Search

Direct-to-implant (DTI) breast reconstruction restores patient body image immediately after mastectomy but may increase postoperative complications compared to tissue expander (TE)-based breast reconstruction. Few studies have compared the surgical complications and patient-reported outcomes (PROs) of DTI and TE breast reconstructions in Asian women. This study compared postoperative complications and PROs between DTI and TE breast reconstruction in Chinese women and explores the risk factors of postoperative complications and the influencing factors of PROs. A retrospective chart review of patients undergoing immediate breast reconstruction between 2008 and 2022 was conducted, and BREAST-Q questionnaires of the breast reconstruction module were distributed to eligible patients. Multivariate regression models were used to explore risk factors for postoperative complications and factors that influence BREAST-Q scores. DTI was associated with lower rates of major complications and implant loss but had no significant influence on patient satisfaction or quality of life. Age and axillary lymph node dissection were important complication risk factors for both DTI and TE. The application of acellular dermal matrix significantly increased the risk of seroma or hematoma. In the DTI group, capsular contracture significantly reduced patient satisfaction with breast scores. DTI dual-plane breast reconstruction does not increase complication rates in appropriately selected Chinese patients. In DTI patients, the management of capsular contracture is crucial for improving patient satisfaction. [ABSTRACT FROM AUTHOR]

Optimizing blasting parameters is of paramount importance in minimizing overbreak during tunneling. Hence, this paper proposed an intelligent approach, which integrates separate parameter optimization based on varying rock mass qualities, with the objective of reducing overbreak. This novel intelligent method constructs a comprehensive model with three distinct functions, which can provide precise overbreak prediction, analyze the mechanisms by which input parameters influence overbreak, and integrate feature importance into the blasting parameters optimization process. First, the hyperparameters of seven tree-based algorithms were optimized using the Sparrow Search Algorithm (SSA), and the best predictive model was selected by comparing various performance metrics. Then, the importance and influencing mechanisms of input features on overbreak were revealed through the utilization of the Shapley Additive Explanation. Subsequently, interactions among crucial parameters were investigated, and their design values were recommended. Finally, a novel parameter optimization method was employed to reduce overbreak, which combines the conclusions drawn from the importance analysis of input features with SSA through three key steps: modification of the initial position, expanding the search scope, and neighborhood perturbation. Compared to the unimproved methods, the proposed approach can significantly reduce post-blast overbreak areas in different sections of the tunnel by 12.8 % and 16.4 %, respectively. • Predicted blast overbreak based on deep learning algorithms. • Stabilized importance analysis results of input parameters. • Revealed influencing mechanisms of overbreak via SHAP. • Incorporated feature importance with parameter optimization. [ABSTRACT FROM AUTHOR]

To determine the efficacy of neural interface–based neurorehabilitation, including brain-computer interface, through conventional and individual patient data (IPD) meta-analysis and to assess clinical parameters associated with positive response to neural interface–based neurorehabilitation. PubMed, EMBASE, and Cochrane Library databases up to February 2022 were reviewed. Studies using neural interface–controlled physical effectors (functional electrical stimulation and/or powered exoskeletons) and reported Fugl-Meyer Assessment–upper-extremity (FMA-UE) scores were identified. This meta-analysis was prospectively registered on PROSPERO (#CRD42022312428). PRISMA guidelines were followed. Changes in FMA-UE scores were pooled to estimate the mean effect size. Subgroup analyses were performed on clinical parameters and neural interface parameters with both study-level variables and IPD. Forty-six studies containing 617 patients were included. Twenty-nine studies involving 214 patients reported IPD. FMA-UE scores increased by a mean of 5.23 (95% confidence interval [CI]: 3.85-6.61). Systems that used motor attempt resulted in greater FMA-UE gain than motor imagery, as did training lasting >4 vs ≤4 weeks. On IPD analysis, the mean time-to-improvement above minimal clinically important difference (MCID) was 12 weeks (95% CI: 7 to not reached). At 6 months, 58% improved above MCID (95% CI: 41%-70%). Patients with severe impairment (P =.042) and age >50 years (P =.0022) correlated with the failure to improve above the MCID on univariate log-rank tests. However, these factors were only borderline significant on multivariate Cox analysis (hazard ratio [HR] 0.15, P =.08 and HR 0.47, P =.06, respectively). Neural interface–based motor rehabilitation resulted in significant, although modest, reductions in poststroke impairment and should be considered for wider applications in stroke neurorehabilitation. [ABSTRACT FROM AUTHOR]

Vibration-controlled transient elastography (VCTE) is used in clinical practice to risk-stratify liver transplant (LT) recipients; however, there are currently little data demonstrating the relationship between VCTE and clinical outcomes. A total of 362 adult LT recipients with successful VCTE examination between 2015 and 2022 were included. Presence of advanced fibrosis was defined as liver stiffness measurement (LSM) ≥10.5 kPa and hepatic steatosis as controlled attenuation parameter (CAP) ≥270 dB/m. The outcomes of interest included all-cause mortality, myocardial infarction (MI), and graft cirrhosis using cumulative incidence analysis that accounted for the competing risks of these outcomes. The LSM was elevated in 64 (18%) and CAP in 163 (45%) LT recipients. The baseline LSM values were similar in patients with elevated vs normal CAP values. After a median follow-up of 65 (interquartile range, 20–140) months from LT to baseline VCTE, 66 (18%) patients died, 12 (3%) developed graft cirrhosis, and 18 (5%) experienced an MI. Baseline high LSM was independently associated with all-cause mortality (hazard ratio [HR], 1.97; 95% confidence interval [CI], 1.11–3.50; P =.02) and new onset cirrhosis (HR, 6.74; 95% CI, 2.08–21.79; P <.01). A higher CAP value was significantly and independently associated with increased risk of experiencing a MI over study follow-up (HR, 4.14; 95% CI, 1.29–13.27; P =.017). The VCTE-based parameters are associated with clinical outcomes and offer the potential to be incorporated into clinical risk-stratification strategies to improve outcomes among LT recipients. [Display omitted] [ABSTRACT FROM AUTHOR]

Evaluating the impact of policy interventions on respondents who are embedded in a social network is often challenging due to the presence of network interference within the treatment groups, as well as between treatment and non-treatment groups. In this paper, we propose a novel empirical strategy that combines network sampling based on the identification of independent sets with a stochastic actor-oriented model (SAOM) to infer the direct and net effects of a policy. By assigning respondents from an independent set to the treatment, we are able to block direct spillover of the treatment among the treated respondents for an extended period of time, during which the direct effect of the treatment can be isolated from the associated network interference. We empirically demonstrate this using a simulation-based evaluation of a fictitious policy implementation using both real-life and generated networks, and use a counterfactual approach to estimate the treatment effect of the policy. Our results highlight the effectiveness of our proposed empirical strategy, and notably, the role of network sampling techniques in influencing the evaluation of policy effects. The findings from this study have the potential to help researchers and policymakers with planning, designing, and anticipating policy responses in a networked society. • A policy evaluation technique that samples individuals from an independent set. • Leverages an SAOM and a counterfactual design to isolate direct policy effect from network effect. • Illustrative studies using real world and simulated network data to demonstrate effectiveness. • Offers a way to infer direct and net effect of interventions in a social network. [ABSTRACT FROM AUTHOR]

To examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. This was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two—or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). Forty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. This first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation. • Compression bandaging at community and tertiary care centers achieves similar wound healing results. • There is no significant difference in quality of life between patients in community care and those in tertiary care. • Compression bandaging can be offered in the community. [ABSTRACT FROM AUTHOR]

This study aimed to demonstrate the compliance, feasibility, and acceptability of telehealth monitoring among surgical patients discharged with wounds or drains. This is a cross-sectional feasibility study. Post-surgical breast, plastic, and hepatobiliary patients with wounds and/or surgical drains were recruited using convenience sampling. The control group received conventional care which consisted of daily telephone follow-up. The intervention group used a mobile wound application to take wound and drain images, report drainage amount and symptoms. Compliance was assessed by measuring the percentage of actual to expected patient entries, feasibility was assessed by comparing detection of abnormalities and unexpected hospital visits, and acceptability was assessed by subjective feedback from nurses and patients from the intervention group. 59 patients were recruited, with 30 patients in the control group and 29 patients in the intervention group. 9 specialty nurses were involved in the patients' post-discharge care. The mean compliance rate for the hepatobiliary, breast and plastic patients were 89.9 %, 89.5 % and 75.9 % respectively. 4 patients from the intervention group (13.8 %) and 6 patients from the control group (20.1 %) were flagged as having potential abnormalities. As for unexpected hospital visits, there were 2 (6.9 %) in the intervention group and 1 (3.4 %) in the control group. 25 patients and 9 specialty nurses responded to the feedback survey. 22 patients (88 %) did not face any application issues. 18 patients (72 %) preferred to self-report symptoms via the application rather than to call the nurses and reported feeling safe knowing that they are remotely monitored. Most nurses found the app convenient and timesaving (n = 7, 78 %), with monitoring through pictures as more accurate than phone conversation (n = 8, 89 %). The results suggest that use of a mobile application by surgical patients discharged with wounds or drains is feasible and serves as a viable monitoring tool. [ABSTRACT FROM AUTHOR]

Develop structured, quality improvement interventions to achieve a 15%-point reduction in MRIs performed under sedation or general anesthesia (GA) delayed more than 15 min within a 6-month period. A prospective audit of MRIs under sedation or GA from January 2022 to June 2023 was conducted. A multidisciplinary team performed process mapping and root cause analysis for delays. Interventions were developed and implemented over four Plan, Do, Study, Act (PDSA) cycles, targeting workflow standardization, preadmission patient counseling, reinforcing adherence to scheduled scan times and written consent respectively. Delay times (compared with Kruskal-Wallis and Dunn's tests), delays more than 15 min and delays of 60 min or more at baseline and after each PDSA cycle were recorded. In all, 627 MRIs under sedation or GA were analyzed, comprising 443 at baseline and 184 postimplementation. Of the 627, 556 (88.7%) scans were performed under sedation, 22 (3.5%) under monitored anesthesia care, and 49 (7.8%) under GA. At baseline, 71.6% (317 of 443) scans were delayed over 15 min and 28.2% (125 of 443) scans by 60 min or more, with a median delay of 30 min. Postimplementation, there was a 34.7%-point reduction in scans delayed more than 15 min, a 17.5%-point reduction in scans delayed by 60 min or more, and a reduction in median delay time by 15 min (P <.001). Structured interventions significantly reduced delays in MRIs under sedation and GA, potentially improving outcomes for both patients and providers. Key factors included a diversity of perspectives in the study team, continued stakeholder engagement and structured quality improvement tools including PDSA cycles. [Display omitted] [ABSTRACT FROM AUTHOR]

• Anti-fibrotic therapy of pirfenidone and nintedanib can limit the decline in lung function based on FVC in non-IPF PF-ILD patients. • However, overall improvements in 6MWD, all-cause mortality, or hospitalization were not noted between the group of patients receiving anti-fibrotic versus those receiving placebo. • The clinical benefits of anti-fibrotic therapy need to be weighed against the adverse risks of nausea/vomiting, diarrhea, anorexia/weight loss, and neurological disorders. Anti-fibrotics can reduce restrictive impairment in idiopathic pulmonary fibrosis (IPF). However, its effectiveness in non-IPF progressive fibrosing interstitial lung disease (non-IPF PF-ILD) remains uncertain. We assess the efficacy and safety of anti-fibrotics pirfenidone and nintedanib versus placebo among non-IPF PF-ILD adult patients. Meta-analysis was performed using PubMed, SCOPUS, and Cochrane databases to identify randomized controlled trials (RCTs). At respective centers, non-IPF PF-ILD was defined as clinical and radiological findings inconsistent with IPF and greater than 5 % forced vital capacity (FVC) decline, worsening radiological fibrosis or respiratory symptoms. Among seven RCTs involving 1,816 non-IPF PF-ILD patients, anti-fibrotics significantly reduced decline in FVC from baseline in milliliters (MD -66.80milliliters; P < 0.01) and percent predicted (MD -1.80 %; P < 0.01) compared to placebo. However, severity of FVC decline was less than 10 % (P = 0.33) in both groups. No significant difference in the decline of 6MWD from baseline in meters (P = 0.19) while on anti-fibrotics, although those on pirfenidone had less decline in 6MWD (MD -25.12 m; P < 0.01) versus placebo. The rates of all-cause mortality (P = 0.34), all-cause hospitalization (P = 0.44), and hospitalization for respiratory etiology (P = 0.06) were comparable in both groups. Adverse events of nausea/vomiting (54.2 % vs. 20.3 %; P < 0.01), diarrhea (65.2 % vs. 27.6 %; P = 0.02), anorexia/weight loss (23.0 % vs. 7.7 %; P < 0.01), neurological disorders (20.8 % vs. 12.6 %; P < 0.01), and events requiring therapy discontinuation were higher (18.4 % vs. 9.9 %; P < 0.01) in the anti-fibrotic group. Other adverse events of skin (P = 0.18) and respiratory disorders (P = 0.20) were equal. The advent of anti-fibrotics offers alternative treatment to reduce lung function decline. [ABSTRACT FROM AUTHOR]

The planning of pedicle screw placement is a essential step in spinal surgery. Achieving accurate placement and fine-tuning of pedicle screws necessitates precise image slices. However, the posture variations of vertebrae result in the required planes for screw placement not aligning with the standard coordinate system and being challenging to adjust rapidly. In this study, we propose a framework based on reinforcement learning for the optimization of pedicle screw placement planes in three-dimensional spinal images. Our contributions are twofold. Firstly, we decompose the screw planning process into two distinct tasks: the localization for screw placement planes and the automatic planning of pedicle screws. Transforming a 3D task into a plane localization task and 2D planning task is useful for optiomizing planning methods. Secondly, we introduce a method that encodes the relationship between bounding boxes and planes, effectively condensing three-dimensional spatial information into a one-dimensional representation. This method clearly illustrates the spatial relationship of the plane without the use of voxels. Experiments conducted on a public dataset showcase that our method achieves high localization accuracy and stable performance. Moreover, ablation experiments demonstrate that our bounding box and plane encoding method significantly improve the stability of plane localization, with an improvement of 1.47 ± 4.80° over the baseline and 1.61 ± 2.71° over an agent without this encoding method. [ABSTRACT FROM AUTHOR]

As one novel reinforcement used in magnesium composite, nano-layered flaky ternary MAX particle exhibits interesting anisotropic ceramic and metal properties. In order to accurately simulate the mechanical properties and damage behavior of MAX particle reinforced magnesium composite, we developed one finite element (FE) model based on 2D and 3D microstructural observations of 10 vol.% Ti 2 AlC-AZ91D composite. To improve the accuracy, matrix ductile damage, particle internal delamination deformation behaviors, and particle-matrix interfacial behaviors were respectively introduced into this model. The visual deformation processes of crack generation and propagation were carefully presented and discussed. The effects of interfacial strength and particle orientation on material properties were systematically investigated. [ABSTRACT FROM AUTHOR]

Little is known about the use of cangrelor in patients with myocardial infarction (MI) presenting with cardiogenic shock (CS). CAMEO (Cangrelor in Acute MI: Effectiveness and Outcomes) is a multicenter observational registry evaluating platelet inhibition in patients with MI. We examined the duration of cangrelor infusion and the amount of time to transition from cangrelor to an oral P2Y 12 inhibitor in patients with CS. We also assessed major adverse cardiovascular events (MACEs) and bleeding risks, stratified by dosage duration, time to transition and oral P2Y 12 inhibitor potency. Among 2352 cangrelor-treated patients with MI, 249 patients were in CS. Among the patients with CS, 16 (6.4%) received the "bridge" infusion dose, 202 (81.1%) the PCI cangrelor infusion dose, and 30 (12.0%) had a combination of both infusion doses. Patients with CS had a median age of 66 years; 32% were women; 21% were Black patients; 35% had diabetes; 19% received thrombectomy; and 59% received mechanical circulatory support (MCS) (35% intra-aortic balloon pump, 27% Impella). The median duration of infusion was 3.9 (2–21.5 hours) in patients with CS and was 2 (1.6–3.1 hours) for all cangrelor-treated patients. The median duration of transition from cangrelor to oral P2Y 12 inhibitor administration was 0.1 (-0.5–21.0 hours) for patients with CS. In multivariable modeling, chronic lung disease and the use of MCS and was associated with longer cangrelor infusions (defined as > 3.9 hours). Among cangrelor-treated patients with CS, 24.1% of these patients had a bleeding event, and 41.8% had a MACE event. After adjustment, a longer cangrelor infusion duration was associated with increased risk of bleeding (P < 0.05). The median duration of cangrelor infusion was longer for patients presenting with CS. Use of MCS was associated with longer cangrelor infusion durations in patients with CS. Further work is needed to understand the pharmacodynamics of antiplatelet agents in patients with CS. [ABSTRACT FROM AUTHOR]

An increased incidence of Pseudomonas aeruginosa in microbiological surveillance (MS) cultures from gastrointestinal endoscopes was detected between March 2020 and March 2023 in Tan Tock Seng Hospital Singapore. To describe the use of whole-genome sequencing (WGS) in this investigation. WGS was performed for all P. aeruginosa isolates with pairwise comparison of isolates to assess for genomic linkage. Comprehensive review of reprocessing practices and environmental sampling was performed. Twenty-two P. aeruginosa isolates were detected from endoscopic MS cultures. Fifteen (68%) isolates were available for WGS. Eighteen pairwise comparisons of isolates were made, of which 10 were found to be genomically linked. One endoscope had P. aeruginosa repeatedly cultured from subsequent MS that were genomically linked and persistent despite repeat endoscopic reprocessing, establishing the persistence of biofilm that could not be eradicated with routine reprocessing. All P. aeruginosa isolates cultured from other different endoscopes were genetically distinct. Investigation into reprocessing practices revealed the use of air/water valves connected to endoscopes during clinical use. Inspection of these valves revealed the presences of cracks and tears. All other environmental samples were negative. The WGS findings helped to deprioritize common source contamination and supported the hypothesis of biofilm build-up within endoscopes, leading to repeatedly positive MS cultures that were genomically linked. This was possibly related to incomplete reprocessing of the damaged air/water valves, resulting in biofilm build-up. All faulty valves were changed and subsequently cleaned separately with ultrasonic cleaning followed by sterilization which resolved this incident. [ABSTRACT FROM AUTHOR]

The objective of this scoping review was to examine resilience and resilient pain behaviors for those with CLBP in relation to resilience definitions, operationalization (e.g. trait or behavior), and application of theoretical frameworks. This scoping review examined resilience and resilient pain behaviors for those with CLBP in relation to resilience definitions, operationalization (e.g. trait or behavior), and application of theoretical frameworks. To gather data, we used five databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Ovid MEDLINE, PsycInfo, and Scopus. Authors used a systematic data charting spreadsheet (Microsoft Excel) to review and analyze the extracted data. A total of 26 articles, from 2011-2021, were included in the final analysis. A majority of articles were conducted in the United States (11) and cross-sectional secondary data analysis design (13). Resilience definitions varied across the studies. Three studies operationalized resilience as a trait and only one as a behavior. Most studies (20) did not include a theoretical framework. The majority cross-sectional design and heterogeneity of a resilience definition indicates resilience research is still emerging. The lack of operationalized resilience, specifically as a behavior, and the limited use of theoretical frameworks suggest advancements in resilience pain research are needed. This research has implications for nursing practice to support nurse's holistic perspective and the ability to incorporate resilience within nursing care. This research provides the initial steps to developing standard resilience definitions and frameworks to guide nursing practice. [ABSTRACT FROM AUTHOR]

Antiseptics such as chlorhexidine gluconate (CHG) and octenidine dihydrochloride (OCT) are frequently used in hospitals to prevent and control the transmission of meticillin-resistant Staphylococcus aureus (MRSA). Given the increasing prevalence of reduced CHG susceptibility of MRSA, there are concerns about the possibility of reduced OCT susceptibility. This study evaluated the prevalence of reduced CHG and OCT susceptibility over 3 years, and assessed the association between OCT exposure and reduced OCT susceptibility in MRSA. MRSA isolates from inpatients who acquired MRSA in an extended-care facility between 2019 and 2021 were included in antiseptic susceptibility testing. Inpatients were exposed to universal daily CHG bathing from January to September 2019, and universal daily OCT bathing after October 2019. The minimum inhibitory concentrations (MICs) of CHG and OCT were determined using the broth microdilution method. Multi-variable logistic regression was used to assess if OCT exposure was independently associated with reduced OCT susceptibility. Of 186 isolates, 179 (96%) had reduced CHG susceptibility (MIC ≥4 mg/L) and 46 (25%) had reduced OCT susceptibility (MIC ≥2 mg/L). Reduced OCT susceptibility rates were 26.9%, 13.8% and 14.3% in 2019, 2020 and 2021, respectively. Reduced CHG susceptibility rates were 95.4%, 100% and 95.9% in 2019, 2020 and 2021, respectively. OCT exposure was not associated with reduced OCT susceptibility (adjusted odds ratio 0.23, 95% confidence interval 0.08–0.75; P =0.014), after adjusting for age, gender, race, year of sample collection, days at risk in facility, hospitalization in preceding year, and MRSA colonization/infection in preceding year. The prevalence of reduced OCT susceptibility has remained low, despite universal OCT bathing for extended inpatient care. However, the rate of reduced CHG susceptibility was high. OCT exposure was not associated with reduced OCT susceptibility in MRSA. [ABSTRACT FROM AUTHOR]

This paper aims to investigate the scientific integration of data science with product design towards data-driven design (D3). Data science has potential to facilitate design decision-making through insight extraction, predictive analytics, and automatic decisions. A systematic scoping review is conduced to converge various D3 applications in four dimensions: the design dimension about design operations, the data dimension about popular data sources and common data-related challenges, the method dimension about the methodological foundations, and the social/ethical dimension about social/ethical considerations and implications. Based on the state-of-the-art, this paper also highlights potential future research avenues in this dynamic field. [ABSTRACT FROM AUTHOR]

To examine the effectiveness of near-infrared light devices (NIR) on procedure time of successful cannulation, success rate at the first attempt, and pain scores among pediatric patients and explore potential covariates on the intervention effect. Pediatric patients have encountered a high failure rate as compared with adult patients using traditional cannulation. NIR devices might help to access veins with an optimum viewing area and eliminate the number of attempts. However, methodological limitations and inconsistent results from previous reviews were found. A three-step comprehensive search was performed in nine databases. Meta-analysis, subgroup, and meta-regression analyses were conducted. Individual quality assessment and certainty of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations, Assessments, Development, and Evaluation criteria, respectively. We included 18 randomized controlled trials (RCTs) with 5298 children and adolescents across nine countries. NIR light devices significantly reduce −29.43 s of procedure time and −0.47 attempts of peripheral intravenous cannulation compared with traditional methods. Subgroup analysis observed a significantly large effect size on procedure time using AccuVein with pre-procedure training at the clinics. However, NIR light devices do not significantly decrease the procedure time, first attempt success rate, and pain scores. Meta-regression identified sample size as a significant covariate that had an impact on the success rate at the first attempt. The near-infrared light device can statistically significantly reduce the procedure time and the number of attempts. Given the low or very low certainty of the evidence, future well-designed RCTs are necessary. • Near-infrared light devices statistically significantly reduce −29.43 s of procedure time and − 0.47 attempts of peripheral intravenous cannulation compared with traditional methods. • Subgroup analyses observed a statistically significantly large effect size on procedure time using AccuVein with pre-procedure training at the clinics. • Subgroup analysis revealed a statistically significantly large effect size on number of attempts at the clinics. • Meta-regression identify sample size is a significant covariate that had an impact on the success rate at first attempt. [ABSTRACT FROM AUTHOR]

To date, there are no randomized, double-blinded clinical trials comparing catheter ablation to DC cardioversion (DCCV) with medical therapy in patients with persistent atrial fibrillation (PersAF). Conducting a large-scale trial to address this question presents considerable challenges, including recruitment, blinding, and implementation. We conducted a pilot study to evaluate the feasibility of conducting a definitive placebo-controlled trial. This prospective trial was carried out at Barts Heart Centre, United Kingdom, employing a randomized, double-blinded, placebo-controlled design. Twenty patients with PersAF (duration <2 years) were recruited, representing 10% of the proposed larger trial as determined by a power calculation. The patients were randomized in a 1:1 ratio to receive either PVI ± DCCV (PVI group) or DCCV + Placebo (DCCV group). The primary endpoint of this feasibility study was to evaluate patient blinding. Patients remained unaware of their treatment allocation until end of study. During the study, 35% of patients experienced recurrence of PersAF prior to completion of 12 months follow-up. Blinding was successfully maintained amongst both patients and medical staff. The DCCV group had a trend to higher recurrence and repeat procedure rate compared to the PVI group (recurrence of PersAF 60% vs 30%; p =.07 and repeat procedure 70% vs 40%; p =.4). The quality of life experienced by individuals in the PVI group showed improvement, as evidenced by enhanced scores on the AF specific questionnaire (AF PROMS) (3 [±4] vs 21 [±8]) and SF-12 mental-component raw score (51.4 [±7] vs 43.24 [±15]) in patients who maintained sinus rhythm at 12 months. This feasibility study establishes the potential for conducting a blinded, placebo-controlled trial to evaluate the efficacy of PVI versus DCCV in patients with PersAF. [Display omitted] [ABSTRACT FROM AUTHOR]

Hepatopancreaticobiliary cancers are among the most diagnosed cancers in the world. However, although high-income countries have the highest incidence rates, low- and middle-income countries have the highest mortality rates. In this article, we describe the geographic distribution of board-certified hepatopancreaticobiliary surgeons who provide surgical management for patients with these diseases in the Philippines. We draw attention to the geographic disparities in the distribution of these surgeons and the other factors that contribute to the lack of access. Lastly, we suggest ways forward. [ABSTRACT FROM AUTHOR]

Conventional Ti-based implants are vulnerable to postsurgical infection and improving the antibacterial efficiency without compromising the osteogenic ability is one of the key issues in bone implant design. Although zinc oxide (ZnO) nanorods grown on Ti substrates hydrothermally can improve the antibacterial properties, but cannot meet the stringent requirements of bone implants, as rapid degradation of ZnO and uncontrolled leaching of Zn2+ are detrimental to peri-implant cells and tissues. To solve these problems, a lattice-damage-free method is adopted to modify the ZnO nanorods with thin calcium phosphate (CaP) shells. The Ca and P ions from the CaP shells diffuse thermally into the ZnO lattice to prevent the ZnO nanorods from rapid degradation and ensure the sustained release of Zn2+ ions as well. Furthermore, the designed heterostructural nanorods not only induce the osteogenic performances of MC3T3-E1 cells but also exhibit excellent antibacterial ability against S. aureus and E. coli bacteria via physical penetration. In vivo studies also reveal that hybrid Ti-ZnO@CaP5 can not only eradicates bacteria in contact, but also provides sufficient biocompatibility without causing excessive inflammation response. Our study provides insights into the design of multifunctional biomaterials for bone implants. • A lattice-damage-free method is adopted to modify the ZnO nanorods with thin calcium phosphate (CaP) shells. • The dynamic process of Ca and P diffusion into the ZnO lattice is analyzed by experimental verification and theoretical calculation. • The degradation rate of ZnO nanorods is significantly decreased after CaP deposition. • The ZnO nanorods after CaP deposition can not only sterilize bacteria in contact via physical penetration, but also provide sufficient biocompatibility and osteogenic capability without causing excessive inflammation response.. [Display omitted] [ABSTRACT FROM AUTHOR]

To: (1) report on the prevalence of community-acquired pressure injuries (CAPIs) in patients admitted into the acute care setting; (2) examine the socio-economic and home environment associated with CAPIs; and (3) understand the challenges of caring for patients with CAPIs at home. This mixed-method study recruited patients admitted with CAPIs in the acute care hospital between March 2021 to June 2022. The hospital's pressure injury (PI) database was used to screen patients admitted with CAPIs. A purposive sample of CAPI patients and their caregivers participated in this study. A cross-sectional survey study was first performed to examine the prevalence of CAPIs and the socio-economic and home environment factors. Semi-structured interviews were conducted to understand the caregivers' challenges in caring for patients with CAPIs at home. The CAPI prevalence was reported at 1.1 % during the study period (1039 had CAPIs out of 97 912 patients admitted to the hospital). A total of 70 caregivers and patients consented to participate in the study. The mean age of patients was 84.2 (SD = 10.4) years old; 68.6 % (n = 48) were females. Majority presented with a deep tissue injury (DTI) (37.1 %; n = 26) or unstageable PI (31.4 %; n = 22). More than half of the patients had alternating air mattresses at home (54.3 %; n = 38), and only 10 % (n = 7) had positioning wedges and used a sliding sheet for turning. The mean age of the caregivers was 43.4 years old (SD = 13.1), and 84.3 % (n = 59) were female. Continuous data were summarised using means and standard deviations, and categorical data were summarised using frequencies and percentages. Logistic regression found no significant socio-demographic and clinical predictors of patients having PI stages 2, 3, and 4 compared to patients with DTI and unstageable PI. Challenges to caring for PI at home included high financial burden, physical limitations, and personal challenges in CAPIs management. CAPIs are prevalent among older patients admitted to the acute care setting. Understanding the influence of socio-economic factors is crucial for developing comprehensive strategies to mitigate the occurrence and impact of PIs. Ongoing support and education to the caregivers in the community is essential to address the reported challenges in PI care. • Caregivers are inclusive of both unpaid family members and paid foreign domestic helpers. • CAPI prevalence was 1.1% among patients admitted to the acute care hospital primarily with deep tissue injury or unstageable PI. • Caregivers reported physical challenges, financial burdens, and personal challenges in PI care. [ABSTRACT FROM AUTHOR]

• A comprehensive review on the effects of laser parameters on the microstructures and surface properties, with a specific focus on the biomedical magnesium alloys. • The latest development of five laser surface modification techniques: laser surface melting, laser cladding, laser shock peening, laser surface alloying and laser surface texturing are reviewed. • Future research directions for laser surface modification techniques to enhance magnesium alloys for biomedical applications are presented. Biodegradable implants from magnesium (Mg) alloys have emerged in the biomedical field especially in the orthopedic and cardiovascular stent applications owing to their low density, high specific strength, excellent machinability, good biocompatibility, and biodegradability. The primary shortcoming of Mg-based implants is their low corrosion resistance in the physiological environment, which results in premature mechanical integrity loss before adequate healing and the production of excessive hydrogen gas, which is harmful to the body tissues and negatively affects the biocompatibility of the implant. Laser surface modification has recently received attention because it can improve the surface properties such as surface chemistry, roughness, topography, corrosion resistance, wear resistance, hydrophilicity, and thus cell response to the surface of the material. The composition and microstructures including textures and phases of laser-treated surfaces depend largely on the laser processing parameters (input laser power, laser scan velocity, frequency, pulse duration, pressure, gas circulation, working time, spot size, beam focal position, and laser track overlap) and the thermophysical properties of the substrate (solubility, melting point, and boiling point). This review investigates the impacts of various laser surface modification techniques including laser surface melting, laser surface alloying, laser cladding, laser surface texturing, and laser shock peening, and highlights their significance in improving the surface properties of biodegradable Mg alloys for implant applications. Additionally, we explore how different laser process parameters affect its composition, microstructure, and surface properties in each laser surface modification technique. [ABSTRACT FROM AUTHOR]

Emerging evidence has revealed that cricothyroid (CT) muscle dysfunction in unilateral vocal fold paralysis (UVFP) further impairs patients' voices. Given that CT muscle dysfunction does not influence vocal fold position, the mechanism of voice dysfunction induced by dysfunction of CT muscle in UVFP patients remains controversial. This study compares aerodynamics between UVFP patients with and without CT muscle involvement. This cross-sectional study recruited patients with UVFP manifesting dysphonia, and UVFP was confirmed with videolaryngoscopy and laryngeal electromyography (LEMG). Voice analysis and aerodynamic tests were further performed. Patients with (CT+ group) and without (CT- group) CT muscle involvement were compared. A total of 175 patients (40 in the CT+ group and 135 in the CT- group) with UVFP were analyzed. The CT+ group showed lower maximal sound pressure level (SPL) (P =0.039), mean SPL (P =0.042), peak air pressure (P <0.001), mean peak air pressure (P <0.001) and aerodynamic power (P =0.004) than the CT- group. The decrease in SPL, peak air pressure, and aerodynamic power in UVFP patients with CT muscle dysfunction suggests that the effect of CT muscle dysfunction is mediated by a change in aerodynamics. [ABSTRACT FROM AUTHOR]

Recent advancements in large language models (LLMs) demonstrate great potential in supporting engineering design, especially conceptual design. Prompt engineering plays an important role in facilitating designer-LLM collaboration in conceptual design. This paper proposes a new classification scheme that categorizes design-specific prompts into multiple classes. It also introduces different patterns for synthesizing design prompts, being grounded in the theoretical foundations of prompt engineering and domain-specific design methodology. A design experiment, utilizing ChatGPT, was conducted to investigate the impacts of different syntheses of design prompts on the effectiveness of LLM in concept generation, as measured by the metrics of novelty and diversity. [ABSTRACT FROM AUTHOR]

This systematic review is aimed to evaluate in fixed prosthodontics treated teeth, the effect of the BOPT on periodontal health compared to the horizontal preparation technique using a chamfer finishing line or to the baseline. The electronic databases Cochrane Central Library, PubMed, Scopus, and ScienceDirect were searched based on specific MeSH keywords. The Randomized controlled clinical trials (RCTs) and prospective clinical trials on BOPT printed in English up to July 2022 were selected. Screening, selection, and data extraction were done. The studies were assessed for risk of bias, and descriptive and meta-analyses were performed. Eight studies were included in the systematic review and only three RCTs were involved in the meta -analysis. Two RCTs were assessed as low risk while one has some concerns. were grouped as good, fair, and poor based on NOS. Three of the prospective studies were considered to be of good quality and one study was fair. The meta -analysis revealed no statistically significant difference in the effect of BOPT and chamfer preparation on periodontal health status and success rate (P > 0.05). Considering the limitation of this review, the BOPT is comparable to chamfer preparation and it resulted in an acceptable effect to maintain periodontal health with a high success rate. However, more evidence is required to support these findings. [ABSTRACT FROM AUTHOR]

This paper proposes a new constructive identification and adaptive control method for nonlinear pure-feedback systems, which remedies the 'explosion of complexity' and potential control singularity encountered in the traditional adaptive backstepping controllers. First, to avoid using the backstepping recursive design, alternative state variables and the corresponding coordinate transformation are introduced to reformulate the pure-feedback system into an equivalent canonical model. Then, a high-order sliding mode (HOSM) observer is used to reconstruct the unknown states for this canonical model. To remedy the potential singularity in the control, the unknown system dynamics are lumped to derive an alternative identification structure and one-step control synthesis, where two radial basis function neural networks (RBFNN) are adopted to online estimate these lumped dynamics. In this framework, the online estimation of control gain is not in the denominator of controller, and thus the division by zero in the controllers is avoided. Finally, a new online learning algorithm is constructed to obtain the RBFNNs' weights, ensuring the convergence to the neighborhood of true values and allowing accurate identification of unknown dynamics. Theoretical analysis elaborates that the convergence of both the tracking error and the estimation error is obtained simultaneously. Simulations and practical experiments on a hydraulic servo test-rig verify the effectiveness and utility of the suggested methods. • One-step backstepping-free adaptive control is proposed for pure-feedback systems. • The potential singularity problem in the traditional control methods is resolved. • Precise identification of unknown system dynamics is ensured via novel adaptive law. [ABSTRACT FROM AUTHOR]

• The world's largest Mg-alloy automotive die-casting components have been successfully trial-manufactured by Chongqing University, in cooperation with Chongqing Millison Technologies Inc. and Chongqing Boao Magnesium Aluminium Manufacturing Company Ltd, using Millison's 8800T Giga-press machine. • Various critical facets of the Mg-alloy super-sized HPDC process were examined, offering an insight into both the advantages and challenges associated with this approach. • Mg-alloys demonstrated substantial potential for application in manufacturing of automotive super-sized components, offering a pathway to further light-weighting of current car-body and chassis parts. Since the introduction of Tesla's Giga-Casting process, the automotive industry has widely accepted the concept of super-sized structural components due to their significant potential for enhancing the light-weighting of both electric and internal combustion engine vehicles. These super-sized components can be further lightened by using Mg alloys because of their exceptional lightweight characteristics, with a density only two-thirds that of aluminium alloys and one-fourth that of steel. This outstanding attribute offers the attractive prospect of achieving significant weight reduction without compromising structural integrity. This review examines studies on the Mg-alloy High-Pressure Die Casting (HPDC) process, providing insights into the future prospects of incorporating Mg alloys into super-sized automotive HPDC components. [ABSTRACT FROM AUTHOR]

• This study aimed to explore the differences of the interpretation skills and reading behaviour related to brain CT among resident doctors from different medical specialties. • The resident doctors from different medical specialities may achieve similar imaging reading competency of the brain CT based on eye-tracking results. • Our results may mitigate the queries of the influence from different background on training outcome. Using the eye-tracking technique, our work aimed to examine whether difference in clinical background may affect the training outcome of resident doctors' interpretation skills and reading behaviour related to brain computed tomography (CT). Twelve resident doctors in the neurology, radiology, and emergency departments were recruited. Each participant had to read CT images of the brain for two cases. We evaluated each participant's accuracy of lesion identification. We also used the eye-tracking technique to assess reading behaviour. We recorded dwell times, fixation counts, run counts, and first-run dwell times of target lesions to evaluate visual attention. Transition entropy was applied to assess the temporal relations and spatial dynamics of systematic image reading. The eye-tracking results showed that the image reading sequence examined by transition entropy was comparable among resident doctors from different medical specialties (p = 0.82). However, the dwell time of the target lesions was shorter for the resident doctors from the neurology department (4828.63 ms, p = 0.01) than for those from the resident doctors from the radiology (6275.88 ms) and emergency (5305.00 ms) departments. The eye-tracking results in individual areas of interest only showed differences in the eye-tracking performance of the first-run dwell time (p = 0.05) in the anterior cerebral falx. Our findings demonstrate that resident doctors from different medical specialties may achieve similar imaging reading patterns for brain CT. This may mitigate queries regarding the influence of different backgrounds on training outcomes. [ABSTRACT FROM AUTHOR]

• Older adults can enjoy themselves thanks to a mobile telepresence robot. • The acceptance of mobile telepresence robots was high among older adults. • Mobile telepresence can encourage social interaction and connectedness. • Psychosocial and physiological well-being were improved through telepresence robot. This review aimed to explore the experiences of mobile telepresence robots (MTRs) among older adults (OAs) using a systematic mixed-studies approach. Ten electronic databases were searched for published and unpublished studies from inception to January 2022. The mixed methods assessment tool was used to assess the quality of the studies. A results-based convergent synthesis was employed to integrate quantitative and qualitative results. A total of 3,816 records were retrieved, and 43 studies were included, involving 1,568 participants across 19 countries. More than half of the selected studies had high methodological quality. After integrating findings from seven qualitative subthemes and eight quantitative categories, four themes emerged: (1) enjoyable experience, (2) willingness and acceptance, (3) promoting social connectedness, and (4) improved psychosocial and physiological well-being. The MTRs show promising benefits for OAs and their families. Future research should improve the design and functionalities of MTRs to customize different OAs. [ABSTRACT FROM AUTHOR]

With the persistent threat of emerging infectious diseases (EIDs), digital contact tracing (CT) tools can augment conventional CT for the prevention of healthcare-associated infectious disease transmission. However, their performance has yet to be evaluated comprehensively in the fast-paced emergency department (ED) setting. This study compared the CT performance of a radiofrequency identification (RFID)-based real-time location system (RTLS) with conventional electronic medical record (EMR) review against continuous direct observation of close contacts ('gold standard') in a busy ED during the coronavirus disease 2019 pandemic period. This cross-sectional study was conducted at the ED of a large tertiary care hospital in Singapore from December 2020 to April 2021. CT performance [sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and kappa] of the RTLS, EMR review and a combination of the two approaches (hybrid CT) was compared with direct observation. Finally, the mean absolute error (MAE) in the duration of each contact episode found via the RTLS and direct observation was calculated. In comparison with EMR review, both the RTLS and the hybrid CT approach had higher sensitivity (0.955 vs 0.455 for EMR review) and a higher NPV (0.997 vs 0.968 for EMR review). The RTLS had the highest PPV (0.777 vs 0.714 for EMR review vs 0.712 for hybrid CT). The RTLS had the strongest agreement with direct observation (kappa=0.848). The MAE between contact durations of 80 direct observations and their respective RTLS contact times was 1.81 min. The RTLS was validated to be a high-performing CT tool, with significantly higher sensitivity than conventional CT via EMR review. The RTLS can be used with confidence in time-strapped EDs for time-sensitive CT for the prevention of healthcare-associated transmission of EIDs. [ABSTRACT FROM AUTHOR]

Postmenopausal women are at significant risk for osteoporotic fractures due to their rapid bone loss. Half of all postmenopausal women will get an osteoporosis-related fracture over their lifetime, with 25% developing a spine deformity and 15% developing a hip fracture. By 2050, more than half of all osteoporotic fractures will occur in Asia, with postmenopausal women being the most susceptible. Early management can halt or even reverse the progression of osteoporosis. Consequently, on October 31, 2020, the Taiwanese Osteoporosis Association hosted the Asia–Pacific (AP) Postmenopausal Osteoporotic Fracture Prevention (POFP) consensus meeting, which was supported by the Asian Federation of Osteoporosis Societies (AFOS) and the Asia Pacific Osteoporosis Foundation (APOF). International and domestic experts developed ten applicable statements for the prevention of osteoporotic fractures in postmenopausal women with low bone mass or osteoporosis but no fragility fractures in the AP region. The experts advocated, for example, that postmenopausal women with a high fracture risk be reimbursed for pharmaceutical therapy to prevent osteoporotic fractures. More clinical experience and data are required to modify intervention tactics. [ABSTRACT FROM AUTHOR]

• Greater EOR is associated with better survival outcomes for GBM, but GTR is typically considered the upper limit. • In certain regions such as the anterior temporal lobe, more extensive resection via lobectomy may be feasible. • Here, we aimed to compare the outcomes after lobectomy or GTR for GBM. Overall survival (OS) for glioblastoma multiforme (GBM) has a known association with the extent of tumor resection with gross total resection (GTR) typically considered as the upper limit. In certain regions such as the anterior temporal lobe, more extensive resection by means of a lobectomy may be feasible. In our systematic review and meta-analysis, we aimed to compare the outcomes of lobectomy and GTR for GBM. PubMed and Embase were queried for studies that compared the outcomes after lobectomy or GTR for GBM. The primary outcomes were OS, progression-free survival (PFS), and Karnofksy Performance Status (KPS) score at the latest follow-up. The secondary outcomes were seizure control at the latest follow-up and complication rates. Meta-analysis for OS and PFS was performed using individual-participant data reconstructed from published Kaplan-Meier curves. Random-effect meta-analysis was performed for KPS. The secondary outcomes were pooled using descriptive statistics. Of the 795 records screened, 6 were included in our study. Meta-analysis revealed that anterior temporal, frontal, or occipital lobectomy was associated with significantly better OS (p < 0.001) and PFS (p < 0.001) than GTR, but not KPS (MD = 6.37; 95% CI=(-13.80, 26.54); p = 0.536). Anterior temporal lobectomy was associated with significantly better seizure control rates than GTR for temporal GBM (OR = 27; 95% CI=(1.4, 515.9); p = 0.002). There was no statistically significant difference in complication rates between anterior temporal, frontal, or occipital lobectomy and GTR. In conclusion, lobectomy was associated with significantly better OS, PFS, and seizure control than GTR for GBM. [ABSTRACT FROM AUTHOR]

The lateral wall of the maxillary sinus is supplied by the posterior superior alveolar artery (PSAA). It may be affected by trauma, pathology, or surgery performed to access or correct any fracture involving the maxillary sinus. This study analysed the prevalence and distance of the PSAA from the floor of the maxillary sinus in selected Southeast Asian patients. Methods: This is a cross sectional study conducted using cone-beam computed tomographic images of 83 dentate patients with a mean age of 38.3 years. Results: One hundred sixty-six maxillary sinuses of 54 males and 29 females were evaluated, with PSAA observed in 91.6 % of sinuses. Of the PSAA identified (n = 152), 64.5 % were intraosseous (n = 98), 25.7 % were beneath the sinus membrane (n = 39), and the remaining 15 (9.9 %) were on the external cortex of the lateral sinus wall. The mean distance between PSAA and the lowest point of the sinus floor was 11.44 mm (SD, 3.36). Sixty-four maxillary sinus walls (38.6 %) presented with 2 PSAA branches. The inferior and superior branches were located 6.42 mm (SD, 2.68) and 8.48 mm (SD, 3.56) from the floor of the maxillary sinus, respectively. The mean difference between these 2 branches was 2.25 mm (SD, 1.90). Conclusion: This study confirms the different locations of the PSAA in relation to the lateral wall of the maxillary sinus with no gender influence. Branching of PSAA occurs, and should be highlighted to surgeons. [ABSTRACT FROM AUTHOR]

• Enhanced measures in hospital to prevent nosocomial transmission and clusters. • ARI surveillance in healthcare workers is a good sentinel surveillance for COVID-19. • SARS-CoV-2 test positivity rate in ED patients reflect community COVID-19 incidence. • Hospital surveillance systems complement national COVID-19 reporting systems. [ABSTRACT FROM AUTHOR]

This article utilizes big data technology to design an automatic scoring system for English writing. The research of this thesis specifically answers the following questions: (1) whether the automatic scoring system can effectively improve university student' English writing ability. Which is better to use only traditional teacher feedback or a combination of automatic scoring system and teachers in English teaching feedback? (2) How does the automatic scoring system affect university student? (3) Do students prefer teacher feedback or a combination of automatic scoring system and teacher feedback? Through pre-test and post test, pre-test and post test questionnaires, and interview research methods, the experiment analyzes the impact and changes of writing feedback teaching combined with automatic scoring system and teachers on students' writing learning. In the process of the experiment, two classes of university were selected as the objects of the experiment. The experimental results show that 93% of the students in class A and 92% of the students in class B scored above 90 points at ordinary times. The two data values are similar. The students in both classes have a certain English foundation and the English foundation is similar. More than half of the students can well understand the writing feedback provided by the website. Most of the students held a positive attitude towards the feedback of the automatic scoring system to promote writing revision. The system builds a teaching model with complementary resource advantages to maximize the benefit of feedback teaching in English writing. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of the Enhanced Primary Healthcare (EnPHC) interventions on process of care and intermediate clinical outcomes among type 2 diabetes patients. This was a quasi-experimental controlled study conducted in 20 intervention and 20 control public primary care clinics in Malaysia from November 2016 to June 2019. Type 2 diabetes patients aged 30 years and above were selected via systematic random sampling. Outcomes include process of care and intermediate clinical outcomes. Difference-in-differences analyses was conducted. We reviewed 12,017 medical records of patients with type 2 diabetes. Seven process of care measures improved: HbA1c tests (odds ratio (OR) 3.31, 95% CI 2.13, 5.13); lipid test (OR 4.59, 95% CI 2.64, 7.97), LDL (OR 4.33, 95% CI 2.16, 8.70), and urine albumin (OR 1.99, 95% CI 1.12, 3.55) tests; BMI measured (OR 15.80, 95% CI 4.78, 52.24); cardiovascular risk assessment (OR 174.65, 95% CI 16.84, 1810.80); and exercise counselling (OR 1.18, 95% CI 1.04, 1.33). We found no statistically significant changes in intermediate clinical outcomes (i.e. HbA1c, LDL, HDL and BP control). EnPHC interventions was successful in enhancing the quality of care, in terms of process of care, by changing healthcare providers behaviour. • EnPHC is a multifaceted intervention that exists as an integrated care mode. • It improved seven out of fourteen processes of care in diabetes management. • Intermediate clinical outcomes such as HbA1c, LDL, and HDL were also measured. • Targets were met for three out of four outcomes, but they were not statistically significant. [ABSTRACT FROM AUTHOR]

Recently, various machine learning techniques have been proposed to realize automatic ultrasound (US) image analysis for robotic US acquisition tasks. However, obtaining large amounts of real US images for training is usually expensive or even infeasible in some clinical applications, such as transesophageal echocardiography (TEE). An alternative is to build a simulator to generate synthetic US data for training, but the differences between simulated and real US images may result in poor model performance. This work presents a novel Sim2Real framework to learn robotic US image analysis based on simulated data to address the challenges of limited real US data for robotic TEE. A style transfer model is proposed based on unsupervised contrastive learning to convert real US images into the simulation style. Moreover, a task-relevant model is designed to combine CNNs with vision transformers and trained only on the simulated data to generate task-dependent predictions. We demonstrate the effectiveness of our method in an image regression task to predict the probe position based on US images in robotic TEE. Our results show that using only simulated US data and a small amount of unlabelled real data for training, our method can achieve comparable performance to semi-supervised and fully supervised learning methods. Moreover, the effectiveness of our previously proposed CT-based US image simulation method is also indirectly confirmed. [ABSTRACT FROM AUTHOR]

Incontinence-associated dermatitis (IAD) is a type of irritant contact dermatitis due to prolonged exposure of the skin to moisture induced by urine or/and faeces. The main principles when treating IAD involves protecting the skin from further exposure to irritants, establishing a healing environment, and eradicating skin infections. This study aimed to evaluate the effectiveness of the hydrocolloid crusting method (HCM) versus the standard care method (SCM) in treating IAD. A randomised controlled trial was conducted in an acute tertiary hospital in Singapore between August 2019 to September 2021. Using computer-generated numbers, patients were randomised into either HCM or SCM treatment groups. HCM treatment involved cleansing the affected area with a pH-neutral non-rinse moisturising cleanser, and the application of alternate layers of hydrocolloid powder, and non-sting film barrier spray (repeated three times during each use). Patients in the SCM treatment group received the same cleanser followed by a 30% zinc oxide barrier cream. IAD was assessed daily for up to seven days by the wound care nurses using the IAD severity tool. The primary outcome of the study was the mean difference in IAD score per day between both methods. Forty-four patients were eligible and recruited (22 in HCM; 22 in SCM). Patients in both groups were comparable in age and gender. IAD Category 2 was more predominant in both methods. The most common location of IAD was at the perianal skin and diarrhea related to gastroenteritis was the most prevalent cause of IAD. More patients in the SCM group (n = 12; 54.5%) had their IAD healed within seven days compared to HCM, (n = 7; 31.8%) group. However, the average decrease in IAD scores per day for both methods were found to be similar. HCM can be considered as a treatment of IAD along with the use of SCM. A skin care regimen should include effective cleansing, skin protection, and moisturization in IAD management. • Incontinence-associated dermatitis (IAD) is prevalent in the older population and commonly caused by faecal incontinence. • IAD can be treated with the hydrocolloid crusting method (HCM) and standard care method (SCM). • IAD management should include effective cleansing, skin protection, and moisturization. [ABSTRACT FROM AUTHOR]