Medium Score Group Research Articles

P-240 Is the intelligent Data Analysis Score (iDAScore) a reliable tool to predict pregnancy? Our center’s experience

Abstract Study question Is the intelligent Data Analysis Score (iDAScore) reliable in predicting a positive pregnancy test, clinical pregnancy and miscarriage rate after single vitrified-warmed blastocyst transfer (SVBT)? Summary answer There is a significant increase in positive pregnancy test and clinical pregnancy rates as iDAScore increases. The miscarriage rate is lower with increased iDAScore. What is known already With the improvement of assisted reproductive technology (ART), elective single embryo transfer has become a standard. Optimizing embryo selection is a major challenge to increase reproductive outcomes. The Gardner embryo grading system is widely adopted for the evaluation of blastocyst quality, but this tool is subject to inter- and intra-variability. In recent years, artificial intelligence has found diverse applications in healthcare. Based on time-laps sequences of > 180’000 developing embryos, iDAScore is a new deep-learning model for objective and standardized blastocyst scoring. However, its reliability in predicting pregnancy and miscarriage rates remains unknown. Study design, size, duration This monocentric retrospective pilot study was conducted from May 2023 to December 2023. A total of 206 homologous SVBT cycles from 206 patients were analyzed (one patient, one cycle). Exclusion criteria included: cycles involving preimplantation genetic testing, multiple and/or fresh blastocyst transfer, and blastocysts obtained after testicular sperm extraction. All vitrified-warmed blastocysts were scored using iDAScore version 1.0 model, ranging from 1 – 9.9. Participants/materials, setting, methods Scores were stratified into 3 groups: high-score (9.9 – 7.7), medium-score (7.6 – 5.5) and low-score (5.4 – 3.1). For each group, positive pregnancy test, clinical pregnancy and miscarriage rates were analyzed. SVBT cycles were then stratified into four maternal age groups (< 35, 35-37, 38-40, >41 years) and the same outcomes were analyzed. χ2 was used for statistics analysis. Main results and the role of chance Mean maternal age was 36.8 ± 4.9. Among the 206 vitrified-warmed blastocysts, 122 were scored as high-score, 57 as medium-score and 27 as low-score. Positive pregnancy test rate was significantly higher with increased iDAScore with 58% in the high-score group, 36.8% in the medium-score group and 17% in the low-score group (p < 0.0001). Clinical pregnancy rate, defined as the visualization of a fetal heartbeat at ultrasound scan, was also significantly higher with increased iDAScore, with 51.6% in the high-score group, 31.6% in the medium-score group and 17% in the low-score group (p < 0.0001). The miscarriage rate was lower with increased iDAScore, with 8.1% in the high-score group, 16.6% in the medium-score group and 50% in the low-score group, but this difference was not statistically significative (p 0.032). When adjusted to age group however, the miscarriage rate was found to be significantly lower in the high-score group when compared to the medium-score group (p < 0.0001); statistical analysis was not achieved in the low-score group due to the small sample size. Limitations, reasons for caution The major limitation of our study is its small sample size. Data collection is ongoing, to increase the study power. Additionally, many other factors, such as genetic, hormonal, metabolic and/or immunological, may play a role in achieving pregnancy. Wider implications of the findings Our results indicate that iDAScore may be a strong predictor of pregnancy and could be used as a complementary tool to the Gardner embryo grading system in the decision-making process of which blastocyst to transfer. Trial registration number N/A

Effects of Training to Improve Novice Nurses’ Sense of Coherence

Background: Our previous research concerned the relation between Sense of Coherence, workplace stress, and burnout for nurses in their first three years of work. We found that their psychological state in the first three months on the job was particularly critical to their success and retention. As workplace stress increased over their first three years, their Sense of Coherence declined, and their burnout increased. Follow-up interviews after five years revealed the importance of identifying role models early on and feeling their own growth in the responses of their patients. Based on these findings, in 2015 we instituted a program to improve new nurses’ Sense of Coherence. The present research was to evaluate the effectiveness of this training program. Purpose: The purpose of this study was to evaluate the effectiveness of a training program in raising Sense of Coherence. Method: From June of 2015 to March of 2017, we surveyed Sense of Coherence of 137 new nurses who completed our training program, comparing them to a cohort of 960 nurses whom we had studied in 2010-11 without such a training program. We analyzed their responses using SPSS Version 24.0, taking a probability of less than 5% to be significant. Results: In terms of Sense of Coherence, the training program improved new nurses’ “comprehensibility” and “manageability” in the first three months, but both dropped to levels comparable to the untrained nurses after six months. There was no significant difference in “meaningfulness”, which dropped over the first year in both groups. Categorized into three groups according to SOC score at the time of employment in the intervention group, 36 participants were classified into the low score group, 41 participants were classified into the medium score group, and 44 participants were classified into the high score group. Then changes in SOC in each group were then compared. In the LOW group, the scores for “comprehensibility”, “manageability”, and “meaningfulness” increased significantly throughout the year, while in the HIGH group, scores decreased significantly. Conclusions: Our training program did raise new nurses’ sense of growth over the first year, and significantly improved their “comprehensibility” and “manageability” over the first three months. However, the fact that their Sense of Coherence dropped to control group levels after six months suggests the need for further intervention to maintain “comprehensibility” and “manageability” over the longer term. In the LOW group, the scores for “comprehensibility”, “manageability”, and “meaningfulness” increased significantly throughout the year, however, the total SOC score for the LOW group remained low throughout the year. Thus, additional support is needed over-and-above the training presented in this study for those nurses with low SOC scores at time of employment.

Whole genomic copy number variation score: an indicator of potential diagnostic and prognostic value for lung adenocarcinoma

Objective: To verify the value of whole genomic copy number variation (WGCNV) detection and scoring system in the diagnosis and prognosis of lung adenocarcinoma. Methods: Seventy-six lung adenocarcinoma specimens including ninety-one tumor samples and twenty adjacent non-tumor lung tissue samples were collected using Laser capture microdissection (LCM). Whole genomic amplification (WGA) was used to enrich DNA and construct a sequencing library for next generation sequencing (NGS). Changes of larger than 5Mb CNV in this study were analyzed and scored. The nuclear grading and score of tumor cells in the surgery and pleural effusion cytology of lung adenocarcinoma specimens were evaluated separately. For each case, we evaluated (1) nuclear size, (2) mitotic counts, (3) nuclear atypia, (4) atypical mitoses. The data of disease-free survive (DFS) and overall survive (OS) were collected for assessing the prognostic value of WGCNV score. Meanwhile, receiver operating characteristic (ROC) and area under curve (AUC) were used to define a cut-off value and evaluate the diagnostic significance in lung adenocarcinoma. Results: The WGCNV scores of twenty adjacent non-tumor lung tissue samples were treated as normal control and all of WGCNV scores of tumor samples range from 0 to 9.95, the median score was 2.7. The WGCNV scores were divided into three groups: low score group <1.74, medium score grade 1.74~4.23, high score grade >4.23. The WGCNV score was positively associated with the nuclear grade scoring (r=0.780 90, P<0.001). The result for evaluation of prognostic value of the WGCNV scores showed that comparing with low WGCNV score group, Hazard Ratio (HR) of medium score group was 4.11 (95%CI=0.72~23.57) and high score group was 2.07 (95%CI=0.30~14.12). These results suggested that the risks of the medium and high WGCNV score group elevated. According to the analysis results of ROC curve, when the cut off value was 0.01, the sensitivity and specificity for lung adenocarcinoma diagnosis were 97.8% and 95.0% respectively, the positive predictive value (PPV) and negative predictive value (NPV) were 99.0% and 90.1%, respectively, the AUC was 0.981. In the differentiation of adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) group and invasive adenocarcinoma group, when the cut off value was 1.8, the sensitivity and specificity between the two groups were 78.1% and 94.4%, and the PPV and NPV were 98.0% and 52.0%, respectively, the AUC was 0.896. Conclusion: This study verifies that WGCNV scoring system has a potential diagnostic and prognostic value in lung adenocarcinoma.

Food diversity and its relationship with nutrient intakes and meal days involving staple foods, main dishes, and side dishes in community-dwelling elderly adults

Objectives One of the diversity indicators of food intake in the elderly Japanese population is the Dietary Variety Score (DVS). Studies on elderly people have reported the relationship of food intake with health outcomes, such as body function, higher-level functional capacity, fall risk, and sarcopenia. However, the index have not been studied enough whether it is suggestive of nutrients and the characteristics of the meal by various food intakes. The purpose of this study was to clarify the DVS and its relationship with nutrient intakes and meal days consisting of staple foods, main dishes, and side dishes among elderly adults.Methods The participants were 182 community-dwelling elderly adults (65-84 years) in Itabashi city, Tokyo. For the food diversity indicator, we used the DVS developed by Kumagai et al. and classified the patients as follows: the low score group (0-3 points), the medium score group (4-6 points), and the high score group (7-10 points). Dietary intakes were assessed using a 3-day dietary record. The daily amounts from foods and nutrients, and days of balanced diet with staple foods, main dishes, and side dishes greater than twice a day (hereafter "balanced meal days") were calculated. The relationships between the DVS classification and each dietary index were evaluated by the general linear model adjusted for sex, age, and energy levels. Additionally, we calculated the percentage of people with intakes below the estimated average requirement (EAR) of each nutrient and estimated the risk of below the EAR in the groups by multiple logistic regression analysis.Results The low DVS group had significantly fewer balanced meal days (low 1.4 [1.2-1.6] days, medium 1.8 [1.6-1.9] days, high 1.9 [1.7-2.1] days, p for trend=0.001) than the high DVS group. The low DVS group showed significantly low energy ratios of protein and fat, as well as lower intakes of protein, dietary fiber, phosphorus, magnesium, potassium, vitamin K, and vitamin B12. In contrast, the low DVS group showed significantly higher energy ratios of carbohydrates and grains and higher carbohydrate intake. Compared to the high DVS group, the odds ratio for inadequate vitamin C intake (below the EAR) was significantly high in the low DVS group, and the odds ratios for inadequate intakes of magnesium, zinc, and vitamin B6 were significantly high in the middle DVS group.Conclusion The high DVS group had significant associations with increased intake of protein and micronutrients, as well as balanced meal days. DVS can be a dietary indicator that leads to the intake of a desirable variety of food and nutrients in old age.

A predictive scoring system for insufficient liver hypertrophy after preoperative portal vein embolization

Background: The factors affecting hypertrophy of the future liver remnant (FLR) after portal vein embolization (PVE) remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after PVE and to develop a scoring system predicting insufficient liver hypertrophy. Methods: A total of 152 patients who underwent PVE of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before PVE. Results: After PVE, the FLR volume significantly increased from 364 (151–801) ml, 33.3% (17.9%–53.8%) to 451 (242–866) ml, 41.9% (26.1%–65.1%). The median hypertrophy rate was 23.9% (−5.1%–95.5%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 4 factors; an initial FLR volume ≥35% (2 points), alkaline phosphatase ≥450 IU/dL (1 point), cholinesterase <220 mg/dL (1 point), and the indocyanine green disappearance rate <0.16 (1 point). The constructed scoring system showed the proportion of patients with insufficient liver hypertrophy (<25%) to be 1/22 (4.5%) in the low-score group (0 point), 33/75 (44.0%) in the medium-score group (1–2 points), and 46/55 (83.6%) in the high-score group (3–5 points). The hypertrophy rate of FLR was significantly different among the 3 groups (low-score group, 40.1% [2.1–73.2%]; medium-score group, 26.5% [−5.1–81.4%]; high-score group, 20.1% [1.1–49.8%]) (P < 0.001). Conclusion: The constructed scoring system was able to stratify patients before PVE according to the possibility of developing insufficient liver hypertrophy.

A predictive scoring system for insufficient liver hypertrophy after preoperative portal vein embolization

BackgroundThe factors which affect hypertrophy of the future liver remnant after portal vein embolization remain unclear. The aim of this study was to clarify the clinical factors affecting the hypertrophy rate after portal vein embolization and to develop a scoring system predicting insufficient liver hypertrophy. MethodsThe cases of a total of 152 patients who underwent portal vein embolization of the right portal branch between 2006 and 2016 were reviewed retrospectively. The score to predict insufficient (<25%) hypertrophy was established based on logistic regression analyses of the clinical parameters before portal vein embolization. ResultsAfter portal vein embolization, the future liver remnant volume, expressed as the median (range), significantly increased from 364 (151–801) mL, 33% (18%–54%), to 451 (242–866) mL, 42% (26%–65%). The median hypertrophy rate was 24% (−5% to 96%). A preoperative predictive scoring system for insufficient liver hypertrophy was constructed using the following 3 factors: an initial future liver remnant volume ≥35% (2 points), alkaline phosphatase ≥450 IU/dL (1 point), and cholinesterase <220 mg/dL (1 point). The constructed scoring system indicated the proportion of patients with insufficient liver hypertrophy (<25%) to be 6 out of 42 (14%) in the low-score group (0 points), 44 out of 77 (57%) in the medium-score group (1–2 points), and 30 out of 33 (91%) in the high-score group (3–4 points). The hypertrophy rate of future liver remnant was different among the 3 groups (low-score group, 38.9% [−2.4% to 81.4%]; medium-score group, 22.7% [−5.1% to 95.5%]; high-score group, 18.2% [2.4%–30.7%]) (P < .001). ConclusionThe constructed scoring system was able to stratify patients before portal vein embolization according to the possibility of developing insufficient liver hypertrophy.

An investigation into effectiveness of different reflective learning strategies for learning operational software

Skill certification promotion is one of the main policies facilitated by the technological and vocational education, where application software instruction is regarded as the core curriculum to foster skill certification. With its close connection with problem-solving learning, application software instruction relies heavily on hands-on operation incorporating information technology to adequately unravel the challenges where living or working application is simulated as problem situations. According to Dewey (1963) and Edwards (1996), the process of reflection is characterized by the inference course where learners attempt to analyze and solve the problems. However, more evidence is needed to decide what reflective learning strategies are effective for students' learning. Application software operation is categorized as procedural knowledge. Repeated drills are requisite to reach the ultimate goal of spontaneous reaction without thinking. Features of CAL system offer a well-rounded environment to meet the demands. The purposes of this study were 1) to investigate how different reflective learning strategies can affect learning effectiveness of operational application software acquisition, 2) to identify effective learning strategies and to incorporate the CAL approach with instructional practices to foster learning performance. Aiming at characteristics of operational software, this study proposed operational software learning strategy theory model based on reflective learning and Adaptive Character of Thought-Rational (ACT-R) model theories. The proposed model modified the reflective learning theory and added cyclical loop into CAL to fit for operational software instruction. The CAL system is developed and incorporated into learning activities of reflective learning theory strategy model by collecting frequent operation errors made in the first-year experiment as the source drill items. This study is conducted in a two-year sequence. A total of 172 second-grade students was recruited from a vocational high school. Different reflective learning strategies, individual and group reflective learning strategy, are implemented on two experimental groups in the first year. CAL strategy is later added into the experimental groups in the second year. The results suggest that group reflective learning strategy can enhance learning effectiveness of the holistic and medium-score group students. When reflective learning strategy is incorporated with CAL, in addition to maintaining the first-year learning effectiveness, learning effectiveness of the holistic and low-score group students can be benefited by individual reflective learning strategy. Furthermore, reflective learning incorporating with CAL has greater learning effectiveness than the learning without CAL.

Use of Preoperative CHA2DS2‐VASc Score to Predict the Risk of Atrial Fibrillation After Cardiothoracic Surgery: A Nested Case–Control Study from the Atrial Fibrillation Suppression Trials (AFIST) I, II, and III

To evaluate whether the preoperative CHA2 DS2 -VASc score predicts the risk of atrial fibrillation (AF) after cardiothoracic surgery (CTS). Retrospective, nested case-control study. A total of 560 patients undergoing coronary artery bypass grafting and/or valvular surgery from the Atrial Fibrillation Suppression Trials I, II, and III. All variables showing a univariate association (p≤0.20) with AF occurrence were entered into a backward stepwise multivariate logistic regression analysis to control for potential confounders and to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The population was age 67.8±8.6 (mean±SD) years and 77.1% male, with CHA2 DS2 -VASc scores of 0-1 (low) in 34 patients (6.1%), 2-3 (medium) in 261 patients (46.6%), and more than 3 (high) in 265 patients (47.3%). Post-CTS AF occurred in 177 patients (31.6%), with 27%, 23%, and 41% in the low-, medium-, and high-CHA2 DS2 -VASc score groups, respectively. The high-score group had a 2.3-fold increased odds of developing AF versus the medium-score group (p<0.0001). The differences between the high- and medium-score groups when each group was compared with the low-score group were not statistically significant. On the multivariate logistic regression analysis, CHA2 DS2 -VASc score was associated with development of AF (AOR 1.20, 95% CI 1.06-1.36). Increasing CHA2 DS2 -VASc score was an independent predictor for the development of post-CTS AF, with patients in the high-score group having the highest overall incidence.

地域包括支援センターにおける業務の現状および個人特性・労働環境と職業性ストレスとの関連

The purpose of this study was to identify the current status of operations at community general support centers which provide coordination for elderly care and the correlation of personal traits, work environment and the occupational stress of the staff. Subjects of the study were 251 staff members of community general support centers. The current status of operations at the community general support centers and the personal traits, work environment, effort-remuneration imbalance model (ERI) and general health questionnaire (GHQ) were surveyed. The initial analysis involved a comparison by a chi-square test on: The effort-remuneration ratio (E/R ratio) of personal traits and work environment, risk of over-commitment (OC), and GHQ score. To explore the correlation between the E/R ratio of the three GHQ groups (low, middle and high score groups) and the OC value, one-way analysis of variance was performed. Out of the four basic functions of the community general support centers, 22.0% of the respondents noted that "establishment of a regional, comprehensive/multi-tiered service network" was functioning, and 50.4% of respondents noted that "comprehensive and continuous care management" was functioning. The average effort score was 15.5 +/- 5.3, approximately double the average value of preceding studies. Significant differences found in GHQ scores were related to working hours (p<0.001) and anxiety was related to task content (p<0.001). Moreover, a higher GHQ score was accompanied by a higher E/R ratio and as a result of the multiple comparison, a marked difference was observed between the GHQ low score group and the GHQ high score group (p<0.001), and a significant difference was also found between the GHQ low score group and GHQ medium score group (p=0.012). Items observed to have significant correlation with high E/R ratio were: "Weekly working hours of 50 h or more" (OR: 10.38, 95% CI: 2.52-42.70), "Unstable employment" (OR: 2.75, 95% CI: 1.22-6.21) and "Anxiety related to task content" (OR: 17.04, 95% CI: 3.57-81.24). Items observed to have significant correlation with OC value risk factors were: "Weekly working hours of 50 h or more" (OR: 8.04, 95% CI: 1.99-32.41) and "Anxiety related to task content" (OR: 4.60, 95% CI: 2.04-10.37). We conclude that the basic functions of the community general support centers are not presently very functional. The stress levels of the community general support center staff are high and their health levels are low. This indicates that staff are forced to work with anxiety related to task content under conditions of poor pay and long working hours.

A study of the effects of active listening on listening attitudes of middle managers.

The present study was conducted to clarify the direct effects of active listening (AL) training given to middle managers in a local government. Altogether, 345 middle managers participated in 13 AL training sessions over two years. We developed the Inventive Experiential Learning (IEL) method, and used it as the central training method in this study. To investigate how well the participants learned AL, we asked the middle managers to answer a shorter version of the Active Listening Attitude Scale (ALAS) consisting of two subscales-i.e. "Listening Attitude" and "Listening Skill"-before training, one month after and three months after training. Altogether, 284 middle managers answered the questionnaire three times. The scores of each subscale were analyzed by repeated measurement analysis of variance. The participants were divided into three groups using the percentile values of the original sample of ALAS, i.e. low-score group (-24%), medium-score group (25-75%) and high-score group (76%-), and the proportionate changes were examined. The results showed both the "Listening Attitude" and "Listening Skill" subscales increased significantly after training. Analysis of the percentiles showed that the proportion of the low-score group decreased and that of the high-score group increased in both subscales, from one to three months after training. These changes are considered to indicate that the participants have learned AL although they attended AL training for only one day.