Management of phenylketonuria in European PKU centres remains heterogeneous.

Phenylketonuria (PKU) is a genetic disorder that follows an autosomal recessive inheritance pattern. Dietary treatment is the cornerstone of therapy and is based on natural protein restriction, Phe-free L-amino acid supplements (protein substitutes) and low protein foods. The aim of this project was to collect information about the clinical management of patients with PKU, focusing on understudied or unresolved issues such as blood phenylalanine (Phe) fluctuations and clinical symptoms, particularly gastro intestinal (GI) discomfort and sleep problems. The survey consisted of 10 open-ended and 12 multiple-choice questions that collected information about size of the PKU population in each center, the center's clinical practices and the outcomes observed by the center concerning adherence, clinical and biochemical abnormalities and clinical symptoms (GI and sleep). The questionnaire was sent to 72 experts from metabolic centers in 11 European countries. Thirty-three centers answered. The results of this survey provide information about the clinical practice in different age groups, concentrating on dietary tolerance, treatment adherence, and metabolic control. All the centers prescribed a Phe-restricted diet, with Phe-free/low Phe protein substitutes and low protein foods. Daily doses given of protein substitutes varied from 1 to 5, with adherence to the prescribed amounts decreasing with increasing age. Respondents identified that improvement in the flavor, taste, volume and smell of protein substitutes may improve adherence. Finally, the survey showed that clinical symptoms, such as GI discomfort and sleep problems occur in patients with PKU but are not systematically evaluated. Twenty-four-hour Phe fluctuations were not routinely assessed. The results highlight a strong heterogeneity of approach to management despite international PKU guidelines. More clinical attention should be given to gastrointestinal and sleep problems in PKU.

Preoperative Oxybutynin Reduces Postoperative Opioid Use Following Common Pediatric Urology Surgeries.

PURPOSE: Urologic surgery involving placement of an indwelling ureteral and/or urethral drain can be associated with significant catheter-related bladder discomfort causing increased postoperative morbidity and opioid medication use. We sought to assess if a single dose of oxybutynin given preoperatively reduces immediate postoperative opioid use in common pediatric urology surgeries. MATERIALS AND METHODS: This single-institution retrospective study identified pediatric patients who underwent surgery on the urinary tract with concomitant placement of a urethral and/or ureteral drain. Patients were given a single weight-based dose of oral oxybutynin in the preoperative area prior to surgery. The primary outcome was receipt of postoperative opioid medication. Multivariable regression analyses were used to assess variables associated with postoperative opioid use. RESULTS: A total of 134 patients were included in our final study population with 42 receiving oxybutynin and 92 who did not. There was no statistical difference between the groups in terms of age, procedure type, anesthesia block, postoperative drain, or intraoperative morphine milligram equivalents per kilogram. Patients who received oxybutynin preoperatively had a decrease in postoperative opioid use (19%) compared to those who did not receive oxybutynin (47%). On multivariable logistic regression analysis, preoperative oxybutynin was associated with a 77% reduced risk of receiving postoperative opioid (odds ratio 0.23, [95% CI 0.09-0.56], P < .001). CONCLUSIONS: For pediatric patients with an indwelling urinary drain after urologic surgery, a single preoperative dose of oxybutynin was significantly associated with lower postoperative utilization of opioids. This relatively low-risk intervention can be easily implemented.

Quantifying sensory thresholds along the migraine cycle: An exploratory longitudinal study.

BACKGROUND: To date, a number of studies on migraine have cross-sectionally evaluated sensory sensitivity with aversion thresholds/scores along the migraine cycle, reporting a decreased tolerance to sensory stimuli in different sensory modalities. Our hypothesis was that patients with migraine would exhibit heightened sensitivity to sound, light, touch and smell on days where they reported greater headache intensity. METHODS: This is an exploratory, longitudinal study, carried out over the course of 27 days. Aversion thresholds or scores to sound, light, touch and smell were quantified in six patients with migraine (11.33 ± 6.53 headache days/month). RESULTS: Patients reported an increased sensitivity to light (padj = 0.0297), touch (padj = 0.0077), and smell (padj = 0.0201) on days with higher headache intensity. However, a greater sensitivity to sound on days with higher headache intensity was only reported when anxiety levels were high (padj = 1.4e-06). Interestingly, variable levels of tolerance to bothersome light over time can also influence the correlation between light sensitivity and headache intensity (padj = 1.4e-06). CONCLUSIONS: Based on the present findings, future longitudinal studies evaluating sensory threshold changes along the migraine cycle in patients with migraine should account for the increased tolerance to bothersome light over time as well as the effect of anxiety on auditory sensitivity.

Patients undergoing double J substitution with a pigtail suture stent report a significant decrease of stent-related symptoms. Results from a prospective multicenter longitudinal trial.

PURPOSE: To compare stent-related symptoms (SRS) in patients with double J (DJ) undergoing substitution with a pigtail suture stent (PSS) after ureteroscopy (URS), through the Ureteral Stent Symptom Questionnaire (USSQ). MATERIALS AND METHODS: Patients with DJ undergoing URS for stone treatment were enrolled in this prospective multicenter longitudinal study. The USSQ was submitted thrice: 2 weeks after DJ, 2 weeks after PSS and 4 weeks after PSS removal (baseline). PRIMARY ENDPOINT: to compare Urinary Symptom Index Score and the rate of patients with pain 2 weeks after DJ and PSS. Secondary endpoints: to compare other USSQ scores and single answers 2 weeks after DJ and PSS, and DJ and PSS USSQ scores with baseline. RESULTS: 93 patients were enrolled. 2 weeks Urinary Symptom Index Score (p < 0.001) and the percentage of patients complaining of pain (60.2% vs 88.2%, p < 0.001) were significantly in favour of PSS compared to DJ. 2 weeks scores were significantly improved with PSS compared to DJ: Pain Index (p < 0.001), VAS (p < 0.001), General Health Index (p < 0.001) and Work Performance Index (p < 0.001). All urinary symptoms were significantly decreased with PSS, including renal pain during micturition and pain interfering with life. Pain Index Score (p = 0.622) and VAS (p = 0.169) were comparable to baseline with PSS, while differed with DJ. CONCLUSIONS: Patients undergoing DJ substitution with PSS after URS report a significant decrease of SRS. Urologists may consider positioning PSS after URS in pre-stented patients to reduce the impact of SRS.

Effects of an intraoperative intravenous Bolus Dose of Dexmedetomidine on postoperative catheter-related bladder discomfort in male patients undergoing transurethral resection of bladder tumors: a randomized, double-blind, controlled trial.

PURPOSE: To investigate whether the effect of intravenous bolus doses of dexmedetomidine on postoperative catheter-related bladder discomfort (CRBD) was dose-dependent in male patients undergoing transurethral resection of bladder tumors (TURBT). METHODS: The study protocol was registered at the Chinese Clinical Trial Registry (ChiCTR 2,000,034,657, date of registration: July 14, 2020). Adult male patients were randomized to one of four groups: placebo (Group C); dexmedetomidine 0.2 µg/kg (Group D 0.2); dexmedetomidine 0.5 µg/kg (Group D 0.5); or dexmedetomidine 1 µg/kg (Group D 1). The primary outcome was the incidence of moderate-to-severe CRBD at 0, 1, 6, 24, and 48 h postoperatively. RESULTS: The incidence of moderate-to-severe CRBD was significantly lower in Group D 0.5 and Group D 1 than in Group C at 0 h (13% vs. 40%, P = 0.006; 8% vs. 40%, P = 0.001), 1 h (15% vs. 53%, P < 0.001; 13% vs. 53%, P < 0.001), and 6 h (10% vs. 32%, P = 0.025; 8% vs. 32%, P = 0.009) postoperatively. Compared with baseline, both the MAP and HR were significantly lower in Group D 1 at 1 min ([94 ± 15] vs. [104 ± 13] mm Hg, P = 0.003; [64 ± 13] vs. [73 ± 13] bpm, P = 0.001) and 30 min ([93 ± 10] vs. [104 ± 13] mm Hg, P < 0.001; [58 ± 9] vs. [73 ± 13] bpm, P < 0.001) postextubation. CONCLUSION: The effect of intravenous bolus doses of dexmedetomidine on postoperative CRBD was dose-independent, whereas intravenous administration of 0.5 µg/kg dexmedetomidine reduced the early postoperative incidence of CRBD with minimal side effects. TRIAL REGISTRATION: Clinical trial number and registry URL: ChiCTR 2,000,034,657, http://www.chictr.org.cn , date of registration: July 14, 2020.

Analysis of Loudness Discomfort Level Tests in Tinnitus Patients.

INTRODUCTION: We aimed to investigate the clinical significance of the loudness discomfort level (LDL) test in tinnitus patients and its relationship with pure-tone audiometry, tinnitogram, and questionnaires. METHODS: We retrospectively reviewed the medical records of 320 tinnitus patients who visited a tertiary university hospital's tinnitus clinic and completed LDL tests between March 2020 and December 2022. Epidemiological data and psychoacoustic test results were collected. RESULTS: The LDL showed no significant differences between frequencies for both ears. The mean LDL did not correlate with mean pure-tone average or hearing thresholds at each frequency. The hearing loss group had a higher LDL at 8 kHz compared to the normal hearing group (p < 0.01). Objective sound intolerance was found in a quarter, correlating with subjective hyperacusis, anxiety, and depression. Weak negative correlations were found between most of questionnaire's scores and LDL on the left side. Tinnitus loudness weak negatively correlated with LDL at most frequencies, except 8 kHz. DISCUSSION/CONCLUSION: Our findings suggest a notable association between LDL levels and emotional factors in tinnitus patients, rather than with auditory thresholds. While lateralized differences in LDL responses were observed, specifically on the left side, these preliminary results do not confirm a causal link and thus do not warrant changes to current clinical testing protocols without further research.

Validity of chronometric TMS for probing the time-course of word production: a modified replication.

In the present study, we used chronometric TMS to probe the time-course of 3 brain regions during a picture naming task. The left inferior frontal gyrus, left posterior middle temporal gyrus, and left posterior superior temporal gyrus were all separately stimulated in 1 of 5 time-windows (225, 300, 375, 450, and 525 ms) from picture onset. We found posterior temporal areas to be causally involved in picture naming in earlier time-windows, whereas all 3 regions appear to be involved in the later time-windows. However, chronometric TMS produces nonspecific effects that may impact behavior, and furthermore, the time-course of any given process is a product of both the involved processing stages along with individual variation in the duration of each stage. We therefore extend previous work in the field by accounting for both individual variations in naming latencies and directly testing for nonspecific effects of TMS. Our findings reveal that both factors influence behavioral outcomes at the group level, underlining the importance of accounting for individual variations in naming latencies, especially for late processing stages closer to articulation, and recognizing the presence of nonspecific effects of TMS. The paper advances key considerations and avenues for future work using chronometric TMS to study overt production.

Long-term prediction of the effects of climate change on indoor climate and air quality.

Limiting the negative impact of climate change on nature and humans is one of the most pressing issues of the 21st century. Meanwhile, people in modern society spend most of the day indoors. It is therefore surprising that comparatively little attention has been paid to indoor human exposure in relation to climate change. Heat action plans have now been designed in many regions to protect people from thermal stress in their private homes and in public buildings. However, in order to be able to plan effectively for the future, reliable information is required about the long-term effects of climate change on indoor air quality and climate. The Indoor Air Quality Climate Change (IAQCC) model is an expediant tool for estimating the influence of climate change on indoor air quality. The model follows a holistic approach in which building physics, emissions, chemical reactions, mold growth and exposure are combined with the fundamental parameters of temperature and humidity. The features of the model have already been presented in an earlier publication, and it is now used for the expected climatic conditions in Central Europe, taking into account various shared socioeconomic pathway (SSP) scenarios up to the year 2100. For the test house examined in this study, the concentrations of pollutants in the indoor air will continue to rise. At the same time, the risk of mold growth also increases (the mold index rose from 0 to 4 in the worst case for very sensitive material). The biggest problem, however, is protection against heat and humidity. Massive structural improvements are needed here, including insulation, ventilation, and direct sun protection. Otherwise, the occupants will be exposed to increasing thermal discomfort, which can also lead to severe heat stress indoors.

Sleep disturbances in hospitalized children: a wake-up call.

Although sleep is essential for (recovery of) health, it is adversely affected by hospitalization, due to disease discomfort, environmental noise, and care routines, causing reduced sleep and increased disturbances. This study evaluates factors affecting sleep quality and quantity in hospitalized children and compares inpatient sleep with sleep at home. Using an observational, prospective study design, we assessed sleep in hospitalized children aged 1-12 years, admitted to a tertiary center, and compared this with home 6-8 weeks after discharge. We measured total sleep time (TST), sleep onset latency (SOL), wake after sleep onset (WASO), sleep efficiency, awakenings, and subjective sleep quality, using actigraphy, sleep diaries, and PROMIS questionnaires. We explored an array of sleep-disturbing factors. Regression analyses identified key determinants affecting sleep patterns, while mixed linear models compared sleep in hospital to sleep at home. Out of 621 eligible patients, 467 were invited, and 272 (58%) consented to participate. Key determinants of sleep included pain, number of previous admissions, (underlying) chronic illness, and environment-, staff-, and disease-related factors. Parents reported lower perceived sleep quality in the hospital compared to at home, 97-min (SE 9) lower TST, 100-min (5) longer WASO, more difficulties with falling asleep, lower sleep satisfaction, and more awakenings. Actigraphy outcomes revealed shorter TST (20 min (6)), but better sleep efficiency and fewer awakenings in the hospital. Conclusion: Sleep in hospital was compromised in comparison to sleep at home, primarily due to disturbances related to treatment, environment, and staff. These findings underscore the necessity and potential of relative simple interventions to improve sleep quality and minimize sleep disturbances in hospitalized children.

Sexual Function and Discomfort in Women After Midurethral Sling Surgery.

INTRODUCTION AND HYPOTHESIS: The purpose of this study was to evaluate medium-term sexual function following midurethral sling (MUS) surgery. METHODS: This was an ambidirectional observational study with a nested matched case-control study performed in a tertiary urogynecology referral center. We assessed sexual discomfort and function using the Pelvi-Perineal Surgery Sexuality Questionnaire (PPSSQ), pre- and postoperatively, in a patient cohort that comprised patients who underwent an MUS procedure between January 2014 and December 2019. We recruited a group of volunteers without a previous history of MUS surgery. The nested case-control study comprised a subgroup of cases from the patients' cohort matched to controls from the volunteer's cohort. Cases and controls were matched for age and menopausal status at a 1:1 ratio. RESULTS: A total of 118 patients and 128 volunteers were recruited. Of these, 105 cases and 105 controls comprised the nested case-control study. There was no statistically significant difference in the mean discomfort and pain scores between cases and controls (19.8 ± 21.2 vs 15.4 ± 15.7 respectively; p = 0.19 primary outcome). Similarly, there was no difference in mean sexual health scores. However, the rate of reported sensation of an obstruction in the vagina was significantly more in cases (16%) than in controls (2.6%; p = 0.001). There were no significant differences between patient-reported sexual function at follow-up compared with their recollection before surgery. CONCLUSION: Midurethral sling surgery does not seem to impair the quality of sexual life in the medium term.

Discomfort/pain due to peri-implant probing at titanium and zirconium implants: A cross-sectional study.

OBJECTIVE: This study was designed to compare discomfort/pain after periodontal and peri-implant probing in patients with titanium compared with zirconium implants. METHODS: One examiner recruited and examined 70 patients, each of whom had a dental implant with a contralateral tooth; 37 patients had titanium implants of various types and 33 patients had zirconium implants; one implant was analyzed for each patient. Periodontal and peri-implant probing pocket depth (PPD) and clinical attachment level (CAL) were assessed. Immediately after probing, patients rated their discomfort/pain with a visual analog scale (VAS). The emergence profiles of implant crowns were assessed on periapical radiographs of the implants. RESULTS: Seventy patients with a median age of 55 years (interquartile range [IQR]: 42-65 years), including 43 females and 16 current smokers, were examined. The mean PPD and bleeding on probing (BOP) were higher around implants than around teeth (p < .001). CAL and suppuration were well-balanced between implants and teeth. Peri-implant probing caused significantly more discomfort/pain than periodontal probing [median VAS score: 12.5 (IQR 4-22) vs. 9 (2-15); p < .001]. Logistic regression revealed that discomfort/pain after peri-implant probing was less intense in patients who had taken analgesic medication (p = .021) and around titanium implants (p = .037). CONCLUSIONS: Peri-implant probing caused significantly more discomfort/pain than periodontal probing. Patients who had taken analgesic medication experienced less discomfort and pain with peri-implant probing than those who had not; furthermore, titanium implants were associated with less pain than zirconium implants.

The analysis of tear meniscus parameters during daily soft contact lens wear using optical coherence tomography.

PURPOSE: To evaluate tear meniscus parameters in soft contact lens wearers (SCL) using optical coherence tomography (OCT) and ImageJ software. METHODS: This prospective study included 50 soft contact lens wearers (group 1: 25 symptomatic SCL wearers (SCLW), group 2: 25 asymptomatic SCL wearers (ASCW)) and 25 healthy non-CL wearers (group 3 (NCLW)). SCLs were fitted on each eye of CL wearers, and the lower tear meniscus was imaged using OCT before CL insertion, immediately afterward, and reimaged 2, 5 and 10 h after insertion. Tear meniscus parameters, including tear meniscus height (TMH), depth (TMD), turbidity, and percentage area occupied by particles (PAOP) were measured in all groups. RESULTS: Turbidity and PAOP measurements at baseline in SCLW were significantly higher than in other groups (p < 0.05). There was no significant difference between TMH, TMD, turbidity, and PAOP parameters calculated at baseline visit and two hours after SCL insertion in all groups (p > 0.05 for 2 comparisons). The symptomatic SCL users had a significant decrease in TMH and TMD in the fifth hour. The turbidity and PAOP measurements of SCLW and ASCW at the fifth and tenth hours were significantly higher than those of NCLW (p < 0.05). CONCLUSION: TMD and height TMH decrease throughout the day in all participants; however, a significant decrease in these parameters was observed only in symptomatic SCL users at the fifth hour, at the earliest. As the duration of CL wear increases, turbidity and PAOP even in asymptomatic SCL wearers become significantly higher than those in healthy non-CL wearers. KEY MESSAGES: What Is Known • Contact lens wear is associated with an increased risk of dry eye. • Tear volume decreases gradually during contact lens wear. What Is New • Tear meniscus turbidity and particle area occupied by particles (PAOP) were higher in symptomatic contact lens wearers and they increase gradually during contact lens wear. • Tear meniscus turbidity and PAOP may be measures of how well the tear film and meniscus are functioning in contact lens wearers.

The mask paradox between perception of discomfort and reality of physiological effects in healthy college students in China: a panel study.

BACKGROUND: During the COVID-19 pandemic, masks proved to be an effective measure in preventing virus transmission. However, many people have reported discomfort and negative perceptions toward wearing masks, especially during physical activity. This study aims to evaluate the discomfort and adverse perceptions related to various mask types among young, healthy adults during light exercise, including sitting, stationary stepping, and stair climbing. The study also examines the extent to which masks influence physiological indicators of physical well-being. METHODS: The study was conducted in two stages at the campus hospital of Shantou University. In Stage 1, 20 healthy college students (10 males, 10 females) were recruited to identify the mask with the most substantial physiological and psychological impact among four types: KN95 respirators, surgical masks, cloth masks, and 3D medical masks. These specific types were chosen due to their widespread use and varying levels of filtration and breathability. In Stage 2, 14 healthy college students (7 males, 7 females) were included to examine the effects of the identified mask across various levels of physical exertion. Subjective perceptions were measured using the Mask-Related Discomfort and Perception Score (MRDPS), and physiological parameters such as body temperature, blood pressure, pulse rate, and vital capacity were recorded. RESULTS: The KN95 respirator and cloth mask were associated with the highest MRDPS, indicating significant discomfort among wearers (p < 0.05). The use of KN95 respirators had the largest impact on MRDPS during stair stepping (ß = 10.357, 95% CI [5.755, 14.959]). Physiological parameters showed minor variations across different masks, with KN95 respirators significantly associated with reduced diastolic blood pressure (ß=-7.806, 95% CI [-12.294, -3.318]) and pulse rate (ß=-10.661, 95% CI [-18.896, -2.425]) in Stage 1. However, after controlling for exercise pace in Stage 2, wearing a KN95 respirator did not significantly affect these parameters. CONCLUSIONS: KN95 respirators and cloth masks were found to cause the most discomfort during light physical activity, with males reporting higher discomfort levels than females. While these masks are associated with varying levels of perceived discomfort, their impact on physiological indicators is relatively modest. Future research should include larger and more diverse samples , continuous monitoring of physiological parameters during exercise, and exploration of the underlying mechanisms of gender differences in mask discomfort.

Evaluation of the relationship between occupational-specific task performance and measures of physical fitness, cardiovascular and musculoskeletal health in firefighters.

INTRODUCTION: Firefighters are required to perform physically strenuous tasks such as hose drags, victim rescues, forcible entries and stair climbs to complete their public safety mission. Occupational-specific tasks are often used to evaluate the ability of firefighters to adequately/safely perform their duties. Depending on the regions, occupational-specific tasks include six to eight individual tasks, which emphasize distinct aspects of their physical fitness, while also requiring different levels of cardiovascular (CVH) and musculoskeletal health (MSH). Therefore, the aim of this study was to evaluate the relationship between specific occupational task performance and measures of physical fitness, cardiovascular and musculoskeletal health. METHODS: Using a cross-sectional design, 282 full-time male and female firefighters were recruited. A researcher-generated questionnaire and physical measures were used to collect data on sociodemographic characteristics, CVH, MSH and weekly physical activity habits. Physical measures were used to collect data on physical fitness and occupational-specific task performance. RESULTS: Absolute cardiorespiratory fitness (abV̇O2max), grip strength, leg strength, push-ups, sit-ups and lean body mass (all p < 0.001) had an inverse association with completion times on all occupational-specific tasks. Age was positively related to the performance of all tasks (all p < 0.05). Higher heart rate variability (HRV) was associated with better performance on all tasks (all p < 0.05). Bodyfat percentage (BF%) and diastolic blood pressure were positively associated with the step-up task (p < 0.05). Lower back musculoskeletal injury (LoBMSI), musculoskeletal discomfort (MSD), and lower limb MSD were associated with a decreased odds of passing the step-up. Upper body MSIs (UBMSI), LoBMSIs and Lower back MSD were associated with decreased odds of passing the rescue drag. CONCLUSION: Firefighters that were taller, leaner, stronger and fitter with a more favourable CVH profile, higher HRV and less musculoskeletal discomfort performed best on all occupational-specific tasks.

Machine learning-based prediction of the risk of moderate-to-severe catheter-related bladder discomfort in general anaesthesia patients: a prospective cohort study.

BACKGROUND: Catheter-related bladder discomfort (CRBD) commonly occurs in patients who have indwelling urinary catheters while under general anesthesia. And moderate-to-severe CRBD can lead to significant adverse events and negatively impact patient health outcomes. However, current screening studies for patients experiencing moderate-to-severe CRBD after waking from general anesthesia are insufficient. Constructing predictive models with higher accuracy using multiple machine learning techniques for early identification of patients at risk of experiencing moderate-to-severe CRBD during general anesthesia resuscitation. METHODS: Eight hundred forty-six patients with indwelling urinary catheters who were resuscitated in a post-anesthesia care unit (PACU). Trained researchers used the CRBD 4-level assessment method to evaluate the severity of a patient's CRBD. They then inputted 24 predictors into six different machine learning algorithms. The performance of the models was evaluated using metrics like the area under the curve (AUC). RESULTS: The AUCs of the six models ranged from 0.82 to 0.89. Among them, the RF model displayed the highest predictive ability, with an AUC of 0.89 (95%CI: 0.87, 0.91). Additionally, it achieved an accuracy of 0.93 (95%CI: 0.91, 0.95), 0.80 sensitivity, 0.98 specificity, 0.94 positive predictive value (PPV), 0.92 negative predictive value (NPV), 0.87 F1 score, and 0.07 Brier score. The logistic regression (LR) model has achieved good results (AUC:0.87) and converted into a nomogram. CONCLUSIONS: The study has successfully developed a machine learning prediction model that exhibits excellent predictive capabilities in identifying patients who may develop moderate-to-severe CRBD after undergoing general anesthesia. Furthermore, the study also presents a nomogram, which serves as a valuable tool for clinical healthcare professionals, enabling them to intervene at an early stage for better patient outcomes.

Analysis of thermal discomfort associated with synoptic conditions in the city of Pelotas, southernmost region of Brazil.

Here, we evaluated the influence of outdoor environmental conditions (synoptic weather conditions) on human thermal discomfort in the five macro-regions of Pelotas city, located in the southernmost region of Brazil. To do this, meteorological sensors (HOBO MX2301A) were installed outside the residences to measure the air temperature, dew point temperature, and relative humidity between 18 January and 20 August 2019. Two well-established simplified biometeorological indices were examined seasonally: (i) humidex for the summer months and (ii) effective temperature as a function of wind for the autumn and winter months. Our findings showed seasonal differences related to human thermal discomfort and outdoor environmental conditions. The thermal discomfort was highest in the afternoons during the summer months and at night during the winter months. The seasonal variation in human thermal discomfort was highly associated with the meteorological conditions. In summer, the presence of the South Atlantic Subtropical Anticyclone (SASA) contributed to heat stress. The SASA combined with the continent's low humidity contributed to the perceived sensation of thermal discomfort. In the winter, thermal discomfort was associated with the decrease in air humidity caused by high atmospheric pressure systems, which led to a decrease in both air temperature and air moisture content. Our findings suggest that a better understanding of the complex interplay between outdoor environmental factors and human thermal comfort is needed in order to mitigate the negative effects of thermal discomfort.

The Relationship Between Discomfort Intolerance And the Fear Of Self-Injection And Testing In Patients With Diabetes Using Insulin: A Cross-Sectional Study.

BACKGROUND: Diabetes is a global problem. Diabetes nurses, in particular, take great responsibility in reducing and controlling the fears of individuals using insulin and increasing their capacity to tolerate discomfort. AIM: This study was conducted to examine the effects of the capacity to tolerate discomfort on the fear of self-injection and the status of testing blood glucose levels in patients with type 1 and type 2 diabetes using insulin. METHODS: This cross-sectional study was conducted between December 2022 and February 2023 with 320 adult patients with type 1 and type 2 diabetes using insulin who were followed up in the Endocrinology and Internal Medicine Clinics of a university hospital in Turkey. The data analysis process included analyses of the frequency, independent-samples t-tests, one-way ANOVA, the Kruskal-Wallis H test, and Pearson's correlation analysis. Data were analysed using the IBM SPSS v27.0 software, considering alpha as 0.05. RESULTS: The mean total Discomfort Intolerance Scale score of the patients was 22.78 ± 6.74, and the mean Fear of Self-Injecting and self-testing was 21.1 ± 6.7. A negative significant correlation was found between the discomfort intolerance levels of the patients and their levels of fear of self-injection and self-testing (p < 0.05). CONCLUSION: Individuals with a higher capacity to tolerate discomfort have lower levels of fear of self-testing and self-injection. Therefore, the fear of self-testing and self-injection in patients using insulin injections may affect diabetes self-management. RELEVANCE TO CLINICAL PRACTICE: Individuals with low tolerance for discomfort should be identified, interventions to increase tolerance in individuals at risk should be planned, and diabetes self-management should be better supported. REPORTING METHOD: The reporting of the results of the study adhered to the STROBE guidelines.

Human-Robot Collaboration With a Corrective Shared Controlled Robot in a Sanding Task.

OBJECTIVE: Physical and cognitive workloads and performance were studied for a corrective shared control (CSC) human-robot collaborative (HRC) sanding task. BACKGROUND: Manual sanding is physically demanding. Collaborative robots (cobots) can potentially reduce physical stress, but fully autonomous implementation has been particularly challenging due to skill, task variability, and robot limitations. CSC is an HRC method where the robot operates semi-autonomously while the human provides real-time corrections. METHODS: Twenty laboratory participants removed paint using an orbital sander, both manually and with a CSC robot. A fully automated robot was also tested. RESULTS: The CSC robot improved subjective discomfort compared to manual sanding in the upper arm by 29.5%, lower arm by 32%, hand by 36.5%, front of the shoulder by 24%, and back of the shoulder by 17.5%. Muscle fatigue measured using EMG, was observed in the medial deltoid and flexor carpi radialis for the manual condition. The composite cognitive workload on the NASA-TLX increased by 14.3% for manual sanding due to high physical demand and effort, while mental demand was 14% greater for the CSC robot. Digital imaging showed that the CSC robot outperformed the automated condition by 7.16% for uniformity, 4.96% for quantity, and 6.06% in total. CONCLUSIONS: In this example, we found that human skills and techniques were integral to sanding and can be successfully incorporated into HRC systems. Humans performed the task using the CSC robot with less fatigue and discomfort. APPLICATIONS: The results can influence implementation of future HRC systems in manufacturing environments.

Subjective Discomfort during Botulinumtoxin Injections Dependent on Injection Site and Needle Size: A Comparison Between 30G, 33G and 34G Needles.

BACKGROUND: Botulinumtoxin application in the face is amongst the most common aesthetic procedures in the head and neck region. It also has numerous medical uses. One of the main reasons for patients to refrain from it is the subjective discomfort that is experienced during injections. OBJECTIVES: The study at hand aimed to determine whether needles with 33G and 34G offer an advantage in terms of individual pain perception during botulinumtoxin injections. METHODS: We conducted a prospective study where patients were asked to grade subjective discomfort on a visual analogue scale for each region (forehead, glabella, temple) that was treated directly after treatment and 15 minutes after. Patients were treated with 30G, 33G or 34G needles, respectively. RESULTS: Ninety-nine patients that underwent treatment of 189 regions were included in the study. Patients were evenly distributed amongst the different needle sizes and regions. Subjective discomfort was greatest in all regions for 30G needles (3.9 ± 1.6 forehead, 4.3 ± 1.7 glabella and 4.0 ± 1.6 temple) followed by 33G (2.7 ± 1.5 forehead, 2.7 ± 1.9 glabella and 2.2 ± 1.2 temple) and 34G (1.7 ± 1.2 forehead, 1.6 ± 1.4 glabella and 1.6 ± 1.4 temple). All differences between needle size were statistically significant (p < 0.05) CONCLUSION: 33G and 34G needles seem to offer smaller discomfort during BTX treatments of the head and neck, with 34G being superior to 33G. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Determinants of discomfort from combined exposure to noise and vibration in dumper operators of mining industry in India.

In the mining industry, dumper operators are exposed to combined noise and vibration, leading to discomfort. Dumpers are heavy earth-moving machines that are used for carrying bulky material in mining industries. Dumper operators are exposed to physical hazards such as vibration, noise, heat, and humidity, throughout their lifetime of work. Fifty-four dumper operators working in mines were selected for this study. Noise was measured as per the guidelines of the Directorate General Mining Safety, India, and whole-body vibration was measured as per the guidelines of ISO 2631-1::1997. Noise Pro DLX, Type 2 noise dosimeters were used for the measurement of personal noise exposure while SV-106 six channels vibration meters were used for whole body vibration (WBV) exposure measurement. Discomfort was calculated using the regression equation developed by Huang and Griffin (2014). The total discomfort level of mine operators was about 192. A predictive equation was derived by using a regression model to determine the contribution of individual variables causing discomfort. It was observed that for every unit increase in noise (LAeq), discomfort increased by 10.20 units, a one-unit increase in vibration (A (8)) led to a 51.7-unit increase in discomfort, while an increase of one unit of exposure time increased the discomfort level by 5.24 units.