Search Results (214)

Background/Objectives: Current guidelines recommend the use of clinical signs to diagnose shock and cellular hypoperfusion in critically ill patients. However, these recommendations are based on limited scientific evidence. The objective was to determine the predictive value of clinical signs to identify shock. Methods: Retrospective cohort study including adult (≥18 years) patients admitted to the critical care resuscitation unit of a tertiary hospital. The primary goal was to determine the predictive value of tachycardia, prolonged capillary refill time (CRT), skin mottling, weak radial pulse, inadequate peripheral perfusion, shock index >0.8, altered mental state, and diaphoresis to identify shock. Two-by-two contingency tables were used for statistical analysis. Results: Three-hundred-seventeen patients (no shock, n = 231; shock, n = 86) were included. As a single clinical sign, skin mottling [sensitivity, 0.38; specificity, 0.92; negative likelihood ratio (LR−), 0.68; positive likelihood ratio (LR+), 4.62], prolonged CRT (sensitivity, 0.44; specificity, 0.89; LR−, 0.62; LR+, 4.17), shock index >0.8 [sensitivity, 0.77; specificity, 0.64; LR−, 0.36; LR+, 2.15], a weak radial pulse [sensitivity, 0.62; specificity, 0.79; LR−, 0.49; LR+, 2.88], and inadequate peripheral perfusion [sensitivity, 0.68; specificity, 0.73; LR−, 0.44; LR+, 2.52] predicted shock. Prolonged CRT, skin mottling, inadequate peripheral perfusion, a weak radial pulse, and a shock index >0.8 predicted shock states with low cardiac output. A shock index >0.8, tachycardia, and a weak radial pulse were predictive of distributive/vasodilatory shock. The accuracy to identify shock were higher if ≥2 clinical signs were present compared to only one. Conclusions: Skin mottling, prolonged CRT, shock index >0.8, weak radial pulse, and inadequate peripheral perfusion can identify patients with shock, particularly shock states with low cardiac output, with high specificity and LR+. Full article

Ensuring proper sizing and fit for U.S. female firefighters’ personal protective clothing and equipment (PPE) is a crucial challenge for researchers and manufacturers. The National Fire Protection Association (NFPA) establishes design and performance standards in the U.S., with NFPA 1977 specifying sizing guidelines for wildland firefighting gear. However, the absence of an anthropometric database representing female firefighters limits the effectiveness of these standards. This research evaluates the effectiveness of NFPA 1977 sizing system by investigating whether correlated body measurements maintain internal consistency and provide data-driven recommendations for improvement. Anthropometric data from 187 U.S. female firefighters were analyzed to assess the 2016 and 2022 NFPA 1977 upper and lower torso sizing systems. Correlation analysis was performed between body measurements and corresponding sizes. Contingency tables presented proportion of participants accommodated. Results indicated significant correlations between chest and wrist measurements and sizes in the upper torso, though these were the only available measurements. In the lower torso, hip size strongly correlated with thigh and knee sizes. However, the system inadequately accommodates female firefighters with larger waist and hip measurements. Furthermore, rise sizes demonstrated inconsistent, weak relationships with hip circumference. Overall, the NFPA 1977 sizing requires revision to better serve U.S. female firefighters. Full article

Introduction: Evidence for the diagnostic yield of noninvasive diagnostic assessment for the diagnosis of peripheral arterial disease (PAD) in diabetic foot syndrome (DFS) is poor. Pulse volume recordings (PVRs) at the forefoot level could be a valuable diagnostic tool in the presence of medial arterial calcification. Patients and methods: Patients with DFS who underwent invasive angiography between 01/2020 and 11/2024 and had corresponding PVRs performed within 30 days prior to the procedure were included. DFS was classified according to the Wagner–Armstrong classification. Clinical characteristics and hemodynamic parameters, including systolic ankle pressures and ankle–brachial index were recorded. PVRs were analyzed semiquantitatively by investigators blinded to the clinical information and quantitatively with determination of upstroke time (UST), upstroke ratio (USR), and maximum systolic amplitude (MSA). Angiographic PAD severity was graded according to the GLASS classification. Statistical analysis included univariate significance tests, 2 × 2 contingency tables, receiver–operator characteristic (ROC) analysis and determination of interobserver agreement. Results: In this study, 90 extremities of 70 patients were analyzed, 47 of whom had an ABI ≥ 1.3. Critical limb-threatening ischemia with non-pulsatile PVRs was evident in 6.7%. An abnormal PVR curve morphology (mildly or severely abnormal) yielded a sensitivity and specificity of 63.3% and 85.7% for detection of severe PAD (GLASS stages 2 and 3). Interobserver agreement of semiquantitative PVR rating was substantial (Cohen’s kappa 0.8) in 51 evaluated cases. For detection of any PAD (GLASS ≥ 1) or severe PAD (GLASS ≥ 2), we found the highest diagnostic accuracy for MSA (area under the curve [AUC] 0.89 and 0.82). With a cut-off value of 0.58 mmHg, MSA had a sensitivity of 91.4% and a specificity of 80.8% for detection of any PAD (GLASS ≥ 1). MSA with a cut-off of 0.27 mmHg had a sensitivity of 72.2% and a specificity of 77.1% for detection of severe PAD, whereas the sensitivity and specificity for detection of inframalleolar disease were 62.9% and 69.4%, respectively. Results were consistent in subgroup analyses. Conclusions: PVRs with extraction of quantitative features offer promising diagnostic yield for detection of PAD in the setting of DFS. MSA outperformed UST and USR but showed limited capability of detecting impaired inframalleolar outflow. Full article

Background: After the end of the COVID-19 pandemic, abusive use of the internet and new information and communication technologies (ICT) among university students was detected. Our research questions were as follows: what has been the impact on the academic performance of university students, and how did the pandemic affect students’ relationship with ICTs? The aim of this research was to explore the use of cell phones and the internet in students from different cultures (Spanish and Japanese) after the pandemic. Methods: This descriptive and exploratory study analysed 206 university students from Spanish and Japanese cultures to understand their perceptions of academic performance after the pandemic, their general use of ICT, and their abusive use of the internet and mobile phones. Instruments included the Internet Overuse Scale (IOS) and the Cell-Phone Overuse Scale (COS), adapted for both Spanish and Japanese populations. Differences between quantitative variables were analyzed using the non-parametric Mann–Whitney U test for independent samples (Spanish and Japanese students or by sex). Contingency tables were created to record and analyse relationships between qualitative variables using the chi-squared test, with statistical significance set at p < 0.05. Results: Approximately 29.6% of participants displayed excessive internet use, while 25.2% showed pathological mobile phone use. A strong association was found between high internet and mobile phone usage. Significant cultural and gender differences were observed, with higher problematic use among Japanese students and female participants. Conclusions: Excessive ICT use remains a concern in university settings, with gender and cultural factors playing key roles. These findings highlight the need for targeted digital well-being interventions. Full article

Agricultural machinery, particularly balers, plays a crucial role in forage management. These machines are prone to fire incidents caused by mechanical friction, heat buildup, and the accumulation of crop residues, among other contributing factors. Despite their operational importance, fire risks associated with balers remain largely understudied. This research aims to identify critical fire risk factors in large square balers through a combined analysis of survey data, temperature monitoring, and residue characterization. A questionnaire survey was conducted among 144 large square baler users to assess fire incidence and potential risk factors. Contingency table analysis and binary logistic regression were applied to identify variables significantly associated with the fire risk. Additionally, temperature data were recorded in six balers during two harvesting seasons, and residue samples were collected and analyzed to assess their ignition potential. Using a rake for windrowing was the only variable significantly associated with increased fire risk, making balers 3.4 times more likely to experience a fire (p = 0.034). Temperature analysis showed that the feeder fork brake (190.6 °C) and hydraulic pump (128.7 °C) were the hottest components, but none of the recorded temperatures exceeded the 250 °C ignition threshold of fine agricultural residues. Residue analysis showed that particles smaller than 250 µm accounted for 39% of the total material, underscoring their potential to contribute to fire propagation. This study highlights the critical influence of raking equipment on fire risk in balers and emphasizes the importance of preventive measures such as enhanced cleaning, real-time temperature monitoring, and improved mechanical design. These findings provide actionable insights for reducing fire hazards in agricultural operations and optimizing baler safety. Full article

The rapid rise of digital media and the accelerated pace of modern life have triggered a “reading crisis” among college students in China, which is characterized by declining deep reading abilities and increasing reliance on fragmented digital content. Understanding the multifaceted factors influencing student reading behavior is crucial for improving educational outcomes and fostering lifelong learning skills. This study examines these factors in China’s top universities using an ecological systems theory framework, which considers how individual attributes (micro), university environment (mezzo), and broader social contexts (macro) interact to shape reading behavior. This study analyzed a logistic regression model based on 1667 samples from 19 top universities in China, followed by cross-analysis using contingency tables. The findings highlight the significant impact of both individual and environmental factors on reading engagement and reveal the mediating role of university policies and resources in fostering students’ reading proficiency. Full article

The aims of this pilot study were to design a training protocol to improve the padel smash, based on the practice of medicine ball throws (shot put) and smashes (powerful smashes and smashes over the side fence), and to test the effectiveness of the designed training protocol. Four high-level male Finnish players completed two weekly sessions, each consisting of four sets of five medicine ball throws (2 kg), followed by five smashes. Sufficient rest between sets and repetitions was ensured to minimize fatigue and reduce injury risk while maximizing power output. Performance was assessed through pre- and post-tests. A paired t-test analyzed the powerful smash, while contingency tables and the Chi-square test (χ²) evaluated the smash over the side fence. Three of the four players showed a significant increase in powerful smash distance, while the success rate of smashes over the side fence improved but did not reach statistical significance. These findings suggest that the designed training protocol improves powerful smashes and smashes over the side fence, potentially optimizing performance. Future research with larger samples is needed to refine training guidelines and explore broader implications for performance, injury prevention, and long-term athlete development. Full article

Background. Despite dentistry’s alarmingly high energy use, plastic waste, and travel emissions, research on Romanian dental students’ sustainability awareness is absent. This study aimed to assess their knowledge of the environmental impact of dental materials and practices, hypothesizing that early exposure to sustainability education would benefit preclinical students most. Materials and Methods. A cross-sectional survey using a form questionnaire with 15 items was conducted on 1800 dental students at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania, for one week in March 2022. The questionnaire, consisting of socio-demographics, students’ perspectives on sustainability in dentistry, and personal sustainability, was analyzed using SPSS 26. Data analysis included the Shapiro–Wilk test for normality, Fisher’s exact test for categorical variables, the Mann–Whitney U test for non-parametric quantitative comparisons, and Z-tests with Bonferroni correction for contingency tables. Results. A response rate of 26.06% was achieved, with 469 participants. The majority (51.1%), particularly males (66.1%), perceived sustainability as promoting durability. The most common definition of sustainability (33.8%) was related to environmental protection, with significantly higher agreement among female students (39.4%) (p = 0.001). While 49.3% of participants identified single-use plastics in patient care as having the greatest environmental impact in dental practices, 39.2% of female students, primarily from clinical study years (50%), ranked patient paperwork and records as the most significant factor (p = 0.031). The highest-carbon-footprint dental procedures were considered to be amalgam and composite fillings (50.7%), with clinical year students indicating this as the most relevant issue (62.8% vs. 47.7%) (p = 0.011). Students aged 25–30 were more actively engaged in sustainability initiatives compared to the younger group (p = 0.005), while all students over 30 identified scaling and polishing as the most impactful procedure (p < 0.001). A majority of students supported future university sustainability initiatives (62.7%) and an elective course on sustainability in dentistry (65%). Female students showed significantly greater interest than male students in both initiatives (66.3% vs. 52.7%, p = 0.003 and 70.8% vs. 49.6%, p < 0.001, respectively). Conclusions. Greater awareness of sustainability was found in preclinical-year dental students and among female students, with knowledge gaps in clinical-year students, particularly regarding the environmental impact of dental practices and materials. Introducing sustainability courses could better prepare future dentists for sustainable practices in dentistry. Research collaborations and curriculum reforms to further promote sustainability would also be beneficial. Full article

The dynamics of Land Use/Land Cover changes are crucial to environmental sustainability, socio-economic development, and spatial planning. These changes stem from complex interactions between human activities, natural processes, and policies. In recent decades, LULC transformations have been linked to global challenges such as biodiversity loss, climate change, and resource degradation. Key drivers include urban sprawl, agricultural expansion and abandonment, and deforestation, emphasizing the need for effective frameworks to monitor and assess their impacts. This study investigates Land Use/Land Cover (LULC) changes in Tuscany (Italy) over the period from 2007 to 2019. To achieve this, statistical analyses were conducted to quantify variations in LULC across different classes and administrative territories represented by provincial local authorities. Specifically, data spanning five temporal intervals (2007, 2010, 2013, 2016, and 2019) enabled a comprehensive comparative analysis of spatial persistence in LULC patterns. Changes were assessed using a statistical approach based on Odds Ratios (OR). Additionally, Generalized Linear Models (GLMs) at the provincial level were employed to facilitate one-to-many provincial comparisons and to evaluate the statistical significance of observed LULC changes. The analysis revealed that certain classes exhibit a greater susceptibility to changes compared to others. Specifically, the classes categorized under ’Artificial Surfaces’ (LC_100) were, on average, 6.7 times more likely to undergo changes than those classified as ’Agricultural Areas’ (LC_200) and 11 times more likely than those under ’Forest and Semi-natural Areas’ (LC_300). Over time, the areas classified as artificial territories have exhibited a progressively decreasing probability of change. Notably, during the first update period (2007–2010), these areas were 3.5 times more susceptible to change compared to the most recent update period (2016–2019). An additional significant finding emerged from the statistical comparison of LULC changes across administrative regions governed by different authorities (Provinces). These findings underscore the potential of using administrative indicators and morphological parameters to analyze LULC change trends. The proposed approach provides a robust framework for interpreting territorial resilience and informing spatial planning strategies effectively. Full article

Objectives: This study investigates the potential of artificial intelligence (AI), specifically large language models (LLMs) like ChatGPT, to enhance decision support in diagnosing epilepsy. AI tools can improve diagnostic accuracy, efficiency, and decision-making speed. The aim of this study was to compare the level of agreement in epilepsy diagnosis between human experts (epileptologists) and AI (ChatGPT), using the 2014 International League Against Epilepsy (ILAE) criteria, and to identify potential predictors of diagnostic errors made by ChatGPT. Methods: A retrospective analysis was conducted on data from 597 patients who visited the emergency department for either a first epileptic seizure or a recurrence. Diagnoses made by experienced epileptologists were compared with those made by ChatGPT 4.0, which was trained on the 2014 ILAE epilepsy definition. The agreement between human and AI diagnoses was assessed using Cohen’s kappa statistic. Sensitivity and specificity were compared using 2 × 2 contingency tables, and multivariate analyses were performed to identify variables associated with diagnostic errors. Results: Neurologists diagnosed epilepsy in 216 patients (36.2%), while ChatGPT diagnosed it in 109 patients (18.2%). The agreement between neurologists and ChatGPT was very low, with a Cohen’s kappa value of −0.01 (95% confidence intervals, CI: −0.08 to 0.06). ChatGPT’s sensitivity was 17.6% (95% CI: 14.5–20.6), specificity was 81.4% (95% CI: 78.2–84.5), positive predictive value was 34.8% (95% CI: 31.0–38.6), and negative predictive value was 63.5% (95% CI: 59.6–67.4). ChatGPT made diagnostic errors in 41.7% of the cases, with errors more frequent in older patients and those with specific medical conditions. The correct classification was associated with acute symptomatic seizures of unknown etiology. Conclusions: ChatGPT 4.0 does not reach human clinicians’ performance in diagnosing epilepsy, showing poor performance in identifying epilepsy but better at recognizing non-epileptic cases. The overall concordance between human clinicians and AI is extremely low. Further research is needed to improve the diagnostic accuracy of ChatGPT and other LLMs. Full article

Objective: Ex vivo confocal laser scanning microscopy (EVCM) is an emerging imaging technique, which offers rapid tissue examination. While the current literature shows promising results in the evaluation of non-melanoma skin cancer, only limited research exists on the application of EVCM in melanocytic lesions. This study aimed to assess the utility of EVCM in the characterization of melanocytic lesions and compare its findings with gold-standard histopathology. Methods: A total of 130 skin lesions, including 76 benign and 54 malignant melanocytic lesions, were prospectively collected and imaged using EVCM. Three blinded investigators were asked to identify characteristic morphologic features observed in the lesions and classify them into benign vs. malignant. The results were then compared with the corresponding histopathology. Sensitivity and specificity were calculated using contingency tables to assess the diagnostic performance. Results: The application of EVCM allowed for the visualization of cellular and tissue-level details, including cellular pleomorphism and atypical melanocytes. A comprehensive list of benign and malignant features identified by EVCM was compiled. Using these diagnostic criteria, the imaging of the inexperienced and dermatohistopathology-experienced investigator reached 67.7% concordance, and the imaging trained dermatologist obtained 69.2% agreement with dermatohistopathology in differentiating benign vs. malignant lesions. The imaging-trained dermatohistopathologist performed best with concordance up to 79.2%. Conclusions: In conclusion, EVCM is a promising technique for the rapid assessment of melanocytic lesions. Our study provides a comprehensive overview of morphologic EVCM features, which will contribute to the development of diagnostic algorithms for accurate diagnosis and appropriate treatment planning. Further studies are needed to evaluate its clinical utility and validate our diagnostic criteria. Full article

Orthorubulavirus suis (LPMV) is the etiologic agent of blue eye disease (BED), which affects pigs of all ages, and it has been endemic in central Mexico since the 1980s. To date, no disease control program has been established. Therefore, there is a need for a serological diagnostic method with high sensitivity and specificity. In this study, the recombinant protein NP of LPMV was produced in the E. coli BL21 system and then purified using affinity chromatography. The purified protein was used to coat plates for an indirect ELISA assay (iELISA). To determine the sensitivity and specificity of the test, a 2 × 2 contingency table was constructed using positive and negative control sera. The specificity and sensitivity levels were 98.1% and 98.7%, respectively. According to our findings, 45% of serum samples (378/839) were positive, with seropositivity percentages in the analyzed states ranging from 72.5% to 6%. To confirm the presence of antibodies, the indirect immunofluorescence technique was applied to iELISA-positive serum samples. In this study, antibodies against the LPMV nucleoprotein were detected, indicating that the virus or defective particles may be circulating in Mexican pigs and highlighting the risk of LPMV spreading to disease-free areas. Full article

The diagnosis of residuals of independence is critical in association analysis and loglinear modeling of two-way contingency tables. Most residual diagnostics depend on large-sample methods, and diagnostic results become dubious when sample sizes are small or data are sparse. In such cases, statistical inference based on non-asymptotic theory or exact inference is desirable. This paper explicitly derives the first four moments of the residuals of independence in a two-way contingency table under a multinomial model. These exact moments are necessary tools for studying the analytical features of the distribution of residuals of independence, such as skewness and kurtosis. Higher-order moments can be found similarly, but the results are more complicated. Full article

Tsunami maps provide critical information about tsunami hazards, potential inundation areas, and safe evacuation routes, yet little research has addressed how different user groups perceive and interpret these maps. Using a questionnaire distributed to 181 participants (24 experts—EXs and 157 general users—GUs) and the chi-square (χ²) test, this research explored their understanding and perception of map elements, symbology, probabilistic data, and uncertainty communication. The results show that while both groups generally understand the maps, significant differences exist in their perception of essential map elements, such as evacuation routes, safe zones, and technical data. On average, EXs identified 7.38 elements that evacuation maps should contain, consistently emphasizing the need for more detailed information, whereas GUs preferred simplicity, selecting an average of 5.11 elements. These results highlight the need to balance detail and clarity in map design to serve both user groups effectively. Notably, the results suggest that at least 33% of EXs and 47% of GUs did not clearly distinguish between tsunami hazard and evacuation maps, highlighting the need for clearer map design and terminology. The study also revealed challenges in communicating probabilistic data and uncertainty to non-experts, suggesting the need for improved methods to present this information effectively. Full article

The analysis of aggregate data has received increasing attention in the statistical discipline over the past 20 years, with the ongoing development of a suite of techniques that are classified as ecological inference. Much of its development has been focused solely on estimating the cell frequencies in a 2 × 2 contingency table where only the marginal totals are given; an approach that has been received with mixed reviews. More recently, the focus has shifted toward analyzing the overall association structure, rather than on the estimation of cell frequencies. This article provides some insight into how informative the aggregate data in a single 2 × 2 contingency table are for assessing the association between the variables. This is achieved through the development of a new index, the aggregate informative index. This new index quantifies how much information, on a [0, 100] scale, is needed in the marginal information in a 2 × 2 contingency table to conclude that a statistically significant association exists between the variables. It is established that, unlike Pearson’s (and other forms of the) chi-squared statistic, this new index is immune to changes in the sample size. It is also shown that the new index remains stable when the 2 × 2 contingency table consists of extreme marginal information. Full article