Explore the vast range of titles available.

Background Over 50% of adults with visual impairment experience severe fatigue. Therefore, we developed a guided E-health intervention based on cognitive behavioral therapy and self-management to reduce fatigue in this population. This pilot study evaluated the usability, feasibility, fidelity and potential effectiveness of E-nergEYEze. Methods E-nergEYEze was developed by a design team and customized by conducting a pilot study using an iterative development strategy. The intervention was first tested in a usability study among adults with visual impairment (n = 5). Participants were asked to think-aloud while exploring the intervention features and a semi-structured interview was performed afterwards. Subsequently, the enhanced intervention was tested in a feasibility study. Adults with visual impairment and severe fatigue (n = 10) followed the intervention partially with guidance from a social worker and one-time computer trainer support. Fatigue severity (Checklist Individual Strength), fatigue impact (Modified Fatigue Impact Scale) and cognitive behavioral therapy skills (Competencies of Cognitive Therapy Scale-Self Report) were measured at baseline and at three months follow-up and analyzed with the Wilcoxon signed-rank test. The intervention was evaluated through evaluation forms. Results The usability study resulted in adjustments to content and lay-out with regard to optically shortened text sentences, separate pages for information and assignments with one read-aloud audio and an additional descriptive explanation of page content. Digital challenges were overcome with mandatory computer training and e-platform modifications. The feasibility study showed a positive trend in reducing fatigue severity (Z -6.108; P < .001; SD 8.4), impact of fatigue (Z − 4.451; P < .001; SD 11.4) and cognitive behavioral therapy skills (Z -2.278; P = .023; SD 19.3). Participants gave useful feedback regarding accessibility, content and guidance, with an overall positive experience. The intervention was rated with a median score of 8 (range 7–10). Conclusion We developed, evaluated and optimized E-nergEYEze by applying a user-centered and iterative approach. E-nergEYEze showed a promising trend to reduce fatigue severity and impact of fatigue and to increase cognitive behavioral therapy skills. The study methods were feasible and the fidelity of the intervention protocol was suitable. Performing a randomized controlled trial is warranted to give insight into whether E-nergEYEze is cost-effective in reducing severe fatigue in adults with visual impairment. Trial registration International Clinical Trial Registry Platform: NL7764. Date registered: 28-05-2019.

Background:Non-pharmacological treatment, such as exercise therapy, is crucial in the treatment of axial spondyloarthritis (axSpA). Physical activity helps maintain axial flexibility and has been shown to improve physical function, pain, fatigue, and quality of life. However, practical, financial and disease-related barriers lower the motivation to exercise, leading to long-term adherence rates of 30% or less. The use of immersive Virtual Reality (VR) as an innovative solution to guide and support exercise therapy for axSpA could lower barriers and boost the motivation to exercise.Objectives:This study aims to (1) examine the feasibility of implementing a study protocol that uses VR to support exercise therapy in patients with axSpA, and to (2) determine the feasibility, acceptability and demand of using VR guided exercise therapy at home or in a physiotherapy practice setting.Methods:A convergent, mixed methods study design was used and included patients with axSpA and healthcare professionals (HCPs). All participants performed supervised VR guided exercises in a laboratory setting, using a recently developed VR guided exercise program Walk in Nature, to improve mental and physical vitality. That included the modules Breathing Tree Exercise, Butterfly Task and Yoga Exercise. Feasibility and acceptability of the VR guided exercise therapy was assessed with a pre and post VR pain VAS score, and a post VR Virtual Reality Sickness Questionnaire (VRSQ), perceived appropriateness (UEQ-s), and satisfaction (IPQ) questionnaire. Perceived demand for VR guided exercise therapy and intention to use VR was assessed in a semi-structured interview with 32 open- and closed-ended questions based on the UTAUT model.Results:In total, 17 participants (8 patients and 9 HCPs: 3 physiotherapists experienced in treating axSpA, 3 physiotherapists experienced in VR guided treatment, and 3 rheumatologists) were included. Patients were mean 47 (±17) years and 50% male, HCPs mean 30 (±3) years and 44% male. Although some participants experienced slight symptoms of cybersickness, VR acceptability was good as both groups had a positive user experience (mean patient UEQ-s 1.57 ± 0.7, mean HCP UEQ-s 1.75 ± 0.55) and a high level of presence in the virtual environment (mean patient IPQ 5.5 (±0.8) and mean HCP IPQ 5.72 ±0.86). In the patients, VAS pain mostly remained unchanged, mean 3.6 (±2.4) before and 3.8 (±3.2) after VR. Secondly, overall perceived demand for this pilot version of VR guided exercise therapy was low, due to difficulty in use and lack of feedback to the patient. However, healthcare professionals saw greater potential in VR guided exercise therapy than patients. Patients preferred to use VR in a physiotherapy setting while healthcare professionals preferred implementation at home.Conclusion:VR guided exercise therapy has potential for patients with axial spondyloarthritis as users have positive user experiences with high levels of presence. Perceived demand may be increased by improving ease of use and by implementing patient feedback in a physiotherapy setting. Efficacy will subsequently be investigated in a future randomized controlled trial.REFERENCES:[1] Brepohl PCA, Leite H. Virtual reality applied to physiotherapy: a review of current knowledge. Virtual Reality 2022 27:1 [Internet]. 2022 Jul 22 [cited 2023 Nov 13];27(1):71–95.Figure 1.Still of the yoga exercise with a virtual yoga coach in VR Walk in NatureTable 1.Acceptability outcomes patients N=8NAge(yrs)SexBASDAIPrior VRTechnical skillsVRSQ generalVAS beforeVAS afterIPQUEQ-s HomeUEQ-s Physio177M2,1NoYesSlightly225,811,750,88264M6,1YesYesNone5,565,772,382,50338M1,2YesYesNone213,632,000,50432M4,2NoYesNone445,712,001,50553F8,1NoYesNone8106,441,133,00642F4,2NoYesSlightly335,130,131,50734F6NoYesNone445,771,751,88832F1,1YesYesNone005,730,381,00Mean(SD)47(17)4,2(2,5)3,6(2,4)3,8(3,2)5,50(0,83)1,57(0.70)1,60(0,84)VRSQ= Motion sickness questionnaire, VAS= Visual Analogue Score pain, IPQ= IGroup Presence questionnaire, UEQ-s= User Experience Questionnaire short formAcknowledgements:NIL.Disclosure of Interests:Myrthe Franke: None declared, Marieke Weenink: None declared, Mirjam Hegeman: None declared, Demy Gerritsen: None declared, Christina Bode: None declared, Harald E. Vonkeman AbbVie, Novartis, Pfizer, UCB, Johnson and Johnson, Galapagos, Boehringer Ingelheim.

Background The airways of the mammalian lung form a tree-like structure, starting from the trachea and branching out to the terminal bronchioles. This tree is composed of heterogeneous sub-structures or compartments, varying in morphological characteristics such as composition of airway epithelium, presence of cartilage plates, and number of smooth muscle cell layers or lumen diameter. These compartments may vary in their reaction to different pathological stimuli. Thus, when studying a particular lung disease, the compartments need to be investigated individually and not as part of a more global portmanteau compartment. In the symmetrically branching primate lungs, dividing the airway tree into generations is a common method to create morphologically homogeneous groups of airway segments. In common lab animals however, an asymmetrical branching pattern is present, where conventional branching-based grouping methods are unable to create meaningful results. Methods Therefore, a morphological clustering approach was tested in the current proof of principle study for its suitability of dividing airways into biologically meaningful sub-compartments. On this basis, an investigation of the distribution of pulmonary airway changes in a bronchopulmonary dysplasia rabbit model was conducted. Results The approach of clustering airway segments by morphology instead of branching pattern proved to be capable of creating meaningful airway compartments. This way, the distribution of differences that would not have been visible in a purely global comparison of morphological characteristics, could be identified between disease model and control group. Conclusions The employed clustering model is applicable to study the contribution of airway sub-compartments in pulmonary diseases. On this basis, targeted strategies for their mitigation may be developed.

Circularly polarized light (CPL) emitted from star-forming regions is an attractive candidate as a cause of single chirality in nature. It has remained difficult, however, to translate the relatively small chemical effects observed on irradiation of molecular systems with CPL into high enantiomeric excesses. Here we demonstrate that irradiation of a racemic amino acid derivative with CPL leads to a small amount of chiral induction that can be amplified readily to give an enantiopure solid phase. A racemate composed of equal amounts of left- and right-handed crystals in contact with the irradiated solution is converted completely into crystals of single-handedness through abrasive grinding when racemization is effected in the solution. The rotation sense of the CPL fully determines the handedness of the final solid state. These findings illustrate the potential effectiveness of CPL in the control of molecular asymmetry, which is relevant for the origin of the single chirality inherent to many biological molecules. Complete chiral symmetry breaking of an amino acid derivative is achieved by circularly polarized light irradiation of a solution of the racemate in contact with racemic crystals, followed by abrasive grinding. The chirality of the amino acid derivative in the resultant crystals is fully determined by the rotation sense of the irradiation.

Background Diabetic foot ulcers have a high impact on mobility and daily functioning and lead to high treatment costs, for example, by hospitalization and amputation. To prevent (re)ulcerations, custom-made orthopedic shoes are considered essential. However, adherence to wearing the orthopedic shoes is low, and improving adherence was not successful in the past. We propose a novel care approach that combines motivational interviewing (MI) with a digital shoe-fitting procedure to improve adherence to orthopedic shoes. The aim of this trial is to assess the (cost-)effectiveness of this novel care approach compared to usual care (no MI and casting-based shoe-fitting) in promoting footwear adherence and ulcer prevention. Methods The trial will include people with diabetes, with IWGDF Risk categories 1–3, who have been prescribed orthopedic shoes. Participants will be randomized at the level of the podiatrist to the novel care approach or usual care. The primary outcome is the proportion of participants who adhere to the use of their orthopedic shoes, that is, who take at least 80% of their total daily steps with orthopedic shoes. A temperature microsensor will be built into the participants’ orthopedic shoes to measure wearing time continuously over 12 months. In addition, daily activity will be measured periodically using log data with an activity monitor. Data from the temperature microsensor and activity monitor will be combined to calculate adherence. (Re-)experienced complications after receiving orthopedic shoes will be registered. Questionnaires and interviews will measure the experiences of participants regarding orthopedic shoes, experiences of podiatrists regarding motivational interviewing, care consumption, and quality of life. Differences in costs and quality of life will be determined in a cost-effectiveness analysis. Discussion This trial will generate novel insights into the socio-economic and well-being impact and the clinical effectiveness of the novel care approach on adherence to wearing orthopedic shoes. Trial registration Netherlands Trial Register NL7710 . Registered on 6 May 2019

Glycoprotein IIb/IIIa inhibitors are used routinely in patients with acute coronary syndromes who are undergoing invasive procedures, but the optimal timing of administration is unknown. The early, routine use of eptifibatide was found to be no better than the delayed, provisional use of the drug and was associated with more bleeding. The early, routine use of eptifibatide was found to be no better than the delayed, provisional use of the drug and was associated with more bleeding. The optimal timing for the initiation of treatment with glycoprotein IIb/IIIa inhibitors in patients who have acute coronary syndromes without ST-segment elevation and are undergoing invasive procedures has not been determined. It is also not clear whether such treatment should be administered routinely to all such patients before the procedure or whether such treatment should be provisional. The 2007 guidelines of the American College of Cardiology and the American Heart Association 1 recommend that patients with high-risk features receive aspirin and either clopidogrel or a glycoprotein IIb/IIIa inhibitor before angiography (i.e., early therapy) (class I recommendation). The European Society of Cardiology . . .

Background:Despite advances in pharmacologic treatment, approximately 20% of individuals with rheumatoid arthritis (RA) suffer from persistent pain, despite disease remission and the absence of damage and despite chronic use of painkillers, including opioids. Effective alternatives such as pain education and cognitive behavior therapy are time consuming and require professional supervision. Innovative treatments are needed that allow self-administration and on-demand treatment. The Virtual Reality (VR) training program Reducept incorporates pain education, relaxation and mindfulness, acceptance and commitment therapy with gaming elements aimed at gaining control over chronic pain.Objectives:This study aims to (1) examine the feasibility of implementing a study protocol that uses VR Reducept for the treatment of persistent pain, and (2) to determine the acceptability of using VR for pain management in an outpatient RA-population.Methods:A convergent, mixed methods design was used. First, 6 healthy volunteers were enrolled to examine the feasibility and possible side effects of a single hospital-based VR session. This was repeated in a group of 21 RA-patients (16 female, 5 male) with chronic pain despite stable low disease activity. The Oculus Go VR-headset was used in combination with Reducept (Figure 1). Pain intensity (NRS) was assessed before and after each VR application. Side-effects were assessed with the Virtual Reality Sickness Questionnaire (VRSQ). User experience was assessed using a combination of scale-based items and semi-close-ended/open-ended questions. Patients’ perspective on the VR working mechanisms was explored with in-depth interviews after VR use. Secondly, a 8 week longitudinal study was conducted in 7 RA-patients to examine the feasibility of implementing a study protocol for 3x weekly VR Reducept self-administration at home. Outcome variables were usability, satisfaction with use, effects on pain intensity (NRS), arthritis self-efficacy scale (ASES), quality of life (SF-36) and side effects (VRSQ).Results:VR Reducept had good usability and tolerability. In single use, the most prevalent side-effects were general discomfort, fatigue and eyestrain. However, in most cases these symptoms were already present before use and did not worsen. 13 out of 21 (62%) patients experienced small improvements in pain. Mean NRS pain intensity before VR was 5.29 (±1.84) and after VR 4.57 (±2.06)(Figure 2). Overall, participants had a positive attitude towards VR. Patients perceived the following working mechanisms: relaxation, focus shifting/distraction, being involved, raised awareness and more control over the pain. In repeated home use, sufficient data was available for 5 of the 7 patients; 1 patient did not use VR at all and 1 patient dropped out after the first session due to virtual reality sickness. With repeated use, severity of reported side effects was mostly none or slight. Individual pain intensity scores appeared to fluctuate strongly over time. After 8 weeks, 4 out of 5 patients experienced overall small improvements in pain compared to baseline and 1 patient remained unchanged. Mean NRS pain was 5.2 (±0.98) at baseline and 4.4 (±0.8) at 8 weeks. There was no change in quality of life or in arthritis self-efficacy.Conclusion:This study provides promising indications for the feasibility and acceptability of implementing a study protocol for testing the effectiveness of VR Reducept for the treatment of persistent pain in RA-patients with stable low disease activity.REFERENCES:[1] de Vries FS, van Dongen RTM, Bertens D. Pain education and pain management skills in virtual reality in the treatment of chronic low back pain: A multiple baseline single-case experimental design. Behav Res Ther. 2023 Mar;162:104257. doi: 10.1016/j.brat.2023.104257. Epub 2023 Jan 18. PMID: 36731183.Figure 1.Image from VR Reducept of the journey through the nervous system, with gaming elements aimed at controlling the painFigure 2.Pain scores before and after single use of VR ReduceptAcknowledgements:NIL.Disclosure of Interests:Anna de Jong: None declared, Femke de Greef: None declared, Tessa Hippert: None declared, Demy Gerritsen: None declared, Mirjam Hegeman: None declared, Peter ten Klooster: None declared, Christina Bode: None declared, Harald E. Vonkeman AbbVie, Novartis, Pfizer, UCB, Johnson and Johnson, Galapagos, Boehringer Ingelheim.

The number of patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) is increasing. Since these patients have a CHA2DS2-VASc score of 1 or higher, they should be treated with oral anticoagulation to prevent stroke. However, combination therapy with oral anticoagulation for prevention of embolic stroke and dual platelet inhibition for prevention of coronary thrombosis significantly increases bleeding complications. The optimal combination, intensity and duration of antithrombotic combination therapy is still not known. In the rather small randomized WOEST trial, the combination of a vitamin K antagonist (VKA) and clopidogrel decreased bleeding compared to the conventional triple therapy with VKA, clopidogrel and aspirin. In the PIONEER AF-PCI trial, two rivaroxaban-based treatment regimens significantly reduced bleeding complications compared to conventional triple therapy without increasing embolic or ischemic complications following PCI. Dual therapy with rivaroxaban and clopidogrel appeared to provide an optimal risk–benefit ratio. In the RE-DUAL PCI trial, dual therapy with dabigatran also reduced bleeding complications compared to conventional triple therapy. With respect to the composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization dabigatran-based dual therapy was non-inferior to VKA-based triple therapy. The upcoming trials AUGUSTUS with apixaban and ENTRUST-PCI with edoxaban will further examine the use of NOACs in this setting. While recent guidelines recommend NOAC-based dual therapy in only a subset of patients (those who are at increased risk of bleeding), the available data now suggest that this should be the preferred choice for the majority of patients. Adding aspirin to this primary choice for up to 4 weeks in patients at especially high ischemic risk would likely prevent atherothrombotic events, but this needs further investigation. Taken together, it is time to adjust our practice and move to dual therapy consisting of a NOAC plus clopidogrel in most patients.

Due to operation at low Reynolds numbers, low pressure turbines of aircraft engines mostly show large laminar boundary layers and transitional separation bubbles which considerably change their viscous losses when interacting with impinging wakes. The change of loss depends on several wake parameters, among others on wake passing frequency and wake orientation. In the present work, these parameters are expressed in terms of Strouhal number and flow coefficient and their influence is investigated by means of unsteady Reynolds-averaged Navier-Stokes (RANS) simulations. Different combinations of both wake parameters which are typical of aircraft engine conditions, are prescribed upstream of a high lift turbine cascade, while the Reynolds number and Mach number are kept constant. The solver TRACE by DLR and MTU Aero Engines together with the γ − Re Θ transition model by Langtry and Menter has been used. Further, the wake profile is representative for upstream turbine profiles and is prescribed by a correlation framework which has been calibrated in previous work. A newly developed quasi-unsteady wake model (QUWM) is applied in order to model the effects of periodically passing wakes in steady state simulations involving mixing plane interfaces. It is shown that the gap between unsteady and steady state simulations is narrowed significantly by the QUWM while still maintaining quick turnaround times that are crucial in industrial flow solver applications.

Background Podiatrists are key professionals in promoting adequate foot self-care for people with diabetes at high-risk of developing foot ulcers. However, merely informing patients about the advantages of foot self-care is insufficient to realise behavioural change. Motivational interviewing (MI) is a promising person-centred communication style that could help to create a working alliance between healthcare providers and patient to improve foot self-care. This study aims to observe and analyse the application of MI in consultations carried out by MI-trained and non-MI-trained podiatrists with their patients, and explore podiatrists’ attitudes and experiences towards MI. Methods Eighteen podiatrists (median age: 28.5 years, 10 female and 8 male) followed a three-day basic training in MI and 4 podiatrists (median age: 38.5 years, 4 female) were not trained in MI. To observe and rate the MI-fidelity in daily clinical practice, audio recordings from the MI-trained and non-MI-trained podiatrists were scored with the Motivational Interviewing Treatment Integrity code. Individual, semi-structed, in-depth interviews were conducted with the MI-trained podiatrists to explore their attitudes towards and experiences with MI. These data sources were triangulated to describe the effect of training podiatrists in MI for their clinical practice. Results The MI-trained podiatrists scored significantly higher than the non-MI-trained podiatrists on two of four global MI-related communication skills (empathy, p  = 0.008 and change talk, p  = 0.008), on one of five core MI-adherent behaviours (affirmation, p  = 0.041) and on one of the other behaviour counts (simple reflections, p  = 0.008). The podiatrists mainly reported their attitudes and experiences regarding partnership and cultivating change talk, during the interviews. In addition, they also mentioned facilitators and barriers to using MI and indicated whether they experienced MI as having added value. Conclusions The MI-trained podiatrists used the principles of MI at a solid beginner proficiency level in their clinical practice in comparison to the non-MI-trained podiatrists, who did not reach this level. This achievement is in accordance with the basic MI-training they received. This multi-method study reveals that podiatrists can be effectively trained in applying MI in daily clinical practice. Trial registration Netherlands Trial Register NL7710. Registered: 6 May 2019.