Minimum Size Research Articles

Sustainable bio-sourced nanoemulsions: Pectin-based delivery systems for vitex essential oil and its therapeutic potentials

Herein we report the feasibility of pectin vitex essential oil (VEO) nanoemulsions (NE). NE formulations were prepared both in the absence and presence of a conventional surfactant (Tween 80) by ultrasonication using pectin aqueous solutions as the aqueous phase and VEO as the oil phase. Different surfactant amounts and various ultrasonication times were employed. Droplet size and Zeta potential measurements were performed and their data were statistically evaluated. The minimum droplet size (prediction: 299.342 nm) could be achieved when employing an ultrasonication time of 5.9 min in the absence of the conventional surfactant. SEM characterization delivered supporting results related to the droplet sizes obtained. Stability tests showed that pectin VEO NE formulations were stable after 42 days. The results clearly showed that it was possible to generate VEO containing NEs in one pot and at once using pectin, which also acted as a natural surfactant, without the need for an additional conventional surfactant. Considering also moisturizing property of pectin and the antifungal activity of VEO, their combination in the form of a nanoemulsion could be promising for potential women’s health applications.

Exploring antibacterial effectiveness: A comparative analysis of green and chemical synthesis of silver nanoparticles against Staphylococcus aureus

BackgroundSilver nanoparticles (AgNPs) are renowned for their broad-spectrum antibacterial properties. Various synthesis methods, particularly green synthesis using biogenic agents, have garnered significant attention. However, the detailed impact of green-synthesized AgNPs on the antibacterial mechanism against Staphylococcus aureus remain unclear, limiting the full potential of green synthesis compared to chemical methods. MethodsAgNPs were synthesized via chemical (sodium citrate, NaBH4) and green synthesis (green tea leaves, cassia seed extract) methods. The synthesized AgNPs were evaluated for toxicity and antibacterial activity against Staphylococcus aureus. Significant findingsThis study revealed a strong correlation (R2>0.9) between minimal inhibitory concentration (MIC) and AgNP size for both synthesis methods, with a similar exponential trend. MIC values were 45, 40, 25, and 5 µg mL-1 for citrate-, NaBH4-, green tea extract-, and cassia seed extract-assisted synthesis, respectively. Green-synthesized AgNPs showed higher antibacterial activity than chemical AgNPs at comparable sizes. Chemical AgNPs exhibited low and fluctuating scavenging activity, while green methods were more consistent. Cytotoxicity was noted in chemical AgNPs and at high concentrations of green tea extract-assisted AgNPs. Bacterial membrane disruption and ROS accumulation were also observed, contributing to the enhanced antibacterial activity of green-synthesized AgNPs.

INFORMATION SECURITY AND THE CONTINUAL USAGE OF E-COMMERCE PLATFORMS: A CASE OF GHANA

Objective: This study investigates the impact of information security and trust on continued e-commerce usage in Ghana, where online commerce has become essential despite growing cyber threats. Theoretical Framework: Social exchange theory was used to explain how individuals form trust in social interactions. It helps to reveal how people weigh relationship rewards and costs, navigate power dynamics, and make choices. Method: Out of 117 collected responses, 100 were valid for analysis. Partial Least Squares-SEM (PLS-SEM) was used for structural equation modeling, following the "10-times rule" for minimum sample size. Results and Discussion: The research demonstrates that Information Security significantly enhances continual usage and directly impacts consumer trust. Also, we found that, trust serves as a mediator between information security and continual usage. Further, the study reveals that ICT skills play a key mediating role in the relationship between trust and continual usage. The findings highlight the importance of prioritizing information security, implementing user-friendly security measures, and offering training to improve users’ ICT skills. Research Implications: These insights have practical implications for e-commerce businesses, policymakers, and individuals. It emphasizes the necessity of robust information security measures to build trust and encourage continual usage among Ghanaians. Originality/Value: The study adds to existing literature by underscoring the essential role of Information Security in cultivating Ghanaian consumers trust and loyalty in the e-commerce environment.

Rapid de-escalation of anti-MRSA therapy guided by S. aureus nares screening for patients with pneumonia: protocol of a randomized controlled trial (SNAP study).

The current Infectious Disease Society of America and American Thoracic Society (IDSA/ATS) guidelines recommend linezolid or vancomycin as an empiric treatment for methicillin-resistant Staphylococcus aureus (MRSA) pneumonia in hospitalized patients with specific risk factors,. A nasal PCR-assay for MRSA, with its high negative predictive value, can guide a rapid antibiotic de-escalation avoiding unnecessary anti-MRSA treatment. The indiscriminate use of these drugs has contributed to the emergence of resistant S. aureus strains leading to adverse effects without any survival benefit, increasing hospital stays and associated costs. Aim of the study is the use of this diagnostic tool to reduce empirical anti-MRSA treatment duration in pneumonia, shortening antimicrobial therapy days while measuring in-hospital mortality, length of stay and adverse drug event incidence. It is a prospective, randomized single-center controlled trial planned to be conducted in the Azienda Consorziale Policlinico di Bari. The research project will have a duration of 12 months following the approval of the Ethical Committee of the University of Bari. The minimum sample size is 38 patients per group, for a total of 76 subjects, calculated assuming a standard deviation of 10, a power of 90%, a type I error of 5% and a 10% drop-out rate. We will enroll eligible patients ensuring their evidence-based management according to guidelines, we will perform a nasal swab for MRSA in patients in the experimental group and discontinue the empirical anti-MRSA therapy if the nasal swab result is negative. For both arms, follow-up visits will be on day 2, 5, 7, 14, and 28 relatives to the enrollment visit (day 0). Data will be collected on the clinical course of pneumonia and laboratory tests. Our study will provide evidence on the duration (in days) of the antibiotic intake as a primary outcome of the study. Secondary outcome measures include in-hospital mortality, the length of stay and days of mechanical ventilation (in VAP), and the incidence of adverse events related to the administration of the therapy. https://classic.clinicaltrials.gov/ct2/show/NCT06238297, identifier NCT06238297.

Subclinical impairment of the left atrium is associated with MRI-based lung volume but not with parameters from pulmonary function testing

Left atrial (LA) physiology and hemodynamics are intimately connected to cardiac and lung function in health and disease. This study examined the relationship between MRI-based left atrial (LA) size and function with MRI-based lung volume and pulmonary function testing (PFT) parameters in the population-based KORA study cohort of 400 participants without overt cardiovascular disease. MRI quantification assessed LA size/function in sequences with and without ECG synchronization, alongside lung volume. Regression analysis explored the relationship of LA with MRI lung volume and PFT parameters. Among 378 participants (average age 56.3 ± 9.2 years; 42.3% women), non-gated LA size averaged 16.8 cm2, while maximal and minimal LA size from gated measurements were 19.6 cm2 and 11.9 cm2 respectively. The average MRI-derived lung volume was 4.0 L, with PFT showing a total lung capacity of 6.2 L, residual lung volume of 2.1 L, and forced vital capacity of 4.1 L. Multivariate regression analysis, adjusted for age, gender, and cardiovascular risk factors, revealed an inverse association between maximum LA size, non-gated LA, and LA area fraction with lung volume (ß = − 0.03, p = 0.006; ß = − 0.03, p = 0.021; ß = − 0.01, p = 0.012), with no significant association with PFT parameters. This suggests that MRI-based assessment may offer greater sensitivity in detecting subclinical LA impairment than PFT.

Minimum habitat size required to detect new rare species.

Conservation of species requires the protection of the associated suitable habitat. However, it is usually not known how much habitat is required to detect a single rare species. This problem is important, and it is related directly to the success and optimization of conservation planning. However, to date, no statistical methods have been developed to address this problem adequately. In this study, from a statistical sampling theory, we propose an estimator to estimate the minimum area required to conserve one or more additional new rare species. The estimator is highly accurate, as demonstrated by numerical tests. Applying the estimator in a tropical forest plot showed that the additional habitat size required for discovering an additional individual of a previously unseen tropical tree species is about 3.86 ha with a SE of 1.10 ha. In conclusion, the proposed estimator may be applied to conservation planning by assisting conservation biologists and policymakers to balance urban-related and conservation-related land uses by estimating the minimum detection areas required for species.

Fog-assisted de-duplicated data exchange in distributed edge computing networks

The Internet of Things (IoT) generates substantial data through sensors for diverse applications, such as healthcare services. This article addresses the challenge of efficiently utilizing resources in resource-scarce IoT-enabled sensors to enhance data collection, transmission, and storage. Redundant data transmission from sensors covering overlapping areas incurs additional communication and storage costs. Existing schemes, namely Asymmetric Extremum (AE) and Rapid Asymmetric Maximum (RAM), employ fixed and variable-sized windows during chunking. However, these schemes face issues while selecting the index value to decide the variable window size, which may remain zero or very low, resulting in poor deduplication. This article resolves this issue in the proposed Controlled Cut-point Identification Algorithm (CCIA), designed to restrict the variable-sized window to a certain threshold. The index value for deciding the threshold will always be larger than the half size of the fixed window. It helps to find more duplicates, but the upper limit offset is also applied to avoid the unnecessarily large-sized window, which may cause extensive computation costs. The extensive simulations are performed by deploying Windows Communication Foundation services in the Azure cloud. The results demonstrate the superiority of CCIA in various metrics, including chunk number, average chunk size, minimum and maximum chunk number, variable chunking size, and probability of failure for cut point identification. In comparison to its competitors, RAM and AE, CCIA exhibits better performance across key parameters. Specifically, CCIA outperforms in total number of chunks (6.81%, 14.17%), average number of chunks (4.39%, 18.45%), and minimum chunk size (153%, 190%). These results highlight the effectiveness of CCIA in optimizing data transmission and storage within IoT systems, showcasing its potential for improved resource utilization and reduced operational costs.

Single-species quotas drive discards by multi-species trawlers in the Celtic Seas ecoregion when their relative abundance fluctuates

Abstract Our study investigated discarding patterns by bottom otter trawlers over 17 years prior to the full implementation of the Landing Obligation. A generalized additive modelling approach was applied to at-sea sampling data to examine the most important drivers of the discards per unit effort (DPUE) of cod, whiting, hake, and haddock in the Celtic Seas ecoregion from 2002 to 2018. Many operational, environmental, regulatory, and spatio-temporal factors were tested. Fish above and below the minimum conservation reference size (MCRS) were modelled separately to compare drivers of discarding of these categories of unwanted catch. In the full time period analysis, the three most important factors in determining DPUE were geographic location, an interaction between geographic location and year, and year interacting with month. Further analysis of a subset of the time series indicated that quota availability significantly impacted the DPUE for <MCRS haddock, <MCRS whiting, and >MCRS hake, while the quota allocated for one species often significantly influenced the DPUE of other species and size classes. Quota interacting with abundance had a significant impact for all >MCRS species and <MCRS hake. This indicates that changes in relative abundance compound discarding under quota constraints. Collectively, these results empirically demonstrate that single-species quotas majorly contribute to discards in a mixed-fisheries context.

A Semi-Supervised Transformer-Based Deep Learning Framework for Automated Tooth Segmentation and Identification on Panoramic Radiographs.

Automated tooth segmentation and identification on dental radiographs are crucial steps in establishing digital dental workflows. While deep learning networks have been developed for these tasks, their performance has been inferior in partially edentulous individuals. This study proposes a novel semi-supervised Transformer-based framework (SemiTNet), specifically designed to improve tooth segmentation and identification performance on panoramic radiographs, particularly in partially edentulous cases, and establish an open-source dataset to serve as a unified benchmark. A total of 16,317 panoramic radiographs (1589 labeled and 14,728 unlabeled images) were collected from various datasets to create a large-scale dataset (TSI15k). The labeled images were divided into training and test sets at a 7:1 ratio, while the unlabeled images were used for semi-supervised learning. The SemiTNet was developed using a semi-supervised learning method with a label-guided teacher-student knowledge distillation strategy, incorporating a Transformer-based architecture. The performance of SemiTNet was evaluated on the test set using the intersection over union (IoU), Dice coefficient, precision, recall, and F1 score, and compared with five state-of-the-art networks. Paired t-tests were performed to compare the evaluation metrics between SemiTNet and the other networks. SemiTNet outperformed other networks, achieving the highest accuracy for tooth segmentation and identification, while requiring minimal model size. SemiTNet's performance was near-perfect for fully dentate individuals (all metrics over 99.69%) and excellent for partially edentulous individuals (all metrics over 93%). In edentulous cases, SemiTNet obtained statistically significantly higher tooth identification performance than all other networks. The proposed SemiTNet outperformed previous high-complexity, state-of-the-art networks, particularly in partially edentulous cases. The established open-source TSI15k dataset could serve as a unified benchmark for future studies.

Methylphenidate reduces spatial attentional bias by modulating fronto-striatal connectivity.

Spatial attention bias reflects tendency to direct attention to specific side in space. This bias reflects asymmetric dopamine (DA) signaling in the striatum. Administration of DA agonists reduces spatial bias, yet the underlying mechanism is not yet clear. To address this, the current study tested whether methylphenidate (MPH; an indirect DA agonist) reduces orienting bias by modulating fronto-striatal connectivity. 54 adults with consistent bias completed the greyscales task which detects subtle biases during fMRI scanning under MPH (20mg) or placebo, in a double-blind design. As hypothesized, MPH reduced bias by increasing orienting towards non-preferred hemispace, regardless of whether the initial bias was left or right. MPH-induced increases were found in activation of the medial superior frontal gyrus (mSFG: F[1;53] = 4.632, cluster-defining threshold of P< 0.05, minimal cluster size = 0, p_FWE = 0.036, η2= 0.08) and its functional connectivity with the caudate (left caudate: F[1;53] = 12.664, p_FWE = 0.001, η2= 0.192; right caudate: F[1;53] = 11.069, p_FWE = 0.002, η2= 0.172), when orienting towards the non-preferred hemispace. MPH also reduced mSFG activation and fronto-striatal connectivity for the preferred hemispace. Results suggest modulation of frontal excitability due to increased caudate-mSFG functional connectivity. This mechanism may underlie the positive effect of dopaminergic agonists on abnormal patterns of directing attention in space.

Pengaruh Brand Ambassador Boy Group EXO dan Variasi Produk Terhadap Minat Beli Konsumen Produk Skincare Scarlett Whitening dengan Brand Image Sebagai Variabel Intervening

The purpose of this study was to determine whether brand ambassadors and product variations have a direct influence on buying interest, and to determine the effect of brand ambassadors and product variations on buying interest through Brand Image mediation. The research approach used is quantitative research. The type of data used in this study is primary data, namely research data obtained directly from original sources (respondents). The population in this study are all consumers who have and have not used Scarlett Whitening products. From the calculation using the formula (hair, 2020) recommends that the minimum sample size is 5 times the number of indicator items contained in the questionnaire, the indicators in this study consisting of 3 independent variables and 1 dependent variable totaled 23 indicators, so the sample size of this study was determined to be 115 respondents. The research data was processed using the smartPLS 4.0 analysis tool and the research method in this study used Structural Equation Modeling (SEM), namely an equation model with a variance-based approach or component-based structural equation modeling. The results of this study indicate that the first and third hypotheses are not supported because, Brand ambassador (X1) and Product Variety (X2) have no significant effect on Purchase Intention (Y), the second and fourth hypotheses are supported because, Brand ambassador (X1) and Product Variety (X2) have a significant effect on Brand Image (M), the fifth hypothesis is supported because, Brand Image (M) has a significant positive effect on Purchase Interest (Y), and it can be concluded that Brand ambassadors (X1) and Product Variety (X2) cannot affect Purchase Interest (Y) directly, but Brand ambassadors (X1) and Product Variety (X2) can affect Purchase Interest (Y) by going through Brand Image (M) as a mediating variable.

Field evidence and indicators of rockfall fragmentation and implications for mobility

Rockfall fragmentation can play an important role in hazard studies and the design of protective measures. However, the current lack of modeling tools that incorporate rock fragmentation mechanics is a limitation to enhancing studies and design. This research investigates the fragmentation patterns of rockfalls and analyzes the resulting distribution of fragment sizes within corresponding rockfall deposits. We focus on small rock fragments, which provide insights into the dynamics of the rockfall event and can be used as input for numerical modeling. We analyzed multiple rockfall events from locations worldwide, each exhibiting different degrees of fragmentation. Using image analysis techniques, we mapped all visible blocks, determined their volumes, and measured the distances they travelled from the initial point of impact. A key finding is the identification of three indicators of fragmentation. First, in cases where fragmentation was largely absent, we observed a trend of increasing block size with distance from the impact point or source area, which aligns with previously published findings. However, for energetic rockfall events characterized by intense fragmentation, we observed that small fragments exhibited longer travel distances compared to larger fragments. This distinction allowed us to differentiate blocks primarily resulting from the disaggregation process from those primarily resulting from dynamic fragmentation, with implications for rockfall mobility. Second, although the size distribution of rockfall deposits exhibits a power-law scaling for volumes larger than a minimum size threshold corresponding to a rollover of the distribution, in some case studies a deviation from power-law scaling is observed, indicating a process of larger block comminution due to fragmentation. Third, we found that rockfalls with fragmentation experience reduced mobility, indicated by higher reach angles, and higher lateral dispersion showing a wider distribution of trajectories. We interpret these findings as being directly related to the energy-consuming nature of fragmentation, which prevents farther deposition of fragmented rock blocks.

A tunable transition metal dichalcogenide entangled photon-pair source

Entangled photon-pair sources are at the core of quantum applications like quantum key distribution, sensing, and imaging. Operation in space-limited and adverse environments such as in satellite-based and mobile communication requires robust entanglement sources with minimal size and weight requirements. Here, we meet this challenge by realizing a cubic micrometer scale entangled photon-pair source in a 3R-stacked transition metal dichalcogenide crystal. Its crystal symmetry enables the generation of polarization-entangled Bell states without additional components and provides tunability by simple control of the pump polarization. Remarkably, generation rate and state tuning are decoupled, leading to equal generation efficiency and no loss of entanglement. Combining transition metal dichalcogenides with monolithic cavities and integrated photonic circuitry or using quasi-phasematching opens the gate towards ultrasmall and scalable quantum devices.

Length matters: Effects of fishing gear and fishing behavior on the catch efficiency of demersal seines

Raiding seals pose a big problem to gillnet fishers in areas with high seal abundances. As moving to active gears could be a potential solution for that problem, one gear of particular interest in areas with relatively flat sea bed structure is the so-called “MiniSeine” – a demersal seine that is reduced in size so it can be operated from small vessels. Besides its ability to catch most of the species targeted by gillnet fishers, it offers various advantages compared to other active gears. To reduce the gear in size to fit on a small vessel, the present study assessed how seine rope length (4 coils vs 8 coils), seine rope diameter (18 mm vs. 22 mm) and seine net configurations of different sizes and shapes (three different designs) affect the catch efficiency and the ratio of fish below minimum conservation reference size (MCRS). In general, shorter seine ropes (4 coils) resulted in significantly lower catches than longer ones (8 coils), except for the smallest seine configuration. Larger seine net configurations and longer seine ropes caught generally less fish below MCRS, both up to around 10 %. The seine rope diameter did not affect catches significantly. As potential “adjusting screw” to counteract lower catches due to shorter seine ropes, the effect of different layout patterns of the seine ropes on the catch efficiency was assessed. Laying out the second seine rope perpendicular to the first one can increase the fishing area to more than three times while CPUE showed a tendency to be increased compared to the standard layout pattern. Besides its importance for a successful development of the MiniSeine, these findings are of equal interest for the large-scale demersal seine fishery.

Improving Cardiopulmonary Resuscitation Quality and Resuscitation Training by Using Real-Time Audiovisual-Assisted Devices.

Context Cardiac arrest occurring outside of a medical facility is a significant cause of death and disability worldwide. In developing nations, it accounts for a notable portion of total mortality, with only a small percentage of those affected surviving beyond the initial emergency department intervention. Despite the critical importance of high-quality cardiopulmonary resuscitation (CPR) in these situations, there has been limited research on the effectiveness of audiovisual feedback devices in improving CPR performance among laypersons or non-medical caregivers. These caregivers, often untrained in advanced medical procedures, play a crucial role in the immediate response to cardiac arrest before professional help arrives. This study aims to address this gap by evaluating the impact of such devices on CPR quality delivered by non-medical individuals. Aim This study aimed to determine whether the use of audiovisual devices would improve cardiopulmonary resuscitation performance among non-medical care providers. Materials and methods Using amultiple-choice questionnaire, an audiovisual aid-based prospective observational study (non-interventional observation study) was conducted at a medical college hospital in Kochi from June 2022 to February 2024. A minimum sample size of 66 was derived from pilot studies, with 95% confidence and 90% power. A total of 146 participants met the inclusion criteria (non-medical personnelof 18-50 years of age). After the exclusion ofpregnant women and non-interested participants, the study participants were analyzed for the quality of cardiopulmonary resuscitation in a mannequin with the help of audiovisual devices.Statistical analysis was conducted using IBM SPSS Statistics for Windows, Version 20 (IBM Corp., Armonk, New York, released in 2011). Categorical variables were expressed as frequency and percentage. McNemar's Chi-square test wasapplied to compare the CPR compression rates with and without the visual feedback device, and the kappa statistic was used to assesshow consistently participants performed within the same compression rate category (less than 100, 100-120, or more than 120 compressions per minute) with and without the feedback device. Results The improvement inCPR quality, which was visualized as a green color in the CPR feedback device, was significant, with 109 participants (74.7%) showing good outcomes. The chest compression rate also significantly improved from 95 to 117 with the use of feedback devices (p -0.011, Kappa - 0.167) among non-medical care providers. While the kappa value suggests that some variability exists in compression rates when switching between with and without feedback, the overall improvement is still noteworthy. Conclusion The majority of participants (74.7%) were able to consistently maintaingreen light in the visual feedback watch, which means their chest compression rate was within optimal range (100-120/min) when using the audiovisual feedback device. This indicated that use of audiovisual devicessignificantly improved compression rates among non-medical care providers andeffectively helped them perform high-quality CPR.

Prophylactic antibiotics in patients with alcohol-associated hepatitis receiving steroids: A systematic review and meta-analysis.

The benefits of prophylactic antibiotics in patients with alcohol-associated hepatitis (AH) receiving steroids remain unclear. We aimed to assess the clinical impact of prophylactic antibiotics in AH patients receiving steroids. We systematically reviewed four electronic databases from inception to 30 November 2023. Pooled estimates were analysed using random-effects models. The primary outcome was 90-day survival. Secondary outcomes included infection at days 30 and 90 days, hepatorenal syndrome (HRS), acute kidney injury (AKI), hepatic encephalopathy (HE) and drug-related adverse events (AE). Trial sequential analyses were performed for the primary outcome of 90-day mortality. We screened 419 articles and included six eligible studies (four RCTs and two matched cohort studies) with a total of 510 patients. Compared to standard medical treatment (SMT), prophylactic antibiotics were associated with a lower risk of infection at 30 days (OR: 0.35, 95%CI: 0.20-0.59, I 2 = 0%), infection at 90 days (OR: 0.26, 95%CI: 0.10-0.67, I 2 = 0%) and a lower rate of HE (OR: 0.32, 95%CI: 0.12-0.87, I 2 = 0%). However, prophylactic antibiotics did not improve 90-day survival, sepsis-related mortality, HRS, or AKI. The risks of drug-related AE and fungal infections were similar in patients with AH who received prophylactic antibiotics or SMT. Using trial sequential analysis, the minimum sample size required to detect a 15% relative risk reduction in 90 days mortality with prophylactic antibiotics was 1171. In hospitalized AH patients receiving steroid therapy, prophylactic antibiotics reduced the risk of infection and HE, but did not improve survival or prevent AKI compared to SMT.

Creep condition-oriented design of molybdenum alloys with La2O3 addition assisted by microstructure-based crystal plasticity modeling

Molybdenum (Mo) alloys are essential for applications requiring outstanding mechanical properties at high temperatures across various industrial sectors. Understanding and predicting the creep properties of Mo alloys is crucial for service safety and the design of new materials. This study introduces a physics-based crystallographic creep model dedicated to the characteristic hierarchical microstructure of Mo–La2O3 alloys. By sourcing most parameters from existing literature and calibrating others within recommended ranges, the model efficiently predicts creep behavior beyond its initial calibration scope. Through the integration of microstructure descriptors, we systematically explored the impact of different microstructural features on the creep behavior and identified the underlying mechanisms. This analysis yielded two pivotal concepts: the minimum acceptable grain size and the necessary nanoparticle number density. These metrics, readily obtainable from the model, quantify the requisite grain size and nanoparticle content to achieve the target steady-state creep rates for operational demands, thus providing essential insights for the creep condition-oriented design of Mo–La2O3 alloys. The model is also expected to be adaptable for developing other Mo alloys reinforced by second phase particles, aimed at achieving desired creep properties under specified conditions, assuming that relevant parameters are accessible through literature or lower-scale simulations.

The Impact of Leg Length and Offset Change on Dislocation Risk Following Primary Total Hip Arthroplasty

BackgroundSoft tissue management in total hip arthroplasty includes appropriate restoration and/or alteration of leg length (LL) and offset to re-establish natural hip biomechanics. The purpose of this study was to evaluate the effect of LL and offset-derived variables in a multivariable survival model for dislocation. MethodsClinical, surgical, and radiographic data was retrospectively acquired for 12,582 patients undergoing primary total hip arthroplasty at a single institution from 1998 to 2018. There were twelve variables derived from preoperative and postoperative radiographs related to LL and offset that were measured using a validated automated algorithm. These measurements, as well as other modifiable and nonmodifiable surgical, clinical, and demographic factors, were used to determine hazard ratios for dislocation risk. ResultsNone of the LL or offset variables conferred significant risk or protective benefit for dislocation risk. By contrast, all other variables included in the multivariable model demonstrated a statistically significant effect on dislocation risk with a minimum effect size of 28% (range 0.72 to 1.54) (sex, surgical approach, acetabular liner type, femoral head size, neurologic disease, spine disease, and prior spine surgery). ConclusionsContrary to traditional teaching and our hypothesis, operative changes in LL and offset did not demonstrate any clinically or statistically significant effect in this large and well-characterized cohort. This does not imply that these variables are not important in individual cases, but rather suggests the overall impact of LL and offset changes is relatively minor for dislocation risk compared to other variables that were found to be highly clinically and statistically significant in this population. These results may also suggest that surgeons do a good job of restoring native LL and offset for patients, which may mitigate their analyzed impact.

Video-Based Coaching for Laparoscopic Salpingectomy: A Randomized Controlled Trial.

To evaluate the effect of video-based coaching on the gynecology resident performance of laparoscopic salpingectomy. PGY-1 and PGY-2 residents were randomized before their gynecology rotations to standard gynecology curriculum (control group) or standard curriculum plus two video-coaching sessions by a fellowship-trained minimally invasive gynecologic surgeon (VBC group). Residents were video recorded intraoperatively performing three unilateral laparoscopic salpingectomies. Participants in the VBC group were coached between the procedures. The primary outcome was the improvement in modified GOALS (Global Operative Assessment of Laparoscopic Skills) and OSA-LS (Objective Structured Assessment of Laparoscopic Salpingectomy) scores, compared with baseline, in the VBC and control groups, with videos independently graded by three blinded minimally invasive gynecologic surgeons. A minimum sample size of 18 participants (nine per group) was needed to achieve 90% power to detect a difference of 5.0 points. From October 2021 to December 2022, 28 PGY-1 and PGY-2 residents completed the study with 14 participants per group. Baseline characteristics were similar between groups. In the VBC group, modified GOALS scores significantly improved by 3.0 points from video 1 to video 2 ( P =.04) and by 3.2 points from video 1 to video 3 ( P =.02). Modified OSA-LS scores also increased significantly in the VBC group, by 6.1 points from video 1 to video 3 ( P =.02). In the control group, modified GOALS and OSA-LS scores improved from baseline but were not significant ( P =.2, P =.5). Video-based coaching also enhanced resident comfort and confidence in performing laparoscopic surgery. Video-based coaching improves resident performance of laparoscopic salpingectomy and can be used as an adjunct to resident surgical training. ClinicalTrials.gov , NCT05103449.

The effect of ABM on attentional networks and stress-induced emotional reactivity in a mixed clinical sample with depression: A randomized sham-controlled trial

Research on the efficacy of Attention Bias Modification for depressive symptoms has predominantly yielded unfavorable outcomes. Despite adhering to rigorous conventions in randomized controlled trials, findings from these studies have indicated minimal effect sizes, thereby raising concerns about their limited clinical significance. This may be attributed to the overlapping mechanisms in ABM and the sham comparator, both affecting attentional processes. Participants with a diagnosis of major depressive disorder, with and without comorbid anxiety (N = 101) were randomized to a two-week preregistered randomized trial of ABM compared to sham. Attentional networks were assessed prior to and after the intervention by the Attention Network Task (ANT), and emotional reactivity was assessed in response to a lab-stressor. Irrespective of condition, participants improved their performance on the alerting and executive attentional networks, but not orienting, and stress-induced emotional reactivity was marginally decreased. Changes in attentional networks predicted post-intervention depression scores. It is imperative to reconsider the employment of a sham comparator in the exploration of the clinical efficacy of ABM.