Spearman Rank Coefficient Research Articles

Access to healthcare services during the COVID-19 pandemic: a cross-sectional analysis of income and user-access across 16 economically diverse countries

BackgroundNational health systems have different strengths and resilience levels. During the COVID-19 pandemic, resources often had to be reallocated and this impacted the availability of healthcare services in many countries. To date there have been few quantitative contemporary studies of inequalities in access to healthcare within and between countries.In this study, we aim to compare inequality within and between 16 economically diverse countries.MethodsOnline surveys were conducted on 22 150 adults in 16 countries across six continents in 2022. Quota sampling and post-stratification weighting was used to obtain an age, gender, geographically, and educationally representative sample. The study assesses the differences in challenges in access to healthcare during the pandemic (for GP, surgical/clinical and digital GP services) using country-specific expanded health-needs-adjusted Erreygers’ concentration indices and compares these values between countries using a Spearman’s rank correlation coefficient.ResultsResults show wide variation in income-related challenges in access within countries for different types of care. For example, Erreygers’ concentration index for digital services in Colombia exhibited highly regressive inequality at 0·17, compared to Japan with an index of -0·15. Inequalities between countries were also evident, with Spearman rank coefficients of -0·69 and -0·65 (p-values of 0·003 and 0·006) for digital and surgical access, indicating that lower income countries had greater inequality in healthcare access challenges.ConclusionDuring the pandemic, inequalities in challenges to accessing healthcare were greatest in low and middle-income countries. Digital technologies offer a reasonable means to address some of this inequality if adequate support is provided and accessible digital infrastructure exists.

Assessing Team Performance in a Longitudinal Neonatal Resuscitation Simulation Training Program: Comparing Validity Evidence to Select the Best Tool.

Introduction Neonatal resuscitation is a high-acuity, low-occurrence event that requires ongoing practice by interprofessional teams to maintain proficiency.Simulation provides an ideal platform for team training and evaluation of team performance. Our simulation center supports a longitudinal in situ simulation training program for delivery room teams. In addition to adherence to the Neonatal Resuscitation Program standards, team performance assessment is an essential component of program evaluation and participant feedback. Multiple published teamwork assessment tools exist. Our objective was to select the tool with the best validity evidence for our program's needs. Methods We used Messick's framework to assess the validity of evidence for potential teamwork assessment tools. Four possible tools were identified from the literature: the Mayo High Performance Teamwork Scale (Mayo), Team Performance Observation Tool (TPOT), Clinical Teamwork Scale (CTS), and Team Emergency Assessment Measure (TEAM). Relevant context included team versus individual focus, external evaluator versus self-evaluation, and ease of use (which included efficiency, clarity of interpretation, and overall assessment). Three simulation experts identified consensus anchors for each tool and independently reviewed and scored 10 pre-recorded neonatal resuscitation simulations. Raters assigned each tool a rating according to efficiency, ease of interpretation, and completeness of teamwork assessment. Interrater reliability (IRR) was calculated using intraclass correlation for each tool across the three raters. Average team performance scores for each tool were correlated with neonatal resuscitation adherence scores for each video using Spearman's rank coefficient. Results There was a range of IRR between the tools, with Mayo having the best (single 0.55 and multi 0.78). Each of the three raters ranked Mayo optimally in terms of efficiency (mean 4.66 + 0.577) and ease of use (4+1). However, TPOT and CTS scored highest (mean 4.66 ± 0.577) for overall completeness of teamwork assessment. There was no significant correlation to NRP adherence scores for any teamwork tool. Conclusion Of the four tools assessed, Mayo demonstrated moderate IRR and scored highest for its ease of use and efficiency, though not completeness of assessment. The remaining three tools had poor IRR, which is not an uncommon problem with teamwork assessment tools. Our process emphasizes the fact that assessment tool validity is contextual. Factors such as a relatively narrow (and high) performance distribution and clinical context may have contributed to reliability challenges for tools that offered a more complete teamwork assessment.

The Departmental Scholarly Index: A Metric of Research Productivity.

While bibliometric ranking systems have been designed to use citations, funding, and alumni productivity, there is a need for a simple metric that objectively evaluates the work of a group or organization. The present study describes a bibliometric tool, the Departmental Scholarly Index (DSI), for this purpose. Publications from academic plastic surgery programs in qualifying states of the Southeastern Society of Plastic and Reconstructive Surgeons released in 2022 were collected via PubMed affiliation search. Publications were recorded in a running list alongside the title and 2022 impact factor of their respective journals. The impact factors were averaged by summing the impact factors and dividing by the number of articles to obtain a raw average. Any publication in a journal with an impact factor greater than five multiples of the raw average was removed as an outlier. The remaining impact factors were then summed and give the final numerical value representing the DSI. A total of 464 articles published in 139 individual journals were returned from PubMed between January 1, 2022, and December 31, 2022, for the 22 constituent departments. Calculated Spearman's rank coefficients comparing the DSI ranking with both the Doximity and Persad-Paisley rankings yielded values of 0.66 (P < 0.01) and 0.62 (P < 0.01), respectively. Overall, the DSI rankings largely agree with either the Persad-Paisley or Doximity rankings with notable differences seen in the rankings of Mayo Florida and the University of Alabama. A clear academic ranking of Southeastern Society of Plastic and Reconstructive Surgeons programs was generated from these data. The DSI represents a novel and simple approach to applying objective value to research with the advantage of using data bound to the most recent publication productivity.

MRI-based assessment of the mylohyoid muscle in oral squamous cell carcinoma, a 7-point scoring method.

To investigate preoperative MRI evaluation of the features of the mylohyoid muscle (MM) predictive of its infiltration in oral squamous cell carcinoma (OSCC) treatment planning, defining the most appropriate sequences to study its deep extension into the floor of the mouth (FOM). We applied a 7-point score to retrospectively evaluate preoperative imaging of patients who underwent surgery for OSCC over 11 years. The results were compared with histopathological findings using Spearman's rank coefficient. Receiver operating characteristic curves were employed to assess the score's ability to predict MM infiltration, determining optimal thresholds for sensitivity, specificity, and predictive values. The Mann-Whitney U-test confirmed that infiltration judgments did not overlap around this threshold. Cohen's K statistical coefficient was used to evaluate the interobserver agreement. Fifty-two patients (mean age 66.4 ± 11.9 years, 36 men) were evaluated. Histopathological examination found MM infiltration in 21% of cases (n = 11), with 90% classified in the highest Score categories. A score > 4 proved to be the best cut-off for predicting the risk of MM infiltration, with a sensitivity of 91% (CI: 0.57-0.99), specificity 61% (CI: 0.45-0.76), PPV 38% (CI: 0.21-0.59), and NPV 96% (CI: 0.78-0.99). At the subsequent single-sequence assessment, the TSE-T2wi had the highest diagnostic accuracy, with sensitivity 90% (CI: 0.57-0.99), specificity 70% (CI: 0.53-0.82), PPV 45% (CI: 0.25-0.67), and NPV 96% (CI: 0.80-0.99). The 7-point score is a promising predictor of safe surgical margins for MM in OSCC treatment, with the particular benefit of T2-weighted sequences. Our scoring system for tumor infiltration of MM, which is easy to use even for less experienced radiologists, allows for uniformity in radiological language, thereby ensuring crucial preoperative information for the surgeon. The relationship of the MM to an oral lesion may impact surgical planning. As the score increases, there is a greater incidence of infiltration in the MM. Our score system improves radiologists' reporting for MM involvement by tumor.

Experimental study on the influence of the riser on the gas-liquid flow in the horizontal pipeline of the offshore pipeline-riser system

The study of gas-liquid interface evolution and pressure fluctuation mechanism in the pipeline-riser system is the key to ensuring the safety of oil and gas transportation. This paper investigates the influence of the riser on the gas-liquid interface in the system with a 1657 m pipeline and risers of 16 m, 22 m, and 29 m. In severe slugging, the differential pressure in the horizontal pipeline exhibits a low-frequency large-amplitude fluctuation consistent with those in the riser. During the gas blowdown of the riser, the pressure fluctuation breaks the force equilibrium of the gas-liquid interface and induces numerous liquid slugs in the horizontal pipeline. A strong correlation is found between the differential pressure in the riser and the slug velocity in the horizontal pipeline by the Spearman Rank coefficient. The correlations between the slug velocity and the gas volume fraction and the void fraction under different riser heights are established, and the errors are 15% and 10%, respectively. The linear relationship between the Strouhal number of liquid slugs and the Lockhart-Martinelli parameter is constructed during the gas blowdown.

Prostate magnetic resonance imaging utilization and its relationship with advanced prostate cancer detection

BackgroundThe rise in advanced prostate cancer has coincided with increased use of Magnetic Resonance Imaging (MRI), leading to the hypothesis that this increase in surveillance registries is an artifact of more sensitive imaging tools. We assessed the association between regional variation in prostate MRI and advanced prostate cancer diagnoses. MethodsWe utilized SEER-Medicare data (2004–2015), including men > 65 diagnosed with localized prostate cancer. The predictor variable was the utilization of prostate MRI in each hospital referral region (HRR, representing regional healthcare markets). We compared the proportion of disease recorded as locally advanced or of regional risk group (cT3, cT4, and cN1) which would plausibly have been detected by prostate MRI. We conducted adjusted multivariable analysis and performed correlation analysis with Spearman rank coefficient at the level of the HRR. Sensitivity analysis for years 2011 to 2015 was conducted. ResultsOf 98,921 men diagnosed, 4.01% had locally advanced or regional disease. The median prostate MRI utilization rate was 4.58% (IQR [3.03%, 8.12%]). Adjusted multivariable analysis revealed no statistically significant correlation between MRI utilization and proportion of advanced prostate cancer (aOR = 1.01, 95% CI, [0.99,1.03]) in each region. The correlation between MRI usage and advanced diagnosis was not significant (Spearman Ρ = 0.09, P = 0.4). Sensitivity analysis conducted between 2011 and 2015 showed similar results (aOR = 1.008, 95% CI, [0.989, 1.027]; Spearman Ρ = 0.16, P = 0.1). ConclusionsDuring our study period, HRR-level utilization of MRI was not associated with higher incidences of advanced prostate cancer. This suggests the rising advanced prostate cancer diagnoses observed in this period are unlikely an artifact of greater sensitivity of modern imaging tests, but potentially due to other factors such as changes in screening or risk factors. With increased utilization and evolving techniques in recent years, the association between MRI and advanced prostate cancer detection warrants continued monitoring.

A transfer learning-based ensemble learning model for electric vehicles lithium-ion battery capacity estimation using electrochemical impedance spectroscopy

Lithium-ion battery capacity estimation is crucial to ensure the operational reliability and safety of electric vehicles. Electrochemical Impedance Spectroscopy (EIS) can provide rich physical degradation information of the battery, which makes the EIS-based data-driven method a promising solution for accurate battery capacity estimation. However, batteries tend to present diverse degradation patterns due to the diverse operating conditions and manufacturing, resulting in large capacity estimation errors in practical applications. Therefore, this paper proposes a transfer learning (TL) based ensemble learning (EL) method based on multi-layer perception for the battery capacity estimation. First, the influential impedance features are identified from the EIS using Spearman rank coefficient analysis. Second, three TL models are developed based on distinct TL strategies to enable sufficient knowledge transfer considering the different degradation pattern. Further, an EL method with Gaussian kernel-based weighted assignment technique is proposed to integrate the developed TL models and improve the estimation robustness. The performance of the developed model has been successfully validated only using the first 1/3 cycles of the historical data from target battery obtained under different operating conditions and batteries. The results reveal that the proposed method can largely suppress estimation errors, presenting more accurate capacity estimation compared to other methods with an RMSE lower than 1%.

Potential drug-drug interactions analysis in Polish pediatric pneumonology units, including cystic fibrosis patients.

The lack of data on drug-drug interactions in pediatrics represents a relevant problem in making appropriate therapeutic decisions. Our study aimed to investigate the incidence and risk factors for potential drug-drug interactions (pDDIs) in pediatric pneumonology units, including cystic fibrosis patients. We performed a 6-month prospective observational study during which clinical pharmacists, using the Lexicomp Drug Interactions checker, screened medical records to identify pDDIs. Spearman's rank coefficient, logistic regression, and the Mann-Whitney U test were used to identify correlations, analyze risk factors for pDDIs, and compare cystic fibrosis patients with the rest, respectively. Recommendations were provided for the D and X pDDIs categories. Within the 218 patients, 428 pDDIs were identified, out of which 237 were classified as clinically significant. Almost 60% of patients were exposed to at least one relevant interaction. The number of pDDIs correlated with the number of; drugs (rs = 0.53, P < .001), hospitalization length (rs = 0.20, P < .01), and off-label medicines (rs = 0.25, P < .001). According to the multivariate analysis, at least 6 administered medications (OR = 4.15; 95% CI = 2.21-7.78), 4 days of hospitalization (OR = 6.41; 95% CI = 2.29-17.97), and off-label therapy (OR = 3.37; 95% CI = 1.69-6.70) were the risk factor for pDDIs. Despite significant differences in the number of medications taken, comorbidities, and off-label drugs, cystic fibrosis patients were not more exposed to pDDI. Given the lack of data on pDDIs in the pediatric population, the need for close cooperation between clinicians and clinical pharmacists to improve the safety and efficacy of pharmacotherapy is highlighted.

Coastal ecological security assessment in Laizhou Bay, China: from the perspective of demographic-social-economic-natural complex ecosystem.

Assessment of ecological security is essential for understanding the status of bay ecosystem and developing appropriate management strategy. Based on the driving force-pressure-state-impact-response (DPSIR) model, the demographic, economic, social, and ecological data of Laizhou Bay and its three neighboring counties were selected for the period from 2015 to 2021. An ecological security evaluation index system of Laizhou Bay containing 26 indicators was established, and the weights of each indicator were determined by the methods of AHP and EWM, and a comprehensive evaluation of the ecological security of Laizhou Bay was carried out by ESI. Correlations between indicators were analyzed by the Spearman's rank coefficient of correlation. The results showed that there were significant correlations between marine conditions and indicators such as population size in the surrounding area, mariculture area, industrial and domestic wastewater discharge, and treatment rate. Overall, from 2015 to 2021, the ecological security of Laizhou Bay showed a favorable trend, from a relatively unsafe level to a generally safe level, and then to a relatively safe level. Through the comprehensive evaluation of the ecological security of Laizhou Bay, we can recognize the utilization of marine resources and ecological carrying capacity, guide the rational development and utilization of marine resources, and promote the sustainable development of the marine economy.

Correlation Analysis of the Terrorist Attacks and Social Attributes in The Gulf States

Terrorist attacks are a significant threat to global security as they can cause a large number of deaths, economic losses, and trigger public panic. This paper focuses on the Gulf states as the survey region. This study comprehensively investigates the correlation between national-scale terrorist attacks and various potential factors in the social, political, economic, and military fields, based on the Spearman rank coefficient and gray correlation analysis. The potential factors are divided into two categories: those with a positive correlation and those with a negative correlation to terrorist attacks. The study shows a strong correlation between the adolescent fertility rate (births per 1,000 women aged 15-19) and the occurrence of terrorist attacks. This correlation has not been previously noted in relevant studies, indicating a need for greater attention to be paid to the impact of terrorist attacks on the human rights of children and adolescents.

Comparison and Agreement between Cardiovascular Computed Tomography-Derived Mid-Diastolic and End-Diastolic Ventricular Volume in Patients with Congenital Heart Disease.

Prospective electrocardiogram (ECG)-triggered cardiovascular computed tomography (CCT) is primarily utilized for anatomical information in congenital heart disease (CHD) and has not been utilized for calculation of the end-diastolic volume (EDV); however, the mid-diastolic volume (MDV) may be measured. The objective of this study was to evaluate the feasibility and agreement between ventricular EDV and MDV. 31 retrospectively ECG-gated CCT were analyzed for the study of the 450 consecutive CCT. CCT images were processed using syngo.via with automatic contouring followed by manual adjustment of the endocardial borders of the left ventricles (LV) and right ventricles (RV) at end-diastolic and mid-diastolic phase (measured at 70% of cardiac cycle). The correlation and agreements between EDV and MDV were demonstrated using Spearman rank coefficient and intraclass correlation coefficient (ICC), respectively. Mean age ± SD was 28.8 ± 12.5 years, 19 were male (61.3%) and tetralogy of Fallot (TOF) was the most common diagnosis (58.1%), 35% (11/31) patients with a pacemaker, ICD or other such contraindication for a CMRI, 23% (7/31) with claustrophobia, and 6.5% (2/31) with developmental delay with refusal for sedation did not have a previous CMRI. The mean ± SD indexed LV EDV and LV MDV were 91.1 ± 24.5 and 84.8 ± 22.3 ml/m2, respectively. The mean ± SD indexed RV EDV and RV MDV were 136.8 ± 41 and 130.2 ± 41.5 ml/m2, respectively. EDV and MDV had a strong positive correlation and good agreement (ICC 0.92 for LV and 0.95 for RV). This agreement was preserved in a subset of patients (21) with dilated RV (indexed RV EDV z-score > 2). Intra-observer reliability (0.97 and 0.98 for LV and RV MDV, respectively) and inter-observer reliability (0.96 and 0.90 for LV and RV MDV, respectively) were excellent. In a select group of patients with CHD, measuring MDV by CCT is feasible and these values have good agreements with EDV. This may be used to derive functional data from prospectively ECG-triggered CCT studies. Further large-scale analysis is needed to determine accuracy and clinical correlation.

Linking Vascular Structure and Function: Image-Based Virtual Populations of the Retina.

This study explored the relationship among microvascular parameters as delineated by optical coherence tomography angiography (OCTA) and retinal perfusion. Here, we introduce a versatile framework to examine the interplay between the retinal vascular structure and function by generating virtual vasculatures from central retinal vessels to macular capillaries. Also, we have developed a hemodynamics model that evaluates the associations between vascular morphology and retinal perfusion. The generation of the vasculature is based on the distribution of four clinical parameters pertaining to the dimension and blood pressure of the central retinal vessels, constructive constrained optimization, and Voronoi diagrams. Arterial and venous trees are generated in the temporal retina and connected through three layers of capillaries at different depths in the macula. The correlations between total retinal blood flow and macular flow fraction and vascular morphology are derived as Spearman rank coefficients, and uncertainty from input parameters is quantified. A virtual cohort of 200 healthy vasculatures was generated. Means and standard deviations for retinal blood flow and macular flow fraction were 20.80 ± 7.86 µL/min and 15.04% ± 5.42%, respectively. Retinal blood flow was correlated with vessel area density, vessel diameter index, fractal dimension, and vessel caliber index. The macular flow fraction was not correlated with any morphological metrics. The proposed framework is able to reproduce vascular networks in the macula that are morphologically and functionally similar to real vasculature. The framework provides quantitative insights into how macular perfusion can be affected by changes in vascular morphology delineated on OCTA.

Conducting an in situ evaluation of erodibility in a Mediterranean semi-arid and conventional vineyard in Granada province (Southern Spain) through rainfall simulation experiments

AbstractVineyards in Europe has been fundamental for food, drink and cosmetic production, and job creation; however, in recent decades due to increased cultivation intensity, numerous negative consequences, including erosion, have been observed. Erodibility or susceptibility to erosion is a little-studied parameter in vineyards but is crucial for analyzing the vulnerability of this crop. Therefore, in this research, a small portable rainfall simulator was used as a useful tool for assessing erodibility, combined with other methods such as soil analyses or infiltration measurements in a semi-arid vineyard located in the Granada province (Spain) considering 20 different hotspots at diverse hillslope positions along the inter-rows and close to the traffic roads. The experiments were conducted in spring 2022 under dry soil conditions. Our results display susceptibility to erosion, particularly on steeper parts such as the shoulder and backslopes. In these areas, runoff gained momentum, carrying a significant sediment load, diminishing the effectiveness of stone cover, and occasionally leading to its removal, especially near the roads. Nevertheless, it is observed that increased roughness plays a mitigating role by slowing down runoff. Using linear correlation analysis and Spearman rank coefficient, we observed this effect is linked to factors such as stoniness, vegetation, and moderate tillage. Conversely, in the flatter zones, primarily in lower areas, reduced runoff and delayed onset are primarily influenced by factors such as roughness, type of cover, material composition, and organic matter content. We concluded that this study case can demonstrate that erodibility in vineyards can shed light as an extra parameter to inform farmers, rural inhabitants, and policymakers about the extreme problem of the vulnerable soils of vineyards.

Development of a Composite Score for the Clinical Assessment of Anti-IgLON5 Disease.

To develop a composite score to assess the severity of the multiple symptoms present in anti-IgLON5 disease. The anti-IgLON5 disease composite score (ICS) was designed to evaluate 17 symptoms divided into 5 clinical domains (bulbar, sleep, movement disorders, cognition, and others). Each symptom was scored from 0 (absent/normal) to 3 or 6 (severe) depending on the contribution of the symptom to neurologic disability with a maximum ICS of 69. The ICS was tested in patients from 2 cohorts (Barcelona, Spain, and GENERATE, Germany) that included cases personally seen by the authors (internal) and patients whose ICS was obtained from information of questionnaires completed by the referring neurologists (external). Test-retest and interrater reliabilities of the ICS were assessed by the intraclass coefficient (ICC) and the correlation between the ICS and modified Rankin scale (mRS) with the nonparametric Spearman rank coefficient. The Wilcoxon signed rank test was used to compare the ICS at diagnosis of anti-IgLON5 disease and follow-up in a subset of patients with available clinical information. A total of 86 patients (46 from Barcelona cohort; 40 from GENERATE cohort) were included. The median ICS was 15 (range 2-31). The ICS was higher in the Barcelona cohort than in the German cohort (18 vs 12, p < 0.001), due to higher partial scores in sleep and movement disorder domains. There were no significant differences in the ICS between internal and external patients (15 vs 14, p = 0.96). The ICS correlated with the mRS score (r = 0.429, p < 0.001). Test-retest and interrater reliabilities were excellent with an ICC of 0.997 (95% CI 0.992-0.999) and 0.973 (95% CI 0.925-0.990), respectively. ICS was retested during follow-up in 27 patients, and it was similar to that at diagnosis in 10 clinically stable patients (median ICS at diagnosis 11.5 vs 11.5 at follow-up; p = 1), higher in 8 patients who worsened (12.5 vs 18; p = 0.012), and lower in 9 patients who improved after immunotherapy (14 vs 10; p = 0.007). The ICS is a valid method to assess the extension and severity of the different clinical manifestations of anti-IgLON5 disease.

Blood RNA biomarkers for tuberculosis screening in people living with HIV before antiretroviral therapy initiation: a diagnostic accuracy study

Undiagnosed tuberculosis remains a major threat for people living with HIV. Multiple blood transcriptomic biomarkers have shown promise for tuberculosis diagnosis. We sought to evaluate their diagnostic accuracy and clinical utility for systematic pre-antiretroviral therapy (ART) tuberculosis screening. We enrolled consecutive adults (age ≥18 years) referred to start ART at a community health centre in Cape Town, South Africa, irrespective of symptoms. Sputa were obtained (using induction if required) for two liquid cultures. Whole-blood RNA samples underwent transcriptional profiling using a custom Nanostring gene panel. We measured the diagnostic accuracy of seven candidate RNA signatures (one single gene biomarker [BATF2] and six multigene biomarkers) for the reference standard of Mycobacterium tuberculosis culture status, using area under the receiver-operating characteristic curve (AUROC) analysis, and sensitivity and specificity at prespecified thresholds (two standard scores above the mean of healthy controls; Z2). Clinical utility was assessed by calculating net benefit in decision curve analysis. We compared performance with C-reactive protein (CRP; threshold ≥5 mg/L), WHO four-symptom screen (W4SS), and the WHO target product profile for tuberculosis triage tests. A total of 707 people living with HIV (407 [58%] female and 300 [42%] male) were included, with median CD4 count 306 cells per mm3 (IQR 184-486). Of 676 participants with available sputum culture results, 89 (13%) had culture-confirmed tuberculosis. The seven RNA signatures were moderately to highly correlated (Spearman rank coefficients 0·42-0·93) and discriminated tuberculosis culture positivity with similar AUROCs (0·73-0·80), but none statistically better than CRP (AUROC 0·78, 95% CI 0·72-0·83). Diagnostic accuracy was similar across CD4 count strata, but lower among participants with negative W4SS (AUROCs 0·56-0·65) compared with positive (AUROCs 0·75-0·84). The RNA biomarker with the highest AUROC point estimate was a four-gene signature (Suliman4; AUROC 0·80, 95% CI 0·75-0·86), with sensitivity 83% (95% CI 74-90) and specificity 59% (55-63) at the Z2 threshold. In decision curve analysis, Suliman4 and CRP had similar clinical utility to guide confirmatory tuberculosis testing, but both had higher net benefit than W4SS. In exploratory analyses, an approach combining CRP (≥5 mg/L) and Suliman4 (≥Z2) had sensitivity of 80% (70-87), specificity of 70% (66-74), and higher net benefit than either biomarker alone. RNA biomarkers showed better clinical utility to guide confirmatory tuberculosis testing for people living with HIV before ART initiation than symptom-based screening, but their performance did not exceed that of CRP and fell short of WHO recommended targets. Interferon-independent approaches might be required to improve accuracy of host-response biomarkers to support tuberculosis screening before ART initiation. South African Medical Research Council, European and Developing Countries Clinical Trials Partnership 2, National Institutes of Health National Institute of Allergy and Infectious Diseases, The Wellcome Trust, National Institute for Health and Care Research, Royal College of Physicians London.

358 Quantifying Cognitive and Affective Dysfunction in Chiari Malformation Type I Patients With the Cerebellar Cognitive Affective Syndrome Scale and the Cerebellar Neuropsychiatric Rating Scale

INTRODUCTION: Cognitive and affective dysfunction in Chiari Malformation Type I (CM1) patients are well-documented, but often rely on extensive neuropsychological tests. METHODS: Symptomatic CM1 patients considering surgical decompression were assessed by a board-certified neuropsychologist using the 105-point CNRS (N = 87) and the 10-task CCAS (N = 23), as well as a full neuropsychological battery (N = 24: Wechsler Full Scale IQ, Digit Span, Coding; WRAML Finger Windows; DKEFS Trail Making; verbal list learning; Grooved Pegboard). Descriptive and correlative measures were computed. RESULTS: The study included 66 adults and 21 children. A neuropsychological battery revealed impairment in 29% of patients on 1 test, 12.8% on 2 tests, and 20.8% on 3 or more tests. The CCAS indicated 26% with "possible CCAS" (1 task), 27% with "probable CCAS" (2 tasks), and 18% with "definite CCAS" (3 or more tasks). The median CNRS composite score was 31.0 (IQR: 18.5, 49.0), with positive and negative symptom sub-scores of 18.0 (10.0, 26.5) and 14.0 (7.5, 23.5), respectively. Moderate correlation with the neuropsychological battery was found between impairment detected by CCAS (Spearman rank coefficient ρ = 0.67, p = 0.002) and CNRS (ρ = 0.56, p = 0.003). CONCLUSIONS: A high prevalence of cognitive and affective impairments in pre-operative CM1 patients was observed by all three testing batteries. In this first report of CNRS and CCAS usage in CM1 patients, increased CNRS and CCAS impairment correlated with impairment on standard neuropsychological testing. These tools show promise for future studies CM1, providing a more concise alternative to traditional testing for cognitive and affective dysfunction.

The influence of chronotype on temporal patterns of eating and diet composition in shift and non-shift workers

When and what you eat can be linked to circadian preference (i.e., chronotype) and occupation (e.g., shift worker). Evening chronotypes, with a later circadian preference, tend to have meals later, distribute energy intake toward the end of the day(1), and more unhealthy eating habits than morning chronotypes(2); whereas night shift work is associated with later mealtimes and poor diet quality as a result of circadian disruption due to their work(3). What is unclear is whether chronotype influences the occupation-induced dietary patterns observed in shift workers. This study aimed to investigate associations between chronotype, temporal patterns of eating and diet composition in shift and non-shift workers. Adults from shift (SW) and non-shift (N-SW) populations were recruited. A Chrononutrition Questionnaire captured chronotype, duration of eating window (DEW), time of first eating occasion (FEO) and last eating occasion (LEO) while diet composition (energy, protein, total fat, saturated fat, carbohydrate, fibre, alcohol) was extracted from 7-day food diaries. Associations between chronotype and DEW/FEO/LEO, and between DEW/FEO/LEO and diet composition were determined by Spearman Rank Coefficients. 95 participants were enrolled (N-SW: n = 39; SW: n = 56); predominantly female (71%), morning chronotype (37%), on average 40.46 ± 15.08 years with BMI of 27.04 ± 5.77kg/m2. 84 returned food diaries. Later chronotype was positively associated with later times of FEO (N-SW: r = ,50, SW: r = ,69) and LEO (N-SW: r = ,63, SW: r = ,54) on free (non-work) days (p≤.002), and longer DEW (r = ,42) and later LEO (r = ,60) on workdays for non-shift workers (p&lt;.01). However, there were no significant differences in diet composition by day/shift type between chronotypes across the study population. On afternoon shifts, longer DEW was associated with greater energy (r = ,60) and total fat intake (r = ,60) and later LEO with greater alcohol intake (r = ,59) (p&lt;.05). On night shifts, a longer DEW was associated with lower alcohol intake (r=-.45, p&lt;.05). Amongst non-shift workers, later FEO was associated with lower fibre intake on workdays (r=-.58, p&lt;.001). Additionally, non-shift workers who were later chronotypes had later LEO, which on workdays associated with lower fibre (r=-.45) and alcohol intake (r=-.43); and on work-free days, associated with lower alcohol intake (r=-.45) (p&lt;.05). Not surprisingly, evening chronotypes across the study population had longer and/or later eating windows on work-free days (i.e., free of constraints), as did non-shift workers on workdays, while the influence of chronotype on DEW, FEO, and LEO across shifts were less clear. Hence, for shift workers, occupation appeared to be a greater driver of temporal eating patterns than chronotype. Additionally, later eating times of evening chronotypes was not associated with negative diet composition. The exception was lower fibre intake amongst non-shift workers; but regardless of chronotype, shift workers may benefit from having a shorter and earlier DEW on afternoon shifts to minimise energy, fat, and alcohol intake.

Peri-implant Tissue Health and Bone Resorption in Implant- Supported Fixed Partial Rehabilitations.

To evaluate peri-implant tissue health and bone resorption in patients with implant-supported fixed partial rehabilitations. In particular, possible correlations between plaque accumulation and bone loss, as well as other periimplant health parameters, were investigated. A total of 44 patients rehabilitated with fixed implant-supported partial rehabilitations were included. The following parameters were recorded: spontaneous bleeding (SB), suppuration, bleeding on probing (BOP), plaque index (PI), and probing depth (PD). Periapical radiographs were taken to measure crestal bone loss (BL). A nonparametric test (Spearman rank coefficient; rs) was used to identify possible correlations between the clinical parameters recorded. A total of 121 implants were analyzed. Global PI and BOP were 49.58% and 20.25%, respectively. There were no cases of suppuration, and only 2 implants showed spontaneous bleeding. Mean BL was 1.53 mm (SD: 0.98). No implants showed peri-implantitis. There was a weak, statistically significant correlation between PI and BL (rs = 0.27, P [2-tailed] = .99) and between PI and the other peri-implant parameters (BOP: rs = 0.14, P = .14; PD: rs = 0.04, P = .65; SB: rs = -0.08, P = .34). A very weak correlation was also found between BL and BOP (rs = 0.1, P = .2) and between BL and PD (rs = 0.02, P = .7). Correlation was found between BL and age (rs = 0.13, P = .81) and between the other peri-implant parameters and age using dichotomization (> or < 65 years; PI: rs = -0.14, P = .11; PD: rs = -0.21, P = .01; BOP: rs = -0.21, P = .01; SB: rs = 0.05, P = .53). No statistically significant correlations were found between the clinical parameters evaluated and the sex or the dental arch treated (maxilla vs mandible). In contrast, the correlation between periodontal parameters and years elapsed since surgery (follow-up) was significant. The present research suggests that in implant-supported fixed partial rehabilitations, dental implants with greater plaque accumulation are more likely to present augmented probing depth, peri-implant inflammation, and bone loss, although the correlation is statistically very weak. Patient age and time of follow-up also significantly affected peri-implant health parameters.

The Quantification of Radiation Fibrosis Using Clinically Indicated Magnetic Resonance Imaging for Head and Neck Cancer Patients.

Currently, no objective method exists to measure the extent of fibrosis in swallowing musculature in head and neck cancer (HNC) patients. We developed and psychometrically tested a method of quantifying fibrosis volume using magnetic resonance imaging (MRI).The overall aim of this study was to determine if clinical MRI is a reliable tool to measure fibrosis of the pharyngeal musculature in patients with HNC managed with RT and to assess its potential to capture changes in fibrosis over time. Eligible participants were adults with HNC treated with radiation therapy (RT) who received minimally two MRIs and videofluoroscopic swallow (VFS) studies from baseline (pre-RT) up to 1-year post-RT. Two neuroradiologists independently contoured fibrosis volume in batches from MRIs using Vitrea™. Sufficient inter-rater reliability was set at Intraclass Correlation Coefficient (ICC) > 0.75. Two speech-language pathologists independently rated VFSs for swallowing impairment using standardized scales, with discrepancies resolved by consensus. MRI and VFS scores were correlated using Spearman's rank coefficient. Participants included 42 adults (male = 33); mean age 59 (SD = 8.8). ICC (95% Confidence Interval) for fibrosis volume was 0.34 (0, 0.76) for batch one and 0.43 (0, 0.82) for batch two. Consensus meetings were held after each batch. Sufficient reliability was reached by batch three (ICC = 0.95 (0.79, 0.99)). Fibrosis volume increased significantly from 3 to 12 months (mean change = 1.28mL (SD = 5.21), p = 0.006), as did pharyngeal impairment from baseline to 12 months (mean score change = 3.05 (SD = 3.02), p = 0.003). Fibrosis volume moderately correlated with pharyngeal impairment at 3 and 12 months (0.49, p = 0.004 and 0.59, p = 0.005, respectively). We demonstrated a reliable measure of fibrosis volume in swallowing musculature from existing clinical MRIs and identified that larger fibrosis volume was associated with worse swallowing function. The reliable capture of fibrosis volume offers a pragmatic method for early detection of fibrosis and concomitant dysphagia.

Impact of Atopic Dermatitis on Quality of Life of Caregivers: A Systematic Review and Meta-Analysis.

Abstracts: Background: Atopic dermatitis (AD) is a chronic dermatological condition that affects both patients and their caregivers. Aims: To summarize evidence on the impact of AD on the quality of life (QoL) of caregiver. Methods: Observational studies were searched for in Medline, Embase, Cochrane Library, SCOPUS, and CINAHL databases up till March 1, 2023. Results: Seventy studies with a total of 33,291 study participants were identified. The Dermatitis Family Index (DFI) questionnaire featured in 29 studies and was chosen for further meta-analysis. The pooled DFI for all studies was 9.35 (95% confidence interval [CI] 6.94-11.76). For individual components, the highest component scores were for 1.24 for expenditure (95% CI 0.80-1.69), followed by 1.14 for emotions (95% CI 0.77-1.50), as well as sleep 1.12 (95% CI 0.71-1.54) and exhaustion 1.12 (95% CI 0.76-1.48). Meta-analysis on the effect of patient QoL on family QoL was conducted on 15 studies, with a pooled Spearman's rank coefficient using Infants' Dermatitis Quality of Life Index (IDQoL) was 0.632 (95% CI 0.558-0.707), whereas that using Children's Dermatology Life Quality Index (CDLQI) was 0.624 (95% CI 0.507-0.741). For the 17 studies correlating AD severity with family QoL, a pooled Spearman's rank coefficient of 0.425 (95% CI 0.330-0.521) was obtained. Conclusions: AD is associated with significant negative impacts on caregiver QoL, particularly in family finance, caregiver burnout, and sleep impairment. This was consistently affected by AD severity and patient QoL in all studies examining this association.