Group Mean Research Articles

Transcranial Magnetic Stimulation Facilitates Neural Speech Decoding.

Transcranial magnetic stimulation (TMS) has been widely used to study the mechanisms that underlie motor output. Yet, the extent to which TMS acts upon the cortical neurons implicated in volitional motor commands and the focal limitations of TMS remain subject to debate. Previous research links TMS to improved subject performance in behavioral tasks, including a bias in phoneme discrimination. Our study replicates this result, which implies a causal relationship between electro-magnetic stimulation and psychomotor activity, and tests whether TMS-facilitated psychomotor activity recorded via electroencephalography (EEG) may thus serve as a superior input for neural decoding. First, we illustrate that site-specific TMS elicits a double dissociation in discrimination ability for two phoneme categories. Next, we perform a classification analysis on the EEG signals recorded during TMS and find a dissociation between the stimulation site and decoding accuracy that parallels the behavioral results. We observe weak to moderate evidence for the alternative hypothesis in a Bayesian analysis of group means, with more robust results upon stimulation to a brain region governing multiple phoneme features. Overall, task accuracy was a significant predictor of decoding accuracy for phoneme categories (F(1,135) = 11.51, p < 0.0009) and individual phonemes (F(1,119) = 13.56, p < 0.0003), providing new evidence for a causal link between TMS, neural function, and behavior.

P159 USING WHATSAPP AS A MEDIUM FOR HEALTH EDUCATION ON SELECTED LIFESTYLE MODIFICATIONS IN HYPERTENSION MANAGEMENT

Background and Objective: Lack of hypertension knowledge negatively affects adherence to lifestyle modifications among hypertensive individuals. Recommended health education for on-going support and self-management can prove difficult to organise for frequent face-to-face sessions. This study aimed at determining the efficacy of using WhatsApp Instant Messaging (WIM) as a health education medium of selected lifestyle medications among hypertensive individuals. Methods: The study used a quasi-experimental design with 24 and 17 subjects in treatment and comparison groups respectively at Queen Elizabeth Central Hospital and run for 6 weeks. Treatment group was supplied with selected health education regarding lifestyle modifications related to hypertension management; physical activity (PA), dietary patterns (DP) and weight management (WM) on a WhatsApp group while the comparison group received none. Data was collected before and after intervention. Data were analysed using Pearson's Chi Square and T-Tests in IBM SPSS Statistics version 23 at 5% significance. Results: At baseline there were no significant differences (p=0.270) in PA between treatment and comparison groups while at endline the differences became significant (p=0.020) meaning that the intervention increased the chances of an individual being physically active. Changes were observed in WM, as weight dropped, on average, by 0.14 kg in the treatment group and increased by 1.6 kg in the comparison group. Mean differences between baseline and endline of the weights were not significant in both groups. Consequentially, the body mass indices decreased in the treatment group (mean decrease=0.12kgm-2) and increased in comparison group (mean=0.82kgm-2). Change in the comparison group was significant (p=0.045). Changes in food frequency of selected food groups were not significantly different. Conclusions: WIM has the potential of being an excellent medium of health education to enhance lifestyle modifications in the management of hypertension.

Visualisation and quantification of subcutaneous injections of different volumes, viscosities and injection rates: An ex-vivo micro-CT study

The effects of subcutaneous (SC) injection parameters such as drug formulation volume, viscosity and injection rate on therapeutic performance and tolerability have not been established for any drug product. In this study four groups of SC injections were performed on fresh ex vivo minipig abdominal tissue samples, varying volume (0.5-1 mL), viscosity (1-11 cP) and rate (0.02-0.1 mL/s). Micro-CT provided high resolution (50 micron) imaging of the SC tissues before and after injection, enabling a detailed 3D visualisation and analysis of how both injection parameters and tissue microstructure influence spatial distribution of injectables. We found that volume was the only significant factor for spatial distribution of injectate within our design space, and there were no significant factors for tissue backpressure. Variability within test groups was typically greater than differences between group means. Accordingly, whilst the higher viscosity formulations consistently exhibited reduced spatial distribution, the sample size was not large enough to establish confidence in this result. Comparing our findings to clinical evidence, we conclude that injection site and depth are more likely to influence PK and bioavailability than volume, viscosity and rate within our experimental space.

Perspectives on managing patients with Down's syndrome among orthodontists in Saudi Arabia: A vignette and a COM-B analysis study.

This study aims to explore perspectives on managing patients with Down's syndrome among orthodontists in Saudi Arabia using a vignette study and COM-B model. This was a cross-sectional study for orthodontists working in Saudi Arabia. Participants were asked about their demographic data. Vignette (clinical scenarios) and COM-B model (C: capability, O: opportunity, M: motivation, and B: behavior) were used to assess orthodontists' perspectives regarding the management of patients with Down's syndrome. A model of Alpha (Cronbach) was used to study the properties of measurement scales. A Pearson's correlation coefficient was used to correlate variables represented by means. An independent t-test and one-way ANOVA, with least significant difference (LSD) as a post hoc test, were used to compare two group means and more than two groups, respectively. Most participants (n = 70, 85.4%) reported that they had no training/exposure to dealing with Down's syndrome patients during their orthodontic clinical training. Participants reported an average of 3.82 (SD = 1.1) when treating moderate Down's syndrome and 2.48 (SD = 1.4) when treating severe Down's syndrome with mild occlusion discrepancies. Participants also showed that their behavior and attitude are significantly related to their capability, opportunity, and motivation regarding the management of patients with Down's syndrome. The average reported agreement ranges from 2.46 (SD = 1) for the hypoplasia of the mandible to 4.38 (SD = 0.8) for the congenitally missing teeth. This study found that orthodontists in Saudi Arabia showed low confidence levels to manage Down's syndrome patients with moderate and severe challenging behavior. Despite this, the likelihood of increasing their confidence levels and attitude regarding the management of patients with Down's syndrome increased by increasing their capability, opportunity, motivation, and knowledge in this field.

The social and defensive function of olfactory behaviors in a pair-living sexually monogamous primate.

Olfactory behaviors serve a wide variety of social functions in mammals. Odor may signal information about attributes of individuals important for mating and reproduction. Olfactory behaviors, such as scent-marking, may also function as part of home range or resource defense strategies. We assessed the potential social and home range defense functions of olfactory behavior in a pair-living and sexually monogamous primate, Azara's owl monkey (Aotus azarae), in the Argentinian Chaco. This is the most extensive investigation of owl monkey olfactory behaviors in the wild. Individuals regularly performed olfactory behaviors (group mean + SD = 1.3 + 0.5 per hour). The patterns were generally comparable to those observed in studies of captive owl monkeys, except that urine washing was the most common behavior in the wild, as opposed to scent-marking and genital inspections. Most olfactory behaviors were performed by adults, and there were striking sex differences in genital inspections: almost all consisted of an adult male inspecting the paired adult female. These findings suggest that olfactory behaviors play an important role in signaling and coordinating reproduction among owl monkeys, particularly during periods of female conception and pregnancy. Additionally, our research indicates that these behaviors may also serve as a defense strategy for maintaining the core area of their home ranges. This study offers the first assessment of the role of olfactory behaviors in reproductive contexts and home range defense in pair-living, monogamous platyrrhine primates.

759. P02.04 PARAVERTEBRAL VERSUS EPIDURAL ANALGESIA IN MINIMALLY INVASIVE ESOPHAGEAL RESECTION (PEPMEN): A RANDOMIZED CONTROLLED MULTICENTER TRIAL

Abstract Background Thoracic epidural analgesia has been the mainstay for pain control in esophageal cancer patients undergoing minimally invasive esophagectomy (MIE). Although effective epidural analgesia potentially contributes to achieving enhanced recovery after surgery (ERAS) goals in patients undergoing MIE, it can have counterproductive side effects such as hypotension, urinary retention and reduced mobility. Paravertebral analgesia may be a promising alternative to epidural analgesia, avoiding potential side effects and improving postoperative recovery. Methods This open randomized controlled superiority trial was conducted across four Dutch centers. A total of 192 patients with esophageal cancer, scheduled for elective transthoracic MIE with intrathoracic anastomosis, were included and randomized to receive either epidural analgesia or paravertebral analgesia. The primary outcome was Quality of Recovery (QoR-40) on the third postoperative day (POD). Secondary outcomes included the quality of life, postoperative pain, opioid consumption, need for inotropic/vasopressor medication, duration of admission, mobilization, complications, readmission, and mortality. Results From December 2019 to February 2023, 94 patients were assigned to epidural and 98 to paravertebral analgesia. QoR-40 score on POD3 did not differ between groups (mean difference 3.7; P=.268). The epidural group had higher QoR-40 scores on POD1 and 2 (mean difference 7.7; P=.018, mean difference 7.3; P=.020) and lower pain scores (1 versus 2; P=&amp;lt;.001, 1 versus 2; P=.033). More patients in the epidural group required vasopressor-medication on POD1 (38.3% versus 13.3%; P&amp;lt;.001). In the paravertebral group, the urinary catheter was removed one day earlier (P=&amp;lt;.001). No significant differences in complications or length of stay were observed. Conclusion This multicenter randomized controlled clinical trial did not show superiority of paravertebral analgesia over epidural analgesia in quality of recovery on the third day after minimally invasive esophagectomy. These results, however, support the safety of paravertebral analgesia as a viable alternative to epidural analgesia, enabling the provision of both techniques to patients in clinical practice.

Acoustic Target Strengths and Swimbladder Morphology of Chub Mackerel Scomber japonicus in the Northwest Pacific Ocean

The Northwest Pacific chub mackerel (Scomber japonicus) is one of the most productive, economically important fishery resources worldwide. Accurately assessing this species and ensuring adherence to total allowable catch limits are crucial owing to fluctuations in their abundance and distribution. Acoustic target strength measurements of S. japonicus were conducted at 38, 70, and 120 kHz using a split-beam echosounder of individuals from nine size groups (mean fork length, 10.8–28.3 cm) swimming freely in a net cage within a seawater tank. An underwater camera was utilized to simultaneously measure swimming angle. Least-squares regression analysis revealed that when the slope was constrained to 20, as per the generally applicable morphometric equation, the resulting values for the constant term (b20) were −67.7, −66.6, and −67.3 dB at 38, 70, and 120 kHz, respectively. S. japonicus mean swimming angle across the groups was −10.5–9.6° (standard deviation [SD], 16.3–33.3°). Furthermore, the ratio of swimbladder height to swimbladder length, the ratio of swimbladder length to fork length, and the tilt angle of the swimbladder (mean ± SD) were 0.191 ± 0.060, 0.245 ± 0.055, and 9.6 ± 3.0°, respectively. These results can be used for the acoustic stock assessment of S. japonicus in the Northwest Pacific Ocean.

Robotic-Assisted Total Knee Arthroplasty Results in Shorter Navigation Working Time With Similar Clinical Outcomes Compared to Computer-Navigated Total Knee Arthroplasty

BackgroundEarly clinical data are important in the appraisal of newly introduced robotic-assisted surgery (RAS) systems in total knee arthroplasty (TKA). However, there are few studies to date comparing 1-year clinical outcomes between RAS and computer-assisted navigation (CAS), the forerunner in reducing alignment outliers. The aim of this study was to determine if there was a difference between these two groups in early clinical outcomes, including functional outcome and patient-reported outcome measures (PROMs). MethodsA total of 158 propensity score-matched patients who underwent primary TKA with either CAS or RAS were retrospectively analyzed. Perioperative outcomes (navigation time, length of stay, complications, readmissions, transfusions, and technical failure), as well as functional outcome measures (range of motion, sit to stand test, timed-up-and-go test, single-leg stance test, calf raises, and step count), and PROMs (Oxford Knee Score, Knee Injury and Osteoarthritis Outcome Score, 12-item Short Form Survey, Forgotten Joint Score-12, and satisfaction) were compared between those who underwent CAS and those who underwent RAS. ResultsNavigation time was shorter in the RAS group compared to the CAS group (mean difference, 15.4 minutes; P < 0.001). There were 2 complications reported in the CAS group (one patellar clunk, one periprosthetic joint infection), but none in the RAS group. There were no other readmissions, transfusions, or technical failures in either group. Postoperatively, there were no clinical differences in function between groups. Clinically meaningful improvement in PROMs was observed in both groups, with no differences. ConclusionsThe use of RAS resulted in shorter navigation time compared to CAS in TKA. No other differences were observed in early clinical outcomes between patients who underwent RAS and CAS.

A method for calculating the grand average of a set of auditory brain-stem responses.

To calculate a grand average waveform for a set of auditory brain-stem responses (ABRs), no generally accepted method exists. Here, we evaluate a new method using temporal adjustment of the underlying ABRs. Compared to a method without temporal adjustment, the new method results in higher amplitudes of the individual waves in the grand average. The grand average produced by the method better represents the group mean wave-amplitudes because it reduces smearing of the individual waves caused by inter-subject latency variability.

The Effects of Visual Arts and Animated Film Therapy in Managing Emotional Fatigue in Preschool Children Hospitalized in the Pediatric Ward of RSUD Poso

Preschool-aged children who experience hospitalization in a pediatric ward often face a variety of emotional challenges, including emotional exhaustion. Hospitalization is a frightening and stressful experience for children, especially when they are separated from their family and peers. Visual art and animation film therapy have been recognized as effective therapeutic methods for addressing children's emotional exhaustion and stress. Visual arts play therapy allows children to express their feelings, overcome anxiety, and build emotional connections with their surroundings. The study aimed to look at the effects of visual art play therapy and animated films on managing emotional exhaustion in hospitalized preschool-age children. The data were collected through observation, interviews, and questionnaires given to parents. The result obtained by the treatment group's mean emotional exhaustion score before the action was 32.20, and after the action was 21.80. Wilcoxon statistical analysis, p-value = 0.001. So, it is concluded that there is a significant decrease in children's emotional exhaustion before and after therapy. The conclusion of this study can help improve the care and well-being of preschool children who experience hospitalization, as well as provide valuable insights for health practitioners and educators in supporting the emotional development of children in challenging medical situations.

Association Between Involvement in Basketball and Cognitive Functioning of Elite Male and Female Basketball Leagues Players in Nigeria

Sports are physical activity that consists of rules, competition, challenge, entertainment and uncertainties. Competitive sports could be seen as those sports governed by a set of rules or customs, which serve to ensure fair competition, and allow consistent adjudication of the winner. This study ascertained the association between level of involvement in basketball and cognitive functioning of elite male and female basketball premier league players in Nigeria. Descriptive survey research design was adopted for the study. The population comprised of male and female basketball players in Nigeria. A total of 240 (120 males from the Premier League and 120 females from the Zenith league) basketball players in Nigeria selected using simple random sampling technique. A self-constructed 15 item questionnaire titled Involvement in Competitive Sports and Cognitive Functioning (ICSCF) was used to elicit information on from the level of cognitive functioning of elite basketball players in Nigeria. The results showed that there are two groups of items. The first group is made of 15 items while the second group is made up of 15 items. The mean of first group was 3.1±1 while the mean of group two was 2.1±0.7. df =28 and P-value = -0.20. P 0.05 this indicated that there was a significant association between the level of involvement of respondents in basketball and their level of cognitive functioning. The study concluded that coaches and trainers should combine both the practical and mental mode of trainings when preparing their athletes for competition for optimal performance outcomes. Keywords: Elite; Competition; Basketball; Premier Leagues; Cognitive Functioning

Immunohistochemistry analyses of the abomasal mucosa show differences in cellular-mediated immune responses to Haemonchus contortus infection in resistant and susceptible young lambs

Haemonchus contortus is known for its high pathogenicity in sheep, and the uncontrolled use of anthelmintics resulted in the emergence of multiple drug-resistant populations. Breeding sheep for gastrointestinal nematode resistance is a sustainable alternative to reduce dependence of anthelmintic drugs, and differences in the degree of resistance between breeds have been reported. Here we compare two sheep breeds (Santa Ines and Ile de France), concerning the differences in innate and adaptive immune response involved in the resistance against H. contortus infection. Immunohistochemical analyses of the abomasum were conducted in naïve Santa Ines (n = 14) and Ile de France (n = 12) lambs randomized into four groups: infected Santa Ines (n = 8), non-infected control Santa Ines (n = 6), infected Ile de France (n = 8), and non-infected control Ile de France (n = 4). The infected lambs were initially infected with H. contortus infective larvae at 14 days of age, and multiple infections were conducted every second day until they reached 66 days of age. There was a significant effect (P < 0.001) of the infection with increase in numbers of CD3+ T; CD79α+ B; GATA3+ Th2/ILC2; POU2F3+ tuft cells; FOXP3+ T reg; and IgE + cells in the fundus of the abomasal mucosa in both Santa Ines and Ile de France lambs. Nevertheless, the infected Santa Ines lambs presented the highest averages for CD79α+ B; GATA3+ Th2/ILC; IgE + cells; and POU2F3+ tuft cells and there was a significant association of the breed and infection status with regards to POU2F3+ tuft cells, with the highest mean in the infected Santa Ines group. The infected Santa Ines group had three lambs with high degree of resistance and five lambs that showed a moderate infection. Our results suggest a mechanism of synergistic coordination between different immune-cell types in promoting resistance of suckling lambs under H. contortus infection.

Inverse Correlation between pks-Carrying Escherichia coli Abundance in Colorectal Cancer Liver Metastases and the Number of Organs Involved in Recurrence.

Colibactin, a genotoxin produced by Escherichia coli strains harboring the polyketide synthetase (pks) gene cluster, causes DNA damage and somatic mutations. pks+E. coli is enriched in primary colorectal cancer (CRC) and is associated with clonal driver mutations, but its role in CRC liver metastasis is unclear. We assessed the association of pks+ E. coli in CRC liver metastasis tissues with systemic and local immune responses and the number of organs involved in recurrence using specimens and clinicopathological data from 239 patients with CRC liver metastasis who underwent metastasectomy. The levels of pks+E. coli in fresh-frozen specimens were quantified as "very low" (<50th percentile), "low" (50th to 75th percentiles), and "high" (>75th percentile) using a digital PCR. Immunohistochemical analysis of tumor-infiltrating immune cells was performed using tissue microarrays. Systemic inflammation was evaluated using serum C-reactive protein (CRP) levels. pks+E. coli was detected in 66.7% (157 of 239) liver metastasis tissues. Higher levels of pks+E. coli were associated with decreased serum CRP levels and reduced densities of CD4+ cells and CD163+ cells in the tumor-immune microenvironment. The "high" pks+ E. coli group had fewer metastatic organs involved than the "very low" pks+ E. coli group (mean number of organs: 1.00 vs. 1.23). These findings suggest that pks+E. coli play a modulating role in CRC metastasis.

Real-time auditory feedback for improving gait and walking in people with Parkinson’s disease: a pilot and feasibility trial

BackgroundTechnology is poised to bridge the gap between demand for therapies to improve gait in people with Parkinson’s and available resources. A wearable sensor, Heel2Toe™, a small device that attaches to the side of the shoe and gives a sound each time the person starts their step with a strong heel strike, has been developed and pre-tested by a team at McGill University. The objective of this study was to estimate feasibility and efficacy potential of the Heel2Toe™ sensor in changing walking capacity and gait pattern in people with Parkinson’s.MethodsA pilot study was carried out involving 27 people with Parkinson’s randomized 2:1 to train with the Heel2Toe[TM] sensor and or to train with recommendations from a gait-related workbook.ResultsA total of 21 completed the 3-month evaluation, 14 trained with the Heel2Toe[TM] sensor, and 7 trained with the workbook. Thirteen of 14 people in the Heel2Toe group improved over measurement error on the primary outcome, the 6-Minute Walk Test, (mean change 66.4 m) and 0 of the 7 in the Workbook group (mean change − 19.4 m): 4 of 14 in the Heel2Toe group made reliable change and 0 of 7 in the Workbook group. Improvements in walking distance were accompanied by improvements in gait quality. Forty percent of participants in the intervention group were strongly satisfied with their technology experience and an additional 37% were satisfied.ConclusionsDespite some technological difficulties, feasibility and efficacy potential of the Heel2Toe sensor in improving gait in people with Parkinson’s was supported.

Lateral femoral wall thickness in trochanteric hip fractures: a systematic review.

Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS). A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test. Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm. A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.

Prospective Research Comparing Different Trochanteric Fracture Fixation Techniques.

Aim Evaluation and comparison of various methods of trochanteric fracture fixation. Methods This study was conducted prospectively at the Orthopaedics Department of Dr. D Y Patil Medical College and Research Centre. The study spanned 18 months and involved 100 patientstreated in the outpatient and the emergency department. Patients who fulfilled that specific criteria were selected for this study and the appropriate surgical intervention for each group was determined through radiological examination. Results Of the 100 patients, 55 (55%) were male and 45 (45%) females. Patients in our collection ranged from 20 to 90 years old. Proximal Femoral Nail (PFN), Dynamic Hip Screw (DHS ), and Proximal Femoral Locking Compression Plate (PFLCP ) groups averaged 56, 58, and 64 years old, respectively. The most common cause of intertrochanteric fracture was domestic falls (60%), followed by road traffic accidents (35%). The Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification rated 40 individuals (40%) as stable and 60 as unstable. Most patients in our study had unstable A3 fractures. PFN patients had 16 A3 fractures. In DHS, 32 patients suffered A3 fractures. Twelve PFLCP patients suffered A3 fractures. The smallest group had A1 fractures. Six PFN patients suffered A1 fractures. Two DHS patients had A1 fractures. Two PFLCP patients suffered A1 fractures. PFN group mean scores improved significantly after one and three months in this study. At six months, the PFN group had a significant mean score improvement. Conclusion PFN results ranged from satisfactory to excellent, offering numerous advantages over other methods such as DHS and PFLCP. The benefits of PFN include a shorter lever arm, fracture site compression, and enhanced rotational stability, which contribute to a lower chance of mechanical failure. Additionally, patients treated with PFN typically experience shorter hospital stays, earlier mobilization, less blood loss, shorter surgery times, faster rehabilitation, and quicker bone healing, making PFN a highly effective treatment option for certain fractures.

The Effect of Gamification on Learners’ English-Speaking Skills Performance: A Case of Five Selected High Schools in Kicukiro District, Rwanda

This paper sought to investigate the effect of gamification on the improvement of English-speaking skills among high school learners. The paper employed a mixed method involving both quantitative and qualitative data, with a sample size of 336 respondents from the target population (N = 2100). The study was analyzed through the lenses of gamified learning theory, or the Theory of Gamified Learning, which was introduced by Lander’s (2014). The t-test was used to analyze the data. Furthermore, guided interviews, the Gameful Experience Questionnaire (GAMEFULQUEST), and classroom observation methods were used to gather data. The findings indicated that the scores of a pre-test had a mean of 42.25 with a standard deviation of 8.42, while the scores of a post-test had a mean of 81.21 with a standard deviation of 8.56. This marked an average increase of 38.96 points from the pre-test to the post-test with the mean difference (MD) (post-test - pre-test): 81.21 minus 42.25 = 38.96. The standard deviations indicated that the scores for variability remained relatively consistent before and after the intervention. The findings also indicated that the difference between the score means of the experimental groups was statistically significant at the 0.05 significance level (P-value 0.01&lt;0.05). The findings of the study showed how gamification contributed to the enhancement of English-speaking performance and how gamification increased students' motivation and made learning fun and enjoyable. The paper recommended that the Rwandan Ministry of Education, in partnership with REB, make investments in the development and implementation of gamified learning platforms that foster interactive and enjoyable learning. Extensive teacher training initiatives that guarantee the successful use of gamification in the classroom should be encouraged.

The Impact Of Endorphin Massage On The Efficient Production Of Postpartum Breast Milk In TPMB Sulastri, Pagelaran District, Pringsewu Regency In 2024.

Initiating breastfeeding within the first day of delivery has been shown to decrease the likelihood of newborn mortality. It is specifically demonstrated to provide exclusive protection against diarrhea, respiratory infections, and pneumonia ASI. The project seeks to investigate endorphin massage's impact on smoothness development in postpartum women at TPMB Sulastri, S.ST., M.Kes in 2024.ASI stands for Automatic Speech Recognition. This research employs a quasi-experiment design utilizing a pretest-posttest control group strategy. The sample included of 14 participants in the intervention group and 14 participants in the control group. Purposive sampling techniques were employed. The instrument utilizes Standard Operating Procedures (SOP) and checklist sheets. A three-day Endorphin massage treatment was administered and assessed using the Mann-Whitney test. The study found that 50% of individuals had a moderate frequency of meal intake. The utilization rate of non-hormonal contraceptives was 71.4%. The weight of newborns does not exceed 100% of the BBLR. The gestational age at the time of labor is 100% accurate. The mean milk output of the intervention group was 2.6 before and 7.5 after. The mean of the control group was 2.5 before and 5.2 after. The endorphin massage significantly impacted the efficient production of breast milk in postpartum moms. This was evidenced by a p-value of 0.000 (&lt; 0.05) and a positive Correlation Coefficient value of 0.88, indicating a highly robust association between the two variables. Ultimately, endorphin massage has a significant impact on facilitating the efficient production of breast milk in mothers throughout the postpartum period. It is desirable for lactating postpartum women to regularly engage in endorphin massage to ensure the continuous and unobstructed flow of breast milk during the entire two-year duration of breastfeeding.

A Modified Triangular Arthroscopic Suture-Based Fixation for Tibial Eminence Fractures: Technique, Outcome and Literature Review.

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient's knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19-56 years) were enrolled. The average postoperative follow-up was 35.4 months (27-53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8-10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23-100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0-90°. The group's mean flexion range of motion was 123 ± 16° (90-150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures.

1-year health outcomes associated with systemic corticosteroids for COVID-19: a longitudinal cohort study.

In patients with coronavirus disease 2019 (COVID-19) requiring supplemental oxygen, dexamethasone reduces acute severity and improves survival, but longer-term effects are unknown. We hypothesised that systemic corticosteroid administration during acute COVID-19 would be associated with improved health-related quality of life (HRQoL) 1 year after discharge. Adults admitted to hospital between February 2020 and March 2021 for COVID-19 and meeting current guideline recommendations for dexamethasone treatment were included using two prospective UK cohort studies (Post-hospitalisation COVID-19 and the International Severe Acute Respiratory and emerging Infection Consortium). HRQoL, assessed by the EuroQol-Five Dimensions-Five Levels utility index (EQ-5D-5L UI), pre-hospital and 1 year after discharge were compared between those receiving corticosteroids or not after propensity weighting for treatment. Secondary outcomes included patient-reported recovery, physical and mental health status, and measures of organ impairment. Sensitivity analyses were undertaken to account for survival and selection bias. Of the 1888 participants included in the primary analysis, 1149 received corticosteroids. There was no between-group difference in EQ-5D-5L UI at 1 year (mean difference 0.004, 95% CI -0.026-0.034). A similar reduction in EQ-5D-5L UI was seen at 1 year between corticosteroid exposed and nonexposed groups (mean±sd change -0.12±0.22 versus -0.11±0.22). Overall, there were no differences in secondary outcome measures. After sensitivity analyses modelled using a cohort of 109 318 patients admitted to hospital with COVID-19, EQ-5D-5L UI at 1 year remained similar between the two groups. Systemic corticosteroids for acute COVID-19 have no impact on the large reduction in HRQoL 1 year after hospital discharge. Treatments to address the persistent reduction in HRQoL are urgently needed.