Full Assessment Research Articles

Data on Mapping 444 Dairy Small Ruminant Farms during a Countrywide Investigation Performed in Greece.

The small ruminant industry is the most important branch of Greek agriculture. Nevertheless, despite the importance of small ruminant farming for Greece, no detailed mapping of the respective farms has been undertaken and published. The present work refers to mapping the dairy sheep and goat industry in Greece through an extensive, countrywide cross-sectional study, in which information was obtained from 325 sheep and 119 goat farms. The objectives were the collection, the classification and the presentation of data obtained from all these farms through interviews, using a questionnaire and through examination of samples collected during the visits. All the farms enrolled in the study were visited by the investigators. Initially, information was obtained by means of a detailed, structured questionnaire with 442 questions. Moreover, samples of milk were collected from the bulk-tank of each farm and faecal samples were collected from female animals in each farm. The milk samples were processed for cytological and microbiological examination. Staphylococcus spp. and Listeria spp. isolates were recovered and identified at a species level; furthermore, a full antibiotic sensitivity pattern assessment was conducted. Faecal samples were processed by standard parasitological tests for the identification of protozoan, trematode, cestode and gastrointestinal and respiratory nematode parasites. The paper presents the cumulative findings of the study, i.e., the answers to the questions during the interviews and the results of the laboratory examinations performed in the samples; the findings are presented separately for sheep and goat farms. The findings can be used as baseline measurements; individual farms and cohorts of farms can be compared against the current results to draw conclusions against the countrywide situation. Moreover, the current results can be used as reference points for the future, in order to assess changes that might have occurred in the meantime. The study also described the differences between farms with sheep or goats; in total, differences in 137 parameters were identified. Some of these can be attributed to the different management systems practiced; sheep flocks are managed mostly under the intensive or semi-intensive system, whilst goat herds are managed mostly under the semi-extensive or extensive system. These findings can be useful in the health management of small ruminants, in providing evidence-based support and within the scope of precise livestock medicine and health management.

Life cycle assessment and shadow cost of steam produced by an industrial-sized high-temperature heat pump

Heat pumps are considered to be a promising technology to mitigate industrial emissions from steam provision. In this work, an existing scale-up framework for generating life-cycle inventory data for residential heat pumps was tested if applicable to large-scale high-temperature heat pumps. The benchmark was experimental data from existing machinery. It was found that the scaling framework underestimated the total mass; thus, a new scaling framework was developed and was applied to data obtained from a test run of a commercially available high-temperature pump. A full life cycle assessment was performed by comparing two different steam pressure levels, 2 and 5-bar, produced by the high-temperature heat pump to relevant benchmarks, such as steam from a fossil fuel-driven steam boiler. Although greenhouse gas emissions were reduced by as much as 98% in the best-case scenario, other midpoint categories exhibited a more mixed result in which sometimes the heat pumps were favorable and at other times the benchmarks had a lower impact. An unexpected finding was that the working fluid and its leakage did not have a significant contribution to the global warming potential but it was almost solely responsible for the ozone depletion potential. Recommendations were derived on how to further improve the environmental impact of high-temperature heat pumps. Ultimately, the life cycle impact assessment results were converted into shadow price to allow for a comparison between different areas of protection and to give policymakers an estimate of the total externalized cost of the technology.

540-P: Clinical Practice Gap Analysis of T1D Risk, Diagnosis, and Screening, and Emerging Therapies

Introduction: Understanding clinical practice gaps in the clinical understanding, diagnosis and staging, and emerging treatments for T1D can inform development of tools to improve physician practices. Methods: A survey instrument of 25 multiple choice, knowledge- and case-based questions allowed participants to assess their clinical knowledge with regard to T1D. The survey was available online to physicians without monetary compensation or charge. Respondent confidentiality was maintained and responses were de-identified and aggregated prior to analyses. Initial data collection occurred from January 8, 2022 to April 6, 2022. Results: In total, 84 diabetologists/endocrinologists (D/Es) and 76 pediatricians completed the full assessment within the data collection period. Physicians demonstrated gaps in the following areas. Conclusion: This educational research on assessment of physicians’ clinical practices yielded important insights into clinical gaps related to T1D risk, diagnosing and staging, and emerging treatments. Further studies are planned to assess the effect of medical education on decreasing these clinical practice gaps. Disclosure A.Larkin: None. Funding Dompe

The prognostic value of non-invasively estimated left atrial pressure in patients undergoing cardiac resynchronization therapy

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovative program under the Marie Sklodowska -Curie grant agreement No. 860745. Background The impact of non-invasively estimated left atrial pressure (LAP) on cardiac resynchronization therapy (CRT) outcome has been previously investigated, yet with inconsistent results. Aim We aim at investigating the association between baseline LAP and CRT outcome applying both the standard guideline approach (Nagueh et al 2016) and the integrated guideline + LA strain approach. Methods Datasets of 219 CRT patients were retrospectively analyzed. All patients had full echocardiographic diastolic function assessment before CRT and were classified based on the guidelines approach for estimation of LAP into normal LAP (nLAP = 40%), elevated LAP (eLAP = 49%) and undetermined LAP (uLAP = 11%, when classification was not possible due to missing data, Figure A, solid bars). All baseline characteristics, comorbidities, and ECG data in addition to LA strain components before CRT were collected and analyzed. The amount of CRT-induced LV reverse remodeling was assessed at 12±6 months after CRT and was defined as percentage decrease of LV end-systolic volume (LVESV) compared to baseline. Patients were followed up for a mean of 4.8 years (interquartile range (IQR): 2.7–6.0) for all-cause mortality. Results Compared to patients with eLAP, patients with nLAP were more of female sex (40% vs. 21%) and they had lower serum creatinine (1.1 ± 0.4 vs. 1.5 ± 0.6 mg/dl). ECG data showed that they had less prevalence of AF (9 vs. 15%). All LA strain indices were better in patients with nLAP (23 ± 9 vs. 12 ± 7% for reservoir strain, 10 ± 4 vs. 7 ± 5% for conduit strain and 11 ± 7 vs. 4 ± 4% for pump strain, P < 0.01 for all comparisons). At follow-up, LVESV was reduced more in patients with nLAP than in patients with eLAP (47 ± 28 vs. 30 ± 30%, P < 0.01, figure B solid bars). Survival rates of patients with nLAP was significantly higher than patients with eLAP (Hazard ratio (HR): 0.40; confidence interval (CI): 0.22–0.27; P < 0.01, figure C solid lines). In the subgroup of uLAP an LA reservoir strain was used to further identify patients with nLAP (LA reservoir strain ≥ 18%). Accordingly, the integrated guideline+LA strain approach improved the feasibility for classification from 89% to 97%, where the percentage of the uLAP dropped from 11% to 3% (only patients with no baseline LA strain remained classified as uLAP, figure A). Patients with nLAP according to the integrated approach showed very similar CRT-induced LV reverse remodeling (figure B dashed bars) and long-term survival as compared to patients with nLAP according to the standard approach (figure C dashed lines). Conclusion Applying the standard guideline approach for LAP, patients with nLAP before CRT show more LV reverse remodeling and better long-term survival after CRT, as compared to patients with eLAP. The guideline + LA strain approach markedly improves the feasibility of LAP estimation, while not influencing the association between LAP and outcome after CRT.

Early evolution of cardiac damage staging following transcatheter aortic valve replacement: prevalence, clinical patterns and prognostic significance

Abstract Funding Acknowledgements Type of funding sources: None. Background The early evolution of extravalvular cardiac damage following transcatheter aortic valve replacement (TAVR) as assessed by a previous validated score system remains unstudied. We sought to assess the patterns of early cardiac damage change among patients with severe aortic stenosis (AS) undergoing TAVR and its prognostic implications. Methods The RECOVERY-TAVR is a multi-center, international retrospective registry including all consecutive patients undergoing TAVR in thirteen high-volume centers. All the enrolled patients with available paired echocardiography assessment pre- and post TAVR were included in this sub-analysis. Patients were categorized according to the extension of cardiac damage based on a previous published and validated classification (stage 0, no damage; stage 1, left ventricular damage; stage 2, left atrial or mitral valve damage; stage 3, pulmonary vasculature or tricuspid valve damage; and stage 4, right ventricular damage). The primary endpoint was a composite of all-cause mortality or first heart failure hospitalization at 1 year. The association of cardiac damage stage evaluated prior and following TAVR along with the staging evolution was assessed with multivariate Cox regression model (that include hemoglobin, NYHA class and max aortic valve gradient) for the primary outcome. Results Of 1331 Patients included in the RECOVERY-TAVR registry with a full echocardiographic pre-TAVR assessment, 892 patients with available paired echocardiography exams were finally included in this analysis (pre-TAVR assessment: median 8 days prior to TAVR; post-TAVR assessment: median 7 days post-TAVR). 63 (7.1%) had stage 0/1, 433 (48.2%) had stage 2, 235 (26.3%) had stage 3 and 161 (18%) had stage 4 myocardial damage. Pre-TAVR myocardial damage staging was associated with the primary outcome (Adj-HR for myocardial stage increase: HR 1.40, 95% CI 1.01 – 1.93). Following TAVR 274 (30.7%) patients experienced myocardial damage improvement and 161 (18.1%) myocardial damage worsening. Post-TAVR myocardial damage staging was more strongly associated with the primary outcome (HR 1.55, 95%CI 1.14 – 2.10) as compared to pre-TAVR assessment. Male Sex (p = 0.044) and post-procedural permanent pacemaker implantation (p = 0.044) was associated with myocardial damage worsening. Early myocardial damage worsening (HR 1.89, 95%CI 1.12 – 3.21), but not early myocardial damage improvement (HR 0.86, 95%CI 0.54 – 1.37) was associated with the primary outcome. Conclusion In patients undergoing TAVR, the extent of extravalvular cardiac damage prior to and early after TAVR has an independent prognostic value while early myocardial damage worsening following TAVR portends a poor prognosis. Whether strategies to improve procedural success and treatments addressing extravalvular myocardial damage early following TAVR may improve outcomes has to be prospectively assessed.

Baseline mechanical dyssynchrony is associated with better diastolic function in patients undergoing cardiac resynchronization therapy

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovative program under the Marie Sklodowska -Curie grant agreement No. 860745. Background Outcome after cardiac resynchronization therapy has been shown to be worse in patients with diastolic dysfunction. Aim We aim at investigating the association between baseline mechanical dyssynchrony (Dyss) and diastolic function, both assessed using conventional 2D echocardiography in heart failure patients undergoing cardiac resynchronization therapy (CRT). Methods Datasets of 219 patients were retrospectively analyzed, including full echocardiographic diastolic function assessment before CRT implantation. Using the guideline approach (Nagueh et al 2016) for estimating left atrial pressure (LAP), patients were classified as elevated LAP (eLAP = 49%), normal LAP (nLAP = 40%), and undetermined LAP (uLAP = 11%). Patients with nLAP and uLAP together were referred to as non-elevated LAP (non-eLAP = 51%). Dyss was defined as the presence of apical rocking (ApRock) and /or septal flash (SF). All baseline characteristics, comorbidities, ECG data and left atrial (LA) strain components (reservoir, conduit, and pump strains) were collected and analyzed. The amount of CRT-induced LV reverse remodeling was assessed at 12±6 months after CRT and was defined as percentage decrease of LV end-systolic volume (LVESV) compared to baseline. Patients were followed up for a mean of 4.8 years (interquartile range (IQR): 2.7–6.0) for all-cause mortality. Results Compared to patients without Dyss, patients with Dyss were significantly more of female sex (39% vs. 14%), had less diabetes mellitus (21 vs. 34%), had lower serum creatinine (1.2±0.5 vs. 1.4±0.6 mg/dl) and less prevalence of ischemic cardiomyopathy, 43% vs. 68%). They used significantly more ACEi (91% vs. 76%). ECG data showed that they had less prevalence of AF (8 vs. 22%) and had wider QRS complex (158±18 vs. 152±18 msec), P-values <0.05 for all comparisons. Baseline LV volumes and EF were not significantly different between patients with and without Dyss. Patients with Dyss show less prevalence of eLAP compared to patients without Dyss (30% vs. 60%, P <0.001, figure A). Additionally, they had better LA function on all LA strain indices (Figure B). In the multivariable analysis for predicting the association with eLAP, the presence of Dyss was independently associated with less eLAP after adjusting for most of the baseline variables (HR: 0.31, CI: 0.1–0.7, P <0.01). At follow up, patients who had both Dyss and non-eLAP before CRT showed the largest amount of LV reverse remodeling compared to other patients. Similarly, the patients with Dyss and non-eLAP showed the best survival compared to other groups (figure C). Conclusion The presence of mechanical dyssynchrony is associated with better diastolic function and lower estimated LAP before CRT. Additionally, the combination of Dyss and non-eLAP before CRT was associated with the most CRT-induced LV reverse remodeling and best long-term survival.

Impact of age-friendly living environment and intrinsic capacity on functional ability in older adults: a cross-sectional study

BackgroundThe World Health Organization (WHO) has proposed healthy aging framework, supposing that intrinsic capacity (IC), environment and their interaction may have influence on functional ability (FA). It was still unclear how the IC level and age-friendly living environment impact on FA. This study aims to confirm the relationship between the IC level and age-friendly living environment with FA, especially in older adults with low IC.MethodsFour hundred eighty-five community-dwelling residents aged ≥ 60 years were enrolled. IC constructed by locomotion, cognition, psychological, vitality, and sensory domains was assessed using full assessment tools recommended by WHO. Age-friendly living environment was measured with 12 questions adapted from the spatial indicators framework of age-friendly cities. FA was assessed using activities of daily living (ADL) and one question about mobile payment ability. Multivariate logistic regression was used to explore the association between IC, environment and FA. The influence of the environment on electronic payment and ADL under the IC layer was assessed.ResultsOf 485 respondents, 89 (18.4%) had ADL impairment, and 166 (34.2%) had mobile payment function impairment. Limited IC (odds ratio [OR] = 0.783, 95% confidence interval [CI] = 0.621–0.988) and poor environment (OR = 0.839, 95% CI = 0.733–0.960) were associated with mobile payment ability impairment. Our results suggested that a supportive age-friendly living environment influenced FA was more prominent in older adults with poor IC (OR = 0.650, 95% CI = 0.491–0.861).ConclusionsOur results confirmed IC and the environment had an impact on mobile payment ability. The relationship between environment and FA showed differences according to IC level. These findings suggest that an age-friendly living environment is important to maintain and enhance elders’ FA, especially in those with poor IC.

Exploring potential applications of measles and rubella microarray patches (MR-MAPs): use case identification.

Innovative vaccine products will be critical in helping to address the existing implementation barriers that have prevented the achievement of the measles and rubella (MR) vaccine coverage targets. Overcoming those barriers will be necessary to achieve the "Immunization Agenda 2030" goals. Microarray patches (MAPs), an innovative needle-free delivery device currently in clinical development, can be a potential game changer in this respect and contribute to the equitable delivery of vaccines in low- and middle-income countries and pandemic preparedness and response. Developing in-depth knowledge of the most desired and impactful uses of MRMAPs can prove critical to identifying the critical attributes of the target product profile, informing policy and adoption decisions, and helping to evaluate the potential public health and economic value of this technology. The first step in this process is the definition of the potential use cases for MR-MAPs, i.e., where and how this product is most likely to be used within the immunization programme. By applying a design-based user-centric approach, we implemented a three-step process, including a desk review, a survey, and interviews, to define the most relevant use cases for MR MAPS. Six use cases have been identified as relevant across all different countries and immunization programme designs and validated by experts. The identified use cases have already informed the demand estimate for MR-MAPs and provided the foundation for developing an initial full vaccine value assessment. We believe that, in the future, they will be highly valuable in ensuring that the roll-out of this promising innovation is designed in a way that maximizes the impact, particularly in populations and countries that are most in need.

Quality of Life and Kidney Function in Older Adults: Prospective Data of the SCOPE Study.

A longitudinal alteration in health-related quality of life (HRQoL) over a two-year period and its association with early-stage chronic kidney disease (CKD) progression was investigated among 1748 older adults (>75 years). HRQoL was measured by the Euro-Quality of Life Visual Analog Scale (EQ-VAS) at baseline and at one and two years after recruitment. A full comprehensive geriatric assessment was performed, including sociodemographic and clinical characteristics, the Geriatric Depression Scale-Short Form (GDS-SF), Short Physical Performance Battery (SPPB), and estimated glomerular filtration rate (eGFR). The association between EQ-VAS decline and covariates was investigated by multivariable analyses. A total of 41% of the participants showed EQ-VAS decline, and 16.3% showed kidney function decline over the two-year follow-up period. Participants with EQ-VAS decline showed an increase in GDS-SF scores and a greater decline in SPPB scores. The logistic regression analyses showed no contribution of a decrease in kidney function on EQ-VAS decline in the early stages of CKD. However, older adults with a greater GDS-SF score were more likely to present EQ-VAS decline over time, whereas an increase in the SPPB scores was associated with less EQ-VAS decline. This finding should be considered in clinical practice and when HRQoL is used to evaluate health interventions among older adults.

Caretakers’ stated willingness to pay for children’s spectacles in cross river state, Nigeria and its implication for a cross-subsidisation scheme: a cross-sectional study

BackgroundUnderstanding caretakers’ willingness to pay (WTP) for their children’s spectacles is essential to improving the sustainability of refractive error services and spectacle provision. Therefore, we investigated the willingness of caretakers to pay for their children’s spectacles in a multi-centre study to develop a spectacle cross-subsidisation scheme in the Cross River State (CRS), Nigeria.MethodsWe administered the questionnaire to all caretakers whose children were referred from school vision screenings to four eye centres for full refraction assessment and dispensing of corrective spectacles from 9 August to 31 October 2019. We collected information on socio-demography, children’s refractive error types, and spectacle prescription and then asked the caretakers about their WTP for the spectacles using a structured questionnaire and bidding format (in the local currency, Naira, ₦).ResultsA total of 137 respondents (response rate = 100%) from four centres were interviewed: with greater proportion of women (n = 92, 67.1%), aged between 41 and 50 years (n = 59, 43.1%), government employees (n = 64, 46.7%) and had acquired college or university education (n = 77, 56.2%). Of the 137 spectacles dispensed to their children, 74 (54.0%) had myopia or myopic astigmatism (equal to or greater than 0.50D). The mean stated WTP for the sample population was ₦3,560 (US$ 8.9) (SD ± ₦1,913.4). Men (p = 0.039), those with higher education (p < 0.001), higher monthly incomes (p = 0.042), and government employees (p = 0.001) were more willing to pay ₦3,600 (US$9.0) or more.ConclusionCombining our previous findings from marketing analysis, these findings provided a basis to plan for a children’s spectacles cross-subsidisation scheme in CRS. Further research will be needed to determine the acceptability of the scheme and the actual WTP.

EE553 Estimating the Economic Burden of Progressive Multifocal Leukoencephalopathy in the United States: A Literature Review and Assessment

Progressive multifocal leukoencephalopathy (PML) is a brain disease that can occur in immunosuppressed patients due to activation of the polyomavirus. PML is often fatal and thus can impose a significant disease burden on individuals. Through a focused literature review, we aimed to assess what is known about the economic burden of PML to support a full assessment at a population level.

Impairment of cognitive functions in children and adolescents with focal epilepsy

IntroductionFrontal Lobe Epilepsy (FLE) and Temporal Lobe Epilepsy (TLE) are the two most frequent types of focal epilepsies and they are connected with difficulties in cognitive functioning. Despite multiple trials to systematize profile of cognitive functioning among children with epilepsy by researchers, the available data are ambiguous. The aim of our study was to compare the cognitive function of children upon diagnosis of TLE and FLE and during follow-up and to compare with a control group of healthy children. Material and methodsStudy included 39 patients with newly diagnosed TLE, 24 patients with FLE whose first epileptic seizure occurred between their 6th and 12th year of life and 24 healthy children matched by age, sex and IQ level. Neuropsychological examination was performed the moment of diagnosis and 2–3 years later using diagnostic tools validated and standardized to the patient’s age. Intergroup comparison was conducted in both stages of study. Also, correlation between localization of epileptic focus and cognitive difficulties was analysed. ResultsChildren with FLE and TLE accomplished worse results in most of the cognitive tasks compared to the control group already in the initial examination. Patients with FLE presented difficulties in memorizing verbal and visual material, attention and in learning new information. Patients with TLE had difficulties in tasks engaging verbal and non-verbal memory and attention. In the follow-up, patients with FLE presented more severe cognitive impairment compared with the other groups. Despite similar tendencies among children with TLE significantly worse results in tasks engaging verbal memory and attention were observed among patients with FLE. It is noteworthy that patients suffering from FLE and TLE present deficits in many aspects of cognitive functioning already at the time of diagnosis. ConclusionChildren and adolescents suffering from epilepsy are at risk of psychosocial difficulties, emotional disorders and mental illnesses. Thus, full assessment of cognitive function is essential in this patient group not only at the moment of diagnosis but also during follow-up in order to quickly introduce an individual support system.

COMPARISON OF A WATERCOOLER AND OTHER ALTERNATIVES IN TERMS OF THEIR ENVIRONMENTAL IMPACTS USING THE LCA METHOD

The environmental impacts of products are evaluated based on an assessment of the influence of material and energy flows that the evaluated product system exchanges with the environment. The University of Southern Denmark is also dealing with this, and from the point of view of sustainable development, drinking watercoolers are being investigated using the Life Cycle Assessment method. This research conducts a Life Cycle Impact Assessment of drinking water supply systems at a university to determine if they fit the institution's sustainability agenda. In the evaluation, the impact of one beverage delivered from watercoolers is compared with beverages from five benchmarked systems. These systems are tap water, ice-chilled water, bottled water, soft drinks and hot drinks. They are set up in scenarios that are directly used for evaluation and subsequent comparison. This study uses a variant of “Cradle-To-Grave” Life Cycle Assessment, where a full assessment occurs from resource extraction to disposal, while using an attributive approach. The results of the life cycle assessment showed which system has the lowest impact and the results are quantified. Finally, based on the results of the life cycle assessment, the most suitable water chiller system is recommended and the University management is provided with information for further decision making.

Performance and satisfaction during the E-learning transition in the COVID-19 pandemic among psychiatry course medical students

BackgroundIn the field of medical education, students faced significant challenges during the COVID-19 pandemic. Abrupt alterations were made in the form of preventative precautions. Virtual classes replaced onsite classes, clinical placements were canceled, and social distance interventions prevented face-to-face practical sessions. The present study aimed to assess students' performance and satisfaction before and after the transition of a psychiatry course from onsite to entirely online during the COVID-19 pandemic. MethodsA retrospective, non-clinical, and non-interventional comparative educational research study included all students registered in the psychiatric course for the academic year 2020 (pre-pandemic/onsite) and 2021 (during the pandemic/online).To assess students' satisfaction, we utilized the National Commission for Academic Accreditation and Assessment (NCAAA) students' satisfaction survey used by the academic quality unit at KSU, College of Medicine.Satisfaction was assessed in six domains: course organization, learning resources, faculty experiences, clinical teaching, practical sessions, and overall satisfaction. The reliability of the questionnaire was measured using Cronbach's alpha test.To assess their performance, students’ grades from both periods were obtained from the exam center. ResultsA total of 193 medical students enrolled in the study; 80 received onsite learning and assessment, while another 113 received full online learning and assessment. The students' mean indicators of course satisfaction for the online courses exceeded their corresponding indicators significantly compared to the onsite courses. These indicators included students' satisfaction in terms of course organization, p < 0.001; medical learning resources, p < 0.050; faculty experience, p < 0.050; and overall course, p < 0.050. There were no significant differences regarding satisfaction in both practical sessions, p > 0.050, and clinical teaching, p > 0.050. The students' performance mean was significantly higher in the online (M = 91.76) compared to the onsite courses (M = 88.58) (p < 0.001), and the Cohen's D statistic showed there was a medium level of enhancement in students' overall grades (Cohen’s d = 0.41). ConclusionStudents perceived the switch to online delivery methods very favorably. Students’ satisfaction significantly improved regarding the themes of course organization, faculty experience, learning resources, and overall course satisfaction, while a similar level of adequate student satisfaction was maintained in terms of clinical teaching and practical sessions during the transition of the course to e-learning. In addition, the online course was associated with a trend toward higher students’ grades. However, the assessment of the achievement of course learning outcomes and the maintenance of this positive impact warrants further investigation.

Life Cycle Assessment of aluminum alloys chips recycling through single and multi-step Friction Stir Consolidation processes

Manufacturing scientists have to find new processes enabling energy and resource efficient circular economy strategies. Solid state recycling processes have proved to be environmentally friendly alternatives to recycle aluminum alloys process scraps like chips. In this paper the environmental characterization of a solid state recycling process named Friction Stir Consolidation (FSC) is presented. A full Life Cycle Assessment (LCA) comparative analysis is developed: the environmental performance of new and different variants of FSC processes and remelting based routes are quantified and compared to one another. Also, different scenarios are analysed to provide guidelines for the correct implementation of FSC based recycling processes. Results revealed that: 1/ FSC is an environmentally friendly solution although a correct industrial implementation is needed to reduce non-productive production steps, 2/ the transition towards a wider use of renewable energy sources would amplify the advantage of FSC with respect to conventional remelting route in terms of environmental sustainability.

Level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia

ObjectivesMalnutrition is very common among older adults. In rural Ethiopia, around 25% of women and 34% of men ≥65 y of age are malnourished. However, the risk factors for malnutrition among older adults in rural areas are not well understood. The aim of this study was to assess the level of malnutrition and associated factors among community-dwelling rural older adults in Fogera Zuriya district, Northwest Ethiopia. MaterialsThis was a community-based, cross-sectional study among randomly selected (N = 634) adults ≥65 y of age in Fogera Zuriya rural district. Participants were selected using a multistage sampling technique. A pretested full Mini-Nutritional Assessment (MNA) tool was used to classify as malnourished (MNA score <17), at risk for malnutrition (MNA score 17–23.5), or otherwise normal. A validated Geriatric Depression Scale form (15 items) was used to assess depression. Ordinal logistic regression was employed to identify factors of malnutrition and the PLUM procedure was used to produce an odds ratio (OR). P < 0.05 was considered statistically significant with the dependent variable. Both crude and adjusted ORs (COR and AOR, respectively) with a corresponding 95% confidence interval were computed. ResultsThis study included 634 older adults. According to the results of the study, the risk for malnutrition was 383 (60%), and being malnourished was 166 (268%). The following factors were significantly associated with the risk for malnutrition and malnutrition:• Age ≥85 y (AOR, 3.47; 95% CI, 1.270–9.465);• Skipping two meals daily (AOR, 6.36; 95% CI, 2.11–19.16);• Skipping 1 meal a day (AOR, 3.05; 95% CI, 1.82–5.12);• Having a poor appetite (AOR, 6.2; 95% CI, 2.50–15.36);• Being depressed (AOR, 4.04; 95% CI, 2.37–6.89);• Low physical activity (AOR, 3.81; 95% CI, 1.50–9.72);• Family size of three of less members (AOR, 1.9; 95% CI, 1.14–3.24); and• Low dietary diversity score (AOR, 1.91; 95% CI, 1.11–3.31) ConclusionsIn this study, the prevalence of malnourished (26%) was almost higher than the national average in Ethiopia (21%). Older age, skipping a meal, poor appetite, depression, low physical activity, and low dietary diversity score were factors significantly associated with the risk for malnutrition and malnutrition. Along with this, improving diet and exercise should be a top priority. Maintaining continuing psychological support, social support, and a balanced family size within the community should be additional interventions.

A Novel Approach for Improving Guitarists’ Performance Using Motion Capture and Note Frequency Recognition

New guitarists face multiple problems when first starting out, and these mainly stem from a flood of information that they are presented with. Students also typically struggle with proper pitch frequency recognition and accurate left-hand motion. A variety of relevant solutions have been suggested in the existing literature; however, the majority have ultimately settled on two approaches. The first is finger motion capture, wherein researchers focus on extracting finger positions through analyzing images and videos. The second is note frequency recognition, wherein researchers focus on analyzing notes and frequencies from audio recordings. This paper proposes a novel hybrid solution that includes both finger motion capture and note frequency recognition in order to conduct a full assessment and give feedback on a guitarist’s performance. To classify hand positions, several classification algorithms are tested. The random forest algorithm obtained superior results, with an accuracy of 99% for overall hand movement and an average of 97.5% for the classification of each finger. Meanwhile, two algorithms were tested for note recognition, where the harmonic product spectrum (HPS) approach obtained the highest accuracy of 95%.

Paxlovid for Treating COVID-19 Patients: A Case-Control Study From Two Hospitals in the Eastern Province of Saudi Arabia.

Background Coronavirus disease 2019 (COVID-19) is an infectious disease that shortly progressed into an unprecedented pandemic spreading all over the world and causing millions of deaths. Many new COVID-19-specific therapies were suggested for the treatment of the patients at increased risk of progression to severe disease, especially those who were unvaccinated and those with a likely inadequate vaccine response. One of the preferred therapies in this setting is Paxlovid, a combination of the oral protease inhibitors nirmatrelvir and ritonavir. Paxlovid was authorized by the Saudi Ministry of Healthfor the treatment of mild to moderate COVID-19. This study aimed to report the effects of Paxlovid on the mortality of the COVID-19 patients at Dammam Medical Complex (DMC) and Qatif Complex Hospital (QCH), two hospitals in the Eastern Provence of Saudi Arabia, and compare the results with the international data. Methods The study was a retrospective study that included all the COVID-19 patients who were treated with Paxlovid at DMC and QCH between January and December 2022. Those patients were compared with control COVID-19 patients who did not receive Paxlovid. The patients were included irrespective of their COVID-19 vaccination status. All the patients were managed according to the Saudi Ministry of Health guidelines. They were followed up through the infectious disease virtual clinics and were monitored for ICU admissions and death of any cause for three months following their COVID-19 infections. Results A total of 92 COVID-19 patients were included. The patients consisted of 47 male and 45 female patients (51.09% and 48.91%, respectively). The mean ± standard deviation for the patients' age was 55.58±19.25 years. Twenty-eight patients were given Paxlovid (30.43%). Eighteen patients (19.57%) died. The use of Paxlovid was associated with lower ICU admissions (0.0% vs. 18.75%, P value <0.05) and with lower deaths (3.57% vs 26.56%, P value <0.05) but the Paxlovid group included less immunocompromised patients (7.14% vs. 60.94%, P value <0.001), cancer patients (0.0% vs. 42.19%, P value <0.001), and chronic kidney disease patients (7.14% vs. 29.69%, P value <0.05) than the control group. Conclusion This study suggests that Paxlovid is highly effective in reducing the risk of severe COVID-19 or mortality. However, larger studies with better qualities are needed for a full assessment of the role of Paxlovid in COVID-19 management in Saudi Arabia.

Morphological Assessment of Nasopalatine Canal Using Cone Beam Computed Tomography: A Retrospective Study of 124 Consecutive Patients.

This study aimed to assess and analyze the morphology and dimensions of the nasopalatine canal (NPC), as well as the adjacent buccal osseous plate (BOP), and to investigate the effect of gender, edentulism, NPC types, absence of maxillary central incisors (ACI) and age on the NPC and BOP, using cone beam computed tomography (CBCT). A total of 124 CBCT examinations (67 female and 57 male patients) were retrospectively included and evaluated. The assessment of the dimensions of the NPC, as well as the dimensions of the adjacent BOP, was performed by three Oral and Maxillofacial Radiologists on reconstructed sagittal and coronal CBCT sections under standardized conditions. Regarding the dimensions of the NPC and the adjacent BOP, the mean values were significantly higher among males than females. Furthermore, edentulous patients showed a significant reduction in BOP dimensions. Additionally, NPC types showed a significant effect on the length of the NPC, and the ACI had a significant effect on reducing BOP dimensions. Age had a significant effect on the diameter of the incisive foramen, with the mean values generally increasing with an increasing age. CBCT imaging of this anatomical structure contributes significantly to its full assessment.

Which Is More Environmentally Friendly? A Comparative Analysis of the Environmental Benefits of Two Waste-to-Energy Technologies for Plastics Based on an LCA Model

Waste plastics are low-value waste; thus, achieving high-value recycling is the most desirable goal. Scientific methods are required to evaluate the environmental benefits and support the technology optimization and market selection of waste-to-energy technology for plastics. This study selected catalytic cracking and incineration power generation of two typical examples of waste plastics energy technologies as the research objects, established a full life cycle assessment model, and used the mid-point method to analyze and compare the environmental benefits of the two technologies. The results showed that catalytic cracking technology is more environmentally friendly. The sensitivity analysis showed that the treatment units had a high impact on the results; process optimization predicted the efficiency of technology optimization and advocated future technological developments to explore the direction of using clean energy, upgrading equipment, and updating catalysts. The results of this study can provide ideas for the optimization of two kinds of waste plastics energy technology. In addition, the comparative data analysis intuitively demonstrated the advantages and disadvantages of waste-to-energy technologies and provided a practical path for the future development of high-value treatments for waste plastics.