Psychometric properties and measurement invariance of a European Portuguese version of the fear of COVID-19 scale / Propiedades psicométricas e invariancia de medida de una versión en portugués europeo de la escala de miedo de la COVID-19

El miedo generalizado de la COVID-19 parece haber exacerbado el impacto negativo de la pandemia. Por eso, es relevante monitorear el miedo de la COVID-19 y su asociación con la salud mental, el bienestar y los comportamientos de las personas, siendo necesarias medidas válidas y fiables de miedo de la COVID-19. Este estudio tuvo como objetivo evaluar las propiedades psicométricas de una versión en portugués europeo de la escala Fear of COVID-19 (FCV-19S-P). Un objetivo secundario fue evaluar la invariancia de medición transversal multigrupo de FCV-19S-P (mujeres vs. hombres). Una muestra de 572 adultos portugueses (72 % mujeres) completaron el FCV-19S-P y medidas de depresión, ansiedad y estrés. Los resultados del estudio respaldaron la validez de esta versión y fiabilidad (alfa de Cronbach = .84; confiabilidad compuesta = .83) y una estructura factorial similar a de la versión original. El miedo de la COVID-19 se asoció positivamente (.23 < r < .31) con depresión, ansiedad y estrés. Los resultados del análisis transversal de invariancia multigrupo respaldaron la invariancia escalar total de la FCV-19S-P y su invariancia residual parcial, lo que sugiere que esta medida puede usarse para llegar a conclusiones válidas con respecto a las comparaciones de género en muestras de adultos portugueses.(AU)

The novelty and uncertainty of the pandemic nourished a gener-alized fear of the COVID-19, which seems to have exacerbated the pan-demic’s negative impact. It is thus relevant to monitor fear of COVID-19 and its association with individuals’ mental health, well-being, and behav-iors. Valid and reliable measures of fear of COVID-19 are necessary for that purpose. This study aimed at assessing the psychometric properties of a European Portuguese version of the Fear of COVID-19 scale (FCV-19S-P). A secondary aim was to assess FCV-19S-P’s multigroup measurement invariance (female vs.male). A sample of 572 Portuguese adults (72 % fe-male) completed the FCV-19S-P and measures of depression, anxiety, and stress. The study results supported this version validityand reliability (Cronbach’s alpha = .84; Composite Reliability = .83), and a factorial struc-ture similar to the original version. Fear of COVID-19 was positively asso-ciated (.23 < r < .31) with depression, anxiety, and stress. Results of the multigroup invariance analysis supported the FCV-19S-P total scalar invar-iance and its partial residual invariance, suggesting that this measure may be used to reach valid conclusions in respect to gender comparisons in samples of Portuguese adults in regard to group observed composite means.(AU)

Evidencias de validez de la Escala de Sentimiento de Autoeficacia Docente en una muestra española / Evidence for the validity of the Teachers’ Sense of Self-Efficacy Scale in a Spanish sample

El sentimiento de autoeficacia docente (SAD) es un constructo de compleja medida pero relevante por su relación con la calidad de la educación. Con este trabajo se pretende acumular evidencias de consistencia y validez para su uso en España de una versión del Teachers’ Sense of Efficacy Scale (TSES). Los datos proceden de un colectivo español de futuros profesores de infantil, primaria y secundaria (N = 744) y se analizan desde un enfoque multivariado adecuado para escala ordinal, mediante análisis factorial confirmatorio (ULSMV) y árboles de decisión (CHAID y CART). Tras evaluar tres modelos de medida, se aportan evidencias de validez de una estructura del constructo en tres factores y 17 ítems, con índices de ajuste aceptables. Además, se avala tanto la convergencia y consistencia del constructo, como la utilidad de los ítems para la predicción de la autoeficacia docente global en los colectivos de estudiantes de grado y de máster que componen la muestra estudiada.(AU)

Teachers’ sense of self-efficacy is a hard construct to measure but is important in view of to its relationship with the quality of education. This work aims to gather evidence regarding the consistency and validity of a version ofthe Teachers’ Sense of Efficacy Scale (TSES) for use in Spain. The data come from a Spanish group of future early-years, primary and high school teachers (N= 744), and they are analysed using a multivariate approach suitable for ordinal scales, with confirmatory factor analysis (ULSMV) and decision trees (CHAID and CART). After evaluating three measurement models, evidence for the validity of a construct structure with three factors and 17 items with acceptable fit indices is provided. In addition, the convergence and consistency of the construct are both en-dorsed, as is the usefulness of the items for predicting overall teacher self-efficacy in the groups ofundergraduate and master’s students in the sam-ple studied.(AU)

Cuestionarios de adherencia al tratamiento antidiabético oral en pacientes con Diabetes Mellitus 2: revisión sistemática / Adherence questionnaires to oral antidiabetic treatment in patients with Diabetes Mellitus 2: systematic review

Introducción: La adherencia a los antidiabéticos orales (ADOs) en pacientes con Diabetes Mellitus tipo 2 (DM2) puede afectar al control de la enfermedad y por tanto, es necesario evaluarla. Para ello se necesitan herramientas rápidas, sencillas, válidas y fiables. De manera que el objetivo de esta revisión fue identificar aquellos cuestionarios validados que se usan para medir la adherencia a los ADOs en la práctica clínica. Método: se llevó a cabo una búsqueda bibliográfica en las bases de datos Medline, Scopus y LILACS. La selección de artículos la realizaron dos autores de manera independiente en base a las recomendaciones Prisma. Los criterios de selección fueron: artículos con cuestionarios validados en pacientes con DM2, en español o inglés y publicados hasta el 31 de noviembre de 2022.Se resumieron las pruebas de fiabilidad (consistencia interna, correlación ítem- total, coeficiente de correlación intraclase) y validez de los cuestionarios (validez de constructo, de criterio y de contenido). Resultados: 23 artículos formaron parte de la revisión. Se obtuvieron 10 cuestionarios de medida de la adherencia a los ADOs los cuales fueron validados en 14 países. El 8-item Self-Reported Medication Adherence Measure (MMAS-8) y el Adherence to Refills and Medications Scale (ARMS) fueron los más usados. Todos presentaron al menos una medida de validez y fiabilidad, siendo la validez de grupos conocidos la menos empleada. Conclusiones: Hay cuestionarios que presentan datos de validez o fiabilidad mejores que otros, pero deberá ser el profesional sanitario quien determine cuál se ajusta mejor a sus pacientes o a su estudio. (AU)

Introduction: adherence to oral antidiabetics (OADs) in patients with Type 2 Diabetes Mellitus (DM2) can affect disease control and therefore needs to be evaluated. For this, fast, simple, valid and reliable tools are needed. Thus, the objective of this review was to identify those validated questionnaires that are used to measure adherence to OADs in clinical practice. Method: a bibliographic search was carried out in the Medline, Scopus and LILACS databases. The selection of articles was performed by 2 authors independently based on Prisma recommendations. The selection criteria were: Articles with validated questionnaires in patients with DM2, in Spanish or English and published until 31 November 2022. Reliability tests (internal consistency, item-total correlation, intraclass correlation coefficient) and validity of the questionnaires (construct validity, criteria and content). Results: 23 articles were part of the review.10 questionnaires to measure adherence to the ODAs were obtained, which were validated in 14 countries. The 8-item Self-Reported Medication Adherence Measure (MMAS-8) and the Adherence to Refills and Medications Scale (ARMS) were the most used. All presented at least one measure of validity and reliability, the validity of known groups being the least used. Conclusions: There are questionnaires that present better validity or reliability data than others, but it should be the healthcare professional who determines which one best suits their patients or their study. (AU)

Home blood pressure self-measurement: “Current situation and new perspectives” / Automedidas domiciliarias de presión arterial: «situación actual y nuevas perspectivas»

The method typically used to diagnose and monitor hypertensive patients has been to measure blood pressure in the physician's surgery; however, it is a well-known fact that this approach poses certain drawbacks, such as observer bias, failure to detect an alert reaction in the clinic, etc., difficulties that affect its accuracy as a diagnostic method.In recent years, the varying international scientific societies have persistently recommended the use of blood pressure measurements outside the clinic (at home or in the outpatient setting), using validated automatic devices. Data from some studies suggest that if we rely solely on in-office measurements, approximately 15–20% of the time we may be wrong when making decisions, both in terms of diagnosis and patient follow-up.Home blood pressure measurements are a simple and very affordable method that has a similar reproducibility and prognostic value as ambulatory blood pressure monitoring, the availability of which is currently very limited. Moreover, ambulatory self-measurements have the significant benefit of being able to improve control of hypertensive individuals.Healthcare professionals and patients should be aware of the methodology of home blood pressure measurement, its usefulness and limitations. (AU)

El método utilizado habitualmente para el diagnóstico y seguimiento de los pacientes hipertensos ha sido la medida de la presión arterial en la consulta, pero es un hecho conocido que este método plantea problemas (sesgos del observador, no detecta reacción de alerta en consulta…) que afectan a su precisión como método diagnóstico.Las diferentes sociedades científicas internacionales, en los últimos años, recomiendan de forma insistente el uso de medidas de presión arterial fuera de la consulta (domiciliarias o ambulatorias) con aparatos automáticos validados para tomar decisiones. Datos de algunos estudios sugieren que si solo utilizamos las medidas de la consulta nos podemos equivocar en torno a un 15-20% de las veces que tomemos decisiones en el diagnóstico y seguimiento de los pacientes.Las medidas domiciliarias de presión arterial son un método sencillo y muy accesible que tienen una reproducibilidad y valor pronóstico similar al de las medidas ambulatorias, cuya disponibilidad actualmente e muy limitada, y que además tienen una utilidad importante que es la posibilidad de mejora del control de los hipertensos.Los profesionales sanitarios y los pacientes deben conocer la metodología de uso de la medida de presión arterial domiciliaria y sus utilidades y limitaciones. (AU)

Análisis del sistema XIDE en la gestión de la sobredemanda asistencial / Analysis of the XIDE system in the management of overdemand for care

Objetivo Valorar el impacto y la idoneidad del sistema de citación XIDE en la gestión de la sobredemanda asistencial del centro de salud de Monforte de Lemos (Lugo). Material y métodos Estudio descriptivo, transversal, observacional y analítico. La población de estudio estuvo formada por los pacientes añadidos a la agenda ordinaria como «forzado» o «forzado urgente». La muestra poblacional se obtuvo durante el periodo del 15 de julio al 15 de agosto de 2022. El análisis comparativo se realizó con periodos previos a la implantación del XIDE y la concordancia XIDE/observadores se estimó mediante el cálculo del índice κ de Cohen. Resultados Observamos un aumento de la presión asistencial, tanto en número de consultas/día como en la proporción de consultas forzadas, que han aumentado en un 30-34%. El grupo mayor de 85 años y las mujeres son los mayoritarios en la sobredemanda. El 83,04% de las consultas urgentes fueron citadas mediante el sistema XIDE. El motivo de consulta más frecuente fue el de sospecha de COVID (24,64%), con una concordancia del 51,4% en este grupo y del 65,5% de forma global. Apreciamos un elevado sobretriaje en los tiempos de atención asignados, incluso cuando coincide el motivo de consulta, con una pobre concordancia estadística con los observadores. Destaca la elevada proporción en la sobredemanda de pacientes pertenecientes a otros cupos del centro de salud, por lo que una adecuada gestión de los recursos humanos con una cobertura adecuada de las ausencias lograría reducirla en un 48,5%, mientras que el sistema XIDE (en el supuesto ideal de una concordancia absoluta) solo lograría reducirla en un 43%. Conclusiones La escasa fiabilidad del XIDE se debe fundamentalmente al triaje inadecuado, más que al fracaso en el objetivo de disminuir la sobredemanda, por lo que no puede sustituir a un sistema de triaje realizado por personal sanitario (AU)

Objective To assess the impact and suitability of the XIDE citation system in the management of over-demand for care at the Monforte de Lemos Health Center (Lugo, Spain). Material and methods Descriptive, cross-sectional, observational and analytical study. The study population was the patients with appointments to the elderly in the ordinary agenda as «forced» or «urgent forced». The population sample was obtained during the period from July 15 to August 15, 2022. The comparative analysis was performed with periods prior to the implementation of XIDE and the XIDE/observer concordance was estimated by calculating Cohen's kappa index. Results We observed an increase in care pressure, both in the number of consultations/day and in the proportion of forced consultations, which have increased by 30-34%. The group over 85 years of age and women are the majority in excess demand. The 83.04% of urgent consultations were cited through the XIDE system, the most frequent reason for consultation being «suspected COVID» (24.64%), with a concordance of 51.4% in this group and 65.5% globally. We appreciate a high overtriage in the assigned attention times, even when the reason for consultation coincides, with a poor statistical concordance with the observers. The high proportion in the overdemand of patients belonging to other places in the health center stands out, so that adequate management of human resources with adequate coverage of absences would reduce it by 48.5%, while the XIDE system (in the ideal assumption of absolute concordance) would only manage to reduce it by 43%. Conclusions The low reliability of the XIDE is mainly due to inadequate triage, rather than the failure to reduce overdemand, so it cannot replace a triage system performed by health personnel (AU)

Revealing immune infiltrate characteristics and potential immune-related genes in hepatic fibrosis: based on bioinformatics, transcriptomics and q-PCR experiments.

Background: The occurrence and progression of hepatic fibrosis (HF) is accompanied by inflammatory damage. Immune genes play a pivotal role in fibrogenesis and inflammatory damage in HF by regulating immune cell infiltration. However, the immune mechanisms of HF are inadequately studied. Therefore, this research aims to identify the immune genes and biological pathway which involved in fibrosis formation and inflammatory damage in HF and explore immune target-based therapeutics for HF. Methods: The expression dataset GSE84044 of HF was downloaded from the GEO database. The crucial module genes for HF were screened according to weighted gene co-expression network analysis (WGCNA). The crucial module genes were mapped to immune-related genes obtained from the ImmPort database to obtain the hepatic fibrosis immune genes (HFIGs). In addition, Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses were performed on HFIGs. Then, the protein-protein interaction (PPI) network was conducted on HFIGs and hub genes were identified from the PPI network. Moreover, immune infiltration analysis was performed to identified correlation between hub gene and immune cell infiltration. To verify the reliability of the GSE84044 expression profile data analysis, a rat model of CCl4-induced HF was established, followed by transcriptome sequencing and immunofluorescence analysis and quantitative reverse transcription (q-PCR) experiments were performed in HF rats and normal rat liver tissues. Finally, CMAP platform was used to explore immune target-based therapeutics for HF. Results: In the bioinformatics analysis of GSE84044 data, 98 HFIGs were screened. These genes were mainly involved in inflammation-related biological pathways such as NOD-like receptor signaling pathway, NF-kappa B signaling pathway, Toll-like receptor signaling pathway and PI3K-Akt signaling pathway. From the PPI network, 10 hub genes were identified, including CXCL8, IL18, CXCL10, CD8A, IL7, PTPRC, CCL5, IL7R, CXCL9 and CCL2. Immune infiltration analysis showed that immune cells like neutrophils, natural killer (NK) cells, macrophages M1 and macrophages M2 were significantly correlated with the hepatic fibrosis process and hub gene expression was significantly correlated with these immune cells. Notably, most of the biological pathways HFIGs riched and all the hub gene expression except CXCL8 were validated in subsequent transcriptome and qRCR experiments. Finally, 15 small molecule compounds with the potential to reverse the high expression of hub genes were screen out as potential therapeutic agents for HF. Conclusion: The immune genes CXCL8, IL18, CXCL10, CD8A, IL7, PTPRC, CCL5, IL7R, CXCL9 and CCL2 may play an essential role in the fibrosis formation and inflammatory damage in HF. The outcomes of this research provide a basis for the study of the immune mechanisms of HF and contribute to the diagnosis and prevention and treatment of HF in clinical practice.

[A gait signal acquisition and parameter characterization method based on foot pressure detection combined with Azure Kinect system].

The gait acquisition system can be used for gait analysis. The traditional wearable gait acquisition system will lead to large errors in gait parameters due to different wearing positions of sensors. The gait acquisition system based on marker method is expensive and needs to be used by combining with the force measurement system under the guidance of rehabilitation doctors. Due to the complex operation, it is inconvenient for clinical application. In this paper, a gait signal acquisition system that combines foot pressure detection and Azure Kinect system is designed. Fifteen subjects are organized to participate in gait test, and relevant data are collected. The calculation method of gait spatiotemporal parameters and joint angle parameters is proposed, and the consistency analysis and error analysis of the gait parameters of proposed system and camera marking method are carried out. The results show that the parameters obtained by the two systems have good consistency (Pearson correlation coefficient r ≥ 0.9, P < 0.05) and have small error (root mean square error of gait parameters is less than 0.1, root mean square error of joint angle parameters is less than 6). In conclusion, the gait acquisition system and its parameter extraction method proposed in this paper can provide reliable data acquisition results as a theoretical basis for gait feature analysis in clinical medicine.

Measuring provider well-being: initial validation of a brief engagement survey.

BACKGROUND: Measurement is one of the critical ingredients to addressing the well-being of health care professionals. However, administering an organization-wide well-being survey can be challenging due to constraints like survey fatigue, financial limitations, and other system priorities. One way to address these issues is to embed well-being items into already existing assessment tools that are administered on a regular basis, such as an employee engagement survey. The objective of this study was to assess the utility of a brief engagement survey, that included a small subset of well-being items, among health care providers working in an academic medical center. METHODS: In this cross-sectional study, health care providers, including physicians and advanced clinical practitioners, employed at an academic medical center completed a brief, digital engagement survey consisting of 11 quantitative items and 1 qualitative item administered by Dialogue™. The emphasis of this study was on the quantitative responses. Item responses were compared by sex and degree, domains were identified via exploratory factor analysis (EFA), and internal consistency of item responses was assessed via McDonald's omega. Sample burnout was compared against national burnout. RESULTS: Of the 791 respondents, 158 (20.0%) were Advanced Practice Clinicians (APCs), and 633 (80.0%) were Medical Doctors (MDs). The engagement survey, with 11 items, had a high internal consistency with an omega ranging from 0.80-0.93 and was shown, via EFA, to have three domains including communication, well-being, and engagement. Significant differences for some of the 11 items, by sex and degree, in the odds of their agreement responses were found. In this study, 31.5% reported experiencing burnout, which was significantly lower than the national average of 38.2%. CONCLUSION: Our findings indicate initial reliability, validity, and utility of a brief, digital engagement survey among health care professionals. This may be particularly useful for medical groups or health care organizations who are unable to administer their own discrete well-being survey to employees.

[Reliability and validity of the Chinese version of URICA-Voice scale].

Objective:To translate the University of Rhode Island Change Assessment of voice scale（URICA-Voice） into Chinese and test its reliability and validity. Methods:The URICA-Voice scale was converted into Chinese by literal translation, cultural adjustment, expert consultation, pre-investigation, and back translation. Convenience sampling was used to recruit patients at four speech therapy centers from February to May 2022. Then the Chinese version of the scale was distributed to them, and the reliability and validity of the scale were tested after data collection. Cronbach ɑ was used to evaluate the reliability. The critical ratio method and Pearson correlation coefficient were used for item analysis. Item-level content validity, scale-level content validity, and confirmatory factor analysis were used to test the validity of the scale. Results:A total of 247 valid questionnaires were collected. ①Item analysis: the critical ratios between a high-score and low-score groups of 32 items were all statistically significant（P<0.01） and all the critical ratios were above 3.00. The Pearson correlation between 32 items and the total score was significant（P<0.01）. ②Validity analysis: I-CVI=1.00, S-CVI/Ave=1.00, χ²/df=2.30, RMSEA=0.07. Except for item 9 and 23, the standardized factor loading coefficients of other items were all above 0.50. AVE of the four dimensions of the scale was all above 0.50, and the combined reliability of the four dimensions was all above 0.70. The correlation coefficients between dimensions were less than the square root of the AVE of the dimension itself. ③Reliability analysis: the Cronbach ɑ of the whole scale was 0.94, and the Cronbach ɑ of the four dimensions were 0.88, 0.92, 0.94, and 0.88 respectively. Conclusion:The Chinese version of URICA-Voice has good reliability and validity, and can be used as a specific measurement tool for evaluating the compliance of voice training in China.

Evaluation of Preoperative Magnetic Resonance Imaging Parameters with Arthroscopic Validation of Subscapularis Tendon Abnormalities in 187 Patients at a Single Center in Turkey.

BACKGROUND This study from a single center in Turkey aimed to evaluate preoperative magnetic resonance imaging (MRI) parameters with arthroscopic validation of subscapularis (SS) tendon abnormalities in 187 patients. MATERIAL AND METHODS Preoperative MRI scans of 187 patients who had undergone arthroscopic shoulder surgery by the senior author (all in lateral decubitus position) were evaluated by 3 researchers. Patients with arthroscopically proven SS tendon rupture (n=69) and without rupture (n=118) were divided into 2 groups and compared with various distances and angles. The following parameters were measured: coracohumeral distance (CHD), coracoid morphology, coraco-glenoid angle (CGA), coracoid angle (CA), coraco-humeral angle (CHA), coracoid overlap (CO), coracoid body-glenoid angle (CBGA), coracoid tip-glenoid angle (CTGA), coracoid tip-body angle (CTBA), coraco-scapular angle (CSA), lesser tuberosity angle (LTA), and lesser tuberosity height (LTH). RESULTS CHD, CHA, CA, and LTA values decreased in the SS tendon rupture group; coracoid type grade and CO increased (all P<0.001, excluding LTA [P=0.022]). The cut-off values of these measurements were CHD=7.25 mm, CHA=107.25°, CA=111.5°, LTA=31.7°, and CO=16.5 mm. The differences in CGA and CBGA values were not statistically significant (P=0.11, 0.441, respectively). CTGA, CTBA, LTH, and CSA measurements were not included in the intergroup comparisons due to insufficient inter-observer reliability (kappa=0.478, 0.239, 0.496, 0.309, respectively). Power (1- b) in post hoc analysis was calculated as 0.941. CONCLUSIONS SS tendon rupture was associated with a reduction in the parameters of CHD, CHA, CA, and LTA and an increase in CO on MRI.

Transcriptome-wide analysis of RNA m6A methylation regulation of muscle development in Queshan Black pigs.

BACKGROUND: N6-methyladenosine (m6A) refers to the methylation modification of N6 position of RNA adenine, a dynamic reversible RNA epigenetic modification that plays an important regulatory role in a variety of life processes. In this study, we used MeRIP-Seq and RNA-Seq of the longissimus dorsi (LD) muscle of adult (QA) and newborn (QN) Queshan Black pigs to screen key genes with m6A modification involved in muscle growth by bioinformatics analysis. RESULTS: A total of 23,445 and 25,465 m6A peaks were found in the whole genomes of QA and QN, respectively. Among them, 613 methylation peaks were significantly different (DMPs) and 579 genes were defined as differentially methylated genes (DMGs). Compared with the QN group, there were 1,874 significantly differentially expressed genes (DEGs) in QA group, including 620 up-regulated and 1,254 down-regulated genes. In order to investigate the relationship between m6A and mRNA expression in the muscle of Queshan Black pigs at different periods, a combined analysis of MeRIP-Seq and RNA-Seq showed that 88 genes were significantly different at both levels. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes results showed that DEGs and DMGs were mainly involved in skeletal muscle tissue development, FoxO signaling pathway, MAPK signaling pathway, insulin signaling pathway, PI3K-Akt signaling pathway, and Wnt signaling pathway. Four DEGs (IGF1R, CCND2, MYOD1 and FOS) and four DMGs (CCND2, PHKB, BIN1 and FUT2), which are closely related to skeletal muscle development, were selected as candidate genes for verification, and the results were consistent with the sequencing results, which indicated the reliability of the sequencing results. CONCLUSIONS: These results lay the foundation for understanding the specific regulatory mechanisms of growth in Queshan Black pigs, and provide theoretical references for further research on the role of m6A in muscle development and breed optimization selection.

Sex-based differences and relationship with the restricted knee flexion angle due to aging: a comparative study.

BACKGROUND: The relationship between inferior patellar mobility (IPM) and knee flexion angle has yet to be elucidated. This study aimed to develop quantitative IPM measurement methods and clarify the relationship between IPM and knee flexion angle in community-dwelling older females. METHODS: This was a cross-sectional study. Overall, 128 healthy older women (age 65-79 years) were recruited from the community to evaluate the relationship between IPM and knee flexion angle. This study was performed between May 2015 and December 2017. The reference value of and sex differences in IPM were evaluated in 205 healthy young adults aged between 19 and 21 years. IPM was compared between healthy older and young women and was objectively measured using our specially designed patellofemoral arthrometer (PFA). Patellar mobility was calculated by normalization to body height. IPM reliability was assessed before all measurements. RESULTS: Intraclass correlation coefficients for intratester and intertester reliabilities varied from 0.87 to 0.99. The normal range based on two standard deviations of inferior patellar displacement/body height was 5.9-13.5% (young men), 5.1-14.3% (young women), and 1.2-8.8% (older women). IPM was significantly lower in older than young women (P < 0.001). There was a significant positive correlation (r = 0.72 and P < 0.01) between IPM and knee flexion angle in healthy older women unable to flex the knee joint fully. CONCLUSIONS: Our PFA has good intratester and intertester reliability. The results suggest that IPM decreases with aging in women. IPM and knee flexion angle are correlated among older women unable to flex the knee joint fully. CLINICAL TRIAL REGISTRATION: Not applicable.

Continuous usage intention of mobile health services: model construction and validation.

BACKGROUND: Mobile health (mHealth) services can not give full play to their value if only it is used in the short term, and their continuous usage can achieve better effects in health management. This study aims to explore the factors that affect continuous usage intentions of mHealth services and their mechanism of action. METHODS: First, considering the uniqueness of health services and social environmental factors, this study constructed an extended Expectation Confirmation Model of Information System Continuance (ECM-ISC) to investigate factors that may influence the intention of continuous usage of mHealth services based on three dimensions, namely individual characteristics, technology and environment. Second, the survey method was used to validate the research model. The questionnaire items were derived from validated instruments and discussed by experts and data were collected both online and offline. The structural equation model was used for data analysis. RESULTS: There were 334 avidity questionnaires through cross-sectional data and these participants had used mHealth services ever. The reliability and validity of the test model were good, in which Cronbach's Alpha values of 9 variables exceeded 0.9, composite reliability 0.8, the average variance extracted value 0.5, and the factor loading 0.8. The modified model had a good fitting effect and strong explanatory power. It accounted for 89% of the variance in expectation confirmation, 74% of the variance in perceived usefulness, 92% of the variance in customer satisfaction, and 84% of the variance in continuous usage intention. Compared with the initial model hypotheses, perceived system quality was deleted according to the heterotrait-monotrait ratio, so paths related to it were deleted; perceived usefulness wasn't positively associated with customer satisfaction, and its path was also deleted. Other paths were consistent with the initial hypothesis. The two new added paths were that subjective norm was positively associated with perceived service quality (ß = 0.704, P < 0.001), and perceived information quality (ß = 0.606, P < 0.001). Electronic health literacy (E-health literacy) was positively associated with perceived usefulness (ß = 0.379, P < 0.001), perceived service quality (ß = 0.200, P < 0.001), and perceived information quality (ß = 0.320, P < 0.001). Continuous usage intention was influenced by perceived usefulness (ß = 0.191, P < 0.001), customer satisfaction (ß = 0.453, P < 0.001), and subjective norm (ß = 0.372, P < 0.001). CONCLUSIONS: The study constructed a new theoretical model including E-health literacy, subjective norm and technology qualities to clarify continuous usage intention of mHealth services, and empirically validated the model. Attention should be paid to E-health literacy, subjective norm, perceived information quality, and perceived service quality to improve continuous usage intention of users and self-management by mHealth Apps managers and governments. This research provides solid evidence for the validity of the expanded model of ECM-ISC in the mHealth field, which can be a theoretical and practical basis for mHealth operators' product research and development.

Association between early ambulation exercise and short-term postoperative recovery after open transforaminal lumbar interbody fusion: a single center retrospective analysis.

BACKGROUND: Early ambulation in patients undergoing transforaminal lumbar interbody fusion (TLIF) surgery is recommended, however, the precise time interval after open surgery has never been specified. Current retrospective analysis was conducted aiming to clarify an accurate time interval. METHODS: A retrospective analysis of eligible patients was conducted using the databases of the Bone Surgery Department, Third Affiliated Hospital of Sun Yat-sen University from 2016 to 2021. Data pertaining to postoperative hospital stay length, expenses, incidence of complications were extracted and compared using Pearson's χ2 or Student's t-tests. A multivariate linear regression model was conducted to identify the relationship between length of hospital stay (LOS) and other outcomes of interest. A propensity analysis was conducted to minimize bias and to evaluate the reliability of results. RESULTS: A total of 303 patients met the criteria and were included for the data analysis. Multivariate linear regression results demonstrated that a high ASA grade (p = 0.016), increased blood loss (p = 0.003), cardiac disease (p < 0.001), occurrence of postoperative complications(p < 0.001) and longer ambulatory interval (p < 0.001) was significantly associated with an increased LOS. The cut-off analysis manifested that patients should start mobilization within 3 days after open TLIF surgery (B = 2.843, [1.395-4.292], p = 0.0001). Further comparative analysis indicated that patients who start ambulatory exercise within 3 days have shorter LOS (8.52 ± 3.28d vs 12.24 ± 5.88d, p < 0.001), total expenses ( 9398.12 ± 2790.82vs 10701.03 ± 2994.03 [USD], p = 0.002). Propensity analysis revealed such superiority was stable along with lower incidence of postoperative complications (2/61 vs 8/61, p = 0.0048). CONCLUSIONS: The current analysis suggested that ambulatory exercise within 3 days for patients who underwent open TLIF surgery was significantly associated with reduced LOS, total hospital expenses, and postoperative complications. Further causal relationship would be confirmed by future randomized controlled trials.

Analyzing the sensitivity of quantitative 3D MRI of longitudinal relaxation at very low field in Gd-doped phantoms.

PURPOSE: Recently, new MRI systems working at magnetic field below 10 mT (Very and Ultra Low Field regime) have been developed, showing improved T1-contrast in projected 2D maps (i.e. images without slice selection). Moving from projected 2D to 3D maps is not trivial due to the low SNR of such devices. This work aimed to demonstrate the ability and the sensitivity of a VLF-MRI scanner operating at 8.9 mT in quantitatively obtaining 3D longitudinal relaxation rate (R1) maps and distinguishing between voxels intensities. We used phantoms consisting of vessels doped with different Gadolinium (Gd)-based Contrast Agent (CA) concentrations, providing a set of various R1 values. As CA, we used a commercial compound (MultiHance®, gadobenate dimeglumine) routinely used in clinical MRI. METHODS: 3D R1 maps and T1-weighted MR images were analysed to identify each vessel. R1 maps were further processed by an automatic clustering analysis to evaluate the sensitivity at the single-voxel level. Results obtained at 8.9 mT were compared with commercial scanners operating at 0.2 T, 1.5 T, and 3 T. RESULTS: VLF R1 maps offered a higher sensitivity in distinguishing the different CA concentrations and an improved contrast compared to higher fields. Moreover, the high sensitivity of 3D quantitative VLF-MRI allowed an effective clustering of the 3D map values, assessing their reliability at the single voxel level. Conversely, in all fields, T1-weighted images were less reliable, even at higher CA concentrations. CONCLUSION: In summary, with few excitations and an isotropic voxel size of 3 mm, VLF-MRI 3D quantitative mapping showed a sensitivity better than 2.7 s-1 corresponding to a concentration difference of 0.17 mM of MultiHance in copper sulfate doped water, and improved contrast compared to higher fields. Based on these results, future studies should characterize R1 contrast at VLF, also with other CA, in the living tissues.

Low-Cost and Reproductible Method to Obtain Mapping of Lymphatic Drainage in Patient with Early Endometrial Cancer.

Introduction: Endometrial cancer is the most common form of gynecological cancer in developed countries. Current recommended therapeutic management takes into account a number of factors such as: TNM stage, justification for primary surgery, desire to preserve fertility. For primary operable cases, surgical staging has become an extremely important pillar, in which the status of the pelvic lymph nodes needs to be known (1-3). Material and Method: Between August 2015 and June 2021, a multicenter prospective observational study was performed in the "Prof. Dr. I. Chiricuta" Oncological Institute Cluj Napoca, 2nd Department of Surgery of "Pius Brinzeu" County Hospital Timisoara, 1st Department of General Surgery of Arad County Hospital, 2nd Department of Obstetrics and Gynecology "Dominic Stanca" Cluj Napoca and "Dr. Carol Davila" Central Military Emergency University Hospital Bucharest, Romania with the main aim of examining the sentinel lymph node detection rate using methylene blue as a tracer. Surgeries were performed by the team of surgeons of the mentioned clinics, and patients were informed about this study and signed an informed consent form for enrollment. Results: A total of 116 cases met the inclusion criteria for this prospective study. The mean age of the included patients was 62.3 years (minimum - 38, maximum - 83). The mean body mass index was 31.8 (minimum - 19.9, maximum - 48.2). In terms of histological type of the endometrial cancer, the majority of cases were endometrioid cancer, amounting to 72.5% of the total (n=84). A considerable number of cases were of mixed type, either with clear cell carcinoma (8.6%, n=10) or mixed carcinosarcoma (17.2%, n=20). The preferred approach for surgery was laparoscopic surgery rather than traditional surgery (72% vs 28%). Another element investigated from a histological point of view is the tumour grading, the degree of differentiation of cells with anarchic development, we note that 50% (n=58) were G2. Of the 116 cases of endometrial carcinoma included in the study, in 83% of cases (n=96) methylene blue tracer injection was successful and sentinel node was identified. The SLN technique continues to be of great interest and use in surgical centers around the world. The method of detecting sentinel lymph nodes varies depending on the individual. According to literature studies, indocyanine (ICG- Indocyanine green) is the gold standard for lymph node mapping, with superior detection rates when compared to other existing versions. Another key factor to consider when selecting a sentinel node identification method is cost-effectiveness. The use of methyl blue as a marker tracer is the most cost-effective option with equivalent detection rate outcomes. Conclusions: Based on the results of our study and other studies in the literature, lymphatic mapping using methylene blue as a tracer in endometrial cancer is a cost-effective method with a favourable detection rate. With this low-cost procedure we can achieve a correct tumor staging, avoiding overtreatment. There are multiple ways to identify the sentinel node using different tracers with higher accuracy, but the objective of the study was not to make a comparison between different tracers, but to present the feasibility of lymph node mapping using methylene blue as a low cost tracer with good reproducibility, short learning curve and optimal detection rate.

Robo-Lap Approach for Anatomical Resections of Postero-Superior Liver Segments by Indocyanine Green Fluorescence: Intraoperative Navigation Based on Vascular Landmarks.

Cornerstones elements of surgical technique to achieve a good efficacy and safety profile in robotic anatomical resections of postero-superior segments have not yet reached an adequate level of standardization. In this technical note, surgical details to perform anatomical resections of postero-superior segments of the liver (Sg7 and Sg8) based on the identification of vascular landmarks and assisted by use of negative staining with indocyanine green (ICG) fluorescence will be described. In Sg7 segmentectomy, dorsal approach to portobiliary pedicle is suggested, followed by root to periphery approach to right hepatic vein along the negative staining demarcation line by indocyanine green. In Sg8 segmentectomy, root to periphery approach to middle hepatic vein allows comfortable indentification of Sg8 portobiliary pedicle. Approach to right hepatic vein is made easier by negative staining demarcation line. Robo-Lap approach allows to perform these procedures with an adequate level of safety and reproducibility.

Evaluation of quality of life in posttreatment upper aerodigestive tract cancer patients.

Background: Cancers of the upper aerodigestive tract constitute approximately 4% of all malignancies. Posttreatment cancer patient faces serious adversities that affect the quality of life. Out of the various scales available to measure the quality of life, we chose the quality of life-oral cancer (QOL-OC), which was developed and evaluated by Nie et al. in 2018. Aims and Objectives: The aim of our study was to assess the quality of life in posttreatment upper aerodigestive tract cancer patients in a tertiary care center and also to check the reliability and validity of the questionnaire QOL-OC. Methodology: We communicated with 89 patients who were pathologically tested positive for upper aero digestive tract cancer from January 2019 to December 2019. Results: The most prevalent adversity was found to be altered salivary flow, followed by diet and difficulty while eating. The QOL-OC was found to be a highly valid and reliable questionnaire. Conclusion: The study points out regarding the prevalence of various adversities in post treatment cancer patients, a discussion has also been made suggesting the importance of multidisciplinary approach that should be provided in such patients. Finally, the study also concludes regarding the generalizability of the questionnaire QOL-OC.

Slowest first passage times, redundancy, and menopause timing.

Biological events are often initiated when a random "searcher" finds a "target," which is called a first passage time (FPT). In some biological systems involving multiple searchers, an important timescale is the time it takes the slowest searcher(s) to find a target. For example, of the hundreds of thousands of primordial follicles in a woman's ovarian reserve, it is the slowest to leave that trigger the onset of menopause. Such slowest FPTs may also contribute to the reliability of cell signaling pathways and influence the ability of a cell to locate an external stimulus. In this paper, we use extreme value theory and asymptotic analysis to obtain rigorous approximations to the full probability distribution and moments of slowest FPTs. Though the results are proven in the limit of many searchers, numerical simulations reveal that the approximations are accurate for any number of searchers in typical scenarios of interest. We apply these general mathematical results to models of ovarian aging and menopause timing, which reveals the role of slowest FPTs for understanding redundancy in biological systems. We also apply the theory to several popular models of stochastic search, including search by diffusive, subdiffusive, and mortal searchers.