Mean Deviation Statistics Research Articles

Biochemical Side Effect of Antiepileptic Drugs on Liver Enzymes, Lipid Profile and Haematological Profile in Epileptic Pediatric Patients

Antiepileptic drugs are large group of medications with variable mechanisms of action. There are various effects have been reported with long-term antiepileptic therapy. To assess the effects of the antiepileptic drugs on blood indices, liver function and lipid enzymes in epileptic pediatric age group. A comparative case-control study was performed in which 50 epilepsy cases were matched with 50 controls for age and sex. The mean age of the cases was 9.1(± 3.7) years, 86% from Benghazi. The 68% were primarily generalized seizure, 64% tonic clonic convulsion. The age at diagnosis between 2 months - 13 years. The 74% used Na-valproate as a single or a combined therapy and Carbamazepine was prescribed as a single medication in 18%. No statistical significant differences in the means of CBC indices and liver function profiles (AST and ALT) in the treatment groups compared to the control. Alkaline phosphatise was highly significant difference in the mean between the two groups (P=0.007). Mean of serum Cholesterol level showed higher in the cases than controls with highly statistical significant difference (P<0.001). HDL mean level is higher for cases on carbamazepine and Na-valproate group compared to controls with statistical significant difference (P=0.011). Cases on carbamazepine and Na-valproate group as well showed higher mean LDL level compared to the controls with statistically significant (P=0.006). No any statistical significant difference in means of CBC indices between epileptic patient treated with AED and control. Carbamazepine group expressed higher mean HDL level as compared to Na-valproate group, this difference is highly significant. Key words: Antiepileptic drugs, liver enzymes, lipid profiles.

Evaluation of Antimicrobial Efficiency, Shear Bond Strength, and Adhesive Remnant Index of TiO2 Infiltrated Orthodontic Adhesive - An In Vitro Study.

Enamel demineralization is an unavoidable adverse effect encountered with bonding brackets in orthodontic therapy. Introducing nanoparticles into the composite adhesive paste can prevent enamel demineralization. Titanium dioxide (TiO2) is known to exhibit direct antimicrobial efficiency. This study aimed to assess the antibacterial efficiency and shear bond strength (SBS) of an orthodontic bonding composite infiltrated with TiO2 nanoparticles. This in vitro study evaluated the efficiency of TiO2 nanoparticle-incorporated light-curing orthodontic composite paste (ENLIGHT, ORMCO). Twenty extracted premolars were randomly and equally allocated to the two study groups, N = 10. While a conventional composite was utilized for the bonding brackets in Group I, a TiO2-incorporated composite was used in Group 2. The adhesive remnant index (ARI) scores given by Artun and Bergland et al. and SBS were determined. Furthermore, the antimicrobial efficiency was estimated using the minimum inhibitory concentration (MIC)/minimum bactericidal concentration (MBC) and agar well diffusion assay for six composite disc specimens. The results were statistically analyzed using the chi-square test and Student's t test, at P < 0.05. After 24 h of curing, no statistical mean difference was observed between the two groups in terms of ARI or SBS scores (P > 0.05). However, there was a significant increase in the antimicrobial efficiency of Group II when compared with Group I (P < 0.05). TiO2 nanoparticle-incorporated orthodontic composites improve the antimicrobial efficiency with no significant change in the SBS. The ARI scores indicate the presence of 50% remnant orthodontic composite on the tooth enamel surface post debonding.

Differential Effect of Advertising Frequency on Sales Turnover and Ads to Sales Ratio

This paper analysed the differential impact of repeated advertising on sales turnover and the attendant effect on accounting Ads to Sales ratio. The paper adopts a quantitative approach and collects marketing and promoting expenditure data (as proxy for Ads activity) from Amazon Company for twenty years (2003 – 2022). The data was analysed by using the t-test of mean difference statistics and a simple regression. The t-test analysis showed that the Ads to sales ratio had a significant increase between two periods of comparison (2003-2012 and 2013-2022); in the same vein, there was a significant increase in mean net sales value by up to nine hundred percent – an increase which dwarfs the hundred percent increases in the Ads to sales ratio over the period. Furthermore, a simple regression analysis shows that marketing expenditures (used as proxy for Ads activity) produced a highly significant positive effect on net sales at a P-value of less than P&lt;0.00001. This finding shows that current literature suggestion that increased Ads may wane consumer brand patronage may not be applicable to all industries, rather, this paper’s result indicates that for companies such as Amazon, increased Ads, or marketing and promotion activities may produce high net sales in some companies such as Amazon. The paper contributes by developing a process framework for repeated advertisement, Ads to sales ratio and net sales. It recommends further application of the proposed framework in related companies by future researchers.

T-test analysis for income comparison between members and non-members of livunzu cooperative in chikwawa district, Malawi.

Abstract This study examines the relationship between agricultural cooperatives and farmers’ income. Agricultural cooperatives have been a well-known avenue for improving small-scale farmers’ economic well-being by widening access to resources, markets and collective action. A simple random sample of 293 rice farming households was surveyed. The study employed the use of descriptive statistics to describe the characteristics of the respondents. A semi-structured questionnaire was used to collect data in a household survey targeting cooperative and non-cooperative members. The study employed the use of SPSS package version 28 in data analysis. T-test analysis was used to establish the statistical differences in means of the cooperative and non-cooperative member farmers. It was established that being in a cooperative improves income in rice farming. The results suggested that policies aimed at improving farmer’s access to market power, and production modalities are important intervention avenues that can affect the income of rice farming in the area. The understanding of the relationship between cooperatives and farmers’ income is important for policy makers, development workers and the farmers in their effort to enhance the economic well-being of the farmers.

Evaluation of improved shallot (Allium cepa L. Aggregatum) varieties for yield and yield related traits in Gamo Zone, Southern Ethiopia

Shallot (Allium cepa var. ascalonicum Backer) is an important vegetable crop cultivated by small holder farmers for consumption in Gamo mid and high lands. However, its production and productivity is constrained by lack of improved shallot varieties in the study area. Field experiment was conducted in Gamo Zone during 2021 and 2022 cropping season. The objective of the experiment was to select well adaptive and high yielding shallot varieties for the study areas. Eight shallot varieties in two sets (bulb propagated sets and seed propagated sets) were evaluated in randomized complete block design with four replications by using double row spacing of 40cm x 20cm in Plot size of 2.4m x 2m. The combined analysis of the mean over years showed that there was a statistical significant mean difference (P&lt;0.01) among the varieties for yield and some yield related traits. Among the bulb propagated varieties tested, the highest number of splits (13.75) per plant (bulb) was recorded by variety ‘’DZSHT-00/2” followed by “Minjar” (12.18). Similarly, “DZSHT-00/2” gave the highest bulb yield (21.22 t ha-1) followed by “Minjar” (19.27 t ha-1). On the other hand, the highest marketable bulb yield of 9.61 t ha-1 was recorded by variety “Tropics” followed by “DZSHT-157-21” (7.47 t ha-1). Hence, varieties “DZSHT-005/2” and “Tropics” are recommended for popularization and production due to their better yield and adaptability in the study area.

COMPARISON OF PHARMACOLOGY AGENTS EFFECT IN TREATING URETERAL STENT RELATED SYMPTOMS: SYSTEMATIC REVIEW &amp; META-ANALYSIS OF RANDOMIZED CONTROLLED TRIAL¬

Objective: We wish to update existing meta-analyses to assess the effectiveness of pharmacological agents against ureteral stent-related symptoms with better design of RCTs, as well as more valid and reliable measurement methods. Material &amp; Methods: Relevant published articles up to February 2022 were obtained from PubMed, CENTRAL, Google Scholar, Science Direct, and DOAJ. All single-blind or double-blind RCTs with various comparisons using pharmacological agents and/or placebo in patients with ureteral stent-related symptoms, with outcome assessment using USSQ at week 1 and week 4 during stent placement was included in the study. Statistical parameter Mean Difference (MD) with 95% CI was used to measure effect size. The p value less than 0.05 indicates statistical significance. Results: Alpha blockers (2 studies, 85 samples) significantly reduced fourth week UIS compared to placebo (MD: – 5.46, 95% CI: – 7.47 to -3.46, I2 = 0%, P = &lt; 0.001), and alpha blockers (2 studies, 42 samples) significantly reduced first week SIS compared to combination therapy (MD: – 0.82, 95% CI: – 1.56 to – 0.08, I2 = 0%, P = 0.03). The results of the meta-analysis of USSQ scores in other domains have no significant differences. Conclusion: Alpha blockers were better than placebo in reducing UIS due to ureteral stent in the fourth week of stent placement, and better than combination therapy in reducing SIS due to ureteral stent in the first-week post stenting. However, more RCTs are needed with larger samples and better designs to reach valid conclusions.&#x0D; Keywords: Stents, Randomized Controlled Trials as Topic, Single-Blind Method.

Impact of methane mitigation strategies on the native ruminant microbiome: A protocol for a systematic review and meta-analysis.

Recently, research has investigated the role of the ruminant native microbiome, and the role microbes play in methane (CH4) production and mitigation. However, the variation across microbiome studies makes implementing impactful strategies difficult. The first objective of this study is to identify, summarize, compile, and discuss the current literature on CH4 mitigation strategies and how they interact with the native ruminant microbiome. The second objective is to perform a meta-analysis on the identified16S rRNA sequencing data. A literature search using Web of Science, Scopus, AGRIS, and Google Scholar will be implemented. Eligible criteria will be defined using PICO (population, intervention, comparator, and outcomes) elements. Two independent reviewers will be utilized for both the literature search and data compilation. Risk of bias will be assessed using the Cochrane Risk Bias 2.0 tool. Publicly available 16S rRNA amplicon gene sequencing data will be downloaded from NCBI Sequence Read Archive, European Nucleotide Archive or similar database using appropriate extraction methods. Data processing will be performed using QIIME2 following a standardized protocol. Meta-analyses will be performed on both alpha and beta diversity as well as taxonomic analyses. Alpha diversity metrics will be tested using a Kruskal-Wallis test with a Benjamini-Hochberg multiple testing correction. Beta diversity will be statistically tested using PERMANOVA testing with multiple test corrections. Hedge's g standardized mean difference statistic will be used to calculate fixed and random effects model estimates using a 95% confidence interval. Heterogeneity between studies will be assessed using the I2 statistic. Potential publication bias will be further assessed using Begg's correlation test and Egger's regression test. The GRADE approach will be used to assess the certainty of evidence. The following protocol will be used to guide future research and meta-analyses for investigating CH4 mitigation strategies and ruminant microbial ecology. The future work could be used to enhance livestock management techniques for GHG control. This protocol is registered in Open Science Framework (https://osf.io/vt56c) and available in the Systematic Reviews for Animals and Food (https://www.syreaf.org/contact).

Individual-Level Social Determinants of Health (SDOH) Measures and Treatment Complications in Acute Leukemia

Background Population studies demonstrate widening survival disparities in AML survival. In our previous analysis, census tract-based measures of socioeconomic status accounted for most of the AML death disparity for non-Hispanic Black (NHB) and Hispanic patients (pts) suggesting that patients' social and physical environments contribute to poor AML endpoints (Abraham et al. Blood 2022). However, these data are retrospective and only provide neighborhood-level information. We prospectively collected individual level data on SDOH and linked this to treatment delivery and complications. Methods Patients were prospectively enrolled from two institutions: a comprehensive cancer center and a minority-serving cancer center for a planned 2 year follow-up. A mixed-methods approach utilized validated questionnaires and semi-structured interviews administered to patients 30-90 days from diagnosis and data was collected on adherence, falls, infections, ER visits, hospitalizations, and ICU admission. Quantitative measures included patient neighborhood and environmental living conditions (AHC HRSN), health literacy (CHLT-6), financial toxicity (COST-FACIT), medication affordability/adherence (ARMS), and mental health (PHQ-4). Quantitative data was supplemented with qualitative data from semi-structured interviews from a subset of patients. We used linear regression to estimate statistical differences in means between groups. Results We report results from 52 patients, predominantly with AML and high-risk MDS followed for up to 6 months. Baseline characteristics are summarized in Table 1. Median age was 62 years. 38% were non-Hispanic White (NHW), 25% NHB, and 23% Hispanic and lived in socioeconomically diverse census tracts. Half the cohort had a high school education or less. 40% had an annual income level &amp;lt; $25,000. 40% pts had a Charlson comorbidity index (CCI) ≥ 5. On the AHC HRSN tool, housing and food insecurity were reported in 10% and 15%, respectively, 40% reported difficulty paying for basic needs and 22% loneliness/isolation. In terms of care delivery, pts aged ≥ 65 years were more likely to miss clinic visits (p=0.026) and chemotherapy treatments (p=0.005). Non-white (p=0.13) pts and those on public insurance (p=0.04) were also more likely to miss clinic visits. Education level, income, and marital status were not associated with missed visits/treatments. Assessing treatment complications 60% of ER visits occurred with annual household incomes under $50,000 (p=0.048). Education and insurance were also linked to treatment morbidity, with 75% of ICU admissions having a high school education or less (p=0.09) and 83% having Medicare or Medicaid (p=0.087). Rates of mechanical ventilation mirrored these findings. Education was associated with lower rates of discharge to SNF or SAR, 72% of college or higher-educated pts were discharged home (p=0.035). Fall rates and infectious complications did not differ based on SDOH. Interestingly age and CCI did not distinguish between any of these treatment complications. Validated patient reported measures of social vulnerability were next examined as predictors of treatment adherence and complications (Table 2). The mean COSTFACIT was 9.8 lower (95% CI -17.6 to -1.93) in those with ER visits than those without ER visits (p=0.061). The mean CHLT-6 score was 0.96 lower (95% CI -1.8 to -0.09) in pts admitted to the ICU (p = 0.03). The PHQ-4 score did not differ based on any complication. Discussion This study represents the first attempt to prospectively link patient reported SDOH to treatment delivery and early complications in leukemia and provides valuable insights into targetable barriers to overcome disparities. Age was the most significant risk factor for missed clinic visits and chemotherapy doses. Older pts may benefit from navigators, caregiver engagement, tailored education given increased reliance on complex outpatient regimens. Treatment complications were strongly associated with SDOH, including education and household income. These findings suggest that pre-treatment ‘fitness’ assessments and greater home-based visits during treatment may mitigate ER visits and life-threatening complications. Importantly, quantitative SDOH measures such as COST-FACIT and CHLT-6 can prospectively identify patients at risk of early complications and become an important tool to triage these resources.

Combination of separation and degradation methods after PFAS soil washing

The current study evaluated a three-stage treatment to remediate PFAS-contaminated soil. The treatment consisted of soil washing, foam fractionation (FF), and electrochemical oxidation (EO). The possibility of replacing the third stage, i.e., EO, with an adsorption process was also assessed. The contamination in the studied soils was dominated by perfluorooctane sulfonate (PFOS), with a concentration of 760 and 19 μg kg−1 in soil I and in soil II, accounting for 97 % and 70 % of all detected per-and polyfluoroalkyl substances (PFAS). Before applying a pilot treatment of soil, soil washing was performed on a laboratory scale, to evaluate the effect of soil particle size, initial pH and a liquid-to-soil ratio (L/S) on the leachability of PFAS. A pilot washing system generated soil leachate that was subsequently treated using FF and EO (or adsorption) and then reused for soil washing. The results indicated that the leaching of PFAS occurred easier in 0.063–1 mm particles than in the soil particles having a size below 0.063 mm. Both alkaline conditions and a continual replacement of the leaching solution increased the leachability of PFAS. The analysis using one-way ANOVA showed no statistical difference in means of PFOS washed out in laboratory and pilot scales. This allowed estimating twenty washing cycles using 120 L water to reach 95 % PFOS removal in 60 kg soil. The aeration process removed 95–99 % PFOS in every washing cycle. The EO and adsorption processes achieved similar results removing up to 97 % PFOS in concentrated soil leachate. The current study demonstrated a multi-stage treatment as an effective and cost-efficient method to permanently clean up PFAS-contaminated soil.

Exhaled nitric oxide in intubated ICU patients on mechanical ventilation—a feasibility study

It can be a clinical challenge to distinguish inflammation from infection in critically ill patients. Therefore, valid and conclusive surrogate markers for infections are desired. Nitric oxide (NO) might be that marker since concentrations of exhaled NO have shown to change in the presence of various diseases. This observational, prospective, single-center feasibility study aimed to investigate if fractional exhaled NO (FeNO) can be measured in intubated patients with or without infection, pneumonia and septic shock in a standardized, reliable setting. 20 intubated patients in the intensive care unit (ICU) were included for analysis. FeNO mean values were measured in the endotracheal tube via the suction channel using a chemiluminescence based analyzer. We developed a pragmatic method to measure FeNO repeatedly and reliably in intubated patients using a chemiluminescence based analyzer. We found a median of 0.98 (0.59–1.44) FeNO mean (ppb) in exhaled breath from all 20 intubated patient. Intubated patient with suspected infection had a significantly lower median FeNO mean compared with the intubated patients without suspected infection. Similarly did patients with septic shock demonstrate a significantly lower median FeNO mean than without septic shock. We found no statistical difference in median FeNO mean for intubated patients with pneumonia. It was feasible to measure FeNO in intubated patients in the ICU. Our results indicate decreased levels of FeNO in infected intubated patients in the ICU. The study was not powered to provide firm conclusions, so larger trials are needed to confirm the results and to prove FeNO as a useful biomarker for distinguishment between infection and inflammation in the ICU.

Weighted mean difference statistics for paired data in the presence of missing values.

Missing data is a common issue in many biomedical studies. Under a paired design, some subjects may have missing values in either one or both of the conditions due to loss of follow-up, insufficient biological samples, etc. Such partially paired data complicate statistical comparison of the distribution of the variable of interest between the two conditions. In this article, we propose a general class of test statistics based on the difference in weighted sample means without imposing any distributional or model assumption. An optimal weight is derived from this class of tests. Simulation studies show that our proposed test with the optimal weight performs well and outperforms existing methods in practical situations. Two cancer biomarker studies are provided for illustration.

A Comparative Analysis of the Occluding Effects on Dentinal Tubules With the Use of Er:YAG Laser and a Commercially Available Desensitizing Agent: An In Vitro Scanning Electron Microscopic Study.

Objective This in vitro scanning electron microscopic (SEM) study aimed to compare the effect of Er:YAG laser and a commercially launched dental productnamely 8% arginine-calcium carbonate on exposed dentinal tubules. Materials and methods A total of 120 tooth samplesprepared from healthy maxillary first premolars extracted due to orthodontic reasons were grouped randomly into four groups of 30 samples each - Group I: control group (C); Group II: laser group (LG); Group III: toothpaste group (TP) and Group IV: laser + toothpaste group (LT). The samples in Group II-IV were treated with the respective test agents and were placed under SEM to study the changes in the dentinal tubule number and diameter. The data obtained from SEM were then subjected to statistical analysis using an unpaired t-test. Results The unpaired t-test revealed extreme statistical differences in means between the test and the control groups and among the test groups (p<0.0001).The results we obtained within the scope of this study showed that both the Er:YAG laser (1.3 W, 100 mJ, 3 Hz, 60 s twice) and dentifrice containing 8% arginine-calcium carbonate as the main ingredient can significantly reduce the number and diameter of the open dentinal tubules. Conclusion Our findings have demonstrated that boththe 8% arginine-calcium carbonate technology and Er:YAG lasersuccessfully reduced the number and diameter of the open dentinal tubules and hence can bepromising agents to deal with dentinal hypersensitivity in future clinical studies.

The Efficacy and Safety of Avanafil During a Treatment of Male Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Erectile dysfunction (ED) contributes to a large burden and impairs the quality of life among males. Avanafil appears to be a promising treatment for ED; however, its efficacy and safety profile remain unclear. This study aimed to evaluate the efficacy and safety of avanafil for the treatment of ED. An extensive search of PubMed, ScienceDirect, Web of Science, and Embase databases with 11 publications was performed, with outcomes evaluated are International Index of Erectile Function - Erectile Function (IIEF-EF), Sexual Encounter Profile (SEP), and Treatment-Emergent Adverse Events (TEAE). Statistical parameter Mean Difference (MD) and Risk Ratio (RR) with 95% Confidence Interval (CI) were used to measure effect size. The pooled estimates demonstrated that changes in IIEF-EF function (MD=4.39, 95% CI [3.41, 5.37], p<0.001), SEP-2 (RR=3.43, 95% CI [2.79, 4.22], p<0.001), SEP-3 (RR=2.30, 95% CI [2.01, 2.62], p<0.001), and TEAE (RR=1.49, 95% CI [1.12, 1.96], p=0.005) were significantly higher in the avanafil group than in the placebo group. Moreover, 200 mg avanafil was superior to that mg 100 mg-avanafil, indicated by the IIEF-EF score (MD=-1.15, 95% CI [-1.40, -0.89], p<0.001). In contrary, there were no significant differences in SEP-2 (RR=0.90, 95% CI [0.75, 1.08], p=0.26), SEP-3 (RR=0.92, 95% CI [0.81, 1.05], p=0.21) and TEAE (RR=1.00, 95% CI [0.87, 1.15], p=0.99) for both 100 mg and 200 mg doses. This review highlights the potential use of this drug in ED treatment. Further large-scale Randomized Controlled Trials investigations involving various racial groups are required to confirm these findings.

Analysis of infections, recoveries and deaths from COVID-19 in rivers state, Nigeria

Introduction: While some patients recovered, others died across the world thereby losing their loved ones. The objective of the current study is to determine statistical difference in means of COVID-19 infected population (laboratory confirmed), discharged cases(recovered) and deaths resulting from COVID-19 pandemic in Rivers State, Nigeria.&#x0D; Material and Methods: In this study, extraction of infected population (laboratory confirmed), discharged cases and deaths from COVID-19 was carried out from data obtained from Nigeria Centre for Disease Control which covered a period of 572 days (25th March 2020 - 17th October 2021). The test for significance of means among the variables was done using one-way Analysis of Variance (ANOVA) followed by Tukey HSD test. The two variables whose means do not significantly differ were tested for strength of relationship and dependence using correlation analysis and cubic polynomial function respectively.&#x0D; Results: Results showed that there is statistically significant difference between infected population, discharged cases and deaths from COVID-19 as obtained from one-way ANOVA (F(2, 1710) = 121.958, p = 0.000). Use of Tukey HSD test indicated that means of infected population and discharged cases do not differ from each other (p&gt;0.01); however, mean deaths from COVID-19 significantly differ from others at 99% confidence intervals (p&lt;0.01). There was weak positive relationship between deaths due to COVID-19 and other two groups (r=0.360, n=571, p=0.000). However, moderate positive correlation existed between COVID-19 infected population and discharged population (r=0. 566, n=571, p=0.000) at 99% confidence interval.&#x0D; Conclusions: Mean of deaths from the study population was significantly different from means from both infected population and discharged (recovered) cases. This implies that only few people died from COVID-19 in Rivers State Nigeria when compared to those who got infected and recovered from COVID-19 pandemic.

The Effect of Early Teenage Pregnancy on Depression and Mental Health in Malaysia

Background: The study focused on analysing the mental health such as emotional, social and psychological well-beings of the teenage girls towards the pregnancy and investigate the various factors such as sexual relationship associated with teenage pregnancy.&#x0D; Methods: The study took a cross-sectional approach and adopted convenient sampling method for data collection. Data was collected from teenage girls aged 12 to 21 years from the state of Sabah. Data collection accomplished through survey data assessment, with survey responses data being collected through structured questionnaire as the effective research tool. The collected data is then statistically analysed for regression, ANOVA, one-way ANOVA and correlation analysis.&#x0D; Results: Exploratory data analysis about the participants were explicated using frequency analysis. The statistical Test outcomes delineated the occurrence of significant relationship between engagements in sexual relationship with the age, marital status, distance of education, school attitude, self-esteem, self-efficacy, perceived social support, Peer community influences, Edinburgh Postnatal Depression Scale (EPDS), coping ability variables and other predictor variables. Similarly One-Way anova test, reveals the existence of statistical significant mean differences among age attribute of teenage girls, their engagement in sexual activity, predictor variables and their demographic details.&#x0D; Conclusions: The life of the teenagers who are engaged in sexual activity were observed to be more challenging in terms of medically, psychologically, and physically. The present study strongly recommends that social activists would adopt possible measures in revealing a better solution towards the teenage pregnancy.

A quasi-experimental study on adult weight loss using a multidimensional approach among a rural population.

The study aimed to investigate the effectiveness of a yearlong digital multidimensional weight-loss intervention among residents in a southern rural community. The intervention utilized a quasi-experimental design to assess weight loss and lifestyle habit changes in volunteer individuals living in a rural community in western North Carolina. The quasi-experimental design featured pre- and post-in-person health assessments, including anthropometric measures such as body composition, blood pressure, and lifestyle habits, through a health risk questionnaire. Upon completion of the in-person pre-assessment, participants received digital health education and challenges via email and challenge runner for 1 year. Following 12 months, participants were asked to complete the post-assessment to review their results. The multidimensional weight-loss intervention was communicated via newspaper and social media to promote participation among community members, utilizing a volunteer sample. Univariate analyses were conducted to determine age, weight, BMI, and body fat percentage. A paired sample t-test was conducted on pre- and post-weight as well as pre- and post-health scores. The health score was derived from the health risk questionnaire. A bivariate Pearson correlation was conducted for post-weight and post-health score analyses. The average participant was female in their mid-40s (N = 67). Results showed insignificant statistical mean differences between pre- and post-weight and pre- and post-health scores. A Pearson correlation indicated a moderate correlation r = -0.36, p = 0.003) between post-weight and post-health score. The negative correlation indicates changes in health behavior reflected in the health score improving as weight decreased. The weight-loss intervention proved unsuccessful in clinical weight loss but demonstrated an association between healthy behavior changes and weight loss. However, further research is needed to solidify the current findings, as there were limitations identified in COVID-19.

Assessment of Concordance between Chairside Ultrasonography and Digital Palpation in Detecting Myofascial Trigger Points in Masticatory Myofascial Pain Syndrome

IntroductionMasticatory myofascial pain is a musculoligamentous syndrome that can mimic odontogenic pain. Pain referral to odontogenic structures can be traced to hyperirritated myofascial trigger points (MTrPs). This pragmatic study evaluated the concordance between ultrasonography and palpation in detecting MTrPs in the masseter and temporalis muscles. MethodsFifty-seven patients suspected to have temporomandibular disorder were included. MTrPs were palpated manually by expert clinicians. Ultrasonography was then performed by a blind sonographer. The quantity of MTrPs and the involved muscle sections, the pain occurrence, and the location of the MTrPs within the muscle sections were compared using the mean difference (MD) and concordance statistics (Cohen κ and the interclass correlation coefficient [ICC]) as applicable. ResultsUltrasonography located MTrPs as 2.1 ± 1.3 mm2 hypoechoic nodules at a depth of 7 ± 3.3 mm. Ultrasonography moderately agreed with palpation on the quantity of MTrPs per patient (MD = 1; 95% confidence interval [CI], 0.06–1.9; ICC = 0.56; 95% CI, 0.32–0.72). Palpation detected marginally more involved muscle sections per patient (MD = 0.7; 95% CI, 0.06–1.34.05; ICC = 0.64; 95% CI, 0.44–0.77) with more pain occurrence per patient (MD = 1.4; 95% CI, 0.56–2.28; ICC = 0.13; 95% CI, −0.26 to 0.41). There was a discordance in the location of the MTrPs within the muscle sections per patient (κ = −0.46; 95% CI, −0.77 to −0.14). ConclusionsUltrasonography and palpation concurred moderately to substantially on the quantity of MTrPs and the involved muscle sections but disagreed on the location of the MTrPs within the muscle sections. Ultrasonography has the potential as a chairside diagnostic aid to help clinicians determine an accurate diagnosis, enhance patient experience during examination, and avoid unnecessary treatments that can mitigate the risk of iatrogenic damage.

Verification Studies Confirm Reproducibility of Post-Hysterectomy Pelvic Proton Radiotherapy

<h3>Purpose/Objective(s)</h3> Post-hysterectomy radiotherapy (RT) is associated with urinary, gastrointestinal, and hematologic toxicity. Concern for organ and target motion has limited exploration of proton RT as a tool to reduce toxicity. Attention to planning and treatment delivery is paramount given sensitivity of protons to small changes in soft tissue in the beam path. We sought to evaluate the consistency of target coverage and organ at risk (OAR) sparing in post-hysterectomy proton RT. <h3>Materials/Methods</h3> The first 10 patients treated with proton RT on an institutional prospective non-randomized trial of proton post-hysterectomy RT for endometrial cancer were included. CT simulation was performed with pelvic immobilization and a rectal balloon, which was also used for treatment. Full and empty bladder and IV contrast scans were obtained. Clinical target volumes (CTV) included the vaginal cuff, proximal 3 cm of vagina, and pelvic lymph nodes to the level of L4/L5. Prescription was 45 Gy (relative biological effectiveness (RBE) 1.1) in 25 fractions. Planning was multi-field optimization with two posterior oblique beams and a posterior beam. Plans were evaluated for robustness to ensure CTV coverage in worst case scenarios of ±5 mm isocenter shifts in x, y, and z directions and ±5% range uncertainty. A variable RBE calculation assuming a linear relationship between RBE and linear energy transfer was used to evaluate for target coverage and increased RBE within OARs. If needed, the plan was modified to limit hot spots without compromising coverage in the calculation with uniform 1.1 RBE. Patients underwent weekly CT-on-rails verification scans. Target coverage and dose to OARs were assessed at each verification and replanning was done if target coverage or OAR constraints did not meet original planning objectives. <h3>Results</h3> The first patient on the study required replan after first verification due to excess air in the rectum at simulation and verification, resulting in rectum V30Gy 90% and V40Gy 81%. After replan, subsequent verifications met objectives. Subsequent patients were planned with air in the rectum or bowel accounted for by evaluation of plans with air overridden to HU = -300 to -450 and HU = 0. Target coverage met acceptable planning parameters in all cases (Table 1). There was no statistical difference in bladder mean, V30Gy, and V45Gy; sigmoid V45Gy; rectum mean, V30Gy, and V40Gy; and small bowel V40% and V45Gy. All patients were successfully treated with protons for all planned fractions. <h3>Conclusion</h3> Proton post-hysterectomy pelvic RT with robust optimization is feasible, reproducible, and associated with appropriate target coverage and acceptable dose to organs at risk as assessed with weekly verification scans.

Vitamin D status among adolescent females with polycystic ovary syndrome

Background. Polycystic ovary syndrome (PCOS) is a complex disorder affecting the hypothalamic-pituitary-ovarian axis and leading to menstrual irregularities and hyperandrogenism. Studies have suggested that low vitamin D levels may play a role in the pathogenesis of PCOS. There is currently insufficient data regarding association of serum vitamin D levels and PCOS in adolescent females. The purpose of the study was to compare 25-hydroxyvitamin D levels in adolescent females with and without PCOS. Materials and methods. Participants were categorized as having PCOS or as controls based on National Institutes of Health PCOS diagnostic criteria. Exact logistic regression analysis was done to compare normal (≥ 30 ng/mL) versus low (&lt; 30 ng/mL) serum 25(OH)D levels in the PCOS and control groups. Data regarding the participant’s age, body mass index (BMI) percentile, serum 25(OH)D levels, and the season the blood was drawn were recorded in the database. Results. Eighty-two participants (32 were in the PCOS group and 50 were in the control group) met the inclusion criteria and were categorized as either PCOS or control. All participants in PCOS group had BMI greater than the 85th percentile. Therefore, participants with BMI percentile of less than 85th in the control group were excluded from analysis. The mean age of participants was 17.3 years. Vitamin D deficiency and insufficiency were frequently diagnosed in our study population. Sufficient 25(OH)D levels were found in only 7 of 82 participants (8.5 %). The majority of participants with BMI greater than 95th percentile were vitamin D deficient with statistical difference in mean 25(OH)D levels based on each category of BMI percentile. Vitamin D deficiency was noted among 65.6 % of participants with PCOS versus 38.0 % in the control group. The mean serum 25(OH)D level was 16.02 ng/ml in the PCOS group and 22.80 ng/ml in the control group. The difference in 25(OH)D levels between the groups was statistically significant (P = 0.036). Conclusions. Vitamin D deficiency was noted among 65.6 % of participants with PCOS versus 38.0 % in the control group. The mean serum 25(OH)D level was 16.02 ng/ml in the PCOS group and 22.80 ng/ml in the control group.

Validation Of Health-related Software Application

In today’s evolving technological society, telehealth, telemedicine, and e-health are powered by the confluence of mobile devices, ubiquitous internet access, and Artificial Intelligence. PURPOSE: To determine the validity of a health-related software application for measurement of heart rate and blood pressure. METHODS: Physiological variables collected twice in participants (Age = 20.8±3.0 yrs; Height = 168.7±8.6 cm; Body Mass = 68.3±14.3 kg; % Body Fat = 21.4±8.3) were heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) via digital monitor (DM) and software application (SA) at rest, seated in a chair with legs uncrossed. Pearson Correlation Coefficient was used to determine the relationship between the measurements. Paired sample t-test was used to determine if statistical mean differences in HR, SBP, and DBP existed, and mean absolute error (MAE) were calculated to get an error estimate on an individual basis. RESULTS: Table 1, for HR, the SA was highly correlated with DM, there were no significant mean differences, and the MAE was 4 bpm. For SBP, correlations were moderate to low, the SA significantly underestimated SBP, and the MAE ranged from 10.6-17.9 mmHg. For DBP, results were similar to the SBP with the exception of the Male Only DBP which was not significant different between devices, however the MAE was 8.8 mmHg.Table 1. Heart rate and blood pressure values for male and female, female only, and male only.CONCLUSION: Resting HR values were consistent between both devices amongst all participants. Systolic BP, however, SA significantly and systematically underestimated DM measurements amongst all participants. Regarding DBP, SA significantly and systematically underestimated DM measurements amongst all participants, except for male only.