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This study aims to quantify the preferences of patients with advanced cancer for quality of life (QoL) outcomes versus survival extension in Malaysia. The secondary aim of this study is to explore the change in preferences over time. A discrete choice experiment was developed to include 7 attributes valued in cancer management: physical, psychological and social functioning, pain control, survival, place of death, and cost. Patients were recruited via convenience sampling from 2 Malaysian public hospitals. The survey questionnaire was administered to patients within 6 months of their cancer diagnosis with a follow-up 3 months later. Conditional logit regression was used to estimate the preference weight, relative attribute importance, and willingness to pay. One hundred valid responses were collected at baseline and 45 at follow-up. Respondents placed higher values on QoL improvements from severe to moderate or mild levels and to achieve home death over survival extension from 6 to 18 months. However, additional improvements (from moderate to mild) in some of the QoL outcomes were not valued as highly as life extension from 12 to 18 months, showing that it was vital for patients to avoid being in "severe" health dysfunction. Improving physical dysfunction from severe to mild yielded 3 times as much value as additional 1-year survival. After 3 months, the respondents' preferences changed significantly, with increased relative attribute importance of physical functioning, pain control, and cost. As QoL outcomes are valued more than survival, palliative care should be introduced as early as possible to alleviate suffering related to advanced cancer. • Patients with advanced cancer had substantially higher preference weights for quality-of-life outcomes (physical, psychological and social functioning, minimal pain, and death at home) over an additional 1-year of survival. • Longitudinal analysis of discrete choice experiment showed that patients' preferences change over time, making it imperative to involve them in the decision-making process constantly. • Although access to novel life-extending treatment is indispensable, early integration of palliative and supportive care into cancer care is equally essential to alleviate suffering related to physical dysfunction and pain. [ABSTRACT FROM AUTHOR]

La artritis reumatoide (AR) cursa generalmente con una afectación mayor en el miembro superior, pudiendo ocasionar dificultades en el desempeño de actividades en el día a día. El objetivo principal de este estudio fue establecer la relación entre la autoeficacia, la intensidad del dolor y la duración de los síntomas en pacientes con AR, y analizar cómo y en qué medida cada uno de ellos influye en la discapacidad funcional, así como, conocer el valor predictivo de la autoeficacia sobre las demás variables. Estudio transversal con una muestra de 117 mujeres con AR. Las variables de evaluación empleadas fueron la escala visual analógica (EVA), el cuestionario QuickDASH y la escala española de autoeficacia en enfermedades reumáticas. Los resultados muestran que el modelo más significativo para la función (R2 = 0,35) incluye la variable función y dolor, por lo que, sí hay relación existente entre la autoeficacia, la intensidad del dolor y la funcionalidad del miembro superior, así como la asociación de las puntuaciones obtenidas en la EVA, QuickDASH y la escala española de autoeficacia en enfermedades reumáticas para su evaluación. Nuestros resultados, concuerdan con estudios previos donde se establece la posible relación entre la autoeficacia y la discapacidad funcional, así como la autoeficacia y su relación con funciones físicas, demostrando que un bajo nivel de autoeficacia implica una disminución de la funcionalidad, pero sin que ninguna variable sea más predictora que otra. Rheumatoid arthritis (RA) primarily affects the upper limbs and can cause disturbances in the performance of daily activities. The main objective of this study was to establish the relationship between self-efficacy, pain intensity, and duration of symptoms in patients with RA and analyse how each influences functional disability, and to determine the predictive value of self-efficacy over the other variables. Cross-sectional study with a sample of 117 women diagnosed with RA. The endpoints were the visual analogue scale (VAS), Quick-DASH questionnaire and the Spanish scale of self-efficacy in rheumatic diseases. The most significant model for function (R2 = 0.35) includes function and pain, therefore, there is a relationship between self-efficacy, pain intensity, and upper limb functionality. Our results agree with previous studies where a relationship between self-efficacy and functional disability is established, as well as self-efficacy and its relationship with physical functions, demonstrating that a low level of self-efficacy implies a decrease in functionality; however, no variable is more predictive than another. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is a frequently observed and remarkably incapacitating disorder worldwide. As a multisystem disorder, OSA has been linked to a plethora of clinical parameters though physical parameters like muscle strength have been scantily studied. Hand grip strength (HGS) is a practical marker of physical function that has been associated with mortality and an array of clinical outcomes as well as physiological parameters like sleep duration. A few seminal studies have observed no link between HGS and OSA severity while no studies evaluated the relationship between objectively determined sleep duration and HGS in OSA. The present study aimed to evaluate the HGS indices among both OSA severity groups and objectively determined sleep duration groups in OSA. 111 treatment-naïve mostly middle-aged individuals with OSA (86 males) were recruited in a tertiary sleep center. Three OSA severity groups were determined by the Apnea-Hypopnea Index while three sleep duration groups were objectively determined by Total Sleep Time (TST). Dominant and non-dominant maximum and average HGS were calculated using a digital hand dynamometer. Short-sleeper individuals with OSA were found to have lower HGS indices than intermediate or sufficient sleepers with OSA while no differences in HGS indices among OSA severity groups were observed. All HGS indices correlated with TST. Future insights can be gleaned from the present results regarding the conceivably transdiagnostic relationship between sleep duration and HGS as well as the potential use of HGS as a marker in OSA. • Insufficient sleep duration was linked to lower hand grip strength (HGS) in OSA. • No link between OSA severity and HGS was observed in OSA. • HGS may serve as a high-yielding clinical marker in OSA. [ABSTRACT FROM AUTHOR]

Resection of intraventricular tumors can be achieved using 2 main operative approaches: transcallosal or transcortical. This study aims to describe preoperative and postoperative factors as well as quality of life (QoL) based on long-term results in these patients. Patients underwent surgery of primary intraventricular lesions between 2007 and 2020 via a transcortical (group A) or transcallosal (group B) route. The main clinical parameters were completeness of resection, overall survival, surgical complications, postoperative neurologic deficits, and seizure rates. QoL was assessed using a modified questionnaire Short-Form 36 inventory. Forty patients (19 women and 21 men) met the inclusion criteria. Group A consisted of 26 patients (12 women and 14 men; median age 45.5 years ± 16.7 standard deviation) and had lower preoperative tumor volume (confounder) compared with group B (7 women and 7 men; age 50.0 ± 17.4 years). Gross total resection was achieved in 65% in group A and 71% in group B. Follow-up was 7.8 ± 3.9 years. New seizures/permanent neurologic deficits occurred in 27%/15% (group A) and 29%/29% (group B) and surgical complications in 23% of patients. Group B had a higher degree of memory impairment (21%) compared with group A (10%). QoL impairment was present in both groups mainly regarding physical role function and mental health index. Keeping in mind the limitations, transcallosal surgery was associated with a higher probability of neurologic deficits and memory impairment in our series. However, it had fewer surgical complications with similar gross total resection and seizure rates. [ABSTRACT FROM AUTHOR]

The current staffing shortage across all disciplines of post-acute and long-term care (PALTC) settings is affecting the health and safety of residents, as well as the well-being of the current staff. The need to retain and recruit new talent to this challenging but fulfilling setting demands that we look to existing evidence-based strategies and identify ways to implement them quickly, effectively, and in a sustainable way. Using the 4 Ms Framework of the Age-Friendly Health System developed by the Institute for Healthcare Improvement and the John A. Hartford Foundation (What Matters, Medication, Mentation, and Mobility), we can build on successful strategies to address what matters to staff, mental health, career mobility, and the overall safety and wellness of our nation's careforce. This paper summarizes "More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce," a series of 6 roundtable discussions held in 2022 that brought together clinicians, industry leaders, and change-makers to share strategies that have been researched and successfully implemented and discuss ways to scale and disseminate them to a broader audience. The role of PALTC leadership is highlighted, with key points from the final roundtable discussion outlined, and challenging leadership to think about what they can begin doing immediately to build trust with existing staff and lay the foundation for a stronger nursing home careforce. Next steps for "More of a Good Thing" include a survey of participants about what they have tried, what has been successful, and what barriers they face; a series of focused interviews with leaders; and potential collaboration with quality improvement organizations to help facilities build on and implement the strategies presented. [ABSTRACT FROM AUTHOR]

To characterize the incidence of stress urinary incontinence (SUI) after radical prostatectomy (RP), its treatment, and impact on quality of life (QoL) and work status 1 year after RP. Prostate cancer patients treated by RP (1998-2016) were selected from CaPSURE. SUI was defined as any pads per day (ppd) 1 year after RP. SUI procedures were tracked by CPT codes (sling and artificial sphincter). Patients reported work status (full-time, part-time, unpaid), UCLA PCa Index urinary function (UF) and bother (UB) and SF36 Index physical function (PF). Associations of incontinence with UF, UB, and PF and work status changes were assessed (ANOVA). Lifetable estimates and Cox proportional hazards regression evaluated risk of undergoing SUI procedures. 664/2989 (22%) men treated with RP reported SUI at 1 year. More men with SUI had ≥GG2, intermediate to high-risk disease and non-nerve-sparing surgery (all P <.01). Cumulative incidence of SUI procedures was 1.4% at 10 years after RP. Age (HR 2.68 per 10 years, 95% CI 1.41-5.08) and number of ppd at 1 year (HR 3.20, 95% CI 2.27-4.50) were associated with undergoing SUI procedures. UF declined at 1 year after RP, while UB and PF remained stable. UF, UB, and PF were inversely associated with number of ppd (all P <.01). Change in work status was not associated with incontinence or QoL scores. Incontinence affected QoL without impacting work status, suggesting that men with SUI after RP may continue working and go under-treated despite impact on QoL. [ABSTRACT FROM AUTHOR]

Presently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST. Mixed methods. A mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken. Qualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire. The developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research. [ABSTRACT FROM AUTHOR]

We sought to assess correlational relationship between mental health and outcomes following lateral lumbar interbody fusion (LLIF). Patients who had undergone LLIF were identified. Patients with indications for surgery including infection, trauma, or malignancy were excluded. Patient-reported outcomes (PROs) included short-form (SF)-12 Mental Component Score (MCS)/Patient Health Questionnaire (PHQ)-9/Patient-Reported Outcomes Measurement Information System−Physical Function (PROMIS-PF)/12-Item Short-Form Physical Component Score (SF-12 PCS)/Visual Analog Scale (VAS) back and leg pain/Oswestry Disability Index (ODI) and were collected preoperatively and at several postoperative time points extending to 1 year. Pearson correlation tests were used to compare the 12-item Short Form Mental Component Score (SF-12 MCS) and PHQ-9 with the other PROs. We included 124 patients. SF-12 MCS positively correlated with PROMIS-PF at 6 months (r = 0.466) and SF-12 PCS preoperatively (r = 0.287) and at 6 months (r = 0.419) (P ≤ 0.041, all). SF-12 MCS negatively correlated with VAS back preoperatively (r = −0.315), at 12 weeks (r = −0.414), and at 6 months (r = −0.746); VAS leg at 12 weeks (r = −0.378); and ODI preoperatively (r = −0.580) (P ≤ 0.023, all). PHQ-9 negatively correlated with PROMIS-PF at all periods except 12 weeks (range: r = −0.357 to −0.566, P ≤ 0.017, all) and SF-12 PCS preoperatively, at 6 weeks, and at 6 months (range: r = −0.363 to −0.562, P ≤ 0.022, all). PHQ-9 positively correlated with VAS back at all periods before 1-year (range: r = 0.415–0.690, P ≤ 0.001, all), VAS leg at 12-weeks (r = 0.467) and 6-months (r = 0.402) (P ≤ 0.028, both), and ODI at all periods except 6-months (range: r = 0.413–0.637, P ≤ 0.008, all). Better mental health scores correlated with superior physical function, pain, and disability scores when measured by both SF-12 MCS and PHQ-9. PHQ-9 more consistently reported significant correlation to all outcomes measured when compared to SF-12 MCS. [ABSTRACT FROM AUTHOR]

Paddle lead spinal cord stimulation (SCS) is used to treat refractory chronic pain. Morbidly obese patients seek SCS to reduce chronic pain. However, these patients face worse surgical outcomes, and the SCS literature has not evaluated safety and efficacy in this patient population. This study is the largest single-surgeon case series to date on morbidly obese patients with paddle lead SCS implantations. The primary objective is to report postoperative complication rates in morbidly obese patients receiving SCS implants. The secondary objective is to report patient-reported pain scores and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function scores in these patients. A retrospective chart review was conducted. The patient charts were reviewed from the day of procedure consent to 6 months postop. Demographic information, pain scores, PROMIS scores, neurological complications, infections, and wound complications were documented. Sixty-seven patients were included. The mean preoperative BMI was 44.47 ± 4.02 kg/m2. The mean age was 58.9 ± 11.4 years old. There were no neurological complications. 3/67 (4%) developed culture-positive infections. Nine out of sixty-seven (13%) patients developed superficial wound dehiscence without underlying infection. The mean postop PROMIS physical function score was 31.6 ± 6.2 (n = 16) and the mean post-op PROMIS pain interference score was 64.0 ± 6.4 (n = 16). There was a reduction in pain scores, from 7.9 ± 1.7 preop to 5.7 ± 2.5 postop (n = 22, P = 0.004). Paddle lead SCS implantation is safe for morbidly obese patients. The only minimal-risk complications present were postoperative infections and wound dehiscence. Surgical care can be modified to further reduce the rates of infection and dehiscence. [ABSTRACT FROM AUTHOR]

• A new adaptive polynomial chaos expansion technique for surrogate modelling. • Novel basis selection strategy comprising basis expansion, pruning, and refinement. • Automatic and simultaneous selection of training samples and truncation degree. • Sparse representation along with sequential sampling and adaptive basis selection. • Validation using benchmarks and physical model and comparison with existing methods. In this paper, a novel adaptive modelling framework for sparse polynomial chaos expansion is proposed, which can automatically determine adequate truncation degree and training sample set simultaneously. Moreover, the curse of dimensionality issue in polynomial chaos expansion, which generally arises in dealing with high input dimension or large truncation degree, can be alleviated to a large extent. In this framework, a new basis selection strategy, which leverages basis expansion, pruning and refinement, is pursued to adaptively select the polynomial terms of proper degree during the modelling process. Besides, an outstanding sequential sampling strategy is adopted to collect samples of high quality and in relatively small quantity for training polynomial chaos expansion model, and a sparse representation method, Bayesian compressive sensing, is employed for regression calculation. To reconcile the sequential sampling and adaptive basis selection in a consistent framework, a stability evaluation process which works in parallel with the sequential sampling process is performed. The performance of the proposed adaptive modelling framework is evaluated on two benchmark functions and a physical model through comparison with an existing adaptive polynomial chaos expansion modelling technique, a sequential sampling-only approach, and several basis adaptivity strategies. Results demonstrate that the proposed method has high adaptiveness in building surrogate models for various problems. It outperforms the existing adaptive polynomial chaos expansion modelling technique in terms of modelling precision and convergence rate, and it has similar performance with the sequential sampling-only method while lessening the burden in regression calculation and enabling adaptive determination of the truncation degree. Limitations of the proposed method are also summarized after comparing it with various basis adaptivity strategies. [ABSTRACT FROM AUTHOR]

Modeling attacks such as machine learning attacks are pretty efficient in breaking hardware security primitives like silicon strong physical unclonable functions (PUFs). As compared to regular strong PUFs such as arbiter PUFs and lightweight (LW)-PUFs, subthreshold current array (SCA)-PUFs exhibit a better resilience against modeling attacks since they utilize the non-linear relationship between the subthreshold current and gate voltage of transistors to obfuscate the corresponding relationship between input challenge and output response. Unfortunately, the degree of non-linearity (DoNL) within SCA-PUFs is still not sufficiently high to resist against state-of-the-art modeling attacks. Therefore, to further enhance DoNL for resisting against modeling attacks, a new strong PUF architecture is proposed in this paper by embedding reconfigurable neural networks (RNNs) into SCA-PUFs. Mathematical foundations are established for finding appropriate RNNs that are able to maximize the DoNL of an SCA-PUF. As shown in the result, when state-of-the-art modeling attacks like Lagrange multiplier attacks (LMAs) are selected, the robustness of the proposed RNN-embedded SCA-PUF is enhanced over 20 times with less than 18.5% power and area overhead as compared to a regular SCA-PUF. • SCA-PUF utilizes the non-linear sunthreshold current of transistors. • SCA-PUF is quite vulnerable to advanced modeling attacks such as LMAs. • RNN-embedded SCA PUF resists LMAs by masking power side-channel information. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What role does social isolation play in the association between physical mobility and cognitive function? • What is the main finding of this study? Based on the multi-wave longitudinal data, this cohort study first found both male and female older adults with physical mobility limitations were more likely to experience social isolation, which was associated with a higher risk of cognitive decline. • What is the meaning of the finding? These findings indicate that reversing social isolation can be a priority intervention target for cognitive decline prevention and promote successful ageing, important for every older adults with impaired physical mobility. This study aimed to examine the mediating role of social isolation between physical mobility and cognitive function, and whether there are gender differences in the above mediating effects among Chinese older adults. This is a prospective and cohort study. We obtained data from the 2011 (Time 1, T1), 2015 (Time 2, T2) and 2018 (Time 3, T3) waves of China Health and Retirement Longitudinal Study, including 3,395 participants aged 60 years or above. Cognition was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing, which was widely used in previous research. We used a cross-lagged model to test the hypothesis that social isolation mediated the association between physical mobility and cognitive function among Chinese older adults. The total effects of T1 physical mobility limitations on T3 cognitive function (β = -0.055, bootstrap p < 0.001) were significantly negative. Social isolation played a mediating role among both males and females (male: β = -0.008, bootstrap p = 0.012; female: β = -0.006, bootstrap p = 0.023), demonstrating that the mediating effect of social isolation between physical mobility and cognitive function was not gender specific. This study confirmed that social isolation mediated the association between physical mobility and cognitive function among both Chinese male and female older adults. These findings indicate that reversing social isolation can be a priority intervention target for cognitive decline prevention and promote successful ageing, particularly among older adults with impaired physical mobility. [ABSTRACT FROM AUTHOR]

To compare patients undergoing anterior cervical discectomy and fusion (ACDF) versus cervical disc replacement (CDR) for time to minimum clinically important difference (MCID) achievement and predictors of delayed MCID achievement for the patient-reported outcomes (PROs), Patient-Reported Outcomes Measurement Information System Physical Function, Neck Disability Index, Visual Analog Scale (VAS) neck, and VAS arm. PROs of patients undergoing ACDF or CDR were collected preoperatively and postoperatively at 6-week/12-week/6-month/1-year/2-year periods. MCID achievement was calculated through comparison of changes in Patient-Reported Outcomes Measurement to previously established values in literature. Time to MCID achievement and predictors for delayed MCID achievement were determined through Kaplan-Meier survival analysis and multivariable Cox regression, respectively. One hundred ninety-seven patients were identified, with 118 and 79 undergoing ACDF and CDR, respectively. Kaplan-Meier survival analysis demonstrated faster time to achieve MCID for CDR patients in Patient-Reported Outcomes Measurement Information System Physical Function (P = 0.006). Early predictors of MCID achievement through Cox regression were CDR procedure, Asian ethnicity, elevated preoperative PROs of VAS neck and VAS arm (hazard ratio, 1.16–7.28). Workers' compensation was a late predictor of MCID achievement (hazard ratio, 0.15). Most patients achieved MCID in physical function, disability, and back pain outcomes within 2 years of surgery. Patients undergoing CDR achieved MCID faster in physical function. Early predictors of MCID achievement were CDR procedure, Asian ethnicity, and elevated preoperative PROs of pain outcomes. Workers' compensation was a late predictor. These findings may be helpful in managing patient expectations. [ABSTRACT FROM AUTHOR]

Patient-Reported Outcomes Measurement Information System (PROMIS) enables the use of computer adaptive testing (CAT). The aim of this prospective cohort study was to compare the most commonly used disease-specific instruments with PROMIS CAT questionnaires in patients with trauma. All patients with trauma (ages 18-75) who underwent an operative intervention for an extremity fracture between June 1, 2018, and June 30, 2019, were included. The disease-specific instruments were the Quick Disabilities of the Arm, Shoulder, and Hand for upper extremity fractures and the Lower Extremity Functional Scale (LEFS) for lower extremity fractures. Pearson's correlation (r) between the disease-specific instruments and the PROMIS CAT questionnaires (PROMIS Physical Function, PROMIS Pain Interference, and PROMIS Ability to Participate in Social Roles and Activities) was calculated at week 2, week 6, month 3, and month 6. Construct validity and responsiveness were calculated. A total of 151 patients with an upper extremity fracture and 109 patients with a lower extremity fracture were included. At month 3 and month 6, the correlation was strong between the LEFS and PROMIS Physical Function (r = 0.88 and r = 0.90, respectively), and at month 3, the correlation was strong between the LEFS and PROMIS Social Roles and Activities (r = 0.72). At week 6, month 3, and month 6, there was a strong correlation between the Quick Disabilities of the Arm, Shoulder, and Hand and PROMIS Physical Function (r = 0.74, r = 0.70, and r = 0.76, respectively). The PROMIS CAT measures are acceptably related to existing non-CAT instruments and may be a useful tool during follow-up after operative interventions for extremity fractures. • Patient-Reported Outcomes Measurement Information System computer adaptive testing (CAT) questionnaires could be used as a supplement to outpatient visits to provide insight into perceived health and the domain of experienced limitations. Knowledge about the results and the clinical consequences has yet to grow, but using these questionnaires could enhance communication between clinicians and patients. • Patient-Reported Outcomes Measurement Information System CAT measures are acceptably related to existing non-CAT instruments, resulting in a lower response burden than that with injury-specific instruments. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between combinations of sarcopenia criteria by the Asian Working Group of Sarcopenia (AWGS) 2019 guideline and incident adverse health outcomes. Longitudinal analyses of a cohort study. We conducted prospective 2-year follow-up analyses (N = 1959) among community-dwelling older adults enrolled in the nationwide Korean Frailty and Aging Cohort Study (KFACS). From the KFACS, 1959 older adults (52.8% women; mean age = 75.9 ± 3.9 years) who underwent assessments for appendicular skeletal mass using dual-energy X-ray absorptiometry, handgrip strength, usual gait speed, 5-times sit-to-stand test, and Short Physical Performance Battery (SPPB) at baseline were included. Participants with each adverse health outcome [mobility disability, falls, and instrumental activities of daily living (IADL) disabilities] at baseline were excluded for each corresponding analysis. Multivariable logistic regression was performed to examine whether sarcopenia defined by different diagnostic criteria was associated with incident adverse health outcomes after 2 years. A total of 444 participants (22.7%) were diagnosed with sarcopenia as defined by AWGS 2019. In the multivariable analysis, sarcopenia defined as both low muscle mass and low physical performance increased the risk of mobility disability (OR 2.14, 95% CI 1.35-3.38) and falls (1.74, 95% CI 1.21-2.49). Only the criterion defined as both low muscle mass and physical performance using the SPPB increased the risk of falls with fracture (2.53, 95% CI 1.01-6.35) and IADL disabilities (2.77, 95% CI 1.21-6.33). However, sarcopenia defined as both low muscle mass and low hand grip strength showed no associations with the incidence of any of the adverse health outcomes. Our study suggests that the predictive value of adverse health outcomes for community-dwelling older adults is better when diagnosed with sarcopenia based on low muscle mass and physical performance. Furthermore, using the SPPB as a diagnostic tool for low physical performance may improve the predictive validity for falls with fracture and IADL disability. Our findings may be helpful for the early detection of individuals with sarcopenia who have a higher risk of adverse health outcomes. [ABSTRACT FROM AUTHOR]

• Significant improvement was detected in FEV1 level of children with CF after a year. • Health related quality of life and BMIp improved after the implentation of project. • QI projects are valuable to improve CF care. A collaboration between the University of Michigan (U of M) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated to improve the health status of people with cystic fibrosis (pwCF) at MU through implementing Quality Improvement (QI) initiatives. The main aim was to improve lung function in children with FEV1pp <80. The secondary aim was to assess the changes in health related quality of life. Included in the project were pwCF who received cystic fibrosis (CF) care at the MU CFC and were 6–18 years of age with an FEV1pp <80. Flow charts were created and a standardized CF care algorithm was implemented. Weekly case review were done to develop individualized treatment plans. Appropriate intervention was applied and patient data were assessed at baseline, 3, 6, 9 and 12 months. The Cystic Fibrosis Revised Questionnaire (CFQ-R) was completed. 55 pwCF were included (mean age:11.8 ± 3.3 years). Mean FEV1pp (SD) at baseline, 6 and 12 month was 63.7 (14.6), 66.9 (16.6), 70.4 (19.2), respectively, with a relative increase of 5.0% in 6 months (p:0.002) and 10.5% in 12 months compared to baseline (p <0.001). Physical functioning, eating problems and respiratory symptoms domains of the CFQ-R questionnaire were improved at the end of the one year for 6–13 (p = 0.024, p = 0.009, p = 0.002) and 13–18 year olds (p = 0.013, p = 0.002, p = 0.038). There was significant improvement in pwCF with FEV1<80%pp after implementing this QI project. The processes and assessments used can be adopted by other low-middle income countries to improve similar measures. [ABSTRACT FROM AUTHOR]

To evaluate the effect of early depressive burden on PROMs in the setting of cervical disc replacement (CDR). Patients who had undergone primary elective CDR with recorded preoperative and 6-week postoperative 9-item Patient Health Questionnaire (PHQ-9) scores were identified. Early depressive burden was calculated via addition of the preoperative and 6-week PHQ-9 scores. Patients were divided into 2 cohorts, those with summative PHQ-9 scores beneath one-half standard deviation less than the mean (Lesser Burden; LB) and those with summative PHQ-9 scores above one-half standard deviation greater than the mean (Greater Burden; GB). Magnitude of improvement in PROMs (ΔPROM) was compared within and between cohorts at 6-weeks (ΔPROM-6W) and final follow-up (ΔPROM-FF). PROMs evaluated included PROMIS-PF/NDI/VAS-Neck (VAS-N)/VAS-Arm (VAS-A)/PHQ-9. Fifty-five patients were included with 34 in the LB cohort. The LB cohort demonstrated improvements from the preoperative baseline in 6-week PROMIS-PF/NDI/VAS-N/VAS-A (P ≤ 0.012, all). The GB cohort demonstrated improvements from the preoperative baseline in 6-week NDI/VAS-N/VAS-A/PHQ-9 (P ≤ 0.038, all). The GB cohort demonstrated greater ΔPROM-6W and ΔPROM-FF in PHQ-9 (P ≤ 0.047, both). The LB cohort demonstrated a greater ΔPROM-FF in PROMIS-PF (P = 0.023). Patients with a greater depressive burden were more likely to experience greater magnitudes of improvements in PHQ-9 at both 6-week and final follow-up and experience clinically meaningful improvement in depressive symptoms. Patients with a lesser depressive burden were more likely to experience a greater magnitude of improvement in PROMIS-PF at final follow-up and experience clinically meaningful improvement in physical function. [ABSTRACT FROM AUTHOR]

To establish minimum clinically important difference (MCID) in anterior lumbar interbody fusion (ALIF) for the physical function patient-reported outcome measures, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), 12-Item Short Form (SF-12) physical component score (PCS), Veterans RAND 12 (VR-12) PCS, and pain patient-reported outcome measures visual analog scale (VAS) back and VAS leg through anchor- and distribution-based calculations. Patients undergoing ALIF with preoperative and 6-month Oswestry Disability Index were included. Using Oswestry Disability Index as the anchor, anchor-based calculation methods were the average change, minimum detectable change, and receiver operating characteristic curve methods. Distribution-based methods were the standard error of measurement, reliable change index, effect size, and half of the standard deviation (0.5ΔSD). Fifty-one patients were identified. Anchor-based methods ranged from 2.9 to 11.5 for PROMIS-PF, 8.2–13.6 for SF-12 PCS, 7.8–16.8 for VR-12 PCS, 0.5–3.9 for VAS back, and 1.0–3.4 for VAS leg. The area under curve ranged from 0.59 (VAS back) to 0.78 (VR-12 PCS). Distribution-based methods ranged from 1.0 to 4.2 for PROMIS-PF, 1.8–12.2 for SF-12 PCS, 1.9–6.2 for VR-12 PCS, 0.4–1.6 for VAS back, and 0.5–1.7 for VAS leg. The MCID values greatly relied on the calculation method. The minimum detectable change method was selected as the most appropriate MCID calculation method. The MCID values that may be utilized for ALIF patients are 7.3 for PROMIS-PF, 8.2 for SF-12 PCS, 7.8 for VR-12 PCS, 3.2 for VAS back, and 2.2 for VAS leg. [ABSTRACT FROM AUTHOR]

Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass. We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses. The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610–149.00, P < 0.05) and the value of the area of the psoas major muscle at the L3 level normalized by the vertebral area not in the first tertile (OR: 0.22, 95% CI: 0.06–0.82, P < 0.05) were significant predictors of a good postoperative 30-day performance status. A good preoperative performance status and exclusion from the first tertile were clinical factors predicting a good postoperative 30-day performance status. In patients with large psoas muscle mass (third tertile), a good 30-day performance status can be expected after surgery, suggesting that surgery in this population should be pursued aggressively. [ABSTRACT FROM AUTHOR]

• CMAP amplitude, muscle strength and walking capacity decrease after immobilisation and return to baseline levels after retraining. • Muscle velocity recovery cycles and MScanFit MUNE generally stay stable during short-term immobilisation and retraining. • Measures of the peripheral nervous system do not contribute to the changes observed in muscle strength and walking capacity. To explore the effects of short-term immobilisation and subsequent retraining on peripheral nervous system (PNS) measures using two novel electrophysiological methods, muscle velocity recovery cycles (MVRC) and MScanFit motor unit number estimation (MUNE) alongside lower limb muscle strength, muscle imaging and walking capacity. Twelve healthy participants underwent 1-week of ankle immobilisation and 2-weeks of retraining. Assessments before and after immobilisation, and after retraining, included MVRC [muscle membrane properties; muscle relative refractory period (MRRP), early and late supernormality ], MScanFit, MRI-scans [muscle contractile cross-sectional area (cCSA)], isokinetic dynamometry [dorsal and plantar flexor muscle strength], and 2-minute maximal walk test [physical function]. After immobilisation, compound muscle action potential (CMAP) amplitude reduced (-1.35[-2.00;-0.69]mV); mean change [95%CI]) alongside reductions in plantar (but not dorsal) flexor muscle cCSA (-124[-246;3]mm2), dorsal flexor muscle strength (isometric −0.06[-0.10;-0.02]Nm/kg, dynamic slow −0.08[-0.11;-0.04]Nm/kg, dynamic fast no changes), plantar flexor muscle strength (isometric −0.20[-0.30;-0.10]Nm/kg, dynamic slow −0.19[-0.28;-0.09]Nm/kg, dynamic fast −0.12[-0.19;-0.05]Nm/kg) and walking capacity (-31[-39;–23]m). After retraining, all immobilisation-affected parameters returned to baseline levels. In contrast, neither MScanFit nor MVRC were affected apart from slightly prolonged MRRP in gastrocnemius. PNS do not contribute to the changes observed in muscle strength and walking capacity. Further studies should include both corticospinal and peripheral mechanisms. [ABSTRACT FROM AUTHOR]

Deficits in physical function that occur with aging contribute to declines in quality of life and increased mortality. There has been a growing interest in examining associations between physical function and neurobiology. Whereas high levels of white matter disease have been found in individuals with mobility impairments in structural brain studies, much less is known about the relationship between physical function and functional brain networks. Even less is known about the association between modifiable risk factors such as body mass index (BMI) and functional brain networks. The current study examined baseline functional brain networks in 192 individuals from the Brain Networks and mobility (B-NET) study, an ongoing longitudinal, observational study in community-dwelling adults aged 70 and older. Physical function and BMI were found to be associated with sensorimotor and dorsal attention network connectivity. There was a synergistic interaction such that high physical function and low BMI were associated with the highest network integrity. White matter disease did not modify these relationships. Future work is needed to understand the causal direction of these relationships. [ABSTRACT FROM AUTHOR]

• The PRWHE is widely used PROM for hand and wrist disorders. • The PRWHE-Slo showed excellent internal consistency and test-retest reliability. • The PRWHE-Slo is freely available for use in clinical and research practice. The Patient-Rated Wrist and Hand Evaluation (PRWHE) is one of the widely used PROMs in the hand rehabilitation. To develop the Slovenian version of the PRWHE (PRWHE-Slo) and to evaluate its psychometric properties. A single-centre observational prospective cohort study. Fifty patients with distal radius fracture (DRF) were enrolled in the study. Construct validity was assessed by examining the correlations between the PRWHE-Slo and QuickDASH, EQ-5D-5L, wrist ROM, and grip strength. Reliability was evaluated by determining internal consistency (Cronbach...s alpha) and test-retest reliability (intraclass correlation coefficient (ICC)). The standard error of measurement (SEM) and the minimal detectable change (MDC) were determined. The responsiveness of the PRWHE-Slo was assessed with the effect size (ES) and standardised response mean (SRM). The Cronbach's alpha value of 0.96 and the ICC (95% CI) value of 0.95 showed excellent internal consistency and reliability for the total PRWHE-Slo score. When assessing construct validity of PRWHE-Slo, there was a strong positive correlation between all subscales and total scores of the PRWHE-Slo and the QuickDASH (r-values ranging from 0.72 to 0.83). The unrelated dimensions such as the function subscale of the PRWHE and the mobility and anxiety/depression subscales of the EQ-5D-5L were not statistically significantly correlated. Grip strength was moderately negatively correlated with all PRWHE subscales, whereas ROM showed no statistically significant correlations with any of the PRWHE-Slo subscales. SEM and MDC for the total PRWHE-Slo score were 5.40 and 14.97, respectively. The PRWHE-Slo proved to be highly responsive in DRF patients with SRM and ES values of 1.27 and 0.91, respectively. The psychometric analysis of this study shows the PRWHE-Slo to be reliable, valid, and responsive PROM for assessing pain and disability in patients after DRF. [ABSTRACT FROM AUTHOR]

The lateral approach to lumbar fusion surgery provides access to the spine without needing to use a transperitoneal pathway thus reducing the incidence of morbidity compared to the anterior approach. Therefore, the frequency in which this approach has been utilized has grown warranting increased need for evaluating patient reported outcomes for this particular surgical technique. The utilization of patient-reported outcome measures (PROMs) administered as surveys is a standard procedure now in spine surgery. These surveys are used to evaluate from the patient's perspective the success of the surgery in alleviating the preoperative symptoms. More information is needed to correlate PROMs with their legacy counterparts in the context of individual pathologies and surgeries. The goal of this study is to correlate Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) scores with Short Form-12 Physical Component Score (SF-12 PCS) and Veterans RAND-12 Physical Component Score (VR-12 PCS) to assess physical function in individuals undergoing Lateral Lumbar Interbody Fusion (LLIF). This study is a retrospective review. Electronic medical records of a single spine surgeon were searched for individuals undergoing primary, elective LLIF. Excluded cases were related to cancer, infection, trauma, or individuals missing the PROMs of interest. A total of 86 patients were included in the final study. Outcome measures included perioperative characteristics, minimal clinically important difference (MCID) achievement rate, and PROMs of SF-12 PCS, Oswestry Disability Index (ODI), VR-12 PCS, and PROMIS-PF. Demographics, perioperative characteristics, and PROMs were collected both preoperatively and postoperatively at six weeks, 12 weeks, six-months, one year, and two years. As we look to compare "legacy" PROMs to the newer generation of measurements, we will use SF-12 PCS, VR-12, and ODI to represent the legacy PROMs. The newer generation will be represented by PROMIS-PF. Pearson's Correlation Coefficient was used to establish the relationship between the legacy PROM values and PROMIS-PF. All PROMs other than ODI showed improvements in the mean score at each consecutive follow-up time point. PROMIS-PF showed a statistically significant Pearson's Correlation Coefficient with SF-12 PCS, VR-12 PCS, and ODI at all time points measured (p<0.05, all). The Pearson's correlation coefficient for 12-week SF-12 PCS until 2-years is reported as strongly correlated (0.500<|r|, r=0.765, r=0.824, r=0.772, r=0.757, respectively). The correlation coefficients of SF-12 PCS for the preoperative and six-week timepoints were considered moderately strong positive correlation (0.300<|r|≤0.500; r = 0.467, and 0.373, respectively). The correlation coefficients of VR-12 for the preoperative and six weeks were considered strongly positive (0.500<|r|; r = 0.576 and 0.536, respectively). The 12 weeks through 2-year timepoints for VR-12 were considered strongly positive (0.500<|r|; r = 0.770, 0.835, 0.838, 0.817, respectively). The correlation coefficient for ODI from preoperative through 2-year follow-up were all considered strongly negative (0.500<|r| for all). PROMIS-PF demonstrated a strong positive correlation with VR-12 PCS, and SF-12 PCS, and a strong negative correlation with ODI in our patient sample. These results suggest PROMIS-PF can be used as an accurate measure of physical function in patients undergoing LLIF. Therefore, the use of PROMIS-PF as a singular survey for patients may be an accurate measure of patient-reported outcomes in spine surgery. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The outcomes of revision minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and lateral lumbar interbody fusion (LLIF) have not been compared in the literature thus far. The purpose of this study is to compare perioperative and patient-reported outcome (PRO) data of revision MIS-TLIF and LLIF. This study is a retrospective cohort study. Patients undergoing elective revision MIS-TLIF and LLIF were identified from a prospective single surgeon registry and grouped into cohorts based on surgical approach. Only patients undergoing fusions at spinal levels accessible through both MIS-TLIF and LLIF were included. In total, 102 patients were included, with 29 MIS-TLIF patients and 73 LLIF patients. Outcome measures were perioperative data, minimal clinically important difference (MCID) achievement rates), and PROs including Veterans Rand-12 Physical and Mental Composite Score (VR-12 PCS, MCS), Patient-Reported Outcome Measurement Information System-physical function (PROMIS-PF), Patient-Health Questionnaire-9 (PHQ-9), Visual Analog Scale-Back and Leg Pain (VAS-BP, LP), and Oswestry Disability Index (ODI). Demographics, perioperative data, and PROs were obtained from the registry and compared through independent samples t-tests or chi-square tests. Improvements in PROs by six weeks and final follow-up were tabulated. Postoperative PROs and changes in PROs were compared through multivariable linear regression to account for age differences. MCID achievement rates were calculated for each group by comparing changes in PROs to thresholds reported in prior literature. MCID achievement rates were then compared between groups using multivariable logistic regression. Patients undergoing LLIF were significantly older (58.7 years) than patients undergoing MIS-TLIF (54.0 years) (p=0.047), but there were no other demographic differences between groups (p≥0.111, all). LLIF patients consumed more narcotics on postoperative day 0 (p=0.035), while there were no other differences in perioperative data. There were no significant differences in baseline PROMs (p≥0.059, all). When controlling for differences in age, there were no differences in 6-week postoperative and final follow-up PROMs (p≥ 0.061, all). The LLIF group reported greater average improvement in VAS-LP scores by six weeks postoperatively compared to the MIS-TLIF group (p=0.049), while other outcomes were statistically similar (p≥0.098, all). The LLIF group also reported greater average final follow-up improvements in PROMIS-PF scores (p=0.003), and similar final follow-up improvements otherwise (p≥0.086, all). There were no significant differences in MCID achievement of any outcome overall (p≥0.052, all). When controlling for age, revision LLIF patients reported earlier and greater reduction in leg pain by six weeks, with similar magnitudes of improvement by final follow-up and greater improvement in physical function at final follow-up. Overall, there were no differences in patients achieving clinically significant improvements in any outcomes. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

In recent years, mental health has increasingly been recognized as an influential determinant of patient outcomes after surgery across many specialties. Patients with back pain, a common manifestation of spine pathology, experience high concomitant rates of depression. Roughly a quarter of patients undergoing spine surgery are regularly taking antidepressant medication, which has been associated with longer hospitals stays and increased cost. Discharge to rehab facilities can contribute significantly to overall cost of care. Recent research has focused on associations between surgical spine patients and nonhome discharge in an effort to identify potential risk factors. In recent years, mental health has increasingly been recognized as an influential determinant of patient outcomes after surgery across many specialties. Patients with back pain, a common manifestation of spine pathology, experience high concomitant rates of depression. Roughly a quarter of patients undergoing spine surgery are regularly taking antidepressant medication, which has been associated with longer hospitals stays and increased cost. Discharge to rehab facilities can contribute significantly to overall cost of care. Recent research has focused on associations between surgical spine patients and nonhome discharge in an effort to identify potential risk factors. The goal of this study was to investigate the association between antidepressant use and discharge disposition, as well as inpatient physical therapy performance. This was a retrospective cohort study. Our patient sample consisted of 1,775 patients undergoing elective lumbar fusion between 2017 and 2021 at a single, academic, teritary care center. Our primary outcome measure was discharge disposition. Secondary outomces included short-term surgical outcomes such as complications and readmission. We also used inpatient physical therapy performance as a secondary outcome, as it is often plays a role in determining discharge disposition. After approval was obtained by the Institutional Review Board, patients undergoing primary 1-3 level lumbar fusion at a single, tertiary care institution from 2017-2021 were retrospectively identified. Patient characteristics, surgical details, and surgical outcomes were collected via chart review. Medications were collected based on active medication lists at the patient's preoperative and first postoperative appointment. A patient was deemed to be taking antidepressants if they were active medication at both the preoperative and follow-up appointment. Inpatient physical therapy metrics including session distance and AMPAC (Activity Measure for Post Acute Care) scores were collected via chart review. Statistical analysis was performed to identify differences between the "antidepressant" and "no antidepressant" groups. A total of 493 patients (27.7%) were taking antidepressants perioperatively. Patients in the antidepressant group were more likely to be female (p<0.001), current smokers (p=0.012), and have a higher Elixhauser comorbidity index (p<0.001). On regression analysis, the antidepressant group was associated with discharge to rehab after surgery (p=0.026). Age (p<0.001), length of stay (p<0.001), 1st session distance (p<0.001), and improvement in gait distance (p<0.001) were associated with nonhome discharge. Antidepressant use was independently associated with discharge to a rehabilitation facility. These patients were still discharged to these facilities without performing significantly worse in in their inpatient physical therapy sessions. These findings suggest that psychosocial factors may play an important role in disposition discharge after spine surgery and patients with depression/anxiety may require additional resources while in the hospital to be discharged safely home. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Obesity is an important independent cardiovascular (CV) risk factor and a chronic inflammatory disease related to the development of insulin resistance, type 2 diabetes, dyslipidaemia, coronary artery disease, hypertension, heart failure, atrial fibrillation and obstructive sleep apnoea. Body Mass Index (BMI) values >27 kg/m2 are associated with an exponential increase in the risk for Major Adverse Cardiac Events (MACE). On the other hand, weight reduction can significantly reduce metabolic, CV and oncological risk. Orlistat, bupropion/naltrexone, liraglutide and semaglutide, combined with lifestyle changes, have proven to be effective in weight loss; the last two have been tested in randomized clinical trials (RCTs) with CV outcomes only in diabetic patients, and not in obese patients. To fill a fundamental gap of knowledge, the SELECT trial on patients with obesity and CV disease treated with semaglutide is ongoing, aiming at MACE as the primary endpoint. The battle against the social and clinical stigma towards obesity must be counteracted by promoting an awareness that elevates obesity to a complex chronic disease. Several actions should be implemented to improve the management of obesity, and cardiologists have a key role for achieving a global approach to patients with excess weight also through the correct implementation of available treatment strategies. • Obesity is an important independent cardiovascular risk factor and a chronic inflammatory disease. • Even a moderate weight reduction can significantly reduce metabolic, CV and oncological risk. • Orlistat, bupropion/naltrexone, liraglutide and semaglutide, combined with lifestyle changes, have proven to be effective in weight loss. • In addition liraglutide and semaglutide as compared to placebo improved CV risk factors and physical function. • Cardiologists play a key role in identifying and screening obese patients and prescribing personalized treatment. [ABSTRACT FROM AUTHOR]

We propose a stochastic memristor utilizing ultrathin native-SiO x films (∼2.7 nm) and dynamic Ag nanoclusters for constructing physical unclonable function (PUF) hardware. The atomically thin solid electrolyte allows for quantum-mechanical tunneling current at high resistance states, which exponentially increases the entropy between separated devices. This results in good uniformity (54.4%), uniqueness (53.7%), and reliability (98.75%) for the prototype native-SiO x mem-PUF array. Furthermore, the proposed device demonstrates reconfigurability for key refreshing and passes all 15 National Institute of Science and Technology (NIST) tests, verifying the high randomness of the generated bits. Overall, this work highlights the potential of the ultrathin native-SiO x memristor for PUF applications. [ABSTRACT FROM AUTHOR]

Family-centered workshops' effects on children with language developmental delay remain unknown. This study assessed the feasibility of workshops for children with language developmental delay. A total of 122 children aged 18-36 months with language developmental delays and their parents participated in six sessions of 2-h family-centered multidisciplinary workshops for 6 weeks. The Mandarin-Chinese Communicative Development Inventory, Peabody Developmental Motor Scale, Emotional Competency Rating Scales, Pediatric Outcomes Data Collection Instrument, Child Health Questionnaire, Pediatric Quality of Life Inventory, Caregiver Strain Index, Impact on Family Scale, PedsQL Family Impact Module, and World Health Organization Quality of Life (QOL) were administered to the children and their parents before and after the workshop. We found improvement of emotion (P = 0.037), upper extremity and physical function (P = 0.038), and transfer and basic mobility (P = 0.019) in children and parental QOL related to children's conditions (P = 0.049), with no effect on communication ability and QOL in children and family strain and function. We also noted more significant improvement in children with pure developmental language delay than in children with nonpure developmental language delay concerning the success rates (from delayed to normal development) for expressive vocabulary (P < 0.001) and word combination (P = 0.002). Satisfaction levels toward the workshop were high. Family-centered workshops improved children's emotions, functional performance, and parental QOL. Although the samples were too small to test different conditions of the developmental delay, the workshops for children with language developmental delays are acceptable and feasible. [ABSTRACT FROM AUTHOR]

Plasticity of the intestinal epithelium is a source of host vulnerability for helminth manipulation. Intestinal helminths alter the function of epithelial cells at diverse stages of lineage differentiation. Organoid-based studies are emerging as a powerful experimental approach to studying direct helminth–host interactions under more physiological conditions. The investigation of direct helminth–host interactions at the epithelial interface is the next frontier of host–parasite interactions. Intestinal helminths remain highly pervasive throughout the animal kingdom by modulating multiple aspects of the host immune response. The intestinal epithelium functions as a physical barrier as well as a sentinel innate immune tissue with the ability to sense and respond to infectious agents. Although helminths form intimate interactions with the epithelium, comprehensive knowledge about host–helminth interactions at this dynamic interface is lacking. In addition, little is known about the ability of helminths to directly shape the fate of this barrier tissue. Here, we review the diverse pathways by which helminths regulate the epithelium and highlight the emerging field of direct helminth regulation of intestinal stem cell (ISC) fate and function. [ABSTRACT FROM AUTHOR]

• The effects of medicines on physical function have not been quantified. • We studied the association between medicine changes and 24-hour activity composition. • As sedative/anticholinergic load increased, sedentary time increased. • Wearable accelerometry bands can be used to monitor the effects of medicines on physical function. Studies have shown that use of medicines with sedative or anticholinergic properties is associated with a decline in physical function; however, the effects have not been quantified, and it is not known how and which specific physical movements are affected. This prospective study quantified the impact of a change in sedative or anticholinergic load over time on 24-hour activity composition. This study used data collected from a randomised trial assessing an ongoing pharmacist service in residential aged care. The 24-hour activity composition of sleep, sedentary behaviour, light-intensity physical activity, and moderate to vigorous physical activity was derived from 24-hour accelerometry bands. Mixed effect linear models were used to regress the multivariate outcome of 24-hour activity composition on medication load at baseline and at 12 months. A fixed effect interaction between trial stage and medication load was included to test for differing sedative or anticholinergic load effects at the two trial stages. Data for 183 and 85 participants were available at baseline and 12 months respectively. There was a statistically significant interaction between medication load and time point on the multivariate outcome of 24-hour activity composition (sedative F = 7.2, p < 0.001 and anticholinergic F = 3.2, p = 0.02). A sedative load increase from 2 to 4 over the 12-month period was associated with an average increase in daily sedentary behaviour by an estimated 24 min. As sedative or anticholinergic load increased, there was an increase in sedentary time. Our findings suggest wearable accelerometry bands are a possible tool for monitoring the effects on physical function of sedative and anticholinergic medicines. The ReMInDAR trial was registered on the Australian and New Zealand Trials Registry ACTRN12618000766213. [ABSTRACT FROM AUTHOR]

Major Depressive Episodes (MDE) following COVID-19 are frequent, can have a characteristic clinical picture, and are associated with immune-inflammatory changes. Vortioxetine is known to improve physical and cognitive performance in patients with depression and shows anti-inflammatory and anti-oxidative activities. This study aimed to retrospectively evaluate the effects of vortioxetine after 1 and 3 months of treatment in 80 patients (44.4% males, 54±17.2 years) with post-COVID-19 MDE. The primary outcome was improvement in physical and cognitive symptoms measured by specific items of Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS), Short Form-36 Health Survey Questionnaire (SF-36), Digit Symbol Substitution Test (DSST), Perceived Deficits Questionnaire for Depression (PDQ-D5). Changes in mood, anxiety, anhedonia, sleep, and quality of life were also investigated, as well as the underlying inflammatory status. Results show that, alongside reduction of depressive symptoms (HDRS, p <0.001), vortioxetine (mean dose: 10.1±4.1 mg/day) significantly improved physical features (all measurements p <0.001) and cognitive functioning (DDST, p =0.02; PDQ-D5, p <0.001) throughout treatment. We also observed significant reductions in inflammatory indexes. Therefore, vortioxetine might be a favorable therapeutic choice in post-COVID-19 patients with MDE because of its beneficial effects on physical complaints and cognition, features that appear to be specifically affected in relation to SARS-CoV-2 infection, and its good safety/tolerability profile. High prevalence and clinical and socioeconomic implications of COVID-19 consequences are a major public health concern and developing tailored, safe interventions is crucial to promote full functional recovery. [ABSTRACT FROM AUTHOR]

To evaluate the influence of symptom duration before anterior cervical discectomy and fusion (ACDF) on patient-reported outcomes (PROs) in workers' compensation patients. A prospective registry was searched for workers' compensation patients who underwent ACDF for herniated disc. Two cohorts based on symptom duration were formed: lesser duration (LD) (<6 months) and prolonged duration (PD) (≥6 months). PROs were collected preoperatively and at 6 weeks, 12 weeks, 6 months, and 1 year postoperatively. PROs were compared within and between groups. Rates of minimum clinically important difference (MCID) were compared between groups. The study included 63 patients. The LD cohort reported improvement in Patient-Reported Outcomes Measurement Information System–Physical Function (PROMIS-PF), Neck Disability Index (NDI), and visual analog scale (VAS) neck at 12 weeks and 6 months and VAS arm at all periods (all P ≤ 0.036). The LD cohort reported improvement in NDI at 12 weeks and 6 months and VAS arm at 6 weeks, 12 weeks, and 6 months (all P ≤ 0.037). Between groups, the LD cohort demonstrated superior scores in PROMIS-PF at 6 weeks, 12 weeks, and 6 months; NDI preoperatively and at 6 weeks, 12 weeks, and 6 months; VAS neck at 12 weeks; and 9-item Patient Health Questionnaire (PHQ-9) at 6 months (all P ≤ 0.045). The LD group was more likely to achieve MCID in PROMIS-PF at 12 weeks (P = 0.012). The PD group was more likely to achieve MCID in PHQ-9 at 6 months (P = 0.023). Regardless of length of symptom duration before ACDF in workers' compensation patients, the patients demonstrated improvements in disability and arm pain. Patients with LD also demonstrated improvements in physical function and neck pain. Patients with LD demonstrated superior scores in physical function, pain, disability, and mental health and were more likely to achieve clinically significant improvement in physical function. Patients with PD were more likely to achieve clinically significant improvement in mental health. [ABSTRACT FROM AUTHOR]

To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics. The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations. Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0–10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS ≥ 7) and potential clinically relevant (NRS ≥ 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed. A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1–4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics. The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clinical approaches that optimize detection and management. [ABSTRACT FROM AUTHOR]

The Japanese Orthopaedic Association (JOA) introduced the concept of locomotive syndrome (LS), which indicates a decline in mobility function by musculoskeletal disorders with new 3-staged category. Additionally, sarcopenia indicates a decline in the quantity and/or quality of skeletal muscle. However, the relationship between low back pain (LBP) and LS or sarcopenia in older people has not been sufficiently understood. This study aimed to investigate the association between them through a cross-sectional locomotorium survey. A total of 302 participants were drawn from the aquatic exercise participants in a rural area of Japan. The body mass index, body fat percentage, skeletal muscle mass index (SMI), spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), and maximum stride of the participants were measured. LBP and LBP-related quality of life (QOL) were evaluated using the Oswestry Disability Index (ODI), visual analogue scale (VAS) of LBP, and the Short-Form 8 (SF-8). Associations between the investigating parameters and sarcopenia or LS were analyzed. There were no significant differences in the findings except grip strength between the non-sarcopenia and sarcopenia groups. However, the LS group showed significantly larger SIA, higher ODI, higher VAS of LBP, lower physical component score (PCS) of the SF-8, longer time in TUG, and lower value in maximum stride than the non-LS group. In addition, the ODI and PCS of the SF-8 significantly deteriorated as the LS stage progressed, and the GLFS-25 score was significantly correlated with ODI (r = 0.706, p < 0.001) and PCS (r = −0.643, p < 0.001) scores. LBP, LBP-related QOL, and physical performance were found to be significantly associated with LS, not sarcopenia, with LBP-related QOL and physical function being closely correlated with 3-stage categories of LS. Thus, these results suggested that LBP is a key factor for LS prevalence. [ABSTRACT FROM AUTHOR]

Intrusion symptoms are a core defining feature of posttraumatic stress disorder (PTSD). It was recently proposed that intrusions may be comprised of two distinct underlying processes: internally-cued intrusions (e.g., trauma-related memories), and externally-cued intrusions (e.g., reactivity to trauma-related cues in one's environment). This is the first study to examine the functional correlates of these two intrusion clusters. Participants included 7460 veterans discharged from 40 Veterans Affairs PTSD residential programs across the United States in fiscal years 2018 through 2020. Latent network modeling and structural equation modeling were used to assess the fit of an 8-factor model of PTSD symptoms, which were assessed using the PTSD Checklist for DSM-5 (PCL-5) PTSD symptoms at admission, and its association with symptoms of depression and generalized anxiety, and emotional and physical functioning. The 8-factor model, with separate intrusion factors, showed superior model fit to the DSM-5 4-factor, 5-factor dysphoric arousal, 6-factor anhedonia, and 7-factor hybrid models of PTSD. Internally-cued intrusions were uniquely associated with dysphoric arousal, decreased avoidance, and worse physical health functioning; whereas, externally-cued intrusions were uniquely associated with greater avoidance, anxious arousal, negative affect, increased generalized anxiety symptoms, and worse emotional functioning. Limitations include the cross-sectional design and use of self-report measures. Findings provide initial support for the clinical utility of a novel 8-factor model of PCL-5 PTSD symptoms, which distinguishes internally- and externally-cued intrusions. These separate intrusion symptom clusters may offer greater specificity and utility in informing the prognosis of and tailored interventions for PTSD. • Intrusions are a core, defining symptom cluster of PTSD. • Internally- v. externally-cued intrusions may represent distinct constructs. • Novel 8-factor model of PTSD showed superior model fit. • Internally- and externally-cued intrusions showed distinct associations with correlates. • New PTSD model with separate intrusion clusters may offer clinical utility. [ABSTRACT FROM AUTHOR]

The relationship between human mobility and nature of science (NOS) salience in the UK news media was examined. This is a mixed-method study. A time series NOS salience data set was established from the content analysis of 1520 news articles related to non-pharmaceutical interventions of COVID-19. Data were taken from articles published between November 2021 and February 2022, which correlates with period of the change from pandemic to endemic status. Vector autoregressive model fitting with human mobility took place. The findings suggest that it was not the number of COVID-19 news articles nor the actual number of cases/deaths, but the specific NOS content that was associated with mobility change during the pandemic. Data indicate a Granger causal negative direction (P < 0.1) for the effect of the NOS salience represented in the news media on mobility in parks, as well as the effect of scientific practice, scientific knowledge and professional activities communicated in news media on recreational activities and grocery shopping. NOS salience was not associated with the mobility for transit, work or residential locations (P > 0.1). The findings of the study suggest that the ways in which the news media discuss epidemics can influence changes in human mobility. It is therefore essential that public health communicators emphasise the basis of scientific evidence to eliminate potential media bias in health and science communication for the promotion of public health policy. The present study approach, which combines time series and content analysis and uses an interdisciplinary lens from science communication, could also be adopted to other interdisciplinary health-related topics. [Display omitted] [ABSTRACT FROM AUTHOR]

Low early postoperative mobility (LEPOM) has been shown to be associated with increased length of hospital stay, complication rates, and likelihood of nonhome discharge. However, few studies have examined preoperative characteristics associated with LEPOM in adult spinal deformity (ASD) patients. To investigate which preoperative patient characteristics may be associated with LEPOM after ASD surgery. Retrospective review. Included were 86 ASD patients with fusion of ≥5 levels for whom immediate-postoperative AM-PAC Basic Mobility Inpatient Short Form (6-Clicks) scores had been obtained. The primary outcome of this study was the likelihood of LEPOM, defined as an AM-PAC score ≤15, which is associated with inability to stand for more than 1 minute. Significant cutoffs for preoperative characteristics associated with LEPOM were determined via threshold linear regression. Multivariable logistic regression was used to assess the impact of preoperative characteristics on the likelihood of LEPOM. LEPOM was recorded in 38 patients (44.2%). Threshold regression identified the following cutoffs to be associated with LEPOM: preoperative Patient Reported Outcomes Measurement Information System (PROMIS) scores of ≥68 for Pain, <28.3 for Physical Function, and ≥63.4 for Anxiety; preoperative Oswestry disability index (ODI) score of ≥60; and body mass index (BMI) of ≥35.2. On multivariate analysis, preoperative PROMIS scores of ≥68 for Pain (odds ratio [OR] 5.3, confidence interval [CI] 1.2–22.8, p=.03), <28.3 for Physical Function (OR 10.1, CI 1.8–58.2, p=.01), and ≥63.4 for Anxiety (OR 4.7, CI 1.1–20.8, p=.04); preoperative ODI score ≥60 (OR 38.8, CI 4.0–373.6, p=.002); BMI ≥35.2 (OR 14.2, CI 1.3–160.0, p=.03), and male sex (OR 5.4, CI 1.2–23.7, p=.03) were associated with increased odds of LEPOM. Preoperative PROMIS Pain, Physical Function, and Anxiety scores; ODI score; BMI; and male sex were associated with LEPOM. Several of these characteristics are modifiable risk factors and thus may be candidates for optimization before surgery. III [ABSTRACT FROM AUTHOR]

• This is the first prospective study of functional decline across glycemic transitions. • A transition from normal to diabetes was associated with an accelerated concomitant decline in cognition and functioning. • Associations with prediabetes were not observed. Evidence about the decline of cognition and physical function across glycemic status (normoglycemia, prediabetes, and diabetes) is inconsistent. We evaluated longitudinal changes in cognition and physical function according to glycemic status and also different glycemic transitions. Population-based cohort study. 9307 participants (mean age 59.7 years, 53.7 % women) were included from the China Health and Retirement Longitudinal Study (2011–2018). Global cognition (assessed by orientation, memory, and executive function) and physical function (calculated as the sum of impaired basic and instrumental activities of daily living) were assessed in each wave. The glycemic status was assessed in waves 2011 and 2015. Diabetes was defined as fasting blood glucose ≥7.0 mmol/L, HbA1c ≥6.5 %, self-reported diabetes, or glucose-lowering medication use. Prediabetes was defined as fasting blood glucose 5.6–6.9 mmol/L or an HbA1c of 5.7–6.4 %. Compared with normoglycemia, baseline diabetes was associated with a faster decline in orientation (−0.018 SD/year, 95%CI -0.032, −0.004) and a faster increase in physical function score (0.082 /year, 95%CI 0.038, 0.126). We did not observe any effect of prediabetes on the changing rate of cognition and physical function. Progression from normoglycemia to diabetes between waves 2011 and 2015 was associated with a significantly faster decline in global cognition, memory, executive function, and physical function compared with stable normoglycemia. Baseline diabetes was associated with accelerated decline of cognition and physical function. Associations with prediabetes were not observed, suggesting an important short diagnostic window when diabetes presents de novo. [ABSTRACT FROM AUTHOR]

Patients with either diabetes (DM) or depression (DP) are prone to developing other diseases and require more medical resources than do the general population. This study aimed to examine health-related quality of life, medical resource use, and physical function of patients with both diabetes mellitus and depression, and the magnitude of effects among patients with different combinations of comorbid diseases. A retrospective cross-sectional study was conducted using the National Health and Nutrition Examination Survey data from 2009 to 2014. Total 16,159 patients were studied and classified into one of 4 groups: both DM and DP(DM+/DP+), DM+/without DP(DP−), without DM (DM−)/DP+, and DM−/DP−, according to the perceived score in Patient Health Questionnaire and diabetes questionnaire in NHANES. Health-related quality of life (HRQoL), medical resource use, and physical function were measured as outcomes of interests. Multivariate logistic regression models were used. Compared with DM−/DP− patients, the DM+/DP+ (adjusted odds ratio [AOR]: 2.59; 95 % CI: 1.77–3.80) and DM−/DP+ (AOR: 2.44; 95 % CI: 1.94–3.06) had greater likely to have worse health. In addition, the DM+/DP+ (AOR: 5.40; 95 % CI: 1.30–22.41) and DM+/DP− (AOR: 2.49; 95 % CI: 1.91–3.25) were more likely to have medical visits, and worse physical function. This study found that both depression and diabetes mellitus worsen HRQoL, increase medical resource use, and decrease physical function. Depression status should be considered by clinicians treating diabetes mellitus patients in order to improve their HRQoL, reduce medical resource use, and improve physical function. • Regarding HRQoL and physical function, DM+/DP+ patients were significantly worse than DM−/DP− patients. • DM+/DP+ patients also used the most medical resources. • The effect of DP is greater than DM on both HRQoL and physical function. [ABSTRACT FROM AUTHOR]

To examine the impact of Patient-Reported Outcomes Measurement Information System (PROMIS) Sleep Disturbance (PROMIS-SD) on clinical outcomes in patients undergoing lumbar decompression. Patients undergoing lumbar decompression with preoperative PROMIS-SD scores were retrospectively included. Patients were separated into 2 cohorts: none to slight sleep disturbance (PROMIS-SD <55) and mild to severe sleep disturbance (PROMIS-SD ≥55). Patient-reported outcome measures including PROMIS Physical Function, PROMIS Anxiety, PROMIS Pain Interference, PROMIS SD, 9-item Patient Health Questionnaire, visual analog scale back/leg, and Oswestry Disability Index were collected preoperatively and up to 1 year postoperatively. Of 87 patients identified, 48 patients had PROMIS-SD scores ≥55. Regardless of preoperative PROMIS-SD score, patients reported significant improvement in physical function, anxiety, pain interference, depression, pain, and disability outcomes in at least 1 time point. Patients in the PROMIS-SD ≥55 cohort reported postoperative improvement in sleep disturbance. Patients in the PROMIS-SD <55 cohort reported superior preoperative patient-reported outcome measures in all domains and superior postoperative improvement in pain interference and sleep disturbance. Minimum clinically important difference attainment rates were higher in the PROMIS-SD ≥55 cohort in physical function, anxiety, pain interference, sleep disturbance, and pain. Patients undergoing lumbar decompression demonstrated significant postoperative improvement in most clinical outcomes regardless of preoperative sleep disturbance. Patients with mild to severe sleep disturbance had higher minimum clinically important difference attainment rates for physical function, mental function, and pain. Patients undergoing lumbar decompression with greater preoperative sleep disturbance may experience more clinically noticeable improvement. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; nevertheless, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease–specific, preference-based utility measure based on the adolescent/adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific, patient-reported measure of HRQOL. Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (eg, factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utilities were used to estimate a preference-based scoring algorithm by regression analysis (tobit models with robust standard errors clustered on participants with censoring at −1). A classification system with 8 dimensions (CFQ-R-8 dimensions; physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among the regression models evaluated, the tobit heteroscedastic–ordered model was preferred, with a predicted utility range from 0.236 to 1, no logical inconsistencies, and a mean absolute error of 0.032. The CFQ-R-8 dimensions is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R. • Cost-effectiveness analysis (CEA) may guide reimbursement decisions for cystic fibrosis (CF) treatments; nevertheless, standard measures of utility used in CEA are insensitive to changes in lung function and health-related quality of life in CF. • We used blinded Cystic Fibrosis Questionnaire-Revised (CFQ-R) data from 4 clinical trials to develop the CFQ-R-8 dimensions (CFQ-R-8D), a new, CF disease–specific, preference-based utility measure with 8 dimensions (physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image). • The CFQ-R-8D enables disease-specific utilities for use in CEA to be generated from the CFQ-R, a measure that is widely used in CF trials. [ABSTRACT FROM AUTHOR]

Mental health and physical health are intrinsically linked, yet the mechanisms are not well understood. We investigated whether moderate-vigorous physical activity (MVPA) mediated the association between depression and physical function (PF) in midlife. Individuals from two UK birth cohorts born within one week in 1958 (n = 7278) and 1970 (n = 6097) with data on depression (ages 33/34; Malaise Inventory), MVPA (age 42; self-reported) and PF (ages 50/56; Short Form-36 subscale). Covariates included sex, childhood and adulthood social class, maternal mental health, childhood mood, alcohol consumption, smoking habits, sleep, marital status, BMI and long-standing illness/disability. Linear or multinomial logistic regression models examined associations between depression, MVPA and PF. We used a parametric g-computation mediation analysis approach to estimate percent differences in PF. Depression was associated with less frequent MVPA and poorer PF. Lower MVPA was associated with worse PF. The direct effect – randomised analogue not operating via MVPA – of depression on PF was −18.8 % (95%CI:--25.8,-11.8) and −15.8 % (20.6,-11.0) in the 1958 and 1970 cohorts, respectively. The indirect effect – operating via MVPA – was −0.5 % (−1.0,-0.03) and −0.2 % (−0.6, 0.3), resulting in a total proportion mediated of 3.1 % (0.1, 6.0) and 0.9 % (−1.6, 3.4). MVPA was self-reported. Intermediate confounders and mediators were measured at the same age, however associations did not change in sensitivity analysis considering age 46 MVPA (1958 cohort). Although higher MVPA was protective against poor PF, there was only minor evidence that it mediated the association between depression and PF. Further investigation into other potential mediators of pathways from mental to physical health is needed. • We studied MVPA as a mediator between depression and physical function. • Depression was associated with less frequent MVPA and worse physical function. • More frequent MVPA was associated with better physical function. • However, MVPA only mediated 0.9 to 3.1 % of the association. • Further inquiry of other mediators (e.g. sedentary behavior, sleep) is needed. [ABSTRACT FROM AUTHOR]

Patient-reported outcomes (PROs) are increasingly utilized to evaluate the efficacy and value of spinal procedures. Among patients with cervical myelopathy, the modified Japanese Orthopaedic Association (mJOA) remains the standard instrument, with Patient-Reported Outcomes Measurement Information System (PROMIS) physical function (PF) and patient satisfaction also frequently assessed. These outcomes have not all been directly compared using a large spine registry at 2 years follow-up for cervical myelopathic patients undergoing surgery. To determine the correlation and association of PROMIS PF, mJOA, and patient satisfaction outcomes in patients undergoing surgery for cervical myelopathy. Retrospective review of a multicenter spine registry database. Adult patients with cervical myelopathy who underwent cervical spine surgery between 2/26/2018 and 4/17/2021. PROMIS PF, mJOA, and North American Spine Society (NASS) patient satisfaction index. The MSSIC database was accessed to gather pre- and postoperative outcome data on patients with cervical myelopathy. Spearman's correlation coefficients relating mJOA and PROMIS PF were quantified up to 2 years postoperatively. The correlations between patient satisfaction with mJOA and PROMIS were determined. Kappa statistics were used to evaluate for agreement between those reaching the minimum clinically important difference (MCID) for mJOA and PROMIS PF. Odds ratios were calculated to determine the association between patient satisfaction and those reaching MCID for mJOA and PROMIS PF. Support for MSSIC is provided by BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program. Data from 2,023 patients were included. Moderate to strong correlations were found between mJOA and PROMIS PF at all time points (p<.001). These outcomes had fair agreement at all postoperative time points when comparing those who reached MCID. Satisfaction was strongly related to changes from baseline for both mJOA and PROMIS PF at all time points (p<.001). Odds ratios associating satisfaction with PROMIS PF MCID were higher at all time points compared with mJOA, although the differences were not significant. PROMIS PF has a strong positive correlation with mJOA up to 2 years postoperatively in patients undergoing surgery for cervical myelopathy, with similar odds of achieving MCID with both instruments. Patient satisfaction is predicted similarly by these outcome measures by 2 years postoperatively. These results affirm the validity of PROMIS PF in the cervical myelopathic population. Given its generalizability and ease of use, PROMIS PF may be a more practical outcome measure for clinical use compared with mJOA. [ABSTRACT FROM AUTHOR]

• The novel lifting disability test is correlated with low back pain questionnaires. • This novel test and 5 repetition sit-to-stand (5R-STS) can measure intervention effectiveness. • Both tests have high test-retest and inter-rater reliability, not considered painful or difficult. • Questionnaire screening for moderately disabled will yield more significant correlation. Lifting disability commonly affects patients with chronic low back pain (CLBP) and may not correlate with the existing lifting-related physical assessment tests, such as the loaded forward reach (LFR) test. The Lift and Place (LAP) test was developed to assess lifting disability in CLBP based on known risk factors. The LAP test was compared with established physical assessment test, including the LFR test and self-reported disability questionnaires. This cross-sectional study measured self-reported disability questionnaires along with LAP and other physical assessment test results Eighty three CLBP and 82 asymptomatic participants aged 18 to 55 with normal BMI according to WHO classification. Oswestry disability index (ODI), Roland–Morris disability questionnaire (RMDQ), Numerical Pain Rating Scale, Trunk Extensor Endurance test, 5 Repetition Sit-To-Stand test, LAP and LFR test. Physical assessment test scores were compared between the two groups. The correlation of assessment test scores with ODI and RMDQ in patients with CLBP was calculated. Receiver operating characteristic (ROC) curve analysis was performed to calculate the area under the curve (AUC) of each assessment tests. Assessment tests, ODI, and RMDQ were measured twice for CLBP patients on separate days to calculate the test-retest intraclass correlation (ICC) reliability. Two researchers scored the assessment tests independently to calculate the inter-rater ICC. Patients with CLBP were slower in the LAP test (CLBP vs asymptomatic: 21.6±4.9 s vs 18.6±3.6 s) and had shorter reach in the LFR test (CLBP vs asymptomatic: 33.6±6.0 cm vs 36.3±6.6 cm). The LAP was correlated with both ODI (r=0.418) and RMDQ (r=0.390), while the LFR was not. In the ROC analysis, the LAP and LFR bore AUCs of 0.685 and 0.379, respectively. Their test-retest ICCs were 0.913 and 0.858, and their inter-rater ICCs were 0.997 and 0.969, respectively. The LAP test demonstrated higher reliability and significant correlation with the ODI and RMDQ, indicating its potential as performance assessment for lifting disability in CLBP. Further studies should investigate the use of LAP and other physical assessments for rapid CLBP screening. [ABSTRACT FROM AUTHOR]

• The study examined the cross-sectional association between characteristics of reproductive history, use of exogenous hormones and fast walking speed among >30,000 French women aged 45 to 69 years. • Age at menarche, age at first birth and duration of breastfeeding were positively associated with fast walking speed. • There was a quadratic association of fast walking speed with parity among parous women. • Among menopausal women, age at menopause was positively associated with fast walking speed. • Fast walking speed increased with reproductive lifetime duration and decreased with time since onset of menopause. • There was no association of fast walking speed with oral contraception and postmenopausal hormone therapy. To investigate the cross-sectional associations of reproductive history and use of exogenous hormones with fast walking speed (WS) in women. Between 2012 and 2020, 33,892 French women aged 45 years or more, recruited at health centers, underwent physical function tests and self-reported information on reproductive history and use of exogenous hormones. Linear mixed models with the center as random intercept were used to estimate the association of exposures with WS. Fast WS. Mean WS was 172.2 cm/s. WS increased with age at menarche (β +1y = 0.23, 95 % confidence interval = 0.05 to 0.40), age at first birth (β +1y = 0.20, 95 % CI = 0.13 to 0.27) and duration of breastfeeding (β for ≥10 vs ≤5months = 1.38; 95 % CI = 0.39 to 2.36). In addition, parity was quadratically associated with WS, with women with 3 children having the highest WS (p for U-shaped relationship < 0.01). Menopausal status had no impact on WS but age at menopause was positively associated with WS (β +5y = 0.52, 95 % CI = 0.17 to 0.87) and partly explained the deleterious impact of artificial menopause on WS. WS increased with reproductive lifetime duration (β +5y = 0.49, 95 % CI = 0.16 to 0.83) and decreased with time since onset of menopause (β +5y = −0.65, 95 % CI = −0.99 to −0.31). By contrast, there was no association of WS with oral contraception and postmenopausal hormone therapy. Our findings suggest that reproductive life characteristics may be associated with WS and timing of exposure could play a role. [ABSTRACT FROM AUTHOR]

• Before and after lung transplantation (LT), patients often find it difficult to have independent gait functions. • Patients who need to have bridging extracorporeal membrane oxygenation applied before surgery had severe impairments in physical functioning. • At 3 months after LT, gait function and muscle strength were not significantly different regardless of extracorporeal membrane oxygenation use. • We may expect favorable early physical recovery after LT when systematic rehabilitation programs are applied. We aimed to investigate the recovery of gait function, muscle strength, and the achievement of an independent gait after lung transplantation (LT) in patients with and without pretransplant extracorporeal membrane oxygenation (ECMO) support. We retrospectively reviewed the medical records of 33 inpatients who underwent bilateral LT and received physical therapy. We assessed the Functional Ambulatory Category (FAC) and Manual Muscle Test (MMT) scores at baseline, 1 month, and 3 months of rehabilitation and the time it took to achieve a FAC score of 3 within 3 months of LT surgery in ECMO and non-ECMO patients. The FAC and MMT scores were generally improved during the first 3 months after LT. The number of patients who achieved a FAC score of 3 at 3 months did not significantly differ between the ECMO and non-ECMO groups (P =.193). At 1 month, significantly fewer patients had reached a FAC of 3 in the ECMO group than in the non-ECMO group (P =.042). There were no significant differences in the FAC (P =.398) and MMT scores (P =.079) at 3 months between the 2 groups. Both groups' gait function and muscle strength were continuously restored 3 months after LT. At 1 month, the gait function was assessed by the FAC score, and the rate to achieve a FAC of 3 was higher in the non-ECMO group than in the ECMO group, but at 3 months, the difference was not significant between the 2 groups. [ABSTRACT FROM AUTHOR]

Surgical and minimally-invasive procedures, including cardiac and radiological, have high-stake patient outcomes. Working pressures, altering shift rotas, and ever-increasing demands have led to worsening sleep patterns for surgeons and allied professionals. Sleep deprivation alone has harmful consequences in relation to clinical outcomes and the physical and mental health of the surgeon, and to offset fatigue, some surgeons use legal stimulants such as caffeine and energy drinks. This stimulant use, however, may come at the cost of negative effects on cognitive and physical function. We aimed to explore evidence behind the use of caffeine, and its consequences on technical performance and clinical outcomes. [ABSTRACT FROM AUTHOR]

Few studies have examined the influence of preoperative disability through the Oswestry Disability Index (ODI) on clinical outcomes in patients undergoing anterior lumbar interbody fusion (ALIF). Patients undergoing ALIF were separated into 2 groups based on ODI<41 (lower disability) versus ODI≥41% (higher disability). Patient-reported outcomes (PROs) were collected at preoperative and postoperative 6-week/12-week/6-month/1-year/2-year time points. Physical function PROs were Patient-Reported Outcomes Measurement Information System Physical Function and 12-item Short Form Physical Component Score. Mental function PROs were 12-item Short Form Mental Component Score and Patient Health Questionnaire-9. Pain PROs were visual analog scale back and visual analog scale leg. ODI was the disability PRO. A total of 148 patients were identified, with 52 patients with lower disability. Higher disability patients demonstrated significant improvement in mental function (P ≤ 0.010, all). Lower disability patients demonstrated superior postoperative PROs in physical function, mental function, back pain, and disability outcomes (P ≤ 0.034, all). Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower for mental function and disability outcomes (P ≤ 0.041, all). Independent of preoperative disability, patients undergoing ALIF reported significant postoperative improvement in physical function, pain, and disability outcomes. Patients with lower preoperative disability continued to report superior PROs in mental function, back pain, and disability postoperatively. Minimum clinically important difference achievement rates for lower disability patients were higher for back pain and lower in mental function and disability outcomes. Patients undergoing ALIF with higher preoperative disability may experience greater clinically meaningful improvement in mental function and disability. [ABSTRACT FROM AUTHOR]

With the Integrated Circuits becoming pervasive in all key industries and applications, PUF's has gained immense popularity for securing the IC's by providing unique identification code to each chip. Designing a highly efficient PUF with optimal values of uniqueness and reliability is a significant challenge. Uniqueness depends on process variations during chip fabrication, and reliability depends on the chip's ability to resist changes to supply voltage and temperature variations. Multiple PUF designs that employ reliability enhancement circuits and security algorithms achieve these design characteristics. Nonetheless, these techniques are design overheads. This paper presents a novel Physical Unclonable Function (PUF) based on the ProHys switch. It deals with hysteresis and proteresis mode of operation, which are complementary to each other. The Prohys PUF befittingly satisfies both uniqueness and reliability criteria, without any additional circuitry or security algorithms. It is the first attempt to design a PUF based on the ProHys switch to the best of our knowledge. The proposed ProHys PUF is designed in TSMC 180 nm CMOS technology, generating an inter-chip variation of 49.85% with 99.7% uniqueness. The minimum reliability of the circuit is 96.9% for a temperature range of -40 °C to 100 °C at a supply voltage range of 1.7V–1.9V. • A novel Physical Unclonable Function (PUF) based on ProHys switch is presented. • It satisfies uniqueness and reliability criteria without any additional circuitry. • This is the first attempt to design a ProHys based PUF, to the best of our knowledge. • Proposed PUF generates an inter-chip variation of 49.85% and uniqueness of 99.7%. • The minimum circuit reliability is 96.9% at a supply voltage range of 1.7 V–1.9 V. [ABSTRACT FROM AUTHOR]