-
Journal of Personalized Medicine Jun 2024Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment....
Anterior cruciate ligament (ACL) instability poses a considerable challenge in traumatology and orthopedic medicine, demanding precise diagnostics for optimal treatment. The pivot-shift test, a pivotal assessment tool, relies on subjective interpretation, emphasizing the need for supplementary imaging. This study addresses this limitation by introducing a machine learning classification algorithm integrated into a mobile application, leveraging smartphones' built-in inertial sensors for dynamic rotational stability assessment during knee examinations. Orthopedic specialists conducted knee evaluations on a cohort of 52 subjects, yielding valuable insights. Quantitative analyses, employing the Intraclass Correlation Coefficient (ICC), demonstrated robust agreement in both intraobserver and interobserver assessments. Specifically, ICC values of 0.94 reflected strong concordance in the timing between maneuvers, while signal amplitude exhibited consistency, with the ICC ranging from 0.71 to 0.66. The introduced machine learning algorithms proved effective, accurately classifying 90% of cases exhibiting joint hypermobility. These quantifiable results underscore the algorithm's reliability in assessing knee stability. This study emphasizes the practicality and effectiveness of implementing machine learning algorithms within a mobile application, showcasing its potential as a valuable tool for categorizing signals captured by smartphone inertial sensors during the pivot-shift test.
PubMed: 38929873
DOI: 10.3390/jpm14060651 -
Bioengineering (Basel, Switzerland) May 2024This work introduces Spiromni, a single device incorporating three different pressurised metered-dose inhaler (pMDI) accessories: a pMDI spacer, an electronic monitoring...
This work introduces Spiromni, a single device incorporating three different pressurised metered-dose inhaler (pMDI) accessories: a pMDI spacer, an electronic monitoring device (EMD), and a spirometer. While there are devices made to individually address the issues of technique, adherence and monitoring, respectively, for asthma patients as laid out in the Global Initiative for Asthma's (GINA) global strategy for asthma management and prevention, Spiromni was designed to address all three issues using a single, combination device. Spiromni addresses the key challenge of measuring both inhalation and exhalation profiles, which are different by an order of magnitude. Moreover, the innovative design prevents exhalation from entering the spacer chamber and prevents medication loss during inhalation using umbrella valves without a loss in flow velocity. Apart from recording the peak exhalation flow rate, data from the sensors allow us to extract other key lung volume and capacities measures similar to a medical pulmonary function test. We believe this low-cost portable multi-functional device will benefit both asthma patients and clinicians in the management of the disease.
PubMed: 38927788
DOI: 10.3390/bioengineering11060552 -
Journal of Neuroengineering and... Jun 2024People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step...
INTRODUCTION
People with Parkinson's Disease (PD) show abnormal gait patterns compromising their independence and quality of life. Among all gait alterations due to PD, reduced step length, increased cadence, and decreased ground-reaction force during the loading response and push-off phases are the most common. Wearable biofeedback technologies offer the possibility to provide correlated single or multi-modal stimuli associated with specific gait events or gait performance, hence promoting subjects' awareness of their gait disturbances. Moreover, the portability and applicability in clinical and home settings for gait rehabilitation increase the efficiency in the management of PD. The Wearable Vibrotactile Bidirectional Interface (BI) is a biofeedback device designed to extract gait features in real-time and deliver a customized vibrotactile stimulus at the waist of PD subjects synchronously with specific gait phases. The aims of this study were to measure the effect of the BI on gait parameters usually compromised by the typical bradykinetic gait and to assess its usability and safety in clinical practice.
METHODS
In this case series, seven subjects (age: 70.4 ± 8.1 years; H&Y: 2.7 ± 0.3) used the BI and performed a test on a 10-meter walkway (10mWT) and a two-minute walk test (2MWT) as pre-training (Pre-trn) and post-training (Post-trn) assessments. Gait tests were executed in random order with (Bf) and without (No-Bf) the activation of the biofeedback stimulus. All subjects performed three training sessions of 40 min to familiarize themselves with the BI during walking activities. A descriptive analysis of gait parameters (i.e., gait speed, step length, cadence, walking distance, double-support phase) was carried out. The 2-sided Wilcoxon sign-test was used to assess differences between Bf and No-Bf assessments (p < 0.05).
RESULTS
After training subjects improved gait speed (Pre-trn_No-Bf: 0.72(0.59,0.72) m/sec; Post-trn_Bf: 0.95(0.69,0.98) m/sec; p = 0.043) and step length (Pre-trn_No-Bf: 0.87(0.81,0.96) meters; Post-trn_Bf: 1.05(0.96,1.14) meters; p = 0.023) using the biofeedback during the 10mWT. Similarly, subjects' walking distance improved (Pre-trn_No-Bf: 97.5 (80.3,110.8) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.028) and the duration of the double-support phase decreased (Pre-trn_No-Bf: 29.7(26.8,31.7) %; Post-trn_Bf: 27.2(24.6,28.7) %; p = 0.018) during the 2MWT. An immediate effect of the BI was detected in cadence (Pre-trn_No-Bf: 108(103.8,116.7) step/min; Pre-trn_Bf: 101.4(96.3,111.4) step/min; p = 0.028) at Pre-trn, and in walking distance at Post-trn (Post-trn_No-Bf: 112.5(97.5,124.5) meters; Post-trn_Bf: 118.5(99.3,129.3) meters; p = 0.043). SUS scores were 77.5 in five subjects and 80.3 in two subjects. In terms of safety, all subjects completed the protocol without any adverse events.
CONCLUSION
The BI seems to be usable and safe for PD users. Temporal gait parameters have been measured during clinical walking tests providing detailed outcomes. A short period of training with the BI suggests improvements in the gait patterns of people with PD. This research serves as preliminary support for future integration of the BI as an instrument for clinical assessment and rehabilitation in people with PD, both in hospital and remote environments.
TRIAL REGISTRATION
The study protocol was registered (DGDMF.VI/P/I.5.i.m.2/2019/1297) and approved by the General Directorate of Medical Devices and Pharmaceutical Service of the Italian Ministry of Health and by the ethics committee of the Lombardy region (Milan, Italy).
Topics: Humans; Parkinson Disease; Aged; Male; Wearable Electronic Devices; Biofeedback, Psychology; Female; Gait Disorders, Neurologic; Middle Aged; Gait
PubMed: 38926876
DOI: 10.1186/s12984-024-01403-z -
Journal of Cardiothoracic Surgery Jun 2024Historically, the majority of patients admitted to inpatient exercise-based cardiac rehabilitation (EBCR) have undergone open heart surgery (OHS). However, with advances... (Comparative Study)
Comparative Study
BACKGROUND
Historically, the majority of patients admitted to inpatient exercise-based cardiac rehabilitation (EBCR) have undergone open heart surgery (OHS). However, with advances in minimally invasive cardiac surgery (MICS), these patient groups are also increasingly referred for inpatient EBCR. Herein, we aimed to compare the progress of these groups during rehabilitation.
METHODS
In this prospective, nonrandomized study, 403 inpatient EBCR patients were recruited from December 2022 until September 2023 and stratified into two groups: OHS, and MICS. Participants completed a 3-4-week certified EBCR program. The primary endpoint was defined as a change in the 6-minute walk test (6MWT). Moreover, a comprehensive panel of quality-of-life (QoL) assessments were performed at admission and discharge.
RESULTS
At baseline, patients with OHS were older (66 years [IQR 59 - 72]), more often male (83%), and underwent emergency/urgent procedures more often (20%) than patients with MICS. Furthermore, patients with MICS showed a better 6MWT at admission (426 meters [IQR 336 - 483]) compared to patients with OHS (381 meters [IQR 299 - 453]). While all patients were able to increase the distance in the 6MWT, regression analyses in fully adjusted models showed no difference in improvements between the two groups (β -5, 95% CI, -26 - 14, p = 0.58). Moreover, during EBCR, we observed significant improvements in all QoL measures in all groups.
CONCLUSIONS
In this study, improvements in fitness, as assessed by the 6WMT were observed in all groups. Furthermore, multiple QoL measures improved equally across all groups. These encouraging results emphasize the importance of EBCR.
Topics: Humans; Male; Female; Aged; Cardiac Surgical Procedures; Prospective Studies; Middle Aged; Cardiac Rehabilitation; Minimally Invasive Surgical Procedures; Quality of Life; Exercise Therapy; Walk Test
PubMed: 38926740
DOI: 10.1186/s13019-024-02871-z -
Nature Jun 2024Small-scale turbulent mixing drives the upwelling of deep water masses in the abyssal ocean as part of the global overturning circulation. However, the processes leading...
Small-scale turbulent mixing drives the upwelling of deep water masses in the abyssal ocean as part of the global overturning circulation. However, the processes leading to mixing and the pathways through which this upwelling occurs remain insufficiently understood. Recent observational and theoretical work has suggested that deep-water upwelling may occur along the ocean's sloping seafloor; however, evidence has, so far, been indirect. Here we show vigorous near-bottom upwelling across isopycnals at a rate of the order of 100 metres per day, coupled with adiabatic exchange of near-boundary and interior fluid. These observations were made using a dye released close to the seafloor within a sloping submarine canyon, and they provide direct evidence of strong, bottom-focused diapycnal upwelling in the deep ocean. This supports previous suggestions that mixing at topographic features, such as canyons, leads to globally significant upwelling. The upwelling rates observed were approximately 10,000 times higher than the global average value required for approximately 30 × 10 m s of net upwelling globally.
PubMed: 38926613
DOI: 10.1038/s41586-024-07411-2 -
Environmental Pollution (Barking, Essex... Jun 2024In densely populated urban areas, the pressure on water resources is considerable and will tend to intensify over the next decades. Preserving water resources therefore...
In densely populated urban areas, the pressure on water resources is considerable and will tend to intensify over the next decades. Preserving water resources therefore seems fundamental, but many questions remain as to the transfer of contaminants to subsurface waters in these largely sealed areas. Because of their toxicity and persistence in the environment, this work focused on the study of polycyclic aromatic hydrocarbons (PAHs), ubiquitous pollutants mainly produced by human activities. To better understand the main factors leading to the retention or transport of these pollutants in urban environments, vertical transects, from the surface to several meters down, were established on three study sites in or near Paris (France), selected according to an urbanization gradient. Soil samples collected at the surface and urban secondary carbonate deposits (USCD), similar to cave speleothems, sampled underground in quarries and aqueducts were analyzed. As the hydrophobic properties of PAHs favor their sorption onto organic matter, the latter was also studied using organic carbon analysis and UV fluorescence spectroscopy. The USCD located closest to the urbanized surface contained high concentrations of PAHs (76.8 ± 5.3 ng.g), while the USCD located at greater depth with organic soil on the surface contained the lowest amount of PAHs (2.9 ± 0.4 ng.g), and no PAHs with log K > 5. The results highlight the predominant role played by the presence of organic topsoil at the surface in retaining and storing large amounts of PAHs (1914 - 2595 ng.g), particularly the most hydrophobic ones (i.e. 60% of the 15 PAHs are characterized by a Log K >5), which are also the most toxic. The lithology and thickness of the bedrock (between the surface and the USCD) also play an important role in the retention of PAHs, particularly those adsorbed on the particulate phase.
PubMed: 38925218
DOI: 10.1016/j.envpol.2024.124437 -
Clinical Physiology and Functional... Jun 2024Diagnosis of asthma can be confirmed based on variability in peak expiratory flow (PEF) or changes in forced expiratory volume in 1 s (FEV) measured with spirometry....
Diagnosis of asthma can be confirmed based on variability in peak expiratory flow (PEF) or changes in forced expiratory volume in 1 s (FEV) measured with spirometry. Our aim was to use methacholine challenge as a model of induced airway obstruction to assess how well relative changes in PEF reflect airway obstruction in comparison to relative changes in FEV. We retrospectively studied 878 patients who completed a methacholine challenge test. To assess congruency along with differences between relative changes in FEV and PEF during airway obstruction, a regression analysis was performed, and a Bland & Altman plot was constructed. ROC analysis, sensitivity, specificity, positive and negative predictive values and κ-coefficient were used to analyze how decrease in PEF predicts decrease of 10% or 15% in FEV. The relative change in PEF was on average less than the relative change in FEV. In the ROC analysis areas under the curve were 0.844 and 0.893 for PEF decrease to predict a 10% and 15% decrease in FEV, respectively. The agreement between changes in PEF and FEV varied from fair to moderate. Airway obstruction detected by change in PEF was false in about 40% of cases when compared to change in FEV. Change in PEF is not a very accurate measure of airway obstruction when compared to change in FEV. Replacing peak flow metre with a handheld spirometer might improve diagnostic accuracy of home monitoring in asthma.
PubMed: 38923340
DOI: 10.1111/cpf.12898 -
Brazilian Dental Journal 2024This study aimed to determine the effect of adding selenium nanoparticles (SeNPs) to mineral trioxide aggregate (MTA HP) concerning alkalinizing potential. Additionally,...
This study aimed to determine the effect of adding selenium nanoparticles (SeNPs) to mineral trioxide aggregate (MTA HP) concerning alkalinizing potential. Additionally, it examined the set material after SeNPs incorporation using Field Emission Scanning Electron Microscopy with Energy Dispersive X-ray analysis (FE-SEM/EDX) for characterizing the elemental composition and morphological alterations resulting from the integration of SeNPs. Cement samples, both before and after SeNPs incorporation, were examined using FE-SEM/EDX. The pH level was also measured with a pH-meter previously calibrated with solutions of known pH, to evaluate the alkalinizing activity of the integrated substance at different concentrations of nanoparticles: Group 1 (control): 0% w/w SeNPs, Group 2: 0.5% w/w SeNPs, Group 3: 1% w/w SeNPs, Group 4: 1.5% w/w SeNPs and Group 5: 2% w/w SeNPs after 1, 7, 14, and 30 days in distal water. The data were analyzed by one-way ANOVA and Tukey tests (P≤0.05). According to FE-SEM/EDX, the morphological characteristics indicate that SeNPs were successfully dispersed and integrated into the MTA repair matrix. EDX examination validates the presence of Selenium, confirming successful integration. The findings confirmed that the MTAHP showed a high pH level with a discernible reduction in the alkalinizing activity with each incorporated concentration of (SeNPs) that significantly differed from the control group across various periods at (P≤ 0.05). Consequently, the findings indicate that the addition of SeNPs to MTA HP has a notable impact on the pH of the storage solution, leading to a significant decrease in pH values for all concentrations and periods when compared to the control group. The alkalinizing action of MTA HP is highly affected by the incorporated SeNPs, making it more suitable for application in pulpal tissue. This study contributes to our understanding of the morphological alterations and elemental composition of SeNP-incorporated MTA HP, enhancing its potential applications in dental and tissue regeneration.
PubMed: 38922250
DOI: 10.1590/0103-6440202405760 -
Advances in Experimental Medicine and... 2024The aim of this chapter is to give an overview of how the perception of rhythmic temporal regularity such as a regular beat in music can be studied in human adults,... (Review)
Review
The aim of this chapter is to give an overview of how the perception of rhythmic temporal regularity such as a regular beat in music can be studied in human adults, human newborns, and nonhuman primates using event-related brain potentials (ERPs). First, we discuss different aspects of temporal structure in general, and musical rhythm in particular, and we discuss the possible mechanisms underlying the perception of regularity (e.g., a beat) in rhythm. Additionally, we highlight the importance of dissociating beat perception from the perception of other types of structure in rhythm, such as predictable sequences of temporal intervals, ordinal structure, and rhythmic grouping. In the second section of the chapter, we start with a discussion of auditory ERPs elicited by infrequent and frequent sounds: ERP responses to regularity violations, such as mismatch negativity (MMN), N2b, and P3, as well as early sensory responses to sounds, such as P1 and N1, have been shown to be instrumental in probing beat perception. Subsequently, we discuss how beat perception can be probed by comparing ERP responses to sounds in regular and irregular sequences, and by comparing ERP responses to sounds in different metrical positions in a rhythm, such as on and off the beat or on strong and weak beats. Finally, we will discuss previous research that has used the aforementioned ERPs and paradigms to study beat perception in human adults, human newborns, and nonhuman primates. In doing so, we consider the possible pitfalls and prospects of the technique, as well as future perspectives.
Topics: Humans; Animals; Auditory Perception; Infant, Newborn; Adult; Primates; Music; Evoked Potentials, Auditory; Acoustic Stimulation; Evoked Potentials; Electroencephalography
PubMed: 38918355
DOI: 10.1007/978-3-031-60183-5_13 -
Research in Social & Administrative... Jun 2024Asthma is a common long-term condition that affects people of all ages. Evidence suggests that a significant proportion of asthma patients in the Gulf Cooperation... (Review)
Review
BACKGROUND
Asthma is a common long-term condition that affects people of all ages. Evidence suggests that a significant proportion of asthma patients in the Gulf Cooperation Council (GCC) do not receive appropriate diagnosis, monitoring and/or treatment. When inadequately treated, asthma can negatively affect quality of life and may lead to hospitalisation and death. Although pharmacists play a role in asthma care globally, there appears to be no defined role for pharmacists in providing care to patients with asthma in the GCC countries.
AIM
This scoping review aims to review and summarise studies conducted in the GCC countries involving pharmacists in the management of adults with asthma or evaluating pharmacists' asthma care knowledge and/or skills.
METHOD
A systematic scoping review was undertaken. Seven databases were searched using relevant search terms for articles published up to May 2023. Studies that evaluated pharmacists roles, knowledge and skills in providing asthma care to adults in the United Arab Emirates (UAE), Qatar, Kuwait, Oman, Saudi Arabia, and Bahrain were considered eligible for inclusion. Extracted data were collated using tables and used to produce narrative descriptive summaries.
RESULTS
Out of the 1588 search results, only seven studies met the inclusion criteria. Of those, only one developed and tested a pharmacist-led inhaler technique educational intervention in the UAE within community pharmacy setting for asthma patients. The remaining six studies assessed community pharmacists knowledge in providing asthma management and patient education in UAE, Saudi Arabia and Qatar. The quality of the included studies varied with four relying on simulated patients to assess pharmacists knowledge. The study that tested the intervention suggested improvement in inhaler technique and asthma symptoms control after receiving the intervention. The findings suggest a need to improve pharmacists knowledge of inhaler technique demonstration (mainly Metered Dose Inhalers), asthma management advice and assessment of asthma control and medication use.
CONCLUSION
This review highlights a lack of research on pharmacist-led asthma interventions and identifies training needs to enable pharmacists to be involved in asthma care in the GCC countries. Future research could develop approaches involving pharmacists to improve asthma care and outcomes in the region.
PubMed: 38918145
DOI: 10.1016/j.sapharm.2024.06.005