Implementation of a virtual curriculum for medical students completing clinical rotations in neurosurgery.

Assessment of a truncation-based R2* fitting technique for quantifying high liver iron concentration (LIC).

The impact of isolated ACL and MCL injuries on career longevity and performance metrics in elite rugby union players.

The aim of this study was to examine the effect of 2-h glucose infusion after an overnight fast on relative resting-state fMRI signal fluctuations. Our hypothesis was that neuronal glucose metabolism would be affected, and that this would lead to changes in signal power at specific frequency bands. Resting state fMRI (rsfMRI) scans were acquired in 9 subjects pre- and post-glucose ∼2h infusion. Fourier spectral analysis was performed using signals localized in the prefrontal cortex. Power spectra were calculated and statistical analysis was performed targeting the full spectral range using both a cluster-based and Wilcoxon signed rank test. For both tests, post-infusion signal power was significantly higher between the 0.015-0.1Hz range. Moreover we observed differences at higher frequencies, normally attributed to cardiac or respiratory related signals. Our findings suggest that prolonged glucose infusion post-fasting may significantly modulate rsfMRI signal fluctuations in the prefrontal cortex that may be related to metabolic responses to glucose infusion. Future studies should investigate the dynamic effects of sustained glucose infusion using continuous fMRI, exploring implications for brain function and metabolic disorders like diabetes.

PurposeThis study aimed to compare the immediate functional impact of wearing ankle foot orthoses (AFOs) designed using the Optimal Segment Kinematics and Alignment approach to Rehabilitation (OSKAR method) versus wearing standard ankle foot orthosis (AFO)-footwear in children with spastic diplegic cerebral palsy.MethodsTen participants, ages seven to 13 years, from local pediatric clinics in a large suburban area participated in the study. Each participant wore both types of orthoses in a randomized order. This was determined by participants choosing a sealed envelope containing a sticker indicating which orthosis to be worn for the first data collection. Participants were assessed using three functional outcome measures: 1) the Pediatric Balance Scale (PBS), 2) Standardized Walking Obstacle Course, and 3) the Six-Minute Walk Test. Non-parametric Wilcoxon signed rank tests were used to compare outcome scores between the two conditions.ResultsTotal scores on the PBS were significantly higher when wearing the OSKAR AFO-footwear combinations (AFOFCs) (median = 50.50) versus standard AFOFCs (median = 47.00), T = 26.50, p = 0.034, r = 0.95, but all other immediate functional scores were comparable between conditions.ConclusionsAFOFCs designed using the OSKAR method may improve functional balance and should be considered when determining the orthotic prescription. These exploratory findings emphasize the need for further investigation of the effectiveness of OSKAR AFOFCs in children with spastic diplegic cerebral palsy (CP).

Abstract The plywood and wood panel industry in India is witnessing rapid growth driven by urbanisation, rising disposable incomes, and increasing demand for modular furniture and construction materials. This study examines the financial performance and customer perception towards Century Plyboards India Ltd, one of India’s leading manufacturers of plywood, laminates, and engineered wood products. A mixed-method research design was adopted, combining secondary financial data analysis with primary survey data collected from 135 respondents comprising contractors, builders, architects, and individual consumers. Financial performance was assessed using key indicators — Earnings Per Share (EPS), Price-to-Earnings Ratio (P/E), Return on Equity (ROE), Dividend Payout Ratio, and Market Price per Share (MPS) — over five years (2021–2025), benchmarked against four industry peers. Statistical analyses including Spearman’s Rank Correlation, Chi-square Test, and the Wilcoxon Signed Rank Test were employed for hypothesis testing. Findings reveal that while Century Ply’s stock valuation and market price have grown significantly, EPS and ROE have experienced recent declines. Customer perception towards product quality, durability, and brand trustworthiness is largely positive, though price-cost effectiveness emerged as the most influential purchase driver. The Wilcoxon test confirmed a statistically significant difference between product perception and customer satisfaction levels, indicating service and quality gaps that warrant management attention. Keywords: Financial Performance, Customer Perception, Century Plyboards, EPS, P/E Ratio, ROE, Plywood Industry, India

Micro, small, and medium enterprises (MSMEs) in the MEK PCM Rungkut area face challenges in digital literacy, particularly in searching for information online, accessing relevant websites, and using email for business communication. These limitations hinder their operational activities, reduce opportunities to utilize digital platforms, and restrict access to broader market opportunities. This community service program is designed to improve the basic digital skills of MSMEs through digital literacy training on the use of internet and email. The methods employed include observation and interviews to identify partner needs, training on information searching, website access, and email usage, as well as evaluation through pre- and post-tests. Data analysis was conducted using a descriptive approach and the Wilcoxon Signed Rank Test. The results showed that 18 out of 20 participants experienced an increase in their post-test scores, with all final scores reaching ≥ 70, indicating that the minimum competency standard had been achieved. The Wilcoxon test yielded a p-value of 0.012 (p < 0.05), indicating a significant improvement in participants' understanding before and after the training. In addition, participants demonstrated positive changes in independently seeking information and using email for business purposes. This study concludes that the program was effective in improving basic digital literacy among MSMEs. Further recommendations include continuous mentoring to support participants in developing more advanced digital skills, particularly in digital marketing and the utilization of other technology-based services.

Dedicated breast positron emission tomography (dbPET) was developed to detect breast cancers smaller than those detectable using whole-body PET (wbPET). Although several studies have explored the use of dbPET, clear criteria for identifying which patients would benefit most from this modality are lacking. Our objective was to determine which patient groups would benefit most from dbPET and how it should be utilized. We conducted a multicenter, prospective exploratory study to investigate how the dbPET maximum standardized uptake values (SUVmax) correlate with patients' clinical characteristics, other imaging modalities, and pathological findings of the lesions. In total, 219 patients with breast cancer (median age [range], 58.0 [30-83] years) were included in this study. The enrolled patients were divided into three groups (primary care, neoadjuvant therapy, postoperative follow-up patients). In this research, we examined the primary care group (n = 92). To investigate which patient groups benefit from dbPET, we examined which factors influence and correlate with dbPET SUVmax. Depending on the items being compared, correlation analysis, Wilcoxon signed rank test was used to examine the following items. Which factors (physical factors, pathological characteristics, etc.) correlate with dbPET SUVmax, differences between dbPET and other imaging examination (detection rate, etc.), and whether dbPET SUVmax L/H ratio (Lesion-to-Healthy (normal) site dbPET SUVmax ratio) incorporating dbPET SUVmax from healthy (normal) mammary gland tissue are necessary for evaluating dbPET SUVmax in lesion areas. dbPET SUVmax in healthy(normal) mammary gland tissue were strongly associated with background mammary density observed on mammography (MMG) examination (positive correlation, p<0.05). Ki-67 showed the strongest positive correlation with both the lesion-site dbPET SUVmax (r=0.56, R2=0.31, p<0.05) and the dbPET SUVmax L/H ratio (lesion-to-healthy (normal) -site ratio) (r=0.47, R2=0.22, p<0.05). Additionally, the tissue grade, MMG and ultrasonography categories were positively correlated with dbPET SUVmax. Regarding the lesion detection rate, dbPET identified 100% of the lesions, including benign findings. The dbPET SUVmax L/H ratio showed a trend nearly identical to that of the dbPET SUVmax. dbPET demonstrated higher detection capabilities than other imaging tests and showed a strong correlation with tissue malignancy. Therefore, they were suggested to be potentially useful for distinguishing benign findings from malignant lesions that are difficult to differentiate using other imaging tests. The dbPET SUVmax of healthy mammary gland tissue were presumed to correlate with the amount of mammary gland tissue within the breast. However, no significant differences were observed in the correlations between the dbPET values and the L/H ratio and the individual parameters. In this study, it remained unclear whether the dbPET values of normal breast tissue should be taken into account when evaluating dbPET values.

Ethical leadership enables PHEIs to build trust and credibility by creating a foundation of respect, credence, and assurance amongst staff, stakeholders, and the community. Further, it promotes a fair, transparent, and supportive environment that increases job satisfaction, making employees more motivated and more likely to stay. Underscoring compliance and ethical behavior, it minimizes risks of scandals, legal problems, and reputational damage. Additionally, it promotes long-term sustainability, ensuring that PHEIs practice ethical, values-driven decision-making that makes them more resilient, equitable, and diverse. The purpose of this study was to examine staff’s perceptions of ethical leadership in Sabah, Malaysia. The sample consisted of 57 administrative and teaching staff from two PHEIs in Kota Kinabalu, Sabah, who were asked to complete the Ethical Leadership Questionnaire on Google Forms. Responses were subsequently transferred onto a spreadsheet, and SPSS 29.0 was used to analyze the data. First, ANOVA results revealed no significant age or gender differences in perceived ethical leadership among staff. Second, Wilcoxon signed rank test revealed that all 10 ethical leadership items were significantly different (p &lt; .001) from the hypothesized value of 3.5, indicating strong disagreement. Third, percentages of agreement indicated that only low proportions of PHEI staff tend to strongly agree/agree that their department heads practice ethical leadership. In light of the findings, some recommendations were made on ways that PHEIs could incorporate ethical leadership elements in their day-to-day management.

Introduction. As part of the health and recreational physical activity, we have been incorporating somatic movement classes into the physical education curriculum at Borys Grinchenko Kyiv Metropolitan University for 7 years. Initially, we trained 1st-year special medical group students, then transferred this expertise to 1st-year core group students who expressed interest in this program. The aim of the study is to investigate the impact of somatic movement classes on the quality of life of students enrolled in the 1st-year of the educational and professional program "Language and Literature (English) (with changes in 2024)" at Borys Grinchenko Kyiv Metropolitan University, with changes effective as of 2024. Material and methods. This article highlights the influence of somatic movement classes on the quality of life of forty-five females aged 17-18, 1st-year Borys Grinchenko Kyiv Metropolitan University students during 17 weeks of the 2nd semester of the 2024-25 academic year, i.e., compare the results obtained on the Ukrainian version of the World Health Organization Quality of Life-BREF Questionnaire at the verification and control stages on the pedagogical experiment of the 2nd semester of the 2024/2025 academic year. Results. The Wilcoxon Signed Ranks Test revealed that none of the significance level (Sig.) values exceeded the established level of p = 0.05, indicating no significant differences between the pre- and post-intervention scores. Conclusions. The absolute values of the total score for the Ukrainian version of the World Health Organization Quality of Life-BREF Questionnaire (the scale WHOQOL-BREFukr), as well as the subscale scores for the "Physical domain," "Social Relationships domain," and "Environment domain," decreased. At the same time, the absolute value of the subscale "Psychological domain" increased.

The third trimester of pregnancy is a critical phase that is often accompanied by increased anxiety due to concerns about the delivery process, the safety of the mother and fetus, and readiness to take on the role of mother. Anxiety that is not managed properly can have a negative impact on the psychological well-being of the mother and the delivery process. Music therapy is a non-pharmacological intervention that is considered safe, easy to implement, and has the potential to reduce anxiety in pregnant women. This study aims to analyze the effect of music therapy on the anxiety levels of pregnant women in the third trimester. This study used a quantitative approach with a quasi-experimental one-group pretest–posttest design. The study sample consisted of 20 pregnant women in their third trimester who were selected using purposive sampling at a community health center. Anxiety levels were measured before and after the intervention using a standardized anxiety questionnaire. The intervention consisted of relaxing instrumental music therapy administered for approximately 20–30 minutes in comfortable conditions. Data analysis was performed using univariate and bivariate analysis with the Wilcoxon Signed Rank Test at a significance level of p &lt; 0.05. The results showed that before the intervention, most respondents were in the moderate to severe anxiety category, whereas after music therapy, severe anxiety was no longer found and there was an increase in the proportion of mild anxiety. The Wilcoxon test showed a statistically significant difference between anxiety levels before and after the intervention (p = 0.000). In conclusion, music therapy has a significant effect in reducing anxiety levels in third trimester pregnant women and has the potential to be an effective non-pharmacological intervention to be integrated into antenatal care.

Neurocognitive function is an important element of academic and sports performance, which is often impaired following sport-related concussion. Neurocognitive assessment provides objective data that can be clinically valuable in the process of concussion diagnosis and management. However, the applicability of existing normative data to specific populations remains uncertain. This study investigated neurocognitive performance in an Irish collegiate athlete sample using the CNS Vital Signs (CNS VS) battery and compared results with the published normative data. A cross-sectional design was employed, recruiting 103 student-athletes (mean age 21.65 ± 2.77 years) from a single Irish technological university. Participants completed the CNS VS battery remotely, assessing verbal memory, visual memory, psychomotor speed, cognitive flexibility, continuous performance, and reaction time. One-sample z-tests/Wilcoxon Signed Rank tests were used to compare participant scores with normative values. The effect of biological sex, concussion history, attention deficit hyperactivity disorder (ADHD) and learning disability (LD), and sport type on neurocognitive scores across the six domains was examined with a series of multiple linear regression analyses. Compared with normative data, participants demonstrated significantly lower performance in visual memory, cognitive flexibility, and reaction time, with small-to-moderate effect sizes. Continuous performance scores were significantly higher, while no difference was observed in verbal memory and psychomotor speed. No statistically significant association was found between participants’ neurocognitive scores and any of the independent variables. These findings indicate substantial differences between contemporary Irish collegiate athletes and CNS VS normative population, suggesting that the existing norms may not be appropriate for interpreting neurocognitive performance in this group.

Abstract Salmonella Paratyphi A is a major cause of paratyphoid fever. Despite growing global concern, knowledge of S. Paratyphi A immunity remains limited, and no licensed vaccine exists. In a controlled human infection model (CHIM) homologous S. Paratyphi A rechallenge showed a non-significant reduction in risk of acute disease. This study evaluates humoral immunity following experimental S. Paratyphi A exposure and vaccination with a bivalent S. Typhi–S. Paratyphi A conjugate vaccine (Sii-PTCV). Serum samples from 2 UK CHIM studies and a Phase I trial in India of Sii-PTCV were analyzed. S. Paratyphi A-specific IgG, serum bactericidal activity (SBA), antibody-dependent monocyte phagocytosis (ADMP), and neutrophil phagocytosis (ADNP) were measured pre and post-exposure or vaccination. Statistical differences were assessed using Wilcoxon matched-pairs signed rank test or the Mann–Whitney test. Experimental challenge significantly increased IgG, SBA, ADMP, and ADNP (all P &amp;lt; 0.0001), with strongest responses in participants who developed systemic infection. No immune marker correlated with protection in rechallenged individuals. Baseline antibody levels were higher in the Indian cohort than in the United Kingdom (P = 0.0041), suggesting prior natural exposure enhances humoral immunity. Vaccination with Sii-PTCV induced significantly greater responses than challenge, particularly for IgG (P &amp;lt; 0.0001), SBA (P &amp;lt; 0.001), and ADMP (P &amp;lt; 0.001). This study highlights differences in S. Paratyphi A immunity between naive and exposed populations. Both challenge and vaccination with S. Paratyphi A elicited strong humoral responses, with vaccination producing higher magnitude responses. The bivalent vaccine shows promise for paratyphoid prevention, though a clear correlate of protection remains to be defined.

Ageism is a serious and growing social issue experienced throughout the world. While education interventions have been shown to effectively address ageism, accessible education interventions targeted to the general public are few. Consequently, this study aimed to evaluate the impact of a freely available, short, self-directed online ageism course ('Challenging Ageism') in reducing self- and other-directed ageism amongst the general public. Utilising a pre- and post- intervention design, the study measured change in (1) self-directed ageism through the Brief Aging Perception Questionnaire (BAP-Q) and (2) other-directed ageism via the Fraboni Scale of Ageism (FSA). Self-selecting participants aged 18 years and over (n = 39, F = 92.3%, 51.3% aged 50 + years) were a subset of those enrolled in the course over a six-month period from July to December of 2023. Change in the outcome measures pre- and immediately post-course were analysed using the Wilcoxon signed rank test for related samples. Significant reductions were obtained between the pre- and post-course test results for self-directed (p = .003) and other-directed (p < .001) ageism, along with several ageism sub-scale measures. While further research with long follow-ups is needed, these findings show promise for addressing ageism with scalable, broad-based solutions that are accessible to all.

Two-view chest X-ray (CXR) is a widely utilized diagnostic tool due to its accessibility, cost-effectiveness, and ability to evaluate thoracic pathologies. The current diagnostic reference levels (DRLs) in Germany for posterior-anterior (PA) and lateral CXR are 12.0 and 40.0 cGy × cm², respectively. This study assessed the dose contributions of PA and lateral CXR for different body mass index (BMI) groups, aiming to determine the best possible BMI thresholds to predict exceedance of the national DRLs.In this retrospective study, 3,982 patients underwent a total of 4,958 two-view chest radiograms using a twin robotic X-ray system. Dose-area products (DAP) of each BMI group were compared between projections using Wilcoxon signed rank tests. Receiver operating characteristic statistics were employed to identify BMI values likely to result in doses above the DRLs.For each BMI group, lateral CXR resulted in higher DAP than PA radiograms (all p<0.001). The smallest median DAP difference was found for underweight patients (BMI <18.5 kg/m²; 12.2 versus 4.8 cGy × cm²; 154.2% higher DAP in lateral CXR), whereas the largest difference was observed among severely obese individuals (>40.0 kg/m²; 142.1 versus 21.7 cGy × cm²; 554.8%). The correlation of BMI and DAP was strong for both lateral and PA CXR (r = 0.614 and 0.641, both p<0.001). The best possible BMI thresholds to predict DRL exceedance were determined to be 26.5 kg/m² for lateral CXR (72.6% sensitivity / 76.1% specificity) and 27.8 kg/m² for PA radiograms (78.1% / 74.4%).BMI information facilitates prediction of DRL exceedance. The findings presented may serve as a basis for future discussions on whether BMI-dependent reference levels could help to optimize dose management in chest imaging. · Lateral views contribute the majority of radiation dose in two-view CXR.. · Patient BMI correlates strongly with dose exposure.. · Recording patient height and weight information is helpful for radiation dose management.. · Huflage H, Razinskas G, Weick S et al. Predicting Exceedance of the National Diagnostic Reference Levels for Two-view Chest Radiography in Germany based on Patients' Body Mass Index. Rofo 2026; DOI 10.1055/a-2810-5285.

Science learning in elementary schools still faces challenges in the form of low student conceptual understanding, caused by the lack of digital interactive student worksheets that can facilitate concept visualization and encourage active student involvement in the learning process. This study aimed to design, validate, and examine the effectiveness of E-Worksheet based on Problem-Based Learning to improve sixth-grade students’ understanding of Earth’s rotation and revolution at SDN Kalibanteng Kidul 03, Semarang City. This research employed a Research &amp; Development (R&amp;D) approach using the ADDIE model, comprising analysis, design, development, implementation, and evaluation. The participants were 22 sixth-grade students. Data were collected through interviews, observations, questionnaires, documentation, and pretest–posttest instruments. Data analysis included normality testing, the Wilcoxon Signed Rank Test, and the N-Gain test. The E-Worksheet was developed using Canva, delivered through the Liveworksheet platform, and integrated with Solar System Scope as a virtual laboratory to enhance visualization. E-Worksheet-based Problem-Based Learning consists of a cover page, identity, general information, learning activities, learning activities arranged in stages based on aspects of conceptual understanding and in line with PBL syntax, and developer profiles. Validation results from material and media experts reached 93%, indicating a very feasible category. The Wilcoxon Signed Rank Test showed a significant difference between pretest and posttest scores (Asymp. Sig. = 0.046 &lt; 0.05). The N-Gain score of 0.30 indicates a moderate improvement in students’ conceptual understanding. These findings demonstrate that the E-Worksheet based on Problem-Based Learning is successfully developed, feasible, and moderately effective in improving students’ understanding of Earth’s rotation and revolution. This study contributes a systematic worksheet that integrates PBL syntax with digital simulations and explicit conceptual understanding, serving as a model for developing interactive problem-based digital science materials and as a reference for other science subjects.

This study aimed to determine the effect of ladder drill training on improving speed and endurance in junior high school football players. The research used an experimental design with a one-group pre-test and post-test approach. Thirty two male players participated as subjects and underwent a six-week ladder drill training program, conducted three times per week. Data on speed were collected using a 20-meter sprint test, while endurance was assessed using the bleep test. The Shapiro–Wilk test was applied to verify data normality, and since the data did not meet the normality assumption, the Wilcoxon Signed Rank Test was used for inferential analysis. The results showed a significant improvement in both sprint performance and endurance levels (p &lt; 0.05), indicating that ladder drill training effectively enhances neuromuscular coordination and cardiovascular endurance simultaneously. In conclusion, that ladder drills, as a form of agility-based exercise, can serve as a practical and efficient conditioning method for developing fundamental physical abilities in young football players. Keywords: Endurance, Speed, Ladder Drill, Football

Domestic Violence (KDRT) remains a serious problem that significantly impacts the psychological condition of women and children, thus requiring empathetic psychosocial assistance with a victim perspective at the community level. This community service activity aims to improve the knowledge and skills of the Women and Children Protection Network (JPPA) cadres in Tanjungmas Village through counseling training with a client-centered therapy (CCT) approach. The implementation method includes Focus Group Discussions (FGDs) and two-day training with interactive lectures, discussions, case studies, and practical simulations. Evaluation is carried out through participant reaction evaluation, learning evaluation using pre-tests and post-tests, and skill evaluation through observation of counseling practices, with analysis of knowledge increases using the Wilcoxon Signed Ranks Test. The results of the activity showed that participants responded positively to the training implementation, there was a significant increase in participant knowledge (p &lt; 0.05), and most participants were able to apply basic counseling skills such as building rapport, empathy, and active listening, although reflection skills still need to be strengthened. Client-centered therapy-based counseling training has proven effective in increasing the capacity of JPPA cadres and is expected to strengthen the quality of psychosocial support for victims of domestic violence at the community level in a sustainable manner.

This retrospective study aims to determine the changes in soft and hard tissue parameters after mandibular molar distalization using clear aligners and its correlation with the treatment duration, and the amount of molar distalization. 23 adult patients (15 Female, 8 Male) were included in this study. Cone beam computed tomography (CBCT) images were evaluated for soft and hard tissue parameters especially lower facial profile including lip and chin. Paired sample t test and the Wilcoxon signed rank test were used to compare changes before and after molar distalization. Bivariate Pearson correlation analysis was conducted to assess relationships between treatment duration and amount of distalization and changes in lower facial profile. Multiple linear regression (MLR) was applied to predict the changes based on amount of distalization and incisors inclination. Significant increase in mandibular plane angle based on MP-FH angle (25.41 ± 5.08, 26.16 ± 5.47, P = 0.021). Furthermore, the total anterior facial height (N-Me) and lower anterior facial height (ANS-Me) significantly increased (135.63 ± 9.39, 136.79 ± 9.77, P = 0.021 and 71.33 ± 5.92, 72.33 ± 1.32, P = 0.030 respectively). However, the lower lip thickness decreased significantly (13.31 ± 3.80, 12.36 ± 3.24, P = 0.001), as well as lower lip length (19.78 ± 2.80, 18.66 ± 2.58, P = 0.003). Pearson correlation analysis revealed significant correlation between the treatment duration and the amount of distalization across most of the parameters. Mandibular molar distalization provides stable mandibular control with negligible rotational or sagittal changes, minimal facial height increase, and reductions in lower lip thickness and length without significant sagittal displacement.

Introduction: Type 2 diabetes mellitus is often called the mother of all diseases which can result in complications. The risk of complications increases over the age of 40 years, so physical activity is needed to improve blood flow and increase the effectiveness of insulin use in the body. Objectives: This study aimed to determine the effect of home-based walking exercise companion physical activity therapy for 45 minutes on random blood glucose levels in patients with type 2 diabetes mellitus. Methods: This research design uses a quasi-experimental one-group pretest-posttest. The sampling technique uses a non-probability sampling technique: purposive sampling. The sample for this study was 19 patients with type 2 diabetes mellitus at the Puskesmas Lidah Kulon. Data were collected using an observation sheet on the results of random blood glucose clinic examinations. Statistical test data analysis used the Wilcoxon signed rank test with α &lt; 0,05. Results: The results of the study showed that the average random blood glucose level before implementation was 247,9474 and after implementation, it was 196,8947. The statistical test results obtained p value 0,00&lt;0,05, which means H1 is accepted. Discussion: The results of the study show that home-based walking exercise companion physical activity therapy for 45 minutes affects reducing random blood glucose levels in patients with type 2 diabetes mellitus