Standardized Measurement Protocol Research Articles

Validating the Cambridge Protocol: Reliability of Hip Muscle Strength Measurements Using a Motorized Dynamometer and Electromyography.

Muscle weakness is common after injury in athletes and in the presence of hip pathology. It will cause abnormal hip biomechanics and can predict future injury. However, objective measurement of hip muscle strength is difficult to perform accurately and reliably. Therefore, it is challenging to determine when an athlete has returned to preinjury levels of strength. In addition, there is currently no standardized method of obtaining measurements, which prevents the data being compared or shared between research centers. The purpose of this study is to comprehensively assess the inter- and intraobserver reliability of our standardized muscle strength measurement protocol. Descriptive laboratory study. Level 3, inception cohort study. A total of 16 healthy male volunteers (age = 28.3 ± 7.9 years) were recruited. Those with a previous history of hip injuries or disorders were excluded. These volunteers underwent strength testing according to the Cambridge Protocol on 4 separate occasions, performed by 2 independent assessors. Maximal voluntary contractions, fatigue torque fluctuations, and electromyography measurements were recorded. Intra- and interobserver reliability was assessed using intraclass correlation coefficient (ICC). Good-to-excellent correlation was seen for both intra- and interobserver reliability across almost all hip movements for maximal contractions: ICC ranged 0.78 to 0.93 and 0.78 to 0.96, respectively. The standard error of the mean for all hip movements was also extremely low at 2% to 3%. The Cambridge Protocol is a highly reliable method for objective measurement of hip muscle strength. We recommend future studies use this protocol, or the principles underpinning it, to enable data sharing and comparison across different studies. This is a description and analysis of hip muscle strength measurement. If widely used, it will allow for accurate and objective strength assessment and closer monitoring of hip injuries and pathology.

Protocol to improve hypertension management in a VA outpatient clinic.

This 20-week quality improvement study describes implementation of a hypertension identification and management program with use of a standardized oscillometric blood pressure (BP) measurement protocol, provider education, and audit/feedback of hypertension control in a Veterans Affairs primary care clinic. A total of 692 male Veterans ages 18-85 years with treated hypertension and at least one clinic visit in the previous year were included for analysis. Mean age was 69.7 years (standard deviation 7.6) and race and ethnicity were 42.0% White, 29.1% Black and 3.0% Hispanic. Prior to program implementation, clinic BP was measured using the auscultatory method with a manual syphgmomanometer. Baseline BP measurements demonstrated bias as determined by terminal digit preference for digits 0 and 8 in 29.5% and 25.2% of systolic (SBP) and 31.6% and 21.8% of diastolic BP measurements, respectively (p < 0.001). Post-implementation of the standardized oscillometric BP measurement protocol, digit preference was eliminated. Protocol compliance was 89.1% at 5 weeks and 92.4% at 20 weeks. Overall average SBP was significantly higher in the post-implementation period compared to average SBP in the 12-month pre-implementation period (137.4 [Standard Deviation (SD) 17.4] vs. 126.3 [SD 15.3]; P < 0.001). Uncontrolled hypertension, (BP ≥ 140/90 mmHg), increased from 17.8% at baseline to 41.8% post-implementation while provider therapeutic inertia declined from 84.5% at baseline to 55.8% after 20 weeks. This study shows that terminal digit preference is reduced with implementation of standardized oscillatory BP measurement and a quality improvement program can reduce therapeutic inertia of hypertension treatment.

Outdoor Radon as a Tool to Estimate Radon Priority Areas—A Literature Overview

Doses from the exposure to outdoor radon are typically an order of magnitude smaller than those from indoor radon, causing a greater interest on investigation of the latter for radiation protection issues. As a consequence, assessment of radon priority areas (RPA) is mainly based on indoor radon measurements. Outdoor radon measurements might be needed to guarantee a complete estimation of radiological risk and may help to improve the estimation of RPA. Therefore, authors have analysed the available literature on outdoor radon to give an overview of outdoor radon surveys and potential correlation with indoor radon and estimation of RPA. The review has shown that outdoor radon surveys were performed at much smaller scale compared to indoor radon. Only a few outdoor radon maps were produced, with a much smaller density, covering a larger area, and therefore putting doubt on the representativeness of this data. Due to a large variety of techniques used for outdoor radon measurements and requirement to have detectors with a high sensitivity and resistance to harsh environmental conditions, a standardised measurement protocol should be derived. This is no simple endeavour since there are more applications in different scientific disciplines for outdoor radon measurements compared to indoor radon.

Novi pristup sagledavanju hipertenzije u hroničnoj bubrežnoj bolesti kroz prizmu poslednjeg KDIGO vodiča 2021

Hypertension associated with chronic kidney disease (CKD) is related with a high risk of cardiovascular disease (CVD), which is the most common cause of morbidity and mortality in patients with CKD. Control of hypertension is important primarily because it reduces the risk of CVD and all-cause mortality in patients with CKD. The new KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of blood pressure in CKD were published in 2021 and represented an updated version of the original guideline from 2012. This guideline covers all topics contained in the original instructions, such as optimal blood pressure targets, lifestyle interventions, choice of antihypertensive drugs, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid control and smoking, are excluded. In addition, this guideline introduces a chapter dedicated to proper blood pressure measurement as all large randomized trials from which the evidence and recommendations of this guide emerged used standardized preparation and measurement protocols adhered to by patients and clinicians. The key recommendation of the KDIGO guideline refers to target systolic blood pressure under120 mmHg in most adults with CKD, provided that the standardized office blood pressure measurement is used. Despite recommendations for lowering target blood pressure, general lack of evidence, especially in patients with diabetes and advanced CKD, still suggests the need to individualize targets according to the characteristics, tolerances, and preferences of each patient. Larger randomized controlled trials are needed to examine the effects of blood pressure targets on major adverse events and mortality in patients with CKD, especially in subpopulations that were not adequately represented in previous studies.

Extracellular vesicle research in reproductive science: Paving the way for clinical achievements†.

Mammalian conception involves a multitude of reciprocal interactions via a molecular dialogue between mother and conceptus. Extracellular vesicles (EVs) are secreted membrane-encapsulated particles that mediate cell-to-cell communication in various contexts. EVs, which are present in seminal, follicular, oviductal, and endometrial fluids, as well as in embryo secretions, carry molecular constituents that impact gamete maturation, fertilization, early embryo development, and embryo-maternal communication. The distribution, concentration, and molecular cargo of EVs are regulated by steroid hormones and the health status of the tissue of origin, and thus are influenced by menstrual phase, stage of conception, and the presence of infertility-associated diseases. EVs have been recognized as a novel source of biomarkers and potential reproductive medicine therapeutics, particularly for assisted reproductive technology (ART). There are still many technological and scientific hindrances to be overcome before EVs can be used in clinical diagnostic and therapeutic ART applications. Issues to be resolved include the lack of standardized measurement protocols and an absence of absolute EV quantification technologies. Additionally, clinically suitable and robust EV isolation methods have yet to be developed. In this review, we provide an overview of EV-mediated interactions during the early stages of reproduction from gamete maturation to embryo implantation and then outline the technological progress that must be made for EV applications to be translated to clinical settings.

Comparison of metabolic syndrome prevalence using four definitions – a case study from Finland

Abstract Background Metabolic syndrome (MetS) is an increasing population health threat in Europe. Several MetS definitions are available. Our aim was to compare four different MetS definitions among Finnish adults, to assess their agreement and to evaluate the impact of the choice of the definition on the prevalence of MetS. Methods Data from FinHealth 2017, a cross-sectional population health survey, focusing on adults over 25 years were applied in the analysis (n = 5667). Measured data on anthropometrics, blood pressure, biomarkers and questionnaire data were used to classify the participants according to the definitions. The definitions chosen for the comparison were those by the World Health Organization (1998), National Cholesterol Education Program Adult Treatment Panel III (2004), International Diabetes Federation (2005) and Joint Interim Statement (2009). Results The four MetS definitions resulted in substantially different MetS prevalences among the Finnish adult population: 18% by WHO, 32% by NCEP-ATP III, 43% by IDF and 46% by JIS. Among all participants, only 13.5% were identified to have MetS according to all four definitions. The component of the definitions with highest prevalence was elevated blood pressure among men and central obesity among women. Prevalence of Mets increased with age; especially steeply among the youngest age groups. Due to varying cut-off points the prevalence of different components varied between the definitions. The agreement, estimated with kappa coefficients, ranged from 0.38 (WHO vs. IDF and WHO vs. JIS) to 0.95 (IDF vs. JIS). Conclusions The differences between observed MetS prevalences using the four different definitions were large. For cross-country comparisons as well as for trend analyses within a country, it is essential to use the same definition of MetS to avoid possible bias due to differences in used definitions as well as to use standardized measurement protocols in measuring different components of MetS. Key messages It is important to use standardized measurement protocols during data collection to achieve comparable data. For cross-country comparisons as well as for trend analyses within countries, it is essential to use identical MetS definitions to avoid possible biases.

Food Losses and Wastage along the Wheat Value Chain in Egypt and Their Implications on Food and Energy Security, Natural Resources, and the Environment

Pushing yield frontiers of cereals and legumes is becoming increasingly difficult, especially in drylands. This paper argues and provides empirical evidence that food loss and wastage constitute a sizeable proportion of the total wheat supply in Egypt. By following the life cycle of food and using standard measurement protocols, we estimated the levels of food loss and wastage along the wheat value chain in Egypt and their socioeconomic, biophysical, and environmental implications. About 4.4 million tons (20.62% of total wheat supply from domestic production and imports in 2017/2018) is estimated to be lost or wasted in Egypt which is also associated with the wastage of about 4.79 billion m3 of water, and 74.72 million GJ of energy. This implies that if Egypt manages to eliminate, or considerably reduce, wheat-related losses and wastage, it will save enough food to feed 21 million more people from domestic production and hence reduce wheat imports by 37%, save 1.1 billion USD of much-needed foreign exchange, and reduce emissions of at least 260.84 million kg carbon dioxide-equivalent and 8.5 million kg of methane. Therefore, investment in reducing food loss and wastage can be an effective strategy to complement ongoing efforts to enhance food security through productivity enhancement in Egypt.

Abstract 52: KDIGO (Kidney Disease: Improving Global Outcomes) Guideline Update On The Management Of Blood Pressure In Chronic Kidney Disease: What’s New And What’s Different From Other Guidelines

Introduction: In 2012, KDIGO released a guideline on BP management in CKD not receiving dialysis. The emergence of new trials and meta-analyses coupled with wider recognition of the importance of standardized BP measurement protocols have prompted a call to update the 2012 guideline. This summary will outline the changes to the prior recommendations and highlight similarities to guidelines from ACC/AHA and ESC/ESH. Methods: A systematic review was undertaken to formally assess the following issues: 1) BP measurement; 2) lifestyle interventions; BP management in 3) patients with CKD, with and without diabetes, 4) kidney transplant recipients, and 5) children with CKD. Results: A total of 6863 citations were screened. Of these, 290 RCTs, 14 observational studies, and 35 systematic reviews were included in the evidence review. A major addition to the KDIGO 2021 guideline is a chapter devoted to BP measurement. KDIGO recommends the use of standardized office BP over routine BP. Out-of-office measurements (ABPM, HBPM) can be used to complement standardized readings. This emphasis on standardized office BP measurement is similar to recommendations from ACC/AHA and ESC/ESH. A systolic BP target of &lt;120 mm Hg is suggested; however, the guidance emphasizes that the target is only applicable when BP is measured using standardized office protocols. RASi are the preferred agents for adults with CKD with increased albuminuria. For lifestyle interventions, dietary sodium intake should be limited to &lt;2 g/day, and ≥150 minutes/week of physical activity is recommended. A BP target of &lt;130/80 mm Hg and use of CCB or ARB are preferred in kidney transplant recipients. BP in children with CKD should be guided by 24-hour MAP using ambulatory monitoring, targeting ≤50th percentile for age, sex, and height. Similar to ACC/AHA and ESC/ESH guidelines, KDIGO also encourages shared-decision making between patients and clinicians in the individualization of BP therapy. Conclusions: KDIGO has revised its guideline for BP management in CKD based on a rigorous development process and emerging new evidence underscoring the importance of standardized office BP measurement and a lower systolic BP target of &lt;120 mm Hg for achieving potential cardiovascular, kidney, and mortality benefits.

Commentary on the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in CKD.

Purpose of ReviewTo summarize and explain the new guideline on blood pressure (BP) management in chronic kidney disease (CKD) published by Kidney Disease: Improving Global Outcomes (KDIGO), an independent global nonprofit organization which develops and implements evidence-based clinical practice guidelines in kidney disease. KDIGO issued its first clinical practice guideline for the Management of Blood Pressure (BP) in Chronic Kidney Disease (CKD) for patients not receiving dialysis in 2012 and now updated the guideline in 2021.Recent FindingsRecommendations in this update were developed based on systematic literature reviews and appraisal of the quality of the evidence and strength of recommendation following the “Grading of Recommendations Assessment, Development and Evaluation” (GRADE) approach. The updated guideline includes five chapters covering BP measurement techniques, lifestyle interventions for lowering BP, and management of BP in three target populations, namely adults (with and without diabetes), kidney transplant recipients, and children. A dedicated chapter on BP measurement emphasizing standardized preparation and measurement protocols for office BP measurement is a new addition, following protocols used in large randomized trials of BP targets with pivotal clinical outcomes.SummaryBased on the available evidence, and in particular in the CKD subgroup of the SPRINT trial, the 2021 guideline suggests a systolic BP target of <120 mm Hg, based on standardized measurements, for most individuals with CKD not receiving dialysis, with the exception of kidney transplant recipients and children. This recommendation is strictly contingent on the measurement of BP using standardized office readings and not routine office readings.

Variations in Clinical Practice of Esophageal High-resolution Manometry: A Nationwide Survey.

Background/AimsEsophageal high-resolution manometry (HRM) enables the comprehensive evaluation of the esophageal motor function. However, protocols are not uniform and clinical practices vary widely among institutions. This study aims to understand the current HRM practice in Korea.MethodsThe survey was sent via email through the Korean Society of Neurogastroenterology and Motility. The questions covered descriptive information, preparation, techniques, analysis, and reporting of esophageal HRM.ResultsThe survey was completed in 32 (74.4%) out of 43 centers, including 24 tertiary and 8 secondary referral centers. Of the 32 centers, 25 (78.1%) performed HRM in a sitting position, while 7 centers (21.9%) reported performing HRM in a supine position. All the centers utilized single wet swallows as a standard, but the volume, frequency, and interval between swallows varied widely. Sixteen centers (50.0%) applied adjunctive tests, including multiple rapid swallows (n = 16) and rapid drink challenges (n = 9). Parameters assessed and documented in the report were similar. In addition to the assessment of the esophagogastric junction and esophageal body, 27 centers (84.8%) and 18 centers (56.3%) included measurements for the upper esophageal sphincter and the pharynx, respectively, in the HRM protocol.ConclusionsWe found a variation in the available HRM practice among centers, even though they broadly agreed in the data analysis. Efforts are needed to develop a standardized protocol for HRM measurement.

Feasibility of ultrasound-based measurement of dorsal scaphoid displacement: A 3D-model study

The present study aimed to develop a reliable dynamic measurement technique, which can be used directly in the outpatient setting, based on dorsal subluxation of the scaphoid on scaphoid shift test. This study was designed to evaluate feasibility and to quantify dorsal subluxation of the scaphoid in relation to the lunate. Based on a scaphoid shift test under ultrasonography, a standardized 3D test model was developed to measure subluxation. Sagittal subluxation ranged between 0 and 6 mm, as checked on the implemented scale. Four hand surgeons trained in ultrasonography (experience level II–V) performed blinded measurements (total of 52, n = 13 per investigator) with a standardized measurement protocol. Dorsal subluxation of the scaphoid was measured in relation to the lunate. Interobserver reliability on intraclass correlation coefficient (ICC) was excellent, at 0.97 (95% confidence interval, 0.930–0.992). Mean overall absolute measurement error was 0.27 mm ± 0.21. Dorsal subluxation of the scaphoid can thus be accurately measured on ultrasound with excellent interobserver reliability, quantifying and improving clinical assessment of scapholunate instability.

Using the PhenX Toolkit to Select Standard Measurement Protocols for Your Research Study.

The goals of PhenX (consensus measures for Phenotypes and eXposures) are to promote the use of standard measurement protocols and to help investigators identify opportunities for collaborative research and cross‐study analysis, thus increasing the impact of individual studies. The PhenX Toolkit (https://www.phenxtoolkit.org/) offers high‐quality, well‐established measurement protocols to assess phenotypes and exposures in studies with human participants. The Toolkit contains protocols representing 29 research domains and 6 specialty collections of protocols that add depth to the Toolkit in specific research areas (e.g., COVID‐19, Social Determinants of Health [SDoH], Blood Sciences Research [BSR], Mental Health Research [MHR], Tobacco Regulatory Research [TRR], and Substance Abuse and Addiction [SAA]). Protocols are recommended for inclusion in the PhenX Toolkit by Working Groups of domain experts using a consensus process that includes input from the scientific community. For each PhenX protocol, the Toolkit provides a detailed description, the rationale for inclusion, and supporting documentation. Users can browse protocols in the Toolkit, search the Toolkit using keywords, or use Browse Protocols Tree to identify protocols of interest. The PhenX Toolkit provides data dictionaries compatible with the database of Genotypes and Phenotypes (dbGaP), Research Electronic Data Capture (REDCap) data submission compatibility, and data collection worksheets to help investigators incorporate PhenX protocols into their study design. The PhenX Toolkit provides resources to help users identify published studies that used PhenX protocols. © 2021 The Authors. Current Protocols published by Wiley Periodicals LLC. Basic Protocol: Using the PhenX Toolkit to support or extend study design

Resting metabolic rate and its adjustments as predictors of risk protein-energy wasting in hemodialysis patients.

Background: The purpose of the present study was to explore the association between resting metabolic rate (RMR) and protein-energy wasting (PEW) risk in Chinese hemodialysis patients by age and gender subgroup.Methods: RMR and body composition (body cell mass (BCM) and fat mass) of 774 patients undergoing hemodialysis were estimated by bio-electrical impedance analysis (BIA). Anthropometric data were collected by a standard measurement protocol, and the upper arm muscle circumference (AMC) was calculated. Biochemical nutritional and dialysis parameters were obtained. Linear regression analysis was used to analyze the relationship among RMR, body composition and nutritional factors.Results: The mean age was 54.96 ± 15.78 years. RMR level in patients was 1463.0 (1240.5, 1669.0) kcal/d. In multiple linear regression models, BCM, left calf circumference (LCC), fat mass were the determinants association with RMR (P<0.001). Among the patients in the sample, 133 (17.2%) had been diagnosed with PEW per International Society of Renal Nutrition and Metabolism (ISRNM) criteria and 363 (46.9%) were being at risk PEW. The area under the receiver-operating characteristic curve (AUC) of RMR for predicting risk PEW was greater than RMR/BCM and RMR/body surface area (BSA). When the cutoff of RMR was 1481 kcal/d it had the higher sensitivity and specificity (82 and 42%), and the AUC was 0.68 in elderly maintenance hemodialysis (MHD) patients (P<0.001). After adjustment for potential confounders, lowest RMR quartile level (<1239) increased the risk of PEW (OR = 4.71, 95% CI: 1.33–16.64, P=0.016) in all patients.Conclusions: Older patients with PEW have a lower RMR reduction. RMR and RMR/BCM may play the role in objective screening to detect risk PEW in MHD patients, especially in males.

Relationship of an adherence score with blood pressure control status among patients with hypertension and their determinants: Findings from a nationwide blood pressure screening program.

This study aimed to examine the relationship of adherence with blood pressure (BP) control and its associated factors in hypertensive patients. This cross‐sectional nationwide BP screening study was conducted in Malaysia from May to October 2018. Participants with self‐declared hypertension completed the Hill‐Bone Compliance to High Blood Pressure Therapy Scale (Hill‐Bone CHBPTS) which assesses three important domains of patient behavior to hypertension management namely medication taking, appointment keeping and reduced salt intake. Lower scores indicate better compliance while higher scores indicate otherwise. Participant's body mass index and seated BP were measured based on standard measurement protocol. Determinants of adherence to treatment were analyzed using multiple linear regression. Out of 5167 screened subjects, 1705 were known hypertensives. Of these, 927 (54.4%) answered the Hill‐Bone CHBPTS and were entered into analysis. The mean age was 59.0 ± 13.2 years, 55.6% were female and 42.2% were Malays. The mean Hill‐Bone CHBPTS score was 20.4 ± 4.4 (range 14‐47), and 52.1% had good adherence. The mean systolic BP and diastolic BP were 136.4 ± 17.9 and 80.6 ± 11.6 mmHg, respectively. BP was controlled in 58.3% of those with good adherence compared to 50.2% in those with poor adherence (p = .014). Based on multiple linear regression analysis, female gender (β = −0.72, 95% confidence interval [CI] −1.30, −0.15, p = .014), older age (β = −0.05, 95% CI −0.07, −0.03, p < .001), and individuals with primary or lower educational level (β = −0.91, 95% CI −1.59, −0.23, p = .009) had better adherence to BP management. Interventional programs targeted at the less adherent groups are needed in order to improve their adherence and BP control.

Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

BackgroundVirtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall.MethodsSeventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures.ResultsThere were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p < 0.0001) with higher step lengths (F(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F(1,32) = 19.77, p < 0.0001) and total time (F(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment.ConclusionsThis comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

Estimating uncertainty: A Bayesian approach to modelling photosynthesis in C3 leaves.

The Farquhar-von Caemmerer-Berry (FvCB) model is extensively used to model photosynthesis from gas exchange measurements. Since its publication, many methods have been developed to measure, or more accurately estimate, parameters of this model. Here, we have created a tool that uses Bayesian statistics to fit photosynthetic parameters using concurrent gas exchange and chlorophyll fluorescence measurements whilst evaluating the reliability of the parameter estimation. We have tested this tool on synthetic data and experimental data from rice leaves. Our results indicate that reliable parameter estimation can be achieved whilst only keeping one parameter, Km , that is, Michaelis constant for CO2 by Rubisco, prefixed. Additionally, we show that including detailed low CO2 measurements at low light levels increases reliability and suggests this as a new standard measurement protocol. By providing an estimated distribution of parameter values, the tool can be used to evaluate the quality of data from gas exchange and chlorophyll fluorescence measurement protocols. Compared to earlier model fitting methods, the use of a Bayesian statistics-based tool minimizes human interaction during fitting, reducing the subjectivity which is essential to most existing tools. A user friendly, interactive Bayesian tool script is provided.

Advanced Platinum-Based Oxygen Reduction Electrocatalysts for Fuel Cells.

ConspectusFuel cells are among the cutting-edge energy technologies. Their commercial development is still hindered by noble platinum (Pt) catalysts for the oxygen reduction reaction (ORR) at the cathode, which not only determine the energy conversion efficiency and service life but also are closely related to the cost and broad application of fuel cells. Given the bright and enormous future of fuel cells, ORR catalysts should possess highly efficient performance yet meet the acceptable Pt costs for large-scale application. Extensive efforts are concentrated on the optimization of Pt-based nanostructures and upgradation of functional carriers to achieve the low-cost and high-activity Pt-based catalysts. By improving the Pt utilization and accessible surface, reducing Pt consumption and catalyst costs, accelerating mass exchange and electron transfer, alleviating the corrosion and agglomeration of carriers and Pt, accompanying with the assistance of robust yet effective functional supports, the service level and life of Pt-based electrocatalysts would be significantly improved and fuel cells could get into commercial market covering broader applications.In this Account, we focus on the recent development of Pt-based catalysts to figure out the problems associated with ORR catalysts in fuel cells. Recent development of Pt-based catalysts is discussed in different stages: (1) multiscale development of Pt-based nanostructures; (2) multielement regulation over Pt-based alloy composition; (3) upgradation of carbon and noncarbon support architectures; (4) development of integrated Pt-based catalysts for fuel cells. Finally, we propose some future issues (such as reaction mechanism, dynamic evolutions, and structure-activity relationship) for Pt-based catalysts, which mainly involve the preparation strategy of Pt-integrated catalysts (combination of Pt nanostructures with nanocarbons), performance evaluation (standard measurement protocols, laboratory-level rotating disk electrode (RDE) measurements, application-level membrane electrode assembly (MEA) service test), advanced interpretation techniques (spectroscopy, electron microscopy, and in situ monitoring), and cutting-edge simulation/calculations and artificial intelligence (simulation, calculations, machine learning, big data screening). This Account calls for the comprehensive development of multiscale, multicomponent, and high-entropy Pt-based alloy nanostructures, and novel and stable carriers, which provide more available options for rational design of low-cost and high-performance Pt-integrated ORR catalysts. More importantly, it will give an in-depth understanding of the reaction mechanism, dynamic development, and structure-performance relationship for Pt-based catalysts in fuel cells and related energy technologies.

Angiographic cerebral venous sinus calibers and drainage patterns in patients with normal intracranial pressure and idiopathic intracranial hypertension

BackgroundNormative venous sinus diameters are not well established. This study seeks to compare two-dimensional digital subtraction cerebral angiographic (DSA) venous sinus calibers for patients with normal intracranial pressure (ICP) and...

Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring.

In addition to typical reflux symptoms, many patients with gastroesophageal reflux disease (GERD) present with extraesophageal symptoms such as cough, hoarseness or asthma, which can be caused by laryngopharyngeal reflux (LPR). Due to their multifactorial origin, those symptoms can be a great diagnostic and therapeutic challenge. Esophageal pH-monitoring is commonly used to determine abnormal esophageal acid exposure and confirm the diagnosis of GERD. However, for better evaluation of acid exposure above the upper esophageal sphincter, a new laryngopharyngeal pH measurement system is now available and may lead to more reliable results in patients with predominantly extraesophageal symptoms. This article aims to present a standardized protocol for simultaneous pH measurement using esophageal and laryngopharyngeal pH probes in order to obtain acid exposure scores from both measurements.

Associations Between Nutritional Status, Sociodemographic Characteristics, and Health-Related Variables and Health-Related Quality of Life Among Chinese Elderly Patients: A Multicenter Prospective Study.

Background: Studies that explore the nutritional status, sociodemographic factors, mental health variables, and physical health variables that affect the health-related quality of life (HRQoL) of elderly patients are scarce in China.Objective: This study aimed to examine the association between health-related quality of life (HRQoL) and nutritional status, sociodemographic characteristics, and health-related variables among Chinese elderly patients.Materials and Methods: Participants were recruited from six tertiary-level hospitals in six provinces or municipalities/cities throughout China from October 2018 to February 2019: a total of 9,996 participants aged 65 years and older were enrolled. The nutritional status and HRQoL were measured using the Mini Nutritional Assessment—Short Form (MNA-SF) and the EuroQoL Five-Dimension Visual Analog Scale, respectively. BMI was taken using standard measurement protocols. Sociodemographic characteristics included age, sex, education, marital status, ethnicity, smoking, alcohol drinking, and current residence. Mental and physical health variables such as frailty and depression were assessed using validated tested instruments. Multiple linear regression analysis was used to analyze whether the nutritional status, sociodemographic characteristics, and health-related variables were associated with HRQoL.Results: According to the MNA-SF scores at the 30- and 90-day follow-up, 9.7% and 9.1% of participants were malnourished, respectively. Higher MNA-SF scores were related to higher HRQoL scores in older patients (regression coefficient; 95% confidence interval) both at the 30-day (0.660; 0.499–0.821) and 90-day (0.622; 0.434–0.809) follow-up. However, there were no significant associations between the body mass index values and HRQoL. Sociodemographic characteristics (such as age, smoking, and current residence), physical health variables (frailty, urinary function, defecation function, sleeping condition, and falling accidents in the past 12 months), and mental health variables (depression) were the main factors influencing HRQoL in this group.Conclusion: There are several factors associated with HRQoL among the population derived from this investigation of a representative sample of the Chinese hospitalized elderly population in tertiary hospitals. These findings could have major importance for the planning of “active aging” policies and programs.Trial Registration: Chinese Clinical Trial Registry, ChiCTR1800017682, registered August 9, 2018.