Distribution Of Scores Research Articles

Quantitative assessment of cervical disc degeneration using disc signal intensity index.

The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine. The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration. Cross-sectional study using retrospectively collected data. Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed. Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease. DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration. A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β= -0.130, p< 0.05), BMI (β= -2.06, p< 0.05), Modic changes (Type1 β= -2.70, p<0.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<0.001; C7/T1: β= 2.63, p<0.001) and the history of diabetes (β=5.31, p<0.01) was associated with high DSI2.(p<0.01) CONCLUSIONS: The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.

The geographical distribution of the family-genetic risk score for drug use disorder in Sweden and its co-localization with areas of social deprivation

Abstract Background Drug use Disorder (DUD), the risk for which is substantially influenced by both genetic and social factors, is geographically concentrated in high-risk regions. An important step toward understanding this pattern is to examine geographical distributions of the genetic liability to DUD and a key demographic risk factor – social deprivation. Methods We calculated the mean family genetic risk score (FGRS) for DUD ((FGRSDUD) and social deprivation for each of the 5983 areas Demographic Statistical Areas (DeSO) for all of Sweden and used geospatial techniques to analyze and map these factors. Results Using 2018 data, substantial spatial heterogeneity was seen in the distribution of the genetic risk for DUD in Sweden as a whole and in its three major urban centers which was confirmed by hot-spot analyses. Across DeSOs, FGRSDUD and s.d. levels were substantially but imperfectly correlated (r = + 0.63), with more scattering at higher FGRSDUD and s.d. scores. Joint mapping across DeSOs for FGRSDUD and s.d. revealed a diversity of patterns across Sweden. The stability of the distributions of FGRSDUD and s.d. in DeSOs within Sweden over the years 2012–2018 was quite high. Conclusions The geographical distribution of the genetic risk to DUD is quite variable in Sweden. DeSO levels of s.d. and FRGSDUD were substantially correlated but also disassociated in a number of regions. The observed patterns were largely consistent with known trends in the human geography of Sweden. This effort lays the groundwork for further studies of the sources of geographic variation in rates of DUD.

Comparing paper-based and mobile application for rank-based peer assessment in interprofessional education: before, during, and after the COVID-19 pandemic

BackgroundEducation was affected during the COVID-19 pandemic, and there was a need to adapt the learning approaches to the situation. At the University of Gadjah Mada, many essential soft skills of healthcare professionals are taught using the interprofessional education (IPE) approach on-site. Our university responded to this crisis by offering online classes and similar types of training. Post-administration of the course, a peer-assessment was conducted, and it was used to provide feedback on the work or performance of peers among students. Peer assessment was done using paper-based and a mobile application during COVID-19. This study aimed to share a best practice for the implementation of a rank-based peer-assessment application for longitudinal interprofessional education in the community setting and to compare the score distribution of a rank-based peer-assessment before and after using mobile application.MethodsQuantitative research design was used by processing secondary data on student peer assessment scores from 3 bachelor programs (medicine, nursing, nutritionist) Community and Family Health Care with Interprofessional Education (CFHC-IPE) in Faculty of Medicine, Nursing, and Public Health, Universitas Gadjah Mada. 4,790 students from 2018 to 2022 (5 years) were tracked before, during, and after the COVID-19 pandemic. The assessments carried out were offline, online, and blended learning, respectively. The assessment was carried out using a paper-based method before and during the pandemic, online-based with a mobile application was used. Thus, the peer-assessment was conducted manually or using paper-based method using a 5-rank scoring system. In 2019, the peer assessment was carried out using a mobile application and applied a 10-rank scoring system.ResultsThe rank-based peer assessment can be well implemented to make students assess their friends more objectively, with an average score 82.02 ± 8.68. The rightward shift in the distribution of scores indicates that the average score has improved after using the mobile application compared to before its use. (82.02 ± 8.68 vs. 62.39 ± 11.13, p < 0.05).ConclusionThe implementation of rank-based peer-assessment using a mobile application was well received during and after the pandemic by interprofessional undergraduate students. The online system made the assessment more objective and the average grades were seen to be better.

Quick-reference criteria for identifying multivariate cognitive change in older adults with mild cognitive impairment and dementia: An ADNI study.

To establish quick-reference criteria regarding the frequency of statistically rare changes in seven neuropsychological measures administered to older adults. Data from 935 older adults examined over a two-year interval were obtained from the Alzheimer's Disease Neuroimaging Initiative. The sample included 401 cognitively normal older adults whose scores were used to determine the natural distribution of change scores for seven cognitive measures and to set change score thresholds corresponding to the 5th percentile. The number of test scores that exceeded these thresholds were counted for the cognitively normal group, as well as 381 individuals with mild cognitive impairment (MCI) and 153 individuals with dementia. Regression analyses examined whether the number of change scores predicted diagnostic group membership beyond demographic covariates. Only 4.2% of cognitively normal participants obtained two or more change scores that fell below the 5th percentile of change scores, compared to 10.6% of the stable MCI participants and 38.6% of those who converted to dementia. After adjusting for age, gender, race/ethnicity, and premorbid estimates, the number of change scores below the 5th percentile significantly predicted diagnostic group membership. It was uncommon for older adults to have two or more change scores fall below the 5th percentile thresholds in a seven-test battery. Higher change counts may identify those showing atypical cognitive decline.

Role of molecular alterations in transplantation decisions for patients with primary myelofibrosis

AbstractThe aim of our study was to analyze the potential survival benefit associated with hematopoietic stem cell transplantation (HSCT) according to clinicobiological scores, which incorporate molecular data (MIPSS70 and MIPSS70+V2) to facilitate decision-making in this context. One transplant (n = 241) and 1 nontransplant cohort (n = 239) were used to test the hypothesis that patients with primary myelofibrosis with higher risk molecular score benefit from HSCT. A weighted propensity score was applied to balance confounding factors with the transplanted cohort as reference. Weighted Cox proportional hazard models and logistic regression analyses were performed. Overall, 105 patients who did not receive transplant could be matched to the 239 patients who did receive transplants. Mean age in matched patients who did and did not undergo transplant was 55.5 and 57.9 years, respectively. Blood cell count and Dynamic International Prognostic Scoring System (DIPSS) score distribution were similar in both groups. HSCT was associated with a higher 6-year overall survival rate in intermediate-2 (60.1% vs 41.5%) and high-risk DIPSS patients (44.4% vs 6.55%), high-risk MIPSS70 (46.5% vs 23.9%), high-risk (73.2% vs 39.7%) or very high-risk MIPSS70+V2 (51.8% vs 24%). Patients with intermediate MIPSS70 scores have an advantage of survival with HSCT only when their myelofibrosis transplant scoring system (MTSS) were low or intermediate. Patients who received transplant had an increased mortality risk the first year, but a significant benefit with HSCT after the 1-year landmark was observed in higher risk patients. This study confirms that, similar to DIPSS, MIPSS70 and MIPSS70+V2 risk score in addition to MTSS can be used to determine which patients with primary myelofibrosis have survival benefit from HSCT over non-HSCT strategies.

Distribution of SALT Scores with Ritlecitinib Treatment up to 24 months from the ALLEGRO Phase 2b/3 and Long-Term Phase 3 Clinical Studies in Alopecia Areata

Background:• Alopecia areata (AA) is an autoimmune disease that has an underlying immuno-inflammatorypathogenesis and is characterized by non-scarring hair loss ranging from small patches to completescalp, face, and/or body hair loss1• Ritlecitinib, an oral JAK3/TEC family kinase inhibitor, demonstrated efficacy and safety up to 48 weeks inpatients aged ≥12 years with AA in the ALLEGRO phase 2b/3 study (NCT03732807; “ALLEGRO-2b/3”)2• The long-term efficacy of ritlecitinib in patients who rolled over from ALLEGRO-2b/3 to the ongoingphase 3, open-label ALLEGRO-LT study (NCT04006457) has been reported in terms of the proportions ofpatients with Severity of Alopecia Tool (SALT) scores of ≤20 and ≤10 (≤20% or ≤10% scalp without hair)at Month 243• However, the distribution of SALT scores in the overall population, including patients not reaching theSALT score ≤20 and ≤10 thresholds, has not yet been describedOBJECTIVE• This study describes changes in the distribution of SALT scores over 24 months of ritlecitinib treatmentin the overall population and in age and disease severity subgroups Methods: Study design and patients• Key inclusion criteria in ALLEGRO-2b/3:- Age ≥12 years- Diagnosis of AA with ≥50% scalp hair loss due to AA (including alopecia totalis [AT] and alopecia universalis [AU])- Maximum duration of current episode of hair loss ≤10 years• This analysis includes patients who received ritlecitinib 50 mg once daily (QD) without a loading dose inALLEGRO-2b/3 and who subsequently rolled over into ALLEGRO-LT where they continued to receiveritlecitinib 50 mg QD (Figure 1)- Continuation criteria for adolescents (aged 12-17 years) in ALLEGRO-LT: ≥50% improvement from baseline in SALT scoreby Month 3 for rollover patients from ALLEGRO-2b/3 and SALT score ≤20 by Month 6 in ALLEGRO-LTFigure 1. Study design and patient populationCombinedritlecitinib50 mg group(N=191)ALLEGRO phase 2b/3 ALLEGRO-LTLoading(4 weeks)Maintenance(20 weeks)Extension(24 weeks)Long-term study(60 months)Group A (n=131) 200 mg 50 mg 50 mg 50 mgGroup B (n=129) 200 mg 30 mg 30 mg 50 mgGroup C (n=130) 50 mg 50 mg 50 mg 50 mgGroup D (n=132) 30 mg 30 mg 30 mg 50 mgGroup E (n=61) 10 mg 10 mg 10 mg 50 mgGroup F (n=63) Placebo Placebo 200 mg 50 mg 50 mgGroup G* (n=61) Placebo Placebo 50 mg 50 mgDe novo group (n=447) 200 mg 50 mg*Data while on placebo were not included in this analysis; data from patients in Groub G were rebaselined from the start of treatment with ritlecitinib.Assessments and statistical analysis• The distribution of patients according to SALT score (as observed) was assessed through Month 24 forthe overall population and subgroups based on age (adults [≥18 years] vs adolescents [12-17 years]) anddisease severity (patients with AT/AU vs those without AT/AU)• The data cutoff date was December 9, 2022 Results: The analysis included 191 patients (27 adolescents and 164 adults) (Table 1)• At the time of data cutoff, 71 patients had discontinued; withdrawal bypatient (n=19), adverse events (n=18), and lack of efficacy (n=14) were themost common reasons for discontinuation• The distribution of participants by SALT score (as observed) at baseline, Month12, and Month 24 are presented for the overall population (Figure 2)(Interactive dynamic plot)• Per the inclusion criteria, all participants had a SALT score of ≥50 at baseline;136/191 patients (71.2%) had SALT &gt;90• Among patients who had a nonmissing SALT score, 56/178 (31.5%), 37/164(22.6%), and 17/120 (14.2%) were in the SALT &gt;90-100 category at Months 6,12, and 24, respectively• Reductions in the number of patients in the other SALT &gt;50 categories wereobserved from baseline through Month 24• At Month 12, 56/164 (34.2%) and 18/164 (11.0%) patients were in the SALT0-10 and &gt;10-20 categories, respectively, with 61/120 (50.8%) and 12/120(10.0%) patients in these categories at Month 24• Among the patients with AT/AU at baseline, 18/69 (26.1%) and 6/69 (8.7%)were in the SALT 0-10 and &gt;10-20 categories, respectively, at Month 12; 25/47(53.2%) and 3/47 (6.4%) were in these categories, respectively, at Month 24(Figure 3) (Interactive dynamic plot)• For the adolescent participants, 10/22 (45.5%) and 4/22 (18.2%) were in theSALT 0-10 and &gt;10-20 categories, respectively, at Month 12, and 11/14(78.6%) and 0/14 (0%) were in these categories at Month 24 (Figure 4) Conclusions:• Over 24 months, daily treatment with ritlecitinib 50 mg resulted in fewer patients inthe highest SALT score categories• These data provide a comprehensive overview of patient response to ritlecitinibtreatment and enable us to understand treatment response and time frames whileon treatment with ritlecitinib • This information can empower clinicians when counseling patients and managingtreatment expectations based on patient characteristics• This study also shows that response to treatment improves over time, whichsuggests that adequate time should be given when assessing treatment efficacy

Family's Caregiving Status and Post-Stroke Functional Recovery During Subacute Period from Discharge to Home: A Retrospective Study.

Background/Objectives: Family members, often informal caregivers, play a crucial role in providing home care for stroke survivors. The period following discharge to home after receiving acute stroke management in a hospital includes the subacute phase of stroke and remains critical to the recovery of stroke patients. This study evaluated the association between family caregiving and post-stroke functional recovery after discharge to home. Methods: Data from 402 patients with stroke were obtained from the Korea University Ansan Hospital Stroke Center from January 2019 to May 2022. The family's caregiving status was evaluated for family burden and supportable environment in the home. This study's outcome of interest was the modified Rankin Scale (mRS) at discharge to home and three months after stroke onset. The repeated mRS scores were analyzed using the Linear Mixed Model. Results: Median days from discharge to 3 months after stroke onset was 81.0 days. The median score of mRS at discharge was 2.0, and the score at three months after stroke onset was 2.0. The distribution of mRS score 0-2 was 60.9% at discharge and 72.1% at three months after stroke onset. In Linear Mixed Models after adjustments with covariables, the family's caregiving status was positively associated with repeated mRS scores (β = 0.17; 95% confidence interval = 0.11, 0.23; p < 0.001). Conclusions: These findings suggest that family caregiving to patients with stroke might be associated with post-stroke functional recovery within the period from discharge to home until three months after stroke onset.

Evaluate Effect of Mirror Therapy on Upper Limb Motor Functions Among Patients with Stroke

Stroke sometimes called as a brain attack occurs when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. Mirror therapy reduce spasticity, muscle pain, improve muscle strength and improves patient quality of life. In which inversion of visual feedback leads to additional activation of hemisphere contralateral to the perceived limb laterally. Sample size is 60 in which 30 samples covered for experimental group, 30 samples covered for control group and Non probability purposive sampling technique used. Medical research council (MRC) scale acts as a tool for measuring the level of muscle strength. The percentage distribution of muscle strength scores reveals that stroke patients in experimental group had significant resistance whereas in control group had no resistance in the muscle strength level. The findings of the study shows the significance difference between the mean and standard deviation of post test muscle strength scores of stroke patients of experimental and control group using ‘t’ test. The obtained ‘t’ value 5.887 is greater than table value 2.05 at 29 DF in 0.05 level of significance. Therefore the obtained ‘t’ value is found to be significant.

Associations Between Deficit Accumulation Frailty and Baseline Markers of Lifestyle in the US POINTER Trial.

Multidomain lifestyle interventions may have the potential to slow biological aging as captured by deficit accumulation frailty indices. We describe the distribution and composition of the 49-component frailty index (FI) developed by the U.S. POINTER clinical trial team of investigators and assess its cross-sectional associations with sociodemographic factors and markers chosen to be representative of behaviors targeted by the trial's multidomain interventions. We draw baseline data from the 2111 volunteers enrolled in U.S. POINTER who were ages 60-79 years and at increased risk for cognitive decline. Frailty components were grouped into nine domains. Associations that FI scores and their domains had with behavioral markers were described with correlations and canonical correlation. The 25th, 50th, and 75th percentiles of the frailty index score distribution were 0.153, 0.189, and 0.235. Higher frailty scores tended to occur among individuals who were older, male, and living in areas of greater deprivation (all p<0.001). They were also associated with poorer self-reported diet, less physical activity, and higher Framingham risk scores (all p<0.001). Associations were diffusely distributed among the frailty component domains, indicating that no individual domain was dominating associations. The U.S. POINTER deficit accumulation frailty index had expected relationships with sociodemographic factors and sensitivity to the behaviors targeted by the trial's interventions. Our analysis supports its use as a secondary outcome to assess whether the multidomain interventions differentially impact an established marker of biological aging.

Adherence and quality of life in patients with epilepsy in Cyprus

Abstract Introduction Epilepsy affects about 50 million people globally1. Patients often struggle with medication adherence due to forgetfulness, side effects, or lack of understanding, yet consistent use is vital for reducing seizures and improving quality of life2. Community pharmacists can improve outcomes by educating patients, aiding adherence, and clarifying drug effects and interactions, beyond just dispensing prescriptions. Aim The study aimed to assess epileptic patients’ adherence and quality of life in Cyprus. Methods This quantitative study, conducted from September 2022 to October 2023, received ethical approval from the Cyprus National Ethics Committee. Data were collected via phone calls using tools translated into Greek to assess adherence among epileptic patients. These tools included the MMAS-8 Morisky, with 8 items (7 Yes/No questions and 1 Likert 5-Point question), and the Readiness for Change scale, featuring a 0-10 ruler and 3 open-ended questions. The MARS-5, with 5 Likert 5-Point questions, and the QOLIE-31 were also used, along with demographic data collection. Inclusion criteria were patients over 18 with epilepsy, on antiepileptic therapy, and Greek-speaking. Of the 151 patients in the registry, 16 were excluded by the Neurologist of the Limassol's General Hospital due to factors like communication issues, recent stroke, quadriplegia, brain paralysis, mental retardation, and Down syndrome. Statistical analysis was performed using SPSS V28. Results In total, 85 epileptic patients participated in the study (out of the 135 patients- response rate 62.96%). The study's demographics included 47 males (55.3%) and 38 females (44.7%), with 18 participants aged 18-34 (21.2%), 46 participants aged 35-64 (54.1%), and 21 participants over 65 (24.7%). Additionally, the age of epilepsy onset was categorised as follows: 39 participants (45.9%) had an onset before 18 years of age, and 46 participants (54.1%) had an onset at 18 years of age or older. The Morisky MMAS-8 results showed 47 participants (55.3%) with high compliance, 26 (30.6%) with medium, and 12 (14.1%) with low compliance. The MARS-5 results indicated 79 participants (92.9%) had high compliance (≥20), while 6 (7.1%) had low compliance (&amp;lt;20). The readiness for change ruler had a mean score of 9.48 (SD = 0.16). Specifically, the distribution of scores was as follows: 1 participant (1.2%) scored 2, 4 participants (4.7%) scored 5, 2 participants (2.4%) scored 7, 4 participants (4.7%) scored 8, 2 participants (2.4%) scored 9, and 72 participants (84.7%) scored 10. The overall quality of life (QoL) score averaged 75.3 (SD = 2.16). Discussion/Conclusion This study is the first comprehensive assessment of adherence and quality of life among epileptic patients in Cyprus. Some patients did not participate due to lack of time and interest. Using the Morisky MMAS-8 and MARS-5 scales, over half showed high medication compliance, but a significant portion had medium to low compliance, indicating a need for targeted interventions. The findings underscore the critical role of community pharmacists in supporting adherence and enhancing quality of life through education, counseling, and personalized care. This study provides a foundation for future research and interventions to improve epilepsy management in Cyprus.

Feasibility and acceptability of the brief patient-reported experience measure consideRATE within the hospital setting for patients with palliative care needs, their families/carers and clinicians.

Supporting clinical teams to improve care for inpatients with palliative care needs and their carers is a known priority. Patient reported experience measures (PREMs) may assist in improvement work. Evidence about how to collect and feedback PREM data for this population and context is required. To determine the feasibility of implementing a brief, validated PREM, consideRATE and appraise its acceptability as perceived by inpatients with palliative care needs, their carers and clinicians. A prospective study using: 1) PREM administration, screening log and field note completion; and; 2) a focus group with clinicians. Eligible participants recruited from three wards (cancer care and internal medicine) of an Australian tertiary metropolitan hospital. Participants included patients screened to have palliative care needs (using the SPICTTM criteria), their carers and multidisciplinary clinicians (including clinical managers). Feasibility: A 71% response rate was achieved (n = 80 from 112 eligible patients approached). Mean screening time to inform eligible patients for PREM completion was 7.5 min. More than half of eligible participants (n = 47, 59%) opted for electronic completion of consideRATE and mean completion time was 6.12 min. A third of participants required assistance for PREM completion (n = 27, 34%). Score distribution varied across response options, albeit with a positive skew towards 'very good' and 'good'. Two thirds of respondents (n = 50, 62.5%) provided ⩾1 free-text response. Acceptability: Clinicians valued consideRATE data noting feedback needed to be: accessible, supported by free-text and responsive to local contexts. It is feasible to implement consideRATE for inpatients with palliative care needs. Clinicians note consideRATE data is acceptable in informing improvement foci.

Agreement of PROMIS Preference (PROPr) scores generated from the PROMIS-29 + 2 and the PROMIS-16.

Preference-based summary scores are used to quantify values, differences, and changes in health-related quality of life (HRQoL) that can be used for cost-effectiveness analyses. The PROMIS-Preference (PROPr) measure is a preference-based summary score comprised of 7 PROMIS domains. The PROMIS-16 is a new PROMIS profile instrument. We evaluated the measurement properties of PROPr generated from the widely used PROMIS-29 + 2 compared with the PROMIS-16. We performed a secondary analysis of data from an online survey of the general US population, with a longitudinal subsample who reported back pain. The survey included both the PROMIS-16 and the PROMIS-29 + 2 profiles. PROPr scores were calculated from each profile and compared by the distribution of scores, overall mean scores, product-moment correlations with pain measure scores (Oswestry Disability Index, Roland-Morris Disability Questionnaire, Pain Intensity, Interference with Enjoyment of Life, Interference with General Activity Scale, and Graded Chronic Pain Scale), and difference in mean scores in subgroups with 13 chronic health conditions (Cohen's d). Of the 4,115 participants in the baseline survey, 1,533 with any reported back pain were invited for the 6-month follow-up survey and 1,256 completed it. At baseline, the overall mean (SD) PROPr score was 0.532 (0.240) from PROMIS-16 and 0.535 (0.250) from PROMIS 29 + 2. At both time points, the correlations of PROPr scores with physical and mental health summary scores from the PROMIS-29 and 4 pain scales were within 0.01 between profiles. Using subgroups with chronic health conditions and comparing between profiles, Cohen's d estimates of the difference in effect size were small (< 0.2). PROPr scores from the 16-item PROMIS profile measure are similar to PROPr scores from the longer PROMIS-29 + 2.

Validity of the Chronic Pain Grade Scale in nonspecific chronic low back pain

Higher pain grades are associated with high psychological burden and increase the risk for the persistence of chronic low back pain (CLBP). Previous results on the criterion validity of the Chronic Pain Grade Scale (CPGS) have been extended to the context of inpatient multidisciplinary orthopedic rehabilitation (MOR) and have been supplemented with additional psychosocial and work-related measures. In this multicenter study, psychological, work- and pain-related outcomes were examined among 1010 individuals with nonspecific CLBP (ICD-10: M51/53/54) prior to the beginning of an inpatient MOR stratified by pain grade (I-IV). Additionally, frequency distributions of scores regarding pain-specific self-efficacy, depression, and subjective prognosis of gainful employment by pain grade in patients were investigated. The CPGS differed between all pain grades in the psychological, work- and pain-related outcomes in the expected direction. In post hoc pairwise comparisons, gradeIV was significantly different from the lower grades. Patients with higher pain grades showed unfavorable levels in psychosocial parameters and more frequently scores in the clinical range than expected. These results confirm the criterion validity of the CPGS. The psychosocial risk pattern observed in higher pain grades supports the importance of conducting early pain-related and psychological diagnostic assessments and implementing systematic allocation to needs-based interdisciplinary multimodal treatments.

Neurodevelopmental Process Monitoring of Cytosine Arabinoside-Exposed Neurons Using Raman Spectroscopy.

Raman spectroscopy is used to monitor the development of live neurons exposed to cytosine arabinoside (ara-C). Ara-C is widely used to culture neurons and exclude non-neuronal cells. In this study, Raman spectra obtained from neurons exposed to ara-C were plotted using an analytical model of neuronal development to evaluate the impact of ara-C on neuronal development. After two days of culturing, neurons were exposed to ara-C for 24 h at final concentrations of 0 (control), 5, and 25 μM. Principal component analysis (PCA) was performed to build an analytical model for evaluating neurodevelopmental disorders caused by ara-C treatment. We projected the Raman spectra obtained from ara-C-treated cells onto the control group dataset. The distribution of PC1 scores for neurons exposed to ara-C at a final concentration of 5 μM was not significantly different from that of the control group. In contrast, under a final concentration of 25 μM, the data population at 10 and 15 days of culturing overlapped significantly with that of neurons at 4 days of normal culturing. These results suggest that Raman spectroscopy can detect very small physiological alterations in the neurons even after a short-term exposure (24 h) of ara-C. Our analytical method has high potential to evaluate the developmental stages for living neurons under exposure to chemicals.

Comparison of the outcome of dynamic hip screw versus proximal femoral nail for treatment of intertrochanteric femoral fractures among elderly patients.

Objective: To compare the outcome of DHS versus PFNA for treatment of intertrochanteric femoral fractures (IFFs) among elderly patients. Study Design: Randomized Clinical Trial. Setting: Sheikh Zayed Hospital, Lahore. Period: 2-03-2022 to 2-09-2022. Methods: In total 90 patients fulfilling inclusion criteria were registered after approval from the ethical review committee of the hospital. Every patient provided written informed consent. Patients were allotted to each group (Group A = PFNA, Group B = DHS) using lottery method. Patients were operated upon by a single surgical team. Data was obtained VIA questionnaires designed for pre- operative period, immediate post-operative period, 1 and 3 months follow up. Patients were interviewed and evaluated by blind researchers at each stage. Harris hip score was used to assess the functional outcomes. Results: In 90 patients (45 in each), 36.2% (n=17) were male in PFNA group and 63.8% (n=30) in DHS group and 65.1% (n=28) were female in PFNA and 34.9% (n=15) in DHS group, p=0.011. Mean age of PFNA group was calculated as 66.00± 3.41 years and mean age of DHS group was 66.80±3.71 years (p=0.714). Distribution of BMI was 28.14+6.20kg/m2 in PFNA group and 27.47+6.24kg/m2 in DHS group, p=0.612. Distribution of Harris hip score at 1 month was 31.11+4.08 in PFNA group and 30.11+4.18 in DHS group, p=0.254 and Harris hip score at 3 months was 88.68+1.23 in PFNA group and 81.68+0.95 in DHS group, p=0.000. Conclusion: We concluded that PFN is superior to DHS in treating Boyd and Griffin type II intertrochanteric fractures of femur. It’s only a matter of time that PFN becomes the new gold standard for these fractures.

Text readability: its impact on reading comprehension and reading time

Recently, the readability of texts has become the focus of reading research because it is believed to have implications for reading comprehension, which is of utmost importance in the field of English as a foreign language (EFL), particularly in the teaching, learning and assessment of reading comprehension. Unfortunately, the influence of text readability on reading comprehension (and reading time) has not been well studied in the EFL context. Most text readability studies are conducted in medical contexts, but these studies are often limited in predicting readability scores for sample texts. To address this gap, the current study aimed to evaluate the influence of text readability levels (based on the Flesch-Kincaid grade level (FKGL)) on students’ reading comprehension and reading time. Data were collected through reading test and analyzed using SPSS version 22. The Friedman test revealed that the distribution of students' reading comprehension score (X2=197.532, p=0.000) and reading time (X2=215.323, p=0.000) are different in each text, suggesting that the readability of texts has a significant influence on both. This study contributed to the practices of reading instruction and assessment. Limitations and suggestions for further research are briefly discussed.

W-system: A system to understand words in Wordle

Abstract Wordle is a popular puzzle game where players share their daily scores on Twitter. Based on this data, we developed a W-system to analyze and predict Wordle game outcomes, providing insights for further game development. The number of reported results varies daily. To explain this variation, we first cleaned the data reported on Twitter and performed autocorrelation and ADF tests, revealing that the series was not stationary. After performing first-order differencing, we confirmed stationarity. Using the AIC criterion, we determined that the ARIMA (1, 1, 0) model was optimal. We performed residual and LB tests, and then predicted the number of reports for the next 60 days, identifying a decreasing trend. Additionally, we investigated whether any attributes of the words affected the percentage of scores reported in Hard Mode using a random forest model. We found that certain vowels, such as A and E, made words easier, while I and O made words harder. To predict the distribution of reported results for a given future solution word, we designed a 24-5-7 fully connected neural network. The input layer consists of a 24-dimensional vector representing letter occurrences, the hidden layer has five neurons, and the output layer is a 7-dimensional vector representing the distribution of scores. We trained the model using MSE error and the Adam optimizer, achieving a final test set loss of 7.22, indicating good generalization ability. For example, for the word EERIE on March 1, 2023, the model predicted distribution with reasonable confidence, accounting for associated uncertainties. We also developed a model to classify solution words by difficulty. We identified eight attributes of words and used the Analytic Hierarchy Process (AHP) to assign weights to each feature. Applying the k-means clustering algorithm, we classified 355 words into three categories: easy, medium, and hard. Using our model, the word EERIE was classified as medium difficulty. We validated our model by plotting a two-dimensional clustering scatter plot using the two features with the highest weights, showing good separation among the three categories, and indicating the accuracy of our classification model.

Tenecteplase versus alteplase for acute stroke within 4·5 h of onset (ATTEST-2): a randomised, parallel group, open-label trial

Tenecteplase has potential benefits over alteplase, the standard agent for intravenous thrombolysis in acute ischaemic stroke, because it is administered as a single bolus and might have superior efficacy. The ATTEST-2 trial investigated whether tenecteplase was non-inferior or superior to alteplase within 4·5 h of onset. We undertook a prospective, randomised, parallel-group, open-label trial with masked endpoint evaluation in 39 UK stroke centres. Previously independent adults with acute ischaemic stroke, eligible for intravenous thrombolysis less than 4·5 h from last known well, were randomly assigned 1:1 to receive intravenous alteplase 0·9 mg/kg or tenecteplase 0·25 mg/kg, by use of a telephone-based interactive voice response system. The primary endpoint was the distribution of the day 90 modified Rankin Scale (mRS) score and was analysed using ordinal logistic regression in the modified intention-to-treat population. We tested the primary outcome for non-inferiority (odds ratio for tenecteplase vs alteplase non-inferiority limit of 0·75), and for superiority if non-inferiority was confirmed. Safety outcomes were mortality, symptomatic intracranial haemorrhage, radiological intracranial haemorrhage, and major extracranial bleeding. The trial was prospectively registered on ClinicalTrials.gov (NCT02814409). Between Jan 25, 2017, and May 30, 2023, 1858 patients were randomly assigned to a treatment group, of whom 1777 received thrombolytic treatment and were included in the modified intention-to-treat population (n=885 allocated tenecteplase and n=892 allocated alteplase). The mean age of participants was 70·4 (SD 12·9) years and median National Institutes of Health Stroke Scale was 7 (IQR 5-13) at baseline. Tenecteplase was non-inferior to alteplase for mRS score distribution at 90 days, but was not superior (odds ratio 1·07; 95% CI 0·90-1·27; p value for non-inferiority<0·0001; p=0·43 for superiority). 68 (8%) patients in the tenecteplase group compared with 75 (8%) patients in the alteplase group died, symptomatic intracerebral haemorrhage (defined by SITS-MOST criteria) occurred in 20 (2%) versus 15 (2%) patients, parenchymal haematoma type 2 occurred in 37 (4%) versus 26 (3%) patients, post-treatment intracranial bleed occurred in 94 (11%) versus 78 (9%) patients, significant extracranial haemorrhage occurred in 13 (1%) versus six (1%) patients, respectively, and angioedema occurred in six (1%) participants in both groups. Tenecteplase 0·25 mg/kg was non-inferior to 0·9 mg/kg alteplase within 4·5 h of symptom onset in acute ischaemic stroke. Easier administration of tenecteplase, especially in the context of interhospital transfers, indicates that tenecteplase should be preferred to alteplase for thrombolysis in acute ischaemic stroke. The ATTEST-2 population was large and representative of thrombolysis-eligible patients in the UK and, together with findings from other trials, provides robust evidence supporting the introduction of tenecteplase in preference to alteplase. The Stroke Association and British Heart Foundation.

Developing a gender measure and examining its association with cardiovascular diseases incidence: a 28-year prospective cohort study

BackgroundCardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide. Examining gender (socio-cultural) in addition to sex (biological) is required to untangle socio-cultural characteristics contributing to inequities within or between sexes. This study aimed to develop a gender measure including four gender dimensions and examine the association between this gender measure and CVD incidence, across sexes.MethodsA cohort of 9188 white-collar workers (49.9% females) in the Quebec region was recruited in 1991–1993 and follow-up was carried out 28 years later for CVD incidence. Data collection involved a self-administered questionnaire and extraction of medical-administrative CVD incident cases. Cox proportional models allowed calculations of hazard ratios (HR) and 95% confidence intervals (CI), stratified by sex.ResultsSex and gender were partly independent, as discordances were observed in the distribution of the gender score across sexes. Among males, being in the third tertile of the gender score (indicating a higher level of characteristics traditionally ascribed to women) was associated with a 50% CVD risk increase compared to those in the first tertile (HR = 1.50; 95% CI: 1.24 to 1.82). This association persisted after adjustment for several CVD risk factors (HR = 1.42; 95% CI: 1.16 to 1.73). Conversely, no statistically significant association between the third tertile of the gender score and CVD incidence was observed in females (HR = 0.79, 95% CI: 0.60–1.05).ConclusionsThe findings suggested that males within the third tertile of the gender score were more likely to develop CVD, while females with those characteristics did not exhibit an increased risk. These findings underline the necessity for clinical and population health research to integrate both sex and gender measures, to further evaluate disparities in cardiovascular health and enhance the inclusivity of prevention strategies.

Comprehensive stress echocardiography uncovers the heterogenity of phenotypes in non-ischemic heart failure with abnormal ejection fraction

Abstract Background Heart failure (HF) with abnormal left ventricular (LV) ejection fraction (EF) manifests in multiple phenotypes, each presenting distinct and potentially actionable therapeutic targets. This study aimed to assess the potential of the ABCDE+ stress echocardiography (SE) protocol in uncovering different phenotypes of non-ischemic HF. Methods With a retrospective analysis of prospectively acquired data, we identified 265 patients (mean age: 65.7±12.6 years; 154 males, 59.9%) with non-ischemic HF with EF&amp;lt;50% (mean =41.4±7.5) enrolled by 23 certified laboratories between 2021 and 2023. Ischemic origin was excluded based on data of angiography and medical history. ABCDE-SE was evaluated with exercise (n=98, 37.0%), dobutamine (n=50, 18.9%), or vasodilators (n=117, 44.1%). The protocol consisted of several steps: A assessed regional wall motion abnormality (RWMA); B evaluated number of B-lines; C measured left ventricular contractile reserve; Step D with coronary flow velocity reserve (CFVR) in the left anterior descending artery (LAD) was completed in 102 patients (38.5%); step E assessed heart rate reserve. Additionally, step F (evaluated in 188 patients at rest and 107 at peak stress) noted the presence of rest or stress-induced moderate-to-severe secondary mitral regurgitation. The SE response was graded on a scale from 0 (all steps normal) to 5 (all ABCDE+ steps abnormal). Results The mean ABCDE score was 1.5±1.2, ranging from 0 (n=59, 22.3%) to 5 (n=2, 0.8%) (see distribution of scores in Figure 1A). Abnormal results were observed in 21 subjects (7.9%) for A, 86 (32.5 %) for B, 147 (55.5%) for C, 42/102 (41.2%) for D, and 101 (38.1%) for E steps. Step F was abnormal in 22/188 (11.8%) at rest and in 16/107 (14.9%) at peak stress. The predominant "solitary phenotypes" (only one step abnormal) were impaired LV contractile function phenotype (step C in 47, 51.1%) followed by chronotropic insufficiency (step E in 17, 18.5%) and congestive phenotype (step B in 17, 18.5%) (see Figure 1B). The most frequent combined phenotype was BCE – congestive phenotype with impaired ventricular and heart rate reserves (28 [62.2%]). Notably, 38 patients (14.3%) demonstrated improved regional contractility, while 27 patients (10.2%) showed new regional wall motion abnormality (see Table). Conclusion Non-ischemic HF patients with abnormal EF exhibit a broad spectrum of phenotypes. Impaired left ventricular contractility, interstitial congestion, and chronotropic insufficiency are the most frequent abnormalities detected by ABCDE-SE. Up to one-quarter of such patients demonstrate normal SE results. This comprehensive approach paves the way for personalized, SE-guided therapy.