Potential Selection Bias Research Articles

Is managerial myopia detrimental to corporate ESG performance?

This study explores the nexus between managerial myopia and corporate Environmental, Social, and Governance (ESG) performance within the framework of China's A-share listed companies from 2010 to 2020. We provide a novel insight into how the temporal orientation of managerial decision-making significantly impacts ESG outcomes, highlighting the adverse effects of a short-term focus on sustainable corporate development. Using a robust dataset, we delineate the mechanisms through which managerial myopia undermines ESG performance, specifically in green innovation and corporate information disclosure quality. Further, it examines the efficacy of external governance mechanisms, such as the increased liquidity of stocks and the engagement of Big 4 accounting firms, as mitigating factors. The paper's methodology combines advanced regression analysis with propensity score matching to validate the causal relationship between managerial myopia and ESG performance, controlling for potential endogeneity and selection bias. The findings suggest that managerial myopia indeed poses a significant challenge to achieving high ESG standards, with implications for both policymakers and corporate governance practices. This study contributes to the broader discourse on corporate sustainability by linking managerial cognitive traits to ESG performance, with a specific focus on the Chinese market, thereby enriching the understanding of ESG dynamics in emerging economies.

The effects of gastrojejunostomy tube placement on pulmonary and gastrointestinal complications following spinal fusion for neuromuscular scoliosis.

To evaluate whether preoperative conversion from a gastrostomy tube (G-tube) to a gastrojejunostomy tube (GJ-tube) decreases short-term postoperative aspiration pneumonia and gastrointestinal complications in children with neuromuscular scoliosis. We conducted a retrospective chart review from January 2006 to October 2021 of pediatric patients who had neuromuscular scoliosis and were fed with a G-tube before spinal fusion. Eligible patients were divided into two groups based on whether they were converted to a GJ-tube preoperatively. Preoperative characteristics and 30-day postoperative outcomes were compared between groups using Chi-square tests. Of 261 eligible patients, 205 were converted to a GJ-tube, while 56 underwent spinal fusion with a G-tube. Common complications following G-tube to GJ-tube conversion were feeding intolerance (25.2%), GJ-tube malfunction (17.7%), and at least one episode of vomiting (17.4%). Within 30 days of discharge, 12.5% of GJ-tube patients and 11.5% of G-tube patients experienced aspiration pneumonia (P = 0.85). The GJ-tube group received postoperative tube feeds 7 hours earlier than the G-tube group on average (51.6 h vs. 44.5 h, P = 0.02). Within 30 days of discharge, one (0.5%) patient from the GJ-tube group died of gastrointestinal complications unrelated to conversion and two (3.6%) patients in the G-tube group died from aspiration pneumonia (P = 0.12). Results suggest that there were no appreciable differences in outcomes between patients converted to a GJ-tube preoperatively compared to those who continued to use a G-tube. However, preoperative characteristics indicate that a higher number of complex patients were converted to a GJ-tube, indicating potential selection bias in this retrospective sample. Level of evidence: Level III.

Psychosocial outcomes of children born via embryo donation.

What are parents' perceptions of their relationships with and the psychosocial adjustments of their children who are born via embryo donation? Families created through embryo donation have well-adjusted parent-child relationships and reassuring child psychosocial outcomes. Embryo donation is an effective and growing form of third-party reproduction, but there is limited research in this field. Prior studies suggest that families created through gamete donation function well regarding parent-child relationship quality and child behavioral and socioemotional adjustment. This is a cross-sectional survey study with 187 total participants. Parents of children born via embryo donation were recruited nationally by contacting all embryo donation programs registered with the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) as well as medically directed embryo donation or 'embryo adoption' centers. Participants completed three online Qualtrics questionnaires. The first was a survey including 33 questions on demographics, the procurement process, and self-reported obstetric outcomes. Participants also completed two standardized measures assessing children's behavior and parents' adjustment to parenthood: the Strengths and Difficulties Questionnaire (SDQ) and the Parental Acceptance-Rejection Questionnaire (PARQ). Scoring of the SDQ and PARQ was totaled and compared to standardized values (SDQ) or previously published results on other forms of gamete donation (PARQ), such as oocyte donation and sperm donation. On the SDQ (n = 46), the average total difficulties scores by age were: 8.2 ± 0.98 for ages 2-4, 7.6 ± 0.93 for ages 5-10, and 3.5 ± 0.77 for ages 11-17; this is compared to the normal reported range of 0-13, which indicates that clinically significant psychosocial problems are unlikely. Across all ages and individual categories (emotional symptoms, conduct problem, hyperactivity, peer problem, prosocial), scores on the SDQ were within the normal ranges. The average PARQ score (n = 70) for all respondents was 27.5 ± 1.18 (range: 24-96), suggesting perceived parental acceptance. Because this study was cross-sectional, it could not capture familial relationships over time. This survey-based study design allows for potential selection bias (parents of well-adjusted children may be more likely to participate). Additionally, the overall sample size is relatively small; however, it remains one of the largest published to date. Another significant limitation to this study is the lack of generalizability: most participants were recruited from private, faith-based, embryo donation programs who are demographically similar. Though embryo donation is an established form of third-party reproduction, it is significantly less robustly studied compared to other forms of gamete donation (oocyte or sperm donation). This study provides a larger data set with a more expanded age range of children compared to the limited number of previously published studies. Furthermore, these findings indicate a high parental disclosure rate with respect to the use of embryo donation which contrasts previous findings. No external funding source was utilized for the completion of this study. No conflicts are disclosed. N/A.

Causal relationship between hypothyroidism and temporomandibular disorders: evidence from complementary genetic methods

BackgroundThe role of thyroid health in temporomandibular disorders (TMDs) has been emphasized in observational studies. However, whether the causation exists is unclear, and controversy remains about which specific disorder, such as hypothyroidism or hyperthyroidism, is destructive in TMDs. This study aims to investigate the overall and specific causal effects of various thyroid conditions on TMDs.MethodsMendelian randomization (MR) studies were performed using genetic instruments for thyrotropin (TSH, N = 119,715), free thyroxine (fT4, N = 49,269), hypothyroidism (N = 410,141), hyperthyroidism (N = 460,499), and TMDs (N = 211,023). We assessed the overall effect of each thyroid factor via inverse-variance weighted (IVW), weighted median, and MR-Egger methods, and performed extensive sensitivity analyses. Additionally, multivariable MR was conducted to evaluate the direct or indirect effects of hypothyroidism on TMDs whilst accounting for TSH, fT4 and hyperthyroidism, and vice versa.ResultsUnivariable MR analyses revealed a causal effect of hypothyroidism on an increased risk of TMDs (IVW OR: 1.12, 95% CI: 1.05–1.20, p = 0.001). No significant association between genetically predicted hyperthyroidism, TSH, or fT4 and TMDs. In the multivariable MR analyses, the effects of hypothyroidism on TMDs occurrence remained significant even after adjSusting for TSH, fT4 and hyperthyroidism (multivariable IVW OR: 1.10, 95% CI: 1.03–1.17, p = 0.006). No pleiotropy and heterogeneity were detected in the analyses (p > 0.05).ConclusionsHypothyroidism might causally increase the risk of TMDs through a direct pathway, highlighting the critical role of managing thyroid health in the prevention of TMDs. Clinicians should give heightened attention to patients with hypothyroidism when seeking medical advice for temporomandibular discomfort. However, caution is warranted due to the potential confounders, pleiotropy, and selection bias in the MR study.

Rural farmers’ perceptions of and adaptations to climate change in Sub-Saharan Africa: Does climate-smart agriculture (CSA) matter in Nigeria and Ethiopia?

The available literature has ignored farmers’ perceptions on the benefits and drawbacks of adopting climate-smart agriculture (CSA) in favor of focusing primarily on profitability and economic constraints. We use the Ethiopian Socioeconomic Survey (ESS) and the General Household Survey from 2018 and 2019 to compare Nigeria and Ethiopia, both of which have sizable rural populations to assess farmers’ climate change perception and their adaptation options in promoting CSA. We first hypothesize that farmers with high tolerance for risk and stable financial resources are more likely to adopt CSA techniques, relying on the adopter perception theory of agricultural innovations and technologies. We address potential selection bias using the Heckman selection model, and estimate our data using multinomial logistic estimator, as well as standard logistic regression for robustness checks. We find that in both Ethiopia and Nigeria, household income and plot size influence farmers’ adaptations to climate change mitigation practices. However, farmers with bigger plots who run the risk of massive production loss tend to adopt measures of coping with climate change. We show that in both Ethiopia and Nigeria, rural farmers’ adaptation decisions are heavily influenced by agricultural extension programs and community social networks. Overall, our work highlights the important role of income, farm size, and climate-related information for investing in climate-smart agricultural methods to curb food insecurity in Sub-Saharan Africa.

Impact of Microdosing Practices on Technical Efficiency: An Analysis Accounting for Selection Bias Among Smallholder Maize Farmers in Burkina Faso

Smallholder maize farmers are currently confronted with the arduous challenge of managing limited financial resources while incessantly facing the issue of land degradation. To address this issue, an alternative solution has been implemented to optimize the use of chemical fertilizer by adopting microdosing. This innovative system not only helps them enhance their agricultural productivity but also allows them to protect the environment. However, it is unclear how microdosing adoption could increase the technical efficiency (TE) of maize production. Therefore, this research aims to assess how the adoption of microdosing affects the technical efficiency of maize production as well as identify the key factors that influence the technical efficiency of maize production in Burkina Faso. To achieve this goal, farm household survey data was conducted with 210 randomly selected farmers from the Plateau Central and northern regions of Burkina Faso. To account for potential selection biases that could result from both observable and unobservable factors, we used a sample selection stochastic production frontier model and a propensity score matching approach. A stochastic meta-frontier approach was applied to estimate TE differences and the technology gap between adopters and non-adopters. The findings showed that adopters of microdosing have an average efficiency of 68 percent, which is higher than the 53 percent estimated for non-adopters. Adopters of microdosing have been found to have high TE and better agricultural technology than non-adopters. The meta-frontier estimation revealed that the adoption of improved maize varieties would yield better returns. This study contributes significantly to the literature on how fertilizer microdosing affects maize productivity, as well as the policy implications of targeting and encouraging smallholder maize farmers in Burkina Faso to optimize the use of productive inputs and improve maize output by using microdosing.

Work-related musculoskeletal disorders among United Arab Emirates schoolteachers: an examination of physical activity

ObjectiveTo estimate the prevalence of work-related musculoskeletal disorders and their association with physical activity among schoolteachers in the United Arab Emirates.MethodsThis observational cross-sectional study involved 209 schoolteachers (aged 20–60) with a minimum of two years of experience. Data, including demographics (gender, age), Nordic Musculoskeletal Questionnaire (NMQ) for WMSD prevalence and pain sites, and Global Physical Activity Questionnaire (GPAQ) for physical activity levels, were collected. Six schools were visited for data collection, with consent from school heads and participants. Schedules were tailored to participant availability, allowing up to three attempts for participation. Non-respondents were identified after three unsuccessful attempts.ResultsOf the total 206 participants, 149 were female, while the remaining 57 were male. Age distribution analysis revealed that 18% of individuals were within the 20 to 30 years range, 26.2% fell within the 30 to 40 years, and 36.9% had 40 to 50 years age brackets. The responses were obtained in Arabic (90%) and English (10%). The study identified a high prevalence (71.4%) of work-related musculoskeletal disorders (WMSD) in UAE schoolteachers, with neck pain being the most common (74.3%). Major risk factors included age, workload, and low physical activity. The data was normally distributed, and Pearson’s Correlation test revealed weak positive correlation (r: 0.14), but statistically significant (p value = 0.04) between WMSD and PA, indicating that it was a contributing factor but other factors beyond PA influenced WMSD prevalence in this cohort. The findings of the study are based on certain limitations such as cross-sectional design and convenient sampling which could have potential selection bias and affect generalizability of the results.ConclusionFindings suggest the need to promote physical activity and reduce workload for teachers, considering their age and gender. Additionally, there is a need to raise awareness regarding ergonomics and the importance of taking short breaks for stretching or physical movement to enhance the overall well-being of schoolteachers in the UAE and similar contexts. Diverse prevalence rates across different body areas underscore the necessity for individualized treatments.

Hypoxia at 3D organoid establishment selects essential subclones within heterogenous pancreatic cancer.

Pancreatic ductal adenocarcinoma (PDAC) is especially hypoxic and composed of heterogeneous cell populations containing hypoxia-adapted cells. Hypoxia as a microenvironment of PDAC is known to cause epithelial-mesenchymal transition (EMT) and resistance to therapy. Therefore, cells adapted to hypoxia possess malignant traits that should be targeted for therapy. However, current 3D organoid culture systems are usually cultured under normoxia, losing hypoxia-adapted cells due to selectivity bias at the time of organoid establishment. To overcome any potential selection bias, we focused on oxygen concentration during the establishment of 3D organoids. We subjected identical PDAC surgical samples to normoxia (O2 20%) or hypoxia (O2 1%), yielding glandular and solid organoid morphology, respectively. Pancreatic cancer organoids established under hypoxia displayed higher expression of EMT-related proteins, a Moffitt basal-like subtype transcriptome, and higher 5-FU resistance in contrast to organoids established under normoxia. We suggest that hypoxia during organoid establishment efficiently selects for hypoxia-adapted cells possibly responsible for PDAC malignant traits, facilitating a fundamental source for elucidating and developing new treatment strategies against PDAC.

Nexus between Corporate Digital Transformation and Green Technological Innovation Performance: The Mediating Role of Optimizing Resource Allocation

Corporate digital transformation, as a key and representational component of the larger digital economy, plays a vital role in furthering both green technological innovation and the transition to a more sustainable economic model. This study collects panel data relating to firms listed on China’s A-share exchanges from 2009 to 2020 and employs textual analysis to estimate the extent of digital transformation within these organizations. It methodically examines the influence of this transformation on the volume and quality of green technological innovations. The findings reveal a substantial enhancement in both the volume and quality of green technological innovations as a result of corporate digital transformation, with a more noticeable improvement in innovation quality. This transition, driven by the mediating function of optimizing resource allocation, facilitates green technological innovation by enhancing human capital composition, curtailing information asymmetry, and augmenting investment in research and development (R&D). Heterogeneity research shows that the influence of digital transformation on green technological innovation is more pronounced in state-owned corporations, low-pollution corporations, and corporations situated in low-carbon pilot cities. Furthermore, this study discovers that the promotive influence of corporate digital transformation tends to diminish with the advancement of the corporation’s lifecycle, peaking during the growth phase. Finally, this study still has some limitations, such as its exclusive focus on Chinese corporations, the need for improvements in the measurement of digital transformation, and potential sample selection biases.

Systemic and surgical treatment in renal cell carcinoma: Does timing matter?

417 Background: Today, targeted systemic therapy is standard 1st line treatment of advanced/metastatic renal cell carcinoma (aRCC). Upfront cytoreductive nephrectomy (CN) has been an important treatment option. Recently its role is under debate, especially in combination with the new 1st line treatments. Our study evaluated the current relevance of initial surgical intervention and the role of inductive systemic therapy in aRCC. Methods: We included 33 patients with aRCC from the University Hospitals in Essen and Münster initiating 1st line treatment from 03/18 to 01/23 pre or post surgery. We retrospectively formed two cohorts, either CN followed by systemic therapy (cohort 1; 13 patients) or vice versa (cohort 2; 20 patients). Patients received either Ipilimumab/Nivolumab (Ipi/Nivo) (42.4%) or a checkpoint inhibitor and tyrosine kinase inhibitor (CPI/TKI) combination (57.6%). Progression-free survival (PFS) was estimated with Kaplan-Meier-method from initiation of systemic therapy or CN to progression or death. In Cohort 2, we additionally analyzed the radiologic response of the primary measured by change of the longest diameter. The radiographic response was analysed according to RECIST1.1. Results: Patients’ age ranged from 44 to 80 years with a median of 63 years. Intermediate and poor prognosis occurred in 61.3% and 38.7% of cases. The two cohorts did not differ significantly regarding baseline characteristics. Median PFS was 8 vs. 23 months (p=0.03) in cohort 1 (95% CI 0.9-15.1) compared to cohort 2 (95% CI 18.8-27.2). In cohort 2 the time between start of systemic therapy and surgery was in median 8.5 months (95% CI 3.3-21.1), the primary had a median diameter of 10.7 cm (95% CI 4.5-13.3). Median reduction of the primary was in total 32.2%, 28.9% in the Ipi/Nivo and 34.7% in the CPI/TKI group (p=0.74). In seven patients (35%) response led to modification of the surgical approach, enabling partial instead of radical nephrectomy. Conclusions: The sequence of systemic therapy followed by surgery was associated with a significant PFS benefit. In addition, prior systemic therapy led to a primary reduction and better operability, in some cases even to kidney sparing surgery. Major limitation is the retrospective nature of our analysis and a potential selection bias. However, the sequence of prior systemic therapy followed by surgery in aRCC was associated with notably better outcomes.

Preventive effect of aripiprazole once-monthly on relapse into mood episodes in bipolar disorder: A multicenter, one-year, retrospective, mirror image study

BackgroundWe conducted a one-year, retrospective, mirror-image study to investigate the clinical effectiveness and safety of aripiprazole once monthly (AOM) in patients with bipolar disorder (BD). We compared pre-treatment conditions with outcomes after 12 months of AOM treatment. MethodsSeventy-five bipolar patients were recruited from 12 hospitals in Korea. We included 75 patients with BD who had received at least three AOM treatments from September 2019 to September 2022 and had accessible electronic medical record (EMRs) for the year before and after the baseline visit. ResultsThe overall number of mood episodes significantly decreased from a mean of 1.5 ± 1.2 episodes pre-AOM to 0.5 ± 1.2 episodes post-AOM. Manic episodes significantly decreased from 0.8 ± 0.8 episodes pre-AOM to 0.2 ± 0.5 episodes post-AOM, and depressive episodes significantly decreased from 0.5 ± 0.8 episodes pre-AOM to 0.2 ± 0.6 episodes post-AOM (p = 0.017). Moreover, the number of psychiatric medications and pills and the proportion of patients treated with complex polypharmacy were significantly decreased post-AOM. LimitationsThe small sample size was insufficient to fully represent the entire population of individuals with BD, and potential selection bias was introduced due to only including subjects who received AOM three or more times. ConclusionThe results of this study suggest that AOM can reduce mood episode relapse and may be clinically beneficial in the treatment of BD patients, potentially reducing issues associated with polypharmacy in some individuals.

Prognostic significance and survival benefits of postoperative adjuvant chemotherapy in patients with stage IA lung adenocarcinoma with non-predominant micropapillary components

BackgroundThe prognostic significance of adjuvant chemotherapy (ACT) for patients with stage IA micropapillary non-predominant (MPNP) lung adenocarcinoma (LUAD) remains unknown. This study aimed to investigate the effects of postoperative ACT in patients with stage IA MPNP-LUAD.MethodsA total of 149 patients with pathological stage IA MPNP-LUAD who underwent surgery at our center were retrospectively analyzed. Propensity score matching (PSM) analysis was conducted to reduce potential selection bias. Kaplan–Meier analyses were used to assess the impact of ACT on recurrence-free survival (RFS), overall survival (OS), and disease-specific survival (DSS). Subgroup analyses were performed for the survival outcomes based on the percentage of micropapillary components. Cox proportional hazards regression analyses were applied to identify risk factors associated with survival.ResultsThe receipt or non-receipt of postoperative ACT had no significant effect on RFS, OS, and DSS among all enrolled patients with stage IA MPNP-LUAD (P > 0.05). For patients with a micropapillary component > 5%, the 5-year rates of RFS, OS, and DSS were significantly higher in the ACT group compared to the observation group, both before and after PSM (P < 0.05). However, the differences between the two groups were not significant for patients with a micropapillary component ≤ 5% (P > 0.05). The resection range (HR = 0.071; 95% CI: 0.020–0.251; P < 0.001), tumor size (HR = 2.929; 95% CI: 1.171–7.330; P = 0.022), and ACT (HR = 0.122; 95% CI: 0.037–0.403; P = 0.001) were identified as independent prognostic factors for RFS through Cox regression analysis.ConclusionPatients with stage IA MPNP-LUAD who have a micropapillary component greater than 5% might benefit from postoperative ACT, while those with a micropapillary component ≤ 5% did not appear to derive the same benefit from postoperative ACT.

Effectiveness of Tofacitinib in Patients Initiating Therapy for Psoriatic Arthritis: Results from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry.

Randomized controlled trials have demonstrated tofacitinib efficacy for psoriatic arthritis (PsA); however, real-world effectiveness data are limited. This real-world analysis assessed baseline demographics/disease characteristics and tofacitinib effectiveness in patients with PsA in the CorEvitas PsA/Spondyloarthritis Registry. This study (NCT05195814) included patients with PsA initiating tofacitinib from December 2017-December 2021, as monotherapy or with oral small molecules (methotrexate/leflunomide/sulfasalazine/apremilast), pre-existing use, or initiated concurrently. mean change from baseline in disease activity/patient-reported outcomes, proportion of patients achieving low disease activity (LDA)/remission at 6 ± 3 months, and discontinuation rates. Of 222 patients with PsA who initiated tofacitinib (60.8% as monotherapy), 123 patients had 6 ± 3months of follow-up. At initiation, 59.7% were female, 92.3% were White, mean age was 56.3 years, PsA duration since diagnosis was 8.2 years, and 25.7% were biologic disease-modifying antirheumatic drug (bDMARD)-naïve. Improvements to 6 ± 3months were observed with tofacitinib for Clinical Disease Activity Index for PsA (cDAPSA), DAPSA, PsA Disease Activity Score (PASDAS), Clinical Disease Activity Index, body surface area (BSA), tender/swollen joint count, patient fatigue, pain, Patient Global Skin Assessment, and Health Assessment Questionnaire-Disability Index. At 6 ± 3months, 25.0%/7.8% of patients treated with tofacitinib achieved cDAPSA-defined LDA/remission, 18.2% achieved minimal disease activity, 30.8%had PASDAS ≤ 3.2, 42.9%/29.4% had resolved enthesitis/dactylitis, and 22.5% achieved BSA = 0%. Tofacitinib discontinuation occurred in 51.2% of patients (51.6% of monotherapy initiators) at/prior to 6 ± 3months (27.6%/23.6%), 57.1% of whom switched to tumor necrosis factor/interleukin-17 inhibitors. Reasons for discontinuation were not reported in 85.3%/79.3% of patients who discontinued at/prior to 6 ± 3 months. This real-world US cohort analysis described patients with PsA newly initiating tofacitinib; most were bDMARD-experienced or receiving monotherapy treatment. In patients who remained on therapy (48.8%), tofacitinib was effective across multiple PsA domains at 6 ± 3 months. Limitations included small patient numbers at follow-up and potential selection bias. ClinicalTrials.gov identifier, NCT05195814.

Pain Reduction and Changes in Serum Cortisol, Adrenocorticotropic Hormone, and Glucose Levels after Epidural Injections With Different Doses of Corticosteroid

BACKGROUND: An epidural steroid injection (ESI) effectively relieves acute lumbar discogenic radicular pain. Corticosteroids, a key ESI component, reduce pain by curbing inflammation and blocking pain signal transmission via C-fibers. While prior research confirms the efficacy of 40 mg and 80 mg methylprednisolone, the effectiveness of lower doses remains uncertain. OBJECTIVES: This trial aimed to compare the pain-relieving effects of ESI using varying methylprednisolone doses (10 mg, 20 mg, and 40 mg). Additionally, it sought to examine changes in fasting plasma glucose (FPG), serum cortisol, and serum adrenocorticotropic hormone (ACTH) levels across these groups. STUDY DESIGN: A prospective observational study. SETTING: Department of Pain Medicine, Affiliated Jinling Hospital, Medical School of Nanjing University, People’s Republic of China. METHODS: Ninety-three patients underwent a single epidural injection of methylprednisolone at different doses: 10 mg (n = 28), 20 mg (n = 32), and 40 mg (n = 33). We evaluated their Numeric Rating Scale (NRS-11) score and Oswestry Disability Index (ODI) score at preinjection and 7 days postinjection. We also measured FPG, serum cortisol, and ACTH levels at baseline and one day postinjection. RESULTS: Significant differences were observed in the likelihood of achieving substantial pain relief among the 3 groups at 7 days postinjection. Specifically, 10 mg vs 20 mg had an odds ratio (OR) of 6.546 (95% CI, 1.161 - 26.513, P = 0.008), and 10 mg vs 40 mg had an OR of 7.753 (95% CI, 1.98 - 30.353, P = 0.003). However, there was no significant difference between 40 mg and 20 mg, with an OR of 0.844 (95% CI, 0.239 - 2.987, P = 0.793) in Model 3. Additionally, the baseline NRS-11 score significantly predicted substantial pain relief, with an OR of 0.47 (95% CI, 0.287 - 0.768, P = 0.003). Furthermore, at 7 days postinjection, the ODI score was significantly lower in the 20 mg group (P = 0.007) and the 40 mg group (P &lt; 0.001) compared to the 10 mg group. Moreover, the difference in serum cortisol and FPG between the 40 mg and 10 mg groups was more pronounced (P &lt; 0.01), while the difference in ACTH was similar among all 3 groups (P = 0.191). LIMITATIONS: Potential selection bias and a short follow-up period may have influenced our study, and certain imaging results were omitted from the regression models. CONCLUSIONS: The effectiveness of ESI in relieving pain was found to be similar for both 20 mg and 40 mg doses, but with fewer changes in FPG and serum cortisol levels for the former (which were not statistically significant). As a result, it may be clinically viable to use a 20 mg dose for achieving short-term pain relief. Moreover, the baseline NRS-11 scores were found to be a reliable predictor of pain relief efficacy, with milder baseline pain intensity being associated with better pain relief outcomes. KEY WORDS: Epidural steroids, epidural injection, herniated disc, methylprednisolone, dose, cortisol, glucose, adrenocorticotropic hormone

Substance use and labour market nexus in South Africa

Substance abuse is a major public concern for the entire world. Using data from the National Income Dynamic Study wave four, this study examines the impact of substance (alcohol and tobacco) consumption on labour market outcomes in South Africa using the multinomial endogenous switching regression technique. This method controls for any potential selection bias and endogeneity problems. The results from the study reveal that individuals’ decisions to consume alcohol only, tobacco only, and a combination of both are driven by socioeconomic, health, and demographic factors. The estimated causal effect shows that substance use reduces individuals’ earnings in almost all cases and increases working hours. The findings suggest that efforts to control the use of alcohol and tobacco in South Africa should focus more on sensitization programmes that address the health, psychological, and economic implications of using these substances.

Abstract B024: Hypoxia at 3D organoid establishment selects essential subclone within heterogenous pancreatic cancer

Abstract Hypoxia is a key microenvironment associated with malignant traits, including epithelial-mesenchymal transition (EMT) and chemotherapy resistance. Pancreatic ductal adenocarcinoma (PDAC) is extremely hypoxic due to hypovascularity and abundant stromal proliferation. This severe condition accelerates the emergence of hypoxia-adapted cells, which contaminate PDAC as a heterogeneous population. Thus, analyzing hypoxia-adapted cells should be prioritized in analyzing/developing PDAC therapeutic strategies. Recently, 3D organoid culture has been widely used to simulate various organ cancers, featuring precise control with respect to cellular selection through diverse culture conditions. However, as the technology of single-cell analysis has revealed more details of the heterogeneity, the current 3D organoid culture system was also known to have limitation that the system has some potential selection bias. Although several selection biases have been identified, very few reports have focused on oxygen concentrations as a selection bias, leaving room for intervention. To overcome the potential selection bias, we focused on oxygen concentration during the establishment of 3D organoids. We subjected identical PDAC surgical samples to normoxia (O2 20%) or hypoxia (O2 1%) from primary culture, yielding glandular and solid organoid morphology, respectively. Pancreatic cancer organoids established under hypoxia displayed higher expression of EMT-related proteins, a Moffitt basil-like subtype transcriptome, and higher 5-FU resistance in contrast to established organoids under normoxia. We suggest that hypoxia during organoid establishment efficiently selects for hypoxia-adapted cells possibly responsible for PDAC malignant traits, facilitating a fundamental source for elucidating and developing new treatment strategies against recalcitrant PDAC. Citation Format: Koichiro Kumano, Hiromitsu Nakahashi, Pakavarin Louphrasitthiphol, Yukihito Kuroda, Yoshihiro Miyazaki, Osamu Shimomura, Shinji Hashimoto, Yoshimasa Akashi, Bryan James Mathis, Jaejeong Kim, Yohei Owada, Tatsuya Oda. Hypoxia at 3D organoid establishment selects essential subclone within heterogenous pancreatic cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B024.

Risk of Bias Assessment and Risk Minimisation Strategies in COVID-19 Diagnostic Test Accuracy Study

It is paramount to assess the risk of biases in may arise from diagnostic test accuracy (DTA) study as it will affect the accuracy and validity of the tests. These biases can be found in published researches and here we look at COVID-19 DTA studies. The evaluation of bias risk in diagnostic research is mainly performed using QUADAS-2. The aim of this review was to determine potential selection and information biases in diagnostic test accuracy studies and strategies to minimize risk of biases. Literature review related to diagnostic test accuracy study is identified through an online search of databases namely PubMed, ScienceDirect, Research Gate, Google Scholar, and official government websites range. Six potential biases in four QUADAS-2 domains are identified in COVID-19 diagnostic test accuracy study which are 1) spectrum bias in patient selection; 2) interpretation bias in index test; 3) differential misclassification bias and nondifferential misclassification bias in reference standard; and 4) partial verification bias and differential verification bias in patient flow. The identified biases exert effects on accuracy of COVID-19 diagnostic tests. Six strategies are recommended to reduce these biases, hence, improving the accuracy of COVID-19 diagnostic tests. The best diagnostic test can give benefits to the population in the mass screening program during COVID-19.

Effects of stress on pain in females using a mobile health app in the Russia-Ukraine conflict

The chronic and acute effects of stress can have divergent effects on health; long-term effects are associated with detrimental physical and mental health sequelae, while acute effects may be advantageous in the short-term. Stress-induced analgesia, the attenuation of pain perception due to stress, is a well-known phenomenon that has yet to be systematically investigated under ecological conditions. Using Flo, a women’s health and wellbeing app and menstrual cycle tracker, with a world-wide monthly active usership of more than 57 million, women in Ukraine were monitored for their reporting of stress, pain and affective symptoms before, and immediately after, the onset of the Russian-Ukrainian conflict. To avoid potential selection (attrition) or collider bias, we rely on a sample of 87,315 users who were actively logging multiple symptoms before and after the start of the war. We found an inverse relationship between stress and pain, whereby higher reports of stress predicted lower rates of pain. Stress did not influence any other physiological symptoms with a similar magnitude, nor did any other symptom have a similar effect on pain. This relationship generally decreased in magnitude in countries neighbouring and surrounding Ukraine, with Ukraine serving as the epicentre. These findings help characterise the relationship between stress and health in a real-world setting.

Relative Age Effect for Different Playing Positions in Adolescent Female Volleyball Players

Understanding the Relative Age Effect (RAE) in female volleyball can provide a deeper insight into potential developmental advantages and selection biases between playing positions and volleyball-related performance characteristics. This study aimed to investigate the occurrence of the RAE in adolescent female volleyball players according to the playing position and the possible differences in anthropometric and performance characteristics between the relative age groups. The study involved 193 young female volleyball players from 12 different regions and 108 sports clubs from all over Greece, with an average age of 14.53 ± 0.31 years, height of 1.67 ± 0.07 m, weight of 57.20 ± 9.10 kg, and body mass index (BMI) of 20.34 ± 2.50. RAE was identified by the birth quarter of each player, categorizing thus the total sample into four sub-groups: Q1 (January–March), Q2 (April–June), Q3 (July–September), and Q4 (OctoberDecember). Anthropometrics, upper and lower limb power, agility, flexibility, and trunk strength were also assessed. The distribution of volleyball players differed significantly across birth quarters (34.19% of Q1, 25.9% of Q2, 22.79% of Q3, 17.09% of Q4; χ2 = 11.788, p = 0.008). Analysis revealed no significant association between birth quarter and playing position (χ2 = 11.314, p = 0.730). Present study’s results indicated no RAE in young female volleyball players regarding their playing position. Also, performance tests did not differ significantly among the RAE groups. Moreover, despite athletes’ early specialization based on assigned playing positions, no differences in athletes’ position-related performance characteristics were observed. These findings suggest that interventions to mitigate RAE should be considered to ensure equitable development opportunities across all playing positions.

Impact of Virtual Reality Mental Health Nursing Simulation on Nursing Students' Competence.

This study investigates the impact of a Virtual Reality (VR)-based Mental Health Nursing Practice Simulation (MHNPS) on nursing students' competency in caring for individuals with mental disorders. Nursing students often face fear, anxiety, and helplessness during mental health (MH) rotations, impeding the attainment of learning objectives in the MH nursing practicum. Therefore, innovative strategies offering practice opportunities are crucial for their competence development. Using a one-group pretest-posttest repeated measures experimental design, 50 nursing students, having completed at least one MH theory course but not yet engaged in MH clinical practicum, were enrolled. Data collection occurred from October 30, 2022, to January 6, 2023. The VR simulation included six modules covering delusion, hallucination, mania, geriatric depression, adolescent depression with suicidal ideation, and obsessive-compulsive disorder. Pre-simulation questionnaires and post-simulation surveys were administered through provided links. Data were analyzed using descriptive statistics and paired t-tests to assess changes over time. Immediate and sustained improvements were observed in mental disorder-related nursing knowledge, communication self-efficacy, critical thinking ability, and MH nursing clinical confidence. Attitudes toward mental illness improved significantly post-intervention (t=-2.22, p=0.031), while the problem-solving process exhibited significant enhancement six weeks later (t=3.87, p<0.001). The findings affirm the simulation intervention's effectiveness in enhancing nursing students' knowledge, self-efficacy, critical thinking, and confidence in MH nursing practice, with no compromise to patient safety. Integrating simulation into MH nursing practicum narrows the gap between theory and clinical practice, elevates MH care quality, and instills confidence in nursing students as professionals. Despite potential subject selection bias in this single-group pre-post intervention study, the program's comprehensive impact on knowledge, skills, and attitudes suggests opportunities for expanding psychiatric nursing practice capabilities through subsequent studies. Caution is warranted in interpreting results, but the developed program lays the groundwork for advancing nursing students' capabilities in psychiatric nursing practice.