Browse Articles

Estimation of the demand for palliative care in a hospital in southern Peru

Objective To estimate the need for palliative care in deceased patients at the Daniel Alcides Carrión Hospital (Tacna, Peru) during 2023. Methodology An analytical cross-sectional study was conducted with data from adult patients who died in a Peruvian hospital in 2023. Data were collected through the review of death certificates and medical records using the EsSalud Intelligent Health Service. Two methods were used to estimate the need for palliative care: the Rosenwax method (medium estimation) and the Murtagh method (medium-high estimation). Results Out of 255 deaths, 239 were analyzed. The median age was 76 years. 58.2% had two or more comorbidities, and only 3.8% had received palliative care previously. According to the Murtagh method, 82.9% of the patients required palliative care, while the Rosenwax method estimated a need of 74.1%. The most common diagnoses requiring palliative care were: neoplasms (33.5%), chronic obstructive pulmonary disease (15.1%), and renal disease (11.3%). An association was found between having two or more comorbidities and a greater need for palliative care. Conclusion It was found that between 7 and 8 out of every 10 patients needed palliative care, an estimate higher than in other regions. Additionally, having two or more comorbidities was associated with the need for these services. These findings highlight the urgent need for palliative care services in Peru, suggesting that their proper implementation is crucial for improving end-of-life care.

A hybrid approach with metaheuristic optimization and random forest in improving heart disease prediction

Abstract Cardiovascular diseases (CVD)  a major cause of morbidity and mortality among the world’s non-communicable disease incidences. Though these practices are in use for diagnostics of different CVDs in clinical settings, need improvement because they are solving the purpose of only 57% of the patients in emergency. Due to this cost of diagnosis for heart disease is increasing which is the reason for analyzing heart disease and predicting it as early as possible. The main motive of this paper is to find an intelligent method for predicting disease effectively by means of machine learning (ML) and metaheuristic algorithms. Optimization techniques have the merit of handling non-linear complex problems. In this paper, an efficient ML model along with metaheuristic optimization techniques is evaluated for heart disease dataset to enhance the accuracy in predicting the disease. This will help to reduce the death rate due to the severity of heart disease. The SelectKBest feature selection is applied to the Cleveland Heart dataset and overall rank is obtained. Accuracy is measured. The optimization techniques namely Genetic Algorithm Optimized Random Forest (GAORF), Particle Swarm Optimized Random Forest (PSORF), and Ant Colony Optimized Random Forest (ACORF) are applied to the Cleveland dataset. Classification algorithms are performed before and after optimization. The output of the experiment explains that the GAORF performed better for the dataset considered. Also, a comparison is made along with the SelectKBest filter methods. The proposed model achieved better accuracy which is the maximum among other optimization and classification techniques.

Correction: An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire

Ferulic acid lipid nano capsules versus its native form in alleviating diabetic nephropathy induced in rats through TGF-β1/Hippo pathway crosstalk modulation

Abstract Diabetic nephropathy is one of the most common leading causes of end-stage renal disease with multifactorial pathophysiological mechanisms. TGF-β1 and Hippo pathway have been reported to have significant role in different kidney diseases. In addition, ferulic acid (FA) has been proposed to have pharmacological actions in different disorders such as Alzheimer, diabetes mellitus, kidney, and cardiovascular diseases but with limited oral use due to poor absorbance and bioavailability. So, recent trends aim to include FA in nano-formulations to improve its absorbance and bioavailability and to make best use of its pharmacological actions when administered orally. Thirty Sprague Dawley male rats were divided into five groups (n = 6). After 28 days, rats were sacrificed, serum and kidney tissue were isolated, histopathological examination, serum creatinine level and oxidative status biomarkers in kidney tissue were estimated, besides ELISA measurements of TGF-β1, PTEN, COX2, and GLUT3 and the relative gene expressions of MST1 and TEAD4 by qRT-PCR. Treated groups show improvement of the investigated parameters in variable degrees. Noteworthy, FA nano-formulation shows superior action over double of the native form.

Tissue of origin characterization of cell free DNA in seminal plasma: Implications for new liquid biopsies

Liquid biopsies are becoming increasingly used for the detection and monitoring of disease states. While cell free DNA (cfDNA) in blood and urine have been well studied, much less is known about the composition of cfDNA in seminal fluid. We sought to characterize cfDNA in seminal fluid through tissue of origin studies using methylation analysis in men aged 21–60 yrs. We confirmed the observations of others that seminal fluid contains an abundance of cfDNA that is both nucleosomal and > 1 kb. However, here we demonstrate for the first time that the high molecular weight (HMW) DNA harbors a lower sperm signal and higher somatic cell signal compared to the nucleosomal fraction. Prostate, granulocytes and kidney showed a mean predicted increased contribution of 6.2%, 4.9% and 2.9%, respectively in the HMW fraction. While sperm was the predominant signal in most men without vasectomies, granulocyte cfDNA made up most of the signal in two of the non-vasectomy subjects. Unexpectedly, the proportion of prostate signal reached as high as 26.5% in the HMW fraction in non-vasectomy subjects. We also observed subject-specific cfDNA size distribution patterns that were reproducible over time, irrespective of abstinence times. These results suggest that seminal fluid is a rich source of cfDNA from various somatic cell types, and enriching for the HMW fraction would yield even higher sensitivity for somatic cfDNA detection. Considering these novel findings, it appears that seminal fluid may be able to serve as liquid biopsy for the detection and monitoring of prostate cancer, benign prostate hyperplasia, prostatitis and infertility.

Quantitative and qualitative condylar changes Post-Stabilization splint in patients with temporomandibular disorder and chewing side preference

Modeling the behavior of a generalized Cholera epidemic model with asymptomatic measures for early detection

To understand how a disease spreads through a society, mathematical formulations are a crucial tool for comprehending the complete dynamics of cholera. Model formulations are essential for thoroughly understanding the propagation of cholera throughout a population. For an assessment of the stable state of a newly established SEIRB system, both qualitative and quantitative evaluations are conducted. The reproductive number is derived to observe the infection spread rate among patients. Additionally, sensitivity analyses are performed to assess the impact of each parameter and to determine the rate of change in each. The existence of positive solutions with linear growth has been verified using global derivatives, and the level of effect in each subsection is determined through the application of Lipschitz criteria. By employing Lyapunov’s first derivative of the function, the framework is analyzed for global stability to evaluate the overall effect of both symptomatic and asymptomatic measures following early detection interventions. The Mittag-Leff1er kernel is utilized to obtain a robust solution via a fractal-fractional operator, enabling continuous monitoring for improved control measures. Simulations are performed to assess the global impact of both symptomatic and asymptomatic consequences of cholera and to observe the actual behavior of the disease. It has been confirmed that individuals with strong immune systems will recover efficiently if the infection is diagnosed early through timely detection measures. This analysis provides insight into the current state of cholera control, comparing outcomes for those receiving treatment and those whose robust immune systems negate the need for medication. Such investigations will enhance our understanding of disease transmission and support the development of effective control strategies based on our validated findings.

Race and gender biases persist in public perceptions of scientists’ credibility

Use of healthcare administrative claims data in observational studies of antirheumatic drug effects on pregnancy outcomes: A scoping review

The safety of antirheumatic drugs in pregnancy and their impact on maternal and neonatal outcomes are understudied. Despite pregnant individuals being excluded from clinical trials, their continued use of medications raises the importance of addressing knowledge gaps regarding safety and impact on outcomes. A scoping review was conducted following JBI methodology and PRISMA reporting guidelines to describe how antirheumatic drugs and associated adverse pregnancy outcomes have been investigated in observational studies using claims data. Electronic databases (MEDLINE (Ovid), Embase (Ovid), and CINAHL (EBSCO)) and grey literature were searched for observational studies using claims data to evaluate antirheumatic drug effects on pregnancy outcomes in individuals with rheumatic diseases. Of 4,325 articles identified, 38 eligible articles were included. The effects of conventional synthetic disease-modifying antirheumatic drugs (n =  37, 97.4%) and tumor necrosis factor inhibitor biological agents (n =  23, 60.5%) were extensively reported. Preterm birth (n =  25, 65.8%), preeclampsia (n =  17, 44.7%), stillbirth (n =  17, 44.7%), caesarean delivery (n =  16, 42.1%), and congenital anomalies (n =  14, 36.8%) were the most reported adverse pregnancy outcomes. Of 14 studies reporting congenital anomalies, 12 (85.7%) specified ICD codes and 4 (28.6%) specified validated definitions for identification in claims data, the most of any reported adverse pregnancy outcome. We found considerable ambiguity and heterogeneity in adverse pregnancy outcome definitions in claims data. There is a need for greater transparency and consistency in outcome reporting in observational studies using claims data. Protocol registration details: OSF, https://osf.io/5e6tp

Multilevel analysis of determinants of cattle deaths in Ethiopia

In Ethiopia, agriculture is a fundamental element of both the economy and the social fabric of the community. The sector employs 80-85 percent of the population and contributes 47% to the total GDP. Livestock contributes to people’s livelihoods through numerous channels: income, food, employment, transport, draft-over, manure, savings and insurance, social status, etc. Ethiopia is believed to have the largest livestock population in Africa. Despite this productive and reproductive performance is accompanied by poor health care, high disease incidence, poor management conditions, and unpredictable climactic conditions causing a significant cause of cattle death. The dependent variable is the count “number of occurrences of cattle death” that occurs randomly over time. A multilevel analysis was carried out with the anticipation that there would be variations in the number of cattle deaths per household throughout the region. Before analyzing the data with a multilevel method, check the variability using intra-class correlation (ICC), revealing that 14.6% of the variance in cattle deaths is attributable to the grouping level (Region) indicating the heterogeneity of cattle deaths between Regions. The multilevel ZINB regression model was identified as the best fit for analyzing cattle deaths per household. Factors such as types of agriculture, feeding areas, treatment methods, vaccination status, household land size, age of the household head, household size, and education level were found to significantly impact cattle mortality in the positive count portion of the random-intercept ZINB regression model. The Ministry of Agriculture should effectively raise awareness among agricultural producers regarding cattle vaccination and enhance the veterinary services available in the country. It is also advisable to promote a mixed farming approach rather than solely focusing on livestock farming to reduce cattle deaths. Farmers should consider reducing their household size and place greater emphasis on the welfare of their cattle.

The transition to an activity-based workplace: Experiences of managers and employees from a sense of coherence perspective in public sector workplaces

Background The Activity-Based Workplace (ABW) is an increasingly popular office design that aims to facilitate new ways of working. Research focusing on the effects of ABWs on various outcomes is growing but there is a lack of studies looking at how managers and employees perceive the transition to ABWs from a salutogenic health-promotion perspective. This study aims to explore how managers and employees experienced a transition period to ABWs through the lens of a sense of coherence. Methods A qualitative design was applied through semi-structured interviews with six managers and focus group interviews with nine employees working in the public sector in Sweden. A content analysis of the interviews was conducted using Aaron Antonovsky’s sense of coherence concept, with the three main aspects of comprehensibility, meaningfulness and manageability acting as a theoretical framework for the analysis. Results Six sub-categories within the three main SOC categories were identified in the material and considered important to the participants during their transition to the ABW. The sub-categories were divided into facilitating factors and barriers to obtaining a sense of coherence. The identified factors were: information and preparation, clear rules, adaptability, leadership, social relations and health and well-being. Conclusions The analysis showed that the managers and employees were exposed to factors which may have acted as both facilitators and barriers to a sense of coherence during the transition to the ABW. When implementing ABWs, consideration must be given to the facilitators and barriers identified in this study during the transition process. The sense of coherence framework appears valuable for gaining a deeper knowledge of managers’ and employees’ experiences during the transition to ABW.

Enhancing hydrodynamic efficiency in Autonomous Underwater Vehicles (AUVs) utilizing adjoint method and proper orthogonal decomposition

In recent years, there has been a significant need for high-performing and efficient Autonomous Underwater Vehicles (AUVs). This is primarily because of their use in offshore mineral exploitation and oceanographic research. While there have been notable breakthroughs in applying the adjoint technique to optimize air and land vehicles, there is still a deficiency in optimizing AUVs using the adjoint method. The present research explores how to improve the hydrodynamic efficiency of an AUV using the gradient-based adjoint technique and Proper Orthogonal Decomposition (POD). This study especially tries to minimize drag forces on the entire AUV by exclusively employing the adjoint approach on the AUV’s wing. The simulation was conducted using computational fluid dynamics methodology utilizing the Reynolds-averaged Navier–Stokes (RANS) model, with velocities ranging from 0.5 m/s to 2 m/s. Numerical computations demonstrated significant reductions in drag force, with the most advantageous improvements obtained when the wing geometry was altered by 9%. More precisely, the optimization resulted in a 9% drop in drag force at a speed of 1 m/s, going from 98.91 N to 90.17 N. By traveling at a speed of 2 m/s, a significant 17% reduction in drag force was achieved, reducing it from 386.34 N to 320.90 N. This signifies a substantial improvement of 20.25% in power consumption. The POD technique was employed to determine the dominant modes in the flow field, resulting in improved simulations and a better comprehension of flow patterns.

Device-aided therapies (DATs) in Parkinson’s disease (PD). The DATs-PD GETM Spanish Registry Protocol Study

Background and objective Device-aided therapies (DATs) are treatments indicated for people with Parkinson´s disease (PwP) experiencing clinical fluctuations that remain suboptimal despite conventional medication. New DATs have recently emerged such as levodopa-entacapone-carbidopa intestinal gel infusion (LECIG) and subcutaneous infusion of foslevodopa/foscarbidopa (fLD/fCD). Understanding the differences between various DATs is essential. Patients and Methods We present here the protocol study of the DATs-PD GETM Spanish Registry. This is a descriptive, observational, prospective, multicenter, open study that is proposed as a clinical registry with progressive inclusion of PwP treated with a DAT in daily clinical practice conditions in more 40 centers from Spain for 10 years. The principal aim is to know the type of DAT that PwP in our country (Spain) receive. Specific objectives are to compare the clinical characteristics of the patients, the effectiveness, safety and tolerability, to identify predictors of a good response and to analyze the response by groups (gender, disease duration, phenotype, etc.). There is a baseline visit (V1; indication of the therapy), start visit (V2; initiation of the therapy) and follow-up visits at 6 months ±  3 months (V3_6M) and after this annually ±  3 months for 10 years (V3_12M, V3_24M, etc.). Results The registry is on going. The first patient was included on April 10, 2024. Patient recruitment and follow-up will be conducted until 31/DEC/2033. It is estimated that the registry will include a minimum of 3,000 patients. Conclusion The present study will help improve the care of PD patients treated with a DAT.

Model interpretability on private-safe oriented student dropout prediction

Student dropout is a significant social issue with extensive implications for individuals and society, including reduced employability and economic downturns, which, in turn, drastically influence social sustainable development. Identifying students at high risk of dropping out is a major challenge for sustainable education. While existing machine learning and deep learning models can effectively predict dropout risks, they often rely on real student data, raising ethical concerns and the risk of information leakage. Additionally, the poor interpretability of these models complicates their use in educational management, as it is difficult to justify identifying a student as high-risk based on an opaque model. To address these two issues, we introduced for the first time a modified Preprocessed Kernel Inducing Points data distillation technique (PP-KIPDD), specializing in distilling tabular structured dataset, and innovatively employed the PP-KIPDD to reconstruct new samples that serve as qualified training sets simulating student information distributions, thereby preventing student privacy information leakage, which showed better performance and efficiency compared to traditional data synthesis techniques such as the Conditional Generative Adversarial Networks. Furthermore, we empower the classifiers credibility by enhancing model interpretability utilized SHAP (SHapley Additive exPlanations) values and elucidated the significance of selected features from an educational management perspective. With well-explained features from both quantitative and qualitative aspects, our approach enhances the feasibility and reasonableness of dropout predictions using machine learning techniques. We believe our approach represents a novel end-to-end framework of artificial intelligence application in the field of sustainable education management from the view of decision-makers, as it addresses privacy leakage protection and enhances model credibility for practical management implementations.

Identification and control of booming noise of thin-walled metal plates of commercial vehicle body subjected to high-speed airflow

The thin walled metal plates (TWMP) on top of a commercial vehicle body are easy to produce vibration and booming noise under the action of high-speed airflow, which reduces the sound quality inside the vehicle. Therefore, the effective control of the noise of TWMP is very important for vehicle comfort performance. Based on experimental, finite element, dynamic and fluid techniques, a method for identification, analysis and optimization of TWMP booming noise under high-speed airflow is proposed in this paper. The problem frequency, the noise source and the cause of booming noise inside the vehicle are identified by amplitude-frequency characteristics analysis and modal analysis. By establishing the dynamic model of damping patch, the matching method of damping patch is proposed. The simulation results are in good agreement with the experimental results, which shows that the method is correct. And the damping coefficient, attachment position and attachment area of the damping plate can be analyzed quickly and accurately by using the method, and the vibration and noise of TWMP can be reduced obviously.

Study of heterogeneity in immune responses to exposure in breast cancer: A protocol for a systematic review

Background Radiation is a treatment modality of interest in both palliative and curative settings for patients with breast cancer (BC). Despite many advances in radiation oncology, anti-radiation resistance remains a problem in mechanistic aspects. Studies show that immune cells respond to radiation in a heterogeneous manner and suggest the determinant role of these responses in the ultimate clinical classification of patients with BC as anti-radiation resistant/sensitive. Objective A systematic review of in vivo and in vitro studies will be defined here to assess the radiation response of immune cells in BC comprehensively. Methods/design A systematic search for in vivo and in vitro studies will collect studies that compare the radiation alone-treated and control (untreated or sham) subjects, as well as subjects treated with radiation in combination and subjects treated with radiation alone. The primary outcome of interest will be measures of the abundance of immune cell subsets. The secondary outcomes will include measures derived from co-culture assays leading to immunoregulatory roles or mechanisms proposed for the potential cross-talks between immune-BC cells that will be influenced by radiation. The review results will be primarily synthesized in a narrative and qualitative manner. Meta-analysis will be considered if there are three or more observations with data available for a specific outcome. We will use the SYRCLE “Risk of Bias” assessment tool for appraising the risk of bias in preclinical in vivo studies, and given the lack of standardized instruments for in vitro studies, we will design a checklist suitable for our specific in vitro research questions and publish it along with our systematic review.

Fluorometric combination analysis of conformational changes in urea-induced unfolding of soybean protein isolates and their complexes with casein

Soybean proteins isolates (SPIs) could misfold to form amorphous aggregates after unfolding due to processing conditions, leading to a decrease in their solubility, and casein might be able to block the formation of amorphous aggregates. The turbidity curves showed that SPIs/7S/11S could maintain a soluble state in the presence of casein. The folding and unfolding processes of SPIs are not a single-step event. Fluorescence phase diagram method was utilized to analyze the unfolding process of SPIs and SPI-casein complexes. The results showed that there was one intermediate (molten globule, MG) in the unfolding process of SPIs, while there were two intermediates (dimer or trimer intermediates and MG) in that of SPI-casein complexes. Further attempts were made to explain the conformational changes of SPIs when binding with casein. The surface hydrophobicity index indicated that the intermediate with strong hydrophobicity was exposed when induced by 2 mol/L urea. The fluorescence quenching experiments using KI as a quencher showed that the Ksv of SPIs and 11S and their complexes with casein all reached peak values when urea concentration was 2 mol/L, while Ksv values of 7S and 7S–casein complex peaked at urea concentration 8mol/L and 6mol/L, respectively. Besides, Ksv and fm changing trends of 7S–casein complex was similar to that of SPIs–casein. Based on the above results, it could be inferred that the interactions between SPIs and casein mainly occurs in 7S. The molecular docking of 7S chains from SPIs and casein showed that SPIs could form a “pocket” conformation to “hold” the casein chain. These findings provide new perspectives for understanding the mechanism of interaction between soy proteins and casein, and may provide a basis for research on the functionality of proteins in the food industry. Note: Ksv is the quenching constant of the quenching agent, and fm is the quenching rate.

Effects of preoperative topical levofloxacin on conjunctival microbiome in patients undergoing intravitreal injections

Purpose Endophthalmitis is a serious eye infection that can occur after intravitreal injections. Topical antibiotics are frequently used as a preventative measure, but their impact on the conjunctival microbiome is not fully understood. Methods Conjunctival swabs were collected from 33 eyes of 33 patients undergoing intravitreal injections, both before and after a 3-day course of prophylactic topical levofloxacin 0.5%. Conjunctival microbiome analysis was conducted using 16S rRNA sequencing on the Illumina MiSeq platform. Bioinformatics processing identified unique amplicon sequence variants (ASVs) to evaluate microbial diversity and community composition. Alpha and beta diversity indices were analyzed. Results Topical levofloxacin treatment resulted in no significant change in alpha diversity indices, including Shannon index, Chao1, Shannon, PD whole tree, and observed ASVs, indicating stable microbial richness and evenness. In contrast, beta diversity analysis, assessed through Bray-Curtis dissimilarity, revealed significant differences in microbial composition between pre- and post-treatment samples. These changes included a decrease in the abundance of Staphylococcus and Bacillus species and an increase in the abundance of Streptococcus, Haemophilus, and Neisseria. Conclusion Although prophylactic topical levofloxacin was found to alter the conjunctival microbiome and showed inconsistent effects on the abundance of pathogenic bacteria, its clinical effectiveness as a preventative measure against endophthalmitis remains inconclusive. Further studies are needed to clarify its role in infection prevention.

Virtual reality-based training for radiopharmaceutical administration: development and educational effectiveness

In Japan, task shifting and sharing are promoted to reduce the workload of physicians. Radiological technologists have been assigned new responsibilities, such as securing venous access for radiopharmaceutical administration. This study aimed to develop a prototype Virtual Reality (VR) training system that allows safe and repeatable training for radiological technologists. Additionally, the educational effectiveness of VR training was evaluated, and the concentration levels of the participants were assessed using multiple physiological indicators. Overall, 17 male and 12 female participants (mean age 20.1 ±  0.9 years) were enrolled in this study and classified into two groups—video-based and immersive VR system groups—both of which simulated radiopharmaceutical administration. Concentration and tension levels were evaluated using electroencephalography (EEG) data, salivary amylase levels, and mood assessments. The educational effectiveness was evaluated using a multiple-choice cognitive test. Compared with the resting levels, the alpha/beta ratio of EEG (indicating relaxed concentration) was significantly decreased by 19% in the video-based VR and increased by 40% in the immersive VR groups (both p < 0.05). No significant difference was observed in salivary amylase levels between the two groups. The cognitive test scores, increased by 2.0 and 3.4 points in the video-based VR and immersive VR groups, respectively; a significant difference was observed between both groups (p <  0.05). However, no correlation was found between the EEG ratio and test performance. Thus, immersive VR promotes a more relaxed and concentrated state and was found to have higher educational effectiveness than video-based VR. This suggests that participatory VR training may be more effective than observational VR training. Further research should explore the relationship between educational effectiveness and the evaluation of medical skills.

Single-cell sequencing uncovers a high ESM1-expression endothelial cell subpopulation associated with bladder cancer progression and the immunosuppressive microenvironment