Rigorous Design Research Articles

Deprescribing as a Way to Reduce Inappropriate Use of Drugs for Overactive Bladder in Primary Care (DROP): Protocol for a Cluster Randomized Controlled Trial With an Embedded Explanatory Sequential Mixed Methods Study.

Potentially inappropriate medication remains a significant concern in general practices, particularly in the context of overactive bladder (OAB) treatment for individuals aged 65 years and older. This study focuses on the exploration of alternative options for treating OAB and the deprescribing of anticholinergic drugs commonly used in OAB. The research aims to comprehensively evaluate the efficiency of deprescribing through a mixed methods approach, combining quantitative assessment and qualitative exploration of perceptions, experiences, and potential barriers among patients and health care personnel. This study aims to evaluate the efficiency and safety of the intervention in which health care staff in primary care encourage patients to participate in deprescribing their drugs for OAB. In addition, we aim to identify factors contributing to or obstructing the deprescribing process that will drive more informed decisions in the field of deprescribing and support effective and safe treatment of patients. The drugs for overactive bladder in primary care (DROP) study uses a rigorous research design, using a randomized controlled trial (RCT) with an embedded sequential explanatory mixed methods approach. All general practices within the North Denmark Region will be paired based on the number of general practitioners (GPs) and urban or rural locations. The matched pairs will be randomized into intervention and control groups. The intervention group will receive an algorithm designed to guide the deprescribing of drugs for OAB, promoting appropriate medication use. Quantitative data will be collected from the RCT including data from Danish registries for prescription analysis. Qualitative data will be obtained through interviews and focus groups with GPs, staff members, and patients. Finally, the quantitative and qualitative findings are merged to understand deprescribing for OAB comprehensively. This integrated approach enhances insights and supports future intervention improvement. The DROP study is currently in progress, with randomization of general practices underway. While they have not been invited to participate yet, they will be. The inclusion of GP practices is scheduled from December 2023 to April 2024. The follow-up period for each patient is 6 months. Results will be analyzed through an intention-to-treat analysis for the RCT and a thematic analysis for the qualitative component. Quantitative outcomes will focus on changes in prescriptions and symptoms, while the qualitative analysis will explore experiences and perceptions. The DROP study aims to provide an evidence-based intervention in primary care that ensures the deprescription of drugs for OAB when there is an unfavorable risk-benefit profile. The DROP study's contribution lies in generating evidence for deprescribing practices and influencing best practices in health care. ClinicalTrials.gov NCT06110975; https://clinicaltrials.gov/study/NCT06110975. DERR1-10.2196/56277.

A visual art intervention program for older people with stroke in residential care settings: A feasibility study.

Stroke poses challenges to the physiological, psychosocial and spiritual well-being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well-being. This was a single-blinded, two-arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well-Being Scale and Caring Factor Survey were used in the study, with three assessment time-points: before the intervention (T1), at the mid-point of the intervention (T2) and immediately after the intervention (T3). Sixty-one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well-being has yet to be confirmed.

Individual, family, and environmental correlates of fundamental motor skills among school-aged children: a cross-sectional study in China

ObjectiveThis cross-sectional study examined the socio-ecological factors influencing fundamental motor skills (FMS) in Chinese school-aged children.MethodsA total of 1012 parent-child pairs were randomly sampled between March-1st and April-15th, 2022. Based on the socio-ecological model of Children’s FMS, three levels of factors: individual-level (e.g., demographic, physical, psychological, and behavioral characteristics of children), family-level (e.g., caregiver demographics, parental support, and socioeconomic status), and environmental factors (e.g., availability of physical activity equipment) were assessed using self-reported scales (e.g., the Self-perception Profile for Children, the Physical Activity Enjoyment Scale, and the 12-item Psychological Well-Being Scale for Children) and objective measures (e.g., ActiGraph GT3X, the Chinese National Student Physical Fitness Standard, and the Test of Gross Motor Development-Third Edition). Multi-level regression models were employed using SPSS.ResultsThe results demonstrated that children’s age, sex, physical fitness, parental support, and the quality of home and community physical activity environments consistently influenced all three types of FMS, including locomotor, ball, and composite skills. Additionally, seven individual-level factors (children’s age, sex, body mass index, light physical activity, sleep duration, perceived motor competence, and physical fitness) were associated with different types of FMS.ConclusionsThe findings underscore the multidimensional and complex nature of FMS development, with individual-level factors playing a particularly significant role. Future research should adopt rigorous longitudinal designs, comprehensive assessment tools covering various FMS skills, and objective measurement of parents’ movement behaviors to better understand the strength and direction of the relationship between socio-ecological factors and children’s FMS.

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

BackgroundIt is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care.MethodsTwo authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software.ResultsA total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger’s test (all P > 0.05).ConclusionsHeparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.

Enhancing pharmaceutical wastewater treatment: Ozone-assisted electrooxidation and precision optimization via response surface methodology

Amid the critical global demand for effective wastewater treatment, our study presents a pioneering approach to address pharmaceutical wastewater treatment. We exploited the potential of electrooxidation (EO) and introduced an innovative process with ozone-assisted electrooxidation (EO/O3), using Pt-coated Ti electrodes (Pt/Ti). The core aim is to tackle the removal of organic pollutants in terms of chemical oxygen demand (COD), color, and the UV absorption peak at 300 nm (UV300). This endeavor took place in a carefully controlled batch-mode reactor. Rigorous experimental design and optimization methodology was conducted using the cutting-edge statistical tool known as the Box-Behnken Design (BBD). Using current density, initial pH, and electrolysis time as independent variables in our statistical models resulted in remarkable outcomes. Under optimized conditions (110.63 A m−2 current density and pH 4.5 in 477 min), our stand-alone electrooxidation effectively reduced COD by 70.5 %, color by 81.25 %, and decreased UV300 by 40.01 %. However, when ozone joined the stage to assist the electrooxidation, the performance raised to new heights. It achieved an impressive 84 % reduction in COD, a remarkable 99.43 % color decrease, and a significant 49.63 % drop in UV300 under optimized conditions (150 A m−2 current density and pH 8.79 in 480 min). In addition, this study was further distinguished by the positive results obtained in the kinetic analysis. The findings showcase ozone-assisted electrooxidation as a highly effective approach for pharmaceutical wastewater treatment, emphasizing the novelty and significance of this study.

Sandpack flooding of microwave absorbent nanofluids under electromagnetic radiation: an experimental study

AbstractElectromagnetic (EM) radiation has long been recognized as an effective method for enhancing the quality and recovery of heavy and extra-heavy crude oil. The incorporation of EM absorbers, particularly nanoparticles, has demonstrated significant potential to boost efficiency and expand the stimulated reservoir volume. However, the application of simultaneous EM radiation and nanofluid injection in a natural porous medium, which is critical for the successful implementation of this approach in field-scale operations, remains an underexplored frontier. In this context, this research represents a pioneering endeavor, aiming to bridge this knowledge gap through a comprehensive statistical and optimization study. The primary objective was to unravel the intricate interplay between five distinct types of magnetic nanoparticles and their concentrations within the base fluid to improve oil production. Notably, it focused on iron oxide (Fe3O4) magnetic nanoparticles and their innovative hybridization with multi-walled carbon nanotubes (MWCNT) and nickel oxide (NiO) nanomaterial. A newly designed glass sandpack was employed as the porous medium, thus mirroring real reservoir conditions more accurately. Then, a rigorous full factorial design scrutinized the multifaceted effects of nanoparticle type and concentration when introduced into deionized water during this process. The results showed that microwave radiation, applied at 400 W, dramatically improved oil recovery, catapulting it from a baseline of 19% to an impressive 39.5% during water injection. The addition of magnetic nanoparticles to the base fluid enhances efficiency. However, the specific type of nanoparticle exerts varying effects on oil recovery rates. Notably, the synthesis of Fe3O4–MWCNT nanoparticles had a substantial impact on the ultimate oil recovery factor, achieving approximately 69%. Furthermore, the hybridization of Fe3O4 nanoparticles with MWCNT and NiO nanoparticles leads to reduced consumption (using low weight percentages) while achieving the highest oil recovery rates during the injection process. Finally, the optimization analysis demonstrated that employing 0.34 wt.% of Fe3O4–MWCNT nanoparticles under 400 W of microwave radiation represents the optimal condition for achieving the highest oil production in a sandpack porous medium. Under these conditions, the oil recovery factor can increase to 78%.

Physical activity interventions to increase children's social and emotional learning: A systematic review and meta‐analysis based on the comprehensive school physical activity programme framework

AbstractMounting evidence from intervention research suggests that physical activity (PA) may contribute to children's social and emotional learning (SEL), which is an essential factor in healthy development and well‐being. However, there have been no systematic reviews or meta‐analyses of PA interventions and their effects on children's SEL. Such research is necessary to assess the growing knowledge base in this area and recommend future directions for research and practice. Based on the comprehensive school physical activity programme (CSPAP) framework, we conducted a systematic review and meta‐analysis of PA interventions to increase elementary school children's (5–12 years) SEL. Following the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) guidelines we searched six electronic databases for articles during 12–30 April 2021. A total of 32 studies were included in the review and 26 studies were included in the meta‐analysis. The meta‐analysis revealed a small to moderate effect of CSPAP‐aligned PA interventions on SEL (Hedges' g = 0.44). However, there was considerable heterogeneity across studies. PA interventions to increase children's SEL show promise but continued investigation is needed with large sample sizes and rigorous randomised designs. Using the CSPAP framework to guide interventions may facilitate an understanding of how to maximise PA opportunities to enhance children's SEL.Context and implicationsRationale for this studyNumerous intervention studies consistently underscore the positive impact of physical activity (PA) on children's social and emotional learning (SEL). However, a notable gap exists: there are no systematic reviews or meta‐analyses that directly examine the effects of PA interventions on children's SEL within the context of the comprehensive school physical activity programme (CSPAP) framework, which offers a methodology for classifying different PA intervention approaches.Why the new findings matterThe findings of this study further enrich the growing body of knowledge, showing that PA interventions have potential to enhance children's SEL. Such research is crucial to evaluate the expanding knowledge in this domain and to propose future directions for both research and practice.Implications for policy makers, university management, funders and studentsThis study suggests the adoption of larger sample sizes and stringent randomised designs in future studies. This will allow researchers to more conclusively address questions related to generalisability and causality. Furthermore, a purposeful incorporation of the CSPAP framework when crafting interventions will offer researchers and practitioners clearer insights into how best to deploy specific PA promotion strategies and understand the synergies between different intervention facets to elevate children's SEL.

Induced Pluripotent Stem Cell-Derived Cardiomyocytes Therapy for Ischemic Heart Disease in Animal Model: A Meta-Analysis.

Ischemic heart disease (IHD) poses a significant challenge in cardiovascular health, with current treatments showing limited success. Induced pluripotent derived-cardiomyocyte (iPSC-CM) therapy within regenerative medicine offers potential for IHD patients, although its clinical impacts remain uncertain. This study utilizes meta-analysis to assess iPSC-CM outcomes in terms of efficacy and safety in IHD animal model studies. A meta-analysis encompassing PUBMED, ScienceDirect, Web of Science, and the Cochrane Library databases, from inception until October 2023, investigated iPSC therapy effects on cardiac function and safety outcomes. Among 51 eligible studies involving 1012 animals, despite substantial heterogeneity, the iPSC-CM transplantation improved left ventricular ejection fraction (LVEF) by 8.23% (95% CI, 7.15 to 9.32%; p < 0.001) compared to control groups. Additionally, cell-based treatment reduced the left ventricle fibrosis area and showed a tendency to reduce left ventricular end-systolic volume (LVESV) and end-diastolic volume (LVEDV). No significant differences emerged in mortality and arrhythmia risk between iPSC-CM treatment and control groups. In conclusion, this meta-analysis indicates iPSC-CM therapy's promise as a safe and beneficial intervention for enhancing heart function in IHD. However, due to observed heterogeneity, the efficacy of this treatment must be further explored through large randomized controlled trials based on rigorous research design.

Challenge of ending TB in China: tuberculosis control in primary healthcare sectors under integrated TB control model–a systematic review and meta-analysis

BackgroundChina has the third-largest burden of tuberculosis (TB) cases in the world with great challenges towards ending TB. Primary health care (PHC) sectors play a critical role in TB prevention and control in communities under the Chinese integrated TB control model. However, there is a lack of comprehensive review of research evidence on TB control in PHC sectors under the integrated TB control model in China.MethodsThis review was conducted following the PRISMA guidelines. Articles published from 2012 to January 2022 were searched from four international and three Chinese databases. Studies conducted inside mainland China and relevant with TB control service in PHC sectors under the integrated model were included. After study selection, data extraction, and quality assessment, the meta-analysis was performed with RevMan using a random-effect model.When I2 was more than 50%, subgroup analysis was performed to explore possible reasons for heterogeneity. We also conducted a post hoc sensitivity analysis for outcomes after meta-analysis by exclusion of studies with a high risk of bias or classified as low quality.ResultsForty-three studies from 16 provinces/municipalities in China were included in this review, and most studies included were of medium quality. PHC sectors in East China delivered TB control service better overall than that in West China, especially in tracing of patients and TB case management (TCM). In meta-analyses, both the pooled arrival rate of tracing and pooled TCM rate in East China were higher than those in West China. TB patients had a low degree of willingness to receive TCM provided by healthcare workers in PHC sectors nationwide, especially among migrant TB patients. There were 9 studies reporting factors related to TB control service in PHC sectors, 6 (2 in East and 4 in West China) of which indentified several characteristics of patients as associated factors. The context of PHC sectors was demonstrated to influence delivery of TB control service in PHC sectors in 5 studies (3 in East, 1 in Middle and 1 in West China). Most studies on strategies to promoting TB control services in PHC sectors were conducted in East China and some of these studies identified several online and offline interventions and strategies improving patients’ treatment compliance [pooled OR (95% CI): 7.81 (3.08, 19.19] and awareness of TB [pooled OR (95% CI): 6.86 (2.16, 21.72)].ConclusionIt is of urgent need to improve TB control in PHC sector in China, particularly in West China. Formative and implementation research with rigorous design are necessary to develop comprehensive, context-specific, and patient-centered TB control strategies to promote ending TB in China.

Retrospective Study on 57 Direct Interproximal Restorations with Supracrestal Tissue Attachment Violation: Follow-ups Between 10 and 23 Years.

A total of 57 interproximal restorations invading the supracrestal tissue attachment were evaluated in terms of crestal bone loss over a mean period of 15 years (10 to 23 years). The distance from the cavity margin to the bone was measured at T0 (after the restoration; baseline) and controlled using radiographs and a measurable landmark. The mean vertical bone loss was 0.46 mm, with a 96.49% survival rate. Smoking habits (P = .02) and tooth type (P = .03) significantly affected bone loss. The proposed technique could help the clinician in adopting a minimally invasive approach in the treatment of heavily compromised teeth. Future research with rigorous study designs would be interesting to guide the clinical decision-making.

Selection pressures on evolution of ribonuclease H explored with rigorous free–energy–based design

Understanding natural protein evolution and designing novel proteins are motivating interest in development of high-throughput methods to explore large sequence spaces. In this work, we demonstrate the application of multisite λ dynamics (MSλD), a rigorous free energy simulation method, and chemical denaturation experiments to quantify evolutionary selection pressure from sequence-stability relationships and to address questions of design. This study examines a mesophilic phylogenetic clade of ribonuclease H (RNase H), furthering its extensive characterization in earlier studies, focusing on E. coli RNase H (ecRNH) and a more stable consensus sequence (AncCcons) differing at 15 positions. The stabilities of 32,768 chimeras between these two sequences were computed using the MSλD framework. The most stable and least stable chimeras were predicted and tested along with several other sequences, revealing a designed chimera with approximately the same stability increase as AncCcons, but requiring only half the mutations. Comparing the computed stabilities with experiment for 12 sequences reveals a Pearson correlation of 0.86 and root mean squared error of 1.18 kcal/mol, an unprecedented level of accuracy well beyond less rigorous computational design methods. We then quantified selection pressure using a simple evolutionary model in which sequences are selected according to the Boltzmann factor of their stability. Selection temperatures from 110 to 168 K are estimated in three ways by comparing experimental and computational results to evolutionary models. These estimates indicate selection pressure is high, which has implications for evolutionary dynamics and for the accuracy required for design, and suggests accurate high-throughput computational methods like MSλD may enable more effective protein design.

The individual-level effects of social media campaigns related to healthy eating, physical activity, and healthy weight: Anarrative review.

Social media are promising channels for health communication promoting positive weight-related behaviors, but no prior studies have synthesized evidence on the independent effects of social media campaigns focused on promoting healthy eating, physical activity (PA), and healthy weight. This study aimed to fill that gap and inform future social media-based obesity-prevention research and practice by reviewing findings from studies testing the effects of such campaigns on individual-level cognitive, behavioral, and anthropometric outcomes. The Web of Science and PubMed databases were searched for peer-reviewed articles published between 2012 and 2023 that explored the independent effects of social media campaigns related to healthy eating, PA, or weight management. Study characteristics and outcomes were extracted and summarized. Eleven studies were included in this review describing campaigns targeting healthy eating-related outcomes (e.g., fruit and vegetable consumption, meal preparation, nutrition label reading), PA, or weight management. Most campaigns (n=7) were developed by universities or research centers. Priority audiences included parents, adult females, adolescents, college students, and adult government employees. The majority (n=8) of the campaigns used single platforms, with the most common being Facebook, Instagram, blogs, and YouTube. Campaigns had mixed effects on cognitive outcomes (e.g., intention, attitude, knowledge), behavioral outcomes (e.g., food choices, PA), and anthropometric outcomes (e.g., weight, waist circumference). Social media campaigns focused on promoting healthy eating, PA, and healthy weight had mixed effects on individual-level cognitive, behavioral, and anthropometric outcomes. Various limitations of the included studies make it difficult to ascertain which factors influence campaign effectiveness. Advancing knowledge in this area is important, particularly given social media's widespread use and potential for broad reach. New research with features such as rigorous study designs, larger and more diverse samples, and strong theoretical foundations may provide important insights into what types of interventions are effective or not and under what conditions.

Investigating seasonal air quality variations consequent to the urban vegetation in the metropolis of Faisalabad, Pakistan

Urban atmospheric pollution is global problem and and have become increasingly critical in big cities around the world. Issue of toxic emissions has gained significant attention in the scientific community as the release of pollutants into the atmosphere rising continuously. Although, the Pakistani government has started the Pakistan Clean Air Program to control ambient air quality however, the desired air quality levels are yet to be reached. Since the process of mapping the dispersion of atmospheric pollutants in urban areas is intricate due to its dependence on multiple factors, such as urban vegetation and weather conditions. Therefore, present research focuses on two essential items: (1) the relationship between urban vegetation and atmospheric variables (temperature, relative humidity (RH), sound intensity (SI), CO, CO2, and particulate matter (PM0.5, PM1.0, and PM2.5) and (2) the effect of seasonal change on concentration and magnitude of atmospheric variables. A geographic Information System (GIS) was utilized to map urban atmospheric variables dispersion in the residential areas of Faisalabad, Pakistan. Pearson correlation and principal component analyses were performed to establish the relationship between urban atmospheric pollutants, urban vegetation, and seasonal variation. The results showed a positive correlation between urban vegetation, metrological factors, and most of the atmospheric pollutants. Furthermore, PM concentration showed a significant correlation with temperature and urban vegetation cover. GIS distribution maps for PM0.5, PM1.0, PM2.5, and CO2 pollutants showed the highest concentration of pollutants in poorly to the moderated vegetated areas. Therefore, it can be concluded that urban vegetation requires a rigorous design, planning, and cost–benefit analysis to maximize its positive environmental effects.

Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review

BackgroundThough still a young field of research, gamified digital interventions have demonstrated potential in exerting a favourable impact on health and overall well-being. With the increasing use of the internet and digital devices, the integration of game elements presents novel opportunities for preventing mental disorders and enhancing mental health. Hence, this review aims to assess the effectiveness of gamified interventions focusing on preventing mental disorders or promoting mental health among adults.MethodsBased on a scoping review across four databases (MEDLINE, Embase, PsycInfo and Web of Science), 7,953 studies were initially identified. After removing duplicates and screening titles, abstracts and full texts, 16 studies were identified as suitable for inclusion in a narrative synthesis of findings. We included interventional studies encompassing an intervention and a control group aiming to investigate the effectiveness of the use of gamified digital mental health interventions and the use of gamified digital elements.ResultsOverall, positive effects of gamified interventions on mental health-related outcomes were identified. In particular, beneficial consequences for psychological well-being and depressive symptoms were observed in all studies. However, further outcomes, such as resilience, anxiety, stress or satisfaction with life, showed heterogenous findings. Most game elements used were reward, sensation and progress, whilst the quantity of elements was not consistent and, therefore, no substantiated conclusion regarding the (optimal) quantity or composition of game elements can be drawn. Further, the outcomes, measurements and analyses differed greatly between the 16 included studies making comparisons difficult.ConclusionIn summary, this review demonstrates the potential of integrating digital game elements on mental health and well-being with still a great gap of research. A taxonomy is needed to adequately address relevant game elements in the field of mental health promotion and prevention of mental disorders. Therefore, future studies should explicitly focus on the mechanisms of effect and apply rigorous study designs.

Effects of acupuncture treatment for myasthenia gravis: A systematic review and meta-analysis.

Randomized controlled trials (RCTs) of acupuncture for myasthenia gravis (MG) were searched and the efficacy of acupuncture in the treatment of MG was evaluated by meta-analysis. We searched for RCTs in six main electronic databases, and collected RCTs of acupuncture treatment for MG from database creation to 28 February 2023. The main outcome was the effective rate and the secondary outcome was the Traditional Chinese Medicine (TCM) relative clinical score, absolute clinical score (ACS) of MG, Quantitive myasthenia gravis score (QMG), quality of life, and adverse events. Odds ratios (ORs) and weighted mean differences (WMD) and 95% confidence intervals (CI) were used to assess pooled effect estimates using Review Manager software. A total of 14 RCTs were included. Meta-analysis showed that the effective rate in the acupuncture group was significantly improved compared with conventional Western medicine alone [OR = 4.28, 95% CI (2.95, 6, 22), P<0.005]. The pooled WMDs revealed that TCM relative clinical score [WMD = -2.22, 95% CI = (-2.53, -1.90), P<0.005], ACS of MG [WMD = -3.14, 95% CI = (-3.67, -2.62), P<0.005], and QMG [WMD = -0.88, 95% CI = (-1.46, -0.29), P<0.005] in the acupuncture group was lower than the control group. Adverse reactions related to acupuncture and quality of life were less mentioned among included RCTs. This meta-analysis demonstrated that acupuncture as an auxiliary may play a positive role in treating MG. It can improve the effective rate of treatment, and reduce TCM relative clinical score, ACS of MG, and QMG. However, the quality of included studies was generally low and caution should be exercised when considering this treatment option. In the future, more rigorous study designs and high-quality RCTs are needed to verify the efficacy of acupuncture in the treatment of MG, because the results of high-quality RCTs are more reliable and accurate.

Algorithmic Problem-Solving Advancements: A Comprehensive Exploration across Diverse Domains

Recent developments in algorithmic problem-solving techniques have significantly influenced diverse domains, from mathematical computations to real-world problem-solving. This paper explores the advancements in algorithm development, emphasizing the application of mathematical reasoning and rigorous design in functions and recursive functions. Additionally, the review spans the landscape of solving mathematical word problems (MWPs), analysing methodologies, and providing insights into the challenges and complexities inherent in natural language processing, machine learning, and artificial intelligence. In a comparative study, computational and algorithmic advances for solving Richards’ equation are evaluated, revealing their joint contributions to a substantial improvement in efficiency. The collective insights from these perspectives underscore the transformative impact of algorithmic advancements across interdisciplinary domains.

Design and Fabrication of PVC Pipe Cutting Machine with Hot Wire Mechanism

The utilization of cutting tools presents inherent limitations, encompassing sluggish production rates, inconsistent cutting precision, and elevated manufacturing expenses in the cutting of PVC (Poly-Vinyl Chloride) pipes. Addressing these challenges requires a systematic design approach to engineers to build sustainable new mechanism for PVC pipe cutting apparatus capable of streamlined operation. This study endeavours to conceptualize and develop a unique mechanism comprised of Ni-Chrome heated wire as a replacement of traditional cutter. The design focus is aimed at enhancing the cutting operation within low cost and enhanced sustainability. The methodology for machine design encompasses a complete machine design approach for each single component if a machine utilizing Solidworks 2023, complemented by rigorous mathematical design calculations. The outcomes of this study manifest in the creation of a prototype of Ni-Chrome heated wire machine capable of cutting the pipes within thickness range from 20-35mm and more based on the heated capability of wire. Noteworthy advantages of this machine design include expedited manufacturing processes, reduced energy consumption, and enhanced labour efficiency, thereby augmenting overall productivity. Future research avenues are suggested to encompass an analysis of operator safety considerations, establishment of periodic maintenance protocols, automation, and optimization of spare parts accessibility to further refine the efficacy and longevity of the proposed system.

Hematološke varijacije povezane sa konzumiranjem alkohola u univerzitetskoj zajednici u Nigeriji

Introduction: Alcohol consumption is widespread, contributing to approximately 3 million deaths worldwide. This study aimed to assess haema-tological indices among alcohol consumers compared to non-consumers in the University of Calabar Community , Nigeria. Materials and Methods: This case-control study enrolled 100 subjects (50 alcohol consumers and 50 non-consumers) from the University of Calabar community. Blood samples were collected aseptically for Full Blood Count and Thrombin Time analysis. Rigorous study design, meticulous data collection, and thorough analysis ensured the reliability of our findings. Results: The mean corpuscular volume (MCV) (76.21 ± 7.35 fl), mean corpuscular haemoglobin (MCH) (25.31 ± 3.26 pg), Platelet (PLT) (154.38 ± 54.89 x 10 9) and Platelet Crit (PCT) (0.14 ± 0.04%) of alcohol consumers were significantly lower than that of the controls respectively (79.36 ± 5.76 fl, 26.47 ± 2.15 pg, 187.22 ± 58.34 x 10 9 and 0.17 ± 0.04%) (p &lt; 0.05). At the same time, the red cells distribution width (RDWCV), Platelet distribution width (PDW), and thrombin time (TT) varied significantly among alcohol consumers (15.14 ± 1.05%, 14.91 ± 0.43fl and 15.22 ± 2.53s) respectively than in the controls (14.74 ± 0.95%, 14.76 ± 0.29 fl and 12.70 ± 1.52s). Other parameters were comparable (p &gt; 0.05) between the two groups of subjects studied. A significant negative correlation (r = 0.801, p = 0.001) was observed between Thrombin time and Plateletcrit in the test subjects. In contrast, a significant positive correlation (r = 0.698, p = 0.001) was observed between Mean Corpuscular Haemoglobin Concentration and Haemoglobin in alcohol consumption. A significant negative correlation (r = 0.973, p = 0.001) was observed between lym-phocytes and granulocytes in percentage in the test subjects. These significant findings provide valuable insights into the haematological variations associated with alcohol consumption. Conclusion: These significant differences observed in this study underscore the impact of alcohol consumption on haematological indices. The study concluded that derangements in some hematological parameters occur in alcoholics, which can affect their quality of life.

Effectiveness of task-specific training for improving balance performance in children with cerebral palsy (CP): a narrative systematic review

IntroductionA body of research has focused on helping children with disabilities stay physically active. As poor balance has been found as a major limitation in physical activities, a systematic review exploring balance intervention programs is warranted.MethodsThe primary aim of this is to systematically evaluate evidence for the effect of task-specific training to improve balance outcomes in ambulant children with cerebral palsy. Seven databases were searched for studies involving ambulant children with cerebral palsy (4–15 years old); balance TST; and balance-related outcomes. The quality of the studies was appraised using the JBI Critical Appraisal Checklists for risk of bias, study design, and quality of evidence. Continuous data were transformed and summarised using standardised mean difference and 95%CI.ResultsSeven randomised controlled trials met the inclusion criteria. The risk of bias was deemed low in most of the studies. Due to heterogeneity of study design and outcome measures, a narrative synthesis was conducted. Positive between-group effects favouring TST were found across the six studies (BBS d = 1.528, 95% CI = 0.7747–2.2813) and follow-up (BBS d = –1.667, 95% CI = –2.459 ÷ –0.874). Despite poor reporting of motor learning strategies, repetitive practice, feedback, and task modulation strategies were used consistently in balance TST.ConclusionsTST could be recommended to be a part of an intervention programme to improve balance performance in children with CP. However, more studies with rigorous study design and adequately powered implementation of a more fun task-oriented training programme are needed.

The Effects of Sport Participation for Adults With Physical or Intellectual Disability: A Scoping Review.

Adults with physical or intellectual disability are less active than those without disability. To review literature regarding sport participation in adults with physical or intellectual disability. Specifically, to examine characteristics of available studies including participants, interventions, outcomes, and impact. A scoping review was completed. Searches of 6 databases and a trial registry plus citation tracking were undertaken. Two independent reviewers screened items for eligibility and extracted data about the studies, participants, interventions, and outcomes. A single reviewer extracted data to quantify impacts of sport participation, classified as favorable, insignificant, or unfavorable. 164 studies involving 11,642 participants were included. Most studies (128/164) used a cross-sectional design. Most participants were men (81%) with physical disability (135/164), and spinal cord injury was the most prevalent underlying health condition (54%). Most studies evaluated a mix of sports (83/164) in a disability-specific context (159/164), with basketball or wheelchair basketball being the most common individual sport (28/164). Physical impairment was the most frequently reported outcome domain (85/334 results). Sports participation impact was classified as 55% favorable, 42% insignificant, and 3% unfavorable. There were many favorable and few unfavorable outcomes for participation in sport for adults with physical or intellectual disability. More research is needed to address the evidence gaps of gender, health condition, and type of sport, and to use more rigorous research designs to evaluate the effects of sport participation. While new evidence is generated, we suggest adults with physical or intellectual disability be encouraged to engage in sport. PROSPERO registration number CRD42018104379.