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Across the empirical sciences, few statistical procedures rival the popularity of the frequentist -test. In contrast, the Bayesian versions of the -test have languished in obscurity. In recent years, however, the theoretical and practical advantages of the Bayesian -test have become increasingly apparent and various Bayesian t-tests have been proposed, both objective ones (based on general desiderata) and subjective ones (based on expert knowledge). Here, we propose a flexible t-prior for standardized effect size that allows computation of the Bayes factor by evaluating a single numerical integral. This specification contains previous objective and subjective t-test Bayes factors as special cases. Furthermore, we propose two measures for informed prior distributions that quantify the departure from the objective Bayes factor desiderata of predictive matching and information consistency. We illustrate the use of informed prior distributions based on an expert prior elicitation effort. Supplementary materials for this article are available online.

Sensory issues are of great interest in ASD diagnosis. However, their investigation is mainly based on external observation (parent reports), with methodological limitations. Unobtrusive olfactory assessment allows studying autism neurosensoriality. Here, 20 male children with high-functioning ASD and 20 matched controls were administered a complete olfactory test battery, assessing olfactory threshold, identification and discrimination. ASD children show lower sensitivity (p = 0.041), lower identification (p = 0.014), and intact odor discrimination (p = 0.199) than controls. Comparing olfactory and clinical scores, a significant correlation was found in ASD between olfactory threshold and the CBCL social problems (p = 0.011) and aggressive behavior (p = 0.012) sub-scales. The pattern featuring peripheral hyposensitivity, high-order difficulties in odor identification and regular subcortical odor discrimination is discussed in light of hypo-priors hypothesis for autism.

ObjectiveTo determine whether apathy or depression predicts all-cause dementia in small vessel disease (SVD) patients.MethodsAnalyses used two prospective cohort studies of SVD: St. George’s Cognition and Neuroimaging in Stroke (SCANS; n=121) and Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort (RUN DMC; n=352). Multivariate Cox regressions were used to predict dementia using baseline apathy and depression scores in both datasets. Change in apathy and depression was used to predict dementia in a subset of 104 participants with longitudinal data from SCANS. All models were controlled for age, education and cognitive function.ResultsBaseline apathy scores predicted dementia in SCANS (HR 1.49, 95% CI 1.05 to 2.11, p=0.024) and RUN DMC (HR 1.05, 95% CI 1.01 to 1.09, p=0.007). Increasing apathy was associated with dementia in SCANS (HR 1.53, 95% CI 1.08 to 2.17, p=0.017). In contrast, baseline depression and change in depression did not predict dementia in either dataset. Including apathy in predictive models of dementia improved model fit.ConclusionsApathy, but not depression, may be a prodromal symptom of dementia in SVD, and may be useful in identifying at-risk individuals.

ObjectivesThe new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk test (ISWT); however, its measurement properties still need to be determined. We aimed, first, to assess the construct validity (through the comparison with the ISWT), within-day reliability and measurement error of the IST in people with COPD; and, second, to identify whether the participants have a learning effect in the IST.DesignCross-sectional study, conducted according to COnsensus-based Standards for the selection of health status Measurement INstruments guidelines.SettingA family health unit in Portugal, April 2022 to June 2023.Participants and analysis63 participants (67.5±10.5 years) attended two sessions to perform two IST and two ISWT, separately. Spearman’s correlations were used to compare the best performances between the IST and the ISWT. Intraclass correlation coefficient (ICC2,1) was used for reliability, and the SE of measurement (SEM), minimal detectable change at 95% CI (MDC95) and Bland and Altman 95% limits of agreement (LoA) were used for measurement error. The learning effect was explored with the Wilcoxon signed-rank test.ResultsThe IST was significant and strongly correlated with the ISWT (0.72<ρ<0.74, p<0.001), presented an ICC2,1 of 0.95 (95% CI 0.92 to 0.97), SEM=11.7 (18.9%), MDC95=32.4 (52.2%) and the LoA were −33.61 to 31.48 for the number of steps. No difference was observed between the number of steps of the two attempts of the IST (p>0.05).ConclusionsThe IST can be suggested as a valid and reliable test to assess exercise capacity in people with COPD, with no learning effect when two IST are performed on the same day. The measurement error of the IST is considered indeterminate.Trial registration numberNCT04715659.

Artificial Intelligence (AI) technologies are transforming educational settings by offering tools that enhance learning experiences. AI-powered applications, such as ChatGPT and Poe, provide real-time assistance, fostering learner autonomy and self-determined motivation. However, limited research has explored their impact on undergraduate students’ learning strategies and motivation. This study investigates the effectiveness of AI-powered educational applications in enhancing metacognitive and social learning strategies, as well as self-determined motivation, among Chinese undergraduate students. This mixed-methods quasi-experimental study involved 310 undergraduates (45% female, 55% male; M age = 21) at the Criminal Investigation Police University of China. Participants were assigned to an AI-integrated experimental group ( n  = 139) or a control group ( n  = 171). Validated questionnaires assessed metacognitive/social strategies (SILL) and autonomous motivation (RAI). Qualitative data from 834 reflective journals were thematically analyzed. ANCOVA was used to compare post-test outcomes, controlling for pre-test scores, while journals provided experiential insights. Ethical approval and informed consent were obtained. Using a quasi-experimental design, this study investigated the impact of AI-integrated instruction on metacognitive strategies, social strategies, and motivation in 310 undergraduate students. ANCOVA revealed significant improvements in the AI group ( p  < .001), with large effect sizes observed for metacognition (η² = 0.39) and motivation (η² = 0.31), which are large effect sizes according to Cohen’s benchmarks. Qualitative analysis of 834 journals highlighted themes of autonomy, support for metacognitive strategies, and reduced anxiety, although risks of superficial application were noted. Mixed methods confirmed AI’s effectiveness in enhancing strategic learning. AI applications facilitate independent academic exploration and enhance learners’ motivation by providing immediate support and personalized learning experiences. These findings highlight the potential of AI-powered tools to foster learner autonomy. However, successful integration into educational settings requires strategic pedagogical approaches to maximize benefits while addressing potential challenges.

The postoperative QoR-15 questionnaire may improve the detection of postoperative complications on an early basis and contribute to optimize treatment and recovery. No validated Spanish QoR-15 questionnaire has been available to date. The Spanish QoR-15 questionnaire (QoR-15E), carried out by official bilingual translators, was administered to 242 adult patients undergoing elective surgery before and 24 h after surgery. Patients were asked about their perceived quality of general recovery using a visual analogue scale (VAS). A random subgroup of 36 patients completed a third questionnaire 30–60 min after having completed the first one, and under the same conditions. The Pearson correlation coefficient between QoR-15E and the VAS score was 0.759. Cronbach's alpha was 0.856 in the postoperative period. Reliability by the split-half method was 0.781. Test-retest correlation coefficient was 0.998. Cohen's d was 0.94. The mean time to complete the preoperative questionnaire was 2.9 ± 0.5 min. The QoR-15E is valid and reliable for assessing postoperative quality of recovery in Spanish-speaking patients, with psychometric and interpretative features similar to those of the original instrument. •The patient perspective is increasingly important to improve the quality of recovery.•Patient-reported outcome measures provide their own health through questionnaires.•The QoR-15 questionnaire has been validated to several languages but not Spanish.•The QoR-15E questionnaire has similar characteristics to those of the original tool.•The QoR-15E questionnaire is valid and reliable for Spanish-speaking patients.

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common metabolic complications during pregnancy. Nutritional and diabetological education constitutes the cornerstone of treatment; however, its actual impact according to maternal knowledge levels requires further evaluation. The objectives of this study were to assess the influence of maternal dietary and lifestyle knowledge on the metabolic control of women diagnosed with GDM and to analyze the effectiveness of nutritional and diabetological education received during pregnancy in achieving favorable obstetric and perinatal outcomes. Methods: A prospective observational cohort study was conducted at a tertiary referral center in women diagnosed with GDM. Participants completed a specific questionnaire to evaluate dietary and lifestyle knowledge relevant to glycemic control. Pregnancy follow-up included anthropometric measurements, maternal biochemical parameters—including oral glucose tolerance tests—and maternal-fetal obstetric outcomes, analyzed in relation to knowledge levels and education received. Results: Results showed that women with lower nutritional knowledge exhibited higher body weight, body mass index, and glucose levels in GDM diagnostic tests. Higher knowledge levels were associated with improved metabolic control. Nutritional and diabetological education during pregnancy proved beneficial, with better maternal-fetal outcomes observed, particularly among women who received reinforced education. Conclusions: Dietary and lifestyle knowledge significantly influenced GDM metabolic control. Nutritional education before and during pregnancy is key to optimizing glycemic management and improving maternal-fetal outcomes, supporting the need for preventive and educational programs targeting women with risk factors.

Background Vancomycin is a commonly prescribed antibiotic to treat gram-positive infections. The efficacy of vancomycin is known to be directly related to the pharmacokinetic/pharmacodynamic (PK/PD) index of the area under the concentration-time curve (AUC) divided by the minimal inhibitory concentration (MIC) of the pathogen. However, in most countries, steady-state plasma concentrations are used as a surrogate parameter of target AUC/MIC, but this practice has some drawbacks. Hence, direct AUC-guided monitoring of vancomycin using model-informed precision dosing (MIPD) tools has been proposed for earlier attainment of target concentrations and reducing vancomycin-related nephrotoxicity. However, solid scientific evidence for these benefits in clinical practice is still lacking. This randomized controlled trial (RCT) aims to investigate the clinical utility of MIPD dosing of vancomycin administered via continuous infusion in hospitalized adults. Methods Participants from 11 wards at two Belgian hospitals are randomly allocated to the intervention group or the standard-of-care comparator group. In the intervention group, clinical pharmacists perform dose calculations using CE-labeled MIPD software and target an AUC24h of 400 to 600 mg × h/L, whereas patients in the comparator group receive standard-of-care dosing and monitoring according to the institutional guidelines. The primary endpoint is the proportion of patients reaching the target AUC24h/MIC of 400–600 between 48 and 72 h after start of vancomycin treatment. Secondary endpoints are the proportion of patients with (worsening) acute kidney injury (AKI) during and until 48 h after stop of vancomycin treatment, the proportion of patients reaching target AUC24h/MIC of 400–600 between 72 and 96 h after start of vancomycin treatment, and the proportion of time within the target AUC24h/MIC of 400–600. Discussion This trial will clarify the propagated benefits and provide new insights into how to optimally monitor vancomycin treatment. Trial registration EudraCT number: 2021-003670-31. Registered June 28, 2021. ClinicalTrials.gov identifier: NCT05535075. Registered September 10, 2022. Protocol version 3, protocol date: April 21, 2023.

IntroductionCervical cancer remains a significant public health concern in Singapore, with current screening rates at 43%, well below the national target of 70%. In 2019, human papillomavirus (HPV) DNA testing was introduced into the national cervical cancer screening programme, but barriers to participation include embarrassment, privacy concerns and discomfort with clinician-sampled tests. Self-sampled HPV DNA testing offers a promising alternative by providing more privacy and convenience. This study aims to evaluate the impact of including self-sampled HPV DNA testing as an alternative to clinician-sampling on screening uptake, clinical outcomes and cost-effectiveness in primary care.Methods and analysisThis pragmatic, open-label, two-arm randomised controlled trial employs a Zelen design. A total of 650 women aged 30–69 who are due for cervical cancer screening will be recruited from National Healthcare Group Polyclinics in Singapore. Participants will be randomly assigned to either the intervention arm (offering both self-sampling and clinician-sampling) or the usual care arm (clinician-sampling only). The primary outcome is the proportion of participants in each arm detected with high-risk HPV. Secondary outcomes include the proportion of participants in each arm who undergo cervical cancer screening (uptake), are referred for colposcopy and are detected with CIN 2/3 or cervical cancer, as well as cost-effectiveness. Acceptability and feasibility of self-sampling will be evaluated through post-screening questionnaires.Ethics and disseminationEthical approval was granted by the National Healthcare Group Domain Specific Review Board. Study results will be disseminated through peer-reviewed journals, healthcare conferences and shared with policymakers to guide potential inclusion of self-sampling in Singapore’s national cervical cancer screening programme. Findings from this trial will provide crucial evidence for the potential inclusion of self-sampling in Singapore’s national cervical cancer screening programme, which could increase screening rates and improve public health outcomes.Trial registration numberClinicalTrials.gov: NCT06528184.

Dermoscopy has been used for the non-invasive diagnosis of demodicosis. Several studies have evaluated the usefulness of this tool in the diagnosis, however, there are differences in the gold standard (SSSB or KOH test) and criteria of positivity used between studies. Added to this, is the lack of controls and objective quantification of the usefulness of dermoscopic signs in clinically observable and relevant ranges. To validate the usefulness of dermoscopy for the diagnosis of demodicosis by calculating the performance indicators for the different dermoscopic signs. Retrospective intrapatient case-control study, which included adults with suspicion of demodicosis. Dermoscopic photographs and scraping of healthy and lesional skin were obtained. Samples were analyzed microscopically by trained personnel. Photographs were evaluated by determining the presence of Demodex tails (DT), dilated follicular openings (DFO) and dilated blood vessels (DBV) in pre-defined ranges. 64 patients were included (total = 256 samples); the presence of demodex on skin scraping was seen in 69%. Under dermoscopy, the presence of DT in range 11–20/field had a positive likelihood ratio (LR) of 12.10 (95%CI 6.52–22.45) and negative LR 0.32 (95%CI 0.23–0.45). Combined and dichotomized performance for at least one positive sign under dermoscopy (DT > 10/field, DFO > 10/field or DBV > 50% of the field): positive LR 7.14 (95%CI 4.80-10.62) and negative LR 0.11 (95%CI 0.06–0.22). The presence of DT, DFO or DBV has a high correlation with a positive mite test, so the diagnosis of demodicosis could be made only through dermoscopy.