Objective Measurement Tools Research Articles

Scale-based screening and assessment of age-related frailty

As the population ages, the prevalence of age-related frailty increases sharply, which increases the risk of poor health status of older adults, such as disability, falls, hospitalization, and death. Across the globe, frailty is moving toward the forefront of health and medical research. Currently, frailty is believed to be preventable and reversible, so the early identification of frailty is critical. However, there are neither precise biomarkers of frailty nor definitive laboratory tests and corresponding clinical testing techniques and equipment in clinical practice. As a result, the clinical identification of frailty is mainly achieved through the widely used frailty scale, which is an objective, simple, time-saving, effective, economical, and feasible measurement tool. In this narrative review, we summarized and analyzed the various existing frailty scales from different perspectives of screening and evaluation, aiming to provide a reference for clinical researchers and practitioners to judge and manage frail older people accurately.

Perspectives of Key Stakeholders on Integrating Wearable Sensor Technology into Rehabilitation Care: A Mixed-Methods Analysis.

Rehabilitation is facing a critical practice gap: Patients seek out rehabilitation services to improve their activity in daily life, yet recent work demonstrates that rehabilitation may be having a limited impact on improving this outcome due to lack of objective data on patients' activity in daily life. Remote monitoring using wearable sensor technology is a promising solution to this address this gap. The purpose of this study was to understand patient and clinician awareness of the practice gap and preferences for integrating wearable sensor technology into rehabilitation care. This study used a mixed-methods approach consisting of surveys and 1:1 interviews with clinicians (physical and occupational therapists or assistants) employed at an outpatient rehabilitation clinic within an academic medical center and patients seeking care at this clinic. Data were analyzed using descriptive statistics and thematic analysis. Data saturation was reached from recruiting nineteen clinicians and ten patients. Both clinicians and patients recognized the importance of measuring activity outside the clinic and viewed wearable sensor technology as an objective measurement tool. Most clinicians (63%) preferred continuous (vs. intermittent) monitoring within a care episode and most patients (60%) were willing to sync their sensor data as often as instructed by their provider. To maximize integration into clinical workflows, clinicians voiced a preference for availability of sensor data in the electronic health record. Clinicians and patients value the use of wearable sensor technology to improve measurement of activity outside the clinic environment and expressed preferences for how this technology could best be integrated into routine rehabilitation care.

Exploring the role of social capital in enhancing physical activity among college and university students: A systematic review.

College and university students often exhibit insufficient levels of physical activity, which negatively impacts their health, mental well-being, and academic performance. Social capital has emerged as a potential factor in promoting physical activity. This systematic review, conducted in line with PRISMA guidelines, examines the existing literature on the role of social capital in enhancing physical activity among college and university students. A search of the Web of Science, Scopus, SportDiscus, and PsychINFO databases identified 10 studies published by August 1, 2024, involving 2,700 students, primarily from North America and Europe. The overall quality of the included studies was high, with all scoring above 85% on quality assessments. The findings indicate that social capital, particularly strong social networks, support from family and friends, and high levels of social cohesion, is significantly associated with higher levels of physical activity among college and university students. Social capital may facilitate physical activity in group settings through mechanisms such as emotional support, role modeling, and social norms. Despite limitations within the existing research evidence, such as reliance on self-reported data and cross-sectional study designs, this review suggests that social capital holds potential for promoting physical activity in this population. Future research should prioritize the use of objective measurement tools and longitudinal designs to more accurately assess the long-term effects of social capital and explore how these findings can inform effective interventions.

User technology for AI-supported objective measurement of Work-related Quality of Life (MI-LQ)

Abstract Background Understanding and enhancing job satisfaction is crucial for improving Work-Related Quality of Life (WrQoL) in today’s office work environments. Our work uses multimodal data collection and analysis techniques to objectively assess WrQoL, thus mitigating respondent bias and survey fatigue. Leveraging machine learning (ML) and automated methods measuring WrQoL presents a promising approach in public health research, particularly concerning stress-related health outcomes. Methods Through a systematic literature search of 9,242 publications to identify WrQoL indicators, we selected over 100 publications for data extraction. A base model, including workload, commute, overtime, valence, and arousal was formulated. To amass a wide data set, Objective measurement tools (computers, smartphones, and wearables) complemented by questionnaire data. This data will inform ML algorithms to predict individual WrQoL indicators. Developed as an input/output data platform, an app-prototype will objectively assess WrQoL, facilitating a field study with office workers to refine the model. A mobile app prototype serves as a user interface and data relay for WrQoL metric analysis. Results Our research develops instruments for measuring WrQoL using smartphones, wearables, and specialized trackers for heart rate variability (HRV) analysis, alongside a software prototype for keyboard and mouse tracking for workload assessment of valence and arousal. Fitness trackers with photoplethysmography functionality are favored for HRV assessment. Conclusions The systematic search identified influences on WrQoL, translated into measurable indicators in a base model. Leveraging user tech for assessment and a ML and mobile app framework, this approach facilitates objective WrQoL determination. By presenting the relationship between digital service use and WrQoL indicators, this methodology promises new insights, informing stress and burnout prevention strategies within public health initiatives. Key messages • Progressive approach: ML-driven WrQoL assessment offers promising avenues for stress prevention in workplace health research. • Methodological Advancement: The novel framework for WrQoL assessment using digital tools contributes to effective workplace health promotion strategies, with potential for tailored interventions.

Association of Short Sleep Duration and Obstructive Sleep Apnea with Central Obesity: A Retrospective Study Utilizing Anthropometric Measures.

Central obesity, as measured by examination instruments, has been shown to be associated with both OSA and short sleep duration. However, objective measurement tools like CT, MRI, and DXA are expensive, cause radiation exposure, and have limited availability, especially in resource-limited settings. Thus, this study aimed to demonstrate the relevance of Body Mass Index (BMI) and Waist-to-Height Ratio (WHtR) as surrogate indicators of visceral obesity in the assessment of OSA and short sleep duration. We also intend to evaluate whether WHtR, in combination with BMI, can be a suitable surrogate marker for visceral adiposity. We recruited 333 adults with complete polysomnographic (PSG) records retrospectively. Logistic regression helped to assess the association of BMI and WHtR as surrogates for central adiposity with OSA and short sleep duration. Moreover, ROC curve analysis was conducted to evaluate the predictive ability of BMI and WHtR. Following the relevant adjustments, logistic regression analysis results showed that the combination of WHtR and BMI acting as central obesity surrogates was significantly associated with OSA and short sleep duration (p<0.05). According to univariate regression analysis, sleep latency and wakeaftersleeponset were independent predictors of the risk of central obesity in patients with short sleep duration and OSA. Additionally, ROC curve analysis demonstrated that the combination of BMI and WHtR provided a better assessment of central adiposity in patients with OSA and short sleep duration, compared to each measure alone. BMI and WHtR are significantly associated with OSA and short sleep duration, and might serve as a potential surrogate marker for central obesity. Sleep latency and wakeaftersleeponset can independently predict the risk of central obesity in patients with short sleep time and OSA. Thus, larger prospective studies are needed to verify our findings.

Development and Testing of an Instrument to Measure Professionalism in Nursing.

Background and Purpose: Evaluation of professionalism in nursing has proven challenging as no objective measurement tool exists. The purpose of this study was to develop and test the Professionalism in Nursing Scale (PNS) for reliability and validity, which will facilitate evaluation of the constructs of professionalism in nursing. Participants were senior nursing students and registered nurses with at least a baccalaureate degree and a minimum of 3 years of experience working either in academia at an accredited university or in a practice setting in a Magnet hospital. Methods: Methodological research was used to design an instrument that measures professionalism in nursing. Phase 1 included item development, scaling, and evaluation of the content validity index, using 10 content experts. Phase 2 included pilot and field testing using participants meeting the inclusion criteria. Questionnaires were sent electronically to evaluate the relevance of each attribute of professionalism using a Likert scale. Phase 3 was scale evaluation, including reliability and validity of the PNS. Results: Final results of exploratory factor analysis supported a 33-item five-factor model. The factors were named Ethics and Interprofessional Collaboration, Excellence, Professional Engagement, Caring, and Self-Awareness. The overall reliability rate of the PNS was 0.97. Findings demonstrated the reliability and validity of the PNS for measuring professionalism in academic and clinician nurses and nursing students. Conclusions: Measuring professionalism in nursing can assist driving improvement of patient care, accountability, and team collaboration. A discussion of the PNS within the context of academia and clinical practice, along with implications for research, practice, education, and policy will be presented.

Multidimensionality of children’s foundational skills: an IRT-based validation of the NEPSY factorial structure

ABSTRACT Objective Measurement tools for children’s foundational skills provide important insights towards the developmental mechanisms of these domains. This study examines the structure of sensorimotor, visuospatial processing (VP), executive function (EF) skills and their interrelationship. The NEPSY is a widely-used neuropsychological instrument, but while validated at the domain-level through classical test theory approaches, no studies have conducted in-depth item-level analyses on its structural and psychometric properties. Method This study examined whether the designed structure of NEPSY is empirically supported by fitting unidimensional and multidimensional Item Response Theory models to item response data of early elementary students in the United States. A confirmatory factor analysis was also conducted to examine the factorial structure of the data. Results Results provide empirical support to the factorial structure of NEPSY, both at the domain level and within the VP sub-domain. The results show that VP and EF are separate constructs and subtests within the VP domain can further be modelled as interrelated but distinct factors – non-motor and motor-based processing. Conclusion Our specific results support the theoretical stance that VP consists of multiple component skills that are distinct because they require different neurological processes. This multidimensional NEPSY model shares some structural commonalities with the Cattell–Horn–Carroll model.

Development and use of Biocheck.UGent™ scoring system to quantify biosecurity in conventional indoor (turkey, duck, breeder) and free-range (layer and broiler) poultry farms

To assess and enhance the application of biosecurity measures in poultry farming, an objective measurement tool (Biocheck.UGent™) was already available for broiler and layer. This study describes the development, validation and application of a risk-based weighted scoring tool for breeder, turkey, duck, free-range layer and free-range broiler production. In collaboration with an expert panel (n= 38), five different questionnaires were developed, following the format of the existing Biocheck.UGent scoring tools. Weights were attributed to external (7–9 subcategories) and internal (3–4 subcategories) biosecurity categories, as well as to the corresponding individual questions within each subcategory. The biosecurity measures were prioritized and weighed based on their relative importance in preventing disease transmission. Upon completion of the questionnaire, and upload of all answers to the Biocheck.UGent website, the algorithm generates a biosecurity score varying between ‘’0’’ which equals the total absence of any biosecurity measure up to ‘’100’’ which refers to full application of all biosecurity measures. The final scoring systems are available online (https://biocheckgent.com/en) for free and have been used to assess biosecurity in 70 breeders, 100 turkeys, 23 ducks, 16 free-range broilers, and 15 free-range layer farms originating from 12 countries so far. On average, the overall biosecurity score (mean ± std. dev) was 78 ± 7 % for breeders, 73 ± 11 % for turkeys, 71 ± 8 % for ducks, 73 ± 8 % for free-range layers and 70 ± 13 % for free-range broilers. There were significant differences (p < 0.05) in biosecurity (both at the overall and subcategory levels) across different poultry types. The overall farm biosecurity score for breeders was significantly higher than that for turkey (p <.001) and duck production (p = 0.001). External biosecurity levels were highest in breeders in comparison to turkeys (p < 0.001), ducks (p = 0.008) and broiler free-range (p = 0.005). There was a notable difference in internal biosecurity levels between duck and turkey (p = 0.041) production as well. The study contributed to the poultry biosecurity database which allows benchmarking of the biosecurity levels of the users’ farm results to national or international averages, indicating room for improvement and aiding to motivate stakeholders to enhance their biosecurity levels.

Towards an Objective Measurement Tool for ADHD-like Traits in Family Dogs: A Comprehensive Test Battery.

Family dogs exhibit neuropsychological deficits similar to attention-deficit/hyperactivity disorder (ADHD) symptoms in humans. Questionnaire methods have mostly been used to assess ADHD-like behaviours in dogs. In addition to our validated questionnaire (Dog ADHD and Functionality Rating Scale-DAFRS; 2024), we developed a simple behavioural test battery covering the ADHD symptom domains (i.e., inattention, hyperactivity, and impulsivity) in dogs. Our main aim was (i) to provide a final external validation step to the DAFRS by examining its associations with the test variables (N = 59); and (ii) to compare owner- and trainer-rated factor scores' associations with the test variables (n = 38). We developed four tests covering the ADHD symptom domains: the attention test (inattention), the plush dog test (impulsivity), the leash test, and the sit test (hyperactivity). All four behavioural variables correlated with their respective questionnaire scores, i.e., the strongest for hyperactivity, and the least strong for inattention. Both owner- and trainer-rated scores (n = 38) correlated with the relevant test variables in an expected direction. Dogs' training status was linked only to the sit test results. Test-retest analyses (n = 34) indicated moderate-to-excellent agreement across all behavioural variables. Our findings support the validity of our novel human-analogue questionnaire for dogs as the behavioural tests strongly correlate with the relevant questionnaire scores, indicating that the two constructs together can effectively assess inattention, hyperactivity, and impulsivity in dogs.

Objective Evaluation of Stellate Ganglion Block Effects Using Ultrasound Wave Intensity Technology: A Study on Hemodynamics.

Emerging evidence suggests that although Horner's syndrome manifests observable facial changes, it may not comprehensively evaluate the hemodynamic alterations associated with stellate ganglion block (SGB). This study endeavors to systematically evaluate the influence of SGB on the elasticity and flow velocity of the common carotid artery (CCA) and brachial artery utilizing ultrasound wave intensity analysis (usWIA). Particularly, it focuses on patients necessitating monitoring for its effects on specific organs or regions. Totally, we selected 33 patients, where only 31 patients (comprising 15 males and 16 females) were included between September 2020 to January 2022 after screening patients who require SGB treatment for painful disorders. The side on which the SGB was administered depended on the patient's painful side, 13 cases underwent left stellate ganglion block (LSGB), and 18 cases underwent right stellate ganglion block (RSGB). Wave intensity (WI) data were collected by usWIA on the CCA and brachial artery before the administration of SGB and after the manifestation of Horner's syndrome. We then compared the changes in these data pre- and post-SGB using SPSS 26.0. The results showed an increase in arterial compliance (AC) of the CCA and brachial artery on the blocked side after SGB (P < 0.05). In contrast, pressure-strain elastic modulus (EP) and arterial stiffness pulse wave velocity (PWVβ) decreased (for all P < 0.05). Furthermore, the minimum velocity (Vmin) of the CCA exhibited a significant increase (P < 0.01), while wave intensity pulse wave velocity (PWVwi) was significantly reduced (P < 0.01). In contrast, on the contralateral side of the CCA, EP and PWVβ increased after SGB (for all P < 0.05), while AC decreased (P < 0.05). SGB has been observed to enhance the elasticity and blood flow velocity of arteries within its innervated areas. In clinical practice, usWIA can serve as an objective measurement tool for assessing the impact of SGB on arterial elasticity and flow velocity in specific organs or regions. Furthermore, unilateral SGB has been noted to diminish the arterial elasticity of the CCA on the contralateral side.

Dynamic correction of dual−energy x-ray absorptiometry images improves chain speed prediction of lamb composition in abattoirs

A prototype, on-line Dual Energy X-ray Absorptiometer (DXA) has shown high precision of the prediction of carcass composition for the purpose of improved sheep meat grading in the Australian lamb supply chain, albeit with small inaccuracies over time. These inaccuracies were present across hours, and more significantly across days, which were unacceptable for any accreditation of this device as an objective carcass measurement tool in Australia. This inaccuracy demanded the creation of a novel image−processing algorithm for the prototype DXA. This DXA was tested for repeatability of predictions of lamb carcass composition over minutes, hours, and days, using two developed image processing algorithms. There was high immediate repeatability for both algorithms when predicting lean muscle % in 40 lamb carcasses, with a maximum CV of 0.65% over five repeated scans. There was a decrease in the CV of the prediction of lean muscle % of 30 lambs scanned three times over a 48-h period from 5.93 to 1.19% when the superior algorithm was used. The inaccuracies of lean muscle % predictions were associated with increases in the unattenuated space pixel values in DXA images. Improvements of the current algorithm are required to demonstrate repeatability over time for the purpose of accreditation within the Australian sheep meat industry, and for possible expansion of this technology into international supply chains.

Assessing Scar Outcomes Using Objective Scar Measurement Tools: An Adjunct to Validated Scar Evaluation Scales.

The assessment of scar outcomes is important to both patient care and research focused on understanding the results of medical and surgical interventions. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) are validated and simple instruments to assess scars. However, these subjective scales have shortcomings. The VSS fails to capture patient perception and has indeterminate validity and reliability. The POSAS captures patient perception, but the observer scale has been shown to have moderate amounts of interrater variability. Studies highlighting the ability of objective scar assessment tools to produce reliable and reproducible results are needed. In this study, the authors aimed to validate the use of the FibroMeter, ElastiMeter, and SkinColorCatch as objective adjuncts in the assessment of hypertrophic scar and keloid outcomes. In this prospective single-center study, scars were assessed using the VSS, the POSAS, and the objective study tools (FibroMeter, ElastiMeter, and SkinColorCatch). Correlations between the different methods of scar assessment were measured. The FibroMeter and SkinColorCatch showed significant correlations with the VSS total and the observer POSAS total. The ElastiMeter showed significant correlations with both the patient and observer POSAS totals. Unexpected correlations between ElastiMeter measurements and the vascularity or pigmentation of scars indicate that scoring of these categories may be influenced by how severe the scar looks to the observer subjectively, underscoring the need for reliable objective scar assessment tools. The results highlight the ability of the FibroMeter, ElastiMeter, and SkinColorCatch to assess scars, and demonstrate their potential in serving as important adjuncts to previously validated scar assessment scales.

Green Neighbourhood Sustainability Index – A measure of the balance between anthropogenic pressure and ecological relevance

Peri-urban landscapes grow more urbanised due to suburbanisation. This, in turn, makes them environmentally and culturally susceptible to changes. Keen demand for residential areas threatens the sustainability of the peri-urban landscape. Green spaces are at particular risk of conversion. Recently, researchers focused on the function of green sites in urban environments. What is more, research on green spaces involves mainly their mapping and analysis of spatiotemporal changes. Nevertheless, there is a research gap in the multi-criteria research on the hypothetical sustainability of green spaces and the identification of areas that are the most at risk of conversion. Therefore, the present study is an attempt to develop a simple technique tool for objective measurement of the sustainability of green spaces in peri-urban areas. To this end, we developed the Green Neighbourhood Sustainability Index (GNSI), with which one can assess the sustainability of the landscape and green spaces using spatial data and GIS technology. The GNSI was then put to the test in the peri-urban zone of Kraków (Poland). The research shows that as the area of agricultural land increases, the sustainability of nearby green spaces decreases. Forest land, on the other hand, improves sustainability. The structure of land use types in the peri-urban zone of Kraków is well balanced. It is both desirable and good for landscape sustainability and harmony. The GNSI can be among the aids used by decision-makers to take science-informed strategic spatial planning decisions to ensure the sustainability of green spaces and the proper functioning of the ecosystem in peri-urban areas, especially in post-socialist transformation countries.

Maternal Sleeping Problems Before and After Childbirth - A Systematic Review.

The perinatal and postpartum period is of great significance for women due to physiological changes, shifts in circadian rhythms, social setting, and psychological well-being, all of which affect the quality and quantity of their sleep. A mixed-studies systematic review was undertaken to enhance our understanding of sleep disturbances and mood disorders in women in late pregnancy and the postpartum period, their connection with breastfeeding, and the assessment of interventions for sleep disturbance. Three electronic databases (PUBMED, EMBASE and Google Scholar) were searched for qualitative, observational, and mixed-method studies from the year 2016 to June 2023. Twenty-nine articles were included in the analysis. The results were synthesized into four overarching themes: (і) the sleep quality of women in the perinatal period; (ii) the relationship between sleep and breastfeeding; (iii) the relationship between sleep quality and emotional disturbance in the perinatal period; (iv) sleep interventions in the researched group. The subjective nature of the perception of sleep disturbances, along with the absence of an objective measurement tool is clearly an inconvenience. It is advisable to include the assessment of maternal sleep hygiene and family sleep patterns during postpartum healthcare provider appointments to develop strategies not only for women's sleep quality but also for their mental well-being.

Critical flicker fusion in patients with epilepsy under antiseizure medication.

Critical flicker frequency (CFF) and flicker frequency (FF) are used as indicators for the neurotoxic adverse events of drugs in pharmacology. In this pilot study, we investigated whether patients with epilepsy (PWE) treated with various antiseizure medications (ASM) had significantly different CFFs compared with healthy controls. In addition, we investigated the appropriateness of CFF as an objective measurement tool in PWE who reported adverse events according to the adverse event profile (AEP). Patients receiving regular antiseizure treatment at our center, along with healthy controls, were included in this study. Clinical neurotoxic symptoms, AEP scores, and serum ASM levels were assessed in the PWE group. We used a CFF device that produced a red-black, green-black, blue-black, or white-black flicker. CFF and FF were compared between PWE and healthy controls. In PWE, the correlation of alterations in CFF and FF with AEP results and through ASM serum concentrations was calculated. A total of 33 PWE and 20 healthy controls participated in the study. Except for two light modalities, CFF and FF were significantly reduced in PWE compared with controls. CFF and FF did not differ significantly between PWE with AEP scores >44 points and those with lower scores. CFF and FF levels did not correlate with changes in AEP scores, serum concentrations, or doses. CFF and FF distinguished PWE with ASM from healthy controls. No clinically relevant differentiation was detected in the heterogenous PWE group. To investigate whether CFF and FF may serve as subtle indicators of neurotoxicity or specific modes of action, additional studies are needed in more homogenous PWE groups.

Physiotherapy interventions on chest wall mobility in obstructive lung diseases: A systematic review

PurposeThe aim of this systematic review was to investigate the effectiveness of physiotherapy interventions on chest mobility in obstructive lung diseases. MethodsSearches were performed in PEDro, Pubmed and Cochrane Central Register of Controlled Trials databases without language restrictions between 2010 and 25th December 2020. Randomized controlled trials (RCTs) investigating physiotherapy interventions on chest wall mobility were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. The assessment of risk of bias was conducted using the PEDro scale for RCTs. The articles were excluded if they have less than 5 out of 10 score. ResultsFive studies included had good to excellent quality. A total of 139 patients were included in all RCTs. Intervention duration ranged from a single session to 12 weeks and the intervention schedules varied, consisting of 1–24 sessions, lasting 5–45 min per sessions. Three studies used respiratory muscle stretching and releasing techniques, one study combined respiratory muscle stretching with aerobic training, and one study planned diaphragmatic breathing. Four studies assessed chest wall mobility with optoelectronic plethysmography, whereas one study used measuring tape. ConclusionsThe result of this first systematic review that investigates the effects of physiotherapy interventions on chest wall mobility in obstructive lung diseases suggests that more and better quality RCTs with objective measurement tools are required.

Validation of cost-efficient EEG experimental setup for neural tracking in an auditory attention task

When individuals listen to speech, their neural activity phase-locks to the slow temporal rhythm, which is commonly referred to as “neural tracking”. The neural tracking mechanism allows for the detection of an attended sound source in a multi-talker situation by decoding neural signals obtained by electroencephalography (EEG), known as auditory attention decoding (AAD). Neural tracking with AAD can be utilized as an objective measurement tool for diverse clinical contexts, and it has potential to be applied to neuro-steered hearing devices. To effectively utilize this technology, it is essential to enhance the accessibility of EEG experimental setup and analysis. The aim of the study was to develop a cost-efficient neural tracking system and validate the feasibility of neural tracking measurement by conducting an AAD task using an offline and real-time decoder model outside the soundproof environment. We devised a neural tracking system capable of conducting AAD experiments using an OpenBCI and Arduino board. Nine participants were recruited to assess the performance of the AAD using the developed system, which involved presenting competing speech signals in an experiment setting without soundproofing. As a result, the offline decoder model demonstrated an average performance of 90%, and real-time decoder model exhibited a performance of 78%. The present study demonstrates the feasibility of implementing neural tracking and AAD using cost-effective devices in a practical environment.

Objective measurement of apathy and its differentiation from depression in dementia based on physiological reactivity to stimuli presented in virtual reality environment

AbstractBackgroundWe aimed to develop a tool for objective measurement of apathy and its differentiation from depression in the context of cognitive impairment.MethodWe exposed older adults with and without cognitive impairment (CI and CN, respectively) to emotional (i.e., positive), aversive and neutral, and to cognitive (congruent; incongruent) stimuli in a virtual reality environment and measured their physiological reactivity as reflected by autonomic nervous system (ANS) functions [heart rate (HR), heart rate variability (HRV), respiration and galvanic skin response (GSR)], and gaze [time to gaze fixation (TTGF) and total fixation duration (TFD)]. Apathy and depression were measured via the Lille Apathy Rating Scale (LARS)‐ and the Geriatric Depression Scale (GDS), respectively.ResultParticipants' characteristics are presented in Tables 1‐2. Compared to CN, CI participants had lower TFD (ANOAVE: F = 7.471, P = 0.006) and GSR reactivity (F = 6.334, P = 0.014) in response to all stimuli. Among participants with CI, those with apathy (LARS score ≥‐7) (n = 21) had shorter TFD compared to those without apathy (F = 19.259, P = 0.001), and those with depression (GDS score ≥5) (n = 46) had longer TFD compared to those without depression ((F = 33.118, P = 0.001) to all stimuli. For all participants, presence of apathy was associated with lower TFD (F = 13.807, P = 0.001) higher TTGF (F = 10.819, P = 0.001), lower HRV reactivity (F = 4.089, P = 0.043) and respiration depth reactivity (F = 8.026, P = 0.005) in response to all stimuli. In contrast, depression was associated with higher TFD (F = 8.448, P = 0.004), lower TTGF (F = 5.290, P = 0.022) and higher HRV reactivity (F = 5.171, P = 0.023) to all stimuli. Increasing LARS scores were negatively associated with respiration rate (R = ‐0.223, P = 0.025) and TFD (R = ‐0.253, P = 0.021) in response to positive emotional stimuli, and with TFD in response to congruent (R = ‐0.265, P = 0.016) and incongruent (R = ‐0.247, P = 0.024) cognitive stimuli. GDS scores were positively associated with HR (R = 0.219, P = 0.049; R = 0.217, P = 0.05 respectively) and respiration depth (R = 0.216, P = 0.048; R = 0.252, P = 0.021 respectively) reactivity to positive and aversive emotional stimuli.ConclusionANS and gaze reactivity to emotional and cognitive stimuli presented in a VR environment is sensitive to cognitive status and to apathy, even in subtle forms. Moreover, this tool can potentially differentiate apathy from depression in the context of cognitive impairment.

Quantitative measurement of pitting edema with a novel edema ruler

Lower extremity edema is a symptom of chronic venous disease and venous insufficiency. However, clinical evaluations rely on the qualitative evaluation of the pitting depth, which is neither well-defined nor quantitative. We created a novel three-dimensionally printed edema ruler as a quantitative method to measure pitting depth. Twenty-five patients (50 legs) with chronic venous disease were evaluated for ankle edema using the edema ruler. The results demonstrate excellent intraclass correlation for both single (0.944, P < .001) and average (0.971, P < .001) measurements. The edema ruler is a noninvasive, useful, and objective tool for the clinical measurement of lower extremity edema.

Adaptation and validation of the PAC-19QoL-specific quality of life questionnaire for the Spanish population with long COVID

Introduction The post-acute (long) COVID-19 Quality of Life instrument is the only specific instrument designed to assess the quality of life in long COVID patients. The present study aims to make a transcultural adaptation and validation into Spanish of the disease-specific (long COVID) quality of life instrument, post-acute (long) COVID-19 Quality of Life, to have a tool for objective measurement of quality of life in this population. Methods A descriptive cross-sectional study was divided into two phases. In phase one, the translation and cultural adaptation of the questionnaire was performed, while in phase two, the questionnaire was validated. The Spanish version of the questionnaire was used with a sample of 206 people, 40 males (19.4%) and 166 females (80.6%), with an age range between 21 and 70 years old. Participants completed the questionnaire through an online platform. Internal consistency, construct validity, convergent validity, test-retest reliability, and ceiling and floor effects of the Spanish version were analyzed. Results The Spanish version of the post-acute (long) COVID-19 Quality of Life instrument showed high internal consistency, with Cronbach's alpha= 0.922 and an intraclass correlation coefficient of 0.936. Mean scores obtained in the PAC-19QoL and SF-12 questionnaires showed that those who had a worse quality of life in the SF-12 tool also a had worse quality of life in the PAC-19QoL tool. Conclusions This study shows that the Spanish version of the post-acute (long) COVID-19 Quality of Life instrument is an appropriate and valid tool for assessing the quality of life of long COVID patients.