Significant Difference In Favour Research Articles

#2120 Impact on CKD classification and comorbidities using GFR estimated by European Kidney Function Consortium equation in kidney transplant recipients

Abstract Background and Aims In 2020, European Kidney Function Consortium (EKFC) proposed a new equation that estimates glomerular filtration rate (GFR) in European population. Few studies have compared EKFC with CKDEPI, particularly in kidney transplant (KT) recipients. Chronic Kidney Disease (CKD) classification by KDIGO is used not only by nephrologists who evaluate more parameters of kidney function, but also by every other specialist who are going to be guided mainly by this stage. Our objective is to compare EKFC equation and CKDEPI in classifying CKD in KT patients and its relationship with associated comorbidities. Method We conduct a retrospective observational study including all KT performed at our centre from 1993 to 2022 with survival greater than one year. We collect creatinine, haemoglobin (Hb), phosphorus (P−), potassium (K+), and bicarbonate (Bic) values at three months and one-year post-transplant. We define anaemia as Hb < 11 g/dl, hyperphosphataemia as serum P− > 4.5 mg/dl, hyperkalaemia as serum K+ > 5 mEq/ml, and acidosis as Bic < 22 mEq/L. We calculate estimated GFR (eGFR) using CKDEPI and EKFC equations, classify CKD stage according to KDIGO, and compare both results in terms of correlation and differences. We use Kappa Coefficient and Chi-Square by contingency tables, and ROC curves with homogeneity test for prediction of these comorbidities. We use SPSS and MedCalc as statistics programs. Results We include 968 KT, with median age at the time of transplant 52.75 year [41.25-61.27]. 294 KT (30.4%) are in women. Comorbidity frequencies are depicted in Table 1. ROC analysis shows no significant differences in predicting acidosis at one year, hyperphosphataemia at any time, hyperkalaemia at 3rd month, anaemia at any time, and composite event at any time. We find significant differences in favour to CKDEPI for acidosis at 3rd month (ΔAUC 0.00575 95% CI [0.00182-0.00969]; p = 0.0042) and for hyperkalaemia at one year (ΔAUC = 0.00853 [0.00161-0.0154]; p = 0.0157). Through contingency tables we compare classification into stages, finding very good agreement based on the Kappa coefficient (κ) but significant differences by Chi-Square. With κ = 0.905, EKFC reclassifies 70 patients, 7.23% overall, but not significantly down nor upstaging (31 vs 39). It reclassifies more men than women: 8.46% vs 4.42%. In 10-year age groups, the largest reclassification occurs in the 70-80 years group, a 17.07% with κ = 0.774, all cases upstaged. At one-year eGFR, contingency tables also show a very good agreement based on κ but significant differences by Chi-Square. EKFC reclassifies 83 KT (κ = 0.887), 8.57% overall. It reclassifies 7.48% women and 9.05% men. In 10-year age groups, the largest reclassification occurs in 20-30 years group with 17.24% (κ = 0.767) and 14.81% in 70-80 years (κ = 0.796). All patients in these groups were upstaged. We resume graphically the reclassification of the groups in Fig. 1, observing how EKFC upstages CKD (worsen CKD stage) in high eGFR stages, and downstages CKD in low eGFR stages. Conclusion Estimation of GFR in KT recipients using the new EKFC equation yields similar results to CKDEPI, showing very good agreement for CKD classification although there is a non-negligible percentage of reclassification, which may be clinically relevant in terms of treatment indications and diagnostic tests. It is to a worse CKD stage in high eGFR and to a better stage in low eGFR, and when EKFC reclassification percentage is greater—in the extreme ages of our cohort—it is always by upstaging. Except for minimal differences which we consider clinically inconsequential, we find no significant differences between both equations in discriminating presence of hyperphosphatemia, hyperkalaemia, anaemia or acidosis.

The Effect of the Gender Inequality Sensitivity Training Program Based on Active Learning

In the study, it was aimed to test the effectiveness of the Gender Inequality Sensitivity Training Program Based on Active Learning, which was prepared to develop sensitivity to gender inequality. The research was conducted with 26 participants studying in the Guidance and Psychological Counselling department of a university in the Central Anatolia Region in the 2019-2020 academic year. This study is a mixed-method research. In the quantitative part of the research, a quasi-experimental application was conducted with a 2x2 pre-test-post-test control group. In the qualitative part, the activity products and assignments obtained during the training were evaluated. The quantitative data of the research were collected through the Attitudes towards Gender Roles Scale and Personal Information Form, and the qualitative data were collected through the activity products and assignments obtained during the training. A 12-week-long Gender Inequality Sensitivity Training Program Based on Active Learning was applied to the experimental group. The findings showed that the training program increased the gender roles total attitude scores and traditional gender role scores of the experimental group participants significantly. In addition, after the experimental procedure, it was determined that there was a significant difference in favour of the experimental group regarding the total score, female, traditional, and male gender role sub-dimensions between the experimental and control groups. Qualitative findings showed that the program increased participants’ awareness of gender issues.

Comparison Between Efficacy of Oral Melatonin and Oral L-theanine in Improving Sleep in Cancer Patients Suffering From Insomnia: A Randomised Double-blinded Placebo-controlled Study

Objectives: The primary objective was to compare the hypnotic efficacy of oral melatonin, oral L-theanine, and placebo in improving sleep in cancer patients with insomnia by the Athens Insomnia Scale (AIS). The secondary objective was to know the prevalence of insomnia in patients with cancer. Materials and Methods: A prospective, double-blinded, placebo-controlled study was conducted after obtaining Institutional Ethics Committee approval. One hundred and twenty patients were randomly assigned to either Group A (melatonin), Group B (L-theanine), or Group C (placebo). They were instructed to take the tablets for 14 consecutive days, two h (hours) before bedtime, and evaluated with AIS on the 1st day, 7th day, and 14th day. Results: There were seven dropouts: Two in Group A, two in Group B, and three in Group C. Significant differences in favour of melatonin treatment were found. There were statistically significant improvements in insomnia in cancer patients on melatonin intake compared to L-theanine. L-theanine had statistically significant improvements in insomnia in comparison to placebo. The mean ± standard deviation AIS on day one in Group A was 14.82 ± 1.29; on day seven was 10.92 ± 1.12; and on day 14 was 5.00 ± 0.70. Similarly, in Group B, the mean ± standard deviation AIS was 15.39 ± 1.03, 13.05 ± 1.06, and 9.55 ± 1.01, and in Group C, the mean AIS was 14.92 ± 1.40, 14.54 ± 1.35 and 13.05 ± 1.61 on the 1st, 7th and 10th day, respectively. There was an improvement in sleep from 1 to 7 days, 7 days to 14 days, and 1 day to 14 days in all the groups (P < 0.005). Conclusion: The hypnotic efficacy of oral melatonin 3 mg was better than oral L-theanine 200 mg in cancer patients having insomnia. Furthermore, L-theanine had a better hypnotic efficacy when compared to a placebo.

EFFECT OF EDUCATION, FAMILY, GENDER AND GENERATIONS ON THE ENTREPRENEURIAL INTENTION

Entrepreneurship is one of the critical factors in improving economic and social development. The need for the creation of employment and national wealth is driven mainly by entrepreneurship. Therefore, there is a need to create new ventures, which requires entrepreneurial intention. Factors such as gender, education, personal traits, and role models affect entrepreneurial intention. Most of the studies on entrepreneurial intention take one of those factors' roles on intention. This study aims to find the role of gender, education, family, and generations on entrepreneurial intention and its sub-factors to fill the current literature gap. In the study, a model was constructed and evaluated experimentally on a sample of 663 university students in Türkiye. The sub-factors of entrepreneurial intention were determined using factor analysis, and the association between gender, education, parental status, and generations, as well as entrepreneurial intention, was analyzed using Mann-Whitney U and Kruskal Wallis tests. Firstly, contrary to general literature results, our analysis shows no evidence that gender influences entrepreneurial intention in general, but there is a difference in a sub-factor (desire for success) in favour of females. Secondly, it is seen that there is a statistically significant difference in favour of those who receive entrepreneurship education in terms of general entrepreneur intention, but only innovativeness and tolerance for uncertainty on sub-factors. Thirdly, there is no statistically significant distinction between parental status, generation, and entrepreneurial intent. In terms of self-confidence, creativity, and drive for achievement, however, there is a statistically significant difference in favour of those who are parents based on the parental status of the participants. Finally, it has been determined that students in Türkiye have a high level of entrepreneurial intention.

Pain management In Total Knee Arthroplasty: Which helps in better post-operative outcomes?

Background: Individuals exhibit variations in pain perception and pain threshold, and these differences exist between the right and left limbs, resulting in biases related to inter-cerebral pain variability and inter-patient pain variability. Currently, there is limited available data comparing adductor canal block (ACB) with femoral nerve block (FNB) in individuals who have undergone bilateral total knee arthroplasty (TKA). Methods: We conducted a prospective, non-randomized, controlled study involving patients scheduled for bilateral total knee arthroplasty (TKA) under central neuraxial anesthesia. Following surgery, patients received intermittent 12-hourly boluses of 15 mL ropivacaine 0.5% through two distinct peripheral nerve blocks (adductor canal block - ACB and femoral nerve block - FNB) in either of the lower limbs. The primary objective was to evaluate the postoperative Visual Analog Scale (VAS) score, while the secondary outcomes included the assessment of quadriceps muscle strength and the degree of flexion at the knee joint. Results: Out of the 70 patients evaluated for eligibility, 63 were enrolled, and 60 were included in the final analysis. Visual Analog Scale (VAS) scores after both blocks during periods of rest at 30 minutes, 6 hours, 12 hours, and 48 hours post-operatively did not exhibit any significant differences. However, VAS scores during rest at 24 hours and during exercise at 24 hours and 48 hours demonstrated a notable disparity. Furthermore, there was a significant difference in favour of adductor canal block (ACB) over femoral nerve block (FNB) regarding quadriceps muscle strength and the degree of knee flexion at 24 hours and 48 hours post-operatively. Conclusions: Adductor canal block (ACB) delivers comparable pain relief to femoral nerve block (FNB) both at rest and during passive exercise for up to 48 hours after surgery. ACB notably maintains the motor strength of quadriceps muscles when contrasted with FNB, and this preservation comes without introducing any additional complications.

Microbiological Effects of Sodium Hypochlorite/-Amino Acids and Cross-linked Hyaluronic Acid Adjunctive to Non-surgical Periodontal Treatment.

To investigate the microbiological outcomes obtained with either subgingival debridement (SD) in conjunction with a gel containing sodium hypochlorite and amino acids followed by subsequent application of a cross-linked hyaluronic acid gel (xHyA) gel, or with SD alone. Forty-eight patients diagnosed with stages II-III (grades A/B) generalised periodontitis were randomly treated with either SD (control) or SD plus adjunctive sodium hypochlorite/amino acids and xHyA gel (test). Subgingival plaque samples were collected from the deepest site per quadrant in each patient at baseline and after 3 and 6 months. Pooled sample analysis was performed using a multiplex polymerase chain reaction (PCR)-based method for the identification of detection frequencies and changes in numbers of the following bacteria: Aggregatibacter actinomycetemcomitans (A.a), Porphyromonas gingivalis (P.g), Tannerella forsythia (T.f), Treponema denticola (T.d), and Prevotella intermedia (P.i). In terms of detection frequency, in the test group, statistically significant reductions were found for P.g, T.f, T.d and P.i (p < 0.05) after 6 months. In the control group, the detection frequencies of all investigated bacterial species at 6 months were comparable to the baseline values (p > 0.05). The comparison of the test and control groups revealed statistically significant differences in detection frequency for P.g (p = 0.034), T.d (p < 0.01) and P.i (p = 0.02) after 6 months, favouring the test group. Regarding reduction in detection frequency scores, at 6 months, statistically significant differences in favour of the test group were observed for all investigated bacterial species: A.a (p = 0.028), P.g (p = 0.028), T.f (p = 0.004), T.d (p <0.001), and P.i (p = 0.003). The present microbiological results, which are related to short-term outcomes up to 6 months post-treatment, support the adjunctive subgingival application of sodium hypochlorite/amino acids and xHyA to subgingival debridement in the treatment of periodontitis.

Faecal microbiota study reveals specific dysbiosis in spondyloarthritis according to subtype, disease activity and treatment

To compare the diversity and composition of the gastrointestinal microbiome of patients with SpA. MiSeq sequencing of the V3-V4 region of the 16S ribosomal RNA gene was performed on DNA isolated from stool. Patients with concurrent SpA and IBD were excluded. Differences were assessed for richness and diversity indices by QIIME 2™. Differences between means >0,2% with a p-value<0,05 were assumed significant. Institutional Ethics Committee endorsement. 69 individuals included, 49 with SpA (ankylosing spondylitis-AS 72,9%, psoriatic arthritis-PsA 18,8%, reactive arthritis-ReA 8,3%) 5 positive controls-dysbiosis and 15 controls-eubiosis. Conventional treatment in 42,9%, anti-IL-17 16,3% and anti-TNF 40,8%. By subtype, statistically significant differences in favour of AS were found for the diversity indices. AS vs PsA there was a difference in favour of AS for Clostridium clostridioforme (p=0,002), Gemmiger formicilis (p=0,009), Roseburia inulivorans (p=0,008) and Lachnospira pectinoschiza. AS vs ReA there was a difference in favour of AS for L. pectinoschiza (p=0,009), Ruminococcus callidus (p=0.006), Clostridium ruminantium (p=0.031); G. formicilis (p=0,034). Diversity and richness showed differences in patients with high activity for Simpson's and Pielou's indices. In high activity, lower enrichment of Bacteroides eggerthii (p= 0,0003), C. ruminantium (p= 0,026) and Alistipes putredinis (p=0,035) was found. The number of ASV was higher in the anti-IL-17 vs conventional group (p=0.025) and a trend between anti-IL-17 vs anti-TNF (p=0.09). In anti-TNF there was a lower proportion for C. clostridioforme (p=0.023), G. formicilis (p=0.030) and R. callidus (p= 0.003). In anti IL-17, Alistipes indistinctus (p= 0.012) was decreased. There are differences in microbial diversity for SpA subtypes. The level of disease activity is plausible to influence the composition of the faecal microbiota. Anti-TNFα treatment may influence the microbiome environment favouring restoration of the gut microbiota, while anti-IL-17 may maintain an inflammatory environment.

Realistic three-dimensional imaging of injuries in forensic medicine - Survey-based method comparison of CRT and VRT

ObjectiveA comparison between Cinematic Rendering Technique (CRT) and Volume Rendering Technique (VRT) in cases with postmortem CT-angiography (PMCTA) was carried out. MethodsFor different injuries seen in PMCTA, a VRT and a CRT image of exactly the same pathological section was generated. Two questionnaires were created, one with CRT and one with VRT reconstructions, with the same questions per 3D-image. The questionnaires were sent to forensic pathologists, lawyers and police officers. In total eleven different injuries had to be analyzed. ResultsIn total 109 questionnaires were answered fully. Of these returnees, 36 stated that they were forensic pathologists. Seventy-three people were assigned to the group of medical laypersons, in the study this group consists mainly of police officers, judges and lawyers. Between the two software programs CRT and VRT that were compared, no significant difference could be identified in any of the participating groups with regard to the assessment of the life-threatening nature of the injury images shown. When asked about the comprehensibility of pathology, there was a significant difference in favour of CRT. This advantage was apparent to named medical laypersons and to forensic pathologists. ConclusionsThe study showed a positive trend that CRT may be more understandable than VRT. Not only the medical laypersons, but also the forensic physicians found CRT to be beneficial.

Impact of the Split Teaching Practice Model on Undergraduate Pre-Service Teachers’ Performance in Science Content Delivery

The study adopted an observational research design to assess the impact of the Split Teaching Practice Model on undergraduate pre-service teachers' performance in science content delivery within classroom settings, without researchers’ intervention. The population consisted of 119 second-year and 102 third-year science education students at Federal University Gusau - Nigeria, engaged in First and Second-phase teaching practice during the 2022/2023 academic session. A convenience sample of 96 pre-service teachers (54 in First-phase, 42 in Second-phase) was obtained. Data collection involved structured classroom observations using instrument tagged Pre-service Teachers' Performance in Science Content Delivery. Validity and reliability of the instrument were established through expert validation and inter-rater reliability assessment, yielding a correlation coefficient of 0.86. Four null hypotheses were tested using t-tests, focusing on lesson planning, presentation, class management, and attainment of objectives. The findings of the study revealed that, significant differences in favour of Second-phase pre-service teachers in aspects like sequential presentation, subject matter mastery, instructional materials usage, time management, and student participation. No significant differences were found in lesson introduction and questioning techniques. Second-phase pre-service teachers outperformed in class management and objective attainment. The study recommended continued adoption of the Split Teaching Practice Model, emphasizing refinement and customization to address specific improvement areas through feedback in teacher training institutions.

Virtual reality based rehabilitation in adults with chronic neck pain: a systematic review and meta-analysis of randomized clinical trials

Chronic neck pain is one of the most frequent musculoskeletal disorders, with high prevalence worldwide. Rehabilitation is an essential component of therapeutic strategy. Virtual reality based rehabilitation (VRBR) is a powerful distraction technique that could be beneficial for chronic neck pain patients. The objective of this systematic review was to analyse the effectiveness of VRBR in chronic neck pain treatment. We followed the PRISMA guidelines and used four databases (CINAHL, Medline (Via PubMed), Scopus and Web of Science) from their inception to August 2023. Eligibility criteria were established using PICOS. Methodological quality was evaluated with the Downs and Black scale and the risk of bias with the Revised Cochrane risk-of-bias tool. The meta-analysis was performed using the RevMan software. Six studies were included in the systematic review and the meta-analysis. We observed significant differences in favour of VRBR for pain intensity (SMD = − 0.46; 95% CI = − 0.74, − 0.19; p = 0.001), disability (MD = − 2.84; 95% CI = − 4.23, − 1.45; p < 0.0001), global perceived effect (MD = 0.49; 95% CI = 0.25, 0.72; p < 0.0001) and patient satisfaction (MD = 0.62; 95% CI = 0.38, 0.86; p < 0.00001). However, at short-term follow-up significant differences were only obtained for disability (MD = − 3.52; 95% CI = − 5.85, − 1.20; p = 0.003). VRBR can significantly improve pain intensity, disability, global perceived effect and patient satisfaction. The small number of articles included in the analysis is a limitation, even considering the good methodological quality of these studies. Investigating the effects of VRBR on mid and long-term follow-up and exploring different types of VR are needed.PROSPERO database, registration number ID: CRD42020222129.

P658 Safety and efficacy of MH002, an optimized live biotherapeutic product, for the treatment of mild to moderate ulcerative colitis: a first-in-disease, double-blind, randomized clinical trial

Abstract Background Treatment options for patients with mild to moderate ulcerative colitis (UC) failing 5-ASA are limited. MH002 is an optimized consortium of 6 non-pathogenic, well-characterized commensal bacteria with immune modulating, wound healing and gut barrier protective effects. This study evaluated the safety, efficacy, and mechanistic effects of MH002 in mild to moderate UC. Methods In this 2:1-randomized, double-blind, placebo-controlled first-in-disease study (EudraCT 2020-001355-33), 45 patients with mild to moderate active UC (Modified Mayo Score [MMS] =4-8 but including Mayo Endoscopic Sub-score [MES] ≥2) received treatment with 400mg MH002 or placebo (PBO) once daily for 8 wks. Full colonoscopies with biopsies were performed at baseline and wk8, biopsies and endoscopy videos were scored by blinded central readers. The primary endpoint was the rate of treatment-emergent adverse events (TEAEs). Exploratory efficacy endpoints included clinical remission (MMS ≤2 with all sub-scores ≤1 and rectal bleeding sub-score =0), endoscopic improvement (MES ≤1), and UC-100 and biomarker normalisation (C-reactive protein [CRP] ≤5mg/L, faecal calprotectin [FCP] ≤250mg/kg). Changes from baseline (CFBL) in MES and stool consistency (Bristol Stool Form Scale) were also evaluated. Results MH002 was safe and well tolerated: a TEAE was reported in 11/31 (35%) patients with MH002 and in 8/14 (57%) with PBO. Most TEAEs were mild and unrelated to study treatment. Early discontinuations (7/45; 16%) occurred similarly in both groups. At wk8, patients achieved clinical remission, endoscopic improvement, and biomarker improvements at higher rates with MH002 vs PBO (Table 1). Clinical remission rates were 14% for MH002 vs 7% for PBO (Per-protocol Set [PPS]: 18% vs 0%). Significant differences in favour of MH002 over PBO were seen in the CFBL for MES at wk8 (P=0.05, 1-sided Wilcoxon) and for stool consistency at wk2 (P=0.0057, 1-sided Student t). In total, 14/45 (31%) and 36/42 (86%) patients had elevated CRP and FCP levels at baseline, resp. Of these, more patients treated with MH002 achieved normalisation at wk8 (CRP: 60% vs 25%; FCP: 36% vs 15%). Decreases in FCP and stool consistency with MH002 were observed as early as wk2 and were greater than with PBO through wk8 (Fig 1). Conclusion MH002 treatment was safe and well tolerated and resulted in clinically meaningful improvements in disease activity and inflammatory parameters. MH002 therefore represents a promising new treatment for mild to moderate UC patients insufficiently controlled with 5ASA. These results warrant further development in a phase 2/3 study.

Whole Language Method or Phonics Method for Better Reading? An Eye-tracking Study

This study aims to compare the reading skills of individuals who learned reading through the Phonics Method (PM) and those who learned reading through the Whole Language Method (WLM) in terms of silent and oral reading performance and processes. A causal-comparative design was followed to reveal the causal relationship between the methods of teaching reading and individuals’ silent and oral reading processes and performance. The data were collected from 136 undergraduate students in Türkiye in the 2019-2020 academic year through two reading comprehension tests and prosodic assessment of oral reading skills to evaluate their L1 reading performance, and an eye-tracking system to evaluate their silent and oral reading processes. According to the teaching literacy method, no significant difference was obtained in the participants' silent and oral reading comprehension tests. However, the PM group demonstrated better prosodic reading skills compared to the WLM group. Similarly, their silent and oral reading processes showed a significant difference in favour of the PM group. Therefore, it can be concluded that the readers who learned reading through the PM had a more favorable reader profile, particularly regarding their reading processes. This study provides direct and cogent support to the discussions in the literature on the effectiveness of these teaching reading methods.

The Effect of Using Travel-Observation Method in Teaching Environmental Problems on Academic Achievement

This research, is there any effect of teaching the subject of environmental problems in the environment and society unit of the 11th grade high school geography course on the academic achievement of the students with the travel-observation method? It was carried out to seek an answer to the question. A quasi-experimental design with pretest-posttest control group was used in the study. The study group of the research consists of 60 students studying at a public school (Anatolian High School) in Kayseri. In the study conducted in the 2022-2023 academic year, the experimental group consisted of 30 students, 13 girls and 17 boys, while the control group consisted of 30 students, 12 girls and 18 boys. The experimental process was carried out over a period of three weeks. The quantitative data obtained as a result of the experimental procedures were analysed using SPSS 25 package programme. Frequency, percentage and arithmetic mean values were used in analysing the data; t- test and two-way Analysis of Variance for Repeated Measures on a Single Factor techniques were applied. According to the results obtained from the research, while the pre-test scores of the experimental and control group students on environmental problems were similar, significant differences were found in the post-test scores in favour of the experimental group. In the intra-group (pretest-posttest) comparison of the experimental and control groups, it was concluded that there was a significant difference in favour of the post-test scores in both groups, but when the effect size was taken into account, the increase in the experimental group was more significant. According to these results, it is recommended to encourage the use of the field trip-observation method in teaching subjects that can be understood by observation such as environmental problems.

Sınıf Öğretmeni Adayları için Aktif Öğrenme Temelli Çocuk Hakları Eğitimi

This study investigated the effect of children’s rights (CR) education on the understanding and attitudes of primary school teacher candidates regarding CR through active learning-based implementations. Explanatory sequential design was employed in the study. The quasi-experimental design with non-equivalent pretest-posttest control group and case study were employed. Experimental implementations were conducted with 72 third year teacher candidates. The experimental group was trained for 13 weeks by employing the Active Learning-Based Children’s Rights Education Curriculum (ACREC) developed in the study and the traditional teaching method was used in the control group. In the qualitative phase, semi-structured interviews with 12 teacher candidates were carried out. The findings revealed that posttest scores showed significant difference in favour of the experimental group, and that the development of understanding was higher in this group. The ACREC was found to contribute to teacher candidates in the context of understanding, attitudes, behaviours and professional development concerning CR.

Patient preferences for disposable and reusable vaginal specula and their willingness to compromise in the era of climate change: A cross-sectional study.

To evaluate patient satisfaction on gynaecological examination with metal, plastic and biobased plastic vaginal specula, and to investigate whether patients are willing to compromise on comfort for a more sustainable healthcare system. Cross-sectional study: population-based survey. Gynaecological outpatient clinics in five Dutch hospitals. Patients during general gynaecology consultation hours. A survey containing two questions about patient demographics, four about comfort and five about sustainability and healthcare was distributed. Comfort score (scale 1-10). (1) temperature, size and ease of insertion, (2) willingness to compromise for a more sustainable healthcare system. In all, 196 patients completed the survey. Biobased plastic vaginal specula scored significantly higher on comfort than the metal ones (mean 8.03 ± 1.65 versus 7.26 ± 1.51 respectively; P < 0.001). The biobased plastic vaginal speculum is significantly the most comfortable on temperature, whereas the metal speculum is the least comfortable (P < 0.007). Most patients are willing to compromise on comfort or are open to the reuse of disposables to contribute to a more sustainable healthcare. The majority of patients (77%) urge healthcare organisations to combat climate change. There is a small but statistically significant difference in favour of a biobased plastic speculum regarding comfort score, although it might be questioned whether this is clinically relevant. Furthermore, patients are willing to compromise on comfort for a more sustainable healthcare, which should be a contributing factor in speculum selection.

The impact of chronotype on VO2max in university students at two different times of the day

Background and Study Aim. To choose the ideal training or performance times, it is crucial to assess VO2 max performance across different time-of-day particular chronotypes. This study aimed to investigate the differences in VO2 max between the chronotype of university students during the morning and evening time of the day. Material and Methods. Fifty-two university students (26 morning type and 26 evening type) with mean age 23.05± 2.07 years, weight 66.71±4.31Kg and height of 170.90±5.18 cm and BMI of 22.75±1.91kg/m2 were recruited based on the results of the Horne-Ostberg Morningness- Eveningness Questionnaire (MEQs) participated in this Cross-over study. VO2 max was measured directly by gas collected using mouth tube breath to breath through the use of the gas analyzer the AD instrument (model-ML206) with an incremental graded maximal exercise test done on the treadmill. Results. The morning type group's VO2 max was significantly better in the morning hour than it was in the evening (p=.013), and when the VO2 max of the evening type group was measured in the morning and evening hours and compared, there was a statistically significant difference in favour of the evening hours (p=.004). Additionally, there is no discernible difference between the VO2 max of the morning type and the evening type group either in the morning hours or the evening hours, but trends indicate that the morning type group has a higher VO2max in the morning hour and the same is true for the evening type group in the evening hour. Conclusion. The findings of this study showed an interaction between chronotype and time of the day in VO2 max. For endurance training, trainers should consider the individual's chronotype and time of the day for exercise prescription.

Evaluation of the effectiveness of prophylactic sealing of pits and fissures of permanent teeth with fissure sealants - umbrella review

BackgroundTooth decay is an infectious disease which, in its initial phase, leads to the formation of cavities in the teeth through decalcification of the enamel and local tissue destruction. In addition to proper oral hygiene, prophylactic sealing of fissures and cavities with a sealant is a method of preventing the development of caries. The aim of this study is to summarise the effectiveness of fissure sealing of permanent teeth with fissure sealants compared to other preventive methods or no intervention.MethodAn umbrella review was carried out to achieve the purpose of our study. Searches were performed in Medline (via PubMed), Embase (via OVID), and Cochrane Library databases. Quality assessment of the included studies was performed using the AMSTAR2 tool. In addition, a manual search for recommendations/clinical practice guidelines on dental prophylaxis was performed.Results204 publications were identified, of which 15 met the inclusion criteria. Based on the results of 3 systematic reviews, there was a statistically significant reduced odds of caries occurrence or development with prophylactic sealing of permanent teeth compared with no intervention – depending on the review and follow-up period odds ratio (OR) ranged from 0.06 [95%CI: (0.01–0.32)] to 0.28 [95%CI: (0.20–0.38)]. In the eight systematic reviews that analysed different sealants, there were no statistically significant differences between the types of materials used for prophylactic tooth sealing. For systematic reviews comparing the efficacy of fissure sealants with fluoride varnish, three reported no statistically significant difference in the efficacy of caries incidence, with only one systematic review based on 1 RCT finding a statistically significant difference in favour of fissure sealants.ConclusionCompared to the no intervention, dental sealing is an effective method for the prevention of dental caries. However, it is not possible to conclude conclusively which type of sealant and which of the available prophylactic methods is more effective in preventing caries.

Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment in primary care (ATLANTIS): a randomised, double-blind, placebo-controlled, phase 3 trial

Most patients with irritable bowel syndrome (IBS) are managed in primary care. When first-line therapies for IBS are ineffective, the UK National Institute for Health and Care Excellence guideline suggests considering low- dose tricyclic antidepressants as second-line treatment, but their effectiveness in primary care is unknown, and they are infrequently prescribed in this setting. This randomised, double-blind, placebo-controlled trial (Amitriptyline at Low-Dose and Titrated for Irritable Bowel Syndrome as Second-Line Treatment [ATLANTIS]) was conducted at 55 general practices in England. Eligible participants were aged 18 years or older, with Rome IV IBS of any subtype, and ongoing symptoms (IBS Severity Scoring System [IBS-SSS] score ≥75 points) despite dietary changes and first-line therapies, a normal full blood count and C-reactive protein, negative coeliac serology, and no evidence of suicidal ideation. Participants were randomly assigned (1:1) to low-dose oral amitriptyline (10 mg once daily) or placebo for 6 months, with dose titration over 3 weeks (up to 30 mg once daily), according to symptoms and tolerability. Participants, their general practitioners, investigators, and the analysis team were all masked to allocation throughout the trial. The primary outcome was the IBS-SSS score at 6 months. Effectiveness analyses were according to intention-to-treat; safety analyses were on all participants who took at least one dose of the trial medication. This trial is registered with the ISRCTN Registry (ISRCTN48075063) and is closed to new participants. Between Oct 18, 2019, and April 11, 2022, 463 participants (mean age 48·5 years [SD 16·1], 315 [68%] female to 148 [32%] male) were randomly allocated to receive low-dose amitriptyline (232) or placebo (231). Intention-to-treat analysis of the primary outcome showed a significant difference in favour of low-dose amitriptyline in IBS-SSS score between groups at 6 months (-27·0, 95% CI -46·9 to -7·10; p=0·0079). 46 (20%) participants discontinued low-dose amitriptyline (30 [13%] due to adverse events), and 59 (26%) discontinued placebo (20 [9%] due to adverse events) before 6 months. There were five serious adverse reactions (two in the amitriptyline group and three in the placebo group), and five serious adverse events unrelated to trial medication. To our knowledge, this is the largest trial of a tricyclic antidepressant in IBS ever conducted. Titrated low-dose amitriptyline was superior to placebo as a second-line treatment for IBS in primary care across multiple outcomes, and was safe and well tolerated. General practitioners should offer low-dose amitriptyline to patients with IBS whose symptoms do not improve with first-line therapies, with appropriate support to guide patient-led dose titration, such as the self-titration document developed for this trial. National Institute for Health and Care Research Health Technology Assessment Programme (grant reference 16/162/01).

THE EFFECTS OF ENVIRONMENTAL EDUCATION GIVEN BY CREATIVE DRAMA METHOD ON ENVIRONMENTAL AWARENESS OF PRESCHOOL CHILDREN

The aim of this study is to examine the effects of environmental education given by creative drama method on 5-6 year old children on environmental awareness of children. The study, which has a mixed model in which qualitative and quantitative methods are used, has a quasi-experimental design with a pre-test and post-test control group. The study was carried out with a total of 26 children. The data were collected by using “Environmental Scale for Children” and by drawing pictures. As a result of the analyses of t-test, a significant difference in favour of the experimental group was found between the two groups (t= -7,676, p&amp;lt;.05). It has been determined that environmental education given by drama method has a positive effect on children's environmental awareness. The content analysis method was used for the analysis of pictures drawn by children at the end of the sessions. It was found that children reflected the importance of trees/forests, living things relation, importance of air and water in their pictures.&lt;p&gt; &lt;/p&gt;&lt;p&gt;&lt;strong&gt; Article visualizations:&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;img src="/-counters-/soc/0056/a.php" alt="Hit counter" /&gt;&lt;/p&gt;

Does primary treatment of proximal humerus fractures show favourable functional outcomes over secondary treatment with reverse shoulder arthroplasty?

Background This multicentre retrospective cohort study assessed whether functional outcomes after primary reverse shoulder arthroplasty (RSA) are favourable compared to secondary placement in elderly patients with displaced proximal humerus fractures (PHFs). Methods Fifty-three patients with primary and 32 with secondary RSA were included. Patient-reported outcome measures (PROMs) were assessed: Constant–Murley Score (CMS), Oxford Shoulder Score (OSS), Disabilities of the Arm, Shoulder and Hand (DASH) score, and Visual Analogue Scale (VAS). In addition, range of motion (ROM) was compared between groups. Result For PROMs, the means (SD) for primary versus secondary were 25.4 (17.7), 29.4 (19.2) for DASH; 38 (8.6), 38 (9.1) for OSS; 63 (19.8), 59 (22.0) for CMS and 2 (2.0), 3 (2.3) for VAS. For ROM, the means were the following: forward flexion 113° (33.6), 106° (34.1); abduction 103° (33.4), 96° (37.3) and external rotation 20° (19.1), 20° (17.8). There were significant differences in favour of primary treatment in forward flexion (p = 0.003, B 19.85) and abduction (p = 0.034, B 17.34). Discussion ROM in patients with complex displaced PHFs after primary RSA is slightly better than that after secondary treatment. Therefore, RSA could be considered primary treatment, especially when optimal ROM is of great importance to the patient. Level of evidence level III, retrospective comparative study treatment study