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Abstracts From The 2026 Health Care Systems Research Network (Hcsrn) Annual Conference, Dallas, Texas, Health Care Systems Research Network Sep 2026

Abstracts From The 2026 Health Care Systems Research Network (Hcsrn) Annual Conference, Dallas, Texas, Health Care Systems Research Network

Journal of Patient-Centered Research and Reviews

The Health Care Systems Research Network (HCSRN) comprises 18 learning health systems with integrated care delivery and embedded research units. The network’s annual conference serves as a forum for research teams from member institutions to disseminate project findings, explore scientific collaborations, and share insights about population-based research practices that can measurably improve health and health care for all. The theme of this year’s conference was “Scaling Learning Health Systems: Data-Driven Pathways to Better Outcomes.” Abstracts presented at HCSRN 2026 are published in this issue supplement of the Journal of Patient-Centered Research and Reviews, the journal of record for HCSRN’s annual …


Creating Collaborative Strategies: The Influence Of Principal Leadership In Teacher Retention In Rural Secondary Schools In Dhalai District, Tripura, Northeast India., Valerian Castelino Sep 2026

Creating Collaborative Strategies: The Influence Of Principal Leadership In Teacher Retention In Rural Secondary Schools In Dhalai District, Tripura, Northeast India., Valerian Castelino

Educational Studies Dissertations

Teacher retention has become a growing concern across India and the world. In rural, tribal, and multilingual contexts, the challenge is even greater. This research, Creating Collaborative Strategies: The Influence of Principal Leadership in Teacher Retention in Rural Secondary Schools in Dhalai District, Tripura, Northeast India, explores how school leadership influences teachers’ decisions to remain in rural schools. The research focuses on Tripura, a small state in Northeast India known for its tribal diversity, geographic isolation, multilingual classrooms, and limited educational resources. The research is informed by a multi-theoretical framework: Herzberg’s Two-Factor Theory, Non-Economic Capital Theory, and Transformational Leadership …


Smart City Pula, Bj Fletcher, Saša Drezgić, Molly Schnoke Sep 2026

Smart City Pula, Bj Fletcher, Saša Drezgić, Molly Schnoke

All Maxine Goodman Levin School of Urban Affairs Publications

No abstract provided.


Spartan Daily, September 15, 2026, San Jose State University, School Of Journalism And Mass Communications Sep 2026

Spartan Daily, September 15, 2026, San Jose State University, School Of Journalism And Mass Communications

Spartan Daily, 2026

Volume 167, Issue 10


From The Archives: Rediscovering The John Preston Papers, Isabella Sumner Sep 2026

From The Archives: Rediscovering The John Preston Papers, Isabella Sumner

TMC Library Newsletter (2015-)

The John Preston, MD Papers, the newest collection at the McGovern Historical Center, contain letters and institutional records documenting life at the Austin State Lunatic Asylum—now Austin State Hospital—during Dr. Preston's 36 years as superintendent. Materials include correspondence from patient's families, physicians, judges, sheriffs, and attorneys, along with budgets, patient records, and even menus for staff and patients. Together, they offer a window into mental health care in Texas during the early 20th century.

Read the full story and explore highlights from the collection on the McGovern Historical Center blog. 


Tarsal Tunnel Syndrome Due To Post-Traumatic Osseous Tunnel Formation: A Rare Case And Surgical Management, Dev Y. Patel, Eshan Doshi, Fiona Zimmerman, Jamal Revolus, Michael Kimball, Michael Franco Sep 2026

Tarsal Tunnel Syndrome Due To Post-Traumatic Osseous Tunnel Formation: A Rare Case And Surgical Management, Dev Y. Patel, Eshan Doshi, Fiona Zimmerman, Jamal Revolus, Michael Kimball, Michael Franco

Cooper Rowan Medical Journal

Tarsal tunnel syndrome (TTS) is classically a compressive neuropathy of the posterior tibial nerve beneath the flexor retinaculum, presenting with plantar foot pain and paresthesias. Standard surgical management of TTS involves release of the flexor retinaculum to decompress the nerve. We report a rare and unusual case of TTS in which the posterior tibial nerve was encased within a post-traumatic osseous tunnel accompanied by dense fibrotic tissue, representing an atypical and previously undescribed etiology of nerve entrapment. In this case, surgical decompression required a modified approach involving meticulous dissection of the tibial nerve from its encasement by heterotopic ossification and …


Evaluating Medical Student Geriatric Competency Using A 5ms-Based Assessment Tool, Lauren R. Hersh Md, Amy Cunningham Phd, Mph, Xiya Wu Md Sep 2026

Evaluating Medical Student Geriatric Competency Using A 5ms-Based Assessment Tool, Lauren R. Hersh Md, Amy Cunningham Phd, Mph, Xiya Wu Md

Cooper Rowan Medical Journal

INTRODUCTION

Driven by an aging Baby Boomer generation, the United States is navigating a demographic transformation with far-reaching implications that include increased demand for chronic disease management and long-term care as well as increased stress on both healthcare costs and infrastructure. Generating a workforce competent in the delivery of care to older patients with complex, multimorbid conditions is fundamental to addressing this shift. Recognizing that the development of primary and specialty care physicians skilled in geriatric care begins in medical school, the American Geriatric Society developed minimum competencies grounded in the Geriatric 5Ms (Mind, Mobility, Medication, Multicomplexity, and …


The Perceptions Of K-5 Teachers Regarding Their Preparedness To Implement Trauma-Informed Practices, Matthew P. Londo Sep 2026

The Perceptions Of K-5 Teachers Regarding Their Preparedness To Implement Trauma-Informed Practices, Matthew P. Londo

Educational Studies Dissertations

Childhood trauma significantly impairs students' cognitive, emotional, and behavioral functioning, yet teachers frequently lack the preparation necessary to address its effects in classroom settings. This mixed-methods study examined the perceptions of K-5 teachers regarding their preparedness to implement trauma-informed practices (TIPs) at a public elementary school in a mid-sized urban district in central Massachusetts. A convergent mixed-methods design was employed to gather data from 20 selected K-5 educators via a structured Likert-scale questionnaire and semi-structured Zoom interviews. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through inductive thematic analysis. Findings revealed that participants employed four primary …


Leakage-Safe Boosting Ensembles With Shap Explainability For Alzheimer's Disease Risk Prediction: A Rigorous Multi-Classifier Benchmark On Global Structured Clinical Data, Hadeer Mahmoud, Fady Salama Sep 2026

Leakage-Safe Boosting Ensembles With Shap Explainability For Alzheimer's Disease Risk Prediction: A Rigorous Multi-Classifier Benchmark On Global Structured Clinical Data, Hadeer Mahmoud, Fady Salama

Sustainable Machine Intelligence Journal

Alzheimer's disease (AD) is a major public health challenge, and scalable non-invasive risk-stratification tools are needed. We benchmarked 11 machine-learning classifiers on a publicly available global structured Alzheimer's prediction dataset (N = 74,283; 24 predictors) using leakage-safe sklearn/imblearn pipelines. Four resampling strategies were assessed with stratified cross-validation; preprocessing included imputation, IQR-based outlier capping, feature engineering, one-hot encoding, and standardization. The leading models underwent HalvingRandomSearchCV optimization, followed by soft-voting and stacking ensembles. Performance was evaluated on a held-out 20% test set and interpreted with SHAP, permutation importance, and built-in feature importance. No resampling was selected in Stage A (composite score = …


Art Beyond Magnolias And Pillared Porticoes, William Lindsey Mcdonald Sep 2026

Art Beyond Magnolias And Pillared Porticoes, William Lindsey Mcdonald

Research Articles

The article is a reflection on antebellum portrait painters, including those associated with the Forks of Cypress, such as Edward Troye, Thomas Sully, Sr., and William Frye. Notably, Troye created a portrait of Parson Dick, an enslaved blacksmith at the Forks of Cypress. The Parson Dick portrait is on display at Pope's Tavern Museum in Florence, AL and visible on their website. Additionally, portraits include those of the James Jackson and Sarah Moore Jackson, and the Jackson racehorses.


Enhanced Biocompatibility Of An Orthodontic Adhesive Modified With Hydroxyapatite Derived From Asian Moon Scallop (Amusium Pleuronectes) Shells, Gufa B. Pamungkas, Eddy H. Habar, Maria Tanumihardja, Rasmidar Samad, Stang Stang, Eka Erwansyah, Nurlindah Hamrun Sep 2026

Enhanced Biocompatibility Of An Orthodontic Adhesive Modified With Hydroxyapatite Derived From Asian Moon Scallop (Amusium Pleuronectes) Shells, Gufa B. Pamungkas, Eddy H. Habar, Maria Tanumihardja, Rasmidar Samad, Stang Stang, Eka Erwansyah, Nurlindah Hamrun

Journal of Dentomaxillofacial Science

Objective: This study aimed to synthesize hydroxyapatite (HAp) derived from Asian moon scallop (Amusium pleuronectes) shells, characterize its physicochemical properties, and evaluate its biocompatibility when incorporated into an orthodontic adhesive.
Materials and Methods: Calcium oxide was obtained by calcining Amusium pleuronectes shells and used as a precursor for hydroxyapatite synthesis via a wet chemical precipitation method. The resulting powder was characterized using X-ray diffraction (XRD), Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and energy-dispersive X-ray spectroscopy (EDX). The synthesized hydroxyapatite was incorporated into an orthodontic adhesive at 2 wt% as the experimental group, whereas the unmodified adhesive …


Icc Agenda 9-15-26, Angela Brock Sep 2026

Icc Agenda 9-15-26, Angela Brock

Individual Course Committee (ICC)

No abstract provided.


Approved Courses 9-15-26, Angela Brock Sep 2026

Approved Courses 9-15-26, Angela Brock

Individual Course Committee (ICC)

No abstract provided.


Assembling A Vignette Of Irish Police Masculinities Through Socio-Historical Rural Crime Research, Clay Darcy Sep 2026

Assembling A Vignette Of Irish Police Masculinities Through Socio-Historical Rural Crime Research, Clay Darcy

Research Outputs: 2025-Present

This paper assembles a vignette of Irish police masculinities from the 1940s and 1950s. Based on historical analysis of a volume of crimes compiled by members of An Garda Síochána (Ireland’s police and security service), and Irish newspaper records, this paper reveals how policing practices and masculinities converged through the detection and recording of rural crimes. An Garda Síochána was exclusively male at the time, and police officers were dominant instrumental figures in rural communities, operating within a tight culture of Catholic religiosity and state censorship. These circumstances allowed them to maintain an assemblage of masculinity that was built on …


A Micro-Computed Tomographic Evaluation Of Root Canal Isthmuses In Maxillary And Mandibular First Molars Of A Black South African Population, Casper Jonker, Anna Catherina Oettlé Sep 2026

A Micro-Computed Tomographic Evaluation Of Root Canal Isthmuses In Maxillary And Mandibular First Molars Of A Black South African Population, Casper Jonker, Anna Catherina Oettlé

Peninsula Dental School

Objective:To evaluate root canal isthmuses in maxillary and mandibular first molars of Black South Africans usingmicro-computed tomography.Methods:The prevalence, location (root third) and type of isthmuses were recorded on 93 maxillary and 84mandibular first molars from 116 skeletonized individuals. Associations with arch side, sex and age were examined bychi-squared test, with strength of association given as the bias-adjusted Cramér’s V and 95% confidence interval (CI).Reliability used percentage agreement and Cohen’s kappa (κ) coefficient.Results:Intra- and inter-observer agreement were excellent: 96.73% (κ= 0.90) and 97.78% (κ= 0.95) for themaxillary teeth and 94.12% (κ= 0.75) and 96.08% (κ= 0.94) for the mandibular teeth. Apical …


The Rbaam-6 Matrix: A Modular, Acoustically Suspended, Self-Healing Dual-Shell Habitat Architecture For High-Survivability In-Situ Mars Colonization, Christopher L. Eckes Sep 2026

The Rbaam-6 Matrix: A Modular, Acoustically Suspended, Self-Healing Dual-Shell Habitat Architecture For High-Survivability In-Situ Mars Colonization, Christopher L. Eckes

Defensive Publications Series

Traditional extraterrestrial architectural paradigms rely on heavy, brute-force physical materials shipped from Earth to withstand the massive atmospheric pressure differentials and environmental hazards of Mars. This paper introduces the Reactive Bio-Acoustic Armor Matrix (RBAAM-6), a novel, 6-layer defense-in-depth habitat architecture. By separating internal tension loads (atmospheric containment) from external compression loads (environmental shielding), the RBAAM-6 utilizes an intermediate, submarine-style 'sally port' buffer zone regulated by interlocking harmonic standing waves. The structure integrates self-healing biological matrices, active kinetic impact countermeasures, a completely modular, snap-tile interior for rapid component replacement, and nitrogen-suppressed utility channels featuring non-energy transparent visual verification zones. This architecture …


Three-Strip Intercropping System For Heat Stress Reduction In Field Corn: A Complete Research & Implementation Protocol, Michael Victor Caldwell Mr. Sep 2026

Three-Strip Intercropping System For Heat Stress Reduction In Field Corn: A Complete Research & Implementation Protocol, Michael Victor Caldwell Mr.

Defensive Publications Series

This protocol describes a three-strip intercropping system combining field corn, forage sorghum shade strips, and perennial wildflower predator habitat strips. The system provides simultaneous heat stress reduction (2–8°F leaf cooling), windbreak protection (5–15% yield increase), and conservation biological control (16–40% pest reduction) for dryland corn in the US Corn Belt. The pest control benefit is specifically activated by the intercrop configuration, and predator populations are sustained through heat events by the wildflower strip. The system requires no new hardware, no irrigation, and no proprietary technology. It can be implemented with existing combine, planter, and sprayer equipment. (This is a Large …


Bounded-Risk Agility Architecture (Braa), Volodymyr Kotegov Sep 2026

Bounded-Risk Agility Architecture (Braa), Volodymyr Kotegov

Defensive Publications Series

BRAA is an engineering and cyber-safety framework for autonomous intelligent systems operating under residual risk. Absolute determinism in stochastic Cognitive Cores is mathematically and empirically unattainable. The objective of BRAA is to keep residual operational risk bounded, measurable, observable, and economically controllable — not to promise its complete elimination.

The architecture is strictly Cognitive-Core-agnostic and infrastructure-agnostic. It treats the underlying inference engines (LLMs, VLMs, agentic loops) as untrusted, replaceable, and volatile components. It places all critical invariants, safety boundaries, and transition rules into a deterministic, immutable runtime environment (the Immutable Core) executed completely outside any prompt space or learned representation. …


Newsclipping, A Mother Who Adds Glory To Mothers Of All Sep 2026

Newsclipping, A Mother Who Adds Glory To Mothers Of All

Eartha M. M. White Textual Material

News clipping: Partial article regarding Mrs. A. E. Barrow being awarded "Mother of the Year" by the Oklahoma American Mothers' Committee, Golden Rule Foundation. Undated.


Newsclipping, Article Fragment Sep 2026

Newsclipping, Article Fragment

Eartha M. M. White Textual Material

News clipping: Article fragment that mentions Dr. George Washington Carver of Tuskegee, Dr. Robert R Moton, president of Tuskegee, Dr. J. R. E. Lee, head of the Florida A. & M. College at Tallahassee, Booker T. Washington, founder of Tuskegee. The article also mentions Bethune-Cookman at Daytona Beach. Undated.


[Cross] John S. Cross Brief Historical Background Sep 2026

[Cross] John S. Cross Brief Historical Background

Community Historical Archaeology Project with Schools (CHAPS) Oral Histories

No abstract provided.


An Introduction To The History Of Medicine In Medical Education, Mary E. Horton Mph, Ma, Phd Sep 2026

An Introduction To The History Of Medicine In Medical Education, Mary E. Horton Mph, Ma, Phd

History of Medicine Seminar

No abstract provided.


Proposed Protocol To Evaluate The Interaction Of Genetic Modifiers And Metabolic Comorbidities On Cognitive Decline In Huntington’S Disease, Maria Camila Gonzalez Tovar, Elena Dike, Juan Carlos Lopez Alvarenga Sep 2026

Proposed Protocol To Evaluate The Interaction Of Genetic Modifiers And Metabolic Comorbidities On Cognitive Decline In Huntington’S Disease, Maria Camila Gonzalez Tovar, Elena Dike, Juan Carlos Lopez Alvarenga

Research Symposium

Background: Huntington’s disease (HD) is a progressive neurodegenerative disorder caused by a CAG trinucleotide repeat expansion in the HTT gene. While CAG repeat length is the primary determinant of disease onset, substantial variability exists in the rate of disease progression and cognitive decline. This variability is influenced by both cis and trans genetic modifiers, including DNA repair genes such as MLH1, MSH3, PMS2, and FAN1. Emerging evidence also suggests that systemic metabolic comorbidities—including diabetes mellitus, dyslipidemia and hypertension—may exacerbate neuronal vulnerability and accelerate neurodegeneration.

Methods: We propose a retrospective, longitudinal cohort study utilizing existing HD datasets containing genetic, metabolic, and …


Lipid Profiles In Alzheimer’S Disease: A Case Series With Longitudinal Comparison To Controls, Maria Camila Gonzalez Tovar, Stephen Michael Garcia, Irum Rahman, Juan Lopez Alvarenga Sep 2026

Lipid Profiles In Alzheimer’S Disease: A Case Series With Longitudinal Comparison To Controls, Maria Camila Gonzalez Tovar, Stephen Michael Garcia, Irum Rahman, Juan Lopez Alvarenga

Research Symposium

Background: Alzheimer’s disease (AD) is a growing problem among the elderly and has several risk factors. The Rio Grande Valley has specific demographic and socioeconomic factors that may influence the likelihood of developing this neurodegenerative disease. Elevated cholesterol is a risk factor for the development of Alzheimer’s; however, this correlation has not been fully explored in the population within the Rio Grande Valley. This area of study is important due to the rapidly aging population within the RGV, as well as the high prevalence of comorbidities such as elevated lipid profiles.

Methods: This study analyzed a case series of 6 …


Leveraging A Model Of Intergroup Competencies: A Reflexive Tool For Developing Diversity Leadership In Higher Education, Arig Al Shaibah Sep 2026

Leveraging A Model Of Intergroup Competencies: A Reflexive Tool For Developing Diversity Leadership In Higher Education, Arig Al Shaibah

Journal of Educational Research and Practice

Despite, or perhaps precisely because of, the current partisan pushback against equity, diversity, and inclusion (EDI) efforts in Western higher education institutions, universities may be well served to renovate their approaches to leadership diversity development to build greater capacity for advancing mission-critical inclusion excellence priorities. This article describes a promising educational intervention that has broad applicability to more meaningfully develop leadership proficiencies that better enable the advancement of EDI goals in higher education. While individual diversity leadership development programming is a micro-level intervention, it could prove beneficial—though insufficient on its own—as a prerequisite for macro-level equity and inclusion policymaking and …


Newsclipping, Why Don't More Negroes Become Lawyers? Sep 2026

Newsclipping, Why Don't More Negroes Become Lawyers?

Eartha M. M. White Textual Material

News Clipping: Partial article references data given to the reporter by the acting dean of Howard University School of Law, William W. Taylor. Undated.


Plasma Vgf As A Predictive Biomarker For Early Acute Kidney Injury In Critically Ill Elderly Patients: A Combined Clinical And Mendelian Randomization Study, Xianyang Guo, Yu Hao, Rujie Chenn, Benji Wang, Shengwei Jin Sep 2026

Plasma Vgf As A Predictive Biomarker For Early Acute Kidney Injury In Critically Ill Elderly Patients: A Combined Clinical And Mendelian Randomization Study, Xianyang Guo, Yu Hao, Rujie Chenn, Benji Wang, Shengwei Jin

Saudi Medical Journal

Objectives: To assess whether VGF nerve growth factor inducible (VGF) can serve as a reliable predictor of acute kidney injury (AKI) among patients requiring intensive care.
Methods: We first conducted a Mendelian randomization (MR) analysis to explore the potential causal link between plasma VGF levels and AKI risk. Subsequently, 128 critically ill individuals admitted to our intensive care unit were prospectively enrolled. Within 24 hours of either hospital admission or clinical decline, both blood and urine specimens were obtained. We measured VGF concentrations in plasma and urine, along with plasma cystatin C (pCysC), plasma and urinary neutrophil gelatinase-associated lipocalin (NGAL), …


Knowledge, Practice And Perceived Barriers Of Healthcare Provider Adherence To The Notifiable Disease Surveillance System (Ndss) In Government Hospitals And Primary Healthcare Centers In Jazan, Saudi Arabia: A Cross-Sectional Study, Moatasem F. Hakmi, Alaa Mathkour, Yousef Zahrani, Rayan I. Binduhayyim, Saad S. Alqahtani, Muhammad Z. Iqbal Sep 2026

Knowledge, Practice And Perceived Barriers Of Healthcare Provider Adherence To The Notifiable Disease Surveillance System (Ndss) In Government Hospitals And Primary Healthcare Centers In Jazan, Saudi Arabia: A Cross-Sectional Study, Moatasem F. Hakmi, Alaa Mathkour, Yousef Zahrani, Rayan I. Binduhayyim, Saad S. Alqahtani, Muhammad Z. Iqbal

Saudi Medical Journal

Objective: To assess and compare healthcare providers' understanding of the Notifiable Disease Surveillance System (NDSS), alongside reported and perceived challenges, across public hospitals and primary healthcare centers in Jazan, Kingdom of Saudi Arabia.
Methods: A cross-sectional study was conducted between 10 January 2025 and 30 December 2025 among health care providers at Jazan hospitals and primary healthcare centers (PHCs) (n = 420). Data were collected via structured self-administered questionnaire that included the following sections: demographic data, knowledge of the NDSS, reporting practices, competency of the Health Electronic Surveillance Network (HESN) and perceived barriers. Descriptive and inferential statistics were used to …


Cranial Mri In Girls With Central Precocious Puberty: Clinical Characteristics And Predictors Of Abnormal Findings, Fahad N. Al Juraibah, Mashael M. Alharbi, Reem D. Alharbi, Joud S. Albaraki, Sarah S. Aldharman, Hala A. Alghamdi, Nagarajkumar Yenugadhati, Abdullah I. Alhammad, Angham N. Almutair, Ibrahim A. Al Alwan Sep 2026

Cranial Mri In Girls With Central Precocious Puberty: Clinical Characteristics And Predictors Of Abnormal Findings, Fahad N. Al Juraibah, Mashael M. Alharbi, Reem D. Alharbi, Joud S. Albaraki, Sarah S. Aldharman, Hala A. Alghamdi, Nagarajkumar Yenugadhati, Abdullah I. Alhammad, Angham N. Almutair, Ibrahim A. Al Alwan

Saudi Medical Journal

Objectives: To describe the clinical profile of girls with central precocious puberty (CPP) and determine the factors associated with abnormal cranial magnetic resonance imaging (MRI) findings.
Methods: This retrospective study included girls aged 8 years or younger with a diagnosis of CPP who received care at King Abdullah Specialized Children's Hospital in Riyadh, Kingdom of Saudi Arabia, between 2015 and 2023. Data on clinical presentation, biochemical results, imaging findings, and treatment were obtained from medical records. Logistic regression analysis was performed to determine variables associated with MRI utilization and the occurrence of abnormal MRI findings.
Results: The cohort comprised 70 …


Thrombosis Rate And Risk Factors In Pediatric Patients With Peripherally Inserted Central Catheters, Ahmed A. Alabdulkarim, Abdullah I. Almojali, Tharaa S. Alhowaish, Dena S. Alsuhaibani, Norah I. Alshafi, Amin I. Alzahrani, Mohammed O. Alotaibi, Yousef A. Alghamdi, Hamad A. Alkhalaf Sep 2026

Thrombosis Rate And Risk Factors In Pediatric Patients With Peripherally Inserted Central Catheters, Ahmed A. Alabdulkarim, Abdullah I. Almojali, Tharaa S. Alhowaish, Dena S. Alsuhaibani, Norah I. Alshafi, Amin I. Alzahrani, Mohammed O. Alotaibi, Yousef A. Alghamdi, Hamad A. Alkhalaf

Saudi Medical Journal

Objective: To determine symptomatic thrombosis incidence in pediatric patients with peripherally inserted central catheters (PICCs) and identify associated patient and procedure-related risk factors in a tertiary pediatric center in Saudi Arabia.
Methods: We conducted a retrospective cohort study at King Abdullah Specialized Children's Hospital, Riyadh, Kingdom of Saudi Arabia, including patients aged 0–14 years who underwent PICC insertion in the Interventional Radiology department between January 2019 and June 2023. Data on demographics, comorbidities, procedural details, and outcomes were extracted from the electronic medical record system (BestCare). Symptomatic thrombosis was defined as Doppler-confirmed thrombosis with clinical signs. Associations were tested using …