Search

Summary: Patients who suffer hip fractures become immobile with reduced quality of life. Our study aims to assess which cemented or cementless hemiarthroplasty resulted in better mobility or quality-of-life scores. Our retrospective review showed that both have similar scores after matching for age, gender, body mass index and comorbidities. Introduction: Hip fractures have mortality rates of up to 10% at 1 month and 30% at 1 year, as well as significant morbidity. This paper seeks to compare mobility and quality-of-life scores of cemented against uncemented hemiarthroplasty for the displaced neck of femur fractures. Our hypothesis is that there is no difference between the mobility and quality of life of patients treated with cemented or uncemented bipolar hemiarthroplasty. Methods: A retrospective review of registry data on hemiarthroplasties performed in our institution between 2011 and 2019 was conducted. From this dataset, 70 cemented hemiarthroplasties and 238 uncemented hemiarthroplasties were identified. Patients were assessed pre- and post-operatively, at 6 weeks, 3 months, 6 months and 12 months to determine functional recovery through mobility and quality-of-life scores. Results: On propensity score matching, both groups showed a reduction in Parker mobility score from 6.5 to 4 ( p = 0.91), SF-36 physical function scores from 52.5 (cemented) to 30 and 57.5 (uncemented) to 25 ( p = 0.79). Comparing the delta changes from pre-fall after matching, no significant differences were observed. From the analysis of the matched set of data, treatment of neck of femur using cemented or non-cemented bipolar hip prosthesis resulted in similar mobility and quality-of-life scores. Conclusion: In our analysis, there was no statistically significant difference in the mobility or quality-of-life scores of the patients undergoing cemented versus uncemented hemiarthroplasty for the displaced neck of femur fractures.

Abstract Background This study aimed to evaluate the effectiveness of Egami, Kobayashi and Sano scores in predicting intravenous immunoglobulin (IVIG) resistance in infant Kawasaki disease (KD), considering its unique clinical presentation. Methods We retrospectively analysed 143 infants aged

Winnie Yeo,1 Nicole TY Ngai,1 Christopher CH Yip,1 Frankie KF Mo,1 Victoria A Yeo,1 Jonathan WH Ko,1 Leung V Li,1 Thomas KH Lau,1 Kwai Tung Lai,1 Elizabeth Pang,1 Claudia HW Yip,1 Horatio L Yeo,1 Carol Chi Hei Kwok,2 Stephanie WY Ko,1 Alex Molassiotis3 1Department of Clinical Oncology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China; 2Department of Clinical Oncology, Princess Margaret Hospital, Kowloon, Hong Kong, People’s Republic of China; 3School of Nursing, The Hong Kong Polytechnic University, Hong KongCorrespondence: Winnie Yeo, Department of Clinical Oncology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, People’s Republic of China, Email winnieyeo@cuhk.edu.hkPurpose: Although risk factors related to chemotherapy-induced nausea and vomiting (CINV) have been identified in previous studies, only a few studies have evaluated the risk factors associated with contemporary antiemetic prophylaxis, including olanzapine/aprepitant- or NEPA-containing regimens. This study aimed to identify the risk factors associated with CINV development in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide chemotherapy.Methods: Data from 304 patients enrolled in 3 previously reported prospective antiemetic studies were included. Multivariate logistic regression models were used to predict risk factors associated with CINV occurrence. Additionally, the likelihood of treatment failure in relation to the number of risk factors in individual patients was evaluated.Results: Multivariate analysis of the entire study group revealed that obesity status (defined as body mass index/= 25.0 kg/m2) and the use of olanzapine/aprepitant- or NEPA-containing anti-emetic regimens were associated with a high likelihood, while a history of motion sickness was associated with a lower likelihood, complete response (CR), and “no nausea” in the overall phase. A history of vomiting during pregnancy was also associated with a lower likelihood of an overall CR. Patients with an increasing number of risk factors had a higher likelihood of treatment failure and shorter time to first vomiting. Those who did not achieve CR and “no nausea” in the first cycle were less likely to achieve these parameters in the subsequent cycle of chemotherapy.Conclusion: The present study confirmed previously reported risk factors for CINV in Chinese breast cancer patients receiving doxorubicin and cyclophosphamide. Further optimization of CINV control is required for patients with identifiable risk factors; olanzapine/aprepitant- or NEPA- containing prophylaxis are the preferred contemporary anti-emetics regimens for Chinese breast cancer patients undergoing doxorubicin and cyclophosphamide chemotherapy.Keywords: cytotoxic, nausea and vomiting, olanzapine, aprepitant, NEPA

BackgroundChildhood remains a vulnerable period and a key determiner for adult health. Various illnesses experienced by children in their early years determine future performance and contribution to society. Acute and chronic infectious diseases, undernutrition, and early childhood non-communicable diseases have greatly been linked to intellectual disability, poor childhood development, increased morbidity, and household and healthcare economic costs. In most developing countries, infections contribute to a larger burden of disease. Despite this being the case, most developing countries have a limited range of diagnostic capacity and access to a wide range spectrum of WHO Access, Watch and Reserve antibiotics. This leads to overuse and misuse of the available antibiotics and a wide range spread of resistance strains. In this study, we evaluated common childhood presentations and indications for antibiotic prescriptions at a community hospital in Malawi.ObjectiveThis study analyzed common childhood Clinical Presentations and antibiotic prescription patterns at the pediatric outpatient department (OPD) at St. Gabriel Community Mission Hospital in Malawi.MethodsA retrospective search of all outpatient routinely corrected data from St. Gabriel Community Mission Hospital between January to December 2022 was carried out. Manual screening was done on all appropriate routines under 14 medical records, and prespecified variables were extracted. Data collected consisted of total OPD patient number, age, sex, diagnosis and prescription.ResultsA total of 2711 children under 15 years of age were included, with 53.9% being males. The majority of them were below the age of 5 (59.5%). 30% of the cases seen in the department were attributable to respiratory presentation, representing the majority of the cases seen. Sepsis and enteric diseases also constituted the majority of the cases seen and contributed 18% and 7% respectively. 68% per cent of the children seen during the period of the study had an antibiotic prescription, with the majority having only one antibiotic prescribed (31.7%). Overall, amoxicillin constituted the most commonly prescribed antibiotic for the whole system, while metronidazole was the most commonly prescribed antibiotic among enteric illnesses. Being under five was associated with a higher likelihood of antibiotic prescription (p

Abstract Although increased sedentary behavior is associated with poor health outcomes among breast cancer survivors, the factors associated with high sedentary time in community-dwelling breast cancer survivors are unknown. This study aimed to identify factors associated with sedentary behavior in Korean community-dwelling breast cancer survivors aged ≥ 50 years. We included 205 breast cancer survivors from the Korea National Health and Nutrition Examination Survey. Total daily sedentary time was evaluated using questions from the Korean version of the Global Physical Activity Questionnaire. We used complex-sample multivariable-adjusted logistic regression analyses to analyze the associations between sociodemographic factors, medical factors, and health-related quality of life and high sedentary time (≥ 420 min/day). Among the Korean community-dwelling breast cancer survivors, 48.2% had a high daily sedentary time. Insufficient aerobic exercise (OR 2.29; 95% CI 1.12–4.69), diabetes (OR 3.37; 95% CI 1.22–9.33), and unemployed status (OR 2.29; 95% CI 1.05–5.02) were independently associated with high sedentary time after the adjustment for multiple sociodemographic and medical confounders. Participants with a low sedentary time (

Abstract Background Physical activity (PA) behaviours and comorbid diseases are associated with muscle strength. However, the association between dynapenia and detailed PA behaviours, including participation in aerobic and resistance exercises and sedentary behaviour (SB), in relation to comorbid diseases has not yet been investigated. Using nationwide data, this study aimed to evaluate the independent association of dynapenia with detailed PA behaviour (participation in aerobic and resistance exercises and SB), and assess the differential associations of detailed PA behaviour with dynapenia according to comorbid diseases with prevalent sarcopenia. Methods A total of 7,558 community-dwelling older adults aged ≥ 65 years who were included in the Korea National Health and Nutrition Examination Survey from 2014 to 2019 were included in the present study. Cross-sectional associations between PA behaviours (participation in aerobic exercise, participation in resistance exercise, and SB) and dynapenia were analysed using complex-sample multivariable-adjusted logistic regression models according to the type of comorbid disease (cardiovascular disease [CVD], diabetes mellitus [DM], and chronic lung disease [CLD]). Results Sufficient aerobic exercise, sufficient resistance exercise, and low sedentary time of

Hui Yee Yeo,1,2 Jacqueline Hui Yi Wong,3 Suz Jack Chan,1 Anna Tiatia Fa’atoese Latu,1 Catherine H Han,4,5 Mudassir Anwar,1 Carlo A Marra1 1School of Pharmacy, University of Otago, Dunedin, New Zealand; 2Clinical Research Center, Hospital Seberang Jaya, Seberang Jaya, Penang, Malaysia; 3Pharmacy Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; 4Auckland Oncology, Auckland, New Zealand; 5Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandCorrespondence: Carlo A Marra, School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, Tel +64-34797275, Fax +64-34797034, Email carlo.marra@otago.ac.nzPurpose: Despite the importance of acknowledging patient preferences in treatment decision-making, little is known about the treatment preferences and the factors underlying those preferences of breast cancer patients. This study aims explore patient experience and perspective regarding treatment preferences and identify the important determinants that shape these preferences in the context of New Zealand.Patients and Methods: Semi-structured online interviews comprised of six focus group discussions and five individual interviews were performed with 26 breast cancer patients. The interviews were recorded, transcribed, and analyzed using the reflexive thematic analysis approach.Results: Four main themes were derived: (1) positive treatment outcomes; (2) the negative impact of treatment-related side effects on quality of life; (3) treatment accessibility, availability, and timeliness; (4) cost of treatment. Patients revealed a strong preference towards treatments that yield longer survival, achieve remission, and prevent cancer recurrence. Additionally, patients favored treatments with minimal side effects that had minimal impact on their quality of life. There was a notable preference for treatments that were easily accessible and available in a timely manner. However, patients faced challenging decisions in balancing the costs of treatments with their benefits, leading to a consistent preference for treatments supported by government funding or medical insurance to alleviate financial burdens.Conclusion: Our study reveals that breast cancer patients in New Zealand have different perceptions and preferences regarding cancer treatment. Patients frequently find themselves making trade-offs among various attributes of a treatment, aligning these decisions with their personal values and beliefs. By considering these preferences and trade-offs in future studies that measure patient preferences, healthcare professionals can enhance their support for patients in making informed choices that align with their values and priorities. Additionally, healthcare policymakers can develop patient-centered policies that cater to the unique needs and preferences of breast cancer patients.Plain Language Summary: Breast cancer is a significant health concern in New Zealand, affecting both the well-being of patients and their families. Despite advancements in treatment, patient preferences regarding treatment risks and benefits are often neglected. This study aims to bridge this knowledge gap by qualitatively exploring the unique experiences and preferences of breast cancer patients in New Zealand, shedding light on the factors influencing their treatment decisions. The study involved a series of interviews with a group of 26 women living with breast cancer. The interview revealed four main themes that shape patients’ preferences for breast cancer treatment: 1. Positive outcomes: Patients revealed a strong preference towards treatments that yield longer survival, achieve remission, and prevent cancer recurrence. 2. Quality of life: Treatment-related side effects negatively impacted patients’ quality of life, affecting them physically, mentally, emotionally, spiritually, and psychosocially. Patients preferred a treatment that entailed few side effects with minimal impact on their quality of life. 3. Treatment accessibility and timeliness: Patients expressed concerns about administrative complexities, long distances to healthcare facilities, timely treatment, and restricted access to treatment options in the country. There was a notable preference for treatments that were easily accessible and available in a timely manner. 4. Cost of treatment: Balancing the cost of treatments with their benefits posed challenging decisions for patients, who consistently voiced a preference for treatments supported by government funding or medical insurance.The study highlights diverse perspectives and preferences among breast cancer patients in New Zealand about treatment preference. Patients frequently find themselves making trade-offs concerning various attributes of a treatment that align with their individual values and beliefs. Integrating these preferences and trade-offs into future studies and healthcare policies can help healthcare professionals and policymakers better support patients in making informed choices aligned with their values, fostering a more patient-centered healthcare system.Keywords: qualitative research, patient preference, breast cancer, reflexive thematic analysis, treatment preference, treatment decision-making

Abstract This research paper presents the development of a nonlinear Muskingum model which achieves precise flood routing through river reaches while considering lateral inflow conditions. Fourteen pairs of flood hydrograph found at two specific United States Geological Survey (USGS) stations located along the Red River of the North, namely Grand Forks and Drayton, are used for the calibrations and validations of the Muskingum model. To enhance the accuracy of the procedure, a reach is divided into multiple sub-reaches, and the Muskingum model calculations are performed individually for each interval using the distributed Muskingum method. Notably, the model development process incorporates the use of the Salp Swarm algorithm. The obtained results demonstrate the effectiveness of the developed nonlinear Muskingum model in accurately routing floods through the very gentle river with a bed slope of (0.0002–0.0003). The events were categorized into three groups based on their dominant drivers: Group A (Snowmelt-driven floods), Group B (Rain-on-snow-induced floods), and Group C (Mixed floods influenced by both snowmelt and rainfall). For the sub-reaches in Group A, single sub-reach (NR = 1), the Performance Evaluation Criteria (PEC) yielded the highest value for SSE, amounting to 404.9 × 106. In Group B, when NR = 2, PEC results the highest value were SSE = 730.2 × 106. The number of sub-reaches in a model has a significant influence on parameter estimates and model performance, as demonstrated by the analysis of hydrologic parameters and performance evaluation criteria. Optimal performance varied across case studies, emphasizing the importance of selecting the appropriate number of sub-reaches for peak discharge predictions.

This research introduces a novel nonlinear Muskingum model for river flood routing, aiming to enhance accuracy in modeling. It integrates lateral inflows using the Whale Optimization Algorithm (WOA) and employs a distributed Muskingum model, dividing river reaches into smaller intervals for precise calculations. The primary goal is to minimize the Sum of Square Errors (SSE) between the observed and modeled outflows. Our methodology is applied to six distinct flood hydrographs, revealing its versatility and efficacy. For Lawler's and Dinavar's flood data, the single-reach Muskingum model outperforms multi-reach versions, demonstrating its effectiveness in handling lateral inflows. For Lawler's data, the single-reach model (NR = 1) yields optimal parameters of K = 0.392, x = 0.027, m = 1.511, and β = 0.010, delivering superior results. Conversely, when fitting flood data from Wilson, Wye, Linsley, and Viessman and Lewis, the multi-reach Muskingum model exhibits better overall performance. Remarkably, the model excels with the Viessman and Lewis flood data, especially with two reaches (NR = 2), achieving a 21.6% SSE improvement while employing the same parameter set. This research represents a significant advancement in flood modeling, offering heightened accuracy and adaptability in river flood routing. HIGHLIGHTS Flooding can have a significant impact on people and environment.; Distributed Muskingum model was introduced to improve the accuracy and efficiency of the model's calculations.; This study suggests WOA to improve the local optimum.; Considering lateral flow is the major feature developed for the new approach in our paper.; The results will be used in Red River of the North to anticipate floods in ND and MN in the US.;

Hui Yee Yeo,1,2 Ai Ch’i Liew,2 Suz Jack Chan,1 Mudassir Anwar,1 Catherine Hye-Won Han,3 Carlo A Marra1 1School of Pharmacy, University of Otago, Dunedin, New Zealand; 2Clinical Research Center, Hospital Seberang Jaya, Penang, Malaysia; 3Faculty of Medical and Health Sciences, University of Auckland, Auckland, New ZealandCorrespondence: Carlo A Marra, School of Pharmacy, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, Tel +64-34797275, Fax +64-34797034, Email carlo.marra@otago.ac.nzObjective: Conventionally, optimal treatment strategies for breast cancer have been largely determined by physicians, with a scant understanding of patients’ treatment values and preferences. Incorporating patient preferences in the decision-making process for breast cancer treatment is gaining recognition and can potentially improve treatment outcomes and compliance. This scoping review aims to synthesize evidence on the key determinants that are most valued by breast cancer patients when deciding on their treatment options.Methods: We searched three electronic databases (PubMed/MEDLINE, SCOPUS, and CINAHL Plus) utilizing a systematic scoping review method. Two reviewers independently screened, applied inclusion criteria, reviewed, and synthesized findings. A mixed-method narrative approach combining the inductive thematic analysis and content analysis methodologies was used to synthesize and summarize the findings.Results: The review included 22 studies, leading to the conceptualization of 5 overarching themes and 17 sub-themes. Among these, the most frequently cited theme was treatment benefits, followed by treatment-related process, treatment-related risk, quality of life, and cost of treatment. Women with breast cancer highly value treatments that offer good effectiveness, prolong survival, prevent recurrence, and maintain quality of life. Patient concerns include treatment-related side effects, safety, the risk of secondary cancer, and direct or indirect out-of-pocket costs. Additionally, patients also consider treatment duration, mode of administration, physician recommendation, and treatment availability and accessibility when deciding on their preferred treatment.Conclusion: The evidence synthesized in this review offers insights into refining breast cancer treatment strategies to align more closely with patient values. Recognizing and integrating patient perspectives in breast cancer care could potentially lead to improved treatment outcomes, enhanced patient compliance, and more personalized care. Healthcare professionals are encouraged to incorporate these key determinants in their treatment decision-making processes, aiming to deliver a patient-centered care that aligns with the unique preferences and values of each patient.Plain Language Summary: Breast cancer is a significant health concern, and treatment decisions have traditionally driven by physicians, often without due consideration for patients’ preferences in their treatment choices. This scoping review aimed to explore and summarize what matters most to breast cancer patients when deciding on their treatment options. We found five main themes that were important to patients:Effectiveness: Patients highly value treatments that are effective in fighting cancer, prolonging survival, and preventing recurrence.Treatment-related process: The length of treatment and availability of different therapies influenced patients’ choices. Patients trust their doctors’ expertise but also value being involved in the decision-making process to have their preferences considered.Side Effects and Safety: Concerns about treatment-related side effects and the risk of secondary cancer were critical factors in decision-making.Quality of Life: Maintaining a good quality of life during treatment is crucial for patients.Financial Burden: The additional direct and indirect out-of-pocket costs of treatment were important considerations for patients.Understanding patients’ preferences is vital in developing personalized treatments that align with their values. Healthcare professionals need to communicate effectively with patients and involve them in the decision-making process. Patient decision aids and tailored financial assistance programs could also be helpful. Further research is needed to identify effective strategies to tailor treatments to meet patients’ preferences. Overall, this review sheds light on what matters most to breast cancer patients, empowering them to be more active participants in their treatment decisions and potentially improving treatment outcomes and overall well-being.Keywords: breast cancer, patient preference, treatment decision making, narrative scoping review

Abstract Background We investigated the sociodemographic and health-related factors associated with health checkup participation in community-dwelling stroke survivors. Methods Among participants of the Korea National Health and Nutrition Examination Survey, 642 stroke survivors were included. We investigated the sociodemographic, medical, and health-related quality of life factors—evaluated by the EuroQol 5-Dimension Questionnaire (EQ-5D)—associated with participation in any type of health checkup. To explore the associations between multiple variables and health checkup participation, a multivariable complex-sample logistic regression model was used. Results One-third of the community-dwelling stroke survivors did not receive a health checkup in the past two years. Insufficient physical activity (OR: 0.5, 95% CI: 0.3–0.9), current smoking (OR: 0.4, 95% CI: 0.2–0.8), low education level (OR: 0.5, 95% CI: 0.3–0.9), living alone (OR: 0.5, 95% CI: 0.3–0.998), and no occupation (OR: 0.5, 95% CI: 0.3–0.9) showed independent negative associations with health checkup participation. Among the five EQ-5D dimensions, mobility, self-care, usual activities, and pain/discomfort dimensions were associated with health checkup participation rate. Conclusion Policies and further research are needed to promote health checkups for stroke survivors who are physically inactive, currently smoking, living alone, unemployed, less educated, or having extreme problems in their daily lives.

Background Early recognition of deterioration events is crucial to improve clinical outcomes. For this purpose, we developed a deep-learning-based pediatric early-warning system (pDEWS) and aimed to validate its clinical performance. Methods This is a retrospective multicenter cohort study including five tertiary-care academic children’s hospitals. All pediatric patients younger than 19 years admitted to the general ward from January 2019 to December 2019 were included. Using patient electronic medical records, we evaluated the clinical performance of the pDEWS for identifying deterioration events defined as in-hospital cardiac arrest (IHCA) and unexpected general ward-to-pediatric intensive care unit transfer (UIT) within 24 hours before event occurrence. We also compared pDEWS performance to those of the modified pediatric early-warning score (PEWS) and prediction models using logistic regression (LR) and random forest (RF). Results The study population consisted of 28,758 patients with 34 cases of IHCA and 291 cases of UIT. pDEWS showed better performance for predicting deterioration events with a larger area under the receiver operating characteristic curve, fewer false alarms, a lower mean alarm count per day, and a smaller number of cases needed to examine than the modified PEWS, LR, or RF models regardless of site, event occurrence time, age group, or sex. Conclusions The pDEWS outperformed modified PEWS, LR, and RF models for early and accurate prediction of deterioration events regardless of clinical situation. This study demonstrated the potential of pDEWS as an efficient screening tool for efferent operation of rapid response teams.

Objective Dysphagia is a common clinical condition characterized by difficulty in swallowing. It is sub-classified into oropharyngeal dysphagia, which refers to problems in the mouth and pharynx, and esophageal dysphagia, which refers to problems in the esophageal body and esophagogastric junction. Dysphagia can have a significant negative impact one’s physical health and quality of life as its severity increases. Therefore, proper assessment and management of dysphagia are critical for improving swallowing function and preventing complications. Thus a guideline was developed to provide evidence-based recommendations for assessment and management in patients with dysphagia. Methods Nineteen key questions on dysphagia were developed. These questions dealt with various aspects of problems related to dysphagia, including assessment, management, and complications. A literature search for relevant articles was conducted using Pubmed, Embase, the Cochrane Library, and one domestic database of KoreaMed, until April 2021. The level of evidence and recommendation grade were established according to the Grading of Recommendation Assessment, Development and Evaluation methodology. Results Early screening and assessment of videofluoroscopic swallowing were recommended for assessing the presence of dysphagia. Therapeutic methods, such as tongue and pharyngeal muscle strengthening exercises and neuromuscular electrical stimulation with swallowing therapy, were effective in improving swallowing function and quality of life in patients with dysphagia. Nutritional intervention and an oral care program were also recommended. Conclusion This guideline presents recommendations for the assessment and management of patients with oropharyngeal dysphagia, including rehabilitative strategies.

BiFe[O.sub.3]-Bi([Zn.sub.1/2][Ti.sub.1/2])[O.sub.3] (BF-BZT) ceramics are made by a solid state reaction method and crystal structure and microstructure are observed. Two distinctive relaxations are observed and ferroelectric hysteresis loops are observed in BF with low electric field and BZT doped ceramics.

Abstract We aimed to examine the association between physical activity (PA) level and dynapenia in older adults with chronic obstructive pulmonary disease (COPD), and whether it varied with sex and obesity status. The current cross-sectional study included total of 1033 community-dwelling participants with COPD aged 65–79 from the Korean National Health and Nutrition Examination Survey. In the multivariable model, high and moderate PA levels were significantly associated with lower odds of dynapenia than low PA levels (high PA level: odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.09–0.74; moderate PA level: OR = 0.55, 95% CI = 0.35–0.87). This inverse association was observed only in males with COPD (high PA level: OR = 0.17, CI = 0.04–0.65; moderate PA level: OR = 0.49, 95% CI = 0.27–0.88) and the normal-weight group (18.5 ≤ body mass index (BMI)

Abstract A numerical simulation was performed to analyze how afterburning affects damage to a concrete structure when an explosive detonates inside a room. TNT was used as the explosive for the interior explosion. A reduced scale structure of a Korean apartment room was constructed with reinforced concrete and used as the target room for this research. Interior explosion experiments were performed using TNT 2 kg and TNT 3 kg explosives, to obtain data to verify and calibrate the numerical model. The numerical model was constructed to precisely simulate these interior explosions, especially considering the effect of afterburning, which is a significant phenomenon in enclosed spaces. Numerical simulations were performed with and without the effect of afterburning, and compared with the experiment results. The results showed that the numerical model could well simulate the effects of afterburning in an interior explosion, and that afterburning effects must be considered to more accurately analyze the damage to concrete structures.

Possible sarcopenia, the loss of handgrip strength in the older population, can lead to poor functional prognosis after stroke. In this retrospective study, we aimed to elucidate the clinical risk factors for possible sarcopenia at discharge in 152 hospitalized patients with subacute stroke. Univariable and multivariable logistic regression analysis was performed to determine the risk factors associated with possible sarcopenia. At the time of discharge, the prevalence of possible sarcopenia was 68.4%. After adjusting for all potential covariates, older age (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.00-1.21; p = 0.04), tube-dependent feeding (OR, 6.66; 95% CI, 1.11-39.84; p = 0.04), and high National Institute of Health Stroke Scale scores (OR, 1.20; 95% CI, 1.00-1.44; p = 0.04) were associated with a higher likelihood of possible sarcopenia at discharge. Higher nonhemiplegic calf circumference (OR, 0.80; 95% CI, 0.67-0.96; p = 0.02) was associated with a lower likelihood of possible sarcopenia. We conclude that tube feeding, high stroke severity, decreased nonhemiplegic calf circumference, and older age are independent risk factors for possible sarcopenia in patients with subacute stroke.