Improving Likert scale big data analysis in psychometric health economics: reliability of the new compositional data approach.

Bipolar psychometric scales data are widely used in psychologic healthcare. Adequate psychological profiling benefits patients and saves time and costs. Grant funding depends on the quality of psychotherapeutic measures. Bipolar Likert scales yield compositional data because any order of magnitude of agreement towards an item assertion implies a complementary order of magnitude of disagreement. Using an isometric log-ratio (ilr) transformation the bivariate information can be transformed towards the real valued interval scale yielding unbiased statistical results increasing the statistical power of the Pearson correlation significance test if the Central Limit Theorem (CLT) of statistics is satisfied. In practice, however, the applicability of the CLT depends on the number of summands (i.e., the number of items) and the variance of the data generating process (DGP) of the ilr transformed data. Via simulation we provide evidence that the ilr approach also works satisfactory if the CLT is violated. That is, the ilr approach is robust towards extremely large or infinite variances of the underlying DGP increasing the statistical power of the correlation test. The study generalizes former results pointing out the universality and reliability of the ilr approach in psychometric big data analysis affecting psychometric health economics, patient welfare, grant funding, economic decision making and profits.

Health-Related Quality of Life during 26-Week Intervention with the New Nordic Renal Diet.

The New Nordic Renal Diet (NNRD) is a whole-food approach, tailored to meet recommended guidelines in patients with moderate chronic kidney disease (stage 3b-4). The NNRD improved various metabolic and physiological endpoints during a 26-week randomized controlled study. Here, we examined the effect of dietary intervention on health-related quality of life (HRQoL). Sixty participants were recruited (NNRD group n = 30, control group n = 30) and 58 completed the study. During the intervention, the NNRD group received food boxes, and recipes once a week. The control group continued their habitual diet. HRQoL was examined at baseline and at the end of the intervention using the validated EuroQol-5D-5L, including a 5-point scale Likert questionnaire at the end of the intervention. Assessed by the EuroQol-5D-5L questionnaire, the NNRD group experienced a reduction in pain/discomfort during the intervention by 26% [-0.44 points (95% CI; -0.73, -0.16)], compared with no change in the control group [0.25 points (95% CI; -0.02, 0.53)] and a between-group difference of -0.70 points (95% CI; -1.03, -0.37, p < 0.001). A larger decrease of body fat mass was associated with a larger decrease in pain/discomfort (p = 0.014). In addition, the NNRD group reported an overall improvement in conducting usual daily activities by 23% [-0.30-point (95% CI; -0.50, -0.11)], while no change was seen in the control group [-0.02 points (95% CI; -0.21, 0.17)], with a between-group difference -0.28 points (95% CI; -0.51, -0.06, p = 0.014). A larger decrease in 24 h urine phosphorus excretion, used as a marker of compliance, was associated with a larger improvement in conducting usual daily activities (p = 0.036). The NNRD group had a clinically relevant improvement in various HRQoL outcomes.

Integrated assessment of irrigation and agriculture management challenges in Nepal: An interdisciplinary perspective.

Agriculture plays a critical role in ensuring food and nutrition security, livelihood, and rural employment in Nepal. Despite substantial investments and institutional reforms, irrigation projects have faced consistently low performance. While existing studies have shed light on technical aspects of irrigation performance, they often focus on specific themes rather than holistic evaluations of sustainability. This research systematically assesses barriers and challenges to effective irrigation water management in Nepal by assessing and ranking the challenges faced by three irrigation systems in western Nepal: Mahakali, Rani Jamara Kulariya, and Babai. To investigate these challenges, we collected data from 449 households, which provided insights into 33 indicators representing key barriers to effective irrigation and agricultural management. The identified challenges were categorized into four broad thematic areas: physical and structural, agricultural and water, socioeconomic and market, and gender and governance. A comprehensive evaluation was conducted to compare these challenges among the three irrigation schemes, different thematic areas, and various locations within each scheme (namely, the head, mid, and tail sections of the system). The findings revealed that timely access and availability of fertilizers, spring water availability and fair market prices of agricultural products are the most significant challenges. The Babai irrigation system faced the most substantial challenges among the three systems, particularly in the mid section. These findings emphasize the interconnectedness of these challenges, highlighting the need for a holistic approach to planning, implementation, and management. Integrated strategies are essential to address socioeconomic, market, and endogenous farming issues, ensuring reliable irrigation water availability for sustainable agricultural production.

Assessment of Patient Satisfaction and Functional Outcomes in Orthognathic Surgery.

Background: Orthognathic surgery is a surgical procedure performed to correct severe jaw misalignments that can affect a patient's facial aesthetics and functional occlusion. While the primary goal of orthognathic surgery is to improve functional outcomes and facial appearance, it is essential to assess patient satisfaction as a crucial aspect of overall treatment success. Materials and Methods: Patient selection: We conducted a prospective study involving 50 patients who underwent orthognathic surgery. All patients had a confirmed diagnosis of severe jaw misalignment, as determined by clinical and radiographic assessments. The surgical procedures performed included maxillary advancement, mandibular setback, or a combination of both, depending on the patient's specific diagnosis. Preoperative orthodontic treatment was provided to align the teeth and prepare the patient for surgery. Patients were evaluated preoperatively and at postoperative intervals of 3 months, 6 months, and 1 year. Results: Patient satisfaction scores and functional outcomes were as follows: aesthetics of facial profile (1-year post-op): mean score = 4.6, chewing function (1-year post-op): mean score = 4.4, speech function (1-year post-op): mean score = 4.3, and overall satisfaction with surgical outcome (1-year post-op): mean score = 4.5. Objective assessments revealed a significant improvement in occlusion and facial aesthetics. The mean reduction in overjet was 4.8 mm, and the mean reduction in overbite was 3.2 mm. Additionally, the mean postoperative ANB angle improved by 3.7°, indicating a better facial balance. Conclusion: Orthognathic surgery in our cohort of 50 patients resulted in high levels of patient satisfaction with both functional outcomes and facial aesthetics. Objective measurements also indicated significant improvements in occlusion and facial balance.

The Clinical Toxicology Recommendations Collaborative: purpose, organization, and methodology.

INTRODUCTION: Scientific societies aim to provide a collective voice and unified stance on important issues. The Clinical Toxicology Recommendations Collaborative was formed in 2016 to develop evidence- and consensus-based recommendations for the management of patients exposed to common and/or serious poisonings for which the management is unclear or controversial. ORGANIZATION: The Clinical Toxicology Recommendations Collaborative is led jointly by the American Academy of Clinical Toxicology, the Asia Pacific Association of Medical Toxicology, and the European Association of Poison Centres and Clinical Toxicologists. The Governance Committee is chaired by a Past-President of one of these Societies and comprised of the six Presidents and Immediate Past-Presidents of the three Societies. A Steering Committee oversees the process of each project workgroup. METHODOLOGY: The overall process is guided by standards set forth by the Institute of Medicine for developing trustworthy guidelines and the Appraisal of Guidelines for Research and Evaluation Instrument. Systematic reviews are produced using the framework set in the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Workgroup members jointly review the evidence and prepare statements on which they vote anonymously using a 9-point Likert scale. A two-round modified Delphi method is used to reach a consensus on clinical recommendations using the RAND/UCLA Appropriateness Method. Final recommendations are approved by unanimous consent of the workgroup and are expressed as both levels of evidence and strength of recommendations. LIMITATIONS: The major limitations of the Clinical Toxicology Recommendations Collaborative process centre around the amount and quality of evidence, the assessment of that evidence, and the voting of the panel. CONCLUSIONS: By using a transparent evidence- and consensus-based approach to produce systematic reviews and clinical recommendations, the Clinical Toxicology Recommendations Collaborative aims to create an international framework for clinical toxicology education and decision-making and foster positive change for the benefit of poisoned patients.

Performance evaluation on vaccination rates monitoring report system of Shenzhen, China.

To evaluate the performance of "Vaccination Rates Monitoring Report System" implemented by Shenzhen CDC, we conducted an analysis of the data quality and identify key areas for system improvement. Following evaluation guidelines provided by WHO and United States CDC, we established six evaluation attributes: representativeness, simplicity, acceptability, data reliability, stability and timeliness. In eastern, central and western regions of Shenzhen, we selected one district from each region, of which the local CDC and ten CHSCs under jurisdiction were chosen for evaluation. On-site inspections, questionnaires survey and interviews were utilized for data collection, while the Likert scale method was used for attributes rating evaluation. A total of 70 participants were surveyed, consisting of 60 CHSCs and 10 CDCs staff. The gender ratio was 1:2.5 (males to females), with the majority falling within the 25-34 age range (46%). Most participants held full-time positions (80%) and had more than 5 years of work experience (62%). The system achieved 100% coverage of all CHSCs and CDCs (100%). The cumulative percentage scores for the overall favorable options of simplicity, acceptability, data reliability, stability, and timeliness were 79%, 85%, 73%, 50%, and 71% respectively. The system operates normally with strong representativeness. Acceptability was rated as "good." Simplicity, data reliability, and system timeliness were rated as "average," while system stability was rated as "poor." Based on these survey results, developers should urgently investigate reasons for poor stability, particularly addressing concerns from CHSCs users. Additionally, the issues and shortcomings identified in other attributes should also be gradually improved.

Measuring the importance of different barriers to opioid agonist treatment using best-worst scaling in an Australian setting.

OBJECTIVE: Opioid agonist treatment (OAT) is an effective treatment for opioid use disorder (OUD), however several client barriers to OAT are reported. Client importance of these barriers using economic preference elicitation measures have not been identified. This paper determines the most important OAT barriers using best-worst scaling (BWS) and compares the results of BWS to Likert scale. METHODS: Cross-sectional self-completed survey with 191 opioid dependent clients who attended Australian needle and syringe sites. Participants were presented 15 Likert scale barriers and 15 BWS barrier scenarios. The BWS data was presented using count analysis, multinomial logit and mixed logit models. The ranking of barrier items was completed using three BWS methods and one Likert scale method, with share preference results (BWS) or mean scores (Likert) used to rank the 15 barriers. RESULTS: The most important client barriers were 'enjoy using opioids', 'lack of support services' and 'hard to access'. The four ranking methods produced different barrier rankings for the most important barriers, but similar results for the least important barriers. CONCLUSION: Policies around OAT as a harm reduction approach, increased support services and increased availability of OAT services would be beneficial in improving OAT uptake. Comparing BWS and Likert methods produced different highest ranked barriers, indicating the method used to identify preferences has significant implications on the type of intervention prioritised.

The Predictive Value of Prostate-Specific Antigen Density: A Retrospective Analysis of Likert 3 Multiparametric MRI of the Prostate.

Background Many international studies have covered the predictors of prostate cancer, but there is limited information pertaining to Likert 3 MRI scores and the diagnosis of clinically significant prostate cancer (cs-PCa). Therefore, this study aimed to assess the detection rate of significant prostate cancer in men with a Likert 3 score multiparametric MRI (mp-MRI) and the predictive value of prostate-specific antigen (PSA) density in detecting significant prostate cancer. Methods This is a retrospective analysis of patients referred for suspected confined prostate cancer. Inclusion criteria were patients with prostate mp-MRI score of Likert 3 and a prostate biopsy performed. Exclusion criteria included grossly abnormal feeling prostate, no biopsy performed, and an mp-MRI score (Prostate Imaging-Reporting and Data System/Likert) of 1, 2, 4, and 5. cs-PCa was defined as ≥ Gleason 3+4 prostate cancer. PSA density (PSAD) was calculated from MRI estimation of prostate volume. PSAD and histology results were subjected to receiver operating characteristic (ROC) curve analysis with the intention to assess the detection rate of significant prostate cancer in men with Likert 3 mp-MRI and the predictive value of PSAD in detecting significant prostate cancer. Results A total of 819 eligible men had a pre-biopsy mp-MRI scan taken between October 2019 and March 2022. A total of 177 men (21.6%, n = 819) were Likert 3 positive, and 31 did not proceed to take prostate biopsies. A total of 146 patients were included in the study. The median PSAD was 0.19 in men with cs-PCa. Prostate cancer was detected in 42 men (28.8% of the total included set), of which 27 (18.5%) had a Gleason 3+3 prostate cancer and 15 (10.3%) had Gleason ≥ 3+4 prostate cancer. Therefore, 35.7% (n = 42) of biopsy-positive men with Likert 3 mp-MRI had cs-PCa. The ROC curve analysis confirms that PSAD is a predictor of cs-PCa. The optimal PSAD threshold was 0.16 (95% CI: 0.14-0.19), which gives an accuracy of 0.7371, a sensitivity of 0.7333, and a specificity of 0.7375. Conclusion The specificity of PSAD is arguably insufficient for it to stand alone as a decision-making tool when counseling men with equivocal mp-MRI on whether or not to undergo prostate biopsy. A predictive model will need to incorporate other independent risk factors. These may include lesion size, multiplicity, location of lesion(s), and age.

Feasibility of acquisitions using total-body PET/CT with a half-dose [68Ga]Ga-FAPI-04 activity in oncology patients.

BACKGROUND: [68Ga]Ga-FAPI-04 (gallium-68-labeled fibroblast activation protein inhibitor-04) PET/CT has been widely used in diagnosing malignant tumors. Total-body PET/CT has a long axial field of view and provides higher sensitivity compared to traditional PET/CT. However, whether the reduced injected dose of [68Ga]Ga-FAPI-04 could obtain qualified imaging has not been evaluated. PURPOSE: To explore the effect of half-dose [68Ga]Ga-FAPI-04 on image quality and tumor detectability in oncology patients. METHODS: A total of twenty-seven patients with tumors or clinically suspected tumors were included, and all patients were scanned with total-body PET/CT after an injected dose of 0.84-1.14 MBq/kg [68Ga]Ga-FAPI-04. All patients obtained superior image quality with 300 s original acquisition time. Images were reconstructed using 180 s, 120 s, 60 s, 40 s, 30 s, 20 s scanning duration by ordered subset expectation maximization algorithm. The subjective image quality of all patients in each time group was scored using 5-point Likert scale. Mediastinal blood pool, liver, spleen, and muscle were analyzed as background using semi-quantitative parameters maximum standardized uptake values (SUVmax), mean standardized uptake values (SUVmean), standard deviation (SD), and signal to noise ratio (SNR). The lesion detection rate, SUVmax, and tumor-to-background ratio (TBR) were calculated for tumors confirmed by pathology. RESULTS: The subjective image quality score decreased with the shortening of scanning time; however, both 180 s and 120 s images met the diagnostic requirements in terms of overall quality, lesion conspicuity, and image noise. The SUVmax of background increased with the reduction of scanning time, while the SUVmean was relatively stable. With the shortening of scanning time, the SD gradually increased, and the SNR gradually decreased, which was consistent with subjective image quality scores. In 180 s and 120 s images, all 11 primary lesions and 79 metastatic lesions were detected. The SUVmax of tumor focus showed an increasing trend as same as the background. Compared with 300 s, the TBR muscle had no statistical difference in 180 s and 120 s. CONCLUSIONS: Half-dose [68Ga]Ga-FAPI-04 in total-body PET/CT imaging can shorten the acquisition time to 120 s with acceptable subjective image quality and 100% tumor detection rate. Total-body PET/CT imaging with a half-dose [68Ga]Ga-FAPI-04 and reduced acquisition time can be used in radiation-sensitive and poor tolerant to prolong horizontal positioning and waiting time populations such as children and gravidas.

Personalidad en adolescentes de la ciudad del Alto en periodo de pandemia por covid -19

Este artículo describe los perfiles de personalidad de 95 adolescentes de la ciudad del Alto de La Paz. Los datos surgen del proceso empírico realizado en periodo de emergencia sanitaria por la pandemia por COVID -19. Los adolescentes en este contexto buscan nuevas e innovadoras maneras de afrontar esta realidad. Para eso se proyectan a partir de sus cualidades, habilidades, competencias y características que permiten la búsqueda de un proyecto de vida o la elección de una carrera universitaria. Se utilizó técnicas de investigación cuantitativa (Cuestionario Big Fives o Cinco Grandes) para reconocer los índices en cada dimensión, sub dimensión y escala de distorsión de la personalidad y se realizó un abordaje cualitativo en el reconocimiento de los perfiles de personalidad. Se observó que existe una tendencia mayor de adolescentes con predisposición a ser creativos e investigadores y no así realistas, sociales y dirigentes. La conclusión es que los datos permitirán a los adolescentes una perspectiva distinta en la elección de carreras universitarias convencionales.

This article describes the personality profiles of 165 adolescents from the City of Alto de La Paz. In times of health emergency it is a problem to set medium-term objectives. Teenagers must seek new and innovative ways to deal with this reality. For this, it is necessary to recognize the qualities, skills, competencies and characteristics of adolescents who are looking for a life project or the choice of a university career. Quantitative research techniques (Big Fives or Big Five Questionnaire) were used to recognize the levels in each dimension, sub-dimension and personality distortion scale and a qualitative approach was carried out in the recognition of personality profiles. It was observed that there is a greater tendency of adolescents with a predisposition to be creative and investigative and not so realistic, social and leaders. The conclusion is that the data will allow adolescents a different perspective in the choice of conventional university careers.

Este artigo descreve os perfis de personalidade de 165 adolescentes da cidade de Alto de La Paz. Em tempos de emergência sanitária é um problema estabelecer objetivos de médio prazo. Os adolescentes devem buscar formas novas e inovadoras de lidar com essa realidade. Para isso, é necessário reconhecer as qualidades, habilidades, competências e características dos adolescentes que buscam um projeto de vida ou a escolha de uma carreira universitária. Técnicas de pesquisa quantitativa (Big Fives ou Big Five Questionnaire) foram utilizadas para reconhecer os níveis em cada dimensão, subdimensão e escala de distorção de personalidade e uma abordagem qualitativa foi realizada no reconhecimento de perfis de personalidade. Observou-se que há uma maior tendência de adolescentes com predisposição a serem criativos e investigativos e não tão realistas, sociais e líderes. A conclusão é que os dados permitirão aos adolescentes uma perspectiva diferente na escolha das carreiras universitárias convencionais.

Something for everybody? Assessing the suitability of AAC systems for children using stated preference methods.

Little is known about what features of AAC systems are regarded by AAC professionals as more suitable for children with different characteristics. A survey was conducted in which participants rated the suitability of hypothetical AAC systems on a Likert scale from 1 (very unsuitable) to 7 (very suitable) alongside a discrete choice experiment. The survey was administered online to 155 AAC professionals in the United Kingdom of Great Britain and Northern Ireland. Statistical modeling was used to estimate how suitable 274 hypothetical AAC systems were for each of 36 child vignettes. The proportion of AAC systems rated at least 5 out of 7 for suitability varied from 51.1% to 98.5% for different child vignettes. Only 12 out of 36 child vignettes had any AAC systems rated at least 6 out of 7 for suitability. The features of the most suitable AAC system depended on the characteristics of the child vignette. The results show that, while every child vignette had several systems that had a good suitability rating, there were variations, that could potentially lead to inequalities in provision.

Effect of the ethnic, profession, gender, and social background on the perception of upper dental midline deviations in smile esthetics by Chinese and Black raters.

BACKGROUND: The purpose of this study was to compare the perception of upper dental midline deviation on the attractiveness of a smile among raters from different ethnicities, professions, genders, and ages and measure to what extent the presence or absence of the associated smiling structures influence the raters' evaluations. METHODS: A male subject (26 years of age) with adequate smile characteristics was selected by 3 experienced orthodontists, and 561 raters from 2 different ethnic groups (281 Chinese raters and 280 Black raters) rated the subject's smile after the subject's upper dental midline was digitally altered from 0 to 5 mm using a 5-point Likert scale on 12 smile photographs divided into two groups: group 1, in the presence of smile related structures, two-thirds of the nose, lips, and chin (NLC), and group 2, in the absence of smile related structures, the lips only (L). RESULTS: There were statistically significant differences (p < 0.05) between the two ethnicities, in 2 mm and 4 mm in-group NLC and 5 mm in-group L, as well as the raters' profession to each midline shift of both groups (NLC) and (L) for both ethnicities except for 0 mm. Regarding the role of associated smile structures, the smile photos were observed in the presence of smile-associated structures, and in its absence (NLC × L), statistically significant differences (p < 0.05) were found when the deviation was 5 mm among the Chinese raters; in 1 mm, and 4 mm among the Black raters. Among different genders, statistical differences were only reported (p < 0.05) for Chinese raters for 5 mm in NLC, while statistical differences were observed for 2 mm and 3 mm in NLC for Black raters. For age categories, differences were observed (p < 0.05) for 4 mm, 5 mm in NLC and 4 mm, and 5 mm in L for Chinese raters, while 5 mm in NLC and 1 mm in L for Black raters. CONCLUSION: Perception of the upper dental midline deviations was influenced by the factors of ethnicity, profession, presence or absence of smile-associated structures, as well as the gender and age of the raters.

Perceptions of Veterinarians and Veterinary Students on What Risk Factors Constitute Medical Disputes and Comparisons between 2014 and 2022.

This study compared the risk perceptions of medical disputes among veterinarians and veterinary students in Taiwan between 2014 and 2022. Online validity-tested questionnaires were used to collect data, with 106 (73 veterinarians and 33 students) and 157 (126 veterinarians and 31 students) surveys collected in 2014 and 2022, respectively. Respondents would be asked to rate their perceptions on how likely each risk factor constitutes a medical dispute according to their past experiences on a five-point Likert scale from 1 to 5: "Very unlikely, unlikely, neutral, likely, very likely." The results showed that overall risk perceptions increased significantly in 2022 compared to 2014, with the top risk factors being attitudes during interactions and complaint management among experienced veterinarians. In contrast, students considered medical skills and clients' perspectives as the top two risk factors, with complaints management ranking as the least significant factor. The findings suggest that effective communication and complaint management are crucial in preventing medical disputes, highlighting the importance of developing these skills in young veterinarians and veterinary students to reduce medical disputes. The study also recommends increasing practical experiences of medical disputes and complaint management in veterinary education to bridge the gap between the perceptions of experienced veterinarians and students.

No way back? A survey on changes in travel demand post-pandemic in Norway.

Research shows a significant reduction in travel demand during the pandemic. Vaccines are currently distributed, allowing us to go back to pre-COVID-19 life, if that is the case. This study provides insight into changes in activities and travel demand during the pandemic and expected changes after the pandemic. Our paper presents the findings from a Likert scale survey (n = 360) conducted in Norway June-July 2021. We investigate how relocated activities impacted travel behaviour during the pandemic, and prospects of lasting impacts of the pandemic. The results show that the prevalence of home office and digital meetings, the new normal for many people during the pandemic, will continue to some degree after the pandemic. There is an increased willingness to commute by active modes, while no pronounced increase in car commutes is reported. However, car use is expected to increase for leisure trips; a significant correlation with the demand of more domestic outdoor travel. One out of five states that they will use public transport less often in the future. We may expect more online shopping, although home-deliveries for groceries is not as popular as for non-edible goods-not during the pandemic nor after. Earlier disruptive events have shown that people tend to adjust back to normal after a while, even if they have stated otherwise. There are certain mid-pandemic habits that go along with political goals and/or employers' interests, implying these might be prolonged into the future.

Penalized optimal scaling for ordinal variables with an application to international classification of functioning core sets.

Ordinal data occur frequently in the social sciences. When applying principal component analysis (PCA), however, those data are often treated as numeric, implying linear relationships between the variables at hand; alternatively, non-linear PCA is applied where the obtained quantifications are sometimes hard to interpret. Non-linear PCA for categorical data, also called optimal scoring/scaling, constructs new variables by assigning numerical values to categories such that the proportion of variance in those new variables that is explained by a predefined number of principal components (PCs) is maximized. We propose a penalized version of non-linear PCA for ordinal variables that is a smoothed intermediate between standard PCA on category labels and non-linear PCA as used so far. The new approach is by no means limited to monotonic effects and offers both better interpretability of the non-linear transformation of the category labels and better performance on validation data than unpenalized non-linear PCA and/or standard linear PCA. In particular, an application of penalized optimal scaling to ordinal data as given with the International Classification of Functioning, Disability and Health (ICF) is provided.

Parametric and nonparametric methods for confidence intervals and sample size planning for win probability in parallel-group randomized trials with Likert item and Likert scale data.

Data on the Likert scale are ubiquitous in medical research, including randomized trials. Statistical analysis of such data may be conducted using the means of raw scores or the rank information of the scores. In the context of parallel-group randomized trials, we quantify treatment effects by the probability that a subject in the treatment group has a better score than (or a win over) a subject in the control group. Asymptotic parametric and nonparametric confidence intervals for this win probability and associated sample size formulas are derived for studies with only follow-up scores, and those with both baseline and follow-up measurements. We assessed the performance of both the parametric and nonparametric approaches using simulation studies based on real studies with Likert item and Likert scale data. The simulation results demonstrate that even without baseline adjustment, the parametric methods did not perform well, in terms of bias, interval coverage percentage, balance of tail error, and assurance of achieving a pre-specified precision. In contrast, the nonparametric approach performed very well for both the unadjusted and adjusted win probability. We illustrate the methods with two examples: one using Likert item data and the other using Like scale data. We conclude that non-parametric methods are preferable for two-group randomization trials with Likert data. Illustrative SAS code for the nonparametric approach using existing procedures is provided.

Assessment of Virtual Peer Learning by Peer Feedback: A Pilot Project.

Introduction Virtual learning has become the preferred modality for health education during and after the coronavirus disease 2019 (COVID-19) pandemic. Peer learning is gaining a lot of significance lately and has been successfully tested in various settings. We combined virtual delivery of health education with peer-assisted learning and evaluated the effectiveness using peer-generated feedback and tested the effectiveness of the model for different cohorts. Methods We performed this study as part of a formal educational course on Health Professions Education. The educators were volunteers from different informal multi-disciplinary groups, working in varied healthcare settings, globally. This involved eight teaching sessions which were delivered virtually and the feedback was recorded as responses to six items (questions), which the learners graded on the Likert scale. The average for each item and the larger domains was then calculated and analyzed.  Results The feedback was provided by all the participants (53/53). In the feedback received item-wise, the best average rating was for legibility of the slides (4.8). The least rating was for adequate checking and assessment of prior knowledge (4.2). In terms of the broader domains, the best feedback was for the teaching material (4.6) and the lowest was for the planning of the sessions (4.4). Overall, the ratings for the domains and the items were above 3 on a scale of 1-5. Conclusions Virtual delivery of healthcare education, facilitated by peer-assisted learning, is an effective model for health education when delivered for a small group, as evidenced by the overall peer feedback. This model can be tested for larger cohorts in the future.

V-EMF treatment of facial scar: First results.

AIM OF STUDY: This is a retrospective study aimed at evaluating the effectiveness of the use of electromagnetic fields and negative pressure treatment (V-EMF) for facial scars, from an aesthetic and functional point of view, and considering the variations in the levels of hydration. MATERIAL AND METHODS: 25 subjects with facial scarring were re-evaluated after being treated with the V-EMF method. The hydration levels of the scars before and after treatment were compared. The results were evaluated considering the satisfaction levels of the patients with the VAS, and of the medical specialists who performed the treatment, and of 3 independent dermatologists with the Likert scale. RESULTS: Mean hydration levels of scars went from 41.8 to 53.3, with mean hydration levels of healthy reference points equal to 54.6. The minimum patient satisfaction level was 2 in the VAS. The minimum level of satisfaction of specialists and dermatologists was equal to IV on the Likert scale for all patients, except for 1 subject in which it was III for the specialist who had treated him. Anti-aging and re-pigmentation effects were also noted as secondary results. CONCLUSIONS: From an aesthetic and functional point of view, and for the overall anti-aging effect of the treated area, V-EMF applied to facial scars has shown extremely promising results.

Cross-Sectional Study on the Comparative Assessment of Mandibular Anesthesia (Inferior Alveolar Nerve Blockage) Manual Skills Shaping among Dentists on Plastic and Biomaterial Models.

BACKGROUND: Providing regional anesthesia skills shaping remains relevant nowadays. A number of studies show that dentists have difficulties with these working independently. The study aim is the comparative analysis of the results of mandibular anesthesia (IANB) manual-skills shaping among dentists on plastic models and cadavers. METHODS: In total, 999 participants were training in the skills of mandibular anesthesia from 2017 to 2021. The participants were divided in a random way into two groups: 700 participants were trained on plastic models, and 299 were trained on the cadaver material. After a lecture on the clinical and anatomical guidelines for IANB, a demonstration of the technique was provided, with subsequent testing of the injection technique. Satisfaction with the aspects of the training was assessed using the Likert scale. RESULTS: the analysis of average values showed that participants from the group in which the manual skills were practiced on cadavers were more satisfied with the main aspects of the training, according to the sum of the main criteria of the modified scale. CONCLUSIONS: The important advantages of cadaver educational technology are that the sensations of tissue resistance are identical to natural ones, the individuality of each object, and the possibility of the visual study of the anesthesia technique, by dissection of the needle course and the location of the anesthetic depot.

Datasets of harmonized risk assessment of grapevine downy mildew and phenological observations in eight Italian regions (2012-2017).

Phytosanitary bulletins released at weekly interval by eight Italian regional plant protection services in the growing seasons 2012-2017 were used to derive an harmonized dataset of grapevine downy mildew infection risk and phenological observations. The downy mildew infection risk (n = 8816) was classified using a 5-point Likert response item ranging from 'very low' (1) to 'very high' (5) by six independent evaluators with domain expertise in agronomy, phytopathology and agrometeorology. Common criteria have been used in the risk assessment, considering (i) the presence of disease symptoms in field surveys, (ii) the host phenological susceptibility, (iii) the weather forecasts in the next week from the bulletin release date, (iv) the advice to apply a fungicide treatment and (v) the outputs of epidemiological models. The phenological observations are provided as BBCH codes (n = 1689), which have been either transcribed from the phytosanitary bulletins or derived from the narrative description of the visual observation. Phenological data refer to the main early and late grapevine varieties in the eight regions (NUTS-2 administrative unit). Each record is associated with the NUTS-2 and NUTS-3 (31 provinces) administrative unit of reference, to the growing season (2012-2017), and refers to the individual risk assessment by the six evaluators. The dataset is hosted by the Centre for Agriculture and Environment of the Italian Council for Agricultural Research and Economics. These data could be helpful to researchers who develop either grapevine phenological models or process-based epidemiological predictive algorithms in order to refine their calibration and evaluation, as well as being a valuable resource for stakeholders in charge of evaluating the effective implementation of Integrated Pest Management in the decision-making process of public plant protection services in Italy. The dataset is freely available here.