Detecting Clinically Relevant Emotional Distress and Functional Impairment in Children and Adolescents: Protocol for an Automated Speech Analysis Algorithm Development Study.

BACKGROUND: Even before the onset of the COVID-19 pandemic, children and adolescents were experiencing a mental health crisis, partly due to a lack of quality mental health services. The rate of suicide for Black youth has increased by 80%. By 2025, the health care system will be short of 225,000 therapists, further exacerbating the current crisis. Therefore, it is of utmost importance for providers, schools, youth mental health, and pediatric medical providers to integrate innovation in digital mental health to identify problems proactively and rapidly for effective collaboration with other health care providers. Such approaches can help identify robust, reproducible, and generalizable predictors and digital biomarkers of treatment response in psychiatry. Among the multitude of digital innovations to identify a biomarker for psychiatric diseases currently, as part of the macrolevel digital health transformation, speech stands out as an attractive candidate with features such as affordability, noninvasive, and nonintrusive. OBJECTIVE: The protocol aims to develop speech-emotion recognition algorithms leveraging artificial intelligence/machine learning, which can establish a link between trauma, stress, and voice types, including disrupting speech-based characteristics, and detect clinically relevant emotional distress and functional impairments in children and adolescents. METHODS: Informed by theoretical foundations (the Theory of Psychological Trauma Biomarkers and Archetypal Voice Categories), we developed our methodology to focus on 5 emotions: anger, happiness, fear, neutral, and sadness. Participants will be recruited from 2 local mental health centers that serve urban youths. Speech samples, along with responses to the Symptom and Functioning Severity Scale, Patient Health Questionnaire 9, and Adverse Childhood Experiences scales, will be collected using an Android mobile app. Our model development pipeline is informed by Gaussian mixture model (GMM), recurrent neural network, and long short-term memory. RESULTS: We tested our model with a public data set. The GMM with 128 clusters showed an evenly distributed accuracy across all 5 emotions. Using utterance-level features, GMM achieved an accuracy of 79.15% overall, while frame selection increased accuracy to 85.35%. This demonstrates that GMM is a robust model for emotion classification of all 5 emotions and that emotion frame selection enhances accuracy, which is significant for scientific evaluation. Recruitment and data collection for the study were initiated in August 2021 and are currently underway. The study results are likely to be available and published in 2024. CONCLUSIONS: This study contributes to the literature as it addresses the need for speech-focused digital health tools to detect clinically relevant emotional distress and functional impairments in children and adolescents. The preliminary results show that our algorithm has the potential to improve outcomes. The findings will contribute to the broader digital health transformation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46970.

Recent trends and technological development in plasma as an emerging and promising technology for food biosystems.

The rising need for wholesome, fresh, safe and "minimally-processed" foods has led to pioneering research activities in the emerging non-thermal technology of food processing. Cold plasma is such an innovative and promising technology that offers several potential applications in the food industry. It uses the highly reactive, energetic and charged gas molecules and species to decontaminate the food and package surfaces and preserve the foods without causing thermal damage to the nutritional and quality attributes of food. Cold plasma technology showed promising results about the inactivation of pathogens in the food industry without affecting the food quality. It is highly effective for surface decontamination of fruits and vegetables, but extensive research is required before its commercial utilization. Recent patents are focused on the applications of cold plasma in food processing and preservation. However, further studies are strongly needed to scale up this technology for future commercialization and understand plasma physics for getting better results and expand the applications and benefits. This review summarizes the emerging trends of cold plasma along with its recent applications in the food industry to extend shelf life and improve the quality of food. It also gives an overview of plasma generation and principles including mechanism of action. Further, the patents based on cold plasma technology have also been highlighted comprehensively for the first time.

The performance of Remicade®-optimized quantification assays in the assessment of Flixabi® levels.

BACKGROUND: The advent of Remicade® biosimilars, Remsima®, Inflectra® and, more recently, Flixabi®, has brought along the potential to decrease the costs associated with this therapy, therefore increasing its access to a larger group of patients. However, and in order to assure a soft transition, one must make sure the assays and algorithms previously developed and optimized for Remicade perform equally well with its biosimilars. This study aimed to: (a) validate the utilization of Remicade-optimized therapeutic drug monitoring assays for the quantification of Flixabi; and (b) determine the existence of Remicade, Remsima and Flixabi cross-immunogenicity. METHODS: Healthy donors' sera spiked with Remicade, Remsima and Flixabi were quantified using three different Remicade-quantification assays, and the reactivity of anti-Remicade and anti-Remsima sera to Remicade and to its biosimilars was assessed. RESULTS: The results show that all tested Remicade-infliximab-optimized assays measure Flixabi as accurately as they measure Remicade and Remsima: the intraclass correlation coefficients between theoretical and measured concentrations varied from 0.920 to 0.990. Moreover, the interassay agreement values for the same compounds were high (intraclass correlation coefficients varied from 0.936 to 0.995). Finally, the anti-Remicade and anti-Remsima sera reacted to the different drugs in a similar fashion. CONCLUSIONS: The tested assays can be used to monitor Flixabi levels. Moreover, Remicade, Remsima and Flixabi were shown to have a high cross-immunogenicity, which supports their high similarity but prevents their switching in nonresponders with antidrug antibodies.

Assessment of six cardiovascular risk calculators in Mexican mestizo patients with rheumatoid arthritis according to the EULAR 2015/2016 recommendations for cardiovascular risk management.

Variability of the 10-year cardiovascular (CV) risk predicted by the Framingham Risk Score (FRS) using lipids, FRS using body mass index (BMI), Reynolds Risk Score (RRS), QRISK2, Extended Risk Score-Rheumatoid Arthritis (ERS-RA), and algorithm developed by the American College of Cardiology and the American Heart Association in 2013 (ACC/AHA 2013) according to the European League Against Rheumatism (EULAR) 2015/2016 update of its evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis (RA) has not been evaluated in Mexican mestizo patients. CV risk was predicted using six different risk calculators in 116 patients, aged 40-75, who fulfilled the ACR/EULAR 2010 classification criteria. Results were multiplied by 1.5 according to the EULAR 2015/2016 update. Global comparison of the risk predicted by all scales was done using the Friedman test, considering a P value of ≤0.05 as statistically significant. Individual comparison between the algorithms was made using the Wilcoxon signed-rank test, and a P value of ≤0.003 was considered statistically significant. All calculators showed to be different in the Friedman test (p ≤ 0.001). Median values of predicted 10-year CV risk were 11.02% (6.18-17.55) for FRS BMI; 8.47% (4.6-13.16) for FRS lipids; 5.55% (2.5-11.85) for QRISK2; 5% (3.1-8.65) for ERS-RA; 3.6% (1.5-9.3) for ACC/AHA 2013; and 1.5% (1.5-4.5) for RRS. ERS-RA showed no difference when compared against QRISK2 (p = 0.269). CV risk calculators showed variability among them and cannot be used indistinctly in RA-patients.

Prospective assessment of rapid diagnostic tests for the detection of antibodies to hepatitis C virus, a tool for improving access to care.

Large-scale hepatitis C screening is required to prevent further spread of the infection, improve access to care in the context of new hepatitis C virus (HCV) drug regimens without interferon-alpha and subsequently reduce the risk of long-term complications of chronic liver disease. Rapid diagnostic tests (RDTs) represent an attractive alternative to enzyme immunoassay using blood from venepuncture. The aim of the present study was to prospectively assess the clinical performance of CE-marked RDTs detecting anti-HCV antibodies in fingerstick capillary whole blood and/or oral fluid. A total of 513 individuals, including 318 patients with chronic HCV infection, 25 patients with resolved HCV infection and 170 HCV-seronegative individuals, were prospectively enrolled. The specificity of RDTs with fingerstick whole blood varied from 98.8% to 100%. The clinical sensitivity was high for the OraQuick(®) and Toyo(®) tests (99.4% and 95.8%, respectively), but low for the Labmen(®) test (63.1%). The specificity and clinical sensitivity in crevicular fluid were both satisfactory for the OraQuick(®) test (100% and 97.6%, respectively). HCV antibody RDTs were easy and rapid to perform in the context of patient care. They were highly specific. Both the OraQuick(®) and Toyo(®) tests reached the expected level of performance for wide-scale use, with a performance advantage for the OraQuick(®) HCV test. RDTs appear to be a promising new tool for wide-scale screening of HCV infection in high-risk to medium-risk populations. Hence, careful assessment of the performance of HCV RDTs must be recommended before they can be implemented in clinical practice.

Cost-effectiveness of sofosbuvir in the treatment of patients with hepatitis C.

In France, 190,306 patients were suffering from chronic hepatitis C in 2012. These patients have a decreased life expectancy and are susceptible to complications associated with chronic hepatitis. Current treatments are poorly tolerated and their effectiveness varies depending on the genotype of the virus. Sofosbuvir, a new class of treatment, has demonstrated in five phase III trials sustained viral response (SVR) rates of over 90% across genotypes, higher than current treatments and has a tolerance profile similar to placebo. The objective was to determine the cost-effectiveness of using sofosbuvir in the treatment of chronic HCV infection. A Markov model was used to compare treatment strategies with and without sofosbuvir. The model simulated the natural history of HCV infection. SVR rates were based on data from clinical trials. Utilities associated with different stages of disease were based on data from the literature. French direct medical costs were used. Price for sofosbuvir was the price used in the early access program for severe fibrosis stages. The incremental cost-effectiveness ratio for sofosbuvir versus current reference treatments was € 16,278/QALY and varied from 40,000 €/QALY for F0 stages to 12,080 €/QALY for F4 stages. The sensitivity analyses carried out confirmed the robustness of this result. Sofosbuvir is a cost-effective treatment option for patients with hepatitis C.

Atención prenatal según la NOM-007 relacionada con morbilidad materna en una unidad de salud en San Luis Potosí durante 2008 / Prenatal care according to the NOM-007 norm, which relates to maternal morbidity in a health center in San Luis Potosí (2008)

La mortalidad materno-infantil refleja el grado de desarrollo social y económico de un país, por lo que la salud reproductiva es una prioridad sanitaria; su prevención depende directamente de la cobertura y calidad de los servicios de salud. OBJETIVOS: evaluar el apego de la atención prenatal a la NOM 007 y su correlación con la morbilidad materna en una unidad de salud de San Luis Potosí, México. METODOLOGIA:estudio descriptivo, correlacional y cuantitativo, cuya unidad de análisis fueron 571 expedientes de embarazadas atendidas durante el 2008. Para probar la hipótesis se utilizó r de Pearson, p = 0,05. RESULTADOS: el rango de edad osciló entre 13 y 43 años, 37,1% adolescentes; 44,3% se incorporó a la atención en el segundo trimestre del embarazo; 38,2% cumplió con mínimo cinco consultas; 46,4% presentó morbilidad, con la infección urinaria como la más común (224 casos). El apego de la atención prenatal fue adecuado en 2,6% de los casos, según las acciones efectuadas; las de promoción de salud fueron las menos realizadas. CONCLUSION: el nivel de apego de la atención prenatal a la NOM 007 se calificó inadecuado en 97,4%, coincidiendo con morbilidad materna (87,5 -100%); esto podría relacionarse con consultas más frecuentes para algunas mujeres, el ingreso tardío a la atención y la consecuente reducción del tiempo para la realización de las acciones. La correlación resultó contraria a lo esperado, pues a mayor apego de la atención prenatal a la norma, mayor morbilidad materna se presentó (r = 0,318, p < 0,000).

Mother and child mortality reflects the level of social and economic development of a country; therefore, reproductive health is a sanitary priority. Mortality prevention depends directly on the coverage and quality of health services. OBJECTIVE: to assess the compliance of prenatal care with the NOM 007 norm and its correlation with maternal morbidity in a health center located in San Luis Potosí, Mexico. METHOGOLOGY: a descriptive, correlational, and quantitative study in which the units of analysis were the medical records of 571 pregnant women cared for during 2008. In order to prove the hypothesis, Pearson’s r was used. The p value was ≤ 0.05. RESULTS: ages ranged from 13 to 43 years. Additionally, 37.1% of the patients were teenagers and 44.3% began receiving attention during the second trimester of their pregnancy; 38.2% attended at least five medical appointments, and 46.4% had morbidity. For the latter group, urinary infection was the most common condition (224 cases). Prenatal attention was adequate in 2.6% of the cases according to the actions performed. Health promotion actions were the least frequent. CONCLUSION: the level of compliance with the NOM 007 norm for prenatal care was considered inadequate in 97.4% of the cases and was consistent with maternal morbidity (87.5-100%). This could be related to more frequent appointments for some women and with late treatment, which resulted in less time to perform said actions. Contrary to expectations, greater compliance meant higher maternal morbidity (r = 0.318, p < 0.000).

Health-related quality of life in a binational population with diabetes at the Texas-Mexico border

OBJECTIVES: To examine physical and mental health domains of health-related quality of life (HRQL) in a binational adult population with type 2 diabetes at the Texas-Mexico border, and to explore individual and social correlates to physical and mental health status. METHODS: Adults 18 years and older with type 2 diabetes residing in the South Texas Lower Rio Grande Valley and in Reynosa, Tamaulipas, Mexico, were recruited using a convenience sampling technique and interviewed face-to-face with a structured survey. HRQL was measured using physical and mental health summary components of the Medical Outcomes Study Short Form. HRQL correlates included demographic characteristics, health factors, access to healthcare, and family support. Samples characteristics were compared using the Student’s t-test or Mann-Whitney U test. Associations between dependent and independent variables were examined using unadjusted and adjusted (multiple variable) logistic regression models. RESULTS: There were no significant differences between Valley and Reynosa respondents in physical or mental health status scores. Valley participants with lower socioeconomic status and those perceiving their supportive relative’s level of diabetes-related knowledge as "low" were more likely to report worse physical health than those lacking those characteristics. In the Reynosa group, lower physical health status was associated with duration of diabetes and insulin use. Both sample populations with clinical depressive symptoms were more likely to have worse physical and mental health than those without such symptoms. CONCLUSIONS: HRQL is an important outcome in monitoring health status. Understanding the levels and influences of HRQL in U.S.-Mexico border residents with diabetes may help improve diabetes management programs.

OBJETIVOS: Analizar los dominios de salud física y mental de la calidad de vida relacionada con la salud (CVRS) en una población binacional de adultos con diabetes tipo 2 en la frontera Texas-México y explorar los factores individuales y sociales relacionados con el estado de la salud física y mental. MÉTODOS: Se realizó un muestreo de conveniencia de personas de 18 años de edad o más con diabetes tipo 2 que vivían en Lower Rio Grande Valley, al sur de Texas, y en Reynosa, Tamaulipas, México, y se les realizó una entrevista estructurada presencial. La CVRS se midió mediante los componentes abreviados de salud física y mental del MOS-SF8 (Medical Outcomes Study Short Form 8). Entre los factores relacionados con la CVRS estaban las características demográficas, los factores de salud, el acceso a la atención sanitaria y el apoyo familiar. Se compararon las características de las muestras mediante la prueba de la t de Student o la prueba de la U de Mann-Whitney. Las asociaciones entre las variables independientes y la dependiente se analizaron mediante modelos de regresión logística múltiple, ajustados y sin ajustar. RESULTADOS: No se encontraron diferencias significativas entre los entrevistados de Valley y de Reynosa en cuanto a la puntuación del estado de salud física y mental. Los participantes de Valley con menor estatus socioeconómico y los que consideraban que los parientes que los apoyaban tenían un "bajo" nivel de conocimiento sobre la diabetes presentaron una mayor probabilidad de informar un peor estado de salud física que los que no tenían esas características. En el grupo de Reynosa, el peor estado de salud física se asoció con la duración de la diabetes y el uso de insulina. En ambos grupos, las personas con síntomas clínicos de depresión tuvieron una mayor probabilidad de informar una peor salud física y mental que los que no presentaban esos síntomas. CONCLUSIONES: La CVRS es un importante criterio en el análisis del estado...

Prevalence of anemia and deficiency of iron, folic acid, and zinc in children younger than 2 years of age who use the health services provided by the Mexican Social Security Institute.

BACKGROUND: In Mexico, as in other developing countries, micronutrient deficiencies are common in infants between 6 and 24 months of age and are an important public health problem. The objective of this study was to determine the prevalence of anemia and of iron, folic acid, and zinc deficiencies in Mexican children under 2 years of age who use the health care services provided by the Mexican Institute for Social Security (IMSS). METHODS: A nationwide survey was conducted with a representative sample of children younger than 2 years of age, beneficiaries, and users of health care services provided by IMSS through its regular regimen (located in urban populations) and its Oportunidades program (services offered in rural areas). A subsample of 4,955 clinically healthy children was studied to determine their micronutrient status. A venous blood sample was drawn to determine hemoglobin, serum ferritin, percent of transferrin saturation, zinc, and folic acid. Descriptive statistics include point estimates and 95% confidence intervals for the sample and projections for the larger population from which the sample was drawn. RESULTS: Twenty percent of children younger than 2 years of age had anemia, and 27.8% (rural) to 32.6% (urban) had iron deficiency; more than 50% of anemia was not associated with low ferritin concentrations. Iron stores were more depleted as age increased. Low serum zinc and folic acid deficiencies were 28% and 10%, respectively, in the urban areas, and 13% and 8%, respectively, in rural areas. The prevalence of simultaneous iron and zinc deficiencies was 9.2% and 2.7% in urban and rural areas. Children with anemia have higher percentages of folic acid deficiency than children with normal iron status. CONCLUSION: Iron and zinc deficiencies constitute the principal micronutrient deficiencies in Mexican children younger than 2 years old who use the health care services provided by IMSS. Anemia not associated with low ferritin values was more prevalent than iron-deficiency anemia. The presence of micronutrient deficiencies at this early age calls for effective preventive public nutrition programs to address them.