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Telehealth intervention involving the HEARTS Technical Package and the additional use of an activity monitor to increase physical activity level post-stroke: Protocol for a feasibility randomized controlled trial
Background Low physical activity level is a common risk factor for recurrent stroke. Feasibility studies show behavior change interventions can increase physical activity participation, but face barriers (e.g., home visits or internet access). Low-cost telehealth approaches, like telephone calls, may overcome these challenges. Another low-cost strategy involves motivational tools supporting “Behavioral Regulation,” such as physical activity monitors. However, evidence is insufficient to support their use in increasing physical activity levels post-stroke. A systematic review suggests integrating these devices into multifaceted behavior change interventions (e.g., the 5As brief intervention outlined in the HEARTS Technical Package) may enhance their effectiveness. Combined with physical activity monitors and telephone follow-up, this approach has proven feasible for individuals post-stroke. These findings underscore the need to explore combining the 5As brief intervention with physical activity monitors to assess potential added benefits. This feasibility randomized controlled trial (RCT) study will investigate whether the telehealth intervention (by telephone call) combining the 5As brief intervention, as outlined in the HEARTS Technical Package, and physical activity monitoring, compared to a control group receiving only the 5As brief intervention, is feasible and supports a fully powered RCT. Methods A feasibility RCT study, with blinded assessment, will assign 24 individuals post-stroke (diagnosed ≥ 6 months), aged ≥ 18 years, inactive, able to walk 10 meters independently, and medically approved for physical activity, to experimental (n = 12) or control group (n = 12). Both groups will undergo the 5As brief intervention (Ask, Advise, Assess, and Assist delivered face-to-face, and Arrange via telephone call follow-up), for 12 weeks, with the experimental group also using a physical activity monitor. Outcomes include feasibility of recruitment, intervention, measurement, and blinding the outcome assessor, cost and clinical outcomes. Discussion The intervention aligns with stroke secondary prevention recommendations and utilizes low-cost telehealth approaches. This study will contribute to defining future RCT phases. Trial registration ClinicalTrials.gov NCT06068036.
Visual outdoor space perception
The impact of corruption on resident entrepreneurship behavior and its mediating effect analysis: An empirical study based on China
This study utilizes data from the 2015 China General Social Survey (CGSS) to investigate the impact of public sector corruption on resident entrepreneurship, including an analysis of heterogeneity among different types of entrepreneurs and the mediating effects of social networks and social trust. The findings reveal that while corruption may exhibit a certain inflection point effect on entrepreneurship, this effect is statistically insignificant due to the relatively low threshold of corruption. Overall, increasing levels of corruption significantly inhibit entrepreneurial choices among residents, particularly affecting “survival-oriented” and “out of system” entrepreneurs compared to “opportunity-oriented” and “within system” entrepreneurs. Furthermore, the study identifies that both objective social networks and subjective social trust serve as significant partial mediators in the relationship between corruption and entrepreneurship. Based on these insights, the paper recommends implementing robust anti-corruption measures, enhancing support for survival-oriented entrepreneurs, and fostering social trust to create a conducive environment for entrepreneurship.
Genetic influence of a STAU2 frameshift mutation and RELN regulatory elements on performance in Icelandic horses
Abstract Selection for performance in horse breeding benefits from precise genetic insights at a molecular level, but knowledge remains limited. This study used whole-genome sequences of 39 elite and non-elite Icelandic horses to identify candidate causal variants linked to previously identified haplotypes in the STAU2 and RELN genes affecting pace and other gaits. A frameshift variant in linkage disequilibrium with the previously identified haplotypes in the STAU2 gene (r2 = 0.85) was identified within a predicted STAU2 transcript. This variant alters the amino acid sequence and introduces a premature stop codon but does not appear harmful or disease-causing and is potentially unique to equine biology. A large portion of the RELN haplotype overlapped with an H3K27me3 modification mark, suggesting a regulatory role of this region. Despite the small sample size, the RELN haplotype’s effects were validated for tölt, trot, and canter/gallop. Additionally, the RELN haplotype significantly influenced the age at which horses were presented for breeding field tests, indicating a potential role of the region in precocity and trainability. Functional experiments are needed to further investigate the regions’ influences on biological processes and their potential impact on horse performance.
Correction: Study of impacts of brickkiln emanations on soil quality of agriculture lands in selected areas of District Bhimber, Azad Jammu and Kashmir, Pakistan
Topological data analysis of pattern formation of human induced pluripotent stem cell colonies
Correction: Student-centered factors influencing inclusion in biomedical majors among first-year undergraduate students
Gut microbiota diversity among humans, elephants, livestock and wild herbivores in Chitwan National Park bears implications for conservation medicine
Common variants in the CPT1A gene are associated with cataracts in Northern breeds of domestic dog
Primary hereditary cataract affects many purebred domestic dog breeds and is a major cause of visual impairment in dogs. Cataracts are common in Northern breeds such as the Siberian Husky, Alaskan Malamute and Samoyed, but their aetiology is currently unknown. Only two genetic loci are known to be causally related to primary hereditary cataracts in the dog. To search for genetic loci associated with cataracts in Northern breeds, we used a genome-wide association study approach in three breeds—Siberian Husky, Alaskan Malamute and Samoyed. Cases were defined as dogs with bilateral posterior polar subcapsular cataracts and controls were at least four years of age with no evidence of cataracts or other ocular abnormality. We found a genome-wide statistical association for cataracts in the Siberian Husky on canine chromosome 18 (P-value: 1.1 x 10 − 7), which was independently replicated in a second larger case-control set (P-value 9.8 x 10 − 29). The Samoyed breed also showed evidence for association in the same genomic region (P-value: 2.4 x 10 − 5). We subsequently used targeted resequencing of the associated region (6.5 Mb) in ten Siberian Huskies and whole genome sequencing of a Husky, Malamute, Samoyed and Norwegian Buhund case to conduct fine-mapping and screen for candidate causal variants. These analyses identified a region of linkage disequilibrium in the four breeds containing common variants in the carnitine palmitoyltransferase 1A (CPT1A) gene that are strongly associated with bilateral posterior polar subcapsular cataracts in the Siberian Husky, Samoyed, Icelandic Sheepdog and Norwegian Buhund and we demonstrate that CPT1A is expressed in the dog lens and retina through RNAseq. Our findings represent a novel locus for cataracts in dogs. However, further work is needed to elucidate the pathophysiology underlying the association between CPT1A and cataracts in Northern breeds.
Introducing an adjustable upper limb prosthesis into a Ugandan clinical service: impacts on free living behaviour and prosthetic use
Abstract Access to prosthetic services in Uganda is poor, negatively impacting people with upper limb difference in function, community participation, and employment. Technologies to improve the efficiency and effectiveness of services are needed, but there is very little evidence of potential solutions. Off-the-shelf, adjustable prosthetic sockets, which can be fitted in minimal time without the complexities associated with traditional socket manufacturing, show promise. We tested the feasibility of introducing the Koalaa ALX, a prosthesis for people with trans-radial limb difference, and a peer-to-peer support system into a Ugandan clinical service. Prosthesis-worn and thigh-worn monitors successfully captured concurrent patterns of wear and free-living physical behaviours (including periods at home and away) at baseline, post-fitting, and six months post-fitting. End-of-study interviews captured participants’ experiences. Four of the eight participants had no previous experience using a prosthesis (new users). The ALX could be easily deployed and supported. All participants wore their ALX, with an increase in wear time among new users at six months. Prosthesis donning and doffing events were associated with behavioural changes (e.g., changes in stepping duration). The interviews revealed good levels of satisfaction, though concerns about access to repairs, cleaning, heat discomfort, and long-term support were noted.
Influences of atmospherics on customer satisfaction and behavioural intentions in the restaurant industry: Evidence from an emerging economy
The emergence of the food service industry is among the most promising sectors that open many great opportunities for its development. Restaurants are also a part of the world’s economy. This is reflected in the increasing demand for high-quality, upscale dining experiences. The restaurant industry is well-positioned for future growth. However, few researchers have explored the impact of restaurant attributes on overall customer satisfaction and behavioural intentions in the context of fine dining restaurants. This study investigates how restaurant attributes influence overall satisfaction and behavioural intentions in an emerging economy such as India. To explore this relationship, we adopted the Stimulus-Organism-Response (SOR) theory proposed by Mehrabian and Russell (1974) [1]. The results show that restaurant attributes can lead to higher customer satisfaction rates, benefiting the industry. Restaurant attributes also play an essential role in creating a positive customer dining experience. Restaurant attributes help provide thoughtful customer service, such as assisting with menu items, remembering customers’ names, or providing helpful suggestions, which can also show customers that they are valued.
A secure and efficient encryption system based on adaptive and machine learning for securing data in fog computing
Correction: Integrating intuitionistic fuzzy and MCDM methods for sustainable energy management in smart factories
Oral microbiome dysbiosis in cryptogenic ischemic stroke patients with high-risk patent foramen ovale
Abstract Patent foramen ovale (PFO) is the most common congenital heart abnormality of foetal origin and has been associated with cryptogenic ischemic stroke (CIS) through several mechanisms, with most theories supporting paradoxical embolism. Other possible but unknown contributing factors, such as the role of the microbiome in PFO-associated strokes, remain unclear. We analysed saliva metagenomes to study the differences in the oral microbiome between young-onset CIS patients with clinically relevant high-risk PFO (n = 52) and those without PFO (n = 52). Age- and sex-matched stroke-free controls (n = 16) with high-risk PFO were included for the comparison. Beta diversity was significantly different between patients and controls with high-risk PFO, but not between patients with and without high-risk PFO. The phylum Ascomycota and class Saccharomycetes were significantly more abundant in patients with high-risk PFO than in those without high-risk PFO. Additionally, the abundance of Lactococcus, including Lactococcus raffinolactis and L. cremoris, was higher in controls with high-risk PFO than in patients with high-risk PFO. These findings highlight that oral dysbiosis and high-risk PFO may form a critical but under-recognized combination in the aetiology of CIS. Future research should focus on elucidating the precise mechanisms of these interactions and developing targeted interventions.
Preparing medical students to incorporate scientific evidence into patient care: A cross-sectional study
Objective To explore teaching- and assessment-related factors that predict medical students’ perceived attainment of sufficient skills to incorporate scientific evidence into patient care. Methods An anonymous questionnaire was distributed to final-semester students in six medical programs in Sweden. The students were asked to rate statements concerning the extent to which 11 national degree outcomes related to the scientific basis of medicine (scholarly degree outcomes) had been adequately assessed during the program; their perceived preparedness for evidence-based patient care; and training during the program regarding the components of a systematic review/health technology assessment (HTA). Results In total, 433 students (median age: 25 years [interquartile range: 24‒28], 59% female) participated in the study (response rate: 68%). A multivariate analysis indicated that experienced adequate assessment on a single scholarly degree outcome (i.e., “Demonstrate knowledge of the scientific foundation of medicine and insight into current research as well as knowledge of the link between science and proven experience”) predicted the students’ perception of having developed sufficient skills in incorporating scientific evidence into patient care (odds ratio: 6.17 [95% confidence interval: 3.10; 12.3]). The educational content predictors of this perception included the teaching of HTA (11.3 [1.44; 89.5]) and training regarding two components of a systematic review/HTA: appraising scientific articles using checklists (2.46 [1.23; 4.90]) and assessing organizational aspects related to the introduction/withdrawal of a health technology (2.65 [1.05; 6.67]). The presence of hands-on, credit-bearing, evidence-based medicine (EBM)-related learning activities during clinical courses was also predictive (4.68 [1.69; 13.0]). Conclusions This study highlights important educational activities that prepare medical students to incorporate scientific evidence into patient care: (i) adequate assessment of key content regarding scholarly outcomes, including the scientific foundation of medicine; (ii) learning activities about HTA and the systematic review process; and (iii) hands-on application of EBM-related learning activities integrated into clinical courses.
High-efficiency water use and process performance for bioproduction of trans-cinnamic acid
Growth faltering or deceleration toward target height: Linear growth interpretation using WHO growth standard 2006 for Indonesian children
Objective When referred to the WHO Growth Standards 2006, children in many developing countries showed growth faltering in childhood. A previous study showed that the faltering affected the whole population, not only the disadvantaged ones. We aimed to look for an alternative explanation for this universal decline in length or height-for-age z-scores (HAZ), as lengths/ heights of Indonesian children were compared to the WHO growth standard 2006: Is it a faltering of growth or is it a deceleration toward target height. Methods We used data on age, gender, height, BMI, parental height and education, household socioeconomic status, and place of residence of children < 5 years old collected by the Indonesia Family Life Survey (IFLS) in 1993, 2000, 2007, and 2014. HAZ was calculated according to the WHO 2006 growth standard. Target heights were calculated from parental heights and converted to target height z-scores (THz). Discrepancies between the two values were used to show the children’s growth patterns in relation to their target heights across ages. Results The study included 11,241 parent-child pairs from four surveys. At birth, infants were around 1.50 z-scores longer than their THz. However, at two years of age, the discrepancies were almost zero. At 2–5 years old, the discrepancies stayed at the same level. The patterns were similar regardless of the position of the target heights among the height distribution, at the upper or the lower part. Conclusion We observed a deceleration toward target height, not growth faltering, in the first two years of life of Indonesian children when the WHO Growth Standard 2006 was used as the reference.
Metagenomic evaluation, antimicrobial activities, and immune stimulation of probiotics from dietary supplements and dairy products
Abstract Probiotics are widely marketed as dietary supplements and dairy products for their purported antimicrobial and immunomodulatory activities, often with limited supporting evidence. We identified and isolated probiotics from commercial dietary supplements and dairy products using metagenomics and cultured-based methods. We assessed their anti-bacterial activity against diverse pathogens and investigated their immunomodulatory effects on phagocytes and natural killer (NK) cells. Metagenomic analysis revealed that Lactobacillus and Bifidobacterium were the predominant genera in dietary supplements, while Streptococcus spp. was dominated in dairy products. However, only 37% of the predominant microorganisms identified by metagenomics were accurately listed on product labels. Among 70 representative probiotic strains, 4.3–17.1% probiotic strains demonstrated strong antibacterial-effects against pathogenic bacteria. Notably, specific strains of Bifidobacterium longum and Lactobacillus plantarum exhibited strong antagonistic activity against extended-spectrum beta-lactamase-producing and carbapenem-resistant Escherichia coli. Some strains of Lactobacillus spp. significantly enhanced phagocytic activity in monocytes and increased IFN-γ production in NK cells, while members of Lactobacillus rhamnosus significantly suppressed TNF-α, IL-6, and IL-8 production in lipopolysaccharide-stimulated macrophages. In contrast, Bifidobacterium animalis stimulated the production of anti-inflammatory cytokines. This study highlights discrepancies in probiotic labeling and demonstrates the antimicrobial and immunomodulatory potential of specific probiotic strains, suggesting their utility in enhancing health and wellness.
Domain generalization for image classification based on simplified self ensemble learning
Domain generalization seeks to acquire knowledge from limited source data and apply it to an unknown target domain. Current approaches primarily tackle this challenge by attempting to eliminate the differences between domains. However, as cross-domain data evolves, the discrepancies between domains grow increasingly intricate and difficult to manage, rendering effective knowledge transfer across multiple domains a persistent challenge. While existing methods concentrate on minimizing domain discrepancies, they frequently encounter difficulties in maintaining effectiveness when confronted with high data complexity. In this paper, we present an approach that transcends merely eliminating domain discrepancies by enhancing the model’s adaptability to improve its performance in unseen domains. Specifically, we frame the problem as an optimization process with the objective of minimizing a weighted loss function that balances cross-domain discrepancies and sample complexity. Our proposed self-ensemble learning framework, which utilizes a single feature extractor, simplifies this process by alternately training multiple classifiers with shared feature extractors. The introduction of focal loss and complex sample loss weight further fine-tunes the model’s sensitivity to hard-to-learn instances, enhancing generalization to difficult samples. Finally, a dynamic loss adaptive weighted voting strategy ensures more accurate predictions across diverse domains. Experimental results on three public benchmark datasets (OfficeHome, PACS, and VLCS) demonstrate that our proposed algorithm achieves an improvement of up to 3 . 38% over existing methods in terms of generalization performance, particularly in complex and diverse real-world scenarios, such as autonomous driving and medical image analysis. These results highlight the practical utility of our approach in environments where cross-domain generalization is crucial for system reliability and safety.