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Purpose: This study aimed to examine the effect of a 6-day basketball tournament on the physical demands, perceptual–physiological responses, well-being, and game statistics of elite under-18 (years of age) players. Methods: Physical demands (player load [PL], steps, impacts, and jumps, all normalized by playing time), perceptual–physiological responses (heart rate and rating of perceived exertion), well-being (Hooper index), and game statistics of 12 basketball players were monitored during 6 consecutive games. Linear mixed models and Cohen d effect sizes were used to assess differences among games. Results: Significant changes were found for PL per minute, steps per minute, impacts per minute, peak heart rate, and Hooper index over the tournament. Pairwise comparisons showed that PL per minute was higher in game #1 than in games #4 (P =.011, large), #5 (P <.001, very large), and #6 (P <.001, very large). PL per minute recorded during game #5 was also lower than in games #2 (P =.041, large) and #3 (P =.035, large). The number of steps per minute was higher in game #1 than in all other games (all P <.05, large to very large). Impacts per minute were significantly higher in game #3 than in games #1 (P =.035, large) and #2 (P =.004, large). The only physiological variable that varied significantly was peak heart rate (higher in game #3 than in game #6; P =.025, large). The Hooper index gradually increased throughout the tournament, indicating poorer player well-being as the tournament advanced. Game statistics did not significantly change among games. Conclusions: The average intensities of each game and the players' well-being gradually decreased throughout the tournament. Conversely, physiological responses were mostly unaffected, and game statistics were unaffected. [ABSTRACT FROM AUTHOR]

Introduction: Peroral endoscopic myotomy (POEM) is the standard treatment for achalasia. Functional luminal imaging probe (FLIP) technology enables objective measurement of lower esophageal sphincter (LES) geometry, with literature linking specific values to improved post-POEM outcomes. Our study assesses FLIP's intraoperative use in evaluating myotomy extent in real-time. Methods: Retrospective data from all patients undergoing POEM with intraoperative FLIP measurements were extracted from June 2020 to January 2023. The primary endpoint was intraoperative FLIP measurements, management changes, and symptom improvement (Eckardt score). Results: Fourteen patients (age 56 ± 14 years, BMI 28 ± 7 kg/m2) were identified. Most patients were female (64%). Predominantly, patients presented with type II achalasia (50%). FLIP measurements were taken before and after myotomy, demonstrating increases in mean distensibility index (DI) 1.6 ± 1. 4 to 5.4 ± 2.1 mm2/mmHg (p < 0.05) and mean diameter (Dmin) 6 ± 1.8 to 10.9 ± 2.3 mm (p < 0.05) at 50 ml balloon fill. Additional myotomy was performed in one patient when an inadequate increase in FLIP values were noted. Mean operative time was 98 ± 28 min, and there were no intraoperative complications. At the 30-day follow-up, median Eckardt score decreased from mean a preoperative score of 7 ± 2 to a post-operative mean of 2 ± 3, with 10 patients (78%) having a score ≤ 2. In total, four patients experienced symptom recurrence, with repeat FLIP values revealing a significant decrease in DI from 7 ± 2.2 post-POEM to 2.5 ± 1.5 at recurrence. FLIP technology identified LES pathology in 3 out of 4 (75%) patients, facilitating referral to LES-directed therapy. Conclusion: Our study adds to the literature supporting the use of FLIP technology during the POEM procedure, with most patients achieving ideal values after a standard-length myotomy. This suggests the potential benefits of shorter myotomies guided by FLIP to achieve comparable outcomes and reduce postoperative GERD risk. Collaborative standardization of study designs and outcome measures is crucial for facilitating prospective trials and cross-setting outcome comparisons. [ABSTRACT FROM AUTHOR]

Summary: In this large population-based matched cohort study, patients with primary aldosteronism were at increased risk of hip fracture, particularly subgroups traditionally considered at higher risk of osteoporosis such as women, patients older than 56 years at diagnosis, patients with established cardiovascular disease at diagnosis, and patients treated with MRA. Purpose: Previous studies suggest that primary aldosteronism (PA) is associated with dysregulated bone homeostasis. The aim of this study was to evaluate the incidence of hip fractures in patients with PA. Methods: We studied a nationwide cohort of 2419 patients with PA (1997–2019) and 24 187 age and sex matched controls from the general population. Hip fractures were identified by ICD codes in the Swedish National Patient Register. We estimated hazard ratios (HRs) for incident hip fractures, adjusted for prior fractures, socioeconomic factors, diabetes, osteoporosis, hyperparathyroidism, and cardiovascular disease (CVD). Pairwise subgroup comparisons were performed by age (18–56 and > 56 years), sex, CVD at baseline, and treatment for PA. Results: During a mean follow up of 8 ± 5 years, 64 (2.6%) patients had a hip fracture after being diagnosed with PA, compared to 401 (1.7%) controls. After adjustments, PA was associated with a 55% increased risk of hip fracture compared to controls (HR 1.55 [1.18–2.03]). HRs were increased in women (HR 1.76 [95% CI 1.24–2.52]), patients aged > 56 years (HR 1.62 [95% CI 1.21–2.17]), and patients with CVD at diagnosis (HR 2.15 [95% CI 1.37–3.37]). PA patients treated with adrenalectomy did not have higher risk than controls (HR 0.84 [95% CI 0.35–2.0]), while patients treated with mineralocorticoid receptor antagonists (MRA) retained a greater risk (HR 1.84 [95% CI 1.20–2.83]). Conclusion: PA is associated with increased hip fracture risk, especially in women, patients diagnosed after the age of 56 years and patients with established CVD at diagnosis. Also, patients treated with MRA seem to have an increased risk of hip fractures, while adrenalectomy may be protective. [ABSTRACT FROM AUTHOR]

Background: A combination of prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe, feasible, and associated with potentially improved survival for severe acute respiratory distress syndrome (ARDS). However, whether ARDS patients, especially non-COVID-19 patients, placed in PP before VV-ECMO should continue PP after a VV-ECMO connection is unknown. This study aimed to test the hypothesis that early use of PP during VV-ECMO could increase the proportion of patients successfully weaned from ECMO support in severe ARDS patients who received PP before ECMO. Methods: In this prospective observational study, patients with severe ARDS who were treated with VV-ECMO were divided into two groups: the prone group and the supine group, based on whether early PP was combined with VV-ECMO. The proportion of patients successfully weaned from VV-ECMO and 60-day mortality were analyzed before and after propensity score matching. Results: A total of 165 patients were enrolled, 50 in the prone and 115 in the supine group. Thirty-two (64%) and 61 (53%) patients were successfully weaned from ECMO in the prone and the supine groups, respectively. The proportion of patients successfully weaned from VV-ECMO in the prone group tended to be higher, albeit not statistically significant. During PP, there was a significant increase in partial pressure of arterial oxygen (PaO2) without a change in ventilator or ECMO settings. Tidal impedance shifted significantly to the dorsal region, and lung ultrasound scores significantly decreased in the anterior and posterior regions. Forty-five propensity score-matched patients were included in each group. In this matched sample, the prone group had a higher proportion of patients successfully weaned from VV-ECMO (64.4% vs. 42.2%; P = 0.035) and lower 60-day mortality (37.8% vs. 60.0%; P = 0.035). Conclusions: Patients with severe ARDS placed in PP before VV-ECMO should continue PP after VV-ECMO support. This approach could increase the probability of successful weaning from VV-ECMO. Trial Registration: ClinicalTrials.Gov: NCT04139733. Registered 23 October 2019. [ABSTRACT FROM AUTHOR]

Background: The Attune TKR was introduced in 2011 as a successor to its predicate design The PFC Sigma. However, following reports of early failures, there are ongoing concerns related to increased loosening rates. Given the concerns, this study aimed to compare revision rates of the Attune implant to an established predicate, and other implant designs used in a high-volume arthroplasty center. Methods: We identified 10,202 patients who underwent primary cemented TKR at our institution with a minimum of 1 year follow-up, involving 2406 Attune TKR (557 S +), 4642 PFC TKR, 3154 other designs. Primary outcomes were revision for all-causes, aseptic loosening of any component, and aseptic tibial loosening. Kaplan–Meier survival and Cox regression models were used to compare groups. Matched cohorts were selected for radiographic analysis. Results: 308 knees were revised. The Attune cohort had the lowest risk of revision, with a rate of 2.98 per 1000 implant-years while the PFC and All Other Implant groups had a rate of 3.15 and 4.4 respectively. Aseptic loosing was the most common cause for revision, with 76% (65/88) involving the tibia. Survival analysis showed no significant differences between the Attune and other cohorts. Radiolucent lines were detected in 7.1% of the Attune S + group, 6.8% of the standard Attune group, and 6.3% of the PFC group, with no significant differences found between them. Conclusion: This study represents the largest non-registry review of the Attune TKR in comparison to a predicate and other designs. There was no significant increased revision rate for all-cause revision or aseptic loosening, or peri-implant radiolucencies. It appears that increased loosening may not be as concerning as originally thought. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

Objective: Rheumatoid arthritis (RA) is an autoimmune disease in which the joint lining or synovium becomes highly inflamed and majorly contributes to disease progression. Understanding pathogenic processes in RA synovium is critical for identifying therapeutic targets. We performed laser capture microscopy (LCM) followed by RNA sequencing (LCM‐RNAseq) to study regional transcriptomes throughout RA synovium. Methods: Synovial lining, sublining, and vessel samples were captured by LCM from seven patients with RA and seven patients with osteoarthritis (OA). RNAseq was performed on RNA extracted from captured tissue. Principal component analysis was performed on the sample set by disease state. Differential expression analysis was performed between disease states based on log2 fold change and q value parameters. Pathway analysis was performed using the Reactome Pathway Database on differentially expressed genes among disease states. Significantly enriched pathways in each synovial region were selected based on the false discovery rate. Results: RA and OA transcriptomes were distinguishable by principal component analysis. Pairwise comparisons of synovial lining, sublining, and vessel samples between RA and OA revealed substantial differences in transcriptional patterns throughout the synovium. Hierarchical clustering of pathways based on significance revealed a pattern of association between biologic function and synovial topology. Analysis of pathways uniquely enriched in each region revealed distinct phenotypic abnormalities. As examples, RA lining samples were marked by anomalous immune cell signaling, RA sublining samples were marked by aberrant cell cycle, and RA vessel samples were marked by alterations in heme scavenging. Conclusion: LCM‐RNAseq confirms reported transcriptional differences between the RA synovium and the OA synovium and provides evidence supporting a relationship between synovial topology and molecular anomalies in RA. [ABSTRACT FROM AUTHOR]

Objective: In the randomized Scleroderma: Cyclophosphamide or Transplantation (SCOT) trial, myeloablation, followed by hematopoietic stem cell transplantation (HSCT), led to the normalization of systemic sclerosis (SSc) peripheral blood cell (PBC) gene expression signature at the 26‐month visit. Herein, we examined long‐term molecular changes ensuing 54 months after randomization for individuals receiving an HSCT or 12 months of intravenous cyclophosphamide (CYC). Methods: Global PBC transcript studies were performed in study participants at pretreatment baseline and at 38 months and 54 months after randomization, as well as in healthy controls using Illumina HT‐12 arrays. Results: Thirty (HSCT = 19 and CYC = 11) participants had 38‐month samples available, and 26 (HSCT = 16 and CYC = 11) had 54‐month samples available. In the paired comparison to baseline, a significant down‐regulation of interferon modules and an up‐regulation of cytotoxic/natural killer module were observed at the 38‐month and 54‐month visits in the HSCT arm, indicating a long‐term normalization of baseline SSc gene expression signature. No differentially expressed modules were detected in the CYC arm. In comparison to samples from healthy controls, 38‐month visit samples in the HSCT arm showed an up‐regulation of B cell and plasmablast modules and a down‐regulation of myeloid and inflammation modules. Importantly, 54‐month HSCT samples did not show any differentially expressed modules compared to healthy control samples, suggesting completion of immune reconstitution. Participants in the CYC arm continued to show an SSc transcript signature in comparison to controls at both time points. Conclusion: Paralleling the observed clinical benefit, HSCT leads to durable long‐term normalization of the molecular signature in SSc, with completion of immune resetting to 54 months after HSCT. [ABSTRACT FROM AUTHOR]

This study aimed to examine protective factors associated with resilience among unaccompanied refugee minors in comparison to their Norwegian peers and to examine associations between resilience factors and characteristics related to positive outcomes among unaccompanied minors. Data stem from the Pathways to Independence study conducted in Bergen municipality, Norway in 2018–2019 where 81 unaccompanied minors aged 15–20 participated (83.3% male; 80% response rate). An age- and sex-matched control group of 324 adolescents was retrieved from the youth@hordaland study conducted in Norway in 2012. Resilience factors were assessed by the Resilience Scale for Adolescents. Unaccompanied minors reported lower scores on Goal Orientation (d = 0.4), Social Competence (d = 0.4), and Social Support (d = 0.7) compared to Norwegian adolescents. Being male was associated with lower scores on Goal Orientation (standardized mean difference [SMD] = − 0.9) and Social Support (SMD = − 0.9) among unaccompanied minors, while being in frequent contact with family in the home country was associated with higher scores on all resilience factors (SMD range = 0.6–1.1). The number of leisure activities was associated with Social Competence (SMD = 0.22). There were no significant associations between the resilience factors and amount of support in the living arrangements or contact with the child welfare services. Unaccompanied minors reported fewer resilience factors compared to Norwegian adolescents, indicating that they may have different needs compared to other adolescents. Our study also suggests that frequent contact with family in the home country may be important to bolster positive development for unaccompanied minors after settlement. [ABSTRACT FROM AUTHOR]

Recent work demonstrates that those who regularly play action video games (AVGs) consistently outperform non‐gamer (NG) controls on tests of various cognitive abilities. AVGs place high demands on several cognitive functions and are often engaged with for long periods of time (e.g., over 2 h), predisposing players to experiencing cognitive fatigue. The detrimental effects of cognitive fatigue have been widely studied in various contexts where accurate performance is crucial, including aviation, military, and sport. Even though AVG players may be prone to experiencing cognitive fatigue, this topic has received little research attention to date. In this study, we compared the effect of a cognitively fatiguing task on the subsequent cognitive performance of action video game players and NG control participants. Our results indicated AVGs showed superior spatial working memory and complex attention abilities while showing no difference from NGs on simple attention performance. Additionally, we found that our cognitive fatigue and control interventions did not differentially affect the cognitive performance of AVGs and NGs in this study. This pre‐registered study provides evidence that AVGs show superior cognitive abilities in comparison to a non‐gaming population, but do not appear more resilient to cognitive fatigue. [ABSTRACT FROM AUTHOR]

Purpose: This study explored how respiration, voice, and speech were affected following expiratory muscle strength training (EMST) and maintenance training in persons with Parkinson's disease (PD) or multiple sclerosis (MS). Method: Nine participants with PD and six with MS participated in a randomised study, where the effects of EMST, sham, and maintenance treatment were investigated. Outcome measures included maximum expiratory pressure (MEP); maximum phonation time (MPT); intelligibility; verbal diadochokinesis (DDK); speech rate; a self-report form on voice, speech, and communication; and open questions about how the participants experienced the intervention. Group comparisons were performed within and between groups. Result: The PD and the MS groups both improved significantly in MEP, and this improvement remained after 3 months of maintenance EMST. An improvement was also seen in DDK. Post-EMST, 33% of the PD group and 80% of the MS group reported a positive effect on communication. Conclusion: The results of this study support previous evidence that EMST has positive effects on expiratory pressure in persons with PD or MS, but its effect on voice and speech remains unclear. Since subjective reports of the intervention and effects on communication were predominantly positive, further research is needed on larger groups to explore appropriate outcome measures. [ABSTRACT FROM AUTHOR]

This pilot randomized controlled trial tested the potential efficacy of a brief internet-based, passive psychoeducation intervention, Free From Abuse, in promoting healthy relationships among young adults. Participants aged 18 to 24 years were randomly assigned to an intervention treatment (n = 71) or a placebo control condition (n = 77). Participants in the treatment arm had a larger increase in recognition of abusive behavior and reduction in domestic violence myth acceptance scores than participants in the control arm postintervention and after one week. This study provides preliminary evidence that brief internet-based passive psychoeducation is potentially useful in promoting healthy relationships among young adults. [ABSTRACT FROM AUTHOR]

(1) Background: This study explores the potential energy expenditure associated with participation in after-school sports activities among primary school children. (2) Methods: The study involved 129 children age (11.35 ± 0.55 years) recruited from eight different public after-school sport programs. (3) Results: Data analyses revealed significant differences between the eight sports in total calories per session, calories per minute, and METs (p < 0.05). All sports showed higher energy expenditure compared to chess (p < 0.05), with soccer and rugby exhibiting the highest energy expenditure per session. Team sports showed elevated energy consumption per session (p < 0.01, r > 0.30), calories per minute (p = 0.01, r > 0.40), and METs (p < 0.01, r > 0.40) in comparison with individual sports. (4) Conclusions: These findings enhance our understanding of the energy expenditure observed in primary school children following various after-school sports activities. The results indicate that team sports, in particular, are pivotal in elevating physical activity levels, thereby playing an essential role in fostering healthier lifestyles among children. [ABSTRACT FROM AUTHOR]

The application of network meta‐analysis is becoming increasingly widespread, and for a successful implementation, it requires that the direct comparison result and the indirect comparison result should be consistent. Because of this, a proper detection of inconsistency is often a key issue in network meta‐analysis as whether the results can be reliably used as a clinical guidance. Among the existing methods for detecting inconsistency, two commonly used models are the design‐by‐treatment interaction model and the side‐splitting models. While the original side‐splitting model was initially estimated using a Bayesian approach, in this context, we employ the frequentist approach. In this paper, we review these two types of models comprehensively as well as explore their relationship by treating the data structure of network meta‐analysis as missing data and parameterizing the potential complete data for each model. Through both analytical and numerical studies, we verify that the side‐splitting models are specific instances of the design‐by‐treatment interaction model, incorporating additional assumptions or under certain data structure. Moreover, the design‐by‐treatment interaction model exhibits robust performance across different data structures on inconsistency detection compared to the side‐splitting models. Finally, as a practical guidance for inconsistency detection, we recommend utilizing the design‐by‐treatment interaction model when there is a lack of information about the potential location of inconsistency. By contrast, the side‐splitting models can serve as a supplementary method especially when the number of studies in each design is small, enabling a comprehensive assessment of inconsistency from both global and local perspectives. [ABSTRACT FROM AUTHOR]

Background and Objectives: Dysphagia is a common complication following stroke. It corresponds to the development of pneumonia, which is always associated with bad prognosis, longer hospital stays and increased mortality. The aim of the study was to assess the impact of physical therapy intervention of dysphagia on preventing pneumonia in acute stroke patients. Methods: A single‐blind randomized controlled trial was carried out on 70 ischemic stroke patients with oropharyngeal dysphagia, age ranged from 49 to 65 years. They were randomly assigned to two groups (control and study) of equal number. Patients in the control group received oral care and nasogastric tube feeding, while patients in the study group received the same program in addition to the designed physical therapy program (exercises and neuromuscular electrical stimulation). The intervention program was applied for 40 min/session, 1 session/day, and 5 days/week for 4 weeks. Gugging swallowing screen (GUSS), and stroke associated pneumonia (SAP) control and prevention criteria were used to assess dysphagia and incidence of pneumonia at baseline, after two and 4 weeks of intervention for both groups. Results: Before treatment, all patients were susceptible to pneumonia after two and 4 weeks of intervention; there were a significant increase in GUSS score in both groups with more improvement in favor of the study group (p < 0.05) and a statistically significant increase in incidence of SAP after 2 weeks of intervention only in the control group (p < 0.05). The results also showed a significant negative correlation between GUSS score and SAP (r = − 0.3662, p = 0.0018) Implications for Physiotherapy Practice: adding physical therapy (exercise therapy and neuromuscular electrical stimulation) to oral care and nasogastric tube feeding is effective in improving oropharyngeal dysphagia and decreasing the incidence of aspiration pneumonia in acute ischemic stroke patients. [ABSTRACT FROM AUTHOR]

Background: "Super‐agers" are adults aged ≥80 with cognitive performance similar to persons two to three decades younger. Characteristics such as larger hippocampal volume, APOE‐ε4 allele absence, higher educational attainment, female sex, and lifelong cognitive stimulation are associated with cognitive performance compatible with super‐aging. These findings are based on predominantly white research samples. Limited data are available on African‐American super‐agers. To fill this gap, we explored potential factors associated with super‐aging in older African‐American adults. Methods: Data from African‐American participants aged ≥80 in the National Alzheimer's Coordinating Center (NACC) dataset were analyzed. Using global Clinical Dementia Rating (CDR) scores, participants were first categorized as impaired (score ≥0.5) or non‐impaired/normal cognition (NC) (score = 0). From the NC group, super‐agers were identified using NACC‐data‐driven cutoffs. Participants were considered super‐agers if their memory performance was similar to persons aged 50–60 with NC, and their performance on other domains was within one standard deviation of the mean for persons aged ≥80. We examined group characteristics (NC, super‐ager, impaired) using chi‐square and ANOVA with pairwise comparisons. Multinomial logistic regression, adjusted for sex and education, evaluated correlates of super‐ager group assignment. Results: Data for 1285 African‐American participants aged ≥80 were analyzed. We identified 24.7% (n = 316) NC, 4.8% (n = 61) super‐agers, and 70.6% (n = 905) impaired. Super‐agers were mostly female and more educated, had similar vascular comorbidities as the other groups, and had less sleep disorders, depression, and alcohol use. After adjusting for sex and education, super‐ager group assignment was associated with less sleep disorders, less depression, and moderate alcohol use. Conclusions: Participants with controlled vascular risk, mental health, alcohol use, and sleep disorders tended to be in the super‐ager group. These factors may be important focus areas in clinical practice to support cognitive resilience with aging in older African‐American adults. [ABSTRACT FROM AUTHOR]

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Objective: Self‐monitored point‐of‐care urate‐measuring devices are an underexplored strategy to improve adherence to urate‐lowering therapy and clinical outcomes in gout. This study observed patient‐led urate self‐monitoring practice and assessed its influence on allopurinol adherence, urate control, and health‐related quality of life. Methods: People with gout (n = 31) and prescribed allopurinol self‐monitored their urate concentrations (HumaSens2.0plus) at baseline and thereafter monthly for 12 months (3 months per quarter). Adherence to allopurinol was measured using medication event monitoring technology (Medication Event Monitoring System cap). Time spent below the target urate concentration (<0.36 mmol/L) was determined. Health‐related quality of life was measured using a survey (EuroQoL EQ‐5D‐5L). Gout flares were recorded. Two‐tailed Spearman correlation and the Wilcoxon matched‐pairs signed‐rank test (P < 0.05) were used for statistical comparisons. Results: Most participants were male (94%) and had urate concentrations below the target (74%) at baseline. Overall, seven participants demonstrated repeated periods of "missed doses" (two or fewer allopurinol doses missed consecutively) and "drug holidays" (three or more missed doses). Most participants (94%) persisted with allopurinol. Time spent within the target urate concentration increased 1.3‐fold (from 79% to 100%; P = 0.346), and the incidence of gout flares decreased 1.6‐fold (from 8 to 5; P = 0.25) in the final quarter compared to that in the first quarter of the study. Health‐related quality of life was reduced for participants reporting at least one gout flare (median utility values 0.9309 vs 0.9563, P = 0.04). Conclusion: Patient‐led urate self‐monitoring may support the maintenance of allopurinol adherence and improve urate control, thus reducing the incidence of gout flares. Further research on patient‐led urate self‐monitoring in a randomized controlled study is warranted. [ABSTRACT FROM AUTHOR]

Purpose: Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care. Design/methodology/approach: Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students. Findings: In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did. Research limitations/implications: The study's strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan's national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different "culture" aspects for a better understanding of gender differences in other countries and in different mental well-being constructs. Practical implications: The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed. Originality/value: These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care. [ABSTRACT FROM AUTHOR]

Acute myeloid leukemia (AML) is a heterogenous blood cancer with a dismal prognosis. It emanates from leukemic stem cells (LSCs) arising from the genetic transformation of hematopoietic stem cells (HSCs). LSCs hold prognostic value, but their molecular and immunophenotypic heterogeneity poses challenges: there is no single marker for identifying all LSCs across AML samples. We hypothesized that imaging flow cytometry (IFC) paired with artificial intelligence-driven image analysis could visually distinguish LSCs from HSCs based solely on morphology. Initially, a seven-color IFC panel was employed to immunophenotypically identify LSCs and HSCs in bone marrow samples from five AML patients and ten healthy donors, respectively. Next, we developed convolutional neural network (CNN) models for HSC-LSC discrimination using brightfield (BF), side scatter (SSC), and DNA images. Classification using only BF images achieved 86.96% accuracy, indicating significant morphological differences. Accuracy increased to 93.42% when combining BF with DNA images, highlighting differences in nuclear morphology, although DNA images alone were inadequate for accurate HSC-LSC discrimination. Model development using SSC images revealed minor granularity differences. Performance metrics varied substantially between AML patients, indicating considerable morphologic variations among LSCs. Overall, we demonstrate proof-of-concept results for accurate CNN-based HSC-LSC differentiation, instigating the development of a novel technique within AML monitoring. [ABSTRACT FROM AUTHOR]

Background: Balance disorders can give rise to sensations of instability, lightheadedness, vertigo, disequilibrium, or syncope, ultimately leading to grave medical, physical, emotional, and societal ramifications. These conditions are highly prevalent among individuals aged 40 and above. Screen time encompasses activities associated with television viewing, video game playing, and non-work-related computer usage. Prolonged screen exposure may engender a spectrum of health issues and even elevate overall mortality rates. However, the available evidence on the potential link between excessive screen time and balance dysfunction remains limited. Aims: The primary aim of this study was to explore the possible association between prolonged screen exposure and impaired balance function. Methods: This cross-sectional study utilized data from participants who completed a comprehensive questionnaire in the NHANES database between 1999 and 2002, all of whom were aged over 40 and under 85 years. Participants' screen time was categorized into two groups (< 4 h/d and ≥4 h/d) for subsequent data analysis. Logistic regression, combined with propensity score matching (PSM), was employed to investigate the correlation between screen time and balance disorders. Results: A total of 5176 participants were enrolled in this study, comprising 2,586 men and 2,590 women, with a prevalence rate of balance disorders at 25.7% (1331/5176). The incidence of balance disorders was found to be significantly higher among individuals who spent 4 hours or more per day on screen time compared to those with less screen time (P<0.001). Multivariate logistic analysis conducted on the unmatched cohort revealed a significant association between screen time and balance disorders, with an odds ratio (OR) 1.8 (95%CI 1.57 ∼ 2.05). These findings remained consistent even after adjusting for confounding factors, yielding an OR 1.43 (95%CI 1.24 ∼ 1.66). Moreover, the association persisted when employing various multivariate analyses such as propensity score matching adjusted model, standardized mortality ratio weighting model and pairwise algorithmic model; all resulting in ORs ranging from 1.38 to 1.43 and p-values < 0.001. Conclusions: After controlling for all covariates, screen time (watching TV, playing video games, and using computers outside of work) was associated with balance dysfunction among middle-aged and older adults. This finding may offer a possible idea for the prevention of dizziness and balance disorders. Nevertheless, additional research is imperative to further validate these results. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the accuracy of an intraoral scanner with near‐infrared imaging (NIRI) feature in the diagnosis of interproximal caries and to compare it with the visual‐tactile method (VTM), bitewing radiography (BWR), and panoramic radiography (PR). Materials and Methods: Six hundred thirty‐nine interproximal surfaces (mesial‐distal) of posterior teeth from 22 volunteers were examined. Results were scored by VTM, BWR, PR, and NIRI. Lesions were scored as 0 for no‐caries, 1 for early‐enamel lesion (EEL), and 2 for lesions involving dentino–enamel junction (DEJ). McNemar, Kappa, and Fleis Kappa tests were used to evaluate the agreement levels. Pearson's Chi‐square test was used to determine the matching rates after validation. Results: A good level of agreement was observed between examination methods (Ƙ = 0.613; p < 0.001). In pairwise comparisons, a moderate agreement was seen between all the methods for lesions with DEJ involvement, while a statistically good agreement was observed between BWR and NIRI (Ƙ = 0.675; p < 0.001). As a result of validation, the accuracy of NIRI for molars was considered 85.2% and 75.7% for premolars in EELs, 85.2% for molars, and 70% for premolars regarding the lesions involving DEJ. Conclusions: Intraoral scanners with the NIRI feature may be used for diagnosing interproximal caries, especially for permanent molars. Clinical Significance: Early detection of proximal caries is one of the most essential topics forming the basis of preventive dentistry. This study investigates a caries diagnostic tool integrated into intraoral scanners to diagnose interproximal caries. A caries diagnostic tool integrated into an intraoral scanner may prevent the harmful effects of ionizing radiation in early caries diagnosis and may improve the patient's oral health status. [ABSTRACT FROM AUTHOR]

AI has increased scholarly interest in predicting financial stock prices, a tough task. Recurrent neural network (RNN) time series price movement analysis is common but ignores market, investor, and headline factors. Graph neural networks excel at capturing complicated relationships and learning representations, making them useful for a variety of applications. This study investigates the predictive capabilities of graph neural networks about stock prices. Recent studies motivated to utilize hypergraphs for capturing intricate group-level data, such as corporate mobility patterns. Using a graph model to obtain paired linkages sets us apart from previous studies on hypergraphs. Also, demonstrated that using RNNs after applying this fundamental graph model is not advisable, in contrast to previous research. This study demonstrates the potential of future Recurrent Neural Networks (RNNs) to acquire knowledge about the long-term interconnections across companies, leading to enhanced predictive capabilities. The proposed model is an innovative ensemble learning framework that created specifically for the purpose of forecasting stock values. Part, one consists of a Graph Convolution Network (GCN), which encodes price and industry pairs. Part two involves a hypergraph convolution network that conducts adversarial training by modifying inputs before the final prediction layer. This modification facilitates the transmission of group-oriented information through hyperedges. There is empirical evidence that suggests that the proposed model outperforms approaches that are considered to be state-of-the-art on average and demonstrates remarkable performance during times when the market is declining. The proposed framework beats the second-best baseline by increments of 1.14%, 3.63%, and 2.45% for three different five-days, ten days and twenty days trade periods. [ABSTRACT FROM AUTHOR]

Background Balloon guide catheters (BGCs) have not been widely adopted, possibly due to the incompatibility of past-generation BGCs with large-bore intermediate catheters. The next-generation BGC is compatible with large-bore catheters. We compared outcomes of thrombectomy cases using BGCs versus conventional guide catheters. Methods We conducted a retrospective study of 110 thrombectomy cases using BGCs (n=55) and non-BGCs (n=55). Sixty consecutive thrombectomy cases in whom the BOBBY BGC was used at a single institution between February 2021 and March 2022 were identified. Of these, 55 BGC cases were 1:1 matched with non-BGC cases by proceduralists, age, gender, stent retriever + aspiration device versus aspiration-only, and site of occlusion. First-pass effect was defined as Thrombolysis In Cerebral Infarction 2b or higher with a single pass. Results The BGC and non-BGC cohorts had similar mean age (67.2 vs 68.9 years), gender distribution (43.6% vs 47.3% women), median initial National Institutes of Health Stroke Scale score (14 vs 15), and median pretreatment ischemic core volumes (12 mL vs 11.5 mL). BGC and non-BGC cases had similar rates of single pass (60.0% vs 54.6%), first-pass effect (58.2% vs 49.1%), and complications (1.8% vs 9.1%). In aspiration-only cases, the BGC cohort had a significantly higher rate of first-pass effect (100% vs 50.0%, p=0.01). BGC was associated with a higher likelihood of achieving a modified Rankin Scale score of 2 at discharge (OR 7.76, p=0.02). No additional procedural time was required for BGC cases (46.7 vs 48.2 min). Conclusion BGCs may be safely adopted with comparable procedural efficacy, benefits to aspirationonly techniques, and earlier functional improvement compared with conventional guide catheters. [ABSTRACT FROM AUTHOR]

Mechanical and thermal trauma during implant surgery may be reasons for initial peri-implant bone loss. Temperature development during drilling and implant insertion were quantified in this series of in vitro and animal experiments. Polyurethane foam material mimicking different classes of alveolar bone was used as a model material for simulating implant surgery. Using thermocouples, temperature development was determined in the model material at depths of 3 mm and 10 mm during site preparation and implant insertion. Additionally, an infrared camera allowed for measuring drill temperatures both in vitro and as part of an animal trial using an intraoral minipig model. Drill diameter and repeated usage of drills did not have a major effect on temperature generation. The addition of a diamond-like carbon coating, bone density, predrilling, and irrigation heavily affected intraosseous temperatures. In vivo, applying regular drill protocols, an intraosseous temperature rise of approximately 3 °K was determined. Implant geometry as well as the amount of undersizing of an osteotomy governed heat generation during implant insertion. Drill protocols and the amount of undersizing of an implant osteotomy constitute parameters by which clinicians can limit trauma during implant surgery. [ABSTRACT FROM AUTHOR]

There are challenges in the practical method of transitioning knowledge in the academic field, even in the University of Applied Science and Technology, which is necessitate updating the assessment of entrepreneurial competencies of lecturers. Challenges such as poor knowledge of recent information, outdated teaching methods, lack of good communication with industries and, worst of all, poor quality of dissemination of knowledge, make it difficult achievement of universities vision of development. This research was conducted during doctoral program research with the aim of developing a model for evaluating the entrepreneurial competencies of university lecturers and specifically at the University of Applied Science and Technology. the mixed method of research was employed in which initially important components of the model were extracted using the grounded theory technique and then the developed model was finalized and each factor was weighted by the AHP multi-criteria analysis. Due to the large length of analysis, this paper is narrowed to the important components of the proposed model and also the data evaluation process by the AHP technique. Data evaluated by the AHP technique was collected through a pairwise comparison questionnaire collected from entire 36 informed respondents. The result provides a practical model of evaluating the entrepreneurial competencies of the university lecturer and in general, the three main factors of individual competencies, competencies in social communication, and also competencies in analyzing and decision-making were classified as main categories, respectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 pandemic has affected physical and occupational therapist education in various ways. OBJECTIVE: This study investigated whether the pandemic changed clinical placement, thus influencing the clinical competence of physical and occupational therapists at a hospital in Japan. METHODS: Eleven therapists (seven physical and four occupational) participated in this study in April 2021. Clinical placement teaching methods were surveyed using an online questionnaire. The Objective Structured Clinical Examination (OSCE), comprising attitudinal and technical items, was used to examine clinical competence. The results were calculated as the sum of the attitudinal and technical scores, and the ratios of these scores to the full score were compared using a paired-sample Wilcoxon signed-rank test. RESULTS: During the pandemic, some schools implemented shortened practical clinical placements. The substituted classes included online-only classes and combined online and face-to-face classes. Regarding clinical competence, scores on the OSCE were mostly high. The median proportion of the total attitudinal score to the perfect score was 100% for all three items (range-of-motion test, muscle strength test, Stroke Impairment Assessment Set). The median proportion of the total technical score to the perfect score ranged from 56.7% to 76.7% for the three items. The ratio of the total attitudinal score to the full score was significantly higher than that of the total technical score to the full score (p = 0.001). CONCLUSIONS: Most clinical placements were canceled or partially administered through online learning during the pandemic. This decrease in clinical placements did not affect newly recruited physical and occupational therapists' clinical competence. [ABSTRACT FROM AUTHOR]

Motivation Single-cell profiling has become a common practice to investigate the complexity of tissues, organs, and organisms. Recent technological advances are expanding our capabilities to profile various molecular layers beyond the transcriptome such as, but not limited to, the genome, the epigenome, and the proteome. Depending on the experimental procedure, these data can be obtained from separate assays or the very same cells. Yet, integration of more than two assays is currently not supported by the majority of the computational frameworks avaiable. Results We here propose a Multi-Omic data integration framework based on Wasserstein Generative Adversarial Networks suitable for the analysis of paired or unpaired data with a high number of modalities (>2). At the core of our strategy is a single network trained on all modalities together, limiting the computational burden when many molecular layers are evaluated. Availability and implementation Source code of our framework is available at https://github.com/vgiansanti/MOWGAN [ABSTRACT FROM AUTHOR]

The Thurstone model is a common model for analyzing the paired comparison data. However, there is lack of asymptotic properties for the moment estimator of parameters in this model. Therefore, we prove uniform consistency and asymptotic normality of the moment estimator in the Thurstome model. Simulation studies and a data example illustrate the theoretical result. [ABSTRACT FROM AUTHOR]

Background: To assess and compare the effectiveness of propolis mouthwash with chlorhexidine mouthwash in the reduction of plaque and gingivitis. Methods: A single centre, latin-square cross-over, double masked, randomized controlled clinical trial was conducted on 45 chronic generalized gingivitis subjects who were chosen from the dental clinic of MAHSA University, Malaysia. A total of 45 subjects were randomly assigned into one of the three different groups (n = 15 each) using a computer-generated random allocation sequence: Group A Propolis mouthwash; Group B Chlorhexidine mouthwash; and Group C Placebo mouthwash. Supragingival plaque and gingival inflammation were assessed by full mouth Plaque index (PI) and gingival index (GI) at baseline and after 21 days. The study was divided into three phases, each phase lasted for 21 days separated by a washout period of 15 days in between them. Groups A, B and C were treated with 0.2% Propolis, Chlorhexidine, and Placebo mouthwash, respectively, in phase I. The study subjects were instructed to use the assigned mouthwash twice daily for 1 min for 21 days. On day 22nd, the subjects were recalled for measurement of PI and GI. After phase I, mouthwash was crossed over as dictated by the Latin square design in phase II and III. Results: At baseline, intergroup comparison revealed no statistically significant difference between Groups A, B and C (p > 0.05). On day 21, one-way ANOVA revealed statistically significant difference between the three groups for PI (p < 0.001) and GI (p < 0.001). Bonferroni post-hoc test showed statistically significant difference between Propolis and Chlorhexidine mouthwash (P < 0.001), with higher reduction in the mean plaque and gingival scores in propolis group compared to chlorhexidine and placebo groups. Conclusions: Propolis mouthwash demonstrated significant improvement in gingival health and plaque reduction. Thus, it could be used as an effective herbal mouthwash alternative to chlorhexidine mouthwash. Trial registration: The trial was retrospectively registered on 25/07/2019 at clinicaltrials.gov and its identifier is NCT04032548. [ABSTRACT FROM AUTHOR]

Background: Previous studies have found that psychological interventions have a positive effect on improving physical and psychological problems in colorectal cancer survivors. However, there is still a lack of high-quality evidence reviews that summarize and compare the impact of different psychological interventions. The aim of this study was to synthesize existing psychological interventions and use network meta-analysis to explore whether psychological interventions improve anxiety, depression, fatigue and quality of life in colorectal cancer (CRC) survivors. Methods: We will extract relevant randomized controlled trials of psychological interventions for CRC survivors from eight electronic databases, including PubMed, Embase, The Cochrane Library, Web of Science, CINAHL, PsycInFO, CNKI, and Wanfang database. Two reviewers will independently screen the literature and extract data. The risk of bias of the included studies will be assessed using the RoB2: Revised Cochrane Risk of Bias Tool. We will then conduct paired meta-analyses and network meta-analyses of the extracted data, using a frequency-based framework and random effects models. Discussion: To the best of our knowledge, this study is the first proposed qualitative and quantitative integration of existing evidence using systematic evaluation and network meta-analysis. This study will inform health policy makers, healthcare providers' clinical intervention choices and guideline revisions, and will help to reduce depression and anxiety in CRC survivors, reduce fatigue, improve quality of life. [ABSTRACT FROM AUTHOR]

Objective: To explore the protective effect of human urine‐derived stem cell exosomes (hUSC‐Exos) on radiation‐induced salivary gland (SG) injuries in Sprague Dawley rats. Methods: Fresh adult urine was collected, and primary hUSCs were isolated and identified. The hUSCs were hypoxia‐pretreated with 1% oxygen for 24 h and then transferred to a normoxic culture environment for 24 h. The hUSC‐Exos were collected and identified for exosomes. A radiation‐induced injury model was established in the rats, and exosomes were introduced by local injection in the SG and tail vein. The submandibular gland was excised for morphological observation 1 week later. Immunohistochemical detection of the glandular tissue was conducted by α‐smooth muscle actin (a‐SMA), stem cell growth factor receptor (c‐Kit) staining, and periodic acid–Schiff staining. Qualitative polymerase chain reaction and western blot analysis were adopted to detect the gene and protein expression of Wnt3a, GSK3β, and Axin. Results: In both the normoxic and hypoxic hUSC‐Exo groups, microvesicular structures with bilayer membranes of approximately 80 nm in diameter were detected, and the expressions of CD9 and CD63 were detected by nanoflow cytometry. Compared with the control group, in the radiation‐induced injury model group, the expression of a‐SMA was significantly higher, the expression of c‐Kit was significantly lower, and the expressions of Wnt3a, GSK3β, and Axin were significantly upregulated; the differences were statistically significant (p < 0.05). Compared with the model group, in the normoxic and hypoxic hUSC‐Exo groups, the expression of a‐SMA was significantly decreased, the expression of c‐Kit was significantly increased, and the expressions of Wnt3a, GSK3β, and Axin were significantly upregulated; the differences were statistically significant (p < 0.05). Conclusion: Hypoxia‐pretreated hUSC‐Exos could repair radiation‐induced SG injuries by activating the Wnt3a/GSK3β pathway to suppress the expressions of a‐SMA and c‐Kit. [ABSTRACT FROM AUTHOR]

Background: Osteochondral allograft transplantation (OCAT) is an accepted knee joint–preserving treatment strategy for focal osteochondral lesions that is often conducted in combination with meniscal allograft transplantation (MAT). Despite its frequent and simultaneous utilization, there remains a lack in the literature reporting on outcomes and failure rates after concomitant procedures. Purpose: To determine (1) the midterm clinical success rate after OCAT+MAT in comparison with a matched-pair cohort undergoing isolated OCAT, (2) whether patient-specific and procedural variables influence the risk of failure, and (3) patient-reported outcome measures over time. Study Design: Cohort study; Level of evidence, 3. Methods: A single-center matched-pair cohort study was conducted investigating outcomes in patients who underwent OCAT of the medial or lateral femoral condyle with and without MAT between 2004 and 2020. Patients were matched 1:1 by age (±5 years), sex (male or female), body mass index (±5), and grouped Kellgren and Lawrence grade (grades 0-1 or 2-4). The minimum follow-up time was 2 years. Radiographic variables (International Cartilage Regeneration & Joint Preservation Society [ICRS] grade and Kellgren and Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery for graft failure or conversion to total knee arthroplasty. Patient-reported, clinical, and radiographic outcomes were compared between groups. Results: In total, 66 patients (33 treated with isolated OCAT, 33 treated with OCAT+MAT; 57.6% male) with a mean age of 26.3 years (range, 18-62 years) were followed for a mean of 5.6 years (minimum, 2 years; range, 24-218 months). The 2 cohorts showed no difference in Kellgren and Lawrence grade postoperatively (P =.59). There was a significantly higher ICRS grade detected at follow-up in the OCAT+MAT group (2.81 ± 1.10) compared with the OCAT group (2.04 ± 0.96) (P <.05). There were no statistically significant differences between the groups regarding reoperation rate (OCAT: n = 6; OCAT+MAT: n = 13; P =.116), time to reoperation (OCAT: 46.67 ± 47.27 months vs OCAT+MAT: 28.08 ± 30.16 months; P =.061), and failure rate (OCAT: n = 4 [12.1%] vs OCAT+MAT: n = 5 [15.2%]; P =.66). In the OCAT+MAT group, an increase of tibial slope by 1° conferred a 1.65-fold increase in the hazard for failure over decreased slope (hazard ratio, 1.65; 95% CI, 1.10-2.50; P <.05). The overall survival rate was 86% at a mean follow-up of 5.6 years. Patient-reported outcome scores were significantly improved at the final follow-up compared with preoperative status. No significant differences were seen between groups with respect to subjective IKDC, Lysholm, Tegner, and KOOS results, except for the KOOS Symptoms subscale score, which was significantly higher in the OCAT+MAT group than in the OCAT group (mean difference, 14.6; P <.05) and did exceed the minimal clinically important difference threshold of 10.7. Conclusion: Midterm results after isolated OCAT and OCAT+MAT show high rates of healing and sustainable subjective improvement of knee function and quality of life. However, it should be noted that the difference in reoperation rate and time to reoperation between the groups is arguably clinically important and that lack of statistical significance may be because of low power. These results imply that isolated OCAT is an efficient joint-preserving treatment that can be combined with MAT in well-selected patients with meniscal insufficiency without negative influence on global clinical outcomes. [ABSTRACT FROM AUTHOR]

We present a novel framework for the multi-domain synthesis of artworks from semantic layouts. One of the main limitations of this challenging task is the lack of publicly available segmentation datasets for art synthesis. To address this problem, we propose a dataset called ArtSem that contains 40,000 images of artwork from four different domains, with their corresponding semantic label maps. We first extracted semantic maps from landscape photography and used a conditional generative adversarial network (GAN)-based approach for generating high-quality artwork from semantic maps without requiring paired training data. Furthermore, we propose an artwork-synthesis model using domain-dependent variational encoders for high-quality multi-domain synthesis. Subsequently, the model was improved and complemented with a simple but effective normalization method based on jointly normalizing semantics and style, which we call spatially style-adaptive normalization (SSTAN). Compared to the previous methods, which only take semantic layout as the input, our model jointly learns style and semantic information representation, improving the generation quality of artistic images. These results indicate that our model learned to separate the domains in the latent space. Thus, we can perform fine-grained control of the synthesized artwork by identifying hyperplanes that separate the different domains. Moreover, by combining the proposed dataset and approach, we generated user-controllable artworks of higher quality than that of existing approaches, as corroborated by quantitative metrics and a user study. [ABSTRACT FROM AUTHOR]

Children from vulnerable backgrounds often have insecure attachment or disorganized attachment, which are related to psychological troubles, and such children need interventions to help them heal. The attachment system reorganizes in middle childhood, and other important adults play a considerable role in children's lives. Thus, it is essential to weigh the impact of psychosocial interventions, while the main focus of the intervention is the staff member's direct work with the child through a trusting relationship. The primary purpose of this study is to investigate whether children's attachment security and mental health outcomes change after participating in a trauma-informed, attachment-based, Trust-Based Relational Intervention (TBRI) provided in a daycare center. It was a case-series study involving twelve children aged 8–11 years. The child attachment interview (CAI), CBCL/6-18, TRF/6-18, and clinical interviews for parents and children were used, measuring the change between the TBRI implementation in the daycare center and after one year. For ten participants, we noticed an improvement in mental health; for seven participants, security scales improved; for two participants, their disorganized attachment changed into insecure–dismissing. We have preliminary evidence that vulnerable children may benefit in terms of attachment security and mental health from the trusting relationship that staff build using the TBRI. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is a potentially effective non-pharmacological treatment for insomnia. Objective: We observed the responses of patients with insomnia to acupuncture in routine clinical practice. In addition, we explored patient characteristics that might affect the treatment response to acupuncture for insomnia. Methods: Medical records of patients with insomnia in a Korean medicine clinic with baseline Insomnia Severity Index (ISI) scores ⩾8 and Pittsburgh Sleep Quality Index (PSQI) scores ⩾5 were reviewed. Acupuncture was applied at ST43, GB41, ST41, SI5, HT3, KI10, HT7 and ST3, for 1–2 months. The ISI and PSQI were measured monthly to assess insomnia severity. The effect of acupuncture over time was analyzed using a multilevel linear model for repeated measures. In addition, logistic regression was used to explore predictors of treatment response. Results: A total of 91 patients with insomnia aged 59.2 ± 12.5 years (mean ± standard deviation (SD)) (90.1% female) were included in the analysis. After the acupuncture treatment, ISI scores were significantly reduced by −3.75 (95% confidence interval (CI) = −4.99, −2.50) and −4.69 (95% CI = −6.22, −3.16) after the first and second month, respectively. The PSQI global scores also improved, and sleep duration showed a tendency to increase by 0.35 h (95% CI = −0.17, 0.86) after acupuncture treatment. Three cases of mild fatigue were reported. In addition, higher baseline pain/discomfort predicted a greater likelihood of response after acupuncture treatment (odds ratio (OR) = 1.66, 95% CI = 1.10, 2.60). Conclusion: In a real-world setting, the insomnia of outpatients in a clinic was slightly alleviated after acupuncture treatment. These findings require validation by randomized controlled trials. [ABSTRACT FROM AUTHOR]

Introduction: Maximal mean power output (MMP) is commonly used to describe the demands and performances of races in professional male cycling. In the female professional cyclist domain, however, there is limited knowledge regarding MMPs in races. Therefore, this study aimed to describe MMPs in female professional cycling races while investigating differences between TOP5 and NOT-TOP5 races. Methods: Race data (N = 1324) were collected from 14 professional female cyclists between 2013 and 2019. Races were categorized as TOP5 or NOT-TOP5. The MMPs were consequently determined over a range of different time frames (5 s to 60 min). To provide these MMPs with additional context, 2 factors were determined: when these MMPs were attained in a race (based on duration and kilojoules spent [kJspent·kg−1]) and these MMPs relative to the cyclist's season's best MMP (MMP%best). Results: Short-duration power outputs (≤1 min) were higher in TOP5 races compared with NOT-TOP5 races. In addition, the timing (both duration and kJspent·kg−1) of all MMPs was later and after more workload in the race in TOP5 compared with NOT-TOP5 races. In contrast, no difference in MMP%best was noted between TOP5 and NOT-TOP5 races. Conclusions: TOP5 races in female cycling are presented with higher short-duration MMPs (≤1 min) when compared with NOT-TOP5 races, and cyclists were able to reach a higher percentage of their seasonal best MMP when they were able to finish TOP5. In addition, these MMPs are performed later and after more kJspent·kg−1 in TOP5 versus NOT-TOP5 races, which confirms the importance of "fatigue resistance" in professional (female) cycling. [ABSTRACT FROM AUTHOR]

In this paper, we develop an estimation and testing procedure for comparing matched-pair ordinal outcomes in studies with confounding factors. The classification method for the categories of ordinal outcomes that is accessible for all units may be prone to mis-classification, and thus another error-free classification method that can only be affordable for a fraction of the units are used, resulting in a dataset with partial validation. The distribution of categorical variables is modelled using correlated bivariate Gaussian latent variables, and the confounding factors are adjusted as covariates. The mis-classification of ordinal outcomes is addressed by estimating the mis-classification probabilities through the partial validation structure of the dataset. The mis-classification probabilities and the other parameters are estimated by a two-stage maximum likelihood estimator, and the difference between the matched-pair ordinal outcomes are assessed by a Wald test statistic. Simulation studies were conducted to investigate the accuracy of the estimates of the model parameters, and the type I error rates and power of the proposed testing procedure. The motivating dataset from the Garki Project was analysed to demonstrate the applicability of the proposed approach. [ABSTRACT FROM AUTHOR]

N-of-1 trials are defined and the popular paired cycle design is introduced, together with an explanation as to how suitable sequences may be constructed. Various approaches to analysing such trials are explained and illustrated using a simulated data set. It is explained how choosing an appropriate analysis depends on the question one wishes to answer. It is also shown that for a given question, various equivalent approaches to analysis can be found, a fact which may be exploited to expand the possible software routines that may be used. Sets of N-of-1 trials are analogous to sets of parallel group trials. This means that software for carrying out meta-analysis can be used to combine results from N-of-1 trials. In doing so, it is necessary to make one important change, however. Because degrees of freedom for estimating variances for individual subjects will be scarce, it is advisable to estimate local standard errors using pooled variances. How this may be done is explained and fixed and random effect approaches to combining results are illustrated. [ABSTRACT FROM AUTHOR]

The study presents a novel approach designed to detect time-continuous states in time-series data, called the State-Detecting Algorithm (SDA). The SDA operates on unlabeled data and detects optimal change-points among intrinsic functional states in time-series data based on an ensemble of Ward's hierarchical clustering with time-connectivity constraint. The algorithm chooses the best number of states and optimal state boundaries, maximizing clustering quality metrics. We also introduce a series of methods to estimate the performance and confidence of the SDA when the ground truth annotation is unavailable. These include information value analysis, paired statistical tests, and predictive modeling analysis. The SDA was validated on EEG recordings of Guhyasamaja meditation practice with a strict staged protocol performed by three experienced Buddhist practitioners in an ecological setup. The SDA used neurophysiological descriptors as inputs, including PSD, power indices, coherence, and PLV. Post-hoc analysis of the obtained EEG states revealed significant differences compared to the baseline and neighboring states. The SDA was found to be stable with respect to state order organization and showed poor clustering quality metrics and no statistical significance between states when applied to randomly shuffled epochs (i.e., surrogate subject data used as controls). The SDA can be considered a general data-driven approach that detects hidden functional states associated with the mental processes evolving during meditation or other ongoing mental and cognitive processes. [ABSTRACT FROM AUTHOR]

Introduction: Survival of patients suffering from metastatic colorectal cancer (mCRC) has increased over the last decades. These benefits appear to be restricted to patients aged 50 and above. However, among the population aged <50, colorectal cancer incidence and mortality rates are significantly rising. The clinical benefit of treatment in this population still is a matter of debate. We aim to compare the clinical outcome between patients aged 50 and younger. Methods: In this retrospective, observational study, we analyzed data from 1,077 patients treated for mCRC at three cancer centers in Austria from January 2005 to December 2019. Patients were divided into two groups based on age at diagnosis: <50 years (eo-CRC) and >50 years (regular-onset CRC, ro-CRC). Propensity score matching was used to control for potential biases, and survival outcomes were compared between the two groups. Results: The differences in tumor characteristics between eo-CRC and ro-CRC in the overall population were primarily related to tumor sidedness and disease-free survival following intended curative resection. Our data show that eo-CRC patients underwent metastases resection more often and received significantly more lines of treatment in the palliative setting. Overall survival was superior in eo-CRC compared to ro-CRC, even after adjusting for sidedness, timing of metastases, sex, number of treatment lines, and resection of metastases by propensity scoring. Conclusion: Our study suggests that younger patients benefit at least to the same magnitude or even more from mCRC-treatment than patients aged 50 or above. [ABSTRACT FROM AUTHOR]

Textual data are increasingly common in test data as many assessments include constructed response (CR) items as indicators of participants' understanding. The development of techniques based on natural language processing has made it possible for researchers to rapidly analyse large sets of textual data. One family of statistical techniques for this purpose are probabilistic topic models. Topic modelling is a technique for detecting the latent topic structure in a collection of documents and has been widely used to analyse texts in a variety of areas. The detected topics can reveal primary themes in the documents, and the relative use of topics can be useful in investigating the variability of the documents. Supervised latent Dirichlet allocation (SLDA) is a popular topic model in that family that jointly models textual data and paired responses such as could occur with participants' textual answers to CR items and their rubric‐based scores. SLDA has an assumption of a homogeneous relationship between textual data and paired responses across all documents. This approach, while useful for some purposes, may not be satisfied for situations in which a population has subgroups that have different relationships. In this study, we introduce a new supervised topic model that incorporates finite‐mixture modelling into the SLDA. This new model can detect latent groups of participants that have different relationships between their textual responses and associated scores. The model is illustrated with an example from an analysis of a set of textual responses and paired scores from a middle grades assessment of science inquiry knowledge. A simulation study is presented to investigate the performance of the proposed model under practical testing conditions. [ABSTRACT FROM AUTHOR]

We revealed the optimal feedback parameters of visual, auditory, and tactile modalities in the operation of aerial display and determined that aerial display could be further improved for use of as a contactless human interface by multimodal feedback combining these parameters. We proposed applying a vibration motor to the sole of the foot instead of fingertips to provide vibration as tactile feedback to operate the aerial display. Sensory evaluation tests were carried out to evaluate the optimal feedback parameters for operating the aerial display in three senses: visual (image change); auditory (touch tone); and tactile (vibration), and to evaluate the effect on the operation with a combination of these parameters. We analyzed the variance of the experimental data using Scheffé's method for obtaining significance levels of paired comparisons. We found that the combination of two or three modalities rather than only a single modality makes the aerial display easy to operate. [ABSTRACT FROM AUTHOR]

For paired mesoscale eddies, the most sensitive initial errors in relation to sea surface height anomaly (SSHA) forecasts are investigated by utilizing the conditional nonlinear optimal perturbation (CNOP) method in a two‐layer quasigeostrophic model and then the sensitive areas are identified accordingly. For counter‐rotating eddies, the CNOP initial errors primarily occur within the eddies themselves, especially in areas characterized by clear high‐to low‐velocity gradients, accompanied by shear structures; while for co‐rotating eddies, besides sharing the feature of the former, their CNOP initial errors also concentrate between the two eddies and are obliquely tangential to their boundaries with a positive and negative shear structure. The utility of the CNOP initial errors in determining the sensitive areas for target observation is assessed through observing system simulation experiments (OSSEs). The OSSEs indicate that giving priority to the implementation of target observations in the sensitive areas identified by large CNOP initial errors, whether within eddies or between two co‐rotating eddies, particularly with a specific array guided by the shear structure of CNOP initial errors, leads to a notable improvement in SSHA forecasting. Finally, the effectiveness of the target observations, especially within the sensitive area situated between two co‐rotating eddies, is interpreted from the perspective of barotropic instability. The results of this study offer valuable scientific insights into the targeted observation of paired mesoscale eddies. These findings have the potential to provide important guidance for initializating paired mesoscale eddies, ultimately contributing to improvements in SSHA forecast accuracy. Plain Language Summary: Sea surface height anomaly (SSHA) is a critical variable for describing ocean surface dynamics, and improving the accuracy of SSHA predictions is of utmost importance. Given that the initialization of mesoscale eddies plays a pivotal role in SSHA forecasts, and these eddies often appear in pairs in the world's oceans, we investigate the impact of paired mesoscale eddies on the sensitivity of SSHA forecasting. Our findings indicate that, for paired mesoscale eddies, in contrast to individual eddies, the sensitive areas associated with SSHA forecasting are not only confined to the eddies themselves, specifically the area within eddies characterized by a high‐to low‐velocity gradient, but also located between two eddies, especially in the case of co‐rotating eddies. Targeting observations in these sensitive areas of paired mesoscale eddies, especially with a specific array, can significantly enhance the accuracy of SSHA forecasts. This improvement can be explained by the mechanism of barotropic instability. This research holds the potential to make a substantial contribution to the initialization of paired mesoscale eddies, consequently enhancing the precision of SSHA forecasts. Key Points: The sensitive areas for targeting observations of paired eddies are revealed through the advanced method of conditional nonlinear optimal perturbationConducting targeted observations with a specific array can significantly enhance the accuracy of sea surface height anomaly forecastingThe specific array for targeted observations is interpreted as a result of the barotropic instability mechanism [ABSTRACT FROM AUTHOR]

Background: The incidence of anterior cruciate ligament (ACL) reconstruction is increasing, and quadriceps tendon (QT) autograft is gaining popularity for both primary and revision ACL reconstruction. Purpose: To evaluate the differences in the patient-reported functional outcomes, concomitant injuries, and graft failure in primary versus revision ACL surgery using QT autograft. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 376 patients with primary ACL reconstruction and 138 patients with revision ACL reconstruction were retrospectively retrieved from a prospectively collected ACL registry. A minimally invasive technique was used for QT autograft harvesting. The surgical procedure and rehabilitation protocol were identical in both groups. To maintain a homogeneous cohort for the study, the groups were matched by age, sex, and preinjury outcome scores (Lysholm knee score, Tegner activity level, and visual analog scale [VAS] for pain). Initial baseline assessments of outcome scores were compared with scores collected at the 2-year postoperative mark. Results: The mean age of the primary group and revision group was 32.9 ± 10.2 years (range, 18-55 years) and 32.3 ± 9.9 years (range, 19-55 years) respectively. Significant preinjury to postoperative improvements were noted in Lysholm (88.2 ± 16.4 vs 83.5 ± 15.0; P =.007) and VAS pain (0.9 ± 1.3 vs 1.5 ± 1.6; P =.001) scores after primary ACL reconstruction compared with revision reconstruction. However, no significant difference was found in Tegner activity level (6.7 ± 1.8 vs 5.9 ± 1.8; P >.430). Primary ACL injury was associated with significantly higher concomitant medial collateral ligament injuries (P =.019), while the revision group was associated with significantly higher concomitant cartilage (P =.001) and meniscal (P =.003) injuries. A significantly higher graft failure rate was noted in the revision group compared with the primary ACL reconstruction group (13.0% vs 5.6%; P =.005). Conclusion: Both primary and revision ACL reconstruction with QT autograft had acceptable functional outcomes. The primary group had better outcomes than the revision group, possibly due to the lower prevalence of meniscal and cartilage injuries in the primary group compared with the revision group. The revision group was associated with higher graft failure than the primary group. QT autograft is a viable graft choice for both primary and revision ACL reconstruction. [ABSTRACT FROM AUTHOR]

Purpose: This study was initiated to analyze the outcome after distal femoral replacement (DFR) for periprosthetic distal femoral fractures (PDFF). Methods: Data from the German Arthroplasty Registry (EPRD) were analyzed. A total of 626 patients could be identified with a DFR for PDFF. Mean age was 78.8 years, and 84.2% were female. Revisions and mortality were analyzed and compared with patient groups with a similar procedure (revision total knee arthroplasty) or similar general condition (fracture total hip arthroplasty, hip hemiarthroplasty). Matched-pair-analyses were performed. Results: Within one year after surgery, 13.2% of the patients had died and further 9.4% were revised. Within four years, 32.7% had died and 19.7% were revised. Revisions were nearly twice as high as in the comparison groups. Periprosthetic infection (PJI) was the most frequent cause for revision, resulting in a PJI rate of 12.8%, which was lower in the comparison groups. Mortality after DFR was as similar high as after fracture hip arthroplasty. Conclusion: PDFF are a serious injury, and the necessary surgical treatment has a high risk of complications. Every third patient after DFR for PDFF had died and every fifth patient needed revision within 4 years after surgery. Efforts should be undertaken to provide optimal treatment to these high-risk patients to reduce unfavorable outcomes. Level of evidence: III. Registration of clinical trials: As this is a registry-derived study of data of the German Arthroplasty Registry (EPRD), no registration was performed. [ABSTRACT FROM AUTHOR]

Background and Aim: Magnesium is essential for the morphogenesis of otoconia. The imbalance in the chemical composition of otoconia can make people susceptible to Benign Paroxysmal Positional Vertigo (BPPV). The primary outcome was to compare serum magnesium levels in BPPV patients with controls. The Ca/Mg ratios in participants are also recorded and analyzed in the present study. Methods: In this case-control study, we measured the serum Mg, Ca, and vitamin D in BPPV patients and age-, sex-matched subjects without BPPV. The results were adjusted for Ca, vitamin D, hypertension, and body mass index. Results: A total of 123 BPPV patients participated in this study. The mean Mg value was higher in patients than controls (2.01 vs. 1.95 mg/dL, p=0.030). Condition logistic regression analyses showed a higher rate of BPPV among subjects with low Ca/Mg ratio (quartile 1), relative to subjects with medium ratio (quartiles 2 and 3) (adjusted OR: 3.92, p=0.003). Conclusion: The present study demonstrated an imbalance of Ca and Mg in the BPPV patients as significantly higher Mg levels and lower serum Ca/Mg ratio. Although it appears decreased Ca/Mg ratio to be a risk factor for BPPV, this result should be confirmed in confirmatory studies. [ABSTRACT FROM AUTHOR]

Many practitioners use the isometric midthigh pull (IMTP) to assess maximal strength in a safe, time-effective manner. However, expensive, stationary force plates are not always practical in a large team setting. Therefore, the purpose of this study was to establish the validity and between-session reliability of peak force, rate of force development (RFD), and impulse during an IMTP using 2 experimental protocols: a traditional fixed bar with a force plate (BarFP) and a flexible chain measured with a force plate (ChainFP) and a load cell (ChainLC). After a familiarization session, 13 resistance-trained men performed 3 trials of the BarFP condition and 3 trials of the chain-based conditions. The identical procedures were replicated twice more, with a week between each testing session. The main findings were (a) no RFD or impulse measures were found to achieve acceptable reliability across all methodological approaches and testing occasions; (b) peak force was reliable across all methods, with coefficient of variation ranging from 4.6 to 8.3%, intraclass correlation coefficient ranging from 0.94 to 0.98, and the least variability associated with the ChainLC condition; and (c) the ChainFP method was found to significantly underrepresent peak force by 4.8% (p, 0.05), with no significant differences between the ChainLC and BarFP methods. Therefore, the ChainLC would seem a valid, reliable, portable, and cost-effective alternative to force plates when assessing maximal isometric strength in the IMTP. [ABSTRACT FROM AUTHOR]

Forensic engineers and crash safety researchers sometimes use the injuries of a seatbelted occupant to infer the injury risk of an unbelted occupant in the same crash, had they instead been wearing a seatbelt. It is unclear, however, whether this inference is valid or how often two occupants in the same collision have similar injuries. Here, we sought to compare the injury outcomes between drivers and front‐seat passengers in frontal collisions using real‐world collision data. We compared the injury severity, quantified using the Abbreviated Injury Scale (AIS), of 22 injury categories between front‐seat occupants with matching seatbelt use and airbag deployment in single‐event frontal collisions recorded in the publicly available National Automotive Sampling System, Crashworthiness Data System (years 1993–2015) database to assess whether they had similar severity injuries. We analyzed the four combinations of seatbelt use and airbag deployment and all seatbelt/airbag conditions combined. In only 3 of 88 combinations of injuries and seatbelt/airbag conditions did more than 50% of occupant pairs have the same AIS score, although the related confidence intervals showed these proportions were not significantly greater than 50%. In contrast, we found 19 combinations of injuries and seatbelt/airbag conditions where one occupant was consistently injured more severely than the other. Our findings show that injury outcome is not similar for both front‐seat occupants in the same frontal collision with similar seatbelt and airbag conditions; however, one may be able to predict that one occupant would be more severely injured than their fellow occupant. [ABSTRACT FROM AUTHOR]

Background: A 2015 study of platelet-rich plasma (PRP) for groin injuries in National Football League (NFL) players alerted the authors to the possibility that PRP is associated with heterotopic ossification (HO). The current study of athletes seen between 2014 and 2019 provides a more comprehensive analysis of that observation. Purpose/Hypothesis: This report describes the early results of groin surgery for athletes who had experienced failed PRP therapy performed by different practitioners and with an assortment of PRP techniques. The primary goal of this cohort study was to determine short-term clinical outcomes after surgery of PRP-treated patients. It was hypothesized that previous PRP treatment would be associated with the presence of HO among patients with core muscle injuries (CMIs). Study Design: Cohort study; Level of evidence, 3. Methods: All athletes seen at 1 institution and identified at their first visit as having received PRP for a CMI were followed and compared with patients with a CMI who had not previously received PRP. Although in many cases HO was observed on clinical examination or imaging, HO was identified intraoperatively in all surgical cases and confirmed pathologically. Successful surgery was defined as return to play at previously high levels of performance or greater as determined by the athletes' own assessments. All patients who had received PRP were followed for ≥2 years. Results: Among 3642 patients with a new CMI seen between 2014 and 2019, 68 (1.9%) patients developed HO within the core muscles and/or adjacent soft tissues. Of the 68 patients, 60 (88.2%) were men, and the mean age was 34.5 years. Of the 68 patients, 62 (91.2%) were athletes and 44 (64.7%) had been treated previously with PRP. HO was observed in 24 (0.7%) patients without previous PRP treatment. Three athletes who received PRP retired early from sports because of HO and scar issues. In total, 22 of 28 (78.6%) NFL players who received PRP developed HO, compared with 0 (0%) of 28 randomly selected, age-, position-, and injury-matched NFL players. After surgical repair, 3-month success rates were 67.9% and 96.4%, respectively, in the PRP and non-PRP groups (P =.006). By 6 months postoperatively, PRP-treated patients were back to similarly high success rates compared with the non-PRP cohort. Scar tissue issues played a prominent role in the relative delay in definitive success. Conclusion: The present, more comprehensive study confirms the previous preliminary analysis that treating CMIs with PRP may be associated with HO. [ABSTRACT FROM AUTHOR]