Ordinal Scale Research Articles

Association between days spent at home and functional status and health among persons living with dementia.

Many persons living with dementias (PLWD) prefer to remain at home as long as possible, and days spent at home (DAH)-defined as the time an individual spends outside of healthcare facilities-has emerged as a person-centred outcome measure in this population. We examined the association between DAH and functional status and health among PLWD. Utilizing a nationally representative cohort of individuals age 65 and older in the United States with dementia from the 2010-2018 Health and Retirement Study (HRS), we assessed the relationship between an ordinal categorical DAH variable and number of activities of daily living (ADLs) (range 0-10; 10 being independent), mobility (0-5; 5 being mobile), and self-rated health (SRH) (0-4; 4 being excellent), controlling for patient characteristics. DAH was defined as the number of self-reported days spent outside a hospital or nursing home in the time between survey waves, typically 730days. We identified 3002 participants (4192 observations, average 1.4 observations per participant). The mean DAH was 704.4days (SD 10.8days) and 64.9% spent all days at home (i.e. 730days). A 2-week decrease in DAH was associated with a lower ADL score by 0.32 points (95% confidence internal [CI]: 0.24-0.40, P-for-trend<0.001), a lower mobility score by 0.18 points (95% CI: 0.13-0.22, P-for-trend<0.001), and a lower SRH by 0.05 points (95% CI: 0.02-0.08, P-for-trend<0.001). We demonstrate that DAH is positively associated with important patient-reported outcomes among the dementia population, strengthening the argument for considering DAH as a meaningful outcome measure for PLWD.

Canadian Midwives' Experiences with Nutrition in Their Training and Practice: A Cross-Sectional Study.

Midwives are primary prenatal care providers well-positioned to offer nutrition advice to pregnant individuals; however, no Canadian study has assessed midwives' experience with nutrition education. The objective of this study was to investigate Canadian midwives' experiences with nutrition in their practice, their level of nutrition education, and their recommendations on select nutrition topics. This cross-sectional study used an anonymous online survey consisting of 4 sections: demographics, opinions on the importance of nutrition, nutrition recommendations for pregnancy, and nutrition topics that midwives would like more information on. Responses were recorded using Likert-type scales, multiple choice, or open-ended questions. Eligible participants, registered Canadian midwives, were recruited through advertisements in e-newsletters via national and provincial midwifery associations, social media posts, and emails to midwifery clinics. An independent samples t test compared differences in means for continuous outcomes, the χ2 test compared categorical variables, and the Mann-Whitney U test compared ordinal variables. A P <.05 was considered statistically significant. In total, 161 midwives completed the online survey. Most midwives (92.5%) indicated that nutrition for pregnancy was important, and 83.2% believed their role in providing nutrition information to pregnant women was important. Almost two-thirds (63.8%) of midwives received nutrition education. Comfort levels were highest (median = 4) when providing nutrition advice on healthy eating, weight gain, Listeria, anemia, heartburn, safe food handling, nutrition for breastfeeding, and weight gain for women with obesity. Almost all the midwives (99.4%) had provided nutrition information to pregnant women, and 85.2% of their recommendations aligned with Canadian guidelines and literature. Canadian midwives valued the importance of nutrition during pregnancy and their role in providing nutrition information to pregnant women. The level of comfort in advising on nutrition ranged from uncomfortable to very comfortable depending on the topic, and most (85.2%) of their advice aligned with Canadian guidelines and relevant literature.

The Potential of the Socio-Demographic Profile of the Visitor in the Museum's Product Strategy

One of the types of cultural sector institutions with a solid potential to use modern management methods are organisations dealing with cultural heritage management, such as castle museums. Today, however, these cathedrals of cultural tourism have to face the pressures of economic and social change to build public authority and recognition, but most importantly, to create interest and an attractive offer for their existing audiences and a hitherto unreached public. The present article aims to develop a systematic review of empirical experiences in the socio-demographic profile of visitors to selected castle museums, to identify untapped potential in the segmentation of museum audiences and to derive propositions for individual solutions aimed at increasing the attendance of selected castle museums. We used a triplet of separated Chi-square tests for each period to identify the socio-demographic profile. Non-parametric Kruskal-Wallis one-way ANOVA (Analysis of Variance) was used to test for differences in ordinal variables (age and education of visitors). In addition to the individual results for each single museum partially, we can identify through the most frequent, most represented and periodically repeated responses the typical visitor profile of the Castle Castle Museums as follows: female, 31 – 45 years old, secondary education with a high school diploma, working as an executive secondary educated professional employee. Such findings could be helpful in the future when creating so-called tailor-made products for the visitor.

Evaluation of treatment response with serial CT in patients with non-tuberculous mycobacterial pulmonary disease.

In patients with non-tuberculous mycobacterial pulmonary disease (NTM-PD), the response to treatment is evaluated based on microbiological, clinical, and radiological data. However, little is known about the dynamics of CT findings. The aim of this study was to evaluate CT changes in NTM-PD in order to define radiological criteria for treatment success. Retrospective multicenter study (Hannover, Heidelberg, Gauting). Sixty patients with NTM-PD and at least two consecutive CT scans were included. Scoring for NTM-PD was performed by evaluating variables of bronchiectasis, mucus plugging, bronchiolitis, cavities, nodules, and consolidations on an ordinal scale from 0 to 3. Differences between baseline and follow-up were calculated, and patients with/without cultural conversion were compared using the Mann-Whitney U-test. For paired comparison of the two consecutive CT scans the Wilcoxon test was used. Comparing patients with and without culture conversion, there were significant differences in temporal changes of bronchiectasis (p < 0.001), cavities (p = 0.006), bronchiolitis (p < 0.001), consolidations (p = 0.004), and total score (p < 0.001). Nodules showed no significant differences between groups (p = 0.060). The Wilcoxon test showed significant differences between both CTs in patients with a microbiological cure for the total score (p < 0.001), cavities (p = 0.005), bronchiolitis (p < 0.001), and consolidations (p = 0.021) with a decrease after microbiological cure, whereas bronchiectasis (p = 0.102) and nodules (p = 0.18) stayed stable. In the case of persistently positive cultures, there was an increase in the total score (p = 0.010) which was attributable to progressivebronchiectasis (p < 0.001). Cavities, consolidations, and bronchiolitis are useful to assess treatment response, whereas bronchiectasis and nodules may remain stable despite successful treatment. Cavities, consolidations, and bronchiolitis can assess treatment response whereas bronchiectasis and nodules may remain stable despite successful treatment. In persistently positive cultures, bronchiectasis showed an increase over time indicating that NTM-PD is a progressive chronic disease. Little is known about CT changes in nontuberculous mycobacteriapulmonary disease (NTM-PD) and criteria to evaluate treatment response. In the case of culture conversion, cavities and bronchiolitis decreased whereas bronchiectasis and nodules remained stable. Cavities and bronchiolitis can evaluate treatment response in NTM, but bronchiectasis and nodules may persist despite successful treatment.

Quantitative 99mTc-pyrophosphate myocardial uptake: Changes on transthyretin stabilization therapy

BackgroundQuantitative technetium-99m-pyrophosphate cardiac single-photon emission computed tomography (99mTc-PYP SPECT/CT) is an emerging method for estimating myocardial burden of transthyretin cardiac amyloidosis (ATTR-CA), but its efficacy in monitoring longitudinal changes remains uncertain. We aimed to investigate longitudinal changes in cardiac ATTR amyloid burden following transthyretin stabilization therapy using visual and quantitative 99mTc-PYP SPECT/CT and to relate these with changes in cardiac biomarkers and function. MethodsThis prospective longitudinal cohort study investigated changes in 99mTc-PYP SPECT/CT in 23 participants with ATTR-CA on transthyretin stabilization therapy (median: 2.6 years). Quantitative analysis included left ventricular (LV) standardized uptake values (SUVs) (SUVmax, SUVmean), cardiac amyloid activity (CAA; SUVmean∗LV activity volume), and percent injected dose (%ID) (mean activity concentration∗LV activity volume/injected activity), calculated using a threshold of >1.5 times left atrial blood pool activity concentration on SPECT/CT. Longitudinal changes of paired continuous and ordinal variables were analyzed using Wilcoxon signed-rank test. ResultsFollowing therapy, visual grade decreased significantly (P = 0.003). Several quantitative 99mTc-PYP metrics also decreased significantly: SUVmax (median −0.75, P = 0.011), CAA (median: −406.6, P < 0.001), and %ID (median: −0.45, P < 0.001). Serum transthyretin levels improved (median: +6.5 mg/dL, P = 0.008). Echocardiographic parameters (global longitudinal strain, LV mass index, and LV wall thickness), N-terminal pro-B-type natriuretic peptide, and estimated glomerular filtration rate remained stable. ConclusionsFavorable changes in 99mTc-PYP myocardial uptake were observed in participants on transthyretin stabilization therapy, whereas echocardiographic parameters and biomarkers remained stable. These results likely signify myocardial ATTR amyloid stabilization rather than amyloid burden regression. Further investigation is needed to understand the implications of these findings.

Assessment of mechanical allodynia in healthy teeth adjacent and contralateral to endodontically diseased teeth: a clinical study.

The present study investigated the prevalence of mechanical allodynia (MA) in healthy teeth adjacent and contralateral to endodontically diseased teeth. This cross-sectional study included 114 patients with symptomatic irreversible pulpitis and apical periodontitis in permanent mandibular first molars who possessed healthy teeth adjacent and contralateral to the endodontically diseased tooth. The mechanical sensitivity of the teeth was determined by percussion testing. The presence or absence of pain on percussion in the teeth adjacent and contralateral to the endodontically diseased tooth and the tooth distal to the contralateral symmetrical tooth was recorded according to coding criteria. The prevalence of MA was computed as a percentage, and binary logistic regression analysis was done. The Fisher exact test and Mann-Whitney U test were used for binary and ordinal data. Age and sex did not influence the prevalence of MA. An increased prevalence of MA was found in patients with higher levels of spontaneous pain (p < 0.001). The prevalence of allodynia was 57% in teeth adjacent to endodontically diseased teeth and 10.5% in teeth contralateral to endodontically diseased teeth. In addition, on the ipsilateral side, there were more painful sensations distal to the diseased tooth than mesially. Despite being disease-free, teeth adjacent and contralateral to endodontically diseased teeth exhibited pain on percussion. There was a direct association between the severity of the patient's pain and the presence of MA.

The use of practice evidence by Australian occupational therapists: Perspectives and actions.

Evidence-based practice supports clinical decision-making by using multiple sources of evidence arising from research and practice. Research evidence develops through empirical study while practice evidence arises through clinical experience, client preferences, and the practice context. Although occupational therapists have embraced the paradigm of evidence-based practice, some studies have identified limits in the availability and use of research, which can lead to reliance on other forms of evidence. This study aimed to understand how Australian occupational therapists use practice evidence, manage potential bias, and enhance trustworthiness. Potential use of a critical appraisal tool for practice evidence was also explored. A 42-item questionnaire was developed to address the study aims. It consisted of a 7-point Likert scale, ordinal and free text questions. Likert scales were collapsed into binary scales and analysed using SPSS. Ordinal data were graphed and free text responses were analysed using manifest content analysis. Most respondents (82%) indicated that practice evidence was an important informant of practice and is used alongside research evidence. Almost all respondents (98%) expressed confusion when reconciling discrepancies between research and practice evidence. There was general acknowledgement that practice evidence is prone to bias (82%), yet 92% were confident in trusting their own practice evidence. Most respondents (74.5%) undertook some measures to appraise practice evidence, and almost all respondents (90%) agreed they would refer to a critical appraisal tool that helped them evaluate practice evidence. Occupational therapists in this study routinely use practice evidence arising from their own experience, client perspectives, and their practice context to inform clinical decision-making. While they agreed that practice evidence was prone to bias and misinterpretation, they generally trusted their own practice evidence. Participants indicated they needed guidance to critically appraise their practice evidence and supported the development of a critical appraisal tool for this purpose.

Relationship between updated MELD and prognosis in alcohol-associated hepatitis: Opportunities for more efficient trial design.

Alcohol-associated hepatitis (AH) is associated with significant mortality. Model for End-Stage Liver Disease (MELD) score is used to predict short-term mortality and aid in treatment decisions. MELD is frequently updated in the course of AH. However, once the most updated MELD is known, it is uncertain if previous ones still have prognostic value, which might be relevant for transplant allocation and trial design. We aimed to investigate the predictive performance of updated MELDs in a prospectively collected cohort of patients with AH by the InTeam consortium. Three hundred seven patients (with 859 MELD values within 60 d of admission) fulfilled the inclusion criteria. The main endpoint was time to death or transplant up to 90 days. We used a joint model approach to assess the predictive value of updated MELDs. Updated MELD measurements had a strong prognostic value for death/transplant (HR: 1.20, 95% CI: 1.14-1.27) (p < 0.0001). Previous MELD values did not add predictive value to the most current MELD. We also showed that MELD at day 28 (MELD28) had a significant predictive value for subsequent mortality/transplant in a landmark analysis (HR: 1.18, 95% CI: 1.12-1.23). We show that the use of an ordinal scale including death, transplant, and MELD28 as a trial outcome could substantially reduce the sample size required to demonstrate short-term benefit of an intervention. We show that updated MELDs during the trajectory of AH predict subsequent mortality or the need for transplant. MELD28 inclusion in an ordinal outcome (together with death or transplant) could increase the efficiency of randomized controlled trials.

Evaluating the Role of Objective Structured Clinical Examination as a Summative Assessment Tool in Undergraduate and Postgraduate Psychiatry Residents.

The Objective Structured Clinical Examination (OSCE) is the gold standard and universal format to assess medical students' clinical competence in a comprehensive, reliable, and valid manner. OSCE is gaining global popularity for assessing medical students in various specialties. Our country uses it in multiple disciplines, but its application in psychiatry remains limited. OSCE is a resource-demanding assessment method that can face numerous challenges. A comprehensive assessment of perceptions regarding OSCE can help identify areas that need improvement. Therefore, this study was conducted to assess the perceptions of students and examiners toward OSCE in psychiatry. This study aims to evaluate the role of Objective Structured Clinical Examination as a summative assessment tool in assessing competency in undergraduate (as part of their ward leaving examinations in psychiatry) and postgraduate psychiatry residents (as part of their six-monthly assessments) and analyze the perceptions of students as well as of the faculty members regarding OSCE. Six MD students and 49 MBBS students took the OSCE as part of their ward-level exams in psychiatry. In the presence of four faculty members of the psychiatry department, students completed their six-month summative exams. The OSCE was held at separate times for UG and PG students. UG and PG students utilized different stations (PG students had a harder level). A 10-item questionnaire was given to examiners and students at the end of the OSCE to get their opinions regarding the OSCE. Furthermore, data gathered from the faculty through an open-ended questionnaire was compiled and displayed thematically. Since the Likert scale survey generated ordinal data, the statistical analysis was conducted using the median, interquartile range (IQR), and chi-square test. The chi-square test was used to compare the variables. A P-value of less than 0.05 was deemed statistically noteworthy. Four faculty members and fifty-five students in all answered the questionnaire. Regarding the OSCE's characteristics, validity, reliability, and transparency, the majority of students expressed positive opinions. In a similar vein, most examiners had positive perceptions pertaining to OSCE's administration, structure, and procedures. Certain areas, such as "improved confidence in teaching clinical skills" and "improved confidence in giving students structured feedback," were also emphasized by thematic analysis of faculty members. In general, both students and examiners had extremely favorable perceptions of and embraced the OSCE. Improved faculty orientation and student preparation for the OSCE may help allay anxiety and overcome hesitation related to the exam.

Comparison between abdominal core muscle strength in males with and without frozen shoulder: A pilot study

Background: The impact of adhesive capsulitis starts from the structures surrounding the shoulder complex and extends to overall deconditioning and affects neuromuscular control due to reduced daily living activities which may be passed along further in the kinetic chain. Context: Studies show there may be a certain link between core muscle activation and shoulder function, however, the literature is scanty in this regard. Aims: To compare the abdominal core muscle strength in males with and without frozen shoulder. Settings and Design: In this observational comparative study, 20 males (40-60 yrs) from a tertiary care hospital visiting the physiotherapy department for the treatment of frozen shoulder were included along with age, Body Mass Index (BMI) and Waist to Hip Ratio (WHR) matched healthy controls. Methods and Material: Abdominal core muscle strength was measured using a pressure biofeedback unit while progressive limb loading was performed. Statistical analysis used: The ordinal data was compared using SPSS Version 24 and Man Whitney U and Wilcoxon W were obtained. Results: The abdominal core muscle strength of male patients with frozen shoulder was weaker compared with healthy controls (p &gt; 0.0001) Conclusions: The abdominal core muscle strength was significantly weaker in the males with frozen shoulder compared to age, BMI and WHR matched healthy controls. Thus Inclusion of core muscle strengthening in the rehabilitation of patients with frozen shoulder may lead to better outcomes in rehabilitation.

Disease-modifying therapies, outcomes, risk factors and severity of COVID-19 in multiple sclerosis: A MENACTRIMS registry based study

BackgroundThere is a lack information regarding risk factors associated with worse COVID-19 outcomes in patients with multiple sclerosis (MS) in the MENA region. MethodsThis is a multicenter, retrospective cohort study that included all MS patients with a suspected or confirmed COVID-19 infection using the MENACTRIMS registry. The association of demographics, disease characteristics, and use of disease-modifying therapies (DMTs) with outcomes and severity of COVID-19 were evaluated by multivariate logistic model. ResultsA total of 600 MS patients with confirmed (n = 542) or highly suspected (n = 58) COVID-19 were analyzed. Seventy-three patients (12.2 %) had a COVID-19 severity score of ≥3 on a 7-point ordinal scale (ranging from 1 [not hospitalized with no limitations on activities] to 7 [death] with a cutoff at 3 [hospitalized and not requiring supplemental oxygen]), and 15 patients (2.5 %) died. Out of 73 patients with a severity score ≥3, 90.4 % were on DMTs; 50.6 % of them were on anti-CD20, including ocrelizumab and rituximab. Multivariate logistic regression showed that older age (odds ratio per 10 years, 1.4 [95 %CI, 1.0–1.8]), disability (OR for EDSS 3.0–5.5, 2.9 [95 %CI. 1.5–5.7], OR for EDSS ≥6.0, 2.3 [95 %CI. 1.0–5.1]), obesity (OR, 3.0 [95 %CI, 1.5–6.0]), and treatment with rituximab (OR, 9.0 [95 %CI, 3.1–25.3]) or off-label immunosuppressive medications (OR, 5.6 [95 %CI. 1.1–27.8]) were risk factors for moderate or severe COVID-19. ConclusionIn this registry-based study of MS patients, age, sex, EDSS, obesity, progressive MS were risk factors for severe COVID-19. Moreover, there was an association found between exposure to anti-CD20 DMTs and COVID-19 severity.

Evaluating Imputation-Based Fit Statistics in Structural Equation Modeling With Ordinal Data: The MI2S Approach

Evaluating Imputation-Based Fit Statistics in Structural Equation Modeling With Ordinal Data: The MI2S Approach

Associations of Cerebral Small Vessel Disease and Chronic Kidney Disease in Patients With Acute Intracerebral Hemorrhage: A Cross-Sectional Study.

Chronic kidney disease (CKD) may be associated with the pathogenesis and phenotype of cerebral small vessel disease (SVD), which is the commonest cause of intracerebral hemorrhage (ICH). The purpose of this study was to investigate the associations of CKD with ICH neuroimaging phenotype, volume, and location, total burden of small vessel disease, and its individual components. In 2 cohorts of consecutive patients with ICH evaluated with MRI, we investigated the frequency and severity of CKD based on established Kidney Disease Improving Global Outcomes criteria, requiring estimated glomerular filtration rate (eGFR) measurements <60 mL/min/1.732 ≥ 3 months apart to define CKD. MRI scans were rated for ICH neuroimaging phenotype (arteriolosclerosis, cerebral amyloid angiopathy, mixed location SVD, or cryptogenic ICH) and the presence of markers of SVD (white matter hyperintensities [WMHs], cerebral microbleeds [CMBs], lacunes, and enlarged perivascular spaces, defined according to the STandards for ReportIng Vascular changes on nEuroimaging criteria). We used multinomial, binomial logistic, and ordinal logistic regression models adjusted for age, sex, hypertension, and diabetes to account for possible confounding caused by shared risk factors of CKD and SVD. Of 875 patients (mean age 66 years, 42% female), 146 (16.7%) had CKD. After adjusting for age, sex, and comorbidities, patients with CKD had higher rates of mixed SVD than those with eGFR >60 (relative risk ratio 2.39, 95% CI 1.16-4.94, p = 0.019). Severe WMHs, deep microbleeds, and lacunes were more frequent in patients with CKD, as was a higher overall SVD burden score (odds ratio 1.83 for each point on the ordinal scale, 95% CI 1.31-2.56, p < 0.001). Patients with eGFR ≤30 had more CMBs (median 7 [interquartile range 1-23] vs 2 [0-8] for those with eGFR >30, p = 0.007). In patients with ICH, CKD was associated with SVD burden, a mixed SVD phenotype, and markers of arteriolosclerosis. Our findings indicate that CKD might independently contribute to the pathogenesis of arteriolosclerosis and mixed SVD, although we could not definitively account for the severity of shared risk factors. Longitudinal and experimental studies are, therefore, needed to investigate causal associations. Nevertheless, stroke clinicians should be aware of CKD as a potentially independent and modifiable risk factor of SVD.

Practical Implications of Sum Scores Being Psychometrics' Greatest Accomplishment.

This paper reflects on some practical implications of the excellent treatment of sum scoring and classical test theory (CTT) by Sijtsma et al. (Psychometrika 89(1):84-117, 2024). I have no major disagreements about the content they present and found it to be an informative clarification of the properties and possible extensions of CTT. In this paper, I focus on whether sum scores-despite their mathematical justification-are positioned to improve psychometric practice in empirical studies in psychology, education, and adjacent areas. First, I summarize recent reviews of psychometric practice in empirical studies, subsequent calls for greater psychometric transparency and validity, and how sum scores may or may not be positioned to adhere to such calls. Second, I consider limitations of sum scores for prediction, especially in the presence of common features like ordinal or Likert response scales, multidimensional constructs, and moderated or heterogeneous associations. Third, I review previous research outlining potential limitations of using sum scores as outcomes in subsequent analyses where rank ordering is not always sufficient to successfully characterize group differences or change over time. Fourth, I cover potential challenges for providing validity evidence for whether sum scores represent a single construct, particularly if one wishes to maintain minimal CTT assumptions. I conclude with thoughts about whether sum scores-even if mathematically justified-are positioned to improve psychometric practice in empirical studies.

The Influence of Customer Income, Price Discounts, and Fashion Product Shopping Lifestyle on Customer Loyalty on TikTok Social Media

Maintaining customer loyalty is the main focus for fashion product sellers. Many factors influence customer loyalty. The aim of this paper is to determine the influence of customer income, price discounts, and fashion product shopping lifestyle on customer loyalty. The objects of this research are factors that influence customer loyalty, namely customer income, product discounts and customer lifestyle. The data scale in this research is an ordinal scale. The number of respondents in the research was 200 customers. We use multiple regression models to determine the influence of independent variables on the dependent variable. The results of this research show that income, price discount and lifestyle have a significant influence and are positively related to customer loyalty, both simultaneously and partially.

Bayesian modeling of spatial ordinal data from health surveys.

Health surveys allow exploring health indicators that are of great value from a public health point of view and that cannot normally be studied from regular health registries. These indicators are usually coded as ordinal variables and may depend on covariates associated with individuals. In this article, we propose a Bayesian individual-level model for small-area estimation of survey-based health indicators. A categorical likelihood is used at the first level of the model hierarchy to describe the ordinal data, and spatial dependence among small areas is taken into account by using a conditional autoregressive distribution. Post-stratification of the results of the proposed individual-level model allows extrapolating the results to any administrative areal division, even for small areas. We apply this methodology to describe the geographical distribution of a self-perceived health indicator from the Health Survey of the Region of Valencia (Spain) for the year 2016.

Can the 6-minute Walking Test Assess Ambulatory Function Impairment in Patients With Cervical Spondylotic Myelopathy?

Prospective cohort study. Investigating the ability of a 6-minute walking test (6MWT) to assess functional status in patients with cervical spondylotic myelopathy (CSM). The 6MWT provides an objective assessment of a patient's ability to walk. There is the potential for its application to the assessment of functional status in patients with CSM. One hundred thirty-five patients from our institution were prospectively enrolled from July 2022 to August 2023. A control group of age-matched and sex-matched healthy individuals was established. The 6MWT was conducted in strict accordance with established guidelines. The Nurick score, the Prolo score, the Cooper-myelopathy-scale score (CMS), the Japanese Orthopedic Association score (JOA) and the European-myelopathy-scale score (EMS) were assessed preoperatively. Visual Analog Scale (VAS) for pain or numbness and Oswestry Neck Disability Index (NDI) were also collected. Radiographic parameters were measured and recorded. Continuous variables between patients and controls were compared by applying the t test. The χ 2 test was used to compare gender ratios between groups. Pearson correlation analysis was used to analyze the association between continuous variables and ordinal variables. Subgroups of CSM patients were analyzed according to global spinal alignment types based on whether the SVA was ≥50mm. Clinical scores and imaging parameters were compared by t test. The preoperative 6-minute walking distance (6MWD) of CSM patients was 309.34 ± 116.71m, which was significantly lower than that of the controls (464.30 ± 52.59m, P <0.01). The 6MWD was significantly correlated with scores on all clinical scales except the VAS. CMS Lower extremity score had the strongest correlation with preoperative 6MWD in CSM patients (r=-0.794, P <0.01). Of the sagittal alignment parameters, only C7 sagittal vertical axis (SVA) and T1 slope were significantly correlated with 6MWD(r=-0.510, -0.360, respectively). CSM patients with SVA >50mm had significantly lower 6MWD than CSM patients with SVA ≤50mm (168.00 ± 137.26 vs. 346.24 ± 84.27m, P <.01). The 6MWD of CSM patients was significantly lower than that of the healthy population and correlated well with commonly used clinical scales. The 6MWD can potentially assist in the assessment of functional status in patients with CSM.

Principal Variables Analysis for Non-Gaussian Data

Principal variables analysis (PVA) is a technique for selecting a subset of variables that capture as much of the information in a dataset as possible. Existing approaches for PVA are based on the Pearson correlation matrix, which is not well-suited to describing the relationships between non-Gaussian variables. We propose a generalized approach to PVA enabling the use of different types of correlation, and we explore using Spearman, Gaussian copula, and polychoric correlations as alternatives to Pearson correlation. We compare performance in simulation studies varying the form of the true multivariate distribution over a range of possibilities. Our results show that on continuous non-Gaussian data, using generalized PVA with Gaussian copula or Spearman correlations provides a major improvement in performance compared to Pearson. On ordinal data, generalized PVA with polychoric correlations outperforms the rest by a wide margin. We apply generalized PVA to a dataset of 102 clinical variables measured on individuals with X-linked dystonia parkinsonism (XDP), a neurodegenerative disorder involving symptoms of both dystonia and parkinsonism. We find that using different types of correlation yields substantively different sets of principal variables; for example, parkinsonism-related metrics appear more explanatory than dystonia-related metrics on the observed data. Supplementary materials for this article are available online.

Performance Evaluation of Fishery Logistics Systems at the Port of the Marine Toll Network Dobo Port, Maluku

The Sea Toll Program is a program organized by the government with the aim of increasing connectivity between islands in Indonesia, increasing distribution and maintaining the availability of basic necessities and important goods, thereby reducing price disparities across all islands. The Maluku Islands, especially Dobo port, is one of the regions in Indonesia that is rich in fish production and is also traversed by the Sea Toll program. Researchers want to see whether the Sea Toll program can support and synergize with the SLIN (National Fish Logistics System) program by measuring the fish logistics performance index (IKLI) at Dobo Port. The data collection technique was carried out using a purposive sampling technique with a questionnaire method. A total of 13 respondents were interviewed and the results of the fish logistics performance index at Dobo Port were 56.1%. Based on the ordinal scale, the IKLI value in Pel Dobo is sufficient but not optimal. There are three lowest dimensions that need to be improved so that the marine highway program in Pel Dobo can improve, namely the management dimension of fish procurement, the benefits dimension and the governance dimension.

Network-based integrative multi-omics approach reveals biosignatures specific to COVID-19 disease phases.

COVID-19 disease is characterized by a spectrum of disease phases (mild, moderate, and severe). Each disease phase is marked by changes in omics profiles with corresponding changes in the expression of features (biosignatures). However, integrative analysis of multiple omics data from different experiments across studies to investigate biosignatures at various disease phases is limited. Exploring an integrative multi-omics profile analysis through a network approach could be used to determine biosignatures associated with specific disease phases and enable the examination of the relationships between the biosignatures. To identify and characterize biosignatures underlying various COVID-19 disease phases in an integrative multi-omics data analysis. We leveraged a multi-omics network-based approach to integrate transcriptomics, metabolomics, proteomics, and lipidomics data. The World Health Organization Ordinal Scale WHO Ordinal Scale was used as a disease severity reference to harmonize COVID-19 patient metadata across two studies with independent data. A unified COVID-19 knowledge graph was constructed by assembling a disease-specific interactome from the literature and databases. Disease-state specific omics-graphs were constructed by integrating multi-omics data with the unified COVID-19 knowledge graph. We expanded on the network layers of multiXrank, a random walk with restart on multilayer network algorithm, to explore disease state omics-specific graphs and perform enrichment analysis. Network analysis revealed the biosignatures involved in inducing chemokines and inflammatory responses as hubs in the severe and moderate disease phases. We observed distinct biosignatures between severe and moderate disease phases as compared to mild-moderate and mild-severe disease phases. Mild COVID-19 cases were characterized by a unique biosignature comprising C-C Motif Chemokine Ligand 4 (CCL4), and Interferon Regulatory Factor 1 (IRF1). Hepatocyte Growth Factor (HGF), Matrix Metallopeptidase 12 (MMP12), Interleukin 10 (IL10), Nuclear Factor Kappa B Subunit 1 (NFKB1), and suberoylcarnitine form hubs in the omics network that characterizes the moderate disease state. The severe cases were marked by biosignatures such as Signal Transducer and Activator of Transcription 1 (STAT1), Superoxide Dismutase 2 (SOD2), HGF, taurine, lysophosphatidylcholine, diacylglycerol, triglycerides, and sphingomyelin that characterize the disease state. This study identified both biosignatures of different omics types enriched in disease-related pathways and their associated interactions (such as protein-protein, protein-transcript, protein-metabolite, transcript-metabolite, and lipid-lipid interactions) that are unique to mild, moderate, and severe COVID-19 disease states. These biosignatures include molecular features that underlie the observed clinical heterogeneity of COVID-19 and emphasize the need for disease-phase-specific treatment strategies. The approach implemented here can be used to find associations between transcripts, proteins, lipids, and metabolites in other diseases.