bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping strategies employed by public psychiatric healthcare workers during the COVID-19 pandemic in southern Gauteng, South Africa
Authors: Scheunemann Ann , Kim Andrew W. , Moolla Aneesa , Subramaney Ugasvaree
Published: August 2023

Within the context of the novel coronavirus pandemic and new challenges to a resource-constrained public healthcare system, many healthcare workers in South Africa have faced numerous stressors that have compromised their mental health. While the current literature on COVID-19 in South Africa highlights the widespread psychosocial stress experienced by healthcare workers during the pandemic, little is known about the coping strategies utilized to continue service delivery and maintain one’s mental health and well-being during this ongoing public health emergency. In this study, we sought to explore the coping strategies used by healthcare workers employed in the public psychiatric care system in southern Gauteng, South Africa during the coronavirus disease (COVID-19) pandemic. Psychiatric healthcare workers (n = 55) employed in three tertiary public hospitals and two specialized psychiatric facilities participated in in-depth interviews between July 2020 and March 2021. We found that coping strategies spanned multi-level and multi-systemic efforts. Intrapersonal, interpersonal, material, and structural coping were mapped across individual, family, and hospital systems. The most commonly utilized coping strategies included positive mindsets and reappraisal, social support systems, and COVID-19 specific protections. Findings also highlighted the contextual and interconnected nature of coping. Healthcare workers applied multiple coping strategies to combat the negative mental health effects of the COVID-19 pandemic. Better understanding these strategies, contexts in which they are employed, and how they interact can be used to develop evidence-based interventions to support healthcare workers experiencing healthcare-related stressors during the COVID-19 pandemic.
Grating-incoupled waveguide-enhanced Raman sensor
Authors: Ettabib Mohamed A. , Bowden Bethany M. , Liu Zhen , Marti Almudena , Churchill Glenn M. , Gates James C. , Zervas Michalis N. , Bartlett Philip N. , Wilkinson James S.
Published: August 2023

We report a waveguide-enhanced Raman spectroscopy (WERS) platform with alignment-tolerant under-chip grating input coupling. The demonstration is based on a 100-nm thick planar (slab) tantalum pentoxide (Ta2O5) waveguide and the use of benzyl alcohol (BnOH) and its deuterated form (d7- BnOH) as reference analytes. The use of grating couplers simplifies the WERS system by providing improved translational alignment tolerance, important for disposable chips, as well as contributing to improved Raman conversion efficiency. The use of non-volatile, non-toxic BnOH and d7-BnOH as chemical analytes results in easily observable shifts in the Raman vibration lines between the two forms, making them good candidates for calibrating Raman systems. The design and fabrication of the waveguide and grating couplers are described, and a discussion of further potential improvements in performance is presented.
Correlation between cerebral hemodynamic functional near-infrared spectroscopy and positron emission tomography for assessing mild cognitive impairment and Alzheimer’s disease: An exploratory study
Authors: Yoon Jin A. , Kong In Joo , Choi Ingyu , Cha Jihyun , Baek Ji Yeong , Choi JongKwan , Shin Yong Beom , Shin Myung Jun , Lee Young-Min
Published: August 2023

This study was performed to investigate the usefulness of functional near-infrared spectroscopy (fNIRS) by conducting a comparative analysis of hemodynamic activation detected by fNIRS and positron emission tomography (PET) and magnetic resonance imaging (MRI) in patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD). Participants were divided into four groups: the subjective memory impairment (SMI), amnestic MCI (aMCI), non-amnestic MCI (naMCI), and AD groups. We recorded the hemodynamic response during the semantic verbal fluency task (SVFT) using a commercial wireless continuous-wave NIRS system. The correlation between the parameters of the neuroimaging assessments among the groups was analyzed. Region of interest-based comparisons showed that the four groups had significantly different hemodynamic responses during SVFT in the bilateral dorsolateral prefrontal cortex (DLPFC). The linear mixed effect model result indicates that the mean ΔHbO2 from the bilateral DLPFC regions showed a significant positive correlation to the overall FDG-PET after controlling for age and group differences in the fNIRS signals. Amyloid PET signals tended to better differentiate the AD group from other groups, and fNIRS signals tended to better differentiate the SMI group from other groups. In addition, a comparison between the group pairs revealed a mirrored pattern between the hippocampal volume and hemodynamic response in the DLPFC. The hemodynamic response detected by fNIRS showed a significant correlation with metabolic and anatomical changes associated with disease progression. Therefore, fNIRS may be considered as a screening tool to predict the hemodynamic and metabolic statuses of the brain in patients with MCI and AD.
Real-time ultrasound evaluation of CORE muscle activity in a simultaneous contraction in subjects with non-specific low back pain and without low-back pain. Protocol of an observational case-control study
Authors: Cervera-Cano María , Sáez-García María Carmen , Valcárcel-Linares David , Fernández-Carnero Samuel , López-González Luis , Gallego-Izquierdo Tomás , Pecos-Martin Daniel
Published: August 2023

Non-specific low back pain represents 90–95% of all cases of low back pain and it has a prevalence of 18% in the adult population, assuming a great socioeconomic impact. The main objective of this observational case-control study study is to evaluate if there are differences in the simultaneous contraction of the core muscles between nonspecific low back pain and healthy subjects. This study will be carried out in the Physiotherapy department of the University of Alcalá. Eighty-two participants <18 years old, will be recruited, paired with NSLBP (n = 41) and healthy (n = 41). The main outcome will be the onset muscle contraction of lateral abdominal wall (internal oblique, external oblique and transversus abdominis), pelvic floor, lumbar multifidus and respiratory diafragm. The maneuvers that the subjects will perform will be abdominal drawing in maneouver, contralateral arm lift, valsalva, and voluntary pelvic floor contraction in sitting and standing. As a secondary objective, to analyze the amount of contraction of each muscle group and the capacity of the diaphragms to be excreted in both groups of subjects. Finally, to relate pain and disability.
Is competition good or bad for the price, quantity, and quality of bank lending?
Authors: Huynh Japan
Published: August 2023

This paper extends the existing literature by examining an important channel through which bank competition could drive the real economy by comprehensively influencing bank lending in three components–price, volume, and quality. For the measurement of bank competition, we build a series of different structural (concentration indicators) and non-structural (Lerner, Boone, and Panzar-Rose H-statistic indexes) measures, given that the reliance on solely one individual measure could lead to a misleading conclusion. Through a sample of commercial banks during 2007–2021 in a single Vietnamese banking market, we find a decline in bank loan growth and a rise in credit risk under the pressure of high competition. With respect to the association between bank competition and the price of credit, our empirical evidence is mixed based on different measures to analyze the banking market structure. Our findings support the view that greater competition results in a less proliferated banking sector with riskier assets. We also confirm that these findings are robust to additional tests, including employing alternative measures of bank lending dimensions and market structure, removing the periods of the financial crisis and the COVID-19 pandemic, and changing the empirical estimation technique. In addition, our deeper analysis reveals that the adverse impact of bank competition on lending, shown by reduced credit supply and increased credit risk, is less pronounced for banks with a higher degree of income diversification. This result suggests that bank diversification may protect the quantity and quality of bank lending from the detrimental competition effect.
Public health concerns for food contamination in Ghana: A scoping review
Authors: Botha Nkosi Nkosi , Ansah Edward Wilson , Segbedzi Cynthia Esinam , Darkwa Sarah
Published: August 2023

Nutrition is sturdily and rapidly becoming the foremost determinant of health in today’s Sars-Cov-2 and climate change ravaged world. While safe food sustains life, contamination obliterates its values and could result in death and short to long term morbidity. The purpose of this scoping review is to explore food contamination in Ghana, between 2001–2022. Using Arksey and O’Malley’s procedure, a systematic literature search from PubMed, JSTOR, ScienceDirect, ProQuest, Scopus, Emeralds Insight, Google Scholar, and Google was carried out. Following the inclusion criteria, 40 published and grey literature were covered in this review. The review revealed the following: Studies on food contamination involving Greater Accra, Ashanti, Central, and Eastern Regions alone account for over 50% of the total number of such studies conducted in Ghana; regulators failed in enforcing regulations, monitoring and supervision; managers failed to provide adequate infrastructure and facilities. The most common food safety risks of public health concern are: i) micro-organisms (E. coli/faecal coliforms, Staphylococcus aureus, Salmonella spp, Bacillus cereus, and Viral hepatitis); ii) drugs (Amoxicillin, Chlortetracycline, Ciprofloxacin, Danofloxacin, and Doxycycline) and; iii) chemicals (Chlorpyrifos). Salad, vegetables, sliced mango, meat pie, and snail khebab are of high public health risks. The following deductions were made from the review: Highly contaminated food results in death, short to long term morbidity, economic loss, and threatens to displace Ghana’s efforts at achieving the Sustainable Development Goals (SDG) 2. Thus, Government must resource key regulatory bodies to enhance their operational capacity, regulators must foster collaboration in monitoring and supervision of food vendors, and managers of food service outlets must provide adequate facilities to engender food safety culture.
How do perceptions of Covid-19 risk impact pregnancy-related health decisions? A convergent parallel mixed-methods study protocol
Authors: Vanstone Meredith , Correia Rebecca H. , Howard Michelle , Darling Elizabeth , Bayrampour Hamideh , Carruthers Andrea , Davis Amie , Hadid Dima , Hetherington Erin , Jones Aaron , Kandasamy Sujane , Kuyvenhoven Cassandra , Liauw Jessica , McDonald Sarah D. , Mniszak Caroline , Molinaro Monica L. , Pahwa Manisha , Patel Tejal , Sadik Marina , Sanya Njideka , Shen Katrina , Greyson Devon
Published: August 2023

Introduction

Pregnant people have a higher risk of severe COVID-19 disease. They have been disproportionately impacted by COVID-19 infection control policies, which exacerbated conditions resulting in intimate partner violence, healthcare access, and mental health distress. This project examines the impact of accumulated individual health decisions and describes how perinatal care and health outcomes changed during the COVID-19 pandemic.

Objectives

Quantitative strand: Describe differences between 2019, 2021, and 2022 birth groups related to maternal vaccination, perinatal care, and mental health care. Examine the differential impacts on racialized and low-income pregnant people.

Qualitative strand: Understand how pregnant people’s perceptions of COVID-19 risk influenced their decision-making about vaccination, perinatal care, social support, and mental health.

Methods and analysis

This is a Canadian convergent parallel mixed-methods study. The quantitative strand uses a retrospective cohort design to assess birth group differences in rates of Tdap and COVID-19 vaccination, gestational diabetes screening, length of post-partum hospital stay, and onset of depression, anxiety, and adjustment disorder, using administrative data from ICES, formerly the Institute for Clinical Evaluative Sciences (Ontario) and PopulationData BC (PopData) (British Columbia). Differences by socioeconomic and ethnocultural status will also be examined. The qualitative strand employs qualitative description to interview people who gave birth between May 2020- December 2021 about their COVID-19 risk perception and health decision-making process. Data integration will occur during design and interpretation.

Ethics and dissemination

This study received ethical approval from McMaster University and the University of British Columbia. Findings will be disseminated via manuscripts, presentations, and patient-facing infographics.

Trial registration

Registration: Clinicaltrials.gov registration number: NCT05663762.
A new systematic collection and classification of odour words by using a product review dataset
Authors: Zushi Naoya , Takeuchi Genki , Ogawa Midori , Gotow Naomi , Kakeya Hideki , Koabayakawa Tatsu , Ayabe-Kanamura Saho
Published: August 2023

The odours encountered on a daily basis are dependent on an individual’s society and culture. Therefore, when conducting olfactory tests, the odour stimuli utilized must be appropriate for the individual’s environment. In this study, we gathered and classified the odours experienced by Japanese individuals in their daily lives through a large dataset of product reviews encompassing food and household items. Specifically, we performed morphological analysis on product review sentences in Japanese that contained odour descriptions, and we compiled the nouns used to describe odours. A total of 617,208 sentences that reviewed odour experiences and their corresponding nouns were collected. The top 100 frequently used odour nouns were classified into 15 clusters according to the context in which they were used. The methodology employed in collecting and classifying odour nouns as presented in this study can be utilized in other situations. It can assist in selecting appropriate odour stimuli for the olfactory test based on the society, culture, and time period.
Development of a human peripheral blood ex vivo model for rapid protein biomarker detection and applications to radiation biodosimetry
Authors: Nemzow Leah , Boehringer Thomas , Bacon Bezalel , Turner Helen C.
Published: August 2023

In the event of a widespread radiological incident, thousands of people may be exposed to a wide range of ionizing radiation. In this unfortunate scenario, there will be a need to quickly screen a large number of people to assess the amount of radiation exposure and triage for medical treatment. In our earlier work, we previously identified and validated a panel of radiosensitive protein biomarkers in blood leukocytes, using the humanized-mouse and non-human primate (NHP) models. The objective of this work was to develop a high-throughput imaging flow-cytometry (IFC) based assay for the rapid measurement of protein biomarker expression in human peripheral blood samples irradiated ex vivo. In this assay design, peripheral human blood samples from healthy adult donors were exposed to 0–5 Gy X-irradiation ex vivo and cultured for up to 2 days. Samples were stained with a cocktail of surface antigens (CD66b, CD20, and CD3), fixed and permeabilized, and intracellularly stained for BAX (Bcl-2-associated X) protein, used here as a representative biomarker. Samples were interrogated by IFC, and a uniform analysis template was created to measure biomarker expression in heterogeneous and specific leukocyte subtype populations at each time point. In this human blood ex vivo model, we show that within gated populations of leukocyte subtypes, B-cells are highly radiosensitive with the smallest surviving fraction, followed by T-cells and granulocytes. Dose-dependent biomarker responses were measured in the lymphocytes, B-, and T-cell populations, but not in the granulocytes, with dose-response curves showing increasing fold changes in BAX protein expression up to Day 2 in lymphocyte populations. We present here the successful use of this ex vivo model for the development of radiation dose-response curves of a candidate protein biomarker towards future applications of dose reconstruction and biodosimetry.
Teaching nature of science in introductory biology: Impacts on students’ acceptance of biological evolution
Authors: Sloane Jeremy D. , Wheeler Lindsay B. , Manson Jessamyn S.
Published: August 2023

The present study investigates the impact of explicit, reflective Nature of Science instruction on students’ evolution acceptance, understanding of evolution as a theory, and understanding of Nature of Science in an introductory biology course. Results revealed similar improvement in evolution acceptance in both the treatment and control groups, but also that Nature of Science instruction had disproportionately large impacts on evolution acceptance for women and individuals who already had high acceptance. We also found evidence of relationships between understanding and acceptance of evolution and Nature of Science understanding, particularly the creativity aspect of Nature of Science. Together, these results suggest that targeted Nature of Science instruction can have differential impacts on students with particular characteristics, such as women and individuals with high acceptance, but also point to the need to consider additional interventions that can reach men and individuals with low acceptance.
Associations between clinical and social factors and anticoagulant prescription among patients with atrial fibrillation: A retrospective cohort study from a large healthcare system
Authors: Khatib Rasha , Glowacki Nicole , Colavecchia Carmine , Mills J. Rebecca , Glosner Scott , Cato Matthew , Brady Peter
Published: August 2023

Background

Patient clinical factors and social determinants of health (SDOH) are associated with an increased risk of stroke for patients with atrial fibrillation (AF); however, the association between these factors and the management of AF is not well characterized, particularly among those factors commonly collected in electronic health records (EHRs). This study used EHR data to evaluate the associations between patient clinical factors and SDOH and prescribing of an oral anticoagulant (OAC) for stroke prevention in AF.

Methods

This analysis included adult patients with newly diagnosed AF who had ≥2 encounters in the Advocate Aurora Health system in Wisconsin between May 2016 and May 2021. Patient-level demographics, comorbidities, medications, and SDOH were retrospectively extracted from EHRs. Area deprivation index (ADI) was linked to patient records as a measure of socioeconomic status.

Results

Of 16,656 patients with AF, 10,898 (65.4%) were prescribed an OAC within the first year of diagnosis. Patients were less likely to be prescribed an OAC (relative risk [95% CI]) if they were widowed (0.98 [0.96–0.99] vs single) or had a history of alcoholism (0.86 [0.79–0.95] vs no history). Most patients (53.3%) received prescriptions from a primary care provider. A linear relationship was found between worsening ADI and increased prescriptions for warfarin vs those for direct-acting OACs.

Conclusions

Although guideline-concordant anticoagulant use remained suboptimal, clinical characteristics were strongly associated for whether a patient with AF would be prescribed an OAC. Disparities in patient care regarding the prescribing of OACs due to SDOH and associated behaviors were small but present, particularly for national ADI.
Knowledge, attitude, and practice (KAP) of antimicrobial prescription and its resistance among health care providers in the COVID-19 era: A cross sectional study
Authors: Nemr Nader , Kishk Rania M. , Elsaid Noha M. Abu Bakr , Louis Nageh , Fahmy Eman , Khattab Sally
Published: August 2023

Antimicrobial resistance (AMR) is considered as a global health and development threat. During COVID-19 pandemic, there has been an increase in antimicrobial resistance. Health care providers (HCPs) play the main role in facing antibiotic resistance because they have the authority to prescribe antibiotics during clinical practice as well as in promoting patients’ compliance with therapies and avoid self-medication. So, this study will serve as an important source of information in context with Covid19 pandemic in Egypt. The data was collected using a validated standardized self-administered online questionnaire compromised of four sections: socio-demographic data of the HCPs, the general knowledge on antibiotics and AMR, the HCP attitude towards antibiotic prescription and AMR and the practice in applying the appropriate antibiotic prescription. Most of HCPs (93.7%) recorded good knowledge level about antibiotic prescription and antimicrobial resistance with mean score of knowledge13.21 ± 1.83. About 79% of HCPs recorded a positive attitude towards proper antibiotic prescription with mean score of attitudes 63.02 ± 7.68. Fifty four percent of HCPs demonstrated a good level of practice with mean score of practice 9.75 ± 2.17. In conclusion, HCPs in our study have a good level of knowledge and attitude about antibiotics. However lower level of proper practice towards the problem of AMR in COVID19 era was noticed. Implementation of effective policies and guidelines is crucial to evaluate the antimicrobial use especially in the COVID-19 era to reduce the unintended consequences of the misuse of antibiotics and its impact on AMR.
Two-photon microscopy for microrobotics: Visualization of micro-agents below fixed tissue
Authors: Huaroto Juan J. , Capuano Luigi , Kaya Mert , Hlukhau Ihar , Assayag Franck , Mohanty Sumit , Römer Gert-willem , Misra Sarthak
Published: August 2023

Optical microscopy is frequently used to visualize microrobotic agents (i.e., micro-agents) and physical surroundings with a relatively high spatio-temporal resolution. However, the limited penetration depth of optical microscopy techniques used in microrobotics (in the order of 100 μm) reduces the capability of visualizing micro-agents below biological tissue. Two-photon microscopy is a technique that exploits the principle of two-photon absorption, permitting live tissue imaging with sub-micron resolution and optical penetration depths (over 500 μm). The two-photon absorption principle has been widely applied to fabricate sub-millimeter scale components via direct laser writing (DLW). Yet, its use as an imaging tool for microrobotics remains unexplored in the state-of-the-art. This study introduces and reports on two-photon microscopy as an alternative technique for visualizing micro-agents below biological tissue. In order to validate two-photon image acquisition for microrobotics, two-type micro-agents are fabricated and employed: (1) electrospun fibers stained with an exogenous fluorophore and (2) bio-inspired structure printed with autofluorescent resin via DLW. The experiments are devised and conducted to obtain three-dimensional reconstructions of both micro-agents, perform a qualitative study of laser-tissue interaction, and visualize micro-agents along with tissue using second-harmonic generation. We experimentally demonstrate two-photon microscopy of micro-agents below formalin-fixed tissue with a maximum penetration depth of 800 μm and continuous imaging of magnetic electrospun fibers with one frame per second acquisition rate (in a field of view of 135 × 135 μm2). Our results show that two-photon microscopy can be an alternative imaging technique for microrobotics by enabling visualization of micro-agents underin vitroandex ovoconditions. Furthermore, bridging the gap between two-photon microscopy and the microrobotics field has the potential to facilitatein vivovisualization of micro-agents.
Remote monitoring, personnel extinguishment or helicopter extinguishment? How to control forest fires more effectively
Authors: Bai Yuntao , Wang Lan , Yuan Xiaolong
Published: August 2023

Forest fires have a great impact on the ecological environment. The government needs to take measures to control forest fires. Forest fires are easily affected by wind speed and other weather conditions, and the difficulty of extinguishing forest fires is easily affected by terrain complexity. Effective management methods can protect the important ecological functions of forests, thereby maintaining long-term development and economic efficiency. The government can put out the fire by remote monitoring, personnel extinguishing and helicopter extinguishing. Different from most articles on how to eliminate forest fires from the technical point of view, this article mainly analyzes from the two aspects of optimizing resource allocation and guiding policy formulation. This article constructs the differential game model under these three modes, and then obtains the equilibrium result. And the comparative analysis. Finally, the conclusion is drawn. The stronger the wind, the more residents need to flee. However, strong winds are not conducive to crews and helicopters fighting the fire. Rather than fighting fires, residents are more inclined to detect forest fires in time through remote monitoring. When the personnel can effectively control the fire, the personnel fire extinguishing mode is preferentially selected. Otherwise, helicopter firefighting mode should be selected.
Plasma metabolomics profiling identifies new predictive biomarkers for disease severity in COVID-19 patients
Authors: Soares Nelson C. , Hussein Amal , Muhammad Jibran Sualeh , Semreen Mohammad H. , ElGhazali Gehad , Hamad Mawieh
Published: August 2023

Recently, numerous studies have reported on different predictive models of disease severity in COVID-19 patients. Herein, we propose a highly predictive model of disease severity by integrating routine laboratory findings and plasma metabolites including cytosine as a potential biomarker of COVID-19 disease severity. One model was developed and internally validated on the basis of ROC-AUC values. The predictive accuracy of the model was 0.996 (95% CI: 0.989 to 1.000) with an optimal cut-off risk score of 3 from among 6 biomarkers including five lab findings (D-dimer, ferritin, neutrophil counts, Hp, and sTfR) and one metabolite (cytosine). The model is of high predictive power, needs a small number of variables that can be acquired at minimal cost and effort, and can be applied independent of non-empirical clinical data. The metabolomics profiling data and the modeling work stemming from it, as presented here, could further explain the cause of COVID-19 disease prognosis and patient management.
Regular walking exercise prior to knee osteoarthritis reduces joint pain in an animal model
Authors: Sakamoto Junya , Miyahara Syouta , Motokawa Satoko , Takahashi Ayumi , Sasaki Ryo , Honda Yuichiro , Okita Minoru
Published: August 2023

We investigated the effect of regular walking exercise prior to knee osteoarthritis (OA) on pain and synovitis in a rat monoiodoacetic acid (MIA)-induced knee OA model. Seventy-one male Wistar rats were divided into three groups: (i) Sedentary + OA, (ii) Exercise + OA, and (iii) Sedentary + Sham groups. The Exercise + OA group underwent a regular treadmill walking exercise at 10 m/min (60 min/day, 5 days/week) for 6 weeks, followed by a 2-mg MIA injection in the right knee. The right knee joint was removed from rats in this group at the end of the 6-week exercise period and at 1 and 6 weeks after the MIA injection. After the 6 weeks of treadmill exercise but before MIA injection, there were no significant differences among the three groups in the pressure pain threshold, whereas at 1 week post-injection, the Exercise + OA group’s pressure pain threshold was significantly higher than that in the Sedentary + OA group, and this difference persisted until the end of the experimental period. The histological changes in articular cartilage and subchondral bone revealed by toluidine blue staining showed no difference between the Sedentary + OA and EX + OA groups. The expression levels of interleukin (IL)-4 and IL-10 mRNA in the infrapatellar fat pad and synovium were significantly increased by the treadmill exercise. Significant reductions in the number of CD68-, CD11c-positive cells and IL-1β mRNA expression and an increase in the number of CD206-positive cells were observed at 1 week after the MIA injection in the Exercise + OA group compared to the Sedentary + OA group. These results suggest that regular walking exercise prior to the development of OA could alleviate joint pain through increases in the expressions of anti-inflammatory cytokines in the rat infrapatellar fat pad and synovium.
A machine learning-based phenotype for long COVID in children: An EHR-based study from the RECOVER program
Authors: Lorman Vitaly , Razzaghi Hanieh , Song Xing , Morse Keith , Utidjian Levon , Allen Andrea J. , Rao Suchitra , Rogerson Colin , Bennett Tellen D. , Morizono Hiroki , Eckrich Daniel , Jhaveri Ravi , Huang Yungui , Ranade Daksha , Pajor Nathan , Lee Grace M. , Forrest Christopher B. , Bailey L. Charles
Published: August 2023

As clinical understanding of pediatric Post-Acute Sequelae of SARS CoV-2 (PASC) develops, and hence the clinical definition evolves, it is desirable to have a method to reliably identify patients who are likely to have post-acute sequelae of SARS CoV-2 (PASC) in health systems data. In this study, we developed and validated a machine learning algorithm to classify which patients have PASC (distinguishing between Multisystem Inflammatory Syndrome in Children (MIS-C) and non-MIS-C variants) from a cohort of patients with positive SARS- CoV-2 test results in pediatric health systems within the PEDSnet EHR network. Patient features included in the model were selected from conditions, procedures, performance of diagnostic testing, and medications using a tree-based scan statistic approach. We used an XGboost model, with hyperparameters selected through cross-validated grid search, and model performance was assessed using 5-fold cross-validation. Model predictions and feature importance were evaluated using Shapley Additive exPlanation (SHAP) values. The model provides a tool for identifying patients with PASC and an approach to characterizing PASC using diagnosis, medication, laboratory, and procedure features in health systems data. Using appropriate threshold settings, the model can be used to identify PASC patients in health systems data at higher precision for inclusion in studies or at higher recall in screening for clinical trials, especially in settings where PASC diagnosis codes are used less frequently or less reliably. Analysis of how specific features contribute to the classification process may assist in gaining a better understanding of features that are associated with PASC diagnoses.
IMU-based classification of resistive exercises for real-time training monitoring on board the international space station with potential telemedicine spin-off
Authors: Ravizza Martina , Giani Laura , Sheiban Francesco Jamal , Pedrocchi Alessandra , DeWitt John , Ferrigno Giancarlo
Published: August 2023

The microgravity exposure that astronauts undergo during space missions lasting up to 6 months induces biochemical and physiological changes potentially impacting on their health. As a countermeasure, astronauts perform an in-flight training program consisting in different resistive exercises. To train optimally and safely, astronauts need guidance by on-ground specialists via a real-time audio/video system that, however, is subject to a communication delay that increases in proportion to the distance between sender and receiver. The aim of this work was to develop and validate a wearable IMU-based biofeedback system to monitor astronauts in-flight training displaying real-time feedback on exercises execution. Such a system has potential spin-offs also on personalized home/remote training for fitness and rehabilitation. 29 subjects were recruited according to their physical shape and performance criteria to collect kinematics data under ethical committee approval. Tests were conducted to (i) compare the signals acquired with our system to those obtained with the current state-of-the-art inertial sensors and (ii) to assess the exercises classification performance. The magnitude square coherence between the signals collected with the two different systems shows good agreement between the data. Multiple classification algorithms were tested and the best accuracy was obtained using a Multi-Layer Perceptron (MLP). MLP was also able to identify mixed errors during the exercise execution, a scenario that is quite common during training. The resulting system represents a novel low-cost training monitor tool that has space application, but also potential use on Earth for individuals working-out at home or remotely thanks to its ease of use and portability.
Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke
Authors: Wang Yun , Leifheit Erica C. , Goldstein Larry B. , Lichtman Judith H.
Published: August 2023

Background

Whether stroke patients treated at hospitals with better short-term outcome metrics have better long-term outcomes is unknown. We investigated whether treatment at US hospitals with better 30-day hospital-level stroke outcome metrics was associated with better 1-year outcomes, including reduced mortality and recurrent stroke, for patients after ischemic stroke.

Methods

This cohort study included Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital’s performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission measures for ischemic stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were <25th percentile of national rates), High-High (both >75th percentile), and Intermediate (all other hospitals). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models assessing patient risks of 1-year all-cause mortality and ischemic stroke recurrence across hospital performance categories, weighted by the IPW and accounting for competing risks.

Results

There were 595,929 stroke patients (mean age 78.9±8.8 years, 54.4% women) discharged from 2,563 hospitals (134 Low-Low, 2288 Intermediate, 141 High-High). For Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% confidence interval [CI] 23.3%-24.3%), 25.2% (25.1%-25.3%), and 26.5% (26.1%-26.9%), and recurrence rates were 8.0% (7.6%-8.3%), 7.9% (7.8%-8.0%), and 8.0% (7.7%-8.3%). Compared with patients treated at High-High hospitals, those treated at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82–0.87) and 9% (0.91; 0.89–0.93) lower risks of 1-year mortality but no difference in recurrence.

Conclusions

Ischemic stroke patients treated at hospitals with better CMS short-term outcome metrics had lower risks of post-discharge 1-year mortality, but similar recurrent stroke rates, compared with patients treated at other hospitals.
Test-retest reliability and sensitivity of senior elite amateur boxers maximal punch force, as quantified by a vertically mounted force plate
Authors: Finlay Mitchell James , Page Richard Michael , Greig Matt , Bridge Craig Alan
Published: August 2023

An ecologically valid, reliable and sensitive method of quantifying punch force variables would be useful for coaches and practitioners monitoring combat-specific performance. The present study utilised a vertically mounted force plate to quantify the peak punch force and rate of force development (RFD) of amateur boxers. Ten male senior elite amateur boxers performed maximal jab, cross, and hook punches across two separate days. The force plate showed excellent within-day and good-to-excellent between-day reliability for peak punch impact force and RFD (ICC 0.89–0.99). The CV% for all punch force variables were similar on day 1 (3–9%) and day 2 (4–10%). Standard error of measurement (SEM) and smallest worthwhile changes (SWC) revealed the force plate can detect small-to-moderate changes in punch performance. The greatest impact forces and RFD were found in the rear hook (2624 ± 581 N, 296448 ± 101823 N.s-1), followed by the lead hook (2524 ± 532 N, 256813 ± 81735 N.s-1), cross 2425 ± 545 N, 193004 ± 62671 N.s-1) and jab (1645 ± 537 N, 116675 ± 41577 N.s-1). The vertically mounted force plate is a reliable and sensitive test of punch performance, thus may be useful in determining the efficacy of training interventions.
Epigenetic regulation in colorectal cancer: The susceptibility of microRNAs 145, 143 and 133b to DNA demethylation and histone deacetylase inhibitors
Authors: Omar Aadilah , Govan Drishna , Penny Clement
Published: August 2023

Globally, colorectal cancer (CRC) is a major health concern. Despite improvements in CRC treatment, mortality rates remain high. Genetic instability and epigenetic dysregulation of gene expression are instigators of CRC development that result in genotypic differences, leading to often variable and unpredictable treatment responses. Three miRNAs, miR-143, -145 and -133b, are most commonly downregulated in CRC and are proposed here as potential tumour suppressors. Although the downregulation of these miRNAs in CRC is largely unexplained, epigenetic silencing has been postulated to be a causative regulatory mechanism. Potential epigenetic modulation of miRNA expression, by means of histone acetylation and DNA methylation, was assessed in this study by treating early (SW1116) and late stage (DLD1) CRC cells with the DNA demethylating agent 5-aza-2’-deoxycytidine (5-Aza-2’C) and the histone deacetylase (HDAC) inhibitor Trichostatin A (TSA), respectively. Subsequent quantification of miRNA expression revealed that while all the selected miRNAs were susceptible to DNA demethylation in early- and late-stage CRC cells, susceptibility to DNA demethylation was significantly pronounced in late-stage DLD1 cells. Conversely, although histone acetylation moderately affected miRNA expression in early-stage CRC, it had a marginal effect on the expression of miRNAs in late-stage CRC cells. Overall, this study provides further understanding of the contribution of epigenetics to the regulation of putative tumour suppressor miRNAs in CRC.
A transition point: Assistance magnitude is a critical parameter when providing assistance during walking with an energy-removing exoskeleton or biomechanical energy harvester
Authors: Shepertycky Michael , Liu Yan-Fei , Li Qingguo
Published: August 2023

Researchers and engineers have developed exoskeletons capable of reducing the energetic cost of walking by decreasing the force their users’ muscles are required to produce while contracting. The metabolic effect of assisting concentric and isometric muscle contractions depends, in part, on assistance magnitude. We conducted human treadmill experiments to explore the effects of assistance magnitude on the biomechanics and energetics of walking with an energy-removing exoskeleton designed to assist eccentric muscle contractions. Our results demonstrate that the assistance magnitude of an energy-removing device significantly affects the energetics, muscle activity, and biomechanics of walking. Under the moderate assistance magnitude condition, our device reduced the metabolic cost of walking below that of normal walking by 3.4% while simultaneously producing 0.29 W of electricity. This reduction in the energetic cost of walking was also associated with an 8.9% decrease in hamstring activity. Furthermore, we determined that there is an assistance magnitude threshold that, when crossed, results in the device transitioning from assisting to hindering its user. This transition is marked by significant increases in muscle activity and the metabolic cost of walking. These results could aid in the future design of exoskeletons and biomechanical energy harvesters, as well as adaptive control systems, that identify user-specific control parameters associated with minimum energy expenditure.
Multisectoral actions in primary health care: A realist synthesis of scoping review
Authors: Khatri Resham B. , Erku Daniel , Endalamaw Aklilu , Wolka Eskinder , Nigatu Frehiwot , Zewdie Anteneh , Assefa Yibeltal
Published: August 2023

Background

Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems.

Methods

We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley’s realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level).

Results

A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals’ social determinants of health.

Conclusion

Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.
A new cost-utility analysis assessing risk factor-guided prophylaxis with palivizumab for the prevention of severe respiratory syncytial virus infection in Italian infants born at 29–35 weeks’ gestational age
Authors: Keary Ian P. , Ravasio Roberto , Fullarton John R. , Manzoni Paolo , Lanari Marcello , Paes Bosco A. , Carbonell-Estrany Xavier , Baraldi Eugenio , Tarride Jean-Éric , Rodgers-Gray Barry
Published: August 2023

Since the last Italian cost-utility assessment of palivizumab in 2009, new data on the burden of respiratory syncytial virus (RSV) and an International Risk Scoring Tool (IRST) have become available. The objective of this study was to provide an up-to-date cost-utility assessment of palivizumab versus no prophylaxis for the prevention of severe RSV infection in otherwise healthy Italian infants born at 29–31 weeks’ gestational age (wGA) infants and those 32–35wGA infants categorized as either moderate- or high-risk of RSV-hospitalization (RSVH) by the IRST. A decision tree was constructed in which infants received palivizumab or no prophylaxis and then could experience: i) RSVH; ii) emergency room medically-attended RSV-infection (MARI); or, iii) remain uninfected/non-medically attended. RSVH cases that required intensive care unit admission could die (0.43%). Respiratory morbidity was considered in all surviving infants up to 18 years of age. Hospitalization rates were derived from Italian data combined with efficacy from the IMpact-RSV trial. Palivizumab costs were calculated from vial prices (50mg: €490.37 100mg: €814.34) and Italian birth statistics combined with a growth algorithm. A lifetime horizon and healthcare and societal costs were included. The incremental cost-utility ratio (ICUR) was €14814 per quality-adjusted life year (QALY) gained in the whole population (mean: €15430; probability of ICUR being <€40000: 0.90). The equivalent ICURs were €15139 per QALY gained (€15915; 0.89) for 29–31wGA infants and €14719 per QALY gained (€15230; 0.89) for 32–35wGA infants. The model was most sensitive to rates of long-term sequelae, utility scores, palivizumab cost, and palivizumab efficacy. Palivizumab remained cost-effective in all scenario analyses, including a scenario wherein RSVH infants received palivizumab without a reduction in long-term sequelae and experienced a 6-year duration of respiratory morbidity (ICUR: €27948 per QALY gained). In conclusion, palivizumab remains cost-effective versus no prophylaxis in otherwise healthy Italian preterm infants born 29–35wGA. The IRST can help guide cost-effective use of palivizumab in 32–35wGA infants.
Validity and reliability of an app-based medical device to empower individuals in evaluating their physical capacities
Authors: Mazéas Alexandre , Blond Marine , Chalabaev Aïna , Duclos Martine
Published: August 2023

Background

Cardiorespiratory fitness and muscle strength are valid markers of health and strong predictors of mortality and morbidity. The tests used to measure these variables require in-person visits with specialized equipment and trained personnel–leading to organizational constraints both for patients and hospitals, and making them difficult to implement at a large scale. In this context, technologies embedded in smartphones offer new opportunities to develop remote tests.

Objectives

This study aimed to test the validity and reliability of MediEval, a newly developed app-based medical device that allows individuals to perform the 6-minute walk test (6MWT) and the 30-second sit-to-stand (30s-STS) test on their own using GPS signal and camera detection with a skeleton extraction algorithm.

Methods

A total of 53 healthy adults performed the two tests in three different sessions to determine the intra- and inter-day reproducibility. Test validity was assessed by comparing the results obtained from the app to gold standard measures. Pearson correlations and concordance correlation coefficients, the relative measurement error, intraclass correlation coefficients, the standard error of measure and the minimal detectable change were computed for each test.s

Results

The results revealed high to excellent validity of the app in comparison to gold standards (ρ = 0.84 for the 6MWT and ρ = 0.99 for the 30s-STS test) with low relative measurement error. The mean differences between the app and the gold standard measures were 8.96m for the 6MWT and 0.28 repetition for the 30s-STS test. Both tests had good test-retest reliability (ICCs = 0.77). The minimal detectable changes were respectively 97.56 meters for the 6MWT and 7.37 repetitions for the 30s-STS test.

Conclusion

The MediEval medical device proposes valid and reproducible measures of the 6MWT and the 30s-STS test. This device holds promise for monitoring the physical activity of large epidemiologic cohorts while refining patient experience and improving the scalability of the healthcare system. Considering minimal detectable change values, it may be important to ask participants to perform several tests and average them to improve accuracy. Future studies in clinical context are needed to evaluate the responsiveness and the smallest detectable changes of the device for specific populations with chronic diseases.