Nonparametric Sign Test Research Articles

Modeling the distribution of jet fuel price returns based on fat-tail stable Paretian distribution.

Jet fuel plays a crucial role as an essential energy source in aerospace and aviation operations. The recent increase in fuel prices has presented airlines with the new challenge of managing jet fuel costs to ensure consistent cash flow and minimize operational uncertainties. The conventional risk prediction models used by airlines often assume that risks are normally distributed according to the classical Central Limit Theorem, which can lead to under-hedging. This paper proposes an innovative approach using the stable Paretian model to analyze the price return of jet fuel in large samples. It comprehensively compares the fitting effect of the stable Paretian distribution with that of the normal distribution based on specific criteria and non-parametric significance tests. Furthermore, it investigates the accuracy of risk measures such as Value at Risk (VaR) and Conditional Value at Risk (CVaR) predicted by both models. In addition to comparing differences in VaR between predicted values and actual values, this paper provides a more comprehensive comparison of risk measures under rolling window forecast situation. Results suggest that despite indistinguishable results in VaR backtest, the stable Paretian distribution has a overall better fitting effect as well as a less biased predicted CVaR based on the AIC of -14099.46, BIC of -14110.98, p = 0.58 in Kolmogorov-Smirnov test and p = 0.46(0.92) in the 0.01(0.05) significance level of Expected Shortfall Regression Test. This might be explained by its ability to capture asset return dynamics while maintaining shape stability with few parameters. This research can provide valuable insights for guiding airlines' risk management decisions. its ability to capture asset return dynamics while maintaining shape stability with few parameters. This research can provide valuable insights for guiding airlines' risk management decisions.

EVALUATING THE LATERALITY OF MARTIAL ARTS PRACTITIONERS THROUGH THE KINEMATIC ANALYSIS OF STRIKING TECHNIQUES

The purpose of this study was to objectively measure and highlight laterality differences of high-performance martial arts athletes with hitting techniques and comparing the results registered by each subject. The hypothesis of this research is that through kinematic analysis on both fighting stances (dominant and non-dominant) we can highlight the differences in laterality for each subject. We used a system of inertial measurement units based on 17 motion tracking sensors composed of 3D gyroscopes, 3D accelerometers and 3D magnetometers namely the MVN Xsens Awinda system. We acquisitioned data from 8 high-performance athletes practicing martial arts with hitting techniques. We calculated and analyzed kinematic parameters for some of the most frequently used techniques in this category of martial arts, more specific direct and circular kicks. In order to obtain information related to the level of laterality of the monitored athletes, we compared the values of these parameters for the technical executions on the dominant and non-dominant side and highlighted the significant differences through the Wilcoxon Signed Rank nonparametric significance test. To facilitate comparisons between subjects in terms of laterality, we drew up an original evaluation scale and created diagrams based on the scores obtained by them. Based on these evaluations, directing and individualizing training and choosing combat tactics can be made much more informed.

Statistical assessment for reusing permeate from dewatering water treatment sludge process: more sustainability in environmental sanitation.

Sludge from water treatment plants (WTPs) is usually processed by physicochemical clarification followed by thickening, which results in the production of an effluent from dewatering/drying sludge processes that can potentially impact the environment. This paper assessed the viability of employing sludge dewatering water from a water treatment sludge plant (WTSP) in São Paulo State, Brazil, for reuse purposes. Water quality variables were monitored in the effluent and receiving stream. The data were analyzed by paired samples Student t-test (parametric significance test), paired samples Wilcoxon signed rank test (non-parametric significance test), and principal component analysis (multivariate analysis). Despite the distribution of data, typically not Gaussian, both Student and Wilcoxon methods agreed in 9 out of 10 studied parameters regarding the influence of WTSP discharge on waterbody; only for total manganese the Wilcoxon approach provided better fit than Student. Principal component analysis helped to evince correlations among all variables. Results provided useful information for understanding the vocation of WTSP effluent for reuse. For direct non-potable reuse, recirculating the final effluent back to the WTP for two months saved 92,000 m3 of water, the volume of drinking water demanded by the city (n = 292,000 inhabitants) in approximately 30h.

JOB DISCRIMINATION AGAINST INDIVIDUALS WITH DISABILITIES

The purpose of this study is to identify the relationship between holding a disability certificate and job discrimination. The motivation for conducting this research is to identify a research gap relating to the insufficient recognition of the issue of dysfunction in human resource management, namely, the discrimination of individuals with disabilities by employers. This paper presents the results of a survey conducted on a sample of 148 people. The results of the nonparametric significance tests are discussed. Contrary to the subjective feelings of the surveyed population, the study found that, in selected areas, both the degree and character of a disability significantly correlate with job discrimination by employers.

Safe Food Coloring Agent as an Alternative to Eosin Stain.

Introduction Eosin stain is a commonly used histological dye that selectively binds to acidic structures in cells, imparting a color between pink and red. Eosin stain can be harmful due to its chemical composition. Inhaling eosin stain in powder form or as aerosolized droplets can cause irritation in the respiratory tract. To overcome the toxic effects of eosin, many naturally available organic substitutes have been tested in histopathology laboratories, including rose extract, beetroot stain, and curcumin. These natural stain alternatives provide effective staining of tissue while ensuring minimal risk to laboratory personnel. Aim The study was conducted to evaluate the efficacy of food coloring agents over eosin stain in histopathological investigations. Materials and method The study was carried out in Kalinga Institute of Dental Sciences, Kalinga Institute of Industrial Technology (KIIT) (Deemed to be University), Bhubaneswar, India. The sample size comprised 30 oral mucosal lesion blocks. After the preparation of four micron thick sections from each block, one was stained with hematoxylin and eosin (H&E) stain and the other with a food coloring agent. Sections were kept in food color stain for three minutes. Next, the sections were dehydrated, cleared, and mounted in dibutylphthalate polystyrene xylene (DPX). To evaluate the staining with H&E and food color, each section was scored 0 for inadequate staining, one for adequate, and two for excellent staining. The tissue components stained for the study were red blood cells (RBCs), collagen fibers, muscle fibers, epithelium overall, basement membrane, cell membrane, desmosomes, keratin, cytoplasm, and nuclei. Kolmogorov-Smirnov tests were used to calculate the inferential statistics for the different variables between the groups. The distribution of the study sample was found to be not normal; therefore, a nonparametric test of significance was applied. Results All the tissue components showed excellent staining by H&E (score 2). Among the tissue components, in most of the samples, keratin, cytoplasm, and RBCs showed excellent staining (score 2) on par with the H&E stain. Other tissue components showed no staining (score 0) to adequate staining (score 1). The basement membrane and cell membrane staining were not adequate (score 0). The nuclear staining by hematoxylin was unaffected by food color and was on par with normal H&E staining. Conclusion We conclude that tomato red food color, which is non-toxic, safe for the health of laboratory personnel, easy to dispose of, and environmentally friendly, could be used as a replacement for eosin in the routine H&E techniques. Our observations could be strengthened by increasing the sample sizes and modifying the stain preparation to ensure positive staining of all tissue components, thereby enhancing the results.

Identifying neural correlates of balance impairment in traumatic brain injury using partial least squares correlation analysis

Objective.Balance impairment is one of the most debilitating consequences of traumatic brain injury (TBI). To study the neurophysiological underpinnings of balance impairment, the brain functional connectivity during perturbation tasks can provide new insights. To better characterize the association between the task-relevant functional connectivity and the degree of balance deficits in TBI, the analysis needs to be performed on the data stratified based on the balance impairment. However, such stratification is not straightforward, and it warrants a data-driven approach.Approach.We conducted a study to assess the balance control using a computerized posturography platform in 17 individuals with TBI and 15 age-matched healthy controls. We stratified the TBI participants into balance-impaired and non-impaired TBI usingk-means clustering of either center of pressure (COP) displacement during a balance perturbation task or Berg Balance Scale score as a functional outcome measure. We analyzed brain functional connectivity using the imaginary part of coherence across different cortical regions in various frequency bands. These connectivity features are then studied using the mean-centered partial least squares correlation analysis, which is a multivariate statistical framework with the advantage of handling more features than the number of samples, thus making it suitable for a small-sample study.Main results.Based on the nonparametric significance testing using permutation and bootstrap procedure, we noticed that the weakened theta-band connectivity strength in the following regions of interest significantly contributed to distinguishing balance impaired from non-impaired population, regardless of the type of stratification:left middle frontal gyrus, right paracentral lobule, precuneus, andbilateral middle occipital gyri. Significance.Identifying neural regions linked to balance impairment enhances our understanding of TBI-related balance dysfunction and could inform new treatment strategies. Future work will explore the impact of balance platform training on sensorimotor and visuomotor connectivity.

Increased Aortic Stiffness With Acute Exercise in Heart Failure: Assessment by Cardiovascular Magnetic Resonance

This study aimed to investigate the acute changes in proximal aortic distensibility, a measure of aortic stiffness, induced by acute exercise in participants with and without heart failure (HF). Participants with HF (n = 24) and without HF (n = 26) underwent cardiovascular magnetic resonance (CMR) (1.5 T) imaging at rest and after submaximal supine bicycle ergometry. The participants were further categorized into HF with reduced ejection fraction (HFrEF) (n = 14) and HF with preserved ejection fraction (n = 10) based on the left ventricular ejection fraction. At rest and immediately after exercise, cine CMR images of the cross-sectional ascending and descending aorta at the pulmonary artery bifurcation level were obtained to determine aortic distensibility (AoD), with lower AoD indicating greater aortic stiffness. Differences in means of values at rest and before and after exercise were compared using the nonparametric Wilcoxon sign test. There was no significant difference in AoD at rest between subjects with HF and controls. However, immediately after exercise, participants with HF but not controls exhibited a significant reduction in AoD, indicating higher aortic stiffness related to exercise (median [interquartile range] for the ascending aorta: 3.16 (1.26) × 10-3 mm Hg-1 to 2.39 (1.57) × 10-3 mm Hg-1 and the descending aorta: 4.19 (2.58) × 10-3 mm Hg-1 to 2.96 (1.79) × 10-3 mm Hg-1) (both p = 0.023). This decrease was particularly observed in participants with HFrEF but not in those with HF with preserved ejection fraction. Exercise-induced aortic stiffness, detectable by noninvasive CMR, may contribute to unfavorable ventricular-vascular interactions during exercise in participants with HF, especially HFrEF.

Cranial Remolding Orthosis Study on the Use of a Temperature Sensor to Measure Wear Time

ABSTRACT Introduction The effectiveness of cranial remolding orthoses (CROs) in treating nonsynostotic deformational plagiocephaly (DP) is anecdotally related to adherence. Efficacy of CROs has been evaluated but lacks evidence regarding necessary wear time to achieve a positive outcome. A 23 hr/d wear schedule is generally prescribed regardless of presentation. The study compares daily wear time to treatment outcomes. Materials and Methods Subjects Infants aged 3–18 months diagnosed with DP were included with initial cranial vault asymmetry (CVA) > 6 mm or cephalic ratio (CR) > 0.90. Subjects were treated with an Orthomerica STARband CRO. A total of 106 subjects enrolled, with 69 completed. Apparatus A questionnaire assessed caregiver’s reported adherence with the CRO. Maximum Integrated’s iButton temperature loggers (iButtons) recorded objective wear time. Procedures 3D head shape measurements via Orthomerica STARScanner, caregivers’ questionnaires, and iButton data were collected every 5–8 weeks. Data Analysis Descriptive statistics were obtained, and data reported as mean ± SD or median [25th, 75th percentiles]. Nonparametric sign tests were used to assess differences from CRO fabrication scan to subsequent follow-ups. Spearman rank correlations and corresponding 95% confidence intervals and P values between average wear time and change of measurements were obtained. Results Self-reported wear time was 22 (22, 23) hrs/d. Measured wear time was 17–18 (12, 20) hrs/d. Longer average wear time was significantly associated with larger reductions in CVA (P = 0.0054), CR (P = 0.0080), and CVAI (P = 0.0059). Conclusions Results showed longer average daily wear increased effectiveness in CRO treatment of plagiocephaly. Increased sample sizing is required to determine if generalizable to brachycephalic and asymmetrical brachycephalic head shapes. Clinical Relevance A CRO wear schedule of 23 hrs a day is currently recommended, but difficult for families to adhere. The impact of the study may indicate a more realistic wear schedule that would improve adherence while achieving optimal outcomes.

Determining the efficacy of barbotage for pain relief in calcific tendinitis

Rotator cuff calcific tendinitis is a common cause of shoulder discomfort. Ultrasound-guided barbotage consists of needle aspiration and a subsequent lavage of calcium deposits in the shoulder. While barbotage has proven benefit, other options have also shown similar symptom improvement. This study aims to examine pain outcomes of patients following barbotage of calcific tendinitis. We hypothesize that barbotage will improve shoulder pain scores compared to preprocedure scores. This is a retrospective chart review of 179 ultrasound-guided barbotage interventions for calcific tendinitis of the rotator at a New England urban medical center. Patient pain scores were analyzed using a Friedman's analysis of variance at a significance level of α=0.05, and statistical significance between groups was elucidated using nonparametric post-hoc tests of significance between groups. Pain scores at preprocedure, 2-month, 6-month, and 12-month follow-ups yielded significant differences. Post-hoc nonparametric analysis revealed pain scores at 2 months were significantly lower than preprocedure and at 6 months. Additionally, 47.5% of cases in this study went on to require a secondary procedure of the respective shoulder after their barbotage treatment. Upon analysis, utilization of barbotage as a treatment for calcific tendonitis of the shoulder appears to produce notable pain reduction in the short term (specifically at the 2-month follow-up), but begins to lose some efficacy over long-term evaluation. Additionally, a large portion of patients required further interventions of their shoulder, including corticosteroid injections, more barbotage, or surgery, raising further concerns over its long-term benefit.

The PocketPerio application significantly increases the accuracy of diagnosing periodontal conditions in didactic and chairside settings

The study aimed to determine the accuracy of diagnosing periodontal conditions using the developed web-based PocketPerio application and evaluate the user’s perspective on the use of PocketPerio. First, 22 third-year dental students (DS3) diagnosed ten cases without PocketPerio (control) and with PocketPerio (test) during a mock examination. Then, 105 DS3, 13 fourth-year dental students (DS4), and 32 senior second-year International Standing Program students (ISP2) used PocketPerio chairside. Statistical analysis was performed using a non-parametric paired two-tailed test of significance with the Wilcoxon matched-pairs signed rank test. The null hypothesis that PocketPerio did not increase the accuracy of periodontal diagnoses was rejected at α < 0.01. Periodontal diagnoses made using PocketPerio correlated with those made by periodontics faculty (“gold standard") in all cases. During the mock examination, PocketPerio significantly increased the accuracy of periodontal diagnoses compared to the control (52.73 vs. 13.18%, respectively). Chairside, PocketPerio significantly increased the accuracy of primary (100 vs. 40.0%) and secondary (100 vs. 14.25%) periodontal diagnoses compared to the respective controls. Students regardless of their training year felt more confident in diagnosing periodontal conditions using PocketPerio than their current tools, provided positive feedback on its features, and suggested avenues for its further development.

Application of the Non-Parametric Signals Test to a Company

Objective: The aim of this paper is to show the application of the Non-Parametric Sign Test in problems involving the testing of central tendency values. Theoretical framework: Non-parametric methods are widely used in the study of populations that are taken in rank order (such as a movie that receives one to four star ratings). The use of non-parametric methods may also be necessary when the data has a ranking but no clear numerical interpretation, such as when accessing preferences. In terms of scale, non-parametric methods result in data that is "in order" (Thatcher et al., 2005) Method: Data was taken from a company in the South of Rio de Janeiro and a case study was carried out using the Non-Parametric Sign Test. Final Considerations: Initially it proved unfeasible to use a Parametric Test because the Anderson-Darling Test showed that the Assumption of Normality was not confirmed and finally the Non-Parametric Sign Test showed that the hypothetical Median really is the correct measure of Central Tendency. Implications of the research: The use of Non-Parametric Tests is widespread in scientific literature and has proven to be highly effective in dealing with data where the assumptions of Normality are not confirmed. Originality/value: Despite being well-known statistical tools, Non-Parametric Tests are widely used and can bring innovations to their application, as in the case of the company in question.

Investigating the individual interests of undergraduate students in STEM disciplines

Despite massive investments in the education sector to empower youth in Qatar, a vital concern remains to retain students in science, technology, engineering, and mathematics (STEM) disciplines at the undergraduate level. Even though the country is committed to fostering a knowledge-based society, the low interest of undergraduates in STEM disciplines remains a vital challenge. To investigate this, the current study uses a survey methodology to investigate the perspectives of 172 undergraduate students to understand quantitatively the factors that influence their individual interests in STEM disciplines. Non-parametric significance tests and binary logistic regressions were employed to quantitatively measure the direct factors and predictors that affect students’ individual interests. Findings indicated that aspects like students’ reason/motivation to join STEM, their interaction with faculty, the habit of skipping classes, the difficulty faced in the curriculum, and their parents’ highest educational qualification have an association with individual interests. Also, it was found that demographics such as age group, ethnicity, undergraduate discipline, undergraduate year, parent’s employment status, and mother’s highest educational qualification do not contribute to significant differences in students’ individual interests. These conclusions provide important implications for educationists and policymakers to devise constructive reforms to enhance undergraduate students’ individual interests, thereby improving their persistence in STEM.

COVID-19, Economic Package and Indian Stock Market: An Event Analysis

The present study is an attempt to analyse the behaviour of securities around the outbreak of the COVID-19 pandemic and the declaration of an economic package by the government of India. In this study, daily prices of securities constituting the BSE 100 index are considered as these securities are highly traded and their trading impact would immediately reflect on the index. To present a sector-specific analysis, the securities are further classified based on sectors and are analysed using the event study methodology. Average abnormal returns (AARs) and cumulative average abnormal returns (CAARs) for overall market and for each sector have been calculated and their significance have been tested using parametric T-statistics, standardised cross-sectional test and non-parametric sign test. Based on the analysis, the study concluded that it was not the pandemic but the actions towards controlling the pandemic that caused a negative impact on the Indian stock market. The economic package declared by the government of India to boost the economy also turned out to be futile and failed in achieving its objectives. Among the sectors, only the technology sector has been positively impacted by the pandemic. The outcome of the study would be beneficial to the trading community in identifying the sectors/securities that would act as hedging in the pandemic situations. JEL Codes: E44, G1, G14, G18

DSFC Education on Knowledge And Attitude To Prevent Diabetic Foot Ulcer

Background: Diabetes Mellitus (DM) is a metabolic disease characterized by hyperglycemia. As the number of DM increases, the incidence of diabetic ulcers will also increase. Approximately 14-24% of diabetic foot ulcer patients require amputation with 50% recurrence after three years. This may be due to a lack of knowledge and information in carrying out foot care independently. Most DM patients still think that all they need to do is control their blood glucose levels, so they pay less attention to the condition or cleanliness of their feet, don't wear sandals, and don't cut their nails properly, which creates a risk of recurring wounds. The research aims to determine the effect of providing Diabetic Self Foot Care (DSFC) health education on patient knowledge and attitudes about preventing diabetic foot ulcers.&#x0D; Method: This research was a descriptive-analytical design with a pretest–posttest cross-sectional study approach. Sampling in this research used a total sampling technique, obtaining a sample of 15 respondents. Data collection used measuring instruments in the form of questionnaires, data analysis uses the non-parametric statistical test Wilcoxon Sign Test.&#x0D; Results: The results of respondents' measurements after being given education about preventing diabetic foot ulcers showed that 15 of the respondents had a positive attitude after being given the education. The results of the analysis through statistical tests were obtained by Asymp.Sig. (2-tailed) 0.001 which means it is smaller than the p-value 0.05, so the result is

A nonparametric mixed exponentially weighted moving average-moving average control chart with an application to gas turbines.

This study aims to develop a nonparametric mixed exponentially weighted moving average-moving average (NPEWMA-MA) sign control chart for monitoring shifts in process location, particularly when the distribution of a critical quality characteristic is either unknown or non-normal. In literature, the variance expression of the mixed exponentially weighted moving average-moving average (EWMA-MA) statistic is calculated by allowing sequential moving averages to be independent, and thus the exclusion of covariance terms results in an inaccurate variance expression. Furthermore, the effectiveness of the EWMA-MA control chart deteriorates when the distribution of a critical quality characteristic deviates from normality. The proposed NPEWMA-MA sign control chart addresses these by utilizing the corrected variance of the EWMA-MA statistic and incorporating the nonparametric sign test into the EWMA-MA charting structure. The chart integrates the moving average (MA) statistic into the exponentially weighted moving average (EWMA) statistic. The EWMA-MA charting statistic assigns more weight to recent w samples, with weights for previous observations decling exponentially. Monte Carlo simulations assess the chart's performance using various run length (RL) characteristics such as average run length (ARL), standard deviation of run length (SDRL), and median run length (MRL). Additional measures for overall performance include the average extra quadratic loss (AEQL) and relative mean index (RMI). The proposed NPEWMA-MA sign control chart demonstrates superior performance compared to existing nonparametric control charts across different symmetrical and asymmetric distributions. It efficiently detects process shifts, as validated through both a simulated study and a real-life example from a combined cycle power plant.

The contagion and spillover effects of stock returns between quasi-vertically integrated firms in Taiwan semiconductor industry

&lt;p&gt;The study intends to investigate whether there are contagion effects resulting from supply-chain stock returns interaction and spillover effects deriving from returns volatility causation in quasi- vertically integrated Taiwan semiconductor industry. 17 paired groups (34 companies) of parent and subsidiary companies were found. The unit root test, LB-Q test, ARCH tests, Bi-GARCH model, parametric t test and nonparametric sign test, ranked sign test and Kruskal-Wallis test are applied. The major findings are as follows: Positive stock returns contagion effect exist in both parent-to-subsidiary and subsidiary-to-parent. Stock returns volatility spillover main and minor effects exist in quasi-vertically integrated supply chain. In general, the contagion effect and volatility spillover effect of parent-to-subsidiary are greater than those of subsidiary-to-parent.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Evaluation of long-term robustness of the International System of Reference (SIR) used in radionuclide metrology based on the meta-analysis of its machine-readable database

In support of the CIPM MRA, the reference system in radionuclide metrology (SIR) is a unique experimental facility that has been able to provide continuous key comparison results for 72 radionuclides for 46 years. These measurement data are now available in a machine-readable format, which allows statistical analysis of these measurement results to be performed efficiently. Such a meta-analysis was conducted to verify whether or not the accumulated data confirmed the bold assumption made in the 1970s of the long-term robustness of the system over decades of operation. It was notably assumed that variation in the properties of the standard solution to be measured or the choice of the 226Ra reference source would have no impact on the measurement. For the majority of radionuclides measured by the SIR, the non-parametric significance tests of the null hypothesis carried out in this study gave no evidence, at the 95% confidence level, that the above statement should be reconsidered. However, this meta-analysis revealed a significant impact of solution density in the case of 109Cd, corroborating previous observations made in the case of 241Am where the robustness of an ionization chamber with respect to the density variation of the solution does not appear to be perfect. The extension of the SIR by a liquid scintillation system is under development. It will improve the robustness of international comparison results for those borderline cases where radionuclides emit only low-energy x-rays or gamma rays (<100 keV).

Promoting diversity in neurosurgery through a virtual symposium.

The rates of women and underrepresented racial and ethnic minority (UREM) students successfully matching into neurosurgical residency are extremely low and do not reflect the makeup of the general population. As of 2019, only 17.5% of neurosurgical residents in the United States were women, 4.95% were Black or African American, and 7.2% were Hispanic or Latinx. Earlier recruitment of UREM students will help to diversify the neurosurgical workforce. Therefore, the authors developed a virtual educational event for undergraduate students entitled "Future Leaders in Neurosurgery Symposium for Underrepresented Students'' (FLNSUS). The primary objectives of the FLNSUS were to expose attendees to 1) neurosurgeons from diverse gender, racial, and ethnic backgrounds; 2) neurosurgical research; 3) opportunities for neurosurgical mentorship; and 4) information about life as a neurosurgeon. The authors hypothesized that the FLNSUS would increase student self-confidence, provide exposure to the specialty, and reduce perceived barriers to a neurosurgical career. To measure the change in participant perceptions of neurosurgery, pre- and postsymposium surveys were administered to attendees. Of the 269 participants who completed the presymposium survey, 250 participated in the virtual event and 124 completed the postsymposium survey. Paired pre- and postsurvey responses were used for analysis, yielding a response rate of 46%. To assess the impact of participant perceptions of neurosurgery as a field, pre- and postsurvey responses to questions were compared. The change in response was analyzed, and a nonparametric sign test was performed to check for significant differences. According to the sign test, applicants showed increased familiarity with the field (p < 0.001), increased confidence in their abilities to become neurosurgeons (p = 0.014), and increased exposure to neurosurgeons from diverse gender, racial, and ethnic backgrounds (p < 0.001 for all categories). These results reflect a significant improvement in student perceptions of neurosurgery and suggest that symposiums like the FLNSUS may promote further diversification of the field. The authors anticipate that events promoting diversity in neurosurgery will lead to a more equitable workforce that will ultimately translate to enhanced research productivity, cultural humility, and patient-centered care in neurosurgery.

Reducing the risk of prenatal alcohol exposure and FASD through social services: promising results from the FAR SEAS pilot project.

Within FAR SEAS, a multi-component evidence-based community intervention was implemented and evaluated in Mazovia (Poland), with the aim of preventing alcohol-exposed pregnancies, and therefore preventing FASD. Multi-disciplinary professionals from different services (social, addiction, and psychology), recruited women of child-bearing age (pregnant and not pregnant) in local communities, screened them for alcohol risk, and allocated participants (n = 441) to groups for low- (70%), moderate- (23%), or high-risk (7%) of alcohol exposed pregnancy, to provide interventions tailored to their needs. The non-parametric sign test, testing differences between pairs of observations before and after intervention was used to evaluate the outcomes. Follow-up data (collected from 93% of participants) indicated positive changes in the key outcome variables: risky alcohol consumption dropped by 81%, contraception use increased by 15% and visiting a gynecologist increased by 39%; as well as in associated psychosocial risk factors (decrease in cigarette and drug use, domestic violence and depressive symptoms). No changes were noted in frequency of other service use (medical, psychological, or social). The most prominent changes were observed in the moderate-risk group. Changing risky behaviors (alcohol consumption and sex without contraception) to prevent alcohol exposed pregnancies is feasible at the local level, even without engagement of medical professionals. Key challenges, related to engaging professionals and local authorities, must be addressed; and procedures should be adapted to local contexts and needs.

Take a break: should breaks be enforced during digital breast tomosynthesis reading sessions?

ObjectivesDigital breast tomosynthesis (DBT) can improve diagnostic accuracy compared to 2D mammography, but DBT reporting is time-consuming and potentially more fatiguing. Changes in diagnostic accuracy and subjective and objective fatigue were evaluated over a DBT reporting session, and the impact of taking a reporting break was assessed.Materials and methodsForty-five National Health Service (NHS) mammography readers from 6 hospitals read a cancer-enriched set of 40 DBT cases whilst eye tracked in this prospective cohort study, from December 2020 to April 2022. Eye-blink metrics were assessed as objective fatigue measures. Twenty-one readers had a reporting break, 24 did not. Subjective fatigue questionnaires were completed before and after the session. Diagnostic accuracy and subjective and objective fatigue measures were compared between the cohorts using parametric and non-parametric significance testing.ResultsReaders had on average 10 years post-training breast screening experience and took just under 2 h (105.8 min) to report all cases. Readers without a break reported greater levels of subjective fatigue (44% vs. 33%, p = 0.04), which related to greater objective fatigue: an increased average blink duration (296 ms vs. 286 ms, p < 0.001) and a reduced eye-opening velocity (76 mm/s vs. 82 mm/s, p < 0.001). Objective fatigue increased as the trial progressed for the no break cohort only (ps < 0.001). No difference was identified in diagnostic accuracy between the groups (accuracy: 87% vs. 87%, p = 0.92).ConclusionsImplementing a break during a 2-h DBT reporting session resulted in lower levels of subjective and objective fatigue. Breaks did not impact diagnostic accuracy, which may be related to the extensive experience of the readers.Clinical relevance statementDBT is being incorporated into many mammography screening programmes. Recognising that reporting breaks are required when reading large volumes of DBT studies ensures this can be factored in when setting up reading sessions.Trial registrationClinical trials registration number: NCT03733106Key Points• Use of digital breast tomosynthesis (DBT) in breast screening programmes can cause significant reader fatigue.• The effectiveness of incorporating reading breaks into DBT reporting sessions, to reduce mammography reader fatigue, was investigated using eye tracking.• Integrating breaks into DBT reporting sessions reduced reader fatigue; however, diagnostic accuracy was unaffected.