A Scoping Review of Decision Support Tools for Patients with Lower Extremity Arterial Disease: Toward Shared Decision-Making.

BACKGROUND: In recent years, decision support tools (DSTs) in various fields of medicine have emerged to aid clinicians and patients in the process of shared decision-making (SDM). This scoping review aims to identify the existing DSTs for selecting treatments in lower extremity arterial disease and to evaluate their effectiveness in facilitating SDM. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews were followed. A literature search was conducted across MEDLINE, EMBASE, and Cochrane databases, along with the Decision Aid Library Inventory, for studies published between January 2000 and June 2023. Articles reporting the development and/or clinical application of a DST specific to lower extremity arterial disease were included. A narrative synthesis of the results was performed and findings were presented in tabular formats. RESULTS: Five studies and 5 unique DSTs were included. Presenting formats included websites, booklets, brochures, and pocket cards. Overall, a high degree of heterogeneity was observed across all DSTs in their format, content, and delivery. A widespread acceptability and satisfaction were reported among patients and clinicians. However, their effect at improving SDM remains uncertain due to the lack of standardized outcome metrics. CONCLUSIONS: The development and implementation of DSTs for lower limb arterial disease treatment discussion remain in the early stages. This review lays the foundation for future studies to continue exploring optimal strategies for DST development and their role in supporting SDM.

Utility of structured follow-up imaging after aortic surgery.

BACKGROUND: Although postoperative follow-up after aortic surgery is recommended by guidelines, its clinical utility is not well documented. We hypothesized that structured follow-up imaging by an aortic program would improve outcomes. We then documented radiologic findings on asymptomatic postoperative imaging. METHODS: All patients who survived to discharge after open thoracic aortic surgery between January 2017 and July 2021 were included, excluding endocarditis. Patients who followed at our center and received scheduled imaging were compared with patients who did not. Survival was analyzed by the method of Kaplan-Meier, and reintervention was assessed using the Fine-Gray subhazard function. Routine imaging was reviewed for aortic growth, pseudoaneurysm, and perigraft density. RESULTS: After aortic surgery, the cumulative incidence of follow-up was 38.6% at 3 years postoperatively. Patients with follow-up were more likely to have a dissection and fewer comorbidities but were similar in regards to socioeconomic factors and distance to hospital. After matching and accounting for immortal time bias, patients with follow-up had a greater reintervention rate (26.0% vs 9.0%) with similar survival (98.7% vs 95.2%, P = .110) at 4 years. The cumulative incidence of pseudoaneurysm, significant perigraft density, and growth ≥3 mm/year on routine imaging was 49.7% at 3 years. CONCLUSIONS: Implementation of structured follow-up imaging by an aortic program resulted in low clinical compliance. Follow-up was associated with increased rates of aortic reintervention. Clinically relevant radiologic findings were common on asymptomatic imaging and increased throughout 5-year follow-up rather than plateauing in the early postoperative period.

Diffusiophoresis of a Weakly Charged Liquid Metal Droplet.

Diffusiophoresis of a weakly charged liquid metal droplet (LMD) is investigated theoretically, motivated by its potential application in drug delivery. A general analytical formula valid for weakly charged condition is adopted to explore the droplet phoretic behavior. We determined that a liquid metal droplet, which is a special category of the conducting droplet in general, always moves up along the chemical gradient in sole chemiphoresis, contrary to a dielectric droplet where the droplet tends to move down the chemical gradient most of the time. This suggests a therapeutic nanomedicine such as a gallium LMD is inherently superior to a corresponding dielectric liposome droplet in drug delivery in terms of self-guiding to its desired destination. The droplet moving direction can still be manipulated via the polarity dependence; however, there should be an induced diffusion potential present in the electrolyte solution under consideration, which spontaneously generates an extra electrophoresis component. Moreover, the smaller the conducting liquid metal droplet is, the faster it moves in general, which means a smaller LMD nanomedicine is preferred. These findings demonstrate the superior features of an LMD nanomedicine in drug delivery.

Vibration Isolation Properties of Novel Spacer Fabric with Silicone Inlay.

Spacer fabrics are good for impact force absorption and have the potential for vibration isolation. Inlay knitting of additional material to the spacer fabrics can give reinforcement to the structure. This study aims to investigate the vibration isolation properties of three-layer sandwich fabrics with silicone inlay. The effect of the presence of the inlay, inlay patterns and materials on the fabric geometry, vibration transmissibility and compression behaviour were evaluated. The results showed that the silicone inlay increases the unevenness of the fabric surface. The fabric using polyamide monofilament as the spacer yarn in the middle layer creates more internal resonance than that using polyester monofilament. Silicone hollow tubes inlay increases the magnitude of damping vibration isolation, whereas inlaid silicone foam tubes have the opposite effect. Spacer fabric with silicone hollow tubes inlaid by tuck stitches has not only high compression stiffness but also becomes dynamic, showing several resonance frequencies within the tested frequency range. The findings show the possibility of the silicone inlaid spacer fabric and provide a reference for developing vibration isolation materials with knitted structure and textiles materials.

Sports Bra Pressure: Effect on Body Skin Temperature and Wear Comfort.

Sports bras are an essential apparel for active women, but may exert excessive pressure that negatively affects thermoregulation, thermal comfort and wear sensation. This study measures skin temperature changes during short durations of exercise on a treadmill with different bra pressures. The results based on 21 female subjects (age: 27.2 ± 4.5 years old) show that bras with more pressure at the underband or shoulder straps do not cause statistically significant skin temperature changes during exercise (p > 0.05). Nevertheless, compared to the optimal bra fit, significant differences in bra-breast skin temperature are found during running, cooling down and sitting when the bra pressure is increased (p < 0.05), particularly under bra cup (T1) in this study. The FLIR thermal images can visualize the skin temperature changes at abdomen throughout the four activity stages. Subjective sensations of bra thermal comfort, pressure and breast support are assessed. Despite the increased pressure on the shoulders and chest wall, perceptions towards thermal comfort remain unchanged. The perceived pressure comfort and support sensation amongst the 4 bra conditions are comparable. Interestingly, positive sensations of pressure comfort and breast support are perceived with a tight-fitting sports bra during treadmill exercise. High pressures induced by sports bras (>4 kPa) that habitually considered harmful to the human body may not lead to wear discomfort but enhance bra support sensation and a sense of security to the wearers.

Effects of textile-fabricated insole on foot skin temperature and humidity for enhancing footwear thermal comfort.

Traditional insole materials which trap heat and moisture inside footwear cause discomfort to the wearer. Here, a novel textile-fabricated insole material with a 3D structure that offers good porosity and breathability for improving the footwear microclimate is proposed. Changes in foot skin temperature and humidity when wearing the textile-fabricated insole throughout treadmill walking are collected from 21 female subjects (age: 25.5 ± 4.5) and compared with traditional and 3D printed insoles. Subjective assessment of their perceived thermal comfort with various insole conditions is also conducted. In comparison to polyurethane, 3D printed thermoplastic polyurethane and leather insoles, textile-fabricated insoles show no significant changes in foot skin temperature. Nevertheless, a significant reduction of the relative humidity of the skin of the sole (3.21%) and heel (24.41%) is found. The findings are a valuable reference for the fabrication of insoles with higher wear comfort.

Diffusiophoresis in suspensions of highly charged soft particles.

Diffusiophoresis phenomenon of aoft particles suspended in binary electrolyte solutions is explored theoretically in this study based on the spherical cell model, focusing on the chemiphoresis component in absence of diffusion potential. Both the electrostatic and hydrodynamic aspects of the boundary confinement, or steric effect, due to the presence of neighboring particles are examined extensively under various electrokinetic conditions. Significant local extrema are found in mobility profiles expressed as functions of the Debye length in general, synchronized with the strength of the motion-inducing double layer polarization. Moreover, a seemingly peculiar phenomenon is observed that the soft particles may move faster in more concentrated suspensions. The competition between the simultaneous enhancement of the motion-inducing electric driving force and the motion-retarding hydrodynamic drag force from the boundary confinement effect of the neighboring particles is found to be responsible for it. The above findings are also demonstrated experimentally in a very recent study on the diffusiophoretic motion of soft particles through porous collagen hydrogels. The results presented here are useful in various practical applications of soft particles like drug delivery.

Mechanical and Thermal Behaviours of Weft-Knitted Spacer Fabric Structure with Inlays for Insole Applications.

Insoles provide resistance to ground reaction forces and comfort during walking. In this study, a novel weft-knitted spacer fabric structure with inlays for insoles is proposed which not only absorbs shock and resists pressure, but also allows heat dissipation for enhanced thermal comfort. The results show that the inlay density and spacer yarn increase compression resistance and reduce impact forces. The increased spacer yarn density provides better air permeability but reduces thermal resistance, while a lower inlay density with a random orientation reduces the evaporative resistance. The proposed structure has significantly positive implications for insole applications.

Evaluation of the design and materials of anti-vibration gloves: Impact on hand dexterity and forearm muscle activity.

Many anti-vibration gloves are available in the market but there are lacks of understanding of their effectiveness in facilitating various hand movements. This study addresses the knowledge gap through a wear trial with five types of anti-vibration gloves made of chloroprene rubber and spacer fabric. Surface electromyography of three forearm muscles of 16 male subjects was conducted during gripping, key pinching, woodblock transporting, screw inserting and screw driving tasks. The correlation between the compression properties of the gloves and hand performance was also evaluated. The results show that hand dexterity is inhibited and more muscle activity is needed to carry the woodblocks with the spacer fabric glove without special design features. A thicker glove can reduce the demand of the flexor digitorum superficialis muscle when using an impact driver. A thinner dorsal side and tailored padding can enhance hand dexterity. The findings can be used as a reference for designing anti-vibration gloves.

Effect of Silicone Inlaid Materials on Reinforcing Compressive Strength of Weft-Knitted Spacer Fabric for Cushioning Applications.

Spacer fabrics are commonly used as cushioning materials. They can be reinforced by using a knitting method to inlay materials into the connective layer which reinforces the structure of the fabric. The compression properties of three samples that were fabricated by inlaying three different types of silicone-based elastic tubes and one sample without inlaid material have been investigated. The mechanical properties of the elastic tubes were evaluated and their relationship to the compression properties of the inlaid spacer fabrics was analysed. The compression behaviour of the spacer fabrics at an initial compressive strain of 10% is not affected by the presence of the inlaid tubes. The Young's modulus of the inlaid tubes shows a correlation with fabric compression. Amongst the inlaid fabric samples, the spacer fabric inlaid with highly elastic silicone foam tubes can absorb more compression energy, while that inlaid with silicone tubes of higher tensile strength has higher compressive stiffness.

Impact of postural variation on hand measurements: Three-dimensional anatomical analysis.

In this article, the impact of postural variations on hand anthropometry and distribution of skin strain ratios has been investigated. The literature suggests the glove fit directly affects hand functions. However, gloves currently manufactured based on a static posture failed to provide optimum fit. Workers often do not wear protective gloves due to discomfort caused by improper design, which increases the risk of hand injury. Full-color three-dimensional scans of the hands are captured with thirty healthy subjects (20 females, 10 males) to analyze the hand measurements and skin deformation with various postures. 42 of the 57 hand dimensions were found to have significant differences (p >0.05) related to hand posture. The skin strain ratios further suggest that the slant of the web space, dorsal-length and surface area should be increased, while the angles of the web space and length of the palm reduced to advance glove patterns. This research contributes to constructing gloves with optimum fit, performance, and comfort. Results show that in consideration of hand postures, the angle of the slant of web space between digits 2 and 5 and the finger length on the dorsal side should be increased, whilst the finger length on the palm side should be reduced in glove pattern design. Gloves currently constructed based on a splayed posture cannot provide a good fit. Consideration should be given to hand measurements in dynamic postures.

Analysis of length of finger segments with different hand postures to enhance glove design.

It is important to understand how the hand and fingers elongate and contract with hand posture for optimally fitting and comfortable gloves. Nevertheless, the measurement and analysis of the finger segments for glove designs remain largely neglected. Here, the length and proportion of the finger segments when splayed and during gripping, and between the dorsal and palm sides of 30 participants are 3D scanned and analysed. The full digit lengths change by 7.6-11.9% with hand posture, but the finger segment changes are not proportional. The ratios of the fingertip to distal interphalangeal joint/full digit, and fingertip to the proximal interphalangeal joint/full digit, are important variables. The results are validated with 10 more subjects based on ratings of a ready-to-wear sports glove. Inaccurate proportioning of the finger regions causes shifting which results in displacement and discomfort. This research contributes to glove pattern engineering, with a focus on the finger segments.

A Novel Bespoke Hypertrophic Scar Treatment: Actualizing Hybrid Pressure and Silicone Therapies with 3D Printing and Scanning.

The treatment of hypertrophic scars (HSs) is considered to be the most challenging task in wound rehabilitation. Conventional silicone sheet therapy has a positive effect on the healing process of HSs. However, the dimensions of the silicone sheet are typically larger than those of the HS itself which may negatively impact the healthy skin that surrounds the HS. Furthermore, the debonding and displacement of the silicone sheet from the skin are critical problems that affect treatment compliance. Herein, we propose a bespoke HS treatment design that integrates pressure sleeve with a silicone sheet and use of silicone gel using a workflow of three-dimensional (3D) printing, 3D scanning and computer-aided design, and manufacturing software. A finite element analysis (FEA) is used to optimize the control of the pressure distribution and investigate the effects of the silicone elastomer. The result shows that the silicone elastomer increases the amount of exerted pressure on the HS and minimizes unnecessary pressure to other parts of the wrist. Based on this treatment design, a silicone elastomer that perfectly conforms to an HS is printed and attached onto a customized pressure sleeve. Most importantly, unlimited scar treating gel can be applied as the means to optimize treatment of HSs while the silicone sheet is firmly affixed and secured by the pressure sleeve.

Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite.

Hypertrophic scars (HS) are considered to be the greatest unmet challenge in wound and burn rehabilitation. The most common treatment for HS is pressure therapy, but pressure garments may not be able to exert adequate pressure onto HS due to the complexity of the human body. However, the development of three-dimensional (3D) scanning and direct digital manufacturing technologies has facilitated the customized placement of additively manufactured silicone gel onto fabric as a component of the pressure therapy garment. This study provides an introduction on a novel and customized fabrication approach to treat HS and discusses the mechanical properties of 3D printed fabric reinforced with a silicone composite. For further demonstration of the suggested HS therapy with customized silicone insert, silicone inserts for the finger webs and HS were additively manufactured onto the fabric. Through the pressure evaluation by Pliance X system, it proved that silicone insert increases the pressure exerted to the HS. Moreover, the mechanical properties of the additively manufactured fabric silicone composites were characterized. The findings suggest that as compared with single viscosity print materials, the adhesive force of the additively manufactured silicone and fabric showed a remarkable improvement of 600% when print materials with different viscosities were applied onto elevated fabric.

Minimizing airflow turbulence in women lowers the work of breathing to levels similar to men.

Smaller airways increase resistance and the propensity toward turbulent airflow, both of which are thought to be mechanisms behind greater resistive and total work of breathing (Wb) in females. Previous research examining the effect of airway size on the Wb between the sexes is limited by the inability to experimentally manipulate airway size. Heliox (21% oxygen, balance helium) is less dense than room air, which reduces turbulent airflow and airway resistance. The purpose of our study was to utilize heliox inspiration in women to provide a stimulus physiologically similar to increasing airway size. We hypothesized that when breathing heliox women would have a Wb similar to men breathing room air. Eighteen healthy young subjects (n = 9 women, 9 men) completed two maximal exercise tests on a cycle ergometer over 2 days. Subjects breathed room air for one test and heliox for the other. Wb was assessed with an esophageal balloon catheter. During the room air trial, when ventilations were >65 L/min, women had a significantly greater Wb compared with men (P < 0.05). The greater Wb in women was due to greater resistance to turbulent flow. For both sexes, breathing heliox resulted in increased expiratory flow (+132 ± 18% of room air), an elimination of expiratory flow limitation, and a reduction in Wb (69 ± 12% of room air) (all P < 0.05). When the women were breathing heliox, Wb was not different from that in the men breathing room air. Our findings support the idea that the smaller conducting airways in females are responsible for a greater total and resistive Wb.NEW & NOTEWORTHY When healthy young women breathe heliox gas during exercise, their work of breathing is not different from men breathing room air. Heliox inspiration reduces airway resistance and promotes laminar flow, which is a physiologically similar effect of increasing airway size. Our findings provide experimental evidence that smaller airways in women are responsible for the greater work of breathing during exercise.

A study of using a simple 2D image analysis method to monitor the surface area of hypertrophic scars on hand during pressure therapy.

Hypertrophic scars are usually evaluated based on scar assessment scales such as Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) which are difficult in recording small changes in the scar conditions over time. This study adopts a simple method to quantify the size of hypertrophic scars on hands by using a camera and tripod set-up for image capturing and a free software, ImageJ, for analysis. The ability to record the changes in scars condition and healing progress of this method were investigated. Four hypertrophic scar samples on the hands were captured at 8 time-points during 24-week of pressure therapy. Three operators were trained for 2h to use the software and then carried out image analysis on 32 scar images to obtain the surface areas of the hand and the scars and repeat the entire measurement for 3 times. The results show that the measured scar surface areas have good intra-operator reliability with an intraclass correlation coefficient (ICC) of 0.943 (0.922, 0.96) and moderate inter-operator reliability with an ICC of 0.554 (0.063, 0.795). No significant within-subject effect of the repeat of measurements (p>0.05) and between-subject effect of the three operators (p>0.05) were found on the scar area measurements and the proportion of the scars on hands but significant differences were found between different time-points of the image capturing (p<0.05). The image analysis method is more sensitive to the change of scars conditions over time than the VSS record. This is an economical and relatively easy method to quantify the changes in the hypertrophic scars which could be useful for monitoring the progress of therapy and encourage treatment compliance.

On-demand manufacturing of clinical-quality biopharmaceuticals.

Conventional manufacturing of protein biopharmaceuticals in centralized, large-scale, single-product facilities is not well-suited to the agile production of drugs for small patient populations or individuals. Previous solutions for small-scale manufacturing are limited in both process reproducibility and product quality, owing to their complicated means of protein expression and purification. We describe an automated, benchtop, multiproduct manufacturing system, called Integrated Scalable Cyto-Technology (InSCyT), for the end-to-end production of hundreds to thousands of doses of clinical-quality protein biologics in about 3 d. Unlike previous systems, InSCyT includes fully integrated modules for sustained production, efficient purification without the use of affinity tags, and formulation to a final dosage form of recombinant biopharmaceuticals. We demonstrate that InSCyT can accelerate process development from sequence to purified drug in 12 weeks. We used integrated design to produce human growth hormone, interferon α-2b and granulocyte colony-stimulating factor with highly similar processes on this system and show that their purity and potency are comparable to those of marketed reference products.

Medicaid Coverage of Guidelines-Based Asthma Care Across 50 States, the District of Columbia, and Puerto Rico, 2016-2017.

Asthma affects more than 24 million Americans, including 6.2 million children. Although asthma cannot be cured, it can be effectively managed with care based on nationally recognized guidelines. Ensuring the availability and accessibility of guidelines-recommended treatments and services can help patients receive the most appropriate care. In this article, we describe the American Lung Association's Asthma Guidelines-Based Care Coverage Project (the Project) to determine the extent of asthma care coverage and associated barriers in state Medicaid programs - information that has been previously unavailable. The Project tracked coverage for 7 areas of guidelines-based asthma care and 9 barriers related to accessing care in Medicaid programs for all 50 states, the District of Columbia, and Puerto Rico. Results from the Project show a lack of consistent and comprehensive coverage across states, as well as coverage-related challenges to accessing asthma care within states.

State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments - United States, 2015-2017.

Cigarette smoking prevalence among Medicaid enrollees (25.3%) is approximately twice that of privately insured Americans (11.8%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Although state Medicaid coverage of tobacco cessation treatments improved during 2014-2015, coverage was still limited in most states (4). To monitor recent changes in state Medicaid cessation coverage for traditional (i.e., nonexpansion) Medicaid enrollees, the American Lung Association collected data on coverage of a total of nine cessation treatments: individual counseling, group counseling, and seven FDA-approved cessation medications† in state Medicaid programs during July 1, 2015-June 30, 2017. The American Lung Association also collected data on seven barriers to accessing covered treatments, such as copayments and prior authorization. As of June 30, 2017, 10 states covered all nine of these treatments for all enrollees, up from nine states as of June 30, 2015; of these 10 states, Missouri was the only state to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers would be expected to reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (5-7).