Functional Variables Research Articles

Sizing and energy management of standalone hybrid renewable energy systems based on economic predictive control

This paper aims to design and run a standalone hybrid renewable energy System (HRES) feeding residential building load. The suggested HRES encompasses photovoltaic panels and wind turbines as energy sources, combined with a hydrogen subsystem and a bank of batteries for energy storage. The meteorological input data includes irradiance, temperature, and wind speed for four seasonal weeks. These data sets are collected for a rural site situated in the town of Ras Munif, northern Jordan. The load profiles characterize a selected benchmark residential building. Consequently, a bi-level mixed integer nonlinear programming (BMINLP) problem is formulated to incorporate the designing problem with the energy management process. The upper level represents the sizing problem, while the lower level problem denotes the energy management strategy (EMS). Each problem has its independent objective function, constraints, and optimization variables. The EMS is an economic-based single objective optimization problem expressed as a mixed integer linear programming (MILP) problem. On the contrary, a mixed integer nonlinear programming (MINLP) approach frames the sizing problem to optimize a techno-economic-based multi-objective function. The interaction between the two problems is that the lower problem is an embedded constraint of the upper problem. Moreover, the candidate solutions from the upper problem are treated as fixed parameters in the lower problem. A multi-objective genetic algorithm is used to execute the overall problem by the MATLAB toolbox. The technical and economic performance parameters, including the investment cost, maintenance, operating costs, and others, are assessed based on the best findings. The key finding demonstrates that the summer week has the lowest total cost and energy loss factor, with around 132,000 $ and 0, respectively. Furthermore, the findings reveal that the entire system's energy loss factor for each sample period is less than 0.0009. This value is substantially less than the permitted limit of 0.01.

Local manufacturing processes contribute to variability in human mesenchymal stromal cell expansion while growth media supplements contribute to variability in gene expression and cell function: a Biomedical Excellence for Safer Transfusion (BEST) collaborative study

Background aimsCulture-derived mesenchymal stromal cells (MSCs) exhibit variable characteristics when manufactured using different methods, source material and culture media. The purpose of this multicenter study was to assess the impact on MSC expansion, gene expression and other characteristics when different laboratories expanded MSCs from cultures initiated with bone marrow−MSC aliquots derived from the same donor source material yet with different growth media. MethodsEight centers expanded MSCs using four human platelet lysate (HPL) and one fetal bovine serum (FBS) products as media supplements. The expanded cells were taken through two passages then assessed for cell count, viability, doubling time, immunophenotype, cell function, immunosuppression and gene expression. Results were analyzed by growth media and by center. ResultsCenter methodologies varied by their local seeding density, feeding regimen, inoculation density, base media and other growth media features (antibiotics, glutamine, serum). Doubling times were more dependent on center than on media supplements. Two centers had appropriate immunophenotyping showing all MSC cultures were positive for CD105, CD73, CD90 and negative for CD34, CD45, CD14, HLA-DR. MSCs cultured in media supplemented with FBS compared with HPL featured greater T-cell inhibition potential. Gene expression analysis showed greater impact of the type of media supplement (HPL versus FBS) than the manufacturing center. Specifically, nine genes were decreased in expression and six increased when combining the four HPL-grown MSCs versus FBS (false discovery rate [FDR] <0.01), however, without significant difference between different sources of HPL (FDR <0.01). ConclusionsLocal manufacturing process plays a critical role in MSC expansion while growth media may influence function and gene expression. All HPL and FBS products supported cell growth.

Failure Probability Prediction for Offshore Floating Structures Using Machine Learning

Summary Accurately estimating the failure probability is crucial in designing civil infrastructure systems, such as floating offshore platforms for oil and gas processing/production, to ensure their safe operation throughout their service periods. However, as a system becomes complex, the evaluation of a limit state function may involve the use of an external computer solver, resulting in a significant computational burden to perform Monte Carlo simulations (MCS). Moreover, the high-dimensionality of the limit state function may limit efficient sampling of input variables due to the “curse of dimensionality.” To address these issues, an efficient machine learning framework is proposed, combining polynomial chaos expansion (PCE) and active subspace. This will enable the accurate and efficient evaluation of the failure probability of an offshore structure, which typically involves a large number of uncertain parameters. Unlike conventional PCE schemes that use the original random variable space or the auxiliary variable space for building a surrogate model, the proposed method utilizes a reduced-dimension space to circumvent the “curse of dimensionality.” An appropriate coordinate transformation is first sought so that most of the variability of a limit state function can be accounted for. Next, a PCE surrogate limit state function is constructed on the derived low-dimensional “active subspace.” The Gram-Schmidt orthogonalization process is used for making basis polynomial functions, which is particularly effective when input random parameters do not follow the Askey scheme and/or when a dependence structure between the input parameters exists. Therefore, a nonlinear iso-probabilistic transformation, which makes the convergence of a surrogate to the true model difficult, is not required, unlike traditional PCE. Numerical examples, including limit state functions related to structural dynamics problems, are presented to illustrate the advantages of the proposed method in estimating failure probabilities for complex structural systems. Specifically, the method exhibits significantly improved efficiency in estimating the failure probability of an offshore floating structure without compromising accuracy as compared to traditional PCE and MCS.

Personality Moderates Intra-Individual Variability in EEG Microstates and Spontaneous Thoughts.

Variability in brain activity that persists after accounting for overt behavioral and physiological states is often considered noise and controlled as a covariate in research. However, studying intra-individual variability in brain function can provide valuable insights into the dynamic nature of the brain. To explore this, we conducted a study on 43 participants analyzing the EEG microstate dynamics and self-reported spontaneous mental activity during five-minute resting-state recordings on two separate days with a twenty days average delay between recordings. Our results showed that the associations between EEG microstates and spontaneous cognition significantly changed from one day to another. Moreover, microstate changes were associated with changes in spontaneous cognition. Specifically, inter-day changes in Verbal thoughts about Others and future Planning were positively related to bottom-up sensory network-related microstate changes and negatively associated with top-down, attention, and salience network-related microstates. In addition, we find that personality traits are related to inter-day changes in microstates and spontaneous thoughts. Specifically, extraversion, neuroticism, agreeableness, and openness to experience moderated the relationship between inter-day changes in EEG microstates and spontaneous thoughts. Our study provides valuable information on the dynamic changes in the EEG microstate-spontaneous cognition organization, which could be essential for developing interventions and treatments for neuropsychiatric disorders.

P7: Institutionalization and Psychotropics

Introduction:Psychobehavioral symptoms are one of the main causes of institutionalization. After the first months of institutionalization, it could be a good opportunity to consider deprescribing psychotropics, at the same time person-centered non-pharmacological measures should be implemented. Also, if dementia stage is moderate or advanced, acetylcholinesterase- olyph-inhibitor (AchEI) should be deprescribed.Objectives:To evaluate the difference between the number of psychotropic drugs in institutionalized patients and those who are at home.Materials and Methods:We selected all the patients admitted in the Acute Geriatric Unit of “Hospital Universitario de Navarra” during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as delirium predisposing factors, drugs on admission and discharge and Drug-Burden-Index (DBI). A descriptive study was carried out and our hypothesis was analyzed.Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia and 22% were Institutionalized. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities: arterial hypertension (81%), Osteoarthritis (55%), heart failure (51%), dislipemia (47%), chronic kidney disease (42%), auricular fibrillation (39%), osteoporosis (33%) and diabetes (31%). Regarding geriatric syndromes: polypharmacy (87,5%), sleep disturbances (48%), hearing loss (43%), chronic pain (41,5%), visual loss and constipation (38%) and depression (33%). The main delirium predisposing factors were: age more than 80 (93.5%), olypharmacy, neurological disease (47%), altered senses, chronic pain and depression. Comparing psychotropic use between institutionalized and non institutionalized: psychotropics (78%vs69%), night psichotropics (72%vs63%), neuroleptics (37%vs18,5%), AchEI (13%vs6,5%), antiepileptics (21%14%). All of them p&lt;0.05. However, there were no statistically significant differences in the use of benzodiazepines, antidepressant or antiparkinsonian.Conclusion:Nowadays, institutionalized patients have more phsychotropic drugs than non-institutionalized ones, especially neuroleptics. Moreover, they are more frequent in patients with severe dementia. Maybe, the explanation is DEPRESCRIPTION AVOIDANCE due to an acute fear of a behavioral decompensation. We recommend educating in non-pharmacological measures and insisting on an adequacy of pharmacological prescriptions periodically.

Assessment of the relationship of systemic vascular dysfunction and cardiac autonomic neuropathy (CAN) with diabetic retinopathy.

Diabetic retinopathy, a form of microvasculopathy, is the leading cause of the visual abnormality. However, there is no conclusive evidence of the relationship of systemic vascular dysfunction with retinal microvasculopathy. In addition, diabetes-associated cardiac autonomic neuropathy may also compromise vascular function. The present study intends to correlate arterial stiffness, endothelial function, and heart rate variability (HRV) as a standardized measure of cardiac autonomic neuropathy with diabetic retinopathy. The present cross-sectional, observational study was conducted in the Department of Physiology. Twenty subjects were recruited in group 1 (T2DM, type 2 diabetes mellitus patients, without retinopathy) and group 2 (T2DM with retinopathy). The vascular parameters such as heart rate, peripheral and central blood pressure, augmentation index [AIx (%)], brachial -ankle pulse wave velocity (baPWV), and reactive hyperaemia index (RHI) were recorded. Independent sample t-test (for parametric data) and Mann-Whitney U test (for non-parametric data) were employed to compare the variables of two groups. Spearman correlation was used to examine the relationship among the parameters. Linear regression analysis was performed to examine the important vascular predictor for diabetic retinopathy. baPWV was significantly higher in group 2 than in group 1 and positively associated with group 2. RHI was significantly less in group 2 than group 1 and negatively associated with group 2. Among HRV metrics, standard deviation of successive differences (SDSD), root mean square of successive differences between normal heartbeats (RMSSD), and high frequency (HF) power were significantly decreased in group 2 than in group 1. SDSD, RMSSD, and HF power were negatively associated with group 2. RHI emerged as a significant predictor of diabetic retinopathy following linear regression. Overall, the result of the present study indicates that metabolic dysregulation of glucose may affect the normal functioning of the autonomic nervous system and vascular function. Therefore, screening of vascular function and cardiac autonomic tone may be advocated in diabetic patients in routine clinics to examine the existence of any comorbid condition, such as diabetic retinopathy, as systemic vascular changes may also affect ophthalmic vasculature.

SGLT2i as a First-line Antihyperglycemic in the Management of Type 2 Diabetes in the Context of Indians: A Systematic Review and Consensus.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have been used for almost a decade and have proven to be effective not only in managing Type 2 diabetes (T2D), but their cardio and renal protective features make them very useful in managing patients with risk of multiple comorbidities. This systematic review was undertaken by the authors because there is no evidence currently available in India that has studied the suitability of SGLT2i as a first-line agent in patients newly diagnosed with T2D in India. First, literature was searched to identify features that are considered important when deciding on a first-line agent for managing T2D. A total of 5 broad topics were identified-glycemic control, extra glycemic effects, antihyperglycemic combination therapy, safety, and cost-effectiveness. These domains had further subheadings, and a total of 16 domains were identified. Metformin is the drug of choice as a first-line agent in such situations and has been considered the gold standard for evaluating the effects of SGLT2i across these domains. A systematic literature review on each domain was conducted to compare SGLT2i with the gold standard in Indian patients newly diagnosed with T2D. Evidence was graded (levels of evidence (LoE)-A, B, and C), and recommendations (class of recommendation (CoR)-I, II, and III) were classified by the expert group as defined in the methodology. According to the systematic reviews conducted, 11 domains had Level A evidence, 2 domains (impact on lipids and gut microbiome) had Level B, and 3 domains had Level C (β-cell function, renal protection, and glycemic variability) evidence. Based on evidence and expert opinion, the authors recommend SGLT2i as a first-line agent for managing newly diagnosed patients with T2D with a Class I recommendation for 13 domains and Class II for the remaining 3 (impact on lipids, gut microbiome, and β-cell function). Although a poorer level of evidence (Level C) was available for the glycemic variability domain, the authors still reported this as Class I recommendations according to their expert opinion and consensus. This article advocates adopting SGLT2 inhibitors as the primary treatment choice for treating patients with newly diagnosed T2D in India.

P204: Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis

Objective:Heart rate variability (HRV), a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower HRV (various indices) than healthy controls, and different types of dementia had distinct HRV features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies.Methods:We gathered studies comparing HRV in patients with dementia and in healthy controls. HRV was analysed in several ways: parasympathetic function in hierarchical order (main analysis); total variability; comparison of HRV between different subtypes of dementia; specific indices of HRV; HRV reactivity.Results:In initial search, we found 3425 relevant articles; 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the meta-analysis. The dementia patients had a significantly lower resting HRV for parasympathetic function (Hedges’g=−0.3596, p=0.0002) and total variability (Hedges’g=−0.3059, p=0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, HRV was significantly lower in mild cognitive impairment (MCI) patients (Hedges’g=−0.3060) and in patients with dementia with Lewy bodies (DLB) (Hedges’g=−1.4154, p&lt;0.0001). Relative to patients with Alzheimer’s disease, HRV in patients with DLB was significantly lower (Hedges’g=−1.5465, p=0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size.Conclusion:Our results support that dementia (especially DLB and MCI) patients to have lower parasympathetic activity than health people. The influence of gender on the results should be carefully interpreted.

Clinical appications of EEG/MEG in AD: diagnosis, prognosis and treatment monitoring

AbstractBackgroundElectroencephalography (EEG) and magnetoencephalography (MEG) capture neuronal functioning directly, thereby providing an objective intermediate marker between pathological changes and cognitive symptoms in neurodegenerative diseases. Both techniques are highly suitable as tools in the context of memory clinics and their use for treatment monitoring is increasingly recognized.MethodWe will highlight recent developments important for the use of EEG / MEG as diagnostic and prognostic markers in dementia and as outcome measures in Alzheimer’s disease (AD) trials.ResultIn memory clinics, both visual and quantitative EEG / MEG are being used as supportive evidence in diagnostic challenges, especially when other pathology specific –likely more invasive‐ biomarkers are not available. Increasing numbers of papers using artificial intelligence to differentiate a specific dementia type from cognitively healthy subjects report fair to excellent accuracies that are especially high for dementia with Lewy Bodies (DLB). Multi‐class classification between six memory clinic diagnoses resulted in MEG‐based diagnostic profiles describing the probability estimates of each class. These diagnostic profiles provide an informative and intuitive tool for clinical use. In pre‐clinical stages of AD spectral changes are predictive of future cognitive decline, and in the mild cognitive impairment stage it differentiates between progression into dementia due to AD or DLB. As EEG / MEG are found to be sensitive to longitudinal changes, there is increasing interest in the use of EEG as outcome measures in clinical trials. Both spectral and functional connectivity measures showed a treatment effect in phase 2 pharmacological studies in early AD, giving objective support for (subtle) clinical effects of the drug on trial. The pursuit of discovering even more sensitive, robust and complementary measures lead to novel neurophysiological markers reflecting functional connectivity, signal variability and neuronal hyperexcitability.ConclusionEEG / MEG provide diagnostic and prognostic information applicable in memory clinics. The use of sensitive conventional and novel markers in (pharmacological) trials can support clinical treatment effects and have potential to reduce the size of trials.

P8: Risk of Delirium According to Demintia and the Use of Psychotropics

Introduction:Psychotropics are often used among dementia in order to reduce behavior problems. In patients with dementia, hospital admission is a stressful event, for hospitalization cause as well as for environment change. Consequently, delirium risk is high and this is proportional to dementia stage. In addition, it ́s known psychotropics promote delirium.Objectives:To evaluate if the patients admitted to an acute geriatric unit develop more delirium depending on dementia diagnosis and dementia stage and depending on the use of psychotropics. To analize if dementia and psychotropics are two independent risk factors for the development of delirium.Material and Methods:We selected all the patients admitted in the Acute Geriatric Unit of HUN during May and June of two consecutive years (2021 and 2022). We collected demographic, administrative, functional and pathological variables, as well as the onset of delirium: delirium signs on admission (DSA) and delirium diagnosis on discharge (DDD) and psychotropics use. A descriptive study was carried out to analyze the relationship between dementia and its stage (GDS), psychotropics use and delirium.Results:658 patients were recluted with a medium age of 87.8, 55.6% were females, 44.5% had dementia. The mean hospital stay was 5.8 days and 11.7% died. Functionally, the mean Barthel was 56.5 and Lawton 1.49. Regarding comorbidities, the most frequent ones were arterial hypertension(81%), Osteoarthritis(55%) and heart failure(51%). The main delirium predisposing factors were: age more than 80(93.5%), polypharmacy(87.5%), and neurological disease(47%). Comparing: -Dementia and non-dementia-patients: DSA(55.7%vs23.7;p0,000), DDD (43.7%vs17.5%;p0.000) -GDS 4-5 and GDS 6-7: DSA(52.7%vs57.2;p0.435), DDD (50.4%vs37.9%;p0.031). -Psychotropics-users and non-psychotropics-users: DSA(42.3%vs27.4%), DDD(31.6%vs22,5%). Night psychotropics DSA(41.8%vs31%), DDD(31.7%vs24%); neuroleptics DSA(53.1%vs33.6), DDD(45.2%vs24.3%); anticholinesterase DSA(51%vs36.9%), DDD(45.1%vs27.7%). All of them p&lt;0.05.Concusions:Dementia and psychotropics are predisposing factors for delirium. Its effect is additive. Neuroleptics have the clearest relationship with delirium. We observed, as dementia was more severe, the risk of delirium was greater but the use of neuroleptics decreased. This could be due to the presence of more hypoactive phases in final stages.

Physical function predicts declarative memory

AbstractBackgroundNo cure currently exists for Alzheimer’s disease; however, early detection may help create therapies and treatments to slow cognitive decline. The concept of early detection is simple, but is complicated by the inability of primary care physicians to recognize symptoms until late disease manifestation and failure to provide appropriate screening tools for disease detection. Thus, the purpose of the present investigation was to determine predictors of cognitive performance among community‐dwelling older adults.Method63 community‐dwelling older adults (80.0 ± 5.5 years) participated in the present investigation. Declarative memory was used as the measure of cognition. Physical function was measured using the Short Physical Performance Battery (SPPB), dual‐task fast walking time, and sit‐to‐stand velocity. Linear regression analysis was used to predict cognition from physical function. Odds ratios were used to determine the magnitude of influence of physical function on cognitive function. ANOVA was used to determine differences in individual physical function variable between low and high cognitive groups.ResultsThe linear regression model included dual‐task fast 10‐m walking time, sex, education, and SPPB score and accounted for 39% of the variance in cognitive ability (p&lt;.001). The physical function variables accounted for 8.8% and 8.5% of unique variance in cognition, respectively. For participants performing below the 50th percentile for dual‐task fast walking time, there was a 3.6‐fold increase in declarative memory scores (CI: 1.44‐9.35). Similarly, SPPB values indicative of mobility dysfunction was associated with a 3.2‐times increase in cognitive impairment (CI: 1.31‐7.87). Results of the one‐way ANOVA revealed significant differences in SPPB (p = .002), peak sit‐to‐stand velocity (p = .007), and dual‐task fast walking time (p = .001). The high cognitive group had significantly better physical function compared to the lower cognitive group.ConclusionResults from the present investigation support the use of physical function in predicting current declarative memory among a sample of community‐dwelling adults with no diagnosed cognitive impairment. Future research is needed to determine the ability to predict changes in cognition longitudinally.

Lung function is related to salivary cytokines and hormones in healthy children. An exploratory cross‐sectional study

AbstractPulmonary mechanics has been traditionally viewed as determined by lung size and physical factors such as frictional forces and tissue viscoelastic properties, but few information exists regarding potential influences of cytokines and hormones on lung function. Concentrations of 28 cytokines and hormones were measured in saliva from clinically healthy scholar children, purposely selected to include a wide range of body mass index (BMI). Lung function was assessed by impulse oscillometry, spirometry, and diffusing capacity for carbon monoxide, and expressed as z‐score or percent predicted. Ninety‐six scholar children (55.2% female) were enrolled. Bivariate analysis showed that almost all lung function variables correlated with one or more cytokine or hormone, mainly in boys, but only some of them remained statistically significant in the multiple regression analyses. Thus, after adjusting by height, age, and BMI, salivary concentrations of granulocyte‐macrophage colony‐stimulating factor (GM‐CSF) in boys were associated with zR5‐R20 and reactance parameters (zX20, zFres, and zAX), while glucagon inversely correlated with resistances (zR5 and zR20). Thus, in physiological conditions, part of the mechanics of breathing might be influenced by some cytokines and hormones, including glucagon and GM‐CSF. This endogenous influence is a novel concept that warrants in‐depth characterization.

Inmovilización con vendaje compresivo vs férula antebraquial en fracturas de radio distal intervenidas mediante reducción abierta y placa bloqueada. Ensayo clínico aleatorizado

IntroductionCurrently, there is a lack of prospective studies to unify criteria about type and time for postoperative immobilization in surgical distal radius fractures. The aim of this study is to compare functional and radiological results in two groups of distal radius fractures treated with internal fixation with locking plate, and immobilized with antebrachial splint or compression bandage for 3weeks. Material and methodA randomized clinical trial was carried out with two parallel groups with 3, 6, and 12weeks of follow-up. Main and secondary functional variables were measured, such as pain on VAS scale, values on PRWE, DASH and MRS scale, range of motion in flexion-extension, complications, etc. In addition, some radiological variables were measured at preoperative period and one week after surgery, such as union time, dorsal displacement, shortening, ulnar variance, etc. ResultsA total of 62 patients were evaluated: 27 immobilized with bandage and 35 with splint. Analysis of the results obtained showed significant differences in both groups for almost all radiological variables from pre to postoperative period, and for all functional variables from 3 to 12weeks after surgery. No significant differences were found between the two groups for any of the radiological and functional variables evaluated (VAS 3-12weeks: P=.584; PWRE 3-12weeks: P=.248; flexion range of motion 3-12weeks: P=.959; extension range of motion: P=.50; union time: P=.89). ConclusionsWe do not find clinical or radiological differences between immobilization with antebrachial splint or compression bandage for distal radius fractures operated with locking plate. A greater number of patients and follow-up are necessary to extrapolate the results to the general population and to establish criteria for good postoperative management of these fractures.

Kernel-Based Independence Tests for Causal Structure Learning on Functional Data.

Measurements of systems taken along a continuous functional dimension, such as time or space, are ubiquitous in many fields, from the physical and biological sciences to economics and engineering. Such measurements can be viewed as realisations of an underlying smooth process sampled over the continuum. However, traditional methods for independence testing and causal learning are not directly applicable to such data, as they do not take into account the dependence along the functional dimension. By using specifically designed kernels, we introduce statistical tests for bivariate, joint, and conditional independence for functional variables. Our method not only extends the applicability to functional data of the Hilbert-Schmidt independence criterion (hsic) and its d-variate version (d-hsic), but also allows us to introduce a test for conditional independence by defining a novel statistic for the conditional permutation test (cpt) based on the Hilbert-Schmidt conditional independence criterion (hscic), with optimised regularisation strength estimated through an evaluation rejection rate. Our empirical results of the size and power of these tests on synthetic functional data show good performance, and we then exemplify their application to several constraint- and regression-based causal structure learning problems, including both synthetic examples and real socioeconomic data.

The effect of a training curriculum on developing strength, speed and heart rate for football players under 19 years of age

The importance of the research lies in identifying the training status of the players and studying the physical and physiological aspects for the purpose of developing strength characterized by speed and heart rate (blood pressure, heart rate, physical efficiency) through a proposed training curriculum, as they are among the physiological indicators that reflect the functional state of the circulatory and respiratory systems to maintain the level. Sports for the maximum possible period for football players (youth category) under (19) years of age. The problem of the research was that most young players have a weakness in strength and speed, which has a clear impact on the balance in their performance and physical skills in the correct manner, which is reflected in their functional capabilities, and that the lack of interest in this aspect led the researchers to delve into preparing appropriate exercises to develop the physical ability and functional variables of the players. Young people to help them improve their level of performance in this game. The sample was represented by a number of players from the Diyala Youth and Sports Directorate at the Al-Muqdadiya and Al-Khalis Youth Forum, amounting to (28) football players who were chosen intentionally. They were divided into two experimental and control groups by lottery, each group consisting of (14) players. The study also reached a number of conclusions, including (the training curriculum exercises contributed to developing the physical ability and functional variables of the players. The training curriculum had a positive impact on the level of recovery after the effort, a decrease in the level of the heart rate during the three-minute period immediately after the completion of the effort) and recommendations (adopting the components of the curriculum Training: When training players, coaches must emphasize developing the strength and speed of the players, and pay attention to raising the level of efficiency of the players’ functional systems.

Maximal daily stepping cadence partially explains functional capacity of individuals with end-stage knee osteoarthritis.

Individuals with end-stage knee osteoarthritis (OA) walk at a lower intensity (ie, slower step cadence) contributing to worse physical function. Previous literature reports daily step counts and sedentary time, with little information regarding stepping bouts or cadence. Determining relationships between daily higher stepping cadence duration and clinical outcomes can move the field toward optimal daily stepping prescription. To quantify daily physical activity patterns of individuals with end-stage knee OA and determine the contribution of high stepping cadence to explain functional capacity variability. Cross-sectional analysis. Veterans Administration medical center. U.S. military veterans (n = 104; age: 67.1 years [7.2]; mean [SD]; male [89.3%]) with end-stage knee OA were enrolled. Not applicable. Functional capacity (6-Minute Walk Test [6MWT]). Physical activity (activPAL wearable sensor; cadence and time sitting, standing, and stepping), pain (Western Ontario and McMaster Universities Osteoarthritis Index-pain subscale) sociodemographic variables, and comorbidities (body mass index and Functional Comorbidity Index) are the main explanatory variables. Participants' wake time was mainly sitting (11.0 h/day) in ≥60-minute bouts (29.7% ± 12.7 of sitting time). Standing (3.4 hours/day) and stepping (1.4 h/day) primarily occurred in 0-5 minute bouts (standing: 87.7% ± 14.4 of standing time, stepping: 98.7% ± 12.7 of stepping time) and stepping cadence was predominantly incidental (1-19 spm; 52.9% ± 9.6 of total stepping time). Backward elimination model results indicated shorter medium-to-brisk cadence bout duration, older age, and higher pain significantly explained shorter 6MWT distance (AdjR2=0.24, p < .01). Individuals with knee OA spend most of their waking hours sitting, while standing and stepping occurs in short bouts at very low stepping cadence. Decreased time in high stepping cadence is associated with lower functional capacity. Future studies should explore if increasing the daily time spent in higher step cadence can improve functional capacity in this population.

Determinants of persistent symptoms after treatment for Lyme borreliosis: a prospective observational cohort study

Patients treated for Lyme borreliosis (LB) frequently report persistent symptoms. Little is known about risk factors and etiology. In a prospective observational cohort study with a follow-up of one year, we assessed a range of microbiological, immunological, genetic, clinical, functional, epidemiological, psychosocial and cognitive-behavioral variables as determinants of persistent symptoms after treatment for LB. Between 2015 and 2018 we included 1135 physician-confirmed LB patients at initiation of antibiotic therapy, through clinical LB centers and online self-registration. Two reference cohorts of individuals without LB (n=4000 and n=2405) served as a control. Prediction analyses and association studies were used to identify determinants, as collected from online questionnaires (three-monthly) and laboratory tests (twice). Main predictors of persistent symptoms were baseline poorer physical and social functioning, higher depression and anxiety scores, more negative illness perceptions, comorbidity, as well as fatigue, cognitive impairment, and pain in 295 patients with persistent symptoms. The primary prediction model correctly indicated persistent symptoms in 71.0% of predictions (AUC 0.79). In patients with symptoms at baseline, cognitive-behavioral responses to symptoms predicted symptom persistence. Of various microbiological, immunological and genetic factors, only lower IL-10 concentrations in exvivo stimulation experiments were associated with persistent symptoms. Clinical LB characteristics did not contribute to the prediction of persistent symptoms. Determinants of persistent symptoms after LB were mainly generic, including baseline functioning, symptoms and cognitive-behavioral responses. A potential role of host immune responses remains to be investigated. Netherlands Organisation for Health Research and Development (ZonMw); the Dutch Ministry of Health, Welfare and Sport (VWS).

Efficacy analysis of laparoscopic sleeve gastrectomy in morbidly obese patients aged 10-21 years

Objective: To investigate the efficacy of laparoscopic sleeve gastrectomy (LSG) in morbidly obese patients aged 10 to 21 years. Methods: We conducted a retrospective analysis of clinical data from 89 out of 200 patients who underwent LSG at the Gastrointestinal Surgery/Weight Loss Center of the First Affiliated Hospital of Jinan University between January 2015 and December 2020. The primary outcome measures were the completion rate of LSG, the incidence of perioperative complications, and weight-related indicators 3, 6, 12, and ≥24 months postoperatively. Additionally, we compared glucose metabolism, lipid metabolism, vitamin levels, liver function, and other relevant biochemical variables before and after surgery. Normally distributed continuous data are presented as x±s. Because the numbers of patients at each follow-up time point were not identical with the number of patients in the study cohort preoperatively, independent sample t-tests were used for intergroup comparisons. Non-normally distributed continuous data are presented as M(Q1, Q3), and Mann-Whitney U tests were used for intergroup comparisons. Results: Among the 89 patients, 35 were male (39.3%), the mean age was (18±2) years, and mean body mass index (BMI) 38.5±4.8 kg/m²; 37 of the patients having a BMI greater than 40 kg/m². Additionally, 63 patients (70.8%) had fatty livers, 34 (38.2%) hyperuricemia, 31(34.8%) sleep apnea syndrome, 20 (22.4%) gastroesophageal reflux, eight (8.9%) type 2 diabetes, and two (2.2%) hypertension. All 89 patients underwent LSG surgery successfully, with no conversions to open surgery. During the perioperative period, there were no cases of major bleeding, gastric leakage, or infections. Notable postoperative symptoms included nausea, vomiting, and pain, most of which improved by the second postoperative day. BMI values 3, 6, and 12 months postoperatively had decreased to 31.5±5.8 kg/m², 28.6±4.3 kg/m², and 26.3±4.4 kg/m², respectively. All of these BMI values differed significantly from preoperative values (all P<0.05). At 12 and ≥24 months postoperatively, the percentages of total weight loss were (31.3±9.3)% and (33.1±10.5)%, respectively, both differing significantly from 3 months postoperatively (20.5±5.1)% (all P<0.05). The percentages of excess weight loss at 12 and ≥24 months postoperatively were 91% (70%, 113%) and 95% (74%, 118%) , respectively, both differing significantly from the percentage of total weight loss 3 months postoperatively (56% [45%, 72%]) (both P<0.05). Alanine transaminase and aspartate transaminase serum concentrations decreased from preoperative values of 44.4 (25.5, 100.5) U/L and 29.0 (9.5, 48.0) U/L to 14.0 (10.8, 18.3) U/L and 13.0 (10.5, 17.3) U/L, respectively, ≥24 months postoperatively. Hemoglobin A1c decreased from 5.6 (5.3, 5.8)% preoperatively to ≥24 months postoperatively 5.3 (5.0, 5.4)%. High-density lipoprotein increased from 1.0 (0.9, 1.2) mmol/L preoperatively to 1.4 (1.1, 1.6) mmol/L ≥24 months postoperatively. Vitamin B12 decreased from 350.0 (256.8, 441.3) μg/L preoperative to 230.3(195.4, 263.9) μg/L ≥24 months postoperatively. All differed significantly from preoperative values (all P<0.05). Conclusion: LSG has favorable efficacy in morbidly obese patients aged 10 to 21 years. However, further confirmation is required through long-term, multicenter, randomized, controlled trials.

Feasibility Study to Compare Oxytocin Function Between Body Mass Index Groups at Term Labor Induction

ObjectiveTo determine the feasibility of a protocol to examine the association between oxytocin system function and birth outcomes in women with and without obesity before induction of labor. DesignProspective descriptive. SettingAcademic medical center in the U.S. Midwest. ParticipantsPregnant women scheduled for induction of labor at 40 weeks of gestation or greater (n = 15 normal weight; n = 15 obese). MethodsWe collected blood samples and abstracted data by chart review. We used percentages to examine adherence to protocol. We used t tests and chi-square tests to describe differences in sample characteristics, oxytocin system function variables, and birth outcomes between the body mass index groups. ResultsThe recruitment rate was 85.7%, protocol adherence was 97.1%, and questionnaire completion was 80.0%. Mean plasma oxytocin concentration was higher in the obese group (M = 2774.4 pg/ml, SD = 797.4) than in the normal weight group (M = 2193.5 pg/ml, SD = 469.8). Oxytocin receptor DNA percentage methylation (CpG −934) was higher in the obese group than in the normal weight group. ConclusionOur protocol was feasible and can serve as a foundation for estimating sample sizes in forthcoming studies investigating the diversity in oxytocin system measurements and childbirth outcomes among pregnant women in different body mass index categories.

Respiratory Parameters as Predictors of Balance and Gait Ability in Patients with Stroke at Discharge

Pulmonary complications are frequent in stroke, contributing to both mortality and morbidity rates. Respiratory parameters in such patients encompass both pulmonary function and respiratory muscle strength. Identifying respiratory function variables that influence the balance and gait ability of patients with stroke is crucial for enhancing their recovery in these aspects. However, no study has assessed predictions for a comprehensive array of balance and gait abilities in such patients. We aimed to examine whether initial respiratory muscle strength and pulmonary function can predict balance and gait ability at discharge from a rehabilitation program. Thirty-one patients with stroke were included in this prospective observational study. Multiple regression models with a forward selection procedure were employed to identify respiratory parameters (including peak expiratory flow and maximal expiratory pressure) that contributed to the results of balance assessments and gait evaluations at the time of discharge. The peak expiratory flow (PEF) served as a predictor explaining 42.0% of the variance. Similarly, the maximal expiratory pressure (MEP) was a predictor variable explaining 32.0% of the variance. PEF and MEP assessments at the initial stage as predictive factors for both balance and gait ability are important in stroke management.