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• 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]

Various security measures for IoT devices have been introduced in recent years. One of the improvements is through the addition of cryptographic hardware along with the central core processor. As IoT devices are resource-constrained, area and power-efficient solutions are needed. Every cryptographic algorithm has a key generator that provides proper keys to encrypt and decrypt the data. This paper focuses on improving the key generators using Physical Unclonable Functions (PUFs). Execution of NIST-STS randomness test and evaluation of crucial performance parameters is done for the generated bit-stream by proposed PUF design. The proposed design is also compared with three designs from the literature based on area and power consumption which are essential parameters for resource-constrained IoT devices. For proposed design number of LUTs, FFs and power consumption are decreased up to 80%, 76% and 67%, respectively, when implemented on Xilinx Artix-7 FPGAs. • PUF based approach to be used for key generation. • A comparative study is done with RO, TERO, and Arbiter PUF. • The output bitstream of the proposed design also checked for randomness, entropy, uniqueness, steadiness, uniformity, and bit-aliasing. • Efficient key generator design for the cryptographic algorithm in terms of area and power consumption is identified as PDL-PUF based design. [ABSTRACT FROM AUTHOR]

Although insomnia is a common core symptom of major depressive disorder (MDD), the burden of moderate-to-severe insomnia symptoms in patients with MDD is not well-understood. This study quantified the clinical, patient-centric, and economic burden of adults with MDD with moderate-to-severe insomnia symptoms (MDDIS) compared to adults with MDD with no-to-mild insomnia symptoms (other-MDD) and adults without MDD. Data from 2019 US National Health and Wellness Survey identified adults self-reporting physician-diagnosed depression, stratified by insomnia status (MDDIS: Insomnia Severity Index [ISI] score ≥15; other-MDD: ISI score <15), and adults not reporting depression (non-MDD). Other-MDD and non-MDD were matched 2:1 to MDDIS on age/sex/race. Matched bivariate analyses examined differences in health-related outcomes by depression-insomnia status. Of 74,994 survey respondents, 2045 (2.7%) were classified as MDDIS, 8220 (11.0%) as other-MDD, and 59,859 (79.8%) as non-MDD. MDDIS respondents (vs other-MDD and non-MDD) reported greater depression severity, anxiety severity, daytime sleepiness, activity impairment, direct costs, and costs due to work productivity impairments, and lower mental and physical functioning (all P < 0.05). Depression diagnosis was not based on clinical/diagnostic interview; causal relationships cannot be determined due to the cross-sectional design. Among US adults with MDD, presence of moderate-to-severe insomnia symptoms is associated with additional burden and notable impairments across several health outcomes versus those with MDD but no-to-minimal insomnia symptoms and general population without MDD. This study highlights the burden of MDDIS and the need for better identification and management of moderate-to-severe insomnia symptoms in adults with MDD. • This study quantifies the burden of MDD with moderate-to-severe insomnia (MDDIS) • Higher depressive, anxiety, and daytime sleepiness symptoms in adults with MDDIS • Higher direct costs and work productivity impairment costs in adults with MDDIS • Lower mental and physical functioning in adults with MDDIS • Burden of MDDIS was significant even when controlling for other depressive symptoms [ABSTRACT FROM AUTHOR]

Pulmonary embolism (PE) is an acute life-threatening event. Besides known physical long-term consequences such as persistent dyspnoea or reduced physical performance, less attention is given to the emotional experience. We used data from patients with PE of the 'Lungenembolie Augsburg (LEA)' cohort study at University Hospital Augsburg. Baseline characteristics were collected during hospital stay and participants received postal questionnaires 3, 6, 12, and 24 months after their PE event. Mental problems were assessed by the Hospital Anxiety and Depression Scale (HADS). Differences in baseline characteristics in patients with or without depression or anxiety at 3 months were tested. Linear mixed models were built to explore long-term effects. About one-in-five of the 297 patients suffered from depressive or anxiety symptoms after PE. Patients with depressiveness 3 months after PE were found to be significantly older, had a higher simplified pulmonary embolism severity index (sPESI), higher education level, more frequently previous depression, lower oxygen saturation, and a longer hospital stay. Linear mixed models revealed significant associations of age, history of depression and sPESI with HADS depression score, and symptoms of dyspnoea with HADS anxiety score after PE. While the association with sPESI decreased over time, persistent dyspnoea and limitations in daily life showed constant associations over the two-year time period for both, depression and anxiety. The findings highlight depression and anxiety to be common in patients with PE and reveal possible predictors. Careful monitoring the mental health of patients with PE is needed for early detection and intervention. • One in five patients suffers from depression or anxiety after pulmonary embolism. • Association of risk stratification and depression decreases over time. • Persistent dyspnoea is associated with emotional harm 2 years after the acute event. • Careful monitoring the mental health of patients with pulmonary embolism is needed. [ABSTRACT FROM AUTHOR]

Lumbar lateral interbody fusion (LLIF) is traditionally performed in 2 stages: placing the interbody cage in the lateral decubitus position, then placing the percutaneous pedicle screw in the prone position. Performing interbody fusion and posterior fixation simultaneously could improve operative efficiency and clinical outcomes associated with longer operative times. We describe the operative steps and report clinical and radiographic outcomes associated with a simultaneous anterior and posterior approach (SAPA) for LLIF. Patients who underwent SAPA LLIF performed by a single surgeon over 1 year were retrospectively reviewed. Demographic, clinical, and radiographic data were analyzed, an operative guideline was created, and a learning curve was constructed using operative times. SAPA LLIF was performed in 11 patients. Three patients experienced transient postoperative femoral nerve plexopathy with symptoms of ipsilateral hip flexion weakness and/or anterior thigh numbness; there were no other complications in the cohort. Radiographically, patients achieved significant increases in disc height (8.3 mm vs. 13.5 mm, P = 0.002) and foraminal height (20.2 mm vs. 25.3 mm, P = 0.0001). Patients showed significant improvements in Oswestry Disability Index (52 vs. 27.8, P = 0.002) and Patient-Reported Outcome Measurement Information System Physical Function (32.6 vs. 39, P = 0.048) and Pain Interference (64.9 vs. 59.6, P = 0.001) at 3 months. A downward trend in operative time was observed for 1-level SAPA LLIF. SAPA LLIF is a safe approach for LLIF that results in favorable clinical outcomes. This technique can potentially improve operative efficiency further along the course of a surgeon's learning curve. [ABSTRACT FROM AUTHOR]

Objective: CAR T-cell therapy is an effective treatment for various relapsed or refractory haemato-oncological diseases. However, this therapy results in significant immunosuppression that lasts for months. Whether these patients are at risk during a rehabilitation stay, e.g., due to infections, has not yet been answered. Methods: We describe the rehabilitation stay under special hygienic conditions of the five patients rehabilitated in our clinic after CAR T-cell therapy. Complications that occurred during rehabilitation are reported, as well as the positive effects of rehabilitation on physical performance, polyneuropathic complaints, anxiety and depression, and individual limitations. Results: One patient reported signs of infection already at the beginning of rehabilitation. This was treated with antibiotics, and rehabilitation could be continued. No complications occurred in any of the other patients. All patients reported having benefited physically and psychologically from the rehabilitation, and two expressed the intention to return to work. Conclusions: As far as we know, this is the first report on several patients after CAR T-cell therapy. Based on the limited data, there is no reason to withhold a rehabilitation stay from patients after CAR T-cell therapy. [ABSTRACT FROM AUTHOR]

La espondiloartritis axial (EspAax) es una enfermedad musculoesquelética con manifestaciones diversas. En la práctica clínica se ha observado variabilidad y limitaciones en la recogida de las variables necesarias para su seguimiento. El objetivo del proyecto CREA fue consensuar estrategias de mejora para la valoración inicial y el seguimiento de los pacientes con EspAax en España. Se realizó una encuesta con 33 preguntas a una muestra representativa de reumatólogos expertos del territorio español sobre la práctica clínica, los recursos y las limitaciones actuales en el seguimiento de los pacientes con EspAax. En 10 reuniones regionales se discutieron los resultados de la encuesta y se propusieron 107 estrategias que fueron valoradas mediante un consenso Delphi en el que participaron 85 expertos. La falta de tiempo en consulta, de personal de enfermería y/o de apoyo, y el retraso en la realización de pruebas de imagen fueron las limitaciones más destacadas en el seguimiento de los pacientes con EspAax. Se propusieron 202 estrategias relacionadas con la evaluación de los índices de calidad de vida e impacto de la enfermedad; las comorbilidades y manifestaciones extraarticulares; las pruebas de laboratorio; las pruebas de imagen; la exploración física y metrología; y los índices de actividad y función. De todas, 54 se consideraron altamente aconsejables. No se encontraron diferencias regionales en los valores de consenso. Las propuestas consensuadas como altamente aconsejables en el estudio actual son aplicables a todo el territorio nacional, permiten realizar un seguimiento y control más estrecho y homogéneo de los pacientes con EspAax, facilitar un manejo integral y responden a las necesidades no cubiertas detectadas en la encuesta inicial. Axial spondyloarthritis (axSpA) are musculoskeletal diseases with different manifestations. In clinical practice, variability, and limitations in the collection of the outcomes required for follow-up have been observed. The objective of the CREA project was to agree on improvement strategies for the initial assessment and follow-up of patients with axSpA in Spain. A survey with 33 questions was conducted by a representative sample of rheumatologists on clinical practice, resources, and present limitations in the follow-up of patients with axSpA. The results of the survey were discussed in 10 regional meetings, and 105 strategies were proposed and evaluated through a Delphi consensus in which 85 experts participated. The lack of time for clinical visits, the lack of nurses and/or support staff and the delay in performing the imaging tests were the most prominent limitations in the follow-up of patients with axSpA. One hundred and five strategies were proposed related to the evaluation of disease activity, physical function, quality of life and disease impact, to the evaluation of comorbidities and extra-articular manifestations, laboratory tests; imaging tests, physical examination and metrology. Of the total, 85 were considered highly advisable. No regional differences were found. The proposals agreed upon as highly advisable in the present study are applicable to the entire national territory, allow tighter and more homogeneous monitoring of the patients with axSpA, facilitate more comprehensive management of the disease, and respond to the unmet needs detected in the initial survey. [ABSTRACT FROM AUTHOR]

Newer Patient-Reported Outcomes (PROs) may offer benefits over legacy PROs in ease of administration and interpretation. We aim to study the influence of preoperative pain interference (PI) using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (PROMIS-PI) on postoperative clinical outcomes in patients undergoing lumbar decompression. Patients undergoing lumbar decompression without fusion were separated into 2 cohorts: PROMIS-PI < 64 (lesser PI) and PROMIS-PI ≥ 64 (greater PI). PROs included PROMIS physical function, PROMIS anxiety (PROMIS-A), PROMIS sleep disturbance (PROMIS-SD), PROMIS-PI, Patient Health Questionnaire-9, Visual Analog Scale (VAS) back, VAS leg, and Oswestry Disability Index (ODI) and were collected at preoperative and postoperative time points. Demographics, perioperative characteristics, PROs, and Minimum Clinically Important Difference (MCID) were compared among groups through non-parametric inferential statistics. One-hundred and seven patients were identified. Independent of preoperative PI, patients reported significant postoperative improvement in PROMIS physical function, PROMIS-A, PROMIS-PI, VAS back, VAS leg, and ODI. The greater PI cohort reported significant postoperative improvement in Patient Health Questionnaire-9 and PROMIS-SD. The lesser PI cohort reported superior preoperative PROs in all domains. Postoperatively, the lesser PI cohort reported superior 6-week PROMIS-A and PROMIS-SD. MCID achievement rates were higher in the greater PI cohort for PROMIS-PI, VAS back, VAS leg, and ODI. Patients with lower preoperative PI reported superior postoperative anxiety and sleep disturbance. Patients with greater preoperative PI had higher MCID achievement rates in PI, pain, and disability. Patients with greater preoperative PI undergoing lumbar decompression may demonstrate higher rates of clinically tangible improvement. [ABSTRACT FROM AUTHOR]

• Pulmonary rehabilitation (PR) is recommended after COPD exacerbations. • We need priority access criteria to programs according to baseline characteristics. • Airflow severity grades or outcomes assessed do not influence success rate of PR. • Barthel dyspnoea index and short physical performance battery are sensitive to PR. Individuals with COPD may be staged according to symptoms and exacerbation history (GOLD groups: A-D) and on airflow obstruction (GOLD grades: 1–4). Guidelines recommend pulmonary rehabilitation (PR) for these individuals, including those recovering from an exacerbation (ECOPD) To evaluate whether in individuals with clinically severe COPD, recovering from an ECOPD, the effect size of an in-hospital PR program would be affected by airflow severity grades and assessed outcome measures. Retrospective, multicentre study. Participants were compared according to different GOLD airflow grades. In addition to the MRC dyspnoea scale, six-minute walking distance test and COPD assessment test (CAT), Barthel dyspnoea index (Bid), and Short Physical Performance Battery (SPPB) were assessed, evaluating the proportion of individuals reaching the minimum clinically important difference (MCID) (responders). Data of 479 individuals, completing the program were evaluated. Most of the participants were allocated in GOLD grades 4, (57.6%) and 3 (22.1%). All outcome measures significantly improved after PR (p < 0.05), without any significant difference in the proportion of responders in any measure. in individuals with severe COPD, recovering from ECOPD the success rate of PR does not depend on airflow severity, or outcome measure assessed. In addition to the most used outcome measures, also Bid and SPPB are sensitive to PR. [ABSTRACT FROM AUTHOR]

Ascites is the most common complication of decompensated cirrhosis of liver requiring paracentesis for diagnostic and therapeutic purposes. The ascitic fluid leak can develop after paracentesis in patients with cirrhosis leading to significant morbidity if persistent. We aimed to study the incidence and predictors of post-paracentesis leak in patients with ascites. In this prospective study, patients with cirrhosis undergoing therapeutic paracentesis were followed up, and those patients who developed persistent leak were included as cases. Controls were randomly selected in a 2:1 ratio from the group of patients who did not develop leak. Clinical and laboratory parameters were compared between the two groups. A total of 256 patients underwent 1126 sessions of therapeutic abdominal paracentesis over a period of 14 months. Post-paracentesis leak was seen in 55 (4.8%) patients while only 20 (1.7%) patients had persistent leak. The management of leak was in a stepwise manner initially with tincture benzoin with tight dressing followed by topical cyanoacrylate adhesive and followed by autologous blood patch in those not responding. The persistent leak group had higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh score, lower mid-upper arm circumference, short physical performance battery score, and handgrip strength. On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (odds ratio 10.35, 95% confidence interval 1.61–66.54, P = 0.014). Persistent leak after paracentesis develops in a minority of patients with cirrhosis. The presence of parietal edema is a risk factor for persistent leak. The majority of these patients can be managed in a stepwise approach. [ABSTRACT FROM AUTHOR]

• Preoperative patient activation is an independent predictor of minimum clinically important difference (MCID) for PROMIS pain at 1-year follow-up. • Preoperative patient activation is an independent predictor of MCID for PROMIS physical function at 1-year follow-up. • Routine preoperative assessment of patient activation may help identify patients at risk for poor clinical outcomes. Patient activation is a patient's willingness to take independent actions to manage their own health care. The goal of this study is to determine whether preoperative patient activation measure (PAM) predicts minimum clinically important difference (MCID) for Patient-Reported Outcomes Measurement Information System (PROMIS) pain, physical function, depression, and anxiety for patients undergoing elective spine surgery. Retrospective review. A single-institution, academic database of patients undergoing elective spine surgery. MCID at 1-year follow-up for PROMIS pain, physical function, depression and anxiety. We retrospectively reviewed a single-institution, academic database of patients undergoing elective spine surgery. Preoperative patient activation was evaluated using the PAM-13 survey, which was used to stratify patients into four activation stages. Primary outcome variable was achieving MCID at 1-year follow-up for PROMIS pain and physical function. Multivariable logistic regression analysis was used to determine impact of patient activation on PROMIS pain and the physical function. Of the 430 patients, 220 (51%) were female with a mean age of 58.2±16.8. Preoperatively, 34 (8%) were in activation stage 1, 45 (10%) in stage 2, 98 (23%) in stage 3, and 253 (59%) in stage 4. At 1-year follow up, 248 (58%) achieved MCID for PROMIS physical function, 256 (60%) achieved MCID for PROMIS pain, 151 (35.28%) achieved MCID for PROMIS depression, and 197 (46%) achieved MCID for PROMIS anxiety. For PROMIS physical function, when compared to patients at stage 1 activation, patients at stage 2 (aOR:3.49, 95% CI:1.27, 9.59), stage 3 (aOR:3.54, 95% CI:1.40, 8.98) and stage 4 (aOR:7.88, 95% CI:3.29, 18.9) were more likely to achieve MCID. For PROMIS pain, when compared against patients at stage 1, patients at stage 3 (aOR:2.82, 95% CI:1.18, 6.76) and stage 4 (aOR:5.44, 95% CI:2.41, 12.3) were more likely to achieve MCID. For PROMIS depression, when compared against patients at stage 1, patients at stage 4 were more likely to achieve MCID (Adjusted Odds Ratio (aOR):2.59, 95% CI:1.08–6.19). For PROMIS anxiety, when compared against patients at stage 1, stage 3 (Adjusted Odds Ratio (aOR):3.21, 95% CI:1.20–8.57), and stage 4 (aOR:5.56, 95% CI:2.20–14.01) were more likely to achieve MCID. Patients at higher stages of activation were more likely to achieve MCID for PROMIS pain, physical function, depression, and anxiety at 1-year follow-up. Routine preoperative assessment of patient activation may help identify patients at risk of poor outcomes. [ABSTRACT FROM AUTHOR]

The burden of osteoarthritis (OA) has increased steadily due to an aging population, increasing life expectancy, obesity and lifestyle factors. Total hip replacement has become one of the most prevalent and successful operations globally and it is projected that demand will continue to grow as the incidence of OA continues to increase. Patients undergoing the operation expect much-improved function and pain relief but also increasingly need to return to work postoperatively, especially given the growing demand for the procedure and the encouragement of older people to continue working by most governments in the developed world. This review provides an overview of function and employment outcomes after hip arthroplasty. Despite the generally good success rate, some patients do not attain good functional outcomes and it is important that we develop ways to identify these patients preoperatively. We describe the effect of demographic, clinical and other factors on functional outcomes, as well as trajectories of physical function and pain recovery beyond the first few weeks after total hip replacement. Regarding employment outcomes, many people in work preoperatively are likely to resume to work after recovery; however, patients feel that they lack guidance from clinicians about returning to work postoperatively. Our review encompasses factors associated with return to work, timing of return to work, and potential temporary or permanent limitations that people might experience at work depending on type of employment. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess patient satisfaction relating to inpatient stays. In this prospective observational study, adult patients with oncological (oral cancer, medication-related osteonecrosis of the jaw) and non-oncological (mandibular fracture) diagnoses, and who had undergone surgery, were contacted 4 weeks after discharge. Two validated questionnaires were used: EORTC QLQ-C30 for quality of life and IN-PATSAT32 for patient satisfaction. For quality of life, the mandibular fracture group had a lower impairment of physical functioning (M = 83.59, SD = 24.44; p = 0.029) in comparison with both other groups (M = 68.84, SD = 26.24; M = 59.33, SD = 24.43, for oral cancer and osteonecrosis, respectively). Regarding patient satisfaction, patients with oral cancer were slightly more satisfied with doctors' availability (M = 48.91, SD = 24.11; p = 0.583) compared with the other groups (M = 36.54, SD = 19.11; M = 46.67, SD = 20.86, for mandibular fracture and ostenecrosis, respectively). Patients with an unplanned inpatient stay following an acute event tended to be less satisfied than patients with a planned inpatient stay. Within the limitations of the study it seems that knowledge of these influencing external factors and their effects can support physicians and nursing staff in providing improved patient care. [ABSTRACT FROM AUTHOR]

The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM). This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews. There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs −1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy. These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity. • Standardised surgical assessment and shared decision-making lead to de-escalation of surgery • Rationalised de-escalation of oncoplastic procedures does not affect outcomes • Comparable postoperative functional and aesthetic outcomes regardless of surgical technique, if appropriate selection. • Patient engagement is crucial for high satisfaction and positive experience • Current algorithms have grey zones that may be addressed by this approach [ABSTRACT FROM AUTHOR]

The phase 3 KEYNOTE-412 study (NCT03040999), pembro + CRT (pembro arm) showed a trend toward improved EFS vs placebo + CRT (pbo arm) in pts with LA HNSCC, although the difference was not statistically significant (HR, 0.83 [95% CI, 0.68-1.03]; P =0.0429 [superiority threshold, P =0.0242]). Prespecified HRQoL outcomes from KEYNOTE-412 are presented. Pts aged ≥18 yrs with LA HNSCC were randomly assigned 1:1 to pembro 200 mg IV once Q3W or matching pbo + CRT. Pts received 1 priming dose of pembro/pbo 1 week before CRT followed by 2 doses of pembro/pbo during CRT and maintenance pembro/pbo for up to 14 doses. Prespecified secondary end points were mean change from baseline (BL) in EORTC QLQ-C30 global health status/quality of life (GHS/QoL) and physical functioning scores as well as EORTC QLQ-H&N35 pain, problems with swallowing, and speech scores. Prespecified exploratory end points included rate of improvement, stability, and deterioration, and mean change from BL in other prespecified scales of QLQ-C30, QLQ-H&N35, and EQ-5D VAS. Analysis population included pts who received ≥1 dose of treatment and completed ≥1 HRQoL assessment for a specific end point. Analysis was done at week 45 when respective completion and compliance rates of ≥60% and ≥80% were met per blinded data review. Treatment difference (least squares mean [LSM] change from BL) was estimated from a constrained longitudinal data analysis method. Completion and compliance rates were >95% at BL for all measures. Completion rates were >60% and compliance rates were >80% for all measures at week 45. LSM change from BL to week 45 for pembro vs pbo was 1.95 (95% CI, −0.10 to 4.00) vs 6.08 (95% CI, 4.02 to 8.13) for QLQ-C30 GHS/QoL (LSM difference: −4.13 [95% CI, −6.73 to −1.53]) and −5.54 (95% CI, −7.34 to −3.73) vs −3.46 (95% CI, −5.26 to −1.66) for QLQ-C30 physical functioning (LSM difference: −2.07 [95% CI: −4.51 to 0.36]). No meaningful differences in LSM change from BL to week 45 were observed between treatment arms for QLQ-H&N35 pain (1.44 [95% CI, −1.27 to 4.15]), problems with speech (−1.27 [95% CI, −4.60 to 2.07]), and swallowing (−0.31 [95% CI, −3.75 to 3.13]) scales or in EQ-5D VAS (−1.44 [95% CI, −3.74 to 0.85]). Similar percentages of pts for the pembro vs pbo arms had improved or stable scores for QLQ-C30 GHS/QoL (43.0% vs 47.6%) and QLQ-H&N35 pain (49.9% vs 50.3%), problems with speech (40.3% vs 41.4%), and swallowing (34.4% vs 34.3%) scales. Patient-reported outcomes and disease symptom scores were generally similar between pembro and pbo arms, suggesting addition of pembro to CRT did not meaningfully impact HRQoL at week 45 in pts with LA HNSCC. [ABSTRACT FROM AUTHOR]

Melilite-spinel porous ceramics with high apparent porosity, sufficient strength and ultralow thermal conductivity were successfully prepared via a direct-thermal decomposition route using the solid waste of phosphorus tailings and coal gangue as raw materials. The micropores are derived from the in situ decomposition of dolomite and kaolinite, whose morphology, distribution form and quantity determine the thermal insulation performance and physical properties of porous ceramics. Melilite-spinel porous ceramics with an ultralow thermal conductivity of 0.036 W/(m·K) (tested at 200 °C), an apparent porosity of 61.3% and a compressive strength of 2.95 MPa, exhibited promising application prospects in thermal insulation materials used for high-temperature fields. [ABSTRACT FROM AUTHOR]

Background In animal studies, a meal containing Alaska pollack protein (APP) induces fast-twitch muscle hypertrophy. To our knowledge, no interventional studies have examined the benefits of APP intake on muscle mass and muscle weakness and the prevention of sarcopenia in older individuals. Objectives We evaluated the effects of APP intake on skeletal muscle mass, muscle strength, and physical performance among healthy community-dwelling older Japanese women. Methods In this double-blind randomized controlled trial, healthy women ≥ 65 y old were allocated to an APP or whey protein control (CON) group. Participants ingested test protein meals (5.0–5.1 g protein/serving) daily for 24 wk. Between-group differences in the change of skeletal muscle mass index (SMI) as the primary outcome and muscle strength as a secondary outcome were tested using multifrequency BIA and a handheld dynamometer, respectively, at baseline, and 4, 12, and 24 wk. The mean changes in the measured primary and secondary outcome variables from baseline to 4, 12, and 24 wk were compared using unpaired t tests. Results There were no between-group differences in nutritional status, food intake, or total energy and protein intakes at baseline, 12 wk, or 24 wk. The change in SMI was 0.12 kg/m2 (95% CI: 0.01, 0.23 kg/m2) and 0.11 kg/m2 (95% CI: 0.03, 0.19 kg/m2) greater in the APP group than in the CON group at 12 wk and 24 wk (P  ≤ 0.03) and knee extension strength was 0.07 Nm/kg BW (95% CI: 0.02, 0.12 Nm/kg BW) and 0.05 Nm/kg BW (95% CI: 0.00, 0.09 Nm/kg BW) higher in the APP group than in the CON group at these times (P  ≤ 0.015), respectively. The groups did not differ at 4 wk. Conclusions Daily intake of a meal containing APP compared with whey protein increases skeletal muscle mass and lower-extremity muscle strength in healthy older women, suggesting that an APP-containing meal may be useful in the prevention of sarcopenia in this group. This trial was registered at as UMIN000035718. [ABSTRACT FROM AUTHOR]

The purpose of this case series is to describe the change in capability to perform self-selected activities in adolescent and young adult patients with chronic pelvic pain and surgically proven endometriosis following pelvic floor physical therapy as part of multidisciplinary treatment. Retrospective case series Tertiary care pediatric hospital Twenty patients with ages ranging from 14 to 22 years and a median age of 16.5 years with biopsy-confirmed endometriosis Pelvic floor physical therapy Patient-Specific Functional Scale (PSFS) outcome measure Patients had a clinically significant functional improvement (median score of 6.0 points on the PSFS outcome measure; interquartile range, 3.8-13.5) over the course of care (median number of 12 visits; range 4-48 visits) (P <.001). Patients with chronic pelvic pain and surgically proven endometriosis experienced significant functional improvement after physical therapy treatment. The results of this case series suggest that physical therapy is a viable additional intervention for adolescents and young adults with chronic pelvic pain and endometriosis and warrants further research. [ABSTRACT FROM AUTHOR]

Purpose: We examined the associations between pulmonary impairments and physical function and whether age, HIV serostatus, or smoking modified these relationships.Methods: Using Multicenter AIDS Cohort Study data, we examined associations between pulmonary function (diffusing capacity for carbon monoxide [DLCO], one-second forced expiratory volume [FEV1]) and subsequent physical outcomes (gait speed, grip strength, frailty [non-frail, pre-frail, frail]) using mixed models.Results: Of 1,048 men, 55% were living with HIV, median age was 57(IQR=48,64) and median cumulative pack-years was 1.2(IQR = 0,18.1); 33% and 13% had impaired DLCO and FEV1(<80% predicted), respectively. Participants with impaired DLCO had 3.5 kg (95%CI: -4.6, -2.4) weaker grip strength, 0.04 m/sec (95%CI: -0.06, -0.02) slower gait speed and 4.44-fold (95%CI: 1.81, 10.93) greater odds of frailty compared to participants with normal DLCO. Participants with impaired FEV1 had 3.1 kg (95%CI: -4.8, -1.4) weaker grip strength, similar gait speed (-0.001 m/sec [95%CI: -0.04, 0.03]) and 5.72-fold (95%CI: 1.90, 17.19) greater odds of frailty compared to participants with normal FEV1. Age, but not smoking or HIV, significantly modified the DLCO effect on gait speed and grip strength.Conclusions: Pulmonary impairment and decreased physical function were associated. Preserving pulmonary function may help preserve physical function in aging men with and without HIV. [ABSTRACT FROM AUTHOR]

Background: Inhalation injuries can cause problems with diaphragmatic mobility and pulmonary function, which are accompanied by significant morbidity and mortality. No previous studies have determined the outcomes of acupoint transcutaneous electrical stimulation (Acu-TENS) in the treatment of inhalation burn injuries. The current study is therefore aimed at evaluating the influences of Acu-TENS on pulmonary functions and diaphragmatic mobility in adult-male patients experiencing after burn inhalation injury.Methods: This randomized controlled study was double blinded in an inpatient setting and was conducted between June 2018 and July 2019. Forty-male participants with inhalation-injury (20-40 yrs.) were randomly allocated into two study and control groups equal in numbers; the same pulmonary rehabilitation program plus early mobility exercise was conducted in both groups. The study group (group A) received additional Acu-TENS while shame Acu-TENS was carried out on the control group (group B). The intervention program continued for four weeks, three sessions a week for 45 min bilaterally on the bilateral Ding-Chuan points (Ex-B1). Spirometry was used to assess pulmonary functions, the 5-points-Likert scale was used to assess dyspnea, and ultrasonography was used to assess diaphragmatic mobility (DM), and evaluations were performed before and after interventions.Results: At baseline assessment, no significant differences were detected between the two study groups (p˃0.05). In the post-interventional program, a noteworthy difference was detected in all outcome measures in the two study groups (p˂0.05), supporting group A. After 4 weeks of intervention, the mean (SD) for FVC, FEV1, and DM was 83.7 ± 4.34, 86.75 ± 4.59, and 5.93 ± 1.13 in group A, 79.65 ± 5.14, 83.1 ± 4.44, and 5.08 ± 1.15, in-group B. The mean difference for FVC, FEV1, and DM was 4.05 (1: 7.09), 3.65 (0.75: 6.54), and 0.85 (0.11: 1.57) between groups after treatment, respectively.Conclusion: Depending on the study findings, Acu-TENS on bilateral Ding-Chuan points could be considered an effective approach for improving pulmonary functions and diaphragmatic mobility in patients with inhalation injuries after thermal burn. Future studies with a larger sample size and longer duration on different types of burn injuries are recommended. [ABSTRACT FROM AUTHOR]

Brain injury in out-of-hospital cardiac arrest (OHCA) survivors affects health status and health-related quality of life (HRQoL). It is unknown how HRQoL evolves over time, and assessments at different time points may lead to different results. In a NORCAST sub study, OHCA survivors eligible for health status (EQ-5D-3L) and HRQoL (SF-36) assessments were examinated six months and five years after OHCA. At five-year follow-up, survivors also retrospectively assessed their health status for each consecutive year following OHCA. The next of kin independently assessed health status and HRQoL of their respective OHCA survivors. Among 138 survivors alive after six months and 117 after five years, 80 (88% male) completed both follow-ups. Health status and HRQoL remained stable over time, except for increasing SF-36 mental summary score and decreasing physical functioning and physical component score. Anxiety and depression levels were generally low, although younger survivors stated more anxiety than older survivors. Retrospective assessment showed reduced health status for the first two years, which increased only from the third year. Explorative analyses revealed that younger age, longer time to return of spontaneous circulation (tROSC) and late awakening affected health status, particularly in the first two years post-arrest. OHCA survivors showed stable health status and HRQoL with only minor differences between six months and five years. Younger survivors with long tROSC, late awakening, and more anxiety and depression symptoms at six months, had reduced health status the first two years with significant improvements towards the fourth year. [ABSTRACT FROM AUTHOR]

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The coating of hydroxyapatite (HAP) on the surface of bio-inert metallic implants to augment their bioactivity is in use for the last two decades. Substitution of various materials in HAP further improves the functionality of these coatings. We demonstrate coating of Ti6Al4V alloy sheets with strontium and niobium reinforced HAP using microwave (MW) irradiation technique. Physical characterization revealed, uniform semicrystalline hydroxyapatite coating with enhanced surface roughness and microhardness. The increased surface roughness was accompanied by higher wettability and more protein adsorption. Electrochemical corrosion assessment showed a dramatic increase in corrosion potential and a noticeable decline in corrosion current density suggesting an enhanced anticorrosive behaviour. These implants also exhibited improved hemocompatibility and bacteriostatic properties. Cell viability and confocal microscopy studies of the coated samples showed enhanced cell attachment on the surface. We propose microwave irradiation as a fast and hassle-free alternative for one-pot synthesis and deposition of ionic substituted HAP on metallic implants. [ABSTRACT FROM AUTHOR]

We aim to compare perioperative/postoperative clinical outcomes between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and anterior lumbar interbody fusion (ALIF) in patients presenting for revision surgery. A retrospective database was reviewed for procedures between November 2005 and December 2021. Revision MIS-TLIF/ALIFs were included, whereas primary fusions or diagnosis of infection/malignancy/trauma were excluded. Patients were grouped into MIS-TLIF/ALIF cohorts. Preoperatively/postoperatively collected patient-reported outcome measures (PROMs) included visual analog scale back/leg score, Oswestry Disability Index, Patient-Reported Outcome Measurement Information System–Physical Function (PROMIS-PF), and Short-Form 12-Item Survey Mental/Physical Composite Scores. A total of 164 patients were eligible, with 84 patients in the MIS-TLIF cohort. The presence of degenerative spondylolisthesis and central stenosis, narcotic consumption on postoperative day 0/1, and postoperative urinary retention rates was greater in the MIS-TLIF cohort (P ≤ 0.036, all). Preoperative PROMs between cohorts did not significantly differ. Significantly favorable postoperative PROM scores were shown in the MIS-TLIF cohort with PROMIS-PF at 12 weeks/6 months (P ≤ 0.033, all). Most patients in both cohorts achieved overall minimum clinically important difference for visual analog scale back/leg score, Oswestry Disability Index, Short-Form 12-Item Survey Physical Composite Score, and PROMIS-PF. No differences were noted between cohorts within rates of MCID achievement. Patients undergoing revision fusion via MIS-TLIF or ALIF reported similar 1-year postoperative mean outcomes and rates of meaningful clinical achievement for physical function, mental health, disability, and back/leg pain. However, patients undergoing revision MIS-TLIF reported improved physical function at 12 weeks and 6 months. Perioperatively, patients undergoing revision MIS-TLIF were noted to consume significantly greater quantities of narcotics. [ABSTRACT FROM AUTHOR]

A frequently used patient-reported outcome measure for assessing physical functioning in patients with hip problems is the 5-item Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS). Nevertheless, its content validity (whether this instrument adequately reflects the construct of physical functioning) is unknown. This study aimed to assess the content validity of the HOOS-PS. A quantitative and qualitative research approach was used. Physical functioning was defined as the ability to perform activities that require physical actions, ranging from self-care to more complex activities that require a combination of skills, often within a social context. Patients (n = 51) and experts (n = 25) completed questionnaires regarding the relevance, comprehensiveness, and comprehensibility of the HOOS-PS. Semistructured interviews (n = 5) explored issues identified in the quantitative data in more depth. Thematic content analysis was conducted using a coding frame. One of the 5 items was considered relevant to measure physical functioning. Comprehensiveness was considered insufficient by both patients and experts. Furthermore, comprehensibility was considered inadequate. Several items were found ambiguous or double barreled. Regarding interpretability, floor or ceiling effects were not found. This study showed concerns about the content validity of the HOOS-PS: most items are considered not relevant, the HOOS-PS is considered not comprehensive, and several items are considered not comprehensible. These findings challenge the applicability of the HOOS-PS in clinical practice, research, value-based healthcare, and benchmarking. • This study showed that the content validity of the Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS) in patients undergoing hip arthroplasty is problematic in 3 areas: (1) lack of relevance, (2) insufficient comprehensiveness, and (3) insufficient comprehensibility of the items. • Given that the HOOS-PS does not reflect physical functioning in total hip arthroplasty patients, this will challenge the applicability of the HOOS-PS in clinical practice, research, and benchmarking. • The lack of content validity in the observed data can subsequently lead to drawing incorrect conclusions. [ABSTRACT FROM AUTHOR]

Background: When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association.Methods: Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N).Results: The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function.Conclusions: Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis. [ABSTRACT FROM AUTHOR]

While Latinx Americans in the general population are more likely to have obesity than non-Hispanic Whites, limited research has examined ethnic differences in obesity and its correlates among military veterans. To address this gap, we examined the prevalence, physical health and functional correlates of obesity in a population-based sample of Latinx and White U.S. military veterans. Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of veterans. Bivariate and multivariate analyses were conducted to evaluate the relation between obesity, and health and functioning measures in Latinx and White veterans. The prevalence of obesity was significantly higher among Latinx veterans (weighted 43.6% vs. 35.5%; odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.10–1.81). While obesity was associated with a greater number of medical conditions, reduced functioning, higher somatic symptoms, and insomnia severity in both Latinx and White veterans, these differences were more pronounced in Latinx relative to White veterans, with higher rates of arthritis, liver disease, diabetes, high blood pressure and cholesterol, heart attack, stroke, migraine, and physical disability, and greater physical, mental, and psychosocial dysfunction. Obesity is more prevalent in Latinx than in White U.S. veterans, and the associated elevated health and functional impairments are more pronounced in Latinx veterans. Characterization of co-occurring physical and functioning problems among Latinx and White veterans with obesity may help inform ethnically-sensitive obesity prevention and treatment efforts in this population. Study Highlights. • 43.6% of Latinx veterans in the U.S. meet the criteria for obesity putting this population at risk for negative health consequences. • Latinx veterans had 40% greater odds of having obesity relative to White veterans. • This study provides new information about physical health and functioning associated with obesity separately for Latinx and White veterans. [ABSTRACT FROM AUTHOR]

Shared decision-making in pelvic exenteration is a complex and detailed process, which must balance clinical, oncological and patient-reported outcomes (PROs), whilst addressing and valuing the patient priorities. Communicating patient-centred information on quality of life (QoL) and functional outcomes is an essential component of this. The aim of this systematic review was to understand the impact of pelvic exenteration on QoL PROs over a longitudinal period and to develop QoL trajectories to support decision-making in this context. MEDLINE, Embase and Web of Science databases were searched between 1st January 2000 and 20th December 2021 Studies reporting on PROs, including QoL, in adults undergoing pelvic exenteration were included. Risk of bias was assessed using the ROBINS-I assessment tool. Data from studies reporting QoL using the same outcome measure at the same candidate timepoint were extracted and synthesised to develop a longitudinal QoL trajectory. Fourteen studies consisting of 1370 patients were included in this review. QoL trajectories were constructed in the domains of physical function, psychological function, role function, sexual function, body image and general and specific symptoms. Decision-making was only assessed by one study, with satisfaction with decision-making reported to be high. There is an initial decline in QoL scores in the domains of physical function, role function, sexual function, body image and general health and symptoms deteriorating during the first 3–6 months post-operatively. Psychological function is the only QoL domain that remains stable throughout the post-operative period. Mapping QoL trajectories provides a visual representation of post-operative progress, highlighting the enduring impact of pelvic exenteration on patients and can be used to inform pre-operative shared decision-making. [ABSTRACT FROM AUTHOR]

Purpose: This study examined whether employment status during mid-life and older adulthood is associated with physical function impairment.Methods: Participants were 2700 women in the multiracial/multiethnic Study of Women's Health Across the Nation. Time-varying, lagged, and cumulative exposure analyses modeled associations between self-reported employment status and the likelihood of severe physical function impairment across 19 years of follow-up.Results: Independent of demographic variables, women who were not working (OR = 1.58, 95% CI = 1.22, 2.04) or employed part-time (OR = 1.29, 95% CI = 1.04, 1.61) were more likely to report severe physical function impairments than women employed full-time. This same pattern was seen in lagged analyses predicting risk of physical function impairment from employment status at the prior assessment (not working vs. full-time: OR = 1.53, 95% CI = 1.08, 2.18; part-time vs. full-time: OR = 1.53, 95% CI = 1.17, 2.00). The likelihood of severe physical function impairment increased by 20% for every additional 10% of follow-up spent not working (OR = 1.02, 95% CI: 1.01, 1.03). Associations were robust to adjustment for health-related variables, body mass index, and physical activity.Conclusions: Women with lower levels of employment from mid-life to older adulthood were more likely to experience severe impairment in physical function. However, the underlying mechanisms, and the timescales over which associations unfold, require further study. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the relationship between frequently used patient-reported outcome (PRO) measures and a multitask performance outcome (PerfO) measure of general physical function (PF) and to examine the association of these measures with depressive mood, pain, and age.Methods: Frequently used PRO measures of general PF (Patient-Reported Outcomes Measurement Information System [PROMIS] PF item bank, PROMIS PF Short Form 20a, Short Form 36 Physical Function Scale) and a PerfO test battery, namely, the Physical Performance Test (PPT), were administered to 78 adult patients from 3 inpatient clinics (cardiology and angiology, rheumatology and clinical immunology, and psychosomatic medicine) at Charité - Universitätsmedizin Berlin. Pearson correlations were used to investigate the associations between PRO measures and the PPT. To explore the predictive value of age, depressive symptoms, and pain intensity, we conducted multiple linear regression analysis for each PF measure.Results: We found strong linear relationships between PRO measures and PPT sum scores. Correlations between PPT sum scores and PROMIS PF T-scores were r > 0.75. For all PRO and PerfO measures, age was a predictor of general PF whereas depressive mood was not found to be a relevant predictor. Moreover, pain intensity was found to be a significant predictor of PRO measures but not for PPT sum scores.Conclusions: Our findings suggest that frequently used PRO measures and a multitask PerfO measure of general PF can be used to measure a common PF construct. Nevertheless, PF scores based on PRO measures should ideally be controlled for self-rated pain intensity. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the treatment preference among oncologists, patients with lung cancer, and their family members in China.Methods: A face-to-face discrete choice experiment survey was conducted among oncologists, patients, and their family members. Participants completed 13 choice sets describing 6 key attributes, namely, overall survival time, risk of severe adverse effect, severity of pain, appetite, physical functioning status, and monthly cost. Mixed logit model and latent class analysis were used to estimate attribute level preference weights and the relative importance (RI) for attributes. The willingness to pay (WTP) and maximum acceptable risk (MAR) were also estimated. The RI, WTP, and MAR of oncologists, patients, and family members were compared.Results: A total of 121 oncologists and 161 dyads of patients and family members completed the survey. Overall survival time, physical functioning status, and pain were the 3 most important attributes across all 3 groups. Oncologists and family members had higher RI on overall survival time than patients (48% and 51% vs 38%). Patients had higher RI on physical functioning status and pain (23% and 14%) than oncologists (13% and 12%) and family members (16% and 11%). For extending survival, patients had the least WTP, and family members had the highest MAR. The latent class analysis identified 2 classes in the patient group and 3 classes in oncologist and family member groups.Conclusions: There were differences in preferences for survival, risk, quality of life, and costs associated with cancer treatments among patients, oncologists, and family members. This finding highlights the need of involving patients in treatment decision making in China. [ABSTRACT FROM AUTHOR]

• Patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) have decreased physical function at discharge. • Renal impairment is associated with reduced physical function following allo-HSCT. • Patients with allo-HSCT require continued follow-up on physical function. Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has improved outcomes and prognosis, but it has many complications and is associated with impaired physical function. To solve this problem, it is necessary to further analyze the factors that cause the decline in physical function. In the present study, we hypothesized that kidney disease following allo-HSCT would be associated with impaired physical function, in addition to conventional factors, and tested this hypothesis retrospectively. Thirty-one patients who underwent allo-HSCT at the Department of Hematology in our hospital from January 2016 to October 2021 were included in the analysis. Correlation analysis and stepwise multiple regression analysis with change in 30-second sit to stand test (Δ30-s STS) as the dependent variable were performed to identify predictors of physical function decline from pretransplant to discharge. The mean age of participants was 43.9 years (SD = 11.8), the mean time from transplant to discharge was 103.1 days (SD = 35.0), and approximately 30% of patients had kidney disease following allo-HSCT. All patients were ambulatory and independent at discharge, but 30-s STS was significantly reduced (P <.001). Among various factors, age (β = −0.464, P <.05), total corticosteroid dose (β = −0.380, P <.05), and kidney disease after allo-HSCT (β = −0.307, P <.05) were the independent predictors of Δ30-s STS (R 2 = 0.592, adjusted R 2 = 0.547, F = 13.072, P <.01). Kidney disease after allo-HSCT is one of the factors that may contribute to poor physical function, and patients who experience this condition may require additional follow-up to improve physical function. [ABSTRACT FROM AUTHOR]

In people recovering from traumatic brain injury, is a 3-month ballistic resistance training program targeting three lower limb muscle groups more effective than non-ballistic exercise rehabilitation for improving mobility, strength and balance? Does improved mobility translate to better health-related quality of life? A prospective, multicentre, randomised trial with concealed allocation, intention-to-treat analysis and blinded measurement. A total of 144 people with a neurological movement disorder affecting mobility as a result of traumatic brain injury. For 3 months, the experimental group had three 60-minute sessions of non-ballistic exercise rehabilitation per week replaced by ballistic resistance training. The control group had non-ballistic exercise rehabilitation of equivalent time. The non-ballistic exercise rehabilitation consisted of balance exercises, lower limb stretching, conventional strengthening exercises, cardiovascular fitness training and gait training. The primary outcome was mobility measured using the High-Level Mobility Assessment Tool (HiMAT). Secondary outcomes were walking speed, strength, balance and quality of life. They were measured at baseline (0 months), after completion of the 3-month intervention (3 months) and 3 months after cessation of intervention (6 months). After 3 months of ballistic resistance training, the experimental group scored 3 points (95% CI 0 to 6) higher on the 54-point HiMAT than the control group and remained 3 points (95% CI –1 to 6) higher at 6 months. Although there was a transient decrement in balance at 3 months in the experimental group, the interventions had similar effects on all secondary outcomes by 6 months. Participants with a baseline HiMAT < 27 gained greater benefit from ballistic training: 6 points (1 to 10) on the HiMAT. This randomised trial shows that ballistic resistance training has a similar or better effect on mobility than non-ballistic training in people with traumatic brain injury. It may be better targeted towards those with more severe mobility limitations. ACTRN12611001098921. [ABSTRACT FROM AUTHOR]

The functionalized foldable protective layer proficiently alleviates the potential detriment endured by space station solar panels due to prolonged and uninterrupted exposure to the environment. Soft actuators demonstrate significant value in foldable protective layers due to their intrinsic response characteristics and programmability. However, current soft actuators still struggle to meet the requirements of work stability and scene applicability in the space environment. A PMT (Polydimethylsiloxane (PDMS)/Multi-walled carbon nanotubes (MWCNTs)-Thermoplastic polyimides (TPI)) soft actuator was proposed to address this issue in this paper. The PMT soft actuators exhibit strong interlayer interfacial adhesion, stable physical and chemical performance, and excellent mechanical performance. Notably, the PMT soft actuators can sense thermal, electric fields, infrared light, and mechanical force simultaneously with only one active layer. Furthermore, analytical models were calibrated to provide predictions, and the thermal and photoelectric actuation processes of PMT soft actuators with different structures and application scenes were predicted accurately. The experimental results validated the application value of PMT actuators as foldable protective layers for space station solar panels. The preparation, testing, application, and model construction of the PMT system provide new research ideas and development opportunities for the practical application of functional polymers in intelligent sensing and actuation systems. [Display omitted] • The PMT actuators showed superior sensing and actuation capabilities under multiple stimuli. • An application test validated the value of PMT actuators as foldable protective layers for space station solar panels. • The analytical model accurately predicts the actuation of PMT soft actuators with different structures and scenes. [ABSTRACT FROM AUTHOR]

Patient-reported outcome measures (PROMs) are increasingly being used in clinical care, research, and to inform policy decisions. Prior studies have demonstrated that non-English speaking patients and those of African American race and lower socioeconomic status are less likely to complete PROMs. In spine surgery populations, these groups have been shown to present with worse physical and mental health, and these disparities persist postoperatively. However, few studies have examined trends in PROMs completion rates and baseline function for spine patients broadly, including those managed nonoperatively. As the use of PROMs expands, it is pivotal that disparities in both completion rates and scores be identified, as these may bias clinical decision making, research, and policy decisions. The purpose of this study was to evaluate disparities in PROM completion rates and baseline function scores among newly presenting spine patients. Retrospective review of new patients presenting to a single multidisciplinary spine clinic from June 2020 to September 2022. A total of 10,803 consecutive new patients. The primary outcomes of interest were whether patients completed PROMs at their clinic visit, and the PROMIS Physical Function (PF), Pain Interference, and Pain Intensity t-scores reported by respondents. Chi-square and two-sided independent samples t-tests were performed to compare demographics, social vulnerability (measured using the Centers for Disease Control Social Vulnerability Index [SVI]), and diagnoses between patients who did and did not complete PROMs at the first visit. Multivariate logistic regression was used to assess likelihood of PROMs completion by race, ethnicity, and SVI, after adjusting for age, sex, body mass index (BMI), and diagnosis type. Multivariate linear regression was performed to assess the impact of race, ethnicity, and SVI on PROMIS scores in the responder group, after controlling for the same factors. Overall, 7392/10803 (68.4%) patients completed PROMs at the first clinic visit. During the study period, 783 (7.2%) underwent surgery; the remaining 10020 (92.8%) were managed nonoperatively. Patients of nonwhite race (61.4 vs 71.8%, p<0.001), Hispanic ethnicity (56.5 vs 69.5%, p<0.001), and a diagnosis other than cervical-only or lumbar-only pathology (52.9 vs 76.8%, p<0.001) were less likely to complete PROMs. Further, nonresponders resided in areas of higher social vulnerability (SVI 0.35 ± 0.26 vs 0.31 ± 0.24, p<0.001). Age, BMI, and sex were not associated with statistically significant differences in PROMs completion rates. After adjusting for these factors and diagnosis type, patients of nonwhite race (OR=0.661, 95% CI: 0.599-0.729), Hispanic ethnicity (OR=0.569, 95% CI: 0.448-0.721), and increased social vulnerability (OR=0.608, 95% CI: 0.511-0.723) remained less likely to complete PROMs (all p<0.001). In the multivariate models assessing PROMIS scores by race, ethnicity, and SVI, patients of nonwhite race reported lower levels of physical function (PROMIS PF β=-6.5, p=0.032) and higher levels of pain intensity (β=0.6, p=0.005). Hispanic ethnicity and increased social vulnerability were each associated with increased pain intensity (Hispanic β=1.5, p=0.004; SVI β=1.1, p=0.002) but no significant differences in baseline physical function were observed. Race, ethnicity, and SVI were not associated with any statistically significant differences in pain interference scores. Our study highlights disparities in PROM completion rates and suggests that nonwhite patients, those of Hispanic ethnicity, and those at increased social vulnerability may be underrepresented in spine patient-reported outcomes. As these subpopulations may also have worse physical function or pain intensity, additional strategies are needed to better capture patient reported health status in order to avoid bias in clinical care, outcomes research and health policy. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The impact of sarcopenia on surgical outcomes has been well-documented, but its specific influence on the posterior lumbar interbody fusion (PLIF) surgery requires further exploration. In this context, the present aims to investigate the impact of sarcopenia on clinical outcomes following one or two-level PLIF. Additionally, the present study also aims to evaluate if muscle indices, including gluteal muscle index, derived from CT scans, can predict clinical outcomes. Prospective observational study. A total of 115 patients who underwent one or two-level PLIF from December 2021 to December 2022 were enrolled and analyzed prospectively. Sarcopenia diagnosis, muscle indices, and demographic data were analyzed using regression analysis to identify predictive factors for the Oswestry Disability Index (ODI) 12-month postoperatively. Sarcopenia was defined according to the 2018 Asian Working Group for Sarcopenia (AWGS) guidelines. Appendicular skeletal muscle mass (ASM) was measured using a full-body DEXA scan, with low ASM defined as < 7.0 kg/m² in men and < 5.4 kg/m² in women. Muscle strength was assessed using handgrip strength (HGS), with thresholds of 29 kg for men and 18 kg for women. Poor physical performance was identified using physical performance test, including 6-meter walk speed of less than 1.0 m/s or sit-to-stand time of 12 seconds or more. Muscle indices, including psoas muscle index (PMI), paraspinal muscle index (PaMI), and gluteal muscle index (GMI), were derived from CT scans. Out of 115 patients, 77 (65.2%) were diagnosed with sarcopenia according to the AWGS criteria. The sarcopenia group had statistically significantly lower BMI, ASM, PaMI, GMI, and poor preoperative ODI compared to the normal group. RM-ANOVA analysis showed significant differences in ODI scores between groups at 3-, 6-, and 12-months postoperatively, with the sarcopenia group exhibiting significant poorer outcomes at 12-months (sarcopenia vs normal group, 0.183 ± 0.149 vs 0.107 ± 0.055, P < 0.001). Multivariate regression analysis identified poor sit-to-stand test results, weak HGS, lower ASM, and lower GMI as poor predictive factors for ODI 12-month postoperatively. Patients diagnosed with sarcopenia exhibited poorer clinical outcomes 12-months postoperatively. In our study cohort, poor sit-to-stand test results, weak HGS, lower ASM, and lower GMI were identified as predictive factors for poor outcomes. Therefore, the presence of sarcopenia in patients considering fusion surgery necessitates careful consideration, as it may predispose them to poorer clinical outcomes. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Patients undergoing anterior/posterior lumbar fusion surgery can undergo either a single-stage or multi-stage operation depending on surgeon preference. There is limited evidence directly comparing outcomes between single- and multi-stage lumbar fusion surgery. To assess differences in outcomes between patients who underwent single- versus multi-stage lumbar fusion procedures in a multi-center setting. Not Applicable Not Applicable Not Applicable The Michigan Spine Surgery Improvement Collaborative database was queried for lumbar fusion surgeries between July 2018 and January 2022. Patients who underwent single-stage and multi-stage procedures were included. Primary outcomes included postoperative complications and improvement in patient-reported outcomes (PROs) which include: NASS patient satisfaction, PROMIS Physical Function, and EQ-5D. Propensity matching was conducted followed by Poisson generalized estimating equation models for multivariate analyses. Following propensity matching, 355 patients underwent single-stage procedures and 355 patients underwent multi-stage procedures. Patients undergoing multi-stage procedures had more complications, less patient satisfaction after 1 year, and were less likely to experience improvement in back pain after 90 days and at 2 years (1.17[1.02-1.34, p = 0.026], 0.83[0.74-0.93, p < 0.001], 0.86[0.75-0.99, p = 0.039], and 0.76[0.60-0.96, p = 0.023], respectively). On a matched cohort of patients undergoing lumbar 360 fusion, we observed that patients who undergo a multi-stage approach have higher postoperative complication rates and lower patient satisfaction compared to those who underwent single-stage procedures. Our findings suggest that single-stage lumbar 360 fusion surgery is tolerated well, if not better, than the multi-staged approach. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

There is a paucity of literature comparing clinical outcomes by specific cervical level. To compare clinical outcomes through patient-reported outcome measures (PROMs) and minimum clinically important difference (MCID) achievement for patients undergoing 1-level anterior cervical discectomy and fusion (ACDF) or cervical disc replacement (CDR) at each individual cervical level. Retrospective Review. Patients undergoing 1-level ACDF or CDR. Patient-Reported Outcomes Measurement Information System Physical. Function (PROMIS-PF), Visual Analog Scale (VAS) Neck, VAS Arm, and Neck Disability Index (NDI). Patients undergoing 1-level ACDF or CDR were separated into 5 different cohorts depending on surgical level: C3-C4, C4-C5, C5-C6, C6-C7, and C7-T1. Patient demographics, perioperative characteristics, and PROMs were collected. PROMs of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Visual Analog Scale (VAS) Neck, VAS Arm, and Neck Disability Index (NDI) were collected at preoperative and up to 2-year postoperative time points. MCID achievement was calculated by comparing deltaPROM to previously established values. Univariate analysis was utilized for demographics, perioperative characteristics, and preoperative PROMs. Multivariable linear and logistic regression accounting for demographic and perioperative characteristics were utilized for postoperative PROM comparison and MCID achievement, respectively. A total of 437 patients, with 25 patients undergoing surgery at C3-C4, 57 at C4-C5, 208 at C5-C6, 138 at C6-C7, and 9 at C7-T1. The mean postoperative follow-up was 9.81±7.87 months. Patients undergoing surgery at C3-C4 demonstrated inferior PROMIS-PF at the 6-week postoperative time point (p=0.009). Patients undergoing surgery at C7-T1 demonstrated superior VAS Neck at the final postoperative follow-up (p=0.009). No significant differences were reported in magnitude of postoperative improvement or MCID achievement. Patients undergoing ACDF or CDR demonstrated similar postoperative improvement in most PROMs. Magnitude of postoperative improvement and MCID achievement were similar regardless of operated level. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Steroid injections have gained prominence in the management of lumbosacral canal stenosis, a condition characterized by narrowing of the spinal canal in the lower back. This nonsurgical approach aims to alleviate pain and inflammation, providing relief for patients experiencing symptoms such as back pain, leg pain, and numbness. The injections deliver anti-inflammatory medication directly to the affected area, offering a targeted therapeutic option for those seeking conservative treatment for lumbosacral canal stenosis. N/A N/A N/A N/A A systematic review and meta analysis were done by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE (including MEDLINE InProcess) (OvidSP), Web of Science, Embase (OvidSP), and Scopus databases. ROB2 Cochrane Tools Assessment for RCTs. In the analysis, we used RevMan Cochrane software. Our comprehensive analysis included 22 studies, 18 randomized clinical trials, and 4 observational studies. The pooled analysis revealed a significant improvement in ODI score (mean difference [MD]: 5.83, 95% confidence interval [CI]: 1.58 to 10.08, p = 0.007, I2 = 99%) and VAS score (MD: 1.52, 95% CI: 0.30 to 2.74, p = 0.01, I2 = 96%) in patients who received placebo/control when compared to the patients who got steroid injection. No statistically significant differences were found in the NRS score, adverse events, weight change, Roland Morris disability score, SF-36 physical functioning change, or opioid intake between the two groups. However, a substantial enhancement in walking distance was noted among patients who received a steroid injection. Steroid injections offer a valuable adjunct in the management of lumbosacral canal stenosis. They provide effective short-term relief from pain and inflammation, allowing patients to engage in rehabilitation. However, their role as a long-term solution is limited. Combining injections with comprehensive treatment strategies can yield optimal results. Regular evaluation and personalized approaches are essential for achieving sustained relief and improving the quality of life for individuals with lumbosacral canal stenosis. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Modic changes have been linked to vertebrogenic chronic low back pain (CLBP). Vertebral endplates are innervated by the basivertebral nerve, making it a promising target for basivertebral nerve ablation (BVNA). This study aimed to evaluate the long-term efficacy and safety of BVNA for CLBP with Modic changes (ClinicalTrials.gov Ref #NCT05692440). This is a small-scale longitudinal series performed in a community practice setting. BVNA was performed by a single surgeon (WS) using the INTRACEPT® device (Relievant Medsystems, Inc.). Fifty-six patients with CLBP (pain persisting for ≥ 6 months) were recruited for BVNA, and 26 of them completed their 12 months follow-up. At baseline the average age was 71.9±9.3, 69.6% (N=39) were male, and 62.5% (N=35) experienced CLBP for over five years. Clinical improvements were recorded using the Oswestry Disability Index (ODI), the Visual Analog Scale (VAS) scale, the SF-36 Physical Component Summary (SF-36 PCS) and Mental Component Summary (MCS), at baseline, 1-month, 3-months, 6-months, and 12-months. The BVNA procedure was performed by a single surgeon (WS) using the INTRACEPT® device (Relievant Medsystems, Inc.). ODI pain intensity declined by 21.1 percent [95% CI: 14.7,27.5] at 1 month, 21.2 percent [95% CI: 14.7,27.6] at 3 months, 22.9 percent [95% CI: 16.4,29.3] at 6 months, and 22.9 percent [95% CI: 16.5,29.4] at 12 months from baseline. VAS pain intensity was reduced by 2.6 [95% CI: 1.5,3.7] at 1 month, 2.5 [95% CI: 1.4,3.6] at 3 months, 2.7 [95% CI: 1.6,3.8] at 6 months, and 3.0 [95% CI: 1.9,4.1] at 12 months from baseline. SF-36 PCS improved by 10.9 [95% CI: 7.3,14.5] at 1 month, 11.5 [95% CI: 7.9,15.1] at 3 months, and 12.3 [95% CI: 8.7,15.9] at 6 months, and 11.3 [95% CI: 7.7,15.0] at 12 months from baseline. SF-36 MCS improved by 6.0 [95% CI: 2.3,9.7] at 1 month, 6.7 [95% CI: 3.0,10.4] at 3 months, 7.4 [95% CI: 3.7,11.1] at 6 months, and 7.6 [95% CI: 3.9,11.3] at 12 months from baseline. All the measurements at every timepoint were significantly improved compared to baseline at a significance level of 5%. This study provides independent evidence that BVNA performed with the INTRACEPT® device in a community practice setting effectively improves pain, physical function, and mental function in CLBP patients. Further research with larger cohorts and longer follow-up periods is warranted to solidify the long-term benefits and potential limitations of BVNA for CLBP patients. To our knowledge, this is the first independently funded US study on basivertebral nerve ablation and the first independently funded study on an FDA-cleared device, the INTRACEPT® device. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

The aging population prompts studying risk factors and markers to predict healthy aging. Telomere length is a promising candidate for assessing various age-related traits. To investigate the association between physical performance and telomere length. We enrolled 323 older Mexican adults from the "Cohort of Obesity, Sarcopenia, and Frailty of Older Mexican Adults" affiliated with the Instituto Mexicano del Seguro Social and assessed their physical performance using the Short Physical Performance Battery, dividing participants into low (≤7) and high (>7) groups. Absolute telomere length was determined by qPCR, and individuals were classified into short (≤4.22 kb) and long (>4.22 kb) groups. We calculated the mean and adjusted mean, considering sex and age, among others, with 95% CI. We estimated the effect size between physical performance and telomere length using Cohen's d for unequal group sizes and calculated the odds ratio for physical performance based on telomere length. Participants with low physical performance had significantly shorter telomeres (mean 4.1 4.4 4.7 kb, adjusted mean 3.5 4.0 4.5 kb, p <0.001), while those with high physical performance exhibited longer telomeres (mean 5.5 5.7 5.9 kb, adjusted mean 4.7 5.3 5.8 kb, p <0.001), with a medium-to-high telomere length effect size (d = 0.762). The odds of low physical activity increased 2.1 3.6 6.1 -fold per kb of telomere attrition (adjOR 1.7 3.3 6.3 , p <0.001). Decreased physical function is associated with shorter telomere length. Absolute telomere length presents a promising biomarker for distinguishing between healthy and unhealthy aging, warranting further investigation. [ABSTRACT FROM AUTHOR]

Urolithin A (UA) is a gut metabolite derived from ellagic acid. This systematic review assesses the potential geroprotective effect of UA in humans. In five studies including 250 healthy individuals, UA (10–1000 mg/day) for a duration ranging from 28 days to 4 months, showed a dose-dependent anti-inflammatory effect and upregulated some mitochondrial genes, markers of autophagy, and fatty acid oxidation. It did not affect mitochondrial maximal adenosine triphosphate production, biogenesis, dynamics, or gut microbiota composition. UA increased muscle strength and endurance, however, had no effect on anthropometrics, cardiovascular outcomes, and physical function. Unrelated adverse events were mild or moderate. Further research across more physiological systems and longer intervention periods is required. • Urolithin A (UA), derived from ellagic acid-rich foods, extends healthspan and lifespan in animal models. • In humans, UA shows a potential effect on decreasing inflammation and enhancing muscle strength and endurance. • The impact of UA on human healthspan and lifespan requires further exploration. [ABSTRACT FROM AUTHOR]

Food insecurity has been associated with mobility difficulty (MD) in old age. However, there is a scarcity of research on this topic from low- and middle-income countries, while the bio-psychological factors underlying this association are largely unknown. We investigated the food insecurity-MD link in Ghana and explored how sleep, anxiety, loneliness, and physical activity (PA) mediate the association. Community-based, representative cross-sectional data from the Aging, Health, Well-being, and Health-seeking Behavior Study were analyzed (N = 1201; M age = 66.5; women = 63%). MD was assessed with items from the SF-36 of the Medical Outcomes Study. We assessed food insecurity with items on hunger and breakfast-skipping frequency due to lack of food and resources. Adjusted OLS and mediation models via bootstrapping technique evaluated the associations. Results revealed the expected association between food insecurity and MD, such that greater food insecurity was significantly and positively associated with MD across paths (from β = 0.33 to β = 0.42, p <.001). Analyses of indirect effects showed that sleep problems (27.8%), anxiety (15.5%), loneliness (17.5%), and PA (18.0%) mediated the association between food insecurity and MD. Cross-level interactions revealed that food insecurity significantly modified the link between each mediator and MD. Our data provide novel evidence that bio-psychological mechanisms may underlie the food insecurity-MD link and should, therefore, be considered relevant targets for interventions to prevent/manage MD in later life. • Roles of biopsychosocial factors in food insecurity (FI)-mobility link is lacking. • FI increased mobility difficulty (MD) across all paths (β = 0.33 to β = 0.42, p <.001). • Sleep, anxiety, loneliness, and physical activity mediated the FI-MD association. • Significant cross-level interactions of FI and mediators on MD were observed. • Efforts to address FI-related MD should consider managing biopsychosocial factors. [ABSTRACT FROM AUTHOR]