Lack of Fall Prevention Education in Patients Experiencing Fall-Related Hip Fracture: A Qualitative Study.

Introduction: We aimed to describe patient awareness regarding fall prevention and education, perceived causes of falls, and changes in attitude after experiencing a fall through interviews with older Korean patients who experienced falls with resultant hip fractures. Materials and Methods: We conducted face-to-face semi-structured in-depth interviews with 11 patients who were admitted to Kangbuk Samsung Hospital for hip fractures caused by falls and were referred to the Department of Rehabilitation Medicine for postsurgical rehabilitation between June 2022 and June 2023. The data were analyzed using the phenomenological method developed by Colaizzi. Results: Before hip fracture, none of the patients had received fall prevention education or perceived its necessity; however, they recognized its necessity retrospectively. Participants described the causes of falls as carelessness, actions taken at the time of the fall, environmental factors, and decreased physical function. Most participants believed that falls could be prevented through personal caution and activity restrictions. Some mentioned fall prevention education, exercise, wearing appropriate shoes, environmental adjustments, and seeking assistance from others as methods of preventing future falls. Most patients reported adopting a safety-seeking attitude after experiencing hip fracture. Many patients had negative thoughts such as guilt or thoughts of death, whereas only a few reported increased interest in education and exercise. Conclusions: We observed a lack of fall prevention education, misunderstanding regarding the cause of falls, and negative psychological changes after experiencing hip fractures due to falls in older Korean individuals. Recognizing and managing patient perceptions is crucial for effective fall prevention, requiring both healthcare provider awareness and active participation from patients and caregivers.

Effect of body position on peak expiratory flow during mechanical insufflation-exsufflation in people with cervical spinal cord injury: a pilot study.

This prospective pilot study investigated the influence of body position on peak cough flow (PCF) during mechanical insufflation-exsufflation (MI-E) treatment in people with tetraplegia. Fifteen participants with cervical spinal cord injury (C-SCI) were randomized into two groups, which differed in the starting position, that is, the patients were either supine or reclined. Four sessions of MI-E in alternating positions with each session comprising three different maneuvers: five voluntary coughs, five MI-E-assisted coughs, and five MI-E-assisted with manual thrusts were performed with continuous airflow measurement reporting PCF from every cough. PCF was associated with the application maneuvers, total insufflation volume (TIV), and interaction between position and maneuvers but not with the application position. The estimated mean PCF was 1.808, 3.529, and 3.925 L/s when supine and 1.672, 3.598, and 3.909 L/s when reclined from voluntary cough, MI-E, and MI-E with manual thrust, respectively. The estimated PCF change compared to voluntary cough was 1.721 (95% CI, 1.603-1.838) L/s from the combined MI-E and 2.116 (95% CI, 2.005-2.228) L/s from the MI-E with manual thrust, calculated from the linear mixed-model analysis. PCF moderately correlated with TIV (R2 = 0.64). Therefore, either position can be used for C-SCI patients as long as MI-E can be performed with manual thrust and sufficient TIV is provided.

Efficacy and Safety of Botulinum Toxin Type A (NABOTA) for Post-stroke Upper Extremity Spasticity: A Multicenter Phase IV Trial.

OBJECTIVE: To evaluate the efficacy and safety of Daewoong botulinum toxin type A (NABOTA) after its launch in South Korea. METHODS: This prospective, multicenter, open-label phase IV clinical trial included 222 patients with stroke. All patients visited the clinic at baseline and at weeks 4, 8, and 12 after injection of upto 360 units of NABOTA into the wrist, elbow, and finger flexor muscles at the first visit. The primary outcome was the change in Modified Ashworth Scale (MAS) score for the wrist flexor muscles between baseline and week 4. The secondary outcomes were the changes in MAS, Disability Assessment Scale (DAS), and Caregiver Burden Scale (CBS) scores between baseline and each visit, and the Global Assessment Scale (GAS) score at week 12. RESULTS: There was a statistically significant decrease in the MAS score for the wrist flexors between baseline and week 4 (-0.97±0.66, p<0.001). Compared with baseline, the MAS, DAS and CBS scores improved significantly during the study period. The GAS was rated as very good or good by 86.8% of physicians and by 60.0% of patients (or caregivers). The incidence of adverse events was 14.4%, which is smaller than that in a previous trial. CONCLUSION: NABOTA showed considerable efficacy and safety in the management of upper limb spasticity in stroke patients.

Site-specific ecological risk assessment of metal-contaminated soils based on the TRIAD approach.

Ecological risk assessment based on scientific data is crucial for understanding causal relationships between chemical pollution and environmental risks. Simultaneously, a balance is required between socioeconomic factors and scientific evidence. The TRIAD approach, which incorporates three lines of evidence (LoE)-chemical (Chem-LoE), ecotoxicological (Ecotox-LoE), and ecological (Eco-LoE)-was applied in five sites of an abandoned mine for site-specific soil ecological risk assessment (SERA). In combination, the three LoEs showed that two sites had extremely high risks, one site had moderate risk, and the other site had low risk. At all sites, Chem-LoE exhibited high-integrated risk values. In Ecotox-LoE and Eco-LoE, some species were not affected despite high metal concentrations in the soil samples collected from the sites, indicating that the bioavailability of metals differed according to the physiochemical properties of the soil medium. This study is significant as multiple analyses were performed considering ecosystem structure to reduce uncertainty in SERA. The results provide information to support effective decision-making risk management to protect the soil ecosystem. Moreover, these findings will be useful in establishing policies and priorities for soil risk management.

Gene Expression Profile Changes in the Stimulated Rat Brain Cortex After Repetitive Transcranial Magnetic Stimulation.

Repetitive transcranial magnetic stimulation (rTMS) is gaining popularity as a research tool in neuroscience; however, little is known about its molecular mechanisms of action. The present study aimed to investigate the rTMS-induced transcriptomic changes; we performed microarray messenger RNA, micro RNA, and integrated analyses to explore these molecular events. Eight adult male Sprague-Dawley rats were subjected to a single session of unilateral rTMS at 1 Hz (n = 4) or sham (n = 4). The left hemisphere was stimulated for 20 minutes. To evaluate the cumulative effect of rTMS, eight additional rats were assigned to the 1-Hz (n = 4) or sham (n = 4) rTMS groups. The left hemisphere was stimulated for 5 consecutive days using the same protocol. Microarray analysis revealed differentially expressed genes in the rat cortex after rTMS treatment. The overrepresented gene ontology categories included the positive regulation of axon extension, axonogenesis, intracellular transport, and synaptic plasticity after repeated sessions of rTMS. A single session of rTMS primarily induced changes in the early genes, and several miRNAs were significantly related to the mRNAs. Future studies are required to validate the functional significance of selected genes and refine the therapeutic use of rTMS.

Sorption of anthracene (C14H10) and 9-anthroic acid (C15H10O2) onto biochar-amended soils as affected by field aging treatments.

There is a lack of information on how aging affects the sorption of ionizable organic compounds on biochar-amended soils. To that end, this study investigates the sorption of two hydrophobic solutes (anthracene (ANT) and 9-anthroic acid (9-ANCA)) onto biochar-amended (5%, w/w) soils as a function of aging period (0, 6, and 12 months), electrolyte (5 mM CaCl2 and 10 mM KCl), and aqueous pH. The isotherm plot of both solutes was fairly linear (r2 > 0.998) and the linear sorption coefficient (Kd, L kg-1) was obtained from this. In CaCl2 solution at pH 5, the log Kd of ANT tended to decrease (from 3.90 to 3.72) with an increasing aging period, which was attributed to clogged pore surface, whereas the differences in 9-ANCA sorption (from 2.56 to 2.51) were not significant (α = 0.05). The increased ANT sorption at acidic pH (<4) could be attributed to π-π interaction. Aqueous Ca2+ ions played an important role in 9-ANCA sorption by forming a Ca-bridge between anionic solute and negatively charged adsorbent surface, thus accounting for up to 35% of its sorption at alkaline pH (>8). The spectroscopic data and isoelectric point measurement results indicated that the number of oxygen-containing functional groups and the content of elemental oxygen were both higher in aged samples, resulting in a more polar (negatively charged) surface. The formation of surface polar groups and the associated deformation altered the adsorbent nature of the tested biochar, thereby fortifying the hydrophilic retention propensity for ionizable organic solutes.

Effect of HNO3 and H2SO4 on the Paddy Ecosystem: A Mesocosm Study with Exposure at PNEC and HC50 Levels.

Paddy mesocosms comprising of rice (Oryza sativa), snail (Pomacea canaliculata), and worm (Tubifex tubifex) were used to assess the damage caused by two acids (HNO3 and H2SO4) at predicted no-effect concentration (PNEC) and hazardous concentration for 50% of species (HC50) levels. In the fourth week, the fresh weight and shoot height of O. sativa at H2SO4-HC50 were reduced by 83.2% and 30.3%, respectively. Wilted leaves (%) at HC50 were approximately twice that at PNEC. No P. canaliculata and T. tubifex were recovered at HC50. At H2SO4-PNEC, the length and weight of P. canaliculata were reduced by 7.4% and 25.9%, respectively, whereas fewer adult (46.5%) and juvenile (84%) T. tubifex were recovered. In the 20th week, rice growth and productivity were correlated with initial pH (pHi) and nitrogen levels. Poor correlation with chlorophyll at the active tillering stage suggests the disturbance of nutrient uptake by roots. Partial least squares path modeling (PLS-PM) results further supported that the pHi directly affects grain yield and quality, as well as plant growth. The indirect effect via intervening fourth-week-variables was also substantial. Therefore, it is important to measure initial pH upon acid spill to estimate the risk to the paddy ecosystem. Information on the change in soil properties associated with acidity will also aid in predicting the yield and quality of grain to be harvested.