Small Sample Size Research Articles

‘How anxious I am’: the effect of different online modalities on Chinese language beginners’ classroom anxiety

ABSTRACT Foreign language classroom anxiety (FLCA) is ‘a distinct complex set of self-perceptions, beliefs, feelings and behaviours related to classroom language learning arising from the uniqueness of the language learning process’ (Horwitz, Horwitz and Cope 1986: 128) [Foreign language classroom anxiety. The Modern Language Journal 70, no. 2: 125–32] which potentially has a negative impact on achievement and engagement in language learning. The purpose of the investigation reported here was to examine how two online modalities – Zoom video conferencing and the virtual world, Second Life – affected FLCA among Chinese language beginners performing tasks using the different modes. Through statistical and thematical analyses of survey data along with open-ended questions from 55 participants, it was found that the relationship between FLCA levels experienced by learners on these modalities was influenced by various factors such as gender differences, task-related language skills, and self-perceived language proficiency. The study also suggests that FLCA is dependent on the learners’ immediate learning experience, particularly in relation to their level of engagement and task awareness. Despite the small sample size, the study sheds light on the advantages and limitations of each modality in terms of its effect on students’ FLCA and performance in task-based language teaching.

Perinatal outcomes in grand multiparous women stratified by parity- A large multicenter study

ObjectiveTo assess the effect of each additional delivery among grand multiparous (GMP) women on maternal and neonatal outcomes. MethodsA multi-center retrospective cohort study that examined maternal and neonatal outcomes of GMP women (parity 5–10, analyzed separately for each parity level) compared to a reference group of multiparous women (parity 2–4). The study population included grand multiparous women with singleton gestation who delivered in one of four university-affiliated obstetrical centers in a single geographic area, between 2003 and 2021. We excluded nulliparous, those with parity > 10 (due to small sample sizes), women with previous cesarean deliveries (CDs), multifetal gestations, and out-of-hospital deliveries. The primary outcome of this study was postpartum hemorrhage (PPH, estimated blood loss exceeding 1000 ml, and/or requiring blood product transfusion, and/or a hemoglobin drop > 3 g/Dl). Secondary outcomes included unplanned cesarean deliveries, preterm delivery, along with other adverse maternal and neonatal outcomes. Univariate analysis was followed by multivariable logistic regression. ResultsDuring the study period, 251,786 deliveries of 120,793 patients met the inclusion and exclusion criteria. Of those, 173,113 (69%) were of parity 2–4 (reference group), 27,894 (11%) were of parity five, 19,146 (8%) were of parity six, 13,115 (5%) were of parity seven, 8903 (4%) were of parity eight, 5802 (2%) were of parity nine and 3813 (2%) were of parity ten.GMP women exhibited significantly higher rates of PPH starting from parity eight. The adjusted odds ratios (aOR) were 1.19 (95 % CI: 1.06–1.34) for parity 8, 1.17 (95 % CI: 1.01–1.36) for parity 9, and 1.39 (95 % CI: 1.18–1.65) for parity 10. Additionally, they showed elevated rates of several maternal and neonatal outcomes, including placental abruption, large-for-gestational age (LGA) neonates, neonatal hypoglycemia, and neonatal seizures. Conversely, they exhibited decreased risk for other adverse maternal outcomes, including preterm deliveries, unplanned cesarean deliveries (CDs), vacuum-assisted delivery, and third- or fourth-degree perineal tears and small-for-gestational age (SGA) neonates. The associations with neonatal hypoglycemia, and neonatal seizure were correlated with the number of deliveries in a dose-dependent manner, demonstrating that each additional delivery was associated with an additional, significant impact on obstetrical complications. ConclusionOur study demonstrates that parity 8–10 is associated with a significantly increased risk of PPH. Parity level > 5 correlated with increased odds of placental abruption, LGA neonates, neonatal hypoglycemia, and neonatal seizures. However, GMP women also demonstrated a reduced likelihood of certain adverse maternal outcomes, including unplanned cesarean, preterm deliveries, vacuum-assisted deliveries, SGA neonates, and severe perineal tears. These findings highlight the importance of tailored obstetrical care for GMP women to mitigate the elevated risks associated with higher parity.

Genetic Associations With an Amyotrophic Lateral Sclerosis Reversal Phenotype.

The term "ALS Reversal" describes patients who initially meet diagnostic criteria for amyotrophic lateral sclerosis (ALS) or had clinical features most consistent with progressive muscular atrophy (PMA) but subsequently demonstrated substantial and sustained clinical improvement. The objective of this genome-wide association study (GWAS) was to identify correlates of this unusual clinical phenotype. Participants were recruited from a previously created database of individuals with the ALS Reversal phenotype. Whole-genome sequencing (WGS) data were compared with ethnicity-matched patients with typically progressive ALS enrolled through the CReATe Consortium's Phenotype-Genotype-Biomarker (PGB) study. These results were replicated using an independent ethnically matched WGS data set from Target ALS. Significant results were further explored with available databases of genetic regulatory markers and expression quantitative trait loci (eQTL) analysis. WGS from 22 participants with documented ALS Reversals was compared with the PGB primary cohort (n = 103) and the Target ALS validation cohort (n = 140). Two genetic loci met predefined criteria for statistical significance (two-sided permutation p ≤ 0.01) and remained plausible after fine-mapping. The lead single nucleotide variant (SNV) from the first locus was rs4242007 (primary cohort GWAS OR = 12.0, 95% CI 4.1 to 34.6), which is in an IGFBP7 intron and is in near-perfect linkage disequilibrium with a SNV in the IGFBP7 promoter region. Both SNVs are associated with decreased frontal cortex IGFBP7 expression in eQTL data sets. Notably, 3 Reversals, but none of the typically progressive individuals (n = 243), were homozygous for rs4242007. The importance of the second locus, located near GRIP1, is uncertain given the absence of an associated effect on nearby gene transcription. We found a significant association between the Reversal phenotype and an IGFBP7 noncoding SNV that is associated with IGFBP7 expression. This is biologically relevant as IGFBP7 is a reported inhibitor of the insulin growth factor-1 (IGF-1) receptor that activates the possibly neuroprotective IGF-1 signaling pathway. This finding is limited by small sample size but suggests that there may be merit in further exploration of IGF-1 pathway signaling as a therapeutic mechanism for ALS. This study was registered with ClinicalTrials.gov (NCT03464903) on March 14, 2018. The first participant was enrolled on June 22, 2018.

Factors Associated with Anxiety and Depression among Elite Collegiate Badminton Players in Japan: Exploratory Analysis

This study focused on mental health and fatigue in elite university student-athletes competing in badminton at the national level, comparing them with control university students and examining related factors. Among university athletes, anxiety and depression showed a moderately negative correlation with life satisfaction outside of sports, as determined by partial correlation tests adjusted for fatigue. Athletes demonstrated a 47% rate of anxiety and a 30% rate of depression. These values showed no significant difference from those of the anxiety (29%) and depression (21%) rates in a non-athlete university student sample. In addition, this study suggested that the evaluation of fatigue using a checklist of individual strength might produce low reliability and validity for elite university student-athletes in badminton. These exploratory findings highlight the importance of focusing on athletes’ overall life satisfaction and suggest the potential need for effective mental health interventions beyond sports. However, because of the exploratory nature of this study and the small sample size, further research is necessary to confirm these results.

Fuzzy Evaluation Model for Critical Components of Machine Tools

The rapid progression of emerging technologies like the Internet of Things (IoT) and Big Data analytics for manufacturing has driven innovation across various industries worldwide. Production data are utilized to construct a model for quality evaluation and analysis applicable to components processed by machine tools, ensuring process quality for critical components and final product quality for the machine tools. Machine tool parts often encompass several quality characteristics concurrently, categorized into three types: smaller-the-better, larger-the-better, and nominal-the-better. In this paper, an evaluation index for the nominal-the-better quality characteristic was segmented into two single-sided Six Sigma quality indexes. Furthermore, the process quality of the entire component product was assessed by n single-sided Six Sigma quality indexes. According to numerous studies, machine tool manufacturers conventionally base their decisions on small sample sizes (n), considering timeliness and costs. However, this often leads to inconsistent evaluation results due to significant sampling errors. Therefore, this paper established fuzzy testing rules using the confidence intervals of the q single-sided Six Sigma quality indices, serving as the fuzzy quality evaluation model for components of machine tools.

Vicarious Dissonance: Pre-Registered Meta-Analysis.

The vicarious cognitive dissonance process predicts that observing an inconsistent act by a member of the ingroup causes uncomfortable arousal in the observer, inducing a motivation to reduce this discomfort. This meta-analysis examined the effect of vicarious cognitive dissonance based on 24 studies (N = 16,769). Our results indicated a small effect for the vicarious cognitive dissonance (g = 0.41 [0.27, 0.54], p <.001) with important variability between the outcomes. Our moderator analysis was limited by the low number of included studies. Publication bias analyses indicate a small true effect size (e.g., 3PSM: g = 0.22, p = .042), that was inflated by small sample sizes (R-index = 14.6%). We discussed theoretical issues concerning the psychological processes underlying vicarious cognitive dissonance, and methodological questions concerning operationalization. We proposed ways of improving the design and procedure to ensure that the effects found in the literature exist and are replicable.

2300 A survey on the underlying knowledge of doctors’ in conducting polypharmacy review and medication optimisation in older adults.

Abstract Introduction Polypharmacy is common among older adults and could result in adverse outcomes if not reviewed and optimised regularly (Davies et al, 2020). The aim of this survey is to assess and report on the variation in doctors’ understanding of medication reviews at Maidstone and Tunbridge Wells hospitals (MTW). Method A short, anonymised, online questionnaire was circulated to all current doctors at MTW via email and WhatsApp groups. Results 38 doctors of different grades (Foundation Year One-Consultant) from a variety of medical and surgical specialties responded. Of these, 41% could correctly define appropriate polypharmacy, but only 6% could define problematic polypharmacy. Most respondents (59.5%) had not received any training on structured medication reviews (SMR). 51.4% were not aware of any tools used in medication optimisation. 43% said they ‘always carry out’ medication reviews in clinical practice and 8.3% said that they never do. Less than half (38%) felt confident in completing SMR. The main barriers to routine implementation of SMR identified by the respondents were: lack of confidence (27%), time pressures (26%), senior clinicians not giving importance to SMR (16%), 3% felt it was not the doctor’s responsibility. Most respondents (91.7%) said that they would benefit from further training in SMR. Conclusions The results show that there is a wide variation in the respondents’ understanding and practice of medication reviews. Also, that there is a clear and well- founded demand for training. Once training has been formulated and delivered a follow up survey of those attending should be used to help gauge its effectiveness. The small sample size is a limitation of this study affecting its generalisability as is the fact that it was a self-selected group completing the survey.

Recurrence-Free Survival after Postoperative Hormone Therapy for Catamenial Pneumothorax.

Catamenial pneumothorax (CP) is a rare form of spontaneous pneumothorax that is linked to endometriosis; thus, it predominantly manifests in women of reproductive age. Considerable research has explored the potential benefits of postoperative hormone therapy following various surgical interventions. This study was performed to examine the clinical implications of postoperative hormone treatment in patients with CP. The study included patients who underwent surgical intervention for CP between November 2009 and February 2023. These procedures included wedge resection, diaphragm resection, and total pleural coverage. Recurrence-free survival was analyzed using the Kaplan-Meier log-rank test to assess the impact of hormone therapy. Additionally, Cox proportional hazards analysis was employed to identify risk factors associated with postoperative CP recurrence. The study included 41 patients, with a median age of 38.4 years. Among them, 27 individuals received hormone therapy, 8 of whom experienced recurrence during a median follow-up period of 1 year. Patients who received hormone therapy exhibited a lower rate of recurrence than those who did not; however, the difference was not statistically significant, likely due to the small sample size. Side effects of hormone therapy included depression (6.8%), excessive sweating (3.4%), and headache (3.4%). In the analysis of risk factors for postoperative recurrence, diaphragm resection emerged as a protective factor (hazard ratio, 0.16; 95% confidence interval, 0.03-0.77; p=0.022). Hormone treatment combined with surgery did not significantly impact recurrence in patients with CP. The application of diaphragm resection was the sole factor that displayed significance in preventing CP recurrence.

One versus 2years of alendronate following denosumab: the CARD extension.

When denosumab is discontinued, antiresorptive therapy is critical to attenuate high-turnover bone loss. The ideal choice and duration of antiresorptive therapy are not yet defined, however. In the Comparison of Alendronate or Raloxifene following Denosumab (CARD) study, we demonstrated that 12months of alendronate was better able to maintain the bone mineral density (BMD) gains achieved with 12months of denosumab versus 12months of raloxifene. In this extension, we wished to determine if 12months of alendronate would be sufficient in maintaining these denosumab-induced BMD gains. In the CARD study, postmenopausal osteoporotic women aged 60-79 at high fracture risk received 12months of denosumab 60-mg SC every 6months followed by 12months of either alendronate 70mg weekly (N = 26) or raloxifene (N = 25). All subjects in the alendronate arm were then offered participation in a 1-year extension in which they were randomized to continue alendronate for an additional 12months (N = 10) or to receive calcium and vitamin D alone (N = 8). The primary outcome was change in spine BMD between months 24 and 36. Exploratory endpoints included changes in areal BMD (aBMD) at other anatomic sites as well as changes in serum bone turnover markers. The CARD study demonstrated the effectiveness of 12months alendronate in preserving denosumab-induced BMD gains. In the extension, aBMD was maintained at the spine, total hip, and femoral neck in both those randomized to an additional year of alendronate and those randomized to calcium/vitamin D alone. We did, however, observe a transient comparative decrease between months 24-30 in the calcium/vitamin D group at the total hip (P = 0.008) and femoral neck (P = 0.040). At the end of 24months of the CARD study, bone turnover markers serum c-telopeptide (CTX) and procollagen N-propeptide of type I collagen (PINP) were suppressed in both groups and then increased more between months 24-36 in the calcium/vitamin D group than the alendronate group (P = 0.051 for CTX, P = 0.030 for P1NP). Both CTX and PINP remained below the month 0 baseline in both groups (P < 0.05 for all comparisons). With the limitations of our small sample size, these data suggest that both 1 and 2years of alendronate effectively maintain BMD gains achieved with 1year of denosumab and prevented any rebound in bone turnover marker levels above pre-denosumab baseline. This is the first randomized trial to assess minimum duration of bisphosphonate after short-term denosumab and may be helpful to guide clinical care. Similar studies performed after longer durations of denosumab would be helpful to further define optimal management. ClinicalTrials.gov registration number: NCT03623633.

Motor adaptation to continuous lateral trunk support force during walking improves trunk postural control and walking in children with cerebral palsy: A pilot study

PurposeTo determine whether the application of continuous lateral trunk support forces during walking would improve trunk postural control and improve gait performance in children with CP. Materials and methodsNineteen children with spastic CP participated in this study (8 boys; mean age 10.6 ± 3.4 years old). Fourteen of them were tested in the following sessions: 1) walking on a treadmill without force for 1-min (baseline), 2) with lateral trunk support force for 7-min (adaptation), and 3) without force for 1-min (post-adaptation). Overground walking pre/post treadmill walking. Five of them were tested using a similar protocol but without trunk support force (i.e., control). ResultsParticipants from the experimental group showed enhancement in gait phase dependent muscle activation of rectus abdominis in late adaptation period compared to baseline (P = 0.005), which was retained during the post-adaptation period (P = 0.036), reduced variability of the peak trunk oblique angle during the late post-adaptation period (P = 0.023), and increased overground walking speed after treadmill walking (P = 0.032). Participants from the control group showed modest changes in kinematics and EMG during treadmill and overground walking performance. These results suggest that applying continuous lateral trunk support during walking is likely to induce learning of improved trunk postural control in children with CP, which may partially transfer to overground walking, although we do not have a firm conclusion due to the small sample size in the control group.

Longitudinal Coadaptation of Older Adults With Wearables and Voice-Activated Virtual Assistants: Scoping Review.

The integration of smart technologies, including wearables and voice-activated devices, is increasingly recognized for enhancing the independence and well-being of older adults. However, the long-term dynamics of their use and the coadaptation process with older adults remain poorly understood. This scoping review explores how interactions between older adults and smart technologies evolve over time to improve both user experience and technology utility. This review synthesizes existing research on the coadaptation between older adults and smart technologies, focusing on longitudinal changes in use patterns, the effectiveness of technological adaptations, and the implications for future technology development and deployment to improve user experiences. Following the Joanna Briggs Institute Reviewer's Manual and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, this scoping review examined peer-reviewed papers from databases including Ovid MEDLINE, Ovid Embase, PEDro, Ovid PsycINFO, and EBSCO CINAHL from the year 2000 to August 28, 2023, and included forward and backward searches. The search was updated on March 1, 2024. Empirical studies were included if they involved (1) individuals aged 55 years or older living independently and (2) focused on interactions and adaptations between older adults and wearables and voice-activated virtual assistants in interventions for a minimum period of 8 weeks. Data extraction was informed by the selection and optimization with compensation framework and the sex- and gender-based analysis plus theoretical framework and used a directed content analysis approach. The search yielded 16,143 papers. Following title and abstract screening and a full-text review, 5 papers met the inclusion criteria. Study populations were mostly female participants and aged 73-83 years from the United States and engaged with voice-activated virtual assistants accessed through smart speakers and wearables. Users frequently used simple commands related to music and weather, integrating devices into daily routines. However, communication barriers often led to frustration due to devices' inability to recognize cues or provide personalized responses. The findings suggest that while older adults can integrate smart technologies into their lives, a lack of customization and user-friendly interfaces hinder long-term adoption and satisfaction. The studies highlight the need for technology to be further developed so they can better meet this demographic's evolving needs and call for research addressing small sample sizes and limited diversity. Our findings highlight a critical need for continued research into the dynamic and reciprocal relationship between smart technologies and older adults over time. Future studies should focus on more diverse populations and extend monitoring periods to provide deeper insights into the coadaptation process. Insights gained from this review are vital for informing the development of more intuitive, user-centric smart technology solutions to better support the aging population in maintaining independence and enhancing their quality of life. RR2-10.2196/51129.

Efficacy of Motor Imagery in the Rehabilitation of Stroke Patients: A Scope Review

This review examines the efficacy of motor imagery (MI) as a supplementary rehabilitation technique for stroke patients. Nine randomized controlled trials (RCTs) were analyzed, highlighting MI's potential to enhance motor recovery, mobility, balance, and psychological well-being. Significant improvements in upper-limb function were observed with combined mental and physical practice, evidenced by notable gains in Fugl-Meyer Assessment (FMA) and Action Research Arm Test (ARAT) scores. MI-based exercise programs improved mobility and balance in elderly patients, reducing fall risk as measured by the Timed Up and Go (TUG) test and Berg Balance Scale (BBS). MI was also found to enhance self-efficacy and functional performance, with significant increases in Functional Independence Measure (FIM) and General Self-Efficacy Scale (GSES) scores. Neuroimaging studies revealed that MI activates cortical areas associated with motor control, supporting its role in promoting neural plasticity. Despite these promising results, the heterogeneity in participant characteristics, stroke severity, and MI protocols across studies poses challenges to standardization. Additionally, small sample sizes and reliance on self-report measures limit the generalizability of findings. Nevertheless, MI's low cost, minimal risk, and ease of integration into existing rehabilitation protocols make it a valuable adjunct to physical therapy. Standardized guidelines and personalized MI exercises tailored to individual needs are essential for maximizing benefits. Integrating MI into clinical practice can significantly enhance both physical and psychological recovery outcomes for stroke patients, offering a comprehensive approach to rehabilitation.

The effect of virtual reality versus standard-of-care treatment on pain perception during paediatric vaccination: Study protocol for a randomised controlled trial.

To study the effects of virtual reality (VR) on pain perception among a paediatric population while being vaccinated. We will also investigate the effects of VR on the fear experienced by children during the vaccination procedure, as well as parental satisfaction levels. Many studies, for example, in the fields of oncology, dermatology or plastic surgery, have described the benefits of using VR to reduce the perception of pain among paediatric populations. These results are encouraging, but their main limitations were the small sample sizes they included or their methodological design. This will be a randomised clinical trial. SPIRIT guidelines were followed to report this protocol, and we will use the CONSORT and CONSORT-EHEALTH guidelines to report the randomised clinical trial. The sample will comprise 148 children aged 3-14 years who will come for vaccination at the Tres Forques Health Center. The participants will be randomly allocated into intervention group (VR; n = 74) or (the control group standard-of-care; n = 74) at a 1:1 ratio. The intervention group will view experiences with a VR headset as a distraction measure. The study variables will be the level of pain and fear perceived by the child during vaccination, parental satisfaction with the vaccination procedure, and sociodemographic and vaccination variables. The start of the study is planned for September 2020, and the results will be expected in September 2021. This study aims to identify what measures reduce pain and fear in children during vaccination, which in turn, can help to improve the degree of parental satisfaction with these procedures. Vaccination is an independent function of the nursing profession. Identifying which distraction measures reduce the perception of pain and fear in the paediatric population will not only improve children's experiences but will also improve the satisfaction of both parents and children, thus increasing the degree of compliance with the vaccination schedule.

The effectiveness of stretching exercises in patients with fibromyalgia: A systematic review.

Fibromyalgia is one of the most prevalent chronic pain disorders. Fibromyalgia is characterised by generalised pain. In addition, patients with fibromyalgia often have co-morbidity. Since no cure is available, the treatment is based on symptom management, with physical exercise being the recommended first-line treatment. Different exercise modalities have been examined, including the practice of stretching exercises. The aim of the systematic review is to summarise the efficacy of stretching exercises on fibromyalgia symptoms and to study the content and the quality of the current evidence. The review followed the recommendations of the PRISMA statement. The search for articles was performed in April 2023. We searched on MEDLINE, PubMed, CINAHL, Web of Science, SCOPUS, AMED, PEDro, ClinicalTrials.gov and the Cochrane Collaboration Trials Register. The search was updated in March 2024. The protocol was registered in PROSPERO. Risk of Bias was assessed using the Cochrane Risk of Bias tool, and quality assessment was performed using the GRADE approach. In total, 2586 studies were found in the database searches, of which nine were included in the analysis. The primary outcome was pain. Secondary outcomes were self-reported quality of life, fatigue and physical and mental functioning. The available evidence shows that stretching exercises may improve pain, health-related quality of life and physical and mental functioning, but the level of evidence is low. The main limitation is due to issues with the heterogeneity of the interventions and small sample sizes. Trial registration: PROSPERO registration number CRD42023399614. Key Points •Stretching exercises show promise in the treatment of fibromyalgia. They may improve pain, health-related quality of life, physical functioning and mental health, but the level of evidence is low. •This study goes beyond previous research by presenting a more comprehensive and detailed analysis of the content and methodological quality of the current evidence. •Further research with clearly outlined protocols must be carried out to advance our understanding of the benefits of stretching exercises on fibromyalgia symptoms.

Mathematics teachers’ practices in light of the effective teaching practices

Recognising the pivotal role of effective teaching practices in enhancing student learning outcomes, the National Council of Teachers of Mathematics (NCTM) has outlined a comprehensive framework of key strategies. However, empirical research on these practices remains limited. Therefore, this study aimed to investigate the extent to which mathematics teachers apply NCTM-identified effective teaching practices and examine potential differences attributable to teachers' gender and teaching experience. Adopting a quantitative approach and employing a descriptive survey, the study systematically assessed eight designated practices using a validated observation checklist in the Jazan Education Administration, observing 38 mathematics teachers during routine classes. The results indicated a moderate level of implementation overall, with ten practices demonstrating high application. Statistical analyses found no significant differences in practice implementation based on gender or teaching experience at the .05 level. The limitations included the study's relatively small sample size, potentially limiting generalisability, and the observational nature of the checklist, which may not fully capture nuanced teaching dynamics. Future research could focus on developing training initiatives to enhance educators' application of NCTM-recommended practices and undertake qualitative inquiries to understand barriers to integration and teachers' attitudes towards these practices. Finally, this study contributes to the discourse on effective mathematics teaching by providing empirical insights into current practices and highlighting avenues for further investigation and professional development in educational settings.

Testing the hypothesis of a nested block covariance matrix structure with applications to medicine and natural sciences

This paper addresses the challenge of testing the hypothesis of what the authors call a nested block circular‐compound symmetric (NBCCS) covariance structure for the population covariance matrix. This is a covariance structure which has an outer block compound symmetric structure, where the diagonal blocks are themselves block circular matrices, while the off‐diagonal blocks are formed by all equal matrices. The NBCCS null hypothesis is decomposed into sub‐hypotheses, allowing this way for a simpler way to obtain a likelihood ratio test and its associated statistic. The exact moments of this statistic are derived, and its distribution is carefully examined. Given the complicated nature of this distribution, highly precise near‐exact distributions were developed. Numerical studies are conducted to assess the proximity between these near‐exact distributions and the exact distribution, highlighting the performance of these approximations, even in the case of very small sample sizes. Furthermore, three datasets, on bone mineral content, metabolic rates of glucose, and soil moisture are used to exemplify the practical application of the methodology derived in this study.

Analyzing Composite Stock Price Index Volatility in Response to Changes in Data Structure Using Bayesian Markov-Switching GARCH

Rapid economic growth was observed to have motivated economic actors and investors to maximize business performance using different methods. An example of these are stocks or shares securities showing that a person or entity has a stake in a company. Investors are primarily drawn to stocks due to their potential for substantial profits closely tied to the volatility in the stock market. The prevalence of this volatility has long been addressed using the ARCH/GARCH model, but it is not ideal for datasets experiencing structural changes. Therefore, a model was developed using the Bayesian Markov-switching GARCH approach to effectively capture the heteroscedastic component and structural changes in data and mitigate certain limitations, especially those associated with a small sample size. This study adopted the composite stock price index (CSI) data from March 2020 to April 2021 to model and understand the volatility. The results showed that the Bayesian Markov-switching GARCH model with the most negligible variance provided the best fit. It was also discovered that a more minor error variance corresponded to lower data volatility. Moreover, the concept of value at risk was used to assess the investment risk based on the criterion that a decrease in the CSI investments led to a reduction in the level of risk faced by the investors.

Periodontitis and Diabetes Complications: A Danish Population-Based Study.

Conflicting evidence suggests a link between diabetes-related microvascular complications and periodontitis. Reliable estimates have been hindered by small sample sizes and residual confounding. Moreover, the combined effects of microvascular complications and dyslipidemia on periodontitis have not been explored. Therefore, this study aimed to investigate the association between individual and combined diabetic microvascular complications (i.e., neuropathy and retinopathy) and moderate/severe periodontitis in a Danish population-based study. In addition, we assessed whether dyslipidemia modified these associations. This study comprised 15,922 participants with type 2 diabetes from the Health in Central Denmark study. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for individual and joint microvascular diabetes complications. The models adjusted for potential confounders, including sociodemographic factors, lifestyle behaviors, and health conditions. Inverse probability of treatment weighting (IPTW) balanced measured confounders between periodontitis and nonperiodontitis participants. Sensitivity analyses tested the findings' robustness by estimating E-values for unmeasured confounding and varying microvascular complication definitions. After IPTW, adjusted models revealed that diabetic neuropathy (OR 1.36, 95% CI 1.14 to 1.63) and retinopathy (OR 1.21, 95% CI 1.03 to 1.43) were significantly associated with moderate/severe periodontitis. Moreover, the coexistence of microvascular complications increased the odds 1.5-fold for moderate/severe periodontitis (OR 1.51, 95% CI 1.23 to 1.85). An effect modification of dyslipidemia on an additive scale was found, indicated by a positive relative excess risk due to interaction of 0.24 for neuropathy, 0.11 for retinopathy, and 0.44 for both complications. Sensitivity analysis ruled out unmeasured confounders and microvascular complication definitions as explanatory factors. Diabetic neuropathy and retinopathy, individually and combined, were associated with moderate/severe periodontitis. In addition, dyslipidemia had an additive positive effect modification on diabetic microvascular complications, elevating the odds of moderate/severe periodontitis. These findings may aid in identifying at-risk subgroups for diabetes-related microvascular complications and periodontitis, optimizing efforts to mitigate disease burden.

New insights on hidradenitis suppurativa phenotypes and treatment response: An exploratory automated analysis of the SUNSHINE and SUNRISE trials.

Defining hidradenitis suppurativa (HS) subtypes was previously limited by small sample sizes and poor interrater reliability; no study has investigated subtype treatment responses. The objective of this analysis was to characterize HS clusters in adult patients with moderate to severe HS and evaluate secukinumab treatment responses between clusters. Clusters were identified via an unsupervised machine learning clustering analysis using baseline data from the randomized, placebo-controlled SUNSHINE (NCT03713619) and SUNRISE (NCT03713632) phase 3 trials. To assess treatment responses, patients received secukinumab every 2 (SECQ2W) or 4 weeks (SECQ4W) or placebo, for 16 weeks, after which, placebo patients randomly switched to SECQ2W/SECQ4W, and SECQ2W/SECQ4W patients maintained their original treatment, until week 52. Baseline outcomes included patient characteristics, disease characteristics and severity, HS-associated comorbidities and previous treatment exposures. Treatment response was assessed via the HS clinical response (HiSCR), abscess and inflammatory nodule (AN) count, flares and NRS30 (skin pain). Based on baseline data, three clusters were identified from 1084 patients (Cluster 1: 54.1%, Cluster 2: 17.8%, Cluster 3: 28.1%). Cluster 1 was predominantly female (65.4%) and was characterized by milder HS. Cluster 2 had more patients from the Asia Pacific, Middle East and Africa region (58.5%) and was characterized by moderate HS. Cluster 3 had the highest rates of previous exposure to biologics (45.9%) and prior HS-related surgeries (47.5%) and was characterized by severe HS. SECQ2W and SECQ4W demonstrated efficacy versus placebo in all clusters at week 16; SECQ2W and SECQ4W efficacy was maintained to week 52. SECQ2W treatment showed a trend for greater efficacy versus SECQ4W in Cluster 3 through week 52. Three HS clusters were identified. Secukinumab demonstrated benefit over placebo in all clusters. However, patients with more severe disease may take longer to respond and more frequent secukinumab dosing may be required for these patients. SUNSHINE (NCT03713619) and SUNRISE (NCT03713632).

A Comprehensive Survey of 2024 Funding for Radiation Oncology Visiting Medical Student Electives.

Visiting electives provide an opportunity for medical students to engage with radiation oncology (RO) programs, likely influencing residency match outcomes. However, some student's out-of-pocket costs may be prohibitive, and in attempts to offset the financial burden of visiting electives, particularly for students underrepresented in medicine (URiM), some institutions offer scholarships. Here, we characterized the current domestic landscape of funded RO electives. Visiting electives were identified through the FREIDA and VSLO databases in April 2024. Funded elective availability and departmental characteristics were identified via internet search by two independent reviewers. Fisher's exact test was used to determine whether there was a difference in the distribution of scholarships across the US due to the small sample size. Ninety-two visiting electives were identified, with 40 programs offering URiM elective scholarships (43.5%). Twelve (30%) were funded specifically by RO departments, and 28 (70%) were part of broader institutional URiM scholarship initiatives. The median stipend provided was $2000 (IQR $500), range $1000-$5000. Analysis of scholarships by US census division and metro area revealed unequal distribution. Electives in New England, Mountain, and East North Central divisions had higher funding proportion compared to electives in the East South Central, West South Central, and Middle Atlantic divisions. Only 1/9 electives in New York City were funded compared with 4/6 in Los Angeles. Departments with funded electives had more faculty physicians and medical residents. In our review of the 2024 landscape, over 40% of RO electives offer financial support. However, we identified geographical disparities in the distribution of scholarships, highlighting the need for interventions to address unequal access to a wide array of training programs. Our study represents a valuable resource for students interested in RO and highlights the continued need to positively contribute to increasing diversity in the field. Future work exploring the impact of funded electives is needed.