Hasil untuk "Special situations and conditions"

R. Parasuraman, D. Manzey

A. Hill

Sharon Olsen, Ruth McLaren, Aidan Scrooby et al.

Abstract Background Dual task (DT) assessments evaluating walking combined with a cognitive task are valuable tools for testing functional capacity and monitoring age-related decline. Despite this, motor-cognitive DT assessments are underutilised in clinical practice. This has been attributed in part to methodological challenges, including heterogeneity in DT measurement protocols and poor reliability of outcome measures. To address these barriers, this scoping review systematically identified motor-cognitive DT walking assessments used with healthy older adults and examined current practice in reporting and standardisation. The purpose was to inform the refinement of DT assessments to enhance their precision and reproducibility, facilitating their future integration into routine clinical practice. Method A systematic search of five electronic databases identified studies that investigated motor-cognitive DT walking assessments in community-dwelling, cognitively healthy older adults. The reporting and standardisation of measurement procedures was extracted using the COSMIN framework. The findings were analysed descriptively. Results The review included 38 studies investigating a walking motor task combined with a variety of cognitive tasks. The most common walking tasks were unidirectional gait, the timed up and go (TUG), or walking and turning tasks. The most prevalent cognitive tasks included serial subtraction, animal naming, and reciting alternate alphabet letters. There was substantial variability in the administration of DT assessments and no studies fully reported the procedures for set up, test performance, and data collection. Of particular concern was the poor reporting of general task instructions, task prioritisation, and practice trials. Conclusion The review identified a lack of standardisation in DT walking measurement procedures, which likely contributes to measurement variability and limits clinical replication. Given that measurement variability inherent in single task assessments is compounded when motor and cognitive tasks are combined, it is critical to address these sources of inconsistency to ensure DT measures detect and accurately reflect true performance changes. Recommendations are made to improve standardisation of DT measurements with the aim of facilitating their broader adoption and implementation in clinical practice.

Almoustapha Mahamane Wazodan, Ibrahim Alkassoum, Mahamane Moustapha Lamine et al.

BackgroundRapid data collection is paramount for monitoring and evaluating public health activities. Several techniques are used, including the Lot Quality Assurance Sampling (LQAS) method, which originated in the industrial sector and has many applications in the public health sector. The objective of this study was to demonstrate the application of the LQAS method to evaluate the coverage of seasonal malaria chemoprevention by classifying geographical areas according to their performance and whether the objectives were achieved.MethodologyThe data were collected by interviewing the mother or caregiver and by looking for evidence (completed SMC cards) of the administration of medicines. The sample included 50 children aged 3 to 59 months per health district, chosen in five localities (village/district) drawn at random, a rate of 10 children per locality. The decision value (D) is the value beyond which the batch is considered inadequate. When the lower decision threshold is 75% and the upper threshold is 90%, for a sample of 50 children, the decision value is 7. It is therefore not acceptable that, with a sample size of 50 children, more than 7 children did not receive treatment during the campaign.ResultsApplying LQAS rules to the data, we found that 100% (19/19) of districts were performing well in the first and fourth cycles of the SMC campaign, as reported by mothers and caregivers. In cycle 1, coverage was 99.47% (945/950), and the administration rate of the second and third doses was 98.4% (935/950) and 98% (931/950), respectively. In cycle 4, 99.3% (943/950) of children had received their first dose of treatment, and for the second and third doses, the administration rate was 99.4% (944/950) and 99,2% (942/950), respectively.Based on documented evidence (SMC card or Blister), 63% (12/19) of districts were performing well in cycle 1, and 63% (12/19) were performing well in cycle 4 of the SMC campaign.ConclusionThis study demonstrates the feasibility of applying the LQAS method in the evaluation of chemoprevention coverage for seasonal malaria. The results suggest that all the districts are performing well for both rounds according to mothers’ reports, but according to the evidence, a certain number of districts are non-performing. This classification of zones helps guide interventions and inform appropriate strategies for each zone.

Djihad Bencherit, Naila Charbi, Asma Saad et al.

Background Children are generally attracted to colorful foods. However, some food dyes are suspected of exacerbating the activity of children and inducing other health problems that can reach reprotoxicity and carcinogenicity. Objective This study aims to explore the presence of dyes such as E102, E104, E110, E121, E122, E123, E124, E127, E129, E132, E133, E143 and E171 in food products widely consumed by children in Algeria notably sweets and chocolates, beverages and ice creams, yogurts and biscuits. Material and Methods This work was carried out on 228 products including 57 biscuits, 47 drinks and ice creams, 20 yogurts and 104 sweets and chocolates. Information mentioned on the composition label of this products were recorded to determine the presence of studied dyes Results Here, we report the abundance of the yellow dyes E102 (24.1%) and E110 (18%) in the tested products. Also, apart from E121, all the other assessed dyes were found. Sweets and chocolates are the products containing the most studied dyes. The analysis of the presence of combinations of these dyes shows that 7% of analyzed foods contain 2 dyes in their composition while 20% of the products contain at least 3 dyes at the same time. Additionally, 37.5% of sweets and chocolates contain a combination of at least 3 dyes in their ingredient list. Conclusions In overall, except the E121, all assessed dyes were identified on the labels of food products widely consumed by children which encourage parents to be made aware of the risks associated with the ingestion of omnipresent dyes in children’s diets.

Marília da Silva Alves, Roberto Jerônimo dos Santos Silva, Cleidison Machado Santana et al.

Apesar dos investimentos realizados ao redor do mundo, seja no âmbito acadêmico, seja na implementação de políticas públicas, os níveis de atividade física não têm aumentado a contento. Assim, o objetivo deste trabalho é identificar quais os fatores que influenciam na participação em Programas Comunitários de Atividade Física na realidade brasileira. Para isso, utilizando a Pesquisa Nacional de Saúde 2019, investigou-se 20.014 sujeitos considerando como desfecho a participação nesses programas, com variáveis independentes divididas em biológicas e sociodemográficas. Para a análise dos dados utilizou-se da regressão logística binária, com p < 0,05, através do software Jamovi® versão 2.3.21. Observou-se que pessoas do gênero feminino (OR = 1,54; IC 95%: 1,40 - 1,69), “pessoas idosas” (OR = 1,10; IC 95%: 1,01 - 1,21) e pessoas “não brancas” (OR = 1,51; IC95%: 1,38 - 1,66) apresentaram chances elevadas de participação nos Programas Comunitários de Atividade Física. Para o segundo bloco, identificou-se que quem apresentou renda acima de cinco salários mínimos tiveram chances reduzidas em 34% (OR = 0,66; IC 95%: 0,57 - 0,76) quando comparados aos que relataram renda de até um salário, e, os que residiam próximo aos locais públicos para lazer apresentaram chances elevadas de participação (OR = 1,71; IC 95%: 1,52 - 1,92). Em suma, aspectos biológicos e sociodemográficos influenciaram na participação em Programas Comunitários de Atividade Física, contudo, a existência de locais públicos de lazer próximos às residências foi o fator de maior impacto evidenciado.

Nabil Mehta, Alexander J Acuna, Johnathon R McCormick et al.

# Background In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). # Purpose The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. # Methods This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. # Results Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). # Conclusion Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. # Level of Evidence 3b

Gabriele Ciravegna, Pietro Barbiero, Francesco Giannini et al.

The large and still increasing popularity of deep learning clashes with a major limit of neural network architectures, that consists in their lack of capability in providing human-understandable motivations of their decisions. In situations in which the machine is expected to support the decision of human experts, providing a comprehensible explanation is a feature of crucial importance. The language used to communicate the explanations must be formal enough to be implementable in a machine and friendly enough to be understandable by a wide audience. In this paper, we propose a general approach to Explainable Artificial Intelligence in the case of neural architectures, showing how a mindful design of the networks leads to a family of interpretable deep learning models called Logic Explained Networks (LENs). LENs only require their inputs to be human-understandable predicates, and they provide explanations in terms of simple First-Order Logic (FOL) formulas involving such predicates. LENs are general enough to cover a large number of scenarios. Amongst them, we consider the case in which LENs are directly used as special classifiers with the capability of being explainable, or when they act as additional networks with the role of creating the conditions for making a black-box classifier explainable by FOL formulas. Despite supervised learning problems are mostly emphasized, we also show that LENs can learn and provide explanations in unsupervised learning settings. Experimental results on several datasets and tasks show that LENs may yield better classifications than established white-box models, such as decision trees and Bayesian rule lists, while providing more compact and meaningful explanations.

Pilar I. Vidal-Carreras, Julio J. Garcia-Sabater, J. Marin-Garcia

Improving the delivery of patient care is an ongoing challenge in the National Health Service (NHS). This challenge is not insignificant in the process of chemotherapy administration for oncology patients. The present research is motivated by a public Spanish hospital in which oncology patients receive medical care in the Oncology Day Hospital (ODH). At the ODH, oncology patients receive different health services by different specialists on a single day. Any discoordination in patient flow will contribute to longer waiting times and stays in the ODH. As oncology patients tend to have special health conditions, any extra time in the hospital is a source of risk and discomfort. This study applies value stream mapping methodology in a Spanish ODH to improve this situation, reducing hospital waiting times and shorting the length of stay. For that purpose, the path of the oncology patients is mapped and the current state of the system is analyzed. Working at takt time and levelling the workload are proposed for improving the working conditions for healthcare personnel. As a result, the quality of service for oncology patients who need a well-defined care profile is improved. The singular characteristics of the Spanish NHS make it challenging to implement new ways of working, so this study has significant theoretical and managerial implications offering directions in which improvement is possible.

Irja Rzepka, C. Zehetmair, Emma Roether et al.

Due to pre-, peri- and post-migratory stress factors, refugees often experience higher levels of psychological stress than the general population. Post-traumatic stress disorder, in particular, has an increased prevalence in the refugee population. However, living conditions in the early post-migratory phase are characterized by many challenges. In the present qualitative study, 14 refugees with symptoms of PTSD from temporary accommodations in Germany were interviewed in semi-structured interviews about their individual experiences of the impact of their trauma sequelae symptoms on their current living conditions and interactions. Participants reported dealing with post-traumatic symptoms primarily through distraction strategies, such as working or learning the language or social interaction. Many reported a sense of mistrust as a result of traumatic experiences. Current stress factors cited included uncertain asylum status, worry about family members and lack of ability to influence living situations. The interactions between the post-traumatic symptoms and the living conditions of the refugees were highlighted. The effects of the symptomatology of trauma sequelae and the framework conditions under which refugees live can lead to aggravated psychological distress. Therefore, special attention must be paid to refugee mental health care.

Irene Lobon, Manuel Solís-Moruno, Manuel Solís-Moruno et al.

The role of somatic mutations in complex diseases, including neurodevelopmental and neurodegenerative disorders, is becoming increasingly clear. However, to date, no study has shown their relation to Parkinson disease’s phenotype. To explore the relevance of embryonic somatic mutations in sporadic Parkinson disease, we performed whole-exome sequencing in blood and four brain regions of ten patients. We identified 59 candidate somatic single nucleotide variants (sSNVs) through sensitive calling and a careful filtering strategy (COSMOS). We validated 27 of them with amplicon-based ultra-deep sequencing, with a 70% validation rate for the highest-confidence variants. The identified sSNVs are in genes with synaptic functions that are co-expressed with genes previously associated with Parkinson disease. Most of the sSNVs were only called in blood but were also found in the brain tissues with ultra-deep amplicon sequencing, demonstrating the strength of multi-tissue sampling designs.

G. Skouteris, D. Hermosilla, P. López et al.

L. Tang, Gang Wang, Enmao Wang et al.

ABSTRACT As the conventional inert gas used for coal firefighting, mainly CO2 and N2, experience certain deficiencies when used in coal firefighting under particular geological conditions, composite inert gas can be a feasible choice in such situations. Nevertheless, the fire inhibition characteristics and application potential of composite inert gas have not been explored in depth. To expedite the wider use of composite inert gas in preventing and controlling coal spontaneous combustion, the fire inhibition characteristics and application potential of composite inert gas have been evaluated by using temperature programmed experiment and engineering analogy for the first time. The results show that the fire inhibition effect falls in the order of as N2 < composite inert gas < CO2, and as the result of the competitive adsorption, the composite inert gas exhibits better performance than N2 and more resembles CO2 in the fire inhibition; Moreover, since the composite inert gas has lower toxicity and cost than CO2, the cost of composite inert gas is only 57.1% of CO2, it offers an overall more balanced performance taking into account fire protection effect, safety, and fire protection cost. The unique advantages of composite inert gas allow broad application in the prevention and control of the coal spontaneous combustion under some special geological environments.

K. Hunt, Manni Waraich

In this chapter on neurosurgery and anaesthesia, the authors give clear guidance for the management of time critical brain and neurological conditions, including raised intracerebral pressure, severe head injury, subarachnoid and intracerebral haemorrhage, sodium disturbances, venous air embolism, acute spinal cord injury, spinal shock, autonomic dysreflexia, dystonic reactions, and status epilepticus. In addition, the definitions, presentation, management strategies, investigations, risk factors, exclusions and causes, and any special considerations for each potential neurosurgical and neurologically related situation are given. Lists of up-to-date online resources and further reading are also provided here, offering invaluable know-how to encourage the reader to broaden their knowledge.

S. Schroer, B. Huggins, C. Azam et al.

The fundamental change in nocturnal landscapes due to the increasing use of artificial light at night (ALAN) is recognized as being detrimental to the environment and raises important regulatory questions as to whether and how it should be regulated based on the manifold risks to the environment. Here, we present the results of an analysis of the current legal obligations on ALAN in context with a systematic review of adverse effects. The legal analysis includes the relevant aspects of European and German environmental law, specifically nature conservation and immission control. The review represents the results of 303 studies indicating significant disturbances of organisms and landscapes. We discuss the conditions for prohibitions by environmental laws and whether protection gaps persist and, hence, whether specific legislation for light pollution is necessary. While protection is predominantly provided for species with special protection status that reveal avoidance behavior of artificially lit landscapes and associated habitat loss, adverse effects on species and landscapes without special protection status are often unaddressed by existing regulations. Legislative shortcomings are caused by difficulties in proving adverse effect on the population level, detecting lighting malpractice, and applying the law to ALAN-related situations. Measures to reduce ALAN-induced environmental impacts are highlighted. We discuss whether an obligation to implement such measures is favorable for environmental protection and how regulations can be implemented.

Victor Garcia-Martin MD, Ana Verdejo-González MD, David Ruiz-Picazo MD et al.

Introduction: Physiological aging frequently leads to degenerative changes and spinal deformity. In patients with hypolordotic fusions or ankylosing illnesses such as diffuse idiopathic skeletal hyperostosis or ankylosing spondylitis, compensation mechanisms can be altered causing severe pain and disability. In addition, if a total hip replacement and/or knee replacement is performed, both pelvic and lower limbs compensation mechanisms could be damaged and prosthetic dislocation or impingement syndrome could be present. Pedicle subtraction osteotomy has proven to be the optimal correction technique for spinal deformation in patients suffering from a rigid spine. Case Presentation: A 70-year-old male patient with diffuse idiopathic skeletal hyperostosis criteria and a rigid lumbar kyphosis, who previously underwent a total hip and knee replacement, had severe disability. We then performed corrective surgery by doing a pedicle subtraction osteotomy. The procedure and outcomes are presented here. Conclusion: In symptomatic patients with sagittal imbalance and a rigid spine, pedicle subtraction osteotomy can indeed correct spinal deformity and re-establish sagittal balance.

محمد احمد علي عبدالرحمن غانم

تعد رکلة الجزاء من أکثر مهارات ضرب الکرة بالقدم أهمية يري الدارس أن رکلة الجزاء هي أسهل وأسرع الطرق لإحراز الأهداف حيث يقف اللاعب في مواجهة مباشرة حارس المرمي دون أي ضغط من دفاع الفريق المنافس مما يتطلب أن يکون لدي اللاعب القائم بالرکلة قدرات خاصة تمکنه من ضبط النفس ومراعاة الدقة التامة في توجيه الکرة للمکان الصحيح داخل المرمي ويهدف البحث الي: - - إلى التعرف على تأثير البرنامج التدريبي باستخدام ثلاثة أساليب مختلفة لإداء رکلات الجزاء للاعبي الدرجة الأولي في کرة القدم. واستخدم البحث المنهج الوصفي والتجريبي. وتکونت عينة البحث من 5 لاعبا وحارسا للمرمي بنادي ليدرز الرياضي . وتمثلت أدوات البحث في المقابلات الشخصية وتصميم استمارة لجمع نتائج التصويب لرکلات الترجيح المقترحة. وتوصلت النتائج الي ان أداء الاسلوب الثاني المتمثل في سرعة خطوات الجري للاعب لرکل الجزاء من المسافة المقطوعة 5ياردة تقريبا وان هذه السرعة تؤدي الي زيادة قوة الکرة وبالتالي سرعة الکرة في الدخول الي المرمي. وقد أدي تأخير تحرک حارس المرمي الي زاوية من الزوايا قبل رکل الکرة مباشرة وخاصة ان حراس المرمي أثناء تنفيذ البرنامج التدريبي ومعرفة أنواع الأساليب والتي تتفق على فکرة واحدة وهي تأخير التصويب حتي تحرک حارس المرمي الي زاوية التصويب الي الزاوية الأخرى. وادي ذلک في الحالات الثلاثة الي الهدار العديد من الفرص لمعرفة الحراس لهذه الفکرة. وأوصي البحث بضرورة استخدام الأسلوب الثاني في تنفيذ رکلات الجزاء الترجيحية سواء في المباريات الرسمية المحلية أو البطولات الدولية. وتطبيق الأسلوب الثاني في تنفيذ الرکلات أثناء الوحدات التدريبية اليومية بتخصيص زمن في نهاية الوحدة أو أثناء التدريب.

Peng Zhou, Xiao-Qiang Zhao

N. Vassilev, M. Vassileva, A. López et al.

Rima Abdul Razzak, Jeff Bagust, Sharon Docherty

Introduction. The subjective visual vertical (SVV) measures the perception of a person’s spatial orientation relative to gravity. Weighted central integration of vestibular, visual, and proprioceptive inputs is essential for SVV perception. Without any visual references and minimal proprioceptive contribution, the static SVV reflects balance of the otolith organs. Normal aging is associated with bilateral and progressive decline in otolith organ function, but age-dependent effects on SVV are inconclusive. Studies on sensory reweighting for visual vertical and multisensory integration strategies reveal age-dependent differences, but most studies have included elderly participants in comparison to younger adults. The aim of this study was to compare young adults with older adults, an age group younger than the elderly. Methods. Thirty-three young and 28 older adults (50–65 years old) adjusted a tilted line accurately to their perceived vertical. The rod’s final position from true vertical was recorded as tilt error in degrees. For otolithic balance, visual vertical was recorded in the dark without any visual references. The rod and frame task (RFT) with tilted disorienting visual frames was used for creating visuovestibular conflict. We adopted Nyborg’s analysis method to derive the rod and frame effect (RFE) and trial-to-trial variability measures. Rod alignment times were also analyzed. Results. There was no age difference in signed tilts of SVV without visual reference. There was an age effect on RFE and on overall trial-to-trial variability of rod tilt, with older adults displaying larger frame effects and greater variability in rod tilts. Alignment times were longer in the tilted-frame conditions for both groups and in the older adults compared to their younger counterparts. The association between tilt accuracy and tilt precision was significant for older adults only during visuovestibular conflict, revealing an increase in RFE with an increase in tilt variability. Correlation of σSVV, which represents vestibular input precision, with RFE yielded exactly the same contribution of σSVV to the variance in RFE for both age groups. Conclusions. Older adults have balanced otolithic input in an upright position. Increased reliance on visual cues may begin at ages younger than what is considered elderly. Increased alignment times for older adults may create a broader time window for integration of relevant and irrelevant sensory information, thus enhancing their multisensory integration. In parallel with the elderly, older adults may differ from young adults in their integration of sensory cues for visual vertical perception.