Browse Articles

The risk of malnutrition as a predictor of arrhythmia recurrence after catheter ablation in patients with paroxysmal non-valvular atrial Fibrillation and heart failure with preserved ejection fraction

Background Malnutrition presents a significant challenge in managing patients with atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF), yet its impact on AF recurrence after catheter ablation in this population remains unclear. Methods We conducted a retrospective analysis of 204 patients with paroxysmal non-valvular AF and HFpEF who underwent radiofrequency or cryoballoon ablation. Risk of malnutrition as assessed using three screening tools: the Controlling Nutritional Status (CONUT) score, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)]. We examined the relationship between risk of malnutrition and AF recurrence post-ablation. Results After a mean follow-up period of 11.2 ±  1.8 months, 43 patients (21.1%) experienced AF recurrence. Despite being classified as overweight or obese based on body mass index, many patients were at risk of malnutrition according to the CONUT score, NRI, and PNI. Adjusted analyses showed that higher CONUT scores (HR: 10.132; 95% CI: 2.545–40.336; P =  0.001), lower NRI (HR: 22.734; 95% CI: 6.399–80.776; P <  0.001), or lower PNI (HR: 9.469; 95% CI: 3.232–27.739; P <  0.001) were significantly associated with increased risk of AF recurrence. Restricted cubic spline regression revealed an inverted U-shaped relationship between the CONUT score and AF recurrence, and L-shaped relationships for both NRI and PNI with AF recurrence. Conclusions Systematic nutritional assessment is crucial in patients with paroxysmal non-valvular AF and HFpEF. High CONUT scores, low NRI, or low PNI serve as independent predictors for AF recurrence. Further large-scale randomized controlled trials are required to validate these findings.

Similarity and quality metrics for MR image-to-image translation

Abstract Image-to-image translation can create large impact in medical imaging, as images can be synthetically transformed to other modalities, sequence types, higher resolutions or lower noise levels. To ensure patient safety, these methods should be validated by human readers, which requires a considerable amount of time and costs. Quantitative metrics can effectively complement such studies and provide reproducible and objective assessment of synthetic images. If a reference is available, the similarity of MR images is frequently evaluated by SSIM and PSNR metrics, even though these metrics are not or too sensitive regarding specific distortions. When reference images to compare with are not available, non-reference quality metrics can reliably detect specific distortions, such as blurriness. To provide an overview on distortion sensitivity, we quantitatively analyze 11 similarity (reference) and 12 quality (non-reference) metrics for assessing synthetic images. We additionally include a metric on a downstream segmentation task. We investigate the sensitivity regarding 11 kinds of distortions and typical MR artifacts, and analyze the influence of different normalization methods on each metric and distortion. Finally, we derive recommendations for effective usage of the analyzed similarity and quality metrics for evaluation of image-to-image translation models.

A data pipeline for secure extraction and sharing of social determinants of health

Objectives Linking neighborhood- and patient-level data provides valuable information about the influence of upstream social determinants of health (SDOH). However, sharing of these data across health systems presents challenges. We set out to develop a pipeline to acquire, deidentify, and share neighborhood-level SDOH data across multiple health systems. Methods We created a pipeline centered around Decentralized Geomarker Assessment for Multi-Site Studies (DeGAUSS) that utilizes containerization to geocode patient addresses and obtain neighborhood-level SDOH variables. We compared DeGAUSS to a third-party vendor geocoding tool available at Duke Health using a cohort of adult patients referred for abdominal transplant from January 1, 2016, to December 31, 2022. We calculated Cohen’s Kappa and percent disagreement at census block group and tract levels, and by Area Deprivation Index, urbanicity, and year. Results The pipeline successfully generated SDOH data for 97.8% of addresses. There was high concordance between DeGAUSS and the vendor tool at the census block group (0.93) and tract levels (0.95). At the block group level, disagreement proportion differed by year and urbanicity, with larger disagreement in the rural category than in micropolitan and metropolitan categories (13%, 7%, 6.2%, respectively). Discussion and conclusion We describe a novel pipeline that can facilitate the secure acquisition and sharing of neighborhood-level SDOH without sharing PHI. The pipeline can be scaled to include additional social, climate, and environmental variables, and can be extended to an unlimited number of health systems.

The effect of muscle energy technique on pain, kinesiophobia, and quality of life in patients with COPD with chronic pain

Development of a mental health-related structural stigma measurement framework in the healthcare system setting: A modified Delphi study

Introduction There is a worldwide dearth in literature on the nature, causes, and consequences of structural stigma in mental healthcare. This study aimed to address this gap by exploring key components for measuring structural stigma in healthcare system settings. Methods We used a modified Delphi method consisting of 3 rounds with global experts (stigma researchers, persons with lived experiences of mental health conditions (PWLEs), and policymakers). In the first round, indicators identified through a literature review (n = 39 studies) were appraised through expert consultation workshops with 22 panellists, including 54.5% women, 41% PWLEs, and 68.2% from low-and-middle income countries (LMICs). Round 2 (n = 53 panellists; 51% women, 8.3% PWLEs, and 56.6% from LMICs) involved ranking indicators through an online survey, and Round 3 (n = 58 panellists; 46% women, 21.7% PWLEs, and 60.4% from LMICs) involved re-ranking the results from Round 2. Smith’s salience index was calculated to measure consensus and Kendall’s coefficient of concordance to determine the degree of agreement. Narrative opinions and feedback from panellists during all three Delphi rounds were also sought. Results A list of indicators within five core measurement domains was identified in Round 1. Round 2 results were heterogeneous as indicated by the low to moderate salience of most indicators. Round 3 resulted in 4–5 indicators in each domain, that were ranked as highly salient by the expert panellists. Experts also provided narrative feedback on the definition of structural stigma, barriers to its measurement, domain-specific comments, and indicators-specific comments. Conclusion The framework aids in defining mental health-related structural stigma in healthcare and framing it in terms of inequities within healthcare system structures. These structures result in negative experiences of PWLEs and limit their access to quality healthcare. This conceptualization, informed by PWLE and stakeholders in LMICs, makes it easier to measure structural stigma and monitor changes in diverse healthcare settings around the world.

Assessing the association between household air pollution exposure and child heath in Mongolia: a birth-cohort study

Abstract Children in Mongolia are exposed to harmful levels of household air pollution (HAP) due to a high reliance on coal for indoor cooking and heating. This study aims to assess the association between HAP and child health outcomes, in a birth cohort from Ulaanbaatar, Mongolia. A composite HAP measure was created using information on cooking and heating fuels and behaviours collected as part of a randomised control trial assessing the impact of swaddling on child health. Child health outcomes (Bayley Scales of Infant Development scores [BSID-II], pneumonia, height and weight) were collected at 7, 13, and 36 months. Linear and Cox proportional hazard model were used to assess the association between HAP and child health outcomes at each time point, adjusting for child, maternal and environmental confounding factors. An increased risk of pneumonia was observed with an increasing HAP score (adjusted hazard ratio: 1.02 [1.01, 1.04]) at 7 months). An increase in HAP exposure was associated with a decrease in the BSID mental score at 13 months (β: − 0.09 [− 0.17, − 0.01]), BSID psychomotor score at 36 months (β: − 0.12 [− 0.23, − 0.02]). A decrease in height-for-age z-score (HAZ) and weight-for-age z-score (WAZ) were associated with increased HAP exposure at 7 (HAZ β: − 0.019 [− 0.030, − 0.010] and 13 months (HAZ β: − 0.020 [− 0.030, − 0.011], and WAZ β: − 0.012 [− 0.019, − 0.005]), however only HAZ was associated with HAP at 36 months (β: − 0.011 [− 0.020, − 0.002]). An increasing HAP score was associated with an increase in the health outcome composite score at 7 months only (β: 0.019; 95% CI 0.003–0.035). HAP exposure was shown to negatively impact child health sustainably over 3 years. There are implications for development of appropriate public health policies to mitigate HAP exposure throughout Mongolia and similar Central Asia settings.

Combined effects of basalt fiber geometrical characteristics on pavement performance of asphalt mixtures

Fibers have been widely adopted in asphalt mixture to improve its pavement performance. Lignin fiber and polyester fiber are the most popular two choices. Lignin fiber is derived from wood, which is not aligned with the principles of sustainable development. The production process for polyester fiber is more complex and costly, presenting both environmental and economic challenges in engineering applications. In contrast, basalt fiber is cost-effective, exhibit excellent wear resistance and impact toughness, and possess high mechanical strength. It is an ideal choice to improve pavement performance of asphalt mixtures. However, most of the existing studies focused on analyzing a single characteristic index of basalt fiber. They neglected the composite effects of geometric characteristics of basalt fiber, such as fiber diameter and length, on the pavement performance of asphalt mixtures at varying fiber contents. Therefore, taking the SMA-13 as an example, the combined effect of basalt fiber geometrical characteristics (fiber diameter, fiber length, and fiber content) on pavement performance are elucidated. Additionally, a random forest algorithm is adopted to perform a weight analysis of fiber characteristics and their correlation with pavement performance.

Thermal performance of Falkner Skan model (FSM) for (GOMoS2)/(C2H6O2-H2O) 50:50% nanofluid under radiation heating source

Sleep problems were unrelated to social media use in the late COVID-19 pandemic phase: A cross-national study

Sleep problems are commonly related to stress and mental health problems. However, social media use has become widespread in the general population during recent years, and their addictive potential may influence people’s sleep routine. In addition, the COVID-19 pandemic gave rise to substantial mental health problems in the population, and restrictions in social life gave social media a unique position as means for both entertainment and interpersonal contact. The aim of the study was to examine sleep problems in relationship to social media use in a cross-national sample two years after the COVID-19 outbreak. Participants were 1405 adults from four countries who completed a cross-sectional online survey. The data were analyzed with independent samples t-tests, Chi Squared tests of independence, and single and multivariable logistic regression analyses. Of the 858 (61.1%) participants who reported sleep problems during the past weeks, a substantial proportion (n = 353, 41.1%) related their sleep problems to their experience with COVID-19. With adjustments for age, gender, employment, and psychological distress, more hours of daily social media use was not significantly associated with sleep problems. However, higher age (OR: 1.13, p = 0.01), female gender (OR: 1.69, p<0.001), having employment (OR: 1.34, p = 0.04), and higher levels of psychological distress (OR: 1.20, p<0.001) were independently associated with sleep problems. While the debate about the pros and cons of social media use continue, this study suggests that higher levels of social media use was not of great concern for people’s sleep quality in the late COVID-19 pandemic phase. However, other aspects of social media use (eg, time of the day, content of interactions, associated stress experience) may be more relevant for understanding sleep problems and may be taken into consideration for people who experience such problems.

Investigating new drugs from marine seaweed metabolites for cervical cancer therapy by molecular dynamic modeling approach

Evaluating interdisciplinary breastfeeding and lactation knowledge, attitudes and skills: An evaluation of a professional graduate programme for healthcare professionals

Breastfeeding theoretical and skills training is important for health care professionals engaging with the mother infant dyad to increase breastfeeding exclusivity and duration. The aim of this study was to evaluate the knowledge, attitudes and practices (KAPs) of health care professionals following completion of a university professional graduate programme in breastfeeding and lactation. A pre and post—educational study design was used. All students enrolled in a six month programme were invited to complete an online anonymous survey at two time points: January 2023 and July 2023. Ethical approval (LS-C-23-17) was obtained in January 2023. Descriptive statistics were utilised to report percentages and means, and independent T tests were used to report mean differences between variables on knowledge, attitude and practices. All students completed the module. The pre survey participant response rate was n = 55 (92.82%) and the post survey participant response rate n = 33 (60%). Comparison of the pre and post questionnaire report nine statistically significant results following completion of the university breastfeeding and lactation programme. Knowledge scores increased specifically with higher mean knowledge scores for reporting “I am confident with my knowledge about breastfeeding” and statistically significant mean difference of 0.29 following completion of the module (95% CI, 0.13 to 0.45) (t (64) = 3.59, p = 0.001). The programme evaluation identifies the importance of a professional graduate breastfeeding and lactation education programme for interdisciplinary health care professionals increasing knowledge, attitudes and practices and ultimately increasing breastfeeding rates in the short and long term, with improved maternal and child health outcomes.

Mesalazine solubility in supercritical carbon dioxide with and without cosolvent and modeling

Measurement and analysis of fish pond water temperature field in summer based on fiber Grating string

To solve the problems of low detection efficiency and inability to adapt to distributed measurement in traditional detection methods, a water temperature field detection system based on a fiber Bragg grating string was designed. In this system, six fiber Bragg gratings with different center wavelengths are connected in series on a single fiber optic cable based on wavelength division multiplexing technology. The fiber Bragg grating string is encapsulated in stainless steel tube and vertically fixed in the measured water body of the fish pond. The space division multiplexing technology is employed to collect information from multiple fiber Bragg grating strings. Water temperature measurement experiments were conducted in the summer pond environment. The experimental results show that the daily variation curve of temperature in each water layer of the fish pond is relatively smooth and approximates a cosine function with a 24-hour period. In summer, the daily average water temperature in the pond is no more than 1°C higher than the average air temperature. The difference between the maximum and the minimum water temperature is approximately 2°C. During the daytime, the temperature gradually decreases from the surface to the deeper water layers, whereas at night, the temperature variation among the water layers is minimal. As depth increases, the amplitude of the water temperature curve oscillations gradually decreases, exhibiting exponential decay. However, the peak time gradually lags behind. There is a correlation between the temperatures of the water layers in the fish pond, and the smaller the distance between the water layers, the stronger the correlation. The experimental results obtained in this study are highly significant for real-time services in aquatic planting and aquaculture. Additionally, this measurement method can provide valuable reference and guidance for measuring temperature fields in other fluids.

Genetic association between immune-mediated inflammatory diseases and peripheral artery disease: a Mendelian randomization study

Protocol for evaluating the effects of integrating music with taekwondo training in children with autism spectrum disorder: A randomized controlled trial

Background Children with autism spectrum disorder (ASD) are known to experience difficulties in coordinating fine- and gross-motor movement. Previous interventional studies have reported significant effect of exercise-based intervention programs on improving motor skills and alleviating symptoms in ASD; however, researchers are yet to know why some participants experienced less improvement than others. One plausible explanation for suboptimal treatment outcomes is insufficient engagement in the exercise programs due to the children’s difficulties in following instructions and performing the correct movements. In the proposed research, we will test the above speculation by manipulating the amount of music-therapy elements into a 10-week Taekwondo training program designed specifically for children with autism. Methods This is a randomized controlled trial. Seventy-two children aged 7 to 9 years who meet the diagnostic criteria of ASD will be recruited and randomized into either the “Taekwondo training with elements of music therapy” group or the “Taekwondo training alone” group. In both groups, the participating children will attend Taekwondo training sessions twice a week over 10 consecutive weeks. In the “Taekwondo training with elements of music therapy” group, elements of music therapy will be incorporated into the Taekwondo training. Assessment will be conducted before the program commences, immediately after the completion of the 10-week program, and 2 months after the post-test. The outcome domains to be evaluated include the immediate effects during the exercise sessions. These effects include the level of engagement in the exercise sessions (primary outcome), enjoyment, physical activity level, and rate of perceived exertion. Furthermore, the evaluation will also cover the overall effects of the training program on gross motor skills, Taekwondo skills performance, executive function, psychosocial functioning, and behavioral problems. Discussion/Findings The findings of this study will inform strategies for the promotion of physical activity and engagement among children with ASD when participating in exercise training classes. The study will also suggest the importance of regular physical activity for the physical and mental well-being of children with ASD. Trial registration Clinical trial registration: URL: http://www.clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT06277778. Registered on 15 February 2024.

Identifying spatiotemporal pattern and trend prediction of land subsidence in Zhengzhou combining MT-InSAR, XGBoost and hydrogeological analysis

Preparation of alkali-activated oil shale residue-slag geopolymer-based binder using calcium carbide slag and sodium carbonate as alkali activator

Based on the reuse of industrial solid wastes such as calcium carbide slag, slag, and oil shale residue, this work utilizes oil shale residue and slag as precursor materials, calcium carbide slag and sodium carbonate as alkaline activator to prepare a geopolymer-based binder. Mix proportion experiments of the geopolymer-based binder with varying oil shale residue contents were designed. Chemical composition and microstructure of the alkaline-activated oil shale residue-slag geopolymer-based binder system were analyzed using X-ray Fluorescence Spectrometer (XRF), X-ray Powder Diffractometer (XRD), and Scanning Electron Microscope (SEM). Meanwhile, the fluidity and mechanical properties of the material were also investigated. The results indicate that as the oil shale residue content increases, the fluidity and 3-day compressive strength and splitting tensile strength of the filling slurry gradually decrease, while the 28-day strength first rises and then falls, reaching a maximum when the oil shale residue content is 20%. When the oil shale residue content is below 20%, the hydration product content gradually increases, and the microstructure tends to be denser. However, as the oil shale residue content further increases, the hydration product gradually decreases, and the microstructure becomes poorer. Therefore, the optimal oil shale residue content is 20%. The geopolymer-based binder system prepared in this paper is a low-carbon, environmentally friendly, and high-performance material system, its research and development are of great significance to the human society.

Study on the influence of working condition variation on lubrication characteristics of EHA internal pump

Self-reported illnesses in Thatta: Evidence from a rural and underdeveloped district in Sindh province, Pakistan

Introduction Self-reported illnesses (SRI) surveys are widely used as a low-cost substitute for weak Disease Surveillance Systems in low- and low-middle-income countries. In this paper, we report findings of a district-level disease prevalence survey of all types of illnesses including chronic, infectious, injuries and accidents, and maternal and child health in a rural district in Pakistan. Methods A district-level survey was conducted in Thatta in 2019 with a population-representative sample of all ages (n = 7811) a. Survey included questions on demographics and SRIs from the respondents. Prevalence was estimated for all SRIs categorized into six major and 16 minor illnesses. The influence of important socio-demographic covariates on the illnesses and multiple comorbidities was explored by estimating prevalence ratios with a Generalized Linear Model of the Poisson family and by Zero-Inflated Poison Distribution respectively. Findings 36.57% of the respondents to the survey reported at least one SRI. Prevalence of communicable illnesses was 20.7%, followed by non-communicable illnesses (4.8%), Gastrointestinal disorders (4.4%), and injuries/disabilities (1.9%). Urban inhabitants were more likely to have Chronic Obstructive Pulmonary Disorders (3.34%) and Diabetes (1.62%). Females were most likely to have injuries (1.20,), disabilities (1.59), and Musculoskeletal Disorders (1.25). Children aged < 1 year (0.80) and elderly >65 years (0.78) were more likely to have comorbidities. Discussion Our estimated prevalence of SRI is quite higher than the prevalence of unknown SRIs in national-level surveys in Pakistan. This research’s findings serve as an example of aiding evidence-based priority settings within the health sector. Our findings on gender, and young and old age as positive predictors of SRI are consistent with similar surveys in a few LMICs. Recommendation and conclusion We provide evidence of a complete disease profile of a district that is otherwise unavailable in the country. This study can reshape the existing health surveys and to aid evidence-based priority settings in the health sector. We, however, support strengthening the Disease Surveillance System as a reliable source of disease prevalence data.

Cryo-EM structure of the calcium-sensing receptor complexed with the kokumi substance γ-glutamyl-valyl-glycine

Abstract Taste is a key element for food palatability and is strongly influenced by the five basic tastes and other taste sensations, such as fatty orosensation, and koku perception, which indicates taste complexity, mouthfulness and lastingness. This study focuses on the taste modifier γ-glutamyl-valyl-glycine (γ-EVG), a potent kokumi substance that enhances taste and koku perception by modulating the calcium-sensing receptor (CaSR). We used cryo-electron microscopy to determine the structure of the CaSR/γ-EVG complex at a resolution of 3.55 Å. Structural analysis revealed important interactions between γ-EVG and the CaSR, involving key residues, such as Pro39, Phe42, Arg66, Ser147, and Glu297. Mutagenesis experiments demonstrated the importance of these residues in peptide binding. Each γ-EVG residue contributed to its binding to the orthosteric ligand binding site of the CaSR. These findings elucidate the molecular basis of kokumi peptide recognition by the CaSR and contribute to a better understanding of positive allosteric modulators of the CaSR. In addition, this research provides valuable insights into the functionality of class C G-protein-coupled receptors in taste perception, potentially informing the development of new taste modifiers and advancing the field of food science.