Wilcoxon Test Research Articles

Complete Blood Counts and Research Parameters in the Detection of Myelodysplastic Syndromes.

100 samples from healthy individuals were used to establish the values of research parameters in normal subjects. A retrospective study was conducted including 66 patients diagnosed with MDS, 90 cytopenic patients due to other diseases (cancer patients receiving therapy, aplastic anemia, other hematological malignancies) and 50 with macrocytic anemia. The Wilcoxon test was applied to detect statistical differences among the groups of patients, considering p < 0.05 significant. The diagnostic performance of the RUO parameters for discriminating MDS among cytopenias was evaluated using receiver operating characteristic (ROC) curve analysis. Amultivariable logistic regression model was performed to identify the potential predictors for having MDS. The area under curve (AUC) and the Hosmer-Lemeshow test of the model were assessed. The performance of the model was verified in a prospective study including 224 cytopenic patients (validation group). In the MDS group, the mean cell volume (MCV), percentage of macrocytic red cells (MAC), red cell distribution width (RDW) and immature platelets fraction (IPF) had increased values compared to the cytopenic and normal patients, while platelets, red and white cell counts, Neu X (related to the cytoplasmic complexity of neutrophils), Neu Y (related to nucleic acid content) and Neu Z (related to cell size) were lower (p < 0.001). Neu X, Neu Y, and Neu Z showed higher AUC for detecting MDS > 0.80; MAC, RDW and IPF AUC > 0.76. The multivariable model demonstrated that Neu X and Neu Y could be used in the recognition of MDS, AUC 0.88. In the validation group, 89.0% of the MDS patients were well classified. MDS are common malignant disorders with a poor prognosis, and early diagnosis is warranted for optimal benefit from treatment. RUO gain insights to detect dysplasia of MDS and could be used in the differential diagnosis of MDS from cytopenias of other etiologies.

Comparative Analysis of the Islamic Banking Financial Performance before and after Collaboration in Financing Distribution with Islamic Fintech: A Study of Mega Islamic Bank

This study examines the comparative the financial performance of Bank Mega Syariah prior to and following partnering with Sharia Fintech in financing distribution. Utilizing a quantitative and descriptive approach, it analyzes key financial ratios including NPF, ROA, ROE, NOM, and BOPO. Data from Bank Mega Syariah's financial reports over a 10-year period (2014-2023) are analyzed. Statistical analysis is performed using SPSS, applying the Paired Sample T-Test is utilized for normally distributed data, while the Wilcoxon Signed Ranks Test is used for non-normally distributed data. The outcomes indicate noteworthy distinctions in NPF, ROA, ROE, and BOPO after the collaboration, while NOM shows no significant variance. The findings suggest a positive impact of collaboration with Sharia Fintech on Bank Mega Syariah's financial performance, particularly in reducing NPF and enhancing ROA, ROE, and BOPO. However, it is noted that regulatory concerns highlighted in the AMS 2022/2023 survey remain a barrier to financial literacy and inclusion via Fintech. This study adds to the comprehension of the dynamic environment of Islamic banking within the framework of Fintech integration, offering insights for policymakers and industry practitioners.

Effect of Diaphragm Strengthening Exercise with Incentive Spirometry on Pain and Core Muscle Stability in Low Back Pain Patients at M.Yunus Hospital Bengkulu

This study examined the effect of diaphragm strengthening exercise with incentive spirometry on pain and core muscle stability in patient with LBP (Low Back Pain). Twenty respondents aged 25-60 years participated in this research group. This research using a pre-experimental one-group pretest-posttest design. Incentive spirometry training was given to one group 3 times a week for 4 weeks. Pain level was measured using the numerical rating scale and core muscle stability was measured using a sphygmomanometer which had been modified to function as a tool to measure core muscle stability. There was a decrease in pain levels and an increase in core muscle stability in research subjects. The results of the wilcoxon test and paired t-test obtained a significance value of less than 0.05. There is an effect of diaphragm muscle strengthening exercises using incentive spirometry on improving pain and core muscle stability in patients with LBP (Low Back Pain).

Effect of Diaphragm Strengthening Exercise with Incentive Spirometry on Pain and Core Muscle Stability in Low Back Pain Patients at M.Yunus Hospital Bengkulu

This study examined the effect of diaphragm strengthening exercise with incentive spirometry on pain and core muscle stability in patient with LBP (Low Back Pain). Twenty respondents aged 25-60 years participated in this research group. This research using a pre-experimental one-group pretest-posttest design. Incentive spirometry training was given to one group 3 times a week for 4 weeks. Pain level was measured using the numerical rating scale and core muscle stability was measured using a sphygmomanometer which had been modified to function as a tool to measure core muscle stability. There was a decrease in pain levels and an increase in core muscle stability in research subjects. The results of the wilcoxon test and paired t-test obtained a significance value of less than 0.05. There is an effect of diaphragm muscle strengthening exercises using incentive spirometry on improving pain and core muscle stability in patients with LBP (Low Back Pain).

Improving skin cancer detection by Raman spectroscopy using convolutional neural networks and data augmentation.

Our previous studies have demonstrated that Raman spectroscopy could be used for skin cancer detection with good sensitivity and specificity. The objective of this study is to determine if skin cancer detection can be further improved by combining deep neural networks and Raman spectroscopy. Raman spectra of 731 skin lesions were included in this study, containing 340 cancerous and precancerous lesions (melanoma, basal cell carcinoma, squamous cell carcinoma and actinic keratosis) and 391 benign lesions (melanocytic nevus and seborrheic keratosis). One-dimensional convolutional neural networks (1D-CNN) were developed for Raman spectral classification. The stratified samples were divided randomly into training (70%), validation (10%) and test set (20%), and were repeated 56 times using parallel computing. Different data augmentation strategies were implemented for the training dataset, including added random noise, spectral shift, spectral combination and artificially synthesized Raman spectra using one-dimensional generative adversarial networks (1D-GAN). The area under the receiver operating characteristic curve (ROC AUC) was used as a measure of the diagnostic performance. Conventional machine learning approaches, including partial least squares for discriminant analysis (PLS-DA), principal component and linear discriminant analysis (PC-LDA), support vector machine (SVM), and logistic regression (LR) were evaluated for comparison with the same data splitting scheme as the 1D-CNN. The ROC AUC of the test dataset based on the original training spectra were 0.886±0.022 (1D-CNN), 0.870±0.028 (PLS-DA), 0.875±0.033 (PC-LDA), 0.864±0.027 (SVM), and 0.525±0.045 (LR), which were improved to 0.909±0.021 (1D-CNN), 0.899±0.022 (PLS-DA), 0.895±0.022 (PC-LDA), 0.901±0.020 (SVM), and 0.897±0.021 (LR) respectively after augmentation of the training dataset (p<0.0001, Wilcoxon test). Paired analyses of 1D-CNN with conventional machine learning approaches showed that 1D-CNN had a 1-3% improvement (p<0.001, Wilcoxon test). Data augmentation not only improved the performance of both deep neural networks and conventional machine learning techniques by 2-4%, but also improved the performance of the models on spectra with higher noise or spectral shifting. Convolutional neural networks slightly outperformed conventional machine learning approaches for skin cancer detection by Raman spectroscopy.

Pengaruh Akupresure Pericardium 6 Terhadap Mual Muntah Pada Pasien Kanker Serviks Post Kemoterapi

Cervical cancer is a type of cancer that attacks the cervix in women and can be treated with chemotherapy. One of the side effects of chemotherapy is nausea and vomiting. Nausea and vomiting can be treated by administering Acupressure Pericardium 6. This study aimed to determine the effect of administering Acupressure Pericardium 6 on nausea and vomiting in post-chemotherapy cervical cancer patients. This type of research is quantitative, using a quasi-experimental pre-test and post-test one-group design. The study employed purposive sampling with 47 respondents, utilizing the INVR index measuring instrument. The results of the analysis showed that the majority were elderly, aged 46–65 years (70.2%), elementary school education level (42.6%), non-working employment status (61.7%), type of chemotherapy drug carboplatin (19.1%), and stage III cervical cancer (42.6%). Before receiving the acupressure pericardium intervention, post-chemotherapy patients experienced 6 frequencies of moderate nausea and vomiting (46.8%), and after the intervention, they experienced 6 frequencies of mild nausea and vomiting (44.7%). After that, a statistical test was carried out using the Wilcoxon test, obtaining a p-value of 0.000 or ≤ 0.05. In conclusion, pericardium 6 acupressure has an effect on nausea and vomiting in post-chemotherapy cervical cancer patients. Future researchers should develop variables and pay more attention to the timing of administering Pericardium 6 acupressure to ensure optimal results.

Enhancing participant understanding and ethical considerations in clinical trial biospecimen research: Insights from an oncology setting in India

This study explores the KAP of clinical trial participants on the use of surplus biospecimens for future research in Indian oncology trials. A hospital-based prospective study was conducted among 112 oncology clinical trial participants. Non-probability purposive sampling technique was used to recruit the participants. This study captured their socio-demographic information and pre and post-KAP assessment by using self-administered questionnaires and its highlights ethical concerns and the lack of global guidelines. The main goal is to understand participants’ understanding and opinions on sample collection, utilization, and storage, as well as the ethical implications. SPSS software used for statistical analysis to evaluate pre and post-intervention KAP scores using frequency, percentage, mean difference, standard deviation, and applied paired t-test and Wilcoxon signed ranks test to assess Different KAP Levels. The study analyzed knowledge, attitude, and practice levels among oncology clinical trial participants using statistical tests. Pre-test to post-test comparisons showed significant increases in knowledge (p &lt; 0.001, Wilcoxon Signed Ranks Test), attitude (p &lt; 0.001, paired-samples t-test), and practice (p &lt; 0.001), highlighting the intervention’s effectiveness. This study highlights the effectiveness of interventions in improving the knowledge, attitude, and practice (KAP) of oncology clinical trial participants in India regarding the use of surplus biospecimens, emphasizing the importance of standardized guidelines in global oncology trials.

Computed tomography for evaluation of abdominal wall hernias-what is the value of the Valsalva maneuver?

To investigate the differences in the visibility and size of abdominal wall hernias in computed tomography (CT) with and without Valsalva maneuver. This single-center retrospective study included consecutive patients who underwent abdominal CTs with Valsalva maneuver between January 2018 and January 2022. Inclusion criteria was availability of an additional non-Valsalva CT within 6 months. A combined reference standard including clinical and surgical findings was used. Two independent, blinded radiologists measured the hernia sac size and rated hernia visibility on CTs with and without Valsalva. Differences were tested with a Wilcoxon signed rank test and McNemar's test. The final population included 95 patients (16 women; mean age 46 ± 11.6 years) with 205 hernias. Median hernia sac size on Valsalva CT was 31 mm compared with 24 mm on non-Valsalva CT (p < 0.001). In 73 and 82% of cases, the hernias were better visible on CT with Valsalva as compared to that without. 14 and 17% of hernias were only visible on the Valsalva CT. Hernia visibility on non-Valsalva CT varied according to subtype, with only 0 and 3% of umbilical hernias not being visible compared with 43% of femoral hernias. Abdominal wall hernias are larger and better visible on Valsalva CT compared with non-Valsalva CT in a significant proportion of patients and some hernias are only visible on the Valsalva CT. Therefore, this method should be preferred for the evaluation of abdominal wall hernias.

Effectiveness of Group Guidance with Group Investigation Learning Model to Develop Students' Assertiveness

Adolescents require assertiveness in socializing and interacting with their social environment in order to be able to express themselves well. However, there are still many adolescents who have not been able to express their thoughts, feelings, and hopes. This research aims to test the efficacy of group guidance services using the group investigation learning model to increase adolescent assertiveness. This research uses a one-group pretest-posttest research design to achieve the research objectives. The research subjects were six students at State Junior High School. The techniques and instruments used for data collection were an assertiveness scale. The assertiveness scale was tested for the level of validity and reliability through the Cronbach alpha formula. Furthermore, the data were analyzed using the Wilcoxon test. The results demonstrated a significant increase in student assertiveness after being given group guidance using the group investigation model. This indicates that the group investigation learning model is effective in increasing the assertiveness of adolescents.

A site-wise reliability analysis of the ABCD diffusion fractional anisotropy and cortical thickness: impact of scanner platforms.

The Adolescent Brain and Cognitive Development (ABCD) project is the largest study of adolescent brain development. ABCD longitudinally tracks 11,868 participants aged 9-10 years from 21 sites using standardized protocols for multi-site MRI data collection and analysis. While the multi-site and multi-scanner study design enhances the robustness and generalizability of analysis results, it may also introduce non-biological variances including scanner-related variations, subject motion, and deviations from protocols. ABCD imaging data were collected biennially within a period of ongoing maturation in cortical thickness and integrity of cerebral white matter. These changes can bias the classical test-retest methodologies, such as intraclass correlation coefficients (ICC). We developed a site-wise adaptive ICC (AICC) to evaluate the reliability of imaging-derived phenotypes while accounting for ongoing brain development. AICC iteratively estimates the population-level age-related brain development trajectory using a weighted mixed model and updates age-corrected site-wise reliability until convergence. We evaluated the test-retest reliability of regional fractional anisotropy (FA) measures from diffusion tensor imaging and cortical thickness (CT) from structural MRI data for each site. The mean AICC for 20 FA tracts across sites was 0.61±0.19, lower than the mean AICC for CT in 34 regions across sites, 0.76±0.12. Remarkably, sites using Siemens scanners consistently showed significantly higher AICC values compared to those using GE/Philips scanners for both FA (AICC=0.71±0.12 vs 0.46±0.17, p<0.001) and CT (AICC=0.80±0.10 vs 0.69±0.11, p<0.001). These findings demonstrate site-and-scanner related variations in data quality and underscore the necessity for meticulous data curation in subsequent association analyses.

Differential dietary intake and contribution of ultra-processed foods during pregnancy according to nutritional status

Differential dietary intake and contribution of ultra-processed foods during pregnancy according to nutritional status

Occlusal veneer restoration treatment outcomes of cracked tooth syndrome: A 22.4-month follow-up study.

The aims of this clinical study were to investigate success rate, vital pulp survival rate, tooth survival rate and patient-reported masticatory ability by evaluating the pain symptoms and signs of the cracked teeth as well as Index of Eating Difficulty (IED) and Oral Health Impact Profile-14 (OHIP-14) questionnaire after cracked teeth were restored with occlusal veneers. 27 cracked teeth of 24 patients with cold and/or biting pains without spontaneous/nocturnal pains were recruited in this study. The cracked teeth were restored with occlusal veneers fabricated by lithium disilicate ceramic. Cold test and biting test were used to evaluate pain signs. IED and OHIP-14 questionnaire were used to evaluate masticatory ability. FDI criteria was used to evaluate restorations. The paired Wilcoxon test was used to analyze significant differences of detection rate of pain signs, OHIP scores and IED grade before and after restorations. Kaplan-Meier survival curve was used to describe the success rate, vital pulp survival rate, and tooth survival rate. 27 cracked teeth were restored with occlusal veneers with average of 22.4-month follow-up. Two cracked teeth had pulpitis and pain signs of the other cracked teeth completely disappeared. OHIP total scores were significantly reduced after treatment. Scores of 'pain', 'occlusal discomfort', 'uncomfortable to eat', 'diet unsatisfactory' and 'interrupted meals' reduced significantly after treatment. After treatment, IED grades of 25 vital teeth were significantly lower than those before treatment. FDI scores of 25 restorations except for 2 teeth with pulpitis were no greater than 2. The 12months accumulated pulp survival rate of the cracked teeth was 92.6%. The 12months accumulated tooth survival rate was 100%. The success rate at the latest recall was 92.6%. Occlusal veneer restorations with success rate of 92.6% and the same pulp survival rate might be an effective restoration for treating the cracked teeth. The occlusal veneer restorations might be an option for treating the cracked teeth when cracks only involve enamel and dentin, not dental pulp.

Technology-Based Strategy to Improve Medication Compliance Among Patients With Schizophrenia Spectrum Disorders.

Non-compliance to medications remains a challenging problem in schizophrenia. Newer strategies with high feasibility and acceptability are always being researched. This study aimed to assess the effectiveness of technology-based intervention in improving medication compliance in individuals with schizophrenia. This was a prospective intervention study where participants were required to use the SuperMD smartphone application (Digital-Health Technologies Pte Ltd, Kuala Lumpur, Malaysia) for a month. A change in the Medication Adherence Rating Scale-Malay Translation (MARS-M) and MalayTranslation of Drug Adherence Inventory-9 (MDAI-9) scores indicated a change in compliance and attitude to medication.Positive and Negative Syndrome Scale (PANSS) was used to assess change in symptoms and insight. Medication compliance was also obtained from the SuperMD application.Paired T-test was used to evaluate the significance of changes in mean scores of research variables over the study period. Wilcoxon signed-rank test was used to analyze the subscale of MDAI-9 and the change in PANSS score. The Kruskal-Wallis test was used to determine the effect of the change of insight on the level of compliance with medication. There were 36 participants in this study.The results showed statistically significant improvement in compliance (0.65, p ≤ 0.01) but not in attitude towards medication (0.78, p = 0.065). There was also an improvement in PANNS score (-2.58, P ≤ 0.01). There was no significant change in insight (χ2(2) = 3.802, p = 0.15). Conclusion:The use of technology-based strategies like SuperMD is effective in improving medication compliance for individuals with schizophrenia.

The Effects of Intermittent Fasting on the Size and Number of Subcutaneus Adipocytes in Obese Mouse Models

Highlights:1. This study helps bridge the gap between systemic effects and tissue-level changes, providing a deeper understanding of how histological analysis can be used to explore the effects of intermittent fasting on adipocytes and body weight regulation.2. This study contributes to obesity management through lifestyle modification, specifically intermittent fasting, by focusing on histological changes in adipose tissue. Abstract The accumulation of adipose tissue can have deleterious effects and lead to obesity. Intermittent fasting (IF), an approach that involves time-restricted eating, has gained popularity as an obesity treatment option because it enhances insulin sensitivity and promotes beneficial changes in glucose metabolism. This study used a time-restricted meal intake (TRM) approach to assess the effects of IF on the histological features of obese mouse models' subcutaneous inguinal adipose tissue. The investigation employed an in vivo experimental posttest-only control group design. Twenty male mice were divided into four groups: a normal control group, an obese control group, a TRM group with a high-fat diet (TRM-HF), and a TRM group with a standard diet (TRM-S). The TRM treatment was administered for fourteen days, with a fasting window from 4 p.m. to 8 a.m. The pre- and post-treatment weight analyses were conducted using the paired t-test for normally distributed data and the Wilcoxon test for non-normally distributed data (p&lt;0.05). One-way analysis of variance (ANOVA) was employed for unpaired data on the post-treatment weight. Per field of view, there were an average of 120,500 cells (49,700–136,200) in the normal control group, 68,380±9,194 cells in the obese control group, 70,860±11,029 cells in the TRM-HF group, and 79,360±5,112 cells in the TRM-S group. The average cell sizes (μm3) were 56,730.142±19,273.257 in the normal control group, 138,934.331±27,670.558 in the obese control group, 106,827.767±20,580.501 in the TRM-HF group, and 68,689.114±8,219.727 in the TRM-S group. The number of cells in each group did not differ significantly, but there were significant variations in cell size. The mice receiving TRM treatment did not exhibit substantial body weight changes, whereas the obese control group showed a significant body weight increase. In conclusion, TRM has an effect on cell size but does not affect the quantity of adipocytes in subcutaneous inguinal fat tissue.

Enhancing Childrens Cognitive Abilities Through “Jelajah Alam” Apllication : Promoting Well-being

The use of technology in the early childhood learning process is rarely found despite the numerous benefits it offers. This study aimed to examine the effectiveness of the "Jelajah Alam" application in enhancing children's cognitive abilities. Research utilized quantitavive quasi-experimental : one sample pre-test post-test design. Research sample consisted of 19 kindergarten children selected through purposive sampling technique. Data measurement used was Nijmeegse Schoolbekwaamheids Testand Coloured Progressive Matrices Test. Data analysis use Wilcoxon signed-rank test. Findings revealed a significant difference between the pre-test and post-test score after implementing the "Jelajah Alam" application. Results indicated that the use of the application was effective in improving children's cognitive abilities. Results suggest that by playing “Jelajah Alam” application, enhance their cognitive ability based on their developmental phase. Result imply that by using technology, Parents and teacher have additional fun alternative to enhance their children cognitive ability.

Comparative Effects of Target-Controlled Infusion of Propofol Versus Spinal and Thiopental-Sevoflurane Anesthesia on Lipid Peroxidation in Elective Cesarean Section: A Prospective, Open-Label Study.

During pregnancy, physiological changes can increase oxidative stress (OS) in both mothers and fetuses. The use of anesthesia for cesarean sections (CSs) could exacerbate this stress due to its impact on the ischemia-reperfusion effect. Our study aimed to explore the effects of target-controlled infusion of propofol on OS during CSs, and to compare these effects with those of spinal and thiopental-sevoflurane anesthesia. The study included ninety parturients undergoing elective CS, allocated into three groups: Group S (spinal) (n = 30), Group P (propofol) (n = 30), and Group TS (thiopental-sevoflurane) (n = 30). Venous blood samples were taken from mothers at three time points, before, during, and after surgery, and one sample was taken from the umbilical vein after delivery. Blood samples were analyzed with the thiobarbituric acid reactive substances (TBARS) assay and blood gas analysis. A statistical comparison between groups was obtained by one-way analysis of variance (ANOVA) and the Wilcoxon test where appropriate. Levels of TBARS after the induction of anesthesia were lower in all groups compared to values preoperatively. In Group P, TBARS levels started to decrease in the first five minutes after the induction (1.90 ± 0.47; P < 0.001) and had significantly lower values compared to Group S (2.22 ± 0.21) and Group TS (2.40 ± 0.20). Two hours after surgery, TBARS values were the lowest in Group P (1.76 ± 0.15, P<0.001), compared to Group S (2.18 ± 0.24) and Group TS (2.41 ± 0.21). TBARS value in umbilical venous blood was significantly lower in Group P (1.56 ± 0.16, P < 0.001) compared to Group S (2.18 ± 0.17) and Group TS (2.09 ± 0.09). Umbilical cord venous blood gas values (pH, PCO2, HCO3, lactates, and base excess (BE)) were not different between the groups, except for PO2, which was significantly lower in Group S (20.5 ± 5.0; P < 0.001) compared to Group P (36.5 ± 19.2) and Group TS (33.5 ± 10.1). Target-controlled infusion of propofol anesthesia could beadvantageous for parturients with compromised oxidative status, especially those undergoing emergency CSs when general anesthesia is required.

Clinical effect of the modified pharyngeal flap of bilateral muscular rings in the treatment of moderate and severe velopharyngeal insufficiency

To introduce the modified pharyngeal flap of bilateral muscular rings (BMR), and to discuss the clinical effect of this operation in the correction of moderate and severe velopharyngeal insufficiency. The clinical data of 18 patients who underwent BMR surgery in the Department of Craniofacial Plastic and Aesthetic Surgery, School of Stomatology, The Fourth Military Medical University from May 2019 to July 2021 were retrospectively analyzed. There were 10 males and 8 females, with a median age of 8.5 years (aged from 5 to 34 years). The patients were diagnosed preoperatively with moderate to severe velopharyngeal insufficiency (velopharyngeal closure ratio<0.7). The results of nasopharyngoscopy and speech assessment were compared and analyzed before operation and at the follow-up 6 months after the operation to evaluate the changes in velopharyngeal function and speech. Eighteen patients underwent BMR, 4 patients had snoring (the symptom disappeared after a few weeks in 3 cases), and 2 patients had local erosion of the wound, which delayed healing. Postoperative nasopharyngoscopy showed that all patients achieved comparatively complete velopharyngeal closure, some patients got enhanced lateral pharyngeal wall motility, and all patients got active motility of posterior pharyngeal wall flap. The postoperative speech assessment was significantly improved compared with that before the operation. The preoperative median score was 9 (range 7-12), and the postoperative median score was 2 (range 0-4). The statistical analysis was performed by paired non-parametric Wilcoxon signed rank test, and the difference was statistically significant (P<0.001). BMR is a reliable method for the treatment of moderate and severe velopharyngeal insufficiency. This technique can achieve functional contraction of the full circumference of the ventilator while preserving the obstructive effect of the posterior pharyngeal wall flap, which is helpful to balance nasal ventilation and velopharyngeal closure and improve the velopharyngeal function of patients.

Drawing a line from CO2 emissions to health—evaluation of medical students’ knowledge and attitudes towards climate change and health following a novel serious game: a mixed-methods study

BackgroundEducation is urgently needed to equip medical students with knowledge, values and skills to promote planetary health. However, the current literature offers little insight into evidence-based approaches and best practices. In response to this pressing need, a novel serious game was introduced into the medical curriculum at Erasmus Medical Center in 2023. The aim of this study was to evaluate the knowledge and attitudes of medical students after they had played a serious game that addresses climate change and health.MethodsIn accordance with a mixed-methods design, quantitative data were collected using pre- and post-intervention surveys. Differences were assessed using the Wilcoxon signed rank test. Focus group discussions were held after the game and thematically analysed.ResultsOne hundred forty-five students (38.6% of the entire cohort) played the game, of which 59 students completed the pre- and post-intervention surveys. After the game, self-reported knowledge increased. Regarding objective knowledge, an increase in the proportion of students who answered one of the two questions correctly was observed, while the proportion of correct responses decreased for the other question. Student’s responses to two out of five attitude questions were significantly more positive. The proportion of students who recognized the importance of climate change education, to inform patients and society about the health impacts of climate change, increased. Moreover, survey results indicated a significant increase in climate worry subsequent to the game. Eleven students participated in the focus group discussions. Thematic analysis highlighted participants’ reflections on the roles and responsibilities in climate change and health, along with their realisation of the tools for action that climate and health co-benefits provide. Another significant aspect was the importance participants placed on learning alongside peers with diverse attitudes. Additionally, participants appreciated the tangible overview of climate change and health provided by the serious game.ConclusionsOur novel serious game addressed an important gap in the medical curriculum. The game can enable medical students to cultivate the necessary knowledge and attitudes to promote health in times of a climate crisis. The accompanying climate worry needs attention through the empowerment of students’ agency to foster change.

Comparison Analysis of Financial Performance and Financial Distress before and during the Covid-19 Pandemic

The purpose study was to analyze a comparison of financial performance and financial distress before and during the Covid-19 pandemic in the Hotel, Restaurant, and Tourism sub-sector companies listed on the Indonesia Stock Exchange for the 2018-2021 period. In this study, a comparative descriptive method was used with a quantitative approach to test the impact of Covid-19 on financial performance and financial distress. The final sample of this study was 19 companies based on the elimination of the criteria that were only needed in this study. The proxies used to measure financial performance are profitability ratios (ROA, ROE, and NPM), while financial distress uses the Altman Z-Score model. Furthermore, these ratios were tested with a different test using the Wilcoxon sign rank test. The results showed that there were significant differences in the ratios of financial performance which included ROA, ROE, and NPM. Meanwhile, financial distress (Z-Score) also experienced significant differences between before and during the Covid-19 pandemic.

Quantifying Sagittal Lip Changes in Patients with Bilateral Cleft Lip Post Abbe Flap Reconstruction.

To objectively quantify results of sagittal lip changes following Abbe flap reconstruction in patients with bilateral cleft lip. Retrospective, observational study. Single institution, 8-year retrospective review. In total, 17 patients with bilateral cleft lip that underwent Abbe flap reconstruction were included in this study. Patients had lateral photographs taken prior to Abbe flap reconstruction and at least 8 months post-Abbe flap. Vegter's index, Sushner's S2 line and Burstone's B line reference lines were used for evaluation of sagittal lip changes. Wilcoxon signed rank tests were used in analysis. The mean pre-Abbe flap upper to lower lip ratio, defined as Vegter's Lip Index, was 0.906 compared to a mean of 0.946 following Abbe flap reconstruction. The mean upper to lower lip ratio for Sushner's S2 and Burstone's B line exhibited an increase in upper lip sagittal projection from -0.164 to 1.459 and 0.259 to 0.957, respectively (P < 0.001). This study quantifies sagittal changes to upper and lower lip position after Abbe flap reconstruction. These findings may aid in operative planning and patient/caregiver expectations during counseling.