The applications of high-flow nasal cannulas in pediatric intensive care units in Taiwan.

BACKGROUND: /purpose: The use of high-flow nasal cannulas (HFNC) in patients admitted to the pediatric intensive care unit (PICU) has gradually increased worldwide; however, details on clinical efficacy remain limited in Taiwan. Therefore, we explored the clinical characteristics and outcomes of pediatric patients using HFNC in the PICU. METHODS: Medical records were retrospectively collected from pediatric patients (aged <18 years) who received HFNC support from December 2021 to January 2023 in the PICU of a medical center. Outcome parameters included treatment failure (defined as increased respiratory support to advanced non-invasive ventilators or intubations), duration of support from HFNC, and changes in clinical parameters after initiating HFNC. RESULTS: A total of 261 episodes of HFNC use were included, with a failure rate of 24.5% and a median support length of 4 days. Multivariable analysis showed that infant age (adjusted odds ratio [aOR]: 2.1, p = 0.02) and accompanying complex chronic disease (aOR: 4.4, p = 0.014) were risk factors for treatment failure and a diagnosis of asthma or bronchiolitis had a lower hazard of treatment failure (aOR: 0.29, p = 0.025) than other diagnoses did. Improvements in clinical parameters, including pulse rate, respiratory rate, SpO2, and CO2 levels, were observed 24 h after the initiation of HFNC. CONCLUSION: The application of HFNC in the PICU in Taiwan is effective but should be performed with care in infants with accompanying complex chronic diseases. In addition to low treatment failure, HFNC utilizations stabilized the clinical parameters of children with asthma/bronchiolitis within one day.

High incidence of cerebrovascular lesions on magnetic resonance imaging in pediatric COVID-19 during omicron outbreak - A retrospective case series.

BACKGROUND: The incidence of pediatric hospitalizations has significantly increased since the spread of the omicron variant of COVID-19. Changes of characteristics in respiratory and neurological symptoms have been reported. We performed a retrospective, cross-sectional study to characterize the MRI change in children with an emphasis on the change of cerebral vasculatures. METHODS: We retrospectively collected clinical and MRI data of 31 pediatric patients with neurological symptoms during the acute infection and abnormalities on MRI during the outbreak of omicron variant from April 2022 to June 2022 in Taiwan. The clinical manifestations and MRI abnormalities were collected and proportion of patients with vascular abnormalities was calculated. RESULTS: Among 31 pediatric patients with post-COVID-19 neurological symptoms, MRI abnormalities were observed in 15 (48.4%), predominantly encephalitis/encephalopathy (73.3%). Notable MRI findings included focal diffusion-weighted imaging (DWI) hyperintensity in cerebral cortex and thalamus, diffuse cortical T2/DWI hyperintensity, and lesions in the medulla, pons, cerebellum, and splenium of corpus callosum. Vascular abnormalities were seen in 12 (80%) patients with MRI abnormalities, mainly affecting the middle cerebral arteries. The spectrum of neurological manifestations ranged from seizures to Alice in Wonderland syndrome, underscoring the diverse impact of COVID-19 on pediatric patients. CONCLUSION: A high proportion of vascular abnormalities was observed in pediatric patients with neurological involvements, suggesting that vascular involvement is an important mechanism of neurological manifestations in omicron variant infection.

Relationship Between Athletes' History of Stressors and Sport Injury: A Systematic Review and Meta-Analysis.

A history of stressors in athletes represents psychosocial factors that may lead to sport injury. However, empirical studies have provided varying results for the relationship between stress history and sport injury. We examined prior literature on the stress history - sport injury relationship within a systematic review and, by meta-analysis, we offered a pooled estimate of the strength of this relationship. We searched seven major academic databases (Sportdiscus, Psyinfo, Academic Search Premier, Ovid, Scopus, Web of Science, and PubMed) from January 2000 to September 2023 and identified 19 empirical studies that examined injuries in sports contexts for meta-analysis. In 19 empirical studies of moderate to high publication quality, we found moderate heterogeneity (Q(17) = 98.61; p < .001), low sensitivity (I2 77.82-83.77), and low publication bias (Z-value = 7.74; p < .001). Further, using a random effect estimate-r, we found a low but significant correlation between stress history and sport injury, yielding a small overall effect size (ES) of r = .12. Furthermore, moderation analyses found adolescents (r = .14), contact-sport athletes (r = .09), non-elite athletes (r = .13), and non-European athletes (America r = .16; Asia r = .14; Oceania r = .14) to have a relatively higher ES than their counterparts in this stress history/sport injury relationship. We concluded that inevitable life stressors may lead to many negative consequences for athletes, such that sports professionals should provide stress management educational programs to enhance athletes' health and well-being.

Pediatric palliative care utilization by decedent children: A nationwide population-based study, 2002-2017.

PURPOSE: This study aimed (1) to describe how trends in pediatric palliative care (PPC) utilization changed from 2002 to 2017, and (2) to examine factors predicting PPC utilization among decedent children in Taiwan. DESIGN: This retrospective, correlational study retrieved 2002-2017 data from three national claims databases in Taiwan. METHODS: Children aged 1 through 18 years who died between January 2002 and December 2017 were included. Pediatric palliative care utilization was defined as PPC enrollment and PPC duration, with enrollment described by frequency (n) and percentage (%) and duration described by mean and standard deviation (SD). Logistic regression was used to examine the associations of various demographic characteristics with PPC enrollment; generalized linear regression was used to examine associations of the demographic characteristics with PPC duration. FINDINGS: Across the 16-year study period, PPC enrollment increased sharply (15.49 times), while PPC duration decreased smoothly (by 29.41%). Cause of death was a continuous predictor of both PPC enrollment and PPC duration. The children less likely to be enrolled in PPC services were those aged 1 to 6 years, boys, living in poverty, living in rural areas, and diagnosed with life-threatening noncancer diseases. CONCLUSION: This study used nationwide databases to investigate PPC enrollment and PPC duration among a large sample of deceased children from 2002 to 2017. The findings not only delineate trends and predictors of PPC enrollment and PPC duration but also highlight great progress in PPC as well as the areas still understudied and underserved. This information could help the pediatric healthcare system achieve the core value of family-centered care for children with life-threatening diseases and their families. CLINICAL RELEVANCE: Pediatric palliative care should be widely and continuously implemented in routine pediatric clinical practice to enhance quality of life for children and their families at the end of life.

Interactive effects of dispositional mindfulness and PETTLEP imagery training on basketball shooting performance: A randomized controlled trial.

The purpose of this study was to examine the interactive effects of dispositional mindfulness and visualized PETTLEP imagery training on basketball mid-range shooting performance and retention. Seventy-three participants (M age = 20.32 ± 1.09) with high/low dispositional mindfulness (high n = 35; low n = 38) selected out of 302 college students were randomly assigned into the following six groups: (a) high mindfulness internal imagery (H-II, n = 13); (b) high mindfulness external imagery (H-EI, n = 11); (c) high mindfulness control (H-CO, n = 11); (d) low mindfulness internal imagery (L-II, n = 13); (e) low mindfulness external imagery (L-EI, n = 12); and (f) low mindfulness control (L-CO, n = 13). Participants engaged in a pretest to measure their basketball shooting performance, then participated in a 6-week (3 times/per-week) intervention, plus a posttest and retention test. A three-way 2 (high/low mindfulness) X 3 (treatments: internal-, external imagery, and control) X 3 (measurement time: pretest, posttest, and retention) mixed ANOVA statistical analysis found dispositional mindfulness interacted with treatments and measurement time. The main effects showed high dispositional mindfulness performed better than low dispositional mindfulness, and internal imagery training performed better than external imagery training on mid-range basketball performance at retention. The 3-way interaction indicated that when using either internal or external imagery, high dispositional mindfulness performed better than low mindfulness on retention but not posttest. For 2-way interaction, high dispositional mindfulness performed better than low dispositional mindfulness on retention but not posttest. Our results extended current knowledge on sport imagery and dispositional mindfulness and gained several theoretical implications for researchers. The limitations, future research directions, and practical implications were also discussed.

Clinical characteristics and factors associated with severe COVID-19 in hospitalized children during the SARS-CoV-2 Omicron pandemic in Taiwan.

BACKGROUND: Since April 2022, a notable increase in COVID-19 cases with the rapid spread of the SARS-CoV-2 Omicron variant has been reported in Taiwan. In the epidemic, children were one of the most vulnerable groups, so we analyzed their clinical presentations and factors associated with severe complications of COVID-19 in children. METHODS: We included hospitalized patients under 18 years old with lab-confirmed SARS-CoV-2 infection from March 1, 2022, to July 31, 2022. We collected the demographic and clinical characteristics of the patients. Patients requiring intensive care were defined as severe cases. RESULTS: Among the 339 enrolled patients, the median age was 31 months (interquartile range (IQR), 8-79.0 months); and 96 patients (28.3%) had underlying diseases. Fever was noted in 319 patients (94.1%) with a median duration of two days (IQR 2-3 days). Twenty-two patients (6.5%) were severe cases, including 10 patients (2.9%) with encephalopathy with abnormal neuroimaging and ten patients (2.9%) with shock. Two patients (0.6%) died. Patients with congenital cardiovascular disease (aOR: 21.689), duration of fever up to four days or more (aOR: 6.466), desaturation (aOR: 16.081), seizure (aOR: 20.92), and procalcitonin >0.5 ng/mL (aOR: 7.886) had a higher risk of severe COVID-19. CONCLUSIONS: Vital signs need close monitoring, early management and/or intensive care may be applied in COVID-19 patients with congenital cardiovascular diseases, fever lasting ≥4 days, seizures, desaturation and/or elevated procalcition since they are at higher risks of severe diseases.

Increasing Trend and Effects of Pediatric Palliative Care on Children With Noncancer Diagnoses.

OBJECTIVES: Pediatric palliative care (PPC), especially among noncancer pediatric patients, faces challenges including late referral, limited patient care, and insufficient data for Asian patients. METHODS: This retrospective cohort study used the integrative hospital medical database between 2014 and 2018 to analyze the clinical characteristics, diagnoses, and end-of-life care for patients aged less than 20 who had died in our children's hospital, a tertiary referral medical center implementing PPC shared-care. RESULTS: In our cohort of 323 children, 240 (74.3%) were noncancer patients who a younger median age at death (5 vs. 122 months, P < 0.001), lower rate of PPC involvement (16.7 vs. 66%, P < 0.001), and fewer survival days after PPC consult compared to cancer patients (3 vs. 11, P = 0.01). Patients not receiving PPC had more ventilator support (OR 9.9, P < 0.001), and less morphine use on their final day of life (OR 0.1, P < 0.001). Also, patients not receiving PPC had more cardiopulmonary resuscitation on the last day of life (OR 15.3, P < 0.001) and died in the ICU (OR 8.8, P < 0.001). There was an increasing trend of noncancer patients receiving PPC between 2014 and 2018 (P < 0.001). CONCLUSIONS: High disparities exist between children receiving PPC in cancer versus noncancer patients. The concept of PPC is gradually becoming accepted in noncancer children and is associated with more pain-relief medication and less suffering during end-of-life care.

Medical clowning influences the emotions of parents of children undergoing cancer treatment: A quasi-experimental study.

BACKGROUND: Medical clowning for children has been found to be effective at enhancing parents' psychological well-being during preoperative preparation, but has not been found during cancer treatment. This study aimed to examine whether and how medical clowning influenced the emotions of parents of children undergoing cancer treatment. METHODS: In this quasi-experimental study, 96 parents of children receiving inpatient cancer treatment were recruited, from June 2018 through April 2020. A demographic questionnaire measuring characteristics of parent and dyadic child, Brief Symptom Rating Scale measuring psychological distress of the parent, and Mood Assessment Scale measuring emotional status of parent and child were administered 1 day before a clowning service. The day after the clowning service, the Mood Assessment Scale again collected emotional status for parent and child. Descriptive analysis, bivariate analysis, and structural equation modeling to fit the actor-partner, cross-lagged model were used. FINDINGS: Parents experienced a low degree of psychological distress that called for emotional management. The indirect effect of medical clowning on parents' emotions through children's emotions was significant, as were the direct effect and total effect of medical clowning on parents' emotions. DISCUSSION: Parents experienced psychological distress during their child's inpatient cancer treatment. Medical clowning can directly improve children's emotions and through this pathway indirectly improve their parents' emotions. APPLICATION TO PRACTICE: There is need to monitor psychological distress and provide interventions for parents of children undergoing cancer treatment. Medical clowns should continue to serve parent-child dyads in pediatric oncology practice and become members of multidisciplinary health care teams.

Influence of mental energy on volleyball competition performance: a field test.

Athletic mental energy is a newly emerging research topic in sport science. However, whether it can predict objective performance in competition remains unexplored. Thus, the purpose of this study was to examine the predictability of mental energy on volleyball competition performance. We recruited 81 male volleyball players (Mage = 21.11 years ± SD = 1.81) who participated in the last 16 remaining teams in a college volleyball tournament. We assessed participants' mental energy the night before the competition and collected their competition performance over the next 3 days. We used six indices of the Volleyball Information System (VIS) developed by the International Volleyball Federation (FIVB) to examine its associations with mental energy. All six factors of mental energy -motivation, tirelessness, calm, vigor, confidence, and concentration correlated with volleyball competition performance. Further, a hierarchical regression found mental energy predicted volleyball receivers' performance (R2 = .23). The findings advance our knowledge of mental energy and objective performance in competition. We suggest that future studies may examine the effects of mental energy on different sports with different performance indices.

The impacts of the scope of benefits expansion on hospice care among adult decedents: a nationwide longitudinal observational study.

OBJECTIVES: Compared to aggressive treatment for patients at the end stage of life, hospice care might be more likely to satisfy such patients' need and benefits and improve their dignity and quality of life. Whether the reimbursement policy expansion affect the use of hospice care among various demographics characteristics and health status was unknown. Therefore, the purpose of this study was to explore the impacts of reimbursement policy expansion on hospice care use, and to investigate the effects on people with various demographics characteristics and health status. METHODS: We used the 2001-2017 Taiwan NHI claims data, Death Registry, and Cancer Registry in this study, and we included people who died between 2002 and 2017. The study period was divided into 4 sub-periods. hospice care use and the initiation time of 1st hospice care use were used as dependent variables; demographic characteristics and health status were also collected. RESULTS: There were 2,445,781 people who died in Taiwan during the study period. The results show that the trend of hospice care use increased over time, going steeply upward after the scope of benefits expansion, but the initiation time of 1st hospice care use did not increase after the scope of benefits expansion. The results also show that the effects of expansion varied among patients by demographic characteristics. CONCLUSION: The scope of benefits expansion might induce people's needs in hospice care, but the effects varied by demographic characteristics. Understanding the reasons for the variations in all populations would be the next step for Taiwan's health authorities.

The implications of airway anomalies on children with congenital heart disease and bronchiolitis.

BACKGROUND: Bronchiolitis is a common airway infection in young children. Hemodynamically significant congenital heart disease (CHD) predicts a more complicated course. However, the role of airway anomalies remains unknown. METHODS: We retrospectively reviewed the records of patients under 2 years old, diagnosed with CHD, and admitted between January 2011 and December 2013, before the palivizumab era. Records of bronchiolitis admissions were also extracted. Patients were grouped according to CHD condition and airway anomalies. RESULTS: A total of 230 patients with CHD were enrolled. A total of 180 (78%) and 71 (31%) patients had hemodynamically significant CHD and airway anomalies, respectively. A total of 52 (22.6%) patients were admitted for bronchiolitis 78 times. Among them, 33 (63.5%) had hemodynamically significant CHD, and 28 (53.8%) had airway anomalies. In patients with bronchiolitis admissions, the mean ventilator use, intensive care unit stay, and hospital stay were 1.08, 4.08, and 15.19 days, respectively. When compared, the mean hospital stay for bronchiolitis patients with airway anomalies was significantly longer than that of those without airway anomalies (19.8 vs. 9.9 days, p = 0.008). When further divided the patients by the presence hemodynamic significance, patients with hemodynamically significant CHD and airway anomaly had longer hospital stay than those who had neither. (21.7 vs. 8.3 days, p = 0.004) Airway anomaly was a significant risk factor for longer hospital stay in linear regression model (p = 0.007). CONCLUSIONS: Airway anomalies are common in children with CHD and are associated with longer hospital stays on bronchiolitis admission. An active survey for airway anomalies and adequate prophylaxis for bronchiolitis infection might be important in the care of children with CHD associated with airway anomalies.

Application of nested multiplex polymerase chain reaction respiratory and pneumonia panels in children with severe community-acquired pneumonia.

Community-acquired pneumonia (CAP) is a serious clinical concern. A lack of accurate diagnosis could hinder pathogen-directed therapeutic strategies. To solve this problem, we evaluated clinical application of nested multiplex polymerase chain reaction (PCR) in children with severe CAP. We prospectively enrolled 60 children with severe CAP requiring intensive care between December 2019 and November 2021 at a tertiary medical center. Nested multiplex PCR respiratory panel (RP) and pneumonia panel (PP) were performed on upper and lower respiratory tract specimens. We integrated standard-of-care tests and quantitative PCR for validation. The combination of RP, PP, and standard-of-care tests could detect at least one pathogen in 98% of cases and the mixed viral-bacterial detection rate was 65%. The positive percent agreement (PPA), and negative percent agreement (NPA) for RP were 94% and 99%; the PPA and NPA for PP were 89% and 98%. The distribution of pathogens was similar in the upper and lower respiratory tracts, and the DNA or RNA copies of pathogens in the lower respiratory tract were equal to or higher than those in the upper respiratory tract. PP detected bacterial pathogens in 40 (67%) cases, and clinicians tended to increase bacterial diagnosis and escalate antimicrobial therapy for them. RP and PP had satisfactory performance to help pediatricians make pathogenic diagnoses and establish therapy earlier. The pathogens in the upper respiratory tract had predictive diagnostic values for lower respiratory tract infections in children with severe CAP.

The impact of the coronavirus disease 2019 epidemic and national public restrictions on Pediatric Intensive Care Units in Taiwan.

BACKGROUND/PURPOSE: Coronavirus disease 2019 (COVID-19) pandemic challenges pediatric health globally by limited medical accessibility. In response to COVID-19 epidemic in Taiwan, public restrictions were applied and the Level 3 alert was announced from May to July in 2021 for local outbreak. This study aims to analyze patients' clinical features and outcomes in the pediatric intensive care unit (PICU) during the COVID-19 epidemic with the Level 3 alert in Taiwan. METHODS: Medical records were retrospectively collected in patients admitted to the PICU of National Taiwan University Children's Hospital from May to July 2021 (Level 3 alert) and May to July 2019 and 2020 (control periods). Clinical characteristics and outcomes were compared between patients in the period with the Level 3 alert and control periods. RESULTS: During the study period, PICU monthly admissions significantly decreased in the Level 3 alert period and were negatively correlated with monthly newly confirmed COVID-19 cases. Patients admitted during the Level 3 alert were older, had higher disease severity, lower proportion of cardiovascular disease, and higher proportion of hematology-oncology diseases than those in the control group. After adjusting for the above factors, admission during Level 3 alert was an independent factor for higher mortality rate and prolonged length of stay (>14 days) in the PICU. CONCLUSION: During the COVID-19 epidemic with strict public restrictions, critically ill patients admitted to the PICU decreased but had increased disease severity, prolonged length of stay in the PICU, and higher mortality, reflecting the impact of quarantine and limited medical access.

Podocalyxin-Like Protein 1 Regulates Pluripotency through the Cholesterol Biosynthesis Pathway.

Deciphering signaling mechanisms critical for the extended pluripotent stem cell (EPSC) state and primed pluripotency is necessary for understanding embryonic development. Here, a membrane protein, podocalyxin-like protein 1 (PODXL) as being essential for extended and primed pluripotency, is identified. Alteration of PODXL expression levels affects self-renewal, protein expression of c-MYC and telomerase, and induced pluripotent stem cell (iPSC) and EPSC colony formation. PODXL is the first membrane protein reported to regulate de novo cholesterol biosynthesis, and human pluripotent stem cells (hPSCs) are more sensitive to cholesterol depletion than fibroblasts. The addition of exogenous cholesterol fully restores PODXL knockdown-mediated loss of pluripotency. PODXL affects lipid raft dynamics via the regulation of cholesterol. PODXL recruits the RAC1/CDC42/actin network to regulate SREBP1 and SREBP2 maturation and lipid raft dynamics. Single-cell RNA sequencing reveals PODXL overexpression enhanced chimerism between human cells in mouse host embryos (hEPSCs 57%). Interestingly, in the human-mouse chimeras, laminin and collagen signaling-related pathways are dominant in PODXL overexpressing cells. It is concluded that cholesterol regulation via PODXL signaling is critical for ESC/EPSC.

Abusive head trauma: current practice of investigation and management in Taiwan.

INTRODUCTION: Abusive head trauma (AHT) is a worldwide leading cause of fatal head injuries in children under 2 years. This study aims to present the development of child protection medical service in Taiwan in the past decade. MATERIALS AND METHODS: This study reviews the evolution of the pediatric protection network and the cross-system professional training in Taiwan from 2013 to 2022. The recommendations of Taiwan Pediatric Association on the prevention and management of AHT and the Medical Professionals Manual of Child Abuse and Neglect proposed by the Ministry of Health and Welfare were reviewed. RESULTS: Considering the impact of the high incidence of severe sequelae and the mortality caused by of AHT, 10 regional centers for child protection medical service were founded in Taiwan to identify, recognize, and properly manage cases of AHT, which is easily overlooked by the healthcare providers. The child protection network across the healthcare, social welfare administration, and judicial systems facilitate the early detection, management, and proper disposition of the children with AHT. CONCLUSION: An increasing of the incidence of AHT is expected after the setting up of the child protection network and the continuing cross-system professional trainings. There is more consensus of the diagnosis and management of AHT than before in Taiwan. However, there is no end to protecting children from AHT.

Epidemiology of Cardiomyopathy in Taiwanese Population Aged Younger Than 65 Years.

Background: Few studies have investigated the epidemiology of cardiomyopathy (CMP) in the general population in Taiwan. The aim of this study was to investigate this issue. Methods: We identified patients aged < 65 years and diagnosed with CMP between 2001 and 2014 from the National Health Insurance Database of Taiwan 2000-2014. Those with known or presumed causes of CMP were further identified. Results: We identified 38,868 CMP patients (male/female = 2.13). Half had known or presumed causes of CMP, including coronary artery disease (23.6%), congenital heart disease (1.6%), metabolic disease (8.4%), conduction disturbance/dyssynchrony (2.2%), myocarditis (0.5%), muscular dystrophy (1.42%), Kawasaki disease (0.2%), nutrition problems or alcoholism (2.9%), and unspecified causes (12.4%). The incidence rates of CMP without known causes were 1.13 and 8.70 per 100,000 person-years in pediatric (0-19 years) and adult (20-64 years) populations, respectively. After an initial peak during infancy (9.16 per 100,000 person-years), the incidence declined to a nadir in those aged from 5 to 14 years, and then steadily increased during adulthood (26.51 per 100,000 person-years in those aged 60-64 years). Although mortality was higher in the pediatric (11.4%) than in the adult (1.5%) patients, the proportion of sudden death to all deaths was similar in the pediatric (9.9%) and adult (10.5%) patients. Conclusions: This study provides an epidemiological continuum of CMP in a Taiwanese population aged < 65 years. The results revealed an initial peak during infancy, followed by a decline in adolescence and a subsequent steady rise. The prognosis was poorer in the pediatric patients, and poorest in the infants. However, the risk of sudden death was the same in the adult and pediatric patients.

Microrna-486-5P Regulates Human Pulmonary Artery Smooth Muscle Cell Migration via Endothelin-1.

Pulmonary arterial hypertension (PAH) is a fatal or life-threatening disorder characterized by elevated pulmonary arterial pressure and pulmonary vascular resistance. Abnormal vascular remodeling, including the proliferation and phenotypic modulation of pulmonary artery smooth muscle cells (PASMCs), represents the most critical pathological change during PAH development. Previous studies showed that miR-486 could reduce apoptosis in different cells; however, the role of miR-486 in PAH development or HPASMC proliferation and migration remains unclear. After 6 h of hypoxia treatment, miR-486-5p was significantly upregulated in HPASMCs. We found that miR-486-5p could upregulate the expression and secretion of ET-1. Furthermore, transfection with a miR-486-5p mimic could induce HPASMC proliferation and migration. We also found that miRNA-486-5p could downregulate the expression of SMAD2 and the phosphorylation of SMAD3. According to previous studies, the loss of SMAD3 may play an important role in miRNA-486-5p-induced HPASMC proliferation. Although the role of miRNA-486-5p in PAH in in vivo models still requires further investigation and confirmation, our findings show the potential roles and effects of miR-486-5p during PAH development.

Factorial validity and measurement invariance of the psychological need satisfaction in exercise scale across gender.

BACKGROUND: Based on the self-determination theory, the psychological requirements for competence, autonomy, and relatedness boost beneficial exercise behaviour for healthy living. However, there is no valid, reliable Malay version scale to investigate the extent to which these psychological needs are met. The main purpose of this study was to examine the psychometric properties of a Malay version of the Psychological Need Satisfaction in Exercise (PNSE-M) scale. In addition, the purpose of this study was to confirm the measurement and structural invariance of the PNSE-M across gender. METHODS: The study participants included 919 students (male: 49.6%, female: 50.4%), with a mean age of 20.4 years (standard deviation = 1.5). The participants were selected through convenience sampling. The 18-item PNSE-M was used to measure psychological need satisfaction in exercise. The English version of the PNSE was translated into Malay using standard forward-backward translation. Confirmatory factor analysis (CFA) and invariance tests were performed on the three domains of the PNSE-M model. Composite reliability (CR), average variance extracted (AVE), internal consistency based on Cronbach's alpha, and test-retest reliabilities using intraclass correlation coefficient (ICC) were also computed. RESULTS: After some model re-specification, the CFA findings based on the hypothesised measurement model of three factors and 18 items indicated acceptable factor structure (CFI = .936, TLI = .923, SRMR = .054, RMSEA = .059). The CR and AVE values were .864-.902 and .573-.617, respectively. Cronbach's alpha was .891-.908, and the ICC was .980-.985. The findings supported the full measurement and structural invariance of the PNSE-M for both male and female participants. The CFA model matched the data well for both male (CFI = .926, SRMR = .057, RMSEA = .066) and female (CFI = .926, SRMR = .060, RMSEA = .065) participants. CONCLUSION: The PNSE-M with three factors and 18 items is considered to be a valid, reliable instrument for university students in Malaysia. It is valid for use to make meaningful comparisons across gender.

Clinical implications of airway anomalies and stenosis in patients with heterotaxy syndrome.

In heterotaxy syndrome, bronchopulmonary situs usually reflects atrial situs, resulting in either right (RAI) or left atrial isomerism (LAI). This study determines airway anomalies and its implications in patients with heterotaxy. This retrospective study included 223 patients with heterotaxy syndrome who received an integrated cardiac computed tomography evaluation. Patient database from 1995 to 2020 was reviewed. The patients were examined by a congenital heart disease team comprising pediatric cardiologists, radiologists, pulmonologists, and cardiovascular surgeons. Among the 223 patients, 189 (84.8%, M/F = 1.66) had RAI and 29 had LAI (13.0%, M/F = 0.71). Five patients had indeterminate isomerism (2.2%, M/F = 1.5). Discordant bronchopulmonary and atrial situs occurred in 4% patients, while discordant bronchopulmonary, atrial, and splenic situs occurred in 23.2% patients. Lower airway stenosis was observed in 61 patients (27.4%), including 27.5%, 20.7%, and 60% RAI, LAI, and indeterminate isomerism patients, respectively (p = 0.189). One patient had an intrinsic long segment lower tracheal stenosis and received slide tracheoplasty. Initial cardiac operation was performed in 213 patients. Higher surgical mortality occurred in patients with RAI (19.5% vs. none for LAI and indeterminate isomerism, p = 0.038). In patients with RAI, lower airway anomaly/stenosis increased the duration of ventilator usage (p = 0.030) but did not affect surgical mortality. Total anomalous pulmonary venous return to systemic veins and pulmonary venous stenosis were major surgical risk factors. Bronchopulmonary isomerism shares a similar isomeric pattern to cardiac atrial appendage. Lower airway anomalies/stenosis was common in patients with heterotaxy, resulting in prolonged ventilator therapy in patients with RAI.

Combinations of action observation and motor imagery on golf putting's performance.

Motor imagery (MI) and action observation (AO) have been found to enhance motor performance, but recent research found that a combination of action observation and motor imagery (AOMI) together is even better. Despite this initial finding, the most effective way to combine them is unknown. The present study examined the effects of synchronized (i e., concurrently doing AO and MI), asynchronised (i.e., first doing AO then MI), and progressive (first asynchronised approach, then doing synchronized approach) AOMI on golf putting performance and learning. We recruited 45 university students (Mage = 20.18 + 1.32 years; males = 23, females = 22) and randomly assigned them into the following four groups: synchronized group (S-AOMI), asynchronised group (A-AOMI), progressive group (A-S-AOMI), and a control group with a pre-post research design. Participants engaged in a 6-week (three times/per-week) intervention, plus two retention tests. A two-way (group × time) mixed ANOVA statistical analysis found that the three experimental groups performed better than the control group after intervention. However, we found progressive and asynchronised had better golf putting scores than synchronized group and the control group on the retention tests. Our results advance knowledge in AOMI research, but it needs more research to reveal the best way of combining AOMI in the future. Theoretical implications, limitations, applications, and future suggestions are also discussed.