Significant Mean Differences Research Articles

(153) Hyperbaric Oxygen Therapy as a Treatment for Erectile Dysfunction: A Meta-analysis

Abstract Introduction Hyperbaric oxygen therapy (HBOT) is a medical treatment in which the patient is exposed to 100% oxygen at a higher than atmospheric pressure. Over the past few decades, HBOT has been used to treat a variety of medical conditions, including radiation cystitis, decompression sickness and carbon monoxide poisoning. In recent times, there has been a rising curiosity regarding the potential therapeutic benefits of hyperbaric oxygen therapy in the treatment of erectile dysfunction (ED), a prevalent condition that affects a vast number of men globally. Objective The aim of this study was to review and meta-analyze available data regarding the use of HBOT for erectile dysfunction, including its potential mechanisms of action and effectiveness. Methods Two investigators (GS and TN) screened 54 articles and included only those that evaluated the impact of HBOT on ED symptoms using the IIEF score. Prospective non-randomized studies or randomized controlled clinical trials were included, while non-original studies, conference abstracts, and case reports were excluded. Data extraction was performed in duplicate. Data analysis was conducted using Review Manager 5.41, and the presence of heterogeneity between studies was evaluated. The results were presented as the Mean Difference (MD) with 95% confidence intervals (CI). The significance level was set at P = 0.05. Results A total of five studies that reported outcomes using the IIEF scores were included in this analysis, which comprised a total of 175 patients who received HBOT and 178 control patients. The IIEF scores were analyzed by stratifying the studies according to the indication for HBOT or the cause of ED. In patients with post-robotic assisted laparoscopic prostatectomy (RALP)-induced ED, the analysis showed a significant Mean Difference (MD) of -4.13[-6.08, -2.18] p<0.0001 in favor of the control group. Conversely, patients who received HBOT for reasons other than ED exhibited a MD of 4.58[2.63,6.52] p<0.00001. In the group that received HBOT for pure vasculogenic ED, the MD was 10.50[9.92,11.08] in favor of HBOT. Patients with urethral strictures exhibited a MD of 4.25[2.29-6.21] favoring the HBOT intervention. Meta-analysis of these data revealed a nonsignificant difference in erectile function scores, with an MD of 3.86[-2.13, 9.86] p<0.00001. Conclusions The use of HBOT in the treatment of ED appears to be a promising approach. While further research is needed to establish the efficacy and long-term effects of this treatment, preliminary studies have shown encouraging results in terms of improving erectile function in men with vasculogenic ED. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast Investor: Sprout.

Abstract TP66: Decreased Order to Administration Times Following Transition to Tenecteplase for Acute Ischemic Stroke

Introduction: Alteplase was the first approved tissue plasminogen activator and standard of care for acute ischemic stroke (AIS). The utilization of Tenecteplase as a thrombolytic agent in AIS has offered many organizations several advantages over Alteplase, including ease of preparation and administration. Both thrombolytic agents require a Physician's order and reconstitution by a certified Pharmacist or Registered Nurse prior to administration. Our academic comprehensive stroke center transitioned from Alteplase to Tenecteplase as standard thrombolysis for acute ischemic stroke in November 2022. Treatment times were monitored to explore the benefits of a single bolus administration. Methods: A retrospective chart review was conducted at a single academic comprehensive stroke center. Patients were included if they received thrombolytic therapy in the Emergency Department for a diagnosis of AIS. Patients prior to November 2022 received Alteplase, and those after November 2022 received Tenecteplase. We evaluated the time frame for the medication bolus order for Alteplase and Tenecteplase to the administration time. Results: Of 140 patients screened, 108 were included in the study, with 51 in the alteplase group and 57 in the Tenecteplase group. Mean order to administration times were 10.9 minutes in the alteplase group and 7.37 minutes in the Tenecteplase group, with statistical significance (P=0.0052). There was no significant difference in mean door-to-needle time (59.27 Alteplase vs 53.09 Tenecteplase, P= 0.1803). Conclusions: In a single CSC, the transition from Alteplase to Tenecteplase reduced the order to administration time by 3.53 minutes. The decreased administration time highlights one of Tenecteplase’s potential advantages. Further review is necessary to evaluate additional stroke metrics and clinical outcomes.

Classroom practices in primary schools’ mathematics teaching supported by the Interactive Mathematics Software for Rwanda

Over recent decades, the integration of technological resources in education increased growingly. However, studies about the assessment of information and communications technology integration in primary school mathematics activities remained few. This research intended to comparatively examine the aspects of classroom practices observed during the implementation of the Interactive Mathematics (IM) Software in primary schools in Rwanda. Designed as quasi-experimental, it involved the experimental groups from Primary-2, Primary-3, Primary-4, and Primary-5 and analyzed aspects of school statuses, the school years, and the educational cycles. Data collected using Likert-scale measurements from 63 classroom observations were analyzed using Microsoft Excel and a two-sample t-test analysis was conducted to determine if the significance of mean differences. The findings revealed no significant difference between lower and upper primary based on a p-value of 0.829368908 (p-value>.05) and between the 2019 and 2020 teaching periods (considering the same teacher) based on the p-value=0.324542 (p-value>.05). However, the findings revealed that private and public schools’ mean differences were significant based on the calculated p-value<em> </em>equal to 0.007144 (p-value<.01). The study made various recommendations towards using IM software to promote quality mathematics education in primary schools in Rwanda and pre-service teacher training to boost the initiation process of their technology-enhanced pedagogy knowledge to teach mathematics.

PHYSICAL ACTIVITY IN PRIMARY SCHOOLS: A KEY MEDICINE TO HEALTH PROMOTION IN ETHIOPIA

Engaging in physical activity within school settings improves early adolescents overall health status as well as their academic achievements. Therefore, the current study, aimed at primary schools, has been considered an essential medicine for promoting physical activity among older children. Eight hundred thirty-five older children aged 11 to 14 with a mean age of 12.95 ±0.937 SD were selected. A cross-sectional study was utilized to achieve the objective of this survey. Self-reported PAQ-C measure was conducted. The PAQ-C survey was analyzed using IBM SPSS (Ver. 26) to achieve this studys intended physical activity goal. The internal coherence of the data was assessed by Cronbachs alpha (0.819). The finding indicated a low level of participation with an average mean score of 2.49 (SD 0.63). A significant mean difference was observed between grades five and eight with 0.18461 (CI = 0.0066, 0.3626), P-value = 0.039<0.05), and Kola Shara primary school had the most significant mean difference (mean value = 0.78975, P = 0.000<0.05). As a result, grade five was more active than grade level, and Shara Primary School had better participation. However, the overall composite mean score was below the average. Therefore, the study demonstrated low participation in physical activity among the selected schools in the Gamo zone, southern Ethiopia. Finally, the study suggests that further research is needed to understand the factors that hinder the promotion of physical activity in school settings.

지역문화정책 대상범위에 관한 연구

The purpose of this study is to investigate the scope of local cultural policies through an empirical study on the cultural enjoyment gap. For this purpose, the cultural enjoyment status of culturally marginalized groups derived from the review of previous studies was compared and analyzed within the same basic local government. In addition, the experience level of each cultural genre was investigated and analyzed by dividing cultural enjoyment into viewing, participation, and education stages. The results of the analysis showed that, first, when it comes to leisure time for cultural enjoyment, those in their 60s and older, those with lower income levels, and those living in towns and villages have more leisure time on an average weekday. Second, 25% of all respondents have experienced veiwing cultural events. Movies and museums were found to be universal cultural enjoyment genres, and in most genres, the underrepresented groups were found to be real. Third, direct participation in cultural events was lower among those under the age of 50, those with lower median income, and those living in the urban. Fourth, the experience of cultural education was also low, with significant mean differences by class.

Factors associated with infant feeding intention among usual-risk pregnant women.

To identify the factors associated with infant feeding intention among usual-risk pregnant women. A quantitative cross-sectional study was conducted in two primary healthcare institutions in Fortaleza, Ceará, Brazil, with usual-risk pregnant women. A non-probabilistic convenience sampling method was used, and 119 pregnant women participated. Data collection took place from May 2022 to February 2023. The data collection process involved using forms and the Infant Feeding Intention Scale. Ethical considerations were strictly adhered to. The study revealed statistically significant differences in the infant's means. The majority of pregnant women (96.6%) declared that they would breastfeed after giving birth. The intention to breastfeed exclusively was statistically higher in mothers with younger children and previous experience of breastfeeding or complications in the current pregnancy. This study clarified that the intention to breastfeed up to 6 months is influenced by variables encompassing the age of the youngest child, previous breastfeeding experience, and pregnancy complications, emphasizing the intricate nature of the determinants of intention to breastfeed.

Evaluation of improved shallot (Allium cepa L. Aggregatum) varieties for yield and yield related traits in Gamo Zone, Southern Ethiopia

Shallot (Allium cepa var. ascalonicum Backer) is an important vegetable crop cultivated by small holder farmers for consumption in Gamo mid and high lands. However, its production and productivity is constrained by lack of improved shallot varieties in the study area. Field experiment was conducted in Gamo Zone during 2021 and 2022 cropping season. The objective of the experiment was to select well adaptive and high yielding shallot varieties for the study areas. Eight shallot varieties in two sets (bulb propagated sets and seed propagated sets) were evaluated in randomized complete block design with four replications by using double row spacing of 40cm x 20cm in Plot size of 2.4m x 2m. The combined analysis of the mean over years showed that there was a statistical significant mean difference (P<0.01) among the varieties for yield and some yield related traits. Among the bulb propagated varieties tested, the highest number of splits (13.75) per plant (bulb) was recorded by variety ‘’DZSHT-00/2” followed by “Minjar” (12.18). Similarly, “DZSHT-00/2” gave the highest bulb yield (21.22 t ha-1) followed by “Minjar” (19.27 t ha-1). On the other hand, the highest marketable bulb yield of 9.61 t ha-1 was recorded by variety “Tropics” followed by “DZSHT-157-21” (7.47 t ha-1). Hence, varieties “DZSHT-005/2” and “Tropics” are recommended for popularization and production due to their better yield and adaptability in the study area.

Therapeutic Painting and Sexual Violence Expressed by Students in Selected Secondary Schools in Bundibugyo District in Uganda

Sexual violence has often caused distress to many people, and a lot has been written proposing solutions to this vice. Restoring hope among people who have been affected by sexual violence in Secondary schools in Bundibugyo District requires concerted effort and adopting ways that help to relieve the affected people of stress resulting from their experience with sexual violence. The current study focused on how therapeutic painting can be utilised to describe in detail lived experiences relating to ever-increasing sexual violence in secondary schools in the Bundibugyo district. Despite the various forms of violence that affect secondary school students, sexual violence seems to be a vice that greatly affects school children, and young children are always shy to verbally express how they are affected. Therefore, this study aimed to investigate the relationship between Visual art therapy and sexual violence expression by students in selected Secondary Schools in Bundibugyo District. The following objective guided the study: To examine the statistical relationship between therapeutic painting and sexual violence expression by students in selected Secondary Schools in Bundibugyo District. 400 S2 students participated in this study, these included; Semuriki High School-Izahura-163, Bukonjo Seed School-17, Bundikahungu Seed school-75, St Mary’s Simbya Secondary School-145. Methodology entailed methods such as in-session semi-structured interviews, observation methods, and focus group discussion. An explanatory sequential design was adopted in this study. The study established that there was a statistically significant difference in means; thus, there was a relationship between therapeutic painting and sexual violence expressed by students in selected Secondary Schools in Bundibugyo District (z =-6.736, p <0.0001). Hence, the null hypothesis was rejected. The findings led to the conclusion that therapeutic painting intervention helped to improve the expression of sexual violence among victims, helped them to gain relaxation, lost hope, and lessened the anxiety that had resulted from their experience with sexual violence

Perioperative vaginal misoprostol versus intraoperative pericervical hemostatic tourniquet outcome during abdominal myomectomy: A systematic review and meta-analysis

Background: Abdominal myomectomy is a commonly performed surgical procedure for removing fibroids. Various techniques and interventions have been explored to minimize blood loss during abdominal myomectomy. This study aims to assess and compare the efficacy of perioperative vaginal misoprostol and intraoperative pericervical hemostatic tourniquet in minimizing blood loss during abdominal myomectomy. Method: Eligible studies were identified using several databases. Analysis was conducted using RevMan version 5.3. This systematic review and meta-analysis were registered in PROSPERO on June 20, 2023, with registration number CRD42023434191. We included three studies with 88 participants. Results: Of the 73 records identified initially, 3 met the inclusion criteria—sample sizes of the included studies involving 88 participants. There was a significant mean difference in intraoperative blood loss ( p = 0.022 (95% CI, 0.0706–0.901) and operative time ( p = 0.015, 95% CI, 0.116–1.066) between groups. There was no significant mean difference in postoperative hematocrit ( p = 0.053 (95% CI, −0.734 to 0.00411)) and intraoperative blood transfusion (OR = 1.60 (95% CI, 0.587–4.405), p = 0.355)) between group. Conclusion: Our studies indicate that using tourniquets lowered intraoperative bleeding and shortened operating time among the participants. Intraoperative vaginal misoprostol has no significant advantage over the tourniquet group in either intraoperative blood transfusion needs or postoperative hematocrit.

P303 Determining the threshold for moderate-to-severe disability in inflammatory bowel disease using IBD-Disk

Abstract Background The IBD-Disk is a validated 10-question visual scale, which has been shown to measure functional disability associated with inflammatory bowel diseases (IBD). The aim of this study is to assess the correlation between the IBD-Disk, the daily-life burden associated with IBD, and disease activity. Methods We conducted a cross-sectional study over 6 months between April and September 2023. IBD patients responded to the IBD-Disk and 2 visual analog scales (VAS): 1) Daily-life IBD burden (scored from 0 to 10, score > 5 indicates high burden) 2) Overall perceived health status (0=poor, 10=good). Means were compared using the Wilcoxon-Mann-Whitney test. The correlation of the overall IBD-Disk with daily-life IBD burden and overall health was analyzed using Spearman's correlation coefficient. The diagnostic performance of IBD-Disk in detecting severe disability was studied using the area under the Receiver Operating Characteristic (ROC) curve. Results We included 142 patients, 55.6% male and 72.5% with Crohn's disease. The median age of the series was 38 years [30 - 48]. The mean IBD-Disk total score was 35.7 ± 21.6. Energy, Emotion, and Sleep obtained the highest scores. Mean values for daily-life burden and self-rated overall health status were 4.9 ± 3.1 and 5.9 ± 2.6 respectively. There was a significant difference in means between the overall IBD-Disk score, IBD daily-life burden and overall health status between patients in clinical remission and patients with active disease (Table 1). We observed 43.7% patients (n=62) with a high daily-life burden. The correlation between the overall IBD-Disk score and the VAS of daily-life burden was r=0.787 (p<0.001) and was inversely related to the VAS of overall health status with a coefficient r=-0.632 (p<0.001). At an optimal overall IBD-Disk score cut-off equal to 38/100, the area under the receiver operating characteristic curve (AUROC) for high IBD daily-life burden [VAS>5] was 0.907 (95% confidence interval [CI]: 0.858-0.955; p<0.001) (Figure 1) Conclusion Our work has demonstrated excellent item homogeneity in the classical Arabic version of the IBD-Disk, and a good correlation between each item and the remaining total score. However, a prospective measurement of the intra-class correlation coefficient of the classical Arabic version will be necessary to assess its reproducibility over time.

A study on the effectiveness of training programs in improving biomedical waste handling in a tertiary care hospital, Bengaluru: A pre-post study

BackgroundIn addition to being centres for healing, hospitals are major producers of infectious waste. The current study was carried out at a 700-bed tertiary care hospital in Bengaluru to assess Biomedical Waste (BMW) management practices at the source of generation and to ascertain the efficacy of training on the knowledge, attitude, and practice (KAP) of healthcare workers (HCW). MethodsBefore the structured training program, each participant filled out the pre-test questionnaire. The structured training program on BMW (M and H) rules was conducted using audiovisual learning techniques. Immediately after the end of the training session, participants were given the 1st post-test questionnaire. Three months after the training session, the participants were given the 2nd post-test questionnaire. ResultsOut of 183 participants involved in the study, 33.9 % of the participants were males, while 66.1 % were females. Wilcoxon Signed Rank Test was applied to the pre-and post-interventional knowledge and practices. There was a significant mean difference between pre-interventional (4.7 ± 1.7) and post-interventional knowledge (post-test 1–8.8 ± 1.3; post-test 2–7.3 ± 1.4) regarding Bio-medical waste management. Similarly, a significant difference in mean between pre-interventional (5.9 ± 1.4) and post-interventional practices (post-test 1–8.6 ± 1.1; post-test 2–7.3 ± 1.2) regarding BMW management. ConclusionThe study concluded that regular training programs on BMW and its hazards for all HCWs including group D workers should be conducted.

Incidence of Dry Socket in Relation to Psychological Stress: A Retrospective Study

This study concerns with the incidence of dry sockets among a sample of patients attending different dental clinics after tooth extraction for three consecutive years in relation to their age, sex, tooth location and to patients perceived stress.Dry socket patients records were investigated for age, sex and tooth location. And a control group was chosen of exactly the same age and sex distribution as that of the patients but free from any symptoms . A questionnaire sheet with a list of possible life events for the last twelve months before the extractions were distributed among both, then the results was subjected to statistical analysis.Out of 956 patients, 58 (6%) developed dry sockets, (36%) of them were located on wisdom teeth with the lower ones comprising (25.86%). There were significant difference in mean perceived psychological stress between the patients (477.07 ± 7.38 L.C.U) and those in control group (240.44 ± 7.12 L.C.U.) regarding different ages and sexes.There were higher incidence of dry sockets in this study than most other studies around the world and female /male ratio was nearly equal. They occurred mostly on lower and posterior more than upper and anterior teeth wisdom teeth were most, highly affected, and there were a relationship between psychological stress and dry socket.

The Effectiveness of Kinesio-Taping and Muscle Energy Technique Versus Knee Strengthening Exercises on Pain and Function in Subjects with Osteoarthritis of the Knee

Background: An approach known as Kinesio-taping will be used to support the knee joint and muscle. MET isa sort of manual therapy that uses moderate isometric contractions to relax the muscles and reduces discomfort,stress and strain. It also prevents knee instability by enhancing quadriceps and hamstring muscle strength andfunction in patients with OA knees.Objective: The purpose of the study was to investigate the effectiveness of Kinesio-taping and muscle energytechniques for pain and function in terms of NPRS and KOOS in subjects with OA knee.Methodology: Forty osteoarthritis patients were randomly assigned to one of two groups (A or B). Group A(n=20) will receive Kinesio-taping and (MET) post-isometric relaxation for the hamstring, quadriceps, andgastrocnemius muscles along with interferential therapy. Group B (n=20) will receive knee strengthening exercisesfor both hamstring and quadriceps and interferential therapy for a period of thrice a week for 6 weeks. The NPRS(numerical pain rating scale) and KOOS (knee injury and osteoarthritis outcome score) were used to assess painand functional improvement before and after the tests.Results: Group A showed a significant mean difference (P = >0.001) between the NPRS and KOOS. Hence Group-AKinesio-taping and muscle energy technique along with IFT are significant in treating individuals with pain andfunction in Osteoarthritis of the knee.Conclusion: This study concluded that the Kinesio-taping and MET (post isometric relaxation) with IFT (GroupA) shows effectiveness in improving the pain and function in the OA knee.

Anatomical Dimensions and Types of the Anterior Clinoid Process in Libyan population by Using Computed Tomography: A cross Sectional Study

The anterior clinoid process (ACP) has a complex anatomical feature and surrounded by important structures which may complicate the surgical procedures during the anterior clinoidectomy. Our objective was to measure dimensions of anterior clinoid process, and to determine variations of its types. Forty-nine of cranial computed tomography scans were performed from adult Libyan patients on routine examination of paranasal sinus at Benghazi Medical Center between February 1, 2023, and April 14, 2023. The right and left ACP length and the base width were measured on the axial CT images. Data analysis was done using SPSS version 23. The means and standard deviations were calculated. The paired Student’s t test was used to determine the statistically significant differences in means between the right and left ACP. (P ≤ 0.05) was considered statistically significant at (95%) confidence interval. The length of the right and left ACPs were 11.2 ± 2.2 mm and 11.6 ± 2.4mm, respectively. The width of the right and left ACPs were 5.37± 1.22 mm and 5.42 ± 1.24mm, respectively. Type 2 anterior clinoid process was the commonest (75.5 %) while type 1 was the least common (4.1 %). There was no statistically significant difference between right and left sided measurements. Our study outcomes may be helpful for pre-operative planning. Presence of any variations may result in unnecessary injury to the complicated surgical procedures that involve removal of ACPs. Further research studies required with large sample size of population will give well understanding about the parameter of ACPs.

Body composition assessment in 6-month-old infants: A comparison of two- and three-compartment models using data from the Baby-bod study.

An appreciation of infant body composition is helpful to understand the 'quality' of growth in early life. Air displacement plethysmography (ADP) using PEA POD and the deuterium dilution (DD) technique are commonly used body composition approaches in infants. We evaluated the comparability of body composition assessed using both techniques with two-compartment (2C) and three-compartment (3C) models in 6-month-old infants. Infant fat mass (FM) and percent fat mass (%FM) obtained from a 2C model using PEA POD (2C-PP) and a 2C model using the deuterium dilution technique (2C-DD) were compared to those derived from a 3C model, and to each other, using Bland-Altman analysis and Deming regression. Measurements were available from 68 infants (93% Caucasian, 53% male). The mean biases were not significant between any of the method comparisons. However, significant constant and proportional biases were identified in 2C-DD vs 3C and 2C-PP vs 2C-DD, but not in the 2C-PP vs 3C comparison. Furthermore, we observed significant associations between the mean differences and infants' percent total body water (%TBW). While no significant between-method mean differences were found in body composition estimates, some comparisons revealed significant constant and proportional biases and notable associations between the mean differences and %TBW were observed. Our results emphasise the importance of method choice, ensuring methodological uniformity in long-term studies, and carefully considering and regulating multiple pre-analytical variables, such as the hydration status of the participants.

Prenatal tobacco smoke exposure and risk for cognitive delays in infants born very premature

Prenatal tobacco smoke exposure (TSE) and prematurity are independent risk factors for abnormal neurodevelopment. The objectives were to compare differences in Bayley-III cognitive, language, and motor scores at 2 years corrected age (CA) in 395 infants born very preterm (≤ 32 weeks gestation) with and without prenatal TSE. We performed multivariable linear regression analyses to examine associations between prenatal TSE and neurodevelopmental outcomes and a mediation analysis to estimate direct effects of prenatal TSE on outcomes and indirect effects through preterm birth. In total, 50 (12.6%) infants had prenatal TSE. Infants with prenatal TSE had lower mean [95% CI] Cognitive score (82.8 [78.6, 87.1]) vs. nonexposed infants (91.7 [90.1, 93.4]). In children with and without prenatal TSE, there were significant differences in mean [95% CI] Language scores (81.7 [76.0, 87.4] vs. 92.4 [90.2, 94.6], respectively) and mean [95% CI] Motor scores (86.5 [82.2, 90.7] vs. 93.4 [91.8, 95.0], respectively); scores remained significant after controlling for confounders. Preterm birth indirectly mediated 9.0% of the total effect of prenatal TSE on Cognitive score (P = NS). However, 91% of the remaining total effect was significant and attributable to TSE’s direct harmful effects on cognitive development (β = − 5.17 [95% CI − 9.97, − 0.38]). The significant association is largely due to TSE’s direct effect on cognitive development and not primarily due to TSE’s indirect effect on preterm birth.

Association between fear of falling and falls following acute and chronic stroke: a systematic review with meta-analysis.

To examine the association between falls and fear of falling in people with stroke and to evaluate the differences between patients with acute stroke and those with chronic stroke with regard to any such association. Articles were searched in Medline, CINAHL, AMED, Embase, PsycINFO, Cochrane Library of Reviews and PEDro from inception until March 2023. Experimental, observational or explorative studies investigating the association between fear of falling and falls in people with stroke were included. Articles were screened by 2 independent reviewers. Data were extracted by an independent reviewer. A total of 26 reports were included in this review (n = 2863). Fear of falling, assessed by a single-question survey, was significantly associated with falls (relative risk = 1.44; 95% confidence interval (95% CI) = 1.22, 1.70; I2 = 0%) in people with acute stroke. Significant mean differences in fear of falling, based on the Falls Efficacy Scale (mean difference = 12.80; 95% CI = 1.81, 23.78; I² = 28%) and Activities-specific Balance Confidence Scale (mean difference = -9.99; 95% CI = -15.36, -4.62; I² = 57%), were also reported between fallers and non-fallers in people with chronic stroke. A small, but significant, association exists between falls and fear of falling in both acute and chronic stroke patients.

Institutional and family support impact on health-related quality of life of children with autism spectrum disorders during the COVID-19 pandemic.

Children with autism spectrum disorder (ASD) tend to have a notably poorer quality of life than the general population, especially during the COVID-19 pandemic. This study aimed to analyze the association between institutional support and family support on the health-related quality of life (HRQoL) of children with ASD during the COVID-19 pandemic. A cross-sectional study was conducted in October 2022 in a School for Special Needs in Malang City, East Java Province, Indonesia. The pediatric quality of life inventory (PedsQL) and Institutional and Family Support questionnaire were used to measure the HRQoL and support perceived by parents of children with ASD. We analyzed each component of the PedsQL and the Institutional and Family Support questionnaire. The independent T-test was performed to analyze the association between HRQoL and perceived support by parents of children with ASD. The results showed that most participants (72.7%) were women aged 40. As many as 69.39% of participants had more than one child, and 16.33% declared they had other children who experienced the same problem (special needs children). This study indicated that the average health-related quality of life score in children with ASD was 57.41 (9.418). The finding of this study showed a significant mean difference in HRQoL scores in children with ASD who received high institutional and family support compared to those who had low (p = 0.028, 95% confidence interval [CI] = -11.071 to 0.664). Institutional support positively impacts children with ASD's quality of life. Therefore, it is essential to improve the adequacy of support felt by families while caring for children with ASD.

What are we missing? An alternative way to explore distributed leadership effectiveness

Existing research has revealed various beneficial teacher-level outcomes of distributed leadership (DL). Yet these studies lack important operational nuances. The DL effectiveness literature mainly stresses one dimension of DL study operations of how leadership is distributed (e.g., interaction), being grounded in the agency view. However, it is also important to consider other dimensions of what leadership work is distributed to whom. Therefore, our study adopted the study operation of one DL research stream derived from the structural view. Specifically, our research investigated which leadership function distribution patterns for teachers were connected to teacher-level outcomes, especially teachers’ current work environment satisfaction (SENV) and professional learning communities (PLCs). We employed Latent Class Analysis and U.S. lower secondary school teacher samples from the Teaching and Learning International Survey data. Two patterns emerged: the Dualistic Distribution and Fully Stretched-Over Distribution patterns. Importantly, the relationships between the two patterns and the teacher-level outcomes were varied. We discovered no mean difference in teacher SENV between the two patterns in contrast to the previous DL effectiveness research, but a significant mean difference in teachers’ PLCs. These findings suggest considering more operational nuances of what leadership work is distributed to teachers for what outcome to better explore DL effects on teachers.

Association of Dialysis Adequacy, Physical and Emotional Symptoms with Erythropoietin-stimulating agent Responsiveness in Iraqi Patients Undergoing Hemodialysis

Background: Erythropoietin (EPO)-deficient anemia occurs in patients with chronic kidney disease (CKD). Erythropoietin-stimulating agents (ESAs) are the standard treatment for CKD anemia, but patient responses vary. Hemodialysis patients are often anemic due to hypo erythropoiesis and their chronic inflammatory state. Inadequate dialysis is considered one of the factors that are linked to ESA hypo responsiveness. Dialysis patients may experience many symptoms that lower their quality of life. End stage renal disease (ESRD) symptoms are assessed using Dialysis Symptom Index (DSI). Objective: The current study was designed to measure the association between physical, and emotional symptoms and ESA responsiveness. Also, to determine how dialysis adequacy affects response level.Materials and Methods: The current study included 150 CKD anemic patients in a multicenter dialysis units. patients were examined for the response to Epoetin alfa (Eprex) after 12 weeks in this cross-sectional study. Clinical, demographic, and laboratory data were collected. The erythropoietin resistance index (ERI) evaluated the effect of erythropoietin dosage on hemoglobin levels. Dialysis adequacy (Kt/V) measured the efficacy of dialysis. The severity of symptoms was evaluated using the 30-question Dialysis Symptom Index (DSI). Results: 150 patients in all were enrolled, with a mean age of 51.6 ± 14.9 for the male patients. There was a significant difference in kt/v among study groups, mainly between hypo response and resistance groups (P-value < 0.01). However, there was no statistically significant difference in the DSI mean (P = 0.4). kt/v was positively correlated with the duration of dialysis and parathyroid hormone (PTH) (R = 0.27, P-value < 0.001), (R = 0.19, P-value = 0.01). additionally, The DSI was strongly connected with the age of the patients (R = 0.18, P-value = 0.02). Conclusion: One of the main causes of Eprex resistance in this study was insufficient dialysis. Patients who received longer hemodialysis sessions exhibited higher hemodialysis sufficiency. However, there was no significant association between DSI and degree of response across research groups, and older hemodialysis patients experienced higher dialysis-related symptoms.