Pairwise Comparisons Research Articles

A Randomized Controlled Crossover Trial to Determine the Effects of Three Nostril Regulated Breathing Practices on Attention and Mood.

Previous studies on nostril regulated breathing have contrasting findings attributed to lack of controls or not taking into account baseline nostril patency. This randomized crossover study on the effects of three nostril regulated yoga breathing practices and two controls on mood states and attention attempted to address these issues. Forty-five participants between 20 and 45 years (group mean age ± SD; 24.3±3.8 years; M;F 23:22) were assessed in five sessions in random order on five separate days. Nostril patency recorded pre-interventions in 225 sessions showed right nostril dominant at rest (RNDR) in 136 and left nostril dominant at rest (LNDR) in 89 sessions. The sessions were: (i) SAV or right uninostril breathing, (ii) CAV or left unnostril breathing, (iii) (AV or alternate nostril yoga breathing, (iv) breath awareness (BAW), and (v) quiet seated rest (QS). The practices were for 15 min each. Nostril patency was recorded pre, Brief mood introspection scale (BMIS), Global Vigor and Affect Scale (GVA) and Six letter cancellation test (SLCT) were recorded pre and post each session. Data analysis used general linear mixed model analysis, with fixed effects of states (pre and post), sessions and baseline nostril dominance (right or left). A significant interaction of sessions, states and nostril dominance at baseline was observed for total global affect (GA) (F9,396.194=2.871, p=0.003) which increased after SAV, CAV, AV and QS in participants right nostril dominant at rest (NDR) (padj<0.05 in all cases). A significant main effect of states was observed followed by significant post-hoc pair wise comparison in right NDR for (i) pleasant mood after SAV, CAV, AV and QS, (ii) positive mood after SAV and AV, and (iii) global vigor after SAV, CAV, AV and QS, and (iv) a decrease in negative mood after CAV and AV. While the volunteers who had left NDR showed a significant increase in (i) PU after CAV, AV, and QR, (ii) PT after CAV, and (iii) GV after CAV and QS. Nostril dominance pre intervention appears to influence the effects of nostril regulated yoga breathing practices.

Combination Therapy with Atropine 0.05% and Myopi-X® Glasses: Is it Effective in Myopia Control?

To investigate whether the combination therapy of Myopi-X® peripheral progressive addition lenses (PAL; Novax®) and atropine 0.05% provides an additive effect compared to monotherapies with either Myopi-X® PAL or atropine 0.05%. This retrospective cross-sectional study reviewed the clinical records of 51 patients, categorized into three groups: 27 in the Myopi-X group, 13 in the atropine 0.05% group, and 11 in the combination therapy group using Myopi-X peripheral PAL with atropine 0.05%. Baseline characteristics, including age, cycloplegic spherical equivalent (SE), and axial length (AL), were compared between the groups. Twelve months after treatment initiation, changes in SE and AL were assessed and compared between the groups. Among the 51 patients analyzed, the baseline characteristics differed significantly between the groups, with the atropine 0.05% group showing a higher average age, longer AL, and lower SE compared to the other groups. After 12 months, no significant differences were found in SE changes between the treatment groups (p=0.35). Similarly, changes in AL did not significantly differ between the groups (p=0.10), although age had a significant impact on AL change (p=0.01). No significant differences were observed in pairwise comparisons of SE or AL changes between the groups. In this study, combining atropine 0.05% with Myopi-X PALs did not provide an additive benefit. The literature suggests that both treatments are effective in slowing myopia progression individually; however, in our study, their combination did not significantly improve SE progression or axial elongation compared to monotherapies. Further randomized studies with larger patient groups are needed to confirm these findings and assess long-term effects.

Challenging cases of adherent periarterial vein during subinguinal Fisch technique and subinguinal micro-varicocelecotmy and sclerotherapy: a prospective comparative study

BackgroundTo the best of our knowledge, there is a gap in the review of literature about the most suitable varicocelectomy technique in isolating and ligating adherent periarterial vein(s). Consequently, leaving the artery intact or ligating it together with the adherent vein may pose a challenge. We conducted a comparative prospective study to assess the outcomes of the three techniques namely Fisch, sclerotherapy and microvaricoclectomy (MSV).ResultsThe patients who underwent MSV showed the longest operative time (66.29 ± 2.78 min), followed by Fisch technique (56.94 ± 3.07 min) then sclerotherapy (55.45 ± 1.99). Thus, the difference in the operative time between the three techniques was statistically significant (P < 0.001). Regarding the postoperative right vein diameter, MSV group showed the largest diameter (2.14 ± 0.15 mm), followed by Fisch technique (2.13 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Regarding the postoperative left vein diameter, MSV group showed again the largest diameter (2.17 ± 0.21 mm), followed by Fisch technique (2.14 ± 0.15 mm) then sclerotherapy (1.75 ± 0.42 mm). Moreover, the patients who underwent sclerotherapy showed the highest postoperative progressive sperm motility percent (25.27 ± 4.00%), followed by Fisch technique (21.56 ± 7.30%) then MSV group (19.85 ± 6.33%). Post hoc pair wise comparisons revealed that sclerotherapy and Fisch technique had a significantly higher effectiveness in reducing operative time than MSV. Additionally, it revealed that sclerotherapy technique had a significantly higher effectiveness in reducing postoperative vein diameters measurement than MSV and Fisch technique. Post hoc pair wise comparisons revealed that sclerotherapy technique had a significantly higher effectiveness in improving the postoperative progressive sperm motility percent than MSV.Patients who underwent the 3 techniques demonstrated statistically significant differences between baseline and post-operative vein diameter, reflux duration, sperm concentration, progressive sperm motility, progressive motile count/ejaculate and sperm abnormal forms.ConclusionThe 3 techniques showed significant improvement in the semen parameters after 3 months in the studied patients. However, sclerotherapy technique showed a significantly higher effectiveness in improving the postoperative progressive sperm motility percent compared to MSV.

The relationship between hemolysis and I-index: investigating its use as a screening test in hyperbilirubinemia

Hemolysis (H-index) and icteric indexes (I-index) are widely used in clinical laboratories to control interferences. Since I-index correlates with bilirubin, it can aid in deciding whether to analyze bilirubin levels. The study aims to evaluate I-index use for this purpose, considering H-index interference on I-index. This retrospective study included H-index, I-index and total bilirubin results, all analyzed using the Mindray BS800M. Total bilirubin was analyzed using the Vanadate oxidase method. Patients were categorized according to their H-index values in multiples of 0.5. Group-0 had the lowest hemolysis (<0.5 g/L), and Group-10 had the highest hemolysis (>5 g/L), with a total of 11 groups. ROC analysis determined optimal I-index cut-offs to differentiate normal and abnormal bilirubin levels, calculating PPV, NPV, specificity and sensitivity. Indexes of 55,306 patients and total bilirubin results of 26,781 patients were evaluated. There was no significant difference between the groups in pairwise comparison for bilirubin results but significant differences were observed in I-index values. When the I-index values were examined, there were significant differences between Group 0,1,2,3,4, and all groups from 0 to 10 (p < 0.001). As hemolysis increased, the I-index cutoff values decreased. While the cut-off values for Group-0 and Group-4 ranged from 16.70 to 14.15 μmol/L, in Group-5 (hemolysis 2.5-3 g/L), the cut-off was 6.50 μmol/L, in Group-6 and Group-7, it was −2.35 μmol/L. In Group-10, this value dropped to −42.55 μmol/L. Our findings suggest using the I-index to spot hyperbilirubinemia and save on testing. However, different cut-off values should be calculated according to the hemolysis value.

Charting the future of green HRM practices: insights from theories, context, characteristics and methodologies (TCCM) framework and analytical hierarchy process (AHP) analysis

PurposeThe term “green human resource management” (Green HRM) is becoming more prevalent in both academics and business. This study’s main objective is to locate current understanding and trends in Green HRM literature by examining the available Green HRM literature. And prioritize the Green HRM practices in higher education institutions (HEIs). The study also identifies prevailing theories, context, characteristics and methodologies as current research interests to identify potential future research areas in Green HRM.Design/methodology/approachThe study opted for a multi-method approach, combining theories, context, characteristics and methodologies (TCCM) for literature review and the analytical hierarchy process (AHP) for methodological analysis. The article selection process is illustrated via a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart. The study examines Green HRM literature using the TCCM framework as it aids in identifying commonly used theories, constructs and methods, suggesting future research directions (FRDs). After identifying core Green HRM practices, the study prioritizes them for the HEIs using the AHP.FindingsThe comprehensive analysis of the literature is provided by the TCCM framework, which identifies the most influential theories, contexts, characteristics and methodologies used in Green HRM literature. The most used theory was found to be the ability-motivation-opportunity (AMO) theory, followed by social identity theory. In context, the hospitality industry was the dominating sector/industry of the domain. Under the characteristics, various variables in Green HRM literature were identified and classified as antecedents, mediators, moderators and outcomes. The most used research method was quantitative, and the most opted research design was empirical. FRDs are also suggested analyzing the current trends of the Green HRM field. The finding of AHP indicates that green recruitment and selection holds the highest level of importance among Green HRM in HEIs.Research limitations/implicationsThis study is vital for past-future orientation, in which the past is explored in order to build new routes of Green HRM research. It used research publications from the Scopus database, and future studies may use other databases to improve understanding of Green HRM research.Practical implicationsAHP weights and ranks aid decision-makers in assessing Green HRM practice importance, facilitating pairwise comparisons before implementation in the HEIs and other service industries. It guides managers on allocating appropriate importance to each practice for informed decision-making.Social implicationsThis study enriches Green HRM literature using the TCCM framework, categorizing literature into four key areas and offering valuable FRDs for future researchers. Its comprehensive review provides crucial insights into the research landscape of Green HRM, aiding in understanding theories, variables, relevant sectors and methodologies. The study offers comprehensive theoretical implications in the realm of Green HRM.Originality/valueExisting research indicates that no study has employed a multi-method approach combining the TCCM framework and AHP in Green HRM research. The initial TCCM phase conducts a thorough analysis, examining theories, contexts, characteristics and methodology, a unique methodology. It connects TCCM findings to FRDs. In the subsequent phase, AHP prioritizes Green HRM practices for the HEIs based on identified research gaps from TCCM. This innovative fusion of TCCM and AHP, resulting in FRDs and implications, represents the novelty of this paper.

Comparative analysis of retinal vascular structural parameters in populations with different glucose metabolism status based on color fundus photography and artificial intelligence

ObjectiveMeasure and analyze retinal vascular parameters in individuals with varying glucose metabolism, explore preclinical retinal microstructure changes related to diabetic retinopathy (DR), and assess glucose metabolism’s impact on retinal structure.MethodsThe study employed a cross-sectional design encompassing a 4-year period from 2020 to 2024. Fundus photographs from 320 individuals (2020–2024) were categorized into non-diabetes, pre-diabetes, type 2 diabetes mellitus (T2DM) without DR, and T2DM with mild-to-moderate non-proliferative DR (NPDR) groups. An artificial intelligence (AI)-based automatic measurement system was used to quantify retinal blood vessels in the fundus color photographic images, enabling inter-group parameter comparison and analysis of significant differences.ResultsBetween January 2020 and June 2024, fundus color photographs were collected from 320 individuals and categorized into four groups: non-diabetes (n = 54), pre-diabetes (n = 71), T2DM without overt DR (n = 144), and T2DM with mild-to-moderate NPDR (n = 51). In pairwise comparisons among individuals with pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly different (P &amp;lt; 0.05). Within the T2DM population, FBG, HbA1c, age, SBP, and DBP were significant predictors for mild-to-moderate NPDR (P &amp;lt; 0.05). Average venous branching number (branch_avg_v) was significantly different among pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR groups. In patients with T2DM with mild-to-moderate NPDR, Average length of arteries (length_avg_a) and average length of veins (length_avg_v) increased, whereas branch_avg_v, average venous branching angle (angle_avg_v), average venous branching asymmetry (asymmetry_avg_v),overall length density (vessel_length_density), and vessel area density (vessel_density) decreased significantly (P &amp;lt; 0.05). Logistic regression analysis identified length_avg_a, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density as independent predictors of mild-to-moderate NPDR in patients with T2DM. Receiver Operating Characteristic (ROC) curve analysis demonstrated that length_avg_a, length_avg_v, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density had diagnostic value for mild-to-moderate NPDR (P &amp;lt; 0.05).ConclusionIn individuals diagnosed with T2DM, specific retinal vascular parameters, such as branch_avg_v and vessel_density, demonstrate a significant correlation with mild-to-moderate NPDR. These parameters hold promise as preclinical biomarkers for detecting vascular abnormalities associated with DR.

Repeatability of tear film lipid layer interferometry measurements: A randomized, crossover study.

This study aimed to assess intrasession repeatability, diurnal intravisit and day-to-day intervisit reproducibility of qualitative tear film lipid layer interferometry grading obtained from the Keratograph 5M (Oculus Optikgeräte GmbH, Wetzlar, Germany), and automated quantitative layer thickness measurements obtained from the TearScience LipiView II Ocular Surface Interferometer (Johnson & Johnson Vision, Milpitas, CA), in community residents, not stratified by dry eye or blepharitis status. Forty community residents (24 women, 16 men; age mean ± standard deviation, 36 ± 14 years) were recruited in an investigator-masked, randomized, crossover study. Participants attended two sessions 6 hours apart on the same day and a third session on a separate day. During each session, tear film lipid layer grading and thickness measurements were performed in triplicate, in a masked manner, with 10-minute intervals between each measurement. There were no significant differences in lipid layer grading and thickness measurements in all pairwise intrasession, diurnal intravisit, and day-to-day intervisit comparisons (all p≥0.19), and positive correlations were observed in all cases (all p<0.001). The weighted Cohen κ coefficients for intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility of qualitative lipid layer grading ranged from 0.670 to 0.867. The test-retest repeatability of quantitative lipid layer thickness measurements ranged from 4.5 to 11.7 nm, and the Bland-Altman biases were within the order of 3 nm in all pairwise comparisons. The intraclass correlation coefficients for lipid layer thickness measurements exceeded 0.80 for all intrasession comparisons and were between 0.60 and 0.80 for all diurnal intravisit and day-to-day intervisit comparisons. Both qualitative grading and automated quantitative thickness measurements of tear film lipid layer interferometry demonstrated relatively favorable levels of intrasession repeatability and diurnal intravisit and day-to-day intervisit reproducibility. The study findings would support the use of either qualitative or quantitative measurement in clinical and research settings, as a reliable tool for assessing lipid layer interferometry.

Molecular characterization of rice blast fungus (Pyricularia oryzae) from West Sumatra and their virulence to several rice cultivars

Global rice production is severely impacted by rice blast disease, which is a devastating condition caused by the fungal pathogen Pyricularia oryzae. Many countries have reported blast diseases associated with rice yield loss. In Indonesia, this disease also destroys rice production in several rice fields in West Java, East Java, Central Java, Sumatra, and Sulawesi. The objectives of this study were to identify rice blast fungal isolates in West Sumatra and assess the resistance level of eight local and modern rice genotypes to this disease. Additionally, the rice genotypes were also evaluated for the presence of Pi genes associated with blast resistance by utilizing 25 simple sequence-repeats (SSR) markers known to be linked to rice blasts. The seedlings of all rice genotypes were exposed to fungal isolates to determine their blast resistance capacity based on leaf morphological traits. Before conducting blast resistance testing, the local isolates of rice blast fungus were molecularly identified by aligning sequences in a pairwise comparison. Based on the identification process, three P. oryzae (MoK19-49, MoK19-45, and MoK19-28) fungal isolates were identified. The confirmed P. oryzae isolate MoK19-28 was then used to assess the blast resistance of the rice genotypes using the SES-blast test. The resistance levels of all genotypes were evaluated by observing the morphology of infected leaves for 24 days. Four genotypes, namely Cantik Manis (CM), Bungo Sungkai (BS), Inpari 48 Blas (IB), and Inpago 9 (Ip9), exhibited resistance to leaf blast caused by P. oryzae isolate MoK19-28. Meanwhile, Pulau Batu (PB), Mundam Putiah (MP), and IR64-Sub1 (IR) displayed intermediate resistance to the disease. In contrast, the blast fungus P. oryzae isolate MoK19-28 severely impacted the Kuriak (K) genotype. The rice variety IB contains several Pi genes, specifically Pi1, Pi9, Pikh, and Pi37, which are associated with enhanced resistance to leaf blast caused by P. oryzae isolate MoK19-28. This genetic characteristic sets it apart from susceptible genotypes. This work has successfully identified multiple blast-resistant rice genotypes that could potentially be used in future rice improvement initiatives.

Pathway Of Low Anterior Resection syndrome (LARS) relief after Surgery (POLARiS): protocol for an international, open-label, multi-arm, phase 3 randomised superiority trial within a cohort, with economic evaluation, process evaluation and qualitative sub-study, to explore the natural history of LARS and compare transanal irrigation and sacral neuromodulation to optimised conservative management for people with major LARS following a high or

IntroductionAs a result of improving survival rates, the adverse consequences of rectal cancer surgery are becoming increasingly recognised. Low anterior resection syndrome (LARS) is one such consequence and describes a...

Advanced Multiparametric MRI Strategies for Tumor Restaging After Neoadjuvant Therapy in Locally Advanced Gastric Cancer.

This study tested the diagnostic accuracy of multiparametric magnetic resonance imaging (mpMRI) in restaging locally advanced gastric cancer after neoadjuvant therapy (NAT) using pathologic T stage (ypT) and pathologic N stage (ypN) as the reference standard. Between August 2022 and September 2023, the study enrolled a prospective cohort of 70 gastric cancer patients who underwent NAT and subsequent surgical resection. MRI procedures, including DLSB T2-weighted imaging (T2WI), ZOOMit diffusion-weighted imaging (DWI), and XD-VIBE dynamic contrast-enhanced imaging (DCE), were performed after NAT and before surgery. Four abdominal radiologists independently assigned radiologic T stage (yrT) and radiologic N stage (yrN) based on individual and combined sequences. Inter-reader agreement was quantified using Kendall's coefficient. Diagnostic accuracy was determined by comparing MRI assessments and pathologic outcomes, with pairwise comparisons analyzed via the McNemar test. Subgroup analysis evaluated the performance in identifying good responders to NAT. Inter-reader agreement was almost perfect for T restaging and substantial for N restaging. Diagnostic accuracy for T restaging was 0.432 using DLSB-T2WI, 0.586 using ZOOMit DWI, 0.557 using XD-VIBE DCE, and 0.586 using mpMRI. The accuracy demonstrated by DWI, DCE and mpMRI was superior to that of T2WI (all P < 0.05). For N restaging, the accuracy of the mpMRI protocol was 0.443. Notably, mpMRI achieved an AUC of 0.879 (95% confidence interval 0.835-0.915) for differentiating ypT0-1 tumors. Advanced mpMRI strategies can serve as a valuable tool for restaging gastric cancer after NAT. Accurately differentiating good responders to neoadjuvant therapy through mpMRI holds significant clinical implications for personalized treatment strategies and improved patient outcomes.

The Attitudes of Secondary School Students Studying in Different School Types Towards Physical Education and Sports Lessons: Comparison of Village and City

The main aim of this study was to determine the attitudes of secondary school students towards physical education and sports lessons by making comparisons according to settlement and school types. In selecting the study group, the stratified purposeful sampling method, which is a type of purposive sampling method and one of the non-random sampling methods, was adopted. The data were collected and evaluated using a personal information form and BES course attitude scale. SPSS statistical program was used to analyze the data and the significance value was accepted as .05. As a result of the analysis, it was determined that the data were normally distributed and t-test was used for pairwise comparisons, Post-Hoc Tukey and One-Way Variance Analysis (ANOVA) were used for more than two comparisons. According to the results of the research, no significant differences were found in the mean scores of the students' attitudes towards the BES course according to variables such as gender, residence in the city center or rural area, mother's occupation, father's education level, school type and place of residence. However, significant differences were found in the mean scores of the students' attitudes towards the BES course in terms of factors such as being on the school team, gym status, class levels, transportation to school, location of the school, father's occupation, mother's education level.

Beyond the first try: How many quit attempts are necessary to achieve substance use cessation?

Substance use disorder (SUD) is a chronically relapsing disorder. Thus, individuals with SUD may need several attempts before achieving abstinence. The present study investigated the variables associated with the number of quit attempts before achieving successful abstinence. Data were collected from 421 International Quit & Recovery Registry participants. Participants answered several questions for each substance they reported being in recovery from, such as the age of first use, how many times they had attempted to quit that substance, and whether they still used that substance. The number of quit attempts was associated with the substance one was trying to quit, SUD severity (i.e., mild, moderate, severe SUD) for that substance, the number of years using that substance, and the age of use onset. Pairwise comparisons among substances indicated that pain medication and opioids had a significantly higher number of quit attempts than all other substances (ps < .001) but were not different from each other (p = 1.0). Pairwise comparisons across levels of SUD severity showed a significantly higher number of attempts for those with moderate than mild SUD (p < .001) and for those with severe than mild or moderate SUD (ps < .001). Opioids and pain medication require significantly more attempts than all other substances, according to our findings. Thus, such substances might need more targeted and effective interventions. Additionally, more severe SUD and more years of use were also associated with more quit attempts. Such findings suggest the need for more effective early interventions to decrease the number of attempts before successful abstinence.

Abstract TMP78: Beyond Recanalization: Predicting Poor Outcomes in Successful Vertebrobasilar Thrombectomy

Background: Successful recanalization following endovascular thrombectomy (EVT) in vertebrobasilar artery occlusions (VBAOs) does not uniformly translate into favorable functional outcomes. Identifying predictors of futile recanalization is critical for improving patient selection and treatment strategies. This study aimed to compare patients with good versus poor functional outcomes despite successful recanalization in VBAO and to establish predictive factors for futile recanalization. Methods: We retrospectively analyzed patients who achieved successful recanalization after EVT for VBAO from a prospectively maintained database between 2014-2024. Functional outcomes were assessed using the modified Rankin Scale (mRS) at 90 days; dichotomized into good (mRS 0-3) and poor (mRS 4-6) outcomes. Demographic data, clinical characteristics, procedural variables, and imaging findings were compared between the groups using pairwise comparisons and multivariable logistic regression models to identify predictors of futile recanalization. Results: Among the 163 patients who qualified for final analysis, 73 (44.8%) had good functional outcomes, while 90 (55.2%) had poor outcomes despite successful recanalization. Age (72 years vs. 64 years, p=0.0014), baseline NIHSS score (22 vs. 14, p&lt;0.0001), and serum glucose levels (142 mg/dL vs. 124 mg/dL, p=0.0109) were significantly higher in patients with poor outcomes. In addition, intubation (57.1% vs. 25.4%, p&lt;0.001) and prior history of diabetes mellitus (34.4% vs. 17.8%, p=0.017) and coronary artery disease (33.3% vs. 16.4%, p=0.014) were more prevalent in the poor outcome group. Multivariable analysis confirmed that advanced age (OR 0.73, 95% CI: 0.57-0.93, p=0.012), higher serum glucose (OR 0.90, 95% CI: 0.82-0.99, p=0.025), NIHSS at 24-36 hours post-last known well (OR 0.61, 95% CI: 0.38-0.98, p=0.039), and mRS at discharge (OR 0.0001, 95% CI: 0.0002-0.064, p=0.005) were independent predictors of poor functional outcomes, indicating futile recanalization. A subgroup analysis of patients with complete recanalization (mTICI 2c/3) further validated these findings. Conclusion: Futile recanalization after EVT for VBAO is linked to older age, elevated serum glucose levels, higher NIHSS scores at 24-36 hours, and poor mRS at discharge. These factors should be carefully considered in clinical decision-making to improve patient selection for EVT in VBAO.

Abstract TMP92: Circadian Variability in Pediatric Stroke

Introduction: Ischemic stroke in adults demonstrates circadian variation in the timing of onset of symptoms, with the highest risk between 6am and noon (1-4). The influence of circadian timing on stroke biology may differ between children and adults, possibly related to the immature circadian system, variations in school versus work schedules, and diverse stroke pathophysiology (5). The goal of our study was to assess whether timing of ischemic stroke onset demonstrates circadian variability in children. Methods: We queried the International Pediatric Stroke Study, an international multicenter observational registry of children &lt;18 years with arterial ischemic stroke (AIS). Included patients were aged 29 days-18 years with outpatient AIS and known time of stroke symptom onset. Clinical and radiographic features were compared according to 4 distinct time epochs: 6:00-11:59 (morning), 12:00-17:59 (afternoon), 18:00-23:59 (evening) and 00:00-5:59 (night). Clinical outcomes were defined by the Pediatric Stroke Outcome Measure (PSOM). Baseline, clinical and outcome characteristics were compared between the 4 time epochs using independent samples Kruskal-Wallis and Chi-square tests. Pairwise comparisons were conducted where needed. Results: A total of 478 patients met inclusion criteria, 54% male, mean age 9.9±SD 5.7 years. Time of stroke onset by hour is shown in Figure 1. Most strokes occurred in the afternoon (n=185, 38.7%), followed by morning (n=156, 32.6%). Table 1 shows demographic and clinical characteristics by time epoch; clinical and arteriopathy risk factors were more prevalent in nighttime strokes (23/36, 70%, p=0.034). Median PSOM scores at 6 months appeared to be better after evening strokes (0.5, IQR 0-1.5) as compared to morning strokes (1, IQR 0.5-2) and afternoon strokes (1, IQR 0.5-3, p=0.033), but failed adjustment for multiple comparisons (figure 2). Conclusion: Circadian influence on stroke timing appears to differ between adults and children. Further prospective studies with larger sample sizes are needed to understand the impact of circadian rhythm on stroke in childhood.

Using evidence-based imaging referral guidelines to facilitate appropriate imaging: Are they all the same?

Countries worldwide have selected, adopted, adapted, and translated evidence-based imaging referral guidelines from radiology professional bodies. This study establishes the concordance of three imaging referral guidelines from the ACR, ESR, and RCR, and examines the emergency department cervical spine imaging appropriateness rates. A retrospective analysis of the electronic medical records was performed between October 1st to December 31st, 2022, evaluating 452 radiography and 153 CT imaging referrals. For each case, the initial clinical diagnosis was integrated with the corresponding clinical notes for analysis. Evaluation of the appropriateness rating was dichotomised to either 'indicated' or 'not indicated' for analytical and practical purposes. The inter-rater agreement for the imaging referral guidelines was calculated using Fleiss' Kappa and Cohen's Kappa. The overall appropriateness rate of X-ray cervical spine imaging referrals was 13.3% -75.2%, depending on the imaging referral guidelines utilised. The appropriateness rate of CT cervical spine was 90.8%, which was an identical rate for all three of the guidelines. Fleiss' Kappa indicated the guidelines for X-ray of the cervical spine had slight agreement (κ=0.135 (95% CI, 0.088 to 0.183), p<0.001) and almost perfect agreement amongst guidelines for CT cervical spine (κ=1.000 (95% CI, 0.909 to 1.091), p<0.001). For pairwise comparison, ACR AC and ESR iGuide for X-ray demonstrated moderate agreement (κ=0.765, p<0.001); however, RCR iRefer had no level of agreement with both. For CT, there was almost perfect agreement between all the guidelines. The guidelines demonstrated slight agreement for X-ray cervical spine and almost perfect agreement for CT cervical spine, complicating audit process and influencing audit output. Multidisciplinary buy-in positively impacts CT cervical spine appropriateness rates. Harmonising and prioritising guideline development for commonly encountered clinical scenarios is required.

Leveraging Large Language Models to Generate Clinical Histories for Oncologic Imaging Requisitions.

Background Clinical information improves imaging interpretation, but physician-provided histories on requisitions for oncologic imaging often lack key details. Purpose To evaluate large language models (LLMs) for automatically generating clinical histories for oncologic imaging requisitions from clinical notes and compare them with original requisition histories. Materials and Methods In total, 207 patients with CT performed at a cancer center from January to November 2023 and with an electronic health record clinical note coinciding with ordering date were randomly selected. A multidisciplinary team informed selection of 10 parameters important for oncologic imaging history, including primary oncologic diagnosis, treatment history, and acute symptoms. Clinical notes were independently reviewed to establish the reference standard regarding presence of each parameter. After prompt engineering with seven patients, GPT-4 (version 0613; OpenAI) was prompted on April 9, 2024, to automatically generate structured clinical histories for the 200 remaining patients. Using the reference standard, LLM extraction performance was calculated (recall, precision, F1 score). LLM-generated and original requisition histories were compared for completeness (proportion including each parameter), and 10 radiologists performed pairwise comparison for quality, preference, and subjective likelihood of harm. Results For the 200 LLM-generated histories, GPT-4 performed well, extracting oncologic parameters from clinical notes (F1 = 0.983). Compared with original requisition histories, LLM-generated histories more frequently included parameters critical for radiologist interpretation, including primary oncologic diagnosis (99.5% vs 89% [199 and 178 of 200 histories, respectively]; P < .001), acute or worsening symptoms (15% vs 4% [29 and seven of 200]; P < .001), and relevant surgery (61% vs 12% [122 and 23 of 200]; P < .001). Radiologists preferred LLM-generated histories for imaging interpretation (89% vs 5%, 7% equal; P < .001), indicating they would enable more complete interpretation (86% vs 0%, 15% equal; P < .001) and have a lower likelihood of harm (3% vs 55%, 42% neither; P < .001). Conclusion An LLM enabled accurate automated clinical histories for oncologic imaging from clinical notes. Compared with original requisition histories, LLM-generated histories were more complete and were preferred by radiologists for imaging interpretation and perceived safety. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Tavakoli and Kim in this issue.

Effects of the Presence of Adjacent Tooth and Material Type on the Marginal and Internal Adaptation of Endocrowns Fabricated by the Digital Impression Technique.

To assess the effects of the presence of adjacent tooth and material type on the marginal and internal adaptation of endocrowns fabricated by the digital impression technique. An endodontically treated molar tooth was used for the fabrication of endocrowns in this in vitro study. Five groups of specimens (n = 17) were evaluated based on the material type and presence of adjacent tooth: three groups of monolithic zirconia (Zir), lithium disilicate (LDS), and zirconia-reinforced lithium silicate (ZLS) in the presence of adjacent teeth, and two groups of zirconia endocrowns, one in the absence of an adjacent anterior tooth (second premolar; Zir-no ant.) and one in the absence of a posterior adjacent tooth (second molar; Zir-no post.). Marginal and internal adaptation of endocrowns was evaluated by the silicone replica technique. Data were analyzed by ANOVA with Tukey test for pairwise comparisons and generalized estimating equation with Bonferroni correction for pairwise comparisons (α = 0.05). The largest marginal gap was found in the ZLS, followed by the LDS and Zir groups (p < 0.05). The Zir group showed significantly higher internal adaptation than the ZLS group (p < 0.05); LDS had no significant difference with the ZLS and Zir groups (p > 0.05). The Zir group showed larger marginal and internal gaps than the Zir-no ant. and Zir-no post. groups (p < 0.05); the latter two groups had no significant difference (p > 0.05). All groups showed the largest gap at the pulpal and the smallest gap at the marginal and cervical areas (p < 0.05). Zirconia endocrowns showed the highest marginal and internal adaptation. Digital impression technique in absence of anterior or posterior adjacent tooth would result in higher marginal and internal adaptation of endocrowns.

Evolutionary dynamics of cooperation driven by a mixed update rule in structured prisoner's dilemma games.

How to understand the evolution of cooperation remains a scientific challenge. Individual strategy update rule plays an important role in the evolution of cooperation in a population. Previous works mainly assume that individuals adopt one single update rule during the evolutionary process. Indeed, individuals may adopt a mixed update rule influenced by different preferences such as payoff-driven and conformity-driven factors. It is still unclear how such mixed update rules influence the evolutionary dynamics of cooperation from a theoretical analysis perspective. In this work, in combination with the pairwise comparison rule and the conformity rule, we consider a mixed updating procedure into the evolutionary prisoner's dilemma game. We assume that individuals adopt the conformity rule for strategy updating with a certain probability in a structured population. By means of the pair approximation and mean-field approaches, we obtain the dynamical equations for the fraction of cooperators in the population. We prove that under weak selection, there exists one unique interior equilibrium point, which is stable, in the system. Accordingly, cooperators can survive with defectors under the mixed update rule in the structured population. In addition, we find that the stationary fraction of cooperators increases as the conformity strength increases, but is independent of the benefit parameter. Furthermore, we perform numerical calculations and computer simulations to confirm our theoretical predictions.

Marginal Fit and Fracture Resistance of Vertical Versus Horizontal Margins in Monolithic Zirconia Crowns.

The use of vertical margin design in all-ceramic restoration has generated inquiries regarding its clinical efficacy under diverse dynamic oral conditions. This research aims to assess the marginal fit and fracture resistance of monolithic zirconia crowns featuring vertical margin design as opposed to those with conventional horizontal margin design. Two metal dies were employed to generate replicated resin dies mimicking mandibular first molar preparation. The metal dies were precision-engineered with two margin designs: vertical margin design presenting a shoulderless configuration (Featheredge) and horizontal margin design (Radial Shoulder). Forty zirconia crowns were produced on the replicated resin dies using two varieties of monolithic zirconia, with twenty crowns in each category: pre-shaded and multilayered zirconia. Both sets were further subdivided into two groups based on the finish line configuration utilized (n = 10). The vertical marginal gap of the zirconia crowns was gauged before and after thermocycling (5-55oC/5000 cycles), followed by loading the crowns until fracture occurred. Statistical analysis was performed using one-way analysis of variance (ANOVA), accompanied by Bonferroni's post hoc test and independent t-test for pairwise comparisons. The Shoulder subgroup of BruxZir exhibited the highest mean marginal gap value (120.06 ± 10.15 µ), while the Featheredge subgroup of BruxZir displayed the lowest value (49.72 ± 6.53 µ). Among the BruxZir group, the Featheredge subgroup showcased the highest mean fracture resistance value (4251.57 ± 279.90 N), whereas the Shoulder subgroup recorded the lowest value (1721.60 ± 225.16 N). Monolithic zirconia crowns with vertical margin design (Featheredge) demonstrated statistically enhanced performance compared to conventional horizontal margin design, as evidenced by lower marginal gap values and increased fracture resistance tolerance.

Comparing interfractional stability of heart dose among three breath-hold radiotherapy techniques in breast cancer

IntroductionBreath holding can reduce the cardiac dose in radiotherapy for left-sided breast cancer. We evaluated whether any of the existing commonly used breath-hold techniques was superior in maintaining a more reproducible mean heart dose (MHD) during treatment. Methods and MaterialsThis was a single-institution, interventional, non-randomized, three-armed prospective trial, comparing the reproducibility of MHD in breath-hold radiotherapy using voluntary deep inspiration breath hold (vDIBH), active breathing control (ABC) and surface guided radiotherapy (SGRT). The MHD were determined based on the anatomy in planning computer tomography and each weekly cone beam computer tomography (CBCT) during radiotherapy. The reproducibility of MHD was measured by calculating the interfractional variation of MHD (represented by the standard deviation) across the CBCT, and the difference between the cumulative MHD at CBCT and at planning CT. These two measures of reproducibility were then compared among vDIBH, ABC and SGRT. ResultsOf the 55 patients recruited, 19 had ABC, 20 had SGRT and 16 had vDIBH. SGRT was associated with a slightly greater interfractional variation of the MHD, compared with vDIBH (Least Square Means (LSM): 28.8cGy (SGRT) vs 10.5cGy (vDIBH), p=0.0052) and ABC (LSM: 28.8cGy (SGRT) vs 15.1cGy (ABC), p=0.026). In the SGRT group, the cumulative MHD at CBCT was lower than that at planning CT (mean difference: -22.1cGy, p=0.013). No such difference existed in vDIBH and ABC. In terms of the reproducibility of cumulative MHD at CBCT as compared to that in planning CT, there was no significant difference between vDIBH (mean: -12.1cGy), ABC (mean: -4.8cGy) and SGRT (mean: -22.1cGy) (p-value for pairwise comparison all >0.1). ConclusionSGRT was associated with a slightly greater interfractional variation of MHD compared with vDIBH and ABC, but the difference may not be clinically significant. All three breath-hold techniques were broadly comparable in their reproducibility of MHD at CBCT relative to the planning CT.