Standardized Assessment Protocol Research Articles

The role of corneal epithelial thickness in ocular surface health

Abstract The corneal epithelium (CE), which is made up of five to seven layers, is crucial for maintaining the integrity of the cornea and the health of the ocular surface. The present review delves into the importance of corneal epithelial thickness (CET) in the identification and treatment of a range of ocular surface diseases (OSDs), such as keratoconus (KCN), dry eye disease (DED), and the aftermath of refractive procedures. Spectral-domain optical coherence tomography (SD-OCT) can be used to provide reliable and precise CET values, providing valuable insights into epithelial remodeling patterns and their correlation with disease severity. In DED, CE irregularities correlate with clinical symptoms, revealing a distinctive thinning pattern in the superior epithelium, especially in severe cases. This is attributed to mechanical friction from frequent blinking. Contrasting studies on overall CET in DED patients highlight the need for standardized assessment protocols. In KCN, epithelial thickness mapping (ETM) demonstrates specific thinning patterns, aiding in early detection and management. Postrefractive surgery, epithelial remodeling contributes to residual refractive errors, emphasizing the epithelium’s role in compensating for stromal irregularities. This review underscores the importance of CET analysis in clinical practice, advocating for the integration of advanced imaging technologies like SD-OCT. Understanding the dynamic changes in CET can enhance early diagnosis, guide surgical decisions, and improve treatment outcomes for various OSDs, ultimately contributing to better ocular health maintenance.

Tracking the quality of graphene oxide suspension during long-term storage

Graphene oxide is a popular material because of not only its cost–efficient production but also its unique properties. However, after long-term storage, several changes occur in the structure of graphene oxide obtained using the modified Hummers’ method, affecting its stability and physicochemical properties. Despite the obvious problem, there is only a limited number of works devoted to ageing factors, their impact on the properties and structure of graphene oxide itself, and operational modes of materials and devices based on graphene oxide. Therefore, to facilitate the widespread industrial application of graphene oxide, it is crucial to establish standardized protocols for storage and quality assessment of graphene oxide. In this paper, the prepared samples were extensively characterized using various techniques, including transmission electron microscopy, X-ray photoelectron spectroscopy, UV–Vis and fluorescence spectroscopy techniques. Among the various analytical methods, comprehensive spectroscopic analysis of the absorption and fluorescence properties has proven to be the most sensitive to sample ageing. We investigated the change in optical and physicochemical properties of graphene oxide during its long-term storage under various conditions. It was found that graphene oxide precipitated during storage, and the O/C ratio in graphene oxide decreased slightly from 0.49 to 0.47. Still, the type of oxygen-containing functional groups did not change, which might indicate possible intra-structural changes. Using transmission electron microscopy, molecular dynamic and density functional theory simulation, we showed that the rearrangement of functional groups on the surface leads to the formation of large sp2 domains that interact with each other, leading to aggregation of the graphene oxide.

Expert consensus on the terminology, diagnostics and management of persisting symptoms after concussion with a focus on mental health, postural stability, electroencephalogram and balance testing: A cross-sectional Delphi-like survey.

Persisting symptoms after concussion (PSaC) are a pathological manifestation of head injuries that present with symptoms after the acute phase of head trauma has subsided. Insufficient research about PSaC has led to gaps in knowledge and incorrect terminology being applied. Furthermore, gaps exist in standardised assessment protocols and understanding of mental health symptoms associated with sports. The study aimed to; 1) Determine expert consensus on appropriate terminology for symptoms lasting >4 weeks, 2) Investigate associations with mental health and postural stability symptoms, 3) Evaluate experts' views on quantitative balance and electroencephalogram (EEG) testing. A Delphi-like survey was designed in REDCap and sent to identified experts in the field of sports-related concussions (SRC). Expert consensus was defined as ≥75% agreement. Expert consensus identified the following mood and motor control symptoms being associated with PSaC: increases in emotional state (80%), irritability (87%), nervousness (87%), sadness (80%), balance impairment (80%), dizziness (87%) and feeling slow (80%). Numbness and tingling were not considered longer-term effects (80%). Additionally, 93% of respondents acknowledged mental health symptoms as potential longer-term effects, with 80% agreeing on inadequate current management. Respondents indicated PSaC are only somewhat adequately managed (73%) or not managed well enough (27%). The use of EEG and quantitative balance testing remains open for debate. The survey response rate was 21%. Improving mental health management for athletes with PSaC and standardising terminology is crucial. Future research is required to establish effective diagnosis and treatment methods. Addressing these issues may result in better care and safer return to play for athletes.

The unseen impact - a deep dive into neurocognitive impairment among patients with intracranial meningiomas: a comprehensive systematic review of the literature.

Meningiomas are the most common intracranial tumors, predominantly affecting adults, with a higher incidence in female and elderly populations. Despite their prevalence, research on neurocognitive impairment in meningioma patients remains limited compared to intra-axial tumors such as gliomas. We conducted a comprehensive systematic review of the current literature on neurocognitive outcomes in meningioma patients pre- and post-surgery. Our review revealed significant disparities in reported neurocognitive outcomes, with prospective studies suggesting tumor-related factors as the primary contributors to postoperative deficits, while retrospective studies imply surgical intervention plays a significant role. Regardless of study design or specifics, most studies lack baseline preoperative neurocognitive assessments and standardized protocols for evaluating neurocognitive function. To address these gaps, we advocate for standardized neurocognitive assessment protocols, consensus on neurocognitive domains to be targeted in this population by tailored test batteries, and more prospective studies to elucidate correlations between tumor characteristics, patient attributes, surgical interventions, neurocognitive status, and planning for implementing tailored neurocognitive rehabilitation strategies early in the postoperative course which is crucial for achieving optimal long-term neurocognitive outcomes and enhancing patients' quality of life.

Food Addiction Screening, Diagnosis and Treatment: A Protocol for Residential Treatment of Eating Disorders, Substance Use Disorders and Trauma-Related Psychiatric Comorbidity.

Food addiction, or ultra-processed food addiction (UPFA), has emerged as a reliable and validated clinical entity that is especially common in individuals seeking treatment for eating disorders (EDs), substance use disorders (SUDs) and co-occurring psychiatric disorders (including mood, anxiety and trauma-related disorders). The clinical science of UPFA has relied on the development and proven reliability of the Yale Food Addiction Scale (YFAS), or subsequent versions, e.g., the modified YFAS 2.0 (mYFAS2.0), as well as neurobiological advances in understanding hedonic eating. Despite its emergence as a valid and reliable clinical entity with important clinical implications, the best treatment approaches remain elusive. To address this gap, we have developed and described a standardized assessment and treatment protocol for patients being treated in a residential program serving patients with psychiatric multi-morbidity. Patients who meet mYFAS2.0 criteria are offered one of three possible approaches: (1) treatment as usual (TAU), using standard ED treatment dietary approaches; (2) harm reduction (HR), offering support in decreasing consumption of all UPFs or particular identified UPFs; and (3) abstinence-based (AB), offering support in abstaining completely from UPFs or particular UPFs. Changes in mYFAS2.0 scores and other clinical measures of common psychiatric comorbidities are compared between admission and discharge.

A Scoping Review of PTSD and Depression in Adult Burn Patients: A Call for Standardized Screening and Intervention Research.

Despite the growing incidence of burn injuries globally and the advancements in physical recovery, the psychological aspect of burn trauma recovery remains inadequately addressed. This review aims to consolidate existing literature posttraumatic stress disorder (PTSD) and depression in adult burn survivors, recognizing the need for a holistic approach to burn recovery that encompasses both physical and mental health. The comprehensive analysis of 156 studies revealed significant variations in methodological approaches, leading to challenges in creating standardized protocols for mental health assessment in burn care. Key findings include the identification of a wide range of psychological assessment tools and a substantial research gap in low and middle-income countries, where the majority of burn injuries occur. Only 7.0% of the studies assessed interventions for PTSD or depression, indicating a lack of focus on treatment modalities. The studies identified demographic factors, patient history, psychosocial factors, burn injury characteristics, and treatment course as risk factors for PTSD and depression post-burn injury. The review highlights the need for early screening, intervention, and attention to subjective experiences related to burn injury, as these are strong predictors of long-term psychological distress. It also emphasizes the complexity of addressing psychological distress in burn survivors and the need for more standardized practices in assessing PTSD and depression specific to this population.

Protocol-based assessment and management of first episode psychosis: Comparison of short and medium-term outcomes in psychopathology, quality of life, functioning and family burden across two sites in India

BackgroundStandard assessment and management protocols exist for first episode psychosis (FEP) in high income countries. Due to cultural and resource differences, these need to be modified for application in low-and middle-income countries. AimsTo assess the applicability of standard assessment and management protocols across two cohorts of FEP patients in North and South India by examining trajectories of psychopathology, functioning, quality of life and family burden in both. MethodFEP patients at two sites (108 at AIIMS, North India, and 115 at SCARF, South India) were assessed using structured instruments at baseline, 3, 6 and 12 months. Standard management protocols consisted of treatment with antipsychotics and psychoeducation for patients and their families. Generalised estimating equation (GEE) modelling was carried out to test for changes in outcomes both across and between sites at follow-up. ResultsThere was an overall significant improvement in both cohorts for psychopathology and other outcome measures. The trajectories of improvement differed between the two sites with steeper improvement in non-affective psychosis in the first three months at SCARF, and affective symptoms in the first three months at AIIMS. The reduction in family burden and improvement in quality of life were greater at AIIMS than at SCARF during the first three months. ConclusionsDespite variations in cultural contexts and norms, it is possible to implement FEP standard assessment and management protocols in North and South India. Preliminary findings indicate that FEP services lead to significant improvements in psychopathology, functioning, quality of life, and family burden within these contexts.

The Pathophysiology and Management of Pathologic Scarring-a Contemporary Review.

Significance: Pathologic scarring occurs secondary to imbalances in the cellular mechanisms of wound healing and affects millions of people annually. This review article aims to provide a concise overview of the pathophysiology and management of pathologic scarring for clinicians and scientists alike. Recent Advances: Contemporary research in the field has identified aberrations in transforming growth factor-β/small mothers against decapentaplegic (TGF-β/SMAD) signaling pathways as key drivers of pathologic scar formation; indeed, this pathway is targeted by many treatment modalities and translational investigations currently underway. Although intralesional injection of corticosteroids has been the gold standard in the treatment of pathologic scarring, studies show greater treatment efficacy with the use of combination injections such as triamcinolone/5-fluorouracil and triamcinolone/botulinum toxin. Adjunctive therapies including ablative fractional carbon dioxide/erbium-doped yttrium aluminum garnet and non-ablative pulsed-dye lasers, microneedling, and carboxytherapy have shown encouraging results in small cohort studies. Translational investigations involving the use of nanogels, RNA interference, and small molecules targeting TGF-β/SMAD pathways are also currently underway and hold promise for the future. Critical Issues: The heterogeneous nature of hypertrophic scars and keloids poses significant challenges in formulating standardized treatment and assessment protocols, thereby limiting the conclusions that can be drawn. Future Directions: Rigorous clinical trials into the individual and synergistic effects of these therapies would be ideal before any definitive conclusions or evidence-based treatment recommendations can be made. Owing to the heterogeneity of the pathology and patient population, well-conducted cohort studies may be the next best option.

Auditory and language features in children with 18q deletion: Our experience and a brief review of the literature

Abstract 18q deletion is a rare genetic condition that occurs approximately 1 in 40,000 live births. The aim of this study is to describe four cases of 18q deletion, analyzing their auditory and language skills. A secondary aim is to compare our findings with those reported in the literature in order to propose a standardized assessment protocol and guidelines for auditory treatment and rehabilitation. All children underwent a detailed audiological evaluation including otoscopy, pure-tone audiometry, and auditory brainstem responses. We also administered language and speech tests according to the children’s age and skills. Comorbidities and disease severity varied depending on the genetic mutation. Data from the literature review are consistent with our findings. Therefore, the type of auditory rehabilitation changed among patients. Despite the heterogeneity of phenotypes and severity, hearing loss and stenotic external auditory canals were detected in all our patients with 18q deletion. Accurate diagnosis and follow-up are mandatory to improve auditory and language skills and quality of life. Due to the complexity of the cases, no standardized assessment protocols or treatment can be routinely proposed.

Envisioning the Future of ChatGPT in Healthcare: Insights and Recommendations from a Systematic Identification of Influential Research and a Call for Papers

Background and Aims: ChatGPT represents the most popular and widely used generative artificial intelligence (AI) model that received significant attention in healthcare research. The aim of the current study was to assess the future trajectory of the needed research in this domain based on the recommendations of the top influential published records.
 Materials and Methods: A systematic search was conducted on Scopus, Web of Science, and Google Scholar (27–30 November 2023) to identify the top ten ChatGPT-related published records in healthcare across the three databases. Classification of the records as “top” denoting high influence in the field was based on citation counts.
 Results: A total of 22 unique records from 17 different journals representing 14 different publishers were identified as the top ChatGPT-related publications in healthcare subject. Based on the identified records’ recommendations, the following themes appeared as important areas to consider in future ChatGPT research in healthcare: improving healthcare education, improved efficiency of clinical processes (e.g., documentation), addressing ethical concerns (e.g., patient privacy and consent), supporting research tasks (e.g., data analysis, manuscript preparation), mitigating ChatGPT output biases, improving patient education and engagement, and developing standardized assessment protocols for ChatGPT utility in healthcare.
 Conclusions: The current review highlighted key areas to be prioritized in assessment of ChatGPT utility in healthcare. Interdisciplinary collaborations and standardizing methodologies are needed to synthesize robust evidence in these studies. Based on these recommendations and the promising potential of ChatGPT on healthcare, JMJ launched a call for papers for a special issue entitled “Evaluating Generative AI-Based Models in Healthcare”.

Using ultrasound shear wave elastography to characterize peripheral nerve mechanics: a systematic review on the normative reference values in healthy individuals.

Ultrasound shear wave elastography (SWE) is an emerging non-invasive imaging technique for peripheral nerve evaluation. Shear wave velocity (SWV), a surrogate measure of stiffness, holds promise as a biomarker for various peripheral nerve disorders. However, to maximize its clinical and biomechanical value, it is important to fully understand the factors that influence nerve SWV measurements. This systematic review aimed to identify the normal range of SWV for healthy sciatic and tibial nerves and to reveal the factors potentially affecting nerve SWV. An electronic search yielded 17 studies eligible for inclusion, involving 548 healthy individuals (age range, 17 to 72 years). Despite very good reliability metrics, the reported SWV values differed considerably across studies for the sciatic (1.9-9.9 m/s) and tibial (2.3-9.1 m/s) nerves. Factors such as measurement proximity to joint regions, limb postures inducing nerve axial stretching, and transducer alignment with nerve fiber orientation were associated with increased SWV. These findings suggest regional-specific nerve mechanical properties, non-linear elastic behaviour, and marked mechanical anisotropy. The impact of age and sex remains unclear and warrants further investigation. These results emphasize the importance of considering these factors when assessing and interpreting nerve SWE. While increased SWV has been linked to pathological changes affecting nerve tissue mechanics, the significant variability observed in healthy nerves highlights the need for standardized SWE assessment protocols. Developing guidelines for enhanced clinical utility and achieving a comprehensive understanding of the factors that influence nerve SWE assessments are critical in advancing the field.

ScarPath: Standardization of delivering patient-centered integrated scar care.

A pathological scar is a badly healing scar that is painful, itchy, red, thick and causes disability, diminished quality of life and socio-economic burden. Oscare, an aftercare and research center in Antwerp, Belgium, has built up a tradition in late stage translational research in assessment and treatment of pathological scars post burn, post trauma and post-surgery.
 Adequate patient-oriented assessment of physical scar features is crucial in the clinical evaluation and follow-up of scars, in defining scar treatment options for the patient, and for medico-legal reasons (e.g., for reimbursement of treatment and proof of disability). Moreover, scar assessment is an essential component for scientific research focused on evaluating newly developed wound or scar treatment modalities. Patient perception is evaluated with questionnaires, patient reported outcome measures to inform individual patient and scar care. Objective measures should always be combined with PROMs to get a full scope of on the impact and disability. Recent discussions with stakeholders have shown that the time consuming aspect of data collection is one of the important hurdles in new developments of scar research and treatment and is considered as a barrier to integrated care. Moreover, no standardized assessment protocols are available within this field of research.
 We address this gap by introducing a recently developed Electronic Data Capturing (EDC) platform ‘ScarPath’. A user friendly tool for scar assessment and holistic follow-up which will lead to a more standardized method of scar evaluation and enables a better treatment outcome, patient participation and empowerment in assessing evolution of scars during treatment. Moreover, ScarPath creates possibilities for testing new scar treatments in large pragmatic trials by offering a simple and patient oriented scar evaluation tool. In the future mathematical machine learning models based upon the automated data collection will lead to predictions in terms of scar evolution and recommendations for therapy.
 Oscare created ScarPath in collaboration with the University of Antwerp. The content was established in joined agreement and based on the clinical and research experience in our aftercare centre and on both literature evidence and empirical studies. In 2019 ScarPath was enrolled in the workflow in our aftercare center and in 2020 a HORIZON2020 – Digital Health Europe Twinning project was completed. This project enhanced knowledge exchange and training between Oscare and a French rehabilitation center.
 The ScarPath project will benefit patients suffering from scars, a common comorbidity in severe burns and often developed after trauma or surgery. Although we focus on researchers and clinicians to implement ScarPath in their standard clinical trials and big data collection, patients are key partners and the main focus. The results will be beneficial for the scar patient, allowing individualized and optimal scar care. ScarPath is able to assist the patient in the follow-up across multiple professionals and to process care data for multiple patients.

The Influence of General and Local Muscle Fatigue on Kinematics and Plantar Pressure Distribution during Running: A Systematic Review and Meta-Analysis.

Fatigue has the potential to alter how impact forces are absorbed during running, heightening the risk of injury. Conflicting findings exist regarding alterations in both kinematics and plantar pressure. Thus, this systematic review and subsequent meta-analysis were conducted to investigate the impact of general and localized muscle fatigue on kinematics and plantar pressure distribution during running. Initial searches were executed on 30 November 2021 and updated on 29 April 2023, encompassing PubMed, The Cochrane Library, SPORTDiscus, and Web of Science without imposing any restrictions on publication dates or employing additional filters. Our PECOS criteria included cross-sectional studies on healthy adults during their treadmill running to mainly evaluate local muscle fatigue, plantar pressure distribution, biomechanics of running (kinematics, kinetics, and EMG results), and temporospatial parameters. The literature search identified 6626 records, with 4626 studies removed for titles and abstract screening. Two hundred and one articles were selected for full-text screening, and 20 studies were included in qualitative data synthesis. The pooled analysis showed a non-significant decrease in maximum pressure under the right forefoot's metatarsus, which was more than the left rearfoot after local muscle fatigue at a velocity of 15 km/h (p-values = 0.48 and 0.62). The results were homogeneous and showed that local muscle fatigue did not significantly affect the right forefoot's stride frequency and length (p-values = 0.75 and 0.38). Strength training for the foot muscles, mainly focusing on the dorsiflexors, is recommended to prevent running-related injuries. Utilizing a standardized knee and ankle joint muscle fatigue assessment protocol is advised. Future experiments should focus on various shoes for running and varying foot strike patterns for injury prevention.

A proposed scheme for comprehensive and systematic evaluation of normal pressure hydrocephalus

AbstractBackgroundAs ageing population continues to rise across the globe, age‐related conditions such as normal pressure hydrocephalus (NPH) are expected to become a prevalent health problem effecting gait and cognition in the elderly. Alas, the vague definition of NPH, coupled with the absence of standardized assessment protocols, can potentially result in unnecessary surgical interventions and complications. We aim to demonstrate the feasibility of our proposed objective scheme for a comprehensive and systematic evaluation of NPH, which we anticipate will be beneficial in guiding future management of this enigmatic disorder.MethodParticipants suspected of idiopathic NPH (iNPH) selected to undergo a trial of fluid diversion (i.e. large volume spinal tap) were enrolled to receive structured assessment with various biomarkers. This assessment includes pre‐fluid diversion evaluation of the following: iNPH grading scale (Kubo et al., 2008), voxel based morphometry analysis of the MRI, tablet‐based digitalized Montreal Cognitive Assessment, International Consultation on Incontinence Questionnaires, urodynamic studies. Tests that were conducted both pre‐ and post‐fluid diversion test included actigraphy, video gait analysis using Kinovea®, in‐house tablet‐based go/no‐go test and conjunction search test. During the fluid diversion trial, participants underwent an infusion test for objective quantification of cerebrospinal fluid dynamics. Cerebrospinal fluid was collected and analyzed for levels of Alzheimer’s disease biomarkers, specifically Aβ and tau species, using ELISA, as well as an α‐synuclein seeding assay. The decision to operate was made according to subjective improvement, which is the current standard of care, and subsequent assessments were repeated at 4‐month intervals for 1, 2, and 3 years postoperativelyResultBetween May 2022 and November 2022, six participants were recruited. Each test was completed by at least three out of the six participants. The participant who completed the most tests completed all but one of the tests. It is important to note that none of the participants recruited underwent shunt surgery.ConclusionThe proposed scheme for the assessment of NPH demonstrates feasibility, however, certain optimizations are necessary. Further research should be conducted to determine the correlation between these parameters and their performance in predicting long‐term responsiveness to shunt surgery.

Review and critique of current testing protocols for upper-limb prostheses: a call for standardization amidst rapid technological advancements.

This article provides a comprehensive narrative review of physical task-based assessments used to evaluate the multi-grasp dexterity and functional impact of varying control systems in pediatric and adult upper-limb prostheses. Our search returned 1,442 research articles from online databases, of which 25 tests-selected for their scientific rigor, evaluation metrics, and psychometric properties-met our review criteria. We observed that despite significant advancements in the mechatronics of upper-limb prostheses, these 25 assessments are the only validated evaluation methods that have emerged since the first measure in 1948. This not only underscores the lack of a consistently updated, standardized assessment protocol for new innovations, but also reveals an unsettling trend: as technology outpaces standardized evaluation measures, developers will often support their novel devices through custom, study-specific tests. These boutique assessments can potentially introduce bias and jeopardize validity. Furthermore, our analysis revealed that current validated evaluation methods often overlook the influence of competing interests on test success. Clinical settings and research laboratories differ in their time constraints, access to specialized equipment, and testing objectives, all of which significantly influence assessment selection and consistent use. Therefore, we propose a dual testing approach to address the varied demands of these distinct environments. Additionally, we found that almost all existing task-based assessments lack an integrated mechanism for collecting patient feedback, which we assert is essential for a holistic evaluation of upper-limb prostheses. Our review underscores the pressing need for a standardized evaluation protocol capable of objectively assessing the rapidly advancing prosthetic technologies across all testing domains.

Extracorporeal Shockwave Therapy Improves Outcomes Following Secondary Alveolar Bone Grafting

Background: Recent studies have reported that extracorporeal shock wave therapy (ESWT) enhances bone formation during mandibular distraction osteogenesis. This study seeks to investigate the clinical outcomes in children undergoing ESWT alongside secondary alveolar bone grafting procedures at our institution. Methods: Retrospective review of all children that underwent secondary alveolar cleft bone grafting with adjunctive ESWT between 2019 and 2021. Variables including age, gender, cleft type, cleft width, pre-operative cleft dentition, volume of bone graft placed intraoperatively, ESWT settings, pain medication utilization, length of stay (LOS), follow-up, cone beam computed tomography (CBCT) data, and complications were recorded. Results: Twenty patients met inclusion criteria. Median age at surgery was 9 years (range 8-16). Four (20%) patients were female; 16 (80%) were male. Eight (40%) patients had bilateral alveolar clefts; 12 (60%) had unilateral clefts. All (100%) patients were discharged on the day of surgery. Twelve (60%) patients required a median of 1.3 oxycodone doses post-operatively (range 0-6.5). All patients received ESWT treatments intra and post-operatively. All patients demonstrated an increase in bone graft volume visualized on CBCT: median increase of 6.8% (range 1.3%-35.7%) between 106.5 days (17.5% of ideal visualized, range 5%-42%) and 245.5 days (27.9% of ideal, range 8%-55.7%). Three (15%) patients experienced minor complications. Conclusions: Initial outcomes suggest that ESWT may expedite visualization of bone consolidation and facilitate recovery without increasing complications. ESWT could further represent an opportunity to improve care in craniofacial surgery. Pertinent considerations, the role of standardized assessment protocols, and future directions will be reviewed.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers.

Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

International standardization and optimization group for intersphincteric resection (ISOG-ISR): modified Delphi consensus on anatomy, definition, indication, surgical technique, specimen description and functional outcome.

Intersphincteric resection (ISR) is an oncologically complex operation for very low-lying rectal cancers. Yet, definition, anatomical description, operative indications and operative approaches to ISR are not standardized. The aim of this study was to standardize the definition of ISR by reaching international consensus from the experts in the field. This standardization will allow meaningful comparison in the literature in the future. A modified Delphi approach with three rounds of questionnaire was adopted. A total of 29 international experts from 11 countries were recruited for this study. Six domains with a total of 37 statements were examined, including anatomical definition; definition of intersphincteric dissection, intersphincteric resection (ISR) and ultra-low anterior resection (uLAR); indication for ISR; surgical technique of ISR; specimen description of ISR; and functional outcome assessment protocol. Three rounds of questionnaire were performed (response rate 100%, 89.6%, 89.6%). Agreement (≥80%) reached standardization on 36 statements. This study provides an international expert consensus-based definition and standardization of ISR. This is the first study standardizing terminology and definition of deep pelvis/anal canal anatomy from a surgical point of view. Intersphincteric dissection, ISR and uLAR were specifically defined for precise surgical description. Indication for ISR was determined by the rectal tumour's maximal radial infiltration (T stage) below the levator ani. A new surgical definition of T3isp was reached by consensus to define T3 low rectal tumours infiltrating the intersphincteric plane. A practical flowchart for surgical indication for uLAR/ISR/abdominoperineal resection was developed. A standardized ISR surgical technique and functional outcome assessment protocol was defined.

Measuring geomorphology in river assessment procedures 2: Recommendations for supporting river management goals

AbstractFluvial geomorphology, which describes the form and processes of rivers, is increasingly being incorporated into river assessment procedures. However, the complexity of geomorphic processes makes a single universal and standardized assessment protocol a challenging and possibly impractical task. In this paper, we present a set of recommendations for choosing appropriate river assessment procedures and measuring geomorphic indicators to effectively capture important geomorphic processes required to support river management goals. We outline steps for building a river assessment procedure based on an adaptive approach rather than a one‐size‐fits‐all approach, where the geomorphic indicators, spatial and temporal scale, and methodologies used are carefully chosen based on the goals of the management project; the assessment aims to support. Guidance for choosing the appropriate geomorphic indicators is based on their significance (usefulness in characterizing the system), ease of measurement, and temporal scale needs. We also present recommendations on measurement techniques for each indicator while highlighting recent technological and methodological advancements that help overcome resource challenges often faced in river assessment. Given the wealth of scientific and technological developments in the field of geomorphology, it is possible to improve how geomorphic form and function are measured and incorporated into river assessments that support watershed management goals.

Can auditory evoked responses elicited to click and/or verbal sound identify children with or at risk of central auditory processing disorder: A scoping review.

(Central) auditory processing disorders, (C)APDs are clinically identified using behavioral tests. However, changes in attention and motivation may easily affect true identification. Although auditory electrophysiological tests, such as Auditory Brainstem Responses (ABR), are independent of most confounding cognitive factors, there is no consensus that click and/or speech-evoked ABR can be used to identify children with or at-risk of (C)APDs due to heterogeneity among studies. This study aimed to review the possibility of using ABR evoked by click and/or speech stimuli to identify children with or at risk of (C)APDs. The online databases of PubMed, Web of Science, Medline, Embase, and CINAHL were explored using combined keywords for all English and French articles published until April 2021. Additional gray literature was also included such as conference abstracts, dissertations, and editorials in ProQuest Dissertations. Thirteen papers met the eligibility criteria and were included in the scoping review. Fourteen papers were cross-sectional and two were interventional studies. Eleven papers used click stimuli to assess children with/at risk of (C)APDs, and speech stimuli were utilized in the remaining studies. Despite the diversity of the results, especially in click ABR assessments, most studies indicated increases in the wave latencies and/or decreases in the wave amplitudes of click ABR in children with/at risk of (C)APDs. The results of speech ABR assessments were more consistent, as prolongation of the transient components of speech ABR was observed in these children, while sustained components remained almost unchanged. Although both click and speech-evoked ABRs could be used to assess children with (C)APDs, it appears that speech-evoked ABR assessments yield more reliable findings. These findings, however, should be interpreted with caution given the heterogeneity among studies. Well-designed studies on children with confirmed (C)APDs using standard diagnostic and assessment protocols are recommended.