Mean Improvement Research Articles

Exercise Interventions and Intelligence in Children and Adolescents: A Meta-Analysis.

Mixed evidence exists on whether physical exercise interventions influence intelligence measures in children and adolescents. To determine the effect of exercise interventions on intelligence in children and adolescents. Relevant articles were identified in PubMed, Web of Science, PsycINFO, and Scopus (until February 22, 2024). Randomized controlled trials assessing the effects of exercise interventions on intelligence in youth (≤19 years). A random-effects meta-analysis was performed for intelligence measures reported in ≥3 studies. Subanalyses examined the moderating effect of variables such as participants' intelligence quotient (IQ), age, or intervention duration. Fourteen randomized controlled trials (n = 3203 participants; age range = 5-14 years) were included. Exercise interventions significantly improved general intelligence compared with control groups (standardized mean difference = 0.54, 95% confidence interval [CI] = 0.11-0.97, P = .01), which corresponded to a mean improvement in the IQ score of 4.0 points (95% CI = 1.44-6.64, P = .01). Significant benefits of exercise interventions were also observed for fluid intelligence (standard mean difference = 0.20, 95% CI = 0.06-0.34, P = .006). Crystallized intelligence could not be meta-analyzed because of a lack of studies. Subanalyses revealed similar benefits in participants with low/borderline versus normal IQ, children versus adolescents, and interventions with different durations. The heterogeneity observed in the characteristics of the exercise interventions and the populations included can be a potential confounding factor. Exercise interventions are associated with improvements in intelligence (including both general and fluid intelligence) in youth.

The effect of central and peripheral luminance on visual acuity.

Lighting conditions significantly influence visual acuity (VA), visual function, and quality of life. Previous research highlighted a correlation between luminance and VA but left a gap in understanding the impact of surrounding luminance. This study focused on investigating the effects of both central and peripheral luminance on VA. This study aimed to investigate the influence of both central and surrounding luminance on VA through distance VA measurements. A dual-component lighting system was utilized, comprising a self-illuminated ETDRS chart and a skyLED system for consistent surrounding illumination. Two experimental setups were conducted: the first varied the central luminance (25 ± 2-341 ± 10 cd/m²), while the second maintained a constant central luminance (150 ± 5 cd/m²) and varied the surrounding luminance (4 ± 2 cd/m² OFF-105 ± 10 cd/m² ON). Sixty-six participants with refractive errors between 0.0 D and -2.75 D were tested under various lighting conditions. Both uncorrected refractive error (URE) and corrected refractive error (CRE) eyes were evaluated. Paired t-tests were used to evaluate the statistical significance of differences in VA scores. Experiment 1 demonstrated a significant increase in VA scores, with mean improvements of -0.120 LogMAR for URE eyes and -0.073 LogMAR for CRE eyes as chart luminance increased from 26 cd/m² to 153 cd/m². Experiment 2 further showed a notable improvement in VA scores under varied surrounding luminance conditions, with mean improvements of - 0.118 LogMAR for URE eyes and -0.073 LogMAR for CRE eyes as luminance increased from 4 cd/m² to 102 cd/m². This study emphasizes the significant impact of both central and peripheral luminance on VA. The introduction of the skyLED lighting system underlines the importance of optimal lighting for visual performance.

Comparative Efficacy of Quadratus Lumborum Muscle Energy Technique with Gluteus Medius Strengthening Versus Gluteus Medius Strengthening Alone in Sacroiliac Joint Dysfunction: A Randomized Controlled Trial

Background: Pain in the sacroiliac joint is the most prevalent and often overlooked. The sacroiliac joints are thought to be sources of pain in roughly 10% to 25% of patients with chronic lower back pain. Due to the biomechanical nature of the joint, muscle imbalance is the most important cause of sacroiliac joint dysfunction. The hamstring and gluteus medius are the primary muscles involved in postural dysfunction-related muscle imbalance; however, the quadratus lumborum’s role in the compensatory mechanism is becoming more apparent, and its potential for treatment in conjunction with gluteus medius strengthening has not yet been investigated. Gluteus medius exercises, along with conventional treatment, are routinely given to patients with sacroiliac joint dysfunction; however, the aim of this study is to explore the additional effects of the muscle energy technique (MET) on the quadratus lumborum along with strengthening of the gluteus medius on pain, disability and quality of life of patients with sacroiliac joint dysfunction. Methods: Using a computer-generated random number table, seventy patients with unilateral sacroiliac joint pain were divided equally and randomly into two groups. Prior to initiating treatment, baseline measurements were taken using a hand-held dynamometer, visual analog scale (VAS), Oswestry Disability Index (ODI-U) and short form 36-item survey (SF-36v2) to assess strength, pain, functional disability and quality of life, respectively. Over the course of four weeks, all patients received twelve sessions, and both the pre- and post-intervention outcome measures were documented. Results: After 4 weeks of treatment, both groups showed statistically significant (p < 0.005) mean improvements in muscle strength, pain, disability and quality of life before and after intervention. However, the mean improvements in post-intervention on a dynamometer, VAS, ODI and SF-36 were better in the MET with exercise group (METGME) as compared to the conventional group with exercise (CTGME), with a larger effect size. Conclusions: The muscle energy technique, applied to the quadratus lumborum in combination with gluteus medius strengthening, is more effective clinically and significantly in improving pain, disability and quality of life in comparison to conventional treatment of sacroiliac joints with gluteus medius exercises.

Quality of life improvement after radiotherapy for bone metastases assessed using real-world data: a secondary analysis of a Nationwide Multicenter Cohort Study.

Single-center studies or randomized controlled trials have evaluated the impact of radiotherapy for bone metastases on quality of life (QOL). We investigated the real-world impact of radiotherapy for bone metastases on QOL using nationwide multicenter cohort data. We conducted a prospective observational study at 26 centers in Japan. Of 333 patients who received radiotherapy for bone metastases between December 2020 and March 2021, 232 (70%) were enrolled in the study. Patient-reported QOL was evaluated at enrollment and at two- and six-month follow-up using the European Organization for Research and Treatment of Cancer (EORTC) QOL Questionnaire Core 15-Palliative and the EORTC QOL Questionnaire Bone Metastases module (QLQ-BM22). Possible predictors (patient-, tumor -, and treatment-related factors) of QOL improvement were screened using logistic regression models. QOL scores showed significant improvement at two-month follow-up in seven (global health status/QOL, emotional functioning, pain, insomnia, painful sites, pain characteristics and functional interference) of the 14 scales. Of these seven scales, mean improvement ≥ the minimal clinically important difference (defined by a change of 10 or more on the 0 to 100 scale) was seen in four scales (pain, insomnia, pain characteristics and functional interference). We did not find any predictors of QOL improvement in the functional interference scale of QLQ-BM22. Radiotherapy for bone metastases performed in daily practice is effective in improving some scales of QOL.

A randomized, double-blind, placebo-controlled, mechanistic trial on the safety, tolerability and pharmacodynamics of ninerafaxstat in patients with angina and chronic coronary syndrome

Abstract Background/Introduction Symptoms of angina resulting from reversible myocardial ischemia in chronic coronary syndromes have a negative impact on quality of life. Metabolic alterations are a key feature of ischemia, including reduced ATP generation by mitochondrial oxidative phosphorylation, NAD+ depletion, anaerobic glycolysis, proton & lactate accumulation leading to contractile dysfunction. Ninerafaxstat is a novel cardiac mitotrope that shifts metabolism from fatty acids towards glucose utilization, optimizing myocardial energy production during ischemia. Purpose We aimed to investigate the safety, tolerability, impact on myocardial glucose utilization and preliminary anti-ischemic efficacy of ninerafaxstat administered for 8 weeks to patients with symptomatic chronic stable angina who were on anti-anginal therapy and had evidence of myocardial stress hypoperfusion using 15O-H2O PET imaging. Methods IMPROVE-Ischemia was an international, randomized, double-blind, placebo-controlled mechanistic trial comparing ninerafaxstat vs. placebo in patients with symptomatic chronic coronary syndrome. The primary endpoint was the safety and tolerability of ninerafaxstat. Key efficacy evaluations were undertaken at baseline and end-of-treatment (Week 8) including imaging core laboratory assessments of 15O-H2O PET perfusion rest and stress imaging to quantify absolute myocardial blood flow (MBF), dobutamine stress echo with contrast for evaluation of LV contractile response during demand stress using the wall motion score index (WMSI) and, in a subgroup of subjects, 18F-FDG-PET imaging of myocardial glucose metabolism. Results The study randomized 58 subjects (mean age 68.6±7.1 years) with symptomatic stable angina and inducible hypoperfusion from 4 sites across 3 countries (Denmark, Finland, Sweden). 22% had type 2 diabetes and 50% had undergone percutaneous and/or surgical coronary revascularization. The majority (68%) were on ≥2 (up to 4) regular anti-anginals. Ninerafaxstat was well tolerated without impact on systemic hemodynamics. At Week 8, ninerafaxstat significantly increased myocardial glucose utilization and, in those with dobutamine-induced deterioration in wall motion at baseline assessment (n=25, pre-specified subgroup), resulted in a ~50% improvement in mean and peak stress WMSI, without altering rest or hyperemic stress MBF (Table 1). Conclusion(s) Treatment with ninerafaxstat was well-tolerated and showed a neutral hemodynamic profile. Ninerafaxstat significantly increased myocardial glucose utilization consistent with its mechanism of action and improved myocardial contractile response to dobutamine stress in subjects with baseline stress inducible deterioration of wall motion. These findings support a direct, metabolically-mediated, anti-ischemic effect of ninerafaxstat on top of existing anti-anginal agents, supporting its further development in cardiac pathologies characterised by ischemia.

Long-term clinical outcome of a novel bilateral capsulotomy with focused ultrasound in refractory obsessive-compulsive disorder treatment.

Magnetic resonance-guided focused ultrasound (MRgFUS) capsulotomy is a promising treatment for refractory obsessive-compulsive disorder (OCD); however, long-term clinical outcome studies are lacking. We aimed to investigate the long-term efficacy and safety of MRgFUS capsulotomy in patients with refractory OCD. Ten of the eleven patients who underwent MRgFUS capsulotomy for treatment-resistant OCD between 2013 and 2014 were included in this study. Clinical outcomes were assessed after 10 years of follow-up post-MRgFUS capsulotomy using tools such as neuropsychological test, the Frontal Systems Behavior Scale (FrSBe), and a locally developed MRgFUS-patient-centered outcomes questionnaire. After 10 years of follow-up, there was a mean improvement of 52.3% in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score. Seven out of the ten participants responded fully (Y-BOCS reduction ≥35% + CGI-I 1 or 2) to the procedure, two of whom achieved remission (Y-BOCS score ≤12 and CGI-S 1 or 2). Obsessive-compulsive symptoms and overall functioning significantly reduced and improved, respectively (Y-BOCS = 20.7 after 2 years vs. 16.4 after 10 years, p = 0.012; Global Assessment of Functioning = 57.4 after 2 years vs. 69.0 after 10 years, p = 0.011). The patients experienced significantly improved frontal lobe-related functions (FrSBe Sum before 91.0 ± 17.6 vs. after 78.6 ± 17.7, p < 0.05). No adverse effects, including cases of suicide and neurological deficits, were reported. The majority of the respondents were generally satisfied with MRgFUS capsulotomy. MRgFUS capsulotomy is an effective and safe treatment option for the treatment of severe refractory OCD with sustained efficacy even after 10 years.

A Novel Method of Bridge Deflection Prediction Using Probabilistic Deep Learning and Measured Data

The deflection control of the main girder in suspension bridges, as flexible structures, is critically important during their operation. To predict the vertical deflection of existing suspension bridge girders under the combined effects of stochastic traffic loads and environmental temperature, this paper proposes an integrated deflection interval prediction method based on a Convolutional Neural Network (CNN), Long Short-Term Memory (LSTM), a probability density estimation layer, and bridge monitoring data. A time-series training dataset consisting of environmental temperature, vehicle load, and deflection monitoring data was built based on bridge health monitoring data. The CNN-LSTM combined layer is used to capture both local features and long-term dependencies in the time series. A Gaussian distribution (GD) is adopted as the probability density function, and its parameters are estimated using the maximum likelihood method, which outputs the optimal deflection prediction and probability intervals. Furthermore, this paper proposes a method for identifying abnormal deflections of the main girder in existing suspension bridges and establishes warning thresholds. This study indicates that, for short time scales, the CNN-LSTM-GD model achieves a 47.22% improvement in Root Mean Squared Error (RMSE) and a 12.37% increase in the coefficient of determination (R2) compared to the LSTM model. When compared to the CNN-LSTM model, it shows an improvement of 28.30% in RMSE and 6.55% in R2. For long time scales, the CNN-LSTM-GD model shows a 54.40% improvement in RMSE and a 10.22% increase in R2 compared to the LSTM model. Compared to the CNN-LSTM model, it improves RMSE by 38.43% and R2 by 5.31%. This model is instrumental in more accurately identifying abnormal deflections and determining deflection thresholds, making it applicable to bridge deflection early-warning systems.

Short-Term Powered Mobility Intervention is Associated With Improvements in Development and Participation for Young Children with Cerebral Palsy: A Randomized Clinical Trial.

The objective of this study was to evaluate the effects of 2 short-term powered mobility interventions across developmental domains, participation, and perceptions of intervention implementation for young children with cerebral palsy and their families. This randomized, crossover clinical trial compared 2 powered mobility interventions: the Explorer Mini (Permobil AB, Timra, Sweden) and an adapted ride-on toy car. Analyses included 24 children aged 12 to 36months, recruited from 3 sites. Each device was trialed in the home for an 8-week period for a total of 16weeks. Three in-person study visits took place at baseline, crossover, and study completion, and 2 additional virtual check-ins were conducted for each device trial period. Outcome measures included all domains of the Bayley Scales of Infant and Toddler Development, Fourth Edition (Bayley-4); Child Engagement in Daily Life (CEDL) participation questionnaire; and t3 perceptual implementation measures: Acceptability of Intervention Measure, Intervention Appropriateness Measure, and Feasibility of Intervention Measure. Analyses included descriptive statistics, 2 by 3 group × time analysis of variance, and post hoc t tests as warranted. Statistically significant mean improvements were observed in all domains of the Bayley-4 and in the self-care subscale of the CEDL regardless of device order. Caregivers ranked both devices as acceptable and feasible to implement, although the Explorer Mini was ranked slightly more favorably than the adapted ride-on toy car, with a device order effect being observed. Short-term powered mobility intervention may advance multiple domains of development and participation for young children with cerebral palsy. Caregivers rated 2 different powered mobility devices favorably as part of their child's early intervention strategies. This study enhances the quality of evidence available to clinicians and families to support decision-making about powered mobility intervention for young children with motor disabilities, especially those who may be reluctant to begin powered mobility due to stigma or concern for motor skill development.

Aluminum dust concentration detection based on LSTM-Kalman filter

Industrial dust emissions present serious hazards, including respiratory issues and explosion risks. Traditional dust concentration detection methods are often compromised by environmental factors. This study introduces a novel FFT-KF-LSTM-NET model to predict high-concentration aluminum powder levels, utilizing 128 sets of electrostatic induction measurement data. By applying the Fast Fourier Transform (FFT) to eliminate low-frequency interference, integrating Long Short-Term Memory (LSTM) networks for advanced time series analysis, and using the Kalman Filter (KF) for rapid model convergence, this approach significantly enhances prediction accuracy. The model achieves an 82% improvement in Mean Squared Error (MSE), reducing it to 0.1336, outperforming traditional methods. Furthermore, by modeling the voltage signal generated by charged dust particles in the electrostatic induction sensor's sensing area and using the first derivative of the voltage signal as a learning feature, the model's prediction speed is increased from 1.5 s-2 s–0.5 s, with improved anti-interference capabilities. These advancements position the FFT-KF-LSTM-NET model as a crucial tool for real-time, reliable dust concentration detection in industrial environments.

Improvements in visual function early after cataract surgery in eyes implanted with multifocal intraocular lenses.

To compare the improvements in all-distance visual acuity (VA) and contrast sensitivity early after cataract surgery among eyes implanted with multifocal and monofocal intraocular lenses (IOLs). Nonrandomized comparative study. Forty-two eyes with a trifocal IOL (Alcon, PanOptix®), 42 eyes with a combined bifocal and extended-depth-of-focus (EDF) IOL (Johnson & Johnson, Synergy®), and 84 eyes with a monofocal IOL were recruited. Uncorrected or corrected VA at various distances, and photopia and mesopic contrast VA were examined at 1day and 3 months postoperatively. Improvements in these VAs were compared between time points and among groups. Mean uncorrected as well as corrected VA improved significantly between 1day and 3 months postoperatively at almost all distances in the trifocal and combined bifocal + EDF groups (P ≤ 0.018), and at the intermediate distance of 1.0m and far distances in the monofocal group (P ≤ 0.031). Mean improvements in near uncorrected VA at 0.3m, intermediate VA at 0.5m, and far VA at 2.0, 3.0, and 5.0m were significantly greater in the multifocal groups than in the monofocal group (P ≤ 0.032). Improvements in photopic and mesopic contrast VA at most contrasts were significantly better in the multifocal groups (P ≤ 0.021). Mean uncorrected or corrected VA at almost all distances and contrast sensitivity at most contrasts improved significantly early after surgery in eyes implanted with multifocal IOLs, and the improvements in VA at most distances and in contrast sensitivity were better with multifocal IOLs than with monofocal IOLs.

Effectiveness of video-based teaching in surgery residents: A randomized control trial

Objective: To determine the effectiveness of video-based teaching in surgery residents by comparing it to the routine operating room traditional teaching. Methodology: The randomized control trial was done at four institutions from September 2022 to March 2023. Interventional group underwent video-based instruction of basic surgical skills whereas the control group was taught through traditional operating room teaching. Pre and post-test mean scores were analyzed on SPSS version 20 through paired t-test. Learning gain was calculated. Supervisors’ perceptions were recorded on survey form regarding direct observations and recorded video evaluations of resident skills on post-test. Results: Out of sixty (n=60), fifty-five newly inducted surgical residents completed the study including both females (n=13) and male residents (n=42). Video intervention Group (27.93±3.72) and control group (23.07±4.62) both showed improvements in their post-test scores as compared to pretest scores of 13.68±3.25 and 13.52±3.60 respectively. Mean score difference improvement was more in video intervention group (13.9±3.8) in comparison to control group (9.5±4.3) provided both groups exhibits improvements in all seven domains of the global rating system (reflected by the p &lt;0.0001). However, learning gain of 65% was observed in intervention group as compared to learning gain (41%) of control group. Evaluators(n=5) observed that recorded video evaluations helped to provide integrated feedback, despite being time (40%) and resource intensive (60%). Conclusion: Video-based teaching has higher learning gain irrespective of the fact that both groups exhibit statistically significant results in all seven domains of the global rating system. Recorded video evaluation was found feasible and reliable tool for formative assessment. doi: https://doi.org/10.12669/pjms.40.10.7856 How to cite this: Niaz K, Mahboob U, Masood D, Maqbool A. Effectiveness of video-based teaching in surgery residents: A randomized control trial. Pak J Med Sci. 2024;40(10):2373-2378. doi: https://doi.org/10.12669/pjms.40.10.7856 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Patient-Level Value Analysis in Total Hip Arthroplasty: Optimizing the Value of Care Delivery

Background: Value is defined as the ratio of patient outcomes to the cost of care. One method to assess value is through patient-level value analysis (PLVA). To our knowledge, this tool has not previously been implemented in the setting of total hip arthroplasty (THA). The purposes of this study were to perform PLVA for a 1-year episode of care among patients undergoing primary THA and to identify characteristics that affect value in a metropolitan health-care system. Methods: The patient-reported outcome (PRO) measure database of the institution was queried for all primary THAs from 2018 to 2019. The PRO measure that was utilized was the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS-JR). Cost was evaluated with use of time-driven activity-based costing (TDABC) for a 1-year episode of care (consisting of the day of surgery, inpatient stay, discharge facility, postoperative appointments, and physical therapy). The primary outcome was the 1-year value quotient, or the ratio of the 1-year change in HOOS-JR to the cost of the episode of care (VHOOS). The value quotient was compared among all included patients and evaluated for variables that may affect the overall value of the episode of care. Results: In total, 480 patients were included in the analysis. The mean improvement in the HOOS-JR was +34.9 ± 16.1 (95% confidence interval [CI]: 33.5, 36.3). The mean cost was $13,835 ± $3,471 (95% CI: $13,524, $14,146). The largest contributor to cost was implants (39.0%), followed by post-recovery care (i.e., inpatient stay and specialized nursing facilities; 24.1%). Change in the HOOS-JR was poorly correlated with the cost of care (r = −0.06; p = 0.19). THAs performed at an ambulatory surgery center (ASC) with discharge to home demonstrated higher value (VHOOS = 0.42) than THAs performed at a hospital with discharge to a rehabilitation facility (VHOOS = 0.15; analysis of variance F-test, p &lt; 0.01). Conclusions: Our study found that PROs did not correlate with costs in the setting of primary THA. Implants were the largest cost driver. Surgical setting (an ASC versus a hospital) and discharge destination influenced value as well. PLVA is a value measurement tool that can be utilized to optimize components of the care delivery pathway. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Study of malleus as a prognostic indicator on hearing outcomes after tympanomastoid surgery: A prospective observational study

Tympanomastoid surgery comprises a range of surgeries (cortical, radical, modified radical). Pre-operative auditory deficit in a patient with cholesteatoma may be correlated with ossicular chain status. The incus is often expected to be eroded, which may not be true for the malleus. The presence of malleus and it’s significance on the post-operative needs to be studied further. The purpose of our study is to determine the effect of intraoperative status of malleus on the post-operative hearing outcomes of patients undergoing canal wall-down mastoidectomy. A prospective observational study of 24 patients was conducted, where pre-operatively pure tone audiometry (PTA) was performed. Intraoperatively, the status of malleus was noted. Canal wall down mastoidectomy was done. Post-operative PTA was recorded after 3 months and both audiograms compared. An air bone gap (ABG) of less than 20dB post-operatively was considered significant functional improvement. In patients with a preserved malleus, mean improvement was 25.2dB (±9.8), whereas patients in whom malleus was remove had mean 16.8dB (±10.49) improvement. Similar results were found by Lu et al, Blom et al and Haberman et al. Haberman et al theorised the concentration of sound waves and preservation of middle ear volume as a contributing factor to the results. Hence it was concluded that relatively better post-operative audiological outcomes were obtained when malleus was present/preserved intraoperatively.

EVALUATION OF AN ALLIED HEALTH PROFESSIONAL PREHABILITATION SERVICE IN NEURO-ONCOLOGY

Abstract AIMS The evidence base for the benefits of prehabilitation in the cancer population is increasing. So far, the focus has been on colorectal, breast and lung cancer sites with no current research into the effects in patients with primary or secondary brain tumours. It is hypothesised that patients with brain cancer would benefit from prehabilitation as current evidence demonstrates the positive effects of exercise, cognitive and language rehabilitation in this patient group. The aim of this project is to demonstrate the feasibility and impact of a two-year prehabilitation pilot service. The service comprises physiotherapy, occupational therapy and speech and language therapy for patients with brain cancer in the pre-operative phase. METHOD A pilot study was carried out at a tertiary UK neurosurgery centre. Patients over the age of 17 with a diagnosis of primary or secondary brain tumour awaiting surgery were eligible for the prehabilitation service. The impact was measured through Length of Stay, Quality of Life (EQ-5D-5L), emergency department attendances and admission rates 90 days post-surgery. RESULTS 128 patients were seen in prehabilitation from 01/11/2022 to 31/01/2024. Length of hospital stay post-surgery was lower for the prehabilitation group (0.9 days with 95% confidence interval) compared to control group. A mean improvement in the EQ-5D-5L Index from pre-operative assessment to post-surgery follow up was demonstrated CONCLUSION This study reveals data demonstrating the benefits of prehabilitaiton for patients with brain tumours. Prehabilitation for this patient group appears to improve clinical outcomes alongside patients’ quality of life. Future directions for the service will focus on expanding the provision to patients with spinal and benign tumours, where this is also a possibility of therapeutic need in the pre and post-operative phase.

Improved Bald Eagle Search Optimization Algorithm for the Inverse Kinematics of Robotic Manipulators.

The inverse kinematics of robotic manipulators involves determining an appropriate joint configuration to achieve a specified end-effector position. This problem is challenging because the inverse kinematics of manipulators are highly nonlinear and complexly coupled. To address this challenge, the bald eagle search optimization algorithm is introduced. This algorithm combines the advantages of evolutionary and swarm techniques, making it more effective at solving nonlinear problems and improving search efficiency. Due to the tendency of the algorithm to fall into local optima, the Lévy flight strategy is introduced to enhance its performance. This strategy adopts a heavy-tailed distribution to generate long-distance jumps, thereby preventing the algorithm from becoming trapped in local optima and enhancing its global search efficiency. The experiments first evaluated the accuracy and robustness of the proposed algorithm based on the inverse kinematics problem of manipulators, achieving a solution accuracy of up to 10-18 m. Subsequently, the proposed algorithm was compared with other algorithms using the CEC2017 test functions. The results showed that the improved algorithm significantly outperformed the original in accuracy, convergence speed, and stability. Specifically, it achieved over 70% improvement in both standard deviation and mean for several test functions, demonstrating the effectiveness of the Lévy flight strategy in enhancing global search capabilities. Furthermore, the practicality of the proposed algorithm was verified through two real engineering optimization problems.

Investigating the effect of video-based training on adherence of surgical positioning standards: a randomized controlled trial

BackgroundThe operating room is a high-risk environment where proper patient positioning is crucial for minimizing injury and ensuring optimal access to surgical sites. This process requires effective collaboration among surgical team members, particularly operating room nurses who play a vital role in patient safety. Despite advancements in technology, challenges such as pressure injuries persist, with a significant incidence rate. Video-based training (VBT) emerges as a promising educational tool, enhancing knowledge retention and fostering a learner-centered approach. This study aims to evaluate the impact of VBT on adherence to surgical positioning standards, highlighting its potential to improve safety protocols in the operating room.MethodsIn this clinical trial, 62 qualified operating room nurses (50 women, 12 men, average age: 28.90 ± 3.75 years) were randomly divided into control and intervention group (n = 31 in each group). The control group only received positioning recommendations, but in the intervention group, in addition to the recommendations, video-based surgical positioning training was performed for 1 month, at least 3 times a week. The performance of nurses in both groups was evaluated through a researcher-made checklist at baseline and post-intervention.ResultsBased on findings, there was no significant difference between the two groups in compliance with surgical positioning standards at baseline (p = 0.07). However, after the intervention, compliance scores significantly improved in the VBT group compared to the control group (p < 0.001). The VBT group showed a mean improvement of 62.12 points, while the control group improved by 10.77 points (p < 0.001).ConclusionsThis preliminary study demonstrated a notable improvement in compliance with surgical positioning standards among operating room nurses following VBT intervention. Despite the promising results, the small sample size and preliminary nature of the research necessitate further studies to confirm these findings and assess long-term outcomes. These initial insights highlight the potential of innovative training methods in enhancing surgical practices.

7217 Impact of INZ-701 on Bone and Mineral Metabolism Biomarkers and Clinical Outcomes in Adults with ENPP1 Deficiency - Results from 48-week Phase 1/2 Open Label Study

Abstract Disclosure: K. Gunter: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. R.A. Wermers: Research Investigator; Self; Inozyme Pharma. R. Fuhr: Employee; Self; Parexel GmbH. Research Investigator; Self; Inozyme Pharma. D. Schnabel: Research Investigator; Self; Inozyme Pharma. A. Besancon: Research Investigator; Self; Inozyme Pharma. M.A. Nour: Research Investigator; Self; Inozyme Pharma. D. Wenkert: Stock Owner; Self; Inozyme Pharma. Y. Sabbagh: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. Background: ENPP1 Deficiency is a rare disorder due to inactivating mutations in the ENPP1 gene that result in low levels of inorganic pyrophosphate (PPi), a critical regulator of mineralization. Subsequent pathologic soft tissue calcification results in severe vascular calcification and ∼50% infant mortality. By early adolescence the majority of survivors develop FGF-23 mediated hypophosphatemic rickets, characterized by bone deformities, short stature, joint/ligament calcification and musculoskeletal pain. No targeted therapy exists for this disease. INZ-701 is a recombinant ENPP1-Fc investigational product. Purpose: To describe the safety, tolerability, immunogenicity, and exploratory efficacy (bone and mineral metabolism biomarkers and clinical outcomes) of INZ-701 in adults with ENPP1 Deficiency through the end of the phase 2 study period (week 48). Methods: Phase 1/2, multicenter, open-label, multiple ascending dose study including three adults in each of three dose cohorts (0.2, 0.6 and 1.8 mg/kg, total N=9) with genetic variants in ENPP1 and PPi &amp;lt;1300 nM (NCT04686175). Participants were dosed subcutaneously on Day 1, then twice weekly from Day 8 to end of study. Data through wk 48 as of July 6, 2023 are included; topline wk 48 data will be presented. Per protocol, participants may continue to receive INZ-701 beyond wk 48. Results: Rapid increase in mean PPi from baseline of 426±407 nM was noted in all patients, reaching the healthy volunteer range within 6 hrs of the first dose with sustained elevation through wk 48. Mean PPi across the 0.2, 0.6 and 1.8 mg/kg dose cohorts from day 32 to wk 48 was 1299±131 nM, 1356±136 nM, and 1282±81 nM, respectively. There were improvements from baseline to wk 48 in mean pooled FGF-23 (-22 pg/mL) and serum phosphate (+0.18 mg/dL), with dose-dependent changes in bone specific alkaline phosphatase consistent with bone healing. DEXA revealed improvements in spine BMD and BMC. There were trends towards improvement in mean % predicted change in 6MWT from baseline to wk 48: cohort 1, 76.7% (SE 10.5) to 85.0% (SE 3.0); cohort 2, 52.2% (SE 10.9 ) to 79.0% (SE 2.9); cohort 3, wk 48 data not available. Improvements were also observed in physician and patient global impression of change score (with no patients deteriorating) and PROMIS pain intensity score. INZ-701 was well tolerated with no drug-related serious or severe (&amp;gt; grade 2) adverse events. Low titers of non-neutralizing anti-drug antibodies (≤160) were observed in 7/9 patients. Long half-life of approximately 126 hours suggests the potential for once-weekly dosing. Conclusions: In adults with ENPP1 Deficiency, INZ-701 was well tolerated with no related serious or severe adverse events. INZ-701 demonstrated a rapid and sustained increase in PPi levels from baseline to week 48 with corresponding improvements in bone mineral biomarkers, functional performance, and patient and physician-reported outcomes. Presentation: 6/3/2024

Long Term 5G Base Station Traffic Prediction Method Based on Spatial-Temporal Correlations

In the domain of 5G network management, accurately predicting traffic volumes at base stations remains a critical yet challenging endeavor, primarily due to the complexities inherent in the spatial and temporal data interactions. Current methods often fall short in effectively harnessing long-term trends and spatial interconnections among base stations. To bridge these gaps, this paper introduces the GCformer model, a novel approach that capitalizes on both spatial relationships and temporal patterns for multi-base station traffic prediction. Spatially, the proposed model employs graph convolutional networks to integrate diverse spatial information and construct insightful adjacency matrices that includes Euclidean distances and non-Euclidean distances (area types of base station locations and similarities in traffic flow among various stations), thereby enhancing the predictability of traffic dynamics. Temporally, the application of the Transformer's attention mechanism enables better capture of long-term relational dependencies in the temporal domain of 5G base station traffic data. Additionally, a time-variant optimization module is designed to establish diurnal cycle data for each base station's traffic, replacing the traditional positional encoding with a more nuanced model that improves the learning of historical data correlations. Empirical results from exhaustive case studies confirm the superiority of the GCformer model in forecasting traffic volumes. The GCformer exhibits a 4.01% improvement in mean squared error and a 3.37% enhancement in mean absolute error compared to the best-performing baseline model, showcasing its potential to significantly improve operational strategies in 5G networks.

Assessing and enhancing legal literacy in cancer care: A nationwide analysis of a training intervention for healthcare workers.

6 Background: We previously showed the significant extent to which legal barriers requiring appropriate navigation are encountered by patients with cancer and their caregivers. Despite this, structured training on legal topics is not offered for healthcare workers (HCW). We performed a nationwide analysis to ascertain baseline legal knowledge in HCWs, and investigate the impact of a training program aimed at improving knowledge gaps in legal, financial, and social services navigation. Methods: This is a retrospective analysis of HCWs participating in legal and financial training sessions from 2021-2023 led by attorneys from Triage Cancer, a nonprofit organization providing free education on legal issues that impact individuals with cancer. Pre-training surveys assessed baseline knowledge, comfort, and frequency with which HCWs counseled patients with cancer, on legal barriers. Impact of training was evaluated via surveys at 1 week and 6 months post-training. Survey scores were descriptively analyzed to summarize changes in knowledge compared to baseline. Paired t-tests evaluated self-rated competence before and after legal training. Results: The pre-intervention survey was completed by 2141 HCWs who were primarily White (63.9%), female (89.8%), and social workers (39.3%) during the most recent survey year. HCWs served patients of ≥20 cancer types including breast (33.4%), hematologic (12.7%), and lung (6.9%), and reported assisting patients with health insurance options (82.6%), financial navigation (53.3%), and disability insurance claims (46.5%). Only few HCWs reported feeling “comfortable” or “very comfortable” assisting patients with health insurance (22.1%), finances (17.2%), or disability insurance (9.5%). The 1-week and 6-month post-intervention surveys were completed by 852 and 211 individuals, respectively, and standardized questionnaire scores demonstrated improvement in tested knowledge from baseline (26% questions correct) to 1-week (67.5%) and 6-month (35%) follow-up. Self-rated improvement in HCW competence following intervention at 1-week (surveyed using 10-point scale, mean improvement 3.14, 95% CI [3.05, 3.25]) and 6-months (corrected mean improvement 2.52 [2.29, 2.75]) were significant (p &lt; 0.001 for both). At 6-month follow-up, 90.5% of surveyed HCWs reported changing behavior or practice based on the training, noting the education facilitated patient care through navigation of health and disability insurance and appeals; reducing financial burden, stress, and anxiety; and improving quality of life (Likert scales ranged 3.17-3.41 with 3 for Agree and 4 for Strongly Agree). Conclusions: This study showcases the necessity, success, and practicality of implementing a legal training for HCWs who note high frequency of legal concerns from their patients, but lack the comfort or expertise in appropriately navigating these.

A Descriptive, PostHoc Analysis of Efficacy and Safety of Risankizumab in Diverse Racial and Ethnic Patient Populations With Moderate-to-Severe Psoriasis.

Historically, patients with skin of color are underdiagnosed with psoriasis and underrepresented in clinical trials. In this study, we assess the efficacy and safety of risankizumab in patients with moderate-to-severe plaque psoriasis by race and ethnicity in the open label extension LIMMitless (NCT03047395). Patients received continuous treatment with 150mg risankizumab through their initial trial and the open label extension. Patients self-identified their race and ethnicity. Efficacy was assessed using Psoriasis Area Severity Index (PASI) and Dermatology Life Quality Index (DLQI). Safety is reported by events/100 patient-years. A total of 897 patients (race: 662 White, 196 Asian, 25 Black or African American, 14 Other; ethnicity: 98 Hispanic or Latino, 799 non-Hispanic or Latino) were included in this analysis. Compared to baseline, patients had a mean percent reduction in PASI between 94.6% (Asian) and 99.3% (Black or African American) and reported mean percent improvements in DLQI ranging from 87.1% (Asian and Black or African American) to 93.7% (Hispanic or Latino) at week 100. While the data presented here comprise a small retrospective descriptive analysis and cannot detect statistical differences, efficacy of risankizumab for the treatment of moderate-to-severe plaque psoriasis appears similar across the racial and ethnic groups studied and no new safety signals were detected.