Discomfort Ratings Research Articles

Isotretinoin Combined Laser/Light-Based Treatments Versus Isotretinoin Alone for the Treatment of Acne Vulgaris: A Meta-Analysis.

This study aims to compare the efficacy and safety of oral isotretinoin with and without laser/light-based treatments for acne. This study was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines; this meta-analysis utilized data from PubMed, EMBASE, ClinicalTrial.gov, and the Cochrane Central Register of Controlled Trials until December 2023. We evaluated clinical improvement, lesion reduction, adverse events, as well as intraoperative and postoperative discomfort rates. Analyses were performed using Review Manager 5.3. This review included six articles with a total of 285 patients. Isotretinoin combined with laser/light therapy outperformed in clinical improvement rates, significantly reducing acne vulgaris and acne scars lesions compared to isotretinoin alone. Additionally, there was no significant difference in the incidence of adverse events between the two groups. The study suggests that combining isotretinoin with laser/light-based therapy for acne yields superior efficacy and satisfaction without increased complications (e.g., dryness, hyperpigmentation, and scarring). However, patients experience notable treatment-related discomfort.

Ileocecal intussusception in ileocecal intussusception in foals

Intussusception is a serious condition that can affect young animals (aged 3 to 12 months), characterized by the invagination of one part of the intestine into another, leading to lesions and intestinal necrosis. It can occur spontaneously or secondarily due to intestinal motility disorders. Enteritis is a predisposing factor, and in older foals, worm infestations, including ascarids, flatworms, Clostridium infections, and mesenteric arteritis, are risk factors. Other factors include sudden dietary changes and pedunculated masses. Clinical signs typically begin with abdominal discomfort, increased heart and respiratory rates, loss of appetite, and a distended abdomen on the right side, among other symptoms. Diagnosis is made through ultrasonography, and hematological tests may reveal toxemia due to rupture or necrosis of the intestinal loops. Prompt diagnosis and treatment improve the animal's prognosis.

Time and environmental conditions for heat stress recovery based on human physiological responses: Developing a predictive model

Breaks can protect workers exposed to high temperatures from heat stress and other health risks. However, the most suitable recovery conditions and how the body physiologically responds to them remain uncertain. The aim of this study was to provide scientific evidence of the human physiological response to step changes in environmental parameters of recovery stage through climate chamber experiments and to develop a predictive model. Volunteer subjects experienced 60 min of walking exercise in air temperatures of 32 and 36 °C, RH 60%, and an air velocity of 0.2 m/s to form two heat stress levels, and then moved into a resting space under designated environmental conditions, such as a standard effective temperature (SET) range of 15.6–26.0 °C. The results showed that the recovery time for physiological parameters decreased with decreasing SET, accompanied by a simultaneous increase in thermal discomfort rate. Correlation analysis suggested that recovery time was related to the physiological stress index at the beginning of the recovery phase (PSI0; r = 0.86) and the SET (r = 0.75) of the recovery environment. A predictive model of heat stress recovery time was developed based on PSI0 and SET, with a determination coefficient of 0.9. According to the model, a SET of 18.8–24.9 °C was suitable for people with high heat stress requiring full recovery in 15–30 min. The research findings contribute to the regulation of health and safety in high-temperature working environments and the operation of restroom environmental conditions.

Development and evaluation of a novel self-contained breathing apparatus pack to reduce musculoskeletal loads and enhance firefighter comfort

Self‑Contained Breathing Apparatus (SCBA) is an essential piece of personal protective equipment for firefighters, providing essential respiratory support and protection. A major challenge in SCBA research is to reduce musculoskeletal disorders and enhance firefighter comfort while carrying the SCBA. In this study, a novel SCBA pack was designed to reduce SCBA‑related musculoskeletal stress. Ten volunteer firefighters were recruited to participate in the test protocol equipped with a novel SCBA (SCBANovel) and a traditional SCBA (SCBATrad) pack. Surface electromyography and pressure data were collected, and subjective ratings of discomfort using a visual analog scale. The results showed that the SCBANovel significantly reduced trapezius and erector spinae muscle activity. Shoulder and waist pressure were reduced by 19.73%‑32.83% and 18.46%‑41.55%, respectively. In addition, the SCBANovel pack reduced lower back discomfort scores by 59.1%, all compared to the SCBATrad pack. The SCBANovel pack showed a significant reduction in musculoskeletal stress and discomfort in firefighters. Practitioner Summary SCBAs are known to be critical in protecting the health of firefighters, but are often associated with firefighter discomfort and musculoskeletal disorders. We developed the SCBANovel pack and explored the effects on the upper body musculoskeletal system and comfort during walking and running compared to carrying the SCBATrad pack. The SCBANovel pack reduced muscle activity in the trapezius and erector spinae muscles and significantly reduced pressure on the shoulders and lower back.

A Machine Learning–Based Ergonomic Assessment of Wireless Hand Control System for Lower‐Limb Disabled Tractor Operators and Abled Female Agricultural Workers

ABSTRACTTractor being the most used power source for agricultural operations needs hand control (HC) and foot control (FC) to maneuver it. FCs restrict lower‐limb disabled agricultural workers from participating in tractor operation, and high requirement of actuation forces to operate FCs may create overexertion and early fatigue to female agricultural workers. Therefore, a sensor‐based HC system has been developed to assist them in tractor operation with minimal actuating force. This study focuses on ergonomic assessment of the HC system to assess the suitability for the abled and disabled agricultural workers, including physiological, psychophysical, and muscle fatigue parameters. Heart rate (HR) of abled male and female, and disabled male and female was observed in the range of 83–118, 85–117, 93–118, and 92–114 beats/min, respectively, during tractor operation. Energy expenditure rate (EER) during tractor operation with FCs (9.7–17.4 kJ/min) was observed higher than with the HC system (7.3–16.5 kJ/min). Body parts discomfort was observed highest for the right hand of all the subjects (4.9–5.3) and maximum overall discomfort was experienced by abled females during the operation with FCs (5.4) as they have to exert higher force. The root mean square (RMS) value of the electromyography signal obtained for extensor digitorum muscle was found to be higher for all the subjects and with both HC and FC (abled male, 17.37–40.43 µV; abled female, 14.76–45.29 µV; disabled male, 15.49–40.23 µV; disabled female, 30.32–54.29 µV) than other upper arm muscles middle deltoid, flexor carpi radialis, and brachioradialis. Muscle workload for all the selected muscles of all the subjects was observed within the recommended limit during the tractor operation with a developed HC system (< 30%). Categorization of overall discomfort rating (ODR) of the subjects using HR, EER, and RMS through machine learning algorithms such as k‐nearest neighbor (KNN), random forest classifier, and support vector machine predicted the ODR with accuracies in the range of 77%–83%. KNN algorithm was found to be most accurate with prediction accuracy of 83%. The developed HC system provides assistantship to the lower‐limb disabled agricultural workers (1%–100% disability of lower limbs) and allows female workers to operate the tractor with minimal physical exertion.

Upper- vs. Whole-Body Cooling During Exercise with Thermal Protective Clothing in the Heat.

INTRODUCTION: Firefighters operating in hot environments face challenges from protective garments that restrict heat dissipation, resulting in increased core temperature, thermal discomfort, and performance decline. Cooling vests represent a viable solution. The study aim was to compare effectiveness of the same amount of cooling power to the upper body (UB) or whole body (WB) in alleviating thermoregulatory and physiological stress, enhancing cognitive function, and reducing ratings of thermal discomfort and exertion, during 60 min of exercise in a hot environment (40°C, 40% relative humidity) while wearing firefighter turnout gear.METHODS: Eight healthy individuals (27.5 ± 3 y) participated in three conditions with either no cooling (Control) or active cooling with a liquid perfused shirt (UB cooling), or with a liquid perfused shirt and pants (WB cooling). In each trial, subjects performed three sets of 15 min of stepping (20 steps ⋅ min-1) and 5 min of rest.RESULTS: Both cooling strategies were beneficial compared to having no cooling at all. Subjects could only complete two exercise bouts during Control, but they completed all three bouts with active cooling. WB cooling provided an advantage over UB cooling for core and skin temperature, and thermal comfort and sensation. The advantage in minimizing the increase in core temperature was only evident during the third exercise bout.DISCUSSION: Active cooling is advantageous under these conditions. WB cooling provided some benefits vs UB cooling during heavy intensity exercise; however, it is uncertain whether these benefits would be observed during light-to-moderate exercise, which more likely reflects an actual firefighting scenario.Mansouri F, Talebian Nia M, Villar R, Cornish SM, Giesbrecht GG. Upper- vs. whole-body cooling during exercise with thermal protective clothing in the heat. Aerosp Med Hum Perform. 2024; 95(9):659-666.

Effects of Energy Drink Consumption on Specific Cardiovascular and Psycho-Behavioral Parameters Among Medical Students at the University of Zakho.

Background The consumption of energy drinks (EDs) among university students has become a prevalent trend, raising concerns about potential health risks. EDs are beveragescontaining various ingredients, most notably caffeine, taurine, and vitamins, that are consumed by the general public and athletes to reduce exhaustion, boost energy, and improve performance. Objectives This study aimed to investigate the prevalence of ED consumption and evaluate the effects of EDuse on cardiovascular health and behavioral patterns in a sample of students atthe University of Zakho. Methods This cross-sectional study involved a sample of 438 medical students aged 18-25 at the University of Zakho. Data were collected using a closed-ended questionnaire assessing socio-demographic characteristics, ED consumption habits, awareness of ED-related health risks, and cardiovascular measures such as blood pressure, pulse rate, presence of chest pain, and palpitation. Results The prevalence of consuming caffeine-content EDs was surprisingly high (70%, n=307) among the University of Zakho's medical students. Further categorization revealed that the prevalence was 42% (n=187) among low-frequency drinkers, 22.2% (n=95) among those who drank once a day, and 5.8% (n=25) among the frequent group. A higher percentage of ED drinkers (30%, n=92) developed tachycardia compared to students with a normal pulse (19.2%, n=59). Additionally, ED drinkers had significantly higher rates of elevated blood pressure (56.4%, n=173), palpitations (63.1%, n=194), and chest discomfort (73.2%, n=225) compared to non-drinkers (p <0.0001). Concerning behavioral characteristics, ED drinkers had a significantly higher rate of fatigability (79.3%, n=243) compared to non-drinkers (p <0.0001). They were more likely to experience somnolence (60.8%, n=187) compared to non-drinkers (p <0.05). Furthermore, the percentage of students with aggressive behavior was substantially higher (p <0.001) among ED drinkers (86.2%, n=265). Conclusion The findings collectively highlight the significant negative impact of energy drink consumption on health in general and cardiovascular and behavioral variables in particular. It also underscores the need for public health strategies and campus interventions to reduce ED consumption and raise awareness about their potential risks.

Effect of prolonged wear and frame tightness of AR glasses on comfort

The present study aimed to investigate the effect of frame tightness on the wearing comfort of augmented reality (AR) glasses during a prolonged video viewing task. A frame prototype of AR glasses with an adjustable frame width was adopted to accommodate variations in head size within the Chinese population, and two hundred participants were recruited to wear the glasses for an hour under five different tightness conditions. Local and overall discomfort ratings were obtained as outcome measures, and the ratings exhibited a significant increase with higher tightness levels. Furthermore, females and older people reported greater discomfort than other participants did, whereas previous spectacle use and body type had nonsignificant effects on wearing comfort. Consideration of approaches to alleviate frame tightness is crucial in the design of AR glasses targeting females and older people. These findings provide valuable ergonomic insights for AR glasses design and offer considerations applicable to the glasses-type wearable device industry.

Affective, perceptual and physiologic responses to isokinetic contractions under blood flow restriction.

Blood flow restriction (BFR) has been shown to enhance the effectiveness of low load resistance exercise, but less research has examined its utility in conjunction with maximal isokinetic contractions, which may depend on the restrictive pressure and speed of contraction. Individuals reported to the laboratory for three visits to complete three sets of 20 maximal elbow flexion exercises at 60°/s and 300°/s under 0%, 40% and 80% of their arterial occlusion pressure. Muscle thickness was measured before and after exercise, and ratings of discomfort, perceived activation, and exercise-induced feelings were obtained at the completion of each exercise. Fatigue was assessed as the decline in average peak torque across the three sets. A total of 27 individuals (11 females, 16 males) completed the study. There was a significant interaction for torque at both 60°/s and 300°/s (P<0.001), with each increasing pressure resulting in greater fatigue. Muscle swelling was present across all conditions but was lowest in the 40% BFR condition applied during the 300°/s speed. At both 60°/s and 300°/s speeds, the 80% BFR pressure was associated with lower enjoyment, greater discomfort, and greater perceived activation (all P<0.05). The combined effects of BFR to maximal isokinetic contractions increased fatigue with less of an impact on muscle swelling. These results indicate that BFR may enhance the effectiveness of long-term isokinetic training, but it is also important to consider the addition of BFR was associated with lower levels of enjoyment and greater discomfort which may decrease adherence.

The role of TENS therapy in reducing the incidence of post-Caesarean section wound infection.

The occurrence of wound infection following a Caesarean section procedure poses a substantial clinical obstacle. Transcutaneous Electrical Nerve Stimulation (TENS) has been identified as a promising supplementary treatment option for improving the healing process and decreasing the incidence of infections. This study assessed the efficacy of TENS therapy in the postoperative care of patients who have had Caesarean section. We randomly assigned a total of 108 women who had Caesarean sections to either a TENS group (n = 54) or control (n = 54). The TENS therapy was provided twice daily for a duration of 30 min for the period of 14 days following the surgery. The main measure of interest in this study was the occurrence of wound infection during 30-day period. Additionally, secondary measures included the rate of wound healing, levels of pain experienced and level of patient satisfaction. In comparison to the control (22.2%, p < 0.05), the TENS group had notably reduced occurrence of wound infection, with the rate of 7.4%. TENS group had superior wound healing results, as measured by REEDA scale, at 7 days (2.1 ± 0.8 vs. 2.5 ± 1.0, p < 0.04), 14 days (1.2 ± 0.5 vs. 1.9 ± 0.7, p < 0.05) and 30 days (0.3 ± 0.5 vs. 0.7 ± 0.6, p < 0.05). Furthermore, TENS group had reduced pain levels on the Visual Analog Scale (VAS) at all evaluation intervals (p < 0.05). TENS group exhibited significantly higher levels of patient satisfaction, as evidenced by 64.8% of participants rating high satisfaction, in contrast to 40.7% in the control group (p < 0.05). The incidence of adverse effects was found to be minor, as indicated by a skin irritation rate of 3.7% and reported discomfort rate of 1.9% at the electrode location. TENS therapy effectively decreased the occurrence of post-Caesarean wound infections, expedited the healing process and enhanced pain control. This treatment was well-received by patients and had little negative consequences. The aforementioned results provided evidence in favour of incorporating TENS into post-Caesarean care regimens, which may have significant consequences for improving patient outcomes and maximizing healthcare resources.

Idiopathic megacolon: relationship between clinical features and diagnostic tests results

AIM: to assess the relationship between clinical features and diagnostic tests results in idiopathic megacolon/megarectum patients.PATIENTS AND METHODS: the retrospective analysis of clinical manifestations and diagnostic tests included 157 patients with idiopathic megacolon/megarectum in 2002-2023. The diagnosis of megacolon/megarectum was verified with a barium enema, Hirschsprung’s disease was excluded byanorectal manometry and (if needed) rectal Swenson’s biopsy.RESULTS: the rate of integral parameter “abdominal discomfort” and Wexner constipation scale rate do not significantly correlate with barium enema, gut transit test, defecography and rectal compliance test results, besides of sigmoid colon width (p = 0.03). The rate of integral parameters “defecation difficulties” correlates with rectum width (p &lt; 0.001) and do not correlate with gut transit time, results of defecography and rectal compliance test (p &gt; 0.05). Distal contrast retention during gut transit test is associated with rectum width only (p &lt; 0.01). The parameters of defecography do not correlate neither clinical features nor other diagnostic tests results (p &gt; 0.05).CONCLUSION: there was not significant relationship between rate of abdominal discomfort, Wexner constipation scale rate and diagnostic tests results. The rate of integral parameters “defecation difficulties” significantly correlates with rectum width (based on barium enema) only. Rectum width seems to be most important parameter to assess the rectum function and in a minor degree — rectal compliance test. The defecography do not correlate either with the severity of clinical symptoms or with the results of other diagnostic methods, which casts doubt on the appropriateness of using this diagnostic test in patients with megacolon.

Evaluating the surgical trainee ergonomic experience during minimally invasive abdominal surgery (ESTEEMA study)

Minimally invasive abdominal surgery (MAS) can exert a physical cost. Surgical trainees spend years assisting minimally-invasive surgeries, increasing the risk of workplace injury. This prospective questionnaire-based cohort study was conducted amongst general surgery residents in Singapore. Residents assisting major MAS surgery were invited to complete anonymous online survey forms after surgery. The Phase 1 survey assessed physical discomfort scores and risk factors. Intraoperative measures to improve ergonomics were administered and evaluated in Phase 2. During Phase 1 (October 2021 to April 2022), physical discomfort was reported in at least one body part in 82.6% (n = 38) of respondents. Over a third of respondents reported severe discomfort in at least one body part (n = 17, 37.0%). Extremes of height, training seniority, longer surgical duration and operative complexity were significant risk factors for greater physical discomfort. In Phase 2 (October 2022 to February 2023), the overall rate of physical symptoms and severe discomfort improved to 81.3% (n = 52) and 34.4% (n = 22) respectively. The ergonomic measure most found useful was having separate television monitors for the primary surgeon and assistants, followed by intraoperative feedback on television monitor angle or position. Close to 20% of survey respondents felt that surgeon education was likely to improve physical discomfort.

Dual vs Single Cardioversion of Atrial Fibrillation in Patients With Obesity

Atrial fibrillation and obesity are common, and both are increasing in prevalence. Obesity is associated with failure of cardioversion of atrial fibrillation using a standard single set of defibrillator pads, even at high output. To compare the efficacy and safety of dual direct-current cardioversion (DCCV) using 2 sets of pads, with each pair simultaneously delivering 200 J, with traditional single 200-J DCCV using 1 set of pads in patients with obesity and atrial fibrillation. This was a prospective, investigator-initiated, patient-blinded, randomized clinical trial spanning 3 years from August 2020 to 2023. As a multicenter trial, the setting included 3 sites in Louisiana. Eligibility criteria included body mass index (BMI) of 35 or higher (calculated as weight in kilograms divided by height in meters squared), age 18 years or older, and planned nonemergent electrical cardioversion for atrial fibrillation. Patients who met inclusion criteria were randomized 1:1. Exclusions occurred due to spontaneous cardioversion, instability, thrombus, or BMI below threshold. Dual DCCV vs single DCCV. Return to sinus rhythm, regardless of duration, immediately after the first cardioversion attempt of atrial fibrillation, adverse cardiovascular events, and chest discomfort after the procedure. Of 2079 sequential patients undergoing cardioversion, 276 met inclusion criteria and were approached for participation. Of these, 210 participants were randomized 1:1. After exclusions, 200 patients (median [IQR] age, 67.6 [60.1-72.4] years; 127 male [63.5%]) completed the study. The mean (SD) BMI was 41.2 (6.5). Cardioversion was successful more often with dual DCCV compared with single DCCV (97 of 99 patients [98%] vs 87 of 101 patients [86%]; P = .002). Dual cardioversion predicted success (odds ratio, 6.7; 95% CI, 3.3-13.6; P = .01). Patients in the single cardioversion cohort whose first attempt failed underwent dual cardioversion with all subsequent attempts (up to 3 total), all of which were successful: 12 of 14 after second cardioversion and 2 of 14 after third cardioversion. There was no difference in the rating of postprocedure chest discomfort (median in both groups = 0 of 10; P = .40). There were no cardiovascular complications. In patients with obesity (BMI ≥35) undergoing electrical cardioversion for atrial fibrillation, dual DCCV results in greater cardioversion success compared with single DCCV, without any increase in complications or patient discomfort. ClinicalTrials.gov Identifier: NCT04539158.

The effects of standing foot-transmitted vibration on self-reported discomfort ratings.

Occupational foot-transmitted vibration (FTV) exposure is common in industries like mining, construction, and agriculture, often leading to acute and chronic injuries. Vibration assessments require technical expertise and equipment which can be costly for employers to perform. Alternatively, researchers have observed that self-reported discomfort can be used as an effective indicator of injury risk. This study aimed to investigate the effect of standing FTV exposure on self-reported ratings of discomfort, and whether these subjective ratings differed by body area and exposure frequency. Participants (n = 30) were randomly exposed to standing FTV at six frequencies (25, 30, 35, 40, 45, and 50 Hz) for 20-45 seconds. Following each exposure, participants rated discomfort on a scale of 0-9 in four body areas: head and neck (HN), upper body (UB), lower body (LB), and total body. Results indicated that participants experienced the most discomfort in the LB at higher frequencies (p < 0.001), consistent with the resonance of foot structures. The HN discomfort tended to decrease as the exposure frequency increased, although not statistically significant (p > 0.0167). The UB discomfort remained relatively low across all frequencies. The study suggests a potential connection between resonant frequencies and discomfort, potentially indicating injury risk. Although self-reported discomfort is insufficient for directly assessing injury risk from FTV, it provides a simple method for monitoring potential musculoskeletal risks related to vibration exposure at resonant frequencies. While professional vibration assessment remains necessary, self-reported discomfort may act as an early indicated of vibration-induced injuries, aiding in implementing mitigation strategies.

Effects of inspiratory muscle training on thoracoabdominal volume regulation in older adults: A randomised controlled trial

ObjectivesWe investigated the effect of inspiratory muscle training (IMT) on inspiratory muscle strength, functional capacity and respiratory muscle kinematics during exercise in healthy older adults. Methods24 adults were randomised into an IMT or SHAM-IMT group. Both groups performed 30 breaths, twice daily, for 8 weeks, at intensities of ∼50 % maximal inspiratory pressure (PImax; IMT) or <15 % PImax (SHAM-IMT). Measurements of PImax, breathing discomfort during a bout of IMT, six-minute walk distance, physical activity levels, and balance were assessed pre- and post-intervention. Respiratory muscle kinematics were assessed via optoelectronic plethysmography (OEP) during constant work rate cycling. ResultsPImax was significantly improved (by 20.0±11.9 cmH2O; p=0.001) in the IMT group only. Breathing discomfort ratings during IMT significantly decreased (from 3.5±0.9–1.7±0.8). Daily sedentary time was decreased (by 28.0±39.8 min; p=0.042), and reactive balance significantly improved (by 1.2±0.8; p<0.001) in the IMT group only. OEP measures showed a significantly greater contribution of the pulmonary and abdominal rib cage compartments to total tidal volume expansion post-IMT. ConclusionsIMT significantly improves inspiratory muscle strength and breathing discomfort in this population. IMT induces greater rib cage expansion and diaphragm descent during exercise, thereby suggesting a less restrictive effect on thoracic expansion and increased diaphragmatic power generation.

The effect of misophonia on cognitive and social judgments.

Misophonia, a heightened aversion to certain sounds, turns common cognitive and social exercises (e.g., paying attention during a lecture near a pen-clicking classmate, coexisting at the dinner table with a food-chomping relative) into challenging endeavors. How does exposure to triggering sounds impact cognitive and social judgments? We investigated this question in a sample of 65 participants (26 misophonia, 39 control) from the general population. In Phase 1, participants saw faces paired with auditory stimuli while completing a gender judgment task, then reported sound discomfort and identification. In Phase 2, participants saw these same faces with novel ones and reported face likeability and memory. For both oral and non-oral triggers, misophonic participants gave higher discomfort ratings than controls did-especially when identification was correct-and performed slower on the gender judgment. Misophonic participants rated lower likeability than controls did for faces they remembered with high discomfort sounds, and face memory was worse overall for faces originally paired with high discomfort sounds. Altogether, these results suggest that misophonic individuals show impairments on social and cognitive judgments if they must endure discomforting sounds. This experiment helps us better understand the day-to-day impact of misophonia and encourages usage of individualized triggers in future studies.

Magnetic resonance-guided focused ultrasound thalamotomy for essential tremor patients with low skull density ratio: a case-matched analysis.

Skull density ratio (SDR) is the ratio between the mean Hounsfield units of marrow and cortical bone, impacting energy transmission through the skull. Low SDR has been used as an exclusion criterion in major trials of magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy for medication-refractory essential tremor (ET). However, some studies have suggested that patients with low SDR can safely undergo MRgFUS with favorable outcomes. In this case-matched study, we aim to compare the characteristics, sonication parameters, lesion sizes, and clinical outcomes of patients with low SDR vs. patients with high SDR who underwent unilateral MRgFUS thalamotomy for medication-refractory ET. Between March 2016 and April 2023, all patients (n = 270) who underwent unilateral MRgFUS thalamotomy for medication-refractory ET at a single institution were classified as low SDR (<0.40) and high SDR (≥0.40). All clinical and radiological data was prospectively collected and retrospectively analyzed using non-case-matched and 1:1 case-matched methodology. Thirty-one patients had low SDR, and 239 patients had high SDR. Fifty-six patients (28 in each cohort) were included in 1:1 case-matched analysis. There were no significant differences in baseline characteristics between the two groups in both non-case-matched and 1:1 case-matched analyses. In both analyses, compared to patients with high SDR, patients with low SDR required a significantly higher maximum sonication power, energy, and duration, and reached a lower maximum temperature with smaller lesion volumes. In the non-case-matched and case-matched analyses, low SDR patients did not have significantly less tremor control at any postoperative timepoints. However, there was a higher chance of procedure failure in the low SDR group with three patients not obtaining an appropriately sized lesion. In both analyses, imbalance was observed more often in high SDR patients on postoperative day 1 and month 3. ET patients with SDR <0.40 can be safely and effectively treated with MRgFUS, though there may be higher rates of treatment failure and intraoperative discomfort.

Service Quality and Residents' Preferences for Facilitated Self-Service Fundus Disease Screening: Cross-Sectional Study.

Fundus photography is the most important examination in eye disease screening. A facilitated self-service eye screening pattern based on the fully automatic fundus camera was developed in 2022 in Shanghai, China; it may help solve the problem of insufficient human resources in primary health care institutions. However, the service quality and residents' preference for this new pattern are unclear. This study aimed to compare the service quality and residents' preferences between facilitated self-service eye screening and traditional manual screening and to explore the relationships between the screening service's quality and residents' preferences. We conducted a cross-sectional study in Shanghai, China. Residents who underwent facilitated self-service fundus disease screening at one of the screening sites were assigned to the exposure group; those who were screened with a traditional fundus camera operated by an optometrist at an adjacent site comprised the control group. The primary outcome was the screening service quality, including effectiveness (image quality and screening efficiency), physiological discomfort, safety, convenience, and trustworthiness. The secondary outcome was the participants' preferences. Differences in service quality and the participants' preferences between the 2 groups were compared using chi-square tests separately. Subgroup analyses for exploring the relationships between the screening service's quality and residents' preference were conducted using generalized logit models. A total of 358 residents enrolled; among them, 176 (49.16%) were included in the exposure group and the remaining 182 (50.84%) in the control group. Residents' basic characteristics were balanced between the 2 groups. There was no significant difference in service quality between the 2 groups (image quality pass rate: P=.79; average screening time: P=.57; no physiological discomfort rate: P=.92; safety rate: P=.78; convenience rate: P=.95; trustworthiness rate: P=.20). However, the proportion of participants who were willing to use the same technology for their next screening was significantly lower in the exposure group than in the control group (P<.001). Subgroup analyses suggest that distrust in the facilitated self-service eye screening might increase the probability of refusal to undergo screening (P=.02). This study confirms that the facilitated self-service fundus disease screening pattern could achieve good service quality. However, it was difficult to reverse residents' preferences for manual screening in a short period, especially when the original manual service was already excellent. Therefore, the digital transformation of health care must be cautious. We suggest that attention be paid to the residents' individual needs. More efficient man-machine collaboration and personalized health management solutions based on large language models are both needed.

Effects of Short-Term Hand Tractor Operation on Upper Limb Responses of Users

ABSTRACT Objectives Continuous exposure to hand-arm vibration integrated with poor posture and forceful movements are known causes of musculoskeletal disorders (MSD). In most related studies, force and vibration levels in experimental research is controlled. This study aims to determine how actual hand tractor field operation can affect the upper limb of users. It intends to characterize upper limb muscle activation applied during actual hand tractor usage. Lastly, it determines the immediate impacts on hand strength and perceived upper limb discomfort after the operation. Methods We recruited 15 farm operators with a mean working experience of 20.1 ± 12.2 years. They were asked to operate a hand tractor on paddy fields for at most 8 minutes. Handle vibration was measured using a tri-axial accelerometer. The total unweighted vibration acceleration was computed and used to represent the handle vibration magnitude. Muscle activation was measured using surface electromyography (sEMG). Six sEMG sensors were attached to the dominant and non-dominant side of the extensor carpi radialis (ECR), bicep, and deltoid. Pre- and post-task hand strength and subjective discomfort rating were also taken. Results The total unweighted handle vibration acceleration is 17.45 ± 7.53 m/s2. This exceeds the allowable safe value. Meanwhile, the percentage of maximum voluntary contraction (% MVC) of the muscles ranged from 6% to 14% with the ECR having a significantly higher activation (p < .05) than the bicep and deltoid. The post-task grip strength of the dominant hand was lower than its pre-task value (p < .01) while that of the non-dominant side did not vary significantly. There is a modest trend of higher hand discomfort of the non-dominant side on post-task than pre-task rating (p < .10). Although, overall, the perceived discomfort ranged from none to mild discomfort. Conclusion In conclusion, the study showed an indication that the effects of vibration on humans are evident even at mild muscle exertion, with the exertion predominantly concentrated on the distal arm area clearly affecting grip strength and hand discomfort. In such cases, future recommendations can revolve around the improvement of the hand tractor handle grip to impose grip comfort and ease.

Individual-specific postural discomfort prediction using decision tree models

The objective of the current study was to explore the utilization of the decision tree (DT) algorithm to model posture-discomfort relationships at the individual level. The DT algorithm has the advantage that it makes no assumptions about the distribution of data, is robust in representing non-linear data with noise, and produces white-box models that are interpretable. Individual-level modelling is essential for examining individual-specific postural discomfort perception processes and understanding the inter-individual variability. It also has practical applications, including the development of individual-specific digital human models and more precise and informative population accommodation analysis. Individual-specific DT models were generated using postural discomfort rating data for various seated upper body postures to predict discomfort based on postural and task variables. The individual-specific DT models accurately predicted postural discomfort and revealed large inter-individual variability in the modelling results. DT modelling is expected to greatly facilitate investigating the human discomfort perception process.