Life Activities Research Articles

Application of Non‐Immersive Virtual Reality in Cerebral Palsy Children: A Systematic Review

ABSTRACTCerebral palsy (CP) is a movement disorder caused by brain damage. Virtual reality (VR) can improve motor function and daily life activities in CP patients. This systematic review examines the use of non‐immersive VR in treating CP children. The objective is to evaluate the effectiveness of non‐immersive VR in rehabilitating CP children as a standalone intervention or in combination with traditional therapy. The review follows the PRISMA guidelines and includes a comprehensive search of five bibliographic databases. Two reviewers independently assess the search results, evaluate full‐text publications, and extract relevant data. The outcomes were described by the International Classification of Functioning, Disability, and Health for Children and Youth (ICF‐CY) framework. A total of 20 English‐language studies published between January 2013 and January 2023 are included in the review based on predefined inclusion and exclusion criteria. The findings demonstrate that non‐immersive VR, when used in conjunction with traditional therapy, yields positive effects on body structure and function (hand function, grip strength, and upper extremity function), activity (motor function, activities of daily life [ADL], balance), and participation (caretakers' assessment, usability, motivation, and user satisfaction) in CP children. Moreover, non‐immersive VR alone is found to be more efficient than traditional therapy in improving manual dexterity in CP children. The non‐immersive VR can be effective in rehabilitating CP children, and the review concludes by recommending future research with larger sample sizes and randomized trials to investigate further the potential benefits of non‐immersive VR in this population.

PRACTICE: Development of a Core Outcome Set for Trials of Physical Rehabilitation in Critical Illness.

Rationale Findings from individual trials of physical rehabilitation interventions in critically ill adults have limited potential for meta-analysis and informing clinical decision-making due to heterogeneity in selection and reporting of outcomes used for evaluation. Objective The objective of this study was to determine a core outcome set (COS) for use in all future trials evaluating physical rehabilitation interventions delivered across the critical illness continuum of recovery. Methods An international, two-round, online, modified Delphi consensus process, following recommended standards, was conducted. Participants (N=329) comprised three stakeholder groups (Researchers, n=58 (18%); Clinicians, n=247 (75%); Patients and Caregivers, n=24 (7%)), and represented 26 countries and 9 healthcare professions. Participants rated the importance of a range of relevant outcomes. Outcomes included in the COS were those prioritised of "critical importance" by all three stakeholder groups. Results Survey response rates were 88% (Round 1) and 91% (Round 2). From a total of 32 initial outcomes, the following outcomes reached consensus for inclusion in the COS: Physical Function, Activities of Daily Living, Survival, Health-related Quality of Life, Exercise Capacity, Cognitive Function, Emotional and Mental Wellbeing, and Frailty. Conclusion This study developed a consensus-generated COS for future clinical research evaluating physical rehabilitation interventions in critically ill adults across the continuum of recovery. Ascertaining recommended measurement instruments for these core outcomes is now required to facilitate implementation of the COS. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Climate Change Intersecting Socio-economic Vulnerabilities of Kalash Indigenous Community in Nothern Pakistan

Climate Change has a significant effect on all walks of life or human activities across the world. However, indigenous communities in different parts of the world are more susceptible to the worst effects of climate change due to their dependency on natural resources. Climate change directly affects natural resources such as forests, water, grazing land, bio-diversity and traditional foods of indigenous communities. This study explores how climate change overlaps or intersects the socio-economic, and bio-cultural marginality of the Kalash indigenous community, living in northern Pakistan. The qualitative research paradigm was used to explore how climate change overlaps or intersects the socio-economic marginality of the Kalash Indigenous community. It reveals that climate change has significantly affected natural resources such as water, biodiversity, forests and crops of Kalash's indigenous community. Climate-induced natural disasters affected their livelihood resources and compelled them to migrate or be displaced from their native town. It reveals that climate change also affects women's marginality in Kalash's indigenous community. It also reveals that climate change overlaps and intersects with the socio-economic marginality of Indigenous communities and policymakers should give priority to indigenous communities who have a dependency on natural resources to protect them from the worst effect of climate change across the world.

Comprehensive Analysis of Treatment Approaches for Lumbar Disc Herniation: A Systematic Review.

Lumbar disc herniation is a common disorder that has an important impact on the quality of life and daily activities of those affected. It is defined as the displacement of the nucleus pulposus beyond the intervertebral space. This systematic review aims to evaluate and compare the efficacy of several treatment modalities, including conservative, pharmaceutical, and surgical interventions. The data sources utilized were PubMed, Google Scholar, Embase, and Cochrane. We conducted a systematic review of English-language articles published between 2019 and 2024, using the PRISMA guidelines. A total of 720 studies were identified during the search. Following the evaluation of the title, abstract, and full text, and the application of exclusion criteria, a total of 15 studies met the requirements for inclusion in the analysis. The results indicate that although conservative treatment is frequently successful in providing immediate relief of symptoms, surgical interventions may be required for patients experiencing neurological deficitsor those who do not respond to conservativetreatments. One limitation of this systematic review is the inclusion of a limited number of studies, which may affect the generalizability of the findings. Additionally, the review was restricted to English-language publications from 2019 to 2024, potentially excluding relevant research published in other languages or outside this timeframe.

Regional variations in psoriatic arthritis: Insights from a nationwide multicenter analysis in Türkiye.

The study aimed to investigate and compare clinical features, disease activity, and the overall disease burden among psoriatic arthritis (PsA) patients across seven distinct geographic regions in Türkiye. A multicenter cross-sectional study involving 1,134 PsA patients from 25 referral centers across seven regions was conducted. Demographic and clinical characteristics, comorbidities, joint involvement, extra-articular manifestations, and disease activity measures were evaluated across regions. A total of 1134 PsA patients from seven different geographic regions in Türkiye participated in this study. The highest number of participants was from the Marmara region (n=409), with subsequent representation from Central Anatolia (n=370), Aegean (n=139), Mediterranean (n=60), Black Sea (n=60), Eastern Anatolia (n=60), and Southeastern Anatolia (n=36) regions. There were significant variations in demographic profile, including age, body mass index, age of disease onset, educational status, comorbidities, and family history of both psoriasis and PsA. Clinical features, such as enthesitis, dactylitis, uveitis, and joint involvement, demonstrated significant variation across regions. Additionally, disease activity measures, including pain, patient and physician global assessments, acute phase reactants, disease activity indices, quality of life, and functional status, displayed considerable regional differences. This nationwide study revealed substantial regional diversity in demographic data, clinical characteristics, disease activity, and quality of life among PsA patients in Türkiye. These findings stress the need to customize treatment approaches to address regional needs and to conduct further research to uncover reasons for disparities. It is crucial to enhance region-specific approaches to improve patient care and outcomes for PsA.

Enzyme metabolism and functions in vitamin biosynthesis pathways

Vitamins, as indispensable organic compounds in life activities, demonstrate a complex and refined metabolic network in organisms. This network involves the coordination of multiple enzymes and the integration of various metabolic pathways. Despite the achievements in metabolic engineering and catalytic mechanism research, the lack of studies regarding detailed enzymatic properties for a large number of key enzymes limits the enhancement of vitamin production efficiency and hinders the in-depth understanding and optimization of vitamin synthesis mechanisms. Such limitations not only restrict the industrial application of vitamins but also impede the development of related bio-technologies. This study comprehensively reviews the research progress in the enzymes involved in vitamin biosynthesis and details the current status of research on the enzymes of 13 vitamin synthesis pathways, including their catalytic mechanisms, kinetic properties, and applications in biology. In addition, this study compares the properties of enzymes involved in vitamin metabolic pathways and the glycolysis pathway, and reveals the characteristics of catalytic efficiency and substrate affinity of enzymes in vitamin synthesis pathways. Furthermore, this study discusses the potential and prospects of applying deep learning methods to the research on properties of enzymes associated with vitamin biosynthesis, giving new insights into the production and optimization of vitamins.

Biosynthesis of fat-soluble vitamins

Vitamins are the essential organic substances to ensure the normal life activities of the human body. At present, vitamins are widely used in the pharmaceutical, food, animal farming, beauty and other industries, appearing in increasing application scenarios. Accordingly, the global demand for vitamins has also increased greatly. The current methods of vitamin production mainly include chemical synthesis and biosynthesis, with the latter being greener, more environmentally friendly, safer, and lower in energy consumption. Establishing the method for the biosynthesis of vitamins is of great scientific significance for achieving the goals of low carbon, energy saving, and emission reduction, as well as carbon emission peak and carbon neutrality in China. This paper reviews the research progress in the biosynthesis of vitamins, especially fat-soluble vitamins (vitamins A, D, E, and K), in recent years.

REQUIREMENTS FOR A LEADER FROM THE POSITION OF STRATEGIC MANAGEMENT OF THE ENTERPRISE ON THE WAY TO SYSTEMIC PERFECTION

The article offers a list of requirements for a leader from the strategic management position of an organization that has chosen a course for systemic excellence. Leadership can be formal or informal. The head of the system is only sometimes the leader. The manager, as a leader, should meet specific requirements. Taking into account the historical experience of developing countries, which are still experiencing transformational processes with negative consequences, the question arises regarding the orientation of culture "as an image of life activity" of active elements - people, from the position of its condition in most subjects of socio-economic activity, about archetypes, in particular the archetype about the understanding of leadership, more in the practical plane, mainly as a formal attribute of power. Management subsystems of organizations in transitional/transformational conditions are not sufficiently focused on system criteria for choosing a leader. The article proposes general requirements for the system leader from the strategic management position, which has chosen a course for system excellence. The proposed list includes the following requirements: possess systemic and strategic thinking and be a carrier of progressive culture "as an image of life activity"; to be clearly aware of their purpose in the system; have high competence in managing complex systems; to clearly regulate one's job duties, powers and personal responsibility for achieving target strategic guidelines; to be a strategist and architect of the organization, especially in terms of defining and carrying out systemic strategic changes; to be a creative person and in every way to stimulate a creative approach to solving problems at all levels of management; to give priority to the goals of the system compared to personal goals and ambitions, to subordinate them to their purpose; have the image and reputation of a highly professional top manager; be oriented towards partnership both within the system itself and in the external environment (use the "win/win" strategy when the interests of all interacting parties are maximally satisfied). For the management subsystem, the list of requirements allows you to focus on the search, development, assessment of suitability, and replacement of the applicant for this role.

The Functional Efficiency of Older Patients after Lumbar Spine Surgery, the Impact of Pain, and the Passage of Time: Tips for Care Providers.

Chronic back pain in adults is often a cause of absenteeism from work, limitations in social interactions, and difficulties in performing daily activities. This study aimed to check whether the functioning of everyday activities in elderly patients after neurosurgery improved over time compared to their condition before the procedure and whether there is a connection between fitness, self-esteem, and pain intensity. This was a cross-sectional study carried out using an anonymous survey. This study included patients over 60 years of age from the neurosurgical ward. The following scales were used to assess cognitive functioning, depression, functional status: basic and instrumental activities of daily living (IADL), back pain disability (QBPDS), pain intensity, and self-esteem. The level of independence in terms of IADL and QBPDS increased, and the intensity of pain decreased. Surgery reduced pain intensity from 8 ± 0.8 to 6.1 ± 1.4 points. The level of self-esteem (RSES) remained at a low level. The passage of time after neurosurgical treatment has a beneficial effect on reducing pain intensity and increasing independence in life activities. Daily physical activity and rehabilitation are important factors supporting the return to independence.

Tinjauan Literatur Sistematis: Pengaruh Lingkungan Sosial dan Perlakuan yang Diterima Remaja dari Lingkungan Sosialnya terhadap Psychological Well-Being

This study examines the influence of the social environment and the treatment that adolescents receive from their social environment on psychological well-being. Psychological well-being is a concept that refers to a person's feelings towards the activities of daily life, which includes six main dimensions. This study uses the literature study method (SLR) to collect and analyze data from various sources. The results of the study are expected to provide a deep understanding of the dynamics of these external factors and their impact on the psychological well-being of adolescents. In addition, the study also aims to identify strategies and interventions that can be used by parents, educators, and the community to support the psychological well-being of adolescents, by reducing the negative effects of bullying and implementing more positive and supportive parenting styles.

Characteristics of health-preserving competence of future physical education teachers in the structure of professional training

This article presents the results of a sociological study aimed at assessing health-preserving competence and its role in the professional training of future physical education teachers. The goal of the research is to characterize the health-preserving competence of future physical education teachers within the structure of professional training during wartime and postwar conditions. Research methods include theoretical analysis of scientific and methodological literature, sociological research, pedagogical research methods (observation), and mathematical analysis methods. The study involved 53 students from the first to fourth years of the specialty 014.11 Secondary Education. Physical Culture at Yuriy Fedkovych Chernivtsi National University. Students' self-assessment of their level of health- preserving competence was divided into four levels: high, sufficient, average, and low. Only 7.4% of respondents rated their level as high, while the majority rated it as sufficient or average. The research identified the main reasons leading to low or average self- assessment of professional culture: insufficient number of practical classes (27.8%), lack of independent work (20.4%), insufficient theoretical knowledge (14.8%), and low level of motivation and interest (14.8%). Key aspects of health-preserving competence for future physical education teachers were determined. Despite the significant attention of higher education institutions to the formation of health-preserving competence, only 51.9% of students regularly implement components of a healthy lifestyle. The most effective means of forming health-preserving competence were identified as the integration of relevant aspects into the curriculum, conducting master classes, practical exercises, and organizing sports events. The study emphasizes the need to improve educational programs to enhance the level of health-preserving competence, which includes increasing the number of practical classes, stimulating students' independent work, and strengthening their motivation to actively apply the acquired knowledge in everyday life and professional activities.

Modern approaches to increase the efficiency of physical education of high school students

The article presents the results of the study and systematization of the prerequisites for the low efficiency of the physical education of school youth, including high school students, the organizational and methodical features of physical exercises with high school children are revealed, current trends in the development of the school physical education system are analyzed, and an attempt is made to identify ways of strengthening productivity of physical exercises classes in high school in the conditions of modern challenges. It was determined that since high school age is a particularly responsible period, as it is the final stage of preparing an individual for a full-fledged life, further education and professional activity. Therefore, the content and methods of physical education of high school students have their own characteristics and requirements for evaluating effectiveness. It has been established that the system of school physical education is low in terms of achieving the expected results in the process of implementing pedagogical tasks and has a number of significant shortcomings. Guidelines for its development at the state level based on taking into account the world's best practices are presented. The need to improve the physical education of schoolchildren in traditional school forms has been identified. It was found that the subject of modern research is the substantiation and development of new methods in the educational process of physical education of high school students. Modern methods are represented by a set of traditional and innovative means and methods of physical education and are aimed at strengthening the pedagogical influence on schoolchildren in various organizational forms, but only a small part of them is reflected in practice.

Disability Assessment with WHODAS 2.0 of People with Fibromyalgia in Poland: A Cross Sectional-Study.

BACKGROUND Fibromyalgia (FM) is a multifactorial syndrome characterized by chronic widespread pain, fatigue, sleep and cognitive impairment and functional symptoms. The aim of this study was to assess disability and its associated factors. The study was conducted among 691 patients with fibromyalgia in Poland using an online survey. MATERIAL AND METHODS This was a cross-sectional study of the disability of patients with fibromyalgia aged 18 years and over in Poland. The study was conducted by means of an online questionnaire distributed to patients affiliated with the National Association of Patients with Fibromyalgia. A total of 691 records were analyzed. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-item version was used to assess disability. The Beck Depression Inventory was used to assess the participants' emotional state. Sociodemographic and selected health data were collected. RESULTS The study group had a significant general level of disability as measured by the WHODAS 2.0 (mean=49.69). The greatest limitations were found in the following areas: life activity (mean=73.43), social participation (mean=64.59), and mobility (mean=62.07). The categorical sociodemographic variables that statistically significantly differentiated the participants in terms of general level of disability were occupational status (P<0.005), pain level (P<0.001), number of medications taken (P=0.005), and level of depression (P<0.001). CONCLUSIONS Disability is present in fibromyalgia and is a major concern. Understanding the determinants of disability in fibromyalgia can contribute to the development of effective therapies and symptom relief.

Media space and the formation of civil society: the role of information technologies

Introduction: The media space and information technologies are rapidly evolving, influencing the formation of civil society and democratic processes. Objectives: This research aims to analyze modern trends in the interaction between the media space, information technologies, and civil society, focusing on the growth of civic activity and participation in social life. Methods: The study employs a mixed-methods approach, combining quantitative surveys to assess public trust in media and qualitative analyses of digital media strategies. Results: The findings highlight varying levels of trust among Europeans in media and technological advancements as tools for fostering a democratic society. Key digital media strategies that increase civic engagement were identified. Conclusions: Research concludes that media space and information technologies hold significant potential for strengthening civil society and supporting freedom of speech. A promising direction is the integration of critical thinking and media literacy, especially in the context of increasing geopolitical tensions. The study emphasizes the need for further innovation in mass media, developing adaptive strategies that align with the dynamics of the digital age and contribute to civil society's development.

Imaging of intracellular mitochondrial membrane potential with a highly photostable NIR fluorescent probe

Mitochondrial membrane potential (ΔΨm) participated in important physiological processes such as ATP synthesis, ion exchange, and plays an important role in maintaining normal life activities of cells. Herein, we synthesized a fluorescent probe EDXB (3-ethyl-2-(2-(6-methoxy-2,3-dihydro-1H-xanthen-4-yl) vinyl) benzothiazol-3-ium iodide) with positive charge, which targets mitochondria by electrostatic attraction. The probe has twisted intramolecular charge transfer (TICT) characteristics, resulting in near-infrared fluorescence emission enhanced with the increase of viscosity, when the probe falls off from the mitochondrial membrane to the low-viscosity cytoplasmic aqueous phase, the fluorescence emission intensity is weakened. Therefore, the EDXB exhibited favorable targeting. In addition, EDXB also has good anti-bleaching and pH stability, which enables it to accurately feedback the change of ΔΨm. In the experiment, the intracellular imaging of EDXB certificated mitochondrial depolarization (decrease of ΔΨm) during various cell injury events including cell inflammation, apoptosis and mitophagy. We expect EDXB to be a useful tool for the analysis of ΔΨm changes.

Exploring the Molecular Mechanism of Skeletal Muscle Development in Ningxiang Pig by Weighted Gene Co-Expression Network Analysis.

With the continuous improvement in living standards, people's demand for high-quality meat is increasing. Ningxiang pig has delicious meat of high nutritional value, and is loved by consumers. However, its slow growth and low meat yield seriously restrict its efficient utilization. Gene expression is the internal driving force of life activities, so in order to fundamentally improve its growth rate, it is key to explore the molecular mechanism of skeletal muscle development in Ningxiang pigs. In this paper, Ningxiang boars were selected in four growth stages (30 days: weaning period, 90 days: nursing period, 150 days: early fattening period, and 210 days: late fattening period), and the longissimus dorsi (LD) muscle was taken from three boars in each stage. The fatty acid content, amino acid content, muscle fiber diameter density and type of LD were detected by gas chromatography, acidolysis, hematoxylin eosin (HE) staining and immunofluorescence (IF) staining. After transcription sequencing, weighted gene co-expression network analysis (WGCNA) combined with the phenotype of the LD was used to explore the key genes and signaling pathways affecting muscle development. The results showed that 10 modules were identified by WGCNA, including 5 modules related to muscle development stage, module characteristics of muscle fiber density, 5 modules characteristic of muscle fiber diameter, and a module characteristic of palmitoleic acid (C16:1) and linoleic acid (C18:2n6C). Gene ontology (GO) enrichment analysis found that 52 transcripts relating to muscle development were enriched in these modules, including 44 known genes and 8 novel genes. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that these genes were enriched in the auxin, estrogen and cyclic guanosine monophosphate-protein kinase G (cGMP-PKG) pathways. Twelve of these genes were transcription factors, there were interactions among 20 genes, and the interactions among 11 proteins in human, pig and mouse were stable. To sum up, through the integrated analysis of phenotype and transcriptome, this paper analyzed the key genes and possible regulatory networks of skeletal muscle development in Ningxiang pigs at various stages, to provide a reference for the in-depth study of skeletal muscle development.

Assessment of Valance Emotional State Using EEG-EDA Coupling and Explainable Classifiers.

Emotion influences human life and impacts daily life activities. During emotional processes, physiological signals interact with each other instead of functioning separately. Although unimodal and multimodal approaches have been explored for emotion classification, there is a lack of inclusion of central and peripheral nervous system signal interaction-based approaches. In this study, an attempt has been made to characterize valance emotional states using Electroencephalogram (EEG)- Electrodermal activity (EDA) based coupling. For this, multimodal signals are obtained from the publicly available DEAP database (n=32 subjects). The EEG signals are decomposed into θ, α, β, and bands and EDA signals are decomposed into phasic and tonic components. Then two EEG, three EDA, and two EEG-EDA coupling-based features are extracted and applied to three classifiers namely Random Forest (RF), Linear discriminant analysis, and Adaptive boosting. In addition, SHAP analysis is performed to explain classifiers' performance with respect to features. The result shows that the proposed approach is able to classify valence emotional states. The feature combination of EEG, EDA, and EEG-EDA coupling-based features with an RF classifier performs best with an F1-score of 68.21%. SHAP analysis in frontal electrodes with γ band obtained better discrimination among different valance states. This study underscores the significance of the coupling studies of EEG with EDA in classifying emotion. Therefore, the proposed approach can be extended to emotional state assessment in clinical settings.

Biomechanical comparison of femoral neck anti-rotation and support system versus femoral neck system for unstable pauwels III femoral neck fractures

BackgroundThe optimal treatment method for managing unstable Pauwels III femoral neck fractures remains undetermined. The aim of this study was to compare the biomechanical properties of two types of Femoral Neck Anti-rotation and Support System (FNAS) and a Femoral Neck System (FNS) in unstable Pauwels III femoral neck fractures.MethodsEighteen synthetic femoral models were implanted with one of three fixation devices: FNS, FNAS I, or FNAS II. An unstable Pauwels III (OTA/AO 31-B2.3) femoral neck fracture was simulated using a custom-made needle and osteotomy guide. Torsion and axial compression loading tests were conducted, and the torque, torsion angle, load to failure, displacement, and stiffness values were recorded.ResultsFNAS II exhibited significantly higher torsional stiffness (0.67 ± 0.10 Nm/°) compared to FNAS I (0.52 ± 0.07 Nm/°, P = 0.01) and FNS (0.54 ± 0.07 Nm/°, P = 0.005). FNS demonstrated significantly greater mean axial stiffness (239.24 ± 11.38 N/mm) than both FNAS I (179.33 ± 31.11 N/mm, P = 0.005) and FNAS II (190.07 ± 34.11 N/mm, P = 0.022). FNAS I (302.37 ± 33.88 N/mm, P = 0.001) and FNAS II (319.59 ± 50.10 N/mm, P < 0.001) showed significantly higher initial axial stiffness compared to FNS (197.08 ± 33.68 N/mm). Both FNAS I and II improved resistance to deforming forces at a load level before approximately 1000 N, which is sufficient to withstand the load from most daily life activities. No significant differences were observed in compression failure load among the groups. The failure patterns at the point of failure included the pull-out of the distal locking screw and reverse oblique intertrochanteric femur fracture for FNS, while for FNAS I and II, the failures were characterized by a cleft on the calcar femorale and a decrease in the load–displacement curve.ConclusionsIn unstable Pauwels III femoral neck fractures, the FNAS II enhances stability and is easier to manage for reoperation. The results of the current study support the potential of FNAS II as an alternative option for treating unstable Pauwels III femoral neck fractures in young individuals.

PSTD Treatment of Joint Forces Operation Combatants: A Case Study.

The participation of military personnel in operations like the Anti-Terrorist Operation (ATO)/Joint Forces Operations (JFO) can lead to significant psychological trauma, potentially resulting in posttraumatic stress disorder (PTSD). Understanding the effectiveness of psychotherapy in treating PTSD among ATO/JFO participants is crucial given its profound impact on personal relationships, life scenarios, and overall well-being. This study evaluates how acceptance and commitment therapy can alleviate PTSD symptoms and enhance well-being in Ukrainian military personnel with combat-related PTSD. The main research method was a psychological experiment, and the case study method was used as an auxiliary research method. The study revealed the following: combatants in the ATO/JFO who have been diagnosed with PTSD should be classified as persons with disabilities due to certain limitations in their life activities, namely, the inability to control their behavior, and difficulties in work and communication. This study proves that cognitive-behavioral psychotherapy has a clear advantage in overcoming PTSD in the military, as it allows transforming psychological trauma into posttraumatic growth. Attachment and acceptance therapy, a form of behavioral therapy, has emerged as one of the most effective treatments for PTSD. It focuses on diagnosing and addressing the psychological consequences of war by analyzing the connections among cognition, affect, and behavior. Given the protracted nature of PTSD, the practical significance of the study is to develop effective psychotherapeutic interventions for the expected recovery of ATO/JFO participants affected by combat operations.

Impact of Joint Laxity on 2-Year KOOS Outcomes of Posterior Stabilized Total Knee Arthroplasty.

The objective of this study was to determine relationships between intraoperative posterior cruciate ligament (PCL) sacrificing posterior stabilized (PS) total knee arthroplasty (TKA) laxity measurements throughout flexion and patient outcomes at 2 years post-TKA and to define clinically relevant laxity thresholds to optimize patient outcomes.In a single-surgeon study, PCL sacrificing TKA using a robotics-assisted platform with a digital joint tensioning device was performed in 115 knees in 115 patients. Final intraoperative joint laxity was recorded, and 2-year Knee Injury and Osteoarthritis Outcome Scores (KOOSs) were obtained. A Simulated Annealing optimization algorithm was used to identify medial and lateral laxity windows which maximized the 2-year KOOS pain score. Wilcoxon nonparametric tests were used to compare outcomes between groups.Significant associations were found between intraoperative joint laxity and 2-year KOOS pain outcomes throughout flexion. Clinically relevant laxity windows were defined medially and laterally in mid-flexion and flexion for improved outcomes, whereas only a lateral laxity window could be defined in extension. When all laxity windows were satisfied, a 14.5-KOOS point improvement was found (97.2 vs. 77.8, p = 0.0060) compared to knees which did not satisfy any window. Improvements in Activities of Daily Living (Δ8.8, p = 0.0143), Sports (Δ22.5, p = 0.0108), and Quality of Life (Δ18.7, p = 0.0011) KOOS subscores were also found in knees which satisfied all windows versus 0-1 window.Intraoperative joint laxity is associated with postoperative outcomes in a PS knee design, wherein patients balanced within identified laxity targets reported improved outcomes over those that did not. Clinically significant thresholds were defined and were predominately found in mid-flexion and flexion for medial and lateral laxity. When target windows were combined further improved outcomes were identified.