Controlled Patients Research Articles

HealthLink: A Decentralized Health Data Management System using Merkle Tree-Based Approach

Abstract: Challenges with health data management in the healthcare industry include security, privacy, and interoperability. Most traditional centralized systems tend to be insecure, inefficient, and deprive the patient of considerable control over their personal health record. HealthLink introduces a decentralized approach to the management of health data employing a Merkle tree-based recovery of these issues. With the application of blockchain technology, HealthLink provides the immutability and security of data while allowing for its integrity. The Merkle tree-based architecture is used for health record verification in a way that is both efficient and secure without exhausting the dataset's content. This system makes it possible to have seamless interoperability among different healthcare providers, thus making health information exchange between them both secure and efficient. By allowing the patients control over their health data, access permissions are provided on demand, thus incorporating enhanced privacy and trust. This would thus place the HealthLink method at the forefront of health data management, providing a robust, secure, and user-centric solution that might be tailored to meet the needs of the healthcare sector as a means of improving patient care and also reducing the efficiency in managing data

Temporal Changes in Faecal Microbiota Composition and Diversity in Dairy Cows Supplemented with a Lactobacillus-Based Direct-Fed Microbial

The rumen microbiota of dairy cows plays a crucial role in fermenting fibrous material, essential for nutrient extraction and overall productivity, detoxification of anti-nutritional toxic compounds, synthesis of vital nutrients, and is essential for optimal animal health. This study investigated the impact of Lentilactobacillus-, Lactocaseibacillus-, and Lacticaseibacillus-based direct-fed microbial (DFM) supplementation on dairy cows’ faecal microbial composition and diversity. The study was carried out on a commercial dairy farm using 50 Holstein-Friesian cows randomly assigned into control (CON) and treatment (TRT) groups. Faecal samples were collected directly from the rectum every two months from September 2021 to January 2023. The bacterial 16S rRNA gene and fungal ITS-1 regions were amplified, sequenced, and analysed. Microbial diversity was assessed through alpha- and beta-diversity metrics. Linear discriminant analysis effect size (LEfSe) was performed to identify which taxa were driving the changes seen in the microbiota over time and treatment. Bacteroidaceae were the most prevalent bacterial family, followed by Lachnospiraceae and Muribaculaceae in both CON and TRT cows. Ascomycota, Basidiomycota, and Mucoromycota were the dominant three fungal phyla in the faeces of both CON and TRT cows. Bacterial genera Fructilactobacillus was abundant in the CON and Absicoccus in the TRT groups. Fungal taxa Chaetothryriales_incertae_sedis and Pseudomentella were absent in the faeces of TRT cows. Significant temporal and specific taxonomic differences were observed between the CON and TRT groups. The study’s findings underscore the dynamic nature of microbial communities and the importance of targeted dietary interventions. Further research is necessary to elucidate these microbial shifts, long-term impacts, and functional implications, aiming to optimise ruminant nutrition and enhance dairy cow performance.

Modulation on Surface Termination Groups to Optimize the Adsorption Energy and Work Function of Nb2CTx for Enhanced Hydrogen Storage in Magnesium Hydride

AbstractExploring high‐performance catalysts for hydrogen storage in magnesium hydride (MgH2) is crucial but still a challenge. Herein, Nb2CTx with controllable surface termination groups is developed as an efficient catalyst and the bifunctional modulation (adsorption energy and work function) of different surface termination groups (F, O, OH, or defects) is explored. First, compared to F and O, the introduction of OH on the surface or the direct removal of functional groups both leads to a significant increase in the adsorption of H by Nb2CTx. Second, compared to the surface bare, OH‐rich Nb2CTx has a lower work function, making it easier for hydrogen to enter Mg/MgH2 from the Nb2CTx surface or escape from the Mg/MgH2 surface into the Nb2CTx, thus facilitating the hydrogen ad/desorption properties of MgH2, i.e., the rate‐determining step (RDS) shifts from penetration to diffusion. The Nb2CTx‐KOH‐catalyzed MgH2 with optimal surface termination groups, therefore exhibits a release of 6.56 wt.% H2 in 5 min at 250 °C, and 6.46 wt.% H2 uptake within 5 min at 150 °C. The dehydrogenation and hydrogen uptake activation energies show 49.5% and 60.1% enhancements over pristine MgH2. In addition, a storage capacity of 5.51 wt.% is maintained after 50 dehydrogenation/hydrogenation cycles.

The Lithuanian Soviet Nomenclature as an Object and Subject of Control

The topic of nomenclature in the context of research on the Soviet period is usually associated with the power and influence exerted by a single group in society. While assessing the evolution of the post-Stalin system, the role of a separate ruling stratum rather than that of an individual leader becomes more apparent. Many studies hesitate to call the post-Stalin system totalitarian and secretary-generals of the Communist Party as unilateral leaders. In individual studies, nomenclature, particularly top ranking, is clearly perceived as an acting and influencing subject, capable of subjecting system resources to its articulated aims. However, the discussion of the role of Lithuanian nomenclature as a certain peripheral elite and its relationship with the system shows that it is impossible to treat it only as an acting subject. The interests and management style of the central government determined greater or lesser control of the Soviet republics. So it is interesting to consider which situations would define the Lithuanian Soviet nomenclature itself as an object of control, and in which areas it could express its own interests and be activity. The Soviet institutional environment was saturated with control. Control measures were designed not only to control processes in society; they were also applied to the system of nomenclature itself by applying hierarchical control principles both to the governing political party and lower executive ranks. Information was collected about ideological compliance and participation in the execution of plans. Transgressions recognised to be ideological were assessed most strictly. The tools of control were diverse: in addition to control bodies (people’s control, GLAVLIT, KGB) Communist party structures and ministries had their own divisions responsible for control of the activities of a particular area and even the suitability of people. In addition to routine planned activity, individual influential officials carried out controlling functions and exposed ad hoc cases. It can be stated that the system was essentially saturated with control activities – the same area was controlled by at least 3-4 levels different levels of officials and this obviously stifled the dynamics of any activity. In the late Soviet period, locality as a factor of social environment can be clearly distinguished whereby local representatives of the nomenclature would often reduce the effect of control by replacing the object ‘what and how to control’ with the consensus of higher ranking officials of the nomenclature regarding the areas and leaders to be controlled and possible consequences of control (including penalties for members of the Communist Party). This model complemented institutional regulation and was applied not only to ensure control inside a republic but also in relation to the supervision carried out by the centre. The government of the republic frequently faced hostility from some leaders controlling the manufacturing industry, but except for one incident, it managed to ‘localise’ both local and arriving leaders, thereby creating a certain closed social network of members of the nomenclature of the republic and simultaneously opening more opportunities for higher ranking officials of Lithuanian nomenclature to express their personal interests, assess the situation subjectively, and act in the area of control as a subject rather than an object. The social network of members of the nomenclature of the republic rather actively and using various measures sought to isolate their own circle therefore ensuring not only the integrity of the circle, but also control of the space subordinate to it, while at the same time maintaining good relations with the centre. The top ranking officials of the republic were very keen to maintain the stability of this network and their primary goal was to preserve the routine of governing, given that this status quo was in line with Brezhnev’s governing style.

Use of ambulatory blood pressure monitoring in hypertensive patient to monitor blood pressure control

To use ambulatory blood pressure monitoring in hypertensive patient for better control of their blood pressure. This was a single centre, observational study that included hypertensive patients who visited the out-patient department of tertiary care hospital Nepal. The study was carried out from June, 2021 to June, 2023. All the patients were assessed through ambulatory blood pressure monitoring machine for 24 hours. Total 259 patient were studied with ambulatory 24 hours blood pressure monitoring. Average age was 44.82±13.67 years. 30 to 50 age group was the maximum user of ABPM (41%) 20 patient in this study were ≥65years of age. 58 % patients were males and 42% were female. All the patient undergoing ABPM were hypertensive. Mean of 24 hours systolic BP was 129.69 ± 12.86 mmHg and diastolic BP was 81.91±9.2 mmHg, awake systolic BP was 134.5 ± 12.5 mmHg and diastolic BP was 86.32±9.44 mmHg, asleep systolic BP was 121± 15.1 mmHg and diastolic BP was 74.46±10.38 mmHg. Only 28 (10.8%) patient of 259 had normal mean daytime blood pressure while 21 patient 8.1% had elevated BP and 210 patient 81.1% had hypertension as per AHA/ACC 2017 classification. Of total hypertensive 210 patient 84% had grade 2 hypertension and 16% had grade 1 hypertension requiring intensification of medication to control blood pressure in majority of the patient. Most of the patient treated with hypertension had inadequate control as seen on ambulatory blood pressure monitoring. ABPM should be utilized in every hypertensive patient to monitor the adequate control of BP.

Management of diverse smart homes: Coordination among controllable loads, EVs, and PVs

Growing energy demand, driven by urbanization, transportation electrification, and smart home devices, highlights the significance of residential electricity consumption. However, controllable loads, including HVAC systems, water heaters, electric vehicles (EVs), and industrial processes, can be managed to balance electricity supply and demand. Therefore, this study addresses the escalating energy demand in residential buildings including the integration of electric vehicles (EVs) and renewable energy technologies. It focuses on controllable loads, which offer flexibility that can be managed to balance supply and demand through demand response programs. First, the controllable loads are categorized as HVAC (air conditioners, electric heaters, and electric heat pumps), uninterruptable (washing machines, dishwashers, and electric cookers), interruptible (water heater), and EVs. Then, this study proposes a detailed clustering approach for homes, categorizing them into six clusters to capture diverse consumption patterns, including scenarios such as work-from-home setups. The analysis includes examining the adaptability of these home clusters and controllable load groups under different EV charging levels (level 1 and level 2) and coordinating them with PV systems. The study evaluates the coordination of each controllable load group with EVs and PVs, aiming to optimize overall energy usage and enhance renewable resource integration. Parameters such as energy management, operation of controllable equipment, and indoor temperature are analyzed to provide insights for homeowners and policymakers to make informed decisions about load management and energy resource utilization in residential settings. Simulation results show that with level 1 chargers, type 2 homes achieve higher average EV avoidance (81.94 %) and lower PV consumption (31.22 %), while with level 2 chargers, all homes reach 100 % EV avoidance.

Digoxin Loading Doses and Serum Digoxin Concentrations for Rate Control of Atrial Arrhythmias in Critically Ill Patients.

Intravenous (IV) digoxin loading dose recommendations for rate control of atrial arrhythmias in critically ill patients are not well studied. When using digoxin in the setting of atrial fibrillation/atrial flutter (AF/AFL), a loading dose (LD) in either a fixed-dose regimen, weight-based dose, or pharmacokinetic-based calculation to target a serum digoxin concentration (SDC) of 0.8-1.5 ng/mL is recommended. The objective of this study was to assess the safety and effectiveness of digoxin LD used in critically ill patients for rate control of AF/AFL and to assess the SDC achieved. This single center retrospective cohort study included patients who received IV digoxin and had a SDC drawn. The primary endpoint was the median SDC achieved after a digoxin LD. Secondary outcomes included the frequency of SDCs ≥1.5 ng/mL and heart rate (HR) control. A total of 92 patients were included. The median total LD of digoxin for the entire cohort was 11mcg/kg (750 mcg). For 61% of the cohort, the LD was distributed over six-hour intervals. The median SDC after completion of the IV digoxin LD was 1.3 ng/mL (0.9, 1.7). The incidence of supratherapeutic SDC was 36% for the total cohort. A target HR < 110 beats per minute within 24 hours from digoxin LD was achieved in 60% of the cohort. In conclusion, a median total digoxin LD of 750 mcg in critically ill patients with AF/AFL, targeting a SDC < 1.5ng/mL may be considered for acute rate control, taking into account drug-drug interactions in the cardiac intensive care unit. Future studies are necessary to confirm our findings.

Abstract 4122290: Association between SGLT2 inhibitors and risk of Dementia and Parkinson’s Disease: A Meta-analysis of 12 Randomized Controlled Trials.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated to reduce the risk of hospitalizations from heart failure and cardiovascular mortality. However, SGLT2i therapy’s potential effects on the risks of dementia and Parkinson’s disease are not well established, with conflicting results based on observational studies. Objective: We sought to evaluate the association between SGLT2i and the risk of dementia and Parkinson’s disease in patients with type 2 diabetes mellitus (T2DM), heart failure, or chronic kidney disease. Methods: We performed a systematic literature search on PubMed, Scopus, and Clinicaltrial.gov for relevant randomized controlled trials (RCTs) from inception until March 2024 without any language restrictions. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model. Results: A total of 12 RCTs with 74, 442 patients (40784 in the SGLT2i group and 33658 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control was 65.3 and 65.2 years respectively. The mean follow-up duration was 2.9 years. Pooled analysis showed that there is no significant association between SGLT2i and the risk of dementia (OR, 1.37 (95%CI: 0.70-2.69), P= 0.36, I2=0%), dementia Alzheimer’s type (OR, 2.62 (95%CI: 0.47-14.49), P= 0.27, I2=0), vascular dementia (OR, O.52 (95%CI: 0.09-2.98), P= 0.46, I2=0%), and Parkinson’s disease (OR, 0.75 (95%CI: 0.25-2.25), P= 0.61, I2=0%) was comparable between SGLT2i and control groups. Conclusion: Our study suggest that there is no significant association between SGLT2i and the risk of dementia, its subtypes, and Parkinson’s disease. Further large-power randomized trials are needed to strengthen the understanding of neuropsychiatric beneficial effects of SGLT2i.

EFFECT OF EXERCISE ON BURST FREQUENCY A MARKER OF SYMPATHETIC ACTIVITY IN HYPERTENSIVE INDIVIDUALS: A SYSTEMATIC REVIEW.

Background: Burst frequency is a factor that is used to know the relationship between sympathetic activity and blood pressure in individuals with hypertension. Various forms of exercise reduce the burst frequency among individuals with hypertension. This systematic review provides suggestion of exercise prescription for reducing blood pressure. Objective: To determine the effects of exercise training and its regulatory mechanisms on burst frequency (BF) a marker of muscle sympathetic nerve activity (MSNA) in hypertensive individuals. Methods: A systematic literature search of electronic databases such as PubMed, Web of Science and Scopus was conducted from inception to July 2024 included randomized controlled trials (RCTs), non-randomized experimental studies (non-RCTs) or pre-post experimental trials on hypertensive patients without associated metabolic disorders, with or without pharmacological treatment, aged between 18 and 70 years, both genders. Patients underwent at least 4 weeks of aerobic, resistance, or breathing exercises with BF as an outcome measure were included. The Revised Cochrane Risk of Bias tool (RoB 2) and Risk of Bias in Non-randomized Studies of Interventions tool (ROBINS-I) was used to evaluate the risk of bias. Results: Five trials were included. Four studies demonstrated a significant reduction in BF among exercise-trained hypertensive individuals, while one study reported no change in BF. Overall, two studies had "some concerns" about performance and attrition bias, one had "high RoB" for selection bias, one had “moderate RoB” due to expected confounding, and one had “serious RoB” due to uncontrolled confounding factors. Conclusion: These findings suggests that HIIT significantly reduces BF, while aerobic and breathing exercises offers lesser benefits, further research should focus on training dosages. Implications: It provides evidence to utilize tailored exercise programme that may reduce sympathetic overactivity in hypertensive patients for better blood pressure control and reduce cardiovascular risk.

Smartphone-Based Cognitive Behavioral Therapy and Customized Sound Therapy for Tinnitus: A Randomized Controlled Trial.

To evaluate the efficacy of a smartphone-based application providing tinnitus-specific cognitive behavioral therapy and customized sound therapy for tinnitus. In a prospective randomized controlled trial, the treatment group participated in daily sound therapy and weekly interactive CBT modules, and the control group did not receive the program (waitlisted). Outcome measures after 8 weeks included the Tinnitus Functional Index (TFI), Generalized Anxiety Disorder (GAD-7), Patient Health Questionnaire (PHQ-9), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Ninety-two patients (mean age = 57.2 ± 11.9 years) were included. The treatment (n = 47) and control (n = 45) cohorts had similar TFI, PHQ-9, GAD-7, PSS, and PSQI scores at presentation (all P > .05). Treatment-group patients had significantly higher improvements than controlled patients in their TFI (16.7 ± 14.9 vs 1.9 ± 10.8, P < .001), PHQ-9 (1.9 ± 4.2 vs -0.7 ± 3.4, P = .002), GAD-7 (1.1 ± 3.6 vs -0.9 ± 3.3, P = .009), and PSQI scores (2.5 ± 3.2 vs -1.1 ± 2.1, P < .001). Treatment-group subjects also significantly improved in 7 of the 8 TFI domains (all P < .05). TFI improvements of ≥20 occurred in 18 (38.3%) treatment subjects. Of the 9 treatment-group patients presenting with moderate-severe depression, 4 (44.4%) improved to minimal depression. Of the 4 treatment-group patients with moderate-severe anxiety, 2 (50.0%) improved to minimal anxiety. Of the 17 treatment-group patients with moderate-severe sleep difficulties, 10 (55.6%) had considerable sleep improvement. This novel smartphone application providing cognitive behavioral therapy and customized sound therapy was effective in reducing symptom severity and improving anxiety, sleep, and mood for tinnitus patients.

Asthma Control According to GINA 2023: Does Changing the Criteria Improve Asthma Control?

Background/Objectives: Achieving disease control is the main goal in asthmatic patients in order to prevent future risks and exacerbations. There are several clinical guidelines that set different definitions of asthma control, and these differences may affect management and treatment in many patients. Our aim was to describe asthma control patterns according to the Global Initiative for Asthma (GINA) 2023 in patients considered to have uncontrolled asthma as per previous GINA 2010 guidelines. Methods: A total of 1299 patients from the COAS study were analyzed. The COAS study was a cross-sectional multicenter study conducted in routine clinical practice that included patients with uncontrolled asthma according to GINA 2010. These patients were then re-classified using the now updated GINA 2023 asthma control criteria. Results: After applying GINA 2023 control criteria, previously uncontrolled patients were now classified as having controlled asthma in 24.3% of cases and partially controlled asthma in 16.3% of cases. Only 59.4% maintained their previous diagnosis of uncontrolled asthma. ACT in the uncontrolled patients remained similar after re-classification, as did the percentage of active smokers, respiratory allergy, rhinitis, and lung function. Conclusions: Changes in clinical guideline criteria affect the definition of asthma control. When excluding pulmonary function abnormalities in GINA 2023 asthma control criteria, the percentage of controlled patients greatly increased.

Patient and Family Engagement in Infection Prevention During the COVID-19 Pandemic: A Q-Methodology Study with Stakeholders from a Canadian University Health Care Center

BackgroundHealth care–associated infections are frequent complications for hospitalized patients, and the COVID-19 pandemic exacerbated this issue. This study aimed to explore stakeholders’ viewpoints on how patients and families should engage in preventing health care–associated infections in hospital settings. MethodsThe authors employed Q-methodology, a mixed methods approach combining by-person factor analysis with in-depth interviews to capture shared viewpoints among participants. The research was conducted in a university-affiliated adult transplant unit using a purposive sample of staff members, patients, and family members. Participants ranked 40 preselected statements on a tablet using the Q-sorTouch Web application (for example, “Staff members should check that patients and family members wash their hands at key moments”) on a continuum from “most agree” (+2) to “most disagree” (-2). Participants then took part in in-depth interviews to elaborate on their rankings. Data analysis included factor extraction and thematic interpretation. ResultsNineteen participants completed the study. Analysis revealed three distinct viewpoints on patient and family engagement in infection prevention and control: (1) a controlling approach in which health care professionals ensure patient and family compliance, (2) an enabling approach that supports shared responsibility and emphasizes autonomy, and (3) a view of patients and family members as vigilant partners. Seven consensus statements emerged, indicating agreement on strategies in which patients and families are passive rather than proactive. ConclusionAlthough a paternalistic model emphasizing health care professional oversight prevailed, alternative perspectives emerged advocating for greater autonomy and responsibility among patients and families. These differing opinions indicate ongoing debate about how best to involve patients and their families in infection control, particularly during periods of heightened risk.

Effect of fenofibrate on residual beta cell function in adults and adolescents with newly diagnosed type 1 diabetes: a randomised clinical trial.

Fenofibrate, a peroxisome proliferator-activated receptor alpha agonist, shows some promise in alleviating beta cell stress and preserving beta cell function in preclinical studies of type 1 diabetes. The aim of this phase 2, placebo-controlled, double-blinded, randomised clinical trial was to investigate the efficacy and safety of fenofibrate in adults and adolescents with newly diagnosed type 1 diabetes. We enrolled 58 individuals (aged 16 to 40 years old) with newly diagnosed type 1 diabetes and randomised them to daily oral treatment with fenofibrate 160 mg or placebo for 52 weeks (in a block design with a block size of 4, assigned in a 1:1 ratio). Our primary outcome was change in beta cell function after 52 weeks of treatment, assessed by AUC for C-peptide levels following a 2h mixed-meal tolerance test. Secondary outcomes included glycaemic control (assessed by HbA1c and continuous glucose monitoring), daily insulin use, and proinsulin/C-peptide (PI/C) ratio as a marker of beta cell stress. We assessed outcome measures before and after 4, 12, 26 and 52 weeks of treatment. Blinding was maintained for participants, their healthcare providers and all staff involved in handling outcome samples and assessment. The statistical analyses for the primary outcome included 56 participants (n=27 in the fenofibrate group, after two withdrawals, and n=29 in the placebo group). We found no significant differences between the groups in either 2h C-peptide levels (mean difference of 0.08 nmol/l [95% CI -0.05, 0.23]), insulin use or glycaemic control after 52 weeks of treatment. On the contrary, the fenofibrate group showed a higher PI/C ratio at week 52 compared with placebo (mean difference of 0.024 [95% CI 0.000, 0.048], p<0.05). Blood lipidome analysis revealed that fenofibrate repressed pathways involved in sphingolipid metabolism and signalling at week 52 compared with placebo. The 52 week intervention evoked few adverse events and no serious adverse events. Follow-up in vitro experiments in human pancreatic islets demonstrated a stress-inducing effect of fenofibrate. Contrary to the beneficial effects of fenofibrate found in preclinical studies, this longitudinal, randomised, placebo-controlled trial does not support the use of fenofibrate for preserving beta cell function in individuals with newly diagnosed type 1 diabetes. EudraCT number: 2019-004434-41 FUNDING: This study was funded by the Sehested Hansens Foundation.

Analysis of Rumor Propagation Model Based on Coupling Interaction Between Official Government and Media Websites

The COVID-19 pandemic has not only brought a virus to the public, but also spawned a large number of rumors. The Internet has made it very convenient for media websites to record and spread rumors, while the official government, as the subject of rumor control, can release rumor-refutation information to reduce the harm of rumors. Therefore, this study took into account information-carrying variables, such as media websites and official governments, and expanded the classic ISR rumor propagation model into a five-dimensional, two-level rumor propagation model that interacts between the main body layer and the information layer. Based on the constructed model, the mean field equation was obtained. Through mathematical analysis, the equilibrium point and the basic reproduction number of rumors were calculated. At the same time, stability analysis was conducted using the Routh Hurwitz stability criterion. Finally, a numerical simulation verified that when the basic regeneration number was less than 1, rumors disappeared in the system; when the basic regeneration number was greater than 1, rumors continued to exist in the system and rumors erupted. The executive power of the official government to dispel rumors, that is, the effectiveness of the government, played a decisive role in suppressing the spread of rumors.

Dexamethasone implantation causing iatrogenic lens injury: a review of literature with case series

Aims: In this study, three cases of iatrogenic lens injuries during Dexamethasone (DXM) implantation will be discussed and current approaches will be reviewed with the literature. Methods: Three patients with iatrogenic lens injury during DXM implantation were evaluated retrospectively. Results: The three patients underwent DXM implantation for cystoid macular edema with central retinal vein occlusion and one patient for EALES disease. The surgical intervention was performed in all three patients in conjunction with cataract surgery. Intraocular lens implanted into the sulcus in all patients. The DXM could be directed to the vitreous in two patients with intact anterior hyaloid, while the other patient underwent anterior vitrectomy and DXM explanation. Anti-vascular endothelial growth factor was injected in the patient who could not implant DXM. The lens was stable in all patients in postoperative controls. There was a decrease in macular thickness at follow-up. Conclusion: Dexamethasone implant is a slow-release tablet for macular edema due to retinal vein occlusion, diabetic retinopathy and non-infectious uveitis. Lens injury during dexamethasone implantation is a rare complication. In our series, the implant occluded the visual axis and most of it was in the lens, managed with cataract surgery. If possible, DXM should be directed to the vitreous, if not, treatment modalities should be specificized on a patient-by-patient basis.

Muscle ultrasound in Spondyloarthritis patients receiving biologic disease-modifying anti-rheumatic drugs early in treatment

Objective: This study evaluated muscle ultrasound in spondyloarthritis (SpA) patients receiving biologic disease-modifying anti-rheumatic drugs (b-DMARDs) early in treatment. Methods: A prospective study was conducted with 110 b-DMARD-naive SpA patients. The baseline and control muscle strength, physical performance tests, ultrasonographic muscle parameters, and disease activity scores of 67 controlled patients were examined. Results: During the follow-up period, there were significant improvements in the thickness of the gastrocnemius medialis (GM) muscle (p&lt;0.001), the length of the GM fascicle (p=0.031), the thickness of the rectus femoris (RF) muscle (p&lt;0.001), the cross-sectional area of the RF (RFCSA) muscle (p&lt;0.001), the thickness of the rectus abdominis (RA) muscle (p&lt;0.001), the thickness of the transverse abdominis (TA) muscle (p=0.004), and the thickness of the external oblique (EO) muscle (p=0.042). Besides, ASDAS-CRP scores were related to GM muscle thickness, RFCSA, and TA muscle thickness percent changes in patients whose disease activity regressed from high to moderate (respectively; p=0.030, p=0.040, p=0.002). Conclusion: Muscle ultrasound examination can show muscle mass improvement in SpA patients during treatment.

Reducing phantom limb pain using phantom motor execution enabled by augmented and virtual reality: participants’ perspectives on an innovative treatment

Purpose Phantom limb pain (PLP) is a condition that greatly diminishes quality of life. Phantom motor execution (PME), enabled by myoelectric pattern recognition combined with virtual and augmented reality, is a novel treatment for PLP. Here we, aimed to describe patients’ experiences of this treatment. Material and Methods Qualitative, using semi-structured interviews one month after completed PME treatment. Twenty-one Swedish and Dutch patients (mean age 57, 16 males, 16 lower limb amputations) participated. The analysis followed the framework approach. Results The main themes were 1) treatment effects on the perception of the phantom limb, 2) living with PLP before and after treatment, and 3) facilitators and barriers to treatment. Most participants learned to control their phantom limb, perceived it more positively and as more complete. This control over the phantom limb became a tool for managing PLP. Most participants’ outlook on life and energy levels improved after treatment. Being mentally focused during treatment was important. Therapists were pivotal to the success of the treatment. Conclusion Controlling the phantom limb improved their perception of it and pain management, self-agency, and quality of life. The therapists’ role was invaluable. We suggest training for patients in phantom limb control before and after amputation.

The concept of state financial control and the legal status of the subjects of its provision

The article is devoted to the study of the concept of state financial control and the legal status of the subjects of its provision. It is noted that, in practice, the system of state financial control bodies is extremely extensive and includes a large number of bodies that do not interact properly. It is proposed to understand state financial control as the activity of state authorities and local self-government regulated by financial and legal norms, based on the principles of legality, independence, objectivity, efficiency and aimed at protecting the financial interests of the state, business entities and citizens. It is emphasized that the Law of Ukraine «On the basic principles of state financial control in Ukraine» does not operate with the concept of «subject of state financial control», but only generally indicates the rights of the state financial control body, and the duties and responsibilities of its officials. It is indicated that the President of Ukraine, being the head of state and possessing a special legal status, supervises financial activities. Control powers in the field of financial resources management can be exercised by the President of Ukraine by adopting decrees, the effect of which is aimed at regulating financial relations. It is noted that the Verkhovna Rada of Ukraine is assigned to the state body of general financial competence, but it determines the main guidelines for the development of the entire financial system of the country by adopting and approving laws. The specific results of the activities of bodies of special competence depend on its actions. It has been established that the Accounting Chamber occupies a separate place in the system of state financial control bodies, it is the highest body of state financial control of Ukraine, it is formed by the Verkhovna Rada of Ukraine, subordinate to and accountable to it. The Accounting Chamber, in accordance with Article 98 of the Constitution of Ukraine, on behalf of the Verkhovna Rada of Ukraine, controls the receipt of funds from the State Budget of Ukraine and their use.

EVOLUTIONARY TRANSFORMATION OF THE QUALITY ASSURANCE SYSTEM OF DEFENSE GOODS, SERVICES AND WORKS IN UKRAINE

It is inadvisable to limit the quality assurance system for defense-related goods/services/works solely to a set of mechanisms; it must necessarily encompass vertical and horizontal connections both among the relevant functional blocks (subsystems) and between the entities involved in their operation. In the context of not only geopolitical challenges but also the ongoing daily struggle against an aggressor state, it is critically important to establish an effective and efficient system for controlling the quality of defense-related goods/services/works. This article is dedicated to the systematization of the characteristics of transformational changes and the outlining of methodological foundations for the effective functioning of the quality assurance system for defense- related goods, works, and services in Ukraine. A conceptual three-level model of the quality assurance system for defense-related goods, services, and works has been formulated by distinguishing the essential parameters of their operation at the global, national, and micro levels. The peculiarities of forming a quality assurance system for defense-related products at both the micro and macro levels have been justified. It has been emphasized that the effectiveness of the evolutionary transformation of the quality assurance system for defense-related products at all levels of its representation should be characterized by the penetration of market forces into the mechanism of its operation. Attention has been drawn to the substantive directions for implementing the requirements of NATO standards in the AQAP series (AQAP 2110) within the framework of a corporate quality management system in accordance with ISO 9001. Since there are no legal or legislative requirements mandating the implementation of quality management systems, the enhancement and improvement of the efficiency of internal business and production processes should be a direct concern of the enterprise itself, driven by market forces. At the same time, the state should create stimulating mechanisms, for instance, by employing soft regulation; in military procurement specifications, it should mandate the presence of a certificate of compliance with AQAP requirements for the enterprises involved. The expected effects of the transformation of the studied system include economic, organizational, and worldview effects. A comparative analysis of the evolutionary transformation of the quality assurance system for defense-related goods, services, and works has been conducted based on the following criteria: the object and subject of control; the function performed by the control subject; the breadth of the controlling institution’s functionality; the perimeter of the controlling institution’s authority; the level of depth of control; and the level of subordination of the controlling institution to the Ministry of Defense. Despite the complexity of the task declared at the state level regarding the functioning of the state guarantee system for the quality of defense-related products, which is influenced not only by objective factors but also by worldview factors, its implementation has the potential to significantly enhance the quality of Ukraine’s defense products and substantially improve Ukraine’s rankings in terms of transparency, institutional maturity, and the ecological soundness of economic relations in the defense sector.

6959 Variation of FIB-4 Classification In A 5-Year Follow-Up Cohort of Patients With Type 2 Diabetes Mellitus Managed By A Multi-Disciplinary Team In A Hospital In Northeastern Mexico

Abstract Disclosure: M. Romero Ibarguengoitia: None. D.P. Morales-Rodríguez: None. A. González-Cantú: None. A. Garza-Silva: None. A. Rivera-Cavazos: None. I. Fernández-Chau: None. A. Cepeda-Medina: None. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a common pathology associated to type 2 diabetes mellitus (T2DM), however the change in its classification over time is unknown in patients with T2DM managed by a multidisciplinary team in a population of Northern Mexico. Therefore, we analyzed the change in the FIB-4 classification for MASLD before and during 3 years of SARS-CoV-2 pandemic. We conducted a retrospective observational cohort study on a population of steelworkers with T2DM from a hospital in Northeastern Mexico from 2018 to 2022 treated by a multidisciplinary team. This team was comprised by an internist or geriatrician based on patient’s age, an endocrinologist, a nutritionist, and other specialties related to T2DM. We analyzed levels of HbA1C, fasting serum glucose (FSG), attendance to various specialties consultations, trends in medication usage and changes in the classification of FIB-4 scale. A total of 999 subjects were studied, with 516 (51.7%) being male, average age (SD) of 60.1 (12.7) years. There was a significant difference in the proportion of patients with controlled HbA1C levels, being 55.5% in 2018 and rising to 64.3% in 2020 and to 70.7% in 2022 (p&amp;lt;0.001). An increase in the proportion of patients in control based on FSG was observed, from 13.8% in 2018 to 54.8% in 2020 and 56.1% in 2022 (p&amp;lt;0.001). Throughout the follow-up period, all patients had at least one annual consultation with an internist or geriatrician according to their age group. Additionally, there was an increase in assistance to endocrinology consultations from 8.5% in 2018 to 9.9% in 2020 and 12.1% in 2022 (p&amp;lt;0.001). There was a rise in the prescription of oral hypoglycemic agents in general from 4.9% in 2018 to 14.2% in 2020, with an increase of GLP-1 analogs from 3.3% in 2018 to 9.3% in 2020 (p&amp;lt;0.001). Regarding the categorization by FIB-4, in 2018, a proportion of 64.8% of patients were observed in the F0-F1 category, 30.2% in the F2 category, and 4.8% in the F3-F4 category (p&amp;lt;0.001). These levels remained similar for 2020, with 62.6% in the F0-F1 category, 32.4% in the F2 category, and 4.9% in the F3-F4 category (p&amp;lt;0.001). In 2022, there is an increase in the proportion of patients in the F0-F1 category, reaching 71.8% of our population, along with a decrease in those classified as F2 to 20.9%, and a slight increase in the proportion of patients in the F3-F4 category to 7.2% (p&amp;lt;0.001). MASLD is a condition that occurs frequently in our population; however, it is possible to stabilize and even decrease its classification through a multidisciplinary and specialized team capable of treating T2DM effectively by optimizing its management with GLP-1 prescription and a prompt referral to endocrinology consultation with the aim of providing a good quality of life for the patients. Presentation: 6/2/2024