Evaluation of phrenic nerve stimulation trigger lag and synchronization in different modes of ventilation.

Phrenic nerve stimulation is currently being investigated for the prevention of diaphragm atrophy in patients with mechanically supported breathing. Patients receiving breathing support from mechanical ventilation are at risk of mismatches between respiratory demand and ventilator support. Our objectives were to determine if a novel phrenic nerve stimulation device provided stimulation during inspiration as intended and did not exacerbate any potential discordances. A benchtop electromechanical simulation model was developed to validate phrenic nerve stimulation with simulated breathing. The phrenic nerve stimulation device was evaluated with a mechanical ventilator attached to a breathing simulator. The trigger ratio and time lag between phrenic nerve stimulation and mechanical ventilation was measured for multiple disease and ventilator parameters. For the 1:1 breath trigger ratio test, 99.79% of intended stimulation breaths received stimulation at the correct time. For the 1:4 breath trigger ratio test, 99.72% of intended stimulation breaths received stimulation at the correct time. For trigger lag times for the inspiratory and expiratory phases, the mean inspiratory lag was 36.10 ± 10.50 ms and 16.61 ± 3.61 ms, respectively. The following discordance scenarios were evaluated in conjunction with simulated phrenic nerve stimulation: asynchrony-false trigger, dyssynchrony-early trigger, dyssynchrony-late trigger, dyssynchrony-early cycling, dyssynchrony-late cycling. Testing demonstrated none of these discordances were exacerbated by the simulated phrenic nerve stimulation. The novel phrenic nerve stimulation device delivered electrical stimulation therapy as intended and did not exacerbate any simulated discordances.

ABa6Cu31Te22 (A = K, Rb, Cs) Featuring Polyanionic Copper-Telluride Frameworks with Ultralow Thermal Conductivity.

Three polyanionic tellurides, ABa6Cu31Te22 (A = K, Rb, Cs), were synthesized in salt flux. The isostructural tellurides crystallize in a new structure type, in the cubic Pa3 space group with a Wyckoff sequence of d10c2b1 and large unit cell volumes of over 5500 Å3. The structures feature a framework of [CuTe4] tetrahedra and [CuTe3] trigonal pyramids with disorder in the Cu sites. The polyanionic frameworks have large square antiprism and cuboctahedral voids where Ba and alkali metal cations are situated, forming [BaTe8] and [ATe12], respectively. The overall compositions are close to being charge balanced. The large [ATe12] cuboctahedra allowed for significant anisotropic displacement of the A cations, as observed from both single crystal X-ray diffraction and heat capacity studies. Alkali cations rattling together with Cu atom displacement and disorder leads to the dispersion of phonons, thus softening the lattice and subsequently reducing the thermal conductivity. Evaluations of the electronic band structure revealed the occurrence of a narrow bandgap together with the presence of a flat band near the valence band maximum, giving rise to the high thermopower. The Cs and Rb analogues show a slope change in the temperature dependence of electrical resistivity around room temperature, which is typical for semimetals or degenerate semiconductors. For the as-synthesized and unoptimized materials, high values of the thermoelectric figure-of-merit of ∼0.2 were observed at 623 K.

Care Needs, Challenges, and Experiences of Sexual and Gender Minority Cancer Survivors in Taiwan: Findings from a Qualitative Study.

OBJECTIVES: This study aimed to explore the care needs, challenges, and experiences of cancer care among sexual and gender minority (SGM) cancer survivors in Taiwan. METHODS: Semi-structured interviews were conducted face-to-face or telephonically with 30 SGM cancer survivors in Taiwan. Data were analyzed using the socio-ecological model and the constant comparative technique. The study used the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. RESULTS: The needs, challenges, and experiences of cancer care among SGM cancer survivors were categorized and presented according to the level of the social-ecological model: (1) intrapersonal level: physical and psychological impacts and changes in outlook on life after cancer diagnosis and treatment; (2) interpersonal level: informal social support resources and challenges for developing intimate relationships; (3) community level: formal social support resources and lack of SGM support groups; and (4) societal and policy level: positive and negative experiences with oncology healthcare providers (HCPs), sexual orientation disclosure, and lack of an SGM-friendly environment. CONCLUSIONS: Multilevel care needs and challenges in cancer care among SGM cancer survivors were identified. Oncology HCPs should be aware of and assess SGM cancer survivors' psychosexual issues and psychological status and provide suitable care resources to individuals. Moreover, training courses on culturally competent cancer care and information on SGM-related health policies (including same-sex marriage) should be provided to oncology HCPs to improve their sensitivity, knowledge, and skills to provide suitable care for SGM cancer survivors. IMPLICATIONS FOR NURSING PRACTICE: The study findings can be used to design and develop training courses for culturally competent cancer care for oncology HCPs to improve the quality of care and reduce cancer care disparities among SGM cancer patients.

Can I catch this ball and do I know if I can? Characterizing the affordance of interceptability for oneself.

In this study, we aimed to characterize the affordance of interceptability for oneself using a manual lateral interception paradigm. We asked a two-fold research question: (1) What makes a virtual ball interceptable or not? (2) How reliably can individuals perceive this affordance for oneself? We hypothesized that a spatiotemporal boundary would determine the interceptability of a ball, and that individuals would be able to perceive this boundary and make accurate perceptual judgments regarding their own interceptability. To test our hypotheses, we administered a manual lateral interception task to 15 subjects. They were first trained on the task, which was followed by two experimental sessions: action and judging. In the former, participants were instructed to intercept as many virtual balls as possible using a hand-held slider to control an on-screen paddle. In the latter session, while making interceptions, participants were instructed to call "no" as soon as they perceived a ball to be uninterceptable. Using generalized linear modeling on the data, we found a handful of factors that best characterized the affordance of interceptability. As hypothesized, distance to be covered and ball flight time shaped the boundary between interceptable and uninterceptable balls. Surprisingly, the angle of approach of the ball also co-determined interceptability. Altogether, these variables characterized the actualized interceptability. Secondly, participants accurately perceived their own ability to intercept balls on over 75% of trials, thus supporting our hypothesis on perceived interceptability. Analyses revealed that participants considered this action boundary while making their perceptual judgments. Our results imply that the perceiving and actualizing of interceptability are characterized by a combination of the same set of variables.

Faecal microbiota of schoolchildren is associated with nutritional status and markers of inflammation: a double-blinded cluster-randomized controlled trial using multi-micronutrient fortified rice.

Faecal microbiota plays a critical role in human health, but its relationship with nutritional status among schoolchildren remains under-explored. Here, in a double-blinded cluster-randomized controlled trial on 380 Cambodian schoolchildren, we characterize the impact of six months consumption of two types of rice fortified with different levels of vitamins and minerals on pre-specified outcomes. We investigate the association between the faecal microbiota (16SrRNA sequencing) and age, sex, nutritional status (underweight, stunting), micronutrient status (iron, zinc and vitamin A deficiencies, anaemia, iron deficient anaemia, hemoglobinopathy), inflammation (systemic, gut), and parasitic infection. We show that the faecal microbiota is characterised by a surprisingly high proportion of Lactobacillaceae. We discover that deficiencies in specific micronutrients, such as iron and vitamin A, correlate with particular microbiota profiles, whereas zinc deficiency shows no such association. The nutritional intervention with the two rice treatments impacts both the composition and functions predicted from compositional analysis in different ways. (ClinicalTrials.gov (Identifier: NCT01706419)).

Geoclimatic drivers of diversification in the largest arid and semi-arid environment of the Neotropics: Perspectives from phylogeography.

The South American Dry Diagonal, also called the Diagonal of Open Formations, is a large region of seasonally dry vegetation extending from northeastern Brazil to northern Argentina, comprising the Caatinga, Cerrado, and Chaco subregions. A growing body of phylogeography literature has determined that a complex history of climatic changes coupled with more ancient geological events has produced a diverse and endemic-rich Dry Diagonal biota. However, the exact drivers are still under investigation, and their relative strengths and effects are controversial. Pleistocene climatic fluctuations structured lineages via vegetation shifts, refugium formation, and corridors between the Amazon and Atlantic forests. In some taxa, older geological events, such as the reconfiguration of the São Francisco River, uplift of the Central Brazilian Plateau, or the Miocene inundation of the Chaco by marine incursions, were more important. Here, we review the Dry Diagonal phylogeography literature, discussing each hypothesized driver of diversification and assessing degree of support. Few studies statistically test these hypotheses, with most support drawn from associating encountered phylogeographic patterns such as population structure with the timing of ancient geoclimatic events. Across statistical studies, most hypotheses are well supported, with the exception of the Pleistocene Arc Hypothesis. However, taxonomic and regional biases persist, such as a proportional overabundance of herpetofauna studies, and the under-representation of Chaco studies. Overall, both Pleistocene climate change and Neogene geological events shaped the evolution of the Dry Diagonal biota, though the precise effects are regionally and taxonomically varied. We encourage further use of model-based analyses to test evolutionary scenarios, as well as interdisciplinary collaborations to progress the field beyond its current focus on the traditional set of geoclimatic hypotheses.

Folate as a potential treatment for lethal ventricular arrhythmias in TANGO2-deficiency disorder.

TANGO2-deficiency disorder (TDD) is an autosomal-recessive genetic disease caused by biallelic loss-of-function variants in the TANGO2 gene. TDD-associated cardiac arrhythmias are recalcitrant to standard antiarrhythmic medications and constitute the leading cause of death. Disease modeling for TDD has been primarily carried out using human dermal fibroblast and, more recently, in Drosophila by multiple research groups. No human cardiomyocyte system has been reported, which greatly hinders the investigation and understanding of TDD-associated arrhythmias. Here, we established potentially novel patient-derived induced pluripotent stem cell differentiated cardiomyocyte (iPSC-CM) models that recapitulate key electrophysiological abnormalities in TDD. These electrophysiological abnormalities were rescued in iPSC-CMs with either adenoviral expression of WT-TANGO2 or correction of the pathogenic variant using CRISPR editing. Our natural history study in patients with TDD suggests that the intake of multivitamin/B complex greatly diminished the risk of cardiac crises in patients with TDD. In agreement with the clinical findings, we demonstrated that high-dose folate (vitamin B9) virtually abolishes arrhythmias in TDD iPSC-CMs and that folate's effect was blocked by the dihydrofolate reductase inhibitor methotrexate, supporting the need for intracellular folate to mediate antiarrhythmic effects. In summary, data from TDD iPSC-CM models together with clinical observations support the use of B vitamins to mitigate cardiac crises in patients with TDD, providing potentially life-saving treatment strategies during life-threatening events.

A generalized risk assessment index for forecasting insect population under the effect of temperature.

Life history traits have been studied under various environmental factors, but the ability to combine them into a simple function to assess pest response to climate is still lacking complete understanding. This study proposed a risk index derived by combining development, mortality, and fertility rates from a stage-structured dynamic mathematical model. The first part presents the theoretical framework behind the risk index. The second part of the study is concerned with the application of the index in two case studies of major economic pest: the brown planthopper (Nilaparvata lugens) and the spotted wing drosophila (Drosophila suzukii), pests of rice crops and soft fruits, respectively. The mathematical calculations provided a single function composed of the main thermal biodemographic rates. This function has a threshold value that determines the possibility of population increase as a function of temperature. The tests carried out on the two pest species showed the capability of the index to describe the range of favourable conditions. With this approach, we were able to identify areas where pests are tolerant to climatic conditions and to project them on a geospatial risk map. The theoretical background developed here provided a tool for understanding the biogeography of Nilaparvata lugens and Drosophila suzukii. It is flexible enough to deal with mathematically simple (N. lugens) and complex (D. Suzukii) case studies of crop insect pests. It produces biologically sound indices that behave like thermal performance curves. These theoretical results also provide a reasonable basis for addressing the challenge of pest management in the context of seasonal weather variations and climate change. This may help to improve monitoring and design management strategies to limit the spread of pests in invaded areas, as some non-invaded areas may be suitable for the species to develop.

Successive bootstrapping deep learning approach and airborne EM-borehole data fusion to understand salt water in the Mississippi River Valley Alluvial Aquifer.

Increasing demands from agriculture and urbanization have decreased groundwater level and increased salinity worldwide. Better aquifer characterization and soil salinity mapping are important for proactive groundwater management. Airborne electromagnetic (AEM) is a powerful tool for aquifer characterization and salinity delineation. However, AEM needs to be interpreted with caution before being used for groundwater quality analysis. This study introduces a framework that utilizes the AEM data for both lithologic modeling and salinity delineation. A resistivity-to-lithology (R2L) model is developed to interpret AEM resistivity to lithology based a depth-dependent multi-resistivity thresholds. Then, a cokriging method is used to integrate AEM data from two different EM systems to predict resistivity at the aquifer. Finally, a resistivity-to-chloride concentration (R2C) model utilizes the resistivity model to estimate chloride concentrations at sand facies. A deep learning artificial neural network (DL-ANN) model is introduced with a successive bootstrapping approach to estimate total dissolved solids first and then use it together with resistivity data to estimate chloride concentration. The methodology was applied to delineating salinity plumes in the Mississippi River Valley alluvial aquifer (MRVA). This study found that the salinity distribution in MRVA is highly correlated with the Jurassic salt basin, salt domes, faulting, seismicity, and river water quality. The result indicates salinity upconing due to excessive pumping.

A Pilot Study to Evaluate the Use of Automated Nicotine Metabolite Ratio Reporting within Primary Care as an Implementation Strategy to Increase the Use of Tobacco Treatments.

INTRODUCTION: Concerns about safety and effectiveness of tobacco treatments reduce their use. We explored integrating the nicotine metabolite ratio (NMR), and messaging about its potential for improving safety and effectiveness, as a strategy to increase use of tobacco treatments within primary care. METHODS: Through a prospective cohort design, we explored the effects of integrating NMR testing within primary care on the provision of tobacco treatment; 65 patients completed assessments including NMR before a clinic visit. At the clinic visit, patients' clinicians received an electronic health record alert about the patient's NMR and personalized treatment recommendations to improve effectiveness and safety. Being asked about smoking and advised to quit, and a referral for tobacco treatment or medication prescription, were assessed within 30 days of the appointment and were compared to a usual care cohort (N=85). RESULTS: The NMR and usual care cohorts reported similar rates of being asked about smoking (92.3% vs. 92.9%, p=1.0), being advised to quit (72.3% vs. 74.1%, p=0.85), being referred for tobacco treatment (23.1% vs. 36.5%, p=0.11), and receiving tobacco use medications (20% vs. 27.1%, p=0.34). In the NMR cohort, fast vs. slow metabolizers were more likely to receive medication (26% vs. 0%, p=0.003) and all patients who received varenicline (n=8) were fast metabolizers. CONCLUSIONS: NMR results and treatment recommendations did not increase tobacco treatment rates in primary care, although it may increase treatment rates and use of varenicline for fast metabolizers. Future studies could test ways to use the NMR to increase tobacco treatment rates in clinical settings. IMPLICATIONS: This study generated a novel implementation strategy, namely an electronic health record alert about patients' NMR and personalized treatment recommendations, in an effort to increase tobacco treatment rates in primary care. While the strategy did not increase tobacco treatment rates, it may have boosted the rate of varenicline prescription for patients who metabolize nicotine faster, aligning with evidence-based practice.

Molecular Epidemiology of SARS-CoV-2 within Accra Metropolis Postlockdown.

Introduction: Currently, sequencing has been the only tool for the identification of circulating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants. However, it is known to be an expensive and laborious approach involving high technical expertise. Considering the reduced adherence to preventive measures postlockdown in Accra, this study presents an alternative method that leverages polymerase chain reaction (PCR) to identify circulating SARS-CoV-2 variants in the Accra Metropolis postlockdown. Methods: This prospective cross-sectional study was conducted between July and December 2022. Nasopharyngeal samples were collected from 268 consenting participants. Samples were subjected to nucleic acid extraction and followed by real-time polymerase chain reaction for the detection and quantification of SARS-CoV-2 RNA. SARS-CoV-2 positive samples were subsequently subjected to variant identification using rapid PCR. Findings. The prevalence of SARS-CoV-2 within the Accra Metropolis was 30.2%. The majority of the SARS-CoV-2 infection was diagnosed in females, participants aged 41-50 years, and symptomatic participants. Participants aged ≤10 years and females recorded the highest viral load while participants aged 41-50 years recorded the highest number of infections. The SARS-CoV-2 variants detected were Alpha (64.2%), Delta (22.2%), and Omicron (13.6%). Predictors of SARS-CoV-2 infection identified were chills, cough, headache, body weakness, sore throat, and dyspnoea in order of decreasing association with SARS-CoV-2 infection. There was a strong association between symptom status, gender, age, and SARS-CoV-2 infection. Conclusion: There was a high prevalence of SARS-CoV-2 within the Accra Metropolis postlockdown within the sampling period. The Alpha variant of SARS-CoV-2 is the predominant circulating variant, and persons presenting with symptoms are most likely to be diagnosed with COVID-19. Children aged ≤10 years serve as a reservoir for infection transmission.

Lymphovascular Invasion in Cutaneous Squamous Cell Carcinoma.

BACKGROUND: Although there is a large body of literature regarding risk stratification and outcomes for perineural invasion (PNI) in cutaneous squamous cell carcinoma (cSCC), there is a relative paucity of studies exploring the role of lymphovascular invasion (LVI) in cSCC and a lack of clear evidence-based guidelines for how to manage patients with these tumors. OBJECTIVE: This article is intended to review the available literature regarding LVI in cSCC and formulate evidence-based recommendations for clinical management. METHODS AND MATERIALS: A literature review was conducted using PubMed to find relevant articles relating to outcomes and management of primary cSCC with LVI. RESULTS: The available literature suggests that LVI is a major risk factor for poor outcomes and increased morbidity and mortality in cSCC. CONCLUSION: Lymphovascular invasion is a very high-risk feature that should place these tumors in the highest-risk category, and management of these tumors should be similar to that of squamous cell carcinoma with PNI.

Text Messages Conveying Parent Drinking Limits: A Potential Avenue for Preventing and Reducing Alcohol Use in College Students.

OBJECTIVE: Although previous research has established that students who perceive that their parents have lower drinking limits consume less alcohol, optimal approaches for effectively communicating these limits are less understood. To address this gap in the literature, the present study examined the effects of hypothetical limit-focused text messages on estimated drinking behavior. METHOD: Undergraduate college students (N=253) completed an online survey in which they were instructed to imagine a scenario where they were planning to go out at night to an event involving drinking. Participants were randomly assigned to a condition where they would receive one of four hypothetical text messages from their mother and/or father containing a range of drinking limits. They were then asked to report how much alcohol they would realistically consume on this night if they were and were not obligated to check in with their parent at the end of the night. RESULTS: Hypothetical text messages from mothers and fathers containing lower drinking limits resulted in lower estimated alcohol consumption. A drinking limit of zero resulted in the least amount of expected alcohol consumption but specifying 1-2 drinks as a limit might produce a similar effect if parents also required their student to check-in at the end of the night. CONCLUSION: Findings from this study provide initial support for future studies to investigate the effects of limit setting text messages sent from parents on college student drinking, as well as the effects of text messages sent from parents requiring that students check-in.

The simulation experiment description markup language (SED-ML): language specification for level 1 version 5.

Modern biological research is increasingly informed by computational simulation experiments, which necessitate the development of methods for annotating, archiving, sharing, and reproducing the conducted experiments. These simulations increasingly require extensive collaboration among modelers, experimentalists, and engineers. The Minimum Information About a Simulation Experiment (MIASE) guidelines outline the information needed to share simulation experiments. SED-ML is a computer-readable format for the information outlined by MIASE, created as a community project and supported by many investigators and software tools. Level 1 Version 5 of SED-ML expands the ability of modelers to define simulations in SED-ML using the Kinetic Simulation Algorithm Onotoloy (KiSAO). While it was possible in Version 4 to define a simulation entirely using KiSAO, Version 5 now allows users to define tasks, model changes, ranges, and outputs using the ontology as well. SED-ML is supported by a growing ecosystem of investigators, model languages, and software tools, including various languages for constraint-based, kinetic, qualitative, rule-based, and spatial models, and many simulation tools, visual editors, model repositories, and validators. Additional information about SED-ML is available at https://sed-ml.org/.

Genomic analysis reveals deep population divergence in the water snake Trimerodytes percarinatus (Serpentes, Natricidae).

Although several phylogeographic studies of Asian snakes have been conducted, most have focused on pitvipers, with non-venomous snakes, such as colubrids or natricids, remaining poorly studied. The Chinese keelback water snake (Trimerodytes percarinatus Boulenger) is a widespread, semiaquatic, non-venomous species occurring in China and southeastern Asia. Based on mitochondrial DNA (mtDNA) and single nucleotide polymorphism (SNP) data, we explored the population genetic structure, genetic diversity, and evolutionary history of this species. MtDNA-based phylogenetic analysis showed that T. percarinatus was composed of five highly supported and geographically structured lineages. SNP-based phylogenetic analysis, principal component analysis, and population structure analysis consistently revealed four distinct, geographically non-overlapping lineages, which was different from the mtDNA-based analysis in topology. Estimation of divergence dates and ancestral area of origin suggest that T. percarinatus originated ~12.68 million years ago (95% highest posterior density: 10.36-15.96 Mya) in a region covering southwestern China and Vietnam. Intraspecific divergence may have been triggered by the Qinghai-Xizang Plateau uplift. Population demographics and ecological niche modeling indicated that the effective population size fluctuated during 0.5 Mya and 0.002 Mya. Based on the data collected here, we also comment on the intraspecific taxonomy of T. percarinatus and question the validity of the subspecies T. p. suriki.

Comparative evaluation of RT-PCR and antigen-based rapid diagnostic tests (Ag-RDTs) for SARS-CoV-2 detection: performance, variant specificity, and clinical implications.

The COVID-19 pandemic has highlighted the critical need for accurate and efficient diagnostic tools for detecting severe acute respiratory coronavirus 2 (SARS-CoV-2) infections. This study presents a comparison of two diagnostic tests: RT-PCR and antigen detection rapid diagnostic tests (Ag-RDTs). This study focused on their performance, variant specificity, and their clinical implications. A simultaneous testing of 268 samples was carried out for SARS-CoV-2 using RT-PCR and Ag-RDTs [flourescence immunoassay (FIA) and lateral flow immunoassay (LFIA)]. Viral load was quantified, and variant identification was performed using a PCR-based assay. The prevalence was found to be 30.2% using reverse transcription PCR (RT-PCR), 26.5% using FIA, and 25% using LFIA. When comparing the FIA and LFIA, the overall diagnostic performance was found to be 80.25% vs 76.54%, 96.79% vs 97.33%, 91.55% vs 90.51%, and 91.88% vs 92.56% for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), respectively. Both Ag-RDTs showed a strong agreement with RT-PCR (κ = 0.78-0.80). The overall accuracies of the FIA and LFIA were 92.41% and 92.13%, respectively. The FIA showed higher sensitivity (73.68%) and PPV (92.08%) than the LFIA (65.79% and 90.56%, respectively) in asymptomatic patients. At low Ct values (<25), both Ag-RDTs had 100% sensitivity, but the sensitivity reduced to 31.82% for FIA and 27.27% for LFIA at Ct values > 30. The diagnostic sensitivity of FIA compared to LFIA for detecting the Alpha variant was 78.85% vs. 69.23% and 72.22% vs. 83.33% for the Delta variant. Both Ag-RDTs had 100% sensitivity for detecting Omicron. Both Ag-RDTs performed well in patients with high viral loads and Omicron variant infections compared to those infected with Alpha and Delta variants. This study confirms the comparable performance of RT-PCR and Ag-RDTs, specifically FIA and LFIA, for SARS-CoV-2 detection. The FIA showed higher sensitivity and PPV in asymptomatic cases, while both Ag-RDTs exhibited strong agreement with RT-PCR results. Notably, Ag-RDTs, particularly FIA, proved effective in detecting the Omicron variant and cases with high viral loads, highlighting their potential clinical utility in managing the COVID-19 pandemic.IMPORTANCEThis study is of utmost importance in providing effective responses to manage the COVID-19 pandemic. It rigorously compares the diagnostic accuracy, variant specificity, and practical considerations of reverse transcription PCR (RT-PCR) and antigen detection rapid diagnostic tests (Ag-RDTs) for severe acute respiratory coronavirus 2 (SARS-CoV-2), answering critical questions. The results of this study will help healthcare professionals choose the appropriate testing methods, allocate resources effectively, and enhance public health strategies. Given the evolution of the virus, understanding the performance of these diagnostic tools is crucial to adapting to emerging variants. Additionally, the study provides insights into logistical challenges and accessibility issues, which will contribute to refining testing workflows, particularly in resource-limited settings. Ultimately, the study's impact extends to global healthcare, providing valuable information for policymakers, clinicians, and public health officials as they work together for mitigating the impact of the pandemic.

Longitudinal assessment of health-related quality of life and clinical outcomes with at home advanced pneumatic compression treatment of lower extremity lymphedema.

OBJECTIVE: This prospective, longitudinal, pragmatic study describes at home treatment with a proprietary advanced pneumatic compression device (APCD) for patients with lower extremity lymphedema (LED). METHODS: Following institutiona review board approval, four participating Veterans Affairs centers enrolled LED patients from 2016 to 2022. The primary outcome measures were health-related quality of life (HR-QoL) questionnaires (lymphedema quality of life-leg and the generic SF-36v2) obtained at baseline and 12, 24, and 52 weeks. The secondary outcome measures were limb circumference, cellulitis events, skin quality, and compliance with APCD and other compression therapies. RESULTS: Because a portion of the trial was conducted during the coronavirus disease 2019 pandemic, 179 patients had 52 weeks of follow-up, and 143 had complete measurements at all time points. The baseline characteristics were a mean age of 66.9 ± 10.8 years, 91% were men, and the mean body mass index was 33.8 ± 6.9 kg/m2. LED was bilateral in 92.2% of the patients. Chronic venous insufficiency or phlebolymphedema was the most common etiology of LED (112 patients; 62.6%), followed by trauma or surgery (20 patients; 11.2%). Cancer treatment as a cause was low (4 patients; 2.3%). Patients were classified as having International Society for Lymphology (ISL) stage I (68.4%), II (27.6%), or III (4.1%). Of the primary outcome measures, significant improvements were observed in all lymphedema quality of life-leg domains of function, appearance, symptoms, and emotion and the overall score after 12 weeks of treatment (P < .0001) and through 52 weeks of follow-up. The SF-36v2 demonstrated significant improvement in three domains at 12 weeks and in the six domains of physical function, bodily pain, physical component (P < .0001), social functioning (P = .0181), role-physical (P < .0005), and mental health (P < .0334) at 52 weeks. An SF-36v2 score <40 indicates a substantial reduction in HR-QoL in LED patients compared with U.S. norms. Regarding the secondary outcome measures at 52 weeks, compared with baseline, the mean limb girth decreased by 1.4 cm (P < .0001). The maximal reduction in mean limb girth was 1.9 cm (6.0%) at 12 weeks in ISL stage II and III limbs. New episodes of cellulitis in patients with previous episodes (21.4% vs 6.1%, P = .001) were reduced. The 75% of patients with skin hyperpigmentation at baseline decreased to 40% (P < .01) at 52 weeks. At 52 weeks, compliance, defined as use for 5 to 7 days per week, was reported for the APCD by 72% and for elastic stockings by 74%. CONCLUSIONS: This longitudinal study of Veterans Affairs patients with LED demonstrated improved generic and disease-specific HR-QoL through 52 weeks with at home use of an APCD. Limb girth, cellulitis episodes, and skin discoloration were reduced, with excellent compliance.

Designing stepping-stones landscapes: a 2D perspective does not lead to more standardization than an in-situ perspective.

Previous research found that when participants across the lifespan could be the architect of their own stepping-stones landscapes, they create nonstandardized configurations with gap-width variation. Yet, architects often use standardized dimensions in their designs for playgrounds and outdoor fitness areas. To scrutinize why architects tend to seek for more standardized designs than the examined target users, we tested the hypothesis that the difference is caused by a different perspective during the making process. After all, landscape architects generally design on 2D maps, while the participants designed in situ. We asked 67 participants to design a stepping-stones landscape on a 2D map and 67 other participants to create the landscape in situ. Contrary to our expectations, we found no indications that designing on a 2D map leads to more standardized configurations. We end with discussing other characteristics of the design processes that could potentially explain the omnipresent standardization in design.