Statistical Significance P-value Research Articles

Survival status and its predictors among adult victims of road traffic accident admitted to public hospitals of Bahir Bar City, Amhara regional state, Northwest, Ethiopia, 2023: multi center retrospective follow-up study

IntroductionRoad traffic accident is the most common cause of death in adults worldwide. Road traffic accident-related deaths increased from time to time in low- and middle-income countries including Ethiopia; however, there is limited evidence about Survival status and its predictors among adult victims of road traffic accidents admitted to Hospitals in Ethiopia specifically in the study area. Thus, this study aimed to assess Survival status and its predictors among adult victims of road traffic accident admitted to Hospitals.MethodsAn institutional-based retrospective follow-up study was conducted from July 01/2019 to June 30/2022. A total of 402 samples were chosen using simple random sampling. Data was collected by a prepared checklist from the victims’ chart and entered into Epi-Data version 4.6 software and then exported to STATA version 14.1 for analysis. Kaplan-Meier failure function and log-rank test were computed. The assumption was checked by Schoenfeld residual test. All variables in bivariable analysis, p-value < 0.25 were entered into multivariable cox-regression model. Adjusted Hazard Ratio with 95% Confidence Interval was reported to declare the strength of association and statistical significance p-value of < 0.05. Model fitness was checked by using Cox-Snell residual. Data was presented by text, table, and graph.ResultThe median survival time was 504 h. From all, 63(15.6%) deaths, 57% of deaths occurred between 24 and 168 h of follow-up with an overall incidence of 15.34deaths per10, 000 victims-hours observation. According to the Kaplan-Meier failure curve together with the log-rank test, the incidence density rate of death among victims who had a complication during admission was71.86per10,000victims-hour observation (95%, CI:53.66–96.25), which is different from those who did not have complication 5.17per10,000person-hour observation (95%, CI:3.26–8.21). The incidence density rate of death among victims who had low level of arterial oxygen saturation (SPO2 < 95%) during admission was 82.87per10, 000 victims-hour observation (95%, CI: 63.15-108.75), which is different from those who had arterial oxygen saturation ≥ 95% 3.16per10, 000victims -hour observation (95%, CI: 1.75–5.71) Develop complication (AHR = 3.1,95% CI:1.44–6.70), systolic blood pressure measurement value ≤ 89 mmHg (AHR = 2.4,95% CI:1.10–5.19), not admitted intensive care unit (AHR = 0.46,95% CI:0.022–0.97), Glasgow Coma Scale score ≤ 8 (AHR = 2.9,95% CI:1.07–7.75), Glasgow Coma Scale score 9–12(AHR = 3.8,95% CI:1.61–8.97) and, level of arterial oxygen saturation ≤ 95% (AHR = 6.5,95% CI:2.38–17.64) were predictors of outcome variable.Conclusion and recommendationsThe median survival time was short. Complication, low systolic blood pressure measurement value, low Glasgow Coma Scale score, not admit to intensive care unit and low level of arterial oxygen saturation were significant predictors of the outcome variable. So that healthcare providers better give special attention and care to those victims admitted to Hospitals. A further prospective study is recommended.

Prevalence of onychomycosis among psoriasis patients: a clinico-mycological and dermoscopic comparative cross sectional study

Onychomycosis, a nail infection caused by dermatophytes, yeast, and molds makes up roughly half of all onychopathies and is the most prevalent nail condition in the world. Clinically, nail psoriasis and onychomycosis can frequently be difficult to distinguish from one another. To assess the prevalence of onychomycosis in patients with psoriasis. Fifty patients with psoriasis associated with nail disease were included in this study. After taking clinical history, nail samples were gathered for dermoscopic inspection, culture, direct microscopy with 20% KOH solution, and nail clipping with PAS stain. Of the 50 patients recruited, 43 were males and 7 were females, with mean age 6–71 years (mean ± SD 44.06 ± 16.2). Eleven patients (22%) tested positive for onychomycosis. Dermatophytes were isolated from 2% of patients, yeast from 14% of patients, and non-dermatophytic mold from 38% of patients. Histopathological results revealed fungal hyphae and spores in 18% of patients. The most prevalent dermoscopic sign in psoriatic patients with onychomycosis was spikes (81.8%) with statistical significance (P-value < 0.001), while nail pitting was the most prevalent dermoscopic feature in nail psoriasis. This study lays the way for an accurate diagnosis of nail lesions by highlighting the significance of cooperation between mycology, histology, and dermoscopy in the diagnosis of onychomycosis in patients with nail psoriasis.

Components and Indicators of Innovators Among Primary School Teachers

The objectives of this study were: 1) to study the components and indicators of innovators in primary school teachers, and 2) to examine the consistency of the components model and indicators of innovators in primary school teachers with empirical data. The participants were 220 primary teachers under the Office of the Basic Education Commission in the Northeastern Region. The researcher determined the sample size based on a 20:1 ratio of the number of parameters and used a multi-stage random sampling. The research instrument was a questionnaire for developing elements and indicators of innovator in primary school teachers. The Item-Objective Congruence (IOC) index ranges from 0.80 to 1.00, the discriminatory power using Pearson Product-Moment Correlation ranges from 0.24 to 0.83, and the reliability of the entire instrument, as measured by Cronbach&amp;rsquo;s alpha coefficient (&amp;alpha;), is 0.97. Data were analyzed using confirmatory factor analysis (CFA). The results revealed the following: 1) the elements and indicators of innovators in primary school teachers were identified through a synthesis of relevant documents and research, consisting of (1) initiative, (2) observation and asking questions, (3) interaction with others, (4) applying, and (5) adapting to the situation, with a total of 11 indicators. 2) The examination of the consistency of the components model and indicators of innovators in primary school teachers with empirical data found that (&amp;chi;2) was equal to 15.073, the degrees of freedom (df) was equal to 22, the chi-square value is the correlation (&amp;chi;2/df) is equal to 0.685. The statistical significance (p-value) was 0.859, and the goodness-of-fit index (GFI) was 0.988. The Relative Harmony Index (CFI) was equal to 1.000. The Harmonic Harmony Index (NFI) was equal to 0.985. The Root Mean Residual Index (RMR) was equal to 0.004. The square root of the mean square of the estimation (RMSEA) was equal to 0.000, indicating that this tool can be used to evaluate the innovators of primary school teachers.

The Status of Canadian Radiology Mentorship Programs, Where We Stand and Where to Improve.

Background: The importance of mentorship in medicine is well-established. Access to mentors is pivotal in enhancing career opportunities and networking, increasing research productivity, and overall wellness and resilience at all career stages. Our study aims to assess the current status of radiology mentorship programs for Canadian medical students and radiology residents. Methods: We distributed an anonymous survey to Canadian radiology program directors in December 2022. The questions pertained to the existing mentorship programs' specific goals, structure, and success. Our null hypothesis was that medical students and residents have similar mentorship opportunities. Results: We have received 12 responses (a response rate of 12/16 = 75%), 9 of which had formal mentorship programs and 3 (25%) did not. Comparing the mentorship program for medical students and residents yielded a P-value = .11 > .05. This result does not reject our null hypothesis, indicating there is no significant difference between these 2 groups. Using qualitative analysis, we categorized the responses into 4 main themes: mentorship programs' goals, structures, evaluation methods, and their results. Conclusion: Although our result did not reach statistical significance (P-value = .11 > .05), the observed trend shows that one third of Canadian medical schools do not offer a radiology mentorship program for medical students, highlighting a potentially significant opportunity for improvement. Qualitative analysis shows that despite various methods for assigning mentees to mentors, developing formalized yet flexible mentorship models that allow students and residents to self-select their mentors might be more beneficial than randomly assigning mentors to them.

Comparison of Various Low Density Lipoprotein Cholesterol Calculators: Is It Time for the Friedewald Equation to Go in India?

Low-density lipoprotein cholesterol (LDL-c) is the main target in the management of dyslipidemia in primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Our study aims to compare the conventional and most popular Friedewald equation, and the more recent Sampson equation (literally unknown in India but more accurate), to the directly estimated LDL-c by the homogenous method. No such comparative study has been done in India. A multicenter retrospective analysis of the lipid profiles of patients whose LDL-c was derived directly by the homogenous method was included. Indirect LDL-c was estimated using the Friedewald and Sampson equations. The accuracy, error, and level of correlation between direct LDL-c and the two equations were assessed for concordance and discordance based on LDL-c categories (≤50, 51-70, 71-100, 101-130, ≥131 mg/dL). Upward discordance is when the calculated LDL-c was at least one category higher and downward discordance is when the calculated LDL-c was at least one category lower than the corresponding direct LDL-c (DLDL-c). Subgroup analyses were also done for triglycerides (TGLs) <150, 151-199, ≥200 mg/dL. TGL >400 were assessed separately. A total of 30,810 samples from four centers were studied. The overall mean DLDL-c was 107.86 mg/dL. The mean estimated LDL-c by Friedewald's equation (FLDL-c) and Sampson's equation (SLDL-c) were 101.37 and 104.37 mg/dL, respectively. There was statistical significance (p-value < 0.0005) in the mean difference when DLDL-c was compared with combined SLDL-c and FLDL-c as per the Games-Howell multiple comparison study, in which the mean difference was greater with the Friedewald equation (6.495) than with the Sampson equation (3.491). The overall concordance between FLDL-c vs DLDL-c and SLDL-c vs DLDL-c was nearly similar (74 vs 77%, respectively). The overall discordance upward was 5% with FLDL-c and 7% with SLDL-c (p-value < 0.0005). The overall discordance downward for FLDL-c and SLDL-c was 22 and 15% (p-value < 0.0005). When subgroup analysis was done for LDL-c ≤ 70, the downward discordance was 41% (FLDL-c) and 32% (SLDL-c), giving a false sense of goal LDL-c being achieved more often with FLDL-c. For LDL-c > 70, the corresponding downward discordance was 16 and 11%, respectively. Starting from TGL ≥ 200 mg/dL, there was consistent underestimation of LDL-c by the Friedewald equation. When TGL was > 400, the mean DLDL-c was 109 mg/dL, while for FLDL-c, it was 82 mg/dL and for SLDL-c, it was 98 mg/dL. Sampson's equation improves the accuracy of the indirectly calculated LDL-c compared to Friedewald's equation. The FLDL-c is estimated falsely low at LDL-c ≤ 70 mg/dL, giving a lower sense of LDL-c goal being achieved, and these patients will be undertreated. By switching to Sampson's equation, 9% in the LDL-c ≤ 70 mg/dL and 5% in the LDL-c > 70 mg/dL can be correctly classified. The shift to Sampson's equation requires a simple formula change and can be easily embraced in India-a small change but in the right direction.

Evaluation of Open-Source Ciliary Analysis Software in Primary Ciliary Dyskinesia: A Comparative Assessment.

Primary Ciliary Dyskinesia (PCD) is a rare genetic disorder characterized by alterations in motile cilia function. The diagnosis of PCD is challenging due to the lack of standardized methods in clinical practice. High-speed video microscopy analysis (HSVA) directly evaluates ciliary beat frequency (CBF) in PCD. Recently, open-source ciliary analysis software applications have shown promise in measuring CBF accurately. However, there is limited knowledge about the performance of different software applications, creating a gap in understanding their comparative effectiveness in measuring CBF in PCD. We compared two open-source software applications, CiliarMove (v219) and Cilialyzer (v1.2.1-b3098cb), against the manual count method. We used high-speed videos of nasal ciliary brush samples from PCD RSPH4A-positive (PCD (RSPH4A)) patients and healthy controls. All three methods showed lower median CBF values for patients with PCD (RSPH4A) than in healthy controls. CiliarMove and Cilialyzer identified lower CBF in patients with PCD (RSPH4A), similarly to the manual count. Cilialyzer, CiliarMove, and manual count methods demonstrated statistical significance (p-value < 0.0001) in the difference of median CBF values between patients with PCD (RSPH4A) and healthy controls. Correlation coefficients between the manual count values against both software methods demonstrated positive linear relationships. These findings support the utility of open-source software-based analysis tools. Further studies are needed to validate these findings with other genetic variants and identify the optimal software for accurate CBF measurement in patients with PCD.

The prominence of Oligoclonal Bands for clinical conversion in Radiologically isolated syndrome: 10-year follow-up study in Isfahan, Iran

BackgroundSince data is limited on radiologically isolated syndrome (RIS) subjects in certain regions like the Middle East, we aimed to further explore the replicability and generalizability of previously suggested predictors among a cohort of Iranian RIS subjects and report the long-term clinically definite MS (CDMS) conversion rate in this cohort. MethodsWe conducted a prospective 10-year cohort on our RIS participants, during which we collected the MRI, paraclinical, and demographic data of the subjects, and identified those who converted to CDMS. ResultsOut of 35 participants, 10 (28.5 %) developed CDMS during an average of 5.58 ± 3.08 years (range: 4 months to 10.33 years). OCB positivity was the only definitive predictor for conversion to CDMS in this cohort (P-value = 0.006), but other previously reported risk factors such as spinal cord lesions or age lacked statistical significance (P-values > 0.05). We also reported the median survival time as 114 months, the proportion surviving after 14 months as 96.9 % ± 3.1 %, and the overall conversion rate as 0.05 cases per year. ConclusionOur results highlight OCB as an important predictive factor of clinical conversion in RIS. The prominence of OCB suggests a need for routine CSF analysis in RIS subjects and could guide clinicians in deciding which RIS subjects benefit from DMTs.

Metagenome comparison (MC): A new framework for detecting unique/enriched OMUs (operational metagenomic units) derived from whole-genome sequencing reads

BackgroundCurrent methods for comparing metagenomes, derived from whole-genome sequencing reads, include top-down metrics or parametric models such as metagenome-diversity, and bottom-up, non-parametric, model-free machine learning approaches like Naïve Bayes for k-mer-profiling. However, both types are limited in their ability to effectively and comprehensively identify and catalogue unique or enriched metagenomic genes, a critical task in comparative metagenomics. This challenge is significant and complex due to its NP-hard nature, which means computational time grows exponentially, or even faster, with the problem size, rendering it impractical for even the fastest supercomputers without heuristic approximation algorithms. MethodIn this study, we introduce a new framework, MC (Metagenome-Comparison), designed to exhaustively detect and catalogue unique or enriched metagenomic genes (MGs) and their derivatives, including metagenome functional gene clusters (MFGC), or more generally, the operational metagenomic unit (OMU) that can be considered the counterpart of the OTU (operational taxonomic unit) from amplicon sequencing reads. The MC is essentially a heuristic search algorithm guided by pairs of new metrics (termed MG-specificity or OMU-specificity, MG-specificity diversity or OMU-specificity diversity). It is further constrained by statistical significance (P-value) implemented as a pair of statistical tests. ResultsWe evaluated the MC using large metagenomic datasets related to obesity, diabetes, and IBD, and found that the proportions of unique and enriched metagenomic genes ranged from 0.001% to 0.08 % and 0.08%–0.82 % respectively, and less than 10 % for the MFGC. ConclusionThe MC provides a robust method for comparing metagenomes at various scales, from baseline MGs to various function/pathway clusters of metagenomes, collectively termed OMUs.

Assessment the Role of Non Invasive Biomarkers as an Early Predictors of Mucosal Healing in Ulcerative Colitis Patients Treated with the Biological Therapy

Abstract Background Ulcerative colitis (UC) is characterized by confluent mucosal inflammation and erosions starting from the anal verge and extending to a variable extent, where patients often complain of diarrhea associated with rectal bleeding, abdominal tenderness, and weight loss. Numerous disease biomarkers have been studied in ulcerative colitis (UC) such as Erythrocyte sedimentation rate(ESR) and C- reactive protein(CRP). On the other hand, fecal calprotectin and Lactoferrin are more specific and sensitive but expensive and still not commonly used in clinical practice due to the need for on demand specimen collection. Objective To evaluate the role of the non-invasive biomarkers as an early predictor of mucosal healing in ulcerative colitis patients treated with biological therapy. Methods Twenty adult patients with ulcerative colitis who received biological therapy (after adequate screening) were included in our study. The patients met the indications for treatment with biological therapy according to European Crohn and Colitis Organization guidelines. The patients were presented to our IBD clinic at tropical medicine department, Ain shams university in the period from 1/2018 to 9/2021. Results There is a strong relationship between clinical response and mucosal healing at 6 months of starting biological therapy as 100% of patients who achieved mucosal healing showed clinical response. Median N/L ratio, median PLT/L ratio and CRP/albumin ratio were 1.58, 425 and 1.19 respectively in patients who achieved mucosal healing at 6 months after 3 months of starting biological therapy with statistical significance (p-value = 0.019, 0.019 and 0.008) respectively in comparison to the patients who didn’t achieve mucosal healing. Both median of L/M ratio and PLT/M ratio were decreased in patients achieved mucosal healing at 6 months after 3 months of starting biological therapy (3.43 and 660) respectively in comparison to patients who didn’t achieve mucosal healing but it didn’t reach any statistical significance. Conclusion Non invasive biomarkers at 3 months like N/L ratio, PLT/L ratio, L/M ratio and PLT/M ratio may be used as non invasive predictors of mucosal healing at 6 months after starting treatment with biological treatment.

Risk Predictors of Severity in Egyptian Patients with Covid-19 Infection

Abstract Background In modern human history, infectious diseases have posed a threat to public health several times, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global public health crisis. Objective Identification of demographic, laboratory and radiological predictors of progression of COVID-19 infection in Egyptian patients. A special concern is focused on the poor prognostic factors associated with mortality, this will help to classify and monitor COVID-19 patients to deliver best medical care in order to decrease mortality and morbidity in Egyptian patients. Patients and Methods A single-center, retrospective cohort study. This study was conducted in Almaza Fever Hospital after obtaining approval from the Research Ethical Committee. Results The current study conducted on (325) known positive COVID-19 patients divided into 2 groups: Group I (204) patients and Group II (121) patients. It was found that an increase in age among Group II (mean age was 66.22 ± 12.18) in comparison to Group I (mean age was 47.78 ± 14.73) with a statistically significant difference (p-value &amp;lt;0.001). There was no statistically significant difference (p-value 0.432) between Sex and severe disease patients. Among Group II (121) out of the total study population 103 (85%) of these were found to have co-morbidities (highly significant, p value &amp;lt; 0.001. Moreover, there was a higher prevalence of co-morbidities among non survivors however this didn’t reach the level of statistical significance (p-value 0.174). The current study showed that there was an increase in hematological parameters (TLC, Neutrophils), biochemical parameters (Urea, Creatinine, AST, D-Dimer, Ferritin, CRP, LDH, IL-6) and a decrease in Lymphocytes within Group II in comparison with Group I with statistically Significant difference (p-value &amp;lt; 0.001), also there was a trend toward higher levels of ALT in group II, however this didn’t reach the level of statistical significance (p-value 0.068). Statistically significant difference (p-value &amp;lt; 0.001) was found between disease severity and CT findings as from a total of (121) severe disease patients 105(86.8%) had CORADS (4-5). Conclusion The current study shows old age, elevated biochemical parameters (creatinine, urea, AST, D-dimer, IL-6, CRP, ferritin and LDH), hematological parameters (TLC) and extensive lung affection could be considered predictors of severity and mortality among Covid-19 patients. Also lymphopenia and associated co-morbidities are considered predictors of severity.

The Effect of Neurophysiological Modulation on Muscle Power and Pain Through Manual Therapy Over Electro- Physiotherapy for Athletes with Illio Tibial Band Syndrome (ITBS)

Introduction and Objectives: Iliotibial Band Syndrome (ITBS) is a common overuse injury in athletes, primarily impacting the knee and hip due to repetitive friction of the iliotibial band against the femur, resulting in pain and restricted hip abduction and knee extension. Muscle power and pain associated with ITBS can be measured using Hand-held Dynamometer (HHD) and Visual-Analog-Scale scores (VAS) respectively. This study aimed to compare the efficacy of two treatment groups, Manual-Therapy (MT) and Electro-Physiotherapy (EPT), in determining the most effective approach for managing ITBS. Materials and Methods: A RCT was conducted at the Sports Medicine Clinic of the Teaching Hospital Karapitiya, enrolling twenty athletes in each group as controls and experimental subjects. The control group received EPT, NSAIDS, and paracetamol for one week, while the experimental group received MT, NSAIDS, and paracetamol for the same duration. Muscle power and pain measurements were assessed using HHD &amp; VAS on D1 and D28. P-values for statistical significance were obtained using RM-ANOVA followed by Bonferroni test. Results: Mean ages for EPT and MT groups were 24.4±6.6 and 25.4±6.6years, respectively. Muscle power (N) for EPT group on D1, and D28 were 101.7±26.3 and 112.7±23 respectively. The same parameters for MT group were 98.1±26 and 186.8±25.3. The mean differences for muscle power of two groups on D1 and D28 were -3.600(P=0.666) and 74.050(P&lt;0.001). VAS scores for EPT group on D1, and D28 were 8.2±0.9 and 7±1 respectively. The same parameters for MT group were 7.9±0.8 and1.8±0.8. The mean differences for pain of two groups on D1 and D28 were 0.250(P=0.395) and -5.200(P&lt;0.001). Partial-Eta-Squared for the two groups were 0.355 and 0.758respectively. ManualTherapy group’s higher effectiveness was statistically significant (p&lt;0.001) and a 35.5% variance in muscle power and 75.8% variance in VAS score was attributable to it. Conclusion:Manual-therapy is superior to electro-physiotherapy in improving muscle power and decreasing in VAS scores of athletes with ITBS.

Inter-rater reliability among healthcare professionals in assessing postoperative wound photos for the presence or absence of surgical wound dehiscence: A Pretest - Posttest study

BackgroundSurgical wound dehiscence (SWD) has various definitions, which complicates accurate and uniform diagnosis. To address this, the World Union Wound Healing Societies (WUWHS) presented a consensus based definition and classification for SWD (2018). AimThis quasi-experimental pretest-posttest study investigates the inter-rater reliability among healthcare professionals (HCP) and wound care professionals (WCP) when assessing wound photos on the presence or absence of SWD before and after training on the WUWHS-definition. MethodsWound expert teams compiled a set of twenty photos (SWD+: nineteen, SWD−: one), and a video training. Subsequently, 262 healthcare professionals received the pretest link to assess wound photos. After completion, participants received the posttest link, including a (video) training on the WUWHS-definition, and reassessment of fourteen photos (SWD+: thirteen, SWD−: one). Primary outcomes1) pretest-posttest inter-rater-reliability among participants in assessing photos in congruence with the WUWHS-definition 2) the impact of training on assessment scores. Secondary outcome: familiarity with the WUWHS-definition. ResultsOne hundred thirty-one participants (65 HCPs, 66 WCPs) completed both tests. The posttest inter-rater reliability among participants for correctly identifying SWD was increased from 67.6 % to 76.2 %, reaching statistical significance (p-value: 0.001; 95 % Confidence Interval [1.8–2.2]).Sub-analyses per photo showed improved SWD posttest scores in thirteen photos, while statistical significance was reached in seven photos.Thirty-three percent of participants knew the WUWHS-definition. ConclusionThe inter-rater reliability among participants increases after training on the WUWHS-definition. The definition provides diagnostic criteria for accurate SWD diagnosis. Widespread use of the definition may improve uniformity in care for patients with SWD.

Prevalence and Association of Risk Factors According to Liver Steatosis and Fibrosis Stages among Nonalcoholic Fatty Liver Disease Patients with Type 2 Diabetes Mellitus in India: A Cross-sectional Study.

Type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) are linked to the global diabetes epidemic, leading to increased disease progression and adverse health outcomes. The renaming of NAFLD to metabolic dysfunction-associated steatotic liver disease (MASLD) at the 2023 European Association for the Study of the Liver Congress highlights the complex relationship between metabolic disorders and liver health. Taking this into consideration, we aimed this study to identify prevalence and risk factors associated with the stages of NAFLD in individuals with T2DM in the Indian population. This observational, cross-sectional study was conducted on 1,521 T2DM patients at Dr Panikar's Speciality Care Centre, Mumbai, between September 1, 2022 and October 31, 2022. Demographic parameters such as age, gender, height, weight, and anthropometric parameters such as body mass index (BMI) and waist circumference were measured. Liver fibrosis and steatosis stages were identified by vibration-controlled transient elastography (VCTE) using FibroScan®. The prevalence of liver steatosis was 75.1% among the 1,521 diabetes cases [S0 (24.9%), S1 (15.1%), S2 (24%), and S3 (36%)], whereas the prevalence of liver fibrosis was 28.0% [F0 (72%), F1 (19%), F2 (5%), F3 (1.5%), and F4 (3.4%)]. The S1 (p = 0.012), S3 (p = 0.001), F1 (p = 0.001), and F2 (p = 0.001) grades showed significant gender-related changes, demonstrating a positive connection. Furthermore, waist circumference was associated with disease severity in both liver steatosis and fibrosis stages (p = 0.001), but BMI was solely associated with the degree of steatosis (p = 0.001). The mean age differences between these categories, however, did not reach statistical significance (p-values of 0.149 and 0.078, respectively, for the steatosis and fibrosis grades). The study reveals a high prevalence of NAFLD (steatosis and fibrosis) in T2DM patients, increasing the risk of advanced fibrosis. In T2DM patients with risk factors including waist circumference and BMI, appropriate screening and intervention are required.

Investigating the Performance of Frequentist and Bayesian Techniques in Genomic Evaluation.

The genomic evaluation process relies on the assumption of linkage disequilibrium between dense single-nucleotide polymorphism (SNP) markers at the genome level and quantitative trait loci (QTL). The present study was conducted with the aim of evaluating four frequentist methods including Ridge Regression, Least Absolute Shrinkage and Selection Operator (LASSO), Elastic Net, and Genomic Best Linear Unbiased Prediction (GBLUP) and five Bayesian methods including Bayes Ridge Regression (BRR), Bayes A, Bayesian LASSO, Bayes C, and Bayes B, in genomic selection using simulation data. The difference between prediction accuracy was assessed in pairs based on statistical significance (p-value) (i.e., t test and Mann-Whitney U test) and practical significance (Cohen's d effect size) For this purpose, the data were simulated based on two scenarios in different marker densities (4000 and 8000, in the whole genome). The simulated data included a genome with four chromosomes, 1 Morgan each, on which 100 randomly distributed QTL and two different densities of evenly distributed SNPs (1000 and 2000), at the heritability level of 0.4, was considered. For the frequentist methods except for GBLUP, the regularization parameter λ was calculated using a five-fold cross-validation approach. For both scenarios, among the frequentist methods, the highest prediction accuracy was observed by Ridge Regression and GBLUP. The lowest and the highest bias were shown by Ridge Regression and GBLUP, respectively. Also, among the Bayesian methods, Bayes B and BRR showed the highest and lowest prediction accuracy, respectively. The lowest bias in both scenarios was registered by Bayesian LASSO and the highest bias in the first and the second scenario were shown by BRR and Bayes B, respectively. Across all the studied methods in both scenarios, the highest and the lowest accuracy were shown by Bayes B and LASSO and Elastic Net, respectively. As expected, the greatest similarity in performance was observed between GBLUP and BRR ( , in the first scenario and , in the second scenario). The results obtained from parametric t and non-parametric Mann-Whitney U tests were similar. In the first and second scenario, out of 36 t test between the performance of the studied methods in each scenario, 14 ( ) and 2 ( ) comparisons were significant, respectively, which indicates that with the increase in the number of predictors, the difference in the performance of different methods decreases. This was proven based on the Cohen's d effect size, so that with the increase in the complexity of the model, the effect size was not seen as very large. The regularization parameters in frequentist methods should be optimized by cross-validation approach before using these methods in genomic evaluation.

Mapping and predicting open defecation in Ethiopia: 2021 PMA-ET study

IntroductionThere has been extensive research conducted on open defecation in Ethiopia, but a notable gap persists in comprehensively understanding the spatial variation and predictors at the household level. This study utilizes data from the 2021 Performance Monitoring for Action Ethiopia (PMA-ET) to address this gap by identifying hotspots and predictors of open defecation. Employing geographically weighted regression analysis, it goes beyond traditional models to account for spatial heterogeneity, offering a nuanced understanding of geographical variations in open defecation prevalence and its determinants. This research pinpoints hotspot areas and significant predictors, aiding policymakers and practitioners in tailoring interventions effectively. It not only fills the knowledge gap in Ethiopia but also informs global sanitation initiatives.MethodsThe study comprised a total weighted sample of 24,747 household participants. ArcGIS version 10.7 and SaT Scan version 9.6 were used to handle mapping, hotspots, ordinary least squares, Bernoulli model analysis, and Spatial regression. Bernoulli-based model was used to analyze the purely spatial cluster detection of open defecation at the household level in Ethiopia. Ordinary Least Square (OLS) analysis and geographically weighted regression analysis were employed to assess the association between an open defecation and explanatory variables.ResultsThe spatial distribution of open defecation at the household level exhibited clustering (global Moran’s I index value of 4.540385, coupled with a p-value of less than 0.001), with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Spatial analysis using Kuldorff’s Scan identified six clusters, with four showing statistical significance (P-value < 0.05) in Amhara, Afar, Harari, Tigray, and southwest Ethiopia. In the geographically weighted regression model, being male [coefficient = 0.87, P-value < 0.05] and having no media exposure (not watching TV or listening to the radio) [coefficient = 0.47, P-value < 0.05] emerged as statistically significant predictors of household-level open defecation in Ethiopia.ConclusionThe study revealed that open defecation at the household level in Ethiopia varies across the regions, with significant hotspots identified in Amhara, Afar, Harari, and parts of Dire Dawa. Geographically weighted regression analysis highlights male participants lacking media exposure as substantial predictors of open defecation. Targeted interventions in Ethiopia should improve media exposure among males in hotspot regions, tailored sanitation programs, and region-specific awareness campaigns. Collaboration with local communities is crucial.

Assessment of Nursing Faculty Members' Knowledge Toward Research: A Cross-Sectional Study.

Background and aim In the context of contributing to healthcare and the well-being of a nation and its communities, nursing research plays a vital role in advancing the discipline of nursing science. Nursing research is essential for improving the quality of nursing care. This study aims to examine the research knowledge level of faculty members at the College of Nursing, University of Raparin, Kurdistan Region, Iraq. Methods We conducted a cross-sectional study involving 43 nursing faculty members at the University of Raparin. The survey was distributed using convenience sampling in April 2024. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (released 2019, IBM Corp., Armonk, NY). Continuous variables were analyzed using mean and standard deviation, while categorical variables were analyzed using frequency and percentage distributions. The association between knowledge scores and demographics was tested using Mann-Whitney, Kruskal-Wallis, Chi-square, and post-hoc tests. Stepwise multiple regression analysis was used to determine the variables that influence the knowledge score. Significance was set at p < 0.05. Results A total of 43 participants were enrolled in this study. The mean age was 32.56 ± 4.75, with 69.8% of participants being male. In terms of educational attainment, 48.8% held master's degrees, 39.5% held bachelor's degrees, and only 11% possessed PhDs. The mean work experience was 5.40 ± 4.04 years, and the mean knowledge score toward research was 3.09 ± 1.97 out of 7. Demographic variables, such as age, marital status, and gender, showed no significant associations with knowledge levels (p > 0.05). However, significant associations were found for education level (p = 0.004) and years of experience (p = 0.011). In the stepwise regression analysis, we observed a significant positive correlation between the level of education and knowledge score (F =10.787, p = 0.002). However, variables, such as age, gender, marital status, years of experience, and participation in research courses, did not demonstrate statistical significance (p-values > 0.05). Conclusion This study highlights a significant lack of research expertise among nursing faculty members, emphasizing the urgent need for targeted interventions and instructional activities in nursing education programs. It is crucial to address this knowledge gap in order to support the professional growth of faculty members and promote the advancement of nursing research and evidence-based practice.Policymakers should also consider implementing mentorship programs that strategically pair less experienced faculty members with seasoned researchers. This initiative aims to cultivate a collaborative learning environment and enhance research skills.

#2822 Can KDPI estimate long-term graft survival in a cohort of Portuguese patients?

Abstract Background and Aims The Kidney Donor Profile Index (KDPI) was introduced in the United States in 2014 to support clinicians' decision-making regarding the acceptance or decline of potential donors. In Portugal, there is no valid stratification score to assist physicians in accepting or declining an organ offer. Our study aims to characterize a cohort of Portuguese kidney transplant recipients and donors and evaluate the correlation between KDPI and long-term graft survival. The results are interpreted considering the nuances of the Portuguese allocation system, which favors an age-matched donor-recipient allocation. Method We conducted an observational single-center retrospective cohort study, which included patients who received a deceased donor kidney transplant at our unit between January 2013 and December 2015. We excluded patients for whom the donor KDPI index was unavailable for retrieval. Besides the KDPI index, we collected data regarding the receptor's demographic, clinical, and immunological characteristics, as well as graft and recipient survival. The primary outcome was death-censored survival, and follow-up ended on the 31st of December 2023. The secondary outcome was survival with a functioning graft. Survival estimates were obtained using Kaplan-Meier curves. We performed univariate and multivariate survival analysis with log-rank tests and Cox proportional-hazards regression models. Results We selected 364 deceased-donor kidney recipients and 212 kidney donors. The mean KDPI was 60% and 53.3% of donors were classified as expanded criteria. The kidney recipients were predominantly male (68.4%), with a mean age of 50.16 years and an average of 4 HLA mismatches. Median follow-up was 102 months. Considering recipient characteristics according to pre-defined KDPI strata (≤ 20%, 21-85%, &amp;gt; 85%), recipients from higher KDPI were significantly older, with a mean age of 40.6, 48.8, and 61.1 years, respectively (p &amp;lt; 0.001), and had a higher average body mass index (p = 0.041). There were no significant differences regarding the number of HLA mismatches (p = 0.624) or the proportion of hypersensitized patients (p = 0.253) between classes. During follow-up, 16.8% patients presented graft failure and 9.9% died with a functioning graft. Cumulative death-censored graft survival at 5, 8, and 10 years was 87.7%, 87.1%, and 84.4% respectively. The cumulative percentage of patients living with a functioning graft at 5, 8, and 10 years was 83.6%, 76.7%, and 68.6%. Death-censored graft survival was lower in recipients of donors with higher KDPI (Fig. 1), although it did not reach statistical significance (p-value = 0.166). The number of HLA mismatches (p = 0.592) or the recipient's age (p = 0.513) did not significantly impact death-censored graft survival, whereas delayed graft function (DGF) was the variable with the strongest association in univariate analysis (p &amp;lt; 0.001). In a multivariate Cox regression model, KDPI (HR 1.02, p = 0.005) and DGF (HR 3.2, p &amp;lt; 0.001) correlated with graft loss, while older recipients (HR 0.971, p = 0.019) seemed to have a protective effect over death-censored survival. Patient survival with a functioning graft was significantly associated with KDPI strata (p = 0.008; Fig. 2), the recipient's age (p = 0.006), and DGF (p &amp;lt; 0.001) in univariate analysis. Considering KDPI kidneys ≥ 90%, 10-year cumulative death-censored survival was 67.9%. Conclusion In our sample, despite not reaching statistical significance, there was a trend for improved death-censored graft survival in patients with lower KDPI, which further emulates the results of other European cohorts. Nevertheless, the 10-year cumulative death-censored survival of higher KDPI kidneys (≥ 90%) was remarkable, showing that long-term acceptable outcomes can be achieved. The impact of KDPI on patient survival with a functioning graft is probably overestimated, given the bias introduced by the Portuguese matching system, which rewards an “old-for-old” donor-recipient allocation.

Exploring the Influencing Factors and Arrival Patterns of Inbound Tourism in Nepal

ABSTRACT Understanding the factors influencing a country's inbound tourism is crucial for shaping effective tourism strategies. This study analyzed historical data from 1964 to 2021 on tourist arrivals, duration of stay, GDP per capita, migration, heritage and attractions, COVID-19 impacts, population growth, and bilateral relationships in Nepal. Initially, regression analysis identified the statistical significance (p-value < 0.05) of these factors on Nepal's inbound tourism. Subsequently, the significant factors were modeled and visualized using neural networks. Historical arrival patterns were then identified using self-organizing maps. The results indicated that population growth, GDP, length of stay, and bilateral relationships positively influenced international arrivals, while migration, heritage, and COVID-19 had negative effects. Five distinct historical arrival patterns were identified form self organizing map comparing with the key drivers of inbound tourism. These findings are vital for tourism planners and policymakers, providing essential insights for the strategic planning and sustainable management of tourism in Nepal.

Path to autonomous soil sampling and analysis by ground-based robots

Good site characterization is essential for the selection of remediation alternatives for impacted soils. The value of site characterization is critically dependent on the quality and quantity of the data collected. Current methods for characterizing impacted soils rely on expensive manual sample collection and off-site analysis. However, recent advances in terrestrial robotics and artificial intelligence offer a potentially revolutionary set of tools and methods that will help to autonomously explore natural environments, select sample locations with the highest value of information, extract samples, and analyze the data in real-time without exposing humans to potentially hazardous conditions. A fundamental challenge to realizing this potential is determining how to design an autonomous system for a given investigation with many, and often conflicting design criteria. This work presents a novel design methodology to navigate these criteria. Specifically, this methodology breaks the system into four components – sensing, sampling, mobility, and autonomy – and connects design variables to the investigation objectives and constraints. These connections are established for each component through a survey of existing technology, discussion of key technical challenges, and highlighting conditions where generality can promote multi-application deployment. An illustrative example of this design process is presented for the development and deployment of a robotic platform characterizing salt-impacted oil & gas reserve pits. After calibration, the relationship between the in situ robot chloride measurements and laboratory-based chloride measurements had a good linear relationship (R2-value = 0.861) and statistical significance (p-value = 0.003).

Exposure to hyperbaric O2 levels leads to blood-brain barrier breakdown in rodents

IntroductionHyperbaric oxygen has been used as a medical treatment tool in hyperbaric chambers and is an integral part of professional and combat divers’ activity. In extreme cases, exposure to hyperbaric oxygen can develop central nervous system oxygen toxicity (CNS-OT), which leads to seizures and eventually death. CNS-OT is caused by neuronal hyperactivity due to high oxygen levels, potentially damaging brain cells including the blood-brain barrier (BBB). However, the effect of hyperbaric oxygen levels on the healthy BBB has not been characterized directly yet.MethodsSix or three different groups of ~ eight rats or mice, respectively, were exposed to increasing levels of partial pressure of oxygen (0.21 to 5 ATA) in a hyperbaric chamber, followed by MRI scanning with gadolinium. Statistical significance (adjusted p-value ≤ 0.05) was assessed using linear regression and ordinary one-way (rats) or two-way (mice) ANOVA with correction of multiple comparison tests. In rats, the effect of 100% oxygen at 5 ATA was independently validated using FITC-Dextran (5 kDa). Statistical significance (p-value ≤ 0.05) was assessed using Welch’s t-test and effect size was calculated by Cohen’s D.ResultsIn rats, analyzed MRI scans showed a significant trend of increase in the % gadolinium in brain tissues as a result of hyperbaric oxygen pressures (p-value = 0.0079). The most significant increase was measured at 4 ATA compared to air (adjusted p-value = 0.0461). Significant increased FITC-Dextran levels were measured in the rats’ brains under 100% oxygen at 5 ATA versus air (p-value = 0.0327; Effect size = 2.0). In mice, a significant increase in gadolinium penetration into the hippocampus and frontal cortex was measured over time (adjusted p-value < 0.05) under 100% oxygen at 3 and 5 ATA versus air, and between the treatments (adjusted p-value < 0.0001).ConclusionsThe BBB is increasingly disrupted due to higher levels of hyperbaric oxygen in rodents, indicating a direct relation between hyperbaric oxygen and BBB dysregulation for the first time. We suggest considering this risk in different diving activities, and protocols using a hyperbaric chamber. On the other hand, this study highlights the potential therapeutic usage of hyperbaric oxygen for controlled drug delivery through the BBB into brain tissues in different brain-related diseases.