Wilcoxon Test Research Articles

Transcutaneous posterior tibial nerve stimulation on demand during multichannel urodynamics: A new approach in the management of overactive bladder

Background:Overactive Bladder Syndrome (OAB) affects individuals across all ages and genders, reducing quality of life. Although Transcutaneous Posterior Tibial Nerve Stimulation (TTNS) is an effective treatment, its acute effects on OAB remain underexplored. Objectives:This study aimed to assess the acute effects of TTNS on OAB through invasive urodynamics (UDI), using an intermittent, on-demand approach; with a focus on urinary urgency as the central axis for its application. Methods:A proof-of-concept trial was conducted involving patients with OAB symptoms and no previous treatment. An initial urodynamic evaluation (UDI DG) identified patients with detrusor overactivity (DO) associated with urgency, who then received on-demand TTNS during a second urodynamic study (UDI TENS). Parameters measured included the number of involuntary detrusor contractions (IDC), episodes of urge urinary incontinence (UUI), and maximum cystometric capacity (MCC). Statistical significance was assessed using Student’s t-test and Wilcoxon test, with a p-value ≤ 0.05 chosen as significance threshold. Results:Of the initial twenty-nine participants, 12 completed the study. UDI DG measurements showed an average of 3.33 ± 1.3 IDCs, 0.67 ± 0.98 UUI episodes, and MCC of 235 ± 79 ml. During UDI TENS results demonstrated a significant reduction in IDCs to 0.08 ± 0.29 (p ≤ 0.001), an absence of UUI episodes, and an increase in MCC to 315 ± 83 ml (p = 0.00012). Conclusions:Our findings suggest that an acute, on-demand TTNS protocol is effective for managing OAB symptoms and improvement of UDI parameters. However, the limited number of participants and absence of a control group highlight the need for further research through larger, controlled studies.

Feasibility of Dark-Field Radiography to Enhance Detection of Nondisplaced Fractures.

Background Many clinically relevant fractures are occult on conventional radiographs and therefore challenging to diagnose reliably. X-ray dark-field radiography is a developing method that uses x-ray scattering as an additional signal source. Purpose To investigate whether x-ray dark-field radiography enhances the depiction of radiographically occult fractures in an experimental model compared with attenuation-based radiography alone and whether the directional dependence of dark-field signal impacts observer ratings. Materials and Methods Four porcine loin ribs had nondisplaced fractures experimentally introduced. Microstructural changes were visually verified using high-spatial-resolution three-dimensional micro-CT. X-ray dark-field radiographs were obtained before and after fracture, with the before-fracture scans serving as control images. The presence of a fracture was scored by three observers using a six-point scale (6, surely; 5, very likely; 4, likely; 3, unlikely; 2, very unlikely; and 1, certainly not). Differences between scores based on attenuation radiographs alone (n = 96) and based on combined attenuation and dark-field radiographs (n = 96) were evaluated by using the DeLong method to compare areas under the receiver operating characteristic curve. The impact of the dark-field signal directional sensitivity on observer ratings was evaluated using the Wilcoxon test. The dark-field data were split into four groups (24 images per group) according to their sensitivity orientation and tested against each other. Musculoskeletal dark-field radiography was further demonstrated on human finger and foot specimens. Results The addition of dark-field radiographs was found to increase the area under the receiver operating characteristic curve to 1 compared with an area under the receiver operating characteristic curve of 0.87 (95% CI: 0.80, 0.94) using attenuation-based radiographs alone (P < .001). There were similar observer ratings for the four different dark-field sensitivity orientations (P = .16-.65 between the groups). Conclusion These results suggested that the inclusion of dark-field radiography has the potential to help enhance the detection of nondisplaced fractures compared with attenuation-based radiography alone. © RSNA, 2024 See also the editorial by Rubin in this issue.

Educational game as a practice for developing students' critical thinking skills regarding manipulations on the Internet

Introduction. Expanded digitalization widens the gap between the increasing immersion of young people in the digital space and their ability to identify, manage and resist the destructive potential of the information flow of the Internet environment. Increasing threats to personal security and improved technologies for manipulating public opinion and consciousness makes developed critical thinking skills and increased resistance to manipulative and destructive online content particularly relevant for the young generation The paper aims to determine the potential of an educational game in developing critical thinking skills among students in relation to manipulations on the Internet. Materials and methods. 147 students of Tomsk State University (Russian Federation) took part in the pilot study. Research methods were: 1) a questionnaire for self-assessment of the ability to identify manipulative techniques and assess the impact of information on own psycho-emotional state; 2) a test task for forming skills in recognizing manipulative techniques. Statistical data was processed using the Mann Whitney U test and the Wilcoxon t-test. Research results. A pilot experimental study revealed the following: 1) respondents tend to overestimate their ability to determine the manipulative potential of Internet content, as well as their ability to resist it and realize its impact on their psycho-emotional state; 2) after the game, the experimental group demonstrates increased skills in identifying all the five manipulation techniques (the number of respondents able to recognize a conspiracy theory increased by 6.8 times, emotional speech by 1.4 times; scapegoating by 7.6 times; attacking by 1.3 times, and a false dichotomy by 10.7 times); 3) in recognizing three manipulation techniques, the experimental and control groups show significant differences (p &lt;0.001). After the game, the participants demonstrate the skills of accurately recognizing conspiracy theory, scapegoating, and false dichotomy. Conclusion. The suggested gaming practice has a high potential for developing critical thinking skills in relation to manipulation techniques on the Internet (in the context of digital interaction and information impact).

Impact of foot ulcer-related factors on quality of life in patients with diabetes: Prospective observational study.

Quality of life (QOL) may be impacted by foot ulcer-related factors, with prevention of diabetes-related foot ulcers or more effective early healing helping to improve overall patient QOL. This study, which examined the relationship between foot ulcer-related factors and QOL in patients with diabetes, was conducted as a secondary analysis of a prospective observational study entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers". We investigated EQ-5D-5L, patient characteristics and foot ulcer-related factors of 73 patients with diabetes-related foot ulcers who visited one wound clinic in Indonesia between August 2020 and February 2021. Results showed that the mean health utility was 0.294 ± 0.371. Factors selected for the multiple regression analysis included inflammation/infection of DMIST, first-ever foot ulcer, and size of DMIST. First-ever foot ulcer (β = 0.309, p = 0.003) and size of DMIST (β = -0.316, p = 0.015) were significantly associated with the health utility (p < 0.001). Significant improvement in the health utility of 15 patients was observed when the ulcer healed (Wilcoxon signed-rank sum test, p = 0.001). In conclusion, not only ulcer severity but also the first-ever foot ulcer itself affected the QOL in patients with diabetes. These results suggest there will be a greater impact on the QOL of patients who develop diabetes-related foot ulcers for the first time, along with the importance of prevention and early healing, through early infection control and wound size reduction.

A Comparison of the Effect of Kegel Exercises and Conventional Therapy versus Conventional Therapy Alone in the Treatment of Functional Constipation in Children: A Randomized Clinical Trial.

There have been few studies on the effect of Kegel exercises on the treatment of functional constipation in children. Hence, the present study investigated the add-on role of Kegel exercises in children with functional constipation. This clinical trial was conducted on children with functional constipation, according to Rome IV, who were referred to the pediatric department of Imam Reza Clinic (Shiraz, Iran) in 2022. The sample consisted of 64 children who were randomly assigned to either the intervention or the control groups. In the control group, a pediatrician administered conventional therapy, including diet training, defecation training, and polyethylene glycol (PEG) syrup (0.7 g/Kg daily). In the treatment group, in addition to conventional therapy, a pediatrician taught Kegel exercises to the child both verbally and in writing in the presence of their parents. To investigate the effectiveness of the intervention, frequency of defecation, defecation time, assistance used for defecation, incomplete emptying, unsuccessful defecation, abdominal pain, and painful defecation were selected as the outcomes. Independent sample t test was used for continuous variables. Categorical variables were reported as frequency and percentages. To examine the difference in categorical outcome variables, Wilcoxon (pre and post), Chi square, and Fisher exact tests were used. Data were analyzed using SPSS software version 21. P<0.05 were considered statistically significant. Twenty-seven (88.4%) patients in the Kegel exercise group reported a defecation time of less than 5 min, while only 12 (37.5%) patients in the control group reached this time, and this difference was statistically significant (P=0.001). Moreover, patients in the treatment group showed significant improvements in terms of incomplete emptying of stool, unsuccessful defecation, abdominal pain, and painless defecation (P=0.001, P=0.001, P=0.001, P=0.037, respectively). After intervention, the use of laxatives, digits, or enemas to assist defecation was not significantly different between the groups (P=0.659). Kegel exercise was an effective adjunctive treatment for pediatric functional constipation.Trial Registration Number: IRCT20230424057984N1.

A novel multi-strategy ameliorated quasi-oppositional chaotic tunicate swarm algorithm for global optimization and constrained engineering applications

Over the last few decades, a number of prominent meta-heuristic algorithms have been put forth to address complex optimization problems. However, there is a critical need to enhance these existing meta-heuristics by employing a variety of evolutionary techniques to tackle the emerging challenges in engineering applications. As a result, this study attempts to boost the efficiency of the recently introduced bio-inspired algorithm, the Tunicate Swarm Algorithm (TSA), which is motivated by the foraging and swarming behaviour of bioluminescent tunicates residing in the deep sea. Like other algorithms, the TSA has certain limitations, including getting trapped in the local optimal values and a lack of exploration ability, resulting in premature convergence when dealing with highly challenging optimization problems. To overcome these shortcomings, a novel multi-strategy ameliorated TSA, termed the Quasi-Oppositional Chaotic TSA (QOCTSA), has been proposed as an enhanced variant of TSA. This enhanced method contributes the simultaneous incorporation of the Quasi-Oppositional Based Learning (QOBL) and Chaotic Local Search (CLS) mechanisms to effectively balance exploration and exploitation. The implementation of QOBL improves convergence accuracy and exploration rate, while the inclusion of a CLS strategy with ten chaotic maps improves exploitation by enhancing local search ability around the most prospective regions. Thus, the QOCTSA significantly enhances convergence accuracy while maintaining TSA diversification. The experimentations are conducted on a set of thirty-three diverse functions: CEC2005 and CEC2019 test functions, as well as several real-world engineering problems. The statistical and graphical outcomes indicate that QOCTSA is superior to TSA and exhibits a faster rate of convergence. Furthermore, the statistical tests, specifically the Wilcoxon rank-sum test and t-test, reveal that the QOCTSA method outperforms the other competing algorithms in the domain of real-world engineering design problems.

The impact of yoga in pregnancy on placental growth factor levels and mean arterial pressure in pre-eclampsia: A randomized controlled trial

Context: Pre-eclampsia is a pregnancy-related condition characterized by hypertension, proteinuria, and edema occurring after 20 weeks of pregnancy or during the postpartum period. Several markers are often assessed to determine the suitable option for confirming pre-eclampsia diagnosis, one of which is the examination of placental growth factor (PlGF) as a placental ischemia indicator. Aims: To evaluate the impact of prenatal yoga on PlGF and mean arterial pressure (MAP) levels in pre-eclampsia within the Madura region. Methods: A randomized controlled trial was conducted on fifty subjects that were randomly allocated to the experimental group with pre-post control groups consisting of 50 participants, namely 25 pregnant women with pre-eclampsia and 25 healthy individuals. The selection was conducted based on the following inclusion criteria: belonging to Madura ethnicity spanning three generations, exhibiting pregnancy duration &gt;20 weeks, maternal ages ranging from 20–35 years, pre-pregnancy body mass index (BMI) &gt;25, a history of hypertension, diabetes mellitus (DM), kidney disorders, pre-eclampsia, chronic hypertension, or family history of chronic high blood pressure and pre-eclampsia among those at risk. PlGF levels were estimated using an ELISA kit, while blood pressure was measured with an Omron brand sphygmomanometer. Results: Statistical analysis performed with the Wilcoxon sign test and T-test indicated significant differences (p&lt;0.005) in systolic blood pressure, diastolic blood pressure, and MAP between the groups. Furthermore, a significant difference was observed in PlGF levels before and after engaging in prenatal yoga practice (p&lt;0.05). Conclusions: The results showed that prenatal yoga contributed to the elevation of PlGF levels in women with pre-eclampsia, compared to their healthy counterparts.

A stacked machine learning model for the vertical total electron content forecasting

We design four Artificial Neural Network (ANN) models, namely a Multilayer Perceptron (MLP), a Convolutional Neural Network (CNN), an Extreme Learning Machine network (ELM) and an ensemble model based on stacking (STACKED) to forecast the ionospheric vertical Total Electron Content (vTEC) from 1 to 24 hours in advance on a single station at mid latitude. The time series used, spanning from January 2006 to December 2018, includes vTEC, provided by the Global Navigation Satellite System (GNSS) receiver at Tsukuba (TSKB), Japan (36.06o N, 140.05o E) and suitable external drivers selected among several helio-geophysical parameters. The selection of appropriate external drivers is made by rating their relevance on the vTEC at forecasting timescales (from 1 to 24 hours). The process, based on eleven machine learning models, highlights that the most important external drivers are: the 10.7 cm Solar Flux (F10.7), the magnitude BT of the Interplanetary Magnetic Field (IMF), and the Auroral Electrojet (AE) index. The forecasting performance of the four models (MLP, CNN, ELM, STACKED) is then analysed. The analysis relies on three statistical metrics to compare actual and forecasted vTEC: the coefficient of determination (R2), the Mean Absolute Error (MAE), and the Root Mean Squared Error (RMSE). Additionally, descriptive statistics are presented using box and whisker plots. The four ANN models show a quite satisfactory capability to forecast vTEC when applied to the test dataset which represents 10% of the available data from 2006 to 2018. Furthermore, by conducting a Wilcoxon signed rank test, it is shown that statistically significant improvements are achieved by the STACKED model with regard to MLP, CNN and ELM. On average, by analysing the forecasted (from 1 to 24 hours in advance) vs the actual vTEC, the STACKED model achieves R2=0.816,RMSE=0.426 TECu, and MAE=0.296 TECu (1 TECunit =1016 electrons/m2) whilst MLP, CNN and ELM show respectively R2=0.808,0.812,0.803,RMSE=0.436 TECu, 0.431 TECu, 0.441 TECu and MAE=0.304 TECu, 0.299 TECu, 0.312 TECu.

Artificial intelligence applications for accurate geothermal temperature prediction in the lower Friulian Plain (north-eastern Italy)

Geothermal energy as a sustainable and clean energy source depends on the accurate estimation of reservoir temperatures. Understanding aquifer temperatures is crucial for optimizing low-enthalpy geothermal system exploitation. Advances in predictive algorithms can improve geothermal efficiency, while conventional methods of indirect temperature measurement and assumptions in geochemical analysis lead to uncertainties. As a solution, this study presents a comprehensive evaluation of six machine learning algorithms including eXtreme gradient boosting (XGBoost), decision tree, generalized regression neural network, extreme randomized trees, radial basis function, and elastic net. We employed essential performance metrics including coefficient of determination (R2) score, root mean square error (RMSE), mean absolute error, mean absolute percentage error (MAPE), and variance accounted for (VAF) to elucidate their predictive accuracy and generalization potential in the lower Friulian Plain (north-eastern Italy) where a geothermal reservoir is present. Among the algorithms scrutinized, XGBoost emerges as a predictive exemplar, achieving a remarkable R2 score of 0.9930 on the test dataset, with consistently low RMSE of 0.788, MAE of 0.587, MAPE of 1.909, and high VAF of 99.30, reaffirming its exceptional precision and robustness. It is worth noting that the other four models show slightly weaker performance than XGBoost, while Elastic Net shows moderate predictive power, which illustrates the complexity of the database. The Wilcoxon signed-rank test confirmed the superior performance of XGBoost in estimating geothermal temperatures compared to other algorithms, with statistical evidence supporting its precision and reliability. A Monte Carlo simulation for uncertainty analysis underlined the importance of model selection, accuracy and uncertainty management in the planning of geothermal projects in the lower Friulian Plain. A sensitivity analysis was performed to identify the main factors influencing the temperature prediction. Among the parameters considered, hydrogen carbonate the highest significance at 0.51, which is essential for accurate temperature prediction because of its buffering capacity which directly influences water's thermal properties. Magnesium and electrical conductivity each contribute with 0.11, also play significant roles due to their impact on the water's heat retention and distribution capabilities. Water depth, with a value of 0.08, also has a significant influence on the temperature profiles in prediction models. In summary, the accurate prediction of XGBoost for the temperature of aquifer in carbonate reservoirs in the lower Friulian Plain, underline its value for optimizing geothermal resources and highlight most important influences on temperature.

Multidisciplinary Simulation Improves Resident Comfort With Perinatal Bereavement Care [ID 2683378

INTRODUCTION: Physicians have difficulty delivering bad news because of discomfort and lack of appropriate education. We introduce an initiative to enhance trainee comfort in delivering the diagnosis of intrauterine fetal demise (IUFD) through multidisciplinary simulation training. METHODS: Twelve obstetrics and gynecology residents participated in perinatal bereavement training with a palliative care specialist utilizing the SPIKES framework, followed by an immersive simulation of an IUFD case and debrief with multidisciplinary physicians. Pre- and post-training surveys were administered. This study was approved by the IRB. RESULTS: Participants were equally distributed in training year (58% female, 33% male). 92% had previously delivered the diagnosis of IUFD, yet 50% had no previous bereavement training, and of those with training, most (84%) had less than 2 hours. Wilcoxon signed-ranks tests showed statistically significant increase in comfort level of delivering bad news (Z=66; P=.003), delivering a diagnosis of fetal demise (Z=64; P=.005), and having the skills and foundation to deliver the news of a fetal demise (Z=28; P=.017). Qualitative responses identified acquisition of verbal and nonverbal skills such as direct patient communication, using the word death, and sitting down at the patient’s eye level prior to delivering the news. Most described the experience as real, immersive, and a safe learning environment. One hundred percent would recommend the course to others. CONCLUSION: Perinatal bereavement education in obstetrics and gynecology residency training is lacking. Multidisciplinary, immersive simulation training significantly increased residents’ comfort and perceived preparedness in delivering the diagnosis of fetal demise.

Changes in preBötzinger Complex neuron discharge associated with changes in PCO2 in decerebrate rabbits

Background: Maskrey and Nicol reported a strong increase in minute ventilation with increase in PCO2 (J Physiol 1980, 301: 49-58). We investigated a) whether there was a ceiling to this effect at high CO2 levels and b) whether the change in ventilation was associated with specific changes in respiratory neurons in the preBötzinger complex (preBC). Methods: The study was approved by the local Animal Care Committee and conformed to NIH standards. Adult New Zealand White rabbits (3-4 kg) were anesthetized, tracheotomized, ventilated, decerebrated and vagotomized. Phrenic nerve activity was recorded from the C5 rootlet, time averaged and used to calculate inspiratory (TI) and expiratory durations (TE) and peak phrenic activity (PPA). PPA was normalized to the value at PCO2 50mmHg. Individual neurons were recorded in the functionally identified preBC using multichannel electrodes at increasing CO2 levels. Statistical analysis used the Wilcoxon signed-rank test to determine changes in respiratory parameters between CO2 levels and Friedman RM-ANOVA to determine changes in neuronal discharge frequency (Fn). A generalized linear mixed model was used to determine associations between CO2-dependent changes in TI, TE, PPA, and changes in Fn for different neuron types. p&lt;0.05 indicated a significant difference. Results: In 34 animals, the increase in minute ventilation with increasing PCO2 was due mostly to the change in PPA. The increase in respiratory rate was due mostly to a decrease in TE. There was little increase in respiratory output at PCO2 &gt; 50 mmHg. In 209 neurons, increasing PCO2 increased Fn in inspiratory augmenting (I aug, n= 70, p&lt;0.0001 for CO2 30 vs 40 and 40 vs 50mmHg), I parabolic (I para, n=43, p&lt;0.0001 for CO2 40 vs 50 mmHg), pre-inspiratory (pre-I, n=35, p&lt;0.01 for CO2 30 vs 40 mmHg), and expiratory decrementing (E dec, n=44, p&lt;0.01 for CO2 40 vs 50 mmHg) neurons, but not in I dec (n=8) and non-respiratory modulated (NRM, n=9) neurons. The strongest correlation was found between the changes in phase timing and PPA and Fn in I aug and pre-I neurons. Conclusion: We found a ceiling effect to the increase in respiratory output at PCO2 levels &gt; 50 mmHg. Inspiratory preBC neuron subtypes were more affected by the changes in PCO2. NIH R01HL159546. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Implementation and Evaluation of a Bystander Naloxone Training Course.

Bystander provision of naloxone is a key modality to reduce opioid overdose-related death. Naloxone training courses are available, but no standardized program exists. As part of a bystander empowerment course, we created and evaluated a brief naloxone training module. This was a retrospective evaluation of a naloxone training course, which was paired with Stop the Bleed training for hemorrhage control and was offered to administrative staff in an office building. Participants worked in an organization related to healthcare, but none were clinicians. The curriculum included the following topics: 1)background about the opioid epidemic; 2)how to recognize the signs of an opioid overdose; 3)actions not to take when encountering an overdose victim; 4)the correct steps to take when encountering an overdose victim; 5)an overview of naloxone products; and 6)Good Samaritan protection laws. The 20-minute didactic section was followed by a hands-on session with nasal naloxone kits and a simulation mannequin. The course was evaluated with the Opioid Overdose Knowledge (OOKS) and Opioid Overdose Attitudes (OOAS) scales for take-home naloxone training evaluation. We used the paired Wilcoxon signed-rank test to compare scores pre- and post-course. Twenty-eight participants completed the course. The OOKS, measuring objective knowledge about opioid overdose and naloxone, had improved scores from a median of 73.2% (interquartile range [IQR] 68.3%-79.9%) to 91.5% (IQR 85.4%-95.1%), P < 0.001. The three domains on the OOAS score also showed statistically significant results. Competency to manage an overdose improved on a five-point scale from a median of 2.5 (IQR 2.4-2.9) to a median of 3.7 (IQR 3.5-4.1), P < 0.001. Concerns about managing an overdose decreased (improved) from a median of 2.3 (IQR 1.9-2.6) to median 1.8 (IQR 1.5-2.1), P < 0.001. Readiness to intervene in an opioid overdose improved from a median of 4 (IQR 3.8-4.2) to a median of 4.2 (IQR 4-4.2), P < 0.001. A brief course designed to teach bystanders about opioid overdose and naloxone was feasible and effective. We encourage hospitals and other organizations to use and promulgate this model. Furthermore, we suggest the convening of a national consortium to achieve consensus on program content and delivery.

Rapid decrease in IL-1Ra and IP-10 plasma levels following tuberculosis treatment initiation

ObjectivesMonitoring tools that could provide quick predictions of tuberculosis (TB) treatment outcomes are urgently needed. Here, we assessed whether the evolution of selected biomarkers of innate immunity may help monitoring TB treatment response within 2 weeks of treatment initiation. MethodsANRS12394-LILAC-TB was a proof-of concept prospective study: HIV-negative and HIV-infected adults with a rifampicin-susceptible TB, documented by a positive Xpert MTB/RIF test, were enrolled in Cambodia and Côte d'Ivoire. Plasma concentrations of IL-1Ra, IP-10 and sCD163 were measured by commercial ELISA kits. A Wilcoxon test for paired data was used for longitudinal comparisons. Results55 patients were enrolled (women: 31%, median age: 37 years; median CD4 count in the 10/13 HIV-infected participants: 53 cells/mm3). Overall, 83% were considered in TB treatment success. Compared to baseline, IL-1Ra plasma levels significantly decreased as soon as Week (W)1, independently of HIV status (-71% in HIV-positive vs. -33% in HIV-negative; p<0.001). IP-10 plasma levels significantly decreased at W1 and W2 compared to baseline (p<0.0001), but that decrease was less marked in HIV-infected participants. ConclusionOur findings suggest that measuring IL-1Ra plasma levels with a standard ELISA technique at baseline then one week after TB treatment onset could help clinicians to quickly assess TB treatment response.

Spiral time-of-flight magnetic resonance angiography for intracranial vascular imaging: performance compared to conventional Cartesian angiogram.

Computed tomography angiography (CTA) and digital subtraction angiography (DSA) usually raise the risk of potential malignancies with cumulative radiation doses. Current time-of-flight magnetic resonance angiography (TOF-MRA) (dubbed as cTOF), which is based on Cartesian sampling mode, may show limited diagnostic conspicuity at sinuous or branching regions. It is also prone to relatively high false positive diagnoses and undesirable display of distal intracranial vessels. This study aimed to use spiral TOF-MRA (sTOF) as a noninvasive alternative to explore possible improvement, such that the application of magnetic resonance angiography (MRA) can be extended to facilitate clinical examination or cerebrovascular disease diagnosis and follow-up studies. Initially, 37 patients with symptoms of dizziness or transient ischemic attack were consecutively recruited for suspected intracranial vascular disease examination from Zhongshan Hospital of Xiamen University between July 2020 and April 2021 in this cross-sectional prospective study. After excluding 1 patient with severe scanning artifacts, 1 patient whose scanning scope did not meet the requirement, and 1 patient with confounding tumor lesions, a total of 34 participants were included according to the inclusion and exclusion criteria. Each participant underwent intracranial vascular imaging with both sTOF and cTOF sequences on a 3.0 T MR scanner with a conventional head-neck coil of 16 channels. Contrast CTA or DSA was also performed for 15 patients showing pathology. Qualitative comparisons in terms of image quality and diagnostic efficacy ratings, quantitative comparisons in terms of signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), vessel length, and sharpness were evaluated. Pair-wise Wilcoxon test was performed to evaluate the imaging quality derived from cTOF and sTOF acquisitions and weighted Cohen's Kappa was conducted to assess the rating consistency between different physicians. Compared to cTOF, sTOF showed better performance with fewer artifacts. It can effectively alleviate false positives of normal vessels being misdiagnosed as aneurysm or stenosis. Improved conspicuity was observed in cerebral distal regions with more clearly identifiable vasculature at finer scales. Quantitative comparisons in selected regions revealed significant improvement of sTOF in SNR (P<0.01 or P<0.001), CNR (P<0.001), vessel length (P<0.001), and sharpness (P<0.001) as compared to cTOF. Besides, sTOF can depict details of M1 and M2 segments of middle cerebral artery (MCA) at metallic implant region, showing its resistance to magnetic susceptibility. The sTOF shows higher imaging quality and lesion detectability with reduced artifacts and false positives, representing a potentially feasible surrogate in intracranial vascular imaging for future clinic routines.

The effect of symbolic play activities on first reading and writing skills

The aim of this research is to reveal the effects of symbolic play content activities organized in kindergarten to first reading and writing skills. For this purpose, mixed-method research has been designed. In the first stage of this research, four experiments, including pretest-posttest applied, a paired experiment-control group, were applied. 30 kindergarten students from 15 experimental and 15 control group-students participated. The data obtained from the experimental process were analyzed with the Man-Whitney U Test and Wilcoxon Signed Rank Test. In the second stage, the data were collected through semi-structured observation and interview forms. 20 first-grade students from 10 experimental and 10 control group-students participated. Qualitative data were analyzed through descriptive analysis. The control group participants who successfully acquired the read-write preparation outcomes in the kindergarten and passed to the first grade were more successful in obtaining the first reading and first writing compared to the supervisory set participants who passed the first grade without acquiring the literacy preparation achievements in the kindergarten.

Shared Decision-Making at the Intersection of Disability, Culture, and Language Accessibility: An Educational Session for Medical Students.

People with disabilities and those with non-English language preferences have worse health outcomes than their counterparts due to barriers to communication and poor continuity of care. As members of both groups, people who are Deaf users of American Sign Language have compounded health disparities. Provider discomfort with these specific demographics is a contributing factor, often stemming from insufficient training in medical programs. To help address these health disparities, we created a session on disability, language, and communication for undergraduate medical students. This 2-hour session was developed as a part of a 2020 curriculum shift for a total of 404 second-year medical student participants. We utilized a retrospective postsession survey to analyze learning objective achievement through a comparison of medians using the Wilcoxon signed rank test (α = .05) for the first 2 years of course implementation. When assessing 158 students' self-perceived abilities to perform each of the learning objectives, students reported significantly higher confidence after the session compared to their retrospective presession confidence for all four learning objectives (ps < .001, respectively). Responses signifying learning objective achievement (scores of 4, probably yes, or 5, definitely yes), when averaged across the first 2 years of implementation, increased from 73% before the session to 98% after the session. Our evaluation suggests medical students could benefit from increased educational initiatives on disability culture and health disparities caused by barriers to communication, to strengthen cultural humility, the delivery of health care, and, ultimately, health equity.

Effect of core stability exercises on knee proprioception, function and quality of life in chronic total knee replacement patients

Background: Chronic osteoarthritis of knee joint leads to severe pain after weight bearing and prolonged activities .TKR is widely used as a successful and effective last-stage surgical treatment for relieving chronic knee pain and functional disability. This research aimed to study the effect of core stability exercises on knee proprioception, function and quality of life in chronic total knee replacement patients. Methods: Total 40 patients with chronic total knee replacement with age between 45-65 years were included. They were divided into two groups: Group-A (n=20) and Group-B (n=20). Both group received conventional treatment, in addition Group-B received core stability exercise. Patients were evaluated pre-intervention (0 week) and post-intervention (4 week) for proprioception (by universal goniometer), for function (LEFS) and for quality of life (SF-12). Statistical analysis was done using SPSS 20 version. Significance level was set at p&lt;0.05. Results: Wilcoxon signed rank test was applied for within group comparison. There was statistically significant difference in mean of proprioception, function and SF-12 PCS in both groups during four week intervention period. Mann Whitney U test was applied for between group comparison. Significant difference was found between Group-A and Group-B in mean difference of proprioception, function. Conclusions: The concluded that the core stability exercise along with conventional treatment is more effective for improving knee proprioception, function and quality of life than alone conventional treatment in chronic total knee replacement patients.

Evaluation of change in knowledge and attitude about noise and its effect on hearing: post awareness programme among adolescents in Varkala, Thiruvananthapuram district, Kerala

Background: There are significant literature evidence across the globe and in India, regarding the effects of recreational noise exposure among young adults and college students, but there is a dearth of literature support regarding its effects among the students of senior grade studying in Indian subcontinent. Since the awareness among school students help in the early preventive measures and hearing conservation, studies must focus on these population to reduce the burden of recreational noise-induced hearing loss on our future generation. This study aims to evaluate the change in knowledge and attitude about noise and its effect on hearing: Post awareness programme among adolescents in Varkala, Thiruvananthapuram district, Kerala. Method: A survey was conducted among the school students within the age group 16-18 years. A questionnaire containing questions related to knowledge and attitude towards noise and its effect on hearing was developed and distributed to the students prior to and after an awareness program making use of a visual awareness material. Wilcoxon signed rank test was used for pre and post comparison. Results: The p value of each aspect related to the knowledge and attitude is less than the significance level, so we can say that there is a significant change in the level of knowledge and attitude after the awareness program. Conclusions: The study highlighted low pre-awareness levels among participants regarding noise's impact on hearing. The awareness program effectively improved understanding, emphasizing its importance for all age groups in dispelling misconceptions and fostering positive attitudes.

Pengaruh Yoga Pranayama dengan Tingkat Stres Perawat yang Bertugas di Ruang Operasi Rumah Sakit Balimed Denpasar

Background: Nurses working in the operating theatre are prone to stress because they are required to have high knowledge and concentration skills in all aspects of perioperative care. Stress management can be done through relaxation with yoga pranayama. Purpose: The purpose of this study was to determine the effect of yoga pranayama on the stress level of nurses on duty in the operating room. Methods: This study used a pre-experimental design with a one-group pre-post test design. The research sample was 23 nurses in the operating room with purposive sampling technique. Data collection using Perceived stress scale questionnaire, analysis using Wilcoxon Sign Rank test. Results: The results showed that the stress level of pre-test nurses was mostly 16 people (69.6%) in the moderate category and the post-test was entirely 23 people (100%) in the mild category. The results of the Wilcoxon Sign Rank Test obtained Zhitung = 4.199&gt; Ztabel = 1.96 and p value = 0.001 &lt;0.05 these results indicate there is an effect of yoga pranayama with the stress level of nurses on duty in the operating room. Conclusion: The results of the study can be concluded that yoga pranayama has a significant effect on the stress level of nurses on duty in the operating room. It is recommended that nurses do Yoga exercises can be done regularly at least once a day to help reduce stress.

The Effect Of Warm Breast Compresson Colostrum Expenditure In Primigravid Mothers

Colostrum is a newborn's first food which is very important for the newborn's antibodies against bacteria, germs and viruses. Colostrum can play a role in protecting the baby's body from infections and bacteria because colostrum contains immunoglobulin substances. Applying warm compresses to the breasts can facilitate colostrum production. Warm compresses will increase blood circulation in the breasts so that oxytocin production will also increase and make colostrum production smoother. This study aims to determine the effect of warm breast compresses on colostrum production in primigravida mothers at the Saumi Midwife Clinic, Trading City. This research uses a quasi-experimental research design with a one group pretest posttest design. The population in this study were all primigravida mothers who visited the Saumi Midwife Clinic in Trading City. Sampling in this study used a purposive sampling technique based on inclusion and exclusion criteria of 15 samples. Data analysis used the Wilcoxon Signed Ranks Test. Based on the research results, it was found that there was an effect of warm breast compresses on colostrum production in primigravida mothers with a p-value =0.004