Assessing the role of visual dysfunctions in the association between visual symptomatology and the use of digital devices / Evaluación del papel de las disfunciones visuales en la asociación entre la sintomatología visual y el uso de dispositivos digitales

Purpose: To evaluate the association between visual symptoms and use of digital devices considering the presence of visual dysfunctions. Methods: An optometric examination was conducted in a clinical sample of 346 patients to diagnose any type of visual anomaly. Visual symptoms were collected using the validated SQVD questionnaire. A threshold of 6 hours per day was used to quantify the effects of digital device usage and patients were divided into two groups: under and above of 35 years old. A multivariate logistic regression was employed to investigate the association between digital device use and symptoms, with visual dysfunctions considered as a confounding variable. Crude and the adjusted odds ratio (OR) were calculated for each variable. Results: 57.02 % of the subjects reported visual symptoms, and 65.02% exhibited some form of visual dysfunction. For patients under 35 years old, an association was found between having visual symptoms and digital device use (OR = 2.10, p = 0.01). However, after adjusting for visual dysfunctions, this association disappeared (OR = 1.44, p = 0.27) and the association was instead between symptoms and refractive dysfunction (OR = 6.52, p < 0.001), accommodative (OR = 10.47, p < 0.001), binocular (OR = 6.68, p < 0.001) and accommodative plus binocular dysfunctions (OR = 46.84, p < 0.001). Among patients over 35 years old, no association was found between symptoms and the use of digital devices (OR = 1.27, p = 0.49) but there was an association between symptoms and refractive dysfunction (OR = 3.54, p = 0.001). Conclusions: Visual symptoms are not dependent on the duration of digital device use but rather on the presence of any type of visual dysfunction: refractive, accommodative and/or binocular one, which should be diagnosed.(AU)

Challenges with mobility devices for female Veterans with spinal cord injuries.

CONTEXT: The growing number of females entering the armed forces has led to an increase in the number of female Veterans with spinal cord injury and diseases (SCI/D) requiring mobility devices. Limited research exists that explores whether mobility devices meet their needs in terms of comfort, fit and design. OBJECTIVE: To characterize respondents with SCI/D who use mobility devices and determine if these devices are meeting their daily needs. DESIGN: Online survey. SETTINGS: Veterans Health Administration. PARTICIPANTS: Female Veterans with SCI/D who received mobility devices in the past five years.Interventions: Participants completed an online survey regarding their challenges in obtaining and using mobility devices for their daily needs. RESULTS: 101 women with SCI/D participated in a nation-wide online survey. Respondents were mainly in their 50s and 59% were not currently employed due to their disability. Most used manual (35%) or power wheelchairs (34%). Many female Veterans felt their devices were not made with female users in mind and some felt they did not meet their needs. Opportunities to improve the assessment, follow-up, maintenance and repair processes were identified. CONCLUSIONS: Given that some female Veterans with SCI/D felt their devices did not meet all their needs, it is important for researchers to engage women in user-centered design of mobility devices and for providers to be mindful of Veterans' daily needs within all steps of the provision process in order for mobility devices to support overall function and usability.

Three-Dimensional Integrated Synaptic Devices Based on a Silver-Cluster Conduction Mechanism with High Thermostability.

During the operation of synaptic devices based on traditional conductive filament (CF) models, the formation and dissolution of CFs are usually uncertain. Moreover, when the device is operated for a long time, the CFs may dissolve due to both the Joule heat generated by the device itself and the thermal coupling between the devices. These problems seriously reduce the reliability and stability of the synaptic device. Here, an artificial synapse device based on polyimide-molybdenum disulfide quantum dot (MoS2 QD) nanocomposites is presented. Research has shown that MoS2 QDs doped into the active layer can effectively induce the reduction of Ag ions into Ag atoms, leading to the formation of Ag clusters and thereby achieving control over the growth of the CFs. Therefore, the device is capable of stably realizing various basic synaptic functions. Moreover, the long-term potentiation/long-term depression (LTP/LTD) of this device shows good linearity. In addition, due to the change in the shape of the CFs, the highly integrated devices with a three-dimensional (3D) stacked structure can operate normally even in a high-temperature environment of 110 °C. Finally, the synaptic characteristics of the devices on learning and inference tests show that their recognition rates are approximately 90.75% (room temperature) and 90.63% (110 °C).

Wearable defibrillator to improve accuracy in selecting candidates to implantable defibrillator: A real-world experience.

AIMS: The indication for implantable cardioverter defibrillator (ICD) for sudden cardiac death (SCD) prevention relies mostly on left ventricular ejection fraction (LVEF) ≤ 35%. The use of a wearable cardioverter defibrillator (WCD) in the case of dynamic alterations of LVEF may help avoid an improper early ICD implant when a favourable evolution in the post-acute phase is observed and may help reduce costs. METHODS: This parallel cohort retrospective study included patients with heart failure with reduced ejection fraction (HFrEF) at high risk of arrhythmias recruited in the acute phase and divided into an early ICD cohort and a WCD cohort for primary prevention during the waiting period established by European Society of Cardiology guidelines. RESULTS: A total of 41 consecutive patients were enrolled: 26 in the WCD group and 15 in the early ICD group. Age, LVEF at baseline, causes of HFrEF and drug therapy in the two cohorts were similar. During the waiting period after the inclusion, three patients (11.5%) in the WCD cohort and four (26.7%) in the early ICD cohort developed relevant ventricular arrhythmias (P = 0.22); none of them had subsequent LVEF recovery. At the end of the waiting period, 13 patients (50%) in the WCD group and 7 (46.7%) in the early ICD group experienced LVEF recovery (P = 0.84). The average cost per patient at the end of the waiting period was €23 934 in the early ICD cohort versus €19 167 in the WCD cohort (-19.9%). This cost savings from WCD use appears even higher when projected over a 10 year period (-41.2%). CONCLUSIONS: WCD may represent a cost-effective strategy to more accurately select candidates for the primary prevention ICD implant among high-risk patients with HFrEF. ICD use provides effective protection from SCD and reduces costs compared with an extensive early ICD implant.

Assessment of the deformation rate of venous diameter during internal jugular vein puncture using a newly developed thin-tip three-dimensional needle.

BACKGROUND: The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture. METHODS: This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate. RESULTS: The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle (p = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively (p = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter (r = 0.24 and 0.41, respectively), with no correlation in the 3D needle group. CONCLUSION: The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.

Novel use of a stent retriever as a distal filler protection device for prevention of secondary embolization.

Distal embolus due to mechanical thrombectomy is a frequent complication and directly results in a poor prognosis. Therefore, it is important to decrease distal embolus as much as possible in mechanical thrombectomy. EmboTrap III may be useful as a filter to prevent distal embolus in patients with a large volume of thrombus. Here, we report the results of one suggestive case and we also provide experimental data from a vessel model. The patient was a 78-year-old female who was admitted to hospital as an emergency case with chief complaints including dysarthria and left hemiplegia, including facial paralysis. She was diagnosed as large vessel occlusion-acute ischemic stroke with right tandem lesions by workup and underwent mechanical thrombectomy. A large volume of secondary thrombus due to flow stasis was assumed based around the occlusion site, and worsening of neurological symptoms was a concern due to distal embolus caused by recanalization of the cervical internal carotid artery. The SEIMLESS technique was performed under distal protection using EmboTrap III. There was no distal embolus or deterioration of neurological symptoms, and a good prognosis was achieved. This outcome suggests that PTA under distal protection using EmboTrap III may be useful for prevention of distal embolus.

Imperceptible augmentation of living systems with organic bioelectronic fibres.

The functional and sensory augmentation of living structures, such as human skin and plant epidermis, with electronics can be used to create platforms for health management and environmental monitoring. Ideally, such bioelectronic interfaces should not obstruct the inherent sensations and physiological changes of their hosts. The full life cycle of the interfaces should also be designed to minimize their environmental footprint. Here we report imperceptible augmentation of living systems through in situ tethering of organic bioelectronic fibres. Using an orbital spinning technique, substrate-free and open fibre networks-which are based on poly (3,4-ethylenedioxythiophene):polystyrene sulfonate-can be tethered to biological surfaces, including fingertips, chick embryos and plants. We use customizable fibre networks to create on-skin electrodes that can record electrocardiogram and electromyography signals, skin-gated organic electrochemical transistors and augmented touch and plant interfaces. We also show that the fibres can be used to couple prefabricated microelectronics and electronic textiles, and that the fibres can be repaired, upgraded and recycled.

Emerging Roles of Graphitic Carbon Nitride-based Materials in Biomedical Applications.

Graphite carbon nitride (g-C3N4) is a two-dimensional conjugated polymer with a unique energy band structure similar to graphene. Due to its outstanding analytical advantages, such as relatively small band gap (2.7 eV), low-cost synthesis, high thermal stability, excellent photocatalytic ability, and good biocompatibility, g-C3N4 has attracted the interest of researchers and industry, especially in the medical field. This paper summarizes the latest research on g-C3N4-based composites in various biomedical applications, including therapy, diagnostic imaging, biosensors, antibacterial, and wearable devices. In addition, the application prospects and possible challenges of g-C3N4 in nanomedicine are also discussed in detail. This review is expected to inspire emerging biomedical applications based on g-C3N4.

Haemodynamic support with percutaneous devices in patients with cardiogenic shock: the current evidence of mechanical circulatory support.

INTRODUCTION: Cardiogenic shock (CS) is a complex life-threatening condition that results from primary cardiac dysfunction, leading to persistent hypotension and systemic hypoperfusion. Among the therapeutic options for CS are various percutaneous mechanical circulatory support (MCS) devices that have emerged as an increasingly effective hemodynamic support option. Percutaneous therapies can act as short-term mechanical circulatory assistance and can be split into intra-aortic balloon pump (IABP) and non-IABP percutaneous mechanical devices. AREAS COVERED: This review will evaluate the MCS value while considering the mortality rate improvements. We also aim to outline the function of pharmacotherapies and percutaneous hemodynamic MCS devices in managing CS patients to avoid the onset of end-organ dysfunction and improve both early and late outcomes. EXPERT OPINION: Given the complexity, acuity and high mortality associated with CS, and despite the availability and efficacy of pharmacological management, MCS is required to achieve hemodynamic stability and improve survival. Various percutaneous MCS devices are available with varying indications and clinical outcomes. The rates of early mortality and complications were found to be comparable between the four devices, yet, IABP seemed to show the most optimal clinical profile whilst ECMO demonstrated its more long-term efficacy.

Comparisons between In-Check DIAL® and PF810® in evaluation and training inspiratory capacity for using dry powder inhalers.

BACKGROUND: Dry powder inhalers (DPIs) rely on both internal resistance and patients' inspiratory capacity for effective operation. Optimal inspiratory technique is crucial for DPI users. This study assessed the accuracy and repeatability of two available devices, PF810® and In-Check DIAL®, and analyzed their measurement errors and consistency in detecting inspiratory capacity. METHODS: The accuracy and repeatability of peak inspiratory flow (PIF) and forced inspiratory vital capacity (FIVC) against various internal resistances of the two devices were assessed using standard waveforms generated by a breathing simulator. The agreement of PIF measurements between the two devices in healthy volunteers and chronic obstructive pulmonary disease (COPD) patients was analyzed with the intraclass correlation coefficient and Bland-Altman graphical analysis. RESULTS: PF810® showed great accuracy and repeatability in measuring PIF, except for square waveforms at the lowest flow rate (20 L/min). In-Check DIAL® exhibited poor accuracy against high resistance levels. In scenarios with no resistance, In-Check DIAL® had significantly smaller measurement errors than PF810®, but larger errors against high resistance levels. The two devices showed excellent agreement (ICC > 0.80, P < 0.05), except for healthy volunteers against medium to high resistance (R3-R5) where the ICC was insignificant. Bland-Altman plots indicated small disagreements between the two devices for both healthy volunteers and COPD patients. CONCLUSIONS: In-Check DIAL® exhibited poor accuracy and larger measurement errors than PF810® when detecting PIFs against higher internal resistances. However, its good performance against lower internal resistances, along with its cost-effectiveness and convenience made it appropriate for primary care. PF810® showed good accuracy and repeatability and could detect additional parameters of inspiratory capacity beyond PIF, though required further studies to confirm its clinical benefits.

Incidence and risk factors of complications during central venous access devices removal in children.

PURPOSE: To quantify the rates and identify risk factors for the complications of central venous access devices (CVADs) removal in children. METHOD: Retrospective (2018-2023) review of children undergoing CVADs removal at a single institution. Data are reported as frequency, percentages and median. Logistic regression analysis was used to identify risk factors associated with difficult removal. Receiver Operating Characteristic Curve (ROC) analysis was conducted to identify the age cut-off and positive likelihood ratio (+LH) for the indwelling time associated with complicated removal. p-Value <0.05 were considered statistically significant. RESULTS: We identified 208 CVAD removals with a median age of 7.2 (0.2-18.4) years including 116 (55.8%) males. The median CVAD placement duration was 1.26 years (0.4-5.7) years. Indications for insertion included acute lymphoblastic leukaemia (ALL; 78/208, 37.5%), lymphomas (31/208, 14.9%), other malignancies (58/208, 27.9%). Removal indications included completion of treatment (144/208, 69.2%), infection (22/208, 10.6%), malfunction (7/208, 3.4%) and other reasons (35/208, 16.8%). There were 20 (9.6%) complications characterised by difficulty removing the CVAD. Complicated removals were more likely to occur in children with ALL as the primary diagnosis (p = 0.001); independently of the indication for insertion, longer indwelling time was associated with higher risk of complicated removal (p < 0.001). Indwelling time >2.09 years was associated with a 2.87 increased risk of difficult removal. CONCLUSION: In our experience, almost 10% of CVAD removals in children result in complications. These findings are associated with an indwelling time >2 years; strategies to prevent complicated removals should be considered in children requiring long-term central venous access.

Hemodynamic effects of pulsatile frequency of right ventricular assist device (RVAD) on pulmonary perfusion: a simulation study.

Right ventricular assist devices (RVADs) have been extensively used to provide hemodynamic support for patients with end-stage right heart (RV) failure. However, conventional in-parallel RVADs can lead to an elevation of pulmonary artery (PA) pressure, consequently increasing the right ventricular (RV) afterload, which is unfavorable for the relaxation of cardiac muscles and reduction of valve complications. The aim of this study is to investigate the hemodynamic effects of the pulsatile frequency of the RVAD on pulmonary artery. Firstly, a mathematical model incorporating heart, systemic circulation, pulmonary circulation, and RVAD is developed to simulate the cardiovascular system. Subsequently, the frequency characteristics of the pulmonary circulation system are analyzed, and the calculated results demonstrate that the pulsatile frequency of the RVAD has a substantive impact on the pulmonary artery pressure. Finally, to verify the analysis results, the hemodynamic effects of the pulsatile frequency of the RVAD on pulmonary artery are compared under diffident support modes. It is found that the pulmonary artery pressure decreases by approximately 6% when the pulsatile frequency changes from 1 to 3 Hz. The increased pulsatile frequency of RA-PA support mode may facilitate the opening of the pulmonary valve, while the RV-PA support mode can more effectively reduce the load of RV. This work provides a useful method to decrease the pulmonary artery pressure during the RVAD supports and may be beneficial for improving myocardial function in patients with end-stage right heart failure, especially those with pulmonary hypertension.

Overcoming Double Jeopardy: Successful Orthotopic Heart Transplant in a Recipient With Bacterial and Fungal Infections.

Although active infection is generally a contraindication before an orthotopic heart transplant, a 16-year-old man diagnosed with dilated cardiomyopathy successfully underwent an orthotopic heart transplant despite having active probable invasive pulmonary aspergillosis and bacterial pneumonia in the presence of septic and cardiogenic shock.

Flexible Hybrid Supercapacitor Achieving 2.2 V with NiCo2S4/Polyaniline/MnO2 and N, S-Co-Doped Carbon Nanofibers for Ultra-High Energy Density.

Flexible all-solid-state asymmetric supercapacitors (FAASC) represent a highly promising power sources for wearable electronics. However, their energy density is relatively less as compared to the conventional batteries. Herein, a novel ultra-high energy density FAASC is developed using nickel-cobalt sulfide (NiCo2S4)/polyaniline (PANI)/manganese dioxide (MnO2) ternary composite on carbon fiber felt (CF) as positive and N, S-co-doped carbon nanofibers (CNF)/CF as negative electrode, respectively. Initially, porous δ-MnO2 nanoworm-like network is decorated on CF using potentiodynamic method. Subsequently, interconnected PANI nanostructures is grown on the MnO2 via a facile in situ chemical polymerization, followed by the electrodeposition of highly porous NiCo2S4 nanowalls. Benefiting from 3D porous structure of conductive CF and redox active properties of NiCo2S4, PANI and MnO2, FAASC achieved a superior energy storage capacity. Later, high-performance N, S-co-doped CNF/CF negative electrode is synthesized using electropolymerization of PANI nanofibers on CF, followed by the carbonization process. The assembled FAASC exhibits a wide voltage window of 2.2 V and remarkable specific capacitance of 143 F g-1 at a current density of 1 A g-1. The cell further delivers a superb energy density of 71.6 Wh kg-1 at a power density of 492.7 W kg-1, supreme cycle life and remarkable electrochemical stability under mechanical bending.

Fabricated advanced textile for personal thermal management, intelligent health monitoring and energy harvesting.

Fabrics are soft against the skin, flexible, easily accessible and able to wick away perspiration, to some extent for local private thermal management. In this review, we classify smart fabrics as passive thermal management fabrics and active thermal management fabrics based on the availability of outside energy consumption in the manipulation of heat generation and dissipation from the human body. The mechanism and research status of various thermal management fabrics are introduced in detail, and the article also analyses the advantages and disadvantages of various smart thermal management fabrics, achieving a better and more comprehensive comprehension of the current state of research on smart thermal management fabrics, which is quite an important reference guide for our future research. In addition, with the progress of science and technology, the social demand for fabrics has shifted from keeping warm to improving health and quality of life. E-textiles have potential value in areas such as remote health monitoring and life signal detection. New e-textiles are designed to mimic the skin, sense biological data and transmit information. At the same time, the ultra-moisturizing properties of the fabric's thermal management allow for applications beyond just the human body to energy. E-textiles hold great promise for energy harvesting and storage. The article also introduces the application of smart fabrics in life forms and energy harvesting. By combining electronic technology with textiles, e-textiles can be manufactured to promote human well-being and quality of life. Although smart textiles are equipped with more intelligent features, wearing comfort must be the first thing to be ensured in the multi-directional application of textiles. Eventually, we discuss the dares and prospects of smart thermal management fabric research.

Dynamic multicolour tuning in π-conjugated polymers towards flexible electrochromic displays.

Multicolour electrochromic materials have been considered as a promising alternative to achieve dynamic full-colour tuning towards next-generation electronic display technology. However, the development of electrochromics with wide colour gamut and subtle multicolour tunability still remains challenging due to inflexible energy level structures in intrinsic active materials. Herein, the electrochromic π-conjugated polymers with rich and subtle colour tunability were designed and developed based on a fine adjustment on the energy level structures. The chromatic transition covers almost full-colour gamut, and each colour scheme has a rich variety of categories stemming from versatile hues, chromas and lightnesses. Moreover, the multicolour π-conjugated polymers also demonstrate superior overall electrochromic performance, including fast switching (∼1.0 s), high colouration efficiency (160.4 cm2 C-1@550 nm) and good reversibility (over 90 % retention after 10,000 cycles). As a proof of concept, ultrathin and flexible prototype devices are developed by utilizing the multicolour π-conjugated polymers as electrochromic active layer, exhibiting a wide colour gamut and highly saturated multicolour tunability. The design principles proposed in this work may also be applicable to diverse optoelectronic applications.

Association between fitness technology use and physical activity mediated by communication behaviors on social media.

Objective: Fitness technologies, such as smartphone applications and wearable tracking devices, have gained widespread popularity. This study had two main objectives: 1) to examine whether fitness technology use is associated with increased physical activity (PA) levels and 2) to investigate whether communication behaviors on social media mediated the association between fitness technology use and PA. Methods: Data were from the U.S. Health Information National Trends Survey 2022 (N = 6,252, weighted N = 258,418,467). Weighted linear regressions were conducted to examine the associations between fitness technology usage, physical activities, and communication behaviors on social media. Mediations were tested using PROCESS macro, a path-analysis based tool. Results: Controlling for demographic and other known influences on PA, the findings revealed that users of fitness technology reported higher levels of both moderate PA (ß = .41, p < 0.001) and strength training (ß = .29, p < 0.001). Additionally, communication behaviors (i.e., sharing personal health information on social media and watching health-related videos on social media) mediated the relationship between fitness technology use and frequencies of strength training. Conclusion: The results underscored the potential of fitness technologies in enhancing PA levels through promoting communication behaviors on social media.