Wilcoxon Rank Test Research Articles

Absolute Lymphocyte Count and Outcomes of Multiple Myeloma Patients Treated with Idecabtagene Vicleucel: The U.S. Myeloma CAR T Consortium Real World Experience

Introduction: Chimeric Antigen Cell (CAR) T-cell therapy with idecabtagene vicleucel (ide-cel) is FDA approved for relapsed refractory multiple myeloma (MM). Investigating factors that may predict response, toxicity and survival is important to guide therapy and inform prognosis. Low pre-lymphodepletion (LD) absolute lymphocyte count (ALC) was found to be associated with worse outcomes in a small cohort of patients (pts) treated with ide-cel (Liu et al. Transplant Cell Ther 2022). We evaluated the impact of pre-apheresis (pre-A) and pre-LD peripheral blood ALC on post-ide-cel outcomes in a large patient cohort. Methods: A total of 215 myeloma pts were treated with ide-cel at 11 U.S. academic medical centers. We studied the effect of ALC including pre-A, pre-LD, absolute and percent reduction in ALC between apheresis and LD on progression free survival (PFS), overall survival (OS), overall hematologic response rate (ORR which included VGPR, CR and sCR) and cytokine release syndrome (CRS) incidence. Associations of ALC parameters with PFS and OS were evaluated using Kaplan-Meier (KM) method and Cox proportional hazard model. Patient demographics and clinical characteristics between ALC groups were compared using Chi square test and Wilcoxon rank test. Results: The median patient age was 64 years (range, 36-83) and 60 % were male. The median prior lines of therapy was 6 (IQR, 5-9), 84.2% had a prior autologous hematopoietic cell transplant (AHCT), 44.7% had extramedullary disease, and 77.1% received bridging therapy (BT). CRS was seen in 81.1% of the pts, mostly grade 1. The median pre-A and pre-LD ALC's were 0.65 x109/L (range, 0.06-5.3) and 0.55 (range, 0-5.0), respectively. The pre-A ALC was significantly higher than pre-LD ALC (mean difference and 95% CI: 0.10 (0.04, 0.40), p=0.002). The median follow-up time after CAR-T infusion was 5.4 (IQR, 2.1-8.3) months. Pre-A and pre-LD ALC's were not significantly associated with PFS or OS, while pts with a high absolute reduction in ALC between apheresis and LD (≥0.27 or top quartile) had a significantly worse six-month PFS (48.4 vs 63.5%, p= 0.04) and OS (76.0 vs 87.7%, p= 0.03). Similarly, patients with a high percent reduction between pre-A and pre-LD ALC (≥37.5% or top quartile) had a worse six-month PFS (41.9 vs 65%, p <0.001) and OS (70.5 vs 89%, P=0.001). PFS and OS differences remained statistically significant after adjusting for age, race, CRS grade, ECOG-PS, extramedullary disease and prior AHCT. Kaplan-Meier estimated PFS and OS curves for absolute ALC reduction groups and percent ALC reduction groups are displayed in Figure 1. The one-month and three-month ORR, and CRS grade were not significantly different between pre-A (≥1 or <1), pre-LD (≥1 or <1), absolute reduction and percent reduction ALC groups. ECOG-PS ≥2 (p= 0.004), ISS III (p= 0.015), and implementation of BT (p <0.01) were found to be associated with high ALC reduction or percent reduction. There was no difference in ALC between pts who received BT vs not. However, more patients in the high ALC reduction (>=0.27: 90.4% vs 72.6%, p=0.008) and high ALC percent reduction (>=37.5: 96.2% vs 70.5%) groups received BT. Moreover, pts who received BT had a worse PFS (six-month PFS: 53.2% vs 85.3%, p <0.001) and OS (six-month OS: 81.9% vs 95.8%, p= 0.02) likely indicating aggressive disease biology. The specific types of BT were not available in our dataset. Conclusion: Pre-apheresis ALC did not impact survival in this large cohort of myeloma patients treated with ide-cel. Reduction in ALC between apheresis and lymphodepletion is a potentially predictive tool of survival outcomes and may be associated with more aggressive disease biology and the need for more aggressive bridging therapy. Investigating the association between specific types of bridging therapy, ALC reduction and outcomes may guide clinical decision making in this heavily pretreated myeloma patient population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A New Fractional-Order Load Frequency Control for Multi-Renewable Energy Interconnected Plants Using Skill Optimization Algorithm

Connection between electric power networks is essential to cover any deficit in the generation of power from any of them. The exchange powers of the plants during load disturbance should not be violated beyond their specified values. This can be achieved by installing load frequency control (LFC); therefore, this paper proposes a new metaheuristic-based approach using a skill optimization algorithm (SOA) to design a fractional-order proportional integral derivative (FOPID)-LFC approach with multi-interconnected systems. The target is minimizing the integral time absolute error (ITAE) of frequency and exchange power violations. Two power systems are investigated. The first one has two connected plants of photovoltaic (PV) and thermal units. The second system contains four plants, namely, PV, wind turbine, and two thermal plants, with governor dead-band (GDB) and generation rate constraints (GRC). Different load disturbances are analyzed in both considered systems. Extensive comparisons to the use of chef-based optimization algorithm (CBOA), jumping spider optimization algorithm (JSOA), Bonobo optimization (BO), Tasmanian devil optimization (TDO), and Atomic orbital search (AOS) are conducted. Moreover, statistical tests of Friedman ANOVA table, Wilcoxon rank test, Friedman rank test, and Kruskal Wallis test are implemented. Regarding the two interconnected areas, the proposed SOA achieved the minimum fitness value of 1.8779 pu during 10% disturbance on thermal plant. In addition, it outperformed all other approaches in the case of 1% disturbance on the first area as it achieved ITAE of 0.0327 pu. The obtained results proved the competence and reliability of the proposed SOA in designing an efficient FOPID-LFC in multi-interconnected power systems with multiple sources.

Abstract 9691: Incidence of Atrial Fibrillation in Patients Hospitalized for COVID Compared to Non-COVID Pneumonia/ARDS

Introduction: Though atrial fibrillation (AF) has been reported with COVID, it is unclear if it is related to myocarditis or lung injury. The aim of this study was to compare incident AF in pneumonia/ARDS with and without COVID. Methods: In this retrospective multicenter cohort study from 17 hospitals (3/2020 to 12/2021) utilizing the University of California COVID Research Data Set (CORDS), we included patients &gt;18 years with primary diagnosis of pneumonia or ARDS during hospitalization by ICD-10. We excluded those with prior AF. Subjects were determined to have COVID based on positive PCR test within 10 days prior or during inpatient admission and compared to a control group with negative PCR test. Clinical data was extracted from electronic medical records. The cohorts were compared using χ2 test for categorical variables and Wilcoxon rank tests for continuous variables. Multivariable logistic regression models were used to investigate the association between COVID and development of new atrial fibrillation. Results: Of the 39,415 subjects, 12.2% had COVID. The COVID+ cohort was younger, had more males, and more co-morbidities. They required more mechanical ventilation, but less ICU care and hemodynamic support (Table 1). Incident AF occurred in 523 (10.85%) of COVID vs 4,899 (14.16%) in the non-COVID group (OR 0.74, p &lt; 0.001), which remained significant after adjustment of demographics and co-morbidities (p &lt; 0.001). AF was associated with higher mortality (26.2% vs. 10.21%, p &lt;0.001) and longer hospitalization (22.5 vs. 15.1 days, p &lt;0.001) in COVID group compared to the controls (Table 2). Conclusions: Incident AF is less in COVID compared to non-COVID pneumonia/ARDS despite requiring more mechanical ventilation, however had higher mortality and prolonged hospitalization.

Impact of Trainee Involvement on Surgical Outcomes of Abdominal and Laparoscopic Myomectomy

<h3>Study Objective</h3> To determine the impact of trainee involvement on operative time and transfusion risk for myomectomy. <h3>Design</h3> Cohort study utilizing the National Surgical Quality Improvement Program (NSQIP) database of abdominal and laparoscopic myomectomies with trainee involvement versus (vs) no trainee involvement from 2008 - 2012 (the most recent years that trainee involvement was a variable in the database). <h3>Setting</h3> Trainee involvement in myomectomy. <h3>Patients or Participants</h3> 1216 patients. <h3>Interventions</h3> Preoperative factors, intraoperative outcomes, and 30-day postoperative complications were evaluated. The primary outcomes were operative time and rate of transfusion. Continuous variables were assessed with Wilcoxon rank tests. Categorical variables were assessed with χ2 tests. <h3>Measurements and Main Results</h3> Overall, 64% (n=775/1216) of myomectomies had trainee involvement. Trainee involvement was associated with a 31 minute (min) longer operative time (92 vs 123min, p<0.01). This difference persisted for abdominal myomectomy (89 vs 115min, p<0.01) including both 1-4 myomas/weight ≤250g (79 vs 104min, p<0.01) and ≥5 myomas/weight >250g (104 vs 143min, p<0.01). However, for laparoscopic myomectomy, there was no difference in operative time (152 vs 155min, p=0.45). There was a higher rate of transfusion between no trainee vs trainee (3% vs 9%, p<0.01) for myomectomies overall. However, when stratified, only abdominal myomectomies with ≥5 myomas/weight >250g demonstrated a higher rate of transfusion (3% vs 18%, p<0.01) and there was no difference in rate of transfusion for laparoscopic myomectomy (6% vs 4%, p=0.47). There was no difference in the number of overall complications of myomectomy (3% vs 4%, p=0.34). <h3>Conclusion</h3> Trainee involvement was associated with increased operative time for abdominal myomectomy and rates of transfusion for abdominal myomectomy with a high fibroid burden. Trainee involvement does not affect operative time or rates of transfusion for laparoscopic myomectomy. When appropriate, myomectomies with trainees should be performed via a minimally invasive approach.

Benefit of [18F] FDG PET/CT in the diagnosis and salvage treatment of recurrent nasopharyngeal carcinoma.

To compare PET/CT, MRI and ultrasonography in detecting recurrence of nasopharyngeal carcinoma and identify their benefit in staging, contouring and overall survival (OS). Cohort A included 1453 patients with or without histopathology-confirmed local recurrence, while cohort B consisted of 316 patients with 606 histopathology-confirmed lymph nodes to compare the sensitivities and specificities of PET/CT, MRI and ultrasonography using McNemar test. Cohorts C and D consisted of 273 patients from cohort A and 267 patients from cohort B, respectively, to compare the distribution of PET/CT-based and MRI-based rT-stage and rN-stage and the accuracy of rN-stage using McNemar test. Cohort E included 30 random patients from cohort A to evaluate the changes in contouring with or without PET/CT by related-samples T test or Wilcoxon rank test. The OS of 61 rT3-4N0M0 patients staged by PET/CT plus MRI (cohort F) and 67 MRI-staged rT3-4N0M0 patients (cohort G) who underwent similar salvage treatment were compared by log-rank test and Cox regression. PET/CT had similar specificity to MRI but higher sensitivity (93.9% vs. 79.3%, P < 0.001) in detecting local recurrence. PET/CT, MRI and ultrasonography had comparable specificities, but PET/CT had greater sensitivity than MRI (90.9% vs. 67.6%, P < 0.001) and similar sensitivity to ultrasonography in diagnosing lymph nodes. According to PET/CT, more patients were staged rT3-4 (82.8% vs. 68.1%, P < 0.001) or rN + (89.9% vs. 69.3%, P < 0.001), and the rN-stage was more accurate (90.6% vs. 73.8%, P < 0.001). Accordingly, the contours of local recurrence were more precise (median Dice similarity coefficient 0.41 vs. 0.62, P < 0.001) when aided by PET/CT plus MRI. Patients staged by PET/CT plus MRI had a higher 3-year OS than patients staged by MRI alone (85.5% vs. 60.4%, P = 0.006; adjusted HR = 0.34, P = 0.005). PET/CT more accurately detected and staged recurrence of nasopharyngeal carcinoma and accordingly complemented MRI, providing benefit in contouring and OS.

Successful Aging for Community-Dwelling Older Adults: An Experimental Study with a Tablet App.

Mobile health (mHealth) technologies offer an opportunity to enable the care and support of community-dwelling older adults, however, research examining the use of mHealth in delivering quality of life (QoL) improvements in the older population is limited. We developed a tablet application (eSeniorCare) based on the Successful Aging framework and investigated its feasibility among older adults with low socioeconomic status. Twenty five participants (females = 14, mean age = 65 years) used the app to set and track medication intake reminders and health goals, and to play selected casual mobile games for 24 weeks. The Older person QoL and Short Health (SF12v2) surveys were administered before and after the study. The Wilcoxon rank tests were used to determine differences from baseline, and thematic analysis was used to analyze post-study interview data. The improvements in health-related QoL (HRQoL) scores were statistically significant (, ) across all participants. The frequent eSeniorCare users experienced statistically significant improvements in their physical health (, ) and HRQoL (, ) scores. Participants reported that the eSeniorCare app motivated timely medication intake and health goals achievement, whereas tablet games promoted mental stimulation. Participants were willing to use mobile apps to self-manage their medications (70%) and adopt healthy activities (72%), while 92% wanted to recommend eSeniorCare to a friend. This study shows the feasibility and possible impact of an mHealth tool on the health-related QoL in older adults with a low socioeconomic status. mHealth support tools and future research to determine their effects are warranted for this population.

Impact of Pre-Operative PROMIS Depression Scores on Total Ankle Replacement Outcomes

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Total ankle replacement (TAR) is an effective procedure to help patients with end-stage osteoarthritis regain mobility and function. While previous studies have suggested that pre-operative factors such as stress or depression may influence the success of TAR, there is limited literature investigating this relationship. The goal of this study is to evaluate differences in functional and pain outcomes following TAR from patients with high and average PROMIS depression scores. Methods: Patients enrolled in the Orthopaedic Foot and Ankle Outcomes Research (OFAR) platform who underwent total ankle replacement were retrospectively analyzed. Patients were included if they had PROMIS outcomes collected both pre- and 12- months post-operatively. Patients were grouped as 'no/low depression' if they scored below 60 on the PROMIS depression scale, and 'high depression' if they scored greater than or equal to 60 (one standard deviation from the population mean). Statistical differences were evaluated non-parametrically using Wilcoxon rank tests and Mann-Whitney U tests. Results: 36 patients who underwent TAR met inclusion criteria for analysis. Based on pre-operative PROMIS depression scores, 28 patients were categorized 'no/low depression' (ND), and 8 were categorized as 'high depression' (HD). Both groups showed significant improvement in PROMIS physical function and PROMIS pain interference at 12-months. While the HD group had a significantly higher baseline PROMIS pain interference (65.8) compared to the ND group (58.4, p &lt; 0.05), there was no significant difference between the two groups at 12-months (50.5 vs. 47.6, respectively). Similarly, while there was a significant difference in PROMIS depression score pre-operatively between HD and ND (62.5 vs. 48.3, p &lt; 0.05), there was no significant difference 12- months post-operatively (52.5 vs. 45.8). Conclusion: Our data suggests that patients with high pre-operative PROMIS depression scores may have worse baseline physical function and pain interference compared to other patients but see greater overall improvement after total ankle arthroplasty. Patients in the 'high depression' group also showed a significant improvement in PROMIS depression score 12- months post-operatively. Additional investigation of large, non-commercial outcomes databases, such as OFAR, may also help determine which surgical interventions impact mental health outcomes.

Correlation of arterial PaCO2 to end tidal CO2 in children undergoing laparoscopic abdominal surgery: An observational study.

The reliability of end tidal carbon dioxide (ETCO2) as a measure of arterial carbon dioxide (PaCO2) in pediatric laparoscopy is unclear. We evaluated the correlation of arterial to end tidal P(a-ET) CO2 during pediatric laparoscopy at two hours of pneumoperitoneum as the primary objective. We also compared P(a-ET) CO2 and alveolar to arterial oxygen gradient P(A-a) O2 and haemodynamics at fixed time points during surgery. A cross-sectional study was conducted in 25 children undergoing laparoscopic abdominal surgery. Arterial blood gases were drawn at T0, baseline, T10: ten minutes, T1h: 1 hour, T2h: 2 hours of pnuemoperitoneum and T 10d: 10 mins after deflation. The P(a-ET) CO2, P(A-a) O2, were measured from the blood gas and ETCO2 and FiO2 values on the monitor. The Pearson's correlation coefficient, the Wilcoxon rank test and Chi square test were used for statistical analysis. At T2h moderate correlation of P(a-ET) CO2 (r = 0.605, P = 0.001) with 40% children documenting accurate P(a-ET) CO2, -1 to +1 mm Hg was seen. Moderate correlation was also seen at T0, T10, T 10d but poor correlation at T 1h. The P(A-a) O2 increased progressively with surgery and did not correlate with P(a-ET) CO2. Heart rate was stable, but systolic blood pressures at T 10 and diastolic at T10, T 1h, T 2h were higher than baseline. Moderate correlation was seen between PaCO2 and ETCO2 at 2 h of pnuemoperitoneum and at T0, T 10, and T 10d. P(A-a) O2 increased with surgery but did not correlate with P(a-ET) CO2.

Effect of dynamic cupping therapy vs. vibrating foam roller on pain, range of motion, function, and quality of life in elderly with subacute and chronic osteoarthritis of knee

Background: Knee osteoarthritis (KOA) is a frequent degenerative disease of joints. The prevalence is approximately 28% among the Indian elderly. Recently complementary and alternative medicine therapies have been used in managing pain and disability. Dynamic cupping therapy is one of the forms used nowadays. Foam rolling and vibration therapy is also a popular intervention in musculoskeletal conditions such as osteoarthritis, osteoporosis, sarcopenia, and low back pain. Nowadays, these two have been combined for the development of vibrating foam rollers. Objectives: This research aimed to compare the result of dynamic cupping therapy to that of a vibrating foam roller on pain, range of motion, function, and quality of life in elderly with sub-acute and chronic KOA. Materials and Methods: The research was carried out on 45 subjects with subacute to chronic KOA who were given thrice a week sessions for 4 weeks’ intervention. Through the randomized method, subjects were divided into a conventional group, dynamic cupping group and vibrating foam roller group outcome measures Numeric Pain Rating Scale, knee range of motion, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and brief Older People's Quality of Life Questionnaire (OPQOL-brief) were used. Results: Wilcoxon rank test revealed a pre-post difference in all three groups with significant P-values which were &lt;0.05 and heterogeneously favored different outcome measures used. Kruskal–Wallis test revealed no difference between the groups. Conclusion: This study concluded that dynamic cupping therapy and vibration foam roller protocols used for the management of KOA are equally effective.

Effect of breathing intervention in patients with COVID and healthcare workers.

BackgroundRegulated breathing facilitates ventilation and reduces breathlessness. However, the effect of Yogic breathing on patients with COVID remains unclear. We aimed to evaluate the efficacy of two breathing protocols, i.e., short breathing technique (SBT) and long duration breathing technique (LBDT).MethodsThree groups including COVID-positive patients, COVID-recovered patients, and healthcare workers (HCWs) were included in the study and segregated into Yoga and control groups. SBT was administered to COVID-positive patients. Both SBT and LBDT were administered to COVID-recovered patients and HCWs. A total of 18 biochemical parameters, a 6-min walk test (6MWT), and a 1-min sit-stand test (1MSST) were assessed on 0th, 7th, and 15th days, where biochemical parameters were the primary outcome. Pre-post estimation of neuropsychological parameters (nine questionnaires) and heart rate variability (HRV) were carried out. The paired t-test or Wilcoxon rank test was applied for pre-post comparison and the Student's t-test or Mann–Whitney U test was used for group comparison. Repeated measures test was applied for data recorded at three time points.ResultsA significant elevation in white blood cell (WBC) count was observed in COVID-positive intervention (p < 0.001) and control groups (p = 0.003), indicating no role of intervention on change in WBC number. WBC count (p = 0.002) and D-dimer (p = 0.002) significantly decreased in the COVID-recovered intervention group. D-dimer was also reduced in HCWs practicing Yogic breathing as compared to controls (p = 0.01). D-dimer was the primary outcome, which remained below 0.50 μg/ml (a cutoff value to define severity) in the COVID-positive yoga group (CYG) and decreased in the COVID-recovered yoga group (RYG) and the HCW yoga group (HYG) after intervention. A 6-min walk test (6MWT) showed an increase in distance covered among the COVID-positive patients (p = 0.01) and HCWs (p = 0.002) after intervention. The high-frequency power (p = 0.01) was found to be reduced in the COVID-positive intervention group. No significant change in neuropsychological parameters was observed.ConclusionYogic breathing lowered D-dimer, which is helpful in reducing thrombosis and venous thromboembolism in patients with COVID-19 besides lowering the chances of vaccine-induced thrombotic thrombocytopenia in vaccinated individuals. The breathing intervention improved exercise capacity in mild to moderate cases of COVID-19. Further studies can show if such breathing techniques can influence immunity-related genes, as reported recently in a study. We suggest that Yogic breathing may be considered an integrative approach for the management of patients with COVID.Trial registrationhttp://ctri.nic.in/Clinicaltrials/login.php, identifier: CTRI/2020/10/028195.

Effect of High-iron Rice Intervention on VO2max of Female Students of Al-Falak Bogor Islamic Boarding School

Female adolescents are at risk of iron deficiency which is known can negatively affect fitness. High-iron rice has been developed through biofortification but there is still lack of evidence regarding its benefit in improving VO2max as a physical fitness indicator. This study aimed to determine impact of high-iron rice intervention towards VO2max value. A total of 18 female students from Al-Falak Bogor Islamic boarding school aged 12-18 years were selected purposively in this quasi-experimental study. High-iron rice contained 50.4 ppm iron provided thrice daily for 4 weeks. A 20 m shuttle run test was conducted to obtain VO2max value. Other data such as food intake, BMI for age, hemoglobin, and serum ferritin were also evaluated. Paired t-test or Wilcoxon Ranks test was performed to analyze difference in data value before and after the intervention. Most nutrient intakes experienced a significant decline (p&lt;0.05) after the intervention, except for iron intake. Hemoglobin concentration also became lower significantly, whereas serum ferritin did not alter significantly. Nevertheless, VO2max improved significantly after the intervention. To summarize, there was an increase in fitness after high-iron rice intervention for 4 weeks in female students.

The effect of physical exercise on vital lung capacity in Tapak Suci athletes

Exercise can have a physiological effect on the body, including the work system of the heart and lungs. The lungs have an important role in human life, where there is an exchange of oxygen with carbon dioxide through the respiratory process. In terms of health, exercise needs to be done by every human being, because exercise can increase the work of the lung muscles, whereas if the lung muscles work well, the ability to accommodate oxygen or the vital capacity of the human lungs also increases. The purpose of this study was to determine the effect of physical exercise on vital lung capacity. This research method uses a pre-experimental approach with pre and post-test one-group design. The sampling technique of this study used a random sampling of 30 respondents. The instruments used were observation sheets from the examination of vital lung capacity and spirometry. Analysis Research data analysis using the Wilcoxon Rank Test. The results of the Wilcoxon Rank Test statistical test obtained P = 0.000 with a safety level of = 0.05 meaning P value = . Conclusion It can be concluded that there is a difference in the vital capacity of the lungs before and after participating in the sacred tapak exercise so that this research is expected to be useful for athletics in improving physical fitness, especially by routinely doing sports or physical exercise such as participating in the sacred tapak exercise.

MODEL PENINGKATAN PERILAKU HEALTH MAINTANANCE ANAK BERBASIS INDIVIDUAL COACHING PADA MASA PANDEMI COVID-19

The COVID-19 pandemic is a challenge throughout the world, where children are one of the most vulnerable groups. Children are the assets of the nation and the future generations of the ideals of the nation's struggle that will determine the future of the nation and state. Therefore, great attention and hope needs to be given to children. The purpose of this study was to analyze the effect of individual coaching on children's health maintenance behavior during the COVID-19 pandemic. This type of research used quasy experiment with one group pre-test-posttest design. The population in this study were 143 parents of Geliting grade IV, V, VI children with a total sample size of 30 people. The technical sample in this study used Stratified Random Sampling. Measurement of health maintenance behavior using a questionnaire.Individual coaching intervention is given for 1 (one) month with several stages, namely: check in, pre visit, visit, post visit, between visits. The research is located at SD Geliting, Kewapante District, Sikka Regency. The study was conducted on 15 November -15 December 2020. Data analysis used univariate and bivariate (Wilcoxon Rank Test). The results of the Wilcoxon Rank Test analysis showed that before and after being given the individual coaching intervention, it gave a price (p-value 0.000 &lt;0.05), this indicates that there was a significant effect caused by the individual coaching intervention. The results of this study prove that individual coaching interventions can improve health maintenance behavior in children. It is hoped that the results of this study can be used as additional interventions to improve health maintenance behavior in children.&#x0D;

Photovoltaic model parameters identification using Northern Goshawk Optimization algorithm

The massive integration of photovoltaic (PV) systems into electric power grids creates a slew of new issues in today's power systems. Accurate modeling of photovoltaic modules is critical in strengthening the characteristics of its systems in simulation assessments. Modeling such PV systems is represented by a nonlinear current-voltage characteristic curve behavior with numerous unknown parameters due to insufficient data in the cells' datasheet. This manuscript presents an application of a recently introduced optimization algorithm called Northern Goshawk Optimization (NGO) for parameter identification of the triple diode model of the PV module. Three commercial PV modules are utilized in this study to accomplish this task. These models are multi-crystalline structures like Photowatt-PWP201 and Kyocera KC200GT and mono-crystalline like Canadian Solar CS6K-280 M. The simulation results show the ability of the NGO to extract the model parameters accurately. Experimental validation of the estimated parameters using the NGO optimizer is accomplished and compared with the simulation results under various environmental conditions. The simulation results show the superiority of the NGO over competitive optimization algorithms in terms of convergence speed and accuracy. The NGO can reduce the cost function to 1.35E-05, 9.42E-05, and 0.000195 for the PWP-201, KC200GT, and Canadian Solar CS6K-M modules. Moreover, the robustness of the NGO is evaluated by the statistical analysis and the Wilcoxon rank test.

Comparison of Early-Onset Sepsis Risk-Stratification Algorithms in Neonates in a Kenyan Nursery.

Risk stratification algorithms (RSAs) can reduce antibiotic duration (AD) and length of stay (LOS) for early-onset sepsis (EOS). Because of higher EOS and antibiotic resistance rates and limited laboratory capacity, RSA implementation may benefit low- and middle-income countries (LMIC). Our objective was to compare the impact of 4 RSAs on AD and LOS in an LMIC nursery. Neonates <5 days of age admitted for presumed sepsis to a Kenyan referral hospital in 2019 (n = 262) were evaluated by using 4 RSAs, including the current local sepsis protocol ("local RSA"), a simplified local protocol ("simple RSA"), an existing categorical RSA that uses infant clinical examination and maternal risk factors (CE-M RSA) clinical assessment, and the World Health Organization's Integrated Management of Childhood Illness guideline. For each RSA, a neonate was classified as at high, moderate, or low EOS risk. We used к coefficients to evaluate the agreement between RSAs and McNemar's test for the direction of disagreement. We used the Wilcoxon rank test for differences in observed and predicted median AD and LOS. Local and simple RSAs overestimated EOS risk compared with CE-M RSA and the Integrated Management of Childhood Illness guideline. Compared with the observed value, CE-M RSA shortened AD by 2 days and simple RSA lengthened AD by 2 days. LOS was shortened by 4 days by using CE-M RSA and by 2 days by using the local RSA. The local RSA overestimated EOS risk compared with CE-M RSA. If implemented fully, the local RSA may reduce LOS. Future studies will evaluate the prospective use of RSAs in LMICs with other interventions such as observation off antibiotics, biomarkers, and bundled implementation.

Isokinetic knee muscle strength asymmetry in university sweep rowers

The prevalence of musculoskeletal injuries in sweep rowing is high. As nearly 50% of power during sweep rowing is contributed by the legs, the presence of muscle imbalances may predispose rowers to overuse injuries. The purpose of the study was to assess knee muscle strength symmetry between dominant and non-dominant limbs of male and female rowers. A descriptive, quantitative research design was used. Twenty-four male and 13 female rowers aged 18–26 years participated. Bilateral isokinetic knee flexion and extension peak torque and hamstrings/quadriceps (H/Q) ratios were assessed at 60°/s and 180°/s using an isokinetic dynamometer. The data was analysed using Mann-Whitney U and Wilcoxon rank tests and significance was set at p≤0.05. In males, the dominant knee extension torque values at 60°/s and 180°/s were significantly larger than that of the non-dominant side (p≤0.05). In females, the non-dominant eccentric H/Q ratio at 60°/s was 15% larger than that of the dominant side (p=0.019). Bilateral differences observed in knee extension torque for males and in H/Q ratio for females highlight the need for isokinetic testing of sweep rowers, to improve performance and prevent injury.

Pregnancy outcome and risk of recurrence after tissue-preserving loop electrosurgical excision procedure (LEEP)

Background/purposeThis study aims to investigate whether women with cervical dysplasia after LEEP have an increased risk of pregnancy/childbirth complications or recurrence of dysplasia in an upcoming pregnancy.MethodsData from 240 women after LEEP were analysed retrospectively. The reference group consisted of 956 singleton births. Fisher’s and Wilcoxon rank tests were used to detect differences between groups. Using logistic regressions, we analysed the effect of surgery-specific aspects of LEEP on pregnancy/childbirth complications and the frequency of CIN recurrences.ResultsWe found that tissue-preserving LEEP did not lead to premature birth or miscarriage and did not increase the likelihood of CIN recurrence.We did not observe differences regarding preterm birth [< 37 (p < 0.28) < 34 (p < 0.31), < 32 weeks of gestation (p < 0.11)] or birth weight (< 2500 g (p < 0.54), < 2000 g (p < 0.77) between groups. However, women after LEEP exhibit a higher risk of premature rupture of membranes (PROM) at term (p < 0.009) and vaginal infections (p < 0.06). Neither volume nor depth of the removed tissue nor an additional endocervical resection seems to influence the likelihood of premature birth or early miscarriage. Performing an endocervical resection protects against CIN recurrence (OR 0.0881, p < 0.003).ConclusionsAfter tissue-preserving LEEP, there is an increased risk of vaginal infections and PROM at term in consecutive pregnancy. LEEP does not affect prematurity or miscarriage. The removal of additional endocervical tissue appears to be a protective factor against recurrence of CIN.

Landslide Susceptibility Prediction Considering Neighborhood Characteristics of Landslide Spatial Datasets and Hydrological Slope Units Using Remote Sensing and GIS Technologies

Landslides are affected not only by their own environmental factors, but also by the neighborhood environmental factors and the landslide clustering effect, which are represented as the neighborhood characteristics of modelling spatial datasets in landslide susceptibility prediction (LSP). This study aims to innovatively explore the neighborhood characteristics of landslide spatial datasets for reducing the LSP uncertainty. Neighborhood environmental factors were acquired and managed by remote sensing (RS) and the geographic information system (GIS), then used to represent the influence of landslide neighborhood environmental factors. The landslide aggregation index (LAI) was proposed to represent the landslide clustering effect in GIS. Taking Chongyi County, China, as example, and using the hydrological slope unit as the mapping unit, 12 environmental factors including elevation, slope, aspect, profile curvature, plan curvature, topographic relief, lithology, gully density, annual average rainfall, NDVI, NDBI, and road density were selected. Next, the support vector machine (SVM) and random forest (RF) were selected to perform LSP considering the neighborhood characteristics of landslide spatial datasets based on hydrologic slope units. Meanwhile, a grid-based model was also established for comparison. Finally, the LSP uncertainties were analyzed from the prediction accuracy and the distribution patterns of landslide susceptibility indexes (LSIs). Results showed that the improved frequency ratio method using LAI and neighborhood environmental factors can effectively ensure the LSP accuracy, and it was significantly higher than the LSP results without considering the neighborhood conditions. Furthermore, the Wilcoxon rank test in nonparametric test indicates that the neighborhood characteristics of spatial datasets had a great positive influence on the LSP performance.

The Impact of Effleurage Technique Massage on Blood Pressure toward Elderly Hypertension in Peguyangan Village

Background: One of the vulnerable groups is elderly. Entering the aging process, the elderly will have a decrease a physiological disfunction which make some of non-spreadable disease appear such as hypertension. In this critical situation, a solution is needed to tackling hypertension. One of the non-pharmacological therapy that can be handle for hypertension is effleurage massage.&#x0D; Aim: The aim of this study is to determine the effect of effleurage technique massage on blood pressure toward elderly hypertension at Peguyangan Village.&#x0D; Method: This study is use a quantitative method with quasy experimental design which research design of pre-post-test control design. Sample of this study were 15 respondents in every group. This massage therapy using effleurage massage technique during 20 minutes while control group rest for 20 minutes. Technique sample is using a purposive sampling. Data analysis with Wilcoxon Rank Test with Significance level α &lt;0,05 from the result in the treatment group shows that the p value (sig). &#x0D; Conclusion: The massage of effleurage technique for 20 minutes affects toward lowering blood pressure in the elderly hypertension but resting for 20 minutes has not significantly on the reducing of hypertension blood pressure in elderly.

Participatory Education by Local Preacherso on Knowledge, Mother's Attitude and Nutritional Information of Children

Mothers as the main caregivers of children in providing feeding practices must be based on knowledge, attitudes, and good practices. The purpose of this study was to see the effect of stunting prevention through participatory counseling regarding the application of balanced nutrition to toddlers by involving local preachers on the mother's knowledge, attitudes, and nutritional intake of stunting toddlers in the stunting locus village, Gedong Tataan district. This researchwasquasi-experimental with a pre and post-test control group design. The research subjects were 21 stunted children under five in the treatment group and 21 stunted children under five as controls.The treatmentgroup was given participatory counseling intervention involving posyandu cadresand local preachers, while the control group was given counseling about balanced nutrition by posyandu cadres. Counseling was carried out for 3 weeks in a row onthe subjects of the treatment and control groups. Wilcoxon Rank Test and Mann Whitney were used to seedifferences in each group on knowledge, attitudes, and nutrient intake. This study showed that there were significant differences in knowledge (p=0,000), attitudes (p=0,000), energy intake (p=0,008), and protein (p=0,000). Stunting prevention interventions through participatory counseling on balanced nutrition involving local preachers have proven effective in increasing mothers' knowledge and attitudes about balanced nutrition as well as the nutritional intake of stunted children under five.