Baseline Measurements Research Articles

Vertebral fracture prevalence and risk factors for fracture in the Gambia, West Africa: the Gambian bone and muscle ageing study

Abstract There are limited data describing the epidemiology of vertebral fractures (VF) from resource-limited settings, where the ageing population is growing most rapidly. We aimed to determine the prevalence, incidence, and risk factors for VF in The Gambia, West Africa. The Gambian Bone and Muscle Ageing Study is a prospective observational study in men and women aged 40 years and over. Rural participants had baseline measurements and plasma samples collected and were followed up 6-8 years later; urban participants had a single measurement. DXA scans were obtained to assess areal bone mineral density (aBMD), body composition and VF. Prevalence and incidence were calculated. Risk factors for prevalent and incident fracture were tested using logistic regression, in men and women separately, with and without adjustment for age and BMI. At baseline, 581 individuals (298 women) had useable scans, 214 (127 women) at follow-up. Prevalence of VF was 14.8%. Those with VF were older (65.6(11.2) vs 61.7(12.3) years, P=.01) and had lower aBMD Z-scores. For example, in women, a 1SD increase in femoral neck Z-score resulted in a lower risk of having a prevalent VF (OR [95% CI]) 0.51 [0.38, 0.73]. In men, lumbar spine Z-scores were predictive of prevalent fracture; (0.71 [0.53, 0.97]). The incidence of VF over follow-up was 12.1%. Low BMD and grip strength were associated with the odds of having an incident VF. Given the importance of prevalent VF in predicting future VF and other fragility fractures in other populations, our findings are a major cause for concern. VF prevalence in Gambian older adults is similar to elsewhere despite fractures not being a perceived issue. Risk factors were like those identified elsewhere including age, aBMD and bone resorption. Understanding the impact of these fractures is important in a region where health of the ageing population needs to be prioritized.

Research on physical health assessment and intervention strategies for college students based on biomarkers

Effective physical health assessments and intervention strategies are crucial for college students, who often face unique stressors that can impact their physiological health. In this analysis, we explore how biomarkers can be utilized to assess physical health and the efficacy of targeted interventions for this demographic. Hypotheses were developed based on the three intervention groups: (1) a face-to-face intervention group receiving a tailored wellness program, (2) an Internet of Things (IoT) gadgets intervention group using a health management assessment, and (3) a control group with only baseline and follow-up measurements. College students (n = 204) were randomized into these groups. Biomarkers related to stress and inflammation (e.g., cortisol levels, high-sensitivity C-reactive protein (hs-CRP)) were measured at baseline, post-intervention (10 weeks), and follow-up (36 weeks). Psychological and physical health outcomes were also assessed using standardized questionnaires. The Mixed-Effects Models, ANOVA, and Structural Equation Modeling (SEM) were used to analyze the differences between groups, changes in biomarkers over time, and the relationships between psychological, physiological, and lifestyle variables. Results indicated that the face-to-face wellness group demonstrated significantly better physical health outcomes compared to both the IoT gadgets group and control group, with diet modification showing the highest effectiveness, followed by physical activity and stress management interventions.

Photo-supported conversations about well-being (BeWellTM) for patients with exhaustion disorders – a controlled clinical intervention study

Introduction Health-promotion approaches to address stress-related exhaustion disorders, reduce personal suffering, improve coping and participation in everyday life are needed in primary care. The aim of this study was to investigate self-reported health and well-being before and after an intervention focusing on well-being with photo-supported conversations (BeWellTM). Material and methods Eighty-one patients (69 women), 20–67 years old, with exhaustion disorders were recruited at Swedish primary health care centres (PHCC) to a controlled clinical study. The intervention group (n = 40) were offered BeWell™ by therapists in addition to care as usual. Controls (n = 41) received only care as usual. The primary outcome, self-rated symptoms of exhaustion (Karolinska exhaustion disorder scale, KEDS), and secondary outcomes, anxiety and depression, sense of coherence, quality of life, occupational balance, and work ability, were assessed by validated questionnaires. Non-parametric statistical analyses were used to compare data collected directly after the treatment period with baseline measures. Results Demographics and self-rated baseline measures of health and well-being were comparable between the groups, apart from sick leave being more common in the intervention group. Participants in the intervention group reduced their level of exhaustion more than the control group (median difference on KEDS −9.0 vs −4.0, p = .035). However, the size of the KEDS reduction was related to baseline KEDS and, not independently associated with group assignment. Both groups improved regarding secondary outcome measures. Conclusion Stress-related symptoms decreased considerably over the treatment period for both groups. The potential benefit of the BeWell™, which was intended to facilitate recovery, needs to be further evaluated.

Effects of various laser applications on surface roughness and bond strength to veneering composites of polyether ether ketone (PEEK) and polyether ketone ketone (PEKK) materials.

The aim of this study was to investigate the bond strength between PEEK/PEKK and composite resins after various laser treatments and to compare the effectiveness of lasers on these polymers. 130 disc-shaped PEEK and PEKK blocks were obtained (10mm diameter-4mm height). One sample from each group (10 in total) was selected for scanning electron microscopy (SEM) analysis. The samples were randomly divided into 5 different surface treatment groups for each material (PEEK and PEKK): Er: YAG laser, Nd: YAG laser, diode laser, femtosecond laser and control (no surface treatment) (n = 12). Baseline and post-treatment surface roughness measurements were performed using a profilometer. The composite resin was bonded and SBS was measured. Comparisons among the groups were conducted via Kruskal-Wallis, one-way ANOVA; Tukey and Dunn tests were used as a post hoc test (p ≤ 0.05). All lasers significantly increased the roughness values of the PEEK and PEKK samples. In terms of shear bond strength; the Er: YAG and femtosecond laser groups had the highest values and the Nd: YAG, diode and control groups had the lowest values of the PEEK samples (p ≤ 0.05). The control group had the highest bond strength values and the femtosecond group had the lowest values for PEKK samples (p ≤ 0.05). All laser treatments increased the surface roughness of the PEEK and PEKK. Lasers increased the bond strength of PEEK to the veneering composite resin and decreased the bond strength values of PEKK. This shows that lasers behave differently in PEEK and PEKK materials.

Combined effects of high-intensity focused electromagnetic therapy and pelvic floor exercises on pelvic floor muscles and sexual function in postmenopausal women. A randomized controlled trial.

This study aimed to explore the impact of high-intensity focused electromagnetic therapy (HIFEMT) on the pelvic floor muscles (PFM), sexual function, and quality of life (QoL) among postmenopausal women. Fifty postmenopausal women with PFM weakness and sexual dysfunction were randomly allocated into two equal groups. The HIFEMT group participated in the PFM training program in addition to HIFEMT, whereas the control group performed PFM training only. For 12 weeks, HIFEMT was scheduled two times a week, while PFM training was performed daily. At baseline and after 12 weeks, PFM strength and endurance were assessed using a perineometer and sexual function was examined using the female sexual function index (FSFI) and menopause-specific quality of life questionnaire (MENQOL). The HIFEMT and control groups showed significant increases in PFM strength and endurance and FSFI scores, and significant declines in MENQOL compared with baseline measures (P<0.05). Compared to the control group, the HIFEMT group showed substantial improvements in all measured variables after 12 weeks (P<0.05). Addition of HIFEMT to PFM training improved the PFM strength, endurance, sexual function, and QoL in postmenopausal women with PFM weakness and sexual dysfunction.

Changes in Acromiohumeral Distance With Clinician-Applied and Self-Applied Inferior Glenohumeral Joint Mobilizations Measured Using Ultrasound Imaging

OBJECTIVE: To measure the change in acromiohumeral distance during clinician-applied and self-applied manual shoulder joint mobilization. We hypothesized that the acromiohumeral distance would be significantly greater with clinician-applied manual joint mobilizations (MJM) than with self-applied joint mobilization. DESIGN: Within-subject, repeated measures design METHODS: Nineteen healthy adults (mean age: 22.9 ± 1.2 years) participated. A traction force of 15% body weight was applied during MJM and self-applied joint mobilization (SJM). Acromiohumeral distance was measured via ultrasound imaging at rest (baseline) and during the two test conditions (2 trials each) to quantify inferior accessory motion. The transducer was placed at the anterolateral border of the acromion and the subacromial space was clearly visualized for acromiohumeral distance measurements. RESULTS: The ICC for acromiohumeral distance measurements ranged from 0.876 to 0.963. Changes in acromiohumeral distance during MJM (3.90 ± 0.51mm) were significantly greater than SJM (1.68 ± 0.49mm, p&lt;0.001). AHD changes between sexes: MJM (female: 3.16 ± 0.58mm, male: 5.15 ± 0.90mm, p=0.060); SJM (female: 0.88 ± 0.51 mm, male 3.05 ± 0.90mm, p=0.029). CONCLUSIONS: Our acromiohumeral distance measurement methodology had excellent test-retest reliability. There was significantly more inferior humeral accessory motion with MJM than SJM. The acromiohumeral distance was 132% greater during MJM and was unchanged or less than resting baseline measurements in almost a third of participants during SJM.

Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial.

As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times（T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy.

Optical and retinal changes influenced by different lighting conditions

Retinal morphology, specifically in its curvature, and ocular aberrations change when the eye adapts to different lighting conditions, including photopic, scotopic, mesopic, blue light, and red light. Sixty healthy young subjects with refractive error less than ±4.00D of sphere and 3.00D of cylinder, not suffering from accommodative problems, ocular or systemic pathology, and not having used electronic devices half an hour before or having taken substances that alter the retina during the 2 hours prior to the study were included. The subjects adapted to five lighting conditions, each for 5 minutes, in a controlled environment. Ocular aberrometry and Optical Coherence Tomography (OCT) were taken to capture images of the central and peripheral retina before (baseline measurement) and after adaptation to each lighting condition. The OCT images were exported and processed to analyze retinal curvature, obtaining parameters such as eccentricity, asphericity and shape factor. The results showed that the shape of the retina is hyperbolic prolate, becoming flatter in scotopic and blue light conditions, and more curved in mesopic conditions. Retinal curvature was closest to baseline under red light and photopic conditions. Aberrometric differences, particularly in the C(2,0) polynomial for defocus, showed higher values in mesopic, baseline, and scotopic conditions, and lower values in photopic, blue light, and red light. Significant differences were also observed in spherical aberrations C(4,0) and C(6,0), vertical coma C(3,-1), and trefoil C(3,-3). The spherical equivalent indicated more myopic values in mesopic, baseline, and scotopic conditions, and more hyperopic values in blue, photopic, and red light, suggesting a link between myopia and lower luminosity. The study concludes that illumination affects retinal curvature and ocular refraction, influencing myopia.

Longitudinal Magnetic Resonance Imaging in Asymptomatic C9orf72 Mutation Carriers Distinguishes Phenoconverters to Amyotrophic Lateral Sclerosis or Amyotrophic Lateral Sclerosis With Frontotemporal Dementia.

We prospectively studied asymptomatic C9orf72 mutation carriers, identifying those developing amyotrophic lateral sclerosis (ALS) or frontotemporal dementia (FTD). We enrolled 56 asymptomatic family members (AFM) with a C9orf72 mutation (AFM C9+), 132 non-carriers (AFM C9-), and 359 population-based controls. Using 3 T magnetic resonance imaging, we measured cortical thickness, gyrification, and subcortical volumes longitudinally. Linear mixed-effects models on non-converting AFM C9+ scans (n = 107) created a reference for these measurements, establishing individual atrophy patterns. Atrophy patterns from presymptomatic phenoconverters (n = 10 scans) served as a template for group comparisons and similarity assessments. Similarity with phenoconverters was quantified using Dice similarity coefficient (DSC) for cortical and Kullback-Leibler similarity (KLS) for subcortical measures. Using longitudinal similarity assessments, we predicted when participants would reach the average similarity level of phenoconverters at their first post-onset scan. Five AFM C9+ converted to ALS or ALS-FTD. Up to 6 years before symptoms, these phenoconverters exhibited significant atrophy in frontal, temporal, parietal, and cingulate cortex, along with smaller thalamus, hippocampus, and amygdala compared to other AFM C9+. Some non-converted AFM C9+ had high DSC and KLS, approaching values of phenoconverters, whereas others, along with AFM C9- and controls, had lower values. At age 80, we predicted 27.9% (95% confidence interval, 13.2-40.1%) of AFM C9+ and no AFM C9- would reach the same DSC as phenoconverters. Distinctive atrophy patterns are visible years before symptom onset on presymptomatic scans of phenoconverters. Combining baseline and follow-up similarity measures may serve as a promising imaging biomarker for identifying those at risk of ALS or ALS-FTD. ANN NEUROL 2024.

Effect of virtual reality video application on fistula puncture-associated pain in patients undergoing hemodialysis: Assessor-blinded randomized trial.

To elucidate the effect of virtual reality video application on fistula puncture-associated pain in patients undergoing hemodialysis. Attention controlled and assessor-blinded randomized trial. Attention controlled and assessor-blinded randomized trial was conducted 28 patients at the hemodialysis center of City Hospital. The patients in the intervention group (n = 14) participated in 12 hemodialysis sessions with virtual reality video application under the researcher's supervision. The patients in the control group (n = 14) received a 6-min training session on diet compliance. The Sociodemographic Form and Visual Analog Scale were used to collect data in person at various time points: baseline (t0), during the 1st to 12th hemodialysis sessions (t1-t12), and 1 week after implementation (t13). Virtual reality video application helped in effectively decreasing pain over time, as revealed by significant differences in the measurements at t1-t12 and t13 (p < 0.05). Time-based variations in within-group differences revealed that the median fistula puncture-associated pain values were significantly higher at baseline and t13 measurements in the intervention group (p < 0.05). In contrast, no significant differences were observed in the median fistula puncture-associated pain values in the control group (p < 0.05). In patients undergoing hemodialysis, the application of virtual reality helps decrease fistula puncture-associated pain values. Advances in technology, particularly virtual reality, may play a vital role in shaping the future of healthcare.

Dynamic Narrowing of the Diaphragmatic Vena Cava in Ovis aries.

Dorset sheep (Ovis aries) are common models in translational cardiovascular research due to physiologic and anatomic similarities to humans. While employing ovine subjects to study single-ventricle physiology, we repeatedly observed position-based changes in central venous pressure (CVP) which could not be explained by hydrostatic (gravitational) effects. Inferior vena cava (IVC) narrowing or compression has been demonstrated in numerous species, and we hypothesised that this phenomenon might explain our observations in O. aries. This study aimed to characterise position-dependent morphology of the IVC in O. aries using catheter-based hemodynamic and dimensional measurements, three-dimensional MRI reconstruction and histological analysis. Baseline measurements revealed a significant reduction in IVC dimensions at the level of the diaphragm (dVC) compared to the abdominal vena cava (aVC) and thoracic vena cava (tVC). We also observed a transdiaphragmatic pressure gradient along the IVC, with higher pressures in the aVC compared to the tVC. We found that variation of position and fluid status altered IVC haemodynamics. Histological data showed variable muscularity along the length of the IVC, with greater smooth muscle content in the aVC than the tVC. These findings will improve understanding of baseline ovine physiology, help refine experimental protocols and facilitate the translation of findings to the clinic.

Reduction of Noise Levels During Caesarean Births Through Audiovisual Feedback is Associated With Lower Stress Levels for Patients.

Noise reduction during surgical procedures leads to improved surgical performance and results. The caesarean birth (CB) is an exceptional operation and a life changing experience. Through the introduction of staff education and implementation of audiovisual feedback, we intended to reduce noise, and subsequently reduce surgical complications and increase the well-being of patients and staff. During Phase I, blinded baseline measurements of noise were conducted. Phase II started after staff education and structured questionnaires on subjective noise and stress were added, and in Phase III audiovisual feedback was introduced. Mean and peak noise levels over the time of the procedure were obtained in A-weighted decibels (dB(A)). Kruskal-Wallis H tests were performed to evaluate the impact of interventions on noise levels. Questionnaires were evaluated using descriptive statistics; stress-scores were compared using independent sample t-tests. Ninety planned CBs were included. Median noise levels were 62.85 dB(A) at baseline. They decreased significantly to 60.60 dB(A) (Phase II) and 59.25 dB(A) (Phase III), respectively. This reduction of 3.6 dB(A) leads to a subjective noise reduction of around 20%. Significant differences for A-weighted and peak noise levels during actual surgery were found after combining staff education with audiovisual feedback. In Phase III, staff reported less stressful noise. Stress also decreased significantly in the patient group. Beeping machines and telephones were identified as the most stressful sources of noise. We show that noise reduction during CB is both necessary and possible. Diminished subjective perception of noise and stress are positive impacts of this intervention. Staff education and audiovisual feedback can help to provide a calm and lower stress environment for patients and staff during caesarean births.

Diminished negative emotion regulation through affect labeling and reappraisal: insights from functional near infrared spectroscopy on lateral prefrontal cortex activation

BackgroundReappraisal, an emotion regulation strategy, includes reinterpretation and affect labeling involving verbalizing emotions. In general, reappraisal is supported by lateral prefrontal cortical regions, which are also known to underlie cognitive regulation. Other research has shown that affect labeling combined with reappraisal of negative emotions increases lateral prefrontal cortex activity more than reappraisal alone does, suggesting that affect labeling facilitates emotional regulation. However, the influence of affect labeling on the efficacy of reappraisal in reducing subjective negative emotions has not been determined.MethodsIn the experiment, 35 participants (mean age = 28.2 years (SD = 9.63); 12 women and 23 men) viewed vignettes that aroused negative emotion. Then, they rated subjective negative emotions as baseline values. Following the baseline rating, the task branched into four conditions, combining affect labeling and emotion regulation factors. In the affect-labeling factor, participants selected emotional labels consistent with their own emotions or not. Regarding the emotion regulation factor, participants engaged in reappraisal to regulate their negative emotions. Throughout the experiment, the intensity of negative emotions was measured three times, mirroring the baseline measurement. Oxyhemoglobin (OxyHb) signal values in prefrontal cortex regions during tasks were measured by functional near-infrared spectroscopy.ResultsDifferences between the subjective negative emotion ratings at baseline and after reappraisal indicated that reappraisal significantly reduced negative emotion with and without affect labeling (t (1173.05) = 29.97, p < 0.001), and the combination of affect labeling and reappraisal was less effective in regulating negative emotions at the subjective level than reappraisal without affect labeling (t (1172.03) = 3.15, p < 0.01). Additionally, there was an increase in OxyHb signal in the bilateral dorsolateral prefrontal and right ventral prefrontal cortices while participants performed reappraisal with affect labeling.ConclusionOur findings suggest that affect labeling, when performed prior to cognitive reappraisal, may influence the process of negative emotion regulation in complex ways. The interaction between affect labeling and reappraisal appears to modulate prefrontal cortex activity, potentially reflecting changes in cognitive processing during emotion regulation attempts. These results highlight the need for further investigation into the intricate relationship between different emotion regulation strategies.

Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial

Background: Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum’s role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Methods: Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the pre- and post-intervention outcome measures were documented. Results: After 4 weeks of treatment, both groups showed statistically significant (p &lt; 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. Conclusions: The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.

Mitigation of pacing-induced cardiomyopathy with superficial right ventricular mid-septal pacing: A long-term retrospective comparison with apical pacing.

It remains unclear if pacing induced cardiomyopathy (PICM) may be minimized by standard pacing of the right ventricle (RV) at sites other than the RV apex. The purpose of this study is to compare the relative frequency of PICM in a population of patients paced at either the superficial RV mid septum (RVMS) or RV apex (RVA), and other outcomes that may differ between these sites. A retrospective evaluation was performed on all patients undergoing pacemaker implantation between 2011 and 2022. Potential study patients were those with Medtronic 3830 superficial RVMS leads placed with septal specific guidance catheters, and any with RVA leads. Patients were included if they had ≥20% RV pacing, available baseline and follow-up measurements of left ventricular ejection fraction (LVEF) at least 6 months postimplantation, and a baseline LVEF ≥50%. PICM was defined as a decline in the LVEF of at least 10%, resulting in LVEF <50%. Patients were excluded for Biventricular devices, and for alternative causes of cardiomyopathy. The study criteria were met in 324 patients, with 220 RVMS and 104 RVA paced patients. PICM occurred in 4.5% of RVMS patients, and 22.1% of RVA patients (p < .001). Additional differences were demonstrated in paced QRS duration (144 ± 15.5 ms in RVMS, 166 ± 19.4 ms in RVA; p < .001); QRS axis (2.3 ± 64.9 in RVMS, -65.2 ± 49.5 in RVA; p < .001), and various qualitative QRS morphologic characteristics. Patients with normal LVEF experienced significantly less PICM with superficial RVMS pacing performed via septal specific guidance catheters than similar counterparts with RVA pacing. Narrower paced QRS duration and less left axis deviation was also demonstrated.

ENHANCING ELS STUDENTS’ LANGUAGE PROFICIENCY THROUGH SPACED REPETITION

In language learning, the method of spaced repetition has gained significant importance. It is undoubtedly a learning technique that can greatly enhance students' vocabulary and grammar acquisition. Spaced repetition allows to improve students' long-term retention of the language content they study enhancing language learning through active engagement, repetition, and visual aids. The effectiveness of spaced repetition as a method of improving English language acquisition was investigated by the authors of the paper. The participants of the research were students at the National Technical University of Ukraine "Igor Sikorsky Kyiv Polytechnic Institute." The experiment involved 76 students, who were divided into two groups: an experimental group and a control group. The experimental group applied spaced repetition to their vocabulary and grammar learning, while the control group continued their studies according to the traditional syllabus without the use of spaced repetition. To assess the impact of spaced repetition, both groups took the same test before and after the experiment. The pre-test served to establish a baseline measurement of each student's vocabulary and grammar proficiency, allowing for a direct comparison of progress made during the study. The post-test, conducted at the end of the experiment, aimed to evaluate the effectiveness of the spaced repetition method by measuring any improvements in language skills. Data was collected through a combination of online surveys and a Likert scale questionnaire. The results demonstrated that the majority of students in the experimental group, who consistently used spaced repetition, reported significant improvements in their language skills, as evidenced by higher scores on the post-experiment test. In contrast, the control group showed less pronounced progress, highlighting the added value of spaced repetition in language learning. The findings underline the versatility and effectiveness of spaced repetition, especially when integrated into the daily learning process. This method not only proved its effectiveness for memorization but also enhanced the practical application of language skills, leading to more confident and accurate communication in English. Additionally, students in the experimental group reported positive impacts on their motivation and time management, further supporting the potential of spaced repetition as a powerful tool for language education across various linguistic fields.

Clinical efficacy and mechanism of the combination of autologous platelet-rich gel and recombinant human acidic fibroblast growth factor in the management of refractory diabetic foot

ObjectiveThis study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment.MethodsNinety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment.ResultsFollowing treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P&amp;lt; 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P&amp;lt; 0.05).ConclusionsThe integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF.

Respiratory Oscillometry in Patients With Acute Hypoxemic Respiratory Failure: A Feasibility Study.

Assessing respiratory mechanics in patients with acute hypoxemic respiratory failure who are not intubated could provide useful information about illness trajectory. Oscillometry is a respiratory function test used to measure total respiratory impedance during tidal breathing, which reveals resistive and elastic properties of the lung. This study assessed the feasibility of oscillometry in patients with acute hypoxemic respiratory failure and described their respiratory mechanics. Adult participants with acute hypoxemic respiratory failure who were receiving noninvasive respiratory support with [Formula: see text] ≥0.4 and flow ≥6 L/min underwent oscillometry at baseline and after resolution of acute hypoxemic respiratory failure. The primary end point was the number of participants who completed the baseline measurement. The feasibility criterion was in obtaining baseline oscillometry measurements in ≥80% of enrolled participants. Of 183 patients screened between July 2022 and August 2023, 29% were unable to cooperate due to altered mental state, 20% with extreme hypoxemia were excluded because of clinical instability, and 12% declined participation. Of the 10 participants (5.4%) recruited, all tolerated oscillometry measurements. At baseline, the median (minimum, maximum) [Formula: see text] was 0.8 (0.4, 0.8), median oxygen saturation of 94% dropped to a nadir of 82% at the end of oscillometry and recovered within 2 min. Lung reactance was increased, with a reactance area of 25 (15-32) cm H2O/L. Hypoxemia resolved in 9 participants. After resolution of acute hypoxemic respiratory failure in 8 (6-16) d, the median reactance area dropped to 15 (14-19) cm H2O/L. Respiratory mechanics in the participants with acute hypoxemic respiratory failure who were not intubated could be assessed by oscillometry in carefully selected cases.

Enhancing real world data interoperability in healthcare: A methodological approach to laboratory unit harmonization

ObjectiveThe primary aim of this study is to address the critical issue of non-standardized units in clinical laboratory data, which poses significant challenges to data interoperability and secondary usage. Despite UCUM (Unified Code for Units of Measure) offering a unique representation for laboratory test units, nearly 60% of laboratory codes in healthcare organizations use non-standard units. We sought to design, implement and test a methodology for the harmonization of units to the UCUM standards across a large research network. MethodsUsing dimensional analysis and a curated equivalence table, the proposed methodology harmonizes disparate units to UCUM standards. The process focused on identifying and converting non-UCUM conforming units, with the goal of enhancing data comparability and interoperability across different systems. ResultsThe methodology successfully achieved over 90% coverage of laboratory data with units in UCUM standards across the TriNetX research network, a significant improvement from baseline measurements. This enhancement in unit standardization directly contributed to increased interoperability of laboratory data, facilitating more reliable and comparable data analysis across various healthcare organizations. ConclusionThe successful harmonization of laboratory data units to UCUM standards represents a significant advancement in the field of biomedical informatics. By demonstrating a practical and effective approach to overcoming the challenges of non-standardized units, our study contributes to the broader efforts to improve data interoperability and usability for secondary purposes such as research and observational studies. Future work will focus on addressing the remaining gaps in unit standardization and exploring the implications of this methodology on clinical outcomes and research capabilities.

Measuring laypeople’s notions of intersex in the Netherlands and Flanders

Abstract Introduction In emancipation policy, the ‘I’ is often added to the LGBTI+-acronym. Yet it is still unknown to what extent this term is known and understood by the general population, and what attitudes toward intersex (people) are. In the current study, we describe the construction and development of the Intersex Knowledge and Attitudes Scale (IKAS), as well as the results from this baseline measurement in the Dutch and Flemish population. Methods The IKAS was developed after a carefully documented stepped process of literature scan, expert consultations, and pretesting. A representative sample of 2,003 respondents (1,000 Dutch and 1,003 Flemish) participated in the study. To determine the dimensionality of the scale, we performed EFA and CFA with measurement invariance constraints. We also performed a baseline measurement of knowledge and attitudes towards intersex people in the general population, and determined predictors of attitudes toward intersex people in regression analyses. Results Two-thirds of the sample had no (correct) knowledge of the term intersex. Even among the intersex respondents, only one person was aware of the term intersex. The average attitude was moderately positive to neutral. Having a female gender or birth sex, an advanced level of education, lower importance of religion, belonging to a minority group, more tolerant gender beliefs, and preexisting knowledge on the topic all resulted in more positive attitudes. Conclusions Both in Flanders and the Netherlands there still is room for improvement in terms of knowledge and attitudes towards intersex people. More knowledge may lead to more understanding, so that intersex people can be more open. Second, it is recommended to challenge beliefs of sex and gender as binary categories, because people who have less issues with people who do not entirely fall in these categories, also have more accepting attitudes toward intersex people. Key messages • It is vital to include intersex in monitoring studies of population attitudes, to be able to genuinely incorporate the ‘I’ in LGBTI+ in emancipation policies. • To increase acceptance of intersex people in society, knowledge about intersex in the general population should be expanded, and acceptance of people who do not fit into the binary should be promoted.