Significance Level Research Articles

Multiple testing of interval composite null hypotheses using randomized p-values

AbstractEquivalence tests are statistical hypothesis testing procedures that aim to establish practical equivalence rather than the usual statistical significant difference. These testing procedures are frequent in “bioequivalence studies," where one would wish to show that, for example, an existing drug and a new one under development have comparable therapeutic effects. In this article, we propose a two-stage randomized (RAND2) p-value that depends on a uniformly most powerful (UMP) p-value and an arbitrary tuning parameter $$c\in [0,1]$$ c ∈ [ 0 , 1 ] for testing an interval composite null hypothesis. We investigate the behavior of the distribution function of the two p-values under the null hypothesis and alternative hypothesis for a fixed significance level $$t\in (0,1)$$ t ∈ ( 0 , 1 ) and varying sample sizes. We evaluate the performance of the two p-values in estimating the proportion of true null hypotheses in multiple testing. We conduct a family-wise error rate control using an adaptive Bonferroni procedure with a plug-in estimator to account for the multiplicity that arises from our multiple hypotheses under consideration. The various claims in this research are verified using a simulation study and real-world data analysis.

Enhancing teaching and learning of evidence-based practice via game-based learning

Introduction: The Singapore Institute of Technology-University of Glasgow (SIT-UofG) Nursing Programme has traditionally taken a didactic teaching approach in the delivery of the Evidence-Based Practice (EBP) module. A hybrid approach was introduced using Game-Based Learning (GBL) to encourage active learning through gameplay. Methods: A Randomised Controlled Trial (RCT) was undertaken encompassing a cohort of 100 Nursing students taking the EBP module in their first year at the Singapore Institute of Technology (SIT) in the 2021/22 academic year. The experimental group (n=27) worked through the online GBL intervention and the EBP module, while the control group (n=27) took the EBP module alone. The GBL included five Learning Quests and three case studies. Results: High levels of satisfaction were reported by both the experimental group (n=22) and the control group (n=15) on the traditional content and delivery of the EBP module. High levels of engagement were reported by the experimental group on the GBL intervention; a one-sample statistics analysis confirming a significant level of engagement (p<0.001). A Mann-Whitney U Test, however, found no significant difference in the Continuous Assessment (CA) scores of the two groups (p=0.507 and 0.461). Conclusion: The introduction of GBL designed to deliver educational content directly associated with the learning outcomes increased the nursing student engagement in the EBP module. These findings and discoveries can be utilised to improve the GBL intervention to the EBP module to have a more positive impact the student CA scores and therefore on student learning. Keywords: Evidence-Based Teaching, Evidence-Based Practice (EBP), Nursing Education, Game-Based Learning (GBL), Teaching and Learning EBP, Nursing Students, Gamification

Relationship between Knowledge, Intentions, and Anaemia Prevention Behavior on Common Symptoms of Anaemia in Adolescent Girls in Rural Areas Indonesia

Anaemia is a prevalent nutritional issue that disproportionately affects teenage girls in Indonesia, particularly those residing in rural regions. A research study found that 23.4% of adolescent ladies suffer from anaemia. Furthermore, individuals residing in rural regions exhibit a heightened susceptibility to anaemia, which is twofold in comparison to their urban counterparts. This study employs a cross-sectional design. The questionnaire is designed to assess the participants' understanding of the elements that contribute to anaemia and their viewpoints on anaemia. It was handed out to a total of 242 participants from various schools in Gowa, South Sulawesi. Out of the students who have mostly good goals, 41.3% can correctly identify their menstrual cycle with a significant level of p=0.001. On the other hand, their understanding of their menstrual cycle is mostly limited. The student had pallor in their face, eyelids, lips, skin, nails, and palms over a prolonged period, as evidenced by the intention and behaviour variable with a p-value of less than 0.05. Nevertheless, the data also reveals a minimal incidence of students who continuously exhibit pallor during their menstrual cycle. In contrast, most pupils in the "never" category exhibit a pallid complexion. The current study's poor comprehension of adolescent anaemia highlights the need for further investigation by educational institutions and governmental authorities. This should include a research of the factors that drive adolescent girls to recognise the symptoms of anaemia.

Evaluating Serum Copeptin as a Promising Biomarker for Predicting Acute Ischaemic Stroke Severity: A Hospital-Based Study on Strokes.

Stroke is the second cause of mortality and the foremost leading cause of disability globally. Many potential biomarkers have been described to contribute to prognosticating the severity in the acute phase of stroke as well as help with risk stratification. Copeptin, an inactive peptide that is produced in an equimolar ratio to arginine vasopressin and adequately mirrors an individual's stress response to acute illnesses like acute ischaemic stroke as evidenced by elevated or increasing levels is being explored in this study to determine its relationship with acute stroke severity and infarct size on admission. This is a cross-sectional study of 80 neuroimaging-confirmed acute ischaemic patients who presented within seven days of symptom onset and 80 control subjects. The ischaemic stroke cases had stroke severity and infarct volume determined on admission by the National Institute of Health Stroke Scale (NIHSS) and neuroimaging (brain CT/MRI). A baseline serum copeptin level was measured in the study subjects. Spearman correlation and Kruskal Wallis test were used to determine the relationship between serum copeptin level with admission NIHSS and infarct size respectively. The receiver operating characteristic (ROC) curve was calculated to determine the sensitivity and specificity of copeptin to predict severity and outcome. The mean age of the study group was 61.3 ± 12.7 years with 55.0% males and 45.0% females. The serum level of copeptin was significantly higher in the stroke cases with a median of 28.6 pmol/L (interquartile range (IQR)- 15.4-31.6 pmol/L) versus 8.8 pmol/L (IQR- 3.2- 10.7 pmol/L) among the stroke-free controls (p= 0.001) at a statistically significant level. There was a weak correlation between copeptin and NIHSS calculated at admission to measure stroke severity (r- 0.02, p= 0.873). Patients with infarct sizes in the fourth quartile (infarct sizes greater than 18.78 cm3) had higher copeptin levels, though this was not statistically significant (H= 2.88; p= 0.410). Admission serum copeptin did not show a statistically significant prognostic value in predicting stroke severity and mortality in stroke patients who presented within seven days of symptomonset with an area under curve (AUC) of 0.51 (95% CI: 0.36-0.65; p= 0.982). In this study, copeptin was higher among the stroke cases compared with the stroke-free controls which suggests a significant prognostic value in risk stratification in the acute phase of stroke; however, this did not significantly correlate with stroke severity and thus warrants further study in this field to elucidate it's fascinating potential as a prognostic biomarker (especially in the acute period) as this may enable allocation of a better-focused therapy for stroke patients.

ANALISIS DANA TRANSFER PEMERINTAH PUSAT DALAM MEMENGARUHI INDEKS PEMBANGUNAN MANUSIA DI DAERAH OTONOMI KHUSUS

This study aims to assess how the allocation of transfer funds from the Central Government to Local Government impacts the Human Development Index (HDI) across Indonesia's autonomous regions. The funds analyzed include the Revenue Sharing Fund (DBH), General Allocation Fund (DAU), Special Allocation Fund (DTK), Specific Purpose Grants (DAK), Local Incentive Fund (DID), and Village Fund. The study spans from 2017 to 2022, covering six years following a change in budget classification for the Transfer to Local Government fund. Data was primarily sourced from the Directorate General of Fiscal Balance (DJPK) at the Ministry of Finance and the Central Bureau of Statistics (BPS). The analysis employs panel data using the Fixed Effect Model (FEM) to handle cross-sectional and time-series data. Results indicate a significant positive effect of the Special Allocation Fund (DTK), comprising Specific Purpose Grants (DAK) and Local Incentive Fund (DID), on the Human Development Index (HDI) in Indonesia's autonomous regions, with a p-value below the significance level of 0.05. However, the General Allocation Fund (DAU) shows no significant effect, with a p-value exceeding 0.05. Additionally, the Revenue Sharing Fund (DBH) and Village Fund partially affect the Human Development Index (HDI).

The Effect Of Health Education Using E-Booklets On Medication Adherence In Type II DM Patients

This study aims to evaluate the effect of health education using E-Booklet on adherence to taking medication in type II diabetes mellitus (DM) patients at the Internal Medicine Polyclinic of Mitra Kasih Hospital. This study describes the level of compliance with taking medication before and after the E-Booklet education intervention. The results showed that before education, the majority of patients (83.6%) had low compliance, while after education, the level of low compliance decreased to 61.8%. Statistical analysis showed a significant effect of E-Booklet education on drug compliance with a p value = 0.003 at a significance level of 0.05. This study contributes theoretically to the science of surgical medical nursing and practically for Mitra Kasih Hospital in improving health education about adherence to taking medication in DM patients.

The Effectiveness of Milk Supplementation on Weight and Height/Length in Stunted Toddles

Stunting or a short child was described as a toddler whose height was lower than the standard height for toddlers his age. Until now, the prevalence of stunted toddlers in Indonesia is still high. The prevalence of stunted toddlers at the Plaosan Community Health Center in the last 3 years showed an increase. The cause of stunting, apart from infection, is also related to nutritional deficiencies (micronutrients and macronutrients). The adverse effected of stunting in the short term are disruption of brain development, intelligenced, impaired physical growth, and metabolic disorders in the body. Supplementary feeded is one of the solutions in handling stunting. This study aims to determined the effectiveness of milk feeded on the weight and height/length of stunted toddlers. The typed of research used was pre-experimental with a one group pretest posttest design. The sample used a total population of 56 toddlers. The dependent variable in this studied was the weight and height/length of stunted toddlers, the independent variabled is the provision of milk for toddlers. Data collection used weight and height measurement sheets and milk feeded observation sheets. Comparative data analysis was conducted using the paired samples t test statistical test. The results of the study show that the average body weight before giving milk was 8737.5 mm and after giving milk 8923.2 mm. Body height/length before milk feeding was 804.6 mm and after milk feeding was 806.63 mm. Different test using paired samples t test obtaining the conclusion that there is a significant difference in the increase in body weight of toddlers with a significance level of 0.000 (p <0.05) and there is a significant difference in increasing the height of toddlers with a significance level of 0.000 (p <0.05). Conclution: Milk is effective to increase the weight and height/length of toddlers, so it is advisable for mothers of toddlers to get their children used to a glass of milk everyday.

Analysis of posture and balance impairments in individuals with chronic nonspecific neck pain-an observational study.

Neck pain is one of the most burdensome chronic musculoskeletal problems globally. Impaired proprioception is associated with Chronic Nonspecific neck pain as the structures of the cervical spine are crucial for proprioception and balance. There is a paucity of literature examining objective measures of balance and postural sway in patients with Nonspecific neck pain. This study was observational and consisted of 126 samples (63 cases and 63 controls who were recruited using convenience sampling. The demographics of the samples were collected and the postural and balance impairment was assessed using Biodex Balance SD. Mean, Median, and SD were obtained and the inferential analysis was done using the Whitney U Test and the level of significance was accepted at p < 0.05. The subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts. There are significant differences in the overall static stability index, (p < 0.001). There was a significant difference in static sway index(p = 0.003), and static stability index lateral (p = 0.004). There was no significant difference for static sway index forward and backward (p = 0.550) and lateral sway index (p = 0.711). Subjects with neck pain showed had a lower static stability index, static sway index, static stability index- forward backward and static sway index lateral scores than the normal counterparts and there was a significant difference between the static sway and static stability index in forward and backward directions as well as in lateral direction. These findings may help to assess the specific balance parameters and address the underlying causes of balance issues in patients with neck pain and also provide a comprehensive care to the patients. The trial was registered with CTRI India with registration number: CTRI/2022/07/044222.

Efficacy of MRI-guided rTMS for post-traumatic stress disorder by modulating amygdala activity: study protocol for a randomised controlled trial

IntroductionPost-traumatic stress disorder (PTSD) is a prevalent and severe psychiatric disorder. Repetitive transcranial magnetic stimulation (rTMS) targeting the dorsolateral prefrontal cortex provides limited relief for symptoms of PTSD. This study...

Colour Stability between In-House 3D-Printed Resin Brackets and Conventionally Aesthetic Brackets: An In Vitro Study

Background: To evaluate colour stability in artificial saliva by mechanically simulating brushing between in-house 3D-printed resin brackets (IH3DBs) and commercially available brackets. Methods: The samples consist of four sets of ten aesthetic brackets each supplied by four different manufacturers: clear Damon, Synovate C, Crystal and in-house 3D printed brackets (IH3DBs). The brackets were immersed in a plastic tank containing artificial saliva maintained at a constant temperature of 37 °C with a 65-minute brushing system. Staining changes at T0 (pre-brushing) and T1 (post-brushing) were measured with a spectrophotometer according to the VITA and Master scale and brightness values. Statistical analysis compared the colour changes with the Wilcoxon test and in case of significance, severity was investigated. The significance level considered was p &lt; 0.05. Results: The IH3DBs shows statistically significant differences for both scales and brightness values. The Damon and the Crystal brackets report a statistically significant difference only for brightness. The Synovate C bracket shows no statistically significant differences. Conclusions: The IH3DB produced chromaticity differences for the VITA and Master scale possibly due to the surface roughness created during the printing process. However, the IH3DBs together with Damon Clear improved brightness, due to the mechanical action of brushing.

Analysis of the structure of the information field of perception of risk factors for non-communicable diseases

When studying the attitude of the population to saving their own health, the question of the connection between abstract knowledge about the harm caused to health by risk factors and a real understanding of the harm caused by these factors to their own health remains poorly understood.The purpose of this work is to analyze the structure of the information field of the population’s attitude to the impact of FR on health.Materials and methods. The material for the analysis was the results of a sociological survey in three pilot regions of the Russian Federation – Tula Region, Stavropol Territory and the Republic of Crimea. The questionnaire consisted of 33 questions concerning risk factors and their impact on the human body and a block of questions concerning sources of medical information and trust in them. The sample size was 1,718 respondents. The following methods were used: descriptive statistics and the sociological method of questioning. Statistical data processing and reweighing were carried out in the statistical data processing package SPSS22.0. In general, the sampling error in the study does not exceed 1.99% for a confidence level of p&lt;0.1.Results. The study showed that abstract knowledge about the harm of a particular FR in almost all FR is quite high, since it is precisely on them that the efforts of the medical community have been directed in recent decades. Moreover, the highest values are expected to have such factors as tobacco use, alcohol consumption, elevated blood sugar (glucose) and high blood pressure. The level of knowledge of the harm of FR, to which the medical community paid less attention, was expected to be lower. The lowest value is such a FR as a low iodine content in salt, which is consumed in food. An assessment of the relationship of variables such as abstract knowledge of harm about FR and understanding of their harm to one’s body using a two-way T-criterion showed that these variables are completely independent of each other at the significance level p&lt;0.001. This result made us look more closely at the factor structure of the studied field of reality and put forward the assumption of independence of knowledge about the harm caused to the human body by FR and behavioral patterns in relation to FR. As a result of factor analysis of 73 variables, 9 factors were identified: the first and most powerful factor (10.33%) – knowledge of the effect of FR on one’s own health; the second most powerful factor (8.71%) – knowledge of the harm of FR; the third highlighted factor (5.46%) – trust in information sources, which included both trust in the media and trust in TV presenters, popular personalities and trust in the leaders of the region and the city; the fourth highlighted factor (4.67%) is the gender characteristics of the control of the FR by the population; the fifth highlighted factor (4.59%) is the sources of information about the FR; the sixth highlighted factor (4.30%) – age–related features of FR control; the seventh highlighted factor (3.32%) – the use of gadgets to control FR and exercise; the eighth highlighted factor (3.00%) – trust in health workers as a source of information; the ninth highlighted factor (2.59%) – smoking and alcohol consumption.Conclusion. The assessment of the effect of FR on the respondents’ own health in the framework of the conducted study turned out to be significantly lower than abstract knowledge about the harmful effects of these FR. The analysis of the factor structure of the studied field confirmed the validity of such a division of knowledge based on ideas about its various forms – «knowledge in itself» and «knowledge for oneself». The analysis made it possible to formulate a number of conditions for improving the effectiveness of preventive work with the population, including to increase the impact of population prevention: it is necessary to more actively involve the most important sources for the population – medical workers, scientific medical workers and health managers; more fully take into account the gender and age characteristics of audiences in preventive measures; the use of mass media should be preceded by an analysis of the level of trust in them from the target audience; the information messages themselves must first be checked for memorability. Preventive measures should change the personal meanings of specific people in relation to FR and HLS, and not be limited to stating general knowledge about them. The study also allows us to determine the directions for further research of the population’s attitude to the FR and their own health as an interdisciplinary task with the necessary involvement of specialists in medical and general psychology, personality psychology and motivation psychology, as well as sociologists.

Characteristics of Herbal Tea Bags From a Mixture of Pandan Leaf Powder (Pandanus amaryfolius Roxb.) and Red Ginger (Zingiber officinale var. Rubrum)

This study investigated the effect of a mixture of pandan leaves and red ginger on the characteristics of herbal tea bags. Utilizing a completely randomized design (CRD) with 5 treatments and 3 replications, the data were statistically analyzed using ANOVA, followed by Duncan's New Multiple Range Test (DNMRT) at a 5% significance level. The treatments involved varying ratios of pandan leaves to red ginger: A (90:10 g), B (80:20 g), C (70:30 g), D (60:40 g), and E (50:50 g). Observations included tests for water content, ash content, polyphenol content, IC50 antioxidant activity, total plate count, and organoleptic properties. The results demonstrated that the mixture of pandan leaves, and red ginger significantly affected water content, ash content, total polyphenols, and IC50 antioxidant activity. Based on chemical, microbiological, and organoleptic analyses, treatment D (60:40 g) was identified as the optimal formulation, yielding the following values: water content (6.55%), ash content (4.44%), total polyphenols (28.63 mg GAE/g), antioxidant IC50 (100.31 ppm), total plate count (6.4 x 10^2), and organoleptic scores for color (3.70%), aroma (3.40%), and taste (3.10%).

Total mixed ration silages based on elephant grass with the addition of agro-industrial byproducts

The present study aimed to evaluate the fermentative profile and losses in total mixed ration silages based on elephant grass (Pennisetum purpureum Schum.) with the addition of agro-industrial byproducts. The experiment was conducted at Campus II, CCA/UFPB, Areia – PB, in a completely randomized design with six repetitions per treatment, totaling 30 experimental units. The agro-industrial byproducts used were pineapple residues, passion fruit peel, sisal mucilage, refinazil, corn bran, soybean meal, and cottonseed cake. Elephant grass constituted the basal forage of the diet. The treatments were as follows: T1: elephant grass + cottonseed cake + refinazil; T2: elephant grass + cottonseed cake + refinazil + pineapple residues; T3: elephant grass + cottonseed cake + refinazil + passion fruit peel; T4: elephant grass + cottonseed cake + refinazil + sisal mucilage; T5: elephant grass + corn bran + soybean meal. The silos remained closed for 68 days. The data were subjected to analysis of variance and Tukey's test, with a 5% significance level. The dry matter content of the silages varied from 32 to 44%. Regarding pH, treatments T2, T4, and T5 presented values above 4.5, while the others remained within the ideal range. No significant differences were observed between treatments regarding lactic acid bacteria (LAB) at the opening of the silages. The elephant grass silages including cottonseed cake and refinazil (T1 and T2) showed promise, with moderate losses and satisfactory presence of lactic acid bacteria. On the other hand, treatments that included passion fruit peel (T3) and sisal mucilage (T4) presented unfavorable conditions, with higher losses and significant presence of mold-forming microorganisms. Notably, the treatment with corn bran and soybean meal (T5) demonstrated adequate fermentation, with a significant increase in lactic acid bacteria, suggesting it to be a viable option for the production of elephant grass silage.

Are there differences in the causes and complications of mandibular third molar extraction in older patients compared to younger patients?

BackgroundAlthough most impacted third molars (ITM) are extracted in the teens and early 20s, some undergo extractions after their 40s. It is unclear whether the reasons for extraction, the degree of impaction, and complications differ in patients in an older age group compared with a younger age group. PurposeThe purpose of this study was to measure the association between age and 1) reason for extraction and 2) postoperative complications. Study design, setting, sampleThis was a retrospective cohort study of patients who had undergone surgical extraction of at least one mandibular ITM at a single institution. We excluded 1) age under 20 years, 2) follow-up period of less than 1 week, and 3) tooth extraction under general anesthesia. Predictor variableThe primary predictor variable was age, classified into 3 groups (20s:20-29; 30s:30-39; over 40s: 40 and greater). Outcome variableThe primary outcome variables were reason for extraction (prophylactic or symptomatic) and presence of complications. The secondary outcome variable was type of complication (post-operative infection, dry socket, neurosensory disturbance, presenting pain over 1 month, retained root requiring secondary treatment). CovariatesThe covariates were sex, laterality of ITM, and difficulty of extraction as measured by the difficulty index, a measure based on depth, orientation, and ramus relationship/space available, with a higher score indicating greater difficulty. AnalysesChi-square test was performed to analyze the association of categorical outcome variables and covariates. Level of statistical significance was set at P<0.05. ResultsOf a total of 831 eligible subjects, there were 555 (66.8%), 159 (19.1%), and 117 (14.1%) in 20s, 30s and over 40s age groups, respectively. The percentage of symptomatic extraction of ITM was significantly higher in the over 40 age group compared with the 20s group (92.3% vs. 69.4%, (p<0.001). Complication rate also significantly differed between over 40s group and the 20s group (7.7% vs. 1.8%, p<0.001). Difficulty index and indications for ITM extraction were significantly different between groups (p<0.001). ConclusionSymptoms, difficulty, and complications related to ITM increase at over 40 years of age. This should be taken into consideration during the joint clinical decision-making process with patients with ITM.

ANO2 Genetic Variants and Anti-VEGF Treatment Response in Neovascular AMD: A Pharmacogenetic Substudy of VIEW 1 and VIEW 2.

This analysis investigated potential associations between gene variants and clinical end points in the VIEW 1 and2 randomized clinical trials of intravitreal aflibercept and ranibizumab in neovascular age-related macular degeneration (AMD). A genome-wide association analysis was conducted in a subgroup of patients from VIEW 1 and 2 consenting to the optional pharmacogenetic analysis. Data were pooled from 780 samples from patients representative of the overall VIEW 1 and 2 populations. After Bonferroni correction for multiplicity and statistical adjustment for baseline risk factors, no significant associations were found between previously identified prognostic AMD gene variants and treatment response according to key prespecified VIEW 1 and 2 end points. Genome-wide, there were no significant genetic associations in patients experiencing gains of ≥15 Early Treatment of Diabetic Retinopathy Study letters after 1 or 2years of treatment. A cluster of variants in ANO2 (encoding anoctamin 2, a calcium-activated chloride channel expressed on photoreceptor cells) on chromosome 12 reached the level of significance for loss of ≥5 letters after 1year of treatment (P < 5 × 10-8), with the ANO2 rs2110166 SNP demonstrating highly significant association (P = 1.99 × 10-8). Carriers of the ANO2 rs2110166 TT genotype showed a robust increase in visual acuity versus baseline compared with a small decrease in those with the TC genotype. None of the potential prognostic candidate genes were associated with the clinical end points for treated patients. Preliminary analyses suggest an association of ANO2 with retinal function, with a potential impact on vision of approximately one line over at least the first year. Further investigation of the function of ANO2 in retinal pathophysiology is merited.

Distribution of catheterisation laboratories in Indonesia 2017–2022: a nationwide survey

BackgroundGeographical terrains of Indonesia pose a major hindrance to transportation. The difficulty of transportation affects the provision of acute time-dependent therapy such as percutaneous coronary intervention (PCI). Also, Indonesia’s aging population would have a significant impact on the prevalence of acute coronary syndrome in the next decade. Therefore, the analysis and enhancement of cardiovascular care are crucial. The catheterisation laboratory performs PCI procedures. In the current study, we mapped the number and distribution of catheterisation laboratories in Indonesia. MethodsA direct survey was used to collect data related to catheterisation laboratory locations in July 2022. The population data was sourced from the Ministry of Home Affairs. The recent growth of catheterisation laboratories was examined and evaluated based on geographical areas. The main instruments for comparing regions and changes throughout time are the ratio of catheterisation laboratories per 100,000 population and the Gini index (a measure of economic and healthcare inequality. Gini index ranges from 0 to 1, with greater values indicating more significant levels of inequality). Regression analysis was carried out to see how the number of catheterisation laboratories was affected by health demand (prevalence) and economic capacity (Gross Domestic Regional Product [GDRP] per Capita). FindingsThe number of catheterisation laboratories in Indonesia significantly increased from 181 to 310 during 2017-2022, with 44 of the 119 new labs built in an area that did not have one. Java has the most catheterisation laboratories (208, 67%). The catheterisation laboratory ratio in the provinces of Indonesia ranges from 0·0 in West Papua and Maluku to 4·46 in Jakarta; the median is 1·09. (IQR 0·71–1·18). The distribution remains a problem, as shown by the high catheterisation laboratory Gini index (0·48). Regression shows that distribution of catheterisation laboratories was significantly affected by GDRP and the prevalence of heart disease. InterpretationThe number of catheterisation laboratories in Indonesia has increased significantly recently, however, maldistribution remains a concern. To improve Indonesia's cardiovascular emergency services, future development of catheterisation laboratories must be better planned considering the facility's accessibility and density. FundingIndonesia Endowment Fund for Education – Lembaga Pengelola Dana Pendidikan (LPDP)

Evaluation of social inclusion in Brazilian adult women with epilepsy: Perception of stigma and quality of life

Epilepsy is a chronic disease characterized by recurrent epileptic seizures that can affect the perception of stigma and compromise the quality of life of those living with it. In addition, sociodemographic factors such as employment and maintaining a job, education, and the autonomy to drive vehicles are often impaired. ObjectiveTo assess the social inclusion of adult women with epilepsy in relation to the perception of stigma and quality of life, and the clinical aspects of the disease. MethodologyData from 70 adult Brazilian women with epilepsy regarding aspects related to their social inclusion were verified. Such data were linked to clinical aspects and scores from the questionnaires: Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and the Epilepsy Stigma Scale (ESS), with a significance level of p < 0.05. ResultsAverage age of 45.5 years, 40 (57.1 %) women were divorced/single/widowed, 31 (44.3 %) women had less than 10 years of formal education, 32 (45.7 %) women had no income, and 57 (81.4 %) did not have a driver's license. The age at the time of the first seizure was 18 years, the seizures were focal in 46 (65.7 %) cases, and 26 (37.1 %) cases were seizure-free in the last year. A high number of women reported that the diagnosis of epilepsy negatively influenced aspects of autonomy such as the possession of a driver's license and going out alone. Longer duration of epilepsy was associated with lower education, not having children, and lower scores on the QOLIE-31. Higher scores on the QOLIE-31 were correlated with lower frequency of seizures and with the age at the time of the first seizure. Values in the dimension − energy and fatigue of the QOLIE-31 were significantly lower in the group with less independence compared to the other two groups with more independence, in latent class analyses (ANOVA, adjusted for age 42.1 ± 35.6 vs 57.2 ± 28.4 vs 73.9 ± 23.8, p = 0.0295). DiscussionClinical aspects of epilepsy and having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy. ConclusionIt was observed that having a partner, autonomy, and independence such as driving vehicles are factors that contribute to social inclusion and to the perception of a better quality of life for adult women with epilepsy.

Treatment outcomes in the inpatient management of severe functional neurological disorder: a retrospective cohort study

BackgroundFunctional neurological disorder (FND) is a heterogeneous condition; severe forms can be disabling. Multidisciplinary treatment and rehabilitation are recommended for severe FND, but there remains a lack of evidence for...

Countermovement Jump and Momentum Generation Associations to Fastball Velocity Performance Among Division I Collegiate Pitchers.

Sakurai, M, Qiao, M, Szymanski, DJ, and Crotin, RL. Countermovement jump and momentum generation associations to fastball velocity performance among Division I collegiate pitchers. J Strength Cond Res 38(7): 1288-1294, 2024-The current study explored the relationships between countermovement jump (CMJ) profiles and baseball pitching performance. Nineteen Division I collegiate pitchers performed in-laboratory pitching and bilateral CMJs. Whole-body kinematics and ground reaction force were collected during both pitching and CMJ evaluations. Statistically significant correlations of concentric impulse and peak power in the CMJ test with fastball velocity were observed (r = 0.71 and 0.68). Concentric impulse in CMJ also showed a statistically significant correlation with linear momentum in the anterior-posterior direction during pitching (r = 0.68). Lean body mass and body mass showed statistically significant correlations with both of the 2 linear momentums during pitching (r = 0.71∼0.83), and concentric impulse in CMJ (r = 0.71 and 0.81). Pelvis and trunk pitching mechanics did not correlate with any of the CMJ variables at the statistically significant level, whereas the direction of the correlations varied (|r| < 0.45). Assessment of a baseball pitcher's CMJ should focus on concentric impulse and peak power because only these showed meaningful relationships with fastball velocity or momentum generation during pitching. An increase in lean body mass is also suggested to be able to generate more impulse and momentum. Baseball coaches, strength coaches, and clinicians are encouraged to include lower-body explosive training to enhance the force and power output capacity of baseball pitchers.

Comparative Study on the Effects of Myrtle and Chamomile Essential Oils on Pain and Episiotomy Wound Healing in Primiparous Women: A Randomized Controlled Clinical

BackgroundEpisiotomy is a common surgical procedure that affects the quality of life of women. Chamomile and myrtle have been used to treat wounds since antiquity. This study aimed to compare the effects of topical formulations containing essential oils (EOs) of chamomile, Myrtus (commonly called myrtle), or a placebo on pain intensity and episiotomy wound healing in primiparous women. Material and methodsThis randomized and controlled clinical trial was conducted in the city of Hamadan in 2020. To this end, 120 parturient mothers were randomly assigned to one of three groups. They applied topical formulations containing 1% EO of chamomile, myrtle, or placebo twice daily for ten days. Data collection was subsequently performed by assessing demographic, gynecological, possible signs of side effects, pain intensity, and the wound healing process six hours after surgery, days 5th and 10th after the intervention. In addition, Visual Analogue Scale (VAS) and Redness, Edema, Ecchymosis, Discharge, and Approximation (REEDA) were utilized to examine pain intensity and healing processes. R software (v. 4.0.5) was employed for data analysis. The statistical significance level was p<0.05. Finally, the components of the myrtle and chamomile EOs were investigated through a gas chromatograph/mass spectrometer (GC/MS). ResultsThere was no significant difference between groups at baseline. Furthermore, the mean pain intensity score in the three groups indicated no statistically significant differences. The group that received chamomile experienced the best wound-healing process (p<0.05) on the 10th day. Phytochemical investigations revealed the presence of α-Bisabolol oxide A, α-Bisabolol oxide B, β-Farnesene, and Chamazulene in Chamomile EO, and α-Pinene, 1,8-Cineol, Linalool,α-Terpineol, Linalool acetate, and Limonene in myrtle EO. ConclusionA chamomile-containing formulation may promote episiotomy healing.