Wilcoxon Test For Paired Samples Research Articles

Impact of root canal disinfection on the bacteriome present in primary endodontic infection: A next generation sequencing study.

To investigate the bacteriome present in teeth with primary endodontic infection (PEI) and apical periodontitis (AP) and to determine quantitatively and qualitatively the impact of chemomechanical preparation (CMP) using 2.5% sodium hypochlorite NAOCl on the bacteriome found in PEI with AP using the Illumina MiSeq platform. Thirty-six paired samples from 18 patients were successfully sequenced and analysed. Samples were collected at two sampling times: before (s1) and after (s2) CMP using 2.5% NaOCl. The DNA was extracted from s1 and s2 samples and quantified using quantitative PCR (qPCR). All 36 samples were sequenced using the Illumina MiSeq platform. Raw V3-V4 amplicon sequencing data were processed with the DADA2 pipeline to generate amplicon sequence variants (ASVs). Alpha diversity metrics representing abundance (Chao1) and diversity and evenness (Shannon, Simpson) were computed. The paired-sample Wilcoxon's test was used to compare alpha diversity metrics and qPCR counts between s1 and s2. The PERMANOVA method (with 999 permutations) was applied to compare community composition between sample types (s1 versus s2) and between patient IDs. ALDEx2 (ANOVA-like differential expression tool for high-throughput sequencing data) to investigate differentially abundant taxa between s1 and s2. A paired-sample Wilcoxon's test was used to compare alpha diversity metrics and qPCR counts between s1 and s2. The qPCR counts were significantly higher in s1 compared to s2 (p = .0007). The Chao1 index indicated no difference in alpha diversity (p < .7019); whereas Shannon (p = .0056) and Simpson (p = .02685) indexes showed higher values in s2. The PERMANOVA test using Adonis2 showed a significant effect of sample time on community composition (R2 = .0630, p = .012). Patient ID also showed a significant effect on community composition (R2 = .6961, p = .001). At the genus level, Dialister, Mogibacterium, Prevotella, and Olsenella were differentially enriched at s1, while Actinomyces, Stenotrophomonas_unclassified, Enterococcus_unclassified, and Actinomyces_unclassified were differentially enriched in s2. The bacteriome present in teeth with PEI with AP is complex and diverse. CMP using 2.5% NaOCl showed a high quantitatively and qualitatively disinfectant impact on the bacteriome present in PEI with AP.

Abstract PO5-06-05: DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE

Abstract Introduction: Breast cancer (BC) is a heterogeneous disease, and during its progression, the tumor phenotype can undergo changes that are often associated with a poor prognosis. In this study, we aim to compare the discordance in estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression between primary and recurrent/metastatic lesions. Methods: This study is a retrospective analysis of 132 non-advanced breast cancer patients who experienced confirmed recurrence/metastasis at the Instituto Nacional de Enfermedades Neoplasicas between 2011 and 2022. Descriptive analysis was conducted to assess the expressions of ER, PgR, HER-2, and Ki-67 in primary and metastatic breast cancer, as well as clinical variables. Normality tests, including Kolmogorov-Smirnov and Shapiro-Wilk, were performed. The paired samples Wilcoxon test was used to determine significant differences between primary and recurrent/metastatic tumors. Additionally, Spearman's rank correlation coefficient was employed to evaluate the relationships of expression discordance. Results: Fifty-nine percent of patients presented locoregional recurrence, while 41% presented visceral metastasis. In the primary tumor, ER and PR expression were found in 63.6% and 55.3% of cases, respectively. HER2 status was determined as 0 (36.3%), +1 (22%), +2 (14.4%), +3 (26.5%), and not determined (0.8%) by IHC. For the recurrent/metastatic tumor, ER and PR expression were found in 59% and 34% of cases, respectively. HER2 status was determined as 0 (27.3%), +1 (19.7%), +2 (25%), +3 (25%), and not determined (3%). The median Ki-67 levels were 37% in the primary tumor and 40% in the recurrent/metastatic tumor. Significant differences were found for ER (p=0.014), PR (p&amp;lt; 0.001), and HER2 (p=0.019), but not for Ki-67 percentage (p=0.139). The discordance rates of ER, PR, HER2, and Ki-67 expression were 27.9%, 47.7%, and 26.3%, respectively. Conclussions: Discordance in hormone receptor expression between primary and recurrent/metastatic tumors is a common phenomenon, with ER showing a discordance rate of 27.9% and PR showing a higher rate of 47.7%. HER2 status also displayed significant discordance, with a 26.3% rate of discordant expression between primary and recurrent/metastatic tumors. The findings from this study emphasize the dynamic nature of breast cancer and the importance of comprehensive evaluation of biomarker expression in both primary and recurrent/metastatic tumors, to choose the best treatment options. Citation Format: Katia Roque, Iris Otoya, Natalia Valdivieso, Zaida Morante, Hugo Fuentes, Silvia Neciosup, Henry Gómez, Jorge Cotito, Gonzalo Ziegler, Estefania Peña, Tatiana Vidaurre, Ramon Andrade de Mello, Carlos Castañeda. DISCORDANCE BETWEEN HORMONE RECEPTORS AND HER2 STATUS IN BREAST CANCER PATIENTS RELAPSE [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-05.

Advantages of UltrafastTM ultrasound in the screening for renal artery disease

Aim: Renal artery disease is the most common cause of secondary hypertension worldwide. B-mode and Doppler ultrasound are considered the modalities of choice for the imaging of the renal arteries. However, an adequate examination can be plagued by difficulties in patients with unfavorable anatomy. UltraFastTM ultrasound is faster, performed with higher frame rates, and enables prospective and ret- rospective data analysis with quantification of flow data in the obtained image, so it may be able to resolve some of the difficulties encountered during conventional ultrasound examinations in patients with suspected renal artery disease. Material and methods: Comparison of the duration of conven- tional and UltraFastTM Doppler examinations of segmental renal arteries was performed on 52 young, healthy volunteers. Duration times were summarized using the median and interquartile range, and comparisons between the two methods were performed using the Wilcoxon test for paired samples. Results: The duration of UltraFastTM ultrasound examinations was significantly shorter in comparison to conventional ultrasound for both kidneys and in total (p &lt;0.001, median difference in duration 65 s, median 64% shorter duration of analysis), while both conventional and UltraFastTM ultrasound examina- tions demonstrated consistent velocity measurements with very high correlation (Rho = 0.94, p &lt;0.001). Conclusions: The study provides evidence that UltraFastTM ultrasound is faster than conventional Dop- pler ultrasonography for the assessment of renal artery disease in healthy adults without a history of renal disease. The findings have important implications for clinical practice, as they suggest that Ultra- FastTM imaging could offer a more efficient and time-saving approach to vascular imaging in patients with suspected renal artery disease.

Evaluating the usability and effectiveness of the Go PainFree telehealth system (beta version) for musculoskeletal pain management in the Philippines

Biomechanical Taping has been shown to effectively reduce pain and enhance function in patients with musculoskeletal pain. When used as an adjunct to physiotherapy, BMT may contribute to increased stability, leading to improved pain management and functionality. Telehealth has emerged as an effective and cost-efficient alternative to traditional physiotherapy. The Go PainFree Telehealth System, employs BMT to alleviate pain and improve functionality, enhancing the overall effectiveness of online therapy services for patients with musculoskeletal conditions.The study determined the usability of the system in managing musculoskeletal conditions for patients accessing healthcare online, focusing on its usefulness, ease of use and learnability, interface quality, interaction quality, reliability, satisfaction, and future use. Also, the study examined the effectiveness of BMT on pain and function in individuals with musculoskeletal conditions when integrated into the system after a single session.This retrospective study reviewed the records of the system between November 2022 and February 2023. Evaluating the system's usability involved the integration of the Telehealth Usability Questionnaire within the system survey, serving as a reliable instrument for assessing the quality of telehealth applications from the users' perspective. Participants rated various parts, including usefulness, ease of use and learnability, interface quality, interaction quality, reliability, and satisfaction and future use. To determine the effectiveness of BMT, the 100-mm Visual Analogue Scale (VAS) was used before and after a single session. Data analysis was conducted using descriptive statistics, allowing for the summarization of demographic information and the reporting of average mean (95 % (CI)) for each usability category of the TUQ. The effectiveness of BMT on pain and function was determined using the Wilcoxon test for paired samples after one session. P < 0.05 indicates significant improvement in pain and function. This study involved 33 participants, with a mean (SD) age of 34.94 ± 2.04, who used the system between November 2022 and February 2023. The majority of reported musculoskeletal conditions pertained to the upper extremity (n = 19), followed by the lower extremity (n = 8), and spine (6). The findings revealed that participants generally considered the system useful, easy to use and learn, and had good interface and interaction quality, as shown by average scores of five in these categories, indicating "somewhat agree." Conversely, participants expressed reservations about the system's reliability, with an average score of 3 reflecting "somewhat disagree." As for their satisfaction with the system and the likelihood of future use, participants showed mixed opinions, with an average score of 4 representing "neither agree nor disagree." The study showed BMT significantly reduced pain scores (Z = −4.80, p < 0.001, two-tailed) and enhanced function scores (Z = −4.87, p < 0.0001, two-tailed) for participants with musculoskeletal conditions.The system was generally regarded by the participants as useful, user-friendly, and characterized by high-quality interface and interaction. Despite these positive perceptions, concerns about the platform's reliability emerged, and opinions about satisfaction and future use were mixed. Still, the integration of BMT into the system yielded significant reductions in pain and improvement in function for the participants with musculoskeletal conditions.

Evolving or unchanged? Investigating perceptual profiles over time in psychosis and comparing with healthy controls

There is a growing body of evidence indicating altered perceptual profiles in psychosis, which can be assessed by evaluating exteroceptive (e.g., auditory and visual) and interoceptive (e.g., heartbeat and breathing) sensory processing through self-administered questionnaires. However, the unexplored question remains whether perceptual alterations depend on the phase of illness. In this observational, STROBE-compliant study, we adopted the Multidimensional Assessment of Interoceptive Awareness (MAIA; eight domains), Adult/Adolescent Sensory Profile (AASP; four domains), and Positive and Negative Symptoms Scale (PANSS) to measure interoception, exteroception, and symptom severity, respectively. Our primary aim was to compare MAIA, AASP, and PANSS differences in patients with psychosis (PSY patients) between post-acute (PSY-T1) and remission phases (PSY-T2). Student&amp;rsquo;s t-tests or Wilcoxon paired-sample tests were used based on the variable distribution. MAIA/AASP data were also collected from healthy controls (HCs). As a secondary aim, we examined MAIA/AASP differences between PSY-T1/T2 and HC using MANOVA and Mann&amp;ndash;Whitney tests. Bonferroni&amp;ndash;Holm correction was implemented. Data were collected from 23 PSY patients (55% females; mean age: 38.35 &amp;plusmn; 12.46 years) and 210 HC (46% females; mean age: 39.81 &amp;plusmn; 13.78 years). No differences were found between PSY-T1 and PSY-T2 (Bonferroni&amp;ndash;Holm P &gt; 0.05) for MAIA/AASP scores, while PANSS total and positive scores were higher in PSY-T1 compared to PSY-T2, with Bonferroni&amp;ndash;Holm p-values of 0.032 and 0.045, respectively. Although MAIA/AASP domains (noticing/body listening and low registration) were increased in PSY-T1 compared to HC, no differences were observed between PSY-T2 and HC. The heterogeneous results in the literature regarding perceptual profiles should be contextualized by considering that fluctuations in patients with psychosis can become significant when compared to the general population.

Beneficial impact of visual stimulation-based digital therapeutics on blood pressure control in non-hypertensive individuals.

Hypertension-related diseases occur in both hypertensive and non-hypertensive individuals. However, few studies to date have explored blood pressure (BP) control in non-hypertensive individuals. This before-after study aimed to examine the impact of visual stimulation-based digital therapeutics (VS-DTx) on BP and heart rate (HR). Eighty-three eligible non-hypertensive participants were included in this study. The McNemar test and Paired Samples Wilcoxon Signed Rank Test were employed to assess decline rates and differences in BP and HR between the control phase and the intervention (using VS-DTx) phase. Pairwise correlation analysis was used to analyze the correlation between the two phases. This study found the systolic BP (SBP) and mean arterial pressure (MAP) in the VS-DTx phase showed a downward trend (66.2% vs 49.3%; 68.7% vs 55.4%). The mean SBP decreased from 114.73 mm Hg to 111.18 mm Hg, and the mean MAP decreased from 87.96 mm Hg to 84.88 mm Hg in the VS-DTx phase. Paired Samples Wilcoxon Test showed differences in both ΔSBP (Z = -3.296; P < 0.01) and ΔMAP (Z = -2.386; P < 0.05) (Δ is defined as the difference between baseline and post-stimulus). The pairwise correlations analysis revealed that VS-DTx affected the MAP reduction (r = 0.33; P < 0.01) between the browsing digital devices phase and the VS-DTx phase. The results indicated that VS-DTx may have a certain effect on BP, including SBP and MAP. This study preliminarily explored the possible effects of VS-DTx on BP, providing certain useful insights for future research in digital BP management.

Cognitive and functional evolution in older adults with and without intellectual disability using a multicomponent intervention: A prospective longitudinal study

BackgroundThe global population is experiencing accelerated biopsychosocial aging. Cognitive impairment is frequently associated with functional impairment in basic and instrumental daily living activities. To maintain optimal cognitive and functional functioning, health professionals recommend that older adults participate in cognitive training. AimsThis study examines the cognitive and functional evolution of older adults with and without Intellectual Disability and the factors associated with favourable evolution following the intervention of a multicomponent programme based on the human occupational model and the person-centred care model. Methods and procedures247 people participated. Descriptive and univariate analyses were performed to examine baseline data. The Wilcoxon paired samples test was used to compare cognitive and functional evolution one year after the intervention. Linear regression was used to detect factors predicting favourable evolution. Outcomes and resultsBoth populations improved cognitively. There was no change in basic activities of daily living. There was an improvement in instrumental activities of daily living in the group with Intellectual Disability. None of the variables collected was a predictor of greater improvement. Conclusions and implicationsThis study demonstrated that older people with Intellectual Disability who have supports to cope with this life stage can improve their cognitive and functional abilities.

Comparison of Multiple Segmentation Methods for Volumetric Delineation of Primary Prostate Cancer with Prostate-Specific Membrane Antigen-Targeted 18F-DCFPyL PET/CT.

This study aimed to assess the accuracy of intraprostatic tumor volume measurements on prostate-specific membrane antigen-targeted 18F-DCFPyL PET/CT made with various segmentation methods. An accurate understanding of tumor volumes versus segmentation techniques is critical for therapy planning, such as radiation dose volume determination and response assessment. Methods: Twenty-five men with clinically localized, high-risk prostate cancer were imaged with 18F-DCFPyL PET/CT before radical prostatectomy. The tumor volumes and tumor-to-prostate ratios (TPRs) of dominant intraprostatic foci of uptake were determined using semiautomatic segmentation (applying SUVmax percentage [SUV%] thresholds of SUV30%-SUV70%), adaptive segmentation (using adaptive segmentation percentage [A%] thresholds of A30%-A70%), and manual contouring. The histopathologic tumor volume (TV-Histo) served as the reference standard. The significance of differences between TV-Histo and PET-based tumor volume were assessed using the paired-sample Wilcoxon signed-rank test. The Spearman correlation coefficient was used to establish the strength of the association between TV-Histo and PET-derived tumor volume. Results: Median TV-Histo was 2.03 cm3 (interquartile ratio [IQR], 1.16-3.36 cm3), and median TPR was 10.16%. The adaptive method with an A40% threshold most closely determined the tumor volume, with a median difference of +0.19 (IQR, -0.71 to +2.01) and a median relative difference of +7.6%. The paired-sample Wilcoxon test showed no significant difference in PET-derived tumor volume and TV-Histo using A40%, A50%, SUV40%, and SUV50% threshold segmentation algorithms (P > 0.05). For both threshold-based segmentation methods, use of higher thresholds (e.g., SUV60% or SUV70% and A50%-A70%) resulted in underestimation of tumor volumes, and use of lower thresholds (e.g., SUV30% or SUV40% and A30%) resulted in overestimation of tumor volumes relative to TV-Histo and TPR. Manual segmentation overestimated the tumor volume, with a median difference of +2.49 (IQR, 0.42-4.11) and a median relative difference of +130%. Conclusion: Segmentation of intraprostatic tumor volume and TPR with an adaptive segmentation approach most closely approximates TV-Histo. This information might be used to guide the primary treatment of men with clinically localized, high-risk prostate cancer.

Can family members reliably assess mood and suicidal ideation in individuals with epilepsy?

BackgroundRoutine detection of depression, anxiety and suicidal ideation in people with epilepsy (PWE) remains suboptimal. We investigated the level of agreement between PWE and their proxies when evaluating these psychiatric symptoms. MethodsFrom October 2021 to March 2022, we conducted a cross-sectional anonymous survey at Vilnius University Hospital Santaros Klinikos (Vilnius, Lithuania). Persons accompanying PWE completed different scales measuring symptoms of depression and anxiety and evaluated suicidal ideation among PWE (defined as a non-zero score of the suicide item of the Beck depression inventory (BDI) or as a score > 1 of the item 4 of the Neurological Disorders Depression Inventory for Epilepsy, NDDI-E). Agreement between PWE and their proxies was measured using the Wilcoxon test for paired samples and Pearson’s correlation analysis. ResultsThe study included 140 PWE (mean age 41.0 ± 18.1, 71 (50.7 %) female) and 140 proxies (mean age 49.0 ± 15.01, 105 (75.0 %) female, 57 (40.7 %) were parents, 51 (36.4 %) – spouses, 15 (10.7 %) – partners, 11 (7.9 %) – children and 6 (4.3 %) – siblings of PWE). There were no statistical differences in paired scores of the BDI, Hospital Anxiety and Depression scale, Generalized Anxiety Disorder scale-7, and the NDDI-E (p > 0.05). Proxies reported statistically higher scores on the Geriatric Depression Scale (Z = − 2.026, p = 0.043) than PWE. The correlation between PWE and proxy evaluations for all instruments was moderate (varying from r = 0.500 to r = 0.688, p < 0.001). For most psychometric scales proxies became less accurate with higher scale scores for anxiety and depression and tended to underestimate the level of such symptoms (correlation between scale results and signed (PWE − proxy) mismatch varied from r = 0.368 to r = 0.641, p < 0.001). The measure of proxy-PWE agreement on suicidal ideation was low (Cohen’s Κ = 0.192, p = 0.025); proxies missed 63 % (NDDI-E) to 70 % (BDI) of cases of suicidal ideation. ConclusionCompanions of PWE provided comparable reports of participant anxiety and depression on a group level but tended to underestimate psychiatric symptoms as their scale scores became higher. Proxies significantly underreported suicidal ideation in those people who did express it. While proxy reporting should not be used interchangeably on an individual level, its use in group studies may be useful and ought to be investigated further.

Immune Contexture Changes Following Blue Light Cystoscopy with Hexaminolevulinate in Bladder Cancer

BackgroundTransurethral resection of bladder tumor (TURBT) is a central component in the diagnosis of non–muscle-invasive bladder cancer (NMIBC) and can be guided by several optical imaging techniques for better visualization of lesions. ObjectiveTo investigate if a change in tumor microenvironment (TME) composition could be observed as an effect of hexaminolevulinate (HAL)-assisted blue light cystoscopy (BLC) in TURBT samples from patients with bladder cancer. Design, setting, and participantsThis was a retrospective study of 40 patients with bladder cancer who underwent either BLC-guided TURBT (n = 20) or white light cystoscopy (WLC)-guided TURBT (n = 20) before radical cystectomy (RC). Tissue samples (n = 80) were collected from paired TURBT and RC specimens for all 40 patients. Tumor tissue was stained using multiplex immunofluorescence and immunohistochemistry. Outcome measurements and statistical analysisImmune cell infiltration was assessed according to the proportions of each immune cell or immune evasion marker and the relative change from TURBT as baseline was calculated. Statistical comparisons between groups were performed using the Wilcoxon rank-sum test or the paired-sample Wilcoxon test. Results and limitationsComparison of relative changes in the TME revealed a significant decrease in stromal infiltration of cytotoxic T cells (p = 0.024), B cells (p = 0.041), and stromal cells expressing PD-1 (p = 0.011) in patients treated with BLC-guided TURBT compared to WLC-guided TURBT. ConclusionsOur pilot study showed that HAL-BLC during TURBT in bladder cancer may influence the immune cell composition and TME. Patient summaryWe investigated the potential therapeutic effect of blue light versus white light for guidance in removing bladder tumors via the urethra in patients with bladder cancer. For blue light guidance, a compound called hexaminolevulinate is used to visualize tumor tissue. We found changes in immune cell composition that may have been influenced by the blue light guidance.

SIMPEDVR: using VR in teaching pediatric emergencies to undergraduate students—a pilot study

The objective of this work was to provide pilot data on feasibility of using virtual reality (VR) to train undergraduate students in pediatric emergency scenarios. We staged VR sessions for a total of 45 medical and nursing students; in every session, each student managed two pediatric emergency virtual scenarios. At the end of the sessions, students completed a Technology Assessment Questionnaire to evaluate the perceived usefulness and perceived ease-of-use of their VR training experience and rated their perceived level of competence in managing the two clinical scenarios. The median perceived usefulness was 91.7/100 (interquartile range (IQR) 80.6–100), while the median perceived ease-of-use was 77.8/100 (IQR 63.9–88.9). The perceived level of competence increased from 2 (IQR 1–3) to 4 (IQR 3–4) on a 5-point Likert scale, for both scenarios (p < 0.001, Wilcoxon test for paired samples). Conclusions: The staged VR sessions had a good perceived usefulness and resulted in an increase in the perceived level of competence. The results on the ease-of-use, however, show that an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made; further work is required to ease the integration of VR into curricula.What is Known:• Virtual reality (VR) is a rising simulation training methodology in Pediatric Emergency Medicine (PEM), however little experience is reported about its use for undergraduate studentsWhat is New:• VR PEM trainiing was found useful by undergraduate students and its use increased their perceived level of competence, although ease-of-use received lower ratings.• Despite the young age, an assumption that millennials and younger students can navigate with confidence VR hardware in a healthcare training setting should not be made

The role of air temperature in Legionella water contamination and legionellosis incidence rates in southern Italy (2018-2023).

Legionnaires' disease is caused by inhalation or aspiration of small water droplets contaminated with Legionella, commonly found in natural and man-made water systems and in moist soil. Over the past 5 years, notification rates of this disease have almost doubled in the European Union (EU) / European Environmental Agency (EEA), from 1.4 in 2015 to 2.2 cases per 100,000 population in 2019. Some studies show that the greater presence of the microorganism in the water network and the increase in cases of legionellosis could be related to the variations in some environmental factors, such as air temperature, which may influence the water temperature. Climate change is currently a prominent topic worldwide because of its significant impact on the natural environment. It is responsible for the increase in numerous waterborne pathologies. The purpose of this study was to correlate the air temperature recorded in Apulia region from January 2018 to April 2023 with the presence of Legionella in the water networks of public and private facilities and the incidence rates of legionellosis during the same period. During the period from January 2018 to April 2023, water samples were collected from facilities involved in legionellosis cases and analyzed for Legionella. During the same period, all the cases notified to the regional epidemiological observatory (OER-Apulia) were included in this study. Statistical analyses were conducted using the Shapiro-Wilk test to determine whether the Legionella load was distributed normally, the Wilcoxon rank sum test to compare the air temperatures (average and range) of the negative and positive samples for Legionella detection, and the multivariate analysis (Poisson regression) to compare the Legionella load with the water sample temperature, average air temperature, and temperature range on the day of sampling. The Wilcoxon test for paired samples was used to compare legionellosis cases between the warmer and colder months. Overall, 13,044 water samples were analyzed for Legionella and 460 cases of legionellosis were notified. Legionella was isolated in 20.1% of the samples examined. The difference in the air temperature between negative samples and positive samples was statistically significant (p-value < 0.0001): on days when water samples tested positive for Legionella a higher temperature range was observed than on days when water samples tested negative (p-value = 0.004). Poisson regression showed a direct correlation between Legionella load, water temperature, and average air temperature. The incidence of legionellosis cases in warmer months was higher than in colder months (p-value = 0.03). Our study highlights a significant increase in the load of Legionella in the Apulian water network, and an association between warmer temperatures and legionellosis incidence. In our opinion, further investigations are needed in different contexts and territories to characterize the epidemiology of legionellosis, and to explain its extreme variability in different geographical areas and how these data may be influenced by different risk factors.

Evaluation of a pregnancy loss education intervention for undergraduate nursing students in Northern Ireland: A pre- and post-test study

BackgroundResearch highlights the importance of compassionate communication, adequate delivery of information, and professional support to help alleviate parental distress following pregnancy loss. However, many healthcare professionals do not feel sufficiently trained to deal with pregnancy loss in practice. We aimed to address this deficiency with an evidence-informed educational intervention to increase knowledge, skills, self-awareness, and confidence regarding pregnancy loss among UK nursing students.MethodsEducational resources, which included an 82-minute podcast and 40-minute online lecture were developed. The podcast focused on the lived experiences of three women who had experienced miscarriage, stillbirth, and termination of pregnancy for medical reasons. The pre-recorded lecture included definitions of types of pregnancy loss, discussion of the importance of communication, and information on the clinical management of pregnancy loss. Students were presented with both the lecture and podcast as a self-directed element of existing curricula. A pre-test/post-test cross-sectional survey design was used to investigate the impact of the educational intervention. The Perinatal Bereavement Care Confidence Scale (PBCCS) was completed by 244 first year BSc Nursing students before and up to a week after receiving the intervention. Quantitative data were analysed using a Paired Samples Wilcoxon test. Responses to open-ended questions, which allowed students to give feedback on the intervention content and delivery were analysed using Qualitative Content Analysis.Results96% (n = 235) of the sample reported having no prior experience or training in the management and support of those experiencing pregnancy loss. At pre-test, 88% (n = 215) of students rated themselves as not confident in dealing with pregnancy loss in a professional capacity. Post-test, we found statistically significant effects for perceived competency on all learning outcomes (p < .001). Qualitative analysis of n = 745 individual text responses to open-ended questions indicated four categories related to the perceived value of using real-life stories for learning, demystifying a taboo subject, and providing tools for practice. Respondents suggested the inclusion of more information on memory-making, support networks, and mental health following pregnancy loss.ConclusionsThe educational intervention increased student nurses’ perceived knowledge, confidence, and skills in caring for families experiencing pregnancy loss. This offers potential for increased quality of care for those experiencing pregnancy loss in healthcare settings, increased patient satisfaction, and improved mental health-related outcomes.

Association between problematic Internet use and specific Internet activities and COVID-19- and earthquake-related stress, anxiety, and depression symptoms among Croatian young adults.

During the COVID-19 pandemic and concomitant earthquakes in Croatia in 2020, increased Internet use (IU) and Internet-based addictive behaviors were associated with decreasing mental well-being. We determined the changes in IU, problematic IU (PIU), and problematic specific Internet activities in young adults during the prolonged stress caused by the pandemic and earthquakes, age differences in PIU and differences in perceived source of stress (pandemic or earthquakes), and association between PIU and increase in specific Internet activities and stress, anxiety, and depression symptoms in young adults. A cross-sectional online survey conducted from September 30, 2021 to October 17, 2021 included 353 young adults aged 22.6 ± 2.1 years, 382 early adults aged 32.1 ± 4.4 years, and 371 middle-aged adults aged 49.0 ± 6.5 years. Data on sociodemographic characteristics, stressors (without perceived stressors, only pandemic-related stressor, only earthquake-related stressor, and both pandemic and earthquake-related stressors), PIU and IU were collected with a self-report questionnaire. The Impact of Event Scale and the Hospital Anxiety Depression Scale were used to evaluate mental symptoms. PIU and problematic specific Internet activities were assessed using Tao et al.'s criteria. Data were anaylzed with paired-sample Wilcoxon test, McNemar's and Pearson's chi-square tests, and structural equation modeling. In 17% of young adults, we found increased PIU (OR = 5.15, 95% CI [2.82, 10.18]), problematic social media use (OR = 2.77, 95% CI [1.56, 5.14]), and uncontrolled online shopping (OR = 5.75, 95% CI [1.97, 22.87]) (p < 0.001 for all). PIU and problematic social media use were more common among young adults (60.8%), as well as problematic online gaming (25.9%). Problematic social media use was more frequent among young adults reporting pandemic stress than among those without perceived stress (69.9% vs. 43.2%). Increased online gaming predicted more severe avoidance symptoms (p = 0.041), increased social media use predicted more severe depression symptoms (p = 0.017), increased online shopping predicted more severe intrusion (p = 0.013) and anxiety symptoms (p = 0.001). PIU predicted more severe intrusion (p = 0.008), avoidance (p = 0.01), anxiety (p < 0.001), and depression (p = 0.012) symptoms. Different effects of the pandemic and earthquakes on IU could reflect a different effect of various stressors on Internet behavior of young adults. Type of problematic Internet behavior may predict for the type of mental health problem.

Intra-abdominal infection after tumor surgery: tigecycline combined with β-lactam antibiotics versus tigecycline alone

BackgroundsTigecycline has a broad spectrum of antimicrobial activity and has been approved for the treatment of complicated intra-abdominal infections. However, it is debatable whether tigecycline should be used alone or in combination. This study aimed to investigate whether tigecycline plus β-lactam antibiotics (combination therapy [CT] group) are superior to tigecycline alone (monotherapy [MT] group) in non-critically ill intra-abdominal infection patients after tumor surgery.MethodsThis was a multicenter, retrospective cohort study. The primary outcome was mortality during the hospital stay. Secondary outcomes were clinical success rate, microbial eradication rate, relapse rate within one week, course of treatment, and adverse effects. Propensity score matching (PSM) was used to adjust the degree of infection before medication between the MT and CT groups. Univariate comparisons were performed using the chi-squared test for qualitative variables and Student’s t-test or the Mann-Whitney U-test for continuous variables, as appropriate. Multivariate logistic regression analysis was performed to examine the relationship between antimicrobial treatments and mortality during hospitalization. The paired samples Wilcoxon test was used to compare the parameters before and after medication.ResultsIn total, 291 patients were included in the final analysis: 128 in MT group and 163 in CT group. Mortality rate was 6.25% in the MT group and 6.13% in the CT group (P = 0.97). Multivariate logistic regression model showed that carbapenem-resistant organisms (OR: 4.35, 95% CI: 2.36 ~ 61.70) and age > 65 (OR: 1.32, 95% CI:1.19 ~ 3.01) were independent risk factors for death. CT group had a shorter defervescence time (P < 0.05), with less likelihood of relapse (P < 0.05) but had a more significant effect on activated partial thromboplastin and prothrombin time.ConclusionsTigecycline plus β-lactam wasn’t superior to tigecycline monotherapy for the treatment of non-critically ill patients with intra-abdominal infection. But for advanced age patients with cancer, tigecycline combination therapy maybe a better choice in terms of mortality.

O-020 What is the recovery time for sperm parameters in men who have suffered a mild Covid-19 infection?

Abstract Study question What is the time required in men who have suffered a mild Covid-19 infection, for the seminal parameters to be restored to the pre-Covid values? Summary answer The effect of Covid-19 infection on the concentration and sperm motility is clearly confirmed and is maintained over time, at least beyond 100 days. What is known already Although several studies have been performed on the effect of SARS-CoV-2 on reproductive health in the short term vs. healthy controls, and the negative effect on sperm parameters has been demonstrated, there is a scarcity of data showing the degree to which the virus affects the semen parameters in one group of patients after coronavirus infection compared to before infection. Moreover, there are no conclusive data regarding the long-term effects of SARS-CoV-2 on semen parameters. Study design, size, duration This prospective study was carried out in 6 reproductive centers between February 2020 and October 2022 including 45 male patients with a confirmed diagnosis of mild COVID-19. For each of the semen parameters (volume, sperm count, active and total motility, normal morphology, and vitality) a standardized index was calculated by dividing the value of the parameter from the subsequent semen analysis by that from the semen analysis of the same individual prior to infection. Participants/materials, setting, methods The median age of the participants was 31 years, proving the absence of a relationship between age and any of the parameters analyzed. The post-Covid test was performed between 17 and 516 days after infection, with a median of 100 days. The time elapsed between both samples was a median of 238 days. The effect of time on the affectation of semen parameters was studied, setting 100 days as the cut-off point. Main results and the role of chance There were significant differences in semen parameters before and after COVID-19 in terms of semen volume, sperm concentration, progressive motility, total motility, and vitality which decreased significantly (p &amp;lt; 0,05) after SARS-CoV-2 infection compared to the pre-infection values. Morphology was not significantly affected. The total sperm count is the most clearly affected seminal parameter. Half of the individuals (median) obtained a total count in the second sample less than 57% of the initial one. Considering the time of spermatogenesis, the subjects were separated into two groups: those who performed the semen analysis in the first 100 days after infection and those who performed it later. No differences in any parameter were found between the two groups with U Mann-Withney test. Using the Wilcoxon test for paired samples, it was demonstrated that the deleterious effect of infection on sperm concentration and motility not only does not improve with time, but it becomes more significant in late sperm analysis, performed more than one hundred days after the infection. Limitations, reasons for caution It should be mentioned that impairment of semen parameters may not be due to a direct effect of the SARS-CoV-2 virus. There are likely to be additional factors that contribute to long-term sperm parameters decrease, but whose identity is currently unknown. Wider implications of the findings The present study revealed the long-term impacts of SARS-CoV-2 on various parameters of sperm quality even with a mild infection. Further efforts should be made to study the long-time effects of COVID-19 infection on male reproduction. Trial registration number Not Applicable

251-OR: The Impact of Identifying Sleep with a Fitbit on Calculated Rates of Nocturnal Hypoglycemia—The Hypo-Metrics Study

Consensus defines nocturnal hypoglycemia as occurring between 00:00 and 06:00 hrs. However, this may introduce bias, as for many, these hours only partially match real sleeping hours. Therefore, we compared rates of hypoglycemia while asleep (defined by Fitbit Charge 4) to rates of conventionally-defined nocturnal hypoglycemia. Hypo-METRICS study participants wore a Fitbit charge 4 and blinded FreeStyle Libre glucose monitor for up to 70 days. Every hypoglycemia episode (≤70mg/dL or ≤54mg/dL for ≥15 min) was classified as ‘asleep’ or ‘awake’ based on Fitbit sleep intervals and ‘nocturnal’ (00:00-06:00 hrs) or ‘day-time’. We compared weekly sensor-detected hypoglycemia (SDH) rates whilst asleep to nocturnal SDH rates using a paired sample Wilcoxon test. We included 542 participants (269 with type 1 diabetes, median (IQR) age 56 (44-66) years, HbA1c 7.3%(6.7-7.9), with 69 (65-70) nights with sleep data/participant). Sleep duration was 6.1 (5.2-6.8) hours. Median weekly rates of SDH while asleep were higher than rates of nocturnal SDH both ≤70mg/dL (1.3 (0.6-2.5) vs 0.9 (0.4-1.8), p&amp;lt;0.001) and ≤54mg/dL (0.4 (0.2-0.9) vs 0.3 (0.1-0.7), p&amp;lt;0.001). Stratifying by type of diabetes did not change the direction or magnitude of the differences in SDH rates. Using clock time to estimate nocturnal hypoglycemia underestimates hypoglycemia whilst asleep by up to a third. Using activity trackers such as Fitbit to identify sleep offers a novel way to estimate hypoglycemia whilst asleep to better reflect lived experience of nocturnal hypoglycemia. Disclosure G.Martine-edith: Other Relationship; Novo Nordisk A/S. R.J.Mccrimmon: Advisory Panel; Sanofi, Speaker's Bureau; Novo Nordisk A/S. E.Renard: Consultant; Abbott Diabetes, Dexcom, Inc., AstraZeneca, Boehringer-Ingelheim, Eli Lilly and Company, Insulet Corporation, MannKind Corporation, Novo Nordisk, Sanofi, Roche Diabetes Care. S.R.Heller: Advisory Panel; Zealand Pharma A/S, Zucara Therapeutics, Other Relationship; Eli Lilly and Company, Research Support; Dexcom, Inc., Speaker's Bureau; Novo Nordisk, Medtronic. M.Evans: Advisory Panel; Zucara Therapeutics, Pila Pharma, Dexcom, Inc., Other Relationship; Novo Nordisk, AstraZeneca, Abbott Diabetes, Speaker's Bureau; Eli Lilly and Company. J.K.Mader: Advisory Panel; Novo Nordisk A/S, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Medtronic, Becton, Dickinson and Company, Pharmasense, embecta, Research Support; A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Dexcom, Inc., Profusa, Inc., Speaker's Bureau; Novo Nordisk A/S, A. Menarini Diagnostics, Abbott Diabetes, Roche Diabetes Care, Eli Lilly and Company, Sanofi, Boehringer Ingelheim Inc., Becton, Dickinson and Company, Ypsomed AG, Viatris Inc., Servier Laboratories, Medtrust, Stock/Shareholder; Decide Clinical Software GmbH. S.A.Amiel: Advisory Panel; Medtronic, Other Relationship; Sanofi, Novo Nordisk. P.Choudhary: Advisory Panel; Medtronic, Novo Nordisk, Dexcom, Inc., MannKind Corporation, Insulet Corporation, Research Support; Abbott Diabetes, Speaker's Bureau; Sanofi, Lilly. Hypo-resolve consortium: n/a. P.Divilly: None. N.Zaremba: None. U.Soeholm: Employee; Novo Nordisk A/S. A.Kingsnorth: None. Z.Mahmoudi: Employee; Novo Nordisk. M.Gomes: Employee; Novo Nordisk A/S. B.E.De galan: Research Support; Novo Nordisk. U.Pedersen-bjergaard: Advisory Panel; Novo Nordisk A/S, Sanofi, Vertex Pharmaceuticals Incorporated. Funding Innovative Medicines Initiative 2 Joint Undertaking (777460)

Evolving the EN 1500 test method for alcohol-based hand rub closer to clinical reality by reducing the organic load on hands and enabling product to be applied to dry hands

The methods currently used in Europe and North America to evaluate the bactericidal efficacy of hand hygiene products have some limitations, e.g., in the selection of test organisms or the method of contamination, and none of the methods allows prediction of actual clinical efficacy. WHO has therefore proposed to develop methods that better reflect typical clinical reality. In a first experiment, we investigated two contamination methods (immersion according to EN 1500 and low-volume according to ASTM E2755) with the EN 1500 test organism Escherichia coli and using 60% v/v iso-propanol. The second experiment was for comparison of the two contamination methods with Enterococcus faecalis. Finally, the two test organisms were compared using the low-volume contamination method. Data within each experiment was statistically compared using the Wilcoxon test for paired samples and data from all experiments were combined and fit to linear mixed effects models. Mixed-effects analysis confirmed that the test organism and contamination method both impacted the pre-values and all three of these were factors that influenced log10 reductions. Higher pre-values resulted in significantly higher log10 reductions, immersion contributed to significantly higher log10 reductions, and E. coli affected significantly lower log10 reductions. An efficacy evaluation against E. faecalis with a low-volume contamination method could be considered as an alternative to the EN 1500 standard. This could help improve the clinical relevance of the test method with including a Gram-positive organism and reducing soil load which allows a product application closer to reality.

The Effect of Device-Controlled Breathing on the Pulse Arrival Time and the Heart Rate Asymmetry Parameters in Healthy Volunteers

Background: The development of wearables has facilitated the monitoring of biomedical parameters in everyday life. One of the most common sensors of these gadgets is the photoplethysmograph (PPG); hence, the proper processing and interpretation of the PPG signal are essential. Besides pulse rate detection, these devices—together with an ECG—compute the pulse arrival time (PAT), from which the actual beat-to-beat blood pressure can be estimated. The heart rate shows asymmetrical accelerations and decelerations, quantified by the parameters of heart rate asymmetry (HRA). In the present study, we investigated the influences of different breathing-patterns on the PATs and HRA parameters. Methods: The authors evaluated 5 min simultaneous respiratory-, ECG- and PPG-signal recordings of 35 healthy, young volunteers specifically expressing the following breathing patterns: metronome-controlled inspiration, and both inspiration and expiration controlled at 1:1 and 1:2 ratios, respectively. The records were analyzed by HRVScan_Merge v3.2 software. The PAT values were calculated at eight different reference points. The HRA parameters and the PAT values at different breathing patterns were compared using the Friedman test and post hoc Wilcoxon paired-sample test. Results: Porta- and Guzik-indices significantly increased at 1:1 breathing compared to 1:2 and single-paced breathing. PATs increased significantly in dual-paced series compared to single-paced series at each reference point. Conclusion: Based on our results, the increased PATs at dual-paced versus single-paced breathing may indicate the involvement of cognitive functions. The symmetrical respiration ratio increases the heart rate symmetry; however, this effect is not detectable in the periphery through the PATs.

Enhancing disaster response of emergency medical teams through "TEAMS 3.0" training package-Does the multidisciplinary intervention make a difference?

In the aftermath of disasters, Emergency Medical Teams (EMTs) are dispatched to help local rescue efforts. Although EMTs are recognized to be a critical component of the global health workforce, concerns have emerged over their functioning and effectiveness. For example, lack of cooperation and coordination between different EMTs has been a longstanding issue, resulting in fragmented disaster management. To enhance the provision of EMT's field teamwork, the Training for Emergency Medical Teams and European Medical Corps (TEAMS) project was established, and later further updated with novel scenarios and exercises (i.e., adapting EMT operations to a sudden disaster; becoming a modular team; reflecting on ethical dilemmas) in the complementary "TEAMS 3.0" project where a more comprehensive training package was developed. The aim of this study was to assess the effectiveness and quality of the TEAMS 3.0 training package in four training programs in Portugal, Germany, Norway, and Turkey. Participants completed a set of questionnaires designed to assess self-efficacy, teamwork, and quality of training. The results from all the trainings suggest an improvement for both teams' self-efficacy and teamwork. The mean score among all the participants (N = 100) for both the self-efficacy scale and teamwork scale was 3.217 (±0.223) prior to training and 3.484 (±0.217) following the training, and 2.512 (±1.313) prior to training and 3.281 (±0.864), respectfully, with statistically significant differences according to Wilcoxon paired samples test (p < 0.05). The quality of training is regarded as high and deemed as an appropriate tool package for addressing the objectives of the project and the perceived needs of EMT disaster deployment. Thus far, the TEAMS 3.0 project has demonstrated to be effective in promoting EMT teamwork capacities.