Earth observation reveals the shifting patterns of China's lake colour driven by climate change and land cover.

Water colour has been recognized as one of the most important Essential Climate Variables of the lake ecosystem, as it is directly related to changes in water constituents and almost all of the lake's ecological changes could alter water colour. Given the high retrieval accuracy from existing Earth observation satellite data, water colour, in terms of Forel Ule Index (FUI), can be a realistic indicator to track the long-term changes in the lake ecosystem and further explore the lake response to environmental changes. This paper aims to comprehensively investigate the spatiotemporal variation patterns of FUI in 159 large lakes (≥25 km2) across China during 2000-2022 based on the MODIS data and detect the climatic and anthropogenic driving forces of these changes. The 23 years of MODIS records revealed an overall downward trend of lake FUI across China, indicating the lakes in China shifted to bluer colour during the past two decades. Through driving factor analyses, the complicated interplay among lake colour, lake morphology, regional climate shifts and human interference dynamics was uncovered. In the long term, it was found the pronounced change in lake colour in the western lake zones was primarily attributed to climate warming and humidification, whereas that in the eastern lake zones was mainly related to the alterations in regional land cover during the past two decades. Seasonally, lake basin's air temperature was identified as the main factor impacting the seasonal patterns of lake colour, followed by wind speed and runoff. Spatially, there was high spatial variability in lake colour across China, which was mainly associated with lake elevation and lake basin's precipitation rate, although the factors exhibited considerable divergence across different zones. Based upon the above findings, the implications for lake environment protection and management in different regions of China were further discussed.

The Effect of Video-Based Action Observation Training and Live Action Observation Training on Motor Function, Activity Participation, and Secondary Outcome Measures in Children With Spastic Diparetic Cerebral Palsy: A Randomized Controlled Study.

BACKGROUND: This study aimed to investigate the effects of Video-Based Action Observation Training and Live Action Observation Training on motor function, activity participation, and secondary outcome measures in children with spastic diparetic cerebral palsy (CP). MATERIALS AND METHODS: Thirty-nine children with spastic diparetic cerebral palsy, aged 5-14 years, with Gross Motor Function Classification System I-III, were distributed in equal numbers to any of the Video-Based Action Observation Training (conventional physiotherapy + Video-Based Action Observation Training), Live Action Observation Training (conventional physiotherapy + Live Action Observation Training), and control (conventional physiotherapy) groups through stratified randomization. For 8 weeks, action observation training groups received 20 minutes of conventional physiotherapy followed by 20 minutes of action observation training, and the control group received 40 minutes of conventional physiotherapy. Primary outcome measures were Gross Motor Function Measurement and Child and Adolescent Scale of Participation, secondary outcome measures were Pediatric Berg Balance Scale, timed-up-and-go test, five times sit-to-stand test (FTSST), Gillette Functional Assessment Questionnaire (GFAQ), and 1-minute walk test (1MWT). RESULTS: Improvements were observed in all other evaluation parameters of the groups except Gross Motor Function Measurement-lying and rolling (P = .066) in the Live Action Observation Training Group, and lying and rolling (P = .317) and crawling and kneeling (P = .063) motor subtests and Gillette Functional Assessment Questionnaire-walking scale (P = .513) in the control group. Comparisons of the increases in all other measurements between the groups, except for the dimensions of Gross Motor Function Measurement-lying and rolling (P = .172), were statistically significant (P < .05) and this difference was in favor of action observation training. CONCLUSION: It was found that 2 different AOTs applied in addition to conventional physiotherapy in children with spastic diparetic cerebral palsy were more effective on all outcomes than was conventional physiotherapy alone.

Think before you pop: Outcomes of non-operative management of ureteroceles.

INTRODUCTION/BACKGROUND: Ureteroceles are often diagnosed antenatally and incidentally and treated in a minimally invasive fashion with endoscopic puncture. Recent literature suggests that observation, or non-operative management, is an effective and viable management option in select patients with ureteroceles and certain radiologic findings, however there is no consensus on how to best select patients for non-operative management. OBJECTIVE: To 1) determine if pediatric ureteroceles managed non-operatively require less or sooner secondary surgical intervention than those managed with up-front incision, 2) describe characteristics of success and failure in pediatric ureteroceles managed non-operatively, and 3) identify risk factors associated with receiving intervention and time to intervention. RESULTS: Of 287 ureteroceles, 65 (23%) were managed non-operatively and underwent secondary surgical intervention less frequently (9% vs. 34%, P < 0.01) and later (median age 40 vs. 20 months) than those managed with puncture. Successful non-operative management was associated with fewer comorbidities, smaller ureterocele size, absence of vesicoureteral reflux (VUR) and high-grade VUR, single collecting system, lesser degree of hydronephrosis, ipsilateral MCDK and intravesical location. For all ureteroceles, high-grade VUR, duplex system, and female sex were associated with shorter time to secondary intervention (intervention after initial management). DISCUSSION: In the largest retrospective review of ureterocele management, smaller ureterocele size, absence of high-grade VUR, single system, ipsilateral MCDK and minimal hydronephrosis were factors that increased the efficacy of non-operative management of select pediatric ureteroceles. Furthermore, time to event analysis showed that non-operative management did not predispose patients to sooner secondary intervention (Figure). Lack of a standardized protocol for ureterocele management is a limitation of this single institution retrospective study as it introduces selection bias to the results, however few patients with low risk characteristics underwent puncture and no high risk patients were observed. CONCLUSION: Smaller ureterocele size, absence of high-grade VUR, single system, ipsilateral MCDK and minimal hydronephrosis are factors that may increase the efficacy of non-operative management of select pediatric ureteroceles, which may delay or avoid secondary surgical intervention.

Remote sensing detection of plastic-mulched farmland using a temporal approach in machine learning: case study in tomato crops.

The increasing use of plastics in rural environments has led to concerns about agricultural plastic waste (APW). However, the plasticulture information gap hinders waste management planning and may lead to plastic residue leakage into the environment with consequent microplastic formation. The location and estimated quantity of the APW are crucial for territorial planning and public policies regarding land use and waste management. Agri-plastic remote detection has attracted increased attention but requires a consensus approach, particularly for mapping plastic-mulched farmlands (PMFs) scattered across vast areas. This article tests whether a streamlined time-series approach minimizes PMF confusion with the background using less processing. Based on the literature, we performed a vast assessment of machine learning techniques and investigated the importance of features in mapping tomato PMF. We evaluated pixel-based and object-based classifications in harmonized Sentinel-2 level-2A images, added plastic indices, and compared six classifiers. The best result showed an overall accuracy of 99.7% through pixel-based using the multilayer perceptron (MLP) classifier. The 3-time series with a 30-day composite exhibited increased accuracy, a decrease in background confusion, and was a viable alternative for overcoming the impact of cloud cover on images at certain times of the year in our study area, which leads to a potentially reliable methodology for APW mapping for future studies. To our knowledge, the presented PMF map is the first for Latin America. This represents a first step toward promoting the circularity of all agricultural plastic in the region, minimizing the impacts of degradation on the environment.

Old, the new, more or less and the conundrum for biomarkers in cardiovascular diseases?

Biomarkers are critical for diagnostic, monitoring and management of cardiovascular diseases. Opportunities to improve how biomarkers are used are important. This editorial on biomarkers in coronary artery disease provides commentary on the study as well as broad benchmarks on what make ideal biomarkers. Biomarker discovery is difficult and opportunities to expand and improve their use should be encouraged.

Behavioral observation and assessment protocol for language and social-emotional development study in children aged 0-6: the Chinese baby connectome project.

BACKGROUND: The global rise in developmental delays underscores the critical need for a thorough understanding and timely interventions during early childhood. Addressing this issue, the Chinese Baby Connectome Project (CBCP)'s behavior branch is dedicated to examining language acquisition, social-emotional development, and environmental factors affecting Chinese children. The research framework is built around three primary objectives: developing a 0-6 Child Development Assessment Toolkit, implementing an Intelligent Coding System, and investigating environmental influence. METHODS: Utilizing an accelerated longitudinal design, the CBCP aims to enlist a minimum of 1000 typically developing Chinese children aged 0-6. The data collected in this branch constitutes parental questionnaires, behavioral assessments, and observational experiments to capture their developmental milestones and environmental influences holistically. The parental questionnaires will gauge children's developmental levels in language and social-emotional domains, alongside parental mental well-being, life events, parenting stress, parenting styles, and family relationships. Behavioral assessments will involve neurofunctional developmental evaluations using tools such as the Griffiths Development Scales and Wechsler Preschool and Primary Scale of Intelligence. Additionally, the assessments will encompass measuring children's executive functions (e.g., Head-Toe-Knee-Shoulder), social cognitive abilities (e.g., theory of mind), and language development (e.g., Early Chinese Vocabulary Test). A series of behavior observation. experiments will be conducted targeting children of different age groups, focusing primarily on aspects such as behavioral inhibition, compliance, self-control, and social-emotional regulation. To achieve the objectives, established international questionnaires will be adapted to suit local contexts and devise customized metrics for evaluating children's language and social-emotional development; deep learning algorithms will be developed in the observational experiments to enable automated behavioral analysis; and statistical models will be built to factor in various environmental variables to comprehensively outline developmental trajectories and relationships. DISCUSSION: This study's integration of diverse assessments and AI technology will offer a detailed analysis of early childhood development in China, particularly in the realms of language acquisition and social-emotional skills. The development of a comprehensive assessment toolkit and coding system will enhance our ability to understand and support the development of Chinese children, contributing significantly to the field of early childhood development research. TRIAL REGISTRATION: This study was registered with clinicaltrials.gov NCT05040542 on September 10, 2021.

Enhancing the Functionalities of Personal Health Record Systems: Empirical Study Based on the HL7 Personal Health Record System Functional Model Release 1.

Background: The increasing demand for personal health record (PHR) systems is driven by individuals' desire to actively manage their health care. However, the limited functionality of current PHR systems has affected users' willingness to adopt them, leading to lower-than-expected usage rates. The HL7 (Health Level Seven) PHR System Functional Model (PHR-S FM) was proposed to address this issue, outlining all possible functionalities in PHR systems. Although the PHR-S FM provides a comprehensive theoretical framework, its practical effectiveness and applicability have not been fully explored. Objective: This study aimed to design and develop a tethered PHR prototype in accordance with the guidelines of the PHR-S FM. It sought to explore the feasibility of applying the PHR-S FM in PHR systems by comparing the prototype with the results of previous research. Methods: The PHR-S FM profile was defined to meet broad clinical data management requirements based on previous research. We designed and developed a PHR prototype as a web application using the Fast Healthcare Interoperability Resources R4 (FHIR) and Logical Observation Identifiers Names and Codes (LOINC) coding system for interoperability and data consistency. We validated the prototype using the Synthea dataset, which provided realistic synthetic medical records. In addition, we compared the results produced by the prototype with those of previous studies to evaluate the feasibility and implementation of the PHR-S FM framework. Results: The PHR prototype was developed based on the PHR-S FM profile. We verified its functionality by demonstrating its ability to synchronize data with the FHIR server, effectively managing and displaying various health data types. Validation using the Synthea dataset confirmed the prototype's accuracy, achieving 100% coverage across 1157 data items. A comparison with the findings of previous studies indicated the feasibility of implementing the PHR-S FM and highlighted areas for future research and improvements. Conclusions: The results of this study offer valuable insights into the potential for practical application and broad adoption of the PHR-S FM in real-world health care settings.

A scoping review of observation-based tools for assessing use of the upper limb in activities.

PURPOSE: To summarise information about tools available to rate observed performance in activities, tested with populations with upper limb impairment. METHODS AND MATERIALS: A scoping review was conducted. Articles were included if they reported psychometric properties of tools that could be used with populations with upper limb impairment, had at least one activity item, and item/s involved use of the upper limbs. Information about the tools was extracted, summarised and key findings are presented. RESULTS: Twenty-seven tools met the inclusion criteria. The results indicated that few tools used client-selected (19%) items or clinician-selected (11%) items. Most tools (70%) used pre-defined items. Fourteen tools (52%) included activity-only items. Eleven tools (41%) had less than half activity items. An in-depth summary of the tools with activity-only items is reported. CONCLUSION: Many tools exist for assessing observed performance in activities to examine use of the upper limb. However, there were few tools (N = 6) available that assess observed performance in client-selected activities.

This review can be used as a comprehensive summary of tools that currently exist to assess observed upper limb use or performance in activities for people with upper limb impairment (n = 27).A small number (n = 6) of assessments of observed performance in client-selected activities were identified that may be accessed by rehabilitation clinicians.Given the importance of client-centred practice, it is recommended that clinicians and researchers should select, modify and test available assessments that utilise client-selected occupations.

Screening and Prediction of Autism in Toddlers Using SORF in Videos of Brief Family Interactions.

The purpose of this study was to validate the utility of the Systematic Observation of Red Flags (SORF) for autism screening during 10-minute parent-child interactions at ages 15-24 months. A total of 54 children participated in this study, including 19 with autism spectrum disorder (ASD), 23 with developmental delay, and 12 typically developing children. Coders coded 10-minute videos of parent-child interactions based on the defined scoring criteria. The discriminative ability for outcome diagnosis was evaluated for total score, social communication score, restricted repetitive behavior score, number of red flags, and composite score. SORF scores demonstrated good discriminative ability between ASD and non-ASD children, with the composite score (AUC = 0.884) showing the best discriminative ability for outcome diagnosis and predicting likelihood of ASD in young children. The composite score represented a simplified measurement, with the cutoff score of 7 and sensitivity and specificity of 0.789 and 0.800, respectively.

Dual Coaching of Medical Clerkship Students' History Taking Skills by Volunteer Inpatients at the Bedside and Faculty Physicians on Zoom During the COVID-19 Pandemic.

Purpose: Coaching is a well-described means of providing real-time, actionable feedback to learners. We aimed to determine whether dual coaching from faculty physicians and real inpatients led to an improvement in history-taking skills of clerkship medical students. Patients and Methods: Expert faculty physicians (on Zoom) directly observed 13 clerkship medical students as they obtained a history from 26 real, hospitalized inpatients (in person), after which students received immediate feedback from both the physician and the patient. De-identified audio-video recordings of all interviews were scored by independent judges using a previously validated clinical rating tool to assess for improvement in history-taking skills between the two interviews. Finally, all participants completed a survey with Likert scale questions and free-text prompts. Results: Students' history-taking skills - specifically in the domains of communication, medical knowledge and professional conduct - on the validated rating tool, as evaluated by the independent judges, did not significantly improve between their first and second patient interviews. However, students rated the dual coaching as overwhelmingly positive (average score of 1.43, with 1 being Excellent and 5 being Poor), with many appreciating the specificity and timeliness of the feedback. Patients also rated the experience very highly (average score of 1.23, with 1 being Excellent and 5 being Poor), noting that they gained new insights into medical training. Conclusion: Students value receiving immediate and specific feedback and real patients enjoy participating in the feedback process. Dual physician-patient coaching is a unique way to incorporate more direct observation into undergraduate medical education curricula.

An open-access database of video stimuli for action observation research in neuroimaging settings: psychometric evaluation and motion characterization.

Video presentation has become ubiquitous in paradigms investigating the neural and behavioral responses to observed actions. In spite of the great interest in uncovering the processing of observed bodily movements and actions in neuroscience and cognitive science, at present, no standardized set of video stimuli for action observation research in neuroimaging settings exists. To facilitate future action observation research, we developed an open-access database of 135 high-definition videos of a male actor performing object-oriented actions. Actions from 3 categories: kinematically natural and goal-intact (Normal), kinematically unnatural and goal-intact (How), or kinematically natural and goal-violating (What), directed toward 15 different objects were filmed from 3 angles. Psychometric evaluation of the database revealed high video recognition accuracy (Mean accuracy = 88.61 %) and substantial inter-rater agreement (Fleiss' Kappa = 0.702), establishing excellent validity and reliability. Videos' exact timing of motion onset was identified using a custom motion detection frame-differencing procedure. Based on its outcome, the videos were edited to assure that motion begins at the second frame of each video. The videos' timing of category recognition was also identified using a novel behavioral up-down staircase procedure. The identified timings can be incorporated in future experimental designs to counteract jittered stimulus onsets, thus vastly improving the sensitivity of neuroimaging experiments. All videos, their psychometric evaluations, and the timing of their frame of category recognition, as well as our custom programs for performing these evaluations on our, or on other similar video databases, are available at the Open Science Framework (https://osf.io/zexc4/).

Performance of ChatGPT on Nursing Licensure Examinations in the United States and China: Cross-Sectional Study.

Background: The creation of large language models (LLMs) such as ChatGPT is an important step in the development of artificial intelligence, which shows great potential in medical education due to its powerful language understanding and generative capabilities. The purpose of this study was to quantitatively evaluate and comprehensively analyze ChatGPT's performance in handling questions for the National Nursing Licensure Examination (NNLE) in China and the United States, including the National Council Licensure Examination for Registered Nurses (NCLEX-RN) and the NNLE. Objective: This study aims to examine how well LLMs respond to the NCLEX-RN and the NNLE multiple-choice questions (MCQs) in various language inputs. To evaluate whether LLMs can be used as multilingual learning assistance for nursing, and to assess whether they possess a repository of professional knowledge applicable to clinical nursing practice. Methods: First, we compiled 150 NCLEX-RN Practical MCQs, 240 NNLE Theoretical MCQs, and 240 NNLE Practical MCQs. Then, the translation function of ChatGPT 3.5 was used to translate NCLEX-RN questions from English to Chinese and NNLE questions from Chinese to English. Finally, the original version and the translated version of the MCQs were inputted into ChatGPT 4.0, ChatGPT 3.5, and Google Bard. Different LLMs were compared according to the accuracy rate, and the differences between different language inputs were compared. Results: The accuracy rates of ChatGPT 4.0 for NCLEX-RN practical questions and Chinese-translated NCLEX-RN practical questions were 88.7% (133/150) and 79.3% (119/150), respectively. Despite the statistical significance of the difference (P=.03), the correct rate was generally satisfactory. Around 71.9% (169/235) of NNLE Theoretical MCQs and 69.1% (161/233) of NNLE Practical MCQs were correctly answered by ChatGPT 4.0. The accuracy of ChatGPT 4.0 in processing NNLE Theoretical MCQs and NNLE Practical MCQs translated into English was 71.5% (168/235; P=.92) and 67.8% (158/233; P=.77), respectively, and there was no statistically significant difference between the results of text input in different languages. ChatGPT 3.5 (NCLEX-RN P=.003, NNLE Theoretical P<.001, NNLE Practical P=.12) and Google Bard (NCLEX-RN P<.001, NNLE Theoretical P<.001, NNLE Practical P<.001) had lower accuracy rates for nursing-related MCQs than ChatGPT 4.0 in English input. English accuracy was higher when compared with ChatGPT 3.5's Chinese input, and the difference was statistically significant (NCLEX-RN P=.02, NNLE Practical P=.02). Whether submitted in Chinese or English, the MCQs from the NCLEX-RN and NNLE demonstrated that ChatGPT 4.0 had the highest number of unique correct responses and the lowest number of unique incorrect responses among the 3 LLMs. Conclusions: This study, focusing on 618 nursing MCQs including NCLEX-RN and NNLE exams, found that ChatGPT 4.0 outperformed ChatGPT 3.5 and Google Bard in accuracy. It excelled in processing English and Chinese inputs, underscoring its potential as a valuable tool in nursing education and clinical decision-making.

Evolving Dynamics of Relational Coordination: A Study of Progression of Care Huddles in Hospital Observation Services.

Health care organizations are increasingly using team huddles to enhance communication, improve patient experience, and deliver timely care. However, established practices, resource constraints, and hierarchical role dynamics can hinder the effectiveness of huddling. This study investigates the dynamics of care huddle implementation through interviews with care providers and managers of an observation unit in a U.S. hospital. Qualitative analysis of interview data reveals that huddle adoption enhances relational coordination (RC), thus highlighting the importance of both coaching interventions in fostering proactive behavior and the building of a work environment aligned toward shared goals. The findings affirm RC as a dynamic change model, examining its interplay with organizational processes and structure. The study underscores the significance of adaptations in work processes, the role of informal boundary spanners in facilitating cross-departmental coordination, and structural changes that increase autonomy for low-power actors. We offer actionable recommendations for health care organizations aiming to improve care coordination.

Does Action Observation of the Whole Task Influence Mirror Neuron System and Upper Limb Muscle Activity Better Than Part Task in People With Stroke?

Background: Task-based action observation and imitation (AOI) is a promising intervention to enhance upper limb (UL) motor function poststroke. However, whether whole/part task must be trained in the AOI therapy needs further substantiation. Objective: The objective of this study is to assess and compare the mirror neuron activity and UL muscle activity during AOI of reaching task in terms of whole task (complete movement) and part task (proximal arm movements and distal arm movements). Methods: In this cross-sectional study, 26 participants with first-time unilateral stroke were asked to observe the prerecorded videos of a reaching task in terms of a whole task and proximal and distal components, followed by imitation of the task, respectively. Electroencephalographic (EEG) mu rhythm suppression and electromyographic amplitude of six UL muscles were measured during the task. Results: The analysis of EEG revealed a statistically significant mu suppression score, indicating mirror neuron system activity, during AOI of the whole task in C3 (p = <0.001) and C4 (p = <0.001) electrodes compared to the part task. Percentage maximum voluntary contraction amplitudes of the deltoid (p = 0.002), supraspinatus (p = <0.001), triceps brachii (p = 0.002), brachioradialis (p = 0.006), and extensor carpi radialis (p = <0.001) muscles showed a significant increase in muscle activity during AOI of the whole task. Also, there seems to be a task observation-specific activation of muscles following AOI of proximal or distal tasks. Conclusion: The practice of the whole task should be given emphasis while framing the AOI treatment module to enhance reaching in people with stroke. Trial registration: Clinical Trials Registry-India (CTRI) identifier: CTRI/2018/04/013466.

Evaluating Practice Patterns of Observation Periods Following Epinephrine Administration for Anaphylaxis Among Pediatric Patients.

Objective Current guidelines recommend that anaphylactic patients be observed for 4-6 hours following epinephrine administration to monitor for biphasic reactions. There is conflicting data regarding the efficacy of these guidelines and the prevalence of biphasic reactions among the pediatric population. This retrospective study aimed to investigate the appropriateness of these guidelines through evaluation of observation periods and patterns of biphasic reaction development among pediatric anaphylactic patients at a single-institution ED. Methods Patients less than 18 years of age who presented to the ED of a tertiary academic medical center between 2017 and 2022 and were treated with epinephrine for anaphylaxis were included in the study. The frequency and timing of biphasic reactions were observed. Duration of ED observation, time between symptom onset and first dose of epinephrine, number and category of anaphylactic symptoms, and allergen type were compared between patients who did and did not experience a biphasic reaction. Additional variables analyzed included persistence of anaphylactic symptoms, additional doses of epinephrine, and adjuvant medications. Contingency tables and two-sample t-tests were used to compare categorical and continuous variables, respectively, between those who did and did not develop a biphasic reaction. Results A total of 292 patients met the inclusion criteria and were included in the analysis. All patients were observed in the ED for a mean of 233.1 minutes. Ten patients (3.4%) developed a biphasic reaction. Six had a reaction within 150 minutes of initial symptom resolution, and four developed one after discharge, within 10 to 33 hours following symptom resolution. There was no significant difference in the length of time observed in the ED (p=0.98) or from symptom onset to the first epinephrine dose (p=0.90) between groups. Presenting with respiratory symptoms was associated with persistent anaphylactic symptoms despite epinephrine administration (p=0.01). Patients with symptoms involving at least two organ systems were 3.45 times more likely to experience persistent symptoms post-epinephrine than those with involvement of only one organ system (OR=3.45; CI: 1.28-9.30). Allergen type, anaphylactic symptoms, or the number of organ systems involved were not linked to developing a biphasic reaction or the need for additional epinephrine doses. Conclusions The patients who developed a biphasic reaction did so either shortly following initial symptom resolution or many hours past the recommended observation period. Extending the observation period of patients within reasonable parameters would not have reduced the number of patients who experienced a biphasic reaction after discharge. The results of this study support potentially adopting a more individualized approach to anaphylaxis management following epinephrine administration. Shortening the observation period for patients at low risk for biphasic reactions could reduce the patient burden on EDs without negatively impacting patient outcomes. Although no significant risk factors for biphasic reactions were identified in this study, closer monitoring of patients with respiratory symptoms and/or involvement of a greater number of organ systems may help mitigate the number of patients who experience persistence of anaphylaxis despite treatment.

The level of skills involved in an observation-based gait analysis.

This study aimed to determine the visual assessment skills during an observation-based gait analysis. Participants (N=40) included 20 physiotherapists (PTs) with>10 years of clinical experience (physiotherapists) and 20 physiotherapy students. Both groups watched a video of the gait of a subject with Guillain-Barré syndrome before and after being provided with information regarding other movements. Further, visual lines were measured using an EMR-8 eye mark recorder, and the results were compared between both groups. The average gaze duration was longer for students than for PTs (F1,79=53.3; p<0.01), whereas PTs gazed more often than the students (F1,79=87.6; p< 0.01). Furthermore, the PTs moved their eyes vertically more often than the students (F1,151=9.1; P< 0.01). We found that being able to discriminate the relative physical relationship of body locations by frequent and rapid vertical gazes could be an indication of the level of skills as an index to express the visual assessment skill in an observation-based gait analysis.

'You're Just Thinking About Going Home': Exploring Person-Centred Medication Communication With Older Patients at Hospital Discharge.

BACKGROUND: The hospital discharge process poses significant safety risks for older patients due to complexities in communication and coordination among stakeholders, leading to potential drug-related problems post-discharge. Adopting a person-centred care (PCC) approach in medication communication by healthcare professionals (HCPs) is crucial to ensure positive health outcomes. This study aimed to explore the practice of PCC in medication communication between older patients and HCPs during the hospital discharge process. METHODS: We conducted a qualitative study using non-participatory direct observations of patient-HCP consultations during hospital discharge, followed by semi-structured interviews with observed patients and, when applicable, their informal caregivers. Data collection occurred from October 2020 to May 2021 at two Swedish hospitals. We gathered data using an observational form and audio-recorded all consultations and interviews. The data were analysed thematically using the systematic text condensation method. RESULTS: Twenty patients were included (median age: 81 years [range: 65-94]; 9 female) in observations and 13 of them participated in interviews. Two patients were accompanied by an informal caregiver during the interviews. Three main themes were identified: (1) The impact of traditional authoritarian structures, depicts power dynamics between patients and their HCPs, showing how traditional structures influence the practice of PCC in medication communication during hospital discharge; (2) Consultation timing and mode not on patients' terms, describes suboptimal times and settings for consultations, along with the use of complex language that hinders effective communication; and (3) Discrepancy in expectations of self-care ability, illustrates a mismatch between the self-care guidance provided by HCPs during hospital discharge and the actual needs and preferences of patients and informal caregivers. CONCLUSION: Medication communication between older patients and HCPs during hospital discharge is frequently inconsistent with the practice of PCC. Not only must HCPs improve their communication strategies, but patients and their informal caregivers should also be better prepared for discharge communication and encouraged to participate in their care. This involvement would give them relevant knowledge and tailor communication to their individual needs, preventing problems in managing their medications after discharge. PATIENT OR PUBLIC CONTRIBUTION: An advisory group of six patients and/or informal caregiver contributors provided input on the study design, edited the consent forms, and helped develop the interview guide.

Conservative management of brain arteriovenous malformations: results of the prospective observation registry of a pragmatic trial.

OBJECTIVE: Many patients recruited in the Treatment of Brain Arteriovenous Malformations Study (TOBAS) are managed conservatively. The aim of this study was to monitor what happened to those patients. METHODS: TOBAS comprises two randomized controlled trials and multiple prospective registries. All patients with brain arteriovenous malformations (AVMs) can participate. This report concerns patients selected for conservative management. The primary trial outcome measure is related death or dependency (modified Rankin Scale [mRS] score > 2) at 10 years. Secondary outcomes include intracranial hemorrhages, nonhemorrhagic neurological events, and serious adverse events (SAEs). For this report, outcome results are presented using patient-years, Kaplan-Meier survival curves, and Cox log-rank tests. There was no blinding. RESULTS: From June 2014 to May 2021, 1010 patients were recruited, of whom 498 (49%) were proposed the prospective observation registry. After exclusions, 434 (87%) patients remained for analysis. The majority of patients had unruptured AVMs (378/434 [87%]), of which 195 (52%) were low grade (Spetzler-Martin grade I or II). During a mean follow-up period of 3.2 years (total 1368 patient-years), the primary outcome occurred in 23 of 434 (5%) patients, corresponding to an incidence of 1.7 (95% CI 1.1-2.5) per 100 patient-years. For unruptured AVMs the incidence was 1.1 (95% CI 0.7-1.9) per 100 patient-years, and for low-grade unruptured AVMs it was 0.6 (95% CI 0.2-1.7) per 100 patient-years. Poor outcomes were more frequent in patients with a history of rupture (HR 5.6 [95% CI 2.4-13.0], p < 0.001), infratentorial AVMs (HR 2.9 [95% CI 1.1-7.3], p = 0.027), and age ≥ 55 years (HR 3.2 [95% CI 1.4-7.6], p = 0.007). Major intracranial hemorrhage occurred in 35 of 434 (8%) patients (incidence of 2.6 [95% CI 1.9-3.6] per 100 patient-years; 2.0 [95% CI 1.3-2.9] per 100 patient-years for unruptured AVMs and 1.3 [95% CI 0.6-2.6] per 100 patient-years for low-grade unruptured AVMs). Major AVM hemorrhages were more frequent in ruptured (HR 4.4 [95% CI 2.1-8.9], p < 0.001), large (HR 2.6 [95% CI 1.1-6.6], p = 0.039), and high-grade (HR 2.5 [95% CI 1.2-5.3], p = 0.013) AVMs and those with deep venous drainage (HR 2.1 [95% CI 1.1-4.2], p = 0.032). SAEs occurred in 48 of 434 (11%) patients (incidence of 3.6 [95% CI 2.7-4.8] per 100 patient-years). For unruptured AVMs the incidence was 2.8 (95% CI 2.0-4.0) per 100 patient-years, and for low-grade unruptured AVMs it was 1.8 (95% CI 1.0-3.2) per 100 patient-years. CONCLUSIONS: Nearly half of TOBAS participants were observed. Rates of untoward neurological events were within expected boundaries.

Common Feeding Practices Used by Chinese Caregivers of 6-10-Month-Old Infants: A Behavioral Observation Study in Shaanxi Province.

OBJECTIVE: To explore the feeding practices and feeding environment of Chinese families with 6-10-month-old infants. DESIGN: One day of caregiver-recorded feeding occasions. SETTING: Homes in Shaanxi, China. PARTICIPANTS: Families recruited using convenience sampling. VARIABLES MEASURED: Videos were coded for feeding practice frequency and acceptance rate, feeding environment, and responsiveness to infant fullness cues and eating pace. ANALYSIS: Wilcoxon rank sum tests examined the differences in feeding practice use based on caregiver type, infant sex, and infant weight status. RESULTS: Twenty-eight families provided videos for coding. The most commonly observed feeding practices were opening the mouth, giving instructions, and interfering with the child's actions. Prompts to eat were accepted 86.9% of the time. Overweight infants' caregivers used significantly more coercive prompts to eat than did caregivers of healthy-weight infants (P < 0.05). Mothers used more autonomy-supportive prompts to eat than did fathers (P < 0.05). Early, active, and late infant fullness cues were captured in 25.6%, 34.8%, and 8.5% of videos, respectively. 53.6% of caregivers fed at the right pace, whereas 14.5% and 31.9% fed too slow or too fast, respectively. Approximately 5.5% of videos had a screen on, and 33.5% of videos included at least 1 other distraction during the meal. CONCLUSIONS AND IMPLICATIONS: Differences in feeding practices among caregivers suggest that targeted advice may further improve feeding practices. Improving the caregiver's ability to identify satiety cues and respond to infant eating speed may also reduce the risk of overfeeding.

Assimilation of ground-based GNSS data using a local ensemble Kalman filter.

Tropical cyclones become increasingly nonlinear and dynamically unstable in high-resolution models. The initial conditions are typically sub-optimal, leaving scope to improve the accuracy of forecasts with improved data assimilation. Simultaneously, the lack of real ground-based GNSS observations over the ocean poses significant challenges when evaluating the assimilation results in oceanic regions. In this study, an Observation System Simulation Experiment is carried out based on a tropical cyclone case. Assimilation experiments using the WRF-PDAF framework are conducted. Conventional and GNSS observation operators are implemented. A diverse array of synthetic observations, encompassing temperature (T), wind components (U and V), precipitable water (PW), and zenith total delay (ZTD), are assimilated utilizing the Local Error-Subspace Transform Kalman filter (LESTKF). The findings highlight the improvement in forecast accuracy achieved through the assimilation process over the ocean. Multiple observation types further improve the forecast accuracy. The study underscores the crucial role of GNSS data assimilation techniques. The assimilation of GNSS data presents potential for advancing weather forecasting capabilities. Thus, the construction of ground-based GNSS observation stations over the ocean is promising.