feasible category for use. According to the results of the distributed learning interest questionnaire, the initial results of the questionnaire were 55.2% for the low category and the final results were 73.4% for the moderate category. The pretest-posttest and N-Gain results were calculated to determine student learning outcomes. The calculation results show that the N-Gain score of 0.69 is in the moderate category and the N-Gain percentage of 69.5% is in the fairly effective category.

Implementation of Think Pair and Share (TPS) Technique in Listening to Short Story Texts Learning

This research aims to determine whether there are differences in students' abilities in listening to short story texts using the Think-Pair-Share (TTPS) cooperative learning method. Conducted as a quasi-experimental study, the sample comprised 11th-grade students from SMA DDI Maros. Data collection involved text analysis techniques, and the obtained data were analyzed through stages including the creation of raw score lists, frequency distributions, descriptive statistical analysis, and inferential statistical analysis. The results indicate significant differences in learning outcomes between students using the TTPS method and those not using it. The use of TTPS improved students' listening comprehension of short story texts, as evidenced by the mean score of 74.36 (high category) in the experimental class compared to 58.46 (low category) in the control class. This demonstrates that the TTPS method effectively enhances students' listening skills.

An efficient interpretable stacking ensemble model for lung cancer prognosis

Lung cancer significantly contributes to global cancer mortality, posing challenges in clinical management. Early detection and accurate prognosis are crucial for improving patient outcomes. This study develops an interpretable stacking ensemble model (SEM) for lung cancer prognosis prediction and identifies key risk factors. Using a Kaggle dataset of 1000 patients with 22 variables, the model classifies prognosis into Low, Medium, and High-risk categories. The bootstrap method was employed for evaluation metrics, while SHAP (Shapley Additive Explanations) and LIME (Local Interpretable Model-agnostic Explanations) assessed model interpretability. Results showed SEM's superior interpretability over traditional models, such as Random Forest, Logistic Regression, Decision Tree, Gradient Boosting Machine, Extreme Gradient Boosting Machine, and Light Gradient Boosting Machine. SEM achieved an accuracy of 98.90 %, precision of 98.70 %, F1 score of 98.85 %, sensitivity of 98.77 %, specificity of 95.45 %, Cohen’s kappa value of 94.56 %, and an AUC of 98.10 %. The SEM demonstrated robust performance in lung cancer prognosis, revealing chronic lung cancer and genetic risk as major factors.

Kemampuan Literasi Matematis Ditinjau dari Motivasi Belajar pada Siswa Kelas XI SMA Negeri 2 Padang Panjang

This research is motivated by the fact that the number of students who have low mathematical literacy skills is caused by various factors. One of the factors that affects mathematical literacy ability is learning motivation. This study aims to determine the ability of mathematical literacy when viewed from the learning motivation of students. This type of research is quantitative descriptive. The sample in this study is grade XI students of SMA Negeri 2 Padang Panjang. The sample selection technique in this study uses the Stratified random sampling technique where the sample is selected based on strata. The instrument used in this study is test questions in the form of essays to see students' mathematical literacy skills. Data analysis was carried out descriptively on all research data. The results showed that the average mathematical literacy ability was 50 which was classified as low. If viewed from high learning motivation is classified as medium with an average score of 69, when viewed from medium learning motivation has low mathematical literacy skills with an average score of 56 and mathematical literacy ability reviewed from low learning motivation is classified as low in the low category with an average score of 25

Analisis Tingkat Literasi Finansial Mahasiswa Manajemen Bisnis Syariah di STAI Al-Kifayah Riau: Konsep, Sikap, dan Perilaku

Purpose: Students must have a good understanding of finance, especially when facing the challenges of financial management in today's era. The purpose of this study was to determine how proficient Sharia Business Management (MBS) students at STAI Al-Kifayah Riau are with basic financial concepts, attitudes, and behaviors related to finance. Methodology: This study was conducted using a quantitative approach through a survey. The stratified random sampling method consisted of 85 MBS students who were randomly selected. Data were collected through a financial literacy questionnaire distributed online via Google Form. Results: The results of the analysis showed that MBS students at STAI Al-Kifayah Riau had high financial literacy in basic financial concepts and products, with 17% in the high category, 28% in the medium category, and 55% in the low category. Financial attitudes, with 21% in the high category, 34% in the medium category, and 45% in the low category, and financial behavior, with 20% in the high category, 31% in the medium category, and 49% in the low category. Limitation: If the sample is only taken from one institution (STAI Al-Kifayah Riau), the results may not be generalizable to students in other institutions or different areas. Contribution: The results show that the majority of MBS students of STAI Al-Kifayah Riau do not understand financial concepts, attitudes, and behaviors. This suggests that education should be conducted to improve students' financial knowledge, especially by offering courses or training that focus more on financial management.

Sensorineural hearing loss in Lyme neuroborreliosis

Background Sensorineural hearing loss (SNHL) has been suggested to occur in patients with Lyme neuroborreliosis (LNB); however, a clear association has never been documented. The present study prospectively investigated the development of SNHL in patients admitted for treatment of LNB using distortion-product-oto-acoustic emissions (DPOAE) as a measure of cochlear function. Methods DOAE were measured in patients with LNB on the day of diagnosis, during treatment, and 30–60 days after discharge. Frequencies were categorized as Low (1, 1.5, 2 kHz), Mid (3, 4, 5 kHz), Mid-high (6, 7, 8 kHz), and High (9, 10 kHz). Pure Tone Audiometry (PTA3) was performed at discharge and 60 days after. Patients were treated with i.v. ceftriaxone or oral doxycycline for 14 days according to guidelines. Results DPOAE measurements were obtained in 25 patients with LNB at admission and in 18 patients at follow-up. Median age was 56 years (IQR, 48–64 years), and 16 (67%) were men. Fourteen (78%) of 18 patients showed improvement in Emission Threshold Levels (ETL) from admission to follow-up in low, mid-, and mid-high frequency categories, where ETLs increased by median levels of 3.2 (−4.1 to 8.3), 7.5 (−2.8 to 9.8), and 4.7 dB (−4.3 to 10.1). A decline was observed in the high frequency category, median −3.3 dB (−9.1 to 6.7). SNHL defined by pure tone average (PTA3) >20 dB was present in 11 out of 23 (48%) at discharge and in 9 out of 16 patients (56%) 60 days after discharge, which differed significantly from matched controls (Mann-Whitney test, p = 0.036). Conclusion LNB can lead to cochlear outer-hair cell dysfunction, resulting in temporary and long-term SNHL.

Adoption Level of Farmers Regarding Cultivation Practices of Areca Nut in Chikmagalur District, Karnataka, India

The study examined the adoption of cultivation practices of areca nut in Chikmagalur district of Karnataka state during the year 2018-19. Chikmagalur is one of the largest and traditional areca nut-producing districts of Karnataka. Two taluks were selected in chikmagalur district based on the highest area under cultivation and the total sample size was 100. Seventeen items were considered to form a table to know the adoption of individual recommended practices by farmers concerning areca nut cultivation. Further to classify the overall adoption of areca nut growers recommended cultivation practices were grouped in to three major categories low, medium and high. The findings of the study revealed that, regarding the overall adoption of farmers about the cultivation of areca nut, less than half (43.00%) of the respondents were found in the medium adoption category, followed by 31.00 per-cent of respondents were found in high adoption category and more than one fourth (26.00%) of respondents were found in low adoption category regarding the adoption of individual recommended cultivation practices by areca nut growers.

Gestational diabetes mellitus in relation to serum per- and polyfluoroalkyl substances: A scoping review to evaluate the need for a new systematic review.

Per- and polyfluoroalkyl substances (PFAS) were used or are being used in the manufacturing of products, including consumer-use products. The resulting environmental contamination has led to widespread human exposure. This review aimed to scope the characteristics of evidence covered and applied methodology of evidence to understand -- regardless of any results on the association of gestational diabetes mellitus (GDM) and PFAS -- if a new systematic review would be justified. We systematically identified reports investigating associations of PFAS with GDM following a pre-specified and pre-registered PECO framework and protocol. The previous systematic reviews included 8-11 reports and either conducted meta-analyses stratified by comparator, analyzed results based on only high and low exposure categories, or pooled results across comparators. Included 20 reports presented data on 24 PFAS with PFOA, PFOS, PFHxS, PFNA, and PFDA being examined in almost all. The comparators employed were heterogeneous across the reports. Because data from at least one new report on GDM is available since the previous systematic reviews and heterogeneous comparators, an updated systematic review using SWiM could add value to the literature.