Test Procedure Research Articles

The Effect of Different Education Methods Before Invasive Urodynamics on Patients’ Anxiety, Pain, Readiness and Satisfaction Levels: Randomized Controlled Clinical Trial

Urodynamic testing is an invasive procedure that causes pain and anxiety. Patient education is an evidence-based nursing intervention that relieves pain and anxiety and increases patient satisfaction. This study was carried out to compare the effects of different education methods utilized before a urodynamic testing procedure on patients' pain, anxiety, readiness for the procedure, and satisfaction. The study is a randomized controlled clinical trial. Participants (n = 80) were randomly assigned to four groups. While patients in the control group were provided with routine clinical information, patients in the intervention group were given education with brochures, videos, and brochure-supported videos. The research data were collected by using a Data Collection Form with items about participants' descriptive characteristics, the Visual Analog Scale, and the State Anxiety Inventory. It was determined that pain expectation before urodynamics and the severity of pain during urodynamics were lower in intervention groups than in the control group. Pain expectation before urodynamics was lower in the brochure-supported video education group than in the brochure education group. Anxiety levels were lower and satisfaction levels were higher in the video education and brochure-supported video education groups than in the control and brochure education groups. Of the methods utilized, it was determined that the most effective one was brochure-supported video education as it affected all parameters positively.

Bootstrapped Edge Count Tests for Nonparametric Two-Sample Inference Under Heterogeneity

Nonparametric two-sample testing is a classical problem in inferential statistics. While modern two-sample tests, such as the edge count test and its variants, can handle multivariate and non-Euclidean data, contemporary gargantuan datasets often exhibit heterogeneity due to the presence of latent subpopulations. Direct application of these tests, without regulating for such heterogeneity, may lead to incorrect statistical decisions. We develop a new nonparametric testing procedure that accurately detects differences between the two samples in the presence of unknown heterogeneity in the data generation process. Our framework handles this latent heterogeneity through a composite null that entertains the possibility that the two samples arise from a mixture distribution with identical component distributions but with possibly different mixing weights. In this regime, we study the asymptotic behavior of weighted edge count test statistic and show that it can be effectively recalibrated to detect arbitrary deviations from the composite null. For practical implementation we propose a Bootstrapped Weighted Edge Count test which involves a bootstrap-based calibration procedure that can be easily implemented across a wide range of heterogeneous regimes. A comprehensive simulation study and an application to detecting aberrant user behaviors in online games demonstrates the excellent non-asymptotic performance of the proposed test. Supplementary materials for this article are available online.

Robotic Manipulation of Cumulus–Oocyte Complexes for Cumulus Cell Removal

The removal of cumulus cells from cumulus–oocyte complexes is a critical step in clinical in vitro fertilization. Since the oocyte is partially occluded by the surrounding cumulus cells and individual cumulus cells are small in size, it is difficult for embryologists to assess the oocyte's maturity before cumulus cell removal and to completely remove all the cumulus cells manually . Furthermore, it is easy for the oocyte to become lost inside the micropipette during aspiration due to the inaccuracy of manual control. To deal with these difficulties, a robotic system was developed to completely remove cumulus cells from mature oocytes. In this study, an EPSANet50 network was developed to accurately assess the maturity of oocytes, avoiding the removal of cumulus cells around the immature oocyte. An adaptive controller was designed to accurately position oocytes at the target position, reducing the loss of oocytes inside the micropipette. An improved Yolov5s network was proposed to quantify the number and size of cumulus cells and assess the completeness of cumulus cell removal. The experimental results on mouse cumulus–oocyte complexes showed that the robotic system had a higher success rate (98.0 ± 1.8% vs. 85.3 ± 2.4%) and lower discard rate (4.1 ± 2.7% vs. 19.6 ± 3.5%) than the manual operation. Moreover, a higher amplification rate and lower non-specific rate were also achieved by the robotic system in the subsequent genetic testing procedure, indicating reduced genetic contamination from the cumulus cells.

Conformity Assessment of a Modernised Locomotive Bogie and Body Connection – Type Tests and Results

Referring to the lecture held on 16th Mini-Conference on Vehicle System Dynamics, Identification and Anomalies, Budapest, 5-7 November 2018, the accredited Notified Body started the conformity assessment process of the modernized bogie-locomotive body connection of MÁV-START Class V63 electric locomotives running with Ganz-MÁVAG UFC-type bogies, in 2017. Since the planned modification of the locomotives was delayed, the Conformity Assessment Body could perform the necessary riding quality and noise test in the summer of 2020 instead of September 2018. The study presents the modification carried out on the locomotives, the test procedures, and the test results. The aim and the novelty of the research was to apply the latest developments of the test procedures on a modified, existing rolling stock. The conformity for the new requirement makes challenges for the development of testing even if theoretically a well-known test method is applied. The article gives an example for the application of a classic test method combined with of the new possibilities, that makes unnecessary the use of additional railway test cars.

An efficient product design tool for aftertreatment system

A numerical simulation technique based on the conservation of mass and energy in the gas phase has been developed to optimize the aftertreatment system with the lowest costs. Both oxygen storage capacity model and catalyst deterioration model have been integrated into the three-way catalyst performance model. Applications have been discussed, including XY-L 1.5L I3 gasoline turbocharged direct injection (GTDI) production hybrid vehicle, BY-L 1.5L I4 GTDI hybrid vehicle, XY-L (overseas version) 1.5L I4 GTDI hybrid vehicle, and G-L7 1.5L I4 GTDI hybrid vehicle. Vehicle tests in support of the proposed model have been described. The developed model covers the complete range of the cold start, high temperature and volume flow conditions. To optimize a three-way catalyst performance, this work simulated the effect of air fuel ratio, space velocity, temperature, biasing adjustment on the catalyst efficiency. The simulations presented the technique’s capability of well predicting emissions on fresh and full useful life aged aftertreatment systems, respectively, and carried out under transient conditions. The investigation indicated that excess fueling was used upon engine start to heat the catalyst up to its full operating temperature of greater than 350°C. The model results prompted a redesign of the I3 and I4 1.5L GTDI China 6b, Euro VId and Tier 3/SULEV30 exhaust systems over the world light vehicle test procedure (WLTP) and federal test procedure (FTP) cycles, respectively, for example, the model suggested that the latest design for the SULEV30 aftertreatment system on XY-L (overseas version) 1.5L I4 GTDI hybrid vehicle with the revised calibrations in the areas of cold-start and closed-loop fuel treated emissions of NMOG, NOx, and CO to the 70% of the SULEV30 standards with a $64 cost reduction relative to the baseline.

Error analysis model-driven workflow for self-calibration stitching testing of X-ray flat surfaces

Self-calibration stitching test is widely utilized for testing X-ray flat surfaces. Various factors, including environment disturbances, motion errors, misalignments, overlapping ratios, and sub-aperture sizes can affect the accuracy. Previous studies have shown that motion errors can introduce slope errors in the test surface, and higher overlapping ratios can increase the test error. However, these error analyses have not been comprehensive or quantitatively sufficient for practical applications. For X-ray flat surfaces with specific accuracy requirements, the necessary control levels for error sources and the optimal test parameters remain unclear. To this end, an error analysis model-driven workflow for self-calibration stitching testing of X-ray flat surfaces is proposed. This model allows for the systematic evaluation of how different error sources and test parameters affect test accuracy. Further, it can guide the determination of the control levels of error sources and test parameters, moving beyond the reliance on empirical experience as seen in previous studies. A flat X-ray mirror with clear aperture of 250 mm × 30 mm and 0.2 nm (50 nrad) RMS accuracy requirement was utilized to demonstrate the procedures of the workflow. Verification experiments demonstrated that this workflow can serve as a standard model for evaluating test accuracy and guiding test procedures to achieve the desired accuracy in self-calibration stitching of X-ray flat mirrors.

Introducing the rubber plate impact method: a versatile alternative to close proximity test for tire-pavement noise characterization on asphalt highways

Despite its widespread use, the close proximity (CPX) test for tire-pavement noise is limited to existing pavements, posing challenges for timely and effective corrections of noisy pavements. Additionally, the CPX test entails significant procurement and operation costs. Addressing these issues, this study introduces the rubber plate impact (RPI) method as a simple experimental technique for assessing tire-pavement noise in both laboratory and field settings. The RPI test utilizes the folding motion of the treaded rubber plate on the road surface to simulate air pumping and tread impact noise as two main contributors to tire-pavement noise. Indoor RPI tests on asphalt concrete samples of dense graded asphalt and porous asphalt mixes revealed dominant effects of air void content and associated surface texture on the level of noise. The RPI testing procedure was verified at 17 highway test sections, where both CPX and RPI tests were conducted for comparison. Multiple linear regressions between RPI and CPX data were analyzed to propose CPX prediction models at different speeds (80, 100, 120 km/h), and the performance of these prediction models was validated with independent noise datasets collected from four different highway routes. The findings suggest promising prospects for the RPI test as a cost-effective and versatile alternative to CPX for tire-pavement noise characterization on asphalt-surfaced roads, with implications for road materials design and noise mitigation strategies.

“When selling anything to an audience, visible publicity is key:” experiences, barriers, and enablers to participate in a COVID-19 study in Malawi

BackgroundMany studies in infectious diseases struggle to recruit participants. The SARS-CoV-2 infection, transmission dynamics, and household impact in Malawi (SCATHIM) study reported a refusal rate of 57.2%. Adequate publicity can lead to more people participating in studies. This study explored the reasons for participating in the SCATHIM study.MethodsA descriptive qualitative study informed by the theory of reasoned action was conducted in Blantyre between January 2022 and March 2022 to assess factors that influence participation in a COVID-19 study among 10 index cases, 10 caregivers, 10 study decliners, and 5 research staff. The data were collected via in-depth interview guides, audio recorded, transcribed, managed via NVIVO and analysed via a thematic approach.ResultsThe factors that motivated participation in the study included one’s knowledge of COVID-19; potential access to medical services, including free COVID-19 tests for members of the household; financial reimbursements; and the ability to contribute scientific knowledge. The barriers to participation included minimal publicity of the study amidst a novel condition, perceived stigma and discrimination, perceived invasion of privacy, discomfort with the testing procedures, and suboptimal financial reimbursements.ConclusionEffective publicity and outreach strategies have the potential to decrease refusal rates in study participation, especially if a condition is novel. Studies on infectious diseases should address stigma and discrimination to promote participation and ensure participant safety.

Electrochemical biosensing of Acinetobacter baumannii gene using chitosan-gold composite modified electrode

In this study, a novel electrochemical biosensor was developed for the sensitive and selective detection of the Acinetobacter baumannii gene sequence. The biosensor was created by immobilizing a capture probe specific to the A. baumannii gene on the surface of chitosan-gold modified pencil graphite electrodes. Following solid-state hybridization on the Chit-Au/PGE surface, the target DNA sequence of the A. baumannii was detected by measuring the guanine signal using square wave voltammetry (SWV). All experimental parameters impacting sensor response are examined in order to improve hybridization efficacy, and the electrochemical biosensor's performance. The limit of detection (LOD) for the A. baumannii gene sequence was calculated and found to be 1.93 nM. Three different non-complementary DNA sequences were used to evaluate the assay selectivity, but no interference effect was obtained. Additionally, the potential applicability of the biosensor to real samples was tested in artificial serum media. The suggested electrochemical test procedure is simple, approachable, and quick, making it a convenient approach for the screening of DNA sequence.

A comparative assessment of uncrushed-river concrete mix of Hari-River, and Kamar-Kalaq: the two widely used concrete mix in Herat, Afghanistan

Concrete, as a cornerstone of modern construction, heavily relies on the quality of its constituent materials, particularly aggregates. Among the critical factors contributing to high-quality concrete are proper gradation, absence of clay particles, and angular shape of aggregates. Adhering to these standards typically results in concrete with superior strength. However, aggregates sourced from riverbeds often possess a natural gradation, contain clay particles, and have rounded shapes. This study delves into a comparative analysis of aggregates sourced from two widely utilized riverbed regions, namely Hari-River and Kamar-Kalaq, situated within Herat province, Afghanistan. Given that over 90% of concrete in Herat province is sourced from these two riverbeds, the findings of this study carry immense significance. The research meticulously examines key parameters, including clay content, gradation, aggregate shape, and compressive strength, to determine the optimal choice for concrete production. Methodologically, samples were acquired following ASTM standards, and rigorous testing procedures were conducted, encompassing clay particle analysis, sieve analysis, and strength testing. The results reveal significant disparities between the two regions, with Hari-River demonstrating superior characteristics across various metrics. Particularly noteworthy is Hari-River’s lower clay content of 2.7% compared to Kamar-Kalaq’s 3.7%. The gradation of Hari-River for both coarse and fine aggregates is superior to that of Kamar-Kalaq when compared to size 67 aggregate range. Additionally, the average 28 days concrete compressive strength of Hari-River aggregates is 27.8 MPa, while that of Kamar-Kalaq is 23.4 MPa.

Quantification of delamination resistance data of FRP composites and its limits

Quantitative delamination resistance data of fibre-reinforced polymer-matrix (FRP) composites for quasi-static or cyclic fatigue loads are determined under different loading modes and load rates, respectively. Such data find use, e.g., in FRP materials’ development, materials’ selection, assessment of durability, or structural design. Round robins during test development yielded repeatability and reproducibility (coefficients of variation) of roughly 10 to 25%. This scatter has several different sources. Intrinsic material variability amounts to a few percent at best, at least for advanced manufacturing processes. This intrinsic scatter is essential for material comparisons and structural design. Measurement resolution specified in standardised test procedures yields a maximum of 4–5% variability. Most of the remaining scatter comes from other, extrinsic sources. Test operator actions, e.g., choice of test set-up, manual data acquisition or data analysis can yield extrinsic scatter. Damage mechanisms during delamination initiation and propagation act on the micro- and meso-scale, typically a few micrometer to a few hundred micrometer in size, with corresponding time-scales estimated to between a few tens of nanoseconds and a few microseconds. Defect size-scales are hence several orders of magnitudes lower than test specimen and structural scales, respectively. Predictive capability of models using such test data for structures are, therefore, limited. Major issues are up-scaling from straight beam-like specimens to larger shell-like structures, possibly with complex shape and varying thickness as well as from unidirectional fibre orientation to multidirectional lay-ups.

Statistical fractal analysis in testing the Hypotheses with imprecise data

A new statistical hypothesis testing procedure using fractal analysis, incorporating the concept of lacunarity for interval population parameters when the sample data are real intervals, is introduced. The decision rules for accepting or rejecting the null and alternative hypotheses are provided, along with testing procedures and numerical examples. Additionally, the proposed tests are extended to statistical hypotheses involving fuzzy data samples with lacunarity.

RSM integrated GWO, Driving Training, and Election-Based Algorithms for optimising ethylic biodiesel from ternary oil of neem, animal fat, and jatropha

The worldwide exploration of the ethanolysis protocol (EP) has decreased despite the multifaceted benefits of ethanol, such as lower toxicity, higher oxygen content, higher renewability, and fewer emission tail compared to methanol, and the enhanced fuel properties with improved engine characteristics of multiple-oily feedstocks (MOFs) compared to single-oily feedstocks. The study first proposed a strategy for the optimisation of ethylic biodiesel synthesis from MOFs: neem, animal fat, and jatropha oil (NFJO) on a batch reactor. The project's goals were to ensure environmental benignity and encourage the use of totally biobased products. This was made possible by the introduction of novel population based algorithms such as Driving Training-Based Optimization (DTBO) and Election-Based Optimization (EBOA), which were compared with the widely used Grey Wolf Optimizer (GWO) combined with Response Surface Methodology (RSM). The yield of NFJO ethyl ester (NFJOEE) was predicted using the RSM technique, and the ideal transesterification conditions were determined using the DTBO, EBOA, and GWO algorithms. Reaction time showed a strong linear relationship with ethylic biodiesel yield, while ethanol-to-NFJO molar ratio, catalyst dosage, and reaction temperature showed nonlinear effects. Reaction time was the most significant contributor to NFJOEE yield.The important fundamental characteristics of the fuel categories were investigated using the ASTM test procedures. The maximum NFJOEE yield (86.3%) was obtained at an ethanol/NFJO molar ratio of 5.99, KOH content of 0.915 wt.%, ethylic duration of 67.43 min, and reaction temperature of 61.55 °C. EBOA outperforms DTBO and GWO regarding iteration and computation time, converging towards a global fitness value equal to 7 for 4 s, 20 for 5 s and 985 for 34 s. The key fuel properties conformed to the standards outlined by ASTMD6751 and EN 14,214 specifications. The NFJOEE fuel processing cost is 0.9328 USD, and is comparatively lesser than that of conventional diesel. The new postulated population based algorithm models can be a prospective approach for enhancing biodiesel production from numerous MOFs and ensuring a balanced ecosystem and fulfilling enviromental benignity when adopted.

Clinical Measures for Tone Assessment in Adults with Central Nervous System Disorders—A Scoping Review in a Rehabilitation Context

Assessment of muscle tone in a clinical setting is important for the physiotherapist to better analyse and establish appropriate treatments for CNS disorders. This study aims to review and summarise how to assess changes in tone in the context of adult rehabilitation. Secondarily, this study aimed to identify the central nervous system disorders, the respective variable/concept under study, and the testing procedures employed. PRISMA-ScR guidelines were followed using the “population”, “concept”, and “context” to define the eligibility criteria and to delineate the research question. PubMed®, Science Direct®, Web of Science™, and Google Scholar® databases were used to search the literature. The search included studies published between 2011 and March 2023 in Portuguese, English, French, and Spanish that assessed an adult population (>19 years) with CNS injury. Review articles, qualitative studies, conference proceedings, letters to the editor, and editorials were excluded. Initially, 1519 references were identified, of which eight met the eligibility criteria. The measurement instruments included the Modified Ashworth Scale (n = 5), the Modified Modified Ashworth Scale (n = 3), the BioTone™ system (n = 2), the Montreal Spasticity Measurement (n = 1), and the Tone Evaluation Scale (n = 1). The health conditions considered included stroke sequelae (n = 7), multiple sclerosis (n = 4), spinal cord injuries (n = 4), cerebral palsy (n = 2), brain tumour (n = 2), and traumatic brain injuries (n = 3). The concepts of spasticity (n = 7) and muscle tone (n = 2) were explored. Considering the variables spasticity and muscle tone in different CNS disorders, mainly stroke, subjective instruments were preferred compared to objective ones, with the Modified Ashworth Scale being highlighted.

Orthostatic testing for heart rate and heart rate variability monitoring in exercise science and practice.

Orthostatic testing, involving the transition from different body positions (e.g., from lying or sitting position to an upright or standing position), offers valuable insights into the autonomic nervous system (ANS) functioning and cardiovascular regulation reflected through complex adjustments in, e.g., measures of heart rate (HR) and heart rate variability (HRV). This narrative review explores the intricate physiological mechanisms underlying orthostatic stress responses and evaluates its significance for exercise science and sports practice. Into this matter, active orthostatic testing (e.g., active standing up) challenges the cardiovascular autonomic function in a different way than a passive tilt test. It is well documented that there is a transient reduction in blood pressure while standing up, leading to a reflex increase in HR and peripheral vasoconstriction. After that acute response systolic and diastolic blood pressures are usually slightly increased compared to supine lying body position. The ANS response to standing is initiated by instantaneous cardiac vagal withdrawal, followed by sympathetic activation and vagal reactivation over the first 25-30 heartbeats. Thus, HR increases immediately upon standing, peaking after 15-20 beats, and is less marked during passive tilting due to the lack of muscular activity. Standing also decreases vagally related HRV indices compared to the supine position. In overtrained endurance athletes, both parasympathetic and sympathetic activity are attenuated in supine and standing positions. Their response to standing is lower than in non-overtrained athletes, with a tendency for further decreased HRV as a sign of pronounced vagal withdrawal and, in some cases, decreased sympathetic excitability, indicating a potential overtraining state. However, as a significant main characteristic, it could be noted that additional pathophysiological conditions consist in a reduced responsiveness or counter-regulation of neural drive in ANS according to an excitatory stimulus, such as an orthostatic challenge. Hence, especially active orthostatic testing could provide additional information about HR(V) reactivity and recovery giving valuable insights into athletes' training status, fatigue levels, and adaptability to workload. Measuring while standing might also counteract the issue of parasympathetic saturation as a common phenomenon especially in well-trained endurance athletes. Data interpretation should be made within intra-individual data history in trend analysis accounting for inter-individual variations in acute responses during testing due to life and physical training stressors. Therefore, additional measures (e.g., psychometrical scales) are required to provide context for HR and HRV analysis interpretation. However, incidence of orthostatic intolerance should be evaluated on an individual level and must be taken into account when considering to implement orthostatic testing in specific subpopulations. Recommendations for standardized testing procedures and interpretation guidelines are developed with the overall aim of enhancing training and recovery strategies. Despite promising study findings in the above-mentioned applied fields, further research, thorough method comparison studies, and systematic reviews are needed to assess the overall perspective of orthostatic testing for training monitoring and fine-tuning of different populations in exercise science and training.

Precise Tool to Target Positioning Widgets (TOTTA) in Spatial Environments: A Systematic Review.

TOTTA outlines the spatial position and rotation guidance of a real/virtual tool (TO) towards a real/virtual target (TA), which is a key task in Mixed reality applications. The task error can have critical consequences regarding safety, performance, and quality, such as surgical implantology or industrial maintenance scenarios. The TOTTA problem lacks a dedicated study and it is scattered in different domains with isolated designs. This work contributes to a systematic review of the TOTTA visual widgets, studying 70 unique designs from 24 papers. TOTTA is commonly guided by the visual overlap -an intuitive, pre-attentive "collimation" feedback- of simple shaped widgets: Box, 3D Axes, 3D Model, 2D Crosshair, Globe, Tetrahedron, Line, Plane. Our research discovers that TO and TA are often represented with the same shape. They are distinguished by topological elements (e.g., edges/vertices/faces), colors, transparency levels, and added. shapes, widget quantity, and size. Meanwhile some designs provide continuous "during manipulation feedback" relative to the distance between TO and TA by text, dynamic color, sonification, and amplified graphical visualization. Some approaches trigger discrete "TA reached feedback" such as color alteration, added sound, TA shape change, and added text. We found the lack of golden standards, including in testing procedures, as current ones are limited to partial sets with different and incomparable setups (different target configurations, avatar, background, etc.). We also found a bias in participants: right-handed, young male, non-color impaired.

A Novel Approach for Testing Fractional Cointegration in Panel Data Models with Fixed Effects

Fractional cointegration in time series data has been explored by several authors, but panel data applications have been largely neglected. A previous study of ours discovered that the Chen and Hurvich fractional cointegration test for time series was fairly robust to a moderate degree of heterogeneity across sections of the six tests considered. Therefore, this paper advances a customized version of the Chen and Hurvich methodology to detect cointegrating connections in panels with unobserved fixed effects. Specifically, we develop a test statistic that accommodates variation in the long-term cointegrating vectors and fractional cointegration parameters across observational units. The behavior of our proposed test is examined through extensive Monte Carlo experiments under various data-generating processes and circumstances. The findings reveal that our modified test performs quite well comparatively and can successfully identify fractional cointegrating relationships in panels, even in the presence of idiosyncratic disturbances unique to each cross-sectional unit. Furthermore, the proposed modified test procedure established the presence of long-run equilibrium between the exchange rate and labor wage of 36 countries’ agricultural markets.

A comparison between a proposed preconsolidated presheared flush (P.P.F) testing procedure and flush procedure to measure the drained residual strength

A comparison between a proposed preconsolidated presheared flush (P.P.F) testing procedure and flush procedure to measure the drained residual strength

Multivariate normality tests with two-step monotone missing data: a critical review with emphasis on the different methods of handling missing values

Two-step monotone missing data is a special case of missing data that attracted the attention of researchers since it not only appears frequently in applications but also since under the hypothesis of multivariate normality a unique and explicit solution to the likelihood equations exists. This importance prompted Yamada et al. [Kurtosis tests for multivariate normality with monotone incomplete data. Test. 2015;24:532–557. doi: 10.1007/s11749-014-0423-1] and Kurita and Seo [Multivariate normality test based on kurtosis with two-step monotone missing data. J Multivar Anal. 2022;188:104–824. doi: 10.1016/j.jmva.2021.104824] to propose four procedures in total for testing multivariate normality with two-step monotone missing data. The aim of this paper is twofold. On the one, to compare, for the first time, the performance of the four aforementioned multivariate normality tests via a Monte Carlo study. The second aim of the paper is to compare the performance of the four existing testing procedures with the respective procedures derived as a combination of 12 popular methods for handling incomplete data and 6 multivariate normality tests for complete data. We show that in several cases the tests proposed by Yamada et al. [Kurtosis tests for multivariate normality with monotone incomplete data. Test. 2015;24:532–557. doi: 10.1007/s11749-014-0423-1] and Kurita and Seo [Multivariate normality test based on kurtosis with two-step monotone missing data. J Multivar Anal. 2022;188:104–824. doi: 10.1016/j.jmva.2021.104824] are unable to achieve the nominal significance level. At the same time, no single procedure was found to be the most powerful in all situations of multivariate alternatives considered. As a consequence, the use of specific combinations of methods of handling missing data and testing multivariate normality with complete data is recommended.

Prenatal screening and prenatal diagnosis clinical laboratory diagnostic pathway

Congenital defects and genetic diseases in the fetus are the focus of prenatal screening and prenatal diagnosis. Obstetrics and gynecology, pediatrics, medical imaging (ultrasound and magnetic resonance imaging), clinical laboratory, pathology, and other disciplines are mostly involved in this multidisciplinary work on maternal and infant health care, which aims to prevent birth defects in strict accordance with laws, regulations, and pertinent industry standards, such as the Notice of the National Health Commission on Issuing the Basic Standards for Prenatal Screening Technical Medical Institutions and the Basic Standards for Prenatal Diagnosis Technical Medical Institutions (Guowei Maternal and Child Letter [2019] No. 297). To further support the implementation of prenatal screening and diagnosis work and streamline workflow, this study has compiled the timing, inspection, and testing procedures of various projects in each link from the standpoint of the disease clinical laboratory diagnostic pathway. This approach improves communication amongst various disciplines in prenatal screening and diagnosis work and offers clinical service quality, and it also helps improve the standard of the birth population and prevent and controll severe birth defects.