Physical Interference Research Articles

The effect of adverse employment circumstances on physical pain: Evidence from Australian panel data

Physical pain is a common health problem with great public health implications. Yet evidence on whether adverse employment circumstances shape physical pain is limited. Using longitudinal data from 20 waves (2001−2020) from the Household, Income and Labour Dynamics of Australia Survey (HILDA; N = 23,748), a lagged design, Ordinary Least Squares (OLS) regressions as well as multilevel mixed effect linear regressions, we investigated the association between past accumulated unemployment and recent employment circumstances with physical pain. We found that adults who spent more years unemployed and looking for work subsequently reported greater physical pain (b = 0.034, 95% CI = 0.023, 0.044) and pain interference (b = 0.031, 95% CI = 0.022, 0.038) than those who spent fewer years unemployed. We also found that those experiencing overemployment (working full-time while wanting to work fewer hours) and underemployment (working part-time while wanting to work more hours) reported greater subsequent physical pain (overemployment: b = 0.024, 95% CI = 0.009, 0.039; underemployment: b = 0.036, 95% CI = 0.014, 0.057) and pain interference (overemployment: b = 0.017, 95% CI = 0.005, 0.028; underemployment: b = 0.026, 95% CI = 0.009, 0.043) than those content with their working hours. These results held after controlling for socio-demographic characteristics, occupation, and other health-related factors. These findings are consistent with recent work that suggested that psychological distress can influence physical pain. Understanding how adverse employment circumstances impact physical pain is crucial to the design of health promotion policies.

Percutaneous electrical nerve field stimulation improves comorbidities in children with cyclic vomiting syndrome.

Children with cyclic vomiting syndrome (CVS) frequently suffer from disabling abdominal pain and comorbidities that impair quality of life. A noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) device is shown to be effective for abdominal pain in children with disorders of gut-brain interaction. We aimed to determine the effects of PENFS on pain, common comorbidities, and quality of life in pediatric CVS. Children aged 8-18 years with drug-refractory CVS were enrolled in a prospective, open-label study receiving 6 consecutive weeks of PENFS. Subjects completed the following surveys at baseline, during/after therapy (week 6), and at extended follow-up approximately 4-6 months later: Abdominal Pain Index (API), State-Trait Anxiety Inventory for Children (STAI-C), Pittsburgh Sleep Quality Index (PSQI), and Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Profile-37. Thirty subjects were included. Median (interquartile range, IQR) age was 10.5 (8.5-15.5) years; 60% were female. Median API scores decreased from baseline to week 6 (p = 0.003) and to extended follow-up (p < 0.0001). State anxiety scores decreased from baseline to week 6 (p < 0.0001) and to extended follow-up (p < 0.0001). There were short-term improvements in sleep at 6 weeks (p = 0.031) but not at extended follow-up (p = 0.22). Quality of life measures of physical function, anxiety, fatigue, and pain interference improved short-term, while there were long-term benefits for anxiety. No serious side effects were reported. This is the first study to demonstrate the efficacy of auricular neurostimulation using PENFS for pain and several disabling comorbidities in pediatric CVS. PENFS improves anxiety, sleep, and several aspects of quality of life with long-term benefits for anxiety.Clinical trial registration: ClinicalTrials.gov, identifier NCT03434652.

External Fixation Prior to Fasciectomy Leads to Substantial Improvement of Advanced Dupuytren's PIP Contractures at Mean Follow-up 15 Months.

The Digit Widget is an external fixation device that can be used to reverse proximal interphalangeal joint (PIPJ) contractures in the hand. Our hypothesis is that usage of the Digit Widget prior to fasciectomy in patients with severe Dupuytren's proximal interphalangeal (PIP) contractures will result in short-term improvement and maintenance of the PIPJ contracture after fasciectomy. Patients who underwent placement of the Digit Widget soft tissue distractor prior to fasciectomy for Dupuytren's disease were identified between January 2015 and December 2018. Multiple fingers were considered separately. Patient Reported Outcome Measurement Information System (PROMIS) Physical Function (PF), Pain Interference, and Depression scores were collected. Patients treated for contractures from etiologies other than Dupuytren's were not included. Multiple linear regression was used to compare initial PIP contractures, PF scores, and final contractures. There were 28 fingers in 24 patients with average age of 56 ± 12 (30.5-69.9) years. Initial mean PIPJ contracture was 81° (50°-120°), which had corrected to 23° at time of removal. Average time between application and fasciectomy was 58 (28-112) days. At final follow-up, average 449 (58-1641) days, the average contracture was 39° (0°-105°). Contracture immediately following fasciectomy was found to be strongly correlated with the contracture at final follow-up. There was no statistical relationship between final PROMIS PF scores and final change in contracture. Digit Widget external fixation is an effective treatment for the correction of advanced PIPJ contractures related to Dupuytren's disease, with an average of 52% improvement in contracture at 15 months.

Effect of Si3N4/TaC nanomaterials on the structural and electrical characteristics of poly methyl methacrylate for electrical and electronics applications

In this study, the casting method was used to prepared PMMA/Si3N4/TaC nanocomposites with variant content (0,2,4,6,8) % wt of Si3N4/TaC nanoparticles. The structural and electrical properties have been investigated. Scanning electron microscope (SEM) indicate that the homogenous, smooth and dispersed of Si3N4 and TaC NPs inside the PMMA matrix due to strong covalent interaction between the Si3N4 and TaC NPs in the PMMA matrix which mean a good method for prepared films. Optical microscope images explained that when increasing in content of nanoparticles that forming network paths inside the polymeric matrix that act as charge carriers. FTIR spectra indicate to a physical interference between the polymer matrix and nanoparticles. The AC electrical properties of nanocomposites obtained that the dielectric constant and dielectric loss rise with rising content of nanoparticles and decrease with rising frequency of applied electric field. While the A.C electrical conductivity rise with rising the frequency and weight content of Si3N4/TaC nanoparticles. This results indicated that the PMMA/Si3N4/TaC nanostructures can be considered as promising materials for electronics and electrical nanodevices.

Longitudinal changes in patient reported outcome measures in patients with cancer six months prior to death: A case-control study.

1585 Background: Provider assessments consistently fall short in determining when cancer patients enter into the terminal phase of their disease. Despite prior desires to spend their last days outside an institution, patients often seek emergency room care and most report never having a palliative consultation at the time of their terminal admission. Patient reported outcome measures (PROMs) are derived directly from the patient and may provide insight into the experience near the end of life to facilitate earlier involvement of supportive oncology. This study aims to compare PROMs in the 6 months prior to death to those not dying among patients with cancer. Methods: This study uses a routine PROMs program implemented since September 2020 for all patients with a cancer diagnosis at a tertiary care hospital. This study focused on PROMs using 3 domains of the Patient Reported Outcomes Measurement Information System (PROMIS): physical function, pain interference, and fatigue; PROMs frequency mirrored patients’ oncologic visits. Using a retrospective case-control study, patients who had died within 6 months of a PROMs response (cases) were compared to controls who were alive at the time of the case’s death. Cases were matched 1:2 to controls by age at PROMs completion, gender, cancer disease site, and stage. Generalized estimating equation (GEE) models adjusted for age at PROMs completion, gender, cancer disease site, stage, and correlations between individual patient encounters were used to compare mean PROMs scores between cases and controls in each domain. Results: In total, 274 cases were compared to 270 unique controls. Univariate comparisons between cases and controls demonstrated significant differences only in Charlson Comorbidity Index (CCI), with cases demonstrating worse CCI (3.3 ± 2.5) compared to controls (2.3 ±2.2; p &lt; 0.001). Time from diagnosis to PROMs completion was not different between groups (4.08 versus 4.10 years, p = 0.798). Over the 6 months prior to death, 10.5%/15.0%/32.0% cases had severe pain/fatigue/physical function scores compared to 3.3%/3.7%.8.7% in controls (p &lt; 0.001). GEE models demonstrated that cases had a higher mean fatigue score of 5.34 points (95% CI = 3.81 to 6.88), higher mean pain interference score of 4.92 points (95% CI = 3.42 to 6.43), and lower mean physical function score of 7.39 points (95% CI = -8.84 to -5.93) indicating more severe symptom scores for cases in all three domains. Conclusions: On average, patients experiencing death within 6 months of PROMs completion demonstrated worse physical functioning, pain interference, and fatigue scores compared to their age, gender, cancer disease site, and stage matched controls. The differences in PROMs scores represent a first step to improving understanding of PROMs during the terminal stage of disease and may guide indicators for earlier need of supportive oncology support.

MinFAST: Minimum Span Frequency Assignment Technique for Integrated Access and Backhaul Networks

We propose novel centralized minimum span frequency assignment (MS-FA) techniques allowing partially overlapped channels (POCs) to improve cost and spectral efficiency for integrated access and backhaul (IAB) networks. We first revisit the conventional MS-FA problem (MS-FAP) that minimizes the required bandwidth for given quality-of-service (QoS) requirements, and then design a novel integer linear programming (ILP)-based <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">optimal</i> MS-FA technique with POCs. However, the optimal technique may not be feasible for large-scale IAB networks due to its NP-hardness. Hence, we propose a novel low-complexity MS-FA algorithm that achieves a near-optimal performance while significantly reducing the computational complexity. To the best of our knowledge, no MS-FA technique exists to consider both POCs and the physical interference model in the literature. Simulation results show that the spectral efficiency becomes significantly improved by reducing the required bandwidth in practical IAB networks.

Using bookmarking methods with orthopedic clinicians and patients with fractures produces score interpretation labels for patient-reported outcome measures

ObjectiveThe objective of this study was to determine the patient-reported outcome measure (PROM) score ranges associated with descriptive labels (i.e., within normal limits, mild, moderate, severe) by using bookmarking methods with orthopedic clinicians and patients who have experienced a bone fracture.Study design and settingWe created vignettes comprised of six items and responses from the Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Function, Physical Function, and Pain Interference item banks reflecting different levels of severity. Two groups of patients with fractures (n = 11) and two groups of orthopedic clinicians (n = 16) reviewed the vignettes and assigned descriptive labels independently and then discussed as a group until reaching consensus via a videoconference platform.ResultsPROMIS Physical Function and Pain Interference thresholds (T = 50, 40, 25/30 and T = 50/55, 60, 65/70, respectively) for patients with bone fractures were consistent with the results from other patient populations. Upper Extremity thresholds were about 10 points (1 SD) more severe (T = 40, 30, 25/20) compared to the other measures. Patient and clinician perspectives were similar.ConclusionBookmarking methods generated meaningful score thresholds for PROMIS measures. These thresholds between severity categories varied by domain. Threshold values for severity represent important supplemental information to interpret PROMIS scores clinically.

Pulsed-field ablation in patients with permanent pacemaker or implantable cardioverter defibrillator: Is it safe?

Abstract Funding Acknowledgements Type of funding sources: None. Aims Pulse field ablation (PFA) is a novel catheter ablation technology with safety benefits due to its tissue selectivity. The risk of physical damage or electromagnetic interference (EMI) of PFA with cardiac implantable electronic devices (CIEDs) is unknown. The aim of our study was to assess the risk of PFA for CIEDs. Methods PFA lesions (45 per CIED) were applied to CIEDs (&amp;lt;5cm from the lead tip and &amp;lt;15cm from the generator). All devices were checked before and after PFA application for sensing and pacing parameters as well as integrity of shock circuits in ICDs using a heart simulator. Devices were interrogated for any spontaneous reprogramming, mode switching or other EMI effects. Results In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1,980 PFA applications. There was no change in device settings, functionality, electrical parameters and there was no visible damage to the CIEDs or leads. The risk on a device-based analysis is 0/44 (95% CI 0%-8%) and on a PFA pulse-based analysis is 0/1,980 (95% CI 0%-0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition, but not tachycardia detection. Conclusions Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In-vivo studies are needed to confirm our findings.

Comparison of the PROMIS and iHOT-12 in Determining Satisfaction Levels After Hip Arthroscopy for FAIS.

The Patient-Reported Outcomes Measurement Information System (PROMIS) has not been fully evaluated for outcomes assessment after hip arthroscopy to correct femoroacetabular impingement syndrome (FAIS). The purpose of this study was to compare the accuracy of the PROMIS Physical Function (PF) and Pain Interference (PI) subscales with the 12-Item International Hip Outcome Tool (iHOT-12) to define patients with 3 unique substantial clinical benefit (SCB) scores-patients who reported ≥80%, ≥90%, and 100% satisfaction at 1 year after hip arthroscopy for FAIS. We hypothesized that the iHOT-12 would be more accurate than the PROMIS-PF and PROMIS-PI subscales in identifying these 3 patient groups. Cohort study (diagnosis); Level of evidence, 2. We reviewed the records of patients who underwent hip arthroscopy for symptomatic FAIS at 3 centers from January 2019 through June 2021 and had 1-year clinical and radiographic follow-up data. Patients completed the iHOT-12, PROMIS-PF, and PROMIS-PI on initial assessment and at 1 year (±30 days) postoperatively. Postoperative satisfaction was reported on an 11-category scale with anchors defined as "0% satisfied" and "100% satisfied." Receiver operator characteristic analysis was performed to determine the absolute SCB values for the iHOT-12 and PROMIS subscales that would most accurately identify those patients who reported ≥80%, ≥90%, and 100% satisfaction. Area under the curve (AUC) values and 95% CIs for the 3 instruments were compared. Included were 163 patients (111 [68%] women and 52 [32%] men), with a mean age of 26.1 years. Corresponding absolute SCB scores for patients who reported ≥80%, ≥90%, and 100% satisfaction were as follows: iHOT-12, 68.4, 72.1, 74.7; PROMIS-PF, 45, 47.7, 49.9; and PROMIS-PI, 55.9, 52.4, 51.9. The AUC ranged between 0.67 and 0.82, with overlapping 95% CIs indicating a minimal difference in accuracy between the 3 instruments. Sensitivity and specificity values ranged between 0.61 and 0.82. The PROMIS-PF and PROMIS-PI subscales were as accurate as the iHOT-12 in defining absolute SCB scores for patients reporting ≥80%, ≥90%, and 100% satisfaction at 1-year follow-up after hip arthroscopy for FAIS.

CI-452768-2 PULSED-FIELD ABLATION IN PATIENTS WITH PERMANENT PACEMAKER OR IMPLANTABLE CARDIOVERTER DEFIBRILLATOR: IS IT SAFE?

Pulse field ablation (PFA) is a novel catheter ablation technology with safety benefits due to its tissue selectivity. The risk of physical damage or electromagnetic interference (EMI) of PFA with cardiac implantable electronic devices (CIEDs) is unknown. The aim of our study was to assess the risk of PFA for CIEDs. PFA lesions (45 per CIED) were applied (Farapulse, Boston Scientific, MA, USA) to CIEDs (<5cm from the lead tip and <15cm from the generator). All devices were checked before and after PFA application for sensing and pacing parameters as well as integrity of shock circuits in ICDs using a heart simulator. Devices were interrogated for any spontaneous reprogramming, mode switching or other EMI effects. In total, 44 CIEDs were tested (16 pacemaker, 21 ICDs, 7 CRT-P/D) with 1,980 PFA applications. There was no change in device settings, functionality, electrical parameters and there was no visible damage to the CIEDs or leads. The risk on a device-based analysis is 0/44 (95% CI 0%-8%) and on a PFA pulse-based analysis is 0/1,980 (95% CI 0%-0.2%). Clinically relevant EMI appeared with oversensing and pacing inhibition, but not tachycardia detection. Bipolar PFA appears safe and does not result in damage to CIEDs or leads. Clinically relevant EMI does occur, but appropriate peri-procedural programming may mitigate this. In-vivo studies are needed to confirm our findings.

Context awareness in the electronic format of dialogue

Modern dialogical speech is undergoing a major transformation due to the use of electronic communication format, which introduces its own changes in the context of communication. Dialogical speech is characterized by a high dependence on the context. In electronically mediated communication, the situation of communication is no longer the same for the communicators: they are in different places, experiencing different stimuli and communication interference, despite the fact that the communicators continue to maintain a dialogue and exchange replicas. Accordingly, the concept of context needs to be supplemented and reinterpreted in connection with the new conditions of its occurrence that is electronic space. The aim of the study is to find the qualitatively essential components for successful mediated communication, which depend on the context of the communication situation. One strategy for achieving successful communication is to remove possible barriers in communication. For this purpose, the detailing of the context of communication, its influence on the effectiveness of communication is carried out, and the concept of semiotic field of dialogue is developed. Under the semiotic field of dialogue we understand the information, which affects the communicants understanding of each other: the references, the presuppositions of the addressee, the presuppositions of the addressor. The material of the study was dialogic communication within the framework of organizational communication. The specific nature of the discourse of corporations and organizations creates its own unique context that is described in the article. The author has identified several groups of interference in the electronic format of dialogical speech, such as physical interference, informational interference, semantic interference and psychological interference.

Does Patient-Reported Outcome Measures Use at New Foot and Ankle Patient Clinic Visits Improve Patient Activation, Experience, and Satisfaction?

Patient-reported outcome measures (PROMs) can help predict clinical outcomes and improve shared clinical decision-making discussions. There remains a paucity of research assessing how the use of PROMs may drive improved patient experience and patient activation. New foot and ankle patients completed PROMIS physical function (PF), pain interference (PI), and depression assessments. Patients were then randomized to viewing and discussing their PROMIS scores with their surgeon or not. Following the clinic visit, patients completed a series of Clinician & Group Survey-Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) questions and the Patient Activation Measure (PAM). Responses to the CG-CAHPS questions and PAM were compared between the 2 groups and after clustering on surgeon. Potential interaction effects by social deprivation were also explored. After enrolling patients but removing those lost to follow-up or with missing data, 97 and 116 patients remained in the intervention control cohorts, respectively. No difference was found in CG-CAHPS responses nor PAM scores between the 2 groups (P > .05). All surgeons were highly rated by all patients. When clustered by surgeon, intervention subjects were less likely to indicate "top box" scores for the understanding domain of the CG-CAHPS question (OR 0.51, P < .001) and had decreased odds of high patient activation compared to control subjects (OR 0.67; P = .005). Among the most socially disadvantaged patients, there was no difference in control and intervention subjects in their likelihood of having high patient activation (P = .09). Highly rated foot and ankle surgeons who show and discuss PROM results may not improve patient experience or activation and may, in fact, decrease understanding or patient activation in select populations. Future work is needed to determine when PROM discussions are most beneficial and how best to present PROMs data, as we suspect that how the information was presented-and not the use of PROMs-resulted in our findings. Health literacy tools and/or communication training may better engage different patient groups regarding PROMs. Level I, randomized controlled trial.

Responsiveness and minimal important change of seven PROMIS computerized adaptive tests (CAT) in patients with advanced chronic kidney disease

BackgroundThe Patient-Reported Outcomes Measurement Information System (PROMIS®) has the potential to harmonize the measurement of health-related quality of life (HRQL) across medical conditions. We evaluated responsiveness and minimal important change (MIC) of seven Dutch-Flemish PROMIS computerized adaptive tests (CAT) in Dutch patients with advanced chronic kidney disease (CKD).MethodsCKD patients (eGFR < 30 ml/min.1.73m2) completed at baseline and after 6 months seven PROMIS CATs (assessing physical function, pain interference, fatigue, sleep disturbance, anxiety, depression, and ability to participate in social roles and activities), Short Form Health Survey 12 (SF-12), PROMIS Pain Intensity single item, Dialysis Symptom Index (DSI), and Global Rating Scales (GRS) of change. Responsiveness was assessed by testing predefined hypotheses about expected correlations among measures, area under the ROC Curve, and effect sizes. MIC was determined with predictive modelling.Results207 patients were included; 186 (90%) completed the follow-up. Most results were in accordance with expectations (70–91% of hypotheses confirmed), with some exceptions for PROMIS Anxiety and Ability to Participate (60% and 42% of hypotheses confirmed, respectively). For PROMIS Anxiety and Depression correlations with the GRS were too low (0.04 and 0.20, respectively) to calculate a MIC. MIC values, representing minimal important deterioration, ranged from 0.4 to 2.5 T-score points for the other domains.ConclusionWe found sufficient responsiveness of PROMIS CATs Physical Function, Fatigue, Sleep Disturbance, and Depression. The results for PROMIS CATs Pain Interference were almost sufficient, but some results for Anxiety and Ability to Participate in Social Roles and Activities were not as expected. Reported MIC values should be interpreted with caution because most patients did not change.

488 Prospective Evaluation of Racial Disparities in Surgical Treatment Of Degenerative Spondylolisthesis Using PROMIS Pain Interference And Physical Function Scores

INTRODUCTION: Spine surgery for degenerative spondylolisthesis is indicated in patients who remain symptomatic despite a course of nonsurgical therapy. Patient’s report of pain interference and physical function are key indicators for intervention. We know that Black and indigenous patients of color have poorer outcomes in back pain. This study aims to identify trends in intervention for degenerative spondylolisthesis based on race and patient-reported outcomes. METHODS: A prospective cohort study of degenerative spondylolisthesis patients seen in Harvard Medical School-affiliated clinics from 2015 to 2022 and who completed the routinely collected PROMIS patient-reported outcome measures (PROMs): Physical Function (PF) and pain Interference (PI). PROMIS scores are standardized to the U.S. population (mean score = 50). Regression analyses were performed to determine factors associated with treatment assignment. RESULTS: In this study, 22 374 patients (mean Age, 66.91(14.22); Female, 64%; BIPOC, 3019 (13%)) completed PROMs at baseline. Medicaid coverage was more prevalent among BIPOC (13% vs. 3.1%; P &lt; 0.001) who were less likely to receive an interventional treatment (351/ 3,019 (12%) vs. 3,021 / 19,355 (16%); P &lt; 0.001) despite a significantly higher pain interference score (62.32 (8.37) vs. 61.51 (8.35); P &lt; 0.001). White race was associated with higher odds of receiving surgical treatment than BIPOC after adjusting for age, comorbidities, medical coverage, physical function, and pain interference at baseline (OR = 1.20; 95 CI, 1.15-1.26; P &lt; 0.001). CONCLUSIONS: Despite higher pain interference scores, BIPOC patients were less likely to be offered spine surgery for degenerative spondylolisthesis, indicating that race is a predictor of spine surgery after accounting for comorbidities, physical function, and disability at diagnosis.

Impact of Sleep Disturbance on Clinical Outcomes in Lumbar Decompression.

To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression. Patients undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively. Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain. Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement.

"Outcome evaluation of physiotherapy &amp; drug management for chronic cervical radiculopathy"

Background: Cervical radiculopathy (CR) is one of the prevalent causes of neck pain and disability. Physiotherapy and pain medications are the common nonoperative management, and in Physiotherapy, there are many concepts of assessment and management. This study aims to determine the comparative effectiveness of three specialized physiotherapy approaches or only pain medications for managing CR cases. Methods: A prospective, assessor, and participant-blind, four-arm Randomized control trial (RCT) has been conducted on 120 patients with chronic cervical radiculopathy in 4 specialized centers of Dhaka city recruited between July and December 2022. Four groups (n=30) was treated through structural diagnosis and management concept (SDM), regional approaches (RA), McKenzie mechanical diagnosis and therapy (MDT) concept prescribed by advanced practice physiotherapist (APP), or pain medications prescribed by the specialist physician for 4 weeks. Discussion: After 24 sessions every group shows improvement in neck pain, ROM, disability and quality of life. During intermediate analysis (14days), no group shows more significant changes than another. After post changes (24days) the pain severity score differ significantly only between Medication and RA, RA and Medication; mean pain affective interference score differ between Medication and RA, RA and Medication; and pain physical interference between Medication and RA; RA and Medication. Mean score of ROM were significantly different between medication and RA, Medication and SDM; MDT and RA, MDT and SDM; RA and Medication, RA and MDT; SDM and Medication, SDM and MDT. Besides mean score of WHOQOL Brief (physical) were significantly different between Medication and SDM (p=.000); MDT and SDM (p=.000); RA and SDM (p=.045); SDM and Medication (p=.000), SDM and MDT (p=.000), SDM and RA. Overall improvement (mean score changes) found in pain, ROM, disability, QOL among all groups. Trial registered to the Clinical Trial Registry India CTRI/2022/03/040922 on 08/03/2022.

Plastic spectral interference in the biological characterization by Raman or SERS spectroscopy

AbstractRaman spectroscopy and surface‐enhanced Raman spectroscopy (SERS) have been widely applied for characterizing biological samples. Nowadays, it is routine to use plastic products for biological sample preparation and analysis during spectral acquisition. However, plastic containers produce undesirable signals severely interfering with the spectra of biological samples, which is neglectable and misleading. Herein, we unveiled the physical and chemical interference of plastic products in the process of Raman spectroscopy characterization. Firstly, we revisited a representative case of interference from polystyrene plastics on normal Raman and SERS spectra of cysteine and demonstrated its physical interference due to misfocusing. Furthermore, we testified SERS spectra of aqueous solution stored in several plastic materials commonly used in biological experiments. The spectra indicate strong spectral interference from the leaching chemicals. To address these problems, we proposed a series of strategies to avoid interference from plastic products in the Raman and SERS characterization of biological samples.

The effect of soundscape composition on bird vocalization classification in a citizen science biodiversity monitoring project

There is a need for monitoring biodiversity at multiple spatial and temporal scales to aid conservation efforts. Autonomous recording units (ARUs) can provide cost-effective, long-term and systematic species monitoring data for sound-producing wildlife, including birds, amphibians, insects and mammals over large areas. Modern deep learning can efficiently automate the detection of species occurrences in these sound data with high accuracy. Further, citizen science can be leveraged to scale up the deployment of ARUs and collect reference vocalizations needed for training and validating deep learning models. In this study we develop a convolutional neural network (CNN) acoustic classification pipeline for detecting 54 bird species in Sonoma County, California USA, with sound and reference vocalization data collected by citizen scientists within the Soundscapes to Landscapes project (www.soundscapes2landscapes.org). We trained three ImageNet-based CNN architectures (MobileNetv2, ResNet50v2, ResNet100v2), which function as a Mixture of Experts (MoE), to evaluate the usefulness of several methods to enhance model accuracy. Specifically, we: 1) quantify accuracy with fully-labeled 1-min soundscapes for an assessment of real-world conditions; 2) assess the effect on precision and recall of additional pre-training with an external sound archive (xeno-canto) prior to fine-tuning with vocalization data from our study domain; and, 3) assess how detections and errors are influenced by the presence of coincident biotic and non-biotic sounds (i.e., soundscape components). In evaluating accuracy with soundscape data (n = 37 species) across CNN probability thresholds and models, we found acoustic pre-training followed by fine-tuning improved average precision by 10.3% relative to no pre-training, although there was a small average 0.8% reduction in recall. In selecting an optimal CNN architecture for each species based on maximum F(β = 0.5), we found our MoE approach had total precision of 84.5% and average species precision of 85.1%. Our data exhibit multiple issues arising from applying citizen science and acoustic monitoring at the county scale, including deployment of ARUs with relatively low fidelity and recordings with background noise and overlapping vocalizations. In particular, human noise was significantly associated with more incorrect species detections (false positives, decreased precision), while physical interference (e.g., recorder hit by a branch) and geophony (e.g., wind) was associated with the classifier missing detections (false negatives, decreased recall). Our process surmounted these obstacles, and our final predictions allowed us to demonstrate how deep learning applied to acoustic data from low-cost ARUs paired with citizen science can provide valuable bird diversity data for monitoring and conservation efforts.

Impact of mixing on water quality in the Bosphorus – Implications on sustainable management of wastewater marine discharges

The study established the water quality modelling of the Bosphorus system, based on hydrodynamic data as well as the results of the water quality survey carried out in the last five years. The model revealed significant decrease in the magnitude of pollutant loads in the upper layer at the exit into The Marmara Sea providing numerical proof that no pollutant transport would take place from sewage discharges to the upper layer. A similar modelling approach was implemented at the Bosphorus/Marmara interface, a significant hotspot as it included two major deep marine outfalls. The results asserted that the entire sewage flow would enter the lower flow in The Bosphorus through the interface without an appreciable mixing with the upper flow. This way, the study provided a significant scientific support for the sustainable management of marine discharges in this area, since they have no physical interference with The Marmara Sea.

Impact of body mass index on PROMIS outcomes following lumbar decompression.

No studies have examined the impact of body mass index (BMI) on newer Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes in patients undergoing lumbar decompression (LD). Patients undergoing LD with preoperative PROMIS measures were stratified into four cohorts: normal (18.5 ≤ BMI < 25kg/m2), overweight (25 ≤ BMI < 30kg/m2), obese I (30 ≤ BMI < 35kg/m2), and obese II-III (BMI ≥ 35kg/m2). Demographics, perioperative characteristics, and patient-reported outcomes (PROs) were obtained. PROs of PROMIS Physical Function (PROMIS-PF), PROMIS Anxiety (PROMIS-A), PROMIS Pain Interference (PROMIS-PI), PROMIS Sleep Disturbance (PROMIS-SD), Patient Health Questionnaire-9 (PHQ-9), Visual Analog Scale (VAS) Back Pain (VAS-BP), VAS Leg Pain (VAS-LP), and Oswestry Disability Index (ODI) were collected at preoperative and up to 2-year postoperative time points. Minimum clinically important difference (MCID) achievement was determined through comparison of previously established values. Comparison between cohorts were determined through inferential statistics. A total of 473 patientswere identified, with stratification of 125 patients in the normal cohort, 161 in the overweight cohort, 101 in the obese I cohort, and 87 in the obese II-III cohort. Mean postoperative follow-up time was 13.51 ± 8.72months. Higher BMI patients had higher operative times, longer postoperative length of stay, and greater narcotic consumption (p ≤ 0.001, all). Patients with higher BMI (obese I, obese II-III) reported inferior preoperative PROMIS-PF, VAS-BP, and ODI scores (p ≤ 0.003, all). Postoperatively, obese I-III cohorts demonstrated inferior PROMIS-PF, PHQ-9, VAS-BP, and ODI scores at final follow-up (p ≤ 0.016, all). However, patients demonstrated similar postoperative changes and MCID achievement regardless of preoperative BMI. Patients undergoing lumbar decompression demonstrated similar postoperative improvement in physical function, anxiety, pain interference, sleep disturbance, mental health, pain, and disability outcomes independent of preoperative BMI. However, obese patients reported worse physical function, mental health, back pain, and disability outcomes at final postoperative follow-up. Patients with greater BMI undergoing lumbar decompression demonstrate inferior postoperative clinical outcomes.