Sample Wilcoxon Signed Rank Test Research Articles

Statistical assessment for reusing permeate from dewatering water treatment sludge process: more sustainability in environmental sanitation.

Sludge from water treatment plants (WTPs) is usually processed by physicochemical clarification followed by thickening, which results in the production of an effluent from dewatering/drying sludge processes that can potentially impact the environment. This paper assessed the viability of employing sludge dewatering water from a water treatment sludge plant (WTSP) in São Paulo State, Brazil, for reuse purposes. Water quality variables were monitored in the effluent and receiving stream. The data were analyzed by paired samples Student t-test (parametric significance test), paired samples Wilcoxon signed rank test (non-parametric significance test), and principal component analysis (multivariate analysis). Despite the distribution of data, typically not Gaussian, both Student and Wilcoxon methods agreed in 9 out of 10 studied parameters regarding the influence of WTSP discharge on waterbody; only for total manganese the Wilcoxon approach provided better fit than Student. Principal component analysis helped to evince correlations among all variables. Results provided useful information for understanding the vocation of WTSP effluent for reuse. For direct non-potable reuse, recirculating the final effluent back to the WTP for two months saved 92,000 m3 of water, the volume of drinking water demanded by the city (n = 292,000 inhabitants) in approximately 30h.

Evaluating Students' Performance in Consonant Phoneme Identification within Word Structures

The prime objectives of this article are to evaluate the bachelor level first year major English students’ performance in consonant sound identification within word structures, and examine the effectiveness of an intuitive-imitative approach in teaching consonant phonemes of the spellings. To attain these objectives, the researchers employed the one-group pretest posttest research design in which 200 phoneme recognition test items as data collection tools regarding the consonant sounds of English were administered to 30 students at Makawanpur Multiple Campus, Hetauda, Nepal in 2023 before and after teaching them the sounds through the intuitive-imitative approach for 30 teaching periods. Population being low, this study involved the census for collecting data. After observing their performance in consonant phoneme identification, it was found that their performance was bad at identifying the phonemes of the spelling's “g” in “Genre”, “c” in “Cello”, “th” in “Thailand”, etc. Their performance was not so good at identifying the phonemes of the spellings “j” in “Join”, “y” in “Yak”, etc. Their performance was satisfactory in identifying the phonemes of the spelling's “g” in “Gene”, “g” in “Gem”, “n” in “Donkey”, etc. Similarly, they were good at identifying the phonemes of spelling “p” in “Punch”, “b” in “Boat’, “k’ in “Book”, etc. A related samples Wilcoxon signed rank test value (p  .05) implies that there was a significant difference in the median scores of the posttest scores and the pretest scores of the students. It suggests that the intuitive-imitative approach was an effective method of teaching sounds. This article is significant in a phonological process and pronunciation, resulting in phonemic awareness.

EvolvRehab–MoveWell telerehabilitation for stroke survivors: study protocol for a feasibility with embedded initial proof-of-concept study

IntroductionStroke is a leading cause of disability throughout the world. Unilateral upper limb impairment is common in people who have had a stroke. As a result of impaired upper limb...

Beneficial impact of visual stimulation-based digital therapeutics on blood pressure control in non-hypertensive individuals.

Hypertension-related diseases occur in both hypertensive and non-hypertensive individuals. However, few studies to date have explored blood pressure (BP) control in non-hypertensive individuals. This before-after study aimed to examine the impact of visual stimulation-based digital therapeutics (VS-DTx) on BP and heart rate (HR). Eighty-three eligible non-hypertensive participants were included in this study. The McNemar test and Paired Samples Wilcoxon Signed Rank Test were employed to assess decline rates and differences in BP and HR between the control phase and the intervention (using VS-DTx) phase. Pairwise correlation analysis was used to analyze the correlation between the two phases. This study found the systolic BP (SBP) and mean arterial pressure (MAP) in the VS-DTx phase showed a downward trend (66.2% vs 49.3%; 68.7% vs 55.4%). The mean SBP decreased from 114.73 mm Hg to 111.18 mm Hg, and the mean MAP decreased from 87.96 mm Hg to 84.88 mm Hg in the VS-DTx phase. Paired Samples Wilcoxon Test showed differences in both ΔSBP (Z = -3.296; P < 0.01) and ΔMAP (Z = -2.386; P < 0.05) (Δ is defined as the difference between baseline and post-stimulus). The pairwise correlations analysis revealed that VS-DTx affected the MAP reduction (r = 0.33; P < 0.01) between the browsing digital devices phase and the VS-DTx phase. The results indicated that VS-DTx may have a certain effect on BP, including SBP and MAP. This study preliminarily explored the possible effects of VS-DTx on BP, providing certain useful insights for future research in digital BP management.

Long – acting injectable aripiprazole in patients with psychosis is associated with improved quality of life, better general clinical outcome and fewer hospitalizations

IntroductionAripiprazole, a D2 receptor partial agonist is suggested to enhance Prefrontal Cortex (PFC) dopamine functioning resulting to an improvement of working memory and GABA transmission related to social functioning. The LAI form of the medication is documented to improve the long-term adherence of the patients resulting in a better assessment of the effects of the drug on behavioral parameters that require a longer time to evaluate.ObjectivesHypothesis testing: “Aripiprazole LAI antipsychotic treatment is associated with i) reduced hospitalizations, ii) improved quality of life and iii) patient functioning”.Methods65 patients participated (Male to Female ratio corresponds to 2:1). 44 of them, the community population manifested psychosis (23 schizophrenia and 21 patients bipolar disorder with psychotic features). The median age was 41 years. 31.8% had dual diagnosis of psychosis and alcohol use disorders, while 25% had dual diagnosis of psychosis and Cannabis Use disorder. 77.3% were on aripiprazole LAI. 21 patients with BD I were prisoners at the Penitentiary of Neapolis of Lasithi of Crete. Median age was 36 years (all men). 90.5% had comorbidity of bipolar disorder type I (BD-I) and alcohol use disorders. 95.2% had comorbidity of BD – I and Cannabis Use Disorder. All were medicated by aripiprazole LAI 400mg/month. For the evaluation of our hypotheses the instruments WHOQOL-BREF questionnaire and the CGI-S scale were used. The quality of life, functionality, and number of hospitalizations were compared in each patient, before the initiation of the LAI medication and during the active treatment period. The minimum of follow-up period was 6 months.Results In 44 patients (in community) hospitalizations decreased statistically significantly from 1.3±1.9 to 0.1±0.4 (Paired Samples Wilcoxon Signed Rank Test p-value&lt;0.001). The CGI-S score decreased statistically significantly from 6.0 ±0.8 to 4.0±1.1 (Paired Samples Wilcoxon Signed Rank Test p-value&lt;0.001). The score of the WHOQOL-BREF scale increased statistically significantly from 0.5 ± 0.5, to 2.9 ± 0.8 (Paired Samples Wilcoxon Signed Rank Test p-value&lt;0.001). For the group of 21 patients (imprisoned) hospitalizations decreased from 0.6 ± 1.8 to 0.0 ± 0.0 (Paired Samples Wilcoxon Signed Rank Test p-value=0.066). The CGI-S score decreased statistically significantly from 5.3 ± 0.8 to 3.2 ± 1.3 (Paired Samples Wilcoxon Signed Rank Test p-value&lt;0.001). The quality-of-life scale score increased statistically significantly from 0.9 ±0.6 to 3.09±0.7 (Paired Samples Wilcoxon Signed Rank Test p-value&lt;0.001).ConclusionsAripiprazole LAI significantly improves the quality of life and functionality of patients with psychosis. We suggest that the improvement might be related to the beneficial effects of the molecule on the Prefrontal Cortex (PFC).Disclosure of InterestNone Declared

A comparison of aminoglycoside antibiotic serum concentrations collected by peripheral veins and peripherally inserted central catheters in adults with cystic fibrosis.

People with cystic fibrosis (PwCF) are frequently hospitalized for treatment of pulmonary exacerbation. The Cystic Fibrosis Foundation Pulmonary Guidelines support the use of intravenous aminoglycosides with therapeutic drug monitoring for the treatment of pulmonary exacerbation due to Pseudomonas aeruginosa. Serum intravenous tobramycin concentrations are commonly collected by peripheral venipuncture (PV). Discomfort associated with collection of samples by PV prompts collection via PICC, but the accuracy of intravenous tobramycin serum levels collected by PICC has not been documented in adult PwCF. The primary study objective was to evaluate the difference between intravenous tobramycin serum levels collected by PV and PICC in adult PwCF. The authors conducted a prospective case-control study of adult PwCF admitted to University of Utah Health for a pulmonary exacerbation receiving tobramycin by a single lumen PICC. The authors compared tobramycin peak and random serum levels collected by PV and PICC using a detailed flush and waste protocol. The authors analyzed a total of 19 patients with peripheral and PICC samples. The mean tobramycin peak collected by PV (27.2 mcg/mL) was similar to the mean peak collected by PICC (26.9 mcg/mL) (paired samples Wilcoxon signed-rank test, p = .94). The correlation coefficient was 0.88 (95% CI = 0.85-0.91, p < .001). Tobramycin serum samples collected by PICC appear to be similar in value to PV collections. Collecting aminoglycoside levels by PICC rather than PV may reduce patient discomfort and improve quality of life. Additional multicenter studies are needed to confirm these results.

Clinical effect of superior oblique re-tucking for recurrent or residual compensatory head position

Objective: To evaluate the effects of re-tucking the superior oblique muscle on recurrent or residual compensatory head position. Methods: A retrospective case series study was conducted. 12 recurrent or residual compensatory head position patients (12 eyes) with congenital superior oblique palsy who underwent superior oblique re-tucking in Tianjin Eye Hospital from March 2015 to February 2021 were included. All patients had a history of superior oblique tucking procedure and showed signs of superior oblique muscle palsy without inferior oblique muscle overaction. During surgery, the Guyton forced duction test is used to evaluate the relaxation of the superior oblique muscle tendon, which affects the re-tucking length of the muscle.Their head position, vertical deviation, eye movement, fovea-disa angle, and Bielschowsky head tilt test were assessed pre-and post-surgery. Statistical analysis was performed using ttest and paired samples Wilcoxon signed rank test. Results: Out of the 12 patients, 8 were male and 4 were female, aged between 2 and 9 years. The initial surgery was done at age 6, with a superior oblique recession length of (7.17±1.03) mm. Recurrent head tilt occurred in 11 patients after (3.82±0.98) months postoperatively, and 1 patient had residual head tilt, with a followup period of six months or more. Ocular motility examination revealed underaction of the superior oblique muscle, positive Bielschowsky's head tilt test, and Guyton forced duction tese indicating relaxation of the paralyzed superior oblique muscle tendon. Scar adhesion was observed at the stop of the superior oblique muscle, as well as the previous sutures. The scar and the sutures around the stop of the superior oblique muscle were released, the mean re-tucking amount was(7.83±1.59)mm. Follow-up at 12 to 18 months postoperatively showed disappearance of compensatory head position, significant improvement in superior oblique muscle lag, normal ocular motility, and no occurrence of Brown syndrome. The results of Bielschowsky head tilt were negative in 9 cases and still positive in 3 cases after superior oblique re-tucking. The primary vertical deviation was 2.5 (2.0, 5.3) prism diopter pre-operatively and 1 (0, 1) prism diopter post-operatively, respectively. The difference was statistically significant (U=6.00, P<0.001). The total amount of FDA in both eyes was (-22.04±5.47)° and (-15.27±6.08)° pre-and post-operatively, respectively. The difference was statistically significant (t=2.87, P=0.009). All 12 patients have normal eye movement after superior oblique re-tucking procedure. All patients had no compensatory head position at last follow-up. Conclusions: Superior oblique re-tucking is suitable for patients with relaxation of the superior oblique muscle tendon and extrocular rotation as the main sign. It can effectively and safely correct the recurrent or residual compensatory head position after re-tucking the superior oblique muscle.

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.

Quality of Life After Early Clot Removal for Acute Iliofemoral Deep Vein Thrombosis

To evaluate patient reported outcome measures after early clot removal for acute deep vein thrombosis (DVT), using the Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-20) and the Short Form Health Survey (SF-36). Cross sectional design. Patients who underwent early clot removal between June 2012 and November 2021 were asked to complete the two questionnaires once. Lower CIVIQ-20 and higher SF-36 scores indicate better quality of life (QoL). Primary endpoints were the median scores. The one sample Wilcoxon signed rank test was used to compare SF-36 physical and mental component summary (PCS and MCS) to the normative and CIVIQ-20 to the minimum. Secondary, non-parametric independent t test or Fisher's exact test examined how age, sex, body mass index, stent placement, re-intervention, and time of questionnaire completion related to QoL. Multivariable linear regression tested whether various variables were associated with QoL. The response rate was 73.5% (n= 39). Median time of questionnaire completion was 1.8 years (interquartile range [IQR] 3.1) after clot removal. The median CIVIQ-20 of 29.0 (IQR 28.0) was slightly higher than the minimum value 20.0 (p < .001). The median PCS (50.5, IQR 16.6) and median MCS (50.2, IQR 14.2) did not differ from the normative of 50.0. However, wide IQRs indicated impairments for a subgroup of patients. None of the tested variables affected QoL except for the finding that re-interventions had a significantly negative impact on the SF-36 MCS (standardised β coefficient of-0.4, p= .030). Overall patient reported outcome measures were satisfactory after early clot removal, but impaired physical and mental functioning levels were present in a subgroup of patients. Re-interventions were found to have a negative impact on mental QoL. This finding was independent of time that had passed between the procedure and questionnaire completion. This study emphasises that mental functioning deserves attention, besides the widely recognised physical consequences after invasive acute iliofemoral DVT treatment.

Reaksi Pasar atas Pergantian Nama Perusahaan yang Terdaftar di Bursa Efek Indonesia Tahun 2012–2022

The aim of research is to analyze market reactions to changes in names of companies listed on the Indonesia Stock Exchange in 2012-2022. The information content of a company name change is tested based on market reactions as proxied by cumulative abnormal returns. The event study approach is used with a window period of seven days with the event date being the date the company decides to change its name at the RUPS/RUPSLB. Sampling of 90 companies was carried out using the purposive sampling method. The hypothesis is tested with a one sample t-test or one sample Wilcoxon signed rank test. The results show that there was a negative market reaction to the change of name of companies listed on the Indonesia Stock Exchange in 2012-2022 on the first to the third day after the announcement of the company name change. This research provides additional empirical information regarding how the market reacts to a company name change.

Evaluation of molecular receptors status in breast cancer using an mpMRI-based feature fusion radiomics model: mimicking radiologists’ diagnosis

ObjectiveTo investigate the performance of a novel feature fusion radiomics (RFF) model that incorporates features from multiparametric MRIs (mpMRI) in distinguishing different statuses of molecular receptors in breast cancer (BC) preoperatively.Methods460 patients with 466 pathology-confirmed BCs who underwent breast mpMRI at 1.5T in our center were retrospectively included hormone receptor (HR) positive (HR+) (n=336) and HR negative (HR-) (n=130). The HR- patients were further categorized into human epidermal growth factor receptor 2 (HER-2) enriched BC (HEBC) (n=76) and triple negative BC (TNBC) (n=54). All lesions were divided into a training/validation cohort (n=337) and a test cohort (n=129). Volumes of interest (VOIs) delineation, followed by radiomics feature extraction, was performed on T2WI, DWI600 (b=600 s/mm2), DWI800 (b=800 s/mm2), ADC map, and DCE1-6 (six continuous DCE-MRI) images of each lesion. Simulating a radiologist’s work pattern, 150 classification base models were constructed and analyzed to determine the top four optimum sequences for classifying HR+ vs. HR-, TNBC vs. HEBC, TNBC vs. non-TNBC in a random selected training cohort (n=337). Building upon these findings, the optimal single sequence models (Rss) and combined sequences models (RFF) were developed. The AUC, sensitivity, accuracy and specificity of each model for subtype differentiation were evaluated. The paired samples Wilcoxon signed rank test was used for performance comparison.ResultsDuring the three classification tasks, the optimal single sequence for classifying HR+ vs. HR- was DWI600, while the ADC map, derived from DWI800 performed the best in distinguishing TNBC vs. HEBC, as well as identifying TNBC vs. non-TNBC, with corresponding training AUC values of 0.787, 0.788, and 0.809, respectively. Furthermore, the integration of the top four sequences in RFF models yielded improved performance, achieving AUC values of 0.809, 0.805 and 0.847, respectively. Consistent results was observed in both the training/validation and testing cohorts, with AUC values of 0.778, 0.787, 0.818 and 0.726, 0.773, 0.773, respectively (all p &amp;lt; 0.05 except HR+ vs. HR-).ConclusionThe RFF model, integrating mpMRI radiomics features, demonstrated promising ability to mimic radiologists’ diagnosis for preoperative identification of molecular receptors of BC.

Comparative Analysis of Stock Prices, Abnormal Return, Cumulative Abnormal Return, and Trading Volume Activity in the Indonesia Stock Exchange: An Event Study of the Russia-Ukraine War

The Russia-Ukraine war has captured international attention and raised concerns about its potential implications on global financial markets. This study aimed to investigate the interplay between geopolitical events, market reactions within the Indonesia Stock Exchange (IDX), and the market efficiency of the IDX. The study employed event study methodology and analyzed changes in stock prices, abnormal returns, cumulative abnormal returns, and trading volume activity. The sample comprised 53 companies in the energy sector and 57 companies in the food and beverage sector listed on the IDX. The analysis focused on data from 10 days before and after three Russia-Ukraine conflict-related events, namely (1) the announcement of Russia’s invasion of Ukraine on the 24th of February 2022, (2) the announcement of an oil import embargo on Russia by the European Union on the 31st of May 2022, and (3) the announcement of the first wheat export ship’s departure from the port of Odesa on the 1st of August 2022. Both paired sample t-tests and paired sample Wilcoxon signed rank tests were conducted to assess the statistical significance of differences in the means of paired samples. The findings revealed significant differences in average stock prices before and after all three events in the energy sector. However, only events 2 and 3 displayed significant differences in average abnormal returns and cumulative abnormal returns. Moreover, events 1 and 3 exhibited significant differences in average trading volume activity. In the food and beverage sector, a significant difference in average stock prices was observed before and after event 2, while all three events presented significant differences in average abnormal returns and cumulative abnormal returns. Furthermore, event 3 showed a significant difference in average trading volume activity. These findings indicated that the IDX displayed varying reactions to different Russia-Ukraine conflict-related events. Notably, events involving multiple countries or entities exerted a greater impact on the energy and food and beverage sectors within the IDX, leading to more pronounced market reactions. Additionally, the findings suggested that the IDX exhibited a semi-strong form of market efficiency.

Cannabis knowledge gaps in nursing education: Pilot testing cannabis curriculum

Cannabis education is recommended for nursing programs; however, knowledge gaps persist. Key objectives of this study were to evaluate prior knowledge deficits, develop an innovative cannabis curriculum, and evaluate efficacy of the curriculum. This pilot study included a pre/postevaluation of 17 students using an online, synchronous educational session. National guidelines were used as a conceptual framework to develop an evidence-based educational intervention inclusive of cannabis pharmacology, the endocannabinoid system, and physiology. Using a paired samples Wilcoxon signed-rank test, a significant increase in both self-assessed (p < .001) and tested knowledge (p < .001) was observed. Students strongly agreed that cannabis education influenced clinical practice. Students strongly recommended that this content be formally integrated into the program curriculum. This study confirmed that cannabis knowledge gaps exist in a single advanced practice nursing program and indicates the benefits of an educational intervention. Further research is needed to validate and generalize these findings.

The Effectiveness of the Flipped Classroom Approach Based on the ADDIE Model in Students of Community- Based Education of Health Sciences at Shahid Beheshti University of Medical Sciences

Introduction: The flipped classroom based on instructional design is one of the student based teaching approaches that is expanding today. This teaching method promotes autonomy and effective cooperative learning in learners. The purpose of this study is to determine the effectiveness of this instructional approach based on the ADDIE model in learners. Method: This semi- experimental study was conducted on Students of Community- Based Education of Health at Shahid Beheshti University of Medical Sciences in 1400. The intervention included the implementation of a virtual flipped class using the ADDIE model for the research methods course with a focus on research proposal writing. The effectiveness of the intervention results was evaluated using the first and second levels of Kirkpatrick’s model's compared to the results of the common approch. Data collection tool was the satisfaction questionnaire and the checklist to evaluate the dimensions of the research proposal. Data were analyzed by Descriptive and inferential tests, including mean and standard deviation, and frequency, and Wilcoxon's test (Related Samples Wilcoxon Signed Rank Test). Result: Results showed satisfaction of more than 60% of the research participants in a very high range. The results of the two Kirkpatrick’s model level showed a statistically significant difference (P&lt;0.05, Z=-2.001) in the learning rate of the flipped classroom approch in a comparison with the common instructional approch showed. The learning results in most of the examined items in the dimensions of proposal writing after the implementation of the flipped class compared to the common approch, led to an improvement of learning by more than 50%. Conclusion: The results of this study indicated that teaching with an flipped classroom approach based on the ADDIE model can improve both learning and quality also, quantity of written proposals.

Evaluating ChatGPT's Ability to Solve Higher-Order Questions on the Competency-Based Medical Education Curriculum in Medical Biochemistry.

Background Healthcare-related artificial intelligence (AI) is developing. The capacity of the system to carry out sophisticated cognitive processes, such as problem-solving, decision-making, reasoning, and perceiving, is referred to as higher cognitive thinking in AI. This kind of thinking requires more than just processing facts; it also entails comprehending and working with abstract ideas, evaluating and applying data relevant to the context, and producing new insights based on prior learning and experience. ChatGPT is an artificial intelligence-based conversational software that can engage with people to answer questions and uses natural languageprocessing models. The platform has created a worldwide buzz and keeps setting an ongoing trend in solving many complex problems in various dimensions. Nevertheless, ChatGPT's capacity to correctly respond to queries requiring higher-level thinking in medical biochemistry has not yet been investigated. So, this research aimed to evaluate ChatGPT's aptitude for responding to higher-order questions on medical biochemistry. Objective In this study, our objective was to determine whether ChatGPT can address higher-order problems related to medical biochemistry.​​​​​​ Methods​​​ This cross-sectional study was done online by conversing with the current version of ChatGPT (14 March 2023, which is presently free for registered users).It was presented with 200 medical biochemistry reasoning questions that require higher-order thinking. These questions were randomly picked from the institution's question bank and classified according to the Competency-Based Medical Education (CBME) curriculum's competency modules. The responses were collected and archived for subsequent research. Two expert biochemistry academicians examined the replies on a zero to five scale. The score's accuracy was determined by a one-sample Wilcoxon signed rank test using hypothetical values. Result The AI software answered 200 questions requiring higher-order thinking with a median score of 4.0(Q1=3.50, Q3=4.50). Using a single sample Wilcoxon signed rank test, the result was less than the hypothetical maximum of five (p=0.001) and comparable to four (p=0.16). There was no difference in the replies to questions from different CBME modules in medical biochemistry (Kruskal-Wallis p=0.39). The inter-rater reliability of the scores scored by two biochemistry faculty members was outstanding (ICC=0.926 (95% CI: 0.814-0.971); F=19; p=0.001)​​​​​​ Conclusion The results of this research indicate that ChatGPT has the potential to be a successful tool for answering questions requiring higher-order thinking in medical biochemistry, with a median score of four out of five. However, continuous training and development with data of recent advances are essential to improve performance and make it functional for the ever-growing field of academic medical usage.

Analysis on the clinical features of sarcoid uveitis

Objective: To analyze the clinical features of patients with sarcoid uveitis. Methods: This was a retrospective case series study. The medical records of 19 086 patients with uveitis admitted to the Department of Ophtalmology, The First Affiliated Hospital of Chongqing Medical University from April 2008 to December 2019 were collected. The general data, medical history, treatment, diagnosis, follow-up, ophthalmic and other auxiliary examinations were retrospectively analyzed. The paired sample Wilcoxon signed rank test was used to compare the best corrected visual acuity (BCVA) of the affected eye at the first visit to the BCVA of the affected eye at the corresponding last visit. Results: A total of 51 patients (97 eyes) with sarcoid uveitis were included, including 15 males (29.4%) and 36 females (70.6%), with a male/female ratio of 1/2.4. There were 46 patients (88 eyes) with presumed sarcoidosis and 5 patients (9 eyes) with definite sarcoidosis. The age of onset was 48 (40, 55) years and 90.2% of patients (46 cases) were involved in both eyes, while 88.2% of the patients (45 cases) were chronic, and only 11.8% (6 cases) showed acute inflammatory response. Anterior uveitis was the most common type (50.5%, 49 eyes). Ophthalmoscopy revealed retinal vasculitis in only 2 eyes (2.1%) and fundus fluorescence angiography (FFA) revealed diffuse vascular leakage of fluorescein in 64 eyes (66.0%). Thirty-one patients (59 eyes) were followed up for≥3 months. Cataract was the most common ocular complication, accounting for 44.1% (26 eyes), and the inflammatory response was controlled in 45 eyes (76.3%) treated with combination of corticosteroids and immunosuppressive agents. The patients were followed up for 21.5 (13.7, 29.3) months. Among 31 patients (59 eyes) followed up for≥3 months, BCVA was≥0.8 in 25 eyes (42.3%) and<0.3 in 15 eyes (25.4%) at the last follow-up, BCVA of 59 affected eyes of 31 patients was better than that at the first visit, the difference was statistically significant (Z=-2.76, P=0.006). Conclusions: Uveitis associated with sarcoidosis or presumed ocular sarcoidosis mainly manifests as a bilateral, chronic anterior uveitis with a subclinical retinal vasculitis. FFA shows subclinical retinal vasculitis in most patients. Glucocorticoid therapy in combination with other immunosuppressive agents can control inflammatory responses and improve visual acuity in most patients.

Character Changes Related to Sports Participation and Contextual Factors Among Secondary School Students

Sports participation is hailed as one of the effective ways of nurturing positive character among the youth. However, some studies have also indicated that sports may lead to undesirable behavior when conducted under certain uncontrolled conditions. The purpose of this study was to assess the influence of selected contextual factors on character changes related to sports participation among secondary school students. The study focused on level of sports participation, gender, age, type of sport, school category, school status, school type, and class level of students as independent variables with potential to influence character changes related to sports participation. A Quasi-experimental research design was utilized, with the dependent variable of character traits assessed at the pre and post three months competitive games season. Purposive sampling was used to select 336 student-athletes from 24 (9.3%) of secondary schools in Nairobi city county. A close-ended questionnaire on character which was adapted from Individual and Team Character in Sport Questionnaire (ITCSQ) and Arizona Sport Summit Accord (ASSA) was utilized for data collection at the pre-and posttests. Matched Sample Wilcoxon Signed Rank test showed significant negative change in honest /integrity character component scores between pre-test and post-test (p=0.006). Multinomial Logistic Regression Analyses showed that boarding status, school category and type of sport can significantly (p&lt;0.05) influence character changes among competitive student-athletes. Therefore it is concluded that boarding status, school category and type of sport can influence outcomes of sports experiences leading to positive or negative character change. It is therefore recommended that curriculum developers and implementers should consider contextual factors to optimize sports experiences and outcomes to promote desirable character changes and development.

Variation of renal function in patients with urothelial carcinoma treated by tislelizumab-based immunochemotherapy.

494 Background: Treatment based on PD-1 ICIs brings advances to the treatment of urothelial carcinoma (UC). Although acute renal insufficiency is not common in iRAEs, the safety of immunotherapy in patients with renal impairment is still unknown. Consequently, we intend to investigate the effect of immunochemotherapy on nephritic function in the short term. Methods: Between July 2019 and September 2022, data of patients (pts) with UC that underwent tislelizumab based immunochemotherapy, including demographic information (age, gender), and creatinine level in baseline, after the first, second and third cycle (C1, C2 and C3) of immunotherapy in the Second Hospital of Tianjin medical University was collected and analyzed retrospectively. Estimated glomerular filtration rate (eGFR) is calculated according to CKD-EPI formula 2009, while pts were subdivided into different groups according to baseline eGFR, referencing to CKD categories in the K-DIGO 2012 guidelines for CKD classes. Data analyses were conducted using paired samples Wilcoxon Signed Rank Test and Kruskal-Wallis H test. Results: 163 pts have been included in our analyse totally. The median age was 67 years (IQR 61-74) and 128 (78.5%) were male. 135 (82%) pts received ICIs as perioperative treatment, while 19 (12%) pts were treated after radical operation. Metastasis is found in 9 (6%) pts before firstly received immunotherapy. Median creatinine (Cr) in baseline was 80.2umol/L (IQR 68.3-95.8), while median EGFR was 82.6 (IQR 64.3-93.8) mL/min/1. 73m2 in all pts. According to CKD categories in the K-DIGO 2012 guidelines, at baseline, 57 pts are classified as G1 (eGFR≥90 mL/min/1.73m2), 74 pts as G2(eGFR &lt;90 mL/min/1.73 m2 and≥60 mL/min/1.73 m2), 30 as G3 (eGFR &lt;60 mL/min/1.73 m2 and≥30 mL/min/1.73 m2), and 2 as G4 (eGFR &lt;30 mL/min/1.73 m2 and≥15 mL/min/1.73 m2). No significant difference in eGFR between pts with CKD G1-2 in comparison to baseline and after the first (C1), second (C2) or third cycle(C3) of tislelizumab based immunotherapy (All p &gt;0.05). Notably, we found that eGFR improved in pts with CKD G3-4 when the first, second and third cycle completed, in comparison to the baseline.(p&lt;0.001, &lt;0.001, =0.002). Conclusions: Despite renal impairment is common in pts with UC, no evidence suggests that it is contraindicated for tislelizumab based treatment. More importantly, PD-1 immunotherapy may provide better nephritic benefits in patients with renal insufficiency. [Table: see text]

Impact of COVID-19 on the productivity of ornamental fish farmers: A case of ornamental fish farms in Colombo district in Sri Lanka

Ornamental fish production in Sri Lanka has become a valuable foreign exchange earner during recent past years. However, COVID-19 pandemic has been explored worldwide and it has affected the world trade and economy from different perspectives. This study was conducted to explore the impact of the COVID-19 pandemic on ornamental fish production. , Moreover, study on present status of ornamental fish farmers’ major constraints and suggestions to overcome those constraints of ornamental fish farmers were also conducted. In Colombo district, four important Divisional Secretariat (DS) divisions were purposely selected for the study, as they are the main ornamental fish production areas of the district. The data was collected from a randomly selected 60 farmers using a field survey from July to October 2020. Descriptive statistics, two sample Wilcoxon signed-rank test and chi-square test were used to analyses the data. Results revealed that, there are both negative and positive impacts on ornamental fish production due to the COVID-19 pandemic. Ornamental fish farmers have to face mainly production and marketing problems. Some of them have engaged in coping strategies and resilience methods during COVID-19 period. Coping strategies have shown a significant association with the income and the production capacity of the farms. However, the majority of ornamental fish farmers haven’t engaged in resilience methods during the COVID-19 pandemic. Other than the COVID-19 pandemic, the major constraints of ornamental fish production were lack of market information about the changes in the overseas markets and demand, the low price given for the product and lack of communication between farmers and exporters. Ideal “ORNAFISBIZ” model is suggested for overcome those constraints in order to protect the ornamental fish farmers in this area.