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Purpose: To examine associations between exercise heart rate (HRex) during a continuous-fixed submaximal fitness test (CF-SMFT) and an intermittent-variable protocol (semistandardized kicking drill [SSD]) in Australian Football athletes, controlling for external intensities, within-session scheduling, and environmental conditions. Methods: Forty-four professional male Australian Football athletes (22.8 [8.0] y) were monitored over 10 sessions involving a 3-minute CF-SMFT (12 km·h−1) as the first activity and a SSD administered 35.7 (8.0) minutes after the CF-SMFT. Initial heart rate and HRex were collected, with external intensities measured as average velocity (in meters per minute) and average acceleration–deceleration (in meters per second squared). Environmental conditions were sampled. A penalized hierarchical linear mixed model was tuned for a Bayesian information criterion minima using a 10-fold cross-validation, with out-of-sample prediction accuracy assessed via root-mean-squared error. Results: SSD average acceleration–deceleration, initial heart rate, temperature, and ground hardness were significant moderators in the tuned model. When model covariates were held constant, a 1%-point change in SSD HRex associated with a 0.4%-point change in CF-SMFT HRex (95% CI, 0.3–0.5). The tuned model predicted CF-SMFT HRex with an average root-mean-squared error of 2.64 (0.57) over the 10-fold cross-validation, with 74% and 86% of out-of-sample predictions falling within 2.7%-points and 3.7%-points, respectively, from observed values, representing the lower and upper limits for detecting meaningful changes in HRex according to the documented typical error. Conclusions: Our findings support the use of an SSD to monitor physiological state in Australian Football athletes, despite varied scheduling within session. Model predictions of CF-SMFT HRex from SSD HRex closely aligned with observed values, considering measurement imprecision. [ABSTRACT FROM AUTHOR]

Purpose: To examine the sex differences in performance and perceived fatigue during resistance training prescribed using traditional (TRA) and autoregulation rest-redistribution training (ARRT) approaches. Methods: Twelve resistance-trained men and 12 women completed 2 sessions including the bench-press exercise matched for load (75% of 1-repetition maximum), volume (24 repetitions), and total rest (240 s). Sessions were performed in a counterbalanced randomized design with TRA consisting of 3 sets of 8 repetitions with 120-second interset rest and ARRT employing a personalized combination of clusters, repetitions per cluster, and between-clusters rest regulated with a 20% velocity-loss threshold. The effects of TRA and ARRT on velocity loss, unilateral isometric peak force, and rating of fatigue (ROF) were compared between sexes. Results: The velocity loss was generally lower during ARRT compared with TRA (−0.47% [0.11%]), with velocity loss being mitigated by ARRT to a greater extent among males compared with females (−0.37% [0.15%]). A smaller unilateral isometric peak force decline was observed after ARRT than TRA among males compared with females (−38.4 [8.4] N). Lower ROF after ARRT than TRA was found among males compared to females (−1.97 [0.55] AU). Additionally, males reported greater ROF than females across both conditions (1.92 [0.53] AU), and ARRT resulted in lower ROF than TRA overall (−0.83 [0.39] AU). Conclusions: The ARRT approach resulted in decreased velocity loss, peak force impairment, and ROF compared with TRA in both sexes. However, male subjects exhibited more pronounced acute within-session benefits from the ARRT method. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was 2-fold: (1) to examine the relationships between psychophysiological responses and locomotor demands with variations in technical performance during 2v2 and 4v4 conditioned games and (2) to compare psychophysiological and locomotor responses among players exhibiting higher and lower technical performance levels during the conditioned games. Methods: Twenty-four male youth soccer players (16.3 ± 0.8 y old) participating at the trained/developmental level underwent monitoring for psychophysiological responses (including heart rate, rating of perceived exertion, and visual analog scale), locomotor demands (such as distance covered), and technical performance variables (including successful and unsuccessful passes and shots, as well as lost balls) across 2v2 and 4v4 formats. These formats were applied 4 times within a single session and were replicated twice over 2 weeks. Results: Large correlations between the number of lost balls per minute and mean heart rate were found in both the 2v2 and 4v4 games (r =.586 and r =.665, respectively). Successful shots were inversely and largely correlated with mean heart rate (r = −.518) in 4v4 games. The number of interceptions per minute was inversely and significantly correlated with the visual analog scale in 2v2 and 4v4 games (r = −.455 and r = −.710, respectively). The frequency of lost balls was significantly higher among players who attained a higher mean heart rate (2v2: +42.9%, P =.031, d = −0.965; 4v4: +57.1%, P <.001, d = −2.072). Conclusions: Coaches should be aware that highly psychophysiologically demanding scenarios may significantly impair technical performance. Therefore, prioritizing technical performance by deliberately adjusting the intensity should be considered. [ABSTRACT FROM AUTHOR]

Purpose: This scoping review aims to identify the primary racket and arm-mounted technologies based on inertial measurement units that enable the quantification of hitting load in racket sports. Methods: A comprehensive search of several databases (PubMed, SPORTDiscus, Web of Science, and IEEE Xplore) and Google search engines was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews guidelines. Included records primarily focused on monitoring hitting load in racket sports using commercialized racket or arm-mounted inertial sensors through noncompetitive and competitive racket-sports players. Results: A total of 484 records were identified, and 19 finally met the inclusion criteria. The largest number of systems found were compatible with tennis (n = 11), followed by badminton (n = 4), table tennis (n = 2), padel (n = 1), and squash (n = 1). Four sensor locations were identified: grip-attached (n = 8), grip-embedded (n = 6), wrist (n = 3), and dampener sensors (n = 2). Among the tennis sensors, only 4 out of the 11 (36.4%) demonstrated excellent reliability (>.85) in monitoring the number of shots hit either during analytic drills or during simulated matches. None of the other racket-sports sensors have undergone successful, reliable validation for hitting-volume quantification. Conclusions: Despite recent advancements in this field, the quantification of hitting volume in racket sports remains a challenge, with only a limited number of tennis devices demonstrating reliable results. Thus, further progress in technology and research is essential to develop comprehensive solutions that adequately address these specific requirements. [ABSTRACT FROM AUTHOR]

Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community. [ABSTRACT FROM AUTHOR]

Purpose: Monitoring player readiness to train and perform is an important practical concept in football. Despite an abundance of research in this area in the male game, to date, research is limited in female football. The aims of this study were, first, to summarize the current literature on the monitoring of readiness in female football; second, to summarize the current evidence regarding the monitoring of the menstrual cycle and its potential impact on physical preparation and performance in female footballers; and third, to offer practical recommendations based on the current evidence for practitioners working with female football players. Conclusions: Practitioners should include both objective (eg, heart rate and countermovement jump) and subjective measures (eg, athlete-reported outcome measures) in their monitoring practices. This would allow them to have a better picture of female players' readiness. Practitioners should assess the reliability of their monitoring (objective and subjective) tools before adopting them with their players. The use of athlete-reported outcome measures could play a key role in contexts where technology is not available (eg, in semiprofessional and amateur clubs); however, practitioners need to be aware that many single-item athlete-reported outcome measures instruments have not been properly validated. Finally, tracking the menstrual cycle can identify menstrual dysfunction (eg, infrequent or irregular menstruation) that can indicate a state of low energy availability or an underlying gynecological issue, both of which warrant further investigation by medical practitioners. [ABSTRACT FROM AUTHOR]

Background: Submaximal fitness test (SMFT) outcome measures are frequently collected with a wide array of technologies and methodological approaches. Purpose: To examine the test–retest reliability of various SMFT outcome measures derived from different protocols and analytical techniques. Methods: Twenty-six semiprofessional adult soccer players performed 3 SMFT protocols, including 2 continuous (3 min, 11 and 12.8 km·h−1) and 1 intermittent (4 × 50 m, 18 km·h−1) twice, each separated by 7 days. Heart-rate (HR) indices (exercise HR, HR recovery) and scapula-mounted (PlayerLoad vector magnitude) and foot-mounted (flight time and contact time, stride length) microelectrical mechanical system–derived variables were collected using different time frames and analytical approaches adopted in the literature and practice. Absolute reliability was quantified as the group mean difference, typical error of measurement, also expressed as the coefficient of variation (where appropriate) and standardized units (ie, d). Intraclass correlation coefficient was used to quantify relative reliability. Results: The highest degrees of reliability were evident for exercise HR (typical error: 1.0%–1.6% points), the vertical component of PlayerLoad (expressed in arbitrary units; coefficient of variation: 5.5%–7.0%), and contact time (coefficient of variation: 1.5%–3.0%). These estimates were not influenced by SMFT protocol or analytical approach. All other measures displayed poorer reliability and/or were different between protocols and analytical methods. Conclusions: SMFT protocols impact the test–retest reliability of various outcome measures; however, exercise HR, vertical PlayerLoad, and contact time (derived from foot-mounted micro-electrical mechanical systems) appear to have stable measurement properties to assist the assessment of aerobic capacity and lower-limb neuromuscular status, respectively. [ABSTRACT FROM AUTHOR]

Time spent in physical activity, sedentary behavior, and sleep collectively impact health of older adults. There is a need for valid self-reported methods for the assessment of movement behaviors across the entire 24-hr day. The aim of this study was to explore the validity of the German version of Daily Activity Behaviours Questionnaire (DABQ), the "Schlaf- und Aktivitätsfragebogen (SAF)," among older adults. Participants were asked to wear activity monitor (activPAL) for a period of 8 days and to complete the German version of DABQ. Seventy-seven participants (45 females; 68 ± 5 years of age) completed the protocol. Spearman's correlation coefficients between DABQ and activPAL estimates for time spent in sleep, sedentary behavior, light physical activity, and moderate to vigorous physical activity were.69,.35,.24, and.52, respectively. The German version of the DABQ showed satisfactory validity to be used in epidemiological research and population surveillance among older adults. [ABSTRACT FROM AUTHOR]

Purpose: Quantifying training intensity provides a comprehensive understanding of the training stimulus. Recent technological advances may have improved the feasibility of using heart-rate (HR) monitoring in swimming. However, the implementation of HR monitoring is yet to be assessed longitudinally in the daily training environment of swimmers. This study aimed to assess the implementation of HR by comparing the training-intensity distribution from an external measure, planned volume at set intensities (PVSI), with the internal training-intensity distribution measured using time in HR zones. Methods: Using a longitudinal observational design, 10 competitive swimmers (8 male and 2 female, age: 22.0 [2.3] y, Fédération Internationale de Natation point score: 842.9 [58.5], mean [SD]) were monitored daily for 6 months. Each session, HR data, and coached-planned and athlete-reported session rating of perceived exertion (Modified Category Ratio 10 scale) were recorded. Based on previously determined training zones from an incremental step test, PVSI was calculated using the planned distance and planned intensity of each swim bout. Training-intensity distributions were analyzed using a linear mixed model (lme4). Results: The model revealed a small to moderate relationship between PVSI and time in HR zone, based on the Nakagawa R-squared value (range.14–.42). Conclusions: Training-intensity distribution differed between the internal measure (ie, HR) and the external measure of intensity (ie, PVSI). This demonstrates that internal and planned external measures of intensity cannot be used interchangeably to monitor training. Further research should explore how to best integrate these measures to better understand training in swimming. [ABSTRACT FROM AUTHOR]

Background: Soccer match outcomes rely on technical accuracy, intensity of play, and athlete motivation, and these parameters can be developed during sport-specific practice such as during small-sided games (SSGs). Verbal encouragement as a coaching technique improves exercise intensity and athlete enjoyment (indicative of motivation), but the impact on technical performance alongside these critical parameters remains unknown. Purpose: To examine the effects of verbal encouragement on technical performance, exercise intensity, and enjoyment during SSGs. Methods: Sixteen male youth soccer players (mean [SD]; age: 17.2 [0.4] y; height: 176.3 [7.0] cm; body mass: 68.0 [4.1] kg; body fat: 11.9% [2.2%]) completed 4 sessions of 4-per-side SSG without a goalkeeper. Two sessions were conducted as SSGs with verbal encouragement and 2 without verbal encouragement. Each SSG lasted 25 minutes (4 × 4-min work, 3-min passive recovery between bouts) on a 25 × 35-m pitch. Heart rate (HR) was continuously recorded, and rating of perceived exertion was collected after each SSG. Video analysis was used to quantify technical actions during SSG. Enjoyment was assessed after each SSG using the Physical Activity Enjoyment Scale. Results: Paired t tests revealed that SSGs with verbal encouragement induced higher HR (% maximum HR and mean HR), rating of perceived exertion, and Physical Activity Enjoyment Scale score than SSGs without verbal encouragement (all P <.001, all d ≥ 0.92, large). Compared with SSGs without verbal encouragement, SSGs with verbal encouragement resulted in an increased percentage of successful passes (P <.001, d = 0.73, medium) and number of interceptions (P <.001, d = 0.89, large) and fewer lost balls (P <.001, d = 0.68, medium). Conclusions: Coaches should use verbal encouragement during SSGs to improve physical effort, technical performance, and psychological status in soccer players. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the soft tissue changes of the face between two positions of occlusion: maximal intercuspal position (MIP) and physiologic rest position (RP). Materials and Methods: In this study, facial surface scans of 83 volunteers in two mandibular positions (MIP and RP) were obtained using a 3D optical scanner. On each 3D image, 21 cephalometric soft tissue landmarks were identified and then compared using t test for various facial parameters (widths, heights, depths, angles, and ratio). Additionally, a regional analysis of the facial surface differences in each patient between the two mandibular positions was performed using a whole scan shell best-fit method and the regional forehead best-fit method. Results: In MIP, facial heights with the nasion-gnathion distance shortened by approximately 1.2 mm (due to the vertical shrinkage of both lips together by 0.8 mm), and the mouth width was significantly widened, while other facial widths displayed no change. The labiomental angle and the upper vermilion arch were altered correspondingly, and regional analysis confirmed the findings with evident changes in the mandibular and subnasal areas with deviations amplified toward the facial midline. Conclusions: By applying 3D facial-scanning technology, this study displayed changes of facial appearance in different mandibular positions (MIP and RP), highlighting the need to instruct and monitor the patient's mandibular position more consistently to achieve accurate and repeatable data in a 3D facial analysis. [ABSTRACT FROM AUTHOR]

Flexible strain sensors are attracting attention in areas such as medical monitoring sensing and rehabilitation therapy monitoring due to their powerful ability to sense, process, transmit and display complex information. However, it is an urgent challenge to realize the trade‐off between excellent performances such as high sensitivity, high linearity, wide strain sensing range and high durability. Herein, we prepare stretchable conductive composites with wrinkle composite micro‐crack structure by combining carboxystyrene butadiene rubber (XSBR) layer and carboxymethyl cellulose@Ag nanowire‐CNTs (CMC@AgNWs‐CNTs) conductive layer. Based on interfacial interactions, it can be adapted to different needs by adjusting the thickness of the strain sensing layer. When the thickness of the strain sensing layer is 4 μm, the strain sensor has a wide sensing range (strain capacity up to 300%) and high sensitivity (strain sensing factor of 484). At a thickness of 8 μm, the strain sensing performance exhibits a wide strain range, high linear fit and good cyclic stability. This work provides a new research idea to improve the comprehensive performance of flexible strain sensors and the contradiction between wide sensing range, high sensitivity and high linearity. [ABSTRACT FROM AUTHOR]

Introduction Respiratory rate (RR) is a crucial vital sign in patient monitoring and is often the best marker of the deterioration of a sick patient. It can be used to help diagnose numerous medical conditions and has been demonstrated to be an independent predictor of patient outcomes in various critical care settings and is incorporated in many clinical early warning scores. Here, we report on the performance of depth-camera-based system for the noncontact monitoring of RR during a ramped RR protocol. The ramped breathing protocol was developed specifically to test the relatively rapid changes in rates, which include clinically important low and high ranges of RRs. Materials and Methods We performed a series of experimental runs with healthy volunteers who were instructed to breathe over a wide range of RRs, where the rates were ramped up from 4 breaths/min to 50 breaths/min then back down to 4 breaths/min in a series of ramped steps. Depth information was acquired from the scene and used to determine a respiratory rate (RRdepth), and this was compared to capnograph or spirometer respiratory rate reference (RRref). A total of 9,482 contemporaneous data pairs (RRdepth, RRref) were collected during the study for comparison. Results A Pearson correlation coefficient of 0.995 was achieved and a line of best fit given by RRdepth = 0.99 × RRref + 0.36 breaths/min. The overall root mean squared difference (RMSD) across the runs was 1.29 breaths/min with a corresponding bias of 0.16 breaths/min, respectively. The associated Bland–Altman analysis found limits of agreement of −2.45 and 2.75 breaths/min. When the data were subdivided according to low, medium, and high RRs, corresponding to ≤10, >10 to 20, and >20 breaths/min, the RMSD accuracies were found to be 0.94, 1.34, and 1.55 breaths/min, respectively. Conclusions The technology performed well, exhibiting an RMSD accuracy well within our target of 3 breaths/min, both across the whole range and across each individual subrange. In summary, our results indicate the potential viability of continuous noncontact monitoring for the determination of RR over a clinically relevant range. [ABSTRACT FROM AUTHOR]

Although real-time event detection during video EEG recording is required to ensure patients' safety, it is limited by the technologists' availability. We sought to explore the efficiency of real-time event detection by the EEG technologists in a single tertiary academic center. We retrospectively reviewed events from continuous inpatient video EEGs (cEEGs) and epilepsy monitoring unit (EMU) recordings in January 2017, when real-time surveillance was only available during the night shift, and June 2017, when a dedicated neurodiagnostic EEG technologist was available for real-time monitoring during all shifts. The events were categorized into those detected immediately (eyes-on), later in the same shift (delayed) or identified on the subsequent shift (missed). Chi-square and Fisher's exact tests were used for statistical comparisons. In January 2017, there were 25 patients (117 days of monitoring) in the EMU and 54 inpatients (146 days of monitoring) on cEEG with 92 total events, (39% seizures). In June 2017, there were 30 patients (133 days of monitoring) in the EMU and 47 additional inpatients (80 days of monitoring) on cEEG with 110 total events, (39% seizures). The number of events identified in real time was low and did not significantly differ among shifts regardless of the availability of the monitoring technologist. Most events were identified at the time of subsequent EEG scanning by the EEG technologist. Partial staffing for continuous video EEG surveillance is insufficient to identify events in real time. EEG technologists are able to identify events during regular EEG scanning. [ABSTRACT FROM AUTHOR]

Objectives This study examines the effectiveness and efficiency of intensive psychodynamic psychotherapy for severely impaired patients. Method: 104 patients in four public mental health centers underwent intensive psychodynamic psychotherapy. The number and duration of psychiatric hospitalizations were monitored for these patients from one year before therapy to eight years after. Several outcome variables were measured every six months, six times in total over two and a half years, using a longitudinal design. A multi-level analytic approach was applied to account for repeated measurements and missing data. Results: Significant improvement was found in all three symptomatic outcome measures (SCL-90, OQ-45, BDI) throughout treatment. The numbers of psychiatric hospitalizations and psychiatric hospitalization days decreased significantly from the level they were in the year before the start of psychodynamic treatment to three years after the start of treatment. These results were maintained for at least up to eight years. After capitalization, the overall cumulative 127.47-day decrease in hospitalization days equals savings of 115,850 NIS. The average cost of treatment after capitalization was 26,770 NIS. The insurer's estimated direct savings is 89,080 NIS (24,054 $). Conclusion: These findings support the hypothesis that psychodynamic psychotherapy is clinically effective and economically efficient for severely impaired patients. [ABSTRACT FROM AUTHOR]

Rationale: Cardiac monitoring has often been identified as an area of overutilization and remains a limited resource in many hospitals. With the aim of reducing telemetry overuse, we added clinical decision support to our health system's telemetry order with guidance on appropriate indications for monitoring. The new order requires selection of an appropriate clinical indication. Aims and Objectives: In this study, we aimed to understand provider engagement with this tool by assessing concordance between selected indications within the order and the clinical presence of those conditions as documented within the patient chart. Methods: We randomly selected 100 telemetry orders from July to October 2022 across four different hospitals at NYU Langone Health. Two independent, blinded reviewers used a structured protocol to identify documentation of actual indications for telemetry in each selected chart. We calculated the rate of concordance between indications selected in the order and indications that were determined to be clinically present on chart review. Results: There were 30,839 telemetry orders placed during the study timeframe. Overall concordance between the selection within the order and the actual indication was 48% (95% confidence interval [CI], 38.21%−57.79%). We observed especially low concordance rates for vague indications, such as 'Other', and for 'Confirmed Stroke', which was the only indication allowing for indefinite telemetry. Conclusion: The overall low concordance suggests a disconnect between the support tool and clinical practice. Providers are more likely to select an indication that reduces downstream work regardless of a patient's true clinical indication. [ABSTRACT FROM AUTHOR]

Systemic lupus erythematosus (SLE) is an autoimmune disease with a variable course with unpredictable flares. Identifying predictors of these flares is essential for monitoring and timely hospital care. To characterize the prevalence of flares within the first five years of SLE diagnosis and determine the clinical and immunological characteristics associated with flare development among patients attending the Rheumatology Clinic at Tikur Anbesa Specialized Hospital (TASH) and Lancet General Hospital. A multicenter, cross-sectional study was conducted from May 2023 to November 2023 at TASH and Lancet General Hospital. The data was collected from electronic medical records and analyzed using SPSS version 26. Logistic regressions were used to determine factors associated with lupus flare. Most patients with SLE were female (95.4%). The most common clinical presentations were musculoskeletal (71.8%), cutaneous (55%), and constitutional (22%). Almost half (44.3%) of the patients had comorbidity illness. Positive ANA test was found in 96.5% of the patients, whereas only 55% had positive anti-dsDNA test. The prevalence of SLE flare in the first five years of SLE diagnosis was 38.9%, and most flares occurred within the first year of diagnosis. Patients with the following characteristics were more likely to have flare-ups: younger age at diagnosis (less than 25 years old), initial presentation with vasculitis, renal flare, and being on low-dose prednisolone. The most common clinical presentations were musculoskeletal, dermatologic, and constitutional manifestations. Age < 25 years at diagnosis, initial clinical presentation with renal manifestation, and being on low-dose prednisolone were predictors of SLE flare. Key Points • This study found a significant gender disparity, with 95% female. • Nearly 39% of patients experienced an SLE flare within the first five years of diagnosis. • Over three-quarters (77%) of flares occurred within the first year of diagnosis. • Age less than 25 years, initial presentation with vasculitis, renal involvement, and being on low-dose prednisolone were identified as predictors of flares. [ABSTRACT FROM AUTHOR]

Introduction: Innovative technologies, including virtual reality (VR), can be used for conducting VR exposure therapy (VRET) for individuals with psychiatric disorders, including claustrophobia. Unfortunately, there is a lack of studies on the effect of VR in treating claustrophobia in Arab countries, including Jordan. Therefore, this study aimed to evaluate the effect of VRET on minimising anxiety symptoms at 1 week post‐therapy and the physiological arousal measures (heart rate, O2 saturation and mean arterial pressure) of participants before and following therapy. Methods: A pre‐/post‐test one‐group design was used, and participants (N = 44) who suffered from claustrophobia from Al‐Zaytoonah University of Jordan were recruited. VRET was conducted using the Cave experience, which consists of four stages and was carried out in 4 to 6 sessions during the period from April to September 2023. Results: The findings revealed a significant difference between pre‐ and post‐VR simulation intervention for anxiety symptoms and physiological measures; in addition, the participants perceived the usability of VR therapy. Conclusion: This study suggested that VRET was effective in managing claustrophobia, particularly in minimising anxiety symptoms. Therefore, VRET can be integrated into the therapeutic methods for individuals with claustrophobia. Also, healthcare professionals, including mental health counsellors, can adopt such therapy in their management and treatment plan. [ABSTRACT FROM AUTHOR]

Background: Risk-based quality management is a regulatory-recommended approach to manage risk in a clinical trial. A key element of this strategy is to conduct risk-based monitoring to detect potential risks to critical data and processes earlier. However, there are limited publicly available tools to perform the analytics required for this purpose. Good Statistical Monitoring is a new open-source solution developed to help address this need. Methods: A team of statisticians, data scientists, clinicians, data managers, clinical operations, regulatory, and quality compliance staff collaborated to design Good Statistical Monitoring, an R package, to flexibly and efficiently implement end-to-end analyses of key risks. The package currently supports the mapping of clinical trial data from a variety of formats, evaluation of 12 key risk indicators, interactive visualization of analysis results, and creation of standardized reports. Results: The Good Statistical Monitoring package is freely available on GitHub and empowers clinical study teams to proactively monitor key risks. It employs a modular workflow to perform risk assessments that can be customized by replacing any workflow component with a study-specific alternative. Results can be exported to other clinical systems or can be viewed as an interactive report to facilitate follow-up risk mitigation. Rigorous testing and qualification are performed as part of each release to ensure package quality. Conclusions: Good Statistical Monitoring is an open-source solution designed to enable clinical study teams to implement statistical monitoring of critical risks, as part of a comprehensive risk-based quality management strategy. [ABSTRACT FROM AUTHOR]

Emergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care. To describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED. A 4-hour online nominal group technique workshop with follow up surveys. Twelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience. This study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice. [ABSTRACT FROM AUTHOR]

Introduction: The preferences of people with profound intellectual and multiple disabilities (PIMD) often remain unfulfilled since it stays challenging to decode their idiosyncratic behavior resulting in a negative impact on their quality of life (QoL). Physiological data (i.e. heart rate (variability) and motion data) might be the missing piece for identifying emotions of people with PIMD, which positively affects their QoL. Method: Machine learning (ML) processes and statistical analyses are integrated to discern and predict the potential relationship between physiological data and emotional states (i.e. numerical emotional states, descriptive emotional states and emotional arousal) in everyday interactions and activities of two participants with PIMD. Results: Emotional profiles were created enabling a differentiation of the individual emotional behavior. Using ML classifiers and statistical analyses, the results regarding the phases partially confirm previous research, and the findings for the descriptive emotional states were good and even better for the emotional arousal. Conclusion: The results show the potential of the emotional profiles especially for practitioners and the possibility to get a better insight into the emotional experience of people with PIMD including physiological data. This seems to be the missing piece to better recognize emotions of people with PIMD with a positive impact on their QoL. [ABSTRACT FROM AUTHOR]

This study analyzes the relationship between work fatigue and musculoskeletal disorders in gas station operators in Pontianak City. This study used with a cross-sectional approach. The sample consists of 150 gas station workers. Data collection was carried out by observing and interviewing. Respondents characteristics were recorded through interviews using a questionnaire. Data on work fatigue were obtained by interviews using the IFRC questionnaire and musculoskeletal data using the Nordic Body Map questionnaire. The study results show that 50% of workers experience a high level of work fatigue, and 26% of workers experience severe musculoskeletal disorders. There is a significant relationship between work fatigue and musculoskeletal diseases (p = 0.001). The study established the need for intervention as a preventive measure by providing sufficient rest time, stretching, setting work shifts, improving ergonomic work positions for gas station operators, and controlling the work environment through environmental improvement and monitoring and using personal protective equipment. [ABSTRACT FROM AUTHOR]

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Biomarkers are often measured in bulk to diagnose patients, monitor patient conditions, and research novel drug pathways. The measurement of these biomarkers often suffers from detection limits that result in missing and untrustworthy measurements. Frequently, missing biomarkers are imputed so that down‐stream analysis can be conducted with modern statistical methods that cannot normally handle data subject to informative censoring. This work develops an empirical Bayes g$$ g $$‐modeling method for imputing and denoising biomarker measurements. We establish superior estimation properties compared to popular methods in simulations and with real data, providing the useful biomarker measurement estimations for down‐stream analysis. [ABSTRACT FROM AUTHOR]

Background: Retinopathy of prematurity (ROP) is a leading cause of avoidable blindness in children, particularly in Latin America, where hyperoxia is a significant risk factor. This study evaluated resource availability and use for administering and monitoring supplemental oxygen in Mexico. Methods: In 2011, an observational study in which 32 government neonatal intensive care units (NICUs) across Mexico were visited. Data collected included occupancy, staffing levels, and equipment to deliver and monitor supplemental oxygen. Preterm infants receiving oxygen were observed. In 2023, 13 NICUs were revisited, and similar data collected. Staffing levels were benchmarked against Argentinian and US recommendations. Results: In 2011, only 38% of NICUs had adequate medical and staffing levels to meet recommended cot-to-staff ratios for all shifts. Staffing ratios were worse during weekends and at night than during weekdays. Only 25.5% of cots had blenders, and 80.1% had saturation monitors. 153 infants were observed 87% of whom were being monitored. Upper and lower oxygen saturations were ≥ 96% in 53%, and ≤ 89% in 8%, respectively. Alarm settings were inadequate, as 38% and 32% of upper and lower alarms were switched off and 16% and 53% were incorrectly set, respectively. In the 13 NICUs with data from 2011 and 2023, cot-to-staff ratios deteriorated over time, and in 2023 no unit had recommended ratios for all shifts. Equipment provision did not change, with similar proportions of babies in oxygen being monitored (79% 2011; 75% 2023). Rates of hyperoxia decreased slightly from 54% in 2011 to 49% in 2023. More upper alarms were set (46% 2011; 75% 2023), but a higher proportion were incorrectly set (52% 2011; 68% 2023). Conclusions: Between 2011 and 2023, cot-to-staff ratios worsened, and equipment for safe oxygen delivery and monitoring remained insufficient. Despite available monitoring equipment, oxygen saturations often exceeded recommended levels, and alarms were frequently not set or incorrectly configured. Urgent improvements are needed in healthcare workforce numbers and practices, along with ensuring adequate equipment for safe oxygen delivery. [ABSTRACT FROM AUTHOR]

Background: A combination of prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) is safe, feasible, and associated with potentially improved survival for severe acute respiratory distress syndrome (ARDS). However, whether ARDS patients, especially non-COVID-19 patients, placed in PP before VV-ECMO should continue PP after a VV-ECMO connection is unknown. This study aimed to test the hypothesis that early use of PP during VV-ECMO could increase the proportion of patients successfully weaned from ECMO support in severe ARDS patients who received PP before ECMO. Methods: In this prospective observational study, patients with severe ARDS who were treated with VV-ECMO were divided into two groups: the prone group and the supine group, based on whether early PP was combined with VV-ECMO. The proportion of patients successfully weaned from VV-ECMO and 60-day mortality were analyzed before and after propensity score matching. Results: A total of 165 patients were enrolled, 50 in the prone and 115 in the supine group. Thirty-two (64%) and 61 (53%) patients were successfully weaned from ECMO in the prone and the supine groups, respectively. The proportion of patients successfully weaned from VV-ECMO in the prone group tended to be higher, albeit not statistically significant. During PP, there was a significant increase in partial pressure of arterial oxygen (PaO2) without a change in ventilator or ECMO settings. Tidal impedance shifted significantly to the dorsal region, and lung ultrasound scores significantly decreased in the anterior and posterior regions. Forty-five propensity score-matched patients were included in each group. In this matched sample, the prone group had a higher proportion of patients successfully weaned from VV-ECMO (64.4% vs. 42.2%; P = 0.035) and lower 60-day mortality (37.8% vs. 60.0%; P = 0.035). Conclusions: Patients with severe ARDS placed in PP before VV-ECMO should continue PP after VV-ECMO support. This approach could increase the probability of successful weaning from VV-ECMO. Trial Registration: ClinicalTrials.Gov: NCT04139733. Registered 23 October 2019. [ABSTRACT FROM AUTHOR]

Background: The underrepresentation of women in leadership remains a pervasive issue, prompting a critical examination of support mechanisms within professional settings. Previous studies have identified challenges women face, ranging from limited visibility to barriers to career advancement. This survey aims to investigate perceptions regarding the effectiveness of women's leadership programs, mentoring initiatives, and a specialized communication course. Particularly it specifically targets addressing the challenges encountered by professional women. Methods: This multi-center, observational, international online survey was developed in partnership between ESICM NEXT and the ESICM Diversity and Inclusiveness Monitoring Group for Healthcare. Invitations to participate were distributed to both females and men through emails and social networks. Data were collected from April 1, 2023, through October 1, 2023. Results: Out of 354 respondents, 90 were men (25.42%) and 264 were women (74.58%). Among them, 251 completed the survey, shedding light on the persistent challenges faced by women in leadership roles, with 10%-50% of respondents holding such positions. Women's assertiveness is viewed differently, with 65% recognizing barriers such as harassment. Nearly half of the respondent's experience interruptions in meetings. Only 47.4% receiving conference invitations, with just over half accepting them. A mere 12% spoke at ESICM conferences in the last three years, receiving limited support from directors and colleagues, indicating varied obstacles for female professionals. Encouraging family participation, reducing fees, providing childcare, and offering economic support can enhance conference involvement. Despite 55% applying for ESICM positions, barriers like mobbing, harassment, lack of financial support, childcare, and language barriers were reported. Only 14% had access to paid family leave, while 32% benefited from subsidized childcare. Participation in the Effective Communication Course on Career Advancement Goals and engagement in women's leadership and mentoring programs could offer valuable insights and growth opportunities. Collaborating with Human Resources and leadership allies is crucial for overcoming barriers and promoting women's career growth. Conclusions: The urgency of addressing identified barriers to female leadership in intensive care medicine is underscored by the survey's comprehensive insights. A multifaceted and intersectional approach, considering sexism, structural barriers, and targeted strategies, is essential. [ABSTRACT FROM AUTHOR]

Chronic myeloid leukemia (CML) is characterized by the Philadelphia chromosome, leading to the BCR::ABL1 fusion gene and hyper-proliferation of granulocytes. Tyrosine kinase inhibitors (TKIs) are effective, and minimal residual disease (MRD) monitoring is crucial. Digital PCR platforms offer increased precision compared to quantitative PCR but lack comparative studies.Eighty CML patient samples were analyzed in parallel using digital droplet PCR (ddPCR) (QXDx™ BCR-ABL %IS Kit) and chip digital PCR (cdPCR) (Dr. PCR™ BCR-ABL1 Major IS Detection Kit).Overall, qualitative and quantitative agreement was good. Sensitivity analysis showed positive percentage agreement and negative percentage agreement were both ≥90 %, and the quadratic weighted kappa index for molecular response (MR) level categorization was 0.94 (95 %CI 0.89, 0.98). MR levels subgroup analysis showed perfect categorical agreement on MR level at MR3 or above, while 35.4 % (17/48) of patient samples with MR4 or below showed discordant categorizations. Overall, Lin’s concordance correlation coefficient (CCC) for the ratio of %BCR::ABL1/ABL1 converted to the International Scale (BCR::ABL1IS) was almost perfect quantitative agreement (Lin’s CCC=0.99). By subgroups of MR levels, Lin’s CCC showed a quantitative agreement of BCR::ABL1IS decreased as MR deepened.Both cdPCR and ddPCR demonstrated comparable performance in detecting BCR::ABL1 transcripts with high concordance in MR3 level or above. Choosing between platforms may depend on cost, workflow, and sensitivity requirements. [ABSTRACT FROM AUTHOR]

Reliable automatic diagnosis of Diabetic Retinopathy (DR) and Macular Edema (ME) is an invaluable asset in improving the rate of monitored patients among at-risk populations and in enabling earlier treatments before the pathology progresses and threatens vision. However, the explainability of screening models is still an open question, and specifically designed datasets are required to support the research. We present MAPLES-DR (MESSIDOR Anatomical and Pathological Labels for Explainable Screening of Diabetic Retinopathy), which contains, for 198 images of the MESSIDOR public fundus dataset, new diagnoses for DR and ME as well as new pixel-wise segmentation maps for 10 anatomical and pathological biomarkers related to DR. This paper documents the design choices and the annotation procedure that produced MAPLES-DR, discusses the interobserver variability and the overall quality of the annotations, and provides guidelines on using the dataset in a machine learning context. [ABSTRACT FROM AUTHOR]

Mental health professionals have relied primarily on clinical evaluations to identify in vivo pathology. As a result, mental health is largely reactive rather than proactive. In an effort to proactively assessmood, we collected continuous neurophysiologic data for ambulatory individuals 8-10 h a day at 1 Hz for 3 weeks (N=24). Data were obtained using a commercial neuroscience platform (Immersion Neuroscience) that quantifies the neural value of social-emotional experiences. These data were related to self-reported mood and energy to assess their predictive accuracy. Statistical analyses quantified neurophysiologic troughs by the length and depth of social-emotional events with low values and neurophysiologic peaks as the complement. Participants in the study had an average of 2.25 (SD = 3.70, Min = 0, Max = 25) neurophysiologic troughs per day and 3.28 (SD = 3.97, Min = 0, Max = 25) peaks. The number of troughs and peaks predicted daily mood with 90% accuracy using least squares regressions and machine learning models. The analysis also showed that women were more prone to low mood compared to men. Our approach demonstrates that a simple count variable derived from a commercially-available platform is a viable way to assess low mood and low energy in populations vulnerable to mood disorders. In addition, peak Immersion events, which are mood-enhancing, may be an effective measure of thriving in adults. [ABSTRACT FROM AUTHOR]

Introduction: Digital healthcare, especially virtual health, has changed nurses' jobs and skills. In the evolving healthcare landscape, nurses healthcare landscape is increasingly required to have diverse competencies to navigate the world of virtual health effectively. Objective: This study aims to qualitatively explore the role of nurses in virtual health and the competencies required to work in virtual health in Saudi Arabia, with a specific focus on SEHA virtual hospital. Methods: An online open survey with nursing experts was employed as the qualitative method approach during the initial phase of an online Delphi study design. Results: Twelve core competencies were identified: digital technology proficiency, professionalism, clinical expertise, leadership, legal and ethical considerations, care coordination, documentation, effective communication, patient assessment and diagnosis, patient safety, patient-centered care, and remote patient monitoring. Conclusions: The research emphasizes the crucial role of nurses in virtual hospitals and clinics, contributing to the expansion of the virtual healthcare environment. It presents a thorough competency framework that can guide the development of training programs and policies, enhancing the effectiveness of virtual healthcare delivery. Impact: The study provides a foundational competencies list that can guide the development of comprehensive training programs for nurses in virtual healthcare. Policymakers and educational leaders are encouraged to use these findings to create standardized practices and policies, enhancing the effectiveness and efficiency of virtual healthcare delivery. [ABSTRACT FROM AUTHOR]

Background: In recent years, the utilization of autogenous vascularized iliac crest flap for repairing jaw defects has seen a significant rise. However, the visual monitoring of iliac bone flaps present challenges, frequently leading to delayed detection of flap loss. Consequently, there's a urgent need to develop effective indicators for monitoring postoperative complications in iliac crest flaps. Methods: A retrospective analysis was conducted on 160 patients who underwent vascularized iliac crest flap transplantation for jawbone reconstruction from January 2020 to December 2022. We investigated the changes in D-dimer levels among patients with or without postoperative complications. Additionally, multivariable logistic regression analysis was performed to explore potential individual risk factors, including surgical duration, age, pathology type, absolute and relative D-dimer levels, and gender, culminating in the development of a nomogram. Results: On the first day following surgery, patients who experienced thrombosis exhibited a substantial increase in plasma D-dimer levels, reaching 3.75 mg/L, 13.84 times higher than the baseline. This difference was statistically significant (P < 0.05) compared to patients without postoperative complications. Furthermore, the nomogram we have developed and validated effectively predicts venous thrombosis, assigning individual risk scores to patients. This predictive tool was assessed in both training and validation cohorts, achieving areas under the curve (AUC) of 0.630 and 0.600, with the 95% confidence intervals of 0.452–0.807 and 0.243–0.957, respectively. Conclusions: Our study illustrates that postoperative plasma D-dimer levels can serve as a sensitive biomarker for monitoring thrombosis-induced flap loss. Moreover, we have developed a novel prediction model that integrates multiple factors, thereby enhancing the accuracy of early identification of patients at risk of thrombosis-associated flap loss. This advancement contributes to improving the overall management and outcomes of such procedures. [ABSTRACT FROM AUTHOR]

Simple Summary: This study evaluated the ability of Large Language Models (LLMs) to classify subjective toxicities from chemotherapy by comparing them with expert oncologists. Using fictitious cases, it was demonstrated that LLMs can achieve accuracy similar to that of oncologists in general toxicity categories, although they need improvement in specific categories. LLMs show great potential for enhancing patient monitoring and reducing the workload of doctors. Future research should focus on training LLMs specifically for medical tasks and validating these findings with real patients, always ensuring accuracy and ethical data management. Introduction: Large Language Models (LLMs), such as the GPT model family from OpenAI, have demonstrated transformative potential across various fields, especially in medicine. These models can understand and generate contextual text, adapting to new tasks without specific training. This versatility can revolutionize clinical practices by enhancing documentation, patient interaction, and decision-making processes. In oncology, LLMs offer the potential to significantly improve patient care through the continuous monitoring of chemotherapy-induced toxicities, which is a task that is often unmanageable for human resources alone. However, existing research has not sufficiently explored the accuracy of LLMs in identifying and assessing subjective toxicities based on patient descriptions. This study aims to fill this gap by evaluating the ability of LLMs to accurately classify these toxicities, facilitating personalized and continuous patient care. Methods: This comparative pilot study assessed the ability of an LLM to classify subjective toxicities from chemotherapy. Thirteen oncologists evaluated 30 fictitious cases created using expert knowledge and OpenAI's GPT-4. These evaluations, based on the CTCAE v.5 criteria, were compared to those of a contextualized LLM model. Metrics such as mode and mean of responses were used to gauge consensus. The accuracy of the LLM was analyzed in both general and specific toxicity categories, considering types of errors and false alarms. The study's results are intended to justify further research involving real patients. Results: The study revealed significant variability in oncologists' evaluations due to the lack of interaction with fictitious patients. The LLM model achieved an accuracy of 85.7% in general categories and 64.6% in specific categories using mean evaluations with mild errors at 96.4% and severe errors at 3.6%. False alarms occurred in 3% of cases. When comparing the LLM's performance to that of expert oncologists, individual accuracy ranged from 66.7% to 89.2% for general categories and 57.0% to 76.0% for specific categories. The 95% confidence intervals for the median accuracy of oncologists were 81.9% to 86.9% for general categories and 67.6% to 75.6% for specific categories. These benchmarks highlight the LLM's potential to achieve expert-level performance in classifying chemotherapy-induced toxicities. Discussion: The findings demonstrate that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM achieved 85.7% accuracy in general categories and 64.6% in specific categories. While the model's general category performance falls within expert ranges, specific category accuracy requires improvement. The study's limitations include the use of fictitious cases, lack of patient interaction, and reliance on audio transcriptions. Nevertheless, LLMs show significant potential for enhancing patient monitoring and reducing oncologists' workload. Future research should focus on the specific training of LLMs for medical tasks, conducting studies with real patients, implementing interactive evaluations, expanding sample sizes, and ensuring robustness and generalization in diverse clinical settings. Conclusions: This study concludes that LLMs can classify subjective toxicities from chemotherapy with accuracy comparable to expert oncologists. The LLM's performance in general toxicity categories is within the expert range, but there is room for improvement in specific categories. LLMs have the potential to enhance patient monitoring, enable early interventions, and reduce severe complications, improving care quality and efficiency. Future research should involve specific training of LLMs, validation with real patients, and the incorporation of interactive capabilities for real-time patient interactions. Ethical considerations, including data accuracy, transparency, and privacy, are crucial for the safe integration of LLMs into clinical practice. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) is a safe, noninvasive technique performed at the patient's bedside, providing immediate results to the operator. It complements physical examination and facilitates clinical decision-making. In infectious diseases, POCUS is particularly valuable, offering an initial assessment in cases of suspected infection. It often leads to an early tentative diagnosis enabling the prompt initiation of antimicrobial treatment without the delay associated with traditional radiology. POCUS provides direct visualization of affected organs, assists in evaluating fluid balance, and facilitates various interventions, all while reducing patient discomfort. For infectious disease specialists, becoming proficient in POCUS is a critical future challenge, requiring dedicated training for effective utilization. [ABSTRACT FROM AUTHOR]

Background Obesity is increasingly prevalent among people with human immunodeficiency virus (HIV, PWH). Obesity can reduce drug exposure; however, limited data are available for long-acting (LA) antiretrovirals. We performed in silico trials using physiologically based pharmacokinetic (PBPK) modeling to determine the effect of obesity on the exposure of LA cabotegravir and rilpivirine after the initial injection and after multiple injections. Methods Our PBPK model was verified against available clinical data for LA cabotegravir and rilpivirine in normal weight/ overweight (body mass index [BMI] <30 kg/m2) and in obese (BMI > 30 kg/m2). Cohorts of virtual individuals were generated to simulate the exposure of LA cabotegravir/rilpivirine up to a BMI of 60 kg/m2. The fold change in LA cabotegravir and rilpivirine exposures (area under the curve [AUC]) and trough concentrations (Cmin) for monthly and bimonthly administration were calculated for various BMI categories relative to normal weight (18.5–25 kg/m2). Results Obesity was predicted to impact more cabotegravir than rilpivirine with a decrease in cabotegravir AUC and Cmin of >35% for BMI >35 kg/m2 and in rilpivirine AUC and Cmin of >18% for BMI >40 kg/m2 at steady-state. A significant proportion of morbidly obese individuals were predicted to have both cabotegravir and rilpivirine Cmin below the target concentration at steady-state with the bimonthly administration, but this was less frequent with the monthly administration. Conclusions Morbidly obese PWH are at risk of presenting suboptimal Cmin for cabotegravir/rilpivirine after the first injection but also at steady-state particularly with the bimonthly administration. Therapeutic drug monitoring is advised to guide dosing interval adjustment. [ABSTRACT FROM AUTHOR]

Background: This study investigates the effectiveness of a self-developed intelligent monitoring system for home-based knee rehabilitation following total knee arthroplasty (TKA). Methods: In this randomized controlled trial, 120 patients undergoing TKA were divided using random digit allocation. Preoperative and one-month postoperative assessments of knee function, quality of life, and isometric knee extension strength were conducted with the Intelligent Monitoring System. Patients received group-specific rehabilitation instructions pre-discharge and performed exercises for one month. Results: Changes in isometric knee extensor strength on the affected side within one month post-surgery for the brace-monitored rehabilitation group showed a significant decrease three days after surgery compared to one day before surgery. Subsequent measurements taken at postoperative days 5, 7, 14, and 21 indicated a gradual increase in strength, although these increases did not reach statistical significance when compared with previous measurements. One month post-surgery, all groups demonstrated significant improvements in knee joint function and mobility compared to pre-surgery levels. Notably, the brace-monitored group showed statistically significant improvements in 36-Item Short-Form Health Survey (SF-36) scores over the conventional rehabilitation group. Conclusions: The Intelligent Monitoring System provides effective real-time monitoring and guidance for home-based knee rehabilitation post-TKA. It significantly enhances knee joint function, isometric knee extension strength, and quality of life shortly after surgery compared to traditional rehabilitation methods. This system offers a promising approach for improving postoperative recovery in TKA patients. Trial registration: This study was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University (Ethics Approval Number 202209008-2). It was registered with the China Clinical Trial Registry, a primary registry of the World Health Organization's International Clinical Trials Registry Platform (Registration Number ChiCTR2300068852). [ABSTRACT FROM AUTHOR]

The purpose of this article is to explore the key themes and safety considerations connected to the inter-hospital transfer of critically unwell adults. First, the evidence base surrounding the subject is critically explored and clinical guidelines and national policy are discussed. Second, safety considerations are explored that highlight the risks and challenges associated with the inter-hospital transfer of critically unwell people. [ABSTRACT FROM AUTHOR]

Despite the global vaccination campaigns, certain patient groups remain highly vulnerable to SARS-CoV-2 and are at high risk for unfavorable COVID-19 outcomes. As previously shown by our group and a more recent report by Chang Su and coworkers, patients with multiple myeloma (MM) undergoing autologous stem cell transplantation (ASCT) represent one of such high-risk populations. This is due to the underlying disease-related immunodeficiency, suboptimal response to vaccines, heavy exposure to dexamethasone, and the use of high-dose melphalan prior to the ASCT procedure. Contracting SARS-CoV-2 and developing COVID-19 during the ASCT procedure remain high-risk events for these patients. It is then crucial to maintain and implement all appropriate strategies to prevent COVID-19 breakthroughs in this clinical setting. This might include targeted pre- and post-exposure prophylaxis with monoclonal antibodies, based on the circulation and prevalence of different SARS-CoV-2 variants/subvariants, and the prompt use of antivirals if, despite prophylaxis, MM patients develop COVID-19 during the transplantation procedure. We emphasize the importance of regularly monitoring MM patients for SARS-CoV-2 infection at all stages of the ASCT procedure. This is crucial to promptly implement measures to reduce the risk of unfavorable COVID-19 outcomes during the current post-pandemic phase. [ABSTRACT FROM AUTHOR]

Background: Multidrug-resistant tuberculosis (MDR-TB) presents persistent global health challenges, characterized by low treatment success rates among patients enrolled for treatment. The World Health Organization recommends decentralization to improve outcomes. This study aims to assess predictors of mortality among MDR-TB patients after decentralization of services in Tanzania. This was a retrospective cohort study involving all MDR-TB patients enrolled in treatment in all 31 regions in Tanzania from 2017 to 2019. The overall mortality rate among MDR-TB patients was calculated using the incidence rate. Additionally, independent factors of MDR-TB mortality were determined using multivariable cox proportional hazards models. Results: The study followed 985 patients for a total of 12,929 months. During this time, it found that approximately 12 out of every 1000 patients died each month. Specifically, the death rates were about 18 out of 1000 patients at 6 months, 8 out of 1000 at 12 months, and 7 out of 1000 at 24 months. Patients who had both MDR-TB and HIV, as well as those who were malnourished, had a lower chance of surviving at 6, 12, and 24 months. Malnourished patients had almost three times the risk of dying [adjusted hazard ratio (aHR) 2.96, with a 95% confidence interval (CI) of 2.10–4.19], while those with HIV had nearly double the risk [aHR 1.91, with a 95% CI of 1.37–2.65]. Conclusion: In summary, our study on MDR-TB patient outcomes in Tanzania between 2017 and 2019 reveals a pattern of high mortality rates within the first 6 months of treatment. Furthermore, malnutrition and HIV co-infection were found to be significant predictors of mortality. To decrease mortality, it is crucial to closely monitor patients during the initial 6 months of treatment, especially those who are malnourished or co-infected with HIV, and ensure they receive appropriate and timely care. Additionally, further investigation is needed to find out what may be contributing to possible rise in mortality rate. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Data Sources Eligibility Criteria Results Conclusion Trial Registration Digital interventions such as remote monitoring of symptoms and physiological measurements have the potential to reduce the economic burden of asthma and chronic obstructive pulmonary disease (COPD) but their cost‐effectiveness remains unclear. This systematic review of randomised controlled trials (RCT) aims to assess whether digital health interventions can be cost‐effective in these patients.Systematic review of RCTs. Study quality was assessed using RoB2 tool.Systematic search in three databases: PubMed, Scopus and Web of Science.Studies were eligible if they were RCTs with health economic evaluations assessing participants with asthma and/or COPD and comparing a digital health intervention to standard of care.We included 35 RCTs, of which 21 were related to COPD, 13 to asthma and one to both diseases. Overall, studies assessed four categories of digital health interventions: (i) Electronic patient diaries (n = 4), (ii) real‐time monitoring (n = 19), (iii) teleconsultations (n = 6) and (iv) others (n = 6). Eleven studies performed a full economic evaluation analysis, while 24 studies performed a partial economic analysis. Most studies involving real‐time monitoring or teleconsultations presented economic results in favour of digital health interventions (indicating them to be cost‐effective or less expensive than the standard of care). Mixed results were obtained for electronic patient diaries. In the studies that conducted a full economic analysis, the incremental cost‐effectiveness ratio (ICER) ranged from 3530,93€/QALY and 286,369,28€/QALY. In the studies that conducted a partial economic analysis, the cost differences between the intervention group and the control group ranged from 0,12€ and 85,217,86€. Half studies with low risk of bias concluded that the intervention was economically favourable.Although costs varied based on intervention type, follow‐up period and country, most studies report digital health interventions to be affordable or associated with decreased costs.PROSPERO: CRD42023439195 [ABSTRACT FROM AUTHOR]

Introduction: Video EEG monitoring (VEM) is an important tool for characterizing clinical events suspected as seizures. It is also used for pre-surgical workups in patients with drug-resistant epilepsy (DRE). In-hospital VEM high cost, long admission waiting periods and some other inconveniences led to an interest in home VEM (HVEM). However, because antiseizure medications cannot be reduced at home, HVEM may require longer monitoring. While the economic aspect is one of the main motivations for HVEM, the cost of HVEM lasting several weeks has not been assessed. Methods: We modeled the cost of HVEM for 8 weeks and compared it to the cost of 1-week in-hospital VEM. Additionally, we modeled the per-patient cost for a combination of HVEM and in-hospital VEM, considering that if in a proportion of patients HVEM fails to achieve its goal, they should undergo in-hospital VEM with drug reduction. Results: The average cost of HVEM up to 4–6 weeks of monitoring was lower than that for the 1-week in-hospital VEM. Combining the 3-week HVEM with 1-week in-hospital VEM (if needed) reduced the per-patient cost by 6.6–28.6% as compared to the situation when all the patients with DRE were referred to the in-hospital VEM. Conclusions: A prolonged intermittent HVEM can be cost-effective, especially if the minimal seizure frequency is about one seizure per week. The study findings support directing efforts into clinical trials and technology development. [ABSTRACT FROM AUTHOR]

Biomimetic electronic skins (e‐skins) are widely used in wearables, smart prosthesis and soft robotics. However, multimodal e‐skins, especially those based on hydrogels, face multiple challenges for practical applications, involving multi‐sensing signal mutual interference, low breathability and stretchability. Here, a breathable and stretchable multimodal e‐skin with a multilayer film microstructure is developed to achieve self‐calibrated sensing of any two of three stimuli: strain, temperature, and humidity, with minimal crosstalk. Hydrogel fibers with different shapes are designed for strain and temperature sensing modules, and the hydrogel film is developed as a humidity sensing module. The multimodal e‐skin exhibits impressive sensing performance, including a low strain detection limit (0.03%), strain linearity (R2 = 0.990), high‐temperature sensitivity (1.77%/°C), and a wide humidity detection range (33–98% RH). Interestingly, due to the directional anisotropy in strain sensitivity of different shaped fibers, the e‐skin realizes self‐calibrated detection of strain and temperature in different directions. By introducing porous elastomer encapsulation membranes, the breathability and wearing comfort of the e‐skin are attained, while the high stretchability (100% strain) is maintained. Furthermore, a personalized human‐machine interaction system is created by integrating the e‐skin with a wireless circuit to realize real‐time and wireless gesture recognition, physiological signals monitoring, and smart prosthesis. [ABSTRACT FROM AUTHOR]

The multi-object tracking is a basic computer vision process having a huge class of real-life tools that range from monitoring of medical video to surveillance. The goal of tracking numerous items is to place numerous objects in a scene, handle their identities throughout time, and construct trajectories for analysis. However, this is a complex task, because of certain issues like occlusions, complicated object dynamics, and variations in the appearance of objects. In this research, a new technique named TPRO-based Deep LSTM is developed for tracking multi-object with occlusion handling. Here, the videos are considered as input wherein the extraction of frames is done from each video. Each frame undergoes pre-processing with filtering to eliminate noise from frames. By using a sparse Fuzzy c-Means (FCM) and Local Optimal-Oriented Pattern (LOOP) features, the localization of objects is done. Moreover, the visual and spatial trackings are considered for hybrid tracking. The second derivative model and neighborhood search model are used to perform visual tracking. Then the occlusion handling is performed. Concurrently, with the use of Deep Long Short-Term Memory (Deep LSTM) the spatial tracking is performed and the Taylor Poor Rich Optimization (TPRO) algorithm assigns the weight and bias of the Deep LSTM. The TPRO is obtained by the unification of the Taylor series along with the Poor and Rich Optimization algorithm. By combining visual and spatial tracking, the final tracked output is generated. The devised method achieves a performance with the highest value of 88.9% for Multiple Object Tracking Precision (MOTP), smallest tracking distance (TD) of 4.185, average MOTP of 0.889, average TD of 4.201, and highest tracking number (TN) of 14. [ABSTRACT FROM AUTHOR]

Background: Digital health technologies such as sensor systems are intended to support healthcare staff in providing adequate patient care. In the Department of Palliative Medicine (University Medical Center Freiburg), we developed and implemented a noninvasive, bed-based sensor system in a pilot study. The aim was to detect distress in patients who were no longer able to express themselves by monitoring heart and respiratory rates, vocalizations, and movement measurements. The sensor system was intended to supplement standard care, which generally cannot guarantee constant monitoring. As there is a lack of data on how healthcare professionals experience such a techno-digital innovation, the aim of this study was to explore how the multiprofessional palliative care team who piloted the sensor system perceived its potential benefits and limitations, and how they experienced the broader context of healthcare technology and research in palliative care. Methods: We conducted a qualitative interview study with 20 members of the palliative care team and analyzed the recorded, verbatim transcribed interviews using qualitative content analysis. Results: The sensor system was described as easy to use and as helpful support for patients, care staff, and relatives, especially against the backdrop of demographic change. However, it could not replace human interpretation of stress and subsequent treatment decisions: this remained the expertise of the nursing staff. A potential reduction in personnel was expected to be a risk of a digital monitoring system. The special conditions of research and digital health technologies in an end-of-life context also became clear. Specifically, healthcare staff were open to health technologies if they benefited the patient and were compatible with professional nursing and/or palliative care attitudes. Additionally, a patient-protective attitude and possible interprofessional differences in priorities and the resulting challenges for the team became apparent. Conclusions: A potential digital solution for distress monitoring was considered useful by palliative care practitioners. However, interprofessional differences and compatibility with existing palliative care practices need to be considered before implementing such a system. To increase user acceptability, the perspectives of healthcare professionals should be included in the implementation of technological innovations in palliative care. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer is a preventable cancer; however, decreasing its prevalence requires early detection and treatment strategies that reduce rates of loss to follow-up. This study explores factors associated with loss to follow-up among HPV-positive women after implementation of a new HPV-based screen-and-treat approach for cervical cancer prevention in Iquitos, Peru. Methods: We conducted semi-structured interviews with "obstetras" (i.e., midwives) (n = 15) working in cervical cancer prevention and women (n = 24) who were recorded as lost to follow-up after positive HPV results. We used the Health Care Access Barriers Model to guide analyses. We utilized manifest content analysis to describe barriers to follow-up according to the obstetras and thematic analysis to report themes from the women's perspectives. We also report the steps and time taken to contact women. Results: We found an incomplete and fragmented patient monitoring system. This incomplete system, in conjunction with challenges in contacting some of the women, led to structural barriers for the obstetras when attempting to deliver positive results. Women in this study expressed a desire to receive treatment, however, faced cognitive barriers including a lack of understanding about HPV results and treatment procedures, fear or anxiety about HPV or treatment, and confusion about the follow-up process. Women also reported having important work matters as a barrier and reported frequently using natural medicine. Reported financial barriers were minimal. Conclusion: This study highlights the barriers to follow-up after implementation of a primary-level HPV-based screen-and-treat approach. While some barriers that have previously been associated with loss to follow-up were not as prominently observed in this study (e.g., financial), we emphasize the need for screen-and-treat programs to focus on strategies that can address incomplete registry systems, structural challenges in results delivery, cognitive barriers in understanding results and treatment, and work-related barriers. [ABSTRACT FROM AUTHOR]

ABSTRACT Recent studies have documented plant responses to climate change extensively, particularly to single‐stress exposures. However, critical factors for stress survival, such as sexual differentiation, are not often considered. The dioicous Marchantia polymorpha stands as an evolutionary milestone, potentially preserving ancestral traits from the early colonizers. In this study, we employed proteomic analyses complemented with physiological monitoring to investigate combined heat and drought responses in Tak‐1 (male) and Tak‐2 (female) accessions of this liverwort. Additionally, targeted transcriptomics was conducted using different natural populations from contrasting environments. Our findings revealed sex‐biased dynamics among natural accessions, particularly evident under control conditions and during early stress responses. Although Tak‐2 exhibited greater diversity than Tak‐1 under control conditions, male accession demonstrated distinct and more rapid stress sensing and signaling. These differences in stress response appeared to be strongly related to sex‐specific plasticity influenced by geoclimatic origin. Furthermore, we established distinct protein gene ages and genomic distribution trends, underscoring the importance of protein diversification over time. This study provides an evolutionary perspective on sexual divergence and stress emergence employing a systems biology approach, which allowed for the establishment of global and sex‐specific interaction networks in the stress response. [ABSTRACT FROM AUTHOR]

Traumatic brain injury (TBI)‐induced post‐traumatic epilepsy (PTE) is a serious brain disease that causes the loss of motor functions, cognitive impairments, and even death. Real‐time and long‐term electrophysiological signal monitoring has significant implication for the treatment of patient with TBI. Brain–computer interfaces (BCIs) utilizing flexible electrodes enable accurate epilepsy identification by electrocorticography (ECoG) signal monitoring. In this study, a customized flexible osteoid electrode is developed, which contributes to demands and personal differentiation among patients with TBI. The end product of osteoid electrode after full osseointegration will be a stable and firmly integrated structure within the bone tissue, providing a secure platform for continuous electrophysiological signal monitoring. The flexibility and conductivity of the osteoid electrode enables high‐quality and long‐term epilepsy monitoring. Biocompatibility of the osteoid electrode is also demonstrated by in vitro cell experiments. Simultaneously, the porous osteoid electrode also exhibits osseointegration ability based on potential long‐term ECoG signal monitoring, which suggests its potential for the comprehensive treatment of TBI patients. This work not only introduces a potential therapeutic scaffold for TBI‐related diseases, but also provides promising techniques for clinical ECoG monitoring in patients with TBI. [ABSTRACT FROM AUTHOR]

Background: Tailoring effective strategies for cancer pain management requires a careful analysis of multiple factors that influence pain phenomena and, ultimately, guide the therapy. While there is a wealth of research on automatic pain assessment (APA), its integration with clinical data remains inadequately explored. This study aimed to address the potential correlations between subjective and APA-derived objectives variables in a cohort of cancer patients. Methods: A multidimensional statistical approach was employed. Demographic, clinical, and pain-related variables were examined. Objective measures included electrodermal activity (EDA) and electrocardiogram (ECG) signals. Sensitivity analysis, multiple factorial analysis (MFA), hierarchical clustering on principal components (HCPC), and multivariable regression were used for data analysis. Results: The study analyzed data from 64 cancer patients. MFA revealed correlations between pain intensity, type, Eastern Cooperative Oncology Group Performance status (ECOG), opioids, and metastases. Clustering identified three distinct patient groups based on pain characteristics, treatments, and ECOG. Multivariable regression analysis showed associations between pain intensity, ECOG, type of breakthrough cancer pain, and opioid dosages. The analyses failed to find a correlation between subjective and objective pain variables. Conclusions: The reported pain perception is unrelated to the objective variables of APA. An in-depth investigation of APA is required to understand the variables to be studied, the operational modalities, and above all, strategies for appropriate integration with data obtained from self-reporting. Trial registration: This study is registered with ClinicalTrials.gov, number (NCT04726228), registered 27 January 2021, https://classic.clinicaltrials.gov/ct2/show/NCT04726228?term=nct04726228&draw=2&rank=1 [ABSTRACT FROM AUTHOR]

Background: Longer length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial. Aims: The PRO‐HOME study aimed to assess the efficacy in reducing LOS of a transitional care program involving a multicomponent intervention inside a technologically monitored in‐hospital discharge facility. Methods: This is a Randomized Clinical Trial on 60 patients (≥65 years), deemed stable and dischargeable from the Acute Geriatrics Unit, equally assigned to the Control Group (CG) or Intervention Group (IG). The latter underwent a multicomponent intervention including lifestyle educational program, cognitive and physical training. At baseline, multidimensional frailty according to the Multidimensional Prognostic Index (MPI), and Health‐Related Quality of Life (HRQOL) were assessed in both groups, along with physical capacities for the IG. Enrolled subjects were evaluated after 6 months of follow‐up to assess multidimensional frailty, HRQOL, and re‐hospitalization, institutionalization, and death rates. Results: The IG showed a significant 2‐day reduction in LOS (median days IG = 2 (2–3) vs. CG = 4 (3–6); p < 0.001) and an improvement in multidimensional frailty at 6 months compared to CG (median score IG = 0.25(0.25–0.36) vs. CG = 0.38(0.31–0.45); p = 0.040). No differences were found between the two groups in HRQOL, and re‐hospitalization, institutionalization, and death rates. Discussion: Multidimensional frailty is a reversible condition that can be improved by reduced LOS. Conclusions: The PRO‐HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients. Trial registration: ClinicalTrials.gov n. NCT06227923 (retrospectively registered on 29/01/2024). [ABSTRACT FROM AUTHOR]

A body area network involving wearable sensors distributed around the human body can continuously monitor physiological signals, finding applications in personal healthcare and athletic evaluation. Existing solutions for near-field body area networks, while facilitating reliable and secure interconnection among battery-free sensors, face challenges including limited spectral stability against external interference. Here we demonstrate a textile metamaterial featuring a coaxially-shielded internal structure designed to mitigate interference from extraneous loadings. The metamaterial can be patterned onto clothing to form a scalable, customizable network, enabling communication between near-field reading devices and battery-free sensing nodes placed within the network. Proof of concept demonstration shows the metamaterial's robustness against mechanical deformation and exposure to lossy, conductive saline solutions, underscoring its potential applications in wet environments, particularly in athletic activities involving water or significant perspiration, offering insights for the future development of radio frequency components for a robust body area network at a system level. Near-field body area wearable sensing networks are limited in application due to the low spectral stability against external interference. Here, the authors demonstrate a robust metamaterial-enabled near-field body area network that maintains spectral stability even under lossy and conductive loadings. [ABSTRACT FROM AUTHOR]