More about the basic assumptions of t-test: normality and sample size

Evaluating the muscle attachment hypothesis for sagittal cresting in Gorilla and Pongo

Primate mandibular morphology is often associated with jaw functionality of the masticatory complex in the context of variation in diets. Recent research into the disparities between the diet and jaw functionality in male and female hominoids is inconclusive and suggests that sexual dimorphism in the mandible may be influenced by external factors such as temporalis and masseter muscle morphology, which in turn may be influenced by sexual selection. As the muscles associated with mastication (i.e., the type of chewing exhibited by primates and other mammals) encompass the mandible as well as the neurocranium, including the sagittal crest among some individuals, this study investigates sex-specific associations between regions of the mandibular ramus and neurocranium associated with mastication in a dentally mature sample of Gorilla and Pongo. A total of four cranial and mandibular variables were measured in two Gorilla taxa (Gorilla gorilla gorilla and Gorilla beringei graueri) and one Pongo taxon (Pongo pygmaeus pygmaeus) (n = 220). For all three taxa, we investigate (a) whether the degree of sexual dimorphism in cranial regions associated with sagittal cresting (sagittal crest size (SCS) and temporalis muscle attachment area (TMAA)) is proportional to the degree of mandibular ramus area (MRA) and coronoid process height (CPH) sexual dimorphism, (b) whether there are sex differences in scaling relationships between TMAA and MRA, and (c) whether there are sex differences in the strength of association between TMAA and CPH. We show that for G. g. gorilla, variables associated with sagittal cresting show higher sexual dimorphism values than our two mandibular ramus variables, which is not the case for G. b. graueri or for P. p. pygmaeus. All three taxa show similar sex-specific scaling relationships between TMAA and MRA, where for males this relationship does not diverge from isometry, and for females there is a negative allometric relationship. Our findings also show intraspecific sex differences in allometric slopes between MRA and TMAA for all three taxa. Only G. g. gorilla shows a significant association between TMAA and CPH, which is observed in both sexes. Although there are some statistical associations between the cranial and mandibular regions associated with mastication, our results show that among male gorillas and orangutans, patterns of variation in the sagittal crest, TMAA, mandibular ramus and the coronoid process cannot be explained by the muscle attachment hypothesis alone. These findings have implications surrounding the associations between social behaviour and the morphology of the craniofacial complex.

The effectiveness of interprofessional peer-led teaching and learning for therapeutic radiography students and Speech and Language Therapy students

BACKGROUND

Therapeutic Radiographers (RT) and Speech and Language Therapists (SLT) work closely together in caring for people with head and neck cancer and need a strong understanding of each others' roles. Peer teaching has been shown to be one of the most effective methods of teaching; however, no studies to date, have involved RT and SLT students. This research aims to establish the effectiveness and perceptions of peer-led teaching between undergraduate RT and SLT students in Ulster University.

METHODS

Twenty SLT students and 14 RT students participated. Knowledge tests were taken online before the peer-led teaching session (T1), after the session (T2) and 3 months later (T3). Students' perceptions of the experience were collected at the end of the session. Wilcoxon signed-rank tests were used to analyse the impact of the intervention on knowledge scores. Qualitative content analysis was used for open text response data.

RESULTS

RT students' own professional knowledge score at T2 was statistically significantly higher than the score at T1; the score at T3 was not deemed to be statistically significantly higher. RT students' SLT knowledge score at T2 and T3 was found to be statistically significantly higher than the score at T1. SLT students' own professional knowledge score was not statistically significantly higher at T2 or T3 than T1. They did have a statistically significantly higher score at T2 on the RT test, but score at T3 was not deemed to be statistically significantly higher. The majority of students across both professions agreed or strongly agreed that the peer-led teaching experience had a positive impact on their learning.

CONCLUSION

This investigation highlights the benefits of an interprofessional peer-led teaching intervention for RT and SLT students and the findings add to the evidence of more objective study of knowledge gain as a result of interprofessional peer teaching.

Examining the Early Academic Performance of Doctor of Physical Therapy Students After Holistic Review: A Retrospective Cohort Study

INTRODUCTION

A diverse health care workforce can help to address systemic health disparities. Holistic review and use of an expanded definition of underrepresented minority (URM) that includes factors beyond race and ethnicity are suggested methods to promote diversity in the physical therapist (PT) workforce and ultimately address societal health disparities.

REVIEW OF LITERATURE

Evidence suggests that holistic review can promote PT student diversity; however, limited evidence exists that describes the academic outcomes of holistic review that consider social determinants of learning (SDOL) factors in the review process. The purpose of this study was to examine the early academic outcomes of students after a holistic review and to examine relationships between SDOL factors and academic performance.

SUBJECTS

A convenience sample of 160 students admitted to a doctor of physical therapy (DPT) program from June 2020 to June 2022 was used.

METHODS

A secondary analysis of students' self-reported responses from their admissions application was used to categorize response data into SDOL groups. An independent-sample t-test was used to test group differences in academic performance, and regression modeling was used to test relationships between SDOL factors and academic performance.

RESULTS

The mean 6-month DPT program grade point average (GPA) of the sample was 3.32 ± .43. Nonstatistically significant differences appeared in early DPT GPA between URM and non-URM student groups. However, after controlling for undergraduate GPA, a history of educational disadvantage was the only SDOL factor that contributed to early DPT GPA variance (2.6%), P < .05.

DISCUSSION AND CONCLUSION

The similar academic performance of URM and non-URM students provides support for using an expanded URM definition in holistic review. Most of the educationally disadvantaged group were first-generation college students, which was associated with lower early GPA. These results provide emerging evidence that first-generation students in DPT programs may benefit from additional academic support.

Kinematic changes of the trunk and lower limbs during voluntary lateral sway postural control in adults with low back pain

Introduction: Voluntary lateral weight shifting is essential for gait initiation. However, kinematic changes during voluntary lateral weight shifting remain unknown in people with low back pain (LBP). This study aims to explore the differences in kinematics and muscle activation when performing a voluntary lateral weight shifting task between patients with LBP and asymptomatic controls without pain. Methods: Twenty-eight participants volunteered in this study (14 in both the LBP group and the control group). The Sway Discrimination Apparatus (SwayDA) was used to generate a postural sway control task, mimicking lateral weight shifting movements when initiating gait. Kinematic parameters, including range of motion (ROM) and standard deviation of ROM (Std-ROM) of the lumbar spine, pelvis, and lower limb joints, were recorded using a motion capture system during lateral weight shifting. The electroactivity of the trunk and lower limb muscles was measured through surface electromyography using root mean square (RMS). The significant level was 0.05. An independent t-test was employed to compare kinematic parameters, and muscle activation between the LBP group and the control group. A paired-sample t-test, adjusted with Bonferroni correction (significant level of 0.025), was utilized to examine differences between the ipsilateral weight shifting towards side (dominant side) and the contralateral side. Results: The results of kinematic parameters showed significantly decreased ROM and std-ROM of the ipsilateral hip in the transverse plane (tROM = -2.059, p = 0.050; tstd-ROM = -2.670, p = 0.013), as well as decreased ROM of the ipsilateral knee in the coronal plane (t = -2.148, p = 0.042), in the LBP group compared to the control group. For the asymptomatic controls, significantly larger ROM and ROM-std were observed in the hip and knee joints on the ipsilateral side in contrast to the contralateral side (3.287 ≤ t ≤ 4.500, 0.001 ≤ p≤ 0.006), but no significant differences were found between the two sides in the LBP group. In addition, the LBP group showed significantly lower RMS of the biceps femoris than the control group (tRMS = -2.186, p = 0.044). Discussion: Patients with LBP showed a conservative postural control pattern, characterized by reduced ROM of ipsilateral joints and diminished activation of the biceps femoris. These findings suggested the importance of voluntary postural control assessment and intervention to maximize recovery.

Positive and negative experiences of caregivers helping power wheelchair users: a mixed-method study

PURPOSE

This study aimed to better understand how the powered wheelchair (PWC) impacts the experiences of family caregivers of PWC users, and explore the strategies and resources used by caregivers to cope with their role.

MATERIALS AND METHODS

This mixed-methods study was part of a larger cross-sectional research study conducted in four Canadian cities. Twenty-three family caregivers of PWC users, who provided at least 2 h of support per week, completed the Power Mobility Caregiver Assistive Technology Outcome (PM-CATOM), an 18-item measure assessing PWC-related and overall burden experienced by family caregivers. We also conducted semi-structured interviews and analysed them using inductive content analysis.

RESULTS

From the quantitative PM-CATOM results, the caregivers perceived low level of burden for the wheelchair-related items, (Median:4.5; Range 3 to 5). Most perceived burden when physically helping the wheelchair user and when providing verbal hints. In terms of overall help, the caregivers experienced some level of burden (Median 3.5: Range 3 to 5). Most caregivers identified burden associated with the limitation to their recreational and/or leisure activities (52.2%) and feeling that they have more to do than they can handle. We identified 3 themes in the interviews: the burden experiences of caring for PWC users, the positive experiences of caregiving, and the coping strategies and resources used by caregivers of PWC users.

CONCLUSION

Our study showed that understanding the experiences of caregivers of AT users is central as they are directly and indirectly impacted by the PWC in their lives and caregiving roles.

A file audit of gym usage in an Australian private inpatient psychiatric hospital

OBJECTIVE

This study aimed to determine the extent to which people admitted to a private psychiatric inpatient unit access and utilise the gymnasium and individualised coaching with an exercise physiologist (EP).

METHODS

An audit of the medical record of 100 consecutive discharges and 60 individuals referred to an EP during the audit period was undertaken. Selected demographic information, physical health status, psychiatric diagnosis and routinely collected outcome data were extracted from files.

RESULTS

Twenty-four percent of people discharged from the hospital had documentary evidence of having attended the gym. These people were noted to have used the gym regularly and had an exercise prescription documented on discharge. Those with substance use disorder were more likely to use the gym than those diagnosed with an affective disorder. There were no significant differences in outcomes between those who were noted to exercise and those who did not.

CONCLUSION

Those who may most benefit from coaching around exercise in the context of hospital admission are not presently the individuals most likely to be referred to an EP. Standardised procedures for assessment, referral, exercise prescription and ongoing monitoring of activity and outcomes are recommended across the care continuum.

Inter-comparison of measurements of inorganic chemical components in precipitation from NADP and CAPMoN at collocated sites in the USA and Canada during 1986-2019

Wet deposition monitoring is a critical part of the long-term monitoring of acid deposition, which aims to assess the ecological impact of anthropogenic emissions of SO2 and NOx. In North America, long-term wet deposition has been monitored through two national networks: the Canadian Air and Precipitation Monitoring Network (CAPMoN) and the US National Atmospheric Deposition Program (NADP), for Canada and the USA, respectively. In order to assess the comparability of measurements from the two networks, collocated measurements have been made at two sites, one in each country, since 1986 (Sirois et al., in Environmental Monitoring and Assessment, 62, 273-303, 2000; Wetherbee et al., in Environmental Monitoring and Assessment, 1995-2004, 2010). In this study, we compared the measurements from NADP and CAPMoN instrumentation at the collocated sites at the Pennsylvania State University (Penn State), USA, from 1989 to 2016, and Frelighsburg, Quebec, Canada, from 2002 to 2019. We also included in the study the collocated daily-vs-weekly measurements by the CAPMoN network during 1999-2001 and 2016-2017 in order to evaluate the differences in wet concentration of ions due to sampling frequency alone. The study serves as an extension to two previous CAPMoN-NADP inter-comparisons by Sirois et al. (Environmental Monitoring and Assessment, 62, 273-303, 2000) and Wetherbee et al., in (Environmental Monitoring and Assessment, 1995-2004, 2010). At the Penn State University site, for 1986-2019, CAPMoN was higher than NADP for all ions, in terms of weekly concentration, precipitation-weighted annual mean concentration, and annual wet deposition. The precipitation-weighted annual mean concentrations were higher for SO42- (2%), NO3- (12%), NH4+ (16%), H+ (6%), and base cations and Cl- (11-15%). For annual wet deposition, CAPMoN was higher for SO4-2, NO3-, NH4+ and H+ (5-17%), and base cations and Cl- (12-17%) during 1986-2019. At the Frelighsburg site, NADP changed the sample collector in October 2011. For 2002-2011, the relative differences at the Frelighsburg site were positive and similar in magnitude to those at the Penn State site. For 2012-2019, the precipitation-weighted annual mean concentrations were 5-27% lower than NADP, except for H+, which was 23% higher. The change in sample collector by NADP had the largest effect on between-network biases. The comparisons of daily-vs-weekly measurements conducted by the CAPMoN network during 1999-2001 and 2016-2017 show that the weekly measurements were higher than the daily measurements by 1-3% for SO42-, NO3-, and NH4+; 3-9% for Ca2+, Mg2+, Na+, and Cl-; 10-24% for K+; and lower for H+ by 8-30% in terms of precipitation-weighted mean concentration. Thus, differences in sampling frequencies did not contribute to the systematically higher CAPMoN measurements. Understanding the biases in the data for these networks is important for interpretation of continental scale deposition models and transboundary comparison of wet deposition trends.

Mind-mindedness and preschool children's behavioral difficulties: The moderating role of maternal parenting distress

Mind-mindedness (MM) is a caregiver's tendency to appreciate their infant's internal mental states. This longitudinal study investigated whether maternal MM (10 months) was linked with children's later behavioral problems (51 months) and the moderating role of maternal parenting distress (PD; 36 months) in a sample of 91 mother-infant dyads. Appropriate MM comments were coded from video-recorded, semi-structured play interactions between mothers and their infants; PD was obtained from maternal completion of the PD subscale of the Parenting Stress Index - Short Form (PSI-SF); and child internalizing and externalizing behavior problems were gathered from maternal report on the Strengths and Difficulties Questionnaire (SDQ). Moderated regression analyses revealed higher early appropriate MM was associated with significantly fewer internalizing emotional problems at 51 months among mothers with lower PD at 36 months, and higher early appropriate MM was associated with lower conduct problems at 51 months in mothers with higher PD at 36 months. Findings demonstrated the importance of considering nuanced contexts such as at-risk mothers and differential presentations of child difficulties in the analysis of the relationship between MM and child behavioral difficulties and the development of MM interventions.

Optimizing Forecasted Activity Notifications with Reinforcement Learning

In this paper, we propose the notification optimization method by providing multiple alternative times as a reminder for a forecasted activity with and without probabilistic considerations for the activity that needs to be completed and needs notification. It is important to consider various factors when sending notifications to people after obtaining the results of the forecasted activity. We should not send notifications only when we have forecasted results because future daily activities are unpredictable. Therefore, it is important to strike a balance between providing useful reminders and avoiding excessive interruptions, especially for low probabilities of forecasted activity. Our study investigates the impact of the low probability of forecasted activity and optimizes the notification time with reinforcement learning. We also show the gaps between forecasted activities that are useful for self-improvement by people for the balance of important tasks, such as tasks completed as planned and additional tasks to be completed. For evaluation, we utilize two datasets: the existing dataset and data we collected in the field with the technology we have developed. In the data collection, we have 23 activities from six participants. To evaluate the effectiveness of these approaches, we assess the percentage of positive responses, user response rate, and response duration as performance criteria. Our proposed method provides a more effective way to optimize notifications. By incorporating the probability level of activity that needs to be done and needs notification into the state, we achieve a better response rate than the baseline, with the advantage of reaching 27.15%, as well as than the other criteria, which are also improved by using probability.

Sample size determination: A practical guide for health researchers

Although sample size calculations play an essential role in health research, published research often fails to report sample size selection. This study aims to explain the importance of sample size calculation and to provide considerations for determining sample size in a simplified manner. Approaches to sample size calculation according to study design are presented with examples in health research. For sample size estimation, researchers need to (1) provide information regarding the statistical analysis to be applied, (2) determine acceptable precision levels, (3) decide on study power, (4) specify the confidence level, and (5) determine the magnitude of practical significance differences (effect size). Most importantly, research team members need to engage in an open and realistic dialog on the appropriateness of the calculated sample size for the research question(s), available data records, research timeline, and cost. This study aims to further inform researchers and health practitioners interested in quantitative research, so as to improve their knowledge of sample size calculation.

What do Patients Want to See on Social Media? Evidence From a Two-Year Experiment

INTRODUCTION

Dermatological information on social media is dominated by misleading and potentially harmful content from nonexperts. Literature suggests that, to address this issue, dermatologists should develop an online presence. However, the successful presence of dermatologists on social media has been criticized for focusing on cosmetic dermatology and not representing the broad spectrum of the specialty.

OBJECTIVES

The aim of this study was to systematically analyze which dermatological topics interest the public most, and to find out whether it is feasible for a dermatologist to become influential on social media while presenting all dermatological topics equally.

METHODS

The study was performed on an educational dermatology YouTube channel. The 101 videos published in a two-year period were divided into cosmetic (51 videos) and medical dermatology (50 videos). Student's t-test was conducted to determine whether there were significant differences in views. Medical dermatology videos were then classified into three categories: Acne, facial dermatoses (excluding acne) and other dermatological diseases. A Kruskal-Wallis test was used to compare these three categories and cosmetic dermatology.

RESULTS

When comparing cosmetic and medical dermatology, no significant differences were found. When comparing the four categories, cosmetic dermatology and acne were found to generate significantly more views that other dermatological diseases.

CONCLUSIONS

The public seems to be particularly interested in cosmetic dermatology and acne. This might make it challenging to become successful on social media while presenting a balanced portrayal of dermatology. However, focusing on popular topics can provide a real chance to be influential and protect vulnerable people from misinformation.

The wicked problem of B(A)ME degree award gaps and systemic racism in our universities

The independent regulator for higher education in England, the Office for Students (OfS), set new national targets in late 2018 to achieve equality of opportunity in higher education by tackling degree award gaps. The sector response to this was to measure degree award gaps between B(A)ME students and white students in their higher education institutions. Analysis of degree award gaps using quantitative methods has revealed an "unexplained gap". We argue that the existence of this "unexplained gap" is evidence of "systemic racism". However, the factors influencing a degree award and their associated gaps across different racialized groups of students are so complex, that its problematisation, never-mind its solution is inherently complex. It is our view, therefore, racialized degree award gaps are a wicked problem. Despite this, it is also our view that it is an important social justice endeavor that we must still seek to address as a sector. To do so, we propose a mixed methods approach that uses dynamic centring and an intersectional lens to better understand the experiences of racialized students within the higher education "system". Current quantitative analysis of degree award gaps simply tells us how different groups of racialized students experience the system. In using a mixed methods approach in the way we outline, we may better understand the racialized lived experience of our students and the factors influencing the experience of different racialized groups within the "system". This solution-focused approach can help create opportunities that enable students to better navigate social structures and systems and improve their experience in the system. However, this will not address the wicked problem of degree award gaps itself, which is complex, pervasive, and messy.

Impact of tranexamic acid on clinical and hematologic outcomes following total shoulder arthroplasty

Background

The purpose of this study is to evaluate the impact of intravenous tranexamic acid on clinical and hematologic outcomes after total shoulder arthroplasty.

Methods

Retrospective review was conducted for 282 consecutive patients undergoing either anatomic shoulder arthroplasty or reverse total shoulder arthroplasty. Univariate analysis and multivariate linear regression were used to compare outcomes for patients receiving intravenous tranexamic acid with those who did not.

Results

Of the 282 patients included in this study, 78 patients received intravenous tranexamic acid and 204 did not. Patients who received intravenous tranexamic acid had significantly lower pre- to postoperative change in hemoglobin and hematocrit, and decreased postoperative drain output. In addition, patients receiving intravenous tranexamic acid were significantly less likely to have a postoperative hematocrit <30. There were no significant differences in length of stay, rate of 30 day hematoma, surgical site infection, deep vein thrombosis, or readmission between groups.

Conclusion

Intravenous tranexamic acid is associated with a significant reduction in change in hematocrit and hemoglobin and postoperative drain output after both anatomic and reverse total shoulder arthroplasty. Despite improving hematologic outcomes for these patients, tranexamic acid appears to have little impact on clinical outcomes such as length of stay and 30-day complication rates.

Risk management in digitalized educational environments: Teachers’ information security awareness levels

With the spread of Information and Communication Technologies (ICT) tools and the Internet, Twenty first century technologies have significantly affected human life, and it has been desired to be obtained continuously. It has become challenging to protect information due to the increase in the methods by which malicious people can get information. As a result, it is crucial to determine people’s awareness levels by revealing the risks and threats to information security. In this context, a study was conducted to show the awareness levels of teachers who come after the family in raising conscious individuals in society. For this purpose, a quantitative research method was adopted for the problem and sub-problems that form the basis of the research. The survey model, one of the research designs used within the framework of the quantitative research method, was used. Information Security Awareness Scale was applied to 394 teachers, and according to the results obtained, it was determined that the information security awareness level of the teachers was moderate. According to the attacks and threats sub-dimension, which includes technical issues, it has been determined that the awareness levels of the teachers are at a medium level. The study results show that female teachers’ information security awareness levels are lower than male teachers. In comparison, the awareness levels of those who received information security awareness training and information technology teachers are higher.

Utilizing Assessment Tools in Decreasing Fall Risk Among Community-Dwelling Adults: A Quality Improvement Project

Although there are standardized fall risk assessment tools in home care clinical practice, there are no standardized tools to reduce fall risk. This quality improvement project aims to test the adaptability of the Fall TIPS (Tailoring Interventions for Patient Safety) tool among the community-dwelling adult population by measuring the impact of the tool’s implementation on client fall risk. Participants included n = 54 clients enrolled in home care and n = 14 members of the clinical team. This project used a quantitative method with a quasi-experimental pre-and post-intervention design. The quality improvement project implemented the Fall TIPS tool, and fall risk was measured using the Morse Fall Risk Assessment (MFRA). The Fall TIPS tool was provided to participants by visiting staff, and interventions were selected based on the participant’s assessment. Participants’ fall risk was scored during in-person home visits, and the results were recorded in the electronic health record. A dependent 2-tailed t-test measured the variance of means between the pre-and-post groups. The pre-intervention MFRA score mean was 63.43 ± 22.52; p = .000 and the mean score in the post-intervention group was 58.15 ± 22.49; p = .000. The mean difference between the pre-and post-groups was 5.28. Implementing the Fall TIPS toolkit in the home care clinical setting reduced fall risk post-intervention and offered tools for future evaluation in home care settings.

The Tricky Task of Fisher-Gardener Research in Conservation Paleobiology

The study of sambaquis (ancient shell mounds) in conservation paleobiology is a complicated subject, especially when comparing body sizes of current and past mollusk valves to observe possible changes. There is a lack of information regarding how ancient fisher-gardeners collected these shellfish. Another obstacle is finding the hypothesis tests and data that can be used to compare current and past body sizes. To this end, we use the t-test (tt), Mann-Whitney (mw), and Bootstrap (bt) analyses to determine data scenarios for yellow clam (Amarilladesma mactroides) shells from two sambaquis units, and from two transects along the beaches of Rio Grande do Sul in southern Brazil. The study finds that the average body size of an Amarilladesma mactroides adult specimen is greater in sambaquis than the current valves across all tests (tt, p = 0.0005; mw, p = 0.006; bt, p = 0.04), even after reducing the sample number. However, when the comparison is only between valves that are larger than average, this does not hold true for two of the statistics (tt, p = 0.24; mw, p = 0.04; bt, p = 0.25). By refining the comparison for recent valves from different levels in the swash zone (upper, middle, and lower levels) with the past valves, we find that body sizes only differ at the middle level of the swash zone (tt, p = 0.004; mw, p = 0.004; bt, p = 0.005), where smaller adults, recruits, and juveniles live. This result could indicate that fisher-gardeners collected large organisms at distinct levels depending on the season (i.e., adults are collected in the upper level during summer and in the lower level during winter).

Psychological Balance Scale: Validation Studies of an Integrative Measure of Well-Being

Studies infer Psychological Balance from the absence of psychopathology. In this article, we investigated this construct as an antecedent of well-being. We present empirical evidence toward the validation of a new theoretical model regarding Psychological Balance, a dynamic state with relatively constant characteristics, comprising Consistency and Flexibility and influenced by a Self/Others Ratio. A battery of 31 items, as indicators of Consistency, Flexibility, and Self/Others Ratio, aided this empirical investigation. In an online study (N = 933), we collected cross-sectional data from the United Kingdom. Results of cross-validation analyses provided evidence toward the validity of the proposed model and the psychometric properties of its instrument. There were statistically significant associations between Consistency (i.e., degree of integration of a universal value structure as self-related characteristics that motivate personal goals and behavior), Flexibility (i.e., degree of ability to re-define meaningful and important goals in response to situational challenge), and five well-being variables (e.g., Meaning in Life). Self/Others Ratio (i.e., ratio of motivation to serve self-interest and the interest of others), operationalized as a binary variable (e.g., close and away from 1), moderated some of these associations. Altogether, this work may contribute toward a nuanced understanding of well-being and form the basis of interventions that aim to decrease emotional discomfort and increase meaning, happiness, and life satisfaction.

Lean management for improving hospital waiting times-Case study of a Vietnamese public/general hospital emergency department

INTRODUCTION

Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to (1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times.

METHODS

Data from a total of 742 patients who presented at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management of X-ray and CT scan online results.

RESULTS

By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical procedures/operations) by 33.3% (from 134.4 to 89.4 min); (2) vascular interventions by 10.4% (from 54.6 to 48.9 min); and (3) admission to other hospital departments by 49.5% (from 118.3 to 59.8 min). Additionally, prior to the implementation of the lean strategy approach, only 22.9% of patients or their proxies (family members or friends), who responded to the survey, expressed satisfaction with the ED services. This percentage increased to 76.5% following the curtailment of non-value-added activities. Through statistical inferential test analyses, it can be confidently concluded that applying lean strategy and tools can improve patient flow in public/general hospital EDs and achieve better staff coordination within the various clinical and administrative hospital departments. To the authors' knowledge, such analysis in a Vietnamese hospital's ED context has not been previously undertaken.

Integrated textile effluent treatment method

Textile wastewater purification is a challenging process. Conventional wastewater treatment methods either lack in efficiency, cost-effectiveness or leads to the generation of secondary pollutants. Additionally, some treatment methods are time-consuming. The research presented in the manuscript is a blend of filtration, biosorption, aeration, solar energy-assisted electrolytic precipitation, pH balance, and germicidal treatments with an aim of reducing the suspended solids, intense color, odor, pH, chemical oxygen demand (COD), total dissolved solids (TDS), electrical conductivity (EC), and heavy metal content of textile effluent. Use of environmentally sustainable surface activated biosorbents derived from waste weeds Water Hyacinth (WH) and Parthenium Hysterophorus (PH) as an alternative to commercial grade Activated Charcoal (AC), comparison of adsorption capacities of proposed adsorbents against AC for effluent decolorization, the application of solar energy to run an electrolytic precipitator, and the unique sequential design of various unit processes like coarse and fine filtration, biosorption, aeration, electrolytic precipitation, pH treatment and germicidal UV-C treatment to treat the effluent are some of the novel methodologies explored in the present study. The invented process provides almost completely decolorized (about 90%-94%), particle-free and odorless treated water, with the acceptable levels of heavy metals (Lead-not detected, Arsenic-not detected, Zinc-0.5-0.8 mg/L), TDS (1,500-1,850 mg/L), COD (149-169 mg/L) pH (7.1-7.15), and EC (2.5-2.8 mMhos/cm) as some of the important parameters, fitting well within the standard pollution limits. Performance efficiency estimation and statistical modeling were done for the data using the t test and f test. The values obtained were (t = 2.78 and f = 4.99 for treated WH against AC) and (t = 3.00 and f = 5.38 for treated PH against AC at 0.05 level of significance) as an essential part of the manuscript, proving the supremacy of the proposed process to achieve the standard pollution norms. Cost-effectiveness was an integral factor addressed in the proposed design, recorded a 1.7 USD per 1,000 L of input effluent, which was well below than most of the reported studies. The invented method in the present investigation thus provides an integrated, efficient, eco-friendly, and cost-effective solution to wastewater treatment. PRACTITIONER POINTS: Effluent decolorization is about 68% in comparison with conventional activated carbon. The adsorbent was found to be three times more active than activated carbon. COD value decreased from 2,352 mg/L to about 150 mg/L on treatment with the novel adsorbent.

Development of an optimized method for processing peripheral blood mononuclear cells for 1H-nuclear magnetic resonance-based metabolomic profiling

Human peripheral blood mononuclear cells (PBMCs) are part of the innate and adaptive immune system, and form a critical interface between both systems. Studying the metabolic profile of PBMC could provide valuable information about the response to pathogens, toxins or cancer, the detection of drug toxicity, in drug discovery and cell replacement therapy. The primary purpose of this study was to develop an improved processing method for PBMCs metabolomic profiling with nuclear magnetic resonance (NMR) spectroscopy. To this end, an experimental design was applied to develop an alternative method to process PBMCs at low concentrations. The design included the isolation of PBMCs from the whole blood of four different volunteers, of whom 27 cell samples were processed by two different techniques for quenching and extraction of metabolites: a traditional one using organic solvents and an alternative one employing a high-intensity ultrasound probe, the latter with a variation that includes the use of deproteinizing filters. Finally, all the samples were characterized by 1H-NMR and the metabolomic profiles were compared by the method. As a result, two new methods for PBMCs processing, called Ultrasound Method (UM) and Ultrasound and Ultrafiltration Method (UUM), are described and compared to the Folch Method (FM), which is the standard protocol for extracting metabolites from cell samples. We found that UM and UUM were superior to FM in terms of sensitivity, processing time, spectrum quality, amount of identifiable, quantifiable metabolites and reproducibility.

Quality of life in individuals with Down syndrome aged 4 to 21 years

BACKGROUND

To date, investigations of quality of life (QoL) in children with Down syndrome (DS) are rather limited. The purpose of this study was twofold: to examine QoL in children with DS and to explore possible differences in the QoL by age and gender.

METHODS

A cross-sectional study of 211 parents of children with DS was conducted using an online survey that included a consent form, a demographic questionnaire and the English version of KidsLife, which is a measure of children's QoL.

RESULTS

Our results demonstrated moderate or favourable levels of QoL except for the emotional well-being domain among children with DS. The children's QoL showed no variance by gender. However, emotional and material well-being, interpersonal relations and social inclusion varied by age.

CONCLUSIONS

The current findings provide important evidence that will help healthcare, educational and social services professionals to understand the multiple aspects of QoL in children with DS and support parents in their efforts to ensure the child's QoL. The results also point to the need to develop interventions aimed at improving QoL in those areas where children with DS are at increased risk for poorer QoL.

Introduction of a psychologically informed educational intervention for pre-licensure physical therapists in a classroom setting

BACKGROUND

There is an increasing need for physical therapists to address psychosocial aspects of musculoskeletal pain. Psychologically informed practice is one way to deliver this type of care through the integration of biopsychosocial interventions into patient management. An important component of psychologically informed practice is patient centered communication. However, there is little research on how to effectively implement patient centered communication into pre-licensure training for physical therapists.

METHODS

Thirty Doctor of Physical Therapy (DPT) students took part in an educational intervention that consisted of one 4-h didactic teaching session and three 1-h experiential learning sessions. Prior to the first session, students performed an examination of a standardized patient with chronic low back pain and were assessed on psychologically informed physical therapy (PIPT) adherent behaviors via a rating scale. Students also completed the Pain Attitudes and Beliefs Scale (PABS-PT). After the last experiential session, students evaluated another standardized patient and were reassessed on PIPT adherent behaviors. Students retook the PABS-PT and qualitative data was also collected.

RESULTS

After the educational intervention, students had positive changes in their pain attitudes and belief scores indicating a stronger orientation toward a psychosocial approach to patient care (p < 0.05). Additionally, after the intervention, students showed improvements in their adherence to using PIPT behaviors in their simulated patient interactions (p < 0.05). Qualitatively, students reported a high acceptability of the educational intervention with common themes indicating improved confidence with treating and communicating with complex patients.

CONCLUSION

Students had attitudes and beliefs shift towards a more psychosocial orientation and demonstrated improved PIPT behaviors in simulated patient interactions after a brief educational intervention. Future research should investigate best practices for implementation of psychologically informed physical therapy for licensed clinicians.

Statistical and Machine-Learning Analyses in Nutritional Genomics Studies

Nutritional compounds may have an influence on different OMICs levels, including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and metagenomics. The integration of OMICs data is challenging but may provide new knowledge to explain the mechanisms involved in the metabolism of nutrients and diseases. Traditional statistical analyses play an important role in description and data association; however, these statistical procedures are not sufficiently enough powered to interpret the large integrated multiple OMICs (multi-OMICS) datasets. Machine learning (ML) approaches can play a major role in the interpretation of multi-OMICS in nutrition research. Specifically, ML can be used for data mining, sample clustering, and classification to produce predictive models and algorithms for integration of multi-OMICs in response to dietary intake. The objective of this review was to investigate the strategies used for the analysis of multi-OMICs data in nutrition studies. Sixteen recent studies aimed to understand the association between dietary intake and multi-OMICs data are summarized. Multivariate analysis in multi-OMICs nutrition studies is used more commonly for analyses. Overall, as nutrition research incorporated multi-OMICs data, the use of novel approaches of analysis such as ML needs to complement the traditional statistical analyses to fully explain the impact of nutrition on health and disease.

Influence of Thermal Retrofitting on Annual Energy Demand for Heating in Multi-Family Buildings

The paper presented the analysis of heat consumption for heating in multi-family residential buildings before and after thermal retrofitting. The analysis involved four groups of buildings, i.e., 43 buildings in total, located in various localities, belonging to one weather station. The predicted level of energy savings resulting from thermal retrofitting was achieved from the energy audits. The actual heat consumption, following the calculation into so-called external standard conditions, was obtained based on the readouts from heat-meters. For each building, the values of heat consumption over the periods of 6–10 years were read. The performance measurements involved the periods before, during, and after thermal retrofitting. The following statistical tests were used for data analysis: Wilcoxon–Mann–Whitney, Shapiro–Wilk, Bartlett, ANOVA, Kruskal–Wallis, Dunn and Holm post-hoc. The performed analyses showed that the mean value of energy savings predicted by audits reached 38.5% when the real mean value of savings, achieved from heat-meters, equaled 30.3%. The annual energy demand factors for heating were calculated for final energy and non-renewable primary energy factors. It was established that most of the analyzed objects fulfilled the primary energy factor requirements found in the Polish technical and construction regulations, which were valid at the time of investment.

Tips for troublesome sample-size calculation

Properly set sample size is one of the important factors for scientific and persuasive research. The sample size that can guarantee both clinically significant differences and adequate power in the phenomena of interest to the investigator, without causing excessive financial or medical considerations, will always be the object of concern.

In this paper, we reviewed the essential factors for sample size calculation. We described the primary endpoints that are the main concern of the study and the basis for calculating sample size, the statistics used to analyze the primary endpoints, type I error and power, the effect size and the rationale. It also included a method of calculating the adjusted sample size considering the dropout rate inevitably occurring during the research. Finally, examples regarding sample size calculation that are appropriately and incorrectly described in the published papers are presented with explanations.