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Modified Vaccinia Ankara Bavarian Nordic (MVA-BN) as a smallpox and mpox vaccine has been approved in its liquid-frozen (LF) formulation in the US, Canada, and EU. A freeze-dried (FD) formulation may offer additional benefits, such as a longer shelf life and reduced dependence on cold chain storage and transport. In a phase 2 clinical trial, 651 vaccinia-naïve participants were vaccinated with two doses of MVA-BN LF or FD, 4 weeks apart. The objectives were to compare MVA-BN FD with LF in terms of vaccine-induced immune responses, safety, and reactogenicity. Non-inferiority of the immune response was assessed by the 95% CI of the geometric mean ratios. Both formulations induced robust vaccinia-specific humoral and cellular immune responses. At peak humoral responses (Week 6), geometric means of total antibody titers were 1096 (95% CI 1013, 1186) from the FD group and 877 (95% CI 804, 956) from the LF group, achieving the primary endpoint of non-inferiority of MVA-BN FD compared to MVA-BN LF. At peak cellular responses (Week 2), geometric means of T cell spot forming units were 449 (95% CI 341, 590) from the FD group and 316 (95% CI 234, 427) from the LF group. Both formulations of MVA-BN were well tolerated, with similar unsolicited AEs and solicited systemic reactions in both groups but slightly more local reactions in the FD group. No vaccine-related serious adverse events (SAEs) or vaccine-related AE of special interest were reported. The FD formulation of MVA-BN was shown to be equivalent to MVA-BN LF.
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Anticorpos Antivirais , Liofilização , Vacina Antivariólica , Humanos , Vacina Antivariólica/imunologia , Vacina Antivariólica/efeitos adversos , Vacina Antivariólica/administração & dosagem , Feminino , Masculino , Adulto , Adulto Jovem , Anticorpos Antivirais/sangue , Pessoa de Meia-Idade , Vacinas de DNA/imunologia , Vacinas de DNA/administração & dosagem , Vacinas de DNA/efeitos adversos , Imunidade Humoral , Imunidade Celular , Adolescente , Varíola/prevenção & controle , Varíola/imunologia , Congelamento , Vacinas AtenuadasRESUMO
Large Language Models (LLMs) have the potential to improve education by personalizing learning. However, ChatGPT-generated content has been criticized for sometimes producing false, biased, and/or hallucinatory information. To evaluate AI's ability to return clear and accurate anatomy information, this study generated a custom interactive and intelligent chatbot (Anatbuddy) through an Open AI Application Programming Interface (API) that enables seamless AI-driven interactions within a secured cloud infrastructure. Anatbuddy was programmed through a Retrieval Augmented Generation (RAG) method to provide context-aware responses to user queries based on a predetermined knowledge base. To compare their outputs, various queries (i.e., prompts) on thoracic anatomy (n = 18) were fed into Anatbuddy and ChatGPT 3.5. A panel comprising three experienced anatomists evaluated both tools' responses for factual accuracy, relevance, completeness, coherence, and fluency on a 5-point Likert scale. These ratings were reviewed by a third party blinded to the study, who revised and finalized scores as needed. Anatbuddy's factual accuracy (mean ± SD = 4.78/5.00 ± 0.43; median = 5.00) was rated significantly higher (U = 84, p = 0.01) than ChatGPT's accuracy (4.11 ± 0.83; median = 4.00). No statistically significant differences were detected between the chatbots for the other variables. Given ChatGPT's current content knowledge limitations, we strongly recommend the anatomy profession develop a custom AI chatbot for anatomy education utilizing a carefully curated knowledge base to ensure accuracy. Further research is needed to determine students' acceptance of custom chatbots for anatomy education and their influence on learning experiences and outcomes.
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BACKGROUND: Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD: This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS: A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION: Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION: Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).
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Efeitos Psicossociais da Doença , Diabetes Mellitus Tipo 2 , Farmacêuticos , Polimedicação , Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Médicos de Família , Equipe de Assistência ao Paciente/economia , Equipe de Assistência ao Paciente/organização & administração , Serviços Comunitários de Farmácia/economia , Serviços Comunitários de Farmácia/organização & administraçãoRESUMO
BACKGROUND: In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations. METHODS AND FINDINGS: In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size. CONCLUSIONS: In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation. TRIAL REGISTRATION: ClinicalTrials.gov NCT01735084 and NCT01174849.
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Perda Auditiva , Otite Média , Vacinas Pneumocócicas , Humanos , Lactente , Vacinas Pneumocócicas/administração & dosagem , Vacinas Pneumocócicas/uso terapêutico , Perda Auditiva/epidemiologia , Austrália/epidemiologia , Pré-Escolar , Feminino , Masculino , Otite Média/epidemiologia , Otite Média/prevenção & controle , Prevalência , Vacinas Conjugadas/administração & dosagem , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/epidemiologia , Esquemas de ImunizaçãoRESUMO
Right-sided colon cancer (RCC) and left-sided colon cancer (LCC) differ in features and outcomes because of variations in embryology, epidemiology, pathology, and prognosis. This study sought to identify significant factors impacting patient survival through Bayesian modelling. Data was retrospectively analysed from a colorectal neoplasia database. Data on demographics, perioperative risks, treatment, mortality, and survival was analysed from patients who underwent colon cancer surgery from January 2010 to December 2021. This study involved 2475 patients, with 58.7% having RCC and 41.3% having LCC. RCC patients had a notably higher mortality rate, and their overall survival (OS) rates were slightly lower than those with LCC (P < 0.05). RCC stages I-IV consistently exhibited worse OS and relapse-free survival (RFS) than LCC (P < 0.05). Factors like age, BMI, ASA score, cancer stage, and comorbidities had significant associations with OS and RFS. Poor and moderate differentiation, lower lymph node yield, and organ resection were linked to lower survival while receiving chemotherapy; higher BMI levels and elective surgery were associated with better survival (all P < 0.05). Our study reveals key differences between RCC and LCC, emphasising the impact of age, BMI, ASA score, cancer stage, and comorbidities on patient survival. These findings could inform personalised treatment strategies for colon cancer patients.
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Neoplasias do Colo , Humanos , Neoplasias do Colo/mortalidade , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Masculino , Feminino , Idoso , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Estadiamento de Neoplasias , Taxa de Sobrevida , Teorema de Bayes , Idoso de 80 Anos ou mais , AdultoRESUMO
Recent decades have witnessed a surge in research interest in bio-nanocomposite-based packaging materials, but still, a lack of systematic analysis exists in this domain. Bio-based packaging materials pose a sustainable alternative to petroleum-based packaging materials. The current work employs bibliometric analysis to deliver a comprehensive outline on the role of bio nanocomposites in packaging. India, Iran, and China were revealed to be the top three nations actively engaged in this domain in total publications. Islamic Azad University in Iran and Universiti Putra Malaysia in Malaysia are among the world's best institutions in active research and publications in this field. The extensive collaboration between nations and institutions highlights the significance of a holistic approach towards bio-nanocomposite. The National Natural Science Foundation of China is the leading funding body in this field of research. Among authors, Jong whan Rhim secured the topmost citations (2234) in this domain (13 publications). Among journals, Carbohydrate Polymers secured the maximum citation count (4629) from 36 articles; the initial one was published in 2011. Bio nanocomposite is the most frequently used keyword. Researchers and policymakers focussing on sustainable packaging solutions will gain crucial insights on the current research status on packaging solutions using bio-nanocomposites from the conclusions.
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Bibliometria , Nanocompostos , Humanos , Publicações , Embalagem de Produtos , Mineração de DadosRESUMO
To keep up with the contemporary health landscape, there is an imperative need for healthcare professionals to practise health advocacy through health promotion on the individual, population, and systems levels. In the Academic Year of 2020/2021, the National University of Singapore (NUS) Department of Pharmacy implemented a new spiral curriculum integrating basic, clinical, and systems sciences with one of its aims to deepen students' health advocacy internalisation and prepare them as future health advocates. A mixed-methods approach was adopted. Questionnaires were disseminated across three time-points to elicit students' levels of internalisation of health advocacy, which were then categorised into levels, and a Mann-Whitney U test was conducted. In comparison with prematriculation, no significant difference was found after students underwent the first year of the curriculum, while a significant difference was found after students underwent two years of the curriculum. Semi-structured interviews were also conducted after each Academic Year to gain deeper insights into the questionnaire results. Thematic analysis of the interviews revealed that curricular integration in the first year was perceived to be lacking. However, with learnt knowledge constantly reinforced and more experiential learning opportunities incorporated throughout the second year, students found the integrated curriculum beneficial in instilling confidence to practise health advocacy. This study offers insights into the prospects of a spiral integrated curriculum in imparting health advocacy, and may even suggest its potential to be applied to other educational settings. Future follow-up studies can also be conducted on the same study population to evaluate long-term impacts and areas for improvement of the curriculum.
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Educação em Farmácia , Farmácia , Estudantes de Farmácia , Humanos , Farmacêuticos , Currículo , Aprendizagem , Educação em Farmácia/métodosRESUMO
BACKGROUND: Mountain biking and hiking continue to grow in popularity. With new participants to these sports, it is likely the number of injuries will increase. To assist medical personnel in the management of these patients we attempted to quantify the types and locations of injuries sustained by mountain bikers and hikers. Objective The objective of this systematic review is to identify the type and anatomical location of injuries for both mountain bikers and hikers. METHODS: A systematic search was undertaken using CINAHL, Cochrane, ProQuest, PubMed and Scopus databases. Reviewers assessed the eligibility of articles by a title/abstract review and final full-text review. Studies were included if the types of injuries were reported by medical personnel and contained anatomical locations. Studies were excluded if it did not take place on a trail or if the injuries were self-reported. Risk of bias was assessed utilising the Joanna Briggs Institute (JBI) checklists for study quality. No meta-analysis or comparison between mountain bikers and hikers was possible due to the high heterogeneity of the definition of injury. RESULTS: A total of 24 studies met the inclusion criteria, 17 covering mountain biking and 7 hiking. This represented 220,935 injured mountain bikers and 17,757 injured hikers. The most common type of injuries sustained by mountain bikers included contusions, abrasions and minor lacerations, which made up between 45-74% of reported injuries in studies on competitive racing and 8-67% in non-competitive studies. Fractures represented between 1.5-43% of all reported injuries. The most injured region was the upper limbs reported in 10 of 17 studies. For hikers the most common injuries included blisters and ankle sprains with blisters representing 8-33% of all reported injuries. The most common body location to be injured by hikers was a lower limb in all 7 studies. CONCLUSIONS: This is the first systematic review to report on the injury epidemiology of the two most common trail users; mountain bikers and hikers. For participants in both activities the majority of injuries were of minor severity. Despite this, the high proportions of upper limb fractures in mountain bikers and ankle sprains in hikers cannot be ignored. TRIAL REGISTRATION: Registration: This systematic review was prospectively registered with the University of York PROSPERO database on the 12/4/2021 (CRD42021229623) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229623.
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Traumatismos do Tornozelo , Contusões , Fraturas Ósseas , Lacerações , Humanos , Vesícula , Fraturas Ósseas/epidemiologiaRESUMO
OBJECTIVES: The primary objectives of this study were to evaluate the change in glycated haemoglobin (HbA1c) and its association to clinical activities. The secondary objective was to elucidate moderators of the relationship between pharmacist-involved collaborative care (PCC) and change in HbA1c. METHODS: This study was a retrospective cohort study conducted in a tertiary hospital over 12 months. Individuals with Type 2 diabetes, aged ≥21 years with established cardiovascular diseases were included while individuals with incomplete care documentation or missing data related to cardiovascular diseases were excluded. Individuals under the care of PCC were matched 1:1 based on baseline HbA1c with an eligible person who received care from the cardiologists (CC). Changes in mean HbA1c were analysed using linear mixed model. Linear regression was used to determine clinical activities that associated with improvement in HbA1c. Moderation analyses were conducted using the MacArthur framework. KEY FINDINGS: A total of 420 participants (PCC:210, CC:210) were analysed. The mean age of the participants was 65.6 ± 11.1 years, with the majority being male and Chinese. The mean HbA1c among participants in the PCC group decreased significantly after 6 months (PCC: -0.4% versus CC: -0.1%, P = 0.016), with maintenance of improvement at 12 months (PCC: -0.4% versus CC: -0.2%, P < 0.001). Frequencies of lifestyle counselling, reinforcement of visits to healthcare providers, health education, resolution of drug-related problems, emphasis on medication adherence, dose adjustments and advice on self-care techniques were significantly higher in the intervention group (P < 0.001). CONCLUSION: Improvements in HbA1c were associated with the provision of health education and medication adjustments.
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Cardiologistas , Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Diabetes Mellitus Tipo 2/tratamento farmacológico , Farmacêuticos , Hemoglobinas Glicadas , Estudos RetrospectivosRESUMO
This study examined the effects of obesity on cartilage mechanics and longitudinal failure probability at the medial tibiofemoral compartment, using combined musculoskeletal simulation and probabilistic failure modelling approaches. The current investigation examined twenty obese females (BMI > 30.0 kg/m2) and 20 healthy weight (BMI < 25.0 kg/m2) females. Walking kinematics were obtained via an 8-camera optoelectric system, and a force plate was used to collect ground reaction forces. Musculoskeletal simulation and probabilistic failure modelling were utilized to explore medial tibiofemoral forces and cartilage probability. Comparisons between groups were undertaken using linear mixed-effects models. Net peak cartilage forces, stress and strain were significantly larger in the obese group (force = 2013.92 N, stress = 3.03 MPa & strain = 0.25), compared to health weight (force = 1493.21 N, stress 2.26 MPa & strain = 0.19). In addition, medial tibiofemoral cartilage failure probability was also significantly larger in the obese group (42.98%) compared to healthy weight (11.63%). The findings from the current investigation show that obesity has a profoundly negative influence on longitudinal medial knee cartilage health and strongly advocates for the implementation of effective weight management programs into long-term musculoskeletal management strategies.
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A man in his 70s, with a history of a glomus jugulare paraganglioma diagnosed 18 years ago, presented with an unprovoked deep vein thrombosis (DVT). The paraganglioma had been treated by radiotherapy, and yearly scans had not shown any progression since treatment. A sclerotic focus in L4 vertebral body was reported on a CT scan of the neck and trunk which was done to exclude a neoplastic process being the precipitating factor for the DVT. Nuclear imaging showed multiple areas of bony uptake, suggestive of metastases. A bone biopsy of the left femur resulted positive for metastatic paraganglioma. A monthly intramuscular injection of octreotide 30 mg was prescribed.
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Tumor do Glomo Jugular , Segunda Neoplasia Primária , Paraganglioma , Humanos , Masculino , Tumor do Glomo Jugular/patologia , Segunda Neoplasia Primária/diagnóstico por imagem , Paraganglioma/patologia , Tomografia Computadorizada por Raios X , Idoso , Trombose VenosaRESUMO
Ecologists and evolutionary biologists have long predicted that organisms in more climatically variable environments should be adapted to handle a wider range of conditions. This intuitive idea, known as the Climatic Variability Hypothesis (CVH), has gained mixed support from empirical studies. We tested the CVH in a novel system by comparing the thermal breadth of coastal and inland populations of Mimulus guttatus. To quantify thermal breadth, we performed a thermal performance experiment and built performance curves. Using these performance curves, we also evaluated evidence for a breadth-performance trade-off and the Hotter-is-Better hypothesis. We did not find support for the CVH; coastal and inland populations did not differ in thermal breadth. However, we found evidence for a breadth-performance trade-off and the Hotter-is-Better hypothesis. Surprisingly, the two most inland populations differed the most in the thermal performance traits we evaluated. Our results highlight the importance of explicitly measuring thermal performance to test explanations of species distribution patterns and the need to examine alternative mechanisms by which organisms occupy different climatic regimes.
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Mimulus , Adaptação Fisiológica , Fenótipo , Evolução BiológicaRESUMO
Chagas disease is a neglected tropical disease caused by Trypanosoma cruzi. Because current treatments present several limitations, including long duration, variable efficacy and serious side effects, there is an urgent need to explore new antitrypanosomal drugs. The present study describes the hit-to-lead optimization of a 2-aminobenzimidazole hit 1 identified through in vitro phenotypic screening of a chemical library against intracellular Trypanosoma cruzi amastigotes, which focused on optimizing potency, selectivity, microsomal stability and lipophilicity. Multiparametric Structure-Activity Relationships were investigated using a set of 277 derivatives. Although the physicochemical and biological properties of the initial hits were improved, a combination of low kinetic solubility and in vitro cytotoxicity against mammalian cells prevented progression of the best compounds to an efficacy study using a mouse model of Chagas disease.
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Doença de Chagas , Tripanossomicidas , Trypanosoma cruzi , Animais , Tripanossomicidas/química , Doença de Chagas/tratamento farmacológico , Relação Estrutura-Atividade , MamíferosRESUMO
Halymenia durvillei is a red alga that is commonly utilized in the Philippines as food and as a source of high-value natural products for industrial applications. However, there are no studies regarding the microbial community associated with H. durvillei and its potential applications. This study aimed to isolate and identify the epiphytic bacteria of H. durvillei and determine their antimicrobial and quorum sensing inhibitory (QSI) effects. The thalli of H. durvillei were collected at the shores of Santa Fe, Bantayan, Cebu, Philippines. Bacterial isolates were identified using 16S rRNA, and their ethyl acetate (EtOAc) extracts were subjected to antimicrobial susceptibility tests against representative species of yeast and Gram-negative and Gram-positive bacteria. Their QSI activity against Chromobacterium violaceum was also determined. Fourteen distinct bacterial colonies belonging to four genera, namely Alteromonas (3), Bacillus (5), Oceanobacillus (1) and Vibrio (5), were successfully isolated and identified. All 14 bacterial isolates exhibited antibacterial effects. EPB9, identified as Bacillus safensis , consistently showed the strongest inhibition against Escherichia coli , Staphylococcus aureus and Staphylococcus epidermidis , with minimum inhibitory concentrations (MICs) ranging from 0.0625 to 1.0 mg ml-1. In contrast, all 14 isolates showed weak antifungal effects. Both B. safensis (EPB9) and Bacillus australimaris (EPB15) exhibited QSI effects at 100 mg ml-1, showing opaque zones of 3.1±0.9 and 3.8±0.4 mm, respectively. This study is the first to isolate and identify the distinct microbial epiphytic bacterial community of H. durvillei and its potential as an abundant resource for new antibacterial and QSI bioactives.
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Background and Aims: To estimate the incidence of hypomagnesemia and identify the effectiveness of a calculated dose of intravenous magnesium sulfate (MgSO4) in correction of hypomagnesemia and its relationship with renal function in critically ill patients. Material and Methods: All patients admitted in the adult intensive care unit were enrolled in the study and magnesium levels were monitored. Patients with serum magnesium levels <1.7 mg/dL received calculated doses of Intravenous MgSO4. The average rise in serum magnesium levels per gram of MgSO4 administered was calculated and relationship with estimated glomerular filtration rate (eGFR) was identified. Results: In total, 27.27% of patients admitted in our intensive care unit had an incidence of hypomagnesemia. The average rise of serum magnesium levels in patients with hypomagnesemia was 0.13 (±0.05) mg/dl. The average rise of serum magnesium levels was 0.10 (±0.04) mg/dL in patients with eGFR ≥ 90 mL/min/1.73 m2 and 0.15 (± 0.05) mg/dL in patients with eGFR < 90 mL/min/1.73 m2. This difference between the two groups (P-value = 0.002) and the trend of increasing average rise in serum magnesium levels with declining eGFR values (P-value = 0.013) were both statistically significant. Conclusion: Incidence of hypomagnesemia in the critically ill population is around 27.27%. Intravenous administration of 1 g of MgSO4 results in a rise of serum magnesium levels by 0.1 mg/dL in patients with normal eGFR and around 0.15 mg/dL in patients with eGFR values between 30 and 89 mL/min/1.73 m2.
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This study examined the effects of minimal and conventional running footwear on medial tibiofemoral cartilage mechanics and longitudinal failure probability. The current investigation examined twenty males who habitually ran in minimal footwear and 20 males who habitually ran in conventional footwear. Kinematic data during overground running were collected using a motion-capture system and ground reaction forces using a force plate. Medial tibiofemoral loading was examined using musculoskeletal simulation and cartilage failure probability via probabilistic modelling. In habitual minimal footwear users, peak medial tibiofemoral cartilage force, stress and strain were significantly greater in conventional (force = 7.43 BW, stress = 5.12 MPa and strain = 0.30), compared to minimal footwear (force = 7.11 BW, stress 4.65 MPa and strain = 0.28), though no significant differences in these parameters were evident in non-habitual minimal footwear users (conventional: force = 7.50 BW, stress = 5.05 MPa and strain = 0.30; minimal: force = 7.40 BW, stress = 4.77 MPa and strain = 0.29). However, in both habitual and non-habitual minimal footwear users, the probability of medial tibiofemoral cartilage failure was significantly greater in conventional (habitual = 47.19% and non-habitual = 50.00%) compared to minimal footwear (habitual = 33.18% and non-habitual = 32.81%) users. The observations from this investigation show that compared to minimal footwear, conventional footwear appears to have a negative influence on medial tibiofemoral cartilage health.
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Reproductive autonomy necessitates that women have access to high quality family planning information and services. Additionally, closely spaced pregnancies increase maternal and infant morbidity and mortality. Although integrating family planning into child immunization services may increase access to information and services and postpartum contraceptive use, evidence on how integration affects service delivery and health outcomes is scarce. One limitation of previous studies is the use of binary integration measures. To address this limitation, this study applied Provider and Facility Integration Index scores to estimate associations between integration and contraceptive use, receipt of family planning information, and knowledge of family planning services availability. This study leveraged pooled cross-sectional health facility client exit interview data collected from 2,535 women in Nigeria. Provider and Facility Integration Index scores were calculated (0-10, 0 = low, 10 = high) for each facility (N = 94). The Provider Integration Index score measures provider skills and practices that support integrated service delivery; the Facility Integration Index score measures facility norms that support integrated service delivery. Logistic regression models identified associations between Provider and Facility Integration Index scores and (a) contraceptive use among postpartum women, (b) receipt of family planning information during immunization visits, and (c) correct identification of family planning service availability. Overall, 46% of women were using any method of contraception, 51% received family planning information during the immunization appointment, and 83% correctly identified family planning service availability at the facility. Mean Provider and Facility Integration Index scores were 6.46 (SD = 0.21) and 7.27 (SD = 0.18), respectively. Provider and Facility Integration Index scores were not significantly associated with postpartum contraceptive use. Facility Integration Index scores were negatively associated with receipt of family planning information. Provider Integration Index scores were positively associated with correct identification of family planning service availability. Our results challenge the position that integration provides a clear path to improved outcomes. The presence of facility and provider attributes that support integration may not result in the delivery of integrated care.
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This two-experiment study aimed to examine the effects of different habitual foot placement angles and also the effects of manipulating the foot placement angle on the kinetics, three-dimensional kinematics and muscle forces of the squat. In experiment 1, seventy lifters completed squats at 70% of their one repetition maximum using a self-preferred placement angle. They were separated based on their habitual foot angle into three groups HIGH, MEDIUM and LOW. In experiment 2, twenty lifters performed squats using the same relative mass in four different foot placement angle conditions (0°, 21°, 42° and control). Three-dimensional kinematics were measured using an eight-camera motion analysis system, ground reaction forces (GRF) using a force platform, and muscle forces using musculoskeletal modelling techniques. In experiment 1, the impulse of the medial GRF, in the descent and ascent phases, was significantly greater in the HIGH group compared to LOW, and in experiment 2 statistically greater in the 42° compared to the 21°, 0° and control conditions. Experiment 2 showed that the control condition statistically increased quadriceps muscle forces in relation to 0°, whereas the 0° condition significantly enhanced gluteus maximus, gastrocnemius and soleus forces compared to control. In experiment 1, patellofemoral joint stress was significantly greater in the HIGH group compared to LOW, and in experiment 2, patellar and patellofemoral loading were statistically greater in the control compared to the 42°, 21°, 0° and control conditions. Owing to the greater medial GRF's, increased foot placement angles may improve physical preparedness for sprint performance and rapid changes of direction. Reducing the foot angle may attenuate the biomechanical mechanisms linked to the aetiology of knee pathologies and to promote gluteus maximus, gastrocnemius and soleus muscular development. As such, though there does not appear to be an optimal foot placement angle, the observations from this study can be utilised by both strength and conditioning and sports therapy practitioners seeking to maximise training and rehabilitative adaptations.
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Pé , Postura , Fenômenos Biomecânicos , Humanos , Articulação do Joelho/fisiologia , Extremidade Inferior , Masculino , Músculo Esquelético/fisiologia , Postura/fisiologiaRESUMO
This two-experiment study aimed to explore habitual and manipulated stance widths on squat biomechanics. In experiment one, 70 lifters completed back squats at 70%, 1 repetition maximum (1RM), and were split into groups (NARROW < 1.06 * greater trochanter width (GTW), MID 1.06−1.18 * GTW and WIDE > 1.37 * GTW) according to their self-selected stance width. In experiment two, 20 lifters performed squats at 70%, 1RM, in three conditions (NARROW, MID and WIDE, 1.0, 1.25 and 1.5 * GTW). The three-dimensional kinematics were measured using a motion capture system, ground reaction forces (GRF) using a force platform, and the muscle forces using musculoskeletal modelling. In experiment two, the peak power was significantly greater in the NARROW condition, whereas both experiments showed the medial GRF impulse was significantly greater in the WIDE stance. Experiment two showed the NARROW condition significantly increased the quadriceps forces, whereas both experiments showed that the WIDE stance width significantly enhanced the posterior-chain muscle forces. The NARROW condition may improve the high mechanical power movement performance and promote the quadriceps muscle development. Greater stance widths may improve sprint and rapid change-of-direction performance and promote posterior-chain muscle hypertrophy. Whilst it appears that there is not an optimal stance width, these observations can be utilized by strength and conditioning practitioners seeking to maximize training adaptations.