Usual Recommendations Research Articles

Haemophilia testing of young girls in Canada: Describing the current recommendations for factor level and genetic testing and the experiences of Canadian parents.

It is widely acknowledged that haemophilia affects women and girls, yet current testing recommendations for factor level and genetic testing vary and do not universally incorporate updated research. Canadian parents have expressed frustration at inconsistent recommendations and reported instances where delayed testing led to missed diagnosis and preventable bleeding. Study aim was to explore and describe the practice of haemophilia-related testing of young girls in Canada. A mixed methods study was carried out with two populations: (1) Nurses working in haemophilia care completed a survey regarding the current testing recommendations of their Haemophilia Treatment Centre (HTC), (2) Parents of obligate or potential haemophilia carriers completed a structured interview with questions about their family experience of haemophilia and testing decisions for daughters. Twenty-six survey responses were received and showed wide variation in the usual recommendations of Canadian HTCs. Different factor level testing recommendations may be given to obligate and potential carriers despite no difference in bleeding risk. Only a minority of HTCs currently recommend an early baseline factor level (<10 years) to obligate carriers (27%) or potential carriers (15%). For genetic testing of potential carriers, 70% of HTC would approve a family request for genetic testing of a minor with specific conditions. The majority of parents interviewed felt dissatisfied with their testing experience (58%) and highlighted many issues related to delayed testing recommendations. Updated, nationally affirmed testing recommendations are needed that align with research on bleeding in women and girls affected by haemophilia.

Awareness, perception and practices regarding Breast-Feeding and IYCF Practices among mothers of Children Up to 2 Years in Two Districts of Central India: A Cross-Sectional Study

Background: Breastfeeding is an absolute necessary intervention for childhood survival. WHO/UNICEF have given utmost emphasis on first 1000 days of life comprising of 270 days in-utero and the first two years post birth as most vital period for nutritional interventions. [1] Infant and Young Child Feeding (IYCF) is a set of renowned and usual recommendations for appropriate feeding of new-born and children below two years of age. Aims &amp; Objectives: To assess the awareness, perception and practices, regarding breast-feeding and IYCF practices among mothers of children up to 2 years, in two districts of Central India. Settings and Design: Cross Sectional Study. Materials and Methods: This Cross-sectional study was carried out in two districts of Central India from January 2021 to December 2021. The study subjects included 400 mothers of babies less than two years old, who had given consent. Interpersonal interview using a pre-designed semi-structured questionnaire was carried out. Data was collected, compiled and analysed using SPSS 25.0 (Trial Version). Result: Only (58.60%) of respondents were completely knowledgeable about exclusive breastfeeding, the value of colostrum feeding, the advantages of breastfeeding (81.69%), and its early onset (64.75%), duration (71.25%), and frequency (74.50%). However, 50.25% of women lacked understanding about the ideal positioning and attachment of the infant to the breast. Conclusion: All beneficiaries should be shown demonstrations of all IYCF practices. Family members should also be counselled and encouraged to support IYCF practices.

Neurological patients confronting climate change: A potential role for the glymphatic system and sleep

Interest in the health consequences of climate change (global warming, heatwaves) has increased in the neurological community. This review addresses the impact of elevated ambient temperatures and heatwaves on patients with neurological and mental health disorders, including multiple sclerosis, synucleinopathies, dementia, epilepsies, mental health, and stroke. Patients with such conditions are highly vulnerable during heatwaves because of functional disorders affecting sleep, thermoregulation, autonomic system reactivity, mood, and cognitive ability. Several medications may also increase the risk of heatstroke. Special attention is devoted to the involvement of common underlying mechanisms, such as sleep and the glymphatic system. Disease prevention and patient care during heatwaves are major issues for caregivers. Beyond the usual recommendations for individuals, we favor artificially induced acclimation to heat, which provides preventive benefits with proven efficacy for healthy adults.

Implementing fencing as adapted physical activity in non-metastatic breast cancer patients: design and early rehabilitation strategy of the FENICE study protocol.

Improving prognosis of BC patients has drawn the attention of health care professionals on disease related long-term side effects and on the multiple treatments BC patients must undergo. Despite advances in procedures, surgery still has multiple detrimental effects, including pain, edema, and limited mobility. For this reason, fostering adapted physical activity (APA) and healthy lifestyle (including a balanced diet and weight management) should become an everyday purpose of healthcare professionals. Fencing may be a well-suited activity to counteract fatigue, pain, and limited arm mobility. The FENICE study is a mono-center, randomized clinical trial targeting women with BC stages I-III within four weeks from BC surgery. Participants in the control arm will receive the usual recommendations based on the good clinical practice guidelines. In the study arm, participants will be treated with the usual clinical and therapeutic recommendations together with APA and correct lifestyle suggestions. The primary objective of the study is to compare whether implementation of APA and healthy lifestyle in BC patient after surgery will result in an overall improvement of physical and mental status. Fencing and its early application in postoperative period may represent a feasible strategy to be implemented in the rehabilitation journey of BC patients. The study protocol FENICE has been approved by an Italian Ethics Committee on May 2023 (R.S 100.23 5th May 2023).

Effects of a foot-ankle muscle strengthening program on pain and function in individuals with knee osteoarthritis: a randomized controlled trial

BackgroundFoot-ankle exercises could improve pain and function of individuals with KOA and need to be tested. ObjectiveTo investigate whether an 8-week foot-ankle muscle strengthening program is effective for individuals with KOA to reduce pain and improve function. MethodsIn this randomized controlled trial, individuals diagnosed with clinical and radiographic KOA were randomized into the intervention (supervised foot-ankle strengthening exercise program three times a week for 8 weeks) or control (usual care and recommendations of the healthcare team) group. Effectiveness was assessed by changes in clinical and functional outcomes between baseline and 8 weeks with pain as the primary outcome. ANCOVA tests using the intervention group as a reference and sex, body mass index, and baseline values as covariates assessed between-group differences. ResultsThe intervention group showed lower pain scores (−4.4 units; 95%CI = −7.5, −1.1), better function (−7.1 units; 95%CI = −12.7, −1.4), higher total functional score (−11.9 units; 95%CI = −20.7, −3.1), with confidence intervals indicating a potential for the differences to be clinically meaningful, and better scores for the 30-s chair stand test (2.7 repetitions; 95%CI = 1.1, 4.1), with a confidence interval indicating a moderate clinically meaningful difference, compared to the controls. ConclusionThe 8-week foot-ankle exercise program showed positive, and potentially clinically meaningful, effects on knee pain and physical function among individuals with KOA, when compared to usual care. Trial registrationNCT04154059. https://clinicaltrials.gov/ct2/show/NCT04154059

Отдаленные результаты ИАГ-лазерной деструкции вросшего эпителия роговицы после Femto-LASIK и ReLEx Smile

Purpose. To evaluate long term cornea characteristics after Nd:YAG laser destruction of epithelial ingrowth in patients after Femto-LASIK and ReLEx Smile and assess its safety according to the state of the corneal endothelium. Material and methods. Due to the rather rare development of this condition, clinical material is presented by 6 cases (6 eyes): 4 men and 2 women aged 22 to 43 years, average 34.6±2.7 years. The average degree of myopia is –4.75 diopters. The Femto-LASIK technique was performed in 3 eyes, and ReLEx Smile – in 3 eyes. All surgeries were carried out without complications, the patients were discharged at the place of residence with the usual recommendations. The timing of epithelial ingrowth after refractive surgery varied from one week to 3 months. The number of sessions of Nd:YAG laser destruction varied regardless of the type of epithelial ingrowth and the technique of previous refractive surgery. The safety of the treatment was confirmed by studying the state of the corneal endothelium of the operated patients. Results. In all 6 cases, it was possible to achieve complete destruction of the zones of epithelial ingrown. Epithelial ingrowth was eliminated at one patient in 5 sessions, at two – in 3 sessions, at two – in 2 sessions and at one – in one session. The number of sessions and the number of impulses in different patients varied greatly and it was not possible to draw a direct parallel between the volume of epithelial ingrown and the total number of impulses. Conclusion. Analysis of long-term results of treatment of epithelial ingrowth by the method of Nd:YAG laser destruction showed good efficiency and atraumaticity for the cornea. The advantage of this technique is its ease of implementation, which is especially important after the ReLEx Smile technology. The use of Nd:YAG laser is effective method of epithelial ingrowth destruction. Key words: Femto-LASIK, ReLEx Smile, epithelial ingrowth, Nd:YAG laser, corneal endothelium, Nd:YAG laser destruction

#2543 NEPHROFLOW FOR ESTIMATION OF VASCULAR ACCESS FLOW FOR HEMODIALYSIS: WHEN TO MEASURE?

Abstract Background and Aims Current guidelines emphasize the need for surveillance of vascular access (VA) for hemodialysis (HD), especially arteriovenous fistulas (AVF). Detecting a reduction in VA flow is auseful tool to anticipate the complications of VA as thrombosis. The DMed NephroFlow(NIPRO®) system, based on ultrasound dilution (UD) methods, has been shown tobe comparable to the classic Transonic® measurement system for estimating VA flow and canbe applied for VA surveillance. Our objetctive is to determine if there are significant differences when performing flow measurements with NephroFlow® between the first hour and the second hour of the HD session, as well as between any of the three days in which the patient attends HD. Method For two consecutive weeks, patients with AVF or graft (gAVF) on HD in our unit underwent VA flow measurements using the NephroFlow® system at the first and second hour of HD, on the 3 days that they attended HD sessions. Interspersing the first hour with the second each week to avoid significant loss in HD quality. For the study, we proceeded according to the usual recommendations of stable flow at 250 ml/min, corresponding ultrafiltration rate, needles in the same vein, without change in dry weight, with the same nurse staff, and transferring all patients to conventional HD. Results Twenty-one patients have been included, 13 male and 8 female, mean age 68±12.3 years. The mean time on HD was 36±23 months. The type of VA was: 10 patients presented a radiocephalic AVF, 5 brachiocephalic AVF, 2 patients a brachiobasilic AVF, and 4 patients a gAVF. The estimated mean flow obtained by NephroFlow ® in the first hour of all sessions and in the second hour was 1056 ± 754 and 1130.16 ± 769 ml/min, respectively; intraclass correlation index was 0.737 and K-W Test H 0.349 (p≤0.05). The mean flow on the first day was 1129±794.5ml/min, ICC = 0.662; second day 1027.5±729ml/min, ICC = 0.812; third day 1121.5±±ml/min, ICC = 0.774. In all cases p&amp;lt;0.05. Conclusion No significant differences have been observed in the VA flow estimated with the NephroFlow® ultrasound dilution system, neither at measurement time (the first or the second hour of HD session) nor day of performance (first, second or third day of HD session of the week). NephroFlow® UD system may be a useful tool for VA surveillance and could be applied when is necessary.

Efficacy of an Educational Intervention for Sodium Restriction in Patients with Hypertension: A Randomized Controlled Trial

There is sound evidence showing the efficacy of non-pharmacological interventions in lowering blood pressure (BP); however, adherence is usually poor. Interventions to induce behavioral changes aim to improve the ability to read labels, choose foods, and eat low-sodium meals, reinforcing adherence to sodium restriction. In this randomized parallel-controlled trial, we assessed the effectiveness of an educational intervention using the Dietary Sodium Restriction Questionnaire (DSRQ) scores. A follow-up period of 6 months was conducted. Participants were randomized into (1) an educational intervention provided by a registered dietitian on individual visits and dietary planning; (2) a control group with the usual care and dietary recommendations. Patients underwent 24-h ambulatory BP monitoring, 12-h fasting blood tests, spot urine collection, and assessment using DSRQ. We randomized 120 participants (67.5% women and 68.3% Caucasians), and 25 participants were lost to follow-up. The 24-h sodium urinary excretion changed in the control (Δ −1610 mg/day; 95% confidence interval [CI] −1800 to −1410) and intervention groups (Δ −1670 mg/day; 95% CI −1800 to −1450) over time. There was no significant difference in the 24-h estimated sodium between groups. In hypertensive patients, DSRQ-based educational intervention is effective for improving the ability to detect and overcome obstacles to a low-sodium restriction diet but is as effective as dietary recommendations for lowering sodium.

Return to sport after forearm fractures in children: A scoping review and survey.

A common question faced by clinicians is when a child may return to sport after treatment for a pediatric forearm fracture. There are few published recommendations and fewer supported by evidence. The aims of this study were to summarize existing published recommendation for return to sport after pediatric forearm fractures and to conduct a survey to determine usual clinical recommendations. A scoping review was performed on Ovid MEDLINE, Cochrane Central Register of Controlled Trials, Embase, Scopus, and Google Scholar in accordance with the Joanna Briggs Institute guidelines. In addition, 64 orthopedic surgeons were anonymously surveyed asking for recommendations regarding return to sport after pediatric forearm fractures. Participants were to assume children were 9 years old and played a sport with an average risk of forearm injury. Twenty-two publications for return to sport were retrieved. Children with distal radius buckle fractures safely commonly returned to sport by 4 weeks after initial injury, while survey respondents recommended over 6 weeks. Survey respondents valued fracture stability the highest when making return to sport recommendations. Children with simple, metaphyseal, single-bone fractures were usually allowed to return to sport at 8-10 weeks post-injury. Diaphyseal and complete fractures were prescribed longer return to sport intervals. Australian respondents also prescribed longer return to sport intervals. Children with distal radius buckle fractures may return to sport by 4 weeks after initial injury, sooner than recommended. Published recommendations remain limited for other fractures. However, our survey suggests children with simple, metaphyseal, single-bone fractures may return to sport at 8-10 weeks. Children with diaphyseal and complete fractures should abstain from sport for longer than metaphyseal and greenstick fractures, respectively. level V.

Human-Centric Aggregation via Ordered Weighted Aggregation for Ranked Recommendation in Recommender Systems

In this paper, we propose an approach to recommender systems that incorporates human-centric aggregation via Ordered Weighted Aggregation (OWA) to prioritize the suggestions of expert rankers over the usual recommendations. We advocate for ranked recommendations where rankers are assigned weights based on their ranking position. Our approach recommends books to university students using linguistic data summaries and the OWA technique. We assign higher weights to the highest-ranked university to improve recommendation quality. Our approach is evaluated on eight parameters and outperforms traditional recommender systems. We claim that our approach saves storage space and solves the cold start problem by not requiring prior user preferences. Our proposed scheme can be applied to decision-making problems, especially in the context of recommender systems, and offers a new direction for human-specific task aggregation in recommendation research.

Abstract P5-04-09: Analysis of an update to a novel breast cancer screening web-app

Abstract Introduction A minority of women with breast cancer in Mexico are diagnosed through a screening program with a low rate of national coverage of about 20%, which translates into late diagnosis and worse outcomes. The detection of high-risk groups through easy-access interventions is essential to increase the screening rate. OBJECTIVE To identify and analyze patients at high risk of breast cancer, through a web app specially designed for this purpose. MATERIAL AND METHODS The web app stratified respondents according to breast cancer risk into 4 categories: very high risk (symptomatic), high lifetime risk, average risk (usual screening recommendations), or low risk. The app was programmed to guide patients to a risk-based information page or urge them to seek medical advice if indicated (https://cuccuanl.com/tamiz_mama/). The web app also provided the contact information of our center, or an appointment could also be scheduled within the app. Distribution was made via social media. An upgrade of the app was launched, which expanded the functionality with the inclusion of the Gail model to identify women with a high lifetime risk for developing breast cancer and the option for a simple interpretation of mammographic results. In version 2.0, the patients were divided into 2 populations, the first one which already had a breast imaging test but wished to know what the BIRADS score obtained meant and the other group were those who answered a simple survey similar to the one available on version 1.0, with added questions to calculate the Gail model risk. RESULTS The web app was originally released in October 2021 with a total number of 1,012 women answering the survey. The update was released in June 2022 with 406 new subjects. 281 patients wished for a risk calculation with no prior breast imaging tests and 124 patients already had a breast image diagnosis test that wanted a simple interpretation. Table1 depicts the answers given between both versions. Among the group of patients that had a mammography but had doubts about the result 12.9% (n=16) reported a BIRADS 0, 12.1% (n=15) BIRADS 1, 46% (n=57) BIRADS 2, 14.5% (n=18) BIRADS 3, and 14.4% (n=18) BIRADS 4 or 5. To date 41 patients have booked an appointment at the cancer prevention clinic directly within the webapp for further evaluation. DISCUSSION AND CONCLUSION The changes in the criteria of high risk did not translate into changes in the proportion of patients considered at high lifetime risk of breast cancer, but these changes made might be more specific for subsequent screening and chemoprevention strategies. The app persisted with a high proportion of symptomatic patients. The results of integration of the simple mammography interpretation were surprising, with a high proportion of subjects with indication for a biopsy founded. In the Mexican population there is a significant gap between the screening mammography and the first consultation with a specialist, averaging 113 days from an abnormal screening test to a diagnosis of breast cancer (1), which delays treatment initiation resulting on a worst outcome. These kinds of apps may empower patients to seek earlier consultation if warranted or educate patients on their personal risk for developing cancer so they may have a closer adherence to early detection programs. These results and subsequent updates might help evolve the app into something more akin to a digital navigator for patients. Bibliography 1)Unger-Saldaña K, Cedano Guadiamos M. Delays to diagnosis and barriers to care for breast cancer in Mexico and Peru: a cross sectional study. The Lancet Global Health. 2020 Apr 1;8:S16. Table 1 Results stratified by risk groups between version 1.0 and 2.0 Citation Format: Jose F. Muñoz Lozano, Omar Zayas Villanueva, Estefania Abundis Marquez, Fernando Alcorta Nuñez, Maria Fernanda Noriega, Carlos Salazar Mejia, Celia B. Gonzalez Alcorta, Diana Cristina Pérez Ibave, Victor Oyervides Juarez, Larisa M. Renteria Garcia, Adelina Alcorta Garza, Juan Francisco Gonzalez Guerrero, David Hernandez, Rafael Piñeiro Retif, Oscar Vidal Gutiérrez. Analysis of an update to a novel breast cancer screening web-app [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-09.

Anatomia foliar comparada de Palicourea rigida e Palicourea coriacea (Rubiaceae) ocorrentes no município de Diorama, Goiás, Brasil

This study aimed to perform a comparative anatomical study between Palicourea coriacea and Palicourea rigida (Rubiaceae), aiming to correlate possible anatomical changes to the variations of climatic factors found in the biome, and contribute to the taxonomic delimitation of the genus. The material was collected according to the usual recommendations in plant anatomy in an area of Cerrado sensu stricto, located in the municipality of Diorama – Goiás. We observed that the studied species share morphoanatomical diagnostic characteristics for the Rubiaceae family. However, some variations were found, such as styloid crystals, which were only found for species of the Psychotria genus, and which were considered a distinctive feature of the Psychotria genus. As styloid crystals were found in both P. coriacea and P. rigida, we suggest that it be used as a distinguishing feature of the tribe.

Effects of a Home-Based Foot–Ankle Exercise Program with Educational Booklet for Foot Dysfunctions in People with Diabetic Neuropathy: Results of the FOCA-II Randomized Controlled Clinical Trial

Exercise rehabilitation and education are important strategies for preventing the progression of diabetic neuropathy-related musculoskeletal deficits. The purpose of this randomized controlled trial was to investigate the effect of an 8-week home-based foot–ankle exercise program using an educational booklet on clinical outcomes (foot muscle strength and functionality; functional balance; diabetic neuropathy symptoms and severity; tactile and vibratory sensitivities; plantar pressure distribution; and foot–ankle, knee, and hip biomechanics during gait). Fifty participants with neuropathy were randomly allocated into an intervention group (59.1 ± 6.4 years, 23.5 ± 4.8 kg/m2, males = 6, females = 19) that performed the exercises for 8 weeks and a control group (56.5 ± 9.4 years, 22.9 ± 3.6 kg/m2, males = 5, females = 20) that received usual care recommendations. Generalized estimating equation method and intention-to-treat approaches were adopted. No significant differences were found for any clinical outcome after 8 weeks. Heel contact area increased in the intervention group compared to controls (p = 0.043, mean difference = 2.7 cm) and heel peak pressure was increased in controls compared to intervention (group effect p = 0.020, mean difference = -64.16 kPa) at 8 weeks. Controls showed increased joint moments for the hip at heel strike (p = 0.007) and for the knee and hip at push off over 8 and 16 weeks (p &lt; 0.001 and p = 0.009, respectively). Although the intervention is easy to perform and showed a good adherence (72%), home-based foot–ankle exercise programs are unlikely to sufficiently modify the main risk factors related to foot ulcers and to change foot–ankle kinematics and kinetics.

Оценка иммунного статуса у беременных женщин с отягощенным аллергологическим анамнезом

Most researchers emphasize that in the structure of diseases of infants, there is a predominance of pathological conditions that occur precisely in the perinatal period, which indicate the correlation of these diseases with the health of the mother and the course of her pregnancy. Objective. Assessment of the immune status and effectiveness of diet therapy in pregnant women with burdened allergic history. Patients and methods. The observation groups consisted of 118 pregnant women. The first group included 83 pregnant women who received a hypoallergenic diet with the exclusion of main allergens, with the replacement of cow's milk with goat's milk, or the exclusion of dairy products as a causally significant allergen. The second group consisted of 35 pregnant women who followed the usual dietary recommendations offered in women's consultations, with the inclusion of cow's milk in the diet. The content of total IgE and allergen-specific IgE antibodies to food proteins in blood serum was determined by the immunoblot method using PROTIA Allergy-Q diagnostic panels. Results. 71.1% of pregnant women of the first group and 40% of women of the second group had the history of allergic diseases. According to skin scarification tests, these women had polyvalent sensitization. When studying the immunological status of pregnant women, attention was drawn to the fact that high levels of total serum IgE were in patients with allergies, with diseases of the gastrointestinal tract, as well as with a combination of these pathologies. 37.3% of the observed pregnant women of the first group, both with and without allergies, had high levels of total serum IgE. At the same time, the level of total IgE was higher in pregnant women suffering from allergic diseases. In addition, IgE sensitization to milk proteins was found in women with normal and high levels of total IgE in the blood. The concentration of allergen-specific IgE antibodies to cow's milk proteins was higher in women with IgE-mediated allergies. The use of a hypoallergenic diet in pregnant women caused the most pronounced decrease in the total IgE content in the blood compared with the indicators before treatment. The majority of the observed women showed a positive trend towards a decrease in IgE sensitization to milk proteins against the background of dietary therapy. Conclusion. All pregnant women with allergic diseases had food sensitization. Gastrointestinal pathology was observed in 34.7% of pregnant women, and its frequency in women with clinically confirmed allergies was 2.3 times higher than in women without allergies. A highly sensitive method for diagnosing food sensitization using PROTIA Allergy-Q panels has made it possible to most accurately identify causally significant allergen products, develop and effectively use personalized hypoallergenic diets for pregnant women. Considering the concept of food programming, the use of hypoallergenic diets in the diet of pregnant women with allergic diseases is one of the options for the prevention of allergic diseases in the future in children born to such mothers. Key words: pregnant women, allergy, food IgE sensitization, diet therapy

Responses of schoolchildren with asthma to recommendations to reduce desert dust exposure: Results from the LIFE-MEDEA intervention project using wearable technology

Current public health recommendations for desert dust storms (DDS) events focus on vulnerable population groups, such as children with asthma, and include advice to stay indoors and limit outdoor physical activity. To date, no scientific evidence exists on the efficacy of these recommendations in reducing DDS exposure. We aimed to objectively assess the behavioral responses of children with asthma to recommendations for reduction of DDS exposure. In two heavily affected by DDS Mediterranean regions (Cyprus & Crete, Greece), schoolchildren with asthma (6–11 years) were recruited from primary schools and were randomized to control (business as usual scenario) and intervention groups. All children were equipped with pedometer and GPS sensors embedded in smartwatches for objective real-time data collection from inside and outside their classroom and household settings. Interventions included the timely communication of personal DDS alerts accompanied by exposure reduction recommendations to both the parents and school-teachers of children in the intervention group. A mixed effect model was used to assess changes in daily levels of time spent, and steps performed outside classrooms and households, between non-DDS and DDS days across the study groups. The change in the time spent outside classrooms and homes, between non-DDS and DDS days, was 37.2 min (pvalue = 0.098) in the control group and −62.4 min (pvalue < 0.001) in the intervention group. The difference in the effects between the two groups was statistically significant (interaction pvalue < 0.001). The change in daily steps performed outside classrooms and homes, was −495.1 steps (pvalue = 0.350) in the control group and −1039.5 (pvalue = 0.003) in the intervention group (interaction pvalue = 0.575). The effects on both the time and steps performed outside were more profound during after-school hours. To summarize, among children with asthma, we demonstrated that timely personal DDS alerts and detailed recommendations lead to significant behavioral changes in contrast to the usual public health recommendations.

Efficacy of a multiple-component and multifactorial personalized fall prevention program in a mixed population of community-dwelling older adults with stroke, Parkinson's Disease, or frailty compared to usual care: The PRE.C.I.S.A. randomized controlled trial.

BackgroundFall risk in the elderly is a major public health issue due to the injury-related consequences and the risk of associated long-term disability. However, delivering preventive interventions in usual clinical practice still represents a challenge.AimTo evaluate the efficacy of a multiple-component combined with a multifactorial personalized intervention in reducing fall rates in a mixed population of community-dwelling elderly compared to usual care.DesignRandomized Controlled Trial (NCT03592420, clinicalTrials.gov).SettingOutpatients in two Italian centers.Population403 community-dwelling elderly at moderate-to-high fall risk, including subjects with Parkinson's Disease and stroke.MethodsAfter the randomization, the described interventions were administered to the intervention group (n = 203). The control group (n = 200) received usual care and recommendations to minimize fall risk factors. In addition, each participant received a fall diary, followed by 12 monthly phone calls. The primary endpoint was the total number of falls in each group over 12 months, while the secondary endpoints were other fall-related indicators recorded at one year. In addition, participants' functioning was assessed at baseline (T1) and 3-month (T3).Results690 falls were reported at 12 months, 48.8% in the intervention and 51.2% in the control group, with 1.66 (± 3.5) and 1.77 (± 3.2) mean falls per subject, respectively. Subjects with ≥ 1 fall and ≥2 falls were, respectively, 236 (58.6%) and 148 (36.7%). No statistically significant differences were observed between groups regarding the number of falls, the falling probability, and the time to the first fall. According to the subgroup analysis, no significant differences were reported. However, a statistically significant difference was found for the Mini-BESTest (p = 0.004) and the Fullerton Advanced Balance Scale (p = 0.006) for the intervention group, with a small effect size (Cohen's d 0.26 and 0.32, respectively), at T1 and T3 evaluations.ConclusionsThe intervention was ineffective in reducing the number of falls, the falling probability, and the time to the first fall at 12 months in a mixed population of community-dwelling elderly. A significant improvement for two balance indicators was recorded in the intervention group. Future studies are needed to explore different effects of the proposed interventions to reduce falls and consequences.

Reliability updating of partial factors for empirical codes: Application to Super-T PSC girders designs at the ultimate limit state in bending

Reliability design code calibrations typically involve the comparison of calculated levels of safety (β) of designs to a range of prospective partial safety factors with the minimum acceptable level of safety (βT). When updating the calibration and the original βT is unknown or undocumented, design-specific probability models and the code-implied level of safety are necessary. This study presents a methodology for updating capacity reduction factors ϕ for a suite of PSC bridge girder section designs for ultimate strength in bending for a design code for which βT is unknown. In the methodology, the code-implied safety as inferred from the notional traffic design load, and the designed girder safety under actual traffic loading are computed. The method is applied to the suite of prestressed concrete Super-T girders designed to the Australian bridge standards AS5100, in which the implicit βT is not known. The results find both code-implied safety and designed girder safety far surpasses the usual recommendations for βT for all designs and regardless of ϕ. As such, only through the relative comparison of code-implied safety and designed girder safety can recommendations be made on increasing ϕ in AS 5100 for Super-T girder ultimate strength in bending. Moreover, the comparison with code-implied safety is taken to indicate the desired degree of reserve capacity available for future traffic growth. The results inform on possible improvements for the next version of AS5100. More significantly, the work illustrates a way to reliability-update partial factors of design codes when βT is not known, and future-proofing structures is seen as necessary.

In-situ experiment on long-term behaviour of GFRP pipes under permanent bending

The present study aims at studying the long-term behaviour of composites (GFRP) subjected to permanent bending. The specificity of this study largely rests on the original conditions of in situ ageing of the specimens within an experimental structure of elastic gridshell, built in 2006 and disassembled in 2014. This prototype was made of rectilinear tubes which were elastically deformed into a 3D stable shape. The structural members constituted hence a unique set of relaxation tests in ambient conditions where a wide variety of curvatures were imposed by the 3D shape. After dismounting, the tubes were sorted according to their permanent curvature in the structure. They were then subjected to three kinds of tests: recovery, longitudinal bending and transverse bending tests. The results were then compared with those obtained during the construction of the prototype, before ageing, and with members aged under the same conditions but not mechanically loaded. The experimental results confirm the usual recommendations for using composites in civil engineering, which suggest limiting the flexural stresses to 30% of the tensile strength to avoid damage or creep problems. At the same time, they confirm the safety and long-term robustness of the concept of double curvature structures obtained by elastic deformation of a composite plane grid.

Perceptions of risk and adherence to care in MS patients during the COVID-19 pandemic: A cross-sectional study

BackgroundThe COVID-19 pandemic has raised concerns for increased risk of infection in patients with multiple sclerosis (MS) and disrupted their routine MS care. The aim of this study is to characterize the extent of MS patients’ perceptions of risk and adherence to care during the pandemic. MethodsA survey was emailed to patients from a large MS center in New York City during the local peak of the pandemic to assess perceptions of infection risk and adherence to MS care including appointments, laboratory studies, MRIs, and taking disease-modifying therapies (DMT). Results529 patients from the MS center responded to the survey during two weeks in April 2020. Patients collectively showed concern about becoming infected with COVID-19 (88%) and perceived a higher infection risk due of having MS (70%) and taking DMTs (68%). Patients frequently postponed appointments (41%), laboratory studies (46%), and MRIs (41%). Noncompliance with DMTs was less common (13%). Decisions to alter usual recommendations for care were made by the patient more often than by the provider regarding adherence to appointments (68%), laboratory studies (70%), MRI (67%), and DMT (65%). Degree of concern for infection was associated with adherence to appointments (p=0.020) and laboratory studies (p=0.016) but not with adherence to MRI and DMTs. Thirty-five patients reported being tested for COVID-19, of whom fourteen reported a positive test. ConclusionPatients with MS were highly concerned about becoming infected during the local peak of the COVID-19 pandemic. Behaviors that deviated from originally recommended MS care were common and often self-initiated, but patients were overall compliant with continuing DMTs.

Antibiotic stewardship in direct-to-consumer telemedicine consultations leads to high adherence to best practice guidelines and a low prescription rate

ObjectiveTo analyze the antibiotic prescription rate in low-risk patients evaluated at a telemedicine program that adopts antibiotic stewardship protocols. MethodsAdult patients who accessed a single direct-to-consumer telemedicine center (Jan/2019–Feb/2020) were retrospectively enrolled. Diseases amenable to antimicrobial treatment were classified under five diagnostic groups: upper respiratory tract infection (URI), acute pharyngotonsillitis (PT), acute sinusitis (AS), urinary tract infection (UTI), and acute diarrhea (AD). Physicians were trained on and advised to strictly follow the current guideline recommendations supported by institutional antibiotic stewardship protocols, readily available online during consultations. We analyzed the antibiotic prescription rate among patients, referral rate, and antibiotic class through descriptive statistics. ResultsA total of 2328 patients were included in the study. A total of 2085 (89·6%) patients were discharged with usual recommendations, medication (if needed), and instructions about red flags, while 243 (10·4%) were referred to a face-to-face consultation. Among the discharged patients, the antibiotic prescription rates by the diagnostic group were URI — 2·5%, PT — 35·0%, AS — 51·8%, UTI — 91.6%, and AD — 1·6%. In most cases, prescribed antibiotics were in line with institutional stewardship protocols. ConclusionsLow prescription rate of antibiotics can be achieved using antibiotic stewardship protocols at direct-to-consumer telemedicine consultations, showing high adherence to international guidelines. These results reinforce telemedicine as a cost-effective and safe strategy for the initial assessment of acute non-urgent symptoms.