Statistical Software Research Articles

CHALLENGES IN BASIC STATISTICS: IMPLICATIONS FOR RESEARCH ACCURACY AND RELIABILITY

The study explores the degree of seriousness of problems encountered in utilizing basic statistics in educational research. Data from 86 respondents at Baguio Central University revealed that these problems were moderately serious, with an average weighted mean of 2.76. The primary issues included poor mathematical skills, inadequate application of statistical knowledge in research, lack of content knowledge in statistics and research, and insufficient textbooks on statistics. These findings suggest that graduate and postgraduate students lack sufficient knowledge and skills in basic statistics necessary for their research endeavors. While the identified problems are moderately serious, addressing them is crucial for successful research outcomes. To mitigate these issues, various resources and strategies can be employed. Online platforms offer opportunities for students to enhance their mathematical and statistical proficiency. Additionally, statistical software such as SPSS, R, MATLAB, Excel, SAS, GraphPad Prism, and Minitab provide tools for data analysis and interpretation, catering to diverse research needs. The study confirms the moderately serious nature of problems encountered in using basic statistics in educational research. Addressing these challenges is imperative to equip students with the necessary skills for successful research endeavors.

Off-label use of tramadol combined with Lacasera® soft drink: A sub-acute toxicological study using Wistar rats to evaluate the effects of combination on human basic haematological parameters and weight changes

Tramadol is a synthetic opioid that is used to treat moderate to severe pain in both acute and chronic conditions. Tramadol is predominantly used off-label for premature ejaculation and euphoria among male youth in Nigeria, especially when dissolved in Lacasera® soft drink, which gives it a pleasant taste. Research has not yet examined the effects of this combination on hematological parameters, despite the fact that this type of abuse is common among young people and poses a public health risk. A 28-day subacute study was conducted with Wistar rats weighing 160-180g. The rats were separated into 8 groups of 6 each. The control groups: 1 and 2 were treated with Lacasera® and deionized water respectively. Groups 3, 4 and 5 received 35mg/kg per day, 70.7mg/kg per day and 106mg/kg per day of Tramadol dissolved in deionized water respectively. Groups 6, 7 and 8 received similar doses of Tramadol dissolved in Lacasera®. Blood samples were analyzed using auto-analyzer and standard methods. The data was analyzed using a statistical tool software (SPSS version 27). All results were presented as mean ± SD. Values were considered significant at p<0.05. Hematological analysis of groups treated with Lacasera®-Tramadol combination shows dose-dependent significant decreases (p<0.05) in PCVs, RBCs, and Hbs. WBCs and platelets increased in groups that received Lacasera®-Tramadol combination. The study concludes that regular or infrequent users of Lacasera® without Tramadol are unlikely to experience serious hematological complications. However, chronic Tramadol-Lacasera® users will experience increased toxicity over time, leading to hemolytic anemia.

Meta-analysis on clinical efficacy of ringheaded thumbtack needle in the treatment of allergic rhinitis.

To evaluate the efficacy and safety of ringheaded thrumbtack needle in the treatment of allergic rhinitis (AR). Clinical studies about treatment of AR with ringheaded thrumbtack needle were searched from databases of CNKI, Wanfang, China Science and Technology Journal, China Biology Medicine disc, PubMed, Embase and Web of Science from their inception to November 2022. Two researchers independently screened the literature and collected related information. The total effective rate, visual analogue scale (VAS) for AR, rhinoconjunctivitis quality of life questionnaire (RQLQ), and recurrence rate were the main outcome indicators. Secondary outcome indicators included quantitative scores of symptoms and signs, 'quartering' symptom evaluation scale, etc. All the included studies were subjected to Meta-analysis using Stata software. A total of 22 clinical studies involving 1 491 participants were included. The results of Meta-analysis indicated that the total effective rate of ringheaded thrumbtack needle in the treatment of AR was higher than that of traditional Chinese and Western medicine ［RR=1.20, 95%CI (1.14, 1.26), P<0.001］, and recurrence rate is lower than conventional therapy ［OR=0.35, 95%CI (0.14, 0.89), P=0.027］. Moreover, The VAS score ［WMD=-1.30, 95%CI (-1.85, -0.75), P<0.001］ and RQLQ score ［WMD=-6.75, 95%CI (-12.74, -0.76), P=0.027］ of AR treated by ringheaded thrumbtack needle were lower than those of traditional Chinese and Western medicine. Ringheaded thrumbtack needle can improve the total effective rate, reduce the disease recurrence, and improve the symptoms of discomfort when AR outbreaks, and has no significant adverse reactions. However, the reliability is limited. Thus, it is still necessary to improve the level of evidence quality by including researches with large samples, rigorous design and international standards.

A meta-analysis of efficacy on dexamethasone and clomiphene in the treatment of polycystic ovary syndrome patients

ObjectivePolycystic ovary syndrome (PCOS) is an endocrine gynecological disease affecting many women of reproductive age. Clomiphene is the first-line treatment for PCOS patients, but most individuals may be resistant to it. This study aims to assess the efficacy of dexamethasone and clomiphene in the treatment of PCOS patients, and to provide a theoretical basis for clinicians to study and treat PCOS.MethodsChinese and English databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Medical Network, and VIP Information Chinese Journal Service Platform (VIP) were searched from the inception to January 2023. Review Manager and Stata software were used for meta- analysis. The risk of bias of eligible studies were assessed using Cochrane’s risk of bias tool. Publication bias was assessed by funnel plots, Begg’s and Egger’s tests.ResultsA total of 12 literatures were finally included, with a total of 1270 PCOS patients. Compared with the control group, dexamethasone combined with clomiphene could significantly improve pregnancy (RR = 1.71, P < 0.00001), ovulation (RR = 1.30, P < 0.00001), luteinizing hormone level (SMD = -0.94, P < 0.00001), estradiol level (SMD = 0.99, P = 0.05), progesterone level (SMD = 5.08, P = 0.002) and testosterone level (SMD = -1.59, P < 0.00001). However, there were no significant effects on ovulation-stimulating hormone level (SMD = 0.15, P = 0.37), adverse reactions (RR = 1.30, P = 0.30), dizziness (RR = 1.50, P = 0.45), and vomiting (RR = 1.67, P = 0.48).ConclusionThe treatment of dexamethasone combined with clomiphene is helpful to improve the ovulation and pregnancy rate in patients with PCOS, and improve the hormone levels of patients.

Predictive Partly Conditional Models for Longitudinal Ordinal Outcomes with Application to Alzheimer’s Disease Progression

AbstractAssessing time-dependent risk factors in relation to the risk of disease progression is challenging, yet important, especially for chronic diseases with slow progression. In this paper, the partly conditional model is extended for characterizing disease progression at time t with longitudinal ordinal outcomes in the presence of time-dependent covariates at time s$$(s &lt; t)$$ ( s &lt; t ) and time-dependent effects. Advantages of the method include direct modeling of disease progression, use of longitudinal risk factors, and flexibility in target period of progression $$u = t - s$$ u = t - s . A generalized estimating equation approach is adopted for parameter estimation, and a new regularity condition requiring a fixed prediction time window $$u_0$$ u 0 is established to consistently estimate the covariance of the estimated parameters. Extensive simulation studies are conducted to assess the properties of the proposed model alongside with an explicit demonstration of the implementation using existing statistical software. The proposed method is applied to a longitudinal Alzheimer’s disease dataset from the National Alzheimer’s Coordinating Center to assess effect of time-dependent cognitive complaint on Alzheimer’s Disease progression.

A 20-Year Autopsy Study of Myocardial Bridging Among Sudden Deaths

Myocardial bridging (MB) is a condition, where the cardiac muscle overlies the intramyocardial segment of the major epicardial coronary artery. This study aims to analyse the demographics and anatomical characteristics of MB within a pool of 2093 sudden cardiac-related death cases examined at the Forensic Unit of Universiti Kebangsaan Malaysia Medical Centre between 2000 and 2019. In this cross-sectional study, postmortem data collected were gender, racial affiliations, MB anatomical properties, and association with cardiac pathologies entered into the statistical software SPSS version 25 for analysis. The prevalence of MB was 12.9%. It was commoner in males (91.5%). MB was predominant between age 21-40 years old (50.2%). Chinese race showed the highest number of recorded MB cases (24.3%) among local races. MB was mostly found in left anterior descending (LAD) artery (98.2%), with the commonest length of 11-20mm (44.6%), depth of 1-5mm (49.8%), and distance from the ostium of 21-40mm (54.0%). The prevalence of isolated MB (43.2%) was nearly comparable to that of MB with cardiac pathologies (56.8%). MB was mostly associated with atherosclerosis (50.1%) and atheroma formation was mostly proximal to MB (78.3%). MB is a common occurrence and commonly found in the LAD as a single entity. It has a higher preponderance in the male gender among the adult population. In conclusion, the findings not only contribute to a deeper understanding of MB but also hold potential implications for identifying and managing risks related to sudden cardiac-related deaths. It is a pathological condition at a certain length and depth whether it exists as an isolated entity or associated with cardiac pathologies. Atherosclerosis tends to form proximal to MB and might pose a risk for myocardial infarction.

The incidence and factors associated with anemia in elective surgical patients admitted to a surgical intensive care unit: a retrospective cohort study

BackgroundAnemia is a frequently reported and commonly documented issue in intensive care units. In surgical intensive care units, more than 90% of patients are found to be anemic. It is a hematologic factor that contributes to extended mechanical ventilation, sepsis, organ failure, longer hospitalizations in critical care units, and higher mortality. Thus, this study aimed to determine the incidence and identify factors associated with anemia in elective surgical patients admitted to the surgical intensive care unit.MethodsA retrospective follow-up study involving 422 hospitalized patients was carried out between December 2019 and December 2022 in the surgical intensive care unit after elective surgery at Tikur-Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Data were gathered from the patients’ charts, and study participants were chosen using methods of systematic random sampling. SPSS 26 (the statistical software for social science, version 26) was used to analyze the data. Bivariable and multivariable binary logistic regression were used to examine associations between variables.ResultsThe incidence of anemia in elective surgical patients admitted to the intensive care unit was 69.9% (95% CI 65.4–74.5%). American Society of Anesthesiologists’ class III (ASA III) [AOR: 8.53, 95% CI 1.92–13.8], renal failure [AOR:2.53, 95% CI (1.91–5.81)], malignancy [AOR: 2.59, 95% CI (1.31–5.09)], thoracic surgery [AOR: 4.07, 95% CI (2.11–7.87)], urologic surgery [AOR: 6.22, 95% CI (2.80–13.80)], and neurosurgery [AOR: 4.51, 95% CI (2.53–8.03)] were significantly associated with anemia in surgical patients admitted to the intensive care unit.ConclusionMore than two-thirds of the intensive care unit-admitted surgical patients experienced anemia. An American Society of Anesthesiologists’ (ASA III score), renal failure, malignancy, thoracic surgery, urologic surgery, and neurosurgery were significantly associated with this condition. Early identification helps to institute preventive and therapeutic measures.

Don't wait any longer, conceive in time: a systematic review and meta-analysis based on semen parameters after varicocelectomy.

Varicocelectomy was considered to be beneficial to patients with varicocele-related infertility. However, there are only a few researchers who have explored the relationship between better timing and postoperative semen improvement in patients. We conducted this meta-analysis by enrolling published prospective studies to find out the best waiting time after varicocelectomy to wait for better improvement of semen quality. An extensive search was conducted in PubMed, Web of Science, and Cochrane Library to identify eligible studies. The included studies were then analyzed comprehensively using STATA software and standardized mean differences (SMDs) and their corresponding 95% confidence intervals were calculated. Our comprehensive analysis showed that after varicocelectomy, follow-up results within 3months or longer showed a significant improvement in semen parameters compared to the preoperative period. Notably, no further improvement in semen parameters was observed when the follow-up period reached six months or longer (semen volume: WMD: -0.07 (-0.29, 0.16); sperm concentration: WMD: -1.33 (-2.33, -4.99); sperm motility: WMD: 2.31 (-0.55, 5.18); sperm morphology: WMD: 1.29 (-0.66, 3.24); sperm total motile count: WMD: 3.95 (-6.28, 14.19)). Three months after varicocelectomy may be the optimal time for semen parameters compared to six months or even longer, which means it is also the preferable time for conception. However, more well-designed prospective studies are needed in the future to validate our conclusion.

Prevalence, perceptions and associated factors of health insurance enrollment among older persons in selected cash grant communities in Ghana: a cross-sectional mixed method

BackgroundUniversal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana.MethodsData were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses.ResultsThe mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00–1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09–1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28–1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services.ConclusionHealth insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030.

Sum or mean in calculation of qualitative scoring methods using the Dragonfly Biotic Index, and an alternative approach facilitating conservation prioritization

Qualitative scoring methods are tools for rapid freshwater health assessments. Total score is often calculated as the sum or mean of the values of the species involved, with minor nuances in interpretation, but with significant implications. We used the Dragonfly Biotic Index (DBI) calculated on Central European odonate species to demonstrate these implications. Each species within a community has a score ranging from 0 (widespread generalists) to 9 (sensitive specialists). A total score is calculated as the sum of the scores of all species (DBIsum) or is calculated by dividing by species richness (DBImean). Despite this duality, there has been little debate on either approach. Using simulated scenarios (high vs low richness, presence or absence of high- or low-scoring species), we tested the implications of DBIsum and DBImean and suggested a total score calculation for conservation prioritization based on permutation. This algorithm shows the percentile of a community compared to a set of randomly assembled communities of the same species richness. We also present the ‘dragDBI’ package for the statistical software R, a tool for more automated DBI-based environmental health assessments. Our permutational calculation is applicable to other macroinvertebrate-based scoring methods, such as the Biological Monitoring Working Party and the Average Score Per Taxon.

What are the perceptions of healthy food choices? A cross-sectional study from Saudi Arabia

Previous studies conducted in Saudi Arabia demonstrated dietary patterns or energy/nutrient intakes with limited information about Saudi’s perception about healthy food choices. Insights in the perceptions of healthy food choices are critical for developing targeted interventions to support Saudi population with the goal of improving healthy eating behaviors and, as a result, lowering the risk of diet-related diseases. Therefore, this study aimed to assess knowledge, attitude as well as the practice of people about healthy food choices in Saudi Arabia. The study employed a descriptive cross-sectional design with 303 participants included in the analysis. The popula-tion settings were at three primary healthcare centers in Tabuk city of Saudi Arabia. Data were collected through self-administered paper–pencil surveys to assess the knowledge, attitude, and practices of healthy food choices. Data were analyzed using the SPSS statistical software version 26. The results revealed that participants in this study performed above average in terms of their perceptions (knowledge, attitude, and practice) of healthy food choices. The major findings of this study showed that statistically significance difference was found between the place of residence in relation to the practices of healthy food choices (F 7,238 and p &lt; 0.05). A significant association was observed between knowledge of healthy food choices and marital status. Multiple comparisons post hoc tests indicated that the married group was a significantly different group at α = 0.044. Additionally, the relationship between monthly income groups and attitudes was statistically significant, with p &lt; 0.05. Findings of this study could assist health educators in developing appropriate programs, awareness messages, and community campaigns to improve perceptions about healthy food choices. The findings observed that considering why practicing healthy food choices that could lower the risk of diseases and promote optimal health could be a challenge.

A comparison of computational algorithms for the Bayesian analysis of clinical trials.

Clinical trials are increasingly using Bayesian methods for their design and analysis. Inference in Bayesian trials typically uses simulation-based approaches such as Markov Chain Monte Carlo methods. Markov Chain Monte Carlo has high computational cost and can be complex to implement. The Integrated Nested Laplace Approximations algorithm provides approximate Bayesian inference without the need for computationally complex simulations, making it more efficient than Markov Chain Monte Carlo. The practical properties of Integrated Nested Laplace Approximations compared to Markov Chain Monte Carlo have not been considered for clinical trials. Using data from a published clinical trial, we aim to investigate whether Integrated Nested Laplace Approximations is a feasible and accurate alternative to Markov Chain Monte Carlo and provide practical guidance for trialists interested in Bayesian trial design. Data from an international Bayesian multi-platform adaptive trial that compared therapeutic-dose anticoagulation with heparin to usual care in non-critically ill patients hospitalized for COVID-19 were used to fit Bayesian hierarchical generalized mixed models. Integrated Nested Laplace Approximations was compared to two Markov Chain Monte Carlo algorithms, implemented in the software JAGS and stan, using packages available in the statistical software R. Seven outcomes were analysed: organ-support free days (an ordinal outcome), five binary outcomes related to survival and length of hospital stay, and a time-to-event outcome. The posterior distributions for the treatment and sex effects and the variances for the hierarchical effects of age, site and time period were obtained. We summarized these posteriors by calculating the mean, standard deviations and the 95% equitailed credible intervals and presenting the results graphically. The computation time for each algorithm was recorded. The average overlap of the 95% credible interval for the treatment and sex effects estimated using Integrated Nested Laplace Approximations was 96% and 97.6% compared with stan, respectively. The graphical posterior densities for these effects overlapped for all three algorithms. The posterior mean for the variance of the hierarchical effects of age, site and time estimated using Integrated Nested Laplace Approximations are within the 95% credible interval estimated using Markov Chain Monte Carlo but the average overlap of the credible interval is lower, 77%, 85.6% and 91.3%, respectively, for Integrated Nested Laplace Approximations compared to stan. Integrated Nested Laplace Approximations and stan were easily implemented in clear, well-established packages in R, while JAGS required the direct specification of the model. Integrated Nested Laplace Approximations was between 85 and 269 times faster than stan and 26 and 1852 times faster than JAGS. Integrated Nested Laplace Approximations could reduce the computational complexity of Bayesian analysis in clinical trials as it is easy to implement in R, substantially faster than Markov Chain Monte Carlo methods implemented in JAGS and stan, and provides near identical approximations to the posterior distributions for the treatment effect. Integrated Nested Laplace Approximations was less accurate when estimating the posterior distribution for the variance of hierarchical effects, particularly for the proportional odds model, and future work should determine if the Integrated Nested Laplace Approximations algorithm can be adjusted to improve this estimation.

Prevalence of cosmetic surgery and its relationship with psychosocial status: a population based study in Sulaymaniyah, Iraq

Purpose This study aims to investigate the prevalence of cosmetic surgery and its relationship with the level of mental health and socioeconomic variables in Sulaymaniyah city in Iraq. Design/methodology/approach This descriptive-analytical and cross-sectional study was conducted on 941 subjects who were selected using multistage sampling method. Data were collected using a checklist as well as a questionnaire. Data analysis was done using chi-square test and multiple logistic regression model using Stata software version 20. Findings The prevalence of cosmetic surgery was 13.4% (female: 17.5%; male: 8.2%). The most common types of cosmetic surgery were rhinoplasty (7.6%) in women and hair transplant (5.5%) in men. Overall, rhinoplasty (7.6%) was the most common type of cosmetic surgery among both groups. In total, the prevalence of having symptoms of mental disorders was 34.5% and it was significantly higher among people with a history of cosmetic surgery (65.1%) than those without any experience of having cosmetic surgery (29.8%) (p &lt; 0.001). Being female (odds ratio [OR] = 2.07; 95% confidence interval [CI]: 1.33–3.22), having mild symptoms of mental disorders (OR = 2.76; 95% CI: 1.71–4.47) and having moderate or severe symptoms of mental disorders (OR = 7.48; 95% CI: 4.60–12.29) were among the important variables that could affect performing cosmetic surgery. Originality/value The prevalence of cosmetic surgery in Sulaymaniyah is high, and based on the findings of this study, gender and mental health status are effective factors in this regard. Designing targeted interventions is suggested with an emphasis on the findings of this study to reduce the rate of cosmetic surgeries.

The Link between Capital Adequacy and Financial Stability: Evidence from Deposit Taking Savings and Credit Co-Operative Societies in Kenya

In Kenya, financial stability of Deposit Taking (DT) Savings and Credit Cooperative Societies (SACCOs) as evident in non-performing loans of DT SACCOS has been an issue of concern over the past few years due to evidence indication fluctuating trends. Consequently, should this continue then this sector’s contribution to financial intermediation through provision of financial services will be negatively affected. Though DT SACCOs have sought to enhance their capital adequacy, its effect on enhancement of financial stability remains an issue for further empirical investigation. In view this, the study sought to investigate the effect of capital adequacy on financial stability of DT SACCOS in Kenya. The study was anchored on agency theory. Positivist research philosophy was adopted in this study. The study adopted explanatory research design. The target population for the study comprised 160 DT SACCOs which were fully operational in the period. A census approach was used for the study. This study utilized quantitative secondary data which was obtained from the society’s financial statements and supervision reports from the savings and credit cooperatives regulatory authority. The study utilized annual panel data for the period of 2017 to 2021. Multicollinearity test, normality tests, autocorrelation test, homoscedasticity, stationarity test and model specification test were carried out prior to panel data analysis. Data was analyzed using descriptive statistics, Pearson’s correlation analysis and panel regression analysis. STATA software was used for the analysis. Ethical standards and regulations were adhered to accordingly. The regression results revealed that capital adequacy had a significant negative effect on NPLs (β=-0.3249614, p-value=0.000&lt;0.05). In view of the findings, the study recommends that regulatory authorities in Kenya should take a proactive response in establishing and enforcing robust capital adequacy standards for DT SACCOs. In addition, higher levels of capital adequacy and improved management efficiency are associated with reduced NPLs ratio among DT SACCOs in Kenya, hence improved financial stability. Keywords: Capital Adequacy, Financial Stability, Deposit Taking, Savings and Credit, Co-Operative Societies

Construction of a prognostic model for extensive-stage small cell lung cancer patients undergoing immune therapy in northernmost China and prediction of treatment efficacy based on response status at different time points

Background and purposeRecently, the emergence of immune checkpoint inhibitors has significantly improved the survival of patients with extensive-stage small cell lung cancer. However, not all patients can benefit from immunotherapy; therefore, there is an urgent need for precise predictive markers to screen the population for the benefit of immunotherapy. However, single markers have limited predictive accuracy, so a comprehensive predictive model is needed to better enable precision immunotherapy. The aim of this study was to establish a prognostic model for immunotherapy in ES-SCLC patients using basic clinical characteristics and peripheral hematological indices of the patients, which would provide a strategy for the clinical realization of precision immunotherapy and improve the prognosis of small cell lung cancer patients.MethodsThis research retrospectively collected data from ES-SCLC patients treated with PD-1/PD-L1 inhibitors between March 1, 2019, and October 31, 2022, at Harbin Medical University Cancer Hospital. The study data was randomly split into training and validation sets in a 7:3 ratio. Variables associated with patients’ overall survival were screened and modeled by univariate and multivariate Cox regression analyses. Models were presented visually via Nomogram plots. Model discrimination was evaluated by Harrell’s C index, tROC, and tAUC. The calibration of the model was assessed by calibration curves. In addition, the clinical utility of the model was assessed using a DCA curve. After calculating the total risk score of patients in the training set, patients were stratified by risk using percentile partitioning. The Kaplan–Meier method was used to plot OS and PFS survival curves for different risk groups and response statuses at different milestone time points. Differences in survival time groups were compared using the chi-square test. Statistical analysis software included R 4.1.2 and SPSS 26.ResultsThis study included a total of 113 ES-SCLC patients who received immunotherapy, including 79 in the training set and 34 in the validation set. Six variables associated with poorer OS in patients were screened by Cox regression analysis: liver metastasis (P = 0.001), bone metastasis (P = 0.013), NLR < 2.14 (P = 0.005), LIPI assessed as poor (P < 0.001), PNI < 51.03 (P = 0.002), and LDH ≥ 146.5 (P = 0.037). A prognostic model for immunotherapy in ES-SCLC patients was constructed based on the above variables. The Harrell’s C-index in the training and validation sets of the model was 0.85 (95% CI 0.76–0.93) and 0.88 (95% CI 0.76–0.99), respectively; the AUC values corresponding to 12, 18, and 24 months in the tROC curves of the training set were 0.745, 0.848, and 0.819 in the training set and 0.858, 0.904 and 0.828 in the validation set; the tAUC curves show that the overall tAUC is > 0.7 and does not fluctuate much over time in both the training and validation sets. The calibration plot demonstrated the good calibration of the model, and the DCA curve indicated that the model had practical clinical applications. Patients in the training set were categorized into low, intermediate, and high risk groups based on their predicted risk scores in the Nomogram graphs. In the training set, 52 patients (66%) died with a median OS of 15.0 months and a median PFS of 7.8 months. Compared with the high-risk group (median OS: 12.3 months), the median OS was significantly longer in the intermediate-risk group (median OS: 24.5 months, HR = 0.47, P = 0.038) and the low-risk group (median OS not reached, HR = 0.14, P = 0.007). And, the median PFS was also significantly prolonged in the intermediate-risk group (median PFS: 12.7 months, HR = 0.45, P = 0.026) and low-risk group (median PFS not reached, HR = 0.12, P = 0.004) compared with the high-risk group (median PFS: 6.2 months). Similar results were obtained in the validation set. In addition, we observed that in real-world ES-SCLC patients, at 6 weeks after immunotherapy, the median OS was significantly longer in responders than in non-responders (median OS: 19.5 months vs. 11.9 months, P = 0.033). Similar results were obtained at 12 weeks (median OS: 20.7 months vs 11.9 months, P = 0.044) and 20 weeks (median OS: 20.7 months vs 11.7 months, P = 0.015). Finally, we found that in the real world, ES-SCLC patients without liver metastasis (P = 0.002), bone metastasis (P = 0.001) and a total number of metastatic organs < 2 (P = 0.002) are more likely to become long-term survivors after receiving immunotherapy.ConclusionThis study constructed a new prognostic model based on basic patient clinical characteristics and peripheral blood indices, which can be a good predictor of the prognosis of immunotherapy in ES-SCLC patients; in the real world, the response status at milestone time points (6, 12, and 20 weeks) can be a good indicator of long-term survival in ES-SCLC patients receiving immunotherapy.

Electronic Auditing and Its Impact on Achieving Quality Financial Reports An Exploratory Study at Al-Tafif Islamic Bank, Babylon Branch

This research aims to determine the effectiveness of electronic auditing in improving the quality of financial reports. To achieve the objectives of the study, a cross-sectional survey method was used to collect data from a sample of employees working at Al-Taif Islamic Bank (Babylon Branch), and primary data was collected using structured electronic Likert-scale questionnaires. SPSS statistical software was used to analyze the collected data; The results of the analysis concluded that electronic auditing improves the quality of financial reports in Iraq. The study concluded that banks should adopt the effective and expanded use of electronic auditing because it provides independent, honest and reliable financial audit information. Banks in Iraq must adopt effective and expanded use of electronic auditing to ensure the detection of financial fraud, thus closing routine financial loopholes.

The roots of legitimacy in ethnic-cultural festivals and their influence on residents’ loyalty: an analysis of two Brazilian Oktoberfests

PurposeLegitimacy is a classic theme, quite present in organisational studies in general, but in the field of tourism it still has room to advance. For that reason, this research seeks to delimit the concept of legitimacy and adapt it to the context of tourism events; and seeks to validate a measurement instrument that allows to evaluate of its recognition in the imagination of residents, and to evaluate the impacts of this construct on residents’ trust in the organisers of Brazilian Oktoberfest, on the negative externalities of those events and, ultimately, on the achievement of residents’ loyalty.Design/methodology/approachThe locus of the research are the cities of Blumenau, Santa Catarina and Santa Cruz do Sul, Santa Catarina, both located in southern Brazil, whose residents answered an online questionnaire about the legitimacy of the Oktoberfest held there. A total of 365 valid questionnaires were collected, tabulated in statistical software and interpreted using exploratory-confirmatory factor analysis and structural equation modelling.FindingsThe results show that festival legitimacy is a theoretical construct that can be measured as either a first-order or second-order factor, consisting of three factors, called moral legitimacy, pragmatic legitimacy and cognitive legitimacy.Originality/valueThis research provides a valid and reliable tool for assessing local residents' acceptance of ethno-cultural festivals. It also shows variations in the perception of legitimacy, demonstrating that this can influence other aspects of residents' perception of ethnocultural events.

A feasibility study using motivational interviewing and a smartphone application to promote physical activity (+Stay-Active) for women with gestational diabetes

BackgroundPhysical activity (PA) interventions have an encouraging role in gestational diabetes mellitus (GDM) management. Digital technologies can potentially be used at scale to support PA. The aim of this study was to assess the feasibility and acceptability of + Stay-Active: a complex intervention which combines motivational interviewing with a smartphone application to promote PA levels in women with GDM.MethodsThis non-randomised feasibility study used a mixed methods approach. Participants were recruited from the GDM antenatal clinic at Oxford University Hospitals. Following baseline assessments (visit 1) including self-reported and device determined PA measurements (wrist worn accelerometer), women participated in an online motivational interview, and then downloaded (visit 2) and used the Stay-Active app (Android or iOS). Women had access to Stay-Active until 36 weeks’ gestation, when acceptability and PA levels were reassessed (visit 3). The primary outcome measures were recruitment and retention rates, participant engagement, and acceptability and fidelity of the intervention. Secondary outcome measures included PA levels, app usage, blood glucose and perinatal outcomes. Descriptive statistics were performed for assessments at study visits. Statistics software package Stata 14 and R were used.ResultsOver the recruitment period (46 weeks), 114 of 285 women met inclusion criteria and 67 (58%) enrolled in the study. Mean recruitment rate of 1.5 participants/clinic with 2.5 women/clinic meeting inclusion criteria. Fifty-six (83%) received the intervention at visit 2 and 53 (79%) completed the study. Compliance to accelerometer measurement protocols were sufficient in 78% of participants (52/67); wearing the device for more than 10 h on 5 or more days at baseline and 61% (41/67) at 36 weeks. There was high engagement with Stay-Active; 82% (55/67) of participants set goals on Stay-Active. Sustained engagement was evident, participants regularly accessed and logged multiples activities on Stay-Active. The intervention was deemed acceptable; 85% of women rated their care was satisfactory or above, supported by written feedback.ConclusionsThis combined intervention was feasible and accepted. Recruitment rates were lower than expected. However, retention rates remained satisfactory and participant compliance with PA measurements and engagement was a high. Future work will explore the intervention’s efficacy to increase PA and impact on clinical outcomes.Trial registrationThe study has received a favourable opinion from South Central—Hampshire B Research Ethics Committee; REC reference: 20/SC/0342. ISRCTN11366562.

Determinants of Disease Progression in Bangladeshi COVID-19 Patients: A Cross-sectional Survey

Background Coronavirus disease 2019 (COVID-19) shows a wide range of clinical manifestations, including asymptomatic presentation to severe pneumonia, acute respiratory distress syndrome, and respiratory failure. Although COVID-19 disease progression was studied elsewhere, it is largely unknown in Bangladesh. Methods We conducted this cross-sectional study in November 2020 to January 2021 on patients diagnosed with COVID-19 confirmed by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). Pearson chi-square tests were used to assess the disease progressions across selected variables. A logistic regression model was used to assess the associated factors of COVID-19 infection for explanatory variables. All statistics were performed using the Stata software version 14.0 (Stata corporation, college station, Texas, USA). Results A total of 384 of respondents were involved in the survey. Of participants, most males (73%), unmarried (69%), aged 18 to 35 years during survey, and lived in urban community (73%). Overall, 41% of patients were in asymptotic condition, 44% were in mild condition, while 17% were moderate to severe conditions. Male patients and patients over 50 years had severe symptoms, accounting for 52% and 50%, respectively. Nearly half of business persons and office employees had severe symptoms. Almost all married patients (98%) had severe symptoms. The severity of symptoms was also higher for patients living in urban areas (79%), smoking (95%), and not physically active (52%). Patients with diabetes, asthma/COPD, and cancer were significantly associated with severe stage of COVID-19 (p≤0.05). Patient’s age, gender, smoking status, diabetics, working conditions significantly affect Covid-19 disease progression. Conclusion The study found that 7.03% of patients had severe, 9.11% had moderate and 40.36% had asymptomatic conditions. The heterogenic association between the disease progressions with age, sex, residence, marital status, smoking habits, diabetes, physical exercise, working conditions, sedentary lifestyles. Findings highlight the idea of using vulnerability ratings for each risk factor related to disease progression.

Investigating the trend of demographic changes, mortality, clinical and paraclinical findings of patients hospitalized in the Corona ward, before and after the start of general vaccination of COVID-19

BackgroundPrioritizing prevention over treatment has been a longstanding principle in the world health system. This study aims to compare the demographic changes, mortality, clinical, and paraclinical findings of patients hospitalized in the Corona ward before and after the start of general vaccination.MethodsThis cross-sectional study utilized the simple random sampling method in 2022, analyzing 300 medical records of patients admitted to the Corona ward at 22 Bahman Khaf Hospital. Data were collected using a checklist with the help of the Medical Care Monitoring System and analyzed using SPSS-22 statistical software and Chi-square statistical test at a significance level of p < 0.05.ResultsBefore the start of general vaccination for COVID-19, the majority of patients were hospitalized in the Corona Intensive Care Unit (59.3%), aged between 51 and 65 years (47.3%), hospitalized for more than 3 days (54%), required intubation (49.3%), had SPO2 < 93% (60.7%), and exhibited common symptoms such as cough, shortness of breath, and loss of consciousness. Paraclinical findings included positive CRP, decreased lymphocytes, and ground glass opacity (GGO). After the start of general vaccination for COVID-19, most patients were hospitalized in the general care department of Corona (68%), aged between 36 and 50 years (47.3%), hospitalized for less than three days (66%), required intubation (20%), had SPO2 ≥ 93% (77.3%), and exhibited common symptoms such as weakness, headache, and body pain. Paraclinical findings were within the normal range.ConclusionsGeneral vaccination for COVID-19 has significantly reduced patient mortality and morbidity. Health policymakers should prioritize general vaccination to achieve herd immunity and improve public health.