Control Test Research Articles

Development of a Large-Scale Pathogen Screening Test for the Biosafety Evaluation of Canine Mesenchymal Stem Cells

BackgroundThe action of mesenchymal stem cells (MSCs) is the subject of intense research in the field of regenerative medicine, including their potential use in companion animals, such as dogs. To ensure the safety of canine MSC batches for their application in regenerative medicine, a quality control test must be conducted in accordance with Good Manufacturing Practices (GMP). Based on guidance provided by the European Medicines Agency, this study aimed to develop and validate a highly sensitive and robust, nucleic acid-based test panel for the detection of various canine pathogens. Analytical sensitivity, specificity, amplification efficiency, and linearity were evaluated to ensure robust assessment. Additionally, viable spike-in controls were used to control for optimal nucleic acid extraction. The conventional PCR-based and real-time PCR-based pathogen assays were evaluated in a real-life setting, by direct testing MSC batches.ResultsThe established nucleic acid-based assays displayed remarkable sensitivity, detecting 100–1 copies/reaction of template DNA. They also exhibited high specificity and efficiency. Moreover, highly effective nucleic acid isolation was confirmed by the sensitive detection of spike-in controls. The detection capacity of our optimized and validated methods was determined by direct pathogen testing of nine MSC batches that displayed unusual phenotypes, such as reduced cell division or other deviating characteristics. Among these MCS batches of uncertain purity, only one tested negative for all pathogens. The direct testing of these samples yielded positive results for important canine pathogens, including tick-borne disease-associated species and viral members of the canine infectious respiratory disease complex (CIRDC). Notably, samples positive for the etiological agents responsible for enteritis (CPV), leptospirosis (Leptospira interrogans), and neosporosis (Neospora caninum) were also identified. Furthermore, we conducted biosafety evaluation of 12 MSC batches intended for therapeutic application. Eleven MSC batches were found to be free of extraneous agents, and only one tested positive for a specific pathogen, namely, canine parvovirus.ConclusionIn this study, we established and validated reliable, highly sensitive, and accurate nucleic acid-based testing methods for a broad spectrum of canine pathogens.

Hair and dietary supplements testing to identify contamination with roxadustat in an adverse analytical finding

Roxadustat is an oral inhibitor of hypoxia-inducible factor (HIF) prolyl hydroxylase, which increases endogenous erythropoiesis. WADA has included roxadustat and other HIF stabilizers on its list of prohibited substances. We describe here the case of an elite athlete (female, 31 years old, 168 cm and 53 kg) with an adverse analytical finding (AAF) with concentration of roxadustat in her urine at 0.289 ng/mL in the A sample and 0.529 ng/mL in the B sample (83% higher than A). A stability study was carried out, showing total stability of roxadustat at this concentration in urine exposed to light for 50 h, so photoisomerization degradation cannot explain the difference in concentration. Her urine had been completely negative in a control test carried out three days previously, while roxadustat had been shown to be present in urine for at least 20 days after administration of pharmacologically effective doses to an athlete. Hair concentration was 0.39 and 0.35 pg/mg in the segments corresponding to the presumed period of intake, with few adjacent segments also positive (0.29–0.33 pg/mg), likely explained by cosmetic treatments. Concentrations found in a patient treated with a pharmacologically active dose (between 100 and 120 mg 3 days a week) were more than 100 times higher (between 41 and 57 pg/mg). Numerous supplements and pharmaceuticals taken by the athlete were analyzed. Only collagen powder showed the presence of roxadustat, at a very low but highly variable concentration (100 pg/g-1000 pg/g). A female volunteer (58 years old, 169 cm and 65 kg), taking this powder at the same doses as the athlete (10 g of powder 5 times for 6 days) presented 7 roxadustat-positive urine samples (although lower than those observed in the athlete) out of 34 sampled over 7 days, the difference in powder sampling location, age, weight, height, pharmacokinetic parameters variability and level of sporting activity between the athlete and the volunteer probably explaining the difference in concentrations observed. All these results could be consistent with an AAF due to contamination by dietary supplements, which are becoming increasingly common due to the current exposome of athletes in our society.

Very rapid improvement of extended nitric oxide parameters, associated with clinical and functional betterment, in patients with chronic rhinosinusitis with nasal polyps (CRSwNP) treated with Dupilumab.

Background: Dupilumab, an anti-IL-4 receptor alpha monoclonal antibody, has been recently approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and moderate to severe asthma, demonstrating a rapid onset of clinical effects. CRSwNP is characterized by an extended type-2 inflammatory involvement that can be assessed by extended nitric oxide analysis. Objective: In this study we investigated whether Dupilumab is associated with a rapid improvement in extended nitric oxide parameters, lung function and clinical outcomes in patients with CRSwNP. : Consecutive patients with CRSwNP and indication to be treated with Dupilumab were evaluated for extended nitric oxide analysis (exhaled, FENO; bronchial, JawNO and alveolar, CalvNO components; nasal, nNO) and lung function 15 and 30 days after treatment initiation, and for clinical outcomes (nasal polyps score, NPS; quality of life questionnaires; visual analogue scales, VAS, for main symptoms, asthma control test, ACT) after 30 days of treatment initiation. 33 patients were enrolled. All extended nitric oxide and lung function parameters significantly improved after 15 days of treatment remaining stable at 30 days. NPS, VAS for main CRSwNP symptoms, quality of life questionnaires and ACT significantly improved after 30 days of treatment initiation. Dupilumab is associated with very rapid improvement in type 2 inflammation in all airway districts and this is associated with improved lung function and clinical parameters in patients with CRSwNP.

Effects of scapular exercises on trunk control ın patients with acute stroke: a double-blind randomized controlled study

Purpose/aimThe ability to perform routine tasks during reaching and activities of daily living (ADLs) is impaired as a result of deterioration in the postural adjustments after stroke. Trunk stability is needed to maintain balance, correct scapular position and posture while moving the upper extremity. The objective was to examine the effect of scapular exercises on the scapular stability, trunk control and ADLs.Materials and methodsPatients (50–85 years) with acute hemiparetic stroke were participated in this double blind randomized controlled study. The patients in both group were treated with the exercise program according to the Bobath concept and isometric scapular exercises were applied to the study group in addition to these exercises. The participants in both groups were taken into the physiotherapy program for 5 days and each program were taken 30 min. Patient assessment included Lateral scapular slide test (LSST), Trunk Impairment Scale (TIS), Trunk Control Test (TCT), Modified Barthel Index (MBI) and Reaching Performance Test (RPT).ResultsSignificant increases were observed distance in protraction, between protraction – retraction at 90° of shoulder abduction and flexion and retraction in 90° of shoulder abduction within both groups. Only the study group produced improvement in protraction of 90° of shoulder flexion (p < 0.05). While both groups achieved a significant improvement in TIS, MBI, RPT scores, TCT scores increased significantly only in study group (p < 0.05).ConclusionsThe adding isometric scapular exercises to the rehabilitation program significantly increased the effectivity of neurorehabilitation on increasing trunk control, independence during ADLs, reaching performance and reducing trunk impairment.

Exacerbations, treatment patterns, utilization, and costs before and after initiating of benralizumab for the treatment of severe eosinophilic asthma

ObjectivesThe purpose of this study was to examine the number of exacerbations, counts of eosinophils, and asthma-related symptoms 1 year before and after initiating benralizumab for the treatment of severe eosinophilic asthma.MethodsPatients with prior exacerbations and newly initiating benralizumab were identified in the claims-based Healthcare Integrated Research Database. Claims were used to assess benralizumab treatment patterns, exacerbations, healthcare resource utilization, and other asthma medication used. Among a subset of patients, medical records were abstracted for Asthma Control Test (ACT) scores and asthma symptoms.ResultsThere were 506 patients meeting inclusion/exclusion criteria for claims-based analyses and 123 for medical-record analyses. The number of patients experiencing exacerbations significantly decreased from baseline to follow-up (40% reduction, McNemar’s χ2 = 204.00, p < .001). The mean number of exacerbations also decreased from 3.2 (1.5) to 1.2 (1.4) (paired t = 24.45, p < .001; Cohen’s D = 1.09). The effects were larger among patients with eosinophils ≥300 cells/µL. Among patients with an ACT available for baseline and follow-up (n = 47), there was a significant reduction in the number of patients with scores <19 (72% vs. 45%, p < .01).ConclusionsTreatment with benralizumab resulted in fewer exacerbations, reduced utilization, and improved ACT scores. This study demonstrates that benralizumab is an effective treatment option for patients with severe eosinophilic asthma.

Development and validation of a new asthma questionnaire to help achieve a high level of control in school-age children and adolescents

BackgroundMaintaining good asthma control minimizes the risk of exacerbations and lung function decline and is a primary goal of asthma management. The Japanese Pediatric Asthma Guidelines (JPGL) employs different classification criteria for control status from other guidelines, stressing a higher level of control. Based on JPGL, we previously developed a caregiver-completed questionnaire for assessing and achieving best asthma control in preschoolers. In this study, we aimed to develop a questionnaire for school-age children and adolescents. MethodsA working questionnaire comprising 14 items for patients and 34 items for caregivers was administered to 362 asthma patients aged 6–15 years and their caregivers. Separately, physicians filled out a questionnaire to determine JPGL-defined control. Logistic regression analysis was performed to construct a model to predict control levels using data from a randomly selected set of completed questionnaires from two-thirds of the subjects. Validation was performed using the remaining questionnaires. ResultsA set of 7 questions, encompassing self-assessed control status at the time of the visit and in the past month, and nocturnal/early morning asthma symptoms for patients and frequency of asthma symptoms, dyspnea, rescue beta-agonist use, and asthma hospitalization for caregivers, were selected and the 7-item model showed a good statistical fit with AIC of 110.5. The model has been named the Best Asthma Control Test for School Children and Adolescents (Best ACT-S). Best ACT-S scores differed significantly in the hypothetical direction among the groups of different JPGL-defined control levels, step-up/down treatment decisions, and presence/non-presence of exacerbations in the previous year. ConclusionsThe Best ACT-S is a valid questionnaire for children/adolescents aiming for best asthma control.

Task-shifting in asthma and chronic obstructive pulmonary disease management: A review of the obstructive lung disease program.

Task shifting, an approach to address physician shortage through redistribution of clinical tasks, may help address the high burden of chronic respiratory diseases like asthma and COPD. We aimed to measure its utility and impact in the Obstructive Lung Disease program (OLD). A retrospective, cross-sectional study was conducted at five integrated outpatient departments of Primary Care Program within Indus Hospital & Health Network, Pakistan, from January 2018 to March 2023. After a formative evaluation, registered nurses were trained as Lung Health Nurses (LHNs) to perform spirometry, collect Patient Reported Outcome Measures (PROMs) including Asthma Control Test (ACT), modified Medical Research Council (mMRC) dyspnea score and COPD Assessment Test (CAT), counsel on inhaler use and tobacco cessation, and refer to pulmonary rehabilitation (PR). Data was collected online contemporaneously on REDCap and later analyzed using Excel and STATA 14. Pre-implementation, a monthly average of 126 asthmatics and 33 COPD patients visited primary care centers. Medical records of 147 OLD patients showed 8% received inhaler education, 3% completed ACT and 2% had mMRC documented. Implementation included capacity building of nine LHNs. Of 7427 referrals to the program, 86% underwent nurse-led assessments. LHNs performed spirometry (92%), PROMs assessments [ACT (89%), CAT (91%), mMRC (85%)], inhaler education (97%), tobacco cessation advice (85%) and made PR referrals (94%). Trained nurses can play a role in providing holistic and timely care for patients with CRDs and strengthen existing healthcare systems. Future directions may include expanding nurse clinical counselling roles through telehealth monitoring and home management.

Asthma control and sputum eosinophils in adult patients: a cross-sectional study in southern Brazil

Asthma control and health related quality of life are an important goal of asthma management, but their association with sputum eosinophilic inflammation has been less firmly established. To investigate the relationship of asthma control and quality of life with sputum eosinophils in clinical practice. Cross-sectional study with a convenience sample, including patients with asthma, aged between 18 and 65 years, attending to outpatient clinic. Patients underwent sputum induction, pulmonary function tests, Juniper’s Asthma Quality of Life Questionnaire (AQLQ), Asthma Control Test (ACT), Global Initiative for Asthma (GINA) criteria for evaluation of asthma control and severity of the disease, blood count analysis, serum IgE and cutaneous prick test. Sputum sample was considered as eosinophilic if the percentage of eosinophils was ≥ 3%. A total of 45 individuals were enrolled, 15 with eosinophilic sputum (≥ 3% eosinophil cells) and 30 with non-eosinophilic sputum (< 3% eosinophil cells). There were no association of ACT an AQLQ scores with sputum eosinophilia (p > 0.05). This study suggested that the finding of sputum eosinophilia was not related to asthma control neither with health-related quality of life in patients with severe asthma.

Lumbopelvic movement control in powerlifters with and without low back pain

ObjectivesTo measure lumbopelvic movement control in powerlifters with and without low back pain (LBP). DesignQuantitative Cross-sectional. ParticipantsTwelve powerlifters with LBP and 28 powerlifters without LBP. SettingPowerlifters were recruited in nine different cities and filmed while performing a movement control test battery. Main outcome measuresLumbopelvic movement control test battery consisting of seven tests, with a possible score between 0 and 13. The tests were rated by a physical therapist blinded to the group allocation and comparisons of the frequency of current/incorrect tests between groups were calculated. ResultsThere was no statistically significant difference in the movement control test battery between the powerlifters with LBP (Median = 7.0, (2–11)) and powerlifters without LBP (Median = 6.0, (1–10)) (P = 0.59). There were no statistically significant differences between groups when the individual movement control tests were analyzed separately. ConclusionsThe lack of significant differences between groups indicates that performance in lumbopelvic movement control test might not be associated with LBP in powerlifters. More studies on associations between LBP and movement control and other body functions are needed to guide assessment and treatment of powerlifters with LBP and for investigation of possible risk factors for LBP in powerlifters.

Effect of Exhaustive Exercise on Lumbopelvic-Hip Complex Stability, Muscle Activity, and Movement Patterns

This study aimed to evaluate the effect of exhaustive exercise on lumbopelvic-hip complex (LPHC) muscle activity, stability, and single-leg squat kinematics. Twenty-two healthy participants (12 females, 23.5 ± 3.1 years) were recruited. LPHC stability was measured by number of errors committed during a seated trunk control test (STCT). Surface electromyography recorded muscle activity of rectus abdominis (RA), external oblique, internal oblique (IO), erector spinae, and gluteus medius during the STCT and single-leg squat, and was normalized to peak activity during the task. Two-dimensional motion analysis quantified frontal and sagittal plane kinematics of the trunk, hip, and knee. Following exhaustive exercise, STCT performance worsened (number of errors: pre: 5.5 (interquartile range (IQR) = 1.4–9.0), post: 8.0 (IQR = 3.6–11.3), p = 0.026.), RA activity increased during the single-leg squat (pre: 42.1 (IQR = 33.6–48.5)%, post: 61.1 (IQR = 39.4–156.7 %, p =.004), and participants displayed less hip and knee flexion (hip: pre: 72.4 ± 22.1°; post: 66.2 ± 22.5°, p =.049; knee: pre: 72.4 ± 15.4°; post: 67.4 ± 18.2°, p =.005). Full-body exhaustive exercise negatively affected isolated LPHC stability and resulted in greater RA activity during the single-leg squat. Hip and knee flexion decreased during a single-leg squat after exhaustive exercise which could indicate decreased athletic performance, but changes in the quality of movement during other tasks should be further investigated.

Cognitive and Exercise Training Improves Intraindividual Variability in Cognitive Performance in Older Adults: Secondary Findings of A Randomized Controlled Trial

AbstractBackgroundIncreased intraindividual variability of cognitive performance is a marker of cognitive decline. Whether computerized cognitive training (CCT) and aerobic exercise counteracts cognitive decline by reducing intraindividual variability is unknown. We investigated the effects of CCT with or without aerobic exercise on reaction time intraindividual variability in older adults.MethodThis was a secondary analysis of an 8‐week randomized controlled trial. Older adults (aged 65‐85 years) were randomized to CCT alone (n = 41), CCT with aerobic exercise (n = 41), or an active control group (n = 42). The CCT group trained using the Fit Brains® platform 3×/week for 1 hour (plus 3×/week of home‐based training). The CCT with aerobic exercise group received 15 min of walking plus 45 min of Fit Brains® 3×/week (plus 3×/week of home‐based training). The control group received sham exercise and cognitive training (3×/week for 1 hour). We extracted reaction times from the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test (Flanker), and Pattern Comparison Processing Speed Test (PACPS). Intraindividual variability was measured as residual intraindividual standard deviation (residual ISD) of raw reaction time latencies. Residual ISD is an unbiased measure of variability that accounts for within and between participant source of variation that could influence reaction time latencies. We also calculated reaction time intraindividual SD (raw‐score ISD) and intraindividual coefficient of variation (ICV).ResultCompared with the control group, residual ISD improved in a processing speed task (PACPS) following CCT alone (mean difference [95% confidence interval]: ‐0.147 [‐0.230 to ‐0.065], p&lt;0.001) and CCT with aerobic exercise (‐0.111 [‐0.195 to ‐0.027], p&lt;0.01). Also, for processing speed, both CCT (‐0.173 [‐0.261 to ‐0.084], p&lt;0.001) and CCT with aerobic exercise (‐0.122 [‐0.213 to ‐0.032], p&lt;0.01) showed greater reduction in raw‐score ISD compared with controls, while only CCT reduced ICV for this task (‐0.108 [‐0.176 to ‐0.040], p&lt;0.001). Inhibitory attention (Flanker) improved only after CCT with aerobic exercise (congruent = ‐0.128 [‐0.250 to ‐0.006], incongruent = ‐0.121 [‐0.237 to ‐0.005], both p&lt;0.05).ConclusionA CCT program promoted cognitive health via reductions in intraindividual variability of cognitive performance and combining it with aerobic exercise resulted in broader benefits.

The risk of sleep‐related cognitive impairment increases in middle‐age to older adulthood

AbstractBackgroundThe association between sleep quality and cognition is widely established but the role of aging in this relationship has been unclear due to inconsistent findings with heterogeneous methods and a lack of studies in wide age ranges. The current study examined how age impacts the sleep‐cognition relationship using a large‐scale dataset with adults from young adulthood to older adulthood. Furthermore, we tested non‐linear effect of age to investigate the presence of age ranges in which the association between sleep and cognition is modified.MethodSample included 711 individuals (ages 36.00‐89.83, 59.66 ± 14.91, 55.7% female) from the Human Connectome Project‐Aging (HCP‐A). Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), and cognitive outcome measures included the NIH Toolbox fluid cognition (Dimensional change Card Sort Test, List Sorting Working Memory Test, Picture Sequence Memory Test, Pattern comparison Processing Speed Test, Flanker Inhibitory Control and Attention Test) and crystallized cognition composite scores (Oral Reading Recognition Test and Picture Vocabulary Test), the Trail Making Test (TMT) A and B, and the Rey Auditory Verbal Learning Test (RAVLT). The association between sleep quality and cognitive performance was measured using linear regression models, with sex, race, use of sleep medication, and years of education as covariates. Age moderation was tested via the interaction between sleep and age on cognition, with age as linear and non‐linear (quadratic) terms.ResultThere was a significant interaction term between the PSQI and non‐linear age term (age2) on TMT‐B (p = 0.02) and NIH Toolbox crystallized cognition (p = 0.02), indicating that the association between poor sleep quality and cognitive performance was moderated by age. Further analyses indicated that there were “critical age ranges” in which the sleep‐cognition association was more salient (ages 50‐75 for TMT‐B and 66‐70 for crystallized cognition).ConclusionThe association between sleep quality and cognitive performance may be modified by age. Individuals of the middle‐age to early older adulthood may be more vulnerable to sleep‐related cognitive impairment, indicating the clinical importance of detection and treatment of sleep disturbance in this particular age group.

Autonomous and smart cleaning mobile robot system to improve the maintenance efficiency of solar photovoltaic array

A solar photovoltaic (PV) array is part of a PV power plant as a generation unit. PV array that are usually placed on top of buildings or the ground will be very susceptible to dirt and dust. Thus, this dirt and dust will be able to reduce the performance and work efficiency of the generation unit. Cleaning PV arrays by manpower requires high effort, cost, and risk, especially in higher location. This study presents the design of a mobile robot that is used to replace human labor to clean PV arrays. That way, the PV array maintenance steps can reduce operational costs and risks. This intelligent controlled mobile robot can maneuver safely and efficiently over PV arrays. gyroscope and proximity sensors are used to detect and follow the sweep path over the entire PV array area. Proportional integral derivative (PID) control test makes the robot can stabilize in about 5.72 seconds to keep on the track. The smart PV cleaning robot has average operation time about 13 minutes in autonomous mode and 20-24 minutes in manual mode. The operation of the robot is effective to give more efficiency on the use of energy, time, and maintenance costs of PV array system.

Prevalence of asthma control in adult patients in Kirkuk City

Abstract Background: Asthma is one of the most common chronic diseases that is widely prevalent worldwide affecting different age groups. Many factors are involved in the pathogenesis and there are many trigger factors that can precipitate acute attacks or interfere with the disease control. Disease controlling inhalers are required to be taken for long duration to control the symptoms, and this is a real problem with the patients to maintain remission and prevent relapse or deterioration in the lung function. Objective: The aim of this study is to know the prevalence of asthma control in adult patients in Kirkuk city. Materials and Methods: Two thousand and five hundreds asthmatic patients were collected from Azadi teaching hospital and private clinics at Kirkuk city during the period from January 2017 to October 2022 (1775 were men and 725 were women. A proper history was taken from the patients regarding the duration of the asthma, treatment used and compliance, smoking, and presence or absence of gastroesophageal reflux disease (GERD). The body mass index (BMI) of the patients was also measured. Regarding the asthma control during the past 4 weeks, this was assessed by using the asthma control test. Results: From the total 2500 asthmatic patients: 2280 (91.2%) were not well-controlled, 220 (8.8%) at least well-controlled, 1590 (63.9%) of patients were on treatment, 1370 (86%) of those on treatment were not well-controlled, and 220 (14%) were at least well-controlled. Obesity, smoking, passive smoking GERD, and non-adherence to inhalers are all associated with poorly controlled asthma. Conclusion: The study shows that most of the asthmatic patients with uncontrolled smoking exposure, GERD, obesity, and non-adherence to controlling inhalers were significantly associated factors. Most of the patients were not on regular controlling inhaler therapy. Rejection of the diagnosis, cost, and technique were all causes for the non-adherence to disease-controlling inhalers.

Seasonal response of nitrogen exchange fluxes to crab disturbance at sediment–water interface in coastal tidal wetlands

Coastal wetlands are hotspots for nitrogen (N) cycling, and crab burrowing is known to transform N in intertidal marsh soils. However, the underlying mechanisms remain unclear. This study conducted field experiments and used indoor control test devices to investigate the seasonal response of nitrogen to crab disturbance at the sediment–water interface in coastal tidal flat wetlands. The results showed that crab disturbance exhibited significant seasonality with large seasonal differences in cave density and depth. Due to crab disturbance, nitrogen fluxes at the sediment–water interface were much greater in the box with crabs than in the box without crabs. In summer, NH4+-N showed a positive flux from the sediment to the overlying water, but NO2−-N and NO3−-N showed positive fluxes from the sediment to the overlying water only in early stages. In winter, NH4+-N showed a positive flux from the sediment to the overlying water, but NO2−-N and NO3−-N both exhibited positive and negative fluxes. These results indicated that the presence of crab burrows can cause the aerobic layer to move downward by approximately 8–15 cm in summer and directly promote nitrification at the sediment surface.

Effectiveness of a Maintenance and Reliever Digihaler System in Asthma: 24-Week Randomized Study (CONNECT2)

BACKGROUNDDigital health tools have been shown to help address challenges in asthma control, including inhaler technique, treatment adherence and short-acting beta2-agonist overuse. The maintenance and reliever Digihaler System (DS) comprises two Digihaler inhalers (fluticasone propionate/salmeterol and albuterol) with an associated patient App and web-based Dashboard. Clinicians can review patients’ inhaler use and Digihaler inhalation parameter data to support clinical decision-making. OBJECTIVECONNECT2 evaluated asthma control in participants using the DS versus standard-of-care (SoC) maintenance and reliever inhalers. METHODSParticipants (≥13 years) with uncontrolled asthma (Asthma Control Test [ACT] score <19) were randomized 4:3 (open-label) to the DS (n = 210) or SoC (n = 181) for 24 weeks. The primary endpoint was the proportion of patients achieving well-controlled asthma (i.e., an ACT score ≥20 or increase from baseline of ≥3 units at Week 24). RESULTSThere was an 88.7% probability that participants using the DS would have greater odds of achieving improvement in asthma control compared with SoC after 24 weeks. Mean odds ratio (95% credible interval) for DS versus SoC was 1.35 (0.846–2.038), indicating a 35% higher odds of improved asthma control with the DS. The DS group had more clinician-participant interactions versus SoC, mainly addressing poor inhaler technique. DS participants’ maintenance treatment adherence was good (Month 1: 79.2%; Month 6: 68.6%); reliever use decreased by 38.2% versus baseline. App and Dashboard usability were rated ‘good’. CONCLUSIONThe positive results in asthma control in this study after 24 weeks demonstrate the effectiveness of the DS in asthma management.

Design, proof-of-concept of single robotic hair transplant mechanisms for both harvest and implant of hair grafts

The design and development of a prototype for a singular robotic hair transplant system capable of harvesting and implanting hair grafts were executed in this study. To establish a proof-of-concept for hair transplant procedures involving harvesting and implantation, a test system using a spherical phantom of the scalp was selected. The developed prototype of the robotic hair transplant system demonstrates the potential to reduce the duration that grafts remain without a blood supply, thereby minimizing hair graft damage. Additionally, the overall operation time for follicular unit extraction is comparatively shorter than that of conventional systems. Results from the robot vision tests indicate an 89.6% accuracy for hair graft detection with a 4 mm hair length phantom and 97.4% for a 2 mm hair length phantom. In the robot position control test, the root mean square error was found to be 1.268°, with a standard error of the mean of 0.203°. These outcomes suggest that the proposed system performs effectively under the conditions of a spherical phantom with a 2 mm hair length and a 5 mm distance between harvests.

In asthma patients: relationship between symptom control, quality of life, and the beck anxiety scale

Aims: Asthma is a chronic disease characterized by recurrent airway obstruction. It affects the quality of life of patients and can lead to anxiety and other psychological disorders. In this study, we aimed to find out how asthma affects patients' quality of life and psychological state by using the SF-36 Quality of Life Scale and the Beck Anxiety Scale (BAS) in patients diagnosed with asthma. Methods: 222 patients diagnosed with asthma in our outpatient clinics were included in the study. Patient demographic characteristics and respiratory function test parameters were recorded. Outcomes were determined by assessing asthma control status with the Asthma Control Test (ACT), patients' emotional state with the BAS, and quality of life with the SF-36. Results: According to ACT, 37.8% of patients were uncontrolled, 33.8% were partially controlled, and controlled 28.4%. The distribution in terms of asthma classification: 29.8% were mild intermittent, 5% mild persistent, 35.1% moderate persistent and 40.1% severe persistent. When comparing between ACT groups in relation to the SF-36 quality of life scale; physical function (p&lt;0.001), physical role difficulties (p&lt;0.001), emotional role difficulties (p&lt;0.001), vitality (p&lt;0.001), mental health (p&lt;0.001), social function (p&lt;0.001), pain (p&lt;0.001), and general health (p&lt;0.001). There was a difference between the groups ACT in relation to BAS (p&lt;0.001). Conclusion: We believe that when regulating the medical treatment of asthma patients, not only their respiratory functions but also their quality of life and psychological status should be evaluated, and measures should be taken to improve the quality of life and psychological disorders.

Parental knowledge and attitudes toward asthma in Jordanian children with asthma, a multi-center cross-sectional study

Objective We explored Jordanian caregivers’ knowledge, attitudes, and practices (KAP) toward asthma in their children. Methods This cross-sectional investigation was conducted on caregivers visiting the pediatrics clinic at the Jordan University Hospital and King Abdullah University Hospital between December 2021 and January 2023. KAP were measured using a literature-validated questionnaire. Differences in KAP scores across participants’ characteristics were examined using the student-t test and ANOVA. Results A total of 108 caregivers were included in the final analysis. Caregivers were aged 30 to 40 years (54.6%) and had at least secondary education (90.7%). The majority of participants displayed appropriate knowledge with respect to asthma’s clinical course. Furthermore, the greater portion of caregivers were knowledgeable about preventing asthma attacks and treating their children during said attacks. Factors affecting knowledge of asthma included age of mothers (p < .05). On the other hand, attitude scores were affected by occupation, type of medication, and family history of asthma (all p < .05). Moreover, employee mothers, children well controlled on both Asthma Control Test and Global Initiative for Asthma scores, and having no pediatric intensive care unit admissions were associated with higher practice treatment scores (all p < .05). Overall practice score was weakly, yet positively correlated with knowledge scores (r = 0.195, p = .043). Similarly, negative attitudes were weakly correlated with higher knowledge scores (r = 0.199, p = .039). Conclusion While the knowledge and practice scores were satisfactory, the clinical status of children with asthma was unsatisfactory. Future studies should examine factors associated with caregiver insecurity and measure their extent of applying asthma prevention guidelines.

Alterations in gut virome are associated with cognitive function and minimal hepatic encephalopathy cross-sectionally and longitudinally in cirrhosis

ABSTRACT Cognitive dysfunction due to minimal hepatic encephalopathy (MHE) adversely impacts patients with cirrhosis and more precise therapies are needed. Gut-brain axis changes are therapeutic targets, but prior studies have largely focused on bacterial changes. Our aim was to determine linkages between individual cognitive testing results and bacteria with the virome using a cross-sectional and longitudinal approach. We included cross-sectional (n = 138) and longitudinal analyses (n = 36) of patients with cirrhosis tested using three cognitive modalities, which were psychometric hepatic encephalopathy score (PHES), inhibitory control test (ICT), Stroop, and all three. Stool metagenomics with virome and bacteriome were analyzed studied cross-sectionally and in a subset followed for development/reversal of MHE repeated at 6 months (longitudinally only using PHES). Cross-sectional: We found no significant changes in α/β diversity in viruses or bacteria regardless of cognitive testing. Cognitively impaired patients were more likely to have higher relative abundance of bacteriophages linked with Streptococcus, Faecalibacterium, and Lactobacillus, which were distinct based on modality. These were also linked with cognition on correlation networks. Longitudinally, 27 patients remained stable while 9 changed their MHE status. Similar changes in phages that are linked with Streptococcus, Faecalibacterium, and Lactobacillus were seen. These phages can influence ammonia, lactate, and short-chain fatty acid generation, which are neuro-active. In conclusion, we found linkages between bacteriophages and cognitive function likely due to impact on bacteria that produce neuroactive metabolites cross-sectionally and longitudinally. These findings could help explore bacteriophages as options to influence treatment for MHE in cirrhosis.