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Clinical Grade of Obstetric Anal Sphincter Injuries and Prediction of Mode of Birth Recommendations: A 20-Year Retrospective Analysis
Get PDFData Availability Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.Objective:
To determine whether assessment of symptoms and clinical grade of obstetric anal sphincter injuries (OASIs) is predictive of subsequent endoanal ultrasound (EAUS) and anal manometry (AM) findings to guide mode of birth recommendations.
Design:
Twenty-year retrospective analysis.
Setting:
Tertiary urogynaecology unit.
Population or Sample:
Women (n = 607) with a history of OASI in the second half of a subsequent pregnancy, 2002–2022.
Methods:
A St Mark's Incontinence Score (SMIS), AM and EAUS were completed. An elective caesarean section (ELCS) was recommended if there was an external anal sphincter (EAS) defect and an incremental maximum squeeze pressure (IMSP) < 20 mmHg.
Main Outcome Measures:
Accuracy, sensitivity, specificity, negative and positive predictive values (NPV and PPV) with 95% CI were calculated for the assessment of anorectal symptoms and clinical grade of tear relative to EAUS and AM findings.
Results:
Accuracy of symptom assessment and clinical grade of tear in determining those with an EAS defect and IMSP < 20 was 75.4% (95% CI 69.3%), 69.6% (95% CI 63.8%–75.0%), 62.7% (95% CI 50.0–74.2) and 43.6% (95% CI 27.8%–60.4%) with 3a, 3b, 3c and fourth degree tears, respectively. 3a tears had the highest NPV for EAS defect and IMSP < 20 (100.0% [95% CI 97.9–100.0]), EAS defect alone (97.1% [95% CI 94.7%–98.4%]) and IMSP < 20 alone (93.5% [95% CI 90.1–82.1]).
Conclusions:
Symptom assessment and clinical grade of OASI cannot be used solely to guide mode of delivery recommendations in a subsequent birth. Absence of symptoms in women with 3a tears has a high NPV, meaning these women can be recommended a vaginal birth.The authors received no specific funding for this work
The Impact of Functional Movement Variability and Movement Creativity on Sport Climbing Performance
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The data that support the findings of this study are available from the corresponding author upon reasonable request.Expertise in sports is underpinned by the ability to adapt to changing individual, task and environmental constraints. The ecological dynamics approach positions movement variability as having functional properties thus enabling adaptation. Additionally, it holds that movement creativity emerges from movement variability in the process of exploration. To test these conjectures, we determined the relationships between movement variability, movement creativity and performance. Twenty-one male climbers, ranging from experienced to high elite level participated. Functional movement variability and climbing performance were assessed in two different tests. The primary goal of the functional movement variability test was to perform a boulder problem in as many different ways as possible, whereas in the performance test, participants had six attempts to progress as far as possible. 2D hip position data (derived from video recordings using Kinovea) were collected to determine the number of distinct successful trajectories performed (movement variability), the degree of originality of each successful trajectory (movement creativity) and the trajectory length of the best attempt in the performance test (performance). Results revealed that both the ability to exhibit functional movement variability (p = 0.005) and the exploration of movement creativity (p = 0.002) were strongly associated with performance. Movement creativity contributed to performance in addition to movement variability (p = 0.024). We propose that variability is more than just the number of different movements; it should also be understood in how distinctly different these movements are, since they may reflect different patterns of exploration and determine the range of novel adaptations within an individual's capacity to be discovered.The project was supported by the Sportinnovator/ZonMw grant, project number 5380010208 awarded to Dominic Orth
Promoting Sustainable Physical Activity Behaviour Change among Older Adults: An Intervention Study
No full text......This research was supported by the China Scholarship Council (CSC) and Loughborough University
Facilitating Access and Adherence to Physical Activity and Exercise for Service Users With Neurological Conditions in the Community: A Service Evaluation
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The data that support the findings of this study are available from the corresponding author upon reasonable request.Rationale:
Many service users with neurological conditions do not meet the recommended physical activity requirements. Cultivating early and ongoing access to physical activity and exercise opportunities is vital to improve or maintain function and general health in this vulnerable group.
Aim:
To evaluate the impact of a pathway that aimed to facilitate access and adherence to physical activity and exercise for service users with neurological conditions.
Methods:
A London‐based NHS healthcare team providing community neurorehabilitation developed a pathway in co‐production with public health, local authority, third sector parties and service users to facilitate physical activity and exercise opportunities. First, NHS neurophysiotherapists offered a bespoke programme on exercise, physical activity and education to service users for up to 12 weeks. The pathway continued in local gyms, supported by a fitness instructor, for at least a further 12 weeks. Using a pre–post design, outcomes relating to function, strength and physical activity were recorded at baseline, 6–12 weeks (health care) and 6 weeks later (telephone survey after transition to local gyms). Data analysis was descriptive.
Results:
Thirty‐five service users (20 men), mean (SD) age 60 (15), with a range of neurological conditions, were eligible and included. Ten participants dropped out: eight (23%) for medical reasons, two (6%) for other reasons. Due to the COVID‐19 pandemic, four (11%) service users could not transition when facilities closed in March 2020. Analysis showed potential beneficial effects on function, strength and physical activity for service users as well as reduced waiting times to access the NHS and local gyms.
Conclusion:
Outcomes suggested the pathway enabled service users to access and adhere to physical activity and exercise following neurorehabilitation. This evaluation included small numbers but could inform service development and future studies.NOCLOR, research institute in London
Reviewing Breakthroughs and Limitations of Implantable and External Medical Device Treatments for Spinal Cord Injury
Get PDFSpinal cord injury (SCI) is a major disability that, to this day, does not have a permanent cure. The spinal cord extends caudally through the body structure of the vertebral column and is part of the central nervous system (CNS). The spinal cord enables neural communication and motor coordination, so injuries can disrupt sensation, movement, and autonomic functions. Mechanical and traumatic damage to the spinal cord causes lesions to the nerves, resulting in the disruption of relayed messages to the extremities. Various forms of treatment for the spinal cord include functional electrical stimulation (FES), epidural electrical stimulation (EES), ‘SMART’ devices, exoskeleton and robotic systems, transcranial magnetic stimulation, and neuroprostheses using AI for the brain–computer interface. This research is going to analyse and review these current treatment methods for spinal cord injury and identify the current gaps and limitations in these, such as long-term biocompatibility, wireless adaptability, cost, regulatory barriers, and risk of surgery. Future advancements should work on implementing wireless data logging with AI algorithms to increase SCI device adaptability, as well as maintaining regulatory and health system integration.This research received no external funding
Physical activity interventions in adult kidney transplant recipients: an updated systematic review and meta-analysis of randomized controlled trials
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Data collection forms, data extracted from included studies, and data used for all analyses can be requested from the corresponding author.For the purpose of open access, the author has applied a Creative Commons Attribution license (CC BY) to any Author Accepted Manuscript version arising from this submission.Supplemental material is available online at: https://ndownloader.figstatic.com/files/53275697 .Background:
Kidney transplant recipients (KTRs) exhibit a high prevalence of cardiovascular disease (CVD) and adverse changes in physical fitness and body composition. Post-transplant management recommends being physically active and evidence in this field is growing. The aim of this review was to update our previous systematic review and meta-analysis of randomized controlled trials (RCTs) assessing the effects of physical activity and exercise training interventions in KTRs.
Methods:
A comprehensive literature search between March 2021 and September 2024 identified seven additional RCTs. Therefore, this updated review and meta-analysis includes 23 RCTs. Outcomes included cardiorespiratory fitness (CRF), strength, blood pressure, body composition, heart rate, markers of dyslipidemia and kidney function, and health-related quality of life.
Results:
Twenty-three RCTs, including 1,139 KTRs, were included. The median intervention length was 12 weeks with participants exercising between 2 and 7×/week. Most studies used a mixture of aerobic and resistance training but reporting and intervention content was highly varied. Significant improvements were observed in CRF (V̇O2peak; +3.87 mL/kg/min, p = .0004), physical function (sit-to-stand-60; +7.72 repetitions, p = .0001), and high-density lipoprotein (HDL; +0.13 mmol/L, p = .02). Isolated studies reported improvements in strength, bone health, lean mass, and quality of life (QoL). All studies were found to have a high or moderate risk of bias.
Conclusions:
Exercise training or increasing physical activity may confer several benefits in adult KTRs, especially through the improvements in CRF and HDL which have been linked to CVD risk. Despite new literature, there is still a need for long-term larger sampled RCTs and more detailed reporting of intervention details and program adherence.No specific funding was granted for the production of this work. CJL, MGB, and REB are funded by the Stoneygate Trust and supported by the National Institute for Health Research Leicester Biomedical Research Center (BRC). TJW is funded by National Institute for Health Research Leicester Biomedical Research Center (BRC). NCB is supported by the National Institute for Health Research Leicester Biomedical Research Center (BRC)
Towards reducing teacher burden in Performance-Based assessments using aivaluate: an emotionally intelligent LLM-Augmented pedagogical AI conversational agent
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The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.Background:
Performance-based assessments (PBAs), such as viva voce exams and oral presentations, offer comprehensive evaluations of student knowledge and skills but place substantial burdens on teachers. The integration of emotionally intelligent, LLM-augmented AI conversational agents presents a potential solution to alleviate teacher burden while maintaining the integrity and effectiveness of PBAs. This study investigates the use of AIvaluate, a pedagogical AI conversational agent designed to support teachers during oral PBAs by offering emotionally intelligent insights and streamlining the assessment process. A counterbalanced mixed-methods study design was employed with 35 teachers and students participating in both traditional face-to-face and AIvaluate-supported assessments. Data was collected through teacher-assigned grades, System Usability Scale (SUS) questionnaires, and qualitative open-response surveys. Quantitative and qualitative analyses were conducted to compare grading outcomes, system usability, and teacher preferences between the two assessment formats. Teachers issued significantly higher grades to students in AIvaluate-supported assessments (p = 0.033), attributed to more structured, consistent questioning and emotional state reporting. The overall SUS score for AIvaluate indicated “acceptable” usability, surpassing the face-to-face format. Thematic analysis revealed key strengths of AIvaluate, including automated question prompts, real-time emotional insights, and the convenience of remote operation. However, teachers noted limitations, such as occasional technical issues and the lack of a personal connection compared to traditional face-to-face interactions. AIvaluate demonstrates the potential to reduce teacher burden in PBAs while maintaining usability and assessment quality. Its emotionally intelligent features and automated functionalities enhance the assessment process, offering a scalable, technology-driven solution for modern education. While AIvaluate shows promise in reducing teacher burden during PBAs, technical limitations, emotional disconnection, and variability in assessment impact emphasise the need for further investigation before large-scale adoption. Future research should explore building further functionality to address the diverse needs of teachers, while focusing on addressing technical limitations and assessing long-term impacts on teacher satisfaction and student outcomes.No funding was obtained for this study
Small Nations, Big Impact: The Significance of Sri Lanka's Strategic Position in Indian Ocean Trade and Geopolitics
Get PDFKnown as the ‘pearl of the Indian Ocean’, Sri Lanka boasts a rich history dating back over 2,500 years. This South Asian nation holds a crucial position along international sea routes, affording it a distinct advantage in global trade. However, since ancient times, this very factor has affected Sri Lankan industries and society both positively and negatively. The aim is to contribute to a deeper understanding of the Island's trading activities and involvement in international trade, geopolitics, and the socioeconomic implications of Sri Lanka’s location in the Indian Ocean. We have conducted a historical analysis spanning from ancient times until the end of the colonial period, using archaeological evidence, information from ancient texts, and other published literature. By identifying historical trends, we have provided valuable insights and guidance for decision-makers on how to leverage Sri Lanka's strategic location and capitalise on its resources for future socioeconomic development
SegRap2023: A benchmark of organs-at-risk and gross tumor volume Segmentation for Radiotherapy Planning of Nasopharyngeal Carcinoma
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Data will be made available on request.The article archived on this institutional repository is a pre-print available on arXiv, arXiv:2312.09576v1 [eess.IV] (https://arxiv.org/abs/2312.09576). It has not been certified by peer review. You are advised to consult the final, peer reviewed version at: https://doi.org/10.1016/j.media.2024.103447 .Comments: A challenge report of SegRap2023 (organized in conjunction with MICCAI2023) [noted on arXiv]..Radiation therapy is a primary and effective treatment strategy for NasoPharyngeal Carcinoma (NPC). The precise delineation of Gross Tumor Volumes (GTVs) and Organs-At-Risk (OARs) is crucial in radiation treatment, directly impacting patient prognosis. Despite that deep learning has achieved remarkable performance on various medical image segmentation tasks, its performance on OARs and GTVs of NPC is still limited, and high-quality benchmark datasets on this task are highly desirable for model development and evaluation. To alleviate this problem, the SegRap2023 challenge was organized in conjunction with MICCAI2023 and presented a large-scale benchmark for OAR and GTV segmentation with 400 Computed Tomography (CT) scans from 200 NPC patients, each with a pair of pre-aligned non-contrast and contrast-enhanced CT scans. The challenge aimed to segment 45 OARs and 2 GTVs from the paired CT scans per patient, and received 10 and 11 complete submissions for the two tasks, respectively. In this paper, we detail the challenge and analyze the solutions of all participants. The average Dice similarity coefficient scores for all submissions ranged from 76.68% to 86.70%, and 70.42% to 73.44% for OARs and GTVs, respectively. We conclude that the segmentation of relatively large OARs is well-addressed, and more efforts are needed for GTVs and small or thin OARs. The benchmark remains available at: https://segrap2023.grand-challenge.org.This work was supported by the National Natural Science Foundation of China [Grant 62271115, Grant 82203197], the Sichuan Science and Technology Program, China (Grant 2022YFSY0055, 2023NSFSC1852), the Sichuan Provincial Cadre Health Research Project (Grant/award number: 2023-803) and the Radiation Oncology Key Laboratory of Sichuan Province Open Fund (2022ROKF04)
Advances in Drug Delivery Integrated with Regenerative Medicine: Innovations, Challenges, and Future Frontiers
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Not applicable.Advances in drug delivery systems adapted with regenerative medicine have transformed healthcare by introducing innovative strategies to treat (and repair in many instances) disease-impacted regions of the human body. This review provides a comprehensive analysis of the latest developments and challenges in integrating drug delivery technologies with regenerative medicine. Recent advances in drug delivery technologies, including the design of biomaterials, localized delivery techniques, and controlled release systems guided by mathematical models, are explored to illustrate their role in enhancing therapeutic precision and efficacy. Additionally, regenerative medicine approaches are analyzed, with a focus on extracellular matrix components, stem cell-based therapies, and emerging strategies for organ regeneration in both soft and hard tissue and in vitro model engineering. In particular, the review also discusses the applications of cellular components, including stem cells, immune cells, endothelial cells, and specialized cells such as chondrocytes and osteoblasts, and highlights advancements in cell delivery methods and cell–cell interaction modulation. In addition, future directions and pivotal trends emphasizing the importance of interdisciplinary collaboration and cutting-edge innovations are provided to address successful therapeutic outcomes in regenerative medicine.This study received no external funding
Data sources:
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