Performance Scale Research Articles

The risk of intraoperative venous air embolism from neurosurgical procedures performed in the lounging position: an in-depth analysis of detection, management, and outcomes of 1000 consecutive cases

OBJECTIVE The overall benefit of employing a sitting/semisitting position for neurosurgical procedures remains under criticism due to concerns for additional risk, especially the risk of intraoperative venous air embolism (VAE). The aim of this single-center cohort study was to evaluate the frequency and severity of VAEs and associated complications in patients undergoing neurosurgery in the lounging position. METHODS From 2010 to 2020, 1000 patients, including 172 patients with a patent foramen ovale, underwent surgery in the lounging position for different neurosurgical pathologies. All patients were monitored intraoperatively using continuous transesophageal echocardiography (TEE). The anesthesia team documented any observed incidences of VAEs and scored their severity according to the Tuebingen classification system (TCS) for VAE (TCS-VAE). The patients’ clinical condition, radiological findings, and hospital course were subsequently analyzed to assess complications in a retrospective analysis of prospectively collected data. RESULTS In the cohort of 1000 patients, 5 underwent cervical spine surgery and 995 underwent suboccipital craniotomy. VAE was detected by TEE in 51.4% (95% CI 48.4%–54.5%) of patients, with synchronous changes in end-tidal CO2 (grade 2–5 TCS-VAE) noted in 10.2% (95% CI 8.3%–12.3%). None of the patients presented with hemodynamic instability (grade 5 TCS-VAE). Patients with high-grade VAEs were significantly older (p = 0.02) and had lower BMIs (p = 0.001) than the respective mean value of the cohort. VAE grade was not associated with any of the outcome measures such as Karnofsky Performance Scale score, duration of ventilation, length of intensive care unit stay, and length of hospital stay. Postoperative acute respiratory distress syndrome (ARDS) was diagnosed in 0.3% (95% CI 0.0%–0.7%, n = 3) of all cases, and ARDS was associated with perioperative VAE grade (p = 0.001). No patient suffered a new permanent neurological deficit due to a paradoxical VAE. CONCLUSIONS In this large cohort, the risk of an intraoperative VAE during neurosurgery in the lounging position was assessed, and contrary to the general perception in the field, no permanent sequelae or fatal adverse events attributable to VAEs were observed. Furthermore, the overall incidence of ARDS was very low. This study clearly establishes that experienced interdisciplinary teams can safely use the lounging position for neurosurgical procedures.

Moving beyond "Better Late than Never": High Symptom Burden and Diminished Functional Status at First Palliative Care Visit for Patients with Gynecological Cancers.

Background: Despite physical and emotional distress in patients with gynecologic malignancies, palliative care (PC) is underutilized. Objectives: We characterize referral practices, symptom burden and functional status at the time of initial PC encounter for patients with gynecologic cancer. Design: Data were extracted from the standardized Quality Data Collection Tool for Palliative Care (QDACT-PC). We describe symptom burden and performance status. Results: At initial specialty PC encounter, patients with gynecologic cancers reported a mean of 3.3 moderate/severe symptoms. Outpatients experienced the most moderate/severe symptoms (mean 3.9) versus inpatient (mean 2.1) or home (mean 1.5). A total of 72.7% of patients had significantly impaired functional status (palliative performance scale [PPS] <70) at initial encounter. Inpatients had a more impaired functional status (mean PPS 48.8) than outpatients (mean PPS 67.0). Conclusions: The symptom burden for gynecologic cancer patients at initial PC encounter is high. Despite better functional status, patients referred in the outpatient setting had the highest symptom burden.

Significance and Priority of Surgical Resection as Therapeutic Strategy Based on Clinical Characteristics of Brain Metastases from Renal Cell Carcinoma

To clarify a rational surgical priority, clinical characteristics were compared between brain metastases (BM) from renal cell carcinoma (RCC) and other cancers. We reviewed 425 consecutive patients with BM who underwent treatments including surgery between January 2014 and December 2022. Primary cancers included lung (n= 220), breast (n= 46), digestive (n= 65), RCC (n= 25), and others (n= 69). Tumor volume (T), edema volume (E), and edema volume/tumor volume ratio (E/T ratio) were compared between RCC and other primary cancers. Cutoff T values for identifying both symptomatic tumors and tumors suitable for surgery were determined by receiver operating characteristic curves. Factors including E/T ratio, age, Karnofsky Performance Scale score, and tumor characteristicswere statistically analyzed. Cutoff values of T and E to determine surgical suitability were 4.973 cm3 (sensitivity, 0.848; specificity, 0.74) and 23.088 cm3 (sensitivity, 0.894; specificity, 0.623), respectively. E/T ratio was significantly higher for RCC than for other cancers (P < 0.01). These results remained consistent after propensity score matching. RCC tended to show a significantly lower frequency of posterior fossa tumor (16%, P < 0.01) and higher rates of single lesions (72%, P= 0.03) and intratumoral hemorrhage (24%, P=0.02). Subgroup analysis limited to surgical cases showed that E was consistent across tumors, T tended to be smaller, and E/T ratio was significantly higher in RCC. Generally, symptomatic BM were indicated for surgery. BM from RCC were characteristically single, low-volume lesions with expanding edema and intratumoral hemorrhage, causing symptoms. These results suggest that surgery should be a high priority for BM from RCC.

Medical management of chronic subdural hematoma with low-dose hydrocortisone: a case series.

Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm3, average midline shift of 9mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm3. Midline shift, present in six, averaged 6.8mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention.

Abnormal hedonic process in patients with stable schizophrenia: Relationships to negative symptoms and social functioning

BackgroundAnhedonia is a deficit of dynamic reward process, and a large proportion of schizophrenia patients continue to experience anhedonia even during the stable phase. However, few studies have examined the multiple aspects of performance in reward processing in patients with stable schizophrenia and evidence suggests that physical and cognitive effort may involve different neural mechanisms. MethodsParallel measures of effort-based expenditure for reward tasks (EEfRT) and self-report questionnaires of pleasure were applied in 61 patients with stable schizophrenia (SSZ) and 46 healthy controls (HCs), and percentages of hard task choices (HTC%) were used to assess motivation in reward processing. Negative symptoms, neurocognitive and social function were evaluated in SSZ patients, and associations with performance in reward tasks were explored. ResultsSSZ patients reported more severe consummatory and anticipatory anhedonia and social anhedonia. HTC% in reward tasks of SSZ patients were significantly lower than that of HCs, especially in cognitive-effort tasks. HTC% in cognitive tasks were correlated with motivation and pleasure dimension of negative symptoms, whereas HTC% in physical tasks were associated with expression dimension. Anticipatory anhedonia and negative symptoms were correlated with Personal and Social Performance Scale (PSP) scores. ConclusionPatients with stable schizophrenia have social anhedonia, physically consummatory and anticipatory anhedonia and reduced reward motivation. They are less willing to make cognitive effort than physical effort for reward. The different associations of physical and cognitive effort with negative symptoms indicate physical and cognitive effort may represent disparate neuropsychological processes. Anticipatory anhedonia is closely related to social functioning.

Clinical evaluation of enhanced recovery versus conventional care in the perioperative period for intradural extramedullary spinal tumors: a study protocol for a multicenter, randomized controlled trial

BackgroundThis randomized clinical trial protocol aimed to investigate the comparative efficacy of an enhanced recovery after surgery (ERAS) protocol versus traditional perioperative care programs in patients with intradural extramedullary spinal tumors.MethodsThe study included 180 patients aged 18–80 years, who were randomly assigned to two groups: Group A receiving traditional perioperative care and Group B receiving accelerated rehabilitation perioperative care. The nurse responsible for patient care was informed of the group assignment, but the patients themselves remained blinded to the intervention. The primary outcome measure was the Karnofsky Performance Scale score, which assessed functional status. The secondary outcomes included the Japanese Orthopedic Association Scale, Numeric Pain Rating Scale, length of postoperative hospital stay, duration of urethral catheterization, patient satisfaction questionnaire, and complication rates. Follow-up assessments were conducted telephonically 1 month, 3 months, and 6 months after the surgery.DiscussionThis study protocol provided a structured approach to assess the potential benefits of ERAS during the perioperative period for patients with intradural extramedullary tumors, aiming to improve patient outcomes and overall care efficiency.Trial registrationThis study has been registered with the China Clinical Trials Registry (Project No: ChiCTR2200063347). Registered on September 5 2022.

Runoff Control Performance of Three Typical Low-Impact Development Facilities: A Case Study of a Community in Beijing

The development of sponge cities advocates for sustainable urban rainwater management, effectively alleviating urban flood disasters, reducing non-point-source pollution, and promoting the recycling of rainwater resources. Low-Impact Development (LID) serves as a key strategy in this context, providing essential support for urban rainwater control and pollution reduction. To investigate the runoff control effects of LID measures and to reveal the relationship between facility runoff control performance and installation scale, this study focuses on a sponge community in Beijing. A SWMM model was constructed to analyze the rainwater flood control and pollutant load reduction effects of different LID facilities, including bio-retention cells, green roofs, and permeable pavements. Using evaluation indicators such as surface runoff, node overflow, and pollutant control rates, this study examined how facility performance varies with installation scale under different rainfall conditions. The combination scheme of LID equipment optimal configuration is designed by using multiple criteria decision analysis (MCDA) and cost–benefit theory. The results indicate significant differences in performance among the various LID facilities across different rainfall scenarios. Specifically, the optimal installation proportion for runoff and overflow control of permeable pavements were found to be between 30% and 70%. Green roofs demonstrate superior performance in handling extreme rainfall events, while bio-retention cells exhibit significant effectiveness in controlling Total Suspended Solids (TSSs). Through comprehensive performance evaluation, this study identified the optimal combination scale under a 3-year rainfall recurrence interval as 30% permeable pavements, 20% green roof, and 60% bio-retention cells. This combination effectively leverages the strengths of each facility, ensuring system stability and efficiency while also demonstrating optimal management efficiency in cost–benefit analyses. The findings of this research provide valuable insights for future urban water management and infrastructure development.

Investigation of Novel Transition Metal Loaded Hydrochar Catalyst Synthesized from Waste Biomass (Rice Husk) and Its Application in Biodiesel Production Using Waste Cooking Oil (WCO)

The decarbonization of transportation plays a crucial role in mitigating climate change, and biodiesel has emerged as a promising solution due to its renewable and eco-friendly nature. However, in order to maintain the momentum of the “green trend” and ensure energy security, an ecologically friendly pathway is important to produce efficient biodiesel. In this work, activated carbon (AC) obtained from rice husk (RH) is hydrothermally prepared and modified through cobalt transition metal for catalyst support for the transesterification process. The physicochemical characteristics of the synthesized catalysts are examined using XRD, FTIR, SEM and EDS, TGA, and BET, while the produced biodiesel is also characterized using Gas Chromatography and Mass Spectroscopy (GC-MS). To optimize the transesterification process, Fatty Acid Methyl Esters (FAME) are produced by the conversion of waste cooking oil. Response Surface Methodology (RSM) is used to validate temperature (75 °C), the methanol-to-oil molar ratio (1:9), catalyst weight percentage (2 wt.%), and retention time (52.5 min). The highest conversion rate of waste cooking oil (WCO) to biodiesel was recorded at 96.3% and tested as per American Society for Testing and Materials (ASTM) standards. Based on the results, it is clear that cobalt-loaded rice husk-based green catalyst (RHAC-Co) enhanced catalytic activity and yield for biodiesel production. Further research should focus on engine performance evaluation and scaling up of the catalyst by optimizing it for the industrial scale.

Investigation of the relationship between the self-efficacy levels in clinical practice and coping behaviors with stress among international nursing students

BackgroundIn this era of rapid globalization, our knowledge regarding the clinical performance perceptions and stress coping behaviors of international students in nursing education is quite limited. The unexplored nature of this topic has the potential to manifest as future clinical challenges. ObjectiveTo examine the relationship between international nursing students' perceived self-efficacy in clinical applications and their coping behaviors with stress. MethodsOur cross-sectional and correlational study collected data from 117 international nursing students at a state university between June 2022 and July 2023. The data collection tools included the Participant Identification Form, Self-Efficacy in Clinical Performance Scale (SECP), and The Coping Behavior Inventory with Stress Scale for Nursing Students (CBIS-NS). t-test, ANOVA, correlation analysis, and Bonferroni test were used for data analysis. ResultsStudents, predominantly Azerbaijani (15.4 %) and 64.1 % female, engaged in practices, mainly in medical (34.2 %) and surgical units (33.3 %). Clinical self-efficacy was high, stress coping moderate. A significant positive link existed between coping behaviors and clinical self-efficacy (p < 0.05). Those in public health/mental health units (8.12 ± 1.46) had higher self-efficacy than surgical unit peers (6.94 ± 1.71) (p < 0.05). Satisfied students showed better stress coping (t = 2.645; p = 0.009). Weak positive links were found between transfer/avoidance coping behaviors and clinical self-efficacy (p < 0.05). ConclusionThis study demonstrated a statistically significant positive relationship between international nursing students' perceptions of clinical performance and coping behaviors with stress. Given the rapid globalization of education in the global era, especially in diverse educational and clinical environments with students from different ethnic backgrounds, it is recommended to develop new intervention strategies to enhance students' clinical performances and foster positive coping behaviors with stress.

Allometric Scaling of Maximal Strength Performance in Physically Active College-Aged Males: Removing the Effects of Body Weight

Allometric Scaling of Maximal Strength Performance in Physically Active College-Aged Males: Removing the Effects of Body Weight

Comparison of Sitting versus Nonsitting Position for the Resection of Brain Metastases in the Posterior Fossa in a Contemporary Cohort.

For surgery of brain metastases, good immediate postoperative functional outcome is of utmost importance. Improved functional status can enable further oncologic therapies and adverse events might delay them. Pros and cons of either sitting or prone positioning for resective surgery of the posterior fossa are debated, but contemporary data on direct postoperative outcome are rare. The aim of our study was to compare the functional outcome and adverse events of surgery for brain metastases in the sitting versus the nonsitting position in the direct postoperative setting. We retrospectively compared surgery of metastases located in the posterior fossa over a 3-year period in two level-A neurosurgical centers. Center 1 performed surgery exclusively in the sitting, while center 2 performed surgery only in the nonsitting position. Worse functional outcome (Karnofsky performance scale) and functional deterioration were seen in the "sitting" group. We found significantly more "sitting" patients to deteriorate to a KPS score of ≤60%. In this study, treating patients with brain metastases in the sitting position resulted in a number needed to harm (NNH) of 2.3 and was associated with worse outcome and more adverse events. Therefore, we recommend the nonsitting position for surgery of brain metastases of the posterior fossa.

Clinical and social characteristics of patients with pulmonary tuberculosis and anxiety-depressive disorders

The purpose of the study was to investigate the complex interrelationships of clinical, psychopathological, and socio-psychological characteristics in patients with pulmonary tuberculosis (TB) and anxiety-depressive disorders (ADD). The study involved 145 patients: 85 patients were diagnosed with pulmonary tuberculosis (the study group) and 60 patients – with anxiety-depressive disorders without tuberculosis (the comparison group). The study assessed the level of anxiety and depressive disorders, asthenia, the nature and intensity of somatic complaints, and signs of vegetative changes; the Personal and Social Performance Scale (PSP) and the WHOQOL-BREF questionnaire were used. A cluster analysis of clinical and social factors in patients with tuberculosis and ADD showed that they had an "infiltration" of individual psychological, socio-demographic, and clinical factors that demonstrated close affinity with each other. Notably, subjective indicators of social and physical well-being were mostly related to the clinical manifestations of ADD, while objective socio-demographic indicators showed greater affinity with the clinical manifestations of the tuberculosis process. In the comparison group, a more significant autonomy of the studied individually and socially oriented parameters, as well as clinical factors, was revealed compared with the study group. A cluster analysis of the entire patient sample (145 patients) allowed obtaining results that complement and largely confirm the results of the analysis of the two samples (the study and the comparison groups). Almost all TB patients are concentrated in clusters characterized by the most severe clinical manifestations and impaired social functioning. TB patients were characterized by the most severe manifestations of ADD with severe asthenia, a high level of somatic complaints on the exhaustion scale, and pronounced signs of vegetative changes. Despite the good formal indicators of social adaptation (family, household), they are characterized by an extremely low level of socially oriented and social functioning and indicators of quality of life. The assessment of the parameters of quality of life and social functioning, their correlations with clinical characteristics, and the establishment of a hierarchy of their relationships should be taken into account when conducting a complex of therapeutic and rehabilitation measures for patients with pulmonary tuberculosis and ADD, which contributes to a more differentiated approach to rehabilitation and the development of optimal therapeutic strategies.

QRCODE: Massively parallelized real-time time-dependent density functional theory for periodic systems

We present a new software module, QRCODE (Quantum Research for Calculating Optically Driven Excitations), for massively parallelized real-time time-dependent density functional theory (RT-TDDFT) calculations of periodic systems in the open-source Qbox software package. Our approach utilizes a custom implementation of a fast Fourier transformation scheme that significantly reduces inter-node message passing interface (MPI) communication of the major computational kernel and shows impressive scaling up to 16,344 CPU cores. In addition to improving computational performance, QRCODE contains a suite of various time propagators for accurate RT-TDDFT calculations. As benchmark applications of QRCODE, we calculate the current density and optical absorption spectra of hexagonal boron nitride (h-BN) and photo-driven reaction dynamics of the ozone-oxygen reaction. We also calculate the second and higher harmonic generation of monolayer and multi-layer boron nitride structures as examples of large material systems. Our optimized implementation of RT-TDDFT in QRCODE enables large-scale calculations of real-time electron dynamics of chemical and material systems with enhanced computational performance and impressive scaling across several thousand CPU cores.

Effect of logotherapy counseling program on chronic sorrow, dignity, and meaning in life of palliative care patients: a randomized controlled trial.

Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients. This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care. The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation. Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients. Clinicaltrials registration number and date: NCT05129059, 19/01/2021.

Psychometric properties of the modified reaching performance scale in persons with multiple sclerosis

BackgroundA valid and reliable assessment tool to describe the quality of the movement pattern of reaching can provide valuable insights into motor performance deficits in persons with MS (pwMS). The Reaching Performance Scale, developed for stroke, is a promising scale to assess movement patterns in pwMS. However, psychometric properties of the scale are lacking in pwMS. ObjectivesFirstly, to investigate the content validity of the modified Reaching Performance Scale for application in patients with MS (mRPS). Secondly, to investigate the psychometric properties (within- and between-session reliability and concurrent validity) of the mRPS for pwMS. MethodsForty-five pwMS (mean EDSS 6.6 pt, IQR 6–7.5) executed the mRPS that rates the quality of movement patterns and compensations during reach to grasp tasks. The content validity was determined by an expert panel based on observations of subjects performing the RPS. The reliability was based on five repetitions within one day, and between two days. For the concurrent validity, outcome measures at two levels of the International Classification of Functioning were correlated with the mRPS: Body Structure and Function level: Fugl-Meyer Assessment of the Upper Limb (FMA-UL), maximal isometric hand grip strength (HGS; Activity level: Action Research Arm Test (ARAT), Box and Blocks Test (BBT), Nine Hole Peg Test (NHPT) and Trunk Impairment Scale 2.0 (TIS 2.0) as well as perceived performance by the Manual Ability Measure-36 (MAM-36). ResultsScale modifications were made only on the ratings of the trunk displacement subscale. The mRPS had excellent agreement scores for within-session reliability (range of Kappa between 0.85 and 0.98) and moderate-to-excellent agreement scores for between-session reliability (K: 0.66–1.00). Regarding validity, the mRPS was highly correlated with the ARAT (rho=0.74, p < 0.001), followed by moderate correlations with trunk performance (TIS 2.0, rho= 0.61, p < 0.001), hand function (BBT: rho=0.64, p < 0.001; NHPT: rho=-0.61, p < 0.001) and perceived performance (MAM36 rho= 0.53, p < 0.001). ConclusionThe mRPS is a reliable measurement tool to describe the movement pattern quality and motor compensations used during reaching in pwMS. Concerning concurrent validity, the mRPS is partially related to other measures of upper limb and trunk performance.

Utilization of Antibiotics for the Treatment of Urinary Tract Infections in End-of-Life Patients.

The use of antibiotics for end-of-life patients is controversial; currently there is limited guidance on the use of antibiotics in hospice patients. The threat of antibiotic resistance, risk of adverse events, variable efficacy, and time to benefit in hospice patients makes their use divisive. Patients' potential care needs are estimated using the palliative performance scale (PPS) with lower scores indicating more care is required. The purpose of this project is to examine the utilization of antibiotics for urinary tract infections (UTIs) in hospice patients. This multi-center retrospective observational cohort study evaluated the prescribing of antibiotics in symptomatic vs asymptomatic hospice patients being treated for UTIs and assessed antibiotic initiation based on PPS of ≥30% or <30%. Patients included in this study were adults initiated on oral antibiotics for UTI. Exclusion criteria included antibiotics initiated prior to admission, prophylactic antibiotics, non-oral antibiotics, or if the patient revoked election of hospice. A total of 56 patients were prescribed antibiotics for UTIs during the 1-year study period. Half of the antibiotics were prescribed appropriately based on documented symptoms when starting the antibiotics. There was not a statistically significant difference between appropriate utilization based on PPS ≥30% or <30% using the Mann-Whitney U test (P = 0.255). The prescribing of antibiotics in end-of-life patients is not always appropriate regardless of the PPS. This may indicate that antibiotics are initiated in asymptomatic hospice patients, and the utilization of unnecessary medications presents the risk of adverse effects.

Edentulism and quality of life in the Salvadoran population: a cross-sectional study

IntroductionEdentulism is the partial or total loss of teeth, it is irreversible and disabling due to its sequelae in the masticatory, phonetic and aesthetic function that affect the quality of life.ObjectiveTo establish the impact of edentulism and sociodemographic factors on the quality of life of the Salvadoran population.Materials and methodsSecondary cross-sectional analysis of data in 3322 users of the Public Health System of El Salvador, aged 15 to > 60 years. The variables under study were sociodemographic, edentulismo and quality of life. Edentulism was determined by clinical examination using the Oral Impact on Daily Performance scale. The statistical analysis was performed using χ2, OR, multiple regression analysis and set the significance threshold at p < 0.05.ResultsPartial edentulism in the upper jaw was present in 68.24% people, partial edentulism in the lower jaw was present in 72.42% people and complete edentulism was observed in 2.02% people. There were significant sex differences and a relationship between sex and quality of life (p < 0.004); the self-perception of severe/very severe impacts was greater in women. People without education or with primary or secondary education only were the most affected (p < 0.05). Tooth loss increases with age, affecting quality of life in a severe/very severe manner. Complete edentulism had greater impacts on quality of life in terms of eating (25.64%), speaking (21.15%), and socializing/enjoying contact with people (10.90%). A severe/very severe impact on quality of life of teeth lost was reported mainly by those over 60 years of age, with an average of 11 missing posterior teeth, 6 missing anterior teeth and 13 missing teeth per patient. Those missing up to 6 anterior teeth were times more likely to perceive severe/very severe impacts on quality of life than those without any missing teeth (OR:5.788). Edentulism affected the quality of life of those examined, especially the loss of upper anterior teeth.

Levelized Cost and Carbon Intensity of Solar Hydrogen Production from Water Electrolysis Using a Scalable and Intrinsically Safe Photocatalytic Z-Scheme Raceway System

The realization of an environmentally sustainable and widely-adopted hydrogen economy may require lowering hydrogen production costs of production pathways with ultra-low greenhouse gas emissions to $1/kg H2. The allocation of new or existing renewable electricity generation solely to hydrogen production remains contentious due to disputes regarding emissions accounting. Photoelectrochemical (PEC) hydrogen production technologies offer a unique solution, as hydrogen is produced directly from solar energy and water, without the need for electricity generation. However, cost projections for past photoelectrochemical designs have suggested that they are not cost competitive compared to conventional electrolysis systems manufactured at scale. Herein, we offer the first illustrative benchmark of cost and carbon intensity of hydrogen produced in a Type 2 Z-scheme photocatalytic reactor design that employs suspended semiconducting nanoparticles organized in two stacked baggies in a raceway design.To explore the near-term and future cost projection for hydrogen production via Type 2 photocatalytic Z-scheme raceways, the authors developed a bottom-up total installed capital cost model. This project cost model incorporates: 1) raceway reactor cost, derived from a Design for Manufacturing and Assembly (DFMA) process-based cost model, 2) mechanical balance of plant, including process equipment, piping, valves, and instrumentation, derived from equipment quotes, scaling, database values, and Aspen estimates; 3) electrical balance of plant, including wiring, derived from time and material cost correlations; 4) Site Preparation, focused on green field installation; and 5) Construction Overhead, including engineering, procurement, and construction (EPC) costs and project contingency. The capital cost model is fed into a Levelized Cost of Hydrogen (LCOH) discounted cash flow model that accounts for electricity and water consumption, in addition to other operating costs, including labor, maintenance, and raceway replacements.A hybrid life-cycle approach was used to develop an inventory of greenhouse gas emissions from all materials and energy flows associated with the facility life cycle. These flows are converted to emissions based on specific emission factors, or by using physical units-based input–output LCA models associated with the broader economic impacts of fuel and materials production, use, and end use.Estimates for levelized cost of hydrogen suggest that a 50 metric ton H2 per day (MTD) raceway plant can approach $2.50/kg H2 at an 8% solar-to-hydrogen efficiency with further cost improvements possible through increased performance and larger plant scales. Carbon intensity is estimated to be well under clean hydrogen targets for global warming potential of <2-4 kg CO2e/kg H2 produced. The results suggest a highly competitive and scalable technology, that justifies further experimental validation and prototyping in the field. Figure 1

Understanding the Effects of Forced and Bubble-Induced Convection in Transport-Limited Organic Electrosynthesis

Organic electrosynthesis offers a sustainable path to decarbonize the chemical industry by integrating renewable energy in chemical manufacturing. However, achieving the selectivity and energy efficiency required for industrial applications is challenging due to the inherent mass transport limitations of most electro-organic reactions. Electrochemical reactions rely on transport of reactants to the electrode surface and become mass transport-limited when the reactant diffusion rate is lower than the reaction rate at the electrode. In organic electrosynthesis with several possible products, mass transport limitations can result in decreased selectivity towards the desired product as the various reaction pathways compete. Convection can mitigate mass transport limitations, but fundamental engineering guidelines for selecting and scaling up convection methods in electrochemical systems do not exist. As a result, the impact of convection on industrial-scale complex organic electrochemical processes remain poorly understood. Here we show that the Sherwood number (Sh)—the ratio of convective mass transport to diffusive mass transport—is a crucial metric to characterize mass transport, determine reactor performance, and enable effective scale-up. We investigate the interplay between mass transport and electrochemical reaction rates under convective flows in the context of the electrosynthesis of adiponitrile, one of the largest organic electrochemical processes in the industry. We use experiments and data-driven predictive models to demonstrate that forced liquid convection and bubble-induced convection produce nearly equivalent mass transport conditions when the corresponding Sherwood numbers are equal. This conclusion shows that the Sherwood number characterizes the mass transport condition independent of the underlying convection mechanism. Additionally, we show that the reactor performance scales with the Sherwood number for a given current density and reactant concentration. This scaling enables accurate prediction of performance irrespective of the convection method, and demonstrates that adiponitrile Faradaic efficiencies of >80% can be achieved for current densities of up to 200 mA/cm2 when Sh > 100. Our results provide guidelines for the design and selection of convection methods, from lab to industrial scale, and contribute to the development of more sustainable chemical manufacturing processes.

The Myanmar Version of the Oswestry Disability Questionnaire: A Cross-Cultural Adaptation, Reliability and Validity Study in the Low Back Pain Population

Objective: To translate and cross-culturally adapt the Myanmar version of the Oswestry Disability Questionnaire (M-ODQ), and examine its reliability and validity in the low back pain (LBP) population. Material and Methods: The M-ODQ was cross-culturally adapted in accordance with the ISPOR guidelines for translation. Prefinal testing was done on 20 individuals with LBP, with minor changes. The test-retest reliability, internal consistency, concurrent and construct validity, plus ceiling and floor effects of the M-ODQ were conducted on 101 individuals with LBP, via calculating the intraclass correlation coefficient ICC(2,1), Cronbach’s alpha, and Spearman’s rank correlation coefficient by correlating with the Myanmar version of the Roland-Morris Disability Questionnaire (M-RMDQ), visual analogue scale (VAS), back performance scale (BPS), and the Stark quality of life (QoL) questionnaire. The level of significance was set at p-value&lt;0.05 for all statistical analyses.Results: The test-retest reliability and internal consistency of the M-ODQ showed an ICC(2,1) of 0.91 and a Cronbach’s alpha of 0.703, thus indicating that the M-ODQ had an acceptable level of reliability. A moderate correlation between the M-ODQ and M-RMDQ (rho=0.56); and fair correlation with the VAS (rho=0.253), BPS (rho=0.336), and the physical component of the Stark QoL questionnaire (rho= -0.274) were found. Weak or no correlation was demonstrated with the mental component of the Stark QoL questionnaire (rho= -0.204). No ceiling or floor effects of the M-ODQ occurred in this study. Conclusion: The M-ODQ is a reliable and valid outcome measure for assessing disability among LBP patients in the Myanmar population.