Score Points Research Articles

Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study.

In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence. In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.). Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women. In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues. BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA.

A new hernia blocking system to prevent recurrent lumbar disc herniation: surgical technique, intraoperative findings and six-months post-operative outcomes.

The aim of this study was to evaluate the performance and safety of a new hernia blocking system (HBS), implanted after a limited discectomy, to prevent recurrence of lumbar disc herniation. Prospective, multicenter (6 sites), cohort clinical investigation. Thirty patients with a postero-lateral disc herniation between L4-S1 and large annular defects (> 6mm wide), who underwent a limited discectomy and were treated with a new HBS (DISC care, NEOS Surgery S.L.), were included. This article presents details about the investigational device, its surgical technique, intraoperative parameters, and up to 6months follow-up outcomes. The primary endpoint of the study was to assess the incidence of early symptomatic reherniation. In addition, disc height, leg and back pain (NRS 0-10), Oswestry Disability Index (ODI), quality of life (EQ-5D-5L) and device safety, were evaluated. gov: NCT04188236; date: 27th November 2019. Thirty patients (43.3% female, 41.7 ± 10.9years) were implanted with the device under evaluation in a mean of 16 ± 9.6min. Six months after surgery, no symptomatic reherniation was detected and disc height was maintained in all patients included. All patients had a significant reduction in leg pain (> 2 points in the NRS), 92.9% improved > 15 points in the ODI and 82.6% significantly improved their quality of life (≥ 12 points in EQ VAS score). No product-related serious adverse events nor reoperations occurred. The implantation of an HBS is a feasible and safe procedure that prevents early disc herniation recurrence in patients at high risk of reherniation.

Utility of Surgical Apgar Score in Predicting Post-operative Complications After Whipple Procedure in Pancreatic Cancer Patients

AbstractAn intraoperative 10-point Surgical Apgar Score, based on estimated blood loss, lowest mean arterial pressure, and lowest heart rate, was developed and validated for predicting postoperative complications in patients undergoing vascular and general surgeries. We sought to estimate the ability of this metric to predict major postoperative complications in patients with pancreatic cancer undergoing the Whipple procedure. This is a prospective, observational, single-centre study involving adult patients undergoing the Whipple procedure, at a major tertiary cancer centre. All eligible patients undergoing Whipple surgery in our institute between March 2018 and October 2021 were included in the study. Demographic data, clinicopathological characteristics, comorbidities, intraoperative variables, and postoperative complications were analyzed. The surgical score was calculated from intraoperative blood loss, lowest heart rate, and lowest mean arterial pressure. All the patients were followed up till 30 days postoperatively. Descriptive statistics and univariate and multivariate analyses were used as appropriate. The occurrence of major postoperative complications represented the primary outcome. A total of 253 patients were analyzed. The mean duration of surgery was 436 min. On statistical analyses, the occurrence of major postoperative complications was significantly associated with SAS ≤ 4 (OR = 8.00, 95% CI = 3.78–16.93, p = 0.000), use of intraoperative vasopressor (OR = 2.247, 95% CI = 1.312–3.846, p = 0.003), and body mass index (BMI) (OR = 1.074, 95% CI = 1.010–1.142, p = 0.022). However, we did not find any significant association between other demographic variables like age, comorbidities, duration of surgery, and preoperative s. albumin with the occurrence of postoperative complications. Lower SAS (≤ 4) is the most powerful predictor of postoperative complications in pancreatic cancer patients undergoing Whipple surgery. The score provides a simple and immediate means of measuring and communicating patient outcomes, using data routinely available in any setting.

Comparative analysis of the effectiveness of instrumentation with manual stainless steel and NiTi files in the endodontic treatment

The aim of this study was to assess the effectiveness in instrumentation and the main differences between the manual systems K and M. Material and methods: Forty Type IV Vertucci standardized lower molars, considering the degree of curvature, were divided into 2 groups (n=10): M Files and K-File Files. After biomechanical preparation, the teeth were filled using the Tagger Hybrid technique. Digital radiographs were taken in the buccolingual and mesiodistal directions, and the quality of the filling was determined by three calibrated and blinded evaluators using a 4-point scoring system. The instrument fracture index was also recorded. The obtained data were subjected to Mann-Whitney tests (p<0.05). Results: In the analysis conducted by experienced professionals, a higher radiographic quality of obturation was observed in the M file group compared to the K-file group (p<0.05). Regarding the perception of undergraduate students regarding the difficulty of procedures, a greater difficulty was observed in preparing molars with K-Files compared to M Files (p<0.05). A higher percentage of fractured K-Files was observed compared to M Files. Conclusion: M Files provided less difficulty in preparing molars for undergraduate students, had a lower incidence of fracture, and favored better radiographic quality of obturation.

Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury

Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair). To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI. Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024. PUs acquired during surgical or first rehabilitative SCI care. The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression. The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01). In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study.

Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI -0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic.

Prospective Outcomes After Serial Platelet-Rich Plasma (PRP) Injection in Vocal Fold Scar and Sulcus.

Vocal fold scar and sulcus pose significant treatment challenges with no current optimal treatment. Platelet-rich plasma (PRP), an autologous concentration of growth factors, holds promise for regenerating the superficial lamina propria. This study aims to evaluate the potential benefits of serial PRP injections on mucosal wave restoration and vocal function. In a prospective clinical trial across two institutions, patients with vocal fold scar underwent four serial PRP injections, one month apart. Blinded independent laryngologists and expert listeners used pretreatment and one-month post-fourth injection videostroboscopy and CAPE-V assessments to evaluate mucosal wave and voice quality changes, respectively. Additionally, patient reported outcome measures (PROMs) were evaluated. In the study, 15 patients received 55 PRP injections without adverse effects. Eight patients (53.3%) had mild, three patients (20%) had moderate, and four patients (26.7%) had severe scar. There was an average reduction of 8.7 points in post-treatment VHI-10 scores (p = 0.007). The raters observed an improvement in post-treatment voice in 73.4% of cases, and CAPE-V scores showed a reduction of 18.8 points on average (p = 0.036). The videostroboscopic VALI ratings showed an improvement in mucosal wave rating from 2.0 to 4.0. On average, the raters perceived the post-PRP exams to be better in 56.7% of cases. PRP has been validated as a safe autologous option for treatment of vocal fold scar. While results for mucosal wave and voice quality varied, there was a consistent improvement in PROMs. 3: Prospective cohort study, with blinded analysis Laryngoscope, 134:5021-5027, 2024.

Continuous characterisation of exacerbation pathophysiology using wearable technologies in free-living outpatients with COPD: a prospective observational cohort study

The most recent exacerbation of COPD (ECOPD) classification criteria relies in part on changes in respiratory rate (RR), heart rate (HR) and oxygen saturation (SpO2). Despite this paradigm shift, a thorough understanding of exacerbation patterns is still lacking, as is the identification of physiological exacerbation biomarkers. Using a convenience sampling approach, this prospective observational cohort study was conducted between February 2023 and January 2024. Continuous measurements of daytime/overnight respiratory (primary outcome), cardiovascular, autonomic, activity and sleep-related parameters were collected by a wearable biometric wristband and ring over 21 consecutive days in free-living outpatients experiencing and receiving treatment (≤3 days) for a current exacerbation from the home environment. The EXACT-PRO questionnaire served as the validated reference for daily symptom burden and to identify 'recovered' versus 'persistent worsening' participants. Unadjusted and adjusted (for age, sex, FEV1) linear mixed-effects models were fitted to estimate associations between each physiological parameter with daily EXACT-PRO score (points, pts), in all, 'recovered', and 'persistent worsening' participants. Results are presented as point estimates with 95% CIs. In 21 participants with COPD (43% female, mean age 66.8, BMI 27.7kg/m2, FEV1 36.3% predicted; 85.7% with GOLD 3-4 disease), significant associations in unadjusted models with daily EXACT-PRO score included RR variability (-1.45 [-2.84,-0.073] pts/breath/min) but not RR, daily step count (-0.56 [-0.82,-0.31] pts/1000 steps), and sleep efficiency (-0.12 [-0.20,-0.037] pts/%asleep). In 'recovered' participants (n=10), significant associations included nighttime HR, movement intensity and nightly SpO2. In 'persistent worsening' participants (n=11), significant associations included HR variability, nightly RR variability, nightly SpO2, sleep efficiency, and skin temperature. Similar results were found in adjusted models. This study provides a prospective continuous characterisation of exacerbations of COPD using remotely collected, ambulatory/free-living data. The physiological patterns presented may contribute to the understanding of exacerbations and may enhance the development of effective remote monitoring solutions. University hospital (MUHC-CAS) grant.

Association between accelerometry and physical activity levels measured by questionnaires in patients on hemodialysis

Purpose This study aimed to evaluate association of accelerometry data with physical activity levels (PAL) measured by three questionnaires and to investigate their ability to discriminate physically inactive from active patients on hemodialysis. Materials and methods A cross-sectional study was conducted. PAL were assessed by accelerometry and questionnaires: Human Activity Profile (HAP), International Physical Activity Questionnaire (IPAQ), and 36-Item Short Form Health Survey (SF-36). Results This study included 105 patients (59.2 ± 12.5 years, 60.0% male). Accelerometer data were significantly correlated with all questionnaire scores. Adjusted activity score (AAS) of HAP presented moderate to strong correlation with daily step count (ρ = 0.552, p < 0.001) and time in moderate and vigorous physical activity (ρ = 0.642, p < 0.001). AAS was associated with daily step count (R2 = 0.29, p < 0.001) and time in moderate to vigorous physical activity (R2 = 0.24, p = 0.001). Cutoff values for AAS of HAP, IPAQ, and physical component summary of the SF-36 for discriminating physically inactive from active patients were 63, 1139 and 44 (threshold of 5000 steps/day), respectively, and 55, 773 and 38 (threshold of 4260 steps/day), respectively. Conclusions PAL scores on questionnaires were associated with accelerometer data, mainly the HAP. Furthermore, this study established cutoff points for questionnaire scores to discriminate physically inactive from active patients.

Exploring Student Academic Achievement and Motivation through Game-Based Learning on Interactive Whiteboards

This study investigates the effectiveness of integrating Wordwall.net games with interactive whiteboards to enhance student motivation and academic achievement in a 10-week financial instruments course. The primary research questions focus on how this combination impacts students' learning motivation and performance. Utilizing a single-group pretest-posttest experimental design, the research involved 33 undergraduate students who completed assessments, including the Financial Instruments Quiz and the Learning Motivation Scale, which encompasses five dimensions: intrinsic goal orientation, extrinsic goal orientation, task value, control beliefs, and self-efficacy. The results revealed a statistically significant increase of 31 points in quiz scores from pre- to post-test, with 97% of participants achieving passing grades after the intervention. Additionally, motivation measures demonstrated considerable gains across all five dimensions. Qualitative feedback highlighted that the interactive game-based format promoted enjoyment, facilitated social collaboration, and increased engagement with digital content. The findings provide empirical evidence that combining Wordwall.net with interactive whiteboards can significantly improve student motivation and understanding of complex concepts. These results suggest that educators should consider this integration to create a more engaging learning environment. Future research is recommended to explore long-term effects and identify specific features of Wordwall.net that enhance learning outcomes when used with interactive whiteboards.

Psychometric Validation and Determination of the Minimal Clinically Important Difference for Bronchiectasis Health Questionnaire in Adults with Bronchiectasis.

The Bronchiectasis Health Questionnaire (BHQ) is a concise, self-administered and disease-specific instrument for measuring health-related quality-of-life (HRQoL) in bronchiectasis. To investigate the psychometric properties of simplified Mandarin BHQ and determine the minimum clinically important difference (MCID) as a reliable clinical endpoint for assessing the efficacy of bronchiectasis treatments. A longitudinal, randomized controlled trial cohort of 357 patients treated with tobramycin inhalation solution or saline inhalation for Pseudomonas aeruginosa infection, along with a cross-sectional observational cohort including 436 patients with bronchiectasis were analyzed. Psychometric analyses encompassed convergent validity, known-groups validity, internal consistency, test-retest reliability, and responsiveness. Both anchor-based and distribution-based approaches were utilized to calculate the MCID for therapeutic response. There were significant positive correlations between BHQ scores and the Quality of Life - Bronchiectasis Respiratory Symptom Scale (QoL-B-RSS), with correlation coefficient 0.698 in the trial cohort and 0.567 in the clinical cohort (both P<0.0001). Known-groups validity indicated significant differences in BHQ scores stratified by baseline Bronchiectasis Severity Index. BHQ scores correlated modestly with both FEV1% predicted and exacerbation frequency within the previous year. In the trial cohort, BHQ demonstrated excellent internal consistency (Cronbach's alpha: 0.893) and test-retest reliability (intraclass correlation coefficient: 0.853). An 8-point improvement in QoL-B-RSS corresponded to a mean increase of 5.49 points in BHQ scores after 4-week treatment. The MCID for BHQ was consistently 3 points. The BHQ (MCID: 3 points) represents a clinically meaningful tool for evaluating therapeutic intervention outcomes and patient-centered outcomes in patients with bronchiectasis.

How Accurate and Effective Are Non-image-guided Thumb Basal Joint Injections When Performed by Experienced Fellowship-trained Hand Surgeons?

Corticosteroid injections are widely used for treating thumb carpometacarpal (CMC) arthritis, yet the accuracy of non-image-guided injections in expert hands is uncertain, with prior studies reporting intraarticular placement in about 60% of thumbs when performed by physicians with different levels of training. Despite their common use, there is a need to assess both the accuracy and the short-term clinical efficacy of these injections, particularly when performed without image guidance by fellowship-trained hand surgeons. (1) What is the accuracy of thumb CMC injections performed without image guidance by fellowship-trained hand surgeons in an office setting? (2) What is the short-term efficacy of thumb CMC injections performed without image guidance? We prospectively enrolled 33 patients with a mean ± SD age of 63 ± 12 years, 76% (25) of whom were female, with symptoms of basal joint arthritis that persisted despite conservative treatment, and we administered 1.5-mL corticosteroid injections without image guidance. We used descriptive statistics to analyze the outcomes, which included VAS, QuickDASH (Q-DASH), and Thumb Disability Examination (TDX) scores. Minimum clinically important differences (MCIDs) were defined as 0.9 points for the VAS, 18 points for Q-DASH, and 17 points for TDX. Of the 33 injections analyzed, 79% (26) were intraarticular. At 6 weeks, patients reported a mean improvement of 22 points in QuickDASH, 24 points in TDX, and 4 points in VAS scores. Importantly, 73% (24 of 33), 55% (18 of 33), and 82% (27 of 33) of the patients achieved the MCID in the patient-reported outcomes, respectively, suggesting that even without image guidance, corticosteroid injections can provide effective short-term relief for thumb CMC arthritis. We found that about 79% of injections were placed intraarticularly, which was comparable with the findings of previous studies using image guidance, and provided meaningful improvements in pain and function for 6 weeks. These findings suggest that for experienced fellowship-trained hand surgeons, non-image-guided injections remain a viable option. Future studies should explore long-term outcomes and the potential role of adjunctive treatments such as antiinflammatory medications and splinting to enhance patient care. Level II, therapeutic study.

Associations of an overall healthy lifestyle with the risk of metabolic dysfunction-associated fatty liver disease

BackgroundMetabolic dysfunction-associated fatty liver disease (MAFLD) affects up to one-third of the global population. Since no approved pharmacotherapy for MAFLD is available, lifestyle modification remains the cornerstone of clinical care. Our study aims to evaluate the association of an overall healthy lifestyle with MAFLD risk.MethodsWe conducted an analysis of 327,387 participants from UK biobank. An overall healthy lifestyle score including six evidence-based lifestyles (diet, alcohol consumption, physical activity, sedentary behavior, sleep, and smoking) was assessed by questionnaires. MAFLD and its subtypes were diagnosed by blood biochemistry, ICD codes, and medication information from touchscreen and verbal interview. The prevalence ratios (PRs) and risk ratios (RRs) were estimated by Poisson regression models with robust variance.ResultsIn the cross-sectional analysis, the PR (95% CI) was 0.83 (0.83 to 0.84) for MAFLD, and 0.83 (0.83 to 0.84) for MAFLD-overweight/obesity (MAFLD-O), 0.68 (0.66 to 0.70) for MAFLD-lean/normal weight and metabolic dysfunction (P-value for heterogeneity < 0.001), and 0.71 (0.71 to 0.72) for MAFLD-type 2 diabetes mellitus (MAFLD-T2D); and 0.68 (0.66 to 0.71) for dual (or more) etiology fatty liver disease (MAFLD-dual) and 0.83 (0.83 to 0.84) for single etiology MAFLD (MAFLD-single) (P-value for heterogeneity < 0.001) for one additional point in the overall healthy lifestyle score. During a median follow-up of 4.4 years, the RR (95% CI) was 0.83 (0.81 to 0.85) for MAFLD, and 0.83 (0.81 to 0.85) for MAFLD-O, 0.71 (0.62 to 0.81) for MAFLD-L, and 0.68 (0.64 to 0.72) for MAFLD-T2D (P-value for heterogeneity < 0.001); and 0.83 (0.81 to 0.85) for MAFLD-dual and 0.70 (0.58 to 0.85) for MAFLD-single (P-value for heterogeneity = 0.08) for one additional point in the overall healthy lifestyle score. These findings were validated in a prospective analysis among 15,721 participants with revisit data, and also supported by fatty liver index and proton density fat fraction data.ConclusionsAn overall healthy lifestyle that includes six evidence-based factors was strongly associated with lower MAFLD risk, especially the subtypes with multiple etiologies.

Multiphase CTA Collateral Score to Identify Intracranial Atherosclerotic Stenosis-Related Large Vessel Occlusion

Objective: Identification of acute ischemic stroke with large vessel occlusion (AIS-LVO) etiology is crucial for effective revascularization therapy. As collaterals are pivotal in maintaining cerebral perfusion in intracranial atherosclerotic stenosis (ICAS), we investigated whether multiphase CT angiography (mCTA) collateral score can be a diagnosis marker of ICAS-related LVO. Methods: We reviewed clinical and imaging data from 92 patients who presented with AIS-LVO and underwent mCTA (57 ICAS-related LVO and 35 embolic LVO). Logistic regression was used to identify ICAS-related LVO. The diagnostic accuracy of the mCTA collateral score for identifying ICAS-related LVO was determined using receiver operating characteristic (ROC) analysis. Results: Compared with patients with embolic LVO, those with ICAS-related LVO had a high median mCTA collateral score (4 vs. 3; P&lt;0.0001). The multinomial logistic regression analysis revealed a significant increase in the mCTA collateral score (OR: 3.717, 95% CI: 2.009-6.876, P&lt;0.0001) in patients with ICAS-related LVO. ROC analysis revealed that the optimal cutoff point of the mCTA collateral score to diagnosis the ICAS-related LVO was 3.5, the area under the curve (AUC) was 0.817 (95% CI: 0.736-0.899; P&lt;0.0001), sensitivity was 80.7%, and specificity was 74.3%. Further analysis revealed that patients with a 4 to 5 mCTA collateral score exhibited a significantly higher median modified Rankin Scale (mRS) at discharge compared with those with a 0 to 3 score (P=0.0464). Conclusions: The mCTA collateral score may be associated with ICAS-related LVO and could be beneficial in identifying the etiology of AIS-LVO.

Processing and Evaluation of Paneer from Coconut Milk and Cow Milk Blends

Paneer is an Indian traditional milk product which occupies an important place as a base product for the production of various culinary preparations. Paneer is a nutritious and wholesome food. It provides one of the methods of conserving, preserving and prolonging shelf life of milk solids in a highly concentrated form.For coagulation of milk 1% of lime juice, which contains citric acid. The shelf life of the developed product during room temperature (3 days) and refrigerated condition. The present study was under taken with different levels (90:10, 80:20, 70:30) of cow milk and coconut milk. Chemical quality (moisture, fat, protein, and yield) and microbial quality (TPC, yeast and mould, coliform) were also analyzed. The coconut paneer with 90:10 ratio of cow milk and coconut milk was found to be best among others. Thus as far as product acceptability judged by organoleptic evaluation the treatment can be rated as P0 &gt; P1&gt; P2&gt; P3. The fresh cow milk paneer (P0) chemical constituents were 50.78 g of moisture, 0.22% of acidity, 5.3 of pH, 20.39 g of protein, 22.8 g of fat, 0 g of fibre, 198 mg /100 g of calcium, 2.2 mg /100 g of iron respectively. The coconut paneer prepared by 10% coconut milk blending with 90% cow milk, the P1 sample chemical constituents were 52.05 g of moisture, 0.20% of acidity, 5.6 of pH, 20.55 g of protein, 23.75 g of fat, 0 g of fibre, 192mg /100 g of calcium, 3.12 mg of iron respectively. The overall acceptability score was observed as highly acceptable with score point of 8.4±0.70in P1 when compared to control P0 was 8.1±0.73. The unit cost production of 100 g of the functional coconut paneer was Rs.25/100gwhereas control was Rs.22/100 g of packets respectively.

CTNI-27. SYSTEMIC DELIVERY OF LOW ENERGY RADIOFREQUENCY ELECTROMAGNETIC FIELDS FOR THE TREATMENT OF PATIENTS WITH PRIMARY BRAIN TUMORS

Abstract BACKGROUND Tumor Treating Fields plus maintenance temozolomide (mTMZ) showed a survival advantage in the first-line glioblastoma (GBM) treatment. The survival benefit remains limited in patients with unmethylated MGMT gene promoter. The AutEMsys device emits low-energy amplitude modulated systemic electromagnetic fields (EMF) at patient specific frequencies. It is an outpatient procedure that can be integrated with mTMZ. METHODS This study involved a prospective compassionate access program targeting adult GBM patients using an intrabuccal EMF exposure via AutEMsys in addition to chemoRT+mTMZ. The program explored the effects on survival and patients’ reported quality-of-life (QOL) by EORTC-QL-C30. Patients underwent a 90-minute session of EMF exposure therapy repeated every 2 weeks until progression, deterioration in QOL or death. All patients had pathological specimens for diagnosis, IDH mutation status through NGS techniques, and MGMT promoter region methylation status. RESULTS 31 participants were enrolled, including 29 with GBM and 2 with diffuse midline glioma. 14 patients (45%) received EMF+chemoRT followed by EMF+mTMZ and 17 patients (55%) received EMF+mTMZ (post chemoRT). Survival time was measured from the start of mTMZ to the date of the last follow-up. The median overall survival (mOS) for all 31 patients was 26.0 months (95% CI: 14.4 – 37.2 months). Specifically for 21 patients with unmethylated MGMT, the mOS was 25.0 months (95% CI: 15.9 – 34.1 months). Similarly, for the 28 patients with IDH wildtype status, the mOS remained 26.0 months (95% CI: 9.6 – 42.4 months). The addition of AutEMsys with chemoRT+mTMZ demonstrated an improved role functioning in 79% of patients with 25% of these with &amp;gt;10-point score. CONCLUSION The AutEMsys device has shown promising initial results when added to chemoRT+mTMZ treatment of GBM. These findings warrant further prospective investigation and validation in a multicenter clinical trial setting.

Survey of fear and compliance of Insulin Degludec and Insulin Aspart injection in type 2 diabetes mellitus patients and analysis of influencing factors.

This study aims to investigate the fear and compliance of Insulin Degludec and Insulin Aspart (IDegAsp) injection in type 2 diabetes mellitus (T2DM) patients and study the factors influencing patient compliance. A total of 120 patients with T2DM treated from February 2019 to March 2022 were investigated and analyzed for fear and compliance on the Diabetes Fear of Injecting and Self-testing Questionnaire of diabetic patients and were divided into compliance and noncompliance groups according to the results to analyze the factors affecting patient compliance. The study found a high level of fear of IDegAsp injection among the 120 T2DM patients, with an average Diabetes Fear of Injecting and Self-testing Questionnaire score of (39.19 ± 4.59) points. Scores for medication compliance, dietary compliance, blood sugar monitoring, and lifestyle changes were (10.48 ± 1.52) points, (12.18 ± 2.27) points, (0.84 ± 0.12) points, and (9.13 ± 2.21) points, respectively. There was no significant difference between the compliance and noncompliance groups in terms of gender, age, lifestyle, educational level, occupation, current treatment method, family monthly income per capita, and medical payment method (P > .05). However, there were significant differences influenced by disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status (P < .05). Multifactorial analysis showed that educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status all affected patient compliance (P < .05). Educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status are important factors affecting the fear and treatment compliance of IDegAsp injection in T2DM patients. These findings have implications for improving patient compliance and alleviating treatment fear.

The Efficacy of the Psychiatry Clerkship in Developing Students' Comprehensive Clinical Skills.

This study investigates the impact of the psychiatry rotation in developing students' clinical skills that are applicable across various medical specialties. Medical students at Saint Louis University completed the same survey before and after completing a 3½-week psychiatry rotation. Students rated 18 statements on a Likert scale. Statements were grouped into six categories to assess students' confidence in (1) managing medical issues of psychiatric patients, (2) addressing injurious behaviors, (3) gathering a clinical history, (4) de-escalating crises, (5) self-regulating emotions, and (6) empathizing with patients. Students' pre- and post-survey numerical responses were added within the six categories and compared using paired t-tests. Forty-three students completed both the pre-clerkship and post-clerkship surveys. For all six clinical skills categories, post-survey composite scores significantly increased. Managing medical complaints had a 7-point median score increase. Addressing injurious behavior had a 3-point median increase. Gathering a clinical history had a 4-point median increase. De-escalating crises had a 4-point median increase. Emotional self-regulation had a 2-point median increase. Empathizing with patients had a 2-point median increase. All six paired t-tests between pre- and post-surveys showed p-values < 0.001, indicating subjective improvement in students' performance for each clinical competency. The psychiatry rotation effectively increased medical students' perceived acquisition of essential clinical skills. These competencies, including gathering a history, emotionally self-regulating, and de-escalating crises, apply to nearly all medical specialties. Further research is needed to investigate which specific opportunities helped students develop these skills and the broader strengths of the psychiatry clerkship.

Evaluation of burning detection using modified VGG19 for LULC classification changes

Abstract. This study aims to evaluate the effectiveness of a modified architecture of convolutional neural network (CNN) VGG19 for detecting fires and changes in land use and land cover classification (LULC). Remote sensing data from the Landsat 8 Operational Land Imagery (OLI) satellite was used to collect images from two distinct regions, one of which was used to obtain a dataset containing 1000 labeled images, and the other region was used to perform inference and verify the generalization of the model in an area with a high annual occurrence of fires. Analyses were conducted using a time series of normalized difference vegetation index (NDVI) and complementary cumulative distribution function (CCDF), to determine the potential for analysis in that area and define the periods of burning, pre-burning and post-burning. The VGG19 architecture was modified to maintain the input sizes of the images, resulting in a significant increase of 20.90 percentage points in the F1 score compared to the original architecture, as well as a 68.76% reduction in convergence time. In addition, the Gradient-weighted Class Activation Mapping (Grad-CAM) technique was used to improve the interpretability of the model at the moment of inference. The proposed methodology offers an approach for detecting burns by altering the LULC classification, and the modified VGG19 showed superior results.

Maximizing the "Functional" in the Functional External Memory Aid Tool for Patient-Centered Treatment Planning in Mild Cognitive Impairment.

The Functional External Memory Aid Tool (FEMAT) is an 11-item performance-based measure that simulates everyday tasks (e.g., medication management) to measure one's use of compensation (e.g., pill organizer). The FEMAT is not a norm-referenced diagnostic tool; rather, it is designed to provide clinicians with information about a patient's function and compensation in a standardized format. To provide further evidence for validity of the FEMAT, the purpose of this study was to conduct a mixed-methods analysis of FEMAT responses to operationalize the types of behaviors elicited during test administration. We adopted an embedded single-case study design to analyze the FEMAT administrations of 12 community-dwelling female participants, ages 73-90 years, who met criteria for mild cognitive impairment. These participants were part of the original validation sample during which they completed the FEMAT (Version 1.0) in a single session with an assessor. Sessions were video-recorded and transcribed. We analyzed the data qualitatively in two phases using theme and subtheme codes and then quantitatively analyzed the data for response trends. Our thematic analysis revealed four themes to operationalize participants' verbal and behavioral FEMAT responses: (a) used an external memory aid (EMA), (b) described using a strategy, (c) discussed memory and comprehension, and (d) discussed functional information. While completing the FEMAT, most participants described using a strategy (85%) and discussed their self-perceived memory and comprehension (33%). Several subthemes also emerged within each theme (e.g., self-perceived memory strengths and barrier). Our analysis suggests that beyond a 4-point item score, the FEMAT elicits behavioral (e.g., used an EMA) and verbal (e.g., discussion of health information) content that may be useful for person-centered treatment planning. This study is part of a comprehensive research agenda establishing the evidence for the validity of the FEMAT to support its use to inform person-centered treatment approaches.