Rank Test Research Articles

Progressive Muscle Relaxation on Family Anxiety with Hypertension

Since hypertension is a chronic condition, long-term care is required. Anxiety within the family is one of the ways that long-term care and the possibility of complications impact the loving family. Extended family stress may lead to subpar treatment for hypertensive individuals, which will impact their pulse. The purpose of this study was to examine what increasing muscle relaxation meant for the anxiety levels of hypertensive families. Analytical methods are utilized in this kind of quasi-experimental study. All households with family members who experience the ill effects of hypertension are the target population. samples from 35 participants in the control group and another 35 participants in the experimental group. The HARS questionnaire was the tool used to gauge the level of anxiety. Using the SPSS software, data management employed the Wilcoxon Signed Ranks Test at a significance threshold of <α (0.05). The outcomes demonstrated that gradual muscle relaxation had an impact on the anxiety levels of the experimental group's families with hypertension. ρ = 0.000 (0.000 <0.05) was the result of the Wilcoxon sign rank test at a significance level of 0.05. The control group's Wilcoxon sign rank test result, at a significance level of 0.05, was ρ = 1.000 (1.000 > 0.05), indicating no effect of progressive muscle relaxation on anxiety. According to the study's findings, gradual muscular relaxation can diminish anxiety. To bring down anxiety levels, this technique can be utilized as a non-pharmacological therapy.

THE RELATIONSHIP OF FEAR OF MISSING OUT (FoMO) AND PEER SOCIAL SUPPORT WITH THE BODY IMAGE OF FEMALE ADOLESCENT AT SENIOR HIGH SCHOOL

Introduction: Adolescent girls are involved and exposed to various comments regarding physical appearance, which can lead to experiences of body dissatisfaction, resulting from failing to meet the unrealistic standards of physical attractiveness set by society. This condition can be influenced by FoMO and social support from peers. This research aims to analyze the relationship between Fear of Missing Out (FoMO) and social support from peers with body image in adolescent girls at SMA Negeri 13 Surabaya. Method: This research use descriptive correlation design with cross-sectional approach. The population was 650 people, with a sample size of 191 female teenagers at senior high school in Surabaya. The sampling technique used is simple random sampling. The independent variables are FoMO and peer social support. The dependent variable is body image. Data was taken using a questionnaire and analyzed using the Spearman's rank test. Results: There is a relationship between FoMO and body image in female adolescents (p=0,031<0.05 and (r) = -0,156). For the peer social support variable, the value obtained was p=0,568>0,05, which means there is no relationship. Discussion: FoMO may be related to body image. Peer social support is not associated with body

Influence of occlusal surface reduction on post endodontic pain following instrumentation and obturation: A randomized double blinded clinical study.

The purpose of this randomized clinical study was to investigate the influence of occlusal surface reduction on postendodontic pain. Sixty patients were included with a diagnosis of acute irreversible pulpitis and acute apical periodontitis and divided randomly into two groups. In the intervention group, occlusal surfaces were reduced and left intact in the control group. Postoperative pain was evaluated at the 6th, 12th, 24th, and 48th h after the root canal instrumentation and 6th and 12th h following obturation using visual analog scale. Data were evaluated using the Chi-square test, t-test, Friedman test, Mann-Whitney U-test, and Wilcoxon rank test. Postoperative pain levels in both groups were reduced significantly over the time period evaluated, however, between the two groups, there was no difference evident. Occlusal surface reduction did not influence the pain following root canal instrumentation and obturation.

The Psychological Impact of COVID-19: A Comparative Analysis of Pre-Lockdown and During-Lockdown Periods Among Saudi General Population.

Prior research has revealed substantial psychological impacts of COVID-19 among the general population. However, there is a noticeable gap in studies addressing the enduring anxiety levels before and during lockdown periods of the COVID-19 pandemic. The study assessed and compared the psychological impact of the COVID-19 pandemic before and during lockdown periods among the general population in Saudi Arabia. A validated and reliable General Anxiety Disorder (GAD)-7 instrument was used to quantify stress levels by measuring anxiety. Nonprobability snowball sampling was used to collect data from 516 participants residing in Saudi Arabia. The difference in scores for each of the seven related questions of GAD-7 was determined using a non-parametric Wilcoxon rank test. A mild level of anxiety was consistently observed both before and during the lockdown, as indicated by GAD-7 scores of 6.17 (SD = 5.5) before the lockdown and 6.42 (SD = 5.7) during the lockdown. There were no differences in GAD-7 scores before 6.17 (SD = 5.5) and during 6.42 (SD = 5.7) the lockdown periods. However, levels of moderate anxiety increased by 5% during the lockdown period. Anxiety levels before and during lockdown were significantly associated with gender (χ2 (3, n = 516) =11.23 p = 0.01) and employment status (χ2 (3, n = 516) = 9.41 p = 0.024). Among the GAD-7 questionnaire items, item number 1 ("Feeling nervous, anxious, or on edge") (p= 0.00) and item number 7 ("Feeling afraid as if something awful might happen") (p= 0.025) showed a significant association with anxiety levels before and during the lockdown periods. The enduring prevalence of mild anxiety, persisting both before and during the lockdown periods, underscores the profound impact of COVID-19 on the mental health of the general population in Saudi Arabia.

Environmental DNA Metabarcoding Detects Predators at Higher Rates Than Electrofishing

ABSTRACTThere are numerous downsides and risks associated with electrofishing; hence, environmental DNA (eDNA) metabarcoding is becoming increasingly common in aquatic ecological studies. Generally, researchers agree that eDNA metabarcoding is more sensitive than electrofishing, and that eDNA metabarcoding is better at detecting rare species. As predatory species tend to be rarer than prey species, eDNA metabarcoding should hypothetically detect more predator species than electrofishing. Instead of supporting the notion that eDNA must replace electrofishing, or that eDNA and electrofishing must display the same results, the current study aims to establish the strengths and weaknesses of eDNA metabarcoding when compared to electrofishing. eDNA metabarcoding and electrofishing data were collected on three sampling dates at four experimental sites. A RV coefficient analysis confirmed that the eDNA metabarcoding data (RV = 0.395, p = 0.057) are statistically different from the electrofishing data. A paired Wilcoxon signed rank test revealed that eDNA data collection techniques detect more predatory species than electrofishing (p = 0.041). When the analysis was conducted for prey species a statistically significant difference did not occur (p = 0.661). Overall, the results of the study suggest that eDNA metabarcoding does not display the same results as electrofishing due to eDNA metabarcoding detecting predatory species at higher rates. The combined use of eDNA alongside electrofishing can help mitigate electrofishing's bias against predatory species, while electrofishing can address reliability concerns associated with eDNA. This collaborative approach ultimately enhances the accuracy of fish community assessments.

Automated biventricular quantification in patients with repaired tetralogy of Fallot using a 3D deep learning segmentation model

BackgroundDeep learning is the state-of-the-art approach for automated segmentation of the left ventricle (LV) and right ventricle (RV) in cardiac magnetic resonance (CMR) images. However, these models have been mostly trained and validated using CMR datasets of structurally normal hearts or cases with acquired cardiac disease, and are therefore not well-suited to handle cases with congenital cardiac disease such as tetralogy of Fallot (TOF). We aimed to develop and validate a dedicated model with improved performance for LV and RV cavity and myocardium quantification in patients with repaired TOF. MethodsWe trained a 3D convolutional neural network (CNN) with 5-fold cross-validation using manually delineated end-diastolic (ED) and end-systolic (ES) short-axis image stacks obtained from either a public dataset containing patients with no or acquired cardiac pathology (n=100), an institutional dataset of TOF patients (n=96), or both datasets mixed. Our method allows for missing labels in the training images to accommodate for different ED and ES phases for LV and RV as is commonly the case in TOF. The best performing model was applied to all frames of a separate test set of TOF cases (n=36) and ED and ES phases were automatically determined for LV and RV separately. The model was evaluated against the performance of a commercial software (suiteHEART®, NeoSoft, Pewaukee, Wisconsin, US). ResultsTraining on the mixture of both datasets yielded the best agreement with the manual ground truth for the TOF cases, achieving a median DICE similarity coefficient of (93.8%, 89.8%) for LV cavity and of (92.9%, 90.9%) for RV cavity at (ED, ES) respectively, and of 80.9% and 61.8% for LV and RV myocardium at ED. The offset in automated ED and ES frame selection was 0.56 and 0.89 frames on average for LV and RV respectively. No statistically significant differences were found between our model and the commercial software for LV quantification (two-sided Wilcoxon signed rank test, p<5%), while RV quantification was significantly improved with our model achieving a mean absolute error of 12ml for RV cavity compared to 36ml for the commercial software. ConclusionWe developed and validated a fully automatic segmentation and quantification approach for LV and RV, including RV mass, in patients with repaired TOF. Compared to a commercial software, our approach is superior for RV quantification indicating its potential in clinical practice.

The Effect of Average Value Mounting and Facebow Transfer on Condylar Guidance Settings in a Semi-Adjustable Articulator - A Comparative Study using Digital Lateral Cephalographs in Edentulous Patients.

While we attempt to restore occlusion in completely edentulous patients there is a consensus among clinicians to articulate the cast using average value and avoid performing facebow transfer. Various studies question the application of facebow transfer in the fabrication of removable complete denture fabrication. This study was therefore aimed to study the effect on condylar guidance with casts mounted by the facebow method, Bonwill's method, and radiographic method. A cross-sectional study was performed using casts of edentulous patients attending the Department of Prosthodontics. After establishing a tentative jaw relationship using wax occlusal rims in the edentulous participants, the casts were mounted by Bonwill's method and the facebow transfer method to a semi-adjustable articulator. Protrusive records of the subjects were used to program the articulator to obtain the condylar guidance values. Digital lateral cephalographs were made both in centric and protrusive jaw relationships. The mandibular condyles were then traced and overlapped to obtain radiographic values. The condylar guidance values obtained by Bonwill's method, facebow method and radiographic method were compared using Wilcoxon's signed rank test and Mann-Whitney U test. The SPSS Statistics for Windows (Version 21.0. Armonk, NY, USA:IBM Corp.), and, at a probability value of 0.05, the significance of every statistical test was predetermined. Ten edentulous 45-70 year olds participated in the study. The mean discrepancy between radiography and facebow methods was 12.8° for the right side and 12.7° for the left (P < 0.005). The difference between radiography and Bonwill's methods was significant (P < 0.005), with a mean difference of 34.3° for the right side and 34.7° for the left side. The difference between Bonwill's method and the facebow method was significant (P < 0.005), with a mean difference of 21.5° for the right side and 22° for the left side. The condylar guidance values obtained by clinical methods (Bonwill's and Facebow) were significantly lesser (P < 0.005) compared to the values obtained by radiographic method.

Abstract P388: Electrical Stimulation of the Porcine Carotid Sinus Nerve Reliably Decreases Blood Pressure and Heart Rate

Introduction: Neuromodulation of the baroafferent pathway via direct carotid sinus nerve (CSN) stimulation is recognized as a potential therapeutic modality for treating uncontrolled hypertension. Although proof of concept has been demonstrated acutely in humans, there are many questions that remain in both acute and chronic applications. A translational non-companion large animal model is vital for safe development of this modality. Here we present data on the effects of CSN and baroafferent stimulation in farm pigs. Hypothesis: We hypothesized that an effective CSN-bioelectode interface in the pig would demonstrate significant and reproducible reductions in blood pressure in tandem with pulse rate (PR). Methods: Acute CSN stimulation was investigated in 9 anesthetized Yorkshire pigs. Following general anesthesia, CSNs were exposed and an application-specific electrode was placed. A fixed current paradigm was employed at constant 100Hz and 100µs pulse width. Following contact mapping to identify the baroafferent neurointerface, electrical current was escalated to establish dose-response curves. The primary outcome was systolic blood pressure (SBP) and secondary outcomes were diastolic pressure (DBP) and PR. Data were analyzed in Matlab to extract the baseline BP and PR, during and following stimulation. Statistical calculations used a one-sample Wilcoxon signed rank test. Explanted electrodes with surrounding tissue were evaluated using micro-computed tomography (μCT) and histologically. Results: Six of 9 animals were responders (n=7, 2 sides were stimulated in one animal), CSN stimulation caused average (mean±SD, p&lt;0.001) decreases in SBP (6.8±7.2mmHg) and DBP (3.9±3.7mmHg), which tracked closely with decreases in PR (6.2±5.7bpm). Average maximum decreases were: SBP, 9.3±9.9mmHg; DBP, 7.7±6.4mmHg; and PR, 9.7±8.3bpm. Upon stimulation withdrawal, there was near-immediate recovery of both BP and HR. μCT and histological analysis of tissue samples demonstrated inter-animal anatomic heterogeneity. Conclusions: CSN stimulation causes reproducible reduction in BP synchronous with PR drops followed by near immediate recovery of both with stimulation withdrawal. Variations in animal response may be due to anatomical variation in CSN anatomy that can be overcome with further anatomical study. Pigs provide a robust large-animal model for investigating CSN stimulation, offering a platform to better understand baroafferent stimulation as treatment for uncontrolled hypertension.

Comparison of muscle response in patients treated with rigid and flexible fixed functional appliances.

The present study was undertaken to evaluate and compare muscle activity after the treatment with rigid and flexible fixed functional appliance. The study was conducted on 14 skeletal Class II malocclusion patients in the age group of 13-17 years, divided into two groups comprising 7 patients in each group. Group I was treated with a rigid fixed functional appliance (MPA IV), and Group II was treated with a flexible fixed functional appliance (Churro Jumper). Masseter and anterior temporalis muscle activities were recorded using needle electromyography (EMG) at postural rest, saliva swallowing, and clenching during five intervals (T0 to T4) during fixed functional appliance treatment. Unpaired t-test, Mann-Whitney U, and Wilcoxon sign rank test were applied for statistical analysis, and a P value of <.05 was considered statistically significant. Group I (MPA IV) showed a significant increase in EMG activity during postural rest position (P = 0.003, P = 0.001), swallowing (P = 0.013, P = 0.005), and clenching (P = 0.001, P = 0.002) in masseter and anterior temporalis muscle, respectively. Group II (Churro jumper) also showed a significant increase in EMG activity during postural rest position (P = 0.000, P = 0.000), swallowing (P = 0.001, P = 0.000), and clenching (P = 0.001, P = 0.000) in masseter and anterior temporalis muscle, respectively. Both rigid (MPA IV) and flexible (Churro Jumper) fixed functional appliances caused a significant increase in EMG activity of masseter and anterior temporalis muscle during postural rest position, swallowing, and clenching in 6 months of the observation period, but the flexible appliance (Churro Jumper) showed more significant increase.

Efficacy of Mucosamin Spray as an Adjunct for Prevention of Oral Mucositis in Children under Chemotherapy: A Two-Center Randomized Clinical Trial.

Chemotherapy-induced mucositis is the most common complication during cancer treatment. This complication can lead to pain, increased risk of infection and malnutrition. Therefore, it is important to find a solution to reduce the severity and duration of side effects. This study aimed to assess the efficacy of Mucosamin spray as an adjunct for prevention of oral mucositis in children under chemotherapy. This parallel-design clinical trial evaluated 48 patients aged 5 to 15 years with leukemia and lymphoma presenting to the Hematology Department of Mofid and Mahak Hospitals. The patients were randomly divided into two groups (n=24). Before starting chemotherapy, all patients received oral hygiene instructions (toothbrushing without flossing). Patients in both groups were requested to use a mouthwash composed of nystatin, aluminum-magnesium hydroxide suspension (aluminum MgS), and diphenhydramine for 1 min every morning on a daily basis starting the day before treatment. Patients in the intervention group were also requested to spray their entire oral mucosa with Mucosamin spray 3 times a day in addition to using the mouthwash. Patients were requested to refrain from eating and drinking for 1h after spraying. The patients were clinically examined by a senior dental student once every other day for 20 days regarding the occurrence, severity, and duration of oral mucositis. Data were analyzed using the Chi-square and Mann-Whitney tests, Kaplan-Meier survival analysis, and log rank test. No significant difference was noted between the two groups in the incidence, severity, or time of development of mucositis (p> 0.05). The 7-day non-recovery percentage was 72.7% (SE= 13.4) and 25.0% (SE= 15.3) in the control and test groups, respectively, indicating shorter duration (faster healing) of mucositis in the intervention group (p= 0.01). Within the limitations of this study, it seems that prophylactic application of Mucosamin spray can shorten the course of oral mucositis, in case of its occurrence.

Can a large language model create acceptable dental board-style examination questions? A cross-sectional prospective study

Background/purposeNumerous studies have shown that large language models (LLMs) can score above the passing grade on various board examinations. Therefore, this study aimed to evaluate national dental board-style examination questions created by an LLM versus those created by human experts using item analysis. Materials and methodsThis study was conducted in June 2024 and included senior dental students (n = 30) who participated voluntarily. An LLM, ChatGPT 4o, was used to generate 44 national dental board-style examination questions based on textbook content. Twenty questions for the LLM set were randomly selected after removing false questions. Two experts created another set of 20 questions based on the same content and in the same style as the LLM. Participating students simultaneously answered a total of 40 questions divided into two sets using Google Forms in the classroom. The responses were analyzed to assess difficulty, discrimination index, and distractor efficiency. Statistical comparisons were performed using the Wilcoxon signed rank test or linear-by-linear association test, with a confidence level of 95%. ResultsThe response rate was 100%. The median difficulty indices of the LLM and human set were 55.00% and 50.00%, both within the range of “excellent” range. The median discrimination indices were 0.29 for the LLM set and 0.14 for the human set. Both sets had a median distractor efficiency of 80.00%. The differences in all criteria were not statistically significant (P > 0.050). ConclusionThe LLM can create national board-style examination questions of equivalent quality to those created by human experts.

THE RELATIONSHIP BETWEEN THE ROLE OF FAMILY AND THE READINESS OF FEMALE STUDENTS IN FACING MENARCHE

The current trend of decreasing menarche age has caused many high-grade elementary school students to experience menarche. Currently, the age of menarche tends to get younger with an average age between 9-12 years old, which causes children to need family roles to prepare themselves to face menarche. This research aimed to determine the relationship of family role with female students’ readiness in facing menarche at Kartika XVII-3 Sungai Raya Elementary School. This research was conducted from February 28 to March 2, 2024. This research was quantitative research, with a cross-sectional approach. The sample collection technique used a questionnaire. With a sample number of 39 using the total sampling method. Data analysis using the Spearman Rank test. The age range of respondents was 9-13 years, with the highest number aged 11 years as much as 46.2%. In the criteria for parental employment, 69.2% of respondents were IRT. As many as 74.4% of children get information sources from families. Family roles 61.5% of respondents have family roles that are not good. There are 69.2% of respondents are not prepared for menarche. The results of the Spearman Rank test found that the p-value &lt; α (0.000 ≤ 0.005) and there was a relationship between the role of family and the readiness of female students in facing menarche at Kartika XVII-3 Sungai Raya Elementary School. The information obtained by the child from the family will further affect a child's readiness to face the first menstruation. Information about menstruation is not conveyed properly and correctly, it will affect the child's readiness to face menstruation. Future researchers are expected to be able to develop more deeply the relationship between family roles and the readiness of schoolgirls to face menarche and can develop other variables that affect the unpreparedness to face menarche so that they can be used for further research.

Absolute Metabolite Quantification in Individuals with Glioma and Healthy Individuals Using Whole-Brain Three-dimensional MR Spectroscopic and Echo-planar Time-resolved Imaging.

MR spectroscopic imaging (MRSI) can be used to quantify an extended brain metabolic profile but is confounded by changes in tissue water levels due to disease. To develop a fast absolute quantification method for metabolite concentrations combining whole-brain MRSI with echo-planar time-resolved imaging (EPTI) relaxometry in individuals with glioma and healthy individuals. In this prospective study performed from August 2022 to August 2023, using internal water as concentration reference, the MRSI-EPTI quantification method was compared with the conventional method using population-average literature relaxation values. Healthy participants and participants with mutant IDH1 gliomas underwent imaging at 3 T with a 32-channel coil. Real-time navigated adiabatic spiral three-dimensional MRSI scans were acquired in approximately 8 minutes and reconstructed with a super-resolution pipeline to obtain brain metabolic images at 2.4-mm isotropic resolution. High-spatial-resolution multiparametric EPTI was performed in 3 minutes, with 1-mm isotropic resolution, to correct the relaxation and proton density of the water reference signal. Bland-Altman analysis and the Wilcoxon signed rank test were used to compare absolute quantifications from the proposed and conventional methods. Six healthy participants (four male; mean age, 37 years ± 11 [SD]) and nine participants with glioma (six male; mean age, 41 years ± 15; one with wild-type IDH1 and eight with mutant IDH1) were included. In healthy participants, there was good agreement (+4% bias) between metabolic concentrations derived using the two methods, with a CI of plus or minus 26%. In participants with glioma, there was large disagreement between the two methods (+39% bias) and a CI of plus or minus 55%. The proposed quantification method improved tumor contrast-to-noise ratio (median values) for total N-acetyl-aspartate (EPTI: 0.541 [95% CI: 0.217, 0.910]; conventional: 0.484 [95% CI: 0.199, 0.823]), total choline (EPTI: 1.053 [95% CI: 0.681, 1.713]; conventional: 0.940 [95% CI: 0.617, 1.295]), and total creatine (EPTI: 0.745 [95% CI: 0.628, 0.909]; conventional: 0.553 [95% CI: 0.444, 0.828]) (P = .03 for all). The whole-brain MRSI-EPTI method provided fast absolute quantification of metabolic concentrations with individual-specific corrections at 2.4-mm isotropic resolution, yielding concentrations closer to the true value in disease than the conventional literature-based corrections. © RSNA, 2024 Supplemental material is available for this article.

Response Rates and Nonresponse Bias Among 20 Years of Pediatrician Surveys

ObjectivesOur objectives were to examine the following: physician survey response rates across a 20-year period; the impact of a token incentive on response rates; whether survey nonresponse bias is present and if it is associated with response rate; and the impact of a token incentive on nonresponse bias. MethodsWe utilized data from 68 American Academy of Pediatrics (AAP) pediatrician surveys from 2000 to 2019 and an AAP administrative database, which included information for both respondents and non-respondents (target sample). Linear regression examined response rates over time. To assess nonresponse bias, a t-test or Wilcoxon rank test compared respondents and the target sample by age, gender, and US Census region. Linear regression or Spearman correlation examined the association of response rate and nonresponse bias. Interrupted time series analyses tested the introduction of a $2 token incentive on both response rates and nonresponse bias. ResultsOverall mean survey response rate was 56.2%. Response rates declined across survey years (β = −0.58, P < 0.001). The $2 incentive generated an 8.7% response rate increase (P < 0.001). The respondent groups had more female pediatricians than the target samples (62.5% vs 60.1%, P < 0.001). Age nonresponse bias was associated with lower response rates (β = −0.47, P < 0.001). The $2 incentive was associated with nonresponse bias shifts toward older, away from female, and away from Northeastern respondents. ConclusionsOur study demonstrates an overall decline in pediatrician survey response rates and a meaningful impact of a token incentive on response rates and nonresponse bias, underscoring the importance of measuring nonresponse bias whenever possible.

The disaggregation of the oswestry disability index in patients undergoing lumbar surgery for degenerative lumbar spondylolisthesis

BACKGROUND CONTEXTThe Oswestry Disability Index (ODI), is a widely used patient-reported outcome measure (PROM) for assessing functional status in individuals with lumbar spine pathology. The ODI is used by surgeons to determine the initial status and monitor progress after surgery. Compiled ODI data enables comparisons between different surgical techniques. Degenerative lumbar spondylolisthesis (DLS) often causes symptoms such as back pain and neurogenic claudication affecting quality of life and activities of daily living captured by the ODI. Despite extensive studies on ODI changes after spinal surgery, little is known about the characteristics and changes in the different ODI subsections. PURPOSETo analyze the baseline characteristics and changes in total ODI and ODI subsections 2 years after elective lumbar surgery. STUDY DESIGNRetrospective analysis on patients prospectively enrolled who underwent spinal surgery for degenerative lumbar spondylolisthesis from 2016 to 2018. The ODI was assessed preoperatively and 2 years postoperatively. PATIENT SAMPLEA total of 265 patients were included in the study, 60% were female. The mean age of the patients was 67±8 years, and the mean BMI was 30±6 kg/m2. OUTCOME MEASURESThe analysis considered the differences in ODI scores before and after surgery, as well as the changes in all ODI subsections 2 years after elective lumbar surgery for DLS. METHODSThe analysis evaluated differences in ODI scores and variations in different subsections. Patients without an ODI follow-up at 2 years were excluded from the study. The study utilized the Wilcoxon Signed Rank Test for all prepost paired samples. The Wilcoxon rank sum test was used for sex and procedure comparisons for overall ODI and ODI subsection analysis. Univariate linear regression was applied for overall and subsection specific ODI outcomes with age and BMI as independent variables, respectively. The statistical significance level was set at p<.05. RESULTSImprovement in ODI was observed in 242 patients (91%). The highest baseline disability values were found for the questions regarding pain intensity (3.4±1.3), lifting (3.2±1.9), and standing (3.4±1.3). The lowest preoperative functional limitations were observed in sleeping (1.6±1.3), personal care (1.6±1.4), traveling (1.6±1.2) and sitting (1.5±1.4). At the 2-year follow-up, there was significant improvement in all questions and the overall ODI (all p<.001). The ODI subsections that showed the greatest absolute improvements were changing degree of pain (−2.6), with 89% of patients experiencing improvement, standing (−2.4) with 87% of patients experiencing improvement, and pain intensity (−2.1) with 81% of patients experiencing improvement. The subsections with the least improvement were personal care (−0.6), sitting (−0.7), and sleeping (−0.9). The study found that female patients had a significantly higher preoperative disability in various subsections but showed greater improvement in total ODI compared to male patients (p=.001). Additionally, improvement in sitting (p<.001), traveling (p<.001), social life (p<.001) and sleeping (p=.018) were significantly higher in female patients. Older patients showed significantly less improvement in sitting (p=.005) and sleeping (p=.002). A higher BMI was significantly associated with less improvement in changing degree of pain (p=.025) and higher baseline disability in various subsections. Patients who underwent decompression and fusion had significantly higher baseline disability in several subsections compared to those who underwent decompression alone. There was no significant difference between decompression alone and decompression with fusion in terms of overall improvement in the ODI and improvement in the subsections. CONCLUSIONThese results offer a more comprehensive understanding of ODI and its changes across different subsections. This insight is invaluable for improving preoperative education and effectively managing patient expectations regarding potential postsurgery disability in specific areas.

An exploratory single-arm open-label clinical study to evaluate the combined effect of Vamana and Sarasvata Churna in reducing excessive daytime sleepiness

BackgroundExcessive Daytime Sleepiness (EDS) is inferred as persistent sleepiness and often a general lack of energy during the day even after apparently adequate or even prolonged nighttime sleep. The subjects may not be identifying excessive daytime sleepiness but may present as feeling tired, lack of energy etc. They may seem apparently healthy and without any other systemic illness. The prevalence was found to be as high as 18 % in 2012 in United Kingdom. Also, it is a risk factor for diseases like Alzheimer's disease, Parkinson's disease and other neurodegenerative diseases. Conventional management (Modafinil, Sodium Oxybate and Stimulants) addresses only the subjective condition in EDS and is associated with adverse effects compromising the quality of life. In the current health scenario there is a need for alternative interventions to manage this disease. On analyzing this condition through Ayurveda, we could understand it as Nidradhikya (Excessive daytime sleepiness) which is caused due to vitiated Kapha Dosha along with Vriddha Tamoguna (increased Tamoguna) that can be managed by Shodhana (biopurification) followed Shamana (pacification) therapies. ObjectiveThis study was aimed to assess the combined effect of Vamana (therapeutic vomiting) and Sarasvata Churna in reducing Excessive Daytime Sleepiness. Materials and methodsThis was a single-arm exploratory open-label clinical trial. 10 subjects having EDS diagnosed using Modified Epworth Sleepiness Scale (MESS) with a score of 10–24 with proper exclusion were recruited from OPD and IPD, Department of Kāyacikitsa, Amrita School of Ayurveda. All the participants were clinically examined, sought for medical history and further checked biochemically to exclude any other systemic illness that may lead to this condition. Only healthy subjects with quality night sleep (assessed by PSQI) and without any other systemic illness were selected. The treatment protocol adopted was Vamana Karma followed by 30 days of Sarasvata Churna as Shamana Aushadha (medicine for pacification). Assessment was done using MESS on 0th day and after 30 days of Shamana Aushadha Sevana. After completion of treatment, the results were statistically analysed using Wilcoxon Signed Rank Test and final conclusion was drawn. ResultsOn analysis of the symptoms using Modified Epworth Sleepiness Scale, the mean total score reduced from 14.8 to 2.8 with 81.08 % relief in these 10 subjects and a significant p value < 0.05 after Vamana followed by 30 days of Shamana Aushadha Sevana. DiscussionVamana helps in Kapha Nirharana (expelling) which removes the Avarana (occlusion) of Manas seen in Nidradhikya. This results in Hrit Shuddhi (purity of heart) that helps in bringing the equilibrium of Mano Gunas (qualities of mind) (Satvoudaryam Tamojayaha) which forms the line of management. Sarasvata Churna which was administered as Shamana Aushadha possesses Medhya (Nootropic), Buddhi Smriti Dhriti Vardhaka (intellect, memory and patience promoting) attributes and is being indicated in Vicetas. Most of the drugs in Sarasvata Churna are Rasayana (rejuvenation) that imparts Indriya Bala (strengthening of senses) and Priti (contempt) to Manas by Prinana (nourishing) of Rasa Dhatu. ConclusionFrom this study, we could conclude that the combination of Vamana Karma followed by Sarasvata Churna administration is effective in reducing EDS.

Glycemic Control in Diabetic Foot Ulcers: A Comparative Analysis of Wound and Wound-free Periods in Adults With Type 1 and Type 2 Diabetes

ObjectiveOur aim in this study was to determine whether there are differences in glycemia during wound and wound-free states among individuals with diabetes at a multidisciplinary diabetic foot and wound clinic from 2012 to 2019. MethodsWe conducted a retrospective analysis of prospectively collected data over 7.4 years from the Johns Hopkins Multidisciplinary Diabetic Foot and Wound Clinic. Participants with diabetic foot ulcers were observed during at least one wound period and one wound-free period and had at least one glycated hemoglobin (A1C) measurement in both a wound and wound-free period. The A1C measurements were aggregated and summarized across wound and wound-free periods, and compared using the Wilcoxon matched-pairs signed rank test. ResultsTwo hundred six eligible participants with a total of 623 wounds were included in this analysis. Participants were followed for a median period of 2.4 years (876 days). There were no significant differences in mean, minimum, and maximum A1C between the aggregate wound and wound-free periods, with median values of 7.6% (interquartile range [IQR] 6.6% to 9.1%) and 7.5% (IQR 6.6% to 9.1%) for mean A1C (p=0.43), 6.9% (IQR 6.0% to 8.0%) and 6.8% (6.0% to 8.1%) for minimum A1C (p=0.78), and 8.6% (IQR 7.1% to 10.9%) and 8.5% (IQR 7.0% to 10.7%) for maximum A1C (p=0.06) in the wound and wound-free periods, respectively. ConclusionsThis retrospective study shows similar levels of A1C during wound and wound-free periods; however, given the limitations of missing A1C and small sample size, further studies leveraging continuous glucose monitoring are needed to determine whether glycemia worsens in the setting of a DFU.

Retrospective review of clinical outcomes of fornix reservoir restoration surgery for conjunctivochalasis with cryopreserved amniotic membrane

Background: Conjunctivochalasis (CCh) is characterized by loose, redundant conjunctival folds that result in tear film instability. For cases that are refractory to conventional therapies, surgical treatment may be used to address the underlying pathophysiology. Aims: The aim of this study was to assess the clinical outcome of fornix reservoir restoration surgery with cryopreserved amniotic membrane (AM) in patients with symptomatic CCh. Setting and Design: This was an observational, retrospective, single-site study. Materials and Methods: Retrospective review of eyes with CCh that underwent fornix deepening reconstruction with conjunctival recession and AM transplantation with at least 3 months of follow-up. Outcome measures, which were assessed at 2 ± 1 weeks postoperatively and at the last follow-up visit, included CCh severity, symptoms, tear break-up time (TBUT), corneal and conjunctival fluorescein staining, subconjunctival hemorrhage, and delayed tear clearance. Statistical Analysis Used: Wilcoxon signed–rank test and Fisher’s exact test were used for statistical analysis. Results: Ten eyes (76.9%) presented with Grade 3 CCh, and 3 eyes (23.1%) presented with Grade 2 CCh along with ocular irritation (100%), epiphora (84.6%), dryness (76.9%), ocular pain (38.5%), and photophobia (23.1%). Following surgical intervention, CCh severity significantly improved to Grade 0 in all eyes. This was accompanied by a significant improvement in corneal staining, symptoms, and resolution of conjunctival staining/subconjunctival hemorrhage. Conclusion: Surgical treatment using the reservoir restoration procedure addresses the pathophysiology of CCh as demonstrated by improved symptoms, TBUT, and corneal and conjunctival staining.

Abstract P429: Stronger Association of Angiotensinogen with Mortality than Renin or Lactate in Critical Illness

Introduction: Sepsis and septic shock remain global healthcare issues associated with high mortality rates affecting millions every year despite best care efforts. Activation of the renin-angiotensin-system (RAS) is an early event in sepsis, and renin levels may more strongly associate with mortality than serum lactate, a widely accepted index of patient status. We postulated that reduced levels of Angiotensinogen (AGT) may reflect a dysfunctional RAS driven by high renin levels but an attenuated expression of Ang II to adequately support tissue perfusion and blood pressure. This study compared the association with mortality of AGT to serum lactate and active renin in a subset of the VICTAS (Vitamin C, Thiamine, and Steroids in Sepsis) cohort (N=103) at baseline (day 0) prior to treatment. Methods: Serum levels of intact AGT and active renin protein were quantified by separate ELISAs. Biomarker discrimination for all-cause 30-day mortality was compared by receiver operating characteristic (ROC) curves generated by logistic regression models adjusted for age, sex, sequential organ failure assessment (SOFA) score, systolic blood pressure, and in-hospital vasopressor support. Association of serum AGT, renin, and lactate with mortality was assessed by Kaplan-Meier curves with log rank test and hazard ratios derived from Cox regression. Results: Median [interquartile range] serum levels for AGT were: 114 [78.2-205.4] nM; renin: 4.9 [2.2-13.6] pM; and lactate: 2.6 [1.7-3.8] mM. ROC curves revealed better discrimination of AGT for mortality than either active renin or lactate. The area under the curve (AUC) of AGT (0.82, 95% CI: 0.70, 0.93) was greater than lactate (AUC=0.68, 95% CI: 0.57, 0.80; p=0.022). Kaplan-Meier curves and log rank test also revealed that AGT levels below 114 nM associated with reduced survival. Renin levels greater than 4.9 pM were also associated with patient mortality albeit less than that for AGT while higher lactate levels (&gt;2.6 mM) were not associated with mortality in this cohort. Conclusion: AGT levels more strongly associated with 30-day mortality than renin or lactate in the VICTAS cohort. Reduced AGT may reflect increased consumption by high renin coupled with reduced expression by the liver ultimately impairing Ang II-AT 1 R tone in critically ill patients. The prospective assessment of circulating AGT may facilitate more precise therapeutic approaches treatment to restore a dysfunctional RAS and improve overall mortality in sepsis.

The Effect of Family Caregiver Empowerment Model Intervention on Fear of Hypoglycemia in People with Type-2 Diabetes Mellitus

Background: Fear of hypoglycemia is a common psychological issue in people with type-2 diabetes mellitus (T2DM). Families play a crucial role in diabetes self-management, but many need a better understanding of their responsibilities. This gap can lead to increased disease management burdens, contributing to psychological problems like fear of hypoglycemia, which worsens blood glucose control. The Family Caregiver Empowerment Model (FCEM) is an intervention that can empower families in their caregiving roles for T2DM management.Purpose: The study aimed to analyze the effect of the FCEM intervention on the fear of hypoglycemia in people with T2DM.Methods: The study used a randomized control group pretest-posttest design. The sample consisted of family members serving as family caregivers. A total of 85 respondents were randomly assigned to either the intervention group (41 respondents) or the control group (44 respondents). FCEM was conducted once per week for ten weeks. Fear of hypoglycemia was measured using the Indonesian version of the Fear of Hypoglycemia Scale questionnaire. The data were analyzed using the Wilcoxon signed rank test and independent t-test.Results: The results showed significant differences in fear of hypoglycemia between the pre-test and post-test in the intervention group (p=0.001) and the control group (p=0.001). However, there was a significant difference in the decrease in fear of hypoglycemia between the treatment and control groups (t=-7.087; p=0.001 &lt; α = 0.05). It suggests that FCEM intervention can significantly reduce the fear of hypoglycemia in patients with T2DM.Conclusion: FCEM intervention can reduce the fear of hypoglycemia in people with T2DM by increasing family support and caregivers' ability to manage T2DM. Nurses can use FCEM intervention in the management of T2DM so that it can improve diabetes self-management outcomes.