The Fragility Index of Risk Factors for Hamstring Injuries.

OBJECTIVE: To determine the Fragility Index of hamstring injury risk factors, defined as the minimum number of participants who would need to change classification to make a hamstring injury risk factor statistically nonsignificant. DESIGN: Retrospective secondary data analysis. METHODS: Studies that investigated 1 or more risk factors for hamstring injury, and presented sufficient data to develop a 2 × 2 contingency table were included. A systematic literature search and reference screening of a recent hamstring injury systematic review were conducted to identify 78 articles. Relative risk and 95% confidence intervals were determined and then systematically recalculated by removing 1 observation from the high-risk injury count and adding it to the high-risk noninjury count. The Fragility Index for a risk factor was the number of observations required to be moved between groups until the relative risk was no longer significant. RESULTS: The median Fragility Index of all hamstring injury risk factors was 3 (Q1-Q3 = 2-6). The Fragility Index for nonmodifiable risk factors was 3 (Q1-Q3 = 2-6) and 3 (Q1-Q3 = 2-5) for modifiable risk factors. Over 35% of all included hamstring injury risk factors had a Fragility Index of ≤2. CONCLUSION: Most statistically significant hamstring injury risk factors are fragile associations. The interpretation of significant hamstring injury risk factors should consider a range of statistical metrics, and while the Fragility Index should never be considered in isolation, it is an intuitive measure to help assess the robustness of findings. J Orthop Sports Phys Ther 2024;54(10):672-678. Epub 4 September 2024. doi:10.2519/jospt.2024.12300.

Intersections of Compassion, Science, and Spiritual Care in Global Health for Public Health Benefits.

Across the globe, spiritual care is offered by individuals, healthcare chaplains, and humanitarian, social and related spiritual groups on account of zeal, voluntary and paid services. Sometimes, services are provided without understanding the connectivity of compassion, spiritual care, and scientific protocols. There are instances where health professionals and managers disagree with spiritual caregivers or reject spiritual services because of poor service deliveries in conflict with healthcare protocols. Against this background, this article focuses on how spiritual care services can be provided scientifically to improve service delivery. It presents leading questions to link the scientific and compassionate approach to spiritual care. These include-What is science? What is compassion? What is spiritual care? What makes compassion and spiritual care scientific? Are there tenets of compassion in religions? How are compassion, science and spiritual care linked? What are the implications of the intersections for public health and safety? Hopefully, the provided answers may improve the service delivery performance of spiritual caregivers and their collaboration with healthcare professionals, social workers, and related groups.

Second Look at Reported Racial-Ethnic Employment Differences in the Supported Employment Demonstration.

OBJECTIVE: The Supported Employment Demonstration (SED) trial, which studied the effects of individual placement and support (IPS) among individuals initially denied Social Security Administration disability benefits for mental illness, reported racial-ethnic differences in IPS' effect on employment. Because of high rates of attrition in the SED, this finding warranted further study. The current reanalysis used a subsample with a directly observed measure of competitive employment and less attrition to try to corroborate the reported racial-ethnic differences. METHODS: The authors compared self-reported employment (collected via telephone interviews) with observed employment (reported monthly by multidisciplinary teams) among a representative subsample (N=614) of the SED, stratified by race and ethnicity. RESULTS: The observed competitive employment outcomes showed no significant racial-ethnic differences among those assigned to participate in IPS. CONCLUSIONS: Congruent with previous research, reanalysis based on more complete data and more rigorous outcome measurements implied an absence of racial-ethnic differences in IPS' effect on observed employment outcomes.

TRU-IMP: techniques for reliable use of images in medical physics; a graphical user interface to analyze and compare segmentations in nuclear medicine.

BACKGROUND: In the context of pharmacokinetic analyses, the segmentation method one uses has a large impact on the results obtained, thus the importance of transparency. Innovation: This paper introduces a graphical user interface (GUI), TRU-IMP, that analyzes time-activity curves and segmentations in dynamic nuclear medicine. This GUI fills a gap in the current technological tools available for the analysis of quantitative dynamic nuclear medicine image acquisitions. The GUI includes various techniques of segmentations, with possibilities to compute related uncertainties. Results: The GUI was tested on image acquisitions made on a dynamic nuclear medicine phantom. This allows the comparison of segmentations via their time-activity curves and the extracted pharmacokinetic parameters. Implications: The flexibility and user-friendliness allowed by the proposed interface make the analyses both easy to perform and adjustable to any specific case. This GUI permits researchers to better show and understand the reproducibility, precision, and accuracy of their work in quantitative dynamic nuclear medicine. Availability and Implementation: Source code freely available on GitHub: https://github.com/ArGilfea/TRU-IMP and location of the interface available from there. The GUI is fully compatible with iOS and Windows operating systems (not tested on Linux). A phantom acquisition is also available to test the GUI easily. .

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life.

BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms. METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology. RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms. CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

Optimization of ventilation efficiency in tunnel-type underground spaces using response surface methodology: a case study of Yunlong Mountain civil defense in Xuzhou.

Civil defense projects, designed as wartime underground spaces, often lack effective natural ventilation and have considerable depth, which complicates their use as public spaces in peacetime. However, the application of passive ventilation technologies can create effective airflow channels within these structures, significantly enhancing ventilation efficiency and thus improving the overall thermal comfort level. For this study, air age, along with average wind speed, temperature, and relative humidity as stipulated by the "Requirements for Environmental Sanitation of Civil Air Defense Works during Peacetime Use" (GBT 17216-2012), were selected as evaluation metrics. This paper compares the ventilation effectiveness between single ventilation shafts and multiple ventilation shafts under positive and negative pressure conditions in underground civil defense structures. The results indicate that negative pressure ventilation in multiple shaft configurations performs optimally across various ventilation approaches. Subsequently, the Response Surface Methodology (RSM) was utilized to further optimize the positioning of multiple ventilation shafts. The study examined the impact of three ventilation shaft locations on average wind speed, temperature, relative humidity, and air age, leading to an optimized design. Specifically, the optimal positions are 54.76 m for Shaft A, 51.45 m for Shaft B, and 79.85 m for Shaft C, achieving an average wind speed of 0.222 m/s, a temperature of 26 °C, a relative humidity reduction to 85.47%, and an average air age of 10.57 s. This research provides practical insights for the optimization of ventilation in underground civil defense facilities.

Indigenous Peoples' evaluation of health risks when facing mandatory evacuation for birth during the COVID-19 pandemic: an indigenous feminist analysis.

BACKGROUND: Indigenous Peoples living on the land known as Canada are comprised of First Nations, Inuit, and Métis people and because of the Government of Canada's mandatory evacuation policy, those living in rural and remote regions of Ontario are required to travel to urban, tertiary care centres to give birth. When evaluating the risk of travelling for birth, Indigenous Peoples understand, evaluate, and conceptualise health risks differently than Eurocentric biomedical models of health. Also, the global COVID-19 pandemic changed how people perceived risks to their health. Our research goal was to better understand how Indigenous parturients living in rural and remote communities conceptualised the risks associated with evacuation for birth before and during the COVID-19 pandemic. METHODS: To achieve this goal, we conducted semi-structured interviews with 11 parturients who travelled for birth during the pandemic and with 5 family members of those who were evacuated for birth. RESULTS: Participants conceptualised evacuation for birth as riskier during the COVID-19 pandemic and identified how the pandemic exacerbated existing risks of travelling for birth. In fact, Indigenous parturients noted the increased risk of contracting COVID-19 when travelling to urban centres for perinatal care, the impact of public health restrictions on increased isolation from family and community, the emotional impact of fear during the pandemic, and the decreased availability of quality healthcare. CONCLUSIONS: Using Indigenous Feminist Methodology and Indigenous Feminist Theory, we critically analysed how mandatory evacuation for birth functions as a colonial tool and how conceptualizations of risk empowered Indigenous Peoples to make decisions that reduced risks to their health during the pandemic. With the results of this study, policy makers and governments can better understand how Indigenous Peoples conceptualise risks related to evacuation for birth before and during the pandemic, and prioritise further consultation with Indigenous Peoples to collaborate in the delivery of the health and care they need and desire.

Optimization of the preparation process of Spirulina blended liquor and Spirulina fermented wine, analysis of volatile components and in vitro antioxidant study.

The optimal conditions were explored for the preparation of Spirulina blended liquor (SBL) and Spirulina fermented wine (SFW), respectively. The parameters obtaining highest alga polysaccharide were calculated by response surface methodology. The optimal conditions for SBL preparation were base liquor of 42% vol, ultrasonication time of 37-min and ultrasonic power of 80 W with polysaccharide content (PC) and alcohol content (AC) of 0.2181 g/L and 39.7% vol, respectively. In the case of SFW, optimum fermentation occurred at 22°C, with a 4% inoculum and 6-day period with PC and AC of 8.533 g/L and 11.2% vol, respectively. Headspace solid-phase microextraction-gas chromatography-mass spectrometry was used to quantitatively analyze the volatile components of SBL and SFW. There were 32 and 40 main aroma compounds in SBL and SFW, respectively. Volatile organic compounds, including α-ionone and ß-ionone, produced by Spirulina were detected in both SBL and SFW. Comparative evaluation of scavenging activity and total reducing power revealed the antioxidant capacity of SFW significantly outperformed that of SBL.

Optimized pyrolytic synthesis and physicochemical characterization of date palm seed biochar: unveiling a sustainable adsorbent for environmental remediation applications.

This study focuses on the optimization and comprehensive characterization of biochar synthesized from date palm seeds (DPS), a prevalent agricultural waste in arid regions. Using response surface methodology (RSM) with a central composite design (CCD), we optimized the pyrolysis process by investigating the effects of time (1-3 h) and temperature (600-900 °C) on critical properties such as specific surface area, pore volume, and yield. The optimized biochar, produced at 828 °C for 1.7 h, demonstrated a high specific surface area of 654.8 m2/g and well-developed microporosity. Characterization techniques, including XRD, FTIR, SEM-EDS, and BET analyses, revealed an amorphous carbon structure with graphitic domains, diverse surface functionalities, and a heterogeneous porous microstructure. The biochar's point of zero charge at pH 7.58 indicates its potential for selective adsorption of charged contaminants. The close agreement between RSM-predicted and experimental values for specific surface area (652.1 m2/g vs. 654.8 m2/g) and micropore volume (0.191 cm3/g vs. 0.190 cm3/g) validates the effectiveness of the model in optimizing biochar properties. This research highlights the potential of DPS-derived biochar as a sustainable adsorbent for environmental remediation, opening avenues for valorizing agricultural wastes and contributing to circular economy principles.

Standardization of gut microbiome analysis in sports.

The gut microbiome plays a significant role in physiological functions such as nutrient processing, vitamin production, inflammatory response, and immune modulation, which, in turn, are important contributors to athlete health and performance. To date, the interpretation, discussion, and visualization of microbiome results of athletes are challenging, due to a lack of standard parameters and reference data for collection and comparison. The purpose of this perspective piece is to provide researchers with an easy-to-understand framework for the collection, analysis, and data management related to the gut microbiome with a specific focus on athletic populations. In the absence of a consensus on microbiome research in the sports field, we hope that these considerations serve as foundational "best practice." Adherence to these standard operating procedures will accelerate the path toward improving the quality of data and ultimately our understanding of the influence of the gut microbiome in sport settings.

How the designed processing parameters affect the liquid mixture density and viscosity of the tretinoin-loaded niosomes at different temperatures?

The current study was conducted to present novel thermophysical data on tretinoin-loaded niosomes paired with a combination of span 60 and tween 80. Measurements were carried out to analyze the liquid mixture density and viscosity of the mentioned multilayered structures for the first time, with consideration given to the diverse molecular weights of surfactants and various stabilizers at different temperatures. Through the application of equations of state, this study has the ability to set the stage for thermodynamic modeling of solutions that involve niosomes, presenting a promising avenue for further research. So, tretinoin-loaded formulations were prepared by investigating the effects of different co-surfactants, including cholesterol or dodecanol, as well as the impact of surfactant molecular weight limited to 650.525-1090.175 g mol-1. This novel investigation was conducted to assess the superior stabilizing capabilities of dodecanol in comparison to cholesterol, with a specific emphasis on optimized vesicle size, highest incorporation efficiency, and lowest zeta potential. In particulars, the response surface methodology (RSM) was applied to optimize the operative factors and the number of experiments. The experimental evidence clearly indicates that the use of dodecanol in the manufacturing process significantly improves the stability of niosomes, while the inclusion of cholesterol leads to higher liquid mixture density and viscosity in the prepared niosomes.

Characterising umbrella reviews in paediatrics: A systematic analysis.

AIM: To characterise typical practices in conducting and reporting umbrella reviews in paediatrics. METHODS: PubMed database was searched for umbrella reviews focusing on children (0-18 years) published from 1 January 2020 to 15 June 2024, regardless of the speciality. The included studies were assessed for reporting practices, result summarisation and critical appraisal methods. RESULTS: Ninety-nine eligible umbrella reviews were included, of which 49 focused on interventions and 50 focused on epidemiology. The median number of included reviews in the umbrella reviews was 18 (range = 3-302), and statistical synthesis was performed in 32 studies. The most frequently used tool for critical appraisal of the included reviews was the updated Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool (n = 56); the original AMSTAR-1 tool was used in seven reviews, and the Risk of Bias in Systematic Reviews tool was used in 12 reviews. Evidence certainty was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework in 14 reviews and by the Ioannidis criteria in 18 reviews. CONCLUSION: Umbrella reviews have heterogeneous characteristics in terms of reporting practices. Greater adherence to guidelines on conducting and reporting umbrella reviews is needed, particularly for improving critical appraisal methods.

FOUNTAIN: a modular research platform for integrated real-world evidence generation.

BACKGROUND: Real-world evidence (RWE) plays a key role in regulatory and healthcare decision-making, but the potentially fragmentated nature of generated evidence may limit its utility for clinical decision-making. Heterogeneity and a lack of reproducibility in RWE resulting from inconsistent application of methodologies across data sources should be minimized through harmonization. METHODS: This paper's aim is to describe and reflect upon a multidisciplinary research platform (FOUNTAIN; FinerenOne mUlti-database NeTwork for evidence generAtIoN) with coordinated studies using diverse RWE generation approaches and explore the platform's strengths and limitations. With guidance from an executive advisory committee of multidisciplinary experts and patient representatives, the goal of the FOUNTAIN platform is to harmonize RWE generation across a portfolio of research projects, including research partner collaborations and a common data model (CDM)-based program. FOUNTAIN's overarching objectives as a research platform are to establish long-term collaborations among pharmacoepidemiology research partners and experts and to integrate diverse approaches for RWE generation, including global protocol execution by research partners in local data sources and common protocol execution in multiple data sources through federated data networks, while ensuring harmonization of medical definitions, methodology, and reproducible artifacts across all studies. Specifically, the aim of the multiple studies run within the frame of FOUNTAIN is to provide insight into the real-world utilization, effectiveness, and safety of finerenone across its life-cycle. RESULTS: Currently, the FOUNTAIN platform includes 9 research partner collaborations and 8 CDM-mapped data sources from 7 countries (United States, United Kingdom, China, Japan, The Netherlands, Spain, and Denmark). These databases and research partners were selected after a feasibility fit-for-purpose evaluation. Six multicountry, multidatabase, cohort studies are ongoing to describe patient populations, current standard of care, comorbidity profiles, healthcare resource use, and treatment effectiveness and safety in different patient populations with chronic kidney disease and type 2 diabetes. Strengths and potential limitations of FOUNTAIN are described in the context of valid RWE generation. CONCLUSION: The establishment of the FOUNTAIN platform has allowed harmonized execution of multiple studies, promoting consistency both within individual studies that employ multiple data sources and across all studies run within the platform's framework. FOUNTAIN presents a proposal to efficiently improve the consistency and generalizability of RWE on finerenone.

Redesigning a Stopped Clinical Trial as an Emulated Trial Using Real-World Data to Explore the Effectiveness of Slow-Release Oral Morphine as a Treatment for Opioid Use Disorder.

Canada is currently experiencing a problematic opioid crisis with increasing mortality rates. Traditional randomized controlled trials (RCTs) that examine the effectiveness of pharmacological treatment options for people with opioid use disorder (OUD) are challenging to conduct. An increasingly popular methodology is through the implementation of emulated clinical trials, a methodology in which key elements of a "target" RCT are replicated using previously collected healthcare-based data. They can possibly address some of the common challenges found in the conduct of RCTs, such as prolonged timelines, high cost, and poor participant recruitment. In effect, emulated trials accelerate knowledge generation by producing real-world evidence that can be akin to phase 3 effectiveness trials, without any need to recruit live participants or administer investigational products. During the COVID-19 pandemic, several trials were stopped due to increased pandemic-related research restrictions, leaving important questions about OUD treatment unanswered. In this commentary, we describe the transition of a traditional RCT to an emulated trial spurred by challenges posed by the COVID-19 pandemic. We describe our transition using a notable published framework with regards to the population sample, interventions, outcomes, and proposed analyses. This commentary aims to help other researchers and trialists apply emulated trials in substance use research and beyond, emphasizing the role of this methodology in clinical research and advancing scientific knowledge that could be otherwise lost or unattainable.

Multiaxial fatigue life assessment of dental implants.

As screwed joints, dental restorations may suffer mechanical failures such as screw loosening and implant or prosthetic screw failure due to fatigue. This work is focused on the failure of the implant and develops a numerical methodology to predict its fatigue life under cyclic loading conditions. This methodology is based on the combination of Critical Plane Methods and the Theory of Critical Distances to account for stress multiaxiality and notch effects. The obtained predictions were validated experimentally, which can be used to identify the main geometrical, assembly and operational factors affecting the fatigue behavior of dental implants. As a result, a powerful and efficient design tool for fatigue life prediction of dental implants is presented. This methodology complements a previously presented one focused on the fatigue life prediction of the prosthetic screw, thereby, offering now a complete design tool package regardless the critical component of the dental restoration, predicting accurately the fatigue response of the restoration, with no need for long-term fatigue test campaigns. This is a pioneering work since no other fatigue design methodology for dental implants with such a solid foundation and experimental validation has been published to date.

Interventional Pharmacoepidemiology: Origins, Current Status, and Future Possibilities.

Interventional pharmacoepidemiology applies quantitative analysis of patterns of medication use and outcomes to help design, guide and then evaluate programs to improve prescription drug use and outcomes. Surveillance of prescribing and drug-taking in large populations is increasingly practical because of the proliferation of detailed data on medication use decisions, often based on paid claims billing data. At the same time, increasingly granular clinical information is available on patient characteristics and outcomes. This can offer important opportunities to identify problematic use, focus interventions to address them, and measure their impact. Alexander et al (Am J Epidemiol. 0000;000(00):0000-0000) review the need for such research and provide methodological guidance for its performance. While randomized controlled trials of such interventions are ideal, real-world considerations often require other evaluation strategies, including stepped-wedge designs and interrupted time-series analysis. As drug therapy becomes more powerful and more costly, and the risks of poor medication choices as well as under-use of effective treatments become even better understood, the health care system will increasingly rely on such approaches to assess current patterns of prescribing and patient adherence, target programs to address problem areas, and measure the effectiveness of such interventions.

Investigating Data Diversity and Model Robustness of AI Applications in Palliative Care and Hospice: Protocol for Scoping Review.

BACKGROUND: Artificial intelligence (AI) has become a pivotal element in health care, leading to significant advancements across various medical domains, including palliative care and hospice services. These services focus on improving the quality of life for patients with life-limiting illnesses, and AI's ability to process complex datasets can enhance decision-making and personalize care in these sensitive settings. However, incorporating AI into palliative and hospice care requires careful examination to ensure it reflects the multifaceted nature of these settings. OBJECTIVE: This scoping review aims to systematically map the landscape of AI in palliative care and hospice settings, focusing on the data diversity and model robustness. The goal is to understand AI's role, its clinical integration, and the transparency of its development, ultimately providing a foundation for developing AI applications that adhere to established ethical guidelines and principles. METHODS: Our scoping review involves six stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting the results; and (6) consulting with stakeholders. Searches were conducted across databases including MEDLINE through PubMed, Embase.com, IEEE Xplore, ClinicalTrials.gov, and Web of Science Core Collection, covering studies from the inception of each database up to November 1, 2023. We used a comprehensive set of search terms to capture relevant studies, and non-English records were excluded if their abstracts were not in English. Data extraction will follow a systematic approach, and stakeholder consultations will refine the findings. RESULTS: The electronic database searches conducted in November 2023 resulted in 4614 studies. After removing duplicates, 330 studies were selected for full-text review to determine their eligibility based on predefined criteria. The extracted data will be organized into a table to aid in crafting a narrative summary. The review is expected to be completed by May 2025. CONCLUSIONS: This scoping review will advance the understanding of AI in palliative care and hospice, focusing on data diversity and model robustness. It will identify gaps and guide future research, contributing to the development of ethically responsible and effective AI applications in these settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56353.

Insights into the methodological perspectives for screening polyunsaturated fatty acids-containing bacteria.

Polyunsaturated fatty acids (PUFA) are vital molecules in the pharmaceutical, medical, and nutritional industries. Exploration of bacterial strains capable of producing significant amounts of PUFAs offers a promising avenue for biotechnological applications and industrial-scale production. However, an extensive screening of several samples from diverse sources is highly needed to identify a potential strain. The present study provides the results of the evaluation of 15 different screening methodologies (including changes in existing protocols in terms of reagent concentration, incubation temperature and time) for identifying PUFA-producing bacteria in comparison to the gold standard method (Gas chromatography-mass spectrometry), for the first time. The results determined the most effective techniques for each critical PUFA, leading to an optimized screening process that saves time and resources. The H2O2 plate assay using 0.5% or 1% H2O2 for 72 & 96 h of incubation at 15 °C consistently outperformed others for finding bacteria containing total nutritionally important long chain-PUFA (LC-PUFA), linoleic acid, and arachidonic acid. Whereas the 2,3,5-triphenyl tetrazolium chloride broth assay at 10-15 °C was the most effective and semiquantitative screening methodology for eicosapentaenoic acid (EPA) and alpha-linolenic acid-containing bacteria. Apart from the methodological perspectives, the study also revealed certain potential strains to be targeted in the ongoing research on PUFA-containing bacteria. Further, the manuscript forms the first report on the presence of docosahexaenoic acid (DHA) in Shewanella decolorationis, EPA in Psychrobacter maritimus and Micrococcus aloeverae, and both EPA and DHA in Arthrobacter rhombi. Altogether, the paper generates several thought-provoking insights on the methodological perspectives and identifies potential PUFA-containing bacteria with practical applications in future bacteria-based PUFA research.