Minimum Required Sample Size Research Articles

Push, Pull and Mooring Factors on Offline-Online Learning Switching Behavior

During the pandemic, many sectors, including education, were affected. The shift from traditional to online learning is an opening for students and educators to explore online learning. Students may connect from anywhere at any time through this learning mode. This sudden shift has impacted the learning behavior of students to a large extent. People can access information anytime and anywhere that is typically available only through a traditional classroom. This study adopts the Push-Pull-Mooring (PPM) theory as the theoretical framework to understand how push, pull, and mooring factors affect students' shift from offline to online learning. A survey was used as the main instrument in this study. A quantitative approach was utilized to achieve the stated research objectives. The questionnaires were distributed among undergraduate students in public and private schools in Malaysia through convenience sampling techniques. The minimal 77 sample size has been determined by utilizing G*Power software. 117 responses were collected from the questionnaires that met the minimum required sample size for this study. The findings emphasize that push and pull factors are essential to student learning. However, the mooring factor does not affect the student's switching behavior. The study sheds light on capturing more essential measures in the theoretical development of switching behavior.

Examining the perception of undergraduate health professional students of their learning environment, learning experience and professional identity development: a mixed-methods study

BackgroundThe quality of the learning environment significantly impacts student engagement and professional identity formation in health professions education. Despite global recognition of its importance, research on student perceptions of learning environments across different health education programs is scarce. This study aimed to explore how health professional students perceive their learning environment and its influence on their professional identity development.MethodsAn explanatory mixed-methods approach was employed. In the quantitative phase, the Dundee Ready Education Environment Measure [Minimum–Maximum possible scores = 0–200] and Macleod Clark Professional Identity Scale [Minimum–Maximum possible scores = 1–45] were administered to Qatar University-Health students (N = 908), with a minimum required sample size of 271 students. Data were analyzed using SPSS, including descriptive statistics and inferential analysis. In the qualitative phase, seven focus groups (FGs) were conducted online via Microsoft Teams. FGs were guided by a topic guide developed from the quantitative results and the framework proposed by Gruppen et al. (Acad Med 94:969-74, 2019), transcribed verbatim, and thematically analyzed using NVIVO®.ResultsThe questionnaire response rate was 57.8% (525 responses out of 908), with a usability rate of 74.3% (390 responses out of 525) after excluding students who only completed the demographic section. The study indicated a “more positive than negative” perception of the learning environment (Median [IQR] = 132 [116–174], Minimum–Maximum obtained scores = 43–185), and a “good” perception of their professional identity (Median [IQR] = 24 [22–27], Minimum–Maximum obtained scores = 3–36). Qualitative data confirmed that the learning environment was supportive in developing competence, interpersonal skills, and professional identity, though opinions on emotional support adequacy were mixed. Key attributes of an ideal learning environment included mentorship programs, a reward system, and measures to address fatigue and boredom.ConclusionsThe learning environment at QU-Health was effective in developing competence and interpersonal skills. Students' perceptions of their learning environment positively correlated with their professional identity. Ideal environments should include mentorship programs, a reward system, and strategies to address fatigue and boredom, emphasizing the need for ongoing improvements in learning environments to enhance student satisfaction, professional identity development, and high-quality patient care.

The Impact of Optimized Blinking on Vision and Related Parameters in Individuals With Computer Vision Syndrome: A Single-Blind Randomized Controlled Trial.

Computer vision syndrome (CVS) has become a significant issue for individuals working on computers and digital devices for extended periods. The ocular and periocular symptoms and signs associated with CVS are a major concern, affecting individuals physically and financially. Additionally, CVS has been linked to the rapid progression of myopia, exacerbating the situation. Blinking has been one of the major treatment methods for the treatment of CVS. This study presents a unique and novel randomized controlled therapeutic trial that evaluates the impact of extended blinking therapyon eyehealth and vision, along with other related parameters. Materialsandmethods: The present studyis a randomized controlled trial conducted from September 2022 to April 2024. Participants aged 18-40 with CVSand a computer vision syndrome questionnaire (CVS-Q)score of ≥6, with mild to moderate refractive error (between -6D and +4D), were included. The sample size was determined based on a pilot study, resulting in a minimum required sample size of 36 patients (18 cases and 18 controls). Participants were randomly assigned to either the case (interventional) or control (conventional) group and were followed up for six months. Cases received conventional CVS treatment plus optimized blinking exercises, while controls received conventional therapy only. Comprehensive ocular assessments were conducted bi-monthly over six months, evaluating changes in uncorrected visual acuity (UCVA), refractive error, near point of accommodation (NPA), near point of convergence (NPC), Schirmer's test, and tear film breakup time (TBUT). The study included 20 patients in the case group and 18 in the control group, primarily aged 20-29 (60.5%). Most patients used laptops for their activities (55.26%). The CVS-Q score significantly decreased in both groups following treatment, with both cases and controls showing significant improvement (p<0.001 for both groups). UCVA in the right eye (RE) and left eye (LE) of the cases improved significantly post-treatment in the interventional group (RE: p=0.002; LE: p<0.001). A significant change in refractive error, which is measured as spherical equivalent (SE), was seen among cases following treatment (RE: p<0.001; LE: p=0.021). Controls showed no significant changes in visual acuity or refractive error. The NPAin the cases improved significantly in the RE (p=0.027) but not in the left. The NPC in the intervention group showed no significant change, while controls showed considerable improvement (p=0.042). Schirmer's test results showed no significant change in either group. However, TBUTin the cases improved significantly (RE: p<0.001; LE: p<0.001). In the controls, TBUT decreased significantly, indicating a deterioration in tear film stability. Asthenopia grades improved considerably in cases, while controls showed only some improvement. Severe symptoms still remained in the control group, emphasizing the potential benefits of the blinking exercise in reducing asthenopia symptoms. Optimized blinking therapy significantly improves vision and refractive error, tear film stability, and discomfort, making it beneficial for chronic computer users to maintain ocular health and enhance productivity and quality of life.

Data-driven prediction of fracture toughness size effect in ductile-to-brittle transition using Two-Step-Scaling procedure

The fracture properties of ferritic steels in transition temperature region are usually statistically treated by models that presuppose the existence of various forms of quenched disorder (critical cleavage triggers). In this study, the fracture toughness from the Euro fracture toughness dataset (stress intensity factor used in the master curve KJc) for reactor steel 22NiMoCr37 is used with the aim of outlining a methodology for using the recently proposed two-step scaling (2SS) method. Three widely different temperatures (−154 °C, −91 °C, and 0 °C), which cover the entire range from lower shelf to upper shelf fracture, are selected to demonstrate the accuracy of extrapolation and interpolation of the fracture toughness CDF (cumulative distribution function) and the pertinent issues related to the procedure application. The obtained predictions at the two lower temperatures are in good agreement with the experimental results and well within the inherent experimental data scatter, while 2SS method is shown not to be applicable in upper-shelf transition region. Special attention is devoted to the effect of statistical sample size on prediction accuracy/reliability along with the minimum sample size requirement. Moreover, the reduction in random sample size affects the Weibull parameters, which in turn impacts the accuracy of predictions, introducing a degree of uncertainty and highlighting limitations in the method.

The Non-Accessible Ureter: Can History, Gender, Age, BMI, Radiology and Stone Size Predict the Requirement of Pre-Stenting in Narrow Ureters

Abstract: Background: The difficulty in access to the ureter during stone removal surgery enhances the chances of redo-surgery, DJ stenting, and associated complications, this failure leads to mistrust in the doctor-patient relationship. Objective: This study aims to provide a comprehensive evaluation of the incidence &amp; management of narrow ureters after failure to negotiate retrograde access of rigid or flexible Ureteroscope (6/7.5 Fr ). Materials and Methods: This is a Prospective, cross-sectional study, conducted at the urology department of Tabba Kidney Institute, from June 2022 to June 2023. The minimum required sample size was 250. Patients aged between &gt; 18 to &lt;60 diagnosed with Unilateral and bilateral ureteric stones and hydronephrosis without ureteric stone obstruction were included in the study. SPSS 22 was used to analyze the data, the chi-square test was applied, with p-value &lt;0.05 as significant. Result: The overall mean age of the study population was estimated as 40.71 ± 12 years, while gender distribution indicated 138 (55.2%) male and 112 (44.8%) female patients. Group distribution identified 172 (68.8%) patients with negotiable ureter (Group A), while 78 (31.2%) with non-negotiable ureter (Group B). Conclusion: We conclude that in our population there is a higher incidence of narrow ureters, as compared to other studies which are not accessible even using the same dilatation technique, so it is safe to counsel the patients pre-operatively about the possibility of the narrow ureter and need for pre-stenting. Tabba Ureter Accessibility (TUA) score can be used as a tool to predict the possibility of a narrow ureter. Keywords: Narrow ureter, Ureteric stone, DJ stent, Ureterorenoscope, Dehydration, Hematuria.

The Effects of Medium-Chain Triglyceride Oil and Butter on Lipid Profiles.

Background and objective Butter coffee drinks, mainly a form of a saturated fat diet, are widely accepted as a "healthy energy-boosting drink", especially in the young and healthy military population. The objective of our study was to determine the effects of medium-chain triglyceride(MCT) oil and butter on lipid profile, especially apolipoprotein B (ApoB), low-density lipoprotein (LDL)-cholesterol (LDL-C), high-density lipoprotein (HDL)-cholesterol (HDL-C), and other risk factors for coronary heart disease, such as BMI, BP, fasting blood glucose, HbA1c, and high-sensitivity C-reactive protein (hs-CRP) levels in healthy adults. Materials and methods We conducted aprospective study of 60 subjects who were randomized to one of the two following regimens: (1) coffee or (2) coffee with butter plus MCT oil combination. The primary outcome was the effect on ApoB. Secondary outcomes were as follows: non-HDL-C, LDL-C, triglycerides, BP, waist circumference, fasting blood glucose, and HbA1c. These parameters were evaluated at the baseline and after 12 weeks. The Mann-Whitney U test was utilized for analysis of the results. Results While 60 subjects were recruited for the study, only 41 completed it, meeting the minimum required sample size (17 per group) necessary to achieve the desired effect size: 21 males (nine in the control group and 12 in the experimental group) and 20 females (10 in each group). Anthropometric measures were similar between the two groups at baseline, and so were age and BMI(average age: 33.00 ± 5.84 years among controls and 30.86 ± 6.14 years in the experimental group; BMI: 27.35 ± 4.63 kg/m2vs. 25.74 ± 2.70 kg/m2). The pulse rate was 69.35 ± 10.98in the control vs. 70.68 ± 10.32 bpm in the experimental group.The waist size was also similar in both groups. Baseline lab findings were as follows: ApoB: 89.85 ± 17.52 (control), 81.60 ± 12.84mg/dL (experimental); hs-CRP: 0.18 ± 0.27(control), 0.17 ± 0.27 mg/L (experimental); LDL-C 113.65 ±23.71(control), 106.50 ± 18.99 mg/dL (experimental); HDL-C 57.35 ± 14.63(control),62.41 ± 16.15 mg/dL (experimental); and triglycerides: 76.00 ± 31.30(control), 56.77 ± 14.77 mg/dL (experimental), and these values were similar. The values after 12 weeks of intervention were as follows: BMI: 27.37 ± 5.24 (control), 26.36 ± 3.55 (experimental); pulse rate: 78.88 ± 14.00(control), 74.20 ± 11.90 bpm (experimental); ApoB 87.1 ± 17.38 (control), 85.7 ±20.59 mg/dL (experimental); hs-CRP 0.26 ± 0.22(control), 0.15 ± 0.14 mg/L (experimental); LDL-C 111.59 ± 20.35 (control), 114.10 ± 26.99 mg/dL (experimental); HDL-C 57.71 ± 12.93(control), 64.85 ± 13.32 mg/dL (experimental); and triglycerides: 74.71 ± 25.39(control), 60.80 ± 15.77 mg/dL (experimental). Conclusion At a significance level of 5%, there was no difference between the two groups, either at the baseline or at 12 weeks of intervention. Based on our findings, adding MCT oil and butter to coffee may be safe. However, further studies with larger sample sizes and longer duration are needed to validate our findings.

Abstract PO5-20-04: A Phase II Study of Ribociclib and Endocrine Treatment of Physician’s Choice for Locoregional Recurrent, Resected Hormone Receptor Positive HER2 Negative Breast Cancer (RaPhLRR Study)

Abstract Background Hormone receptor positive (HR+) breast cancer (BC) is the most common subtype of BC (70-80%). This subset tends to have good prognosis, therefore most patients with localized disease have excellent long-term survival, approaching 100% 5-year relative survival. However, 10% of patients experience loco-regional recurrence (LRR) within 5 year of final surgical management of the primary disease-well within the typical treatment window of adjuvant endocrine therapy. Few studies exists to guide the systemic treatment of patients who have suffered LRR of HR+ HER2 - BC. The randomized controlled CALOR trial demonstrated no benefit to systemic cytotoxic chemotherapy for this subgroup of patients and persistent high rate of subsequent recurrences (50% within 10 years on LRR event). There is no standard of care for managing this patient population. The combination of ribociclib and endocrine therapy (ET) (fulvestrant and aromatase inhibitors) is FDA approved for management of unresectable recurrences and metastatic HR+HER- BC (MONALEESA trials). CDK4/6 inhibitors have been investigated in early BC setting too, several trials showing positive results (monarchE, NATALEE). Data is needed to investigate their use in patients with LRR. Trial design This is a multicenter, single arm phase II study to evaluate efficacy and safety of ribociclib and ET in patients with LRR of HR+HER2- BC. Treatment includes ribociclib for 36 months, 600 mg daily for 21 days, 28-day cycle plus physician’s choice ET for 60 months (fulvestrant or AIs). Ribociclib dose was chosen based on approved dose in metastatic BC. Eligibility Criteria Patients ≥ 18 of age, with LRR of BC (ipsilateral breast, axilla, regional lymph nodes, chest wall), histologically confirmed estrogen receptor positive and/or progesterone receptor positive, HER 2 negative. Patients must have adequate local treatment for LRR (surgery and/or radiation) with negative microscopic margins, no evidence of distant metastatic disease. Prior treatment with neo-adjuvant and adjuvant chemotherapy and ET is allowed, no prior CDK 4/6 inhibitor in the last 12 months. Pre and post-menopausal women are allowed. Patient must enroll within 6 months of the last local therapy. Specific aims Primary objective: to estimate subsequent recurrence-free survival (RFS) at 3 years for ribociclib when administered with ET in patients with HR + HER2- BC with adequately resected local recurrence. Secondary objectives: to estimate distant metastasis-free survival and overall survival, to evaluate safety and tolerability, to identify predictors of LRR. Correlative analysis will explore prognostic and predictive biomarkers of treatment with ribociclib and ET and potential molecular mechanisms of resistance to treatment. Statistical Methods From previous published data (J Clin Oncol. 2018 Apr 10;36(11):1073-1079), we assume that patients receiving standard of-care management following recurrence would have a recurrence free survival (RFS) rate of 80% at 3 years and that treatment with ribociclib + ET will increase it by 7%. We wish to have at least 80% power at that significance level of 0.0487 to correctly detect that improvement in RFS rate at 3 years from 80 to 87%. Because only an improvement in RFS rate is of clinical interest, we have a directional hypothesis, and have used a 1-sided alpha. Using a one-sample survival study design, with assumed accrual duration of 3-years and additional follow-up time of 3 years, the minimum sample size requirement is N=180 patients. Target accrual The minimum sample size requirement is N=180 patients. A bigger sample size of N=200 patients will achieve a power of at least 84%. Current accrual is 6/200. This study will be open at up to 35 sites. Contact information The study is being administered through the HCRN, it can be identified as BRE20-468, NCT05467891, ocdanciu@uic.edu Citation Format: Oana Danciu, Nancy Chan, Kari Wisinski, Trish Millard, Kathleen Kemmer, Sneha Phadke, Zhengjia Chen, Ana Cuesta Fernandez, Melanie Clark, Alison Conlin, Coral Omene, Sima Ehsani, Stephanie Dublis, Vijayakrishna K. Gadi. A Phase II Study of Ribociclib and Endocrine Treatment of Physician’s Choice for Locoregional Recurrent, Resected Hormone Receptor Positive HER2 Negative Breast Cancer (RaPhLRR Study) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-04.

Prevalence of Diabetes Distress among Adults with Diabetes Mellitus in a Rural Area of West Bengal: A Cross-sectional Study

Introduction: Diabetes distress is the emotional burden of diabetics and it may have a devastating impact on the health and well-being of people with diabetes. This study aims to estimate the prevalence of diabetes distress among adults with diabetes mellitus registered in the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) register in a rural area of West Bengal and to identify its distribution across different sociodemographic and treatment-related variables. Materials and Methods: This community-based descriptive, cross-sectional study was conducted in Barrackpore II block of North 24 Parganas district between July 2023 and September 2023. The study population consisted of diabetics registered under the NP-NCD register. The minimum required sample size of 155 was selected through a multistage sampling technique. Socioeconomic and sociodemographic data were collected using standardized questionnaire. Problem Areas in Diabetes questionnaire was used for assessing diabetes distress. Medication Adherence Report Scale questionnaire was used to check for medication adherence. Data were collected by house-to-house visits. Data were analyzed using jamovi (v2.4.8). Results: Out of the 142 participants, 52 (36.6%) had diabetes distress. Odds of diabetes distress were higher among &lt;50 years of age (6.25 [2.41, 16.18]), females (3.66 [1.46, 9.21]), individuals with poor adherence to medications (8.40 [3.26, 21.59]), and individuals procuring medicines from private shops (3.47 [1.00, 12.00]). Conclusion: Diabetes distress is a public health problem among adults living with diabetes, which may have negative impacts on their quality of life and health outcomes. Further research is needed to explore the possible mitigating measures for the same.

VAE-Based Interpretable Latent Variable Model for Process Monitoring.

Latent variable-based process monitoring (PM) models have been generously developed by shallow learning approaches, such as multivariate statistical analysis and kernel techniques. Owing to their explicit projection objectives, the extracted latent variables are usually meaningful and easily interpretable in mathematical terms. Recently, deep learning (DL) has been introduced to PM and has exhibited excellent performance because of its powerful presentation capability. However, its complex nonlinearity prevents it from being interpreted as human-friendly. It is a mystery how to design a proper network structure to achieve satisfactory PM performance for DL-based latent variable models (LVMs). In this article, a variational autoencoder-based interpretable LVM (VAE-ILVM) is developed for PM. Based on Taylor expansions, two propositions are proposed to guide the design of appropriate activation functions for VAE-ILVM, allowing nondisappearing fault impact terms contained in the generated monitoring metrics (MMs). During threshold learning, the sequence of counting that test statistics exceed the threshold is considered a martingale, a representative of weakly dependent stochastic processes. A de la Peña inequality is then adopted to learn a suitable threshold. Finally, two chemical examples verify the effectiveness of the proposed method. The use of de la Peña inequality significantly reduces the minimum required sample size for modeling.

THE ROLE OF BUSINESS MODEL CANVAS (BMC) IN DIGITAL ENTREPRENEURSHIP ON STUDENTS' INTEREST IN INDONESIA

THE ROLE OF BUSINESS MODEL CANVAS (BMC) IN DIGITAL ENTREPRENEURSHIP ON STUDENTS' INTEREST IN INDONESIA

Barriers Impact the Primary Healthcare Providers When Dealing With Emergency Cases: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia.

Introduction Being the first in-line care providers, primary healthcare (PHC) physicians may encounter all forms of medical emergencies, ranging from minor complaints to major life-threatening events; therefore, this study aims to assess the PHC physicians' knowledge and attitude related to the diagnosis and management of emergency cases as well as their preferences for emergency medicine training courses and their preferred methods of training. Methods A descriptive cross-sectional study was conducted among physicians working at PHC in Al-Ahsa, Saudi Arabia, between November and December 2023, excluding those who do not work at PHC. The minimum required sample size was 192. A self-administered online questionnaire was developed using Google Forms and distributed conveniently through social media platforms. It consists of 22 items categorized into four sections:The first section focused on demographic information; the second section assessed knowledge related to the diagnosis and management of emergency cases commonly encountered in PHC, along with actual management experiences; the third section gauged physicians' attitudes, and the fourth section explored participants' preferences for emergency medicine courses and their preferred methods of training in this field. The Kruskal-Wallis rank sum and Wilcoxon rank sum tests were employed to identify predictors of knowledge and attitude. Results The study involved 193 participants, with 96 (50%) females and a median age of 30 years. The participants included 43 (22%) consultants, 69 (36%) family residents, 30 (16%) general practitioners, and 50 (26%) specialists. Participants reported a median of 4.0 years of experience in PHC in Saudi Arabia. The majority, 69 (36%), reported working in the hospital emergency department, with a reported median duration of three months. Roughly 84% of PHC physicians had a positive attitude toward emergency cases diagnosis and management, while 92% showed fair diagnostic knowledge of emergency cases, and 73% showed fair management knowledge. Higher knowledge in the diagnosis and management of PHC was linked to increasing age, being consultants, being employed in the emergency department, and having higher years of experience in PHC (p < 0.05). A positive attitude towardPHC was found to be associated with working as a consultant and being employed in the emergency department (p < 0.05). Approximately 133 (68.9%)expressed a preference for a course in wound care trauma, followed by central nervous system emergencies (n = 124, 64.2%), coronary artery disease emergencies (n = 116, 60.1%), and obstetrics/gynecologic emergencies (n = 114, 59.1%) with 160 (82.9%) favored training through practice in PHC under supervision of qualified staff. Conclusion While many PHC centers are well equipped and prepared for early stabilization and management of emergency cases, PHC physicians showed low competency in dealing with emergency cases. This indicates a great need for enhancing physician's knowledge and skills regarding emergency situations. Nevertheless, courses like basic life support (BLS) and advanced trauma life support (ATLS) should be the bare minimum requirements for PHC physicians. Mote advance training and lectures should be organized to enhance PHC physician competencies to deal with different emergencies.

Bridging the Gaps: The Transformative Effect of Coronavirus Disease 2019 (COVID-19) on Preventive Measures Among Medical and Health Sciences College Students in Madinah, Saudi Arabia.

Background The global impact of coronavirus disease 2019 (COVID-19) has disrupted the activities of medical and health profession education institutions. This study aimed to determine the impact of COVID-19 on medical and health profession education students' knowledge, attitudes, and practices toward preventive measures and their commitment to precautionary measures before, during, and after the pandemic. Materials and methods A cross-sectional study was carried out from January to March 2023 using an online, structured, validated questionnaire survey to gather information from medical and health sciences students from three universities, encompassing five colleges in Madinah, Saudi Arabia. The minimum required sample size was estimated using the Epi Info software as 380. The data was analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States). Statistical tests including Student's t-test, chi-squared test, and analysis of variance (ANOVA) test were applied. Results The findings revealed that personal experiences with COVID-19 infection had a significant impact on students' attitudes and commitment to preventive measures (p<0.05). Among the participants, 172 students (45%) reported having contracted COVID-19. Students with clinical exposure showed a higher level of understanding and adherence to preventive measures (248 students, 68%), compared to pre-clinical students (198 students, 52%) (p<0.05). Positive attitudes were observed toward practices such as sneezing etiquette (289 students, 76%) and flu vaccination (314 students, 83%) (p<0.05). However, negative attitudes were observed toward mask-wearing (155 students, 41%) and social distancing (144 students, 38%), particularly among male students (p<0.05). Conclusion The study provided valuable insights into the impact of the COVID-19 pandemic on medical and health sciences students' knowledge, attitudes, and practices toward preventive measures and the importance of introducing COVID-19 prevention measures in the pre-clinical phase as well as mental health support to promote positive attitudes and enhance adherence to preventive measures.

Toward Generalizable Machine Learning Models in Speech, Language, and Hearing Sciences: Estimating Sample Size and Reducing Overfitting.

Many studies using machine learning (ML) in speech, language, and hearing sciences rely upon cross-validations with single data splitting. This study's first purpose is to provide quantitative evidence that would incentivize researchers to instead use the more robust data splitting method of nested k-fold cross-validation. The second purpose is to present methods and MATLAB code to perform power analysis for ML-based analysis during the design of a study. First, the significant impact of different cross-validations on ML outcomes was demonstrated using real-world clinical data. Then, Monte Carlo simulations were used to quantify the interactions among the employed cross-validation method, the discriminative power of features, the dimensionality of the feature space, the dimensionality of the model, and the sample size. Four different cross-validation methods (single holdout, 10-fold, train-validation-test, and nested 10-fold) were compared based on the statistical power and confidence of the resulting ML models. Distributions of the null and alternative hypotheses were used to determine the minimum required sample size for obtaining a statistically significant outcome (5% significance) with 80% power. Statistical confidence of the model was defined as the probability of correct features being selected for inclusion in the final model. ML models generated based on the single holdout method had very low statistical power and confidence, leading to overestimation of classification accuracy. Conversely, the nested 10-fold cross-validation method resulted in the highest statistical confidence and power while also providing an unbiased estimate of accuracy. The required sample size using the single holdout method could be 50% higher than what would be needed if nested k-fold cross-validation were used. Statistical confidence in the model based on nested k-fold cross-validation was as much as four times higher than the confidence obtained with the single holdout-based model. A computational model, MATLAB code, and lookup tables are provided to assist researchers with estimating the minimum sample size needed during study design. The adoption of nested k-fold cross-validation is critical for unbiased and robust ML studies in the speech, language, and hearing sciences. https://doi.org/10.23641/asha.25237045.

Are the tests overpowered or underpowered? A unified solution to correctly specify type I errors in design of clinical trials for two sample proportions.

As one of the most commonly used data types, methods in testing or designing a trial for binary endpoints from two independent populations are still being developed until recently. However, the power and the minimum required sample size comparisons between different tests may not be valid if their type I errors are not controlled at the same level. In this article, we unify all related testing procedures into a decision framework, including both frequentist and Bayesian methods. Sufficient conditions of the type I error attained at the boundary of hypotheses are derived, which help reduce the magnitude of the exact calculations and lay out a foundation for developing computational algorithms to correctly specify the actual type I error. The efficient algorithms are thus proposed to calculate the cutoff value in a deterministic decision rule and the probability value in a randomized decision rule, such that the actual type I error is under but closest to, or equal to, the intended level, respectively. The algorithm may also be used to calculate the sample size to achieve the prespecified type I error and power. The usefulness of the proposed methodology is further demonstrated in the power calculation for designing superiority and noninferiority trials.

Sample size determination for conducting a pilot study to assess reliability of a questionnaire.

This article is a narrative review that discusses the recommended sample size requirements to design a pilot study to assess the reliability of a questionnaire. A list of various sample size tables that are based on the kappa agreement test, intra-class correlation test and Cronbach's alpha test has been compiled together. For all calculations, type I error (alpha) was set at a maximum value of 0.05, and power was set at a minimum value of 80.0%. For the kappa agreement test, intra-class correlation test, and Cronbach's alpha test, the recommended minimum sample size requirement based on the ideal effect sizes shall be at least 15, 22, and 24 subjects respectively. By making allowances for a non-response rate of 20.0%, a minimum sample size of 30 respondents will be sufficient to assess the reliability of the questionnaire. The clear guideline of minimum sample size requirement for the pilot study to assess the reliability of a questionnaire is discussed and this will ease researchers in preparation for the pilot study. This study provides justification for a minimum requirement of a sample size of 30 respondents specifically to test the reliability of a questionnaire.

An elaboration on sample size determination for correlations based on effect sizes and confidence interval width: a guide for researchers.

This paper aims to serve as a useful guide for sample size determination for various correlation analyses that are based on effect sizes and confidence interval width. Sample size determinations are calculated for Pearson's correlation, Spearman's rank correlation, and Kendall's Tau-b correlation. Examples of sample size statements and their justification are also included. Using the same effect sizes, there are differences between the sample size determination of the 3 statistical tests. Based on an empirical calculation, a minimum sample size of 149 is usually adequate for performing both parametric and non-parametric correlation analysis to determine at least a moderate to an excellent degree of correlation with acceptable confidence interval width. Determining data assumption(s) is one of the challenges to offering a valid technique to estimate the required sample size for correlation analyses. Sample size tables are provided and these will help researchers to estimate a minimum sample size requirement based on correlation analyses.

The mediating role of moral reasoning in spiritual intelligence and caring behaviors in Iranian emergency nurses.

Moral reasoning is necessary to the nursing profession. Therefore, this study aimed to investigate the mediating role of moral reasoning in spiritual intelligence and caring behaviors among Iranian emergency nurses. In this descriptive-analytical study structural equation modeling (SEM) is employed for the data analysis. the minimum required sample size determined by the number of parameters of the model was 18. Considering that 5 to 15 samples were required for each of the parameters; the required sample size was 272. Nurses working in the emergency department of all hospitals in Qom, Iran, were selected by convenience sampling. Demographic characteristics inventory, King's Spiritual Intelligence Self-Report Inventory, Crisham's Nursing Dilemma Test, and Wolf's Caring Behaviors Inventory used for data collection. SPSS (V20) and Mplus were used to analyze the data. The results showed that a significant direct relationship was observed between moral reasoning and caring behaviors. According to SEM results, direct and indirect effects were observed of spiritual intelligence on caring behavior It is therefore recommended managers and hospital officials pay meticulous attention to spiritual intelligence and the power of decision-making in nurses to improve their caring behaviors.

Utilization Patterns of Maternal and Child Health (MCH) Care Services: A Cross-Sectional Study in Rawalpindi, Pakistan

Background: Despite the implementation of various maternal health programs and schemes at both regional and national levels in Pakistan, maternal mortalities and morbidity remain significantly high. This suggests that maternal health services are being underutilized. Aim: This current study focuses on assessing the utilization patterns of maternal health services and the factors associated with their utilization in Rawalpindi, Pakistan. Methods: The cross-sectional study was conducted over one year (2021-2022) among mothers aged 15 to 49 years in the field practice area of DHQ Rawalpindi. The minimum required sample size was determined as 645. Participants were selected using a simple random sampling technique from a randomized list of villages. Data was collected through home visits, utilizing a pretested, standardized questionnaire. In the analysis, the significance of associations between variables was established at P&lt;0.05. Results: Among the 645 potential participants, 632 provided consent for inclusion in the study. Only 58.3% of participants received any Antenatal Care (ANC), and a mere 11.7% received full ANC services. More than half of the participants (52.7%) had experienced pregnancy-related complications. Variables such as younger age and limited decision-making capacity were significantly associated with the lack of full ANC services (P&lt;0.05). Conclusion: This study highlights that a woman’s age, literacy status, parity, socioeconomic status, and occupation are major determinants influencing the utilization of maternal health care services. These determinants should be taken into account when planning future interventions aimed at promoting attitudinal changes and, consequently, enhancing the utilization of maternal health care services.

A Community-based Epidemiological Study on non-fatal Road Traffic Accidents in Puducherry, South India

Introduction: Road traffic accidents are the sixth leading cause of death in India with a greater share of hospitalization, disabilities, deaths and socio-economic losses. Objective: To identify the pattern of non-fatal road traffic accidents, socio-demographic profile of accident victims and antecedent factors influencing these road traffic injuries. Method: A cross-sectional study was conducted for six months in Puducherry. From existing 27 wards of Lawspet, six wards were selected by simple random sampling technique and all the households in selected wards were included. The minimum required sample size was estimated to be 165 by considering prevalence of non-fatal road traffic accidents in Puducherry as 5.6%. Face-to-face interview with a semi-structured questionnaire was used for data collection. Data entry and analysis were performed using Epi-data manager 4.2.0. Results: Total 169 accident victims were included in the study from the households of selected wards. Mean age of the accident victims was found to be 36.2 (11.4) years. Two‑wheeler accidents accounted for 144 (85.2%) and 123 (72.7%) accident victims were drivers at the time of accident. Majority (95.1 %) of the victims did not wear helmet while driving two-wheelers and none of the four-wheel drivers/pillions wore seat belts. Majority of the accidents occurred on usual tar roads 116 (68.6%) and 42 (24.9%) on highways. 102 (60.4%) accidents occurred in bi-directional roads.Conclusion: Simple or minor injuries were high compared to serious injuries requiring hospitalization. Majority of the accidents occurred during Fridays, Saturdays and Sundays. The accidents exhibited a bimodal distribution with day and night time.

Psychometric properties of the Alcohol Use Disorders Identification Test (AUDIT) across cross-cultural subgroups, genders, and sexual orientations: Findings from the International Sex Survey (ISS)

IntroductionDespite being a widely used screening questionnaire, there is no consensus on the most appropriate measurement model for the Alcohol Use Disorders Identification Test (AUDIT). Furthermore, there have been limited studies on its measurement invariance across cross-cultural subgroups, genders, and sexual orientations. AimsThe present study aimed to examine the fit of different measurement models for the AUDIT and its measurement invariance across a wide range of subgroups by country, language, gender, and sexual orientation. MethodsResponses concerning past-year alcohol use from the participants of the cross-sectional International Sex Survey were considered (N = 62,943; Mage: 32.73; SD = 12.59). Confirmatory factor analysis, as well as measurement invariance tests were performed for 21 countries, 14 languages, three genders, and four sexual-orientation subgroups that met the minimum sample size requirement for inclusion in these analyses. ResultsA two-factor model with factors describing ‘alcohol use’ (items 1–3) and ‘alcohol problems’ (items 4–10) showed the best model fit across countries, languages, genders, and sexual orientations. For the former two, scalar and latent mean levels of invariance were reached considering different criteria. For gender and sexual orientation, a latent mean level of invariance was reached. ConclusionsIn line with the two-factor model, the calculation of separate alcohol-use and alcohol-problem scores is recommended when using the AUDIT. The high levels of measurement invariance achieved for the AUDIT support its use in cross-cultural research, capable also of meaningful comparisons among genders and sexual orientations.