Prediction of emergency department revisits among child and youth mental health outpatients using deep learning techniques.

BACKGROUND: The proportion of Canadian youth seeking mental health support from an emergency department (ED) has risen in recent years. As EDs typically address urgent mental health crises, revisiting an ED may represent unmet mental health needs. Accurate ED revisit prediction could aid early intervention and ensure efficient healthcare resource allocation. We examine the potential increased accuracy and performance of graph neural network (GNN) machine learning models compared to recurrent neural network (RNN), and baseline conventional machine learning and regression models for predicting ED revisit in electronic health record (EHR) data. METHODS: This study used EHR data for children and youth aged 4-17 seeking services at McMaster Children's Hospital's Child and Youth Mental Health Program outpatient service to develop and evaluate GNN and RNN models to predict whether a child/youth with an ED visit had an ED revisit within 30 days. GNN and RNN models were developed and compared against conventional baseline models. Model performance for GNN, RNN, XGBoost, decision tree and logistic regression models was evaluated using F1 scores. RESULTS: The GNN model outperformed the RNN model by an F1-score increase of 0.0511 and the best performing conventional machine learning model by an F1-score increase of 0.0470. Precision, recall, receiver operating characteristic (ROC) curves, and positive and negative predictive values showed that the GNN model performed the best, and the RNN model performed similarly to the XGBoost model. Performance increases were most noticeable for recall and negative predictive value than for precision and positive predictive value. CONCLUSIONS: This study demonstrates the improved accuracy and potential utility of GNN models in predicting ED revisits among children and youth, although model performance may not be sufficient for clinical implementation. Given the improvements in recall and negative predictive value, GNN models should be further explored to develop algorithms that can inform clinical decision-making in ways that facilitate targeted interventions, optimize resource allocation, and improve outcomes for children and youth.

How Do Young Soccer Players Train? A 5-Year Analysis of Weekly Training Load and its Variability Between Age Groups in an Elite Youth Academy.

ABSTRACT: Connolly, DR, Stolp, S, Gualtieri, A, Ferrari Bravo, D, Sassi, R, Rampinini, E, and Coutts, AJ. How do young soccer players train? A 5-year analysis of weekly training load and its variability between age groups in an elite youth academy. J Strength Cond Res 38(8): e423-e429, 2024-The aim of this study was to quantify the session rating of perceived exertion (sRPE), duration, and training load accrued across typical training weeks undertaken by youth soccer players. Differences between starters, nonstarters, and variations in training load variables were also investigated. Data were collected from 230 elite youth players in 4 age groups (U15, U16, U17, and U19) during 5 competitive seasons. Mixed models were used to describe variation between age groups and compare starters with nonstarters, with season as a fixed covariate effect. Week-to-week variation in training load was expressed as the percentage coefficient of variation. The main findings may be used to highlight a significant effect of age and playing status on training intensity, duration, and internal training load. Weekly training load increased progressively from the U15 to U17, with significant differences between each age group (p < 0.03). Lower mean weekly perceived intensity (sRPE) was noted in U15 when compared with the older age groups (4.2 vs. 4.6-4.9 arbitrary unit for U16 to U19, p < 0.001). Low weekly training load variation was observed across the different phases of the season in each age group, with the preseason exhibiting the greatest variance (3.6-6.2%). Differences in the training load are likely more attributable to changes in training duration rather than sRPE. Control of session duration seems to play an important role when aiming to control load in the academy environment, and practitioners should closely monitor the differences in duration and load being recorded between starters and nonstarters.

Early warning of atrial fibrillation using deep learning.

Atrial fibrillation (AF), the most prevalent cardiac rhythm disorder, significantly increases hospitalization and health risks. Reverting from AF to sinus rhythm (SR) often requires intensive interventions. This study presents a deep-learning model capable of predicting the transition from SR to AF on average 30.8 min before the onset appears, with an accuracy of 83% and an F1 score of 85% on the test data. This performance was obtained from R-to-R interval signals, which can be accessible from wearable technology. Our model, entitled Warning of Atrial Fibrillation (WARN), consists of a deep convolutional neural network trained and validated on 24-h Holter electrocardiogram data from 280 patients, with 70 additional patients used for testing and further evaluation on 33 patients from two external centers. The low computational cost of WARN makes it ideal for integration into wearable technology, allowing for continuous heart monitoring and early AF detection, which can potentially reduce emergency interventions and improve patient outcomes.

Nutritional counselling and risk factors for obesity: an observational study in toddlers.

BACKGROUND: Nutrition exerts a fundamental role in the prevention of obesity (OB). The aim of this study was to assess the extent to which well recognized risk factors for early OB can be associated to overweight (OW) or OB under a standardized nutritional approach and surveillance in toddlers. METHODS: The eligible population was represented by 676 toddlers aged 24-36 months, assigned to 18 primary care pediatricians trained on nutritional issues who shared a standardized nutritional approach. Six-hundred-twenty-nine children (333 boys), mean age 27.8 ± 4.2 months were effectively included in this observational study. Parents received nutritional advice with particular emphasis to proteins and sugar composition supported by leaflets and reinforced at each visit. Body mass index was assessed at the age of 24-36 months. The following individual and family risk factors were considered: gestational age, birth weight, eutocic/caesarean delivery, milk feeding history, household smoking or antibiotics exposure, parents' weight, height and educational level. Prevalence of OW/OB was compared to a group of 742 toddlers (373 boys) under usual care. RESULTS: Under a standardized nutritional counselling, 28.1% toddlers were classified as OW/OB compared to 36.9% toddlers under usual care (p = 0.005). In unadjusted models, parental OW/OB was significantly associated to OW/OB in toddlers (p < 0.01), while high birth weight did not reach statistical significance (p = 0.07). In adjusted models, including all the explanatory variables studied, only paternal OW/OB vs. normal weight was significantly associated to OW/OB in toddlers (OR 2.035, 95% confidence interval 1.206-3.436). No protective effect of exclusive breast feeding during the first 6 months of age was demonstrated. CONCLUSIONS: Toddlers under a standardized nutrition counselling focused to limit protein and simple sugars, showed lower prevalence of OW/OB compared to usual care. Healthy promotion activities should take into account the influence of paternal BMI on the offspring adiposity.

Microcystins production and antibacterial activity of cyanobacterial strains of Synechocystis, Synechococcus and Romeria from water and coral reef organisms (Brazil) / Producción de microcistina y actividad antibacteriana de cepas cianobacterianas de Synechocystis, Synechococcus y Romeria aisladas de agua y organismos de arrecifes de coral del litoral brasileño

AbstractCyanobacteria are widely distributed in terrestrial, freshwater and marine environments, and over the past decades have been recognized as a powerful source of bioactive compounds. In this study, some cyanobacterial strains were isolated from samples of seawater, brackish water and tissue of reef benthic invertebrates (zoanthid Protopalythoa variabilis, the sponges Cynachrella sp. and Haliclona sp., the coral Siderastrea stellata, and ascidians), collected at the states of Paraíba and Rio Grande do Norte (Northeast of Brazil), during the period between July 2010 and February 2014. After standard isolation methods, the cultivation of the strains was carried out in acclimatized culture chamber (25 °C) under constant aeration, for 15 days at 12-hour photoperiod, using Conway and BG11 media made with filtered seawater. The cyanobacterial cells were analysed for the microcystin production by the ELISA technique and their ethanolic and methanolic extracts for the antibacterial activity against Staphylococcus aureus and Pseudomonas aeruginosa by the agar well diffusion method. The detection of the mcyB gene, one of the genes related to the microcystin synthesis, was done by the Polymerase Chain Reaction (PCR) technique. The majority of the eighteen cyanobacterial strains belonged to Synechococcaceae Family. The genera of Synechocystis, Synechococcus and Romeria were represented by ten, six and two strains, respectively. The production of microcystins was observed in five strains belonging to the genus Synechocystis. The presence of mcyB gene was detected in 12 strains of cyanobacteria: Synechocystis (three strains), Synechococcus (six strains) and Romeria (two strains). Only one strain (Synechocystis aquatilis) showed both the microcystin production and the mcyB gene presence. The antibacterial activity was observed for one strain of Romeria gracilis, one strain of Synechocystis aquatilis and two strains of Synechococcus sp. The ethanolic extracts of R. gracilis strain and two Synechococcus spp. strains inhibited the growth of P. aeruginosa. Among methanolic extracts of cyanobacteria, only one strain of S. aquatilis showed activity against S. aureus, and one R. gracilis strain against P. aeruginosa. Some cyanobacterial strains studied were positive for the microcystin production and antibacterial activity against pathogenic bacteria S. aureus and P. aeuruginosa, and may be further explored for additional biotechnological applications. Rev. Biol. Trop. 65 (3): 890-899. Epub 2017 September 01.

ResumenLas cianobacterias se encuentran ampliamente distribuidas en ecosistemas terrestres, de agua dulce y marinos, y en las últimas décadas han sido reconocidas como una poderosa fuente de compuestos bioactivos. En este estudio, las cepas de cianobacterias fueron aisladas a partir de agua de mar, agua salobre y muestras de tejidos de invertebrados bentónicos de arrecifes (zoanthid Protopalythoa variabilis, las esponjas Cynachrella sp. y Haliclona sp., el coral Siderastrea stellata y ascidias) recogidas en los estados de Paraíba y Rio Grande do Norte, en el noreste de Brasil, en el período comprendido entre julio 2010 y febrero 2014. La mayoría de las dieciocho cepas de cianobacterias pertenecían a la Familia Synechococcaceae. Los géneros: Synechocystis, Synechococcus y Romeria estuvieron representados por diez, seis y dos cepas, respectivamente. Las cepas fueron analizadas para la producción de microcistina por ELISA y para la actividad antibacteriana contra Staphylococcus aureus y Pseudomonas aeruginosa por el método de difusión en agar. La detección del gen mcyB, uno de los genes relacionados con la síntesis de microcistina, se realizó mediante la técnica de reacción en cadena de la polimerasa (PCR). El cultivo de las cepas se realizó en cámara de cultivo aclimatada (25 ° C) bajo aireación constante durante 15 días con un fotoperíodo de 12 horas utilizando los medios Conway y BG11 elaborados con agua de mar filtrada. Se observó la producción de microcistina en cinco cepas pertenecientes al género Synechocystis. La presencia del gen mcyB fue detectada en doce cepas de cianobactérias: Synechocystis (tres cepas), Synechococcus (seis cepas) y Romeria (dos cepas). Sólo una cepa (Synechocystis aquatilis) mostró tanto la producción de microcistina como la presencia del gen mcyB. Se observó la actividad antibacteriana de una cepa de Romeria gracilis, de una cepa de Synechocystis aquatilis y dos cepas de Synechococcus sp. Los extractos etanólicos de las cepas de R. gracilis y Synechococcus sp. inhibieron el crecimiento de P. aeruginosa. Entre los extractos metanólicos de cianobacterias solamente S. aquatilis mostró actividad contra S. aureus y R. gracilis contra P. aeruginosa. Varias cepas de cianobacterias estudiadas en este trabajo fueron positivas para la producción de microcistina y actividad antibacteriana frente a bacterias patógenas de S. aureus y P. aeuruginosa, y pueden ser explotadas para aplicaciones biotecnológicas.

Injuries caused by venomous animals and folk medicine in farmers from Cuite, State of Paraiba, Northeast of Brazil / Relatos de acidentes por animais peconhentos e medicina popular em agricultores de Cuite, regiao do Curimatau, Paraiba, Brasil

Injuries caused by venomous animals reported by the agricultural workers from the municipality of Cuité, Curimataú region of Paraiba State, Northeast of Brazil, and the practices of folk medicine which they use to treat these cases were studied in this work from June to August 2010. The farmers studied aged from 11 to 90 years. The number of people who reported cases of injury by these animals in their families was high (89.3%). Scorpions, wasps, bees and snakes were the most cited and the extremities of the body (hands, feet, legs and head) were the most affected. The practice of folk medicine to treat these injuries includes various procedures ranging from ritualistic treatments, use of animals or parts of them, and some herbal preparations. The folk treatment was reported as effective by most of the workers injured (63.9%). Body parts of dead snakes are used in various zootherapic treatments. In the imaginary of the agricultural workers the venomous animals are considered hazardous (48.7%) or disgusting (11.3%), and several parts of such animals as the rattle, bee sting or snake leather are used as amulet. Several legends have also been reported about snakes, scorpions and bees. The need for educational activities that aim to clarify these workers about the dangers of such practices is urgent.

Acidentes por animais peçonhentos ocorridos com agricultores sindicalizados do município de Cuité, região do Curimataú paraibano, e práticas de medicina popular por eles utilizadas foram estudadas neste trabalho, através de entrevistas livres e questionários semiestruturados durante o período de junho a agosto de 2010. A idade dos agricultores pesquisados variou de 11 a 90 anos e a incidência de pessoas que sofreram algum acidente com esses animais chegou a 89,3%. Escorpiões, marimbondos, abelhas e serpentes foram os animais mais citados. As extremidades do corpo (mãos, pés, pernas e cabeça) foram as regiões mais atingidas. A prática da medicina popular para tratar desses acidentes inclui vários procedimentos que vão desde tratamentos ritualísticos, uso de animais ou partes dele, até preparos fitoterápicos. O tratamento caseiro é reconhecido como sendo eficaz pela maioria dos que sofreram acidentes (63,9%). Serpentes mortas têm várias partes do corpo arrancadas e usadas em tratamentos zooterápicos diversos. No imaginário dos agricultores, os animais peçonhentos são vistos como perigosos (48,7%) ou nojentos (11,3%), e diversas partes desses animais como chocalho, ferrão da abelha ou couro da cobra são usadas como amuletos de sorte. Inúmeras lendas também foram relatadas com cobras, escorpiões e abelhas. A necessidade de atividades educacionais visando esclarecer esses trabalhadores sobre os perigos dessas práticas é urgente.

Estrutura da comunidade dos Tintinnina na região do Atol das Rocas (Rio Grande do Norte) e Arquipélago de Fernando de Noronha (Pernambuco) / Community structure of Tintinnina near the Atol das Rocas Island (Rio Grande do Norte) and Fernando de Noronha Archipelago (Pernambuco)

Os Tintinnina que ocorrem em águas próximas ao Atol das Rocas e Arquipélago de Fernando de Noronha (Nordeste do Brasil) foram estudados usando amostras de plâncton coletadas entre 13 e 30 de março de 1999 em 27 estações oceânicas. O estudo procurou caracterizar a distribuição espacial desses ciliados na área e examinar parâmetros como a diversidade e eqüitabilidade que definem a estrutura da comunidade. O material foi coletado por arrastos verticais desde 200 m de profundidade até a superfície, usando uma rede de plâncton de 20 µm de abertura de malhas, preservado em formol neutro a 4 por cento, e examinado em um microscópio invertido. A maior densidade de indivíduos foi encontrada na estação 26 (122 ind.m-3), situada nas proximidades de Fernando de Noronha; mas altas densidades também foram registradas nas estações 1 (82,7 ind.m-3) e 2 (74,7 ind.m-3), situadas em áreas mais distantes, bem como na estação 5 (80,7 ind.m-3) próxima do Atol das Rocas. Eutintinnus fraknoi (Daday) Kofoid & Campbell, 1929 foi a espécie mais abundante, atingindo 57,8 por cento de dominância na estação 4. O índice de diversidade específica variou de alto (27 por cento das amostras com valores maiores que 3 bits.ind-1) a médio (63 por cento das amostras com valores maiores que 2 bits.ind-1), enquanto a eqüitabilidade variou entre 0,6 e 1,0. As baixas densidades de Tintinnina observadas no material coletado confirmam a condição oligotrófica daquela região.

Tintinnina occurring near the Atol das Rocas Island and Fernando de Noronha Archipelago (northeastern Brazil) were studied using plankton samples gathered from 13 to 30 March, 1999, in 27 fixed oceanic stations. The study sought to characterize the spatial distribution of these ciliates in the area and to examine parameters such as diversity and equitability that define the community structure. The material was collected by vertical hauls from 200 m to the surface using a 20 µm mesh plankton net, preserved in 4 percent neutral formalin, and examined using an inverted microscope. The highest density of individuals was found in station 26 (122 ind.m-3), which is situated very close to Fernando de Noronha; but high densities were also registered in stations 1 (82.7 ind.m-3) and 2 (74.7 ind.m-3), which were situated in the most distant areas, as well as in station 5 (80.7 ind.m-3) close to the Atol das Rocas Island. Eutintinnus fraknoi (Daday) Kofoid & Campbell, 1929 was the most abundant species, attaining 57.8 percent of dominance in station 4. The index of specific diversity fluctuated from high (27 percent of the samples with values higher than 3 bits.ind-1) to medium (63 percent of the samples higher than 2 bits.ind-1), while the equitability fluctuated between 0.6 and 1.0. The low densities of Tintinnina observed in the material collected confirm the oligotrophic condition of that region.

Avaliação do córtex pré-frontal dorso-lateral de pacientes com trantorno bipolar através da espectroscopia por ressonância magnética de hidrogênio (ERM-'ANTPOT 1 H') / Evaluation of the dorsolateral prefrontal cortex in bipolar disorder patients utilizing proton magnetic resonance spectroscopy ('ANTPOT 1H'-mrs)

O córtex pré-frontal dorso-lateral (CPFDL) é uma das regiões cerebrais envolvidas no controle e expressão das emoções. Postula-se que alterações no funcionamento do CPFDL ocorram em pacientes com transtorno afetivo bipolar, e tenham relevância à fisiopatologia desse transtorno. A espectroscopia por ressonância magnética de prótons (ERM-'ANTPOT 1 H') permite medir a concentração de diversos metabólitos cerebrais de forma não invasiva. Entre os metabólitos de maior interesse estão o N-acetil-aspartato (NAA) e o inositol, marcadores do funcionamento neuronal e possivelmente relevantes nas ações benéficas do lítio. O presente protocolo avaliou o CPFDL de pacientes bipolares adultos e adolescentes utilizando ERM-'ANTPOT 1 H') para identificar possíveis alterações na concentração de NAA ou inositol entre os pacientes.The dorsolateral prefrontal cortex (DLPFC) is one of the brain regions involved on the expression and control of emotions. It is believed that patients with Bipolar Affective Disorder present an abnormal functioning of the DLPFC, which might be relevant to the illness pathophysiology. Proton magnetic resonance spectroscopy ('ANTPOT 1 H'-MRS) is a non-invasive techique that alows us to measure the concentration of several brain metabolites. Some relevant metabolites are N-Acetyl-Aspartate (NAA) and inositol, two markers of neural functioning that might also be involved on lithium's therapeutic actions. In this protocol, we utilized 'antpot 1 H'-MRS to examine the DLPFC of adult and adolescent bipolar patients in order to identify possible abnormal concentrations of NAA and inositol among the patients...