Comfort Ratings Research Articles

Effects of thermal histories on human thermal adaptation to district heating environments: A cross-sectional investigation in the severe cold zone, China

Understanding personalized thermal comfort is critical for creating comfortable indoor environments and achieving energy efficiency. Thermal history has a significant impact on human thermal adaptation, but it has received insufficient attention. Combining field investigation and statistical analysis, this study introduces the thermal neutral rate (TNR) and thermal comfort and acceptability rate (TCAR) to analyze the differences in thermal and humidity responses and adaptability among groups with different thermal histories in northern China. Results show that as subjects acclimatize to indoor environments, their thermal neutral temperature rises, and humid sensation votes approach 'neutral' conditions. Participants with no prior northern thermal history require up to 1 year to adapt to district heating environments, while adaptation to humid environments may take 2–3 years. The thermal neutral temperature of the un-adapted subjects was 18.0 °C, and post-adaptation, it varied within the range of 20.2–21.4 °C. For engineers designing indoor environments, maintaining temperatures within the range of 19.1–22.3 °C meets the comfort and acceptability requirements of participants with different thermal histories in the office. These findings provide evidence for understanding human thermal adaptation mechanisms and give recommended heating temperature ranges for comfortable indoor environments in office buildings in the severe cold zone.

Public Perceptions of Surgeon Attire in Saudi Arabia.

Surgeon attire significantly affects patients' perceptions and can improve patient-surgeon relationships, which are crucial for patient comfort, experience, satisfaction, and treatment adherence. Understanding patient preferences for surgeon attire is essential, particularly in Saudi Arabia, for establishing appropriate dress codes in healthcare institutions. This national cross-sectional study aimed to fill this gap by assessing patient preferences for surgeon attire and its impact on patients' confidence in their surgeons across various medical settings. The study used a questionnaire with 16 questions and images of surgeons in different attire styles, focusing on trust, care, approachability, and comfort ratings. The questionnaire included options like scrubs with a white coat, formal attire, and traditional Saudi attire for male surgeons, and various options including niqab and skirts for female surgeons. The survey had four sections covering ratings, attire preferences, opinions on white coats, and demographic data. A total of 612 patients completed the questionnaires, mainly aged 35-54 (33%). Skirt and niqab and white coat attire for females received the highest ratings. Attire other than scrubs, especially jeans and heels with a white coat, had significantly lower ratings. Scrubs and white coats were the most preferred attire for male (23.7%) and female (17%) surgeons. Additionally, 71.24% of participants agreed that surgeons should wear white coats. In Saudi Arabia, male surgeons are preferred in scrubs and white coats, while female surgeons are preferred in skirts with white coats and niqabs. These preferences reflect notions of formality, professionalism, and cultural influences. Jeans received the lowest ratings, possibly due to perceptions of informality. Patients favor scrubs and white coats for hygiene benefits and conveying dedication and expertise. Future research should validate these findings across diverse cultures and medical fields.

Weighted Vest Combined With Vibrotactile Stimulations Decrease the Sympathetic Activity: A Repeated Measures Study.

Mental and neurological disorders are a growing global concern, further intensified by the COVID-19 pandemic. Stress management techniques, such as deep pressure therapy, have gained attention, with weighted vests commonly used for anxiety relief. However, there is limited scientific evidence supporting their efficacy. This study aimed to rigorously assess the effectiveness of a weighted vest incorporating vibrotactile stimulation in reducing anxiety by measuring physiological indicators-pulse rate and skin conductance (SC)-as well as subjective comfort ratings. A total of 30 final-semester college students participated in the study. Participants wore a vibrotactile-weighted vest, and both pulse rate and skin conductance (SC) were measured to gauge anxiety levels. Additionally, participants rated their comfort using a Comfort Rating Scale (CRS). Changes in pulse rate and SC were statistically analyzed, and effect sizes (Cohen's d) were calculated to assess the magnitude of the intervention's impact. The weighted vest with vibrotactile stimulation resulted in a significant reduction in both pulse rate (dpulse = 0.23-0.62) and SC (dsc = 0.32-0.66), indicating a small to medium effect size in anxiety reduction. Subjective evaluations of the vest using the CRS revealed low scores on discomfort-related items, with participants rating unfavorable statements between 1.5/10 and 4.6/10, suggesting overall comfort during use. This study provides compelling evidence that vibrotactile-weighted vests effectively reduce anxiety, as indicated by both physiological measures and subjective comfort ratings. The findings support the potential of this intervention as a formal therapeutic tool for stress and anxiety reduction. Further research may explore long-term effects and broader applications in clinical settings.

Randomised controlled trial of HOYA one-day multifocal contact lenses: The HOMCL trial

Trial designDouble-masked crossover RCT (Research Registry: #8136) comparison of a new HOYA one-day disposable multifocal contact lens (HOMCL) with Alcon DAILIES TOTAL1® Multifocal (ADT1). MethodsSixty presbyopic participants from three countries attended for baseline measurements and fitting of both lens types and then for a fortnight completed daily diaries of symptoms with habitual optical correction, and VF-14 questionnaire. Participants collected either HOMCL or ADT1, when the vision was measured again, and they wore this product for a fortnight, completing daily diaries and VF-14. Participants then collected the other type and had vision and symptoms recorded in the same way. ResultsThere were no serious adverse events. Primary outcomes were no significant differences between the lens types in willingness to purchase nor stated preference; no significant differences in the daily symptom ratings of comfort; statistically significant findings with the daily symptom ratings and VF-14 of better near vision with HOMCL and better distance vision with ADT1. Secondary outcomes were better high contrast distance visual acuity with ADT1 (<1 line), better low contrast distance visual acuity with ADT1; faster Wilkins rate of reading test with HOMCL; no significant differences in near visual acuity, wearing time, or number of lenses required during fitting process. Exploratory analyses were better handling scores with ADT1; and some, but not all of the dry eye data indicating better acceptance of HOMCL by patients with relatively dry eyes. For all measures, there were some participants who preferred/performed better with each lens type. ConclusionsThe differences between the performance of the two products were small. There was a trend in some clinical measurements and the daily diary data and VF-14 questionnaire, for HOMCL to outperform ADT1 for near vision and vice versa for distance vision.

The use of a novel toe-thumb pressure index for assessing arterial status in the lower limb. A reliability and validity study.

This study explored the reliability, validity and perceived comfort of a novel thumb pressure measure and calculation of a toe-thumb index to identify their suitability as an adjunct or alternatives to ankle-brachial and toe-brachial indices. Repeated manual thumb and toe systolic blood pressures were conducted using two raters, over two time points, on 34 healthy participants. Concurrent automated toe, thumb and brachial systolic blood pressures as well as comfort ratings for these measures (using a 10mm visual analogue scale) were captured once by a research assistant. Automated thumb and brachial measures showed fair correlation (ρ=0.36, p=0.03) and a toe-thumb index and toe-brachial index good correlation (ρ=0.62, p<0.01). Intraclass correlation coefficients (ICC) identified moderate intra-rater reliability for manual thumb pressures for Rater 1 and 2 (ICC 0.57, 95% CI [0.14, 0.79] and ICC 0.74, 95% CI [0.49, 0.87], respectively), while inter-rater reliability was poor (ICC=0.16, 95% CI [-0.85, 0.47]). Concurrent validity comparing manual and automated measures for thumb pressure was also poor (ICC -0.05, 95% CI [-1.06, 0.72] and ICC 0.42, 95% CI [-0.16, 0.72] Rater 1 and 2 respectively). Thumb measures were significantly more comfortable than brachial measures (5mm, p<0.00). Thumb systolic pressures are correlated with brachial systolic pressures, with reasonable intra-rater reliability, however, correlation is only fair and measurement error wider than clinically acceptable. Furthermore, manual measures are poorly correlated with automated units. Consequently, caution is required in applying these techniques. As thumb measures were perceived as significantly more comfortable than brachial measures and have an advantage where brachial pressures cannot, or should not, be obtained, further evaluation is warranted.

Comparison on clinical efficacy and adverse reactions between TPICC and ultrasound-guided PICC for advanced tumors: A retrospective study.

Comparing the differences in efficacy and adverse reactions on the application between tunnel peripherally inserted central catheter (TPICC) and ultrasound-guided peripherally inserted central catheter (PICC) in patients with advanced tumors. A retrospective investigation was conducted to collect treatment data. We randomly selected 200 patients with advanced tumors who were admitted to our hospital from January 2020 to January 2022 as the research subjects. The observation group consisted of 100 cases of tunnel PICC catheterization, while the control group consisted of 100 cases of PICC catheterization. We observed and compared the catheterization time, PICC puncture success rate, intraoperative blood loss, pain degree, comfort level, and postoperative complication rate between the 2 groups. Compared with the control group, there was no significant difference at the distribution of PICC indwelling time in the observation group, and the difference was not statistically significant (P > .05). The success rate on PICC puncture in the observation group was higher than that on the control group (P < .05). Intraoperative bleeding volume and numerical rating scale (NRS) of the observation group were lower than those of the control group (P < .05). At 1 month postoperatively, comfort ratings in the observation group and the control group were lower than those of their same groups at 1 week postoperatively (P < .05); At 1 week and 1 month postoperatively, comfort rating in the observation group were lower than that in the control group (P < .05). The incidence of postoperative complication in the observation group was lower than that in the control group (P < .05). TPICC improves the success rate on puncture and the post-catheterization comfort, it reduces NRS and the risks on complications, which owns high safety.

The individualized optimal pillow height and neck support design for side sleepers.

An optimal pillow effectively increases sleep quality and prevents cervical symptoms. However, the influence of body dimension on optimal pillow design or selection strategy has not been clarified quantitatively. This study aims to investigate the individualized optimal pillow height and neck support for side sleepers. Nine healthy subjects were recruited and laid laterally on foam-latex pillow with four height levels (8 cm, 10 cm, 12 cm, 14 cm) and with/without neck support, respectively. Healthiness was evaluated using cervical spine morphology (measured by motion capturing system) and musculoskeletal internal force (simulated by a multi-body model). Comfortability was evaluated by a deviation standardized overall comfort rating. Individualized pillow height was identified by Hφ (calculated by the subject's shoulder width and absolute pillow height). Correlation analysis and linear mixed model were performed between C1-T1 slope and Hφ. A paired-t test was performed on the cervical curve and comfort score comparisons between neck support pillow and flat pillow. The C1-T1 slope of the cervical curve showed statistically significant correlation to Hφ and was well predicted by Hφ through linear relation (R2 = 0.80 for flat pillow, R2 = 0.82 for neck support pillow). The correlation between comfort score and Hφ was moderate or weak. Medium individualized height pillow (Hφ 9.74-11.76 cm) with neck support showed a cervical curve closest to natural standing and the lowest musculoskeletal internal force. Sub-low individualized height pillow (Hφ 11.76-13.78 cm) with neck support showed the highest average comfort score. For side sleepers, cervical curve morphology and optimal individualized pillow height are well predicted by Hφ. Comfortability perception is not sensitive to Hφ. Sub-low individualized height pillow showed the best comfortability and relatively good healthiness. Medium individualized height pillow with neck support showed the best healthiness.

Efficacy and Safety of a Self-Improved Continuous Bladder Irrigation Sensor Device in Patients after Transurethral Resection of the Prostate: A Prospective Study.

To explore the efficacy and safety of a self-improved continuous bladder irrigation (CBI) sensor device after transurethral resection of the prostate (TURP). A total of 160 patients with benign prostatic hyperplasia who received TURP from June 2021 to May 2022 were selected. According to the envelope randomization method, patients were divided into a control group (80 cases) and study group (80 cases). In the control group, the speed of bladder flushing fluid was adjusted according to the clinical experience of nurses. On the basis of the control group, the self-improved CBI sensor device was used in the study group to observe the postoperative comfort and complication rate in the two groups. The comfort of patients in the study group was significantly higher than that of patients in the control group (97.50% vs. 88.75%, P = .023), and the number of postoperative complications in the control group was significantly higher than that in the study group (8.75% vs. 1.25%, P = .021). Meanwhile, the average amount of irrigation fluid in the study group was obviously lower than that in the control group (26.4 L vs. 27.8 L, P = .011). In addition, patients in the study group had a significantly shorter hospital stay than the controls (3.3 days vs. 3.6 days, P = .005). Implementation of the new self-improved CBI sensor device for patients after TURP can improve their awareness regarding disease-related knowledge, alleviate their fear and anxiety, improve their compliance and comfort with treatment and nursing, and reduce the incidence of complications.

Feasibility and acceptability of switching from a previous-generation to a new-generation mask for positive airway pressure therapy of sleep apnea using remote care

PurposeMask selection could affect an individual's experience with positive airway pressure (PAP) treatment for obstructive sleep apnea, but there is very limited data on the impact of switching to a different mask once established on PAP therapy. This study investigated the patient's experience when switching from a previous-generation PAP mask to a new-generation mask via remote care. MethodsA new-generation mask (AirFit F30i or AirFit N30i) was successfully fitted to 215 participants during video conferencing sessions. Participants completed online questionnaires on day 1, day 3, day 7, day 30 and day 90 after mask switch to collect subjective feedback and quality of life data; objective PAP device data were also downloaded. ResultsResidual apnea-hypopnea index showed statistically significant difference from baseline at day 30 (+0.2 ± 0.9/h [p = 0.026]) and day 90 (+0.2 ± 0.8/h [p = 0.006]), however unlikely to be clinically relevant. Average daily usage was significantly increased from baseline at day 30 (+0.2 ± 1.2 h/day [p = 0.010]) but not day 90 (+0.1 ± 1.0 h/day [p = 0.126]). Functional Outcomes of Sleep Questionnaire (FOSQ-10) score was significantly higher at day 90 (change from baseline to day 90: +0.48 ± 2.29 [p = 0.015]). Subjective ratings for comfort, seal, and usability of the new-generation mask were significantly better than the predefined acceptability level. Rates of PAP-related side effects were generally acceptable. ConclusionRemote management of mask change was associated with good outcomes in terms of objective device data and patient acceptability. This approach could be used to improve the overall therapy experience for individuals requiring a PAP therapy mask change for any reason. Clinical trial registrationhttp://clinicaltrials.gov (NCT05262439).

Dynamic response and vibration suitability analysis of the large-span double-connected structure under coupled wind and pedestrian loads

Modern buildings increasingly utilize lightweight, high-strength materials and feature high-rise, large-span structural designs. These structures often exhibit low natural frequencies and are susceptible to resonance from low-frequency dynamic loads such as wind and pedestrian loads. This paper focuses on a large-span double-connected structure and analyzes its dynamic response under the combined effects of wind and pedestrian loads. First, a finite element model of the structure was created using ANSYS, and model validity verification and modal analysis were performed. Second, a Fourier-based pedestrian model was used to simulate pedestrian loads and generate time-range data. The pulsating wind speed was generated from the Davenport spectrum using the harmonic superposition method. Wind load time-range data were calculated for different heights using Bernoulli’s theorem. Finally, the solution yields information about the dynamic response of the structure. The study revealed maximum vertical comfort ratings in the connecting corridor were achieved when crowd density did not exceed 0.3 persons/m2. The connecting corridor’s most unfavorable horizontal comfort level was evaluated as a medium, except for the 0-degree wind angle condition. This paper provides experience in studying the dynamic response and vibration suitability assessment of the large-span double-connected structure under wind and pedestrian loads.

Medical Metaphors That May Reinforce Misconceptions Are Associated With Increased Trust in the Clinician.

This study measured patient reactions to medical metaphors used in musculoskeletal specialty offices and asked: (1) Are there any factors associated with patient thoughts and emotions in response to common metaphors? (2) Is there a difference between patient ratings of metaphors rated as potentially reinforcing misconceptions and those that are more neutral? In a cross-sectional study, 228 patients presenting to multiple musculoskeletal specialty offices rated reactions to 4 metaphors presented randomly from a set of 14. Two were categorized as potentially reinforcing common misconceptions and 2 as relatively neutral. Bivariate tests and multivariable regression identified factors associated with patient ratings of levels of emotion (using the standard assessment manikins) and aspects of experience (communication effectiveness, trust, and feeling comfortable rated on 11-point ordinal scales) in response to each metaphor. Levels of patient unhelpful thinking or distress regarding symptoms were not associated with patient ratings of patient emotion and experience in response to metaphors. Metaphors that reinforce misconceptions were associated with higher ratings of communication effectiveness, trust, and comfort (P < .05). The observation that metaphors that validate a person's understanding of his or her illness may elicit trust even if those metaphors have the potential to reinforce misconceptions may account for the common usage of such metaphors. Clinicians can work to incorporate methods for building trust without reinforcing misconceptions.

The effect of the EXOPULSE Mollii Suit on pain and fibromyalgia-related symptoms-A randomized sham-controlled crossover trial.

Fibromyalgia pain and related symptoms are poorly managed by approved pharmacological and alternative interventions. This trial aimed to evaluate the effects of the EXOPULSE Mollii Suit-a multisite transcutaneous electrical nerve stimulation device-on fibromyalgia pain, fatigue, affective symptoms, disease impact, and quality of life. Adult patients with fibromyalgia were enrolled. Phase 1 implied a randomized, sham-controlled, cross-over, double-blind trial, applying daily 1 h sessions of active or sham intervention, over 2 weeks (2-week washout). In the open-label phase 2, all patients received daily active intervention for 4 weeks. Comparisons on pain, fatigue, disease impact, affective symptoms, quality of life, clinical impression, and comfort ratings were performed using Friedman, Wilcoxon signed rank, and Chi2 tests. Thirty-three patients completed the study (93.9% female, mean age: 51.3 years). Pain (primary endpoint assessed via a visual analog scale) was significantly reduced after the active (pre-active: 6.9 ± 1.4, post-active: 5.9 ± 1.8, pre-sham: 6.8 ± 1.4, post-sham: 6.6 ± 1.5) versus the sham intervention (X2 = 10.60, p = 0.014). This was also the case of other secondary endpoints (i.e., fatigue, anxiety, and disease impact), except depression and quality of life. The Clinical Global Impression of Change (CGI-C) was significantly different between the active and sham intervention periods (X2 p = 0.035), and the different proportions of categories were as follows: 'worsening' (sham: 18.2% vs. active: 0.0%), 'improvement' (sham: 48.5% vs. active 63.6%) or 'no change (sham: 33.3% vs. active 36.4%) respectively. After phase 2, significant positive effects were observed for most of the outcomes, and 78.8% of patients reported improvement according to CGI-C. This study suggests the clinical benefits of the EXOPULSE Mollii Suit in alleviating pain and fibromyalgia-related fatigue, emotional symptoms, and disease impact. It is worth noting that the study has several limitations related to the low number of participants, the short-term analysis of effects in the first blinded and controlled phase, and the open-label nature of phase 2. Future studies with a larger cohort and longer protocol treatment are needed, to further confirm the current results, and evaluate the long-term effects of this technique. Patients with fibromyalgia suffer from pain as well as fatigue, sleep impairment, emotional disturbances, and altered quality of life. Transcutaneous electrical nerve stimulation might help manage those symptoms, but the available systems are limited by the fact that they could be applied at best over two sites. This randomized controlled study is the first to apply a multi-site transcutaneous electrical nerve stimulation device, the EXOPULSE Mollii Suit, with significant effects on fibromyalgia pain and related symptoms.

National Park visitors perceive benefits for themselves and wildlife under blended red-white outdoor lighting

Visitors to Colter Bay Village in Grand Teton National Park were surveyed to elicit their evaluations of experimental outdoor lighting conditions. Luminaires capable of dimming and switching between two LED modules (white, blended red-white) were installed in street and parking areas. The blended red-white lamps consisted of 30 narrowband LED with a peak wavelength 623 nm and two 3000 K white LEDs. Similar “red” lamps were previously shown to reduce impacts to bats and insects. The white and red lamps were closely matched for luminance. Measured horizontal illuminance at survey locations had an interquartile range from 0.63 to 3.82 lx. The red lamps produced lower perceived brightness (VB2(λ)), even after reflection off asphalt, yet survey participants expressed higher ratings for visual comfort and safety under red lighting. Surveys conducted earlier in the evening, with higher levels of predicted solar and measured horizontal illuminance, rated higher on visual comfort and safety, though these correlations were not as strong as the effect of lamp color. Streetlight ratings and support for lighting that protected natural resources were not contingent upon age or gender. Survey participants assessed red lighting as more protective of the environment. These results demonstrate that outdoor lighting designed to reduce ecological impacts can yield superior nocturnal experience for pedestrians.

Subjective impressions with myopia control contact lenses versus single vision lenses: A systematic review and meta-analysis

PurposeTo gain insight into patients’ visual experiences and satisfaction when using different forms of myopia control lenses. MethodsPubMed, Cochrane Library, Embase, Scopus and Web of Science databases were searched for articles assessing subjective visual quality with myopia control lenses compared with single-vision lenses (SVLs) up to July 10, 2023. Eight-hundred-and-three articles were retrieved, reviewed and any questionnaire items on subjective impressions of lens wear were meta-analysed. Subgroup analyses were based on the magnitude of defocus (add power) of multifocal soft contact lenses (MFSCLs) and age groups. A random-effects model was employed for meta-analysis, and I2 statistic used to assess the statistical heterogeneity. ResultsNineteen articles fit the criteria, but only six articles involving MFSCLs had relevant data. MFSCLs were associated with lower subjective ratings of vision at different distances compared to SVLs (p < 0.001), but the differences were less than one unit. MFSCLs also yielded lower ratings when moving or walking and/or climbing stairs at −0.38 (−0.69 to −0.07, p = 0.02; I2 = 85 %, p < 0.001) and for subjective comfort (difference of −0.23, −0.41 to −0.05, p = 0.01; I2 = 63 %, p < 0.001). Subjective ratings for playing sports were not different between groups. Experience with MFSCLs was rated lower by young adults compared to children for all variables. In both children and young adults, ratings were lower with higher add compared to lower add MFSCLs. ConclusionAlthough subjective ratings for vision and comfort were lower with MFSCLs compared to SVLs, the difference was mostly less than one unit. Importantly, young adults rated their visual experience lower compared to children.

Pressure-Relieving Effect of Different Insole Top Covers in People with Diabetes at High Risk of Foot Ulceration.

Pressure-relieving footwear helps prevent foot ulcers in people with diabetes. The footwear design contributes to this effect and includes the insole top cover. We aimed to assess the offloading effect of materials commonly used as insole top cover. We measured 20 participants with diabetes and peripheral neuropathy for in-shoe peak pressures while walking in their prescribed footwear with the insole covered with eight different materials, tested in randomized order. Top covers were a 3 mm or 6 mm thick open or closed-cell foam or a 6 mm thick combination of open- and closed-cell foams. We re-assessed pressures after one month of using the top cover. Peak pressures were assessed per anatomical foot region and a region of interest (i.e., previous ulceration or high barefoot pressure). Walking comfort was assessed using a 10-point Likert scale. Mean peak pressure at the region of interest varied between 167 (SD:56) and 186 (SD:65) kPa across top covers (p < 0.001) and was significantly higher for the 3 mm thick PPT than for four of the seven 6 mm thick top covers. Across 6 mm thick top covers, only two showed a significant peak pressure difference between them. Over time, peak pressures changed non-significantly from -2.7 to +47.8 kPa across top cover conditions. Comfort ratings were 8.0 to 8.4 across top covers (p = 0.863). The 6 mm thick foams provided more pressure relief than the 3 mm thick foam during walking in high-risk people with diabetes. Between the 6 mm thick foams and over time, only small differences exist. The choice of which 6 mm thick insole top cover to use may be determined more by availability, durability, ease of use, costs, or hygienic properties than by superiority in pressure-relief capacity.

An evaluation of a bespoke modified UCBL foot orthosis on subjects with flat foot using kinetic measurements and user comfort scores: A randomized controlled trial

AimThe purpose of this study was to assess and evaluate the effect of a bespoke Modified UCBL Foot Orthosis (MUFO) using both kinetic parameters (Centre of Pressure (CoP) and the Ground Reaction Force (GRF) pattern) and comfort scores in subjects diagnosed with flat foot. MethodThis study included thirty-four young adults with symptomatic flatfeet. Two Kistler force plates (100 Hz) were used to record the CoP sway and GRF pattern during four conditions; 1) an MUFO and standard-fit shoe; 2) the University of California-Berkley Lab (UCBL) insole and standard-fit shoe; 3) barefoot and 4) standard-fit shoe only. The magnitude of subject comfort with UCBL and MUFO also was measured by a 10 cm Visual Analogue Scale (VAS) during walking. ResultsThe MUFO decreased mean lateral displacement in the initial phase and midstance of gait compared to barefoot walking. During the propulsion phase use of the new MUFO produced more lateral excursion with a mean difference of 3 mm) P < 0.001(compared to barefoot walking and standard shoe wear. No significant difference in comfort rate was found between the MUFO and UCBL (P = 0.165). ConclusionThe MUFO produced effective pronation control and decreased the CoP displacement in all of stance phase.

Retrospective Review of Postpartum Lithium Use Including During Lactation.

Introduction: Lithium remains a gold standard treatment for bipolar disorder including during peripartum. Historically, guidelines advised against breastfeeding while taking lithium though recent data suggest it is acceptable for a healthy infant. Lack of awareness of acceptability contributes to decreased patient and clinician comfort and low breastfeeding rates. We report current breastfeeding rates, monitoring practices, and infant outcomes with lithium exposure in breastmilk at our institution. Methods: A retrospective chart review was conducted at a single academic medical center using records from 2013 to 2023. Electronic medical records were queried to identify patients prescribed lithium postpartum. Data were collected on timing of lithium initiation, lithium dose and concentration, breastfeeding status, and infant outcomes. Results: A total of 18 cases of lithium use in the postpartum period were identified. A total of 39% (n = 7) of patients taking lithium postpartum breastfed. Most patients, 61% (n = 11), initiated lithium prior to pregnancy, 11% (n = 2) initiated during pregnancy and 27% (n = 5) started postpartum. Four infant charts were reviewed with no reports of adverse events. Of these infants, average maternal lithium dose was 750 mg daily, with an average maternal serum lithium concentration of 0.62 mmol/L and average infant serum lithium concentration of 0.16 mmol/L. Conclusion: Our data demonstrate most patients using lithium postpartum have been taking lithium long-term and are not breastfeeding. Lithium exposure in breastmilk appears to be tolerated by healthy infants. There is a need for ongoing research and education on acceptability and infant monitoring recommendations to support patients who would like to breastfeed while on lithium.

Application of Silver-Containing Mesh Lipid Hydrocolloid Dressing in Tension Blisters Following Extremity Fractures

Objective: To evaluate the application value of silver-containing mesh lipid hydrocolloid dressing in tension blisters following extremity fractures. Methods: 60 patients with extremity fractures were selected as samples, all of whom had tension blisters. The study period was from September 2022 to September 2023, and they were grouped according to the random number table method. Group A received silver-containing mesh lipid hydrocolloid dressing, while Group B received routine nursing. Results: The healing time and operation time of Group A were shorter than those of Group B, and the number of operations was less than that of Group B (P &lt; 0.05). The quality of life (SF-36) score of Group A was higher than that of Group B (P &lt; 0.05). The skin injury rate of Group A was lower than that of Group B, and the comfort rate was higher than that of Group B (P &lt; 0.05). Conclusion: The intervention of silver-containing mesh lipid hydrocolloid dressing in patients with extremity fractures can promote the recovery of tension blisters, improve the comfort of patients, and reduce skin lesions, which is efficient and feasible.

Comparison of dental force applied during endotracheal intubation with hyper-angulated and macintosh-type video laryngoscopy blades used by emergency medicine trainees: A randomized cross-over manikin study.

This study aimed to compare the effects of Macintosh-type and hyperangulated video laryngoscopy (VL) blades on dental force during endotracheal intubation (ETI) using Glidescope and McGrath VL devices. In this randomized, crossover, manikin study conducted at a university emergency medicine (EM) program, 65 EM trainees included interns and residents performed 520 intubations using four different VL blades (GlideScope VL with Macintosh-type Mac T3 and hyperangular Lo Pro T3 blades and McGrath VL Macintosh-type MAC 4 and hyperangular McGrath X3 blades) in normal and difficult airway scenarios. The primary outcome of this study was the dental pressure (Newton) exerted during ETI. The secondary outcomes included c-spine motion (degree), intubation success (%), duration (seconds), successful glottic view (%), and intubator comfort (7-point Likert). Significant differences were observed in dental force (H(3) = 11.7, P = 0.008), c-spine motion (H(3) = 8.34, P = 0.039), duration (H(3) = 16.56, P = 0.001), and comfort (H(3) = 174.96, P < 0.001) across blade types. Glidescope LoPro T3 provided a significant lower dental force (adjusted P = 0.01), less c-spine motion (adjusted P = 0.031), and shorter intubation duration (adj P < 0.01) than the McGrath Mac 4. First attempt success and intubator comfort were significantly better with all Glidescope blades (z score of 3.7 and 4.7) than with McGrath blades (z score of-4.1 and-4.4). The Glidescope LoPro T3 blade demonstrated advantages in dental force, c-spine motion, and intubation duration compared with McGrath Mac 4. Overall, the Glidescope blades provided superior comfort and higher first attempt success rates.

Optimization scheduling for low-carbon operation of building integrated energy systems considering source-load uncertainty and user comfort

Hydrogen, being a clean energy source, presents novel possibilities for the efficient exploitation of building energy. Nevertheless, the unpredictability in the production of renewable energy, the fluctuating demand from users, and the varying comfort needs within buildings provide substantial obstacles to the functioning of building energy systems. This work suggests an optimal technique for managing a comprehensive energy system based on hydrogen. The strategy takes into account the variability in energy sources and the need for user satisfaction. Firstly, a model of building integrated energy system (BIES) is created, which includes devices for utilizing hydrogen due to its adaptable qualities. Afterwards, the adaptable attributes of electrical, cooling, and heating loads within the building are carefully examined, resulting in the creation of a integrated demand response (IDR) model and a user-integrated comfort rating model. Moreover, a ladder-type carbon tax framework is implemented, employing robust optimization methods to tackle uncertainty in the production of renewable energy and demand. Finally, a model for optimizing the scheduling of energy system operation is formulated. A case analysis is performed utilizing a spacious office building located in the northern region as an instructive example. The findings indicate that the suggested approaches successfully control user involvement in demand response, decrease carbon emissions in the system, improve user energy comfort, and accomplish the economic, low-carbon, and comfortable functioning of BIES.