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The primary purpose of this study was to adapt selected accuracy and precision tests in table tennis to the specific skills of elite table tennis players with impairment. The study included a sample of 23 Para table tennis players with an average age of 31.8 ± 12.22 years (including 30.4% females) who belonged to the senior Polish Para table tennis team. A battery of six tests evaluating stroke accuracy and serve precision was assessed. The analysis of the reliability of these tests confirmed the legitimacy of using this battery of accuracy and precision tests to assess the skills of Para table tennis players in all three integrated sport classes: players in wheelchairs, in a standing position, and with intellectual impairment. Analysis of the data obtained from the tests could provide coaches with relevant information regarding elite Para table tennis players' level of performance and examine selected accuracy and precision elements of their individual technique. [ABSTRACT FROM AUTHOR]

Context: Inappropriate activation of the anterolateral abdominal muscles affects the stability of the lumbopelvic zone and increases the appearance of pain and lesion in the area. Therefore, ways to improve its effective contraction are crucial in rehabilitation. The aim of this study was to compare the activation of the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles in 3 different pelvic positions (down pelvis [DP], horizontal pelvis [HP], and up pelvis [UP]) during sling bridge exercise (SBE) to determinate which position is more effective to promote a correct contraction of the anterolateral abdominal muscles. Design: Cross-sectional study. Methods: Fifteen participants performed 3 variations (DP, HP, and UP) of a one-legged exercise called "supine pelvic lift" on a sling device. The thicknesses of the TrA, IO, and EO were recorded at rest and at the 3 positions using ultrasound imaging. Thickness, change ratio, lateral slide of TrA, and preferential and contraction activation ratio of TrA, IO, and EO were analyzed. Results: TrA and IO showed greater activation (P = .01) in the UP position than the other pelvic positions. In addition, UP position decreased the activation of the EO (P = .01). Conclusion: Based on the results of this study, SBE in the UP position has the potential to improve normal contraction patterns of the musculature and can be used in future intervention of the lumbopelvic zone. [ABSTRACT FROM AUTHOR]

To test the hypotheses that, after the delivery of manual wheelchairs following the WHO 8-step service-delivery process, wheelchair-related health and quality of life, wheelchair skills, wheelchair use, and poverty probability would improve; and that the number of wheelchair repairs required, adverse events, caregiver burden, and the level of assistance provided would decrease. This was a longitudinal, prospective within-subject study including 247 manual wheelchair users, and 119 caregivers, in El Salvador who received a wheelchair following the WHO 8-step process as well as maintenance reminders. Outcome measurements were performed via structured questionnaires and dataloggers at the initial assessment, at wheelchair delivery, and at 3- and 6-month follow-up. Significant improvements in wheelchair-related health indicators (all with p < 0.004) and quality of life (p = 0.001), and a significant reduction in national and "extreme" poverty probability (p = 0.004 and p = 0.012) were observed by six months. Wheelchair use significantly decreased (p = 0.011 and p = 0.035) and wheelchair skills increased (p = 0.009). Caregiver burden did not change (p = 0.226) but the number of activities of daily living (ADLs) that required no assistance significantly increased (p = 0.001) by three months and those who required complete assistance decreased (p = 0.001). No changes were observed in wheelchair repairs (p = 0.967) and breakdowns over time with new wheelchairs. Wheelchair service delivery using the WHO 8-step process on manual wheelchair users in El Salvador has positive effects on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. Further research is needed to determine the relative contributions of the intervention components. Providing manual wheelchairs using the 8-step process of the WHO has benefits on health and quality of life, wheelchair skills, caregiver assistance levels, and poverty. The WHO 8-steps service delivery process for manual wheelchairs can be used in less-resourced settings. [ABSTRACT FROM AUTHOR]

Many non-pharmacological interventions have been proposed for spasticity modulation in spastic stroke subjects. To investigate the immediate effect of dry needling (DN), electrical stimulation (ES), and dry needling with intramuscular electrical stimulation (DN+IMES) on H-reflex in post-stroke spasticity. Spastic subjects with stroke (N = 90) (55–85 years) were evaluated after 1 month of stroke onset using Modified Ashworth Scale (MAS) score ≥1. Subjects were randomly allocated to receive one session of DN – Soleus (N = 30), ES – posterior lateral side of the leg with 100 Hz and 250 μs pulse width (N = 30), or DN+IMES – Soleus (N = 30). MAS, H-reflex, maximum latency, H-amplitude, M-amplitude and H/M ratio, were recorded before and after one session of intervention. Relationships for each variable within group or the difference among groups were calculated by effect size. Significant decrease in H/M ratio in Gastrocnemius and Soleus at post-treatment within DN group (P =.024 and P =.029, respectively), large effect size (d = 0.07 and 0.62, respectively); and DN+IMES group (P =.042 and P =.001, respectively), large effect size (d = 0.69 and 0.71, respectively). No significant differences in all variables at pre-treatment and post-treatment was recorded among ES, DN, and DN+IMES groups. Significant decrease in MAS was recorded at post-treatment compared to pre-treatment within ES group (P =.002), DN group (P =.0001), and DN+IMES group (P =.0001), but not significant (P >.05) among three groups at pre-treatment (P =.194) and post-treatment (P =.485). Single session of DN, ES, and the DN+IMES can significantly modulate post-stroke spasticity by possible bottom-up regulation mechanisms. [ABSTRACT FROM AUTHOR]

Objectives: This laboratory study evaluated the influence of the fluorescence intensity of composite resins on additional tooth wear and the presence of restorative material in different dental thirds during the retreatment of direct veneers. Materials and Methods: The crown dimensions of 60 bovine incisors were reduced to 10 × 8 mm. The teeth were classified according to the fluorescence intensity of the composites: low (LOW) (TPH Spectra), medium (MED) (Opallis), and high (HIGH) (Essentia) groups. The teeth were divided according to the removal methods: conventional (CON) and fluorescence‐aided identification technique (FIT). The specimens were scanned (T0), received veneer preparation, and scanned again (T1). After restorations, the composites were removed and the teeth were scanned (T2). Measurement assessments between T1 and T2 were performed to determine additional wear, presence of residual areas, and the average between additional wear and the presence of residual areas. Kruskal Wallis, Mann–Whitney, Friedman, 2‐way ANOVA, and post‐Tukey tests were performed (α < 0.05). Results: The comparison of composite resins indicated a smaller area of additional wear and greater residue presence in the HIGH group than the LOW group for both techniques in the cervical third. Regarding removal methods, the FIT produced greater additional wear than the CON method for the LOW and MED groups in the middle and cervical thirds. The incisal third exhibited greater additional wear than the other thirds. Conclusions: Composite resins with high fluorescence intensity removed using FIT had less tooth wear. The incisal third was the most affected area for direct veneer removal procedures. Clinical Significance: A FIT has been proposed for composite resin removal; however, the different fluorescence intensities of composite resins can influence tooth wear caused during this procedure. [ABSTRACT FROM AUTHOR]

Women with breast cancer who underwent taxane-based chemotherapy demonstrate diminished postural stability. However, the data concerning dynamic postural stability among women with breast cancer during taxane-based chemotherapy remains insufficient. To investigate postural stability among women with breast cancer during taxane-based chemotherapy. Fifteen women with breast cancer participated in this study. Postural stabilities were assessed at five intervals during the course of chemotherapy treatment. Static postural stability was measured during single leg with eyes open (SEO) and eyes closed (SEC) conditions, while dynamic postural stability was measured during performance of the limit of stability test (LOS). Postural stability was described using 95% confidence ellipse area (EA), center of pressure (COP) path length (PL), and COP average velocity (AV). For static postural stability assessment, SEO condition was found to have significant increases in EA, PL, and AV (p =.001, p <.001, and p =.02, respectively). For dynamic postural stability assessment, a significant difference in EA was observed in the forward, backward, right, and left directions (p =.02, p =.02, p <.001, and p =.01, respectively). In addition, a significant difference in PL was found while performing in a backward direction (p =.02). The findings showed that women with breast cancer may have experienced decreased static and dynamic postural stability. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of fluid management, symptom control, and quality of life on education based on the Roy Adaptation Model. This randomized controlled study was conducted with the participation of 107 patients (53 intervention, 54 control). Data were collected using the "Patient Data Collection Form," "Fluid Control in Hemodialysis Patients Scale," "Dialysis Symptom Index," and "Nottingham Health Profile." The forms were filled out through face-to-face interviews with the patients in the intervention and control groups at the 0th (onset), 1st, and 3rd months. The patients in the intervention group were trained with an education booklet based on the Roy Adaptation Model. The results revealed that the education given according to the Roy Adaptation Model improved the compliance with fluid control, quality of life, and symptom control of hemodialysis patients. It is recommended that education based on the Roy Adaptation Model be systematically used by hemodialysis nurses. The results are limited to the population included in the study, and further research on hemodialysis populations is needed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Providing effective health education is essential for patients with cancer-related pain. One solution is leveraging instant messaging tools for teach-back health education. OBJECTIVES: This study investigated the effects of WeChat-based teach-back health education on patients with advanced cancer who underwent patient-controlled intrathecal analgesia implantation and used hydromorphone. METHODS: This retrospective study evaluated 150 hospitalized patients with advanced cancer pain. Patients were classified into a conventional health education group (N = 50) and a teach-back group (N = 100) based on whether they received WeChatbased teach-back health education. Pain was rated using a numeric rating scale, and sleep quality was measured using the Pittsburgh Sleep Quality Index at one, two, and three months postdischarge. FINDINGS: Patients who received remote teachback health education better managed their pain. Data also demonstrated improvements in patients' sleep quality and caregiver satisfaction, and reductions in the occurrence of adverse reactions. [ABSTRACT FROM AUTHOR]

Purpose: Muscle mechanics is paramount in our understanding of motor performance. However, little is known regarding the sensitivity of fascicle dynamics and connective tissues stiffness to exercise duration and ambient temperature during running, both increasing muscle temperature. This study aimed to determine gastrocnemius medialis (GM) fascicle dynamics in vivo during running in temperate and hot conditions, as well as muscle-tendon unit responses. Methods: Using ultrafast ultrasound, 15 participants (8 men, 7 women; 26 ± 3 yr) were tested before, during (2 and 40 min), and after a running task (40 min at 10 km⋅h-1) in temperate (TEMP; ~23°C) and hot (HOT: ~38°C) conditions. Results: Although core, skin temperatures, and heart rate increased from the beginning to the end of the exercise and in a larger extent in HOT than TEMP (P < 0.001), the physiological stress elicited did not alter running temporal parameters and GM fascicle operating lengths, with similar behavior of the fascicles on their force-length relationship, over time (2 vs 40 min) or across condition (TEMP vs HOT; P ≥ 0.248). Maximal voluntary force production did not reported statistical changes after exercise (P = 0.060), and the connective tissues stiffness measured (i.e., passive muscle and stiffness of the series-elastic elements) did not show neither time (P ≥ 0.281), condition (P ≥ 0.256) nor time-condition interaction (P ≥ 0.465) effect. Conclusions: This study revealed that prolonged running exercise does not alter muscle-tendon unit properties and interplay, which are not influenced by ambient temperature. These findings may rule out potential detrimental effects of heat on muscle properties and encourage further investigations on longer and more intense running exercise. [ABSTRACT FROM AUTHOR]

Background: The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated. Purpose: To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting. Study Design: Descriptive laboratory study. Methods: A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion. Results: The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o'clock labral position (14.1 ± 2.8 mm), and 3-o'clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups (P =.01 to.02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups (P >.99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing. Conclusion: The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbidity in the remaining tendon. Segmental labral reconstruction performed with the IHRF tendon exhibits similar biomechanical outcomes compared with that performed with ITB. Clinical Relevance: This study demonstrates the viability of segmental labral reconstruction with an IHRF tendon and provides a detailed anatomic description of the tendon in the context of an arthroscopic labral reconstruction. Clinicians can use this information during the selection of a graft and as a guide during an arthroscopic graft harvest. [ABSTRACT FROM AUTHOR]

Physical activity levels are low in cancer survivors. Remotely delivered programs which harness wearable technology may potentially be beneficial. To evaluate the feasibility and preliminary efficacy of a remotely delivered, physical activity intervention which harnessed wearable technology. This single arm pre-post longitudinal study included cancer survivors who had completed treatment in the preceding 3 years. Participants were supplied with a Fitbit One® or Flex® for 12 weeks. Physical activity goals were discussed during support phone calls. Outcome measures, assessed at baseline (T1), 12 weeks (T2), and 24 weeks (T3), included feasibility (recruitment, adherence, safety, acceptability) and efficacy [physical activity (Godin leisure time Index, ActiGraph GT3X+), quality of life (functional assessment of cancer therapy – general, short form 36 physical functioning component), functional capacity (six-minute walk test)]. Forty-five participants completed T1 assessments (10 males, 35 females). Thirty-nine (86.6%) of those underwent assessment at T2 and 31 (68.8%) at T3. The intervention was perceived positively with no adverse effects. There were increases in functional capacity (six-minute walk test, p =.002) between T1-T3, an increase in quality of life [short form 36 physical functioning measure (p =.0035), functional assessment of cancer total score (p =.02)] and self-report physical activity levels (p =.000123) between T1-T2, although effect sizes were generally low (d = 0.180 to d = 0.418). Objectively measured physical activity did not change. A physical activity intervention including wearable technology was safe, feasible, and well received by cancer survivors. An intervention based on this proof of concept should be followed up in further studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate therapeutic footwear expectations and usability of individuals with diabetes and foot complications. Design: A prospective multicenter study was conducted on participants with a high risk of developing a diabetic foot ulcer. Setting: Participants were enrolled in 11 different specialized diabetic foot units in Spain between March 2022 and June 2023. Subjects: Patients with diabetes at moderate to high risk of foot ulceration receiving first therapeutic footwear prescription. Interventions: All the patients included in the research were prescribed with their first pair of therapeutic footwear. Main measures: Primary outcome measures were MOS-pre and MOS-post questionnaires evaluating use and usability of prescribed therapeutic footwear. Secondary outcome measures aimed to evaluate footwear clinical efficacy as ulceration rate and self-reported perceived walking distance per day. Results: The use of therapeutic footwear exceeded the patient's pre-provision prediction of their anticipated use in 94% of people (n = 126). Based on the visual analogic satisfaction scale, the median satisfaction of daily wearing their therapeutic footwear was 7 points, Interquartile Range (IQR) [5–8.25]. During the follow-up period, 39 participants (29.1%) experienced diabetic foot ulcer. Perceived walking distance participants reported an improvement in their perceived walking ability during various daily life activities. Conclusions: Diabetes patients at moderate to high risk of diabetic foot ulcer improved their perception of walking ability after therapeutic footwear prescription. Adherence to the therapeutic footwear prescription resulted in less ulcerations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lumbar stabilization exercises (LSE) provide dynamic trunk stability, promote muscle strength and endurance, and improve low back pain rehabilitation and performance. OBJECTIVE: To clarify the differences in trunk muscle activity during LSEs on stable and different unstable surfaces. METHODS: Fifteen healthy males performed three exercises (elbow-toe, hand-knee, and side bridge) on stable (floor) and unstable surfaces. Muscle activity of the bilateral rectus abdominis, internal oblique, external oblique, and erector spinae were recorded. Data were compared using the Friedman test. Pairwise comparisons were performed using Wilcoxon's signed rank test if significant differences were observed. RESULTS: In the elbow-toe exercise, muscle activity of the rectus abdominis and right internal oblique increased in the following order: floor, low-difficulty, and high-difficulty unstable surface. In the hand-knee exercise, muscle activity of the internal oblique on the lower-extremity elevated side, external oblique, and erector spinae on the upper-extremity elevated side were greater on unstable surface exercise performance. In the side bridge exercise, rectus abdominis muscle activity was highest on a high-difficulty unstable surface. CONCLUSION: Trunk muscle activity increased during exercise on unstable surfaces. Since the effects of unstable surfaces vary depending on muscle and exercise types, exercise difficulty and surface stability must be considered accordingly. [ABSTRACT FROM AUTHOR]

Quality experiences in sport programming for children with autism spectrum disorder (ASD) can promote physical and psychosocial benefits and long-term quality participation (QP). Unfortunately, children with ASD often experience sport participation barriers and, consequently, participate less in sport compared with children without disabilities. This study investigated QP priorities and strategies that could foster QP for children with ASD. Caregivers (n = 13), volunteers (n = 26), and staff (n = 14) involved in sport programming for children with ASD rated experiential elements of QP using the Measure of Experiential Aspects of Participation. In addition , a two-round Delphi survey with staff (Round 1: n = 11; Round 2: n = 13) generated 22 strategies for promoting QP—each rated highly with regard to importance (5.69–6.85 on a 7-point scale). Strategies were substantiated with published research evidence. Findings informed the development of a QP tool designed to help instructors implement identified strategies in hopes of improving sport experiences for children with ASD. [ABSTRACT FROM AUTHOR]

Context: Whole-body vibration (WBV) training improves muscle strength and balance. Few studies have focused on the effects of WBV frequencies below 30 Hz. We aimed to investigate the effect of low-frequency WBV training on muscle activity, fatigue recovery, and oxygen consumption (VO2). Design: Prospective single-group, repeated-measures study. Methods: In this controlled laboratory setting study, 20 healthy adults (age 23.26 [1.66] y) performed half squats at 0, 4, 6, 8, 12, 16, 20, 24, and 30-Hz WBV. Muscle activity was evaluated using the root mean square and peak electromyography amplitude of 6 muscles (iliocostalis, rectus abdominis, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius) obtained via surface electromyography. VO2 was measured during the squats using a gas analyzer, and fatigue recovery was evaluated using measurements of lactate after the squats and after a recovery period. Statistical significance was set at P < .05, and analysis of variance was conducted to determine differences in muscle activity, fatigue, recovery, and VO2, with post hoc analyses as appropriate. Results: Of the 6 muscles measured, the muscle activity of the gastrocnemius alone significantly increased from 0 Hz at 4, 8, 12, 16, 24, and 30 Hz based on the root mean square values and at 4, 8, 12, and 30 Hz based on the peak electromyography amplitude values. There were no significant differences in the other muscles. There were no significant differences in VO2 or in lactate levels. Conclusions: Low-frequency WBV during squat exercises significantly increased the activity of the gastrocnemius medialis only at specific frequencies in healthy young adults. Low-frequency WBV is safe and has the potential to increase muscle activity. [ABSTRACT FROM AUTHOR]

Background: Calcitonin gene-related peptide (CGRP) is the most promising candidate to become the first migraine biomarker. However, literature shows clashing results and suggests a methodological source for such discrepancies. We aimed to investigate some of these methodological factors to evaluate the actual role of CGRP as biomarker. Methods: Previous to the experimental part, we performed a literature review of articles measuring CGRP in migraine patients. Using our 399 bio-bank sera samples, we performed a series of experiments to test the validity of different ELISA kits employed, time of sample processing, long-term storage, sampling in rest or after moderate exercise. Analysis of in-house data was performed to analyse average levels of the peptide and the effect of sex and age. Results: Literature review shows the high variability in terms of study design, determination methods, results and conclusions obtained by studies including CGRP determinations in migraine patients. CGRP measurements depends on the method and specific kit employed, also on the isoform detected, showing completely different ranges of concentrations. Alpha-CGRP and beta-CGRP had median with IQR levels of 37.5 (28.2–54.4) and 4.6 (2.4–6.4)pg/mL, respectively. CGRP content is preserved in serum within the 24 first hours when samples are stored at 4°C after clotting and immediate centrifugation. Storages at -80°C of more than 6 months result in a decrease in CGRP levels. Moderate exercise prior to blood extraction does not modulate the concentration of the peptide. Age positively correlates with beta-CGRP content and men have higher alpha-CGRP levels than women. Conclusions: We present valuable information for CGRP measurements in serum. ELISA kit suitability should be tested prior to the experiments. Alpha and beta-CGRP levels should be analysed separately as they can show different behaviours even within the same condition. Samples can be processed in a 24-h window if they have been kept in 4°C and should not be stored for more than 6 months at -80°C before assayed. Patients do not need to rest before the blood extraction unless they have performed a high-endurance exercise. For comparative studies, sex and age should be accounted for as these parameters can impact CGRP concentrations. [ABSTRACT FROM AUTHOR]

In Cardiovascular Rehabilitation (CR), patient adherence to the maintenance phase is a major challenge. Virtual reality-based therapy (VRBT) promotes acute hemodynamic and autonomic repercussions similar to traditional rehabilitation and can increase patient adherence to the program. However, it is unknown whether the combination of VRBT to a traditional CR manages to maintain or even improve clinical and autonomic variables in long term. To analyze whether VRBT combination in a traditional CR can maintain or improve clinical and autonomic variables in cardiac patients in the maintenance phase of these programs. Twenty-six volunteers (62.04 ± 12.22 years) were evaluated, who underwent an initial assessment and two other assessments (in the sixth and 12th week) of the following outcomes: systolic and diastolic blood pressure, respiratory rate, pulse saturation of oxygen, heart rate, perceived exertion, and cardiac autonomic modulation, using linear and non-linear heart rate variability methods. Except for the apparent lack of clinical significance observed in Shannon Entropy, LF (nu), and HF (nu), the combination of VRBT as routine in a traditional program did not cause significant changes in the analyzed variables. combination of VRBT was able to maintain the chronic hemodynamic and autonomic repercussions caused by traditional CR. [ABSTRACT FROM AUTHOR]

The floor apparatus is associated with the highest rate of injury for male and female gymnasts in training and competition. This study aims to determine the magnitude of the upper and lower body impact loading when performing foundation floor tumbling skills and sequences. Fourteen sub‐elite artistic gymnasts (male, n = 9; female, n = 5) performed eight tumbling skills and sequences while wearing four inertial measurement units (IMU; upper back, lower back, forearm, and tibia). The peak resultant acceleration (PRA) during all ground contacts was calculated. The forearm and upper back PRA were analyzed for hand contacts, while the lower back and tibia PRA were analyzed for foot contacts. Descriptive statistics (median and inter‐quartile range), Wilcoxon signed‐rank tests and Friedman's ANOVA were calculated between IMU positions and gymnastics skills. Distal IMUs (forearm and tibia) recorded significantly higher loading than proximal IMUs (upper and lower back) for all ground contacts. Proximal IMUs experienced dampening due to shock attenuation properties of the human body, as these positions are located further away from the impact site. Additionally, some foundation skills exposed gymnasts to higher loading when the skill was performed separately, while other skills exposed gymnasts to higher loading when the skill was performed in a tumbling sequence. Training foundation skills separately and as a part of a tumbling sequence exposes the upper and lower body structures to high levels of impact loading. These results can be used by coaches to help in the design of safe training programs. Highlights: Distal segments (forearm and tibia) experienced significantly higher magnitudes of impact loading than the proximal areas (upper and lower back) during foundation gymnastics skills, most likely due to the shock attenuation properties of the human body when absorbing ground impacts.During the round‐off skill, gymnasts experienced greater lower back impact loading upon landing when performing the skill separately, but experienced greater upper back loading during the hand contact phase when performing the skill as part of a sequence (i.e., round‐off to backwards handspring, and round‐off, backwards handspring to backwards somersault).Impact loading differed between skills performed separately and skills that were performed within a tumbling sequence. Therefore, the loading experienced on the body was different due to the context in which the skill was performed (i.e., having to connect another skill afterward).Skill sequences should be considered as distinct or individual skills, rather than a combination of foundation skills, to better address the observed differences when prescribing and monitoring training loads. [ABSTRACT FROM AUTHOR]

Background/aims Some patient-reported outcome measures ask questions about fixed (ie standardised) activities. Other patient-reported outcome measures ask questions about activities that patients choose or generate. However, patients' appraisals of the importance of fixed and generated activities have not been directly compared and little is known about the construct of activity importance. The aim of this study was to compare patients' importance ratings for fixed and generated activities. It also examined relationships among patients' ratings of activity importance, pain and physical function. Methods Within a prospective cross-sectional design, 60 participants with knee osteoarthritis completed the Brief Pain Inventory, Western Ontario and McMaster Universities Osteoarthritis Index, as well as the McMaster Toronto Arthritis Patient Preference Questionnaire and a Patient-Reported Outcomes Measurement Information System physical function short form, which were modified to measure the importance of generated or fixed activities respectively. Results Participants rated generated activities as more important than fixed activities (P<0.01). They also gave higher importance ratings for fixed activities that they performed than fixed activities that they did not perform (P<0.01). The importance of the generated activities correlated with the Brief Pain Inventory (P<0.05) and Western Ontario and McMaster Universities Osteoarthritis Index (P<0.01), but the fixed activities' importance did not. Participants preferred to rate generated activities more than fixed activities (63.8%) and believed that their ratings of generated activities would better inform physicians than fixed activities (55.0%). conclusions The results from this study identified benefits of including generated activities within patient-reported outcome measures and clarified the construct of activity importance for patients with musculoskeletal pain. Implications for practice Allied health professionals may maximise activity importance for their patients by focusing on patient-generated activities. However, the best instructions for collecting patient-generated activities are unknown. [ABSTRACT FROM AUTHOR]

Purpose: This research was planned to follow the healing process of the oral mucosa in patients in intensive care with an "Impaired Oral Mucous Membrane Integrity" nursing diagnosis based on the "NOC (1100) Oral Health Assessment" outcome criteria. Method: This study, which was planned in a methodological and descriptive type of research, was carried out with 50 patients who were hospitalized in the intensive care clinic of a state hospital between June and December 2022, with a nursing diagnosis of "Impaired Oral Mucous Membrane Integrity." Data were collected using a Patient Information Form and the "NOC (1100) Oral Health Evaluation Scale" for the nursing outcomes classification. In the analysis of the data descriptive statistical methods, Pearson correlation test, Friedman test as well as Cohen's kappa test were used to evaluate the agreement between two independent observers. Findings: In the study, content validity index value of the NOC scale was calculated to be 0.90. The examination of the participants' mean scores on the NOC (1100) Oral Health Assessment Scale showed that there were statistically significant differences in terms of the repeated evaluations, except for the NOC indicators of "Oral mucosal integrity," "Gum integrity," and "Tooth integrity" (p < 0.01). No statistically significant correlation was found between the mean NOC scale scores of the patients according to the variables of age, body mass index, mechanical ventilation time, and length of stay in the intensive care unit (p > 0.05). Conclusions: The findings showed that the Turkish version of NOC (1100) Oral Health Assessment Scale was a valid tool for monitoring the healing process of the oral mucosa in patients in intensive care. Implications of nursing practice: With the use of NOC (1100) Oral Health Assessment Scale, a common language will be formed in the evaluation for monitoring the healing process of the oral mucosa in nursing care. [ABSTRACT FROM AUTHOR]

Background: Isolated gastrocnemius contracture has been associated with more than 30 lower limb disorders, including plantar heel pain/plantar fasciitis, Achilles tendinosis, equinus foot, adult flatfoot, and metatarsalgia. Although many techniques are available for gastrocnemius recession, potential anesthetic, cosmetic, and wound-related complications can lead to patient dissatisfaction. Open and endoscopic recession techniques usually require epidural or general anesthesia, exsanguination of the lower extremities and stitches and can damage the sural nerve, which is not under the complete control of the surgeon at all stages of the procedure. The purpose of this study is to evaluate the clinical results of a surgical technique for gastrocnemius lengthening with a needle, as previously described in cadaver specimens. Methods and results: We performed a prospective study of ultrasound-guided gastrocnemius tendon lengthening in level II using a needle in 24 cases (19 patients) of gastrocnemius contracture. The study population comprised 12 males and 7 females. Mean age was 41 years (18–64). All but 5 recessions were bilateral and occurred simultaneously. The indication for the procedure was gastrocnemius contracture; although the patients also presented other conditions such as non-insertional Achilles tendinopathy in 6 patients (2 were bilateral), insertional Achilles calcifying enthesitis in 4 (1 was bilateral), metatarsalgia in 4, flexible flat foot in 1 and plantar fasciitis in 5 (2 were bilateral). The inclusion criteria were the failure of a previous conservative protocol, that the Silfverskiöld test was positive, and that the pathology suffered by the patient was within the indications for surgical lengthening of the patients and were described in the scientific literature. The exclusion criteria were that the inclusion criteria were not met, and patients with surgical risk ASA 3 or more and children. In these patients, although possible, it is preferable to perform the procedure in the operating room with monitoring, as well as in children since they could be agitated during the procedure at the office. We used the beveled tip of an Abbocath needle as a surgical scalpel. All patients underwent recession of the gastrocnemius tendon, as in an incomplete Strayer release. We evaluated pre- and postoperative dorsiflexion, outcomes, and procedural pain (based on a visual analog scale and the American Orthopedic Foot and Ankle Society scores), as well as potential complications. No damage was done to the sural bundle. Results: Ankle dorsiflexion increased on average by 17.89°. The average postoperative visual analog score for pain before surgery was 5.78, 5.53 in the first week, 1.89 at 1 month, and 0.26 at 3 months, decreasing to 0.11 at 9 months. The mean postoperative American Orthopedic Foot and Ankle Society Ankle-Hindfoot score the average was 50.52 before surgery, 43.42 at 1 week, 72.37 at 1 month, 87.37 at 3 months, and 90.79 at 9 months. Conclusion: Ultrasound-guided needle lengthening of the gastrocnemius tendon is a novel, safe, and effective technique that enables the surgeon to check all the structures clearly, thus minimizing the risk of neurovascular damage. The results are encouraging, and the advantages of this approach include absence of a wound and no need for stitches. Recovery is fast and relatively painless. A specific advantage of ultrasound-guided needle lengthening of the gastrocnemius tendon is the fact that it can be performed in a specialist's office, with a very basic instrument set and local anesthesia, thus reducing expenses. [ABSTRACT FROM AUTHOR]

Linguistic factors influence the likelihood of occurrence of stuttering instances on a certain word within an utterance. However, studies on the relationship between stuttering instances and linguistic factors of Turkish-speaking individuals are scarce. This study aimed to determine the syllable- and word-based measures of stuttering speech samples of Turkish-speaking school-aged children who stutter. Stuttering-like disfluencies (SLDs) and lexical categories were identified after transcription of 61 children's spontaneous speech samples (age range = 6–16). Syllable-, word- and utterance-level measures were employed. Syllable-based and word-based stuttering frequency findings were significantly different (p <.001); SLDs were more likely to occur at the utterance-initial (p <.001) and word-initial (p <.001) positions; content words were more likely to be stuttered and, there was a relation between the occurrence of SLDs and utterance length (p =.001). Since there is great variability between word-based and syllable-based measures, and SLDs tend to occur at word onsets, using word-based measures in Turkish would provide a measure of stuttering frequency that is comparable to the literature. Moreover, findings support that phrases requiring greater demands on utterance planning increase the possibility of occurrence of stuttering instances. [ABSTRACT FROM AUTHOR]

Introduction: In the perioperative period, regional analgesia techniques may play an increasingly important role in "Enhanced Recovery After Surgery (ERAS)" programs, as they can facilitate recovery. We hypothesized that Erector Spinae Plane (ESP) block could improve regional perfusion, thereby limiting blood lactate increase. Therefore, we aimed to evaluate the effect of ESP block on intraoperative blood lactate levels in patients scheduled for elective on-pump cardiac surgery with ERAS protocol. Methods: A total of 68 adult patients scheduled for on-pump cardiac surgery were included. All patients were randomized to the ESP group and the non-ESP group. Blood lactate analyses were performed at intraoperative five-time points. C-Reactive protein (CRP) values were also measured. Results: Blood lactate values were significantly lower in the ESP group than in the Non-ESP group, at the end of CPB [1.78 (1.23–2.78) mmol L−1 to 2.63 (1.70–3.12) mmol L−1] and during the sternal closure period [1.78 (1.27–2.42) mmol L−1 to 2.40 (2.14–2.80) mmol L−1] (p = 0.039, p = 0.009). In addition, CRP values were significantly lower in the ESP group in the postoperative period [0.048 (0.036–0.105) g L−1 to 0.090 (0.049–0.154) g L−1] (p = 0.035). Conclusions: This study showed that preoperative bilateral single-shot ESP block significantly reduces intraoperative final blood lactate and postoperative CRP values. We consider that these results are related to the attenuation of intraoperative hypoperfusion and the alleviation of surgery-related postoperative inflammation. ERAS programs aim to achieve the rapid recovery of patients, a decrease in inflammation, and high-quality analgesia with less opioid consumption. Therefore, our results also prove that it is easier to reach the primary goals of ERAS programs with the application of ESP block in cardiac surgery. [ABSTRACT FROM AUTHOR]

Background: Patients on hemodialysis are particularly vulnerable to COVID-19 and may have a reduced response to vaccination because of a decreased immune response. The nutritional status before or during the infection could also impact on the clinical effectiveness of vaccination. Objectives: We aim to describe the evolution of clinical and nutritional biomarkers of hemodialysis patients infected with SARS-CoV-2 and to assess their association with vaccination status. Methods: An observational, analytic, longitudinal, retrospective multicenter study was carried out in 82 patients on hemodialysis with SARS-CoV-2 infection. Nutritional status was assessed using the Geriatric Nutritional Risk Index (GNRI), anthropometry, and biochemical parameters. The association of the vaccine doses with clinical- and nutritional-related variables was also evaluated. Results: The percentage of vaccinated patients was similar to that of nonvaccinated patients. Before infection, most of the patients were malnourished. They presented lower albumin, creatinine, and urea levels than the well-nourished patients. Significant deterioration of nutritional status after infection was evidenced considering GNRI score, dry weight, and body mass index. Albumin and creatinine also decreased significantly after infection, whereas C-reactive protein increased in the acute phase. Significant inverse correlation was found between the variation of post–pre GNRI scores and basal albumin and C-reactive protein at 7 days. In addition, we observed the opposite trend between albumin at 30 days and basal cholesterol. A negative value in the GNRI variation was associated with bilateral pneumonia, need for hospitalization, and nutritional support. Vaccinated patients presented substantially less bilateral pneumonia and hospitalization. No significant effects were observed between vaccine doses and the variation in nutritional status, although a positive correlation was detected with the albumin at 7 days and C-reactive protein before infection and the number of vaccine doses received. Discussion: COVID-19 is associated with affectations in the nutritional status and biomarkers in hemodialysis patients. In this study, vaccines have shown a protective effect against the clinical consequences of COVID. However, they have shown limitations in preventing the deterioration of nutritional status after infection. The results highlight the importance of promoting the vaccination in these patients as well as incorporating nutritional assessment before, during, and after the infection. [ABSTRACT FROM AUTHOR]

The main objective of this study was to explore the benefits of the use of educational audio-visual materials in facilitating learning for students with hearing loss. The study analysed whether students with hearing loss had a visual learning preference when they watched an audio-visual and if the images present contributed to the retention of more information by this group. The study sample was made up of 28 participants, from 7 to 9 years old, of whom 14 had prelingual hearing loss and 14 were age- and sex-matched students without hearing loss. They were all schooled together in general education classrooms in an oral modality. They were asked to watch an educational video and then to describe its contents orally. The results obtained from analysing the references to the video content indicate that, despite the fact that the hard of hearing group made greater reference to video content transmitted from the images than the group without hearing loss, the effect does not achieve statistical significance. The study reinforces the idea that deafness does not determine a specific learning preference. [ABSTRACT FROM AUTHOR]

The Community Helpers Programme (CHP) is a peer-helping programme providing youth and young adults with tools to support their peers to problem solve and seek mental health and suicide prevention support. This study aims to evaluate the effectiveness of the provincial programme (primary outcomes = knowledge, self-efficacy; secondary outcome = awareness of stigma) and describe the experience of participants, coordinators, and others. The mixed methods evaluation included a longitudinal panel design outcome evaluation along with follow-up interviews. A series of three surveys collecting participant characteristics, knowledge, self-efficacy, and awareness of stigma at pre-training (T0), post-training (T1), and six-months follow-up (T2) were conducted. Mean group scores were calculated for completers (T0 and T1 completers and T0, T1, and T2 completers). Friedman tests were conducted to assess change over time and follow-up Wilcoxon Signed Rank tests determined the significance of changes in scores between each timepoint. Content analysis was conducted on qualitative data. Participants' knowledge of mental health, suicide, and available supports along with self-efficacy increased from T0 to T1, and declined at T2. Awareness of stigma was high at all timepoints. Themes from the qualitative analysis included skill and knowledge development facilitators (e.g., consideration of learner needs, passionate coordinators, engaged learning approaches), sustaining community helper connectedness (e.g., helpers' network, awareness of and communication with local resources), and role and impact of CHP (e.g., addressing stigma, success stories). This evaluation demonstrated that CHP was effective and offered feedback on experiences, including suggestions on CHP strengths and aspects to explore. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of topical sialogogue spray containing 1% malic acid in the treatment of xerostomia in patients with type 2 diabetes mellitus. Material and Methods: A randomized double‐blind controlled clinical trial was conducted on 52 patients with type 2 diabetes mellitus suffering from xerostomia. Patients were assigned equally to test group who received a topical sialogogue spray containing 1% malic acid and control group who received a placebo spray. Both groups were instructed to use the spray on demand for 2 weeks. The Summated Xerostomia Inventory‐Dutch Version questionnaire (SXI‐D) and the unstimulated salivary flow rate were evaluated for all patients at baseline, 2 and 4 weeks after malic acid/placebo application. Results: At 2 week's follow‐up, the unstimulated salivary flow rate increased significantly from 0.059 ± 0.024 to 0.191 ± 0.064 and from 0.055 ± 0.026 to 0.078 ± 0.032 for test and control groups, respectively, with a statistically significant difference favoring the test group. SXI‐D scores showed a significant decrease from 10.73 ± 2.22 to 8.38 ± 2.28 in the test group (p < 0.05), while in the control group it decreased from 10.62 ± 1.75 to 10.23 ± 1.48 (p > 0.05). Conclusion: A sialogogue spray containing 1% malic acid increased the unstimulated salivary flow rate in patients with type 2 diabetes mellitus suffering from xerostomia. [ABSTRACT FROM AUTHOR]

Background and Purpose. Leisure, as an occupation, played a crucial role in promoting individuals' health and well-being. However, the specific impact of leisure as an intervention for individuals with substance use disorder remains unclear. This pilot study was aimed at investigating the effect of a leisure intervention on occupational performance and occupational balance in individuals with substance use disorder. Methods. The sample for this quasiexperimental pretest–posttest with a two-month follow-up design comprised nine individuals aged between 18 and 55 years, selected using a convenience sampling method. The intervention consisted of a 2-month group leisure participation program, conducted twice a week, followed by a 2-month follow-up period. Primary outcome measures included occupational performance and occupational balance, and secondary outcome measures were leisure participation, quality of life, and drug craving. Outcome measures were assessed three times: preintervention, postintervention, and after the follow-up period. The outcome measures included the Canadian Occupational Performance Measure (COPM), Occupational Balance Questionnaire-11 (OBQ11), Nottingham Leisure Questionnaire (NLQ), 36-Item Short-Form Health Survey (SF-36), and Desire to Drug Questionnaire (DDQ). Data analysis was performed using the Friedman test and Wilcoxon signed-rank test as a post hoc procedure, with a significance level set at 5%. Results. The findings showed significant improvements in participants' occupational performance in postintervention and follow-up assessments (p < 0.01 , r = 0.59) and better occupational balance from pre- to postintervention (p < 0.01 , r = 0.59) and after the follow-up period (p < 0.01 , r = 0.60). Furthermore, significant enhancements were observed in leisure participation, quality of life, and a reduction in drug craving. Conclusion. The findings indicate that leisure intervention positively impacted both occupational performance and occupational balance, suggesting its potential as a beneficial therapeutic approach for individuals with substance use disorder. Additional research is warranted to delve deeper into and validate the effectiveness of leisure intervention within this specific population. [ABSTRACT FROM AUTHOR]

Background: Acetaminophen (ACT) has been studied in septic patients with detectable plasmatic levels of cell-free hemoglobin (Hb), where it demonstrated to inhibit the hemoprotein-mediated lipid peroxidation and oxidative injury, with a potential of beneficial effect on the endothelium. On the basis of this background, the aim of this study was to evaluate the sublingual microcirculation and the peripheral tissue perfusion before-and-after administration of ACT on clinical judgment in a cohort of febrile septic and septic shock patients. Methods: Prospective observational study. 50 adult septic and septic shocks treated with ACT for pyrexia, where the sublingual microcirculation and the peripheral tissue perfusion with Near Infrared Spectroscopy (NIRS) and vascular occlusion test (VOT) were evaluated before ACT (t0), after 30 min (t1) and after 2 h (t2). Cell-free Hb and the markers of oxidative stress and endothelial damage were measured at t0 and t2. Results: The study showed a significant increase of the density of the perfused small and total vessels of the sublingual microcirculation 30 min after the infusion of ACT; it also showed an increase of the Microvascular Flow Index (MFI) and a decrease in the heterogeneity of the flow. At a peripheral muscular level, we found an acceleration in the reperfusion curve after VOT at t1, expression of a higher reactivity of the microvasculature. Conclusions: ACT infusion did not show a clear correlation with cell-free Hb; however, it exhibited protective effect toward the microcirculation that was evident in particular in septic patients. This correlation merits further exploration. [ABSTRACT FROM AUTHOR]

Background: Left ventricular diastolic dysfunction has a significant impact on perioperative morbidity and mortality, and its incidence is high in elderly individuals. Anesthetic agents may impair diastolic function, which may increase the incidence of perioperative complications. The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle (LV) diastolic function in patients with diastolic dysfunction. The study was performed on 30 spontaneously breathing subjects (aged 60–80 years) with diastolic dysfunction. Methods: Thirty patients (aged 60–80 years) with diastolic dysfunction scheduled for surgery were recruited between November 2019 and March 2023. Left ventricle function was evaluated once the intravenous remifentanil infusion reached a target-controlled concentration of 2 ng/ml with transthoracic echocardiography. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm), whereas diastolic function focused on changes in transmitral peak flow (E), E/A, mitral septal and lateral e' waves, E/e' ratios and left atrial volume index following remifentanil infusion. Results: Diastolic function measures of LV (mitral E/e', septal and lateral e' waves) statistically significantly improved (E/e' from 10.6 ± 2.9 cm.sn− 1 to 9.5 ± 2.2 cm.sn− 1; p = 0.006) following remifentanil infusion. Left atrial volume index decreased following remifentanil infusion without statistical significance (from 55 ± 14.4 ml.cm− 2 to 51.6 ± 13.3 ml.cm− 2; p = 0.1). Systolic function (ejection fraction and Sm) did not change following remifentanil infusion. Conclusions: Remifentanil improves left ventricular diastolic parameters in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a plasma concentration of 2 ng.ml− 1 might be used safely in patients with left ventricular diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Background/Aims: The incidence of postpartum depression in Indonesia is greater than the global average, and has detrimental effects on mothers, families, society and the country. Mobile applications are widely used to treat postpartum depression, but combining this with readings from the Holy Quran is uncommon in Indonesia. This study aimed to investigate the effect of combining mobile applications with the Holy Quran on postpartum depression symptoms. Methods: A randomised controlled pre-post-test time series was conducted from June to December 2020, involving 128 pregnant women in their third trimester. The 'app' group (64 participants) received the intervention until 2 months postpartum, while the control group (64 participants) received no intervention. The Edinburgh postpartum depression scale, state-trait anxiety inventor, and the Rosenberg self-esteem scale were used to gather data. Results: Postpartum depression scores in the app group were significantly lower than in the control group. There were no differences in the anxiety or self-esteem scores between the app and control groups. The proportion of depression scores of 10 and above decreased by 25% in the app group and 7.8% in the control group. Conclusions: Use of a mobile application in combination with the Holy Quran voice may help reduce postpartum depressive symptoms in Indonesia. Maternity nurses and midwives may wish to recommend use of this app to the women they care for, if appropriate. [ABSTRACT FROM AUTHOR]

Context: Identifying gender-specific differentiation in each sport type is significant. In this way, sport- and gender-specific gains can be predicted. Therefore, this study aimed to examine the effects of skiing on physical performance, pain, quality of life, and gender-based differentiation. Design: Crossover trial. Methods: Sixty-eight volunteers, between 18 and 25 years of age, with no history of severe trauma in the spine and extremities, participated in our study. The skiers group consisted of licensed athletes (17 males and 17 females) who did active skiing for at least the past 2 years, the control group consisted of nonathletic and age-matched participants with no skiing experience (17 males and 17 females). Step test, vertical jump test, Flamingo balance test. hand-grip strength, and back-leg-chest strength measurements were performed to evaluate physical performance. Visual Analog Scale, McGill Pain Questionnaire, and Oswestry Low Back Pain Disability Questionnaire were used to evaluate pain experience. Quality of life was evaluated with Short Form-36 (SF-36). Results: Compared to the sedentary controls. VAS-activity and Oswestry Disability Index scores were lower: and aerobic performance. balance. hand-grip strength, back-leg-chest strength, and quality of life (SF-36-general health, SF-36-vitality, SF-36-mental health, and SF-total score) were higher iii skiers. Skiing was found to be effective in eliminating gender-based differentiation of the variables of hand-grip strength. pain, and quality of life: however, back-leg-chest strength and anaerobic performance variables were found to be ineffective in eliminating gender differentiation. Conclusions: Skiing allows that the individual increases physical performance and quality of life. It can also minimize gender-based differentiation of certain variables, such as muscular force, pain, and quality of life. [ABSTRACT FROM AUTHOR]

Background: The growing need for healthcare services as a result of a consistently rising prevalence of chronic diseases and rapid population aging calls for a new set of activities and practices. Therefore, we developed a program—3S (Simple, Smart, and Speed) Business Intelligence Systems (3S-BIS), which is an ERP software system that helps nursing business to support nursing entrepreneurship —and analyzed its effects on nursing students. Methods: A repeated-measures randomized controlled trial was performed with two groups: experimental (n = 29) and control (n = 30) groups. The former group underwent the five-day 3S-BIS education program. Each session comprised four components: lectures 1 and 2, simulation case study, and debriefing. Post-tests were performed immediately post-intervention and four and eight weeks later. The effectiveness was measured using the following variables: simulation design assessment, evaluation of educational practices in simulation, education satisfaction, self-efficacy for learning, and entrepreneurship. The differences before and after intervention between the experimental and control groups were analyzed using the Friedman test. The Mann–Whitney U test was used for comparisons between groups at each time point, and the Wilcoxon signed-rank test was used for comparisons within groups at each time point. Results: Post-intervention (8 weeks after intervention), the experimental group demonstrated higher simulation design assessment (z = -3.88, p = <.001), evaluation of educational practices in simulation (z = -3.34, p =.001), education satisfaction (z = -3.11, p =.002), self-efficacy for learning (z = -3.04, p =.002), and entrepreneurship (z = -2.15, p =.031) compared to controls. Furthermore, simulation design assessment score in the experimental group significantly differed between T1 (immediately after intervention) and T0 (baseline), and between T3 (8 weeks after intervention) and T0. Evaluation of educational practices in the simulation, education satisfaction, and self-efficacy also significantly differed between T1 and T0, and between T3 and T0. Entrepreneurship significantly differed between T3 and T2 (4 weeks after intervention), and between T3 and T0. Conclusions: The 3S-BIS program contributes to enhancing nursing start-up competency. Subsequent studies should evaluate the effects of the program on nurses who work in home healthcare services. [ABSTRACT FROM AUTHOR]

Background: Various Positive End-Expiratory Pressure (PEEP) titration strategies have been proposed to optimize ventilation in patients with acute respiratory distress syndrome (ARDS). We aimed to compare PEEP titration strategies based on electrical impedance tomography (EIT) to methods derived from respiratory system mechanics with or without esophageal pressure measurements, in terms of PEEP levels and association with recruitability. Methods: Nineteen patients with ARDS were enrolled. Recruitability was assessed by the estimated Recruitment-to-Inflation ratio (R/Iest) between PEEP 15 and 5 cmH2O. Then, a decremental PEEP trial from PEEP 20 to 5 cmH2O was performed. PEEP levels determined by the following strategies were studied: (1) plateau pressure 28–30 cmH2O (Express), (2) minimal positive expiratory transpulmonary pressure (Positive PLe), (3) center of ventilation closest to 0.5 (CoV) and (4) intersection of the EIT-based overdistension and lung collapse curves (Crossing Point). In addition, the PEEP levels determined by the Crossing Point strategy were assessed using different PEEP ranges during the decremental PEEP trial. Results: Express and CoV strategies led to higher PEEP levels than the Positive PLe and Crossing Point ones (17 [14–17], 20 [17–20], 8 [5–11], 10 [8–11] respectively, p < 0.001). For each strategy, there was no significant association between the optimal PEEP level and R/Iest (Crossing Point: r2 = 0.073, p = 0.263; CoV: r2 < 0.001, p = 0.941; Express: r2 < 0.001, p = 0.920; Positive PLe: r2 = 0.037, p = 0.461). The PEEP level obtained with the Crossing Point strategy was impacted by the PEEP range used during the decremental PEEP trial. Conclusions: CoV and Express strategies led to higher PEEP levels than the Crossing Point and Positive PLe strategies. Optimal PEEP levels proposed by these four methods were not associated with recruitability. Recruitability should be specifically assessed in ARDS patients to optimize PEEP titration. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the effectiveness and safety of insulin glargine 300 U/mL (Gla-300) in insulin-naive patients with type 2 diabetes mellitus (T2DM) inadequately controlled on oral antidiabetic drug (OADs) treatment in Turkey. Methods: One hundred eight patients from 20 centers enrolled in the study. Starting from baseline, Gla-300 was self-administered subcutaneously and once daily in the evening. The primary outcome was the mean change in glycated hemoglobin A1c (HbA1c) from baseline to week 24. Results: The mean (±SD) Hb1Ac level of 9.4% (±0.8) at baseline decreased to 7.5% (±0.9) at week 12 (P < .1) and to 7.3% (±0.9) at week 24 (P < .1). Although none of the patients were within the target Hb1Ac level of ≤7% at baseline, the percentage of patients who achieved the target Hb1Ac level was 30.4% at week 12 and increased to 42.9% at week 24. Gla-300 treatment achieved the Hb1Ac target in 21 (19.4%) patients without experiencing a hypoglycemic event and in 27 (25.0%) patients who experienced at least one hypoglycemic event. For each self-monitoring blood glucose time point, significant improvements were observed as compared to baseline (P < .001). Statistically significant improvement (P < .001) was seen in the treatment satisfaction questionnaire - status version scores between baseline and week 24. Conclusion: This study indicated that Gla-300 is effective to provide a successful glycemic control with low risk of hypoglycemia added to OADs in insulin-naive patients with T2DM, and it has the potential to improve the quality of life of patients. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to determine the relationship between knee extension torque induced by repetitive peripheral magnetic stimulation and the characteristics of the participants. Design: This was a basic study with noninvasive intervention. Knee extension torque induced by repetitive peripheral magnetic stimulation (repetitive peripheral magnetic stimulation–induced torque) and maximum voluntary contraction were measured. Stepwise method of multiple regression was performed to determine the factors affecting repetitive peripheral magnetic stimulation–induced torque at 100% intensity and repetitive peripheral magnetic stimulation–induced torque divided by maximum voluntary contraction (percent maximum voluntary contraction). Subcutaneous fat thickness, vastus lateralis muscle thickness measured by ultrasound, maximum voluntary contraction, and mean power frequency of electromyography during maximum voluntary contraction were selected as independent variables. Results: Repetitive peripheral magnetic stimulation was applied to the right vastus lateralis of 30 young healthy adults (average age, 21.1 ± 0.3 yrs). In the multiple regression analysis, repetitive peripheral magnetic stimulation–induced torque (P < 0.001) was shown to be independently and significantly associated with maximum voluntary contraction (β = 0.510), subcutaneous fat thickness (β = −0.358), and vastus lateralis muscle thickness (β = 0.208), while percent maximum voluntary contraction value (P < 0.05) was independently and significantly associated with vastus lateralis muscle thickness (β = 1.059). Conclusions: Repetitive peripheral magnetic stimulation–induced torque decreases with thicker subcutaneous fat and increases with stronger maximum voluntary contraction or with thicker muscle. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to research the clinical effectiveness of high-intensity laser therapy combined with exercise on pain, quality of life, and disability in patients with cervical radiculopathy and compared it with that of placebo and exercise alone. Design: Ninety participants with cervical radiculopathy were randomized into the following three groups: high-intensity laser therapy + exercise (n = 30), placebo + exercise (n = 30), and exercise only (n = 30). Pain, cervical range of motion, disability, and quality of life (36-item Short Form Health Survey) were assessed at baseline and weeks 4 and 12. Results: The mean age of the patients (66.7% female) was 48.9 ± 9.3 yrs. Pain intensity in the arm and neck, neuropathic and radicular pain levels, disability, and several parameters of the 36-item Short Form Health Survey showed an improvement in the short and medium term in all three groups. These improvements were greater in the high-intensity laser therapy + exercise group than in the other two groups. Conclusions: High-intensity laser therapy + exercise was much more effective in improving medium-term radicular pain, quality of life, and functionality in patients with cervical radiculopathy. Thus, high-intensity laser therapy should be considered for the management of cervical radiculopathy. [ABSTRACT FROM AUTHOR]

Turmeric is well-known for its analgesic, anti-inflammatory and anti-arthritic properties but 69.4% of the turmeric rhizome contains Turmerosaccharides whose clinical benefit is still unexplored. Turmacin®/NR-INF-02 is an aqueous extract of Turmeric containing Turmerosaccharides (>10%w/w) with negligible curcuminoids. Previous study with low dose Turmacin® confirmed its safety and efficacy in alleviating induced knee pain in healthy volunteers. Hence, this study aimed to assess the safety and explore the efficacy of moderately high dose Turmacin®. It was an open-label, single-arm interventional trial conducted from August 2018 - January 2019 in a tertiary care teaching hospital. Turmacin® was administered for seven days to 15 healthy volunteers as four capsules of 500 mg each in the morning with food. The stair mill at a speed of 60 steps per minute was used to induce knee pain and Visual Analogue Scale (VAS) was used to measure the pain intensity. Assessments were performed at baseline, Days 5 and 7. One participant reported dyspepsia of mild grade that resolved on its own. When compared to baseline, time to initial discomfort significantly increased on Day-5 (Mean Difference [MD] = 30s, p = 0.016) and Day-7 (MD = 32s, p = 0.007). Whereas the maximum VAS score decreased with time and on Day-7 and it was significantly low when compared with baseline (MD = -0.93, p = 0.008). In summary, Turmacin® supplements given at a dose of 2 g/day was safe and tolerable. Similar to the previous study with low dose Turmacin®, there was a significant increase in pain threshold and decrease in the maximum pain score post intervention. [ABSTRACT FROM AUTHOR]

This study aimed to identify whether an intervention with capoeira changes the psychomotor profile of people with Intellectual Disabilities (ID). This condition (ID) is characterized by global developmental delay, notably neurological and psychomotor aspects. For this study, 20 students from a specialized educational service diagnosed with ID were divided into two groups (control [CON] and intervention [INT]). After the interventions, the CON group indicated progress in the tonicity and balance factors, while in the INT group, the balance factors, body awareness, spatio-temporal structure, global praxis, fine praxis and total test score improved. We conclude that a capoeira intervention program for people with ID improves the psychomotor profile of participants. [ABSTRACT FROM AUTHOR]

Athletes in contact sports are exposed to repetitive impacts as an inherent part of sport. There is concern over the accumulative effect; however, much is still unknown regarding their short-term effects. This study investigated impact accumulation and outcomes over three seasons (2015, 2017, 2019) in NCAA Football Bowl Subdivision players. Impacts were recorded using helmet accelerometers, and virtual reality testing (VR) was done across the season. Incidence rates for impacts (total; ≥25 G to <80 G; ≥80 G) all significantly differed by season (p < 0.05). VR scores changed across the seasons, specifically significant decreases in spatial memory (p < 0.05) in 2015, significant changes in balance and spatial memory (p < 0.05) in 2017, and no significant changes in 2019. Linear regressions predicting VR change score by impact incidence rate were nonsignificant. Monitoring exposure to impacts and changes in outcomes is useful; however, results are fluid, and many factors could indirectly have protective effects on athletes. [ABSTRACT FROM AUTHOR]

Background: The impact of hearing impairment is typically studied in terms of its effects on speech perception, yet this fails to account for the interactive nature of communication. Recently, there has been a move towards studying the effects of age‐related hearing impairment on interaction, often using referential communication tasks; however, little is known about how interaction in these tasks compares to everyday communication. Aims: To investigate utterances and requests for clarification used in one‐to‐one conversations between older adults with hearing impairment and younger adults without hearing impairment, and between two younger adults without hearing impairment. Methods & Procedures: A total of 42 participants were recruited to the study and split into 21 pairs, 10 with two younger adults without hearing impairment and 11 with one younger adult without hearing impairment and one older participant with age‐related hearing impairment (hard of hearing). Results from three tasks—spontaneous conversation and two trials of a referential communication task—were compared. A total of 5 min of interaction in each of the three tasks was transcribed, and the frequency of requests for clarification, mean length of utterance and total utterances were calculated for individual participants and pairs. Outcomes & Results: When engaging in spontaneous conversation, participants made fewer requests for clarification than in the referential communication, regardless of hearing status/age (p ≤ 0.012). Participants who were hard of hearing made significantly more requests for clarification than their partners without hearing impairment in only the second trial of the referential communication task (U = 25, p = 0.019). Mean length of utterance was longer in spontaneous conversation than in the referential communication task in the pairs without hearing impairment (p ≤ 0.021), but not in the pairs including a person who was hard of hearing. However, participants who were hard of hearing used significantly longer utterances than their partners without hearing impairment in the spontaneous conversation (U = 8, p < 0.001) but not in the referential communication tasks. Conclusions & Implications: The findings suggest that patterns of interaction observed in referential communication tasks differ to those observed in spontaneous conversation. The results also suggest that fatigue may be an important consideration when planning studies of interaction that use multiple conditions of a communication task, particularly when participants are older or hard of hearing. WHAT THIS PAPER ADDS: What is already known on this subject: Age‐related hearing impairment is known to affect communication; however, the majority of studies have focused on its impact on speech perception in controlled conditions. This indicates little about the impact on everyday, interactive, communication. What this study adds to the existing knowledge: We investigated utterance length and requests for clarification in one‐to‐one conversations between pairs consisting of one older adult who is hard of hearing and one younger adult without hearing impairment, or two younger adults without hearing impairment. Results from three tasks (two trials of a referential communication task and spontaneous conversation) were compared. The findings demonstrated a significant effect of task type on requests for clarification in both groups. Furthermore, in spontaneous conversation, older adults who were hard of hearing used significantly longer utterances than their partners without hearing impairment. This pattern was not observed in the referential communication task. What are the potential or actual clinical implications of this work?: These findings have important implications for generalizing results from controlled communication tasks to more everyday conversation. Specifically, they suggest that the previously observed strategy of monopolizing conversation, possibly as an attempt to control it, may be more frequently used by older adults who are hard of hearing in natural conversation than in a more contrived communication task. [ABSTRACT FROM AUTHOR]

Background: Excessive jaw muscle activity is a frequent complication after acquired brain injury (ABI). Objective: The study aimed to identify the occurrence and severity of jaw muscle activity and its association with altered state of consciousness in patients with ABI. Methods: A total of 14 severe ABI patients with varied altered state of consciousness were recruited. A single‐channel electromyographic (EMG) device was used to assess the jaw muscle activity for three consecutive nights during Week 1 and Week 4 following admission. Differences in number of EMG episodes/h between Week 1 and 4 were analysed using non‐parametric tests and association between the EMG activity and altered state of consciousness were analysed using Spearman's correlation test. Results: Nine of fourteen (64%) patients showed indications of bruxism (cutoff: >15 EMG episodes/h). The average EMG episodes/h at admission were 44.5 ± 13.6 with no significant changes after Week 4 of admission (43 ± 12.9; p =.917). The EMG episodes/h ranged from 2 to 184 during Week 1 and 4–154 during Week 4. There were no significant correlations between the number of EMG episodes/h during the three nights and the individuals altered state of consciousness during Week 1 and Week 4. Conclusion: Patients with ABI had a conspicuously high but variable level of jaw muscle activity at admission and it tend to remain high after 4 week of hospitalisation which could potentially lead to adverse effects such as excessive tooth wear, headaches and pain in jaw muscles. The lack of associations between individuals altered level of consciousness and EMG activity could be due to low sample size and further studies are clearly warranted in this patient group with special needs. Single‐channel EMG devices can record jaw muscle activity early in the hospitalisation period and might be a helpful tools for early detection of bruxism in ABI patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Vision impairments affect the ability to navigate environments and gain spatial perception of one's surroundings. Existing navigation aids typically provide close-range information, but not feedback on farther distances (i.e., beyond 5 m from the user). OBJECTIVE: To address this gap, the OptiBand, a custom assistive device, was previously designed with a stakeholder who is blind. The OptiBand uses Lidar sensing and haptic feedback to relay information on objects up to 15 m away. In this paper, we sought to evaluate the efficacy of the OptiBand with an in situ user study. METHODS: N = 9 participants (eight blind and one low-vision) used the OptiBand for a period of three months. Users periodically rated spatial perception workload and trust of their assistive navigation aids (at first as a baseline without the OptiBand, and then with the OptiBand). RESULTS: The OptiBand tended to yield lower workload requirements and similar trust levels compared to existing navigation aids. Interview data demonstrated the usefulness of the OptiBand in selected day-to-day tasks such as navigating outdoors and maintaining appropriate interpersonal spacing. CONCLUSIONS: This work provides evidence on benefits of and potential uses of assistive navigation aids like the OptiBand. Researchers interested in similar devices can benefit from our efforts. [ABSTRACT FROM AUTHOR]

Iron deficiency (ID) and ID with anaemia (IDA) are serious global health problems that disproportionately affect women aged 15–49 years. Although food fortification is one of the most effective and sustainable ways to combat nutritional deficiencies, iron remains one of the most difficult micronutrients to fortify, given its tendency to react strongly with food constituents. Therefore, it is important to assess the sensory properties of foods fortified with iron to determine the acceptability and palatability in target populations. We aimed to determine the palatability and acceptability of a novel iron and zinc‐enriched powder fortified in tap water by conducting sensory evaluations in 35 women of reproductive age using a 9‐point hedonic scale, where participants rated the sensory properties of six samples containing different amounts of the active or placebo powder. We found significant differences between samples reconstituted at 1, 2, and 3 g/L for sensory properties, including overall taste. Participants were found to be more willing to drink the mineral‐enriched powder when prepared at the lowest concentration (1 g/L) compared to higher concentrations. Our results provide important insight into the sensory qualities of a novel formulation of an iron and zinc‐enriched powder for at‐home fortification and indicate consumer acceptability in reproductive‐aged women, a key group at risk for ID/IDA. If found to improve iron status, novel treatments like this product will contribute to global efforts to develop safe, acceptable and sustainable interventions for ID and IDA. Key messages: There is a need to develop effective and acceptable treatments for ID/IDA in women of reproductive age, a population most at risk for these conditions.Fortification is one of the most sustainable approaches to combat nutritional deficiencies.Iron is one of the most difficult micronutrients to fortify, as it can result in unacceptable sensory changes that lead to poor long‐term adherence and decreased treatment efficacy.This study provides novel insights into the sensory perceptions of an iron fortification system in reproductive aged women, and can support global efforts towards developing acceptable treatments for ID/IDA in women. [ABSTRACT FROM AUTHOR]

Background: Internal redistribution of gas, referred to as pendelluft, is a new potential mechanism of effort-dependent lung injury. Neurally-adjusted ventilatory assist (NAVA) and proportional assist ventilation (PAV +) follow the patient's respiratory effort and improve synchrony compared with pressure support ventilation (PSV). Whether these modes could prevent the development of pendelluft compared with PSV is unknown. We aimed to compare pendelluft magnitude during PAV + and NAVA versus PSV in patients with resolving acute respiratory distress syndrome (ARDS). Methods: Patients received either NAVA, PAV + , or PSV in a crossover trial for 20-min using comparable assistance levels after controlled ventilation (> 72 h). We assessed pendelluft (the percentage of lost volume from the non-dependent lung region displaced to the dependent region during inspiration), drive (as the delta esophageal swing of the first 100 ms [ΔPes100 ms]) and inspiratory effort (as the esophageal pressure–time product per minute [PTPmin]). We performed repeated measures analysis with post-hoc tests and mixed-effects models. Results: Twenty patients mechanically ventilated for 9 [5–14] days were monitored. Despite matching for a similar tidal volume, respiratory drive and inspiratory effort were slightly higher with NAVA and PAV + compared with PSV (ΔPes 100 ms of –2.8 [−3.8–−1.9] cm H2O, −3.6 [−3.9–−2.4] cm H2O and −2.1 [−2.5–−1.1] cm H2O, respectively, p < 0.001 for both comparisons; PTPmin of 155 [118–209] cm H2O s/min, 197 [145–269] cm H2O s/min, and 134 [93–169] cm H2O s/min, respectively, p < 0.001 for both comparisons). Pendelluft magnitude was higher in NAVA (12 ± 7%) and PAV + (13 ± 7%) compared with PSV (8 ± 6%), p < 0.001. Pendelluft magnitude was strongly associated with respiratory drive (β = -2.771, p-value < 0.001) and inspiratory effort (β = 0.026, p < 0.001), independent of the ventilatory mode. A higher magnitude of pendelluft in proportional modes compared with PSV existed after adjusting for PTPmin (β = 2.606, p = 0.010 for NAVA, and β = 3.360, p = 0.004 for PAV +), and only for PAV + when adjusted for respiratory drive (β = 2.643, p = 0.009 for PAV +). Conclusions: Pendelluft magnitude is associated with respiratory drive and inspiratory effort. Proportional modes do not prevent its occurrence in resolving ARDS compared with PSV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effect of dual-task balance training (DTBT) in improving the mental performance of children with intellectual disabilities. Materials and Methods: Forty-five children (aged 6-13 years) with mild mental retardation (intelligence quotient: 50-79) were randomised to receive cognitive training and DTBT (group A), standard balance and cognitive training (group B), or only cognitive training (control group). The intervention was provided twice a week for 12 weeks (totally 24 sessions). The WISC-R intelligence and MOXO attention tests were used for outcome analysis. All outcome assessments were made before, after, and three months after the study. Results: There were significant improvements after using DTBT compared to the other two sets of interventions, at least in selected aspects of intelligence and mental performance. Conclusions: A precisely planned, progressive DTBT program can be effective in developing and sustaining improvements in mental abilities among children with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is the most important cause of non‐injury‐related disability in young adults. The disease has unknown causes and distresses and affects daily activities. While therapeutic interventions mainly focus on body function and structure to reduce impairment, Cognitive Orientation to Daily Occupational Performance (CO‐OP) is a cognitive approach that provides intervention at the level of activity and participation. Purpose: We aim to examine the effects of CO‐OP approach on fatigue, quality of life, occupational performance, and satisfaction in people living with multiple sclerosis; and to examine whether they could transfer strategies and skills learned during CO‐OP to untrained goals. Methods: A pre‐post design was used. Assessment tools included Montreal Cognitive Assessment, Multiple Sclerosis Impact Scale, Fatigue Impact Scale and the Canadian Occupational Performance Measure. Six individuals living with multiple sclerosis participated in 10 CO‐OP sessions twice a week. The sessions were held in an environment of the participants' choice, along with an extra session added to determine the goals. The study was registered in the ethics committee of University of Social Welfare and Rehabilitation Sciences (IR.USWR.REC.1399.089). Results: The performance improved (2‐point positive change) in 12 out of 18 trained goals and in three out of six untrained goals (self‐report). The improvement was maintained at a 3‐month follow‐up assessment. There was a statistically significant difference in Canadian Occupational Performance Measure (χ2 = 11.565, p = 0.003 same for performance and satisfaction scores), Fatigue Impact Scale (χ2 = 7.000, p = 0.030), and Multiple Sclerosis Impact Scale scores over time (χ2 = 9.478, p = 0.009) respectively. Conclusion: The CO‐OP approach has the potential to improve daily activity performance, reduce pain, and improve the quality of life for people living with multiple sclerosis. A definitive randomised controlled trial is required. [ABSTRACT FROM AUTHOR]

This study aimed to detect the functional and emotional impact of COVID‐19 lockdown on institutionalized older adults with sarcopenia during a 15‐month follow‐up. A prospective longitudinal cohort study was conducted in a nursing home. Participants were screened for sarcopenia, and those with a score of ≥4 points according to SARC‐F questionnaire were included. Assessments were performed pre‐lockdown (T1), 12 months (T2) after, and at a 15‐month follow‐up (T3). Functional measurements included chair stand test, handgrip, biceps brachii and quadriceps femoris strengths, appendicular skeletal mass, gait speed, Short Physical Performance Battery, and Timed Up‐and‐Go test. Emotional assessments included Short‐Form Health Survey, Geriatric Depression Scale—Short Form, and the Mini‐Mental State Examination. The analyzed sample showed a reduction in bicep strength, and other upper and lower limb strength variables showed a decreasing trend with no changes regarding muscle mass. Physical performance showed a change, specifically a deterioration in the subtest related to balance. Cognitive and emotional components were affected and quality of life was decreased. It is of paramount importance to focus on sarcopenic older adults since their characteristics can deteriorate when isolation measures are conducted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the dynamics of multifrequency tone bursts on the masseter vestibular evoked myogenic potential (mVEMP) parameters. Furthermore, it sought to determine the optimal frequency tuning of mVEMP responses. Method: Twenty young adults with normal hearing sensitivity participated in the study. Bilateral tone burst evoked mVEMPs were obtained using the zygomatic montage at 250-, 500-, 750-, 1000-, 1500-, and 2000-Hz stimulation frequencies. Self-monitoring biofeedback was given during the procedure to confirm the tension of the masseter muscle between 49.9 and 150.6 rms. Furthermore, the electromyography (EMG) scaling was done to avoid any muscle-related irregularities. Results: Tone burst evoked mVEMPs were found to be 100% present at the stimulation frequencies of 250, 500, 750, and 1000 Hz. There were no ear and gender effects seen for any of the frequencies. Significant shortening of the P1 and N1 latencies with increasing stimulation frequencies was observed. The peak-to-peak amplitude was the highest at 500 Hz and lowest at 2000 Hz tone bursts under both EMG scaled and unscaled conditions. Conclusion: The present revealed higher response rates and larger amplitudes study of mVEMP at lower frequencies, and, therefore, the frequency tuning was seen for the stimulation frequency at 500 Hz. [ABSTRACT FROM AUTHOR]

An elevated sense of vocal effort due to increased vocal demand is frequently reported by patients with voice disorders. However, effects of vocal warm-up on self-assessed vocal effort have not been thoroughly examined. A recently developed version of the Borg CR-10 Scale facilitates vocal effort assessments, following different vocal warm-up tasks. Effects of a short (5 min) vocal warm-up on self-assessed vocal effort was evaluated using the Borg CR-10. Twenty-six vocally healthy participants (13F, 13M, mean age 22.6), in two randomised groups, underwent sessions of either reading aloud or semi-occluded vocal tract exercises (SOVTE). Vocal effort was evaluated at four times: pre to post vocal warm-up and two silence periods. Non-parametric analyses for repeated measures and calculations for within-subject standard deviation were applied in group comparisons. Following vocal warm-up, vocal effort ratings were increased to a statistically significant degree in both intervention groups compared to baseline ratings. After a 5-min rest in silence following completion of the vocal warm-up, vocal effort ratings returned to baseline levels in both groups. The drop in ratings immediately post warm-up compared to 5 min later was statistically significant for the SOVTE group. Five minutes of vocal warm-up caused increased self-perceived vocal effort in vocally healthy individuals. The increased sense of effort dissipated faster following warm-up for the SOVTE group. When using the Borg CR-10 scale to track vocal effort, it may be beneficial to apply experience-based anchors. [ABSTRACT FROM AUTHOR]