Predictive health monitoring: Leveraging artificial intelligence for early detection of infectious diseases in nursing home residents through discontinuous vital signs analysis.

This research addresses the problem of detecting acute respiratory, urinary tract, and other infectious diseases in elderly nursing home residents using machine learning algorithms. The study analyzes data extracted from multiple vital signs and other contextual information for diagnostic purposes. The daily data collection process encounters sampling constraints due to weekends, holidays, shift changes, staff turnover, and equipment breakdowns, resulting in numerous nulls, repeated readings, outliers, and meaningless values. The short time series generated also pose a challenge to analysis, preventing the extraction of seasonal information or consistent trends. Blind data collection results in most of the data coming from periods when residents are healthy, resulting in excessively imbalanced data. This study proposes a data cleaning process and then builds a mechanism that reproduces the basal activity of the residents to improve the classification of the disease. The results show that the proposed basal module-assisted machine learning techniques allow anticipating diagnostics 2, 3 or 4 days before doctors decide to start treatment with antibiotics, achieving a performance measured by the area-under-the-curve metric of 0.857. The contributions of this work are: (1) a new data cleaning process; (2) the analysis of contextual information to improve data quality; (3) the generation of a baseline measure for relative comparison; and (4) the use of either binary (disease/no disease) or multiclass classification, differentiating among types of infections and showing the advantages of multiclass versus binary classification. From a medical point of view, the anticipated detection of infectious diseases in institutionalized individuals is brand new.

Etiopathogenesis of Psoriasis: Integration of Proposed Theories.

Psoriasis is a chronic inflammatory disease characterized by squamous and erythematous plaques on the skin and the involvement of the immune system. Global prevalence for psoriasis has been reported around 1-3% with a higher incidence in adults and similar proportions between men and women. The risk factors associated with psoriasis are both extrinsic and intrinsic, out of which a polygenic predisposition is a highlight out of the latter. Psoriasis etiology is not yet fully described, but several hypothesis have been proposed: 1) the autoimmunity hypothesis is based on the over-expression of antimicrobial peptides such as LL-37, the proteins ADAMTSL5, K17, and hsp27, or lipids synthesized by the PLA2G4D enzyme, all of which may serve as autoantigens to promote the differentiation of autoreactive lymphocytes T and unleash a chronic inflammatory response; 2) dysbiosis of skin microbiota hypothesis in psoriasis has gained relevance due to the observations of a loss of diversity and the participation of pathogenic bacteria such as Streptococcus spp. or Staphylococcus spp. the fungi Malassezia spp. or Candida spp. and the virus HPV, HCV, or HIV in psoriatic plaques; 3) the oxidative stress hypothesis, the most recent one, describes that the cell injury and the release of proinflammatory mediators and antimicrobial peptides that leads to activate of the Th1/Th17 axis observed in psoriasis is caused by a higher release of reactive oxygen species and the imbalance between oxidant and antioxidant mechanisms. This review aims to describe the mechanisms involved in the three hypotheses on the etiopathogeneses of psoriasis.

Effect of coaches' interpersonal style on young athletes' individual resilience and team adherence intention: a season-long investigation.

BACKGROUND: In the sports context, coaches must be able to improve their players physically, psychologically, and socially. Hence, a fundamental part of this process is the athlete's individual resilience (IR). METHODS: Three hundred and fifteen youth team-sport players (boys: n = 283; Mage = 16.02, SD = 0.56; and girls: n = 32; Mage = 15.92, SD = 0.62) completed the measures of coach's interpersonal style, individual resilience, perceived performance, and team adherence intention (intention to remain on the same team the following year) twice (Time 1: mid-season; Time 2: end-season). Structural equation modeling was used to test the relationships between variables. RESULTS: The results showed that coach support was positively related to IR (p < 0.001) and, in turn, IR to individual (p < 0.01) and team performance (p < 0.05) at Time 1, and to individual performance (p < 0.001) and team adherence intention at Time 2 (p < 0.01). In addition, team performance at Time 2 was positively related to team adherence intention (p < 0.001). Finally, a mediating effect of IR was observed between interpersonal coaching style, individual and team performance, and team adherence intention. CONCLUSIONS: These results show the importance of a supportive interpersonal coaching style to foster athletes' levels of resilience, which could have positive consequences in performance (individual and team) and team adherence intention.

Teachers' Verbal and Nonverbal Communication, Students' Psychological Needs, and Positive and Negative Outcomes in Physical Education.

Focused on physical education (PE), this study examined the association between teachers' communication and students' psychological needs, enjoyment/boredom, PE usefulness, and students' grade perception. Participants were 1,000 students (572 girls; Mage = 14.58 ± 0.65) from 29 Spanish secondary schools. A path model including variables measured at three times was tested: teachers' verbal/nonverbal communication (Time 1), needs satisfaction/frustration (Time 2), and PE outcomes (Time 3). Verbal communication positively predicted needs satisfaction, which, in turn, positively predicted enjoyment, PE usefulness, and students' grade perception and negatively predicted boredom. Verbal communication negatively predicted needs frustration, which was a positive predictor of boredom. Multigroup analysis showed that gender did not moderate the associations in the path model, whereas mediating effects were found between teachers' communication and consequences via students' psychological needs. Teachers should improve their communicative capacities to satisfy students' psychological needs and promote positive PE  outcomes.

How class cohesion and teachers' relatedness supportive/thwarting style relate to students' relatedness, motivation, and positive and negative outcomes in physical education.

The main goal of this study was to examine the links between class cohesion and teachers' relatedness teaching style with students' relatedness needs, motivation, and positive and negative outcomes in Physical Education. A total of 1294 students 10-18 years old (M = 14.40, SD = 1.99), 613 males (M = 14.48, SD = 1.95) and 681 females (M = 14.33, SD = 2.02), agreed to participate. They were enrolled in 88 classes belonging to 13 different primary and secondary schools in southwestern Spain. The study followed a correlational research design. Results of the multilevel path model showed a positive relationship between teachers' relatedness support and class cohesion and behavioral and emotional engagement through relatedness need satisfaction and autonomous and controlled motivation. Results also showed a positive relationship between teachers' relatedness thwarting and disruptive behaviors and problematic relationships through relatedness need frustration and amotivation. In conclusion, teachers' relatedness behaviors and class cohesion can significantly impact the students' relatedness and motivation, which in turn will affect their engagement and behaviors. A whole cascade of consequences begins with the way teachers teach and the cohesion generated in class. These first steps cannot be overlooked.

Organogenic events during gynoecium and fruit development in Arabidopsis.

Angiosperms are the most successful group of land plants. This success is mainly due to the gynoecium, the innermost whorl of the flower. In Arabidopsis, the gynoecium is a syncarpic structure formed by two congenitally fused carpels. At the fusion edges of the carpels, the carpel margin meristem forms. This quasi-meristem is important for medial-tissue development, including the ovules. After the double fertilization, both the seeds and fruit begin to develop. Due to the importance of seeds and fruits as major food sources worldwide, it has been an important task for the scientific community to study gynoecium development. In this review, we present the most recent advances in Arabidopsis gynoecium patterning, as well as some questions that remain unanswered.

Effects of out-of-school physical activity interventions based on self-determination theory in children and adolescents: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to examine the effects of out-of-school physical activity (PA) interventions, based on Self-Determination Theory (SDT), on basic psychological needs (BPN), motivation toward PA, and PA levels in youths. DESIGN: Systematic review and meta-analyses. METHOD: We searched for intervention studies examining the effects of PA interventions based on SDT implemented outside the school published in English and Spanish in six electronic databases up to January 2022. RESULTS: Outcomes of interest were BPN, motivation, and PA levels. In total, nine studies were included in this review. Seven individual meta-analyses were conducted for each variable, revealing nonsignificant clustered effects for the outcomes autonomy satisfaction (g = 0.12, 95% CI [-0.31, 0.55]), competence satisfaction (g = 0.02, 95% CI [-0.28, 0.32]), relatedness satisfaction (g = 0.13, 95% CI [-0.43, 0.68]), autonomous motivation (g = 0.15, 95% CI [-0.38, 0.67]), controlled motivation (g = 0.12, 95% CI [-0.32, 0.55]), amotivation (g = -0.36, 95% CI [-0.88, 0.16]), and PA behavior (g = 0.02, 95% CI [-0.08, 0.12]). CONCLUSION: Meta-analyses suggest that out-of-school PA interventions based on SDT are not effective in increasing levels of needs satisfaction, types of motivation, and PA levels.

Is coaches' perceived team performance associated with their intentions to persist in coaching? The mediating role of coaches' psychological needs and motivation.

This study examined the association between team performance perceived by coaches, coaches' basic psychological needs, motivation, and their intentions to persist in coaching. Participants were 719 coaches (80 females, M = 33.49 years, SD = 10.27, range = 18-67) of different team sports (soccer = 514; basketball = 165; volleyball = 23; handball = 14; and hockey = 3) who completed questionnaire measures at the end of the season. Structural equation modelling adjusted for sex, coaches' experience, age categories, and type of sport revealed that coaches' perceptions of team performance were positively related to their need satisfaction and negatively to their need frustration. In turn, coaches' need satisfaction was positively associated with their autonomous motivation, whereas their need frustration was positively related to controlled motivation and amotivation. Finally, coaches' autonomous motivation was a positive predictor of their intentions to persist, and conversely, coaches' amotivation was a negative predictor of their intentions to persist. We found a significant positive and indirect effect between team performance perceived by coaches and their intention to persist through their need satisfaction and autonomous motivation. These findings represent the first quantitative insight into how coach-perceived team performance could function as a new antecedent relevant to coaches' motivational processes and persistence.

Do sport teams with greater team resilience perceive higher performance at the end of the season? A multilevel analysis.

A team's ability to respond positively to adversities, problems, and obstacles during their season is an essential part of success in collective sports. Grounded in team resilience theory and using a multilevel analytical approach, this study examined the relationship of the characteristics of resilience and vulnerability under pressure with perceived individual and team performance. Participants were 676 soccer players (530 males and 146 females) aged 15-42 years (M = 21.40, SD = 5.38), who played on 64 senior and under-18 soccer teams of several national leagues in Spain. In the final month of the season, factors related to team resilience and individual and team performance were analyzed. We estimated multilevel models by including perceived individual and team performance as dependent variables. Characteristics of resilience and vulnerability under pressure were considered as fixed and random effects (i.e., individual- and team-level intercepts and slopes). At the individual level, results showed that characteristics of resilience were positively associated with subjective individual and team performance, whereas vulnerability under pressure was negatively related to perceived team (but not individual) performance. At the team level, only characteristics of resilience positively predicted team performance. These findings suggest that more resilient teams report more successful performance from an individual and team perspective, whereas teams that are more vulnerable under pressure report poorer team performance. Taken together, the study underscores the importance of practitioners to develop strategies that improve their teams' resilience, given that team resilience helps to achieve positive subjective individual and team outcomes.

Effects of match contextual factors on internal and external load in elite Brazilian professional soccer players through the season.

This study aimed to investigate the effects of contextual match factors (quality of opposition, match outcome, change of head coach or playing style) on internal and external load in elite Brazilian professional soccer players, considering the total and effective playing time. Twenty-two professional male outfield soccer players participated in this study (age 28.4 ± 4.9 years; height 1.78 ± 0.1 cm; body mass 72.9 ± 7.1 kg). The internal (rating of perceived exertion-based load [sRPE]) and external load (distance and accelerometry-based measures) were recorded during 38 matches, over the 2021 season of the Brazilian National 1st Division League using a global position system (10 Hz) integrated with an accelerometer (200 Hz). The main results were: (i) matches played against weak opponents presented greater values of sprinting distances compared to matches against intermediate and strong opponents; (ii) players covered greater high-intensity running distances when drawing than winning the matches; (iii) matches with assistant coaches presented higher mean speed relative to effective playing time (MSEPT) compared to coach 1 and coach 2 conditions. In addition, players covered greater MSEPT and high-acceleration in matches with coach 2 vs. coach 3; (iv) finally, small positive correlations were observed between positional attack sequences and MSTPT, total distance covered, and acceleration. Coaches and practitioners should consider these results when interpreting external load variables during elite Brazilian soccer matches.

Vasoplegia Following Complex Spine Surgery: Incidence and Risk.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: Vasoplegia is a life-threatening form of distributive or vasodilatory shock that is characterized by reduced systemic vascular resistance with resultant hypotension and normal to elevated cardiac output affecting morbidity and mortality. Vasoplegia in the context of Spine Surgery has not been described previously. The purpose of this case series is to determine incidence, risk factors, complications and postoperative outcome in patients with vasoplegia after complex multi-level thoraco-lumbar spine surgery. METHODS: A retrospective review of the electronic medical records at our institution was conducted between January 2014 and June 2018. All patients undergoing multi-level spine surgery (>6 levels) were screened for intraoperative hypotension. Patient demographics, surgical characteristics, neurological status, blood loss, risk factors, medical treatment, complications, hospital course and mortality were collected. All patients included in this study had a minimum follow-up period of 3 months. RESULTS: Out of 8521 surgically treated patients, 994 patients with multi-level thoraco-lumbar spine surgery were identified. A total of 41 patients had intraoperative hypotensive events. Of those, 5 patients with vasoplegia could be identified after elimination of all other potential contributing factors. Vasoplegia did not influence the neurological outcome. One major and three minor complications occurred. All patients showed full recovery. The risk factors identified for vasoplegia include prolonged surgery with osteotomies. CONCLUSIONS: Vasoplegia is a rare condition with an incidence of .6%. Patients experiencing vasoplegia did not appear to experience worse surgical outcomes. The use of special intraoperative hemodynamic monitoring should be considered in selected cases.

Analysis of the Effect of Injuries on Match Performance Variables in Professional Soccer Players: A Retrospective, Experimental Longitudinal Design.

BACKGROUND: Knowing the impact of injuries is essential for their adequate management during reconditioning programs. OBJECTIVE: This study aimed to analyze the changes in match performance parameters in professional soccer players after sustaining an injury, which was defined according to injury severity. METHODS: Two-hundred and seven injuries related to one hundred and sixty-one professional soccer players from the Spanish LaLiga™ were considered for this study. All the injuries were classified according to their severity as minor (from 4 to 7 missed days), moderate (from 8 to 28 missed days), and major (more than 28 missed days). Through Mediacoach® videotracking system, time and external demand variables were collected and subsequently compared between pre-injury and return to play periods. The analyzed variables were (in m min-1): relative distance covered (RD; total distance covered·min-1), distance covered walking (0-6 km h-1), distance covered jogging (6-12 km h-1), distance covered running (12-18 km h-1), distance covered at intense running (18-21 km h-1), distance covered at high-speed running (21-24 km h-1), and sprinting (> 24 km h-1) distance covered. RESULTS: Significant reductions in playing time after suffering moderate and major injuries were observed. Significant reductions after minor injuries were observed in jogging (> 6 km h-1) and running (6-12 km h-1), while significantly greater distances at intense running (18-21 km h-1) and high-speed running (21-24 km h-1) were covered by players who suffer major injuries. Finally, relevant decreases in the maximum speed achieved after moderate and major injuries were found. CONCLUSIONS: In conclusion, this study shows the importance of high loads during reconditioning programs, as well as implementing strategies that allow reaching levels of maximum speed values after the return to play.

Efficacy and safety of CD24Fc in hospitalised patients with COVID-19: a randomised, double-blind, placebo-controlled, phase 3 study.

BACKGROUND: Non-antiviral therapeutic options are required for the treatment of hospitalised patients with COVID-19. CD24Fc is an immunomodulator with potential to reduce the exaggerated inflammatory response to tissue injuries. We aimed to evaluate the safety and efficacy of CD24Fc in hospitalised adults with COVID-19 receiving oxygen support. METHODS: We conducted a randomised, double-blind, placebo-controlled, phase 3 study at nine medical centres in the USA. Hospitalised patients (age ≥18 years) with confirmed SARS-CoV-2 infection who were receiving oxygen support and standard of care were randomly assigned (1:1) by site-stratified block randomisation to receive a single intravenous infusion of CD24Fc 480 mg or placebo. The study funder, investigators, and patients were masked to treatment group assignment. The primary endpoint was time to clinical improvement over 28 days, defined as time that elapsed between a baseline National Institute of Allergy and Infectious Diseases ordinal scale score of 2-4 and reaching a score of 5 or higher or hospital discharge. The prespecified primary interim analysis was done when 146 participants reached the time to clinical improvement endpoint. Efficacy was assessed in the intention-to-treat population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT04317040. FINDINGS: Between April 24 and Sept 22, 2020, 243 hospitalised patients were assessed for eligibility and 234 were enrolled and randomly assigned to receive CD24Fc (n=116) or placebo (n=118). The prespecified interim analysis was done when 146 participants reached the time to clinical improvement endpoint among 197 randomised participants. In the interim analysis, the 28-day clinical improvement rate was 82% (81 of 99) for CD24Fc versus 66% (65 of 98) for placebo; median time to clinical improvement was 6·0 days (95% CI 5·0-8·0) in the CD24Fc group versus 10·0 days (7·0-15·0) in the placebo group (hazard ratio [HR] 1·61, 95% CI 1·16-2·23; log-rank p=0·0028, which crossed the prespecified efficacy boundary [α=0·0147]). 37 participants were randomly assigned after the interim analysis data cutoff date; among the 234 randomised participants, median time to clinical improvement was 6·0 days (95% CI 5·0-9·0) in the CD24Fc group versus 10·5 days (7·0-15·0) in the placebo group (HR 1·40, 95% CI 1·02-1·92; log-rank p=0·037). The proportion of participants with disease progression within 28 days was 19% (22 of 116) in the CD24Fc group versus 31% (36 of 118) in the placebo group (HR 0·56, 95% CI 0·33-0·95; unadjusted p=0·031). The incidences of adverse events and serious adverse events were similar in both groups. No treatment-related adverse events were observed. INTERPRETATION: CD24Fc is generally well tolerated and accelerates clinical improvement of hospitalised patients with COVID-19 who are receiving oxygen support. These data suggest that targeting inflammation in response to tissue injuries might provide a therapeutic option for patients hospitalised with COVID-19. FUNDING: Merck & Co, National Cancer Institute, OncoImmune.

Does coaches' satisfaction with the team determine their interpersonal style? The mediating role of basic psychological needs.

The purpose of the present study was to examine how coaches' satisfaction with the team could be related to their reported interpersonal style towards young athletes, and to analyze the mediating role of basic psychological needs (i.e. need satisfaction and need frustration) in this relationship. Participants were 352 coaches (16-67 years old; Mage = 32.88, SD = 11.14) from 48 clubs, who had between 1 and 52 years of training experience (M = 23.23, SD = 15.02). Structural equation modelling (SEM) was employed to test the relationships between variables. Results showed that satisfaction with the team is positively related to coaches' need satisfaction, and negatively to their need frustration. Need satisfaction positively predicted coaches' need-supportive style, and need frustration predicted their need-thwarting style. Regarding indirect effects, need satisfaction positively mediated the relationship between coaches' satisfaction with the team and their need-supportive style, and need frustration negatively mediated the relationship between coaches' satisfaction with the team and their need-thwarting style. These findings are a first step to highlight satisfaction with the team as an antecedent of coaches' self-reported need-supportive and need-thwarting behaviours towards athletes, and the mediating role of coaches' psychological needs (need satisfaction and need frustration) in this relationship.HighlightsWe examined the satisfaction of the team as antecedent of coaches' interpersonal style.We tested the mediating role of coaches' psychological needs in this relationship.Satisfaction with the team was positively related to need-supportive style.Satisfaction with the team was negatively associated with need-thwarting behaviors.Coaches' psychological needs mediated the relationship between team satisfaction and their interpersonal style.

Perioperative approach to precapillary pulmonary hypertension in non-cardiac non-obstetric surgery.

Pulmonary hypertension (PH) confers a significant challenge in perioperative care. It is associated with substantial morbidity and mortality. A considerable amount of information about management of patients with PH has emerged over the past decade. However, there is still a paucity of information to guide perioperative evaluation and management of these patients. Yet, a satisfactory outcome is feasible by focusing on elaborate disease-adapted anaesthetic management of this complex disease with a multidisciplinary approach. The cornerstone of the peri-anaesthetic management of patients with PH is preservation of right ventricular (RV) function with attention on maintaining RV preload, contractility and limiting increase in RV afterload at each stage of the patient's perioperative care. Pre-anaesthetic evaluation, choice of anaesthetic agents, proper fluid management, appropriate ventilation, correction of hypoxia, hypercarbia, acid-base balance and pain control are paramount in this regard. Essentially, the perioperative management of PH patients is intricate and multifaceted. Unfortunately, a comprehensive evidence-based guideline is lacking to navigate us through this complex process. We conducted a literature review on patients with PH with a focus on the perioperative evaluation and suggest management algorithms for these patients during non-cardiac, non-obstetric surgery.

Medical Prognosis of Infectious Diseases in Nursing Homes by Applying Machine Learning on Clinical Data Collected in Cloud Microservices.

BACKGROUND: treating infectious diseases in elderly individuals is difficult; patient referral to emergency services often occurs, since the elderly tend to arrive at consultations with advanced, serious symptoms. AIM: it was hypothesized that anticipating an infectious disease diagnosis by a few days could significantly improve a patient's well-being and reduce the burden on emergency health system services. METHODS: vital signs from residents were taken daily and transferred to a database in the cloud. Classifiers were used to recognize patterns in the spatial domain process of the collected data. Doctors reported their diagnoses when any disease presented. A flexible microservice architecture provided access and functionality to the system. RESULTS: combining two different domains, health and technology, is not easy, but the results are encouraging. The classifiers reported good results; the system has been well accepted by medical personnel and is proving to be cost-effective and a good solution to service disadvantaged areas. In this context, this research found the importance of certain clinical variables in the identification of infectious diseases. CONCLUSIONS: this work explores how to apply mobile communications, cloud services, and machine learning technology, in order to provide efficient tools for medical staff in nursing homes. The scalable architecture can be extended to big data applications that may extract valuable knowledge patterns for medical research.