Percent Improvement Research Articles

Opioid Prescribing for Chronic Musculoskeletal Conditions: Trends over Time and Implementation of Safe Opioid-Prescribing Practices.

This study aimed (1) to determine the impact of a clinical decision support (CDS) tool on rate of opioid prescribing and opioid dose for patients with chronic musculoskeletal conditions and (2) to identify prescriber and facility characteristics associated with adherence to the Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain in this population.We conducted an interrupted time series analysis to assess trends in percentage of patients from 2016 to 2020, receiving an opioid and the average opioid dose, as well as the change associated with implementation of the CDS toolkit. We conducted a retrospective cohort study to assess the association between prescriber and facility characteristics and safe opioid-prescribing practices. We assessed the impact of the CDS intervention on percent of patients receiving an opioid and average opioid dose (morphine milligram equivalents). We operationalized safe opioid prescribing as a composite score of several behaviors (i.e., prescribing naloxone, initiating a pain agreement, prescribing <90 MME, avoiding extended-release prescriptions for opioid-naïve patients, and avoiding coprescribing opioids and benzodiazepines) and used a hierarchical linear regression model to assess associations between prescriber and facility characteristics and safe opioid prescribing. This CDS intervention had a modest but statistically significant 1.6% reduction on the percent of patients (n = 1,290,746) receiving an opioid (mean: 15% preintervention; 10% postintervention). The average dose of opioid prescriptions did not significantly change. Advanced practice providers and prescribers with higher percentages of patients aged 18 to 64 exhibited safer opioid prescribing, while prescribers with higher percentages of white patients and larger numbers of patients on opioids exhibited less safe opioid prescribing. A CDS intervention was associated with a small improvement in percent of patients receiving an opioid, but not on average dose. Clinicians are not prescribing opioids for chronic musculoskeletal conditions frequently, when they do, they are generally adhering to guidelines.

A PSO optimized RBFNN and STSMC scheme for path tracking of robot manipulator

This article presents the design of super twisting sliding mode control (STSMC) based on radial basis function neural network (RBFNN) for path tracking of two link robot manipulator. The proposed controller is utilized to guarantee and achieve that the surface of sliding can be in equilibrium point within a short time and avoid the problem of chattering at the output. The Lyapunov theory is used in presenting a new convergence proof. Also, the particle swarm optimization (PSO) algorithm is employed to give the optimal parameter values of the proposed controller. Simulation results explain the goodness of the proposed control method for trajectory tracking of 2-link robot manipulator when compared with SMC strategy. Results demonstrate that the the percentage improvement in mean square error (MSE) of using STSMC when compared with the standard SMC are 15.36%, 16.94% and 12.92%, for three different cases respectively.

Visual Image Dehazing Using Polarimetric Atmospheric Light Estimation

The precision in evaluating global ambient light profoundly impacts the performance of image-dehazing technologies. Many approaches for quantifying atmospheric light intensity suffer from inaccuracies, leading to a decrease in dehazing effectiveness. To address this challenge, we introduce an approach for estimating atmospheric light based on the polarization contrast between the sky and the scene. By employing this method, we enhance the precision of atmospheric light estimation, enabling the more accurate identification of sky regions within the image. We adapt the original dark channel dehazing algorithm using this innovative technique, resulting in the development of a polarization-based dehazing imaging system employed in practical engineering applications. Experimental results reveal a significant enhancement in the accuracy of atmospheric light estimation within the dark channel dehazing algorithm. Consequently, this method enhances the overall perceptual quality of dehazed images. The proposed approach demonstrates a 28 percent improvement in SSIM and a contrast increase of over 20 percent when compared to the previous method. Additionally, the created dehazing system exhibits real-time processing capabilities.

Applying objective metrics to neurosurgical skill development with simulation and spaced repetition learning.

Surgical skills laboratories augment educational training by deepening one's understanding of anatomy and allowing the safe practice of technical skills. Novel, high-fidelity, cadaver-free simulators provide an opportunity to increase access to skills laboratory training. The neurosurgical field has historically evaluated skill by subjective assessment or outcome measures, as opposed to process measures with objective, quantitative indicators of technical skill and progression. The authors conducted a pilot training module with spaced repetition learning concepts to evaluate its feasibility and impact on proficiency. The 6-week module used a simulator of a pterional approach representing skull, dura mater, cranial nerves, and arteries (UpSurgeOn S.r.l.). Neurosurgery residents at an academic tertiary hospital completed a video-recorded baseline examination, performing supraorbital and pterional craniotomies, dural opening, suturing, and anatomical identification under a microscope. Participation in the full 6-week module was voluntary, which precluded randomizing by class year. The intervention group participated in four additional faculty-guided trainings. In the 6th week, all residents (intervention and control) repeated the initial examination with video recording. Videos were evaluated by three neurosurgical attendings who were not affiliated with the institution and who were blinded to participant grouping and year. Scores were assigned via Global Rating Scales (GRSs) and Task-based Specific Checklists (TSCs) previously built for craniotomy (cGRS, cTSC) and microsurgical exploration (mGRS, mTSC). Fifteen residents participated (8 intervention, 7 control). The intervention group included a greater number of junior residents (postgraduate years 1-3; 7/8) compared to the control group (1/7). External evaluators had internal consistency within 0.5% (kappa probability > Z of 0.00001). The total average time improved by 5:42 minutes (p < 0.003; intervention, 6:05, p = 0.07; control, 5:15, p = 0.001). The intervention group began with lower scores in all categories and surpassed the comparison group in cGRS (10.93 to 13.6/16) and cTSC (4.0 to 7.4/10). Percent improvements for the intervention group were cGRS 25% (p = 0.02), cTSC 84% (p = 0.002), mGRS 18% (p = 0.003), and mTSC 52% (p = 0.037). For controls, improvements were cGRS 4% (p = 0.19), cTSC 0.0% (p > 0.99), mGRS 6% (p = 0.07), and mTSC 31% (p = 0.029). Participants who underwent a 6-week simulation course showed significant objective improvement in technical indicators, particularly individuals who were early in their training. Small, nonrandomized grouping limits generalizability regarding degree of impact; however, introducing objective performance metrics during spaced repetition simulation would undoubtedly improve training. A larger multiinstitutional randomized controlled study will help elucidate the value of this educational method.

Efficacy of Collagenase Clostridium Histolyticum Injection, a Potential Nonsurgical Intralesional Treatment Option for Plantar Fibromatosis: A Randomized, Open-Label, Dose-Ranging Study

Category: Midfoot/Forefoot; Basic Sciences/Biologics Introduction/Purpose: Plantar fibromatosis (PFi) is characterized by collagen-containing nodules on the foot along the plantar fascia that can cause pain and functional disability. Current treatments focus on symptom relief, which may become ineffective, or surgery, which can have lengthy recovery times. Collagenase clostridium histolyticum (CCH) is approved for Dupuytren’s and Peyronie’s disease treatment, which are both fibroproliferative disorders that may coexist in patients with PFi. This dose-ranging study assessed the efficacy and safety of CCH treatment of PFi. Methods: In this Phase 1, multicenter study, participants were randomly allocated (1:1:1) to receive 0.6, 1.2, or 2.25 mg/mL CCH. All participants underwent the initial treatment period (ITP) and received 1–2 intralesional injections per nodule on Day 1 with 5 follow-up assessments. Participants with palpable treated nodules could receive additional CCH doses (at 2.25 mg/mL; retreatment period, RP), with follow-up at specified intervals. Assessments included a 5-scale measure of nodule hardness (0 [nonpalpable] to 4 [hard]), and the Foot Function Index-Short Form23 (FFI-SF23) reported as a composite score (0 – 100) of 3 subscale scores (disability, difficulty, and pain subscales). Results: After ITP (n=24), 100% (8/8) of participants receiving 2.25 mg/mL CCH showed improvement in nodule hardness, compared with 87.5% (7/8) and 75% (6/8) of participants receiving 1.2 and 0.6 mg/mL, respectively. FFI-SF23 also showed a negative change from baseline across treatment groups, indicating improvement. Participants that received 2.25 mg/mL reported the largest percent improvement (-83.7%). After RP (n=11), 81.8% (9/11) of participants showed improvement in nodular hardness and an FFI-SF23 score change of -9.3%, indicating further improvement from baseline after ITP. CCH had a consistent safety profile in ITP/RP. Conclusion: CCH caused dose-dependent improvement of nodule hardness after treatment, with 2.25 mg/mL utilized for nodule retreatment; FFI-SF23 scores correlated with this finding, indicating CCH may be a potential nonsurgical intralesional option for PFi treatment.

The Importance of Timing of Physical Therapy in Relation to Radiation Therapy during Multimodality Breast Cancer Treatment to Maximize Shoulder Range of Motion

Physical therapy (PT) is an effective tool for improving range of motion (ROM) for breast cancer patients to reduce long-term impairment. There is a paucity of data surrounding when PT should be initiated to optimally reduce upper limb disability. We hypothesized that patients who initiated PT early after surgery and before radiation therapy (RT), would experience greater gains in functionality compared to PT during/after RT. Demographic/clinical variables were assessed via retrospective chart review for patients referred to outpatient PT and receiving multimodality treatment for breast cancer between January 2015 and August 2021. Three distinct cohorts were established: patients who received PT and no RT, PT initiated before radiation therapy (pre-RT), and PT initiated during/after RT (d/a RT). The primary endpoint was percent change of total ROM of the ipsilateral shoulder between the first and last PT visits. Secondary endpoints included absolute change in degrees of total ROM of the ipsilateral shoulder between first and last PT visits. Associations between ROM across PT groups and baseline characteristics were evaluated with analysis of variance (ANOVA) testing. Thirty-seven patients were identified, median age 47 years (range 28-76). Higher tumor stage and axillary lymph node dissection were associated with the receipt of RT (p = 0.023, p = 0.003 respectively). Baseline ROM was associated with both percent and absolute improvement in ROM (p = 0.007). Patients receiving no RT demonstrated the greatest mean percent improvement in ROM with PT (84%), compared to the pre-RT and d/a RT cohorts, which demonstrated a 63% and 40% improvement, respectively. In pairwise comparisons, patients in the no RT group and those in the PT pre-RT group both demonstrated a statistically greater improvement in percent change in ROM compared to patients receiving PT d/a RT (no RT 74% vs d/a RT 20%, p = 0.006; pre-RT 59% vs d/a RT 20%, p = 0.045). There was no difference in percent change in ROM between the no RT and pre-RT groups (p = 0.528). On univariate analysis, baseline worse ROM was associated with statistically worse percent change in ROM after PT (p = 0.008), no other baseline characteristics were associated with ROM after PT. When adjusting for baseline ROM, the no RT cohort continued to be associated with improvement in ROM compared to the PT d/a RT group (p = 0.024), while there was no difference in percent change in ROM between patients who received physical therapy pre-RT compared to no RT (p = 0.829). Physical therapy is helpful in improving shoulder ROM at all stages of multimodality breast cancer treatment, however early initiation of PT prior to the start of RT may help maximize range of motion gains.

Peyronie's disease response to intralesional collagenase clostridium histolyticum therapy is independent of baseline testosterone.

Testosterone plays an important role in collagen metabolism, transforming growth factor-β1 expression, and wound healing, which are all critical factors in pathogenesis of Peyronie's disease. Some clinical studies have suggested an association between Peyronie's disease and hypogonadism. We sought to investigate whether baseline total testosterone levels influence response to intralesional collagenase clostridium histolyticum in Peyronie's disease. A retrospective review of patients receiving collagenase clostridium histolyticum injections with available total testosterone levels within 1 year of initial injection was conducted at a single institution. Baseline demographics, hypogonadal status, total testosterone, number of collagenase clostridium histolyticum cycles, and pre- and post-treatment degrees of curvature were collected. Hypogonadism was defined as total testosterone <300ng/dL. Thirty-six men were included with mean age of 58.2 years (SD 10.4) and mean body mass index 26.8 (SD 3.2). The mean total testosterone was 459.2ng/dL (SD 144.0), and four (11.1%) were hypogonadal. Mean pre-treatment curvature was 47.6°, and mean post-treatment curvature was 27.8°, with mean improvement of 19.9° (40.1%). Hypogonadal status was not significantly associated with more severe curvature, 46.4° among hypogonadal men as to 57.5° among eugonadal men (p=0.32). On linear regression analysis, total testosterone did not significantly predict improvement in degrees (β=-0.02; R2=0.06; p=0.14) or percent (β=0.0; R2=0.05; p=0.18). Improvement in neither degrees nor percent differed significantly by hypogonadal status (p=0.41 and 0.82, respectively). The cycle number did significantly predict greater improvement in curvature on both univariate and multivariate analyses (β=5.7; R2=0.34; p<0.01). Neither total testosterone nor hypogonadism is associated with a degree of improvement after collagenase clostridium histolyticum treatment.

Influence of home-based pulmonary rehabilitation program among people with interstitial lung disease: A pre-post study

ABSTRACT Introduction Access to interstitial lung disease programs may not be available in rural settings. Home-based pulmonary rehabilitation (PR) programs have been proposed as an alternative to hospital-based programs. Method Forty participants with ILD underwent a structured unsupervised home-based pulmonary rehabilitation program from September 2020 to September 2022. Quality of life was assessed using St. George Respiratory Questionnaire (SGRQ) and functional capacity using 6-minute walk test (6MWT). The outcome measures were assessed at baseline and 4 weeks post-unsupervised home-based PR program. Result We recruited 40 participants with ILD. There was statistically significant improvement in the 6-minute walk distance (353.8 m and 368 m, effect size – 0.5, p ≤ .001) and quality of life using SGRQ total score (38.6 and 42.35, effect size – 2.5, p ≤ .001) between before and after receiving home-based PR among all 40 participants with ILD. Conclusion Four weeks of home-based PR program, using minimal resources, deliver short-term improvements in functional exercise capacity and quality of life among ILD participants. Our home-based PR program resulted in a quarter percentage improvement in functional capacity, and we believe that if consistency is maintained, it will result in similar changes corresponding to the already established Minimal Clinically Important Difference (MCID) of 35 m.

The Application of Superior Laryngeal Nerve Block for Non-Cough Laryngeal Hypersensitivity.

To investigate the effect of superior laryngeal nerve (SLN) block in patients with non-cough complaints relating to laryngeal who have failed conventional medical therapy. Retrospective chart review of 46 patients who underwent SLN block for non-cough indications between July 2019 and March 2022 was performed. Demographics, comorbidities, and patient-reported outcomes were collected. The primary diagnoses for this group included: odynophagia, throat pain, cervicalgia, muscle tension dysphonia, globus sensation, hyoid bone syndrome, and Eagle syndrome. The cohort underwent an average of 1.24 bilateral injections (range 0-7) and 0.87 unilateral injections (range 0-4). About 35 of 46 patients reported an average of 51.0% improvement in their symptoms, with the treatment effect lasting 7.60 weeks on average. On subgroup analysis, the patients with spasmodic dysphonia, odynophagia, and hyoid bone syndrome had the best percent improvement on average (75%-77.5%). Patients with globus sensation had the lowest percent improvement on average in response to this therapy, reporting only about 25%. Five patients experienced a mild adverse reaction immediately following injection which resolved spontaneously. The use of in-office SLN block for non-cough disorders involving the larynx requires further study with larger sample sizes to better delineate the efficacy of these applications. 4 Laryngoscope, 134:1765-1768, 2024.

In vivo acute toxicity, antidiabetic and antiulcer activities of polysaccharide from Linum usitatissimum L. seeds

The present study investigated acute oral toxicity, antidiabetic and antiulcer effects of the polysaccharide extracted from linseeds mature and ripe (Linum usitatisimum L., Family: Liliaceae). The acute oral toxicity (in vivo) of linseed polysaccharide was examined in Albino Wistar rats. In vivo antidiabetic activity and antiulcer activity were evaluated in Albino Wistar rats by alloxan-induced diabetic model and ethanol-induced ulcer model, respectively. The effects of linseed polysaccharide administered at 250 mg/kg of body weight dose on fasting blood glucose, body weight, lipid levels and histopathology of the treated pancreas were evaluated. The effects of linseed polysaccharide administered at 250 mg/kg of body weight dose on ulcer index, gastric secretion (gastric juice, pH, free acidity, and total acidity), macroscopic and histopathology analyses of treated gastric mucosa were evaluated. The acute oral toxicity results did not indicate any indication of toxicity associated with the administration of linseed polysaccharide to the treated rats. Linseed polysaccharide exhibited significant hypoglycaemic benefits in comparison to glibenclamide, which was treated as the positive control. In addition, linseed polysaccharide exhibited good gastroprotective properties with a significant improvement in inhibition percentage. Therefore, the results of the present study presented a clear demonstration of the potential uses of linseed polysaccharide as an adjuvant therapy for the management of diabetes mellitus and gastric ulcers.

What Do We Know About Patient Safety Culture in Saudi Arabia? A Descriptive Study.

Patient safety is described as the prevention and mitigation of medical errors that can result in harm while a patient is receiving care. One important way to improve safety is through improving the patient safety culture in healthcare. The purposes of this study are to evaluate the patient safety culture trend in Saudi Arabia and assess the improvement over time. This study is a descriptive study that used a retrospective analysis of a national data set for 3 cycles from 2019 to 2022. To generate a baseline and allow comparison of the hospital's survey results with the aggregated findings from the database, the 10th, 25th, 50th, 75th, and 90th percentiles were calculated to set the percentage of values. Our results found that one of the barriers to developing a strong patient safety culture in Saudi Arabia is management support of patient safety, which caused a blame culture. This could explain the absence of improvement in the average percentage of reporting patient safety events for all 3 cycles. On the other hand, a decrease was observed in organizational learning/continuous improvement as well as a reduction in the positive percentage of patient safety ratings in the last cycle. Moreover, areas of strength in all 3 cycles did not reach the 75th percentile, whereas staffing and response to error domains remained the lowest-scoring composites in all cycles. Our results have determined the percentile of the positive rate that could guide hospitals to improve their culture survey results. More investigations can focus on change over the years in both patient safety culture and the effectiveness of implementing interventions to measure the impact on quality of care.

Clustering-based dragonfly optimization algorithm for underwater wireless sensor networks

Communication and monitoring of the undersea environment have numerous applications, including marine environment studies, offshore research, and mineral extraction. However, factors like as the presence of an underwater current, a limited bandwidth, high water pressure, propagation lag, and error probability make these applications more difficult to implement. Underwater communication might be challenging due to the surroundings. As a clustering approach for sensor nodes in underwater wireless sensor networks (UWSNs), we present a clustering-based dragonfly optimisation (CDFO) algorithm with decentralised forwarding over wireless networks. The CDFO-UWSN approach is used to determine how many clusters should be used for routing. Analogous algorithms have been found to be connected to the proposed method, including the Ant Colony Optimizer (ACO), Adaptive Node Clustering for UWSN (ANC-UWSN), Grey Wolf Optimizer (GWO), and Moth Flame Optimizer (MFO). During the simulation, a performance matrix will be used to account for a variety of parameters such as grid size, transmission range, and node density. The results show that CDFO-UWSN outperforms all other algorithms tested. By establishing more clusters than competing systems, it improves overall routing and boosts network lifetime. This enables a network to run for an extended amount of time. The proposed CDFO-UWSN algorithm outperforms the GWO, ACO, MFO, and DFO algorithms in terms of number of nodes, with a percentage improvement of 78.13 % for 1500*1500 m grid size, and a percentage improvement of 64.71 % in terms of transmission range for 1500*1500 m grid size.

Ride comfort analysis of vehicle seat suspension systems: A co-simulation study

In this study, the vehicle seat suspension system installed with a semi-active magnetorheological (MR) damper is excited by the power spectral density (PSD) and its vibration control performance is evaluated using finite element analysis (FEA). The control system receives the velocity of the sprung and unsprung mass from the seat mounting locations and calculates the desired controllable damping forces available from MR damper. The effectiveness of the control systems is demonstrated by adopting ride quality evaluation method. To predict a better ride comfort and ride quality, co-simulation methodology is utilized considering the dynamic behavior of the real-world seat system. In this case, the multi-body dynamics and control system are coupled by solving the mechanical equations and the control logic. Then, the computed damping force is exchanged between the dynamics and controller in an iterative manner by passing state variables. The simulation results achieved from co-simulation methodology associated with the controller are analyzed by comparing with ISO 2631-1. The co-simulation results studied using vibration dose value (VDV), crest factor (CF) and seat effective amplitude transmissibility (SEAT) in terms of percentage improvement were found to be 44.33%, 26.66% and 17.65% respectively which were better than that for the passive suspension for a random rough road profile. Modified skyhook controller delivers superior performance for vibration suppression of the vehicle seat suspension as compared to other control policies. The application of co-simulation methodology can reduce time and cost for the development of a semi-active seat suspension system.

A Comparison of Some Estimation Methods for Var-Covariance matrix in Big Data with Application

The of the var-covariance matrix estimating is very important and represents a cornerstone in many statistical methods for several scientific fields, as many methods have emerged that are concerned with estimating the var-covariance matrix based on method of maximum likelihood. Nowadays these methods are classical methods and the process of estimating the covariance difficult with the increase in the number of variables under study. In this research, we used two methods to estimate the var-covariance matrix in big data in tow methods . first is Banding Estimator BE and the Tapering Estimator TE. Simulation study were used, as well as real data for living standards obtained from The Iraqi Ministry of Planning, the percentage improvement in average loss (PRIAL) criterion was used, as it was concluded that the BE Banding Estimator works better than the TE Tapering Estimator under big data conditions.

Temporary Peripheral Nerve Stimulation as Treatment for Chronic Pain.

Chronic pain is a growing problem across the world, and in the midst of an opioid epidemic, it is imperative that alternative treatment measures are identified to help alleviate the pain experienced by these patients. Chronic pain greatly affects ones quality of life and many patients do not experience adequate relief with conventional treatment measures. The purpose of this retrospective analysis is to assess the efficacy of peripheral nerve stimulation (PNS) therapy in adult patients suffering from chronic pain refractory to conventional treatment measures who underwent therapy on various anatomical locations. This retrospective analysis consisted of data collected from electronic health records for n = 89 patients who underwent PNS therapy. Data collected relates to patient age, sex, weight, height, body mass index (BMI), diagnosis, targeted nerves, follow-up encounters, pain scores from before and after PNS therapy, and duration of improvement. Statistical analysis used SPSS software, version 26 (IBM), using a paired ttest to assess significance between pre and post PNS therapy pain scores. P values were significant if found to be ≤ 0.05. Further analysis assessed the correlation between age and BMI with visual analog scale (VAS) pain improvement and subjective percentage pain relief. The mean pre-operative (pre-op) pain score before PNS therapy was 6.36 (standard deviation (SD) = 2.18, SEM = 0.23) and the mean post-operative (post-op) pain score after PNS therapy was 4.19 (SD = 2.70, SEM = 0.29). The mean patient-reported percent improvement in pain following PNS therapy was 49.04% (SD = 34.79). The improvement in pain scores between pre-op and post-op was statistically significant (M = 2.17, SD = 2.82, SEM = 0.30, t(88) = 7.26, p < .001), 95% confidence interval (CI) [1.57, 2.76]. The mean duration of improvement for patients was 123days after therapy initiation (min = 6, max = 683, SD = 126). This study demonstrated the potential role for PNS therapy in improving patient-reported pain levels for various neuropathies, targeting various nerves. With PNS therapy's use as a chronic pain treatment and available research being limited, further study needs to be done on the efficacy of PNS therapy for pain management and complications associated with PNS device placements at various locations.

Experimental comparison of unbonded, agglutinated and sintered SiC-based magnetic abrasive particles in magnetic abrasive finishing process

Aluminum grabs a spot in the top ten light metals and henceforth finds a wide range of applications in the aerospace industry and other concerned/allied industries. A high surface finish is obligatory in a few components. The objective of this research is to compare and analyze the internal surface finish obtained by unbonded, agglutinated, and sintered silicon carbide (SiC) based magnetic abrasives in aluminum pipes using magnetic abrasive finishing process. Scanning electron microscopy and atomic force microscopy (AFM) have aided in a close inspection of the topography of the surfaces. AFM topographic images indicate that sintered magnetic abrasive particles yielded a surface roughness value (Ra = 17.7 nm) followed by agglutinated (Ra = 34.98 nm) and unbonded magnetic abrasive particles (Ra = 99.3 nm). Maximum percentage improvement in surface finish (PISF) of 87 % in terms of Ra has been obtained at rotational speed of workpiece (1000 rpm), magnetic flux density (0.85 Tesla), quantity of abrasive particles (15 gm), size of abrasives (80 μm) and machining time (30 mins.).

ENHANCING CONCRETE PERFORMANCE BY UTILIZING CRUSHED GLASS AND WASTE BOTTLE PLASTIC FIBERS FOR IMPROVED STRENGTH AND FLEXURAL PROPERTIES

This research investigates the potential of using crushed glass and waste bottle plastic fibers as sustainable additives to enhance the performance of concrete in terms of strength and flexural properties. The study involves incorporating varying percentages of crushed glass (CG) and waste bottle plastic fibers (PE) fibers into concrete mixtures and assessing the changes in compressive and flexural strength across different curing periods, namely 7, 28, 56, and 90 days. The results reveal that the optimal combination for improved performance is 15% CG and 10% PE fibers, as it consistently demonstrates the highest percentage improvement in both compressive and flexural strength across all curing periods. The findings of this study have significant implications for sustainable construction practices, as incorporating crushed glass and waste bottle plastic fibers in concrete mixtures not only improves the material's performance but also promotes recycling and repurposing waste materials. Furthermore, the use of these recycled materials could lead to cost savings, reduced material volume, lower labor costs, and improved abrasion resistance in construction projects.

Effect of Macroeconomic Dynamics on Bank Asset Quality under Different Market Conditions: Evidence from Ghana

This study assesses the dynamic relationship between macroeconomic factors and bank asset quality based on changes in the condition of stock market returns. A dynamic panel two-step system, the Generalized Method of Moments (system GMM) model, is employed using panel data from 18 universal banks spanning the period of 2007 to 2021. The analysis revealed that the real GDP growth rate, the average lending rate, and the real exchange rate represent a set of macroeconomic factors with a marked influence on banks’ asset quality, where a unit increase in these variables drive 0.02 percent, 0.98 percent, and 0.27 percent improvement in asset quality, respectively. In addition, a high-inflation rate was found to exert an adverse effect of −0.32 percent on asset quality, as it affects borrowers’ financial ability to meet loan repayment obligations. Furthermore, the study verified the existence of a positive relationship between market condition and asset quality, where a rise in the market return drives a 0.07 percent improvement in bank asset quality. This implies that bank performance adapts to changes in market conditions as posited under the Adaptive Market Hypothesis (AMH). Bank managers should consolidate banks’ asset bases during conditions of market stability to withstand periodic market fluctuations to boost trading momentum. Policy recommendations are suggested to foster a conducive business environment for bank stability.

Clinical Trial of Alpha and Beta Defensin Skin Care Regimen for Improvement of Periocular Wrinkles.

Defensins recruit leucine-rich repeat-containing G protein-coupled receptor 6 positive (Lgr6+) stem cells which ultimately regenerate new basal stem cells, healthy keratinocytes, and nascent hair follicles. Thus, defensins are an exciting, novel therapy for the reversal of skin aging. This is a multicenter, prospective, open-label clinical trial. Twenty healthy subjects, aged 45-80, with Fitzpatrick skin types II-IV were enrolled in the study. A skin care regimen containing alpha-defensin 5 and beta-defensin 3 were applied to the face twice daily for 12 weeks. This skin care regimen contains a greater percentage of defensins than that already studied.7 All participants underwent imaging at baseline, day 30, day 60, and day 90. Primary endpoints included investigator scoring on the Fitzpatrick-Goldman wrinkle scale and percent improvement in periorbital wrinkles, laxity, pigmentation, erythema, texture, and radiance. Secondary endpoints were investigator Global Aesthetic Improvement Score (GAIS), subject GAIS, and investigator assessment of tolerability. A final subject questionnaire was completed on day 90.&nbsp; Results: Based on the Fitzpatrick-Goldman wrinkle scale, a statistically significant improvement was noted in both wrinkling and elastosis from baseline to day 90. 30% of subjects were rated as much improved and 50% of subjects were rated as improved on the physician GAIS at the 90 day follow up. Improvements were noted in all aspects of skin quality including wrinkles, laxity, dyschromia, erythema, texture, and radiance.&nbsp; Conclusion: The enhanced formula containing increased concentrations of alpha-defensin 5 and beta-defensin 3 is a safe and efficacious topical therapy for the treatment of periorbital rhytids. Hartman N, Loyal J, Taub A, et al. Clinical trial of alpha and beta defensin skin care regimen for improvement of periocular wrinkles. J Drugs Dermatol. 2023;22(9):874-880. doi:10.36849/JDD.7184.

A randomized trial comparing beam F3 and 5.5 cm targeting in rTMS treatment of depression demonstrates similar effectiveness

BackgroundThe Beam F3 and 5.5 cm methods are the two most common targeting strategies for localizing the left dorsolateral prefrontal cortex (DLPFC) treatment site in repetitive transcranial magnetic stimulation (rTMS) protocols. This prospective, randomized, double-blind comparative effectiveness trial assesses the clinical outcomes for these two methods in a naturalistic sample of patients with major depressive disorder (MDD) undergoing clinical rTMS treatment. Methods105 adult patients with MDD (mean age = 43.2; range = 18–73; 66% female) were randomized to receive rTMS to the Beam F3 (n = 58) or 5.5 cm (n = 47) target. Between group differences from pre-to post-treatment were evaluated with the Patient Health Questionnaire-9 (PHQ-9) [primary outcome measure], Generalized Anxiety Disorder-7 (GAD-7), and clinician-administered Montgomery-Åsberg Depression Scale (MADRS). Primary treatment endpoint was completion of daily treatment series. ResultsPer-protocol analyses showed no statistically significant differences on any measure between the 5.5 cm and F3 groups (all p ≥ 0.50), including percent improvement (PHQ-9: 39% vs. 39%; GAD-7: 34% vs. 27%; MADRS: 40% vs. 38%), response rate (PHQ-9: 37% vs. 43%; GAD-7: 27% vs. 30%; MADRS: 43% vs. 43%), and remission rate (PHQ-9: 22% vs. 21%; MADRS: 20% vs. 19%). Post hoc analysis of anxiety symptom change while controlling for depression severity suggested more favorable anxiolytic effects with 5.5 cm targeting (p = 0.03). ConclusionsSimilar antidepressant effects were observed with DLFPC rTMS using either the Beam F3 or 5.5 cm targeting method, supporting clinical equipoise in MDD patients with head circumference ≤ 60 cm. Comparison to MRI-based targeting and differential effects on anxiety symptoms require further investigation. Trial registrationClinicalTrials.gov identifier: NCT03378570.