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Background: Exact diagnosis, efficient cleaning, shaping as well as disinfection of the root canals lead to successful root canal treatment. The present study compared three different irrigating systems in root canal treatment., Methodology: Sixty recently extracted permanent mandibular molars were classified into four groups: Group I, II, III, and IV with 15 teeth each. Group I comprised Endo-Irrigator Plus system. Group II comprised EndoActivator, Group III utilized passive ultrasonic irrigation (PUI), and Group IV was control, in which no activation of the irrigant was done. Stereomicroscope (X20) magnification was used for checking isthmus cleanliness. The scoring criteria were divided into score 1-5 depending on the amount of debris in root canal walls., Results: The mean ± standard deviation debris removal score in Group I was 2.6 ± 0.80, in Group II was 3.8 ± 0.72, in Group III was 3.9 ± 1.06, and in Group IV was 4.2 ± 0.82. The difference was significant ( P < 0.05)., Conclusion: Authors found that Endo-Irrigator Plus exhibited better cleaning efficacy followed by EndoActivator and PUI., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)

Background The 30-day readmission rates are being used as a quality measure by Centers for Medicare and Medicaid Services (CMS) for specific medical and surgical conditions. Acute respiratory distress syndrome (ARDS) is one of the important causes of morbidity and mortality in the United States (US). The characteristics and predictors of 30-day readmission in ARDS patients in the US are not widely known, which we have depicted in our study. Objective The aim of this study is to identify 30-day readmission rates, characteristics, and predictors of ARDS patients using the largest publicly available nationwide database. Methods We used the National Readmission Database from the year 2013 to extract the patients with ARDS by primary discharge diagnosis with ICD9-CM codes. All-cause unplanned 30-day readmission rates were calculated for patients admitted between January and November 2013. The independent predictors for unplanned 30-day readmission were identified by survey logistic regression. Results After excluding elective readmission, the all-cause unplanned 30-day readmission rate for ARDS patients was 18%. Index admissions readmitted within 30-day had a significantly higher baseline burden of comorbidities with a Charlson Comorbidity Index (CCI) ≥1 as compared to those who were not readmitted within 30 days. In multivariate regression analysis, several predictors associated with 30-day readmission were self-pay/no charge/other (OR 1.19, 95%CI: 1.02-1.38; p  = 0.02), higher-income class (OR 0.86, 95%CI:0.79-0.99; p  = 0.03), private insurance (OR 0.81, 95%CI:0.67-0.94; p  = 0.01), and teaching metropolitan hospital (OR 0.72, 95%CI:0.61-0.94; p  = 0.01). Conclusion The unplanned 30-day readmission rates are higher in ARDS patients in the US. Several modifiable factors such as insurance, socioeconomic status, and hospital type are associated with 30-day readmission among ARDS patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Shah et al.)

Growing concern for falls in acute care settings could be addressed with objective evaluation of fall risk. The current proof-of-concept study evaluated the feasibility of using a chest-worn sensor during hospitalization to determine fall risk. Physical activity and heart rate variability (HRV) of 31 volunteers admitted to a 29-bed adult inpatient unit were recorded using a single chest-worn sensor. Sensor data during the first 24-hour recording were analyzed. Participants were stratified using the Hendrich II fall risk assessment into high and low fall risk groups. Univariate analysis revealed age, daytime activity, nighttime side lying posture, and HRV were significantly different between groups. Results suggest feasibility of wearable technology to consciously monitor physical activity, sleep postures, and HRV as potential markers of fall risk in the acute care setting. Further study is warranted to confirm the results and examine the efficacy of the proposed wearable technology to manage falls in hospitals. [Journal of Gerontological Nursing, 43(7), 53-62.]., (Copyright 2017, SLACK Incorporated.)

Background: Poor healing is an important contributing factor to amputation among patients with diabetic foot ulcers (DFUs). Physiological stress may slow wound healing and increase susceptibility to infection., Objectives: The objective was to examine the association between heart rate variability (HRV) as an indicator of physiological stress response and healing speed (Heal Speed ) among outpatients with active DFUs., Design and Methods: Ambulatory patients with diabetes with DFUs (n = 25, age: 59.3 ± 8.3 years) were recruited. HRV during pre-wound dressing was measured using a wearable sensor attached to participants' chest. HRVs were quantified in both time and frequency domains to assess physiological stress response and vagal tone (relaxation). Change in wound size between two consecutive visits was used to estimate Heal Speed . Participants were then categorized into slow healing and fast healing groups. Between the two groups, comparisons were performed for demographic, clinical, and HRV derived parameters. Associations between different descriptors of HRV and Heal Speed were also assessed., Results: Heal Speed was significantly correlated with both vagal tone ( r = -.705, P = .001) and stress response ( r = .713, P = .001) extracted from frequency domain. No between-group differences were observed except those from HRV-derived parameters. Models based on HRVs were the highest predictors of slow/fast Heal Speed (AUC > 0.90), while models based on demographic and clinical information had poor classification performance (AUC = 0.44)., Conclusion: This study confirms an association between stress/vagal tone and wound healing in patients with DFUs. In particular, it highlights the importance of vagal tone (relaxation) in expediting wound healing. It also demonstrates the feasibility of assessing physiological stress responses using wearable technology in outpatient clinic during routine clinic visits.

Objective: This study aimed to validate a smart-textile based on fiber-optics for simultaneous measurement of plantar temperature, pressure, and joint angles in patients with diabetic peripheral neuropathy (DPN)., Methods: After in-vitro validation in the laboratory, 33 eligible subjects with DPN were recruited (age: 58 ± 8 years, BMI: 31.5 ± 8 kg/m 2 ) for assessing plantar pressure and temperature during habitual gait-speed in a clinical-setting. All participants were asked to walk at their habitual speed while wearing a pair of sensorized socks made from highly flexible fiber optics (SmartSox). An algorithm was designed to estimate temperature, pressure, and toe range of motion from optical wavelength generated from SmartSox. To validate the device, results from thermal stress response (TSR) using thermography and peak pressure measured by computerized pressure insoles (F-Scan) were used as gold standards., Results: In laboratory and under controlled conditions, the agreements for parameters of interest were excellent ( r > .98, P = .000), and no noticeable cross-talks between measurements of temperature, angle, and pressure were observed. During clinical data acquisition, a significant correlation was found for pressure profile under different anatomical regions of interest between SmartSox and F-Scan ( r = .67, P < .050) as well as between thermography and SmartSox ( r = .55, P < .050)., Conclusion: This study demonstrates the validity of an innovative smart textile for assessing simultaneously the key parameters associated with risk of foot ulcers in patients with DPN. It may empower clinicians to objectively stratify foot risk and provide timely care. Another study is warranted to validate its clinical application in preventing limb threating problems in patients with DPN.

Objective: People with diabetic peripheral neuropathy (DPN) often exhibit deteriorations in motor-performance mainly due to lack of plantar-sensation. The study explored effectiveness of plantar electrical-stimulation therapy to enhance motor-performance among people with DPN., Design and Methods: Using a double-blinded model, 28 volunteers with DPN (age: 57.8 ± 10.2 years) were recruited and randomized to either intervention (IG: n = 17) or control (CG: n = 11) group. Both groups received identical plantar-stimulation devices for six weeks of daily use at home; however, only the IG devices were set to deliver stimulation. Balance (ankle, hip, and center of mass [COM] sway) and gait (stride velocity [SV], stride time [ST], stride length [SL], and cadence) were measured using validated wearable sensors. Outcomes were assessed at baseline and at six-week. Clinical assessment including vascular as measured by ankle-brachial-index (ABI) and plantar-sensation as quantified by vibratory plantar threshold (VPT) were also measured at baseline and six weeks., Results: No difference were observed between groups for baseline characteristics ( P > .050). Posttherapy, ankle and COM sway with eyes open were significantly improved ( P < .05, Cohen's effect size d = 0.67-0.76) in the IG with no noticeable changes in CG. All gait parameters were significantly improved in the IG with highest effect size observed for cadence ( d = 1.35, P = .000). Results revealed improvement in VPT ( P = .004, d = 1.15) with significant correlation with stride velocity improvement ( r = .56, P = .037). ABI was improved in the IG in particulate among those with ABI>1.20 ( P = .041, d = 0.99) Conclusion: This study suggests that daily home use of plantar electrical-stimulation may be a practical means to enhance motor-performance and plantar-sensation in people with DPN.

Objective: The objective was to report patterns of physical activity and their relationship to wound healing success in patients with diabetic foot ulcers protected with removable or irremovable offloading devices., Methods: Forty-nine people with diabetic foot ulcers were randomized to wear either a removable cast walker (RCW) or an irremovable instant total contact cast (iTCC). Primary outcome measures included change in wound size, physical activities including position (ie, sitting, standing, lying) and locomotion (speed, steps, etc). Outcomes parameters were assessed on weekly basis until wound healing or until 12 weeks., Results: A higher proportion of patients healed at 12 weeks in the iTCC group ( P = .038). Significant differences in activity were observed between groups starting at week 4. RCW patients became more active than the iTCC group (75% higher duration of standing, 100% longer duration of walking, and 126% longer unbroken walking bout, P < .05). Overall, there was an inverse association between rate of weekly wound healing and number of steps taken per day ( r < -.33, P < .05) for both groups. RCW patients had a significant inverse correlation between duration of daily standing and weekly rate of healing ( r = -.67, P < .05). Standing duration was the only significant predictor of healing at 12 weeks., Conclusion: The results from this study suggest significant differences in activity patterns between removable and irremovable offloading devices. These patterns appear to start diverging at week 4, which may indicate a decline in adherence to offloading. Results suggest that while walking may delay wound healing, unprotected standing might be an even more unrealized and sinister culprit.

Background: Impairment of physical function is a major indicator of frailty. Functional performance tests have been shown to be useful for identification of frailty in older adults. However, these tests are often not translatable into unsupervised and remote monitoring of frailty status at home and/or community settings., Objective: In this study, we explored daily postural transition quantified using a chest-worn wearable technology to identify frailty in community-dwelling older adults., Methods: Spontaneous daily physical activity was monitored over 24 h in 120 community-dwelling elderly (age: 78 ± 8 years) using an unobtrusive wearable sensor (PAMSys™, BioSensics LLC, Watertown, MA, USA). Participants were classified as non-frail and pre-frail/frail using Fried's criteria. A validated software package was used to identify body postures and postural transition between each independent postural activity such as sit-to-stand, stand-to-sit, stand-to-walk, and walk-to-stand. The transition from walking to sitting was further classified as quick sitting and cautious sitting based on presence/absence of a standing posture pause between sitting and walking. A general linear model univariate test was used for between-group comparison. Pearson's correlation was used to determine the association between sensor-derived parameters and age. Logistic regression model was used to identify independent predictors of frailty., Results: According to Fried's criteria, 63% of participants were pre-frail/frail. The total number of postural transitions, stand-to-walk, and walk-to-stand were, respectively, 25.2, 30.2, and 30.6% lower in the pre-frail/frail group when compared to the non-frail group (p < 0.05, Cohen's d = 0.73-0.79). Furthermore, the ratio of cautious sitting was significantly higher by 6.2% in pre-frail/frail compared to non-frail (p = 0.025, Cohen's d = 0.22). Total number of postural transitions and the ratio of cautious sitting also showed significant negative and positive correlations with age, respectively (r = -0.51 and 0.29, p < 0.05). After applying a logistic regression model, among tested parameters, walk-to-stand (odds ratio [OR] = 0.997 p = 0.013), quick sitting (OR = 1.036, p = 0.05), and age (OR = 1.073, p = 0.016) were recognized as independent variables to identify frailty status., Conclusions: This study demonstrated that daily number of specific postural transitions such as walk-to-stand and quick sitting could be used for monitoring frailty status by unsupervised monitoring of daily physical activity. Further study is warranted to explore whether tracking the daily number of specific postural transitions is also sensitive to track change in the status of frailty over time., (© 2017 S. Karger AG, Basel.)

Context: Improvements in postural stability in figure skaters can play a significant role in performance, as well as reducing fall risk., Objective: To explore the effect of custom foot insoles on postural stability in advanced figure skaters., Design: Exploratory study., Setting: Out of laboratory., Participants: Nine advanced figure skaters were recruited and 7 completed the study (age 38 ± 18.5 y, body-mass index 25 ± 3.6 kg/m2)., Intervention: Custom foot insoles., Main Outcome Measures: Primary outcome of changes in postural stability (PS) quantified by center-of-mass sway with secondary outcomes of ankle- and hip-joint sway and joint range of motion. Sway measurements were assessed using body-worn sensors while participants wore skates on ice. PS was assessed in single-leg stance, as well as during gliding on the dominant foot., Results: A significant improvement in static PS was observed after 6-wk use of custom insoles. Center-of-mass sway reduced significantly on average by 48.44% (P = .023), and ankle-joint sway reduced by 45.7% (P = .05) during single-leg-stance balance measurements. During the gliding maneuver nonsignificant changes were observed for both ankle- and knee-joint range of motion., Conclusion: The results of this study suggest proof of concept toward benefits of custom insoles in improving postural stability in advanced figure skaters. To generalize the findings, randomized controlled trials with larger sample sizes are warranted.

Some individuals with mild cognitive impairment (MCI) experience not only cognitive deficits but also a decline in motor function, including postural balance. This pilot study sought to estimate the feasibility, user experience, and effects of a novel sensor-based balance training program. Patients with amnestic MCI (mean age 78.2 yr) were randomized to an intervention group (IG, n = 12) or control group (CG, n = 10). The IG underwent balance training (4 wk, twice a week) that included weight shifting and virtual obstacle crossing. Real-time visual/audio lower-limb motion feedback was provided from wearable sensors. The CG received no training. User experience was measured by a questionnaire. Postintervention effects on balance (center of mass sway during standing with eyes open [EO] and eyes closed), gait (speed, variability), cognition, and fear of falling were measured. Eleven participants (92%) completed the training and expressed fun, safety, and helpfulness of sensor feedback. Sway (EO, p = 0.04) and fear of falling (p = 0.02) were reduced in the IG compared to the CG. Changes in other measures were nonsignificant. Results suggest that the sensor-based training paradigm is well accepted in the target population and beneficial for improving postural control. Future studies should evaluate the added value of the sensor-based training compared to traditional training.

Background: Cancer patients with chemotherapy-induced peripheral neuropathy (CIPN) have deficits in sensory and motor skills leading to inappropriate proprioceptive feedback, impaired postural control, and fall risk. Balance training programs specifically developed for CIPN patients are lacking., Objective: This pilot study investigated the effect of an interactive motor adaptation balance training program based on wearable sensors for improving balance in older cancer patients with CIPN., Methods: Twenty-two patients (age: 70.3 ± 8.7 years) with objectively confirmed CIPN [vibration perception threshold (VPT) >25 V] were randomized to either an intervention (IG) or a control (CG) group. The IG received interactive game-based balance training including repetitive weight shifting and virtual obstacle crossing tasks. Wearable sensors provided real-time visual/auditory feedback from the lower limb trajectory and allowed the perception of motor errors during each motor action. The CG received no exercise intervention and continued their normal activity. Outcome measures were changes in sway of ankle, hip, and center of mass (CoM) in both mediolateral and anteroposterior (AP) directions during 30-second balance tests with increasing task difficulty [i.e. standing in feet-closed position with eyes open (EO) and eyes closed (EC), and in semi-tandem position with EO] at baseline and after the intervention. Additionally, gait performance (speed, variability) and fear of falling [Falls Efficacy Scale-International (FES-I)] were measured., Results: Training was safe despite the participants' impaired health status, great severity of CIPN (VPT 49.6 ± 26.7 V), and great fear of falling (FES-I score 31.37 ± 11.20). After the intervention, sway of hip, ankle, and CoM was significantly reduced in the IG compared to the CG while standing in feet-closed position with EO (p = 0.010-0.022, except AP CoM sway) and in semi-tandem position (p = 0.008-0.035, except ankle sway). No significant effects were found for balance with EC, gait speed, and FES-I score (p > 0.05)., Conclusions: This proof-of-concept study demonstrates that older cancer patients with CIPN can significantly improve their postural balance with specifically tailored, sensor-based exercise training. The training approach has potential as a therapy for improving CIPN-related postural control deficits. However, future studies comparing the proposed technology-based training with traditional balance training are required to evaluate the benefit of the interactive joint movement feedback., (© 2015 S. Karger AG, Basel.)

Malingering by proxy (MAL-BP) is a form of maltreatment that involves a caregiver who fabricates or induces signs or symptoms in a child, dependent adult, or pet in pursuit of external, tangible incentives. Rarely studied, MAL-BP has an unknown prevalence, and is a challenging diagnosis for healthcare professionals. Therefore, a comprehensive computer literature search and review was conducted. The review uncovered a total of sixteen case reports of MAL-BP (eleven human, five veterinary). The motive for malingering was financial in all human cases and medication-seeking in all veterinary cases. Although the strategies employed differed among the identified cases, common themes regarding the best approach to identification of MAL-BP cases became evident. A comprehensive workup including a thorough history, physical examination, appropriate neuropsychological testing, and relevant collateral information forms the basis of an effective identification strategy. The optimal method of management is currently unclear due to a relative paucity of data and guidelines. However, management of these cases would likely include a team-based approach with a prudent assessment of safety for the proxy and a low threshold for referral to appropriate services. Long-term follow-up is essential and should be approached from a biopsychosocial perspective. Attention, research, and guidance on this topic are needed to develop further evidence-based guidelines for the identification and management of MAL-BP., (© 2015 American Academy of Forensic Sciences.)

Background: Individuals with diabetic peripheral neuropathy (DPN) have deficits in sensory and motor skills leading to inadequate proprioceptive feedback, impaired postural balance and higher fall risk., Objective: This study investigated the effect of sensor-based interactive balance training on postural stability and daily physical activity in older adults with diabetes., Methods: Thirty-nine older adults with DPN were enrolled (age 63.7 ± 8.2 years, BMI 30.6 ± 6, 54% females) and randomized to either an intervention (IG) or a control (CG) group. The IG received sensor-based interactive exercise training tailored for people with diabetes (twice a week for 4 weeks). The exercises focused on shifting weight and crossing virtual obstacles. Body-worn sensors were implemented to acquire kinematic data and provide real-time joint visual feedback during the training. Outcome measurements included changes in center of mass (CoM) sway, ankle and hip joint sway measured during a balance test while the eyes were open and closed at baseline and after the intervention. Daily physical activities were also measured during a 48-hour period at baseline and at follow-up. Analysis of covariance was performed for the post-training outcome comparison., Results: Compared with the CG, the patients in the IG showed a significantly reduced CoM sway (58.31%; p = 0.009), ankle sway (62.7%; p = 0.008) and hip joint sway (72.4%; p = 0.017) during the balance test with open eyes. The ankle sway was also significantly reduced in the IG group (58.8%; p = 0.037) during measurements while the eyes were closed. The number of steps walked showed a substantial but nonsignificant increase (+27.68%; p = 0.064) in the IG following training., Conclusion: The results of this randomized controlled trial demonstrate that people with DPN can significantly improve their postural balance with diabetes-specific, tailored, sensor-based exercise training. The results promote the use of wearable technology in exercise training; however, future studies comparing this technology with commercially available systems are required to evaluate the benefit of interactive visual joint movement feedback., (© 2015 S. Karger AG, Basel.)