Related-samples Wilcoxon Signed-rank Test Research Articles

Evaluating the effectiveness of a new curriculum for transcultural nursing education: a mixed-method study

BackgroundIn recent years, limited studies have evaluated the development of cultural awareness, sensitivity, skills, communication and competence among nursing students using different models and curricula.ObjectivesThis study aimed to evaluate the effectiveness of a new internationally developed curriculum for transcultural nursing education.MethodsThis mixed methods study was conducted on nursing students (n = 83) who attended a transcultural nursing course from 2021 to 2022 during the fall semester. A paired samples test was used to compare total scores, and the related-samples Wilcoxon signed-rank test was used to compare subscale scores.ResultsThe vast majority (94.0%) of the participants mentioned Islam as their religion. Turkish was the mother tongue of 91.6% of them, while 10.8% were able to speak English and 6.0% were able to speak Kurdish fluently. The mean score for the achievement of cultural competence subdimension posttest was significantly greater (p < 0.001). Posttest mean scores for challenges and barriers in providing culturally competent care subdimensions were significantly lower (p = 0.003). The mean score on the culturally sensitive communication subdimension pretest was 21.00 ± 4.76, and the mean score on the posttest increased to 23.02 ± 6.05, which was a statistically significantly greater difference (p = 0.024). According to the qualitative results of our study, five main themes were analyzed: transcultural nursing as an opportunity, transcultural nursing as a didactic process, transcultural nursing as a professional field, transcultural care as a safe environment, and transcultural care as an obligation.ConclusionsIn this study, after a semester of continuing education, nursing students developed respect for cultural diversity, cultural competence, and culturally sensitive communication.

#2283 Vitamin D metabolism in end stage kidney failure: people receiving haemodialysis can still synthesise 1,25-dihydroxyvitamin D

Abstract Background and Aims A large proportion of haemodialysed patients remain vitamin D deficient, contributing to the development, and severity, of chronic kidney disease-mineral bone disorder (CKD-MBD). This study aimed to investigate the effect of vitamin D (cholecalciferol) supplementation on serum levels of 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3 and 24,25-dihydroxyvitamin D3 in a group of people receiving haemodialysis. Method Eighty-one haemodialysis patients (dialysis vintage ≥1 month) with low serum total 25(OH)D consented to participate. 40,000IU cholecalciferol was given weekly for 12-weeks followed by a maintenance dose of 20,000IU fortnightly (administered by dialysis nursing staff as part of routine care). Patients remained on active vitamin D (1,25(OH)2D3 and analogues) as part of routine care (clinician prescribed for management of calcium and PTH). Baseline and 12-month data were compared using related-samples Wilcoxon signed rank test (Table 1). NHS research ethics committee approval was received. Results Complete data were available and analysed for 55 patients. 1,25(OH)2D3 levels were low at baseline (48.3pmol/L, IQR 35.9-57.9pmol/L) despite 44 of 55 patients (80%) being prescribed an active vitamin D analogue (normal range 60-120pmol/L). Cholecalciferol supplementation normalised both serum 25(OH)D3 and 1,25(OH)2D3 and significantly increased 24,25(OH)2D3 (Table 1). Conclusion Synthesis of 1,25(OH)2D3 is maintained (in kidney failure) but is substrate dependent, and low serum 25(OH)D was evident at baseline. 1,25(OH)2D3 deficiency is therefore partly a consequence of 25(OH)D deficiency, rather than solely due to elevated FGF23 and reduced renal 1α-hydroxylase activity (which is shown to be present in kidney failure). Cholecalciferol supplementation increases the inactive substrate 25(OH)D3 rather than directly increasing 1,25(OH)2D3. Increases in 25(OH)D3 and 24,25(OH)2D3 are disproportionate to 1,25(OH)2D3 increases, demonstrating the known tight regulation of 1,25(OH)2D3 synthesis and secretion (in response to calcium and parathyroid hormone). Conventional oral vitamin D supplementation may provide a cheap and safe strategy for the management of vitamin D homeostasis in chronic kidney disease.

Feedback perceptions of first year medical residents: An intervention-based survey study.

Feedback in residency is a necessity for progression toward clinical competency and is included in The Accreditation Council for Graduate Medical Education (ACGME) milestones as an essential component for accreditation. Our study elucidates perceptions of feedback of first-year residents and aims to identify how these perceptions change after education on building expertise through deliberate practice. First-year internal medicine and neurology residents of a mid-sized university-affiliated residency program answered a five-question 5-point unipolar response scale questionnaire regarding feedback perceptions before and after attending a workshop about building expertise through effective feedback during residency orientation. Related-Samples Wilcoxon Signed Rank Test was applied for comparing pre- versus post-questionnaire data. Of 31 first-year residents, 29 completed the pre-questionnaire for a completion rate of 93.5%, while 24 of 31 completed the post-questionnaire for a completion rate of 77.4%. Of the five questions, three improved when comparing pre and post responses to, including the questions on confidence in the ability to procure feedback (p = <0.001), the effort put into procuring feedback (p = 0.001), and frequency of seeking feedback (p = 0.002). Interest in receiving feedback and the importance of feedback remained unchanged after workshop attendance. Residents should be educated on building expertise through deliberate practice and how to obtain high-quality feedback, given the emphasis and essentiality of feedback within the milestone assessment system and the core competencies of ACGME. In our study, education on these topics led to significant improvement in resident perceptions of confidence in the ability to procure feedback, effort put into procuring feedback, and frequency at which feedback would be sought.

Optimization of Indonesian Youth Knowledge In Stunting Prevention Assistance

The prevalence rate of stunting in Indonesia in 2021 reached 24.4%, surpassing the WHO standard of 20%. As a result, Indonesia is categorized as having a high stunting issue and holds the 2nd position in Asia. Efforts to reduce stunting are closely related to the role of health cadres. Indonesian youth play a crucial role as agents of change, having a 39.8% influence in community involvement. Kader Muda Sehat training, as an innovative program, aims to train young individuals to become health cadres, enabling them to contribute in assisting the targeted individuals affected by stunting.The objective of this study is to analyze the effectiveness of the Kader Muda Sehat training program in enhancing the knowledge of youths as health cadres in the Banyuresmi Subdistrict, Garut Regency. This study was conducted using a quasi-experimental approach with one-group pre-test-post-test design. Kader Muda Sehat training was conducted over 7 sessions from December 2022 to January 2023, using a hybrid approach, online through Zoom meetings and offline in the Karyasari Village, Banyuresmi Subdistrict, Garut Regency, West Java. The sampling technique used in this study was purposive sampling, consisting of 18 young cadres who met the established inclusion criteria. Data collection of young cadre characteristics and knowledge was carried out using pre-test-post-test questionnaires. The research data were analyzed using univariate and bivariate, specifically the related samples Wilcoxon signed-rank test, utilizing SPSS Statistics V25.0 software. The results showed a p-value of 0.000 (0.000 &lt; 0.05), indicating a positive influence of Kader Muda Sehat training on the level of knowledge of young cadres regarding stunting prevention assistance. Based on results, it was concluded that there was an improvement in the youths' knowledge after receiving Kader Muda Sehat training about stunting prevention assistance. Kader Muda Sehat training is effective in enhancing youths' knowledge of stunting prevention assistance.

(112) Efficacy and Safety of Platelet-Rich Plasma Injections for Peyronie’s Disease: A Randomized Double-Blind Placebo-Controlled Cross-Over Study

Abstract Introduction Peyronie's Disease (PD) is currently treated with intralesional collagenase injection, the only FDA-approved medical therapy. Platelet-derived therapies, such as autologous platelet rich plasma (PRP), have shown potential in tissue regeneration. We are investigating the safety and efficacy of PRP in PD with an ongoing randomized, placebo-controlled, crossover study. Objective The objective of this study is to assess the safety and efficacy of autologous platelet-rich plasma (PRP) treatment in Peyronie's Disease (PD) through a randomized, placebo-controlled, crossover trial. Methods We analyzed data from an ongoing trial conducted between April 2021 and June 2023. Men with PD (write degrees/dorsal only etc) were randomly assigned to receive two 0.5 ml injections of PRP obtained using an autologous platelet separator (Arthrex Angel, Arthrex Inc.) or placebo directly into the dominant plaque, with a two-week interval between injections. Immediate post-procedure assessments included Visual Analogue Pain Scale, and follow-up evaluations focused on identifying complications. After three months, participants crossed over to the other treatment arm for two additional injections. Goniometer measurement assessments were performed prior to each crossover (NCT04512287). Related Samples Wilcoxon-Signed Rank test was used for dependent repeated groups, the serial measurements of degree of curvature at different time points for each patient within a specific group. Findings at p&amp;lt; 0.05 were considered statistically significant. Results The analysis includes data from 29 men who completed all injections and the 6-month follow-up. No minor or major adverse events, such as penile bruising, swelling, edema, allergy, or penile fracture, were reported. Regarding efficacy, we observed a significant reduction in curvature after six months compared to baseline. The pretreatment median curvature was 40.0 (IQR: 15), the median post-treatment curvature 30.0 (IQR: 30) (p=0.014). Furthermore, we did not observe worsening of curvature in subsequent evaluations. Conclusions Our findings from our ongoing clinical trial suggest that PRP treatment for Peyronie's Disease is safe, with minimal adverse events reported. The preliminary efficacy data indicates a significant reduction in curvature after 2 injections each of placebo and PRP treatment compared to baseline. Nevertheless, study completion is necessary prior to reporting true efficacy data comparing PRP vs placebo. Disclosure No.

Effect of Dental Practicality Index training using an online video on decision-making and confidence level in treatment planning by dental undergraduates.

The purpose of this study was to evaluate the effect of Dental Practicality Index (DPI) training using an online video on the treatment planning decisions and confidence level of dental undergraduates (DUs). Ninety-four DUs were shown 15 clinical case scenarios and asked to decide on treatment plans based on 4 treatment options. The most appropriate treatment plan had been decided by a consensus panel of experienced dentists. DUs then underwent DPI training using an online video. In a post-DPI-training test, DUs were shown the same clinical case scenarios and asked to assign the best treatment option. After 6 weeks, DUs were retested to assess their knowledge retention. In all 3 tests, DUs completed the confidence level scale questionnaire. Data were analyzed using the related-samples Wilcoxon signed rank test and the independent-samples Mann-Whitney U test with the level of significance set at p < 0.05. DPI training significantly improved the mean scores of the DUs from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. Training DUs using DPI with an online video improved their decision-making and confidence level in treatment planning.

Correlation and utility of the changes in sST2 level at clinician determined decompensation and recompensation

Abstract Introduction Soluble Suppressor of Tumorigenicity 2 (sST2) biomarker has been shown to demonstrate prognostic capabilities in patients with heart failure (HF), with serial measurements of sST2 at pre-determined time intervals providing additional predictive value for adverse outcomes. We sought to evaluate what level of sST2 level change, at clinician determined decompensation and recompensation during an acute admission for decompensated HF, could provide prognostic information for adverse outcomes. Methods Between January 2020 and February 2022, consecutive patients hospitalized at a secondary care hospital had sST2 measured within 24 hours of decompensated HF admission and following recompensation assessed by qualified clinicians, as part of the INST2ANT-HF study. sST2 samples were batched analysed at the end of recruitment period with a quantitative turbidimetric immunoassay. The primary outcome was the interval change between admission and discharge sST2 in patients admitted with decompensated heart failure. Related-samples Wilcoxon signed rank test was performed to evaluate for difference in sST2 at decompensation and recompensation. Comparison of median sST2 change was made using independent samples median test comparing alive and deceased patients at one year follow up. Results In 162 consecutive patients with paired samples, median age was 71 (IQR 61-80). 23.5% were female and 34% had an ischaemic aetiology. 94.4% presented with NYHA class III and IV and median ejection fraction was 26% (IQR 17-32). Median length of stay in hospital was 8 (IQR 5-13) days. Median levels of sST2 at decompensation and recompensation were 60.5 and 39.5ng/ml respectively (p&amp;lt;0.001) (Fig.1a). In patients who died within the first year, median levels of sST2, at decompensation and following recompensation, were significantly higher than in patients who were alive. (decompensation sST2 83 vs 56ng/ml; p = 0.007 and recompensation sST2 58 vs 34ng/ml; p = 0.036) (Fig. 1b). There was however no significant difference in the absolute or percentage change in sST2 level between those who died and those who survived (19.5 vs 16ng/ml, p= 0.437; 27 vs 35%, p = 0.363). Conclusion Our initial data demonstrates that in a cohort of patients admitted with acute decompensated HF, there was a significant difference in sST2 levels between clinician determined decompensation and recompensation. Higher levels of sST2 at both decompensation and recompensation were associated with a higher risk of mortality at one year. Utilizing newer biomarkers such as sST2 to predict outcomes may allow better risk stratification and identifying patients needing closer follow up. More research is needed however to determine what values would be useful in clinical practice.Figure 1Figure 2

Impact of the COVID-19 pandemic on the cost of chronic diseases treatment and care at public hospitals in Wallaga zones, Oromia Regional State, Ethiopia: a hospital-based, cross-sectional study

ObjectiveGlobally, around one-third of the population has at least one long-term health condition that could be affected by the COVID-19 pandemic. Despite the fact that studies have revealed the direct...

Effects of life design counselling on secondary students with career indecision in a resource-constrained community

ABSTRACT This study examined the effects of life design counselling on secondary students with career indecision in a resource-constrained community. Non-probability, purposive sampling was utilized to select 91 secondary students from two schools (intervention group: N = 17, mean age: 18.00; SD = 1.06; comparison group: N = 74; mean age: 17.41; SD = 1.47). A mixed-methods intervention within a pre-test/post-test quasi-experimental design was employed. Data was generated using the Career Adapt-Abilities Scale and the Career Decision Difficulties Questionnaire. The Mann-Whitney U test and related-samples Wilcoxon Signed Rank Test were used to examine the outcomes. The participants did not exhibit a decrease in career indecision after the intervention but there was an increase in their curiosity. The intervention should be repeated in longitudinal research with larger samples of diverse participants and different designs and assessment measures.

Translation directionality and the Inhibitory Control Model: a machine learning approach to an eye-tracking study.

Based on such physiological data as pupillometry collected in an eye-tracking experiment, the study has further confirmed the effect of directionality on cognitive loads during L1 and L2 textual translations by novice translators, a phenomenon called "translation asymmetry" suggested by the Inhibitory Control Model, while revealing that machine learning-based approaches can be usefully applied to the field of Cognitive Translation and Interpreting Studies. Directionality was the only factor guiding the eye-tracking experiment where 14 novice translators with the language combination of Chinese and English were recruited to conduct L1 and L2 translations while their pupillometry were recorded. They also filled out a Language and Translation Questionnaire with which categorical data on their demographics were obtained. A nonparametric related-samples Wilcoxon signed rank test on pupillometry verified the effect of directionality, suggested by the model, during bilateral translations, verifying "translation asymmetry" at a textual level. Further, using the pupillometric data, together with the categorical information, the XGBoost machine-learning algorithm yielded a model that could reliably and effectively predict translation directions. The study has shown that translation asymmetry suggested by the model was valid at a textual level, and that machine learning-based approaches can be gainfully applied to Cognitive Translation and Interpreting Studies.

Relationships Between the Auditory Nerve's Ability to Recover From Neural Adaptation, Cortical Encoding of and Perceptual Sensitivity to Within-channel Temporal Gaps in Postlingually Deafened Adult Cochlear Implant Users.

As a step toward identifying the origin of the across-electrode variation in within-channel gap detection thresholds (GDTs) measured in individual cochlear implant (CI) users, this study assessed the relationships between the auditory nerve's (AN's) ability to recover from neural adaptation, cortical encoding of and perceptual sensitivity to within-channel temporal gaps in postlingually deafened adult CI users. Study participants included 11 postlingually deafened adults with Cochlear Nucleus devices, including three bilaterally implanted participants. In each of the 14 ears tested, recovery from neural adaptation of the AN was measured using electrophysiological measures of the electrically evoked compound action potential at up to four electrode locations. The two CI electrodes in each ear showing the largest difference in the speed of adaptation recovery were selected for assessing within-channel temporal GDT. GDTs were measured using both psychophysical and electrophysiological procedures. Psychophysical GDTs were evaluated using a three-alternative, forced-choice procedure, targeting 79.4% correct on the psychometric function. Electrophysiological GDTs were measured using the electrically evoked auditory event-related potential (eERP) evoked by temporal gaps embedded in electrical pulse trains (i.e., the gap-eERP). Objective GDT was defined as the shortest temporal gap that could evoke a gap-eERP. Related-samples Wilcoxon Signed Rank test was used to compare psychophysical GDTs and objective GDTs measured at all CI electrode locations. It was also used to compare psychophysical GDTs and objective GDTs measured at the two CI electrode locations with different speeds or amounts of adaptation recovery of the AN. A Kendall Rank correlation test was used to assess the correlation between GDTs measured at the same CI electrode location using psychophysical or electrophysiological procedures. Objective GDTs were significantly larger than those measured using psychophysical procedures. There was a significant correlation between objective and psychophysical GDTs. GDTs could not be predicted based on the amount or the speed of adaptation recovery of the AN. Electrophysiological measures of the eERP evoked by temporal gaps can potentially be used to assess within-channel GDT in CI users who cannot provide reliable behavioral responses. The difference in adaptation recovery of the AN is not the primary factor accounting for the across-electrode variation in GDT in individual CI users.

Detections of organophosphate and pyrethroid insecticide metabolites in urine and sweat obtained from women during infrared sauna and exercise: A pilot crossover study.

Synthetic pesticides such as organophosphates and pyrethroids are commonly used worldwide yet the metabolic and long-term human health effects of these environmental exposures are unclear. Urinary detections of metabolites involving both classes of insecticides have been documented in various global populations. However, reports documenting similar detections in human sweat are sparse. In this study, the concentrations of four insecticide metabolites were measured using liquid chromatography coupled with tandem mass spectrometry in repeated sweat and urine collections (n=85) from 10 women undergoing three interventions (control, infrared sauna and indoor bicycling) within a single-blinded randomised crossover trial. The Friedman test with post-hoc two-way analysis of variance, the related-samples Wilcoxon signed rank test and the Spearman's rank-order correlation test were used to analyse the results. Organophosphate metabolites were detected in 84.6% (22/26) and pyrethroids in 26.9% (7/26) of the collected sweat samples (pooled per individual, per intervention). Urinary concentrations of three of the four metabolites marginally increased after infrared sauna bathing: 3,5,6-trichloro-2-pyridinol (z=2.395, p=0.017); 3-phenoxybenzoic acid (z=2.599, p=0.009); and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane-1-carboxylic acid (z=2.090, p=0.037). Urinary 3-phenoxybenzoic acid also increased after exercise (z=2.073, p=0.038) and demonstrated the most temporal variability (days to weeks) of any of the urinary metabolites. Definitive sweat/urine correlations were not demonstrated. These results indicate metabolites from organophosphate and pyrethroid pesticides can be detected in human sweat and this raises intriguing questions about perspiration and its role in the metabolism and excretion of synthetic pesticides.

Assessing Psychological Resilience and Distress Among Graduate Health Profession Students During the COVID-19 Pandemic.

Resilience, a person's ability to adapt to adverse events, is associated with positive outcomes, especially in the field of healthcare. Research into the effects of the COVID-19 pandemic may help to understand and combat the long-term mental health burden for trainees in health care. This cross-sectional study aimed to assess the impact of the pandemic on health profession students' educational experiences, determine the association between their self-reported resilience and psychological distress and assess group differences between students from different graduate health profession programs in an academic medical center. Graduate health profession students completed a 44-question online survey and the 10-item Connor Davidson Resilience Scale (CD-RISC-10) during the COVID-19 pandemic period between January-March 2021. We used descriptive statistics, independent samples t test, Related-samples Wilcoxon signed rank test, Pearson correlations test and Analysis of variance (ANOVA) to analyze the data. Majority of respondents reported that COVID-19 had a negative impact on their education and caused a reduction in educational opportunities (76.6% and 73% respectively). Majority also reported feeling burned out, lonely/isolated, or frustrated by COVID-19 restrictions (70.0%, 67.4%, and 61.8% respectively). Students reported increased use of both avoidant and adaptive coping strategies during the pandemic. Higher resilience scores were associated with higher self-reported stress, fewer burnout symptoms, and better overall well-being. The COVID-19 pandemic significantly affected students in graduate health profession programs. Instructional quality, educational opportunities, institutional trust, peer socialization, and personal health and wellbeing were perceived to be negatively impacted. Students may require additional support and resources from their training programs to mitigate these concerns. Future studies should evaluate the long-term impact of the COVID-19 pandemic among pandemic-era graduate health profession students.

2080. Differences in Hormonal Measures Among Transgender Individuals Assigned Male at Birth Switching from Tenofovir Disoproxil Fumarate/Emtricitabine to Tenofovir Alafenamide/Emtricitabine for Pre-Exposure Prophylaxis

Abstract Background There are concerns among transgender (TG) individuals about the effect of changing pre-exposure prophylaxis (PrEP) products on hormone concentrations. The objective of this study was to compare hormone concentrations among TG individuals assigned male at birth (AMAB) who switched from tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) to tenofovir alafenamide/emtricitabine (TAF/FTC) for PrEP. Methods An observational cohort study was performed among a subset of TG individuals AMAB enrolled in a clinical trial evaluating TAF/FTC for PrEP. Inclusion criteria for this study were ≥18 years old, TG identity, HIV negative, use of both TDF/FTC and TAF/FTC for ≥12 weeks, and availability of stored blood samples for hormone measurement while on both medications. Estradiol, testosterone (total and free) and sex hormone binding globulin were quantified at two time points: once while on ≥12 weeks of TDF/FTC and after ≥12 weeks on F/TAF. Median hormone concentrations were compared using related-samples Wilcoxon Signed Rank Test. Results Thirty participants met inclusion criteria with mean age of 35.9 ± standard deviation 9.7 years. There were 20 (67%) participants who identified as TG female. The remaining identified as gender non-conforming. Most participants self-identified as either Caucasian (40%), Hispanic or Latino/a/x (33%), Black (13.3%) or Asian (13.3%). Gender affirming therapy was used by 20 (67%) participants. The median (interquartile range, IQR) duration of TDF/FTC use before switching to TAF/FTC was 48 (15 – 60) weeks. Hormone values during TDF/FTC and TAF/FTC by use of gender affirming therapy is displayed in the Figure. Hormonal Values Before and After Switching PrEP Products, by Use of Gender Affirming Therapy Conclusion Switching to TAF-based PrEP was not associated with significant changes in hormone values among TG individuals AMAB. Disclosures Nimish Patel, PharmD, PhD, Gilead: Grant/Research Support Jill Blumenthal, MD, Gilead: Grant/Research Support Sheldon Morris, MD, Gilead: Grant/Research Support.

Renewable Energy Consumption During Covid-19 Pandemic

Currently, the pandemic derived from the outbreak of the Covid-19 virus represents one of the most complicated situations for the world economy because it is a health emergency, which has created remarkable affectations in all types of industries, such as the electrical industry. A brief information about the distribution, commercialization, and diversity in power generation sources is included. This report analyzes the annual average change in percent renewable energy consumption from 2019 to 2020 for the representative group of selected countries: China, France, Germany, Italy, Japan, Portugal, Spain, United Arab Emirates, United Kingdom, and United State; where the parametric (paired t-Test), and the non-parametric technique (related-samples Wilcoxon signed rank test) produced the same result: the average annual change in the percentage consumption of renewable energy from 2019 to 2020 has been significant (p-value&lt; 0.01) for the group of selected countries. We conclude this report by proposing the implementation of a new paradigm: The transformation of an energy dependent on oil into one dependent on renewable sources, such as solar radiation and wind mainly.

Online Flipped Classroom: Developing Postgraduate Science Education Students’ Critical Thinking Skills

During the Covid-19 pandemic, online learning should be carried out through innovative methods. This study aims to determine whether implementing an online flipped classroom, with converting all face-to-face sessions into virtual face-to-face sessions, can facilitate the development of critical thinking skills of postgraduate science education students in the School Physics course. This quantitative study used one group pretest-postest research design. The subjects were postgraduate science education students who took School Physics courses in the first semester at one of the public universities in Indonesia. Online Flipped classroom was supported by Google Classroom Learning Management System (LMS). Critical thinking skills data in School Physics were obtained through tests. Data were analyzed using a description of normalized changes (c) and nonparametric-inferential analysis with the Related-Samples Wilcoxon Signed Rank Test. The results showed that the online flipped classroom could facilitate the development of the students’ critical thinking skills with an average normalized change of .71 in a high category. Even though the students felt the benefits of an online flipped classroom, they still wanted a face-to-face learning mode to be carried out soon.

Influence of contextual factors and reliability of ultrasound skin measures in persons with systemic sclerosis and healthy controls.

To examine the influence of contextual factors upon the evaluation of skin thickness and stiffness by ultrasound and to assess the reliability of these parameters. Ultrasound dermal thickness (by B-mode, 18MHz) and skin stiffness (by shear-wave elastography, 9MHz) were assessed in persons with systemic sclerosis (SSc) and in healthy controls. The influence of contextual factors upon repeated measures was evaluated: (i) room temperature (16-17ºC vs. 22-24ºC); (ii) time of day (morning vs. afternoon), and (iii) menstrual cycle phase (menstrual vs. ovulatory). Differences were analysed using the related-samples Wilcoxon signed-rank test. Inter- and intra-rater reliability of ultrasound skin thickness and stiffness were evaluated in the 17 skin Rodnan sites of 20 persons with SSc and 20 healthy controls, under stable contextual conditions. A significant increase in ultrasound dermal thickness was observed at the leg in the afternoon vs morning, in both patients and controls. Similar observations were made for skin stiffness at the leg (in SSc) and at the foot (in SSc and controls) in the afternoon. No significant changes were observed in association with room temperature and menstrual cycle. Intra- and inter-rater-reliability was good to excellent for ultrasound dermal thickness and stiffness, both in SSc and healthy controls. The timing of the ultrasound procedure within each day seems to influence the ultrasound measures at the legs and feet. Our study corroborates that ultrasound dermal thickness and skin stiffness are reliable domains to quantify skin involvement in SSc.

Comparing Psychoanalytic Process in Consulting Room and Teleconference: A Naturally Occurring Controlled Experiment.

In response to COVID-19, clinicians migrated psychoanalyses to videoconference platforms, creating an opportunity for a controlled empirical study in which only the site varied. There will be no differences in the quality of the psychoanalytic process (QAP) in the consulting room (CR) and in videoconference (VC). Individuals' defensive functioning (adaptive style) will be associated with their capacity to maintain the analytic process when treatment moves from CR to VC. Underlying was the concept that empirical research of clinical psychoanalysis is possible. Forty psychoanalysts of all ranks in the Accreditation Council for Psychoanalytic Education, Inc., accredited programs contributed 50 cases. Participants scored QAP at each site on a 0-to-100 scale. They reported patients' characteristic defense mechanisms using the Defensive Functioning Scale (DFS). To minimize bias, investigators calculated median DFS scores from data provided by clinicians. They compared QAP scores in CR and VC for the entire group without and with DFS scores, and for each DFS level (when feasible) using the related-samples Wilcoxon signed-rank test. There was no difference in QAP between CR and VC for the group as a whole; but QAP of the Minor Image Distorting group degraded significantly from CR to VC. This was the only group showing a significant difference. While statistical significance may not reflect clinical significance, individual differences in adaptation to telepsychoanalysis warrant further study. Empirical research of phenomena occurring naturally in clinical psychoanalysis appears feasible.

The Effects of Radiotherapy on Microhardness and Mineral Composition of Tooth Structures.

The purpose of this study was to evaluate the microhardness and mineral composition alterations in enamel and dentine after radiotherapy. Forty human maxillary premolar teeth (20 pairs) were assigned to nonirradiated and irradiated groups, the latter irradiated by fractional radiation to achieve a total dose of 70 Gy. Microhardness measurement was performed on a Knoop microhardness tester. Chemical components were analyzed using energy dispersive spectroscopy and Fourier transform Raman spectroscopy. The morphology was observed using a scanning electron microscope. The microhardness data were analyzed using a paired t-tested and one-way repeated analysis of variance (ANOVA), and the mineral composition data using related-samples Wilcoxon signed rank test and related-samples Friedman's two-way ANOVA by ranks. The irradiated teeth had a significantly lower microhardness in both enamel and dentine compared with the nonirradiated teeth. The irradiated dentine at 50 μm from the external tooth surface at the cemento-enamel junction showed the lowest microhardness compared with other locations. There was no statistically significant difference in calcium:phosphate ratio and chemical components. There was a reduction in protein:mineral ratio in dentine and at the cemento-enamel junction after irradiation. The irradiated teeth exhibited crack lines at the dentine-enamel junction and in dentine. Fractional radiation reduced microhardness in both enamel and dentine. The cervical dentine exhibited the highest microhardness reduction compared with other enamel and dentine locations.

Hemodynamic response and safety of vasodilator stress cardiovascular magnetic resonance in patients with permanent pacemakers or implantable cardioverter-defibrillators.

Vasodilator stress cardiovascular magnetic resonance (CMR) is a powerful diagnostic modality, but data toward its use in patients with permanent pacemakers (PPMs) or implantable cardioverter-defibrillators (ICDs) is limited. Patients with ICDs (>1% pacing) or PPMs who underwent regadenoson single photon emission computed tomography (SPECT) and all patients with ICDs or PPMs who underwent stress CMR were retrospectively identified. SPECT tests were analyzed for hemodynamic responses and new pacing requirements; CMR studies were examined for safety, device characteristics and programming, hemodynamic responses, and image quality. Changes from baseline were evaluated with the Related-Samples Wilcoxon Signed Rank Test. Of 67 patients (median age 65 [IQR 58-72] years, 31 [46%] female, 31 [46%] Black), 47 underwent SPECT and 20 CMR. With regadenoson SPECT, 89% of patients experienced tachycardic responses above resting heart rates (+19 [13-32] beats per minute, p < .01). During stress CMR, 10 (50%) devices were asynchronously paced approximately 10 beats per minute above resting rates, and the remaining were temporarily deactivated. Those with asynchronous pacing had no changes in heart rates, whereas patients with deactivated devices had near uniform heart rate accelerations. Image quality was diagnostic in the majority of stress CMR sequences, with nonconditional ICDs contributing 40 of 57 (70%) of nondiagnostic segments. This data supports the safety of vasodilator stress CMR with promising diagnostic quality images in patients with CMR conditional ICDs and PPMs. Despite a near uniform tachycardic response to regadenoson in the SPECT environment, high rates of asynchronous pacing during vasodilator stress CMR did not result in competitive pacing or adverse arrhythmic events. Further studies are needed to validate these findings and confirm the diagnostic and prognostic performance of stress CMR in these individuals.