Wilcoxon Matched Pairs Test Research Articles

Music Therapy And Effective Communication Reduces Anxiety Levels In Welcoming Childbirth

Labor pain is a physiological condition that can hinder the delivery process. Excessive pain can disturb the body's homeostasis which can result in excessive and useless energy. Reducing the pain scale can be done by fermacological and non-fermacological measures. It's normal for pregnant women and mothers to experience pain. Measuring the pain scale using the Numerical Rating Scale (NRS) and quasi-experiments. Music therapy is a form of implementation that uses music and songs in an integrated and directed manner to guide mothers in pregnancy with the aim that pregnant women feel relaxed, early stimulation of the fetus. Effective intrapersonal communication between a midwife can help a mother overcome depression during pregnancy and childbirth. It can also help patients stay positive throughout the pregnancy and delivery process, making it fun and easy to deal with issues that arise while raising a child. The anxiety level score in the pre-test measurement is higher than the post-test measurement, indicated by the mean value in the pre-test (22.67) higher than the post-test (16.77) which means that there is a decrease in the anxiety level score in the respondents before and after intervention. The results of this study were that there was a significant effect of classical music therapy on reducing the anxiety level of third-trimester pregnant women. This was evident from the statistical test used, the Wilcoxon Match Pairs Test, with a result (p=0.000) less than (<0.05). The researcher's assumption is that music therapy can distract pregnant women so as to reduce maternal anxiety in welcoming labor and effective communication between midwives and pregnant women can motivate pregnant women to be brave in facing labor and reduce anxiety in welcoming labor.

Longitudinal study on MRI and neuropathological findings: Neither DSC-perfusion derived rCBVmax nor vessel densities correlate between newly diagnosed and progressive glioblastoma.

When evaluating MRIs for glioblastoma progression, previous scans are usually included into the review. Nowadays dynamic susceptibility contrast (DSC)-perfusion is an essential component in MR-diagnostics of gliomas, since the extent of hyperperfusion upon first diagnosis correlates with gene expression and survival. We aimed to investigate if this initial perfusion signature also characterizes the glioblastoma at time of progression. If so, DSC-perfusion data from the initial diagnosis could be of diagnostic benefit in follow-up assessments. We retrospectively identified 65 patients with isocitrate dehydrogenase wildtype glioblastoma who had received technically identical DSC-perfusion measurements at initial diagnosis and at time of first progression. We determined maximum relative cerebral blood volume values (rCBVmax) by standardized re-evaluation of the data including leakage correction. In addition, the corresponding tissue samples from 24 patients were examined histologically for the maximum vessel density within the tumor. Differences (paired t-test/ Wilcoxon matched pairs test) and correlations (Spearman) between the measurements at both timepoints were calculated. The rCBVmax was consistently lower at time of progression compared to rCBVmax at time of first diagnosis (p < .001). There was no correlation between the rCBVmax values at both timepoints (r = .12). These findings were reflected in the histological examination, with a lower vessel density in progressive glioblastoma (p = .01) and no correlation between the two timepoints (r = -.07). Our results suggest that the extent of hyperperfusion in glioblastoma at first diagnosis is not a sustaining tumor characteristic. Hence, the rCBVmax at initial diagnosis should be disregarded when reviewing MRIs for glioblastoma progression.

An assessment of the dose and image quality difference between AP and PA positioned adult radiographic knee examinations

IntroductionKnee X-rays are a standard examination to diagnose multiple conditions ranging from traumatic injuries, degeneration, and cancer. This study explores the differences between adult Anterior-Posterior (AP) and Posterior-Anterior (PA) weight-bearing knee examinations using absorbed radiation dose data and image quality. MethodsThe study modelled and compared AP and PA knee X-ray radiation dose data using Monte-Carlo software, an Ion Chamber, and thermoluminescence dosemeters (TLDs) on a Rando phantom. Imaging parameters used were 66kVp, 4mAs, 100cm distance and 13 × 24cm collimation. The interval data analysis used a two-tailed t-test. The image quality of a sample of the AP and PA knee X-rays was assessed using Likert 5-point ordinal Image Quality Scoring (IQS) and the Wilcoxon matched pairs test. ResultsMonte-Carlo modelling provided limited results; the Ion Chamber data for absorbed dose provided no variation between AP and PA positions but was similar to the AP TLD dose. The absorbed doses recorded with batches of TLDs demonstrated a 27.4% reduction (46.1μGy; p=0.01) in Skin Entrance Dose (ESD) and 9 - 58% dose reduction (1.6 – 16.4μGy; p=0.00-0.2) to the tissues and organs while maintaining diagnostic image quality (p=0.67). ConclusionThe study has highlighted the various challenges of using different dosimetry approaches to measure absorbed radiation dose in extremity (knee) X-ray imaging. The Monte-Carlo simulated absorbed knee dose was overestimated, but the simulated body organ/tissue doses were lower than the actual TLD absorbed doses. The Ion Chamber absorbed doses did not differentiate between the positions. The TLD organ/tissue absorbed doses demonstrated a reduction in dose in the PA position compared to the AP position, without a detrimental effect on image quality. The study findings in laboratory conditions raise awareness of opportunities and potential to lower radiation dose, with further study replicated in a clinical site recommended.

Effect of Hemibridge with Ball and Balloon Exercise on Balance, Gait Speed, Fear of Fall, and Quality of Life in Elderly – A Randomized Controlled Trial

Context: Hemibridge with ball and balloon exercise causes co-contraction of the core, pelvic floor muscles, and lower limb muscles. However, limited data exist about the efficacy of these exercises in elderly individuals. Aim: The aim of this study was to determine the effect of hemibridge with ball and balloon exercise on balance, gait speed, fear of falls, and quality of life in elderly individuals. Settings and Design: A randomized controlled trial was conducted at a tertiary care center and old age homes. Subjects and Methods: Thirty-six (n = 36) elderly individuals were randomly allocated to the control and experimental groups. The control group received conventional balance training, while the experimental group received hemibridge with ball and balloon exercises with conventional balance training exercises. The outcome measures were the Timed-Up and Go test (TUG), 4-m gait speed (4MGS) test, Short Falls-Efficacy Scale (SFES), and RAND 36-Item Short-Form Survey (SF-36). Both groups received treatment for 3 weeks with three sessions a week. Statistical Analysis: The test used for between-group analysis was the Mann–Whitney U-test and for within-group analysis was the Wilcoxon matched-pair test. Results: The between-group results for TUG, 4MGS test, and SFES for the experimental group showed a statistical significance compared to the control group. However, the results of the RAND SF-36 health survey for the experimental group were not statistically significant compared to the control group. Conclusion: Hemibridge with ball and balloon exercise with conventional balance exercises showed beneficial effects on balance, gait speed, fear of falls, and quality of life for the elderly.

Association between serum levels of 12 different cytokines and short-term efficacy of anti-PD-1 monoclonal antibody combined with chemotherapy in advanced gastric cancer.

Gastric cancer (GC) is characterized by aggressive tumor growth and poor prognosis. The benefits of targeted anti-programmed death receptor 1 (PD-1) monoclonal antibody combined with chemotherapy have not yet been characterized. The tumor microenvironment and circulating factors have garnered interest as possible predictors of response and prognosis. The aim of this study was to evaluate whether cytokine levels in the serum of patients were related to tumor response to anti-PD-1 monoclonal antibody combined with chemotherapy and survival in advanced GC. Preoperative serum samples were collected from patients with GC (n=52) and healthy individuals (n=31). The levels of 12 different cytokines were measured using a multiple microsphere flow immunofluorescence assay. The association between cytokine levels and clinical response was analyzed using nonparametric Wilcoxon matched-pair ranked tests. Progression-free survival (PFS) time for all patients was recorded via evaluation of imaging results and follow-up via telephone. Kaplan-Meier and log-rank tests were used to plot survival curves. The levels of interleukin (IL)-6, IL-1β, interferon (IFN)-γ, IL-17, and IL-12p70 in the control group were significantly lower than those in the GC group (p=0.0002, p=0.0065, p=0.0003, p=0.0303, and p=0.0295, respectively). The level of IL-4 was significantly higher in healthy individuals than that in patients with GC (p=0.0201). The cytokine levels in the good responder group were higher than those in the poor responder group before therapy. Patients treated with immunochemotherapy showed an overall reduction in all cytokine levels after treatment initiation. A high baseline level of IFN-γ was associated with a better prognosis. However, high IL-6 levels in patients after two cycles of immunochemotherapy indicated resistance. High IL-4 levels in patients treated with four cycles of immunochemotherapy were associated with better PFS. Our study suggests that low levels of IFN-γ before immune checkpoint inhibitor treatment may be useful for the detection of a poor immunological status. Hence, a reduction in IL-6 levels is predictive of a longer PFS, and increased IL-4 levels are predictive of a good response. IL-4 and IL-6 may, therefore, serve as promising circulating predictive biomarkers for patients who can benefit from anti-PD-1 monoclonal antibodies administered in combination with chemotherapy.

The "Know Your Lemons" Tools: A strategy to improve breast cancer warning signs recognition in Malaysia.

Breast cancer (BC) is the most common cancer in Malaysia, with many diagnosed at late stages. The "Know Your Lemons" (KYL) visual educational tools were developed by KYL Foundation. This study aimed to evaluate participants' confidence levels and perceived knowledge in identifying BC symptoms before and after exposure to KYL tools. A cross-sectional study was carried out among 788 participants in three KYL health campaigns from 2017 to 2020. Perceived knowledge (a 5-item Likert scale was used, zero means "very poor" and 4 means "excellent knowledge") and confidence in identifying BC symptoms were studied. A Wilcoxon Matched-Paired Signed-Rank Test was performed to assess the perceived knowledge. There was a significant improvement in the perceived knowledge Mean (±SD) score (2.84 ± 1.02) versus (4.31 ± 0.66) before and after the campaign (P < 0.01). About 95.6% agreed that the language used in KYL materials was clear and understandable, 89.8% agreed it is acceptable in Malaysian culture, and 80% felt more confident in identifying BC symptoms. Therefore, 90.8% had the intention of breast self-examination and 90.8% would consult a doctor if symptomatic. The majority (92.7%) agreed that the KYL tools clarified the BC tests needed. The KYL tools enhanced perceived BC symptom recognition knowledge and confidence levels.

Investigating the effects of Argireline in a skin serum containing hyaluronic acids on skin surface wrinkles using the Visia® Complexion Analysis camera system for objective skin analysis.

To analyze the effects of Argireline on skin surface wrinkles using the Visia® camera system developed by Canfield Scientific Inc., U.S.A., for facial image capture. Nineteen female participants were recruited from a plastic surgery clinic. Initial facial images captured the left, front, and right sides of the participants' faces, which were documented as timepoint one. Following this, the participants immediately began to apply a facial skin serum containing triple hyaluronic acids produced by CNC cosmetic GmbH, Philippsburg, Germany. The serum was applied once in the morning and once in the evening. Participants received two identical containers labeled L for left and R for right, with each container to be used on the corresponding facial side, particularly around the eye area. One container contained Argireline, a synthetic hexapeptide, which previously was deemed to be a biosafe alternative to botulinum neurotoxin. The study was conducted as double-blind; neither the participants nor researchers knew which of the two containers contained Argireline. Participants were allowed to use their own cosmetic products throughout the study. After four weeks, the participants returned to have their faces recaptured using the Visia® camera, which was documented as timepoint two. The absolute scores of the wrinkles were noted, and results on both sides of the face were calculated and compared. The "TruSkinAge®" measurement provided by the Visia® camera was reviewed for each face side. Results between both time points and both sides of the face were compared. After the data analysis was complete, the company was contacted to determine which container contained Argireline. Nineteen participants returned for facial image capture. There were no significant adverse events, allergic reactions, or skin irritations. The investigation revealed that the wrinkle score slightly decreased for the right and left side of the face following four weeks of serum application. However, this decrease was not significant (p>0.05) based on the Wilcoxon matched pairs tests for the wrinkle scores (right side p=0.060 and left side p=0.176) and Truskin Ages® results (right side p=0.096 and left side p=0.489).Comparing the data from the right side with that from the left side of the face revealed that neither demonstrated a significant reduction in wrinkle score (p=0.829) or Truskin Ages® results (p=0.804). Argireline was included in the serum applied to the right side of the face. However, no statistical significance was seen in the results on this side of the face indicating any possible effects. Wrinkle scores and Truskin Ages® results were observed to decrease non-significantly following the application of a skin serum involving hyaluronic acid. The Visia® imaging method was used to analyze the data objectively. Differences between both sides of the face that were treated with and without Argireline were not statistically significant. Therefore, the effect of Argireline was not proven. While Argireline presented with low toxicity, its efficacy was found not to be significant. Therefore, it is not deemed to be an alternative treatment to botulinum toxin.

Knowledge improvement of agricultural extender through technical guidance of paddy soil test kit

Paddy Soil Test Kit is one of the appropriate instruments to determine the nutrient status of lowland paddy and preparation of site-specific fertilization recommendations to increase rice productivity. Agriculture extension agents as technology transfer agents have a strategic role. Technical Guidance is needed to improve knowledge of agriculture extension. This study aims to analyze the level of knowledge of agricultural instructors on Technical Guidance use of Paddy Soil Test Kit and Preparation of Site-Specific Fertilization Recommendations. Data collection was carried out before and after implementation of Technical Guidance through direct interviews with a questionnaire guide. The evaluation was carried out on all participants of technical guidance, totaling 32 extension workers from representatives of 11 sub-districts throughout Bengkulu Selatan Regency by providing pretest and posttest to determine the increase in knowledge of Technical Guidance participants. The level of knowledge of participants is calculated using index % formula. The significance of increasing knowledge of technical and technical training participants was analyzed using non-parametric Wilcoxon Match Pairs Test statistical analysis. Correlation test to determine level of knowledge on age, experience, and education. Results of the analysis showed that there was a very significant increase (&lt;0.05) in the knowledge of officers after the implementation of technical guidance from an index of 52.58% (low category) to 84.83% (high category). There is no correlation between increasing knowledge about Paddy Soil Test Kit with age (sig &gt; 0.05) which is 0.571, experience 0.661, and education 0.130.

The Effect of Counterpressure Massage on Reducing Pain Intensity in Active Phase I in The Working Area of Kintamani VI Health Center

Labor pain is a physiological condition that is experienced by almost all birthing mothers, but if it is not handled properly it will cause problems. Efforts made to reduce labor pain can use pharmacological and non-pharmacological methods. One of the efforts of non-pharmacological methods is massage counterpressure. The purpose of this study was to determine the effect of knowing counterpressure massage on reducing pain intensity during the first active phase in women giving birth. This study used a pre-experimental design with a one group pre-post test design with a sample size of 20 people. The data collection method used SOP massage counterpressure and VDS (Verbal Descriptor Scale) pain scale observation sheets and the sampling technique used was incidental sampling. Data analysis using the Wilcoxon Match Pairs test. The results of the study showed a value of p = 0.001 &lt;0.05, so it was concluded that there was a significant difference in counterpressure massage in reducing pain in the first active phase of normal labor in the Working Area of the Kintamani VI Health Center.

THE TAX COMPETITION AMONG EUROPEAN COUNTRIES

Background: Taxes are and form the necessary basis for any form of organization in human society. Aims: The aim of the paper is to quantify the outputs of the tax competition among European countries. Specifically, we focus on studying the International Tax Competitiveness Index (ITCI) in the European area and on assessing how this aspect is time dependent. First, we try to find out whether there is a statistically significant relationship in the overall ranking within the ITCI of the surveyed European countries in time. Besides that, we try to confirm whether if the country is at the forefront within the GDP per capita, this country will also be at the forefront of the ITCI. Sample: The research sample consists of 27 European countries, for which the overall ranking of the ITCI and GDP per capita (by purchasing power parity (PPP)) were available from 2014 to 2020. Methods: We use the Spearman correlation coefficient, Sign test, and Wilcoxon Matched Pairs Test to verify the hypotheses. Results: The results show that variations in the country's level of ITCI change only slowly over time, and it is hard to modify them significantly. Moreover, we present the ranking of European countries within ITCI in 2014-2020 and the ranking within the level of GDP per capita (by PPP). Conclusions: We can confirm the assumption that if the country is at the forefront of the ITCI, this country will be located at the forefront of the GDP per capita (by PPP) indicator. Implications: The country's tax system is an important determinant of the country's economic performance.

1087 QUANTITATIVE CHANGES IN INTRACARDIAC FLOW PARAMETERS DURING HEMODIALYTIC SESSIONS

Abstract Background Hemodialysis sessions exert an acute impact on cardiac geometry and mechanics. The recent development of quantitative measurement of intracardiac fluid-dynamics offers a new opportinuty to better understand the fine changes in intracardiac cardiac hemodynamics associated with hemodialysis sessions. Our aim was to assess the impact of an hemodialytic session on intracardiac flow dynamics. Methods We included 26 consecutive patients on chronic hemodialysis in clinically stable phase. They underwent echocardiography including intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler) before and after a single dialysis session. Patients with hemodynamically relevant valvular disease were excluded. A complete fluid-dynamics evaluation included the measurement of multiple parameters such asvortex area (VA); vortex length (VL); vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. Changes in fluidodynamics after dialysis sessions were tested using the Wilcoxon matched-pairs test. Results Mean Vortex Area (VA) (p=0.034), Vortex Depth (VD) (p=0.024) and Vortex Length (VL) (p=0.037) were significantly reduced after the dialysis session. A similar trend towards the reduction of Direct Flow (DF) parameter after the session was found, which was significantly larger for patients with larger baseline left ventricular (LV) end-diastolic diameter (r=0.446; p=0.037). On the other hand, mean Vortex Intensity (VI) was significanlty increased after dialysis (p=0.046). Among energy parameters, the intradialytic change in Kinetic Energy Fluctuation (KEF) (r=0.4; p=0.058) and Shear Stress Fluctuation (SSF) (r=0.435; p=0.038) were most closely correlated with intradialytic weigth change. Some fluid-dynamic parameters had similar trends of intradialytic change, with stonger correlations among geometric parameters. Delta changes in VA were closely related to changes in VI (p&amp;lt;0.001) or LV (p&amp;lt;0.001). VI was also correlated with VL (p&amp;lt;0.001) and with Kinetc Energy Dissipation (KED) (p=0.030), which was also correlated with VL (p=0.044). KEF was correlated with KED (p=0.001) and SSF (p=0.022). Finally, chenges in SSF were correlated with those in Flow Force Parameter (p=0.033) and Flow Force Angle (p=0.034), that were very closely correlated each other (p&amp;lt;0.001). Discussion This is the first study assessing the impact of hemodialytic sessions on intracardiac flow dynamics. Measurement of hyperdoppler indices on hemodialysis chair was feasible and reliable in the whole population. Our results uncovered quantitative chenages of echocardiographic parameters of vortex geometry and energy during hemodialysis.

Air purifiers, comparison between real and declared surface for use: fake it or make it?

Abstract Introduction Air pollution has been recognized as one of the major risk factors for the global burden of disease. In modern society, most exposure occurs indoors, and air quality may be improved with air purifiers utilizing various cleaning techniques. This analysis aims to evaluate whether recommended room surface in which to use these devices as declared by producers is actually in line with their real effective area of activity. Methods A review of devices for the purification of the air was carried out between January-April 2022. Four different types of air purifiers were considered based on the adopted technologies: I) HEPA filters and UV lamps; II) only with HEPA filters; III) only UV lamps and IV) those using other technologies. For each group, based on the CADR (Clean Air Delivery Rate) provided by the producers, the optimal real surface area of the room to use the device was calculated, referring to the standard EN779:2012. This value was compared with the recommended area of the room declared by the producers. Descriptive statistics and Wilcoxon matched pair test used for comparisons. The significance level was set at p &amp;lt; 0.05. Results The analysis was carried out on 252 devices; I) 52 had HEPA filters + UV lamps, with a recommended mean room area of 40 m2 (IQR 49.75), II) 142 devices had only HEPA filters with 52.5 m2 (IQR 46.75), III) 27 devices only UV lamps, 40 m2 (IQR 105), IV) 31 devices with other technologies, 54 m2 (IQR 84.2). As required by EN779:2012, the effective area of activity was calculated using CADR x 0.075: the medians of the 4 groups were I) 12 m2 (IQR 16.5), II) 15.83 m2 (IQR 26.4), III) 4.5 m2 (IQR 22.5), IV) 7.5 m2 (IQR 21.53), respectively. Comparing declared and calculated CADR values, all the groups showed significant differences (p &amp;lt; 0.05). Conclusions Results show that recommended surfaces derived from CADR declared by producers largely overestimate the real volume of the room that devices can purify, whatever the technology used. Key messages • There’s no correspondence between recommended area of room to be sanitized indicated by producers of air purifiers and area that they are actually able to sanitize, which is significantly lower. • It is necessary to be aware of the difference between data indicated by producers and real data, in order to purchase a device that actually corresponds to dimensional needs of the environment itself.

Cerebrospinal fluid characteristics of patients treated with intrathecal nusinersen for spinal muscular atrophy.

There is limited information on the potential effects of repeated intrathecal antisense oligonucleotide drug delivery on cerebrospinal fluid (CSF) biochemical and blood cell profiles. This study aimed to examine longitudinal changes in the biochemical components (glucose, protein) and blood cell counts in the CSF of spinal muscular atrophy (SMA) patients treated with intrathecal nusinersen. We collected and analyzed clinical and CSF parameters (cell count, protein, glucose, culture) of 50 individuals with SMA during nusinersen treatment (22 type 1, 17 type 2, and 11 type 3). The median protein concentration at baseline and during treatment was within the normal range but rose during treatment and was significantly above baseline at the time of the ninth intrathecal injection (p= 0.02, two-tailed Wilcoxon matched-pairs test, and p= 0.0015, Friedman test for repeated measures). Further analysis showed that the increase in CSF protein concentration was evident for SMA types 2 and 3 patients, but not for type 1. This observation was also demonstrated by a significant correlation between the SMN2 gene copy number and the increase in CSF protein concentration (Spearman rank correlation test). Our results demonstrate that a delayed increase in CSF protein concentration is expected during nusinersen treatment for SMA types 2 and 3. This might reflect the medication's effect and a possible therapeutic biochemical marker.

Perbandingan Kinerja Keuangan Perusahaan Sektor Kesehatan yang Terdaftar di Bursa Efek Indonesia Sebelum dan Saat Pandemi Covid-19

The purpose of this study is to compare the financial performance of healtcare sector companies listed on the IDX before and during the Covid-19 pandemic. The type of data used is secondary data in the form of company financial report data for the 2018-2021 period. The research method used is a comparative descriptive method with a quantitative approach. The sampling technique used was purposive sampling. Financial performance is measured using the CR, TATO, DAR, DER, ROA and REO. Hypothesis testing using Paired sample t-test and Wilcoxon Match Pair Test. The test results show that there is no significant difference in financial performance before and during the pandemic when measured by TATO, DAR, DER, ROA, and ROE. Meanwhile, if measured by CR, it shows that there is a significant difference between financial performance before and during the covid-19 pandemic.

Spine kinematics in patients with Parkinson's disease with and without Freezing of Gait

Despite the importance of spine and upper limb movements in walking, most of previous studies on human locomotion focused exclusively on lower limbs [1]. Patients with Parkinson’s disease (PD) are characterized by trunk postural alterations and reduced limb movements [2,3]. It is still unclear to what extent postural alterations in PD concur to, or counteract, poor balance [3]. Specifically, their contribution to the occurrence of freezing of gait (FoG), an episodic failure of forward stepping exposing patients to high risk of falls, is yet to be fully elucidated. We aimed at characterizing spine kinematics in PD patients with and without FoG during walking and standing. We investigated linear gait in a cohort of 14 patients with PD. They were grouped into patients with (PDF, N=6, Unified Parkinson Disease Rating Scale part III [UPDRS-III]: 35(23-49)) and without FoG (PDNF, N=7, UPDRS-III: 31(12-48)), based on their clinical history. All patients performed the experimental protocol after overnight suspension of all dopaminergic drugs (meds-off). They were instructed to perform at least three trials of barefoot walking at self-selected speed on a walkway of 8 meters. A session of quiet standing of about 60 s ended the experiment. Kinematics was monitored by means of a full body marker protocol [4]. Three markers placed on the seventh cervical vertebrae (C7), the maximum kyphosis, and a virtual marker reconstructed in correspondence of the coccyx served as reference points for the calculation of the lordosis and kyphosis spine angles. Specifically, the coccyx was reconstructed in the pelvis reference system based on previous radiography studies [5]. The distance between the C7 and the middle point between the posterior-superior iliac spines (MID-PSIS) was used to estimate the rachis length. Height of the C7 and MID-PSIS were also computed. Trunk inclination was defined as the angle between the vertical axis of the laboratory and the line connecting C7 and MID-PSIS. The shoulder-pelvis angle was computed as the angle between the line connecting the two acromion and the line connecting the anterior superior iliac spines and projected to the frontal and horizontal planes of the pelvis reference system. For the walking sessions, all variables were computed and averaged across gait cycles at steady-state velocity. For the standing sessions, variables were averaged over time. A Kruskal–Wallis test identified differences between groups for each condition (i.e., walking and standing). A Wilcoxon matched-pair test was used to compare standing and walking conditions inside each group. Threshold for statistical significance was set at 0.05. No differences between groups were found in the spine variables during standing and walking. PDF showed higher values of the shoulder-pelvis angles in the frontal plane only during the standing condition. During walking, the average height of the MID-PSIS decreased with respect to standing in both groups, while C7 height decreased selectively in the PDNF group, despite a trend was present also in the PDF group. Only PDNF patients showed increased trunk inclination during walking with respect to standing. Our analyses did not show a clear difference in the spine kinematics during gait and standing between PDF and PDNF patients. We speculate that trunk postural alterations may not be at the basis of the occurrence of FoG, but rather be compensatory (ineffective) attempts to overcome this symptom. Considering the small sample size employed in our study, further analyses on larger cohorts are warranted to confirm these preliminary results.

Protocol based pain management by Ayurveda parasurgical procedures W.S.R to musculoskeletal pain and its critical appraisal – An open labeled clinical trial

BackgroundPain has globally become an attention problem which causes discomfort by affecting the body as well as the mind. The International association of pain estimated that 1 in 5 patients experiences the pain, i.e. 30% of world population. 19.3% (180–200 million) of the total population in India suffer from chronic pain and its severity appeals early approach of patients to hospitals. Ayurveda being the oldest medical science emphasized its importance and treatment of pain with both pharmacological and non-pharmacological (Parasurgical) methods. ObjectiveTo evaluate the efficacy of non-pharmacological (para surgical) procedures in the management of pain. Materials and methodTotal 100 patients with chronic musculoskeletal pain fulfilling the inclusion criteria were recruited by assessing the site, severity and nature of pain. A special protocol was framed by incorporating Ayurveda treatment principles by using Para surgical procedures such as Agnikarma (Therapeutic burn), Jalauka (leech therapy), Alabu (Cupping therapy) and Siravyadha (Vein puncture). The parameters like VAS and VDS pertaining to pain were assessed from baseline and at various time points. Statistical analysis was performed by using Wilcoxon match paired test to assess the results. ResultsThe VAS and VDS scale were used to assess the efficacy of para-surgical procedures which was found to be significant (p < 0.0001) from baseline and at various time points. ConclusionProtocol based pain management by various para surgical procedures was found effective in the management of chronic musculoskeletal pain. The ambiguity in selection of proper parasurgical procedure for pain management is justified by following the protocol.

Novel pictograms to improve pharmacist understanding of the number needed to treat (NNT)

IntroductionNumber needed to treat (NNT) is a clinically useful “yardstick” used to gauge the efficacy of therapeutic interventions. The objective of this project was to develop and pilot a series of pictograms and assess their impact on pharmacist understanding of the NNT. MethodsThree decision aids containing NNT pictograms were developed following a preliminary literature review and three focus groups with current Australian-registered pharmacists and pharmacist interns. Pharmacists then tested the pictograms in a research pilot in clinical encounters until (1) ≥ 3 sessions had occurred or (2) a two-week period had elapsed from commencement. Knowledge assessment was administered both pre- and post-pilot. Transcription and inductive thematic analysis were applied to focus group data. Descriptive statistics, Wilcoxon signed rank, and McNemar's tests were used to analyse the pilot data. ResultsSix core themes regarding NNT decision aid development were identified with >80% consensus across three focus groups (N = 11). Comparison of the pre-post measures (n = 10) showed an increase in median scores after use of NNT decision aids, correlating to a moderate Cohen classified effect size (d = 0.54). Wilcoxon matched pairs test demonstrated a statistically insignificant influence of NNT pictograms on the knowledge assessment survey (P > .05). ConclusionsWhile the NNT is not a new concept, its incorporation as part of pictograms for health practitioner enrichment is novel. This pilot study suggests that utilizing decision aids with NNT pictograms as counselling adjuncts appears promising in the realm of enhancing pharmacists' understanding of the NNT.

Body Balance of Children and Youths with Visual Impairment (Pilot Study).

Aim: The study was designed to assess the effects of surface instability in the response of the balance control system in children and youths with visual impairment (BL) and in normally sighted controls (NE). Materials and Methods: The empirical research study involved 80 individuals, aged from 6 to 20 years, with a mean age of 14.37 (±4.68), including 40 blind individuals and a randomly selected control group 40 normally sighted. Stabilometric measurements were performed with the use of the Platform CQ Stab 2P, with eyes open (EO) and closed (EC) on the solid surface, and then, the same procedure was performed on the platform covered with 1-centimetre-thick foam. Results: Statistical analyses (Wilcoxon matched-pairs test, Mann–Whitney U test) of the results identified during the trials reveal the following findings in the BL group in the EO and EC tests. The results of the foam surface test were higher and the differences were statistically significant in the BL group (sway path EO p = 0.009, EC p = 0.006; mean amplitude EC p = 0.030; mean velocity EO p = 0.009, EC p = 0.006; sway area EO p = 0.017, EC p = 0.009; and number of COP deflections along the sagittal plane EO p = 0.004). No similar correlations were observed in the NE group, except for the mean amplitude EO p = 0.033 and sway area EO p = 0.030. There was one difference between the BL and the NE group for the mean amplitude parameter, p = 0.018, in a solid surface test with open eyes. The results were higher in the BL group. Conclusions: The present study showed no worse balance in the BL group than in the NE group but worse performance on the foam than without it. It indicates the need to develop body balance skills in blind people by improving their proprioceptive sensitivity. In everyday life and training, blind people should experience exteroceptive stimuli, different textures, and unstable surfaces as much as possible.

Return to sports after bucket handle medial meniscus tear repair using inside out technique in recreational sports players.

The main purpose of our study is to determine the outcomes of bucket handle medial meniscus tears repaired with the inside out technique in recreational sports players, and the return of these to pre-injury sports levels. 41 athletes with medial meniscus bucket handle tear were included in the study. 28 cases were associated with ACL tear while rest were isolated tears. Medial meniscus repair was done exclusively with arthroscopy assisted inside out technique. Lysholm score, IKDC score and Tegner staging were used to evaluate functional status of patients with minimum 1-year follow-up. Data was analyzed using Wilcoxon Matched pairs test, and Friedman test. All patients were examined clinically at regular intervals. Lysholm score and IKDC score showed significant increase in their values. Tegner staging showed no significant change compared to their preinjury game level. On VAS pain scale, there was significant decrease in their pain at regular follow up intervals. 2 patients had re-tears of the repaired medial meniscus. Repairing bucket handle tears of the medial meniscus in recreational sports players with the inside out technique yields good results in terms of clinical and functional outcomes. It successfully allows them to return to sports at 1 year.

The Impact of Southern Cross Road (JJLS) Development on the Contribution of Regional Original Income (PAD) from the South Coast Tourism Sector in Bantul Regency 2014-2019

The economic disparity between the North and South Coast of Java is due to uneven infrastructure development. The impact of Southern Cross Road (JJLS) on the development of South Coast tourism (Pansela) Bantul Regency is expected to be able to increase Regional Original Income (PAD). The purpose of this study is 1)Comparing tourist visits number, tourism service entrepreneurs number, and PAD before and after JJLS, 2)Analyzing the effect of tourist visits and tourism service entrepreneurs on PAD, and 3)Calculating the contribution of Pansela’s PAD to Bantul Tourism’s PAD and Bantul’s PAD. This study uses quantitative methods and secondary data from related agencies. The analytical technique uses comparison two correlated samples test (Paired Sample T-Test and Wilcoxon Match Pairs Test), panel data regression Random Effect Model, and quantitative descriptive. The results showed that PAD experienced a significant difference but not in tourist visits number and tourism service entrepreneurs number before and after JJLS. Furthermore, Pansela’s PAD is significantly affected by tourist visits number but not by tourism service entrepreneurs number. Pansela’s PAD is able to make a dominant contribution to Bantul Tourism’s PAD, which is 3-7% of its total contribution to Bantul’s PAD 4-12%.