Assessing inter- and intra-rater reliability of movement scores and the effects of body-shape using a custom visualisation tool: an exploratory study.

BACKGROUND: The literature shows conflicting results regarding inter- and intra-rater reliability, even for the same movement screen. The purpose of this study was to assess inter- and intra-rater reliability of movement scores within and between sessions of expert assessors and the effects of body-shape on reliability during a movement screen using a custom online visualisation software. METHODS: Kinematic data from 542 athletes performing seven movement tasks were used to create animations (i.e., avatar representations) using motion and shape capture from sparse markers (MoSh). For each task, assessors viewed a total of 90 animations. Using a custom developed visualisation tool, expert assessors completed two identical sessions where they rated each animation on a scale of 1-10. The arithmetic mean of weighted Cohen's kappa for each task and day were calculated to test reliability. RESULTS: Across tasks, inter-rater reliability ranged from slight to fair agreement and intra-rater reliability had slightly better reliability with slight to moderate agreement. When looking at the average kappa values, intra-rater reliability within session with and without body manipulation and between sessions were 0.45, 0.37, and 0.35, respectively. CONCLUSIONS: Based on these results, supplementary or alternative methods should be explored and are likely required to increase scoring objectivity and reliability even within expert assessors. To help future research and practitioners, the custom visualisation software has been made available to the public.

Cohen syndrome: Can early-onset recurrent infections and hypotonia provide early diagnosis and intervention for intellectual disability?

INTRODUCTION: Cohen syndrome is a rare disease associated with neurodevelopmental disorders, especially intellectual disability (ID), neutropenia and recurrent infections are consistently reported in cases. Neutropenia is an important part of the syndrome, as well as ID. Homozygous variants in the VPS13B gene, located on chromosome 8q22 and containing 62 exons, have been found to cause Cohen syndrome. Cohen syndrome is commonly diagnosed when dysmorphological findings and developmental delay become more apparent. However, the identification of some findings with increasing age has caused the diagnosis of Cohen syndrome to be delayed. METHODS: Cases diagnosed with ID were evaluated using whole-exome sequencing/clinical exome sequencing method. Family segregation analysis was performed using Sanger sequencing. We presented the clinical and genetic findings of three cases diagnosed with Cohen syndrome and their parents in detail. RESULTS: In this study, we presented the occurrence of symptoms in different age groups, and the prognosis of three cases carrying the VPS13B gene variants, including three different variant types: missense, frameshift and nonsense. Although our cases had different variant types, they shared important similarities on the onset period and prognosis of the symptoms. All cases presented hypotonia, difficulties in swallowing, recurrent respiratory tract infections, neutropenia, delay in motor development, ID and hyperactivity. Our cases did not have a diagnosis of autism spectrum disorder. All cases had increased willingness to engage in social communication. CONCLUSION: We emphasize the importance of early-onset recurrent infections and hypotonia for early diagnosis and preventive genetic counselling in Cohen syndrome.

Interexaminer agreement of gonioscopy examinations in dogs using the European College of Veterinary Ophthalmologists Hereditary Eye Diseases grading scheme.

OBJECTIVE: Prospective observational study with preregistered study protocol to assess interexaminer agreement using the 2022 European College of Veterinary Ophthalmologists Hereditary Eye Disease (ECVO-HED) gonioscopy grading scheme. ANIMALS STUDIED: Sixty client-owned dogs presented for gonioscopy as part of the required certification process prior to breeding. PROCEDURE: Two ECVO diplomates with comparable clinical experience performed gonioscopy with a Koeppe gonioscopy lens and slit-lamp biomicroscope at 10x magnification on all eyes in a randomized fashion. RESULTS: One hundred and eighteen of 120 eyes (60 dogs) were included. In 110/118 eyes (93%), both examiners provided the same breeding recommendation (yes/no). This translated into an agreement on the final breeding recommendation in 58/60 dogs (97%). Examiners disagreed on pectinate ligament abnormality (PLA) grading in 19/118 eyes and iridocorneal angle width (ICAW) grading in 9/118 eyes. PLA grading disagreement was mostly observed between neighboring grades. Disagreement between PLA and ICAW grading sometimes occurred within the same eye accounting for an observed disagreement in iridocorneal angle abnormality (ICAA) grading in 19/118 eyes in total. Cohen's kappa was Κ = 0.62 (95% TI 0.34-0.89), whereas maximum kappa was maxΚ = 0.82 (95% TI 0.59-1). Mixed model analysis suggested no significant examiner influence on breeding recommendations (OR 0.17; 95% CI 0.02-1.12, p = .09). CONCLUSIONS: Although examiners disagreed on ICAA grading in 19/118 eyes, this resulted in a different breeding recommendation (yes/no) in eight eyes and in two dogs only. Therefore, the use of the 2022 ECVO-HED gonioscopy grading scheme seems to result in examiners providing the same breeding recommendations in most cases.

Repeatability and Reproducibility of a Modified Lekholm and Zarb Bone Quality Classification Based on Cone Beam Computed Tomography: An Observatsion Study.

Aim: We propose a modified Lekholm and Zarb classification that considers all possible combinations of cortical and cancellous bone to provide parameters that favor greater repeatability and reproducibility. Materials and Methods: This observational and analytical study consisted of a sample of 50 cone beam computed tomography (CBCT) scans. Two new types (V and VI), three subtypes to type II (II-A, II-B, and II-C), and two subtypes to type III (III-A and III-B) were added to the original bone quality classification. The new types refer to regenerated bone (type V) and bone with some pathology (type VI). The subtypes are described as type II-A: thick cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type II-B: thick cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae in the basal bone and predominant presence of wide and visible medullary spaces; type II-C: thick cortical surrounding the abundant cancellous bone with predominance of very thick and sharp trabeculae in the basal third as well as presence of small and visible medullary spaces; type III-A: thin cortical surrounding the abundant cancellous bone with sharp trabeculae throughout the image and presence of small and visible medullary spaces; type III-B: thin cortical surrounding the abundant cancellous bone with predominance of diffuse trabeculae and presence of diffuse medullary spaces. Five dental specialists were trained in the use of the modified classification and were provided with CBCT-sectioned images of edentulous jaws for classification. Each specialist classified the images twice at a 7-day interval. The strength of intra-examiner and inter-examiner agreement was measured with Cohen's and Fleiss' kappa index, respectively. In addition, the agreement between both classifications was analyzed. All data were analyzed at a 95% confidence level, considering a P-value <0.05. Results: According to the modified Lekholm and Zarb classification, an almost perfect intra-examiner agreement was significant (P < 0.05) in all five specialists, with the kappa index [k] ranging from 0.91 [95% confidence interval (CI): 0.82-0.99) to 0.95 (95% CI: 0.89-1.00). Furthermore, substantial inter-examiner concordance (k=0.76; 95% CI: 0.73-0.79) was significant (P < 0.05). Conclusion: The high repeatability and reproducibility of the modified Lekholm and Zarb classification on CBCT suggest its applicability to distinguish between the various combinations of cortical and cancellous bone and help to define treatment appropriately to optimize results.

Meta-analysis of deep learning approaches for automated coronary artery calcium scoring: Performance and clinical utility AI in CAC scoring: A meta-analysis: AI in CAC scoring: A meta-analysis.

INTRODUCTION: Manual Coronary Artery Calcium (CAC) scoring, crucial for assessing coronary artery disease risk, is time-consuming and variable. Deep learning, particularly through Convolutional Neural Networks (CNNs), promises to automate and enhance the accuracy of CAC scoring, which this study investigates. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a comprehensive literature search across PubMed, Embase, Web of Science, and IEEE databases from their inception until November 1, 2023, and selected studies that employed deep learning for automated CAC scoring. We then evaluated the quality of these studies by using the Checklist for Artificial Intelligence in Medical Imaging and the Quality Assessment of Diagnostic Accuracy Studies 2. The main metric for evaluation was Cohen's kappa statistic, indicating an agreement between deep learning models and manual scoring methods. RESULTS: A total of 25 studies were included, with a pooled kappa statistic of 83 % (95 % CI of 79 %-87 %), indicating strong agreement between automated and manual CAC scoring. Subgroup analysis revealed performance variations based on imaging modalities and technical specifications. Sensitivity analysis confirmed the reliability of the results. CONCLUSIONS: Deep learning models, particularly CNNs, have great potential for use in automated CAC scoring applications, potentially enhancing the efficiency and accuracy of risk assessments for coronary artery disease. Further research and standardization are required to address the major heterogeneity and performance disparities between different imaging modalities. Overall, our findings underscore the evolving role of artificial intelligence in advancing cardiac imaging and patient care.

Evaluation of Five Screening Tools in Detecting Physical Frailty in Cirrhosis and Their Prognostic Role.

Background: Physical frailty (PF) is a syndrome of decreased physical function and reserves, preventing patients from coping with stressful events. PF screening tools in patients with liver cirrhosis (LC) can help evaluate the risk of complications and death. The aim of this study was to assess the performance of five screening tools in detecting PF and their ability to predict 18-month mortality in LC. Methods: The Short Physical Performance Battery (SPPB), Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and 6-Minute Walk Test (6MWT) were compared with the Liver Frailty Index (LFI) as the method of reference. Patients with an LFI ≥ 4.5, SPPB ≤ 8, FFP ≥ 3, CFS ≥ 6 points, and those walking <250 m, were considered frail. Results: A total of 109 consecutive patients with stable LC were included [63.3% male, median age 62 years, (IQR 52-70), MELD 9 (7-14.5), 46.8% with decompensated LC (DC)]. PF was present in 23.9%, 27.5%, 41.3%, 13.8%, and 28.4% as assessed by the LFI, SPPB, FFP, CFS, and 6MWT, respectively. Cohen's kappa measurement of agreement of four of the tools with LFI was 0.568, 0.334, 0.439, and 0.502, respectively (p < 0.001 for each). Kaplan-Meier survival curves at 18 months showed higher mortality in frail patients compared to non-frail patients by any method (log rank p < 0.05). In the multivariate models, PF defined by any method emerged as an independent prognostic factor of 18-month mortality after adjustment for age, gender, and MELD-score. Conclusions: Patients characterized as frail by five screening tools were not identical. However, PF defined by either method was proven to be an independent poor prognostic factor for long-term mortality after adjustment for covariates.

Cohen Syndrome With Complex Medical Complications: A Case Report.

Cohen syndrome (CS) is a rare autosomal recessive disorder marked by developmental delays, distinct facial features, and a variety of systemic manifestations. We present a case of a 28-year-old male previously misdiagnosed with Prader-Willi syndrome who exhibited recurrent generalized weakness, fever, fatigue, and significant hemoglobin drops requiring multiple blood transfusions due to thalassemia major. The patient displayed characteristic CS features, including developmental delays, distinct facial characteristics, morbid obesity, and heterochromia iridis. Severe gastrointestinal bleeding led to a diagnosis of ulcerative colitis (UC) via colonoscopy. Management included blood transfusions, hydrocortisone, mesalamine, and azathioprine, resulting in stabilized UC and improved overall health. CS presents with a spectrum of clinical features that overlap with other syndromic conditions, necessitating careful differential diagnosis. Early diagnosis and supportive care significantly improve quality of life and help manage complications effectively.

A critical review of brexpiprazole oral tablets as the first drug approved to treat agitation symptoms associated with dementia due to Alzheimer's disease.

INTRODUCTION: Agitation is a common and disruptive syndrome in dementia due to Alzheimer's disease (AD). Brexpiprazole was recently approved for this agitation of AD dementia and is the only therapy approved for this indication. AREAS COVERED: The authors review the chemistry, pharmacokinetics, mechanism of action, and pharmacodynamics of brexpiprazole. Phase 2/3 and Phase 3 studies of brexpiprazole for the treatment of agitation in dementia due to AD are described. These studies demonstrated efficacy and safety for the 2 mg/d and 3 mg/d doses. Agitation reduction from baseline was significantly greater in the active treatment groups compared to the participants on placebo as measured by the Cohen-Mansfield Agitation Inventory, the primary outcome. Treatment benefit was demonstrated on the Clinician Global Impression - Severity, the key secondary outcome. Safety and tolerability were comparable in drug and placebo arms of the studies. EXPERT OPINION: Approval by the Food and Drug Administration (FDA) of brexpiprazole for the treatment of agitation in dementia due to AD is an important milestone and regulatory precedent. This is the first approval for the treatment of any neuropsychiatric syndrome of AD. Brexpiprazole has a 'black box' warning for its use in psychosis caused by dementia due to an observed increase in mortality when using this class of antipsychotic agents in patients with dementia. Post-marketing surveillance will be key to understanding the safety profile of brexpiprazole. Brexpiprazole may be prioritized over the 'off label' use of other potential treatments for agitation.

Exponential synchronization of quaternion-valued memristor-based Cohen-Grossberg neural networks with time-varying delays: norm method.

In this paper, the exponential synchronization of quaternion-valued memristor-based Cohen-Grossberg neural networks with time-varying delays is discussed. By using the differential inclusion theory and the set-valued map theory, the discontinuous quaternion-valued memristor-based Cohen-Grossberg neural networks are transformed into an uncertain system with interval parameters. A novel controller is designed to achieve the control goal. With some inequality techniques, several criteria of exponential synchronization for quaternion-valued memristor-based Cohen-Grossberg neural networks are given. Different from the existing results using decomposition techniques, a direct analytical approach is used to study the synchronization problem by introducing an improved one-norm method. Moreover, the activation function is less restricted and the Lyapunov analysis process is simpler. Finally, a numerical simulation is given to prove the validity of the main results.

Sample size planning for estimating the global win probability with precision and assurance.

Randomized controlled trials commonly employ multiple endpoints to collectively assess the intended effects of the new intervention on multiple aspects of the disease. Focusing on the estimation of the global win probability (WinP), defined as the (weighted) mean of the WinPs across the endpoints that a treated participant would have a better outcome than a control participant, we propose a closed-form sample size formula incorporating pre-specified precision and assurance, with precision denoted by the lower limit of confidence interval and assurance denoted by the probability of achieving that lower limit. We make use of the equivalence of the WinP and the area under the receiver operating characteristic curve (AUC) and adapt a formula originally developed for the difference between two AUCs to handle the global WinP. Unequal variances between treatment groups are allowed. Simulation results suggest that the method performs very well. We illustrate the proposed formula using a Parkinson's disease clinical trial design example.

Defining a clinically meaningful within-patient change threshold for the Cohen-Mansfield Agitation Inventory in Alzheimer's dementia.

Introduction: The Cohen-Mansfield Agitation Inventory (CMAI) quantifies the frequency of agitation behaviors in elderly persons. This post hoc analysis of data from the brexpiprazole clinical program aimed to determine a meaningful within-patient change (MWPC) threshold for CMAI Total score among patients with agitation associated with dementia due to Alzheimer's disease. Methods: Data were included from three 12-week, multicenter, randomized, double-blind, placebo-controlled, parallel-arm trials of brexpiprazole for the treatment of agitation associated with dementia due to Alzheimer's disease (ClinicalTrials.gov identifiers: NCT01862640, NCT01922258, NCT03548584). Change in CMAI Total score (range 29-203; higher scores indicate higher frequency of agitation behaviors) from baseline to Week 12 was the primary endpoint in each trial. MWPC thresholds were estimated from anchor-based mean change analyses and receiver operating characteristic (ROC) curves. The Clinical Global Impression-Severity of illness (CGI-S) and Clinical Global Impression-Improvement (CGI-I) scales, both as related to agitation, were used as anchors. Empirical cumulative distribution functions (eCDFs) and probability density functions (PDFs) were plotted as supportive evidence. Distribution-based methods were also employed. Results: Data from 898 patients were analyzed (mean age, 73.7 years; mean baseline CMAI Total score, 73.8). The mean CMAI Total score change corresponding to a difference of small improvement vs. stable (CGI-S one-point decrease vs. no change), or minimally improved vs. no change (CGI-I rating of 3 vs. 4), ranged from -10.6 to -13.5 points. The mean CMAI Total score change corresponding to a difference of moderate improvement vs. stable (CGI-S two-point decrease vs. no change), or much improved vs. no change (CGI-I rating of 2 vs. 4), ranged from -20.2 to -25.7 points. ROC curve analyses generally produced smaller estimates of meaningful change. eCDFs and PDFs showed good distribution and separation of CMAI Total score change between CGI-S/CGI-I categories. In distribution-based analyses, the minimal detectable change for CMAI Total score (10.5-11.8 points) was generally lower than anchor-suggested thresholds. Conclusion: Triangulation of evidence from anchor- and distribution-based analyses supports an MWPC threshold for CMAI Total score of -20 points, with a threshold range of -15 to -25 points, in patients with agitation associated with dementia due to Alzheimer's disease.

An Exact Bayesian Model for Meta-Analysis of the Standardized Mean Difference with Its Simultaneous Credible Intervals.

While Bayesian methodology is increasingly favored in behavioral research for its clear probabilistic inference and model structure, its widespread acceptance as a standard meta-analysis approach remains limited. Although some conventional Bayesian hierarchical models are frequently used for analysis, their performance has not been thoroughly examined. This study evaluates two commonly used Bayesian models for meta-analysis of standardized mean difference and identifies significant issues with these models. In response, we introduce a new Bayesian model equipped with novel features that address existing model concerns and a broader limitation of the current Bayesian meta-analysis. Furthermore, we introduce a simple computational approach to construct simultaneous credible intervals for the summary effect and between-study heterogeneity, based on their joint posterior samples. This fully captures the joint uncertainty in these parameters, a task that is challenging or impractical with frequentist models. Through simulation studies rooted in a joint Bayesian/frequentist paradigm, we compare our model's performance against existing ones under conditions that mirror realistic research scenarios. The results reveal that our new model outperforms others and shows enhanced statistical properties. We also demonstrate the practicality of our models using real-world examples, highlighting how our approach strengthens the robustness of inferences regarding the summary effect.

Adiponectin and Glucocorticoids Modulate Risk for Preterm Birth: The Healthy Start Study.

PURPOSE: Adiponectin is a potent uterine tocolytic that decreases with gestational age, suggesting it could be a maternal metabolic quiescence factor. Maternal stress can influence preterm birth risk, and adiponectin levels may be stress-responsive. We characterized associations between adiponectin and glucocorticoids with preterm birth and modeled their predictive utility. We hypothesized maternal plasma adiponectin and cortisol are inversely related and lower adiponectin and higher cortisol associate with preterm birth. METHODS: We performed a nested case-control study using biobanked fasting maternal plasma. We included low-risk singleton pregnancies, and matched 1:3 (16 preterm, 46 term). We quantified total, high (HMW), and low molecular weight (LMW) adiponectin using ELISA. We validated an HPLC-MS/MS serum assay for use in plasma, to simultaneously measure cortisol, cortisone, and five related steroid hormones. We used linear/logistic regression to compare group means and machine learning for predictive modeling. RESULTS: The preterm group had lower mean LMW adiponectin (3.07 µg/mL vs. 3.81 µg/mL at 15w0d, P=0.045) and higher mean cortisone (34.4 ng/mL vs. 29.0 ng/mL at 15w0d, P=0.031). The preterm group had lower cortisol-to-cortisone and lower LMW adiponectin-to-cortisol ratios. We found HMW adiponectin, cortisol-to-cortisone ratio, cortisone, maternal height, age, and pre-pregnancy BMI most strongly predicted preterm birth (AUROC=0.8167). In secondary analyses, we assessed biomarker associations with maternal self-reported psychosocial stress. Lower perceived stress associated with a steeper change in cortisone in the term group. CONCLUSION: Overall, metabolic and stress biomarkers associated with preterm birth in this healthy cohort. We identify a possible mechanistic link between maternal stress and metabolism for pregnancy maintenance.

Endoscopic combined intrarenal surgery without ureteral access sheath performed for renal stone after Cohen reimplantation.

Introduction: Endoscopic combined intrarenal surgery after anti-reflux operation is rarely performed. Case presentation: A 37-year-old female was referred to our hospital for treatment of left renal stone. She underwent anti-reflux surgery (Cohen reimplantation) for left vesicoureteral reflux at the age of 10 years. Computed tomography revealed a 17 × 11 mm left inferior calyceal calculus. The patient received retrograde double-J stent insertion under radiographic guidance and underwent ultra-mini endoscopic combined intrarenal surgery without ureteral access sheath. The patient was discharged on postoperative Day 5 with no postoperative complications. Postoperative cystography showed no recurrence of vesicoureteral reflux. One month after the operation, kidney-ureter-bladder radiography and computed tomography scan revealed no residual stones or hydronephrosis. Conclusion: Ultra-mini endoscopic combined intrarenal surgery without ureteral access sheath is an effective method for treating renal stones after Cohen reimplantation.

A Prediction Model for Identifying Seasonal Influenza Vaccination Uptake Among Children in Wuxi, China: Prospective Observational Study.

BACKGROUND: Predicting vaccination behaviors accurately could provide insights for health care professionals to develop targeted interventions. OBJECTIVE: The aim of this study was to develop predictive models for influenza vaccination behavior among children in China. METHODS: We obtained data from a prospective observational study in Wuxi, eastern China. The predicted outcome was individual-level vaccine uptake and covariates included sociodemographics of the child and parent, parental vaccine hesitancy, perceptions of convenience to the clinic, satisfaction with clinic services, and willingness to vaccinate. Bayesian networks, logistic regression, least absolute shrinkage and selection operator (LASSO) regression, support vector machine (SVM), naive Bayes (NB), random forest (RF), and decision tree classifiers were used to construct prediction models. Various performance metrics, including area under the receiver operating characteristic curve (AUC), were used to evaluate the predictive performance of the different models. Receiver operating characteristic curves and calibration plots were used to assess model performance. RESULTS: A total of 2383 participants were included in the study; 83.2% of these children (n=1982) were <5 years old and 6.6% (n=158) had previously received an influenza vaccine. More than half (1356/2383, 56.9%) the parents indicated a willingness to vaccinate their child against influenza. Among the 2383 children, 26.3% (n=627) received influenza vaccination during the 2020-2021 season. Within the training set, the RF model showed the best performance across all metrics. In the validation set, the logistic regression model and NB model had the highest AUC values; the SVM model had the highest precision; the NB model had the highest recall; and the logistic regression model had the highest accuracy, F1 score, and Cohen κ value. The LASSO and logistic regression models were well-calibrated. CONCLUSIONS: The developed prediction model can be used to quantify the uptake of seasonal influenza vaccination for children in China. The stepwise logistic regression model may be better suited for prediction purposes.

Detections of bifurcation in a fractional-order Cohen-Grossberg neural network with multiple delays.

The dynamics of integer-order Cohen-Grossberg neural networks with time delays has lately drawn tremendous attention. It reveals that fractional calculus plays a crucial role on influencing the dynamical behaviors of neural networks (NNs). This paper deals with the problem of the stability and bifurcation of fractional-order Cohen-Grossberg neural networks (FOCGNNs) with two different leakage delay and communication delay. The bifurcation results with regard to leakage delay are firstly gained. Then, communication delay is viewed as a bifurcation parameter to detect the critical values of bifurcations for the addressed FOCGNN, and the communication delay induced-bifurcation conditions are procured. We further discover that fractional orders can enlarge (reduce) stability regions of the addressed FOCGNN. Furthermore, we discover that, for the same system parameters, the convergence time to the equilibrium point of FONN is shorter (longer) than that of integer-order NNs. In this paper, the present methodology to handle the characteristic equation with triple transcendental terms in delayed FOCGNNs is concise, neoteric and flexible in contrast with the prior mechanisms owing to skillfully keeping away from the intricate classified discussions. Eventually, the developed analytic results are nicely showcased by the simulation examples.

Perceived stress and its influencing factors among persons living with HIV/AIDS (PLHA) in Kannur district, Kerala, India.

Context: The human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic remains a major healthcare problem for the humanity. It is important to understand the level of stress among people living with HIV/AIDS (PLHA), which may have an influence on their living. Aims: The main aim of the study is to assess the perceived stress and the factors influencing. Settings and Design: Descriptive study. The details of a total of 750 PLHAs registered in the district were collected, and the researcher selected 210 samples using the simple random sampling method. Methods and Material: The researcher used the standardised Perceived Stress Scale developed by Sheldon Cohen in 1983. Statistical Analysis Used: The data analysis was done using descriptive statistics and tests. Results: While analysing the perceived stress of the respondents, more than half 61% of the respondents have reported a moderate level of perceived stress. The study also depicts that perceived stress is being influenced by gender, marital status, occupation, number of dependents, and monthly income of PLHA. Conclusions: PLHAs in the selected geographic area experience a significant level of perceived stress, which indicates the need for programmes to address it.

Single-port-plus-one robot-assisted laparoscopic Lich-Gregoir direct nipple ureteral extravesical reimplantation in pediatric primary obstructive megaureter, comparing to laparoscopic cohen.

PURPOSE: To compare the effects of a single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple approach and traditional laparoscopic Cohen in treating pediatric primary obstructive megaureter. MATERIALS AND METHODS: The clinical data of 24 children with primary obstructive megaureter from January 2021 to November 2021 were analyzed retrospectively. Among them, 12 children (8 boys and 4 girls, the average age were 17.17 ± 6.31 months) treated with the laparoscopic Cohen method were defined as group C. The remaining 12 children (7 boys and 5 girls, the average age was 17.33 ± 6.99 months) underwent single-port-plus-one robotic laparoscopic-modified Lich-Gregoir direct nipple ureteral extravesical reimplantation were defined as group L. The parameters of pre-operation, intraoperative and postoperative were compared. RESULTS: There were no differences in the patient characteristics and average follow-up time between the two groups (P > 0.05).The obstruction resolution rate was 100% in both groups. The total operation time in group L is slightly longer than that in group C(P < 0.001),but the intraperitoneal operation time of the two groups was comparable(P > 0.05). The postoperative parameters included blood loss, gross haematuria time, indwelling catheterization time and hospitalization time in group L is shorter than group C(P < 0.05). One year post-operation, decreasing in ureteral diameter and APRPD, and increasing in DRF were remarkably observed in both two groups(P < 0.05). Ureteral diameter, APRPD, and DRF were not significantly different both in pre-operation and post-operation between Group L and Group C(P > 0.05). CONCLUSION: Single-port-plus-one robot-assisted laparoscopic-modified Lich-Gregoir direct nipple approach and traditional laparoscopic Cohen are both dependable techniques for ureteral reimplantation in the treatment of pediatric primary obstructive megaureter. Since Lich-Gregoir can preserve the physiological direction of the ureter and direct nipple reimplantation enhances the effect of anti-refluxing, this technique is favorable for being promoted and applied in robot surgery.

Examining factors influencing Turkish Jewish attitudes towards the Armenian genocide.

The most prominent issue influencing Turkish-Armenian relations is the international recognition of the Armenian genocide. However, there is a notable absence of empirical analyses regarding the perceptions of the genocide among the Turkish population. This study aims to fill this scholarly gap by exploring, for the first time, the perspectives of Turkish Jews. It analyses evidence collected from interviews conducted with 14 Turkish Jews, utilising Stanley Cohen's (2001) theoretical framework, which aids in delineating significant factors by a categorisation of types of acceptance and denial. The findings highlight a diversity of responses linked to political attitudes, which can be broadly categorised into Kayades and Avlaremoz mindsets. They also show that Turkish Jews' views on the Holocaust influence how they perceive the Armenian genocide. Additionally, the results indicate that Cohen's approach is useful in explaining non-denying responses. In conclusion, the study argues that Turkish Jews' perspectives appear to be strongly related to their stance towards the Turkish state and the Holocaust.

Evaluating the Douglas-Cohen IRT Goodness of Fit Measure With BIB Sampling of Items.

Methods to detect item response theory (IRT) item-level misfit are typically derived assuming fixed test forms. However, IRT is also employed with more complicated test designs, such as the balanced incomplete block (BIB) design used in large-scale educational assessments. This study investigates two modifications of Douglas and Cohen's 2001 nonparametric method of assessing item misfit, based on A) using block total score and B) pooling booklet level scores for analyzing BIB data. Block-level scores showed extreme inflation of Type I error for short blocks containing 5 or 10 items. The pooled booklet method yielded Type I error rates close to nominal α in most conditions and had power to detect misfitting items. The study also found that the Douglas and Cohen procedure is only slightly affected by the presence of other misfitting items in the block. The pooled booklet method is recommended for practical applications of Douglas and Cohen's method with BIB data.