Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Prevalência, incidência e caracterização sociodemográfica e clínica das pessoas com estoma de eliminação em Portugal / Prevalence, incidence, and sociodemographic and clinical characterization of individuals with an intestinal or urinary stoma in Portugal / Prevalencia, incidencia y caracterización sociodemográfica y clínica de las personas con ostomía de eliminación en Portugal

Resumo Enquadramento: Dados que caracterizam as pessoas com estoma em Portugal são escassos. Estabelecer estimativas epidemiológicas pode melhorar o conhecimento sobre esta população e adaptar modelos de cuidados de saúde. Objetivos: Estimar a prevalência e incidência de pessoas com estoma de eliminação em Portugal em 2021. Metodologia: Estudo observacional, longitudinal e retrospetivo, a partir de uma base de dados de dispensa de dispositivos para ostomia. Resultados: Em 2021, o número estimado de pessoas com pelo menos um estoma foi de 22.045. Entre estes, 19.793 [IC95%:19.599;19.994] tinham um estoma de eliminação. Na sua maioria eram homens (61,4%), em média tinham 70,5 anos e residiam preferencialmente na região interior do país. O tipo de estoma de eliminação mais prevalente foi a colostomia (48,8%). A incidência estimada de novos casos foi de 6.622, sendo 5.834 [IC95%:5.680;5.984] referentes a estomas de eliminação. Conclusão: Estes resultados permitiram caracterizar o perfil das pessoas com estoma de eliminação em Portugal. Poderão ser úteis para ajustar os programas de prevenção/acompanhamento em saúde desta população e ainda alocar recursos especializados.

Abstract Background: Data characterizing individuals with a stoma in Portugal is limited. Establishing epidemiological estimates can enhance understanding of this population and facilitate the adaptation of healthcare models. Objectives: To estimate the prevalence and incidence of individuals in Portugal who have undergone intestinal or urinary ostomy in 2021. Methodology: Observational, longitudinal, and retrospective study using a stoma appliance dispensing database. Results: In 2021, an estimated 22,045 individuals had at least one stoma, with 19,793 [95%CI:19,599;19,994] having an intestinal/urinary stoma. Most of these individuals were men (61.4%) with a mean age of 70.5 years and resided in the inland region of Portugal. Colostomy was the most prevalent type of intestinal/urinary stoma (48.8%). The estimated incidence of new cases was 6,622, of which 5,834 [95%CI:5,680;5,984] were intestinal/urinary stomas. Conclusion: These results characterize the profile of individuals with intestinal and urinary stomas in Portugal. They may be useful in adjusting prevention and health monitoring programs for this population and allocating specialized resources.

Resumen Marco contextual: Los datos que caracterizan a las personas con estomas en Portugal son escasos. Establecer estimaciones epidemiológicas puede mejorar el conocimiento sobre esta población y adaptar modelos sanitarios. Objetivos: Estimar la prevalencia y la incidencia de personas con estoma de eliminación en Portugal en 2021. Metodología: Estudio observacional, longitudinal y retrospectivo, basado en una base de datos de dispensaciones de dispositivos de ostomía. Resultados: En 2021, el número estimado de personas con al menos un estoma era de 22.045, de las cuales 19.793 [IC95%:19.599;19.994] tenían un estoma de eliminación. La mayoría de ellos eran hombres (61,4%), tenían una edad media de 70,5 años y vivían principalmente en el interior del país. El tipo de estoma de eliminación más frecuente era la colostomía (48,8%). La incidencia estimada de nuevos casos fue de 6.622, de los cuales 5.834 [IC95%:5.680;5.984] eran estomas de eliminación. Conclusión: Estos resultados han permitido caracterizar el perfil de las personas con estoma de eliminación en Portugal. Podrían ser útiles para ajustar los programas de prevención/seguimiento de la salud de esta población y para asignar recursos especializados.

A deep learning approach for deriving wheat phenology from near-surface RGB image series using spatiotemporal fusion.

Accurate monitoring of wheat phenological stages is essential for effective crop management and informed agricultural decision-making. Traditional methods often rely on labour-intensive field surveys, which are prone to subjective bias and limited temporal resolution. To address these challenges, this study explores the potential of near-surface cameras combined with an advanced deep-learning approach to derive wheat phenological stages from high-quality, real-time RGB image series. Three deep learning models based on three different spatiotemporal feature fusion methods, namely sequential fusion, synchronous fusion, and parallel fusion, were constructed and evaluated for deriving wheat phenological stages with these near-surface RGB image series. Moreover, the impact of different image resolutions, capture perspectives, and model training strategies on the performance of deep learning models was also investigated. The results indicate that the model using the sequential fusion method is optimal, with an overall accuracy (OA) of 0.935, a mean absolute error (MAE) of 0.069, F1-score (F1) of 0.936, and kappa coefficients (Kappa) of 0.924 in wheat phenological stages. Besides, the enhanced image resolution of 512 × 512 pixels and a suitable image capture perspective, specifically a sensor viewing angle of 40° to 60° vertically, introduce more effective features for phenological stage detection, thereby enhancing the model's accuracy. Furthermore, concerning the model training, applying a two-step fine-tuning strategy will also enhance the model's robustness to random variations in perspective. This research introduces an innovative approach for real-time phenological stage detection and provides a solid foundation for precision agriculture. By accurately deriving critical phenological stages, the methodology developed in this study supports the optimization of crop management practices, which may result in improved resource efficiency and sustainability across diverse agricultural settings. The implications of this work extend beyond wheat, offering a scalable solution that can be adapted to monitor other crops, thereby contributing to more efficient and sustainable agricultural systems.

[Analysis of the results of personal monitoring to ionizing radiation at workplaces]. / Analiza wyników rutynowego monitoringu narazenia personelu na promieniowanie jonizujace w miejscach pracy.

BACKGROUND: The paper presents the results of dosimetric measurements routinely performed by the Radiation Protection Department of the Nofer Institute of Occupational Medicine (NIOM) in Lódz in 2022 for people occupationally exposed to X and γ radiation. MATERIAL AND METHODS: The evaluation of the effective dose as part of individual dosimetry was provided using the film or thermoluminescent dosimetry (TLD). Additionally, based exclusively on the TLD method, measurements of the ambient dose equivalent H*(10) and personal dose equivalents Hp(0.07) and Hp(3) were performed. In 2022, the dosimetric service of the Radiological Protection Department of the NIOM covered >30 000 workers employed in >4500 laboratories (mainly health care departments). All measurements were performed in accordance with accredited research procedures (number AB 327). RESULTS: In 2022, the average annual dose of Hp(10) was equal to 0.26 mSv, whereas Hp(0.07) measured using ring and wrist dosimetry was equal to 0.63 mSv and 0.78 mSv, respectively. In turn, the average Hp(3) value was 0.21 mSv. In 2022, there was not a single case of exceeding the annual dose limit among people measured by the NIOM. CONCLUSIONS: The data collected in the "Dosimetry" database of the NIOM and a detailed analysis of annual doses received by people occupationally exposed to ionizing radiation indicate a well-functioning radiological protection system in Poland. Med Pr Work Health Saf. 2024;75(5).

An adapted taxonomy and framework for monitoring road safety strategies: a case study of Morocco.

Traditional approaches to monitoring road safety have primarily focused on measuring outcomes such as the number of fatalities and injuries. While effective in capturing overall trends, this macroscopic approach often overlooks the underlying causes of unsafe conditions. Recognizing these limitations, many countries now embrace a safe system-based approach, which emphasizes a holistic view of road safety, considering various elements and their interactions. In response to this shift, this study introduces a five-step framework designed to provide comprehensive coverage and tailored assistance in selecting and utilizing appropriate Road Safety Indicators (RSIs) for more effective performance monitoring. The framework integrates a novel RSIs taxonomy aligned with critical elements of the safe system. It also incorporates an MCDA-based approach to account for decision-makers' preferences when selecting suitable RSIs. A case study demonstrates the practical application of the proposed steps, including the identification, classification, selection, and development of descriptive sheets for each selected RSI, as well as the continuous updating of the RSIs set. The findings offered valuable insights into the commonly used indicators in international road safety reports, while also revealing the limitations of currents metrics and data in fully capturing critical elements and hierarchical level within the road safety management system.

LC-MS/MS and GC-MS/MS Cross-Checking Analysis Method for 426 Pesticide Residues in Agricultural Products: A Method Validation and Measurement of Uncertainty.

A method was developed to analyze residual pesticides in various vegetables using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and gas chromatography-tandem mass spectrometry (GC-MS/MS). A method can analyze over 200 individual compounds, selectively separate peaks within 30 min, and meet various criteria such as those by the Codex Alimentarius Commission (CODEX). Most compounds showed recovery rates between 70 and 120%, and a relative standard deviation was within 20%. Measurement uncertainty, considering various influencing factors such as instrument precision, method sensitivity, experimental conditions, sample handling, and analytical procedures, was meticulously calculated. The expanded uncertainties of cross-checking 33 available pesticides ranged from 10.1 to 26.2 µg/kg at a confidence level of approximately 95%. Risk assessment of detected pesticides in agricultural products indicated a safety range of 0.00003-2.87240%. The developed method effectively analyzes diverse compounds simultaneously, contributing to agricultural product safety.

Continuous glucose monitoring in patients with inherited metabolic disorders at risk for Hypoglycemia and Nutritional implications.

Managing Inherited Metabolic Disorders (IMDs) at risk for hypoglycemia, such as Glycogen Storage Diseases (GSDs), Hereditary Fructose Metabolism Disorders (HFMDs) and Congenital Hyperinsulinism (CH), poses challenges in dietary treatments and blood glucose monitoring. The effectiveness of Continuous Glucose Monitoring (CGM) remains a subject of ongoing debate, with IMD guidelines maintaining caution. Therefore, a systematic evaluation is needed to understand the potential benefits of CGM during dietary interventions. A systematic literature review was conducted in PubMed according to the PICOS model and PRISMA recommendations on studies published from January 01, 2003, up to October 15, 2023 (PROSPERO CRD42024497744). The risk of bias was assessed using NIH Quality Assessment Tools. Twenty-four studies in GSDs (n = 13), CH (n = 10), and HFMDs (n = 1) were analyzed. In GSDs, Real-time CGM (Rt-CGM) was associated with metabolic benefits during nutritional interventions, proving to be an accurate system for hypoglycemia detection although with some concerns about reliability. Rt-CGM in CH, primarily involving children, also showed potential benefits for glycemic control and metabolic stability with acceptable accuracy, although its use during dietary changes was limited. Few experiences on Flash Glucose Monitoring (FGM) were reported, with some concerns about reliability. Overall, the studies analyzed presented different designs, and their quality was predominantly fair or poor. Heterogeneity and limited consensus on reliability and glycemic targets underscore the need for prospective studies and future recommendations for the use of CGM in optimizing nutritional status and providing personalized dietary education in individuals with IMDs prone to hypoglycemia.

Ceftobiprole and Cefiderocol for Patients on Extracorporeal Membrane Oxygenation: The Role of Therapeutic Drug Monitoring.

INTRODUCTION: Limited data exist on therapeutic ranges for newer antimicrobials in the critically ill, with few pharmacokinetic studies including patients undergoing renal replacement therapy or extracorporeal membrane oxygenation (ECMO). CASE REPRESENTATION: These interventions can potentially alter the pharmacokinetic profile of antibiotics, resulting in therapeutic failures, antimicrobial resistance, or increased toxicity. In this report, we present two ECMO patients treated with cefiderocol and ceftobiprole, where therapeutic drug monitoring (TDM) aided in the successful treatment of severe infections. Antibiotic trough concentrations in both cases were consistent with previously reported therapeutic levels in critically ill and ECMO patients, meeting minimal inhibitory concentrations recommended by the European Committee on Antimicrobial Susceptibility Testing for the respective pathogens. CONCLUSION: Treatment might be suboptimal if doses are not adjusted based on physicochemical properties and extracorporeal support. In an era marked by highly resistant pathogens, these cases highlight the importance of timely access to real-time TDM for optimizing and individualizing antimicrobial treatment.

Multi-Phase Rotating Disk Triboelectric Nanogenerator with DC Output for Speed Monitoring.

Triboelectric nanogenerators (TENGs) are highly efficient devices for harvesting mechanical energy. Nevertheless, conventional TENGs often produce AC output, which, coupled with their high crest factor and pulsed output characteristics, poses limitations on their widespread adoption in real scenarios. In this paper, a multi-phase rotating disk triboelectric nanogenerator (MPRD-TENG) characterized by a low crest factor and DC output is prepared through the method of phase superposition. The findings reveal that by enhancing these parameters, namely, increasing the number of rotating disk TENGs, augmenting the number of grids, and elevating the rotational speed, the crest factor of the MPRD-TENG can be effectively reduced. Furthermore, this innovative MPRD-TENG demonstrates its versatility by successfully powering a fire alarm system, thereby offering a promising solution for early warning and monitoring of offshore oil exploration fires. Ultimately, the implementation of machine learning algorithms to train the DC output data collected by the MPRD-TENG significantly enhances the capability to predict and classify signals corresponding to varying speeds with greater precision. Consequently, the integration of machine learning methods not only facilitates a more effective warning system but also bolsters monitoring capabilities for unforeseen situations encountered in real-world engineering projects.

MOF Nanosheet-Functionalized Poly(lactic acid) Meta-membranes for Long-Term Air Purification and Intelligent Monitoring.

The wide use of conventional polymeric air filters is causing a dramatically increasing accumulation of plastic and microplastic pollution. The development of poly(lactic acid) (PLA) fibrous membranes for efficient air purification is of important significance but frequently challenged by the rapid decay of filtration performance due to the intrinsically poor electret properties of PLA. Here, we propose an electroactivity promotion methodology, involving the one-step synthesis and homogeneous incorporation of high-dielectric ZIF-8 nanosheets (ZIFNSs), to facilitate interfacial polarization and fiber refinement during electrospinning of PLA nanofibers. The preparative electrospun PLA/ZIFNS meta-membranes exhibited an unusual combination of significantly reduced nanofiber diameter (∼462 nm), enhanced surface potential (approaching 10 kV), and increased surface activity and facilitated the formation of electroactive phases. With well-controlled morphological features, the highly electroactive PLA/ZIFNS meta-membranes exhibited exceptional filtration efficiencies for PM2.5 and PM0.3 (99.2 and 96.0%, respectively) even at the highest airflow rate of 85 L/min, in clear contrast to that of its pure PLA counterpart (only 79.3 and 74.6%). Arising from the increased electroactivity and active contact sites, remarkable triboelectric performance and self-charging mechanisms were demonstrated for the PLA/ZIFNS meta-membranes, contributing to long-term efficient PM0.3 filtration (97.5% for over 360 min). Moreover, as triggered by physiological activities like respiration and speaking, the electroactive PLA/ZIFNS meta-membranes enabled real-time monitoring with high sensitivity and specificity. The proposed strategy affords significant promotion of electroactivity and triboelectric performance for PLA nanofibers, which may motivate the development of ecofriendly protective membranes for respiratory healthcare and real-time monitoring.

Enhanced Rock Weathering for Carbon Removal-Monitoring and Mitigating Potential Environmental Impacts on Agricultural Land.

Terrestrial enhanced rock weathering (ERW) is the application of pulverized silicate rock to soils for the purposes of carbon removal and improved soil health. Although a geochemical modeling framework for ERW in soils is emerging, there is a scarcity of experimental and field trial data exploring potential environmental impacts, risks, and monitoring strategies associated with this practice. This paper identifies potential negative consequences and positive cobenefits of ERW scale-up and suggests mitigation and monitoring strategies. To do so, we examined literature on not only ERW but also industry, agriculture, ecosystem science, water chemistry, and human health. From this work, we develop recommendations for future research, infrastructure, and policy needs. We also recommend target metrics, risk mitigation strategies, and best practices for monitoring that will permit early detection and prevention of negative environmental impacts.

Pulse oximetry in pediatric care: Balancing advantages and limitations.

BACKGROUND: Pulse oximetry has become a cornerstone technology in healthcare, providing non-invasive monitoring of oxygen saturation levels and pulse rate. Despite its widespread use, the technology has inherent limitations and challenges that must be addressed to ensure accurate and reliable patient care. AIM: To comprehensively evaluate the advantages, limitations, and challenges of pulse oximetry in clinical practice, as well as to propose recommendations for optimizing its use. METHODS: A systematic literature review was conducted to identify studies related to pulse oximetry and its applications in various clinical settings. Relevant articles were selected based on predefined inclusion and exclusion criteria, and data were synthesized to provide a comprehensive overview of the topic. RESULTS: Pulse oximetry offers numerous advantages, including non-invasiveness, real-time feedback, portability, and cost-effectiveness. However, several limitations and challenges were identified, including motion artifacts, poor peripheral perfusion, ambient light interference, and patient-specific factors such as skin pigmentation and hemoglobin variants. Recommendations for optimizing pulse oximetry use include technological advancements, education and training initiatives, quality assurance protocols, and interdisciplinary collaboration. CONCLUSION: Pulse oximetry is crucial in modern healthcare, offering invaluable insights into patients' oxygenation status. Despite its limitations, pulse oximetry remains an indispensable tool for monitoring patients in diverse clinical settings. By implementing the recommendations outlined in this review, healthcare providers can enhance the effectiveness, accessibility, and safety of pulse oximetry monitoring, ultimately improving patient outcomes and quality of care.

Novel techniques for quantifying oxygen pulse curve characteristics during cardiopulmonary exercise testing in tetralogy of fallot.

Background: Cardiopulmonary exercise testing (CPET) is used in evaluation of repaired tetralogy of Fallot (rTOF), particularly for pulmonary valve replacement need. Oxygen pulse (O2P) is the CPET surrogate for stroke volume and peripheral oxygen extraction. Objectives: This study assessed O2P curve properties against non-invasive cardiac output monitoring (NICOM) and clinical testing. Methods: This cross-sectional study included 44 rTOF patients and 10 controls. Three new evaluations for O2P curve analysis during CPET were developed. Best fit early and late regression slopes of the O2P curve were used to calculate: 1) the early to late ratio, or "O2 pulse response ratio" (O2PRR); 2) the portion of exercise until slope inflection, or "flattening fraction" (FF); 3) the area under the O2P response curve, or "O2P curve area". Results: rTOF patients (median age 35.2 (27.6-39.4); 61% female) had a lower VO2 max (23.4 vs 45.6 ml/kg/min; p < 0.001) and O2P max (11.5 vs 19.1 ml/beat; p < 0.001) compared to controls. Those with a FF occurring <50% through exercise had a lower peak cardiac index and stroke volume, but not VO2 max, compared to those >50%. FF and O2P curve area significantly correlated with peak cardiac index, stroke volume, left and right ventricular ejection fraction, and right ventricular systolic pressure. Conclusion: CPET remains an integral part in the evaluation of rTOF. We introduce three non-invasive methods to assess exercise hemodynamics using the O2P curve data. These evaluations demonstrated significant correlations with stroke volume, cardiac output, and right ventricular pressure.

Electronic monitoring device informed interventions for treatment adherence and clinical outcomes in children and adolescents: A systematic review.

OBJECTIVE: To systematically review literature from randomised controlled trials (RCTs) investigating the effectiveness of electronic monitoring device informed interventions on adherence and clinical outcomes in children and adolescents with chronic conditions. STUDY DESIGN: A systematic review was conducted. An electronic literature search covering studies, with no pre-specified starting date up to June 2024, was performed in Medline, EMBASE, Web of Science, Cochrane and Trials databases was conducted. PARTICIPANTS: RCTs of electronic monitoring device informed interventions in individuals aged 0 to 18 years with chronic conditions, were identified, with no restriction on geography or publication date. METHODS: Extracted data was synthesised. As a result of differences in definitions and analysis of adherence and clinical outcomes across the studies a pooled meta-analysis was not possible therefore, a descriptive analysis was conducted. Risk of bias across all studies was assessed using the Cochrane Collaboration risk of bias tool. RESULTS: 11 RCTs, with 1485 children and adolescents were included. Studies were all from high- and middle-income countries, conducted among children and adolescents with asthma, and one each among children and adolescents with kidney transplant, multiple sclerosis, and epilepsy. Eight of the 11 studies reported a positive effect on adherence. Only four studies reported a positive effect on clinical outcomes and seven studies found no effect on clinical outcomes. CONCLUSIONS: Electronic monitoring device interventions show promise in improving adherence in children and adolescents with chronic conditions, in a limited number of chronic conditions, mostly asthma. Evidence for the efficacy of electronic monitoring device informed interventions on clinical outcomes and from low-income settings is lacking. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42022312057, registered in March 2022. TWEETABLE ABSTRACT: Electronic monitoring device informed interventions may improve treatment adherence in children and adolescents with chronic conditions but evidence from low-income settings is lacking @nyasha_dzavakwa @KatharinaKranz4 @dopapus @hilda_mujuru @rashida_abbferr @vickysimms_epi.

Is therapeutic drug monitoring a dancing partner for TNF-α inhibitors in real-world practice? Answers from an updated systematic review and meta-analysis.

INTRODUCTION: This systematic review aimed to determine the effect of therapeutic drug monitoring (TDM) for tumor necrosis factor-α inhibitors (TNF-αI) in immune-mediated inflammatory diseases (IMIDs) based on real-world evidence, as results from published meta-analyses based on randomized controlled trials (RCTs) may not fully capture the nuances of clinical practice due to strict criteria. METHODS: We searched PubMed, Embase, and the Cochrane Library up to 1 August 2023. Cohort studies comparing TDM (proactive and reactive) with empirical management were included. Primary outcome was effectiveness [for IBDs: clinical remission; for rheumatic diseases: clinical remission or low disease activity], with certainty of evidence appraised using the GRADE approach. Secondary outcomes included treatment failure, serious adverse events (SAEs), IMIDs-related surgeries or hospitalizations, and anti-drug antibodies (ADAs) development risk. RESULTS: Twenty-four cohort studies were included and almost all were on infliximab. For IBDs, compared with empirical management, proactive TDM significantly improved clinical remission (RR = 1.15, 95% CI = 1.04-1.28), reduced IBDs-related surgeries (RR = 0.46, 95% CI = 0.26-0.81), hospitalizations (RR = 0.60, 95% CI = 0.43-0.83), SAEs (RR = 0.23, 95% CI = 0.07-0.76), and ADAs development risk (RR = 0.34, 95% CI = 0.19-0.60). Reactive TDM significantly lowered hospitalization rates and might be cost-effective. Proactive TDM outperformed reactive TDM in secondary outcomes. For rheumatic diseases, benefits of TDM were inconclusive due to limited evidence. CONCLUSIONS: Real-world evidence supports proactive TDM of TNF-αI (particularly infliximab) in IBDs to improve effectiveness, safety, and immunogenicity. However, benefits of TDM for different TNF-αI in other IMIDs remain uncertain. PROTOCOL REGISTRATION: www.crd.york.ac.uk/ PROSPERO identifier is CRD42022370846.

The application of match-event and instrumented mouthguard data to inform match limits: An example using rugby union Premiership and rugby league Super League data from England.

The study aimed to illustrate how contact (from match-event data) and head acceleration event (HAE) (from instrumented mouthguard [iMG]) data can be combined to inform match limits within rugby. Match-event data from one rugby union and rugby league season, including all competitive matches involving players from the English Premiership and Super League, were used. Playing exposure was summarised as full game equivalents (FGE; total minutes played/80). Expected contact and HAE exposures at arbitrary thresholds were estimated using match-event and iMG data. Generalised linear models were used to identify differences in contact and HAE exposure per FGE. For 30 FGEs, forwards had greater contact than backs in rugby union (n = 1272 vs. 618) and league (n = 1569 vs. 706). As HAE magnitude increased, the differences between positional groups decreased (e.g., rugby union; n = 34 and 22 HAE >40 g for forwards and backs playing 30 FGEs). Currently, only a relatively small proportion of rugby union (2.5%) and league (7.3%) players exceeded 25 FGEs. Estimating contact and HAEs per FGE allows policymakers to prospectively plan and model estimated overall and position-specific loads over a season and longer term. Reducing FGE limits by a small amount would currently only affect contact and HAE exposure for a small proportion of players who complete the most minutes. This may be beneficial for this cohort but is not an effective HAE and contact exposure reduction strategy at a population level, which requires individual player management. Given the positional differences, FGE limits should exist to manage appropriate HAE and contact exposure.

Non-invasive and real-time monitoring of polyhydroxyalkanoates production using two-dimensional fluorescence spectroscopy.

Bioplastics are a sustainable and environmental-friendly alternative to the conventional petroleum-based plastics, namely due to their source (biobased) and due to their biodegradability or both. Polyhydroxyalkanoates (PHA) stand out among the bioplastics group by being intracellular biobased, biodegradable and biocompatible polymers. PHA production has been highly investigated during the last decades. However, to date, PHA production has been monitored through offline and time-consuming tools, involving hazardous solvents, not allowing a timely control of the bioprocesses, which often results in a loss of process productivity and hinders its implementation at full scale. Therefore, two-dimensional (2D) fluorescence spectroscopy was assessed for monitoring the PHA content at real-time, as it is a non-destructive, solvent-free and non-invasive technique. The complex information of the biological broth was captured within fluorescence excitation-emission matrices (EEMs), which were deconvoluted through projection to latent structures (PLS) modelling to estimate PHA production by an enriched PHA microbial culture, using fermented brewer's spent grain as feedstock. A good correlation for PHA prediction was achieved, with an average error of ca. 4.0% gPHA/gTS for new predictions. This work demonstrates the great potential of using 2D fluorescence spectroscopy to assess the intracellular PHA content without requiring staining agents. Moreover, it unlocks the possibility of an online and real-time monitoring of the biopolymer production processes, which will contribute towards the improvement of the PHA process productivity and, consequently, its implementation at full scale.

Assessment of tropospheric NO2 concentrations over greater Doha using Sentinel-5 TROPOspheric monitoring instrument (TROPOMI) satellite data: Temporal analysis, 2018-2023.

This study presents a temporal evaluation of the tropospheric NO2 column densities over Greater Doha using TROPOMI satellite data from May 2018 to December 2023, and an assessment of the impact of the preparations and hosting of the FIFA Football World Cup Qatar 2022, on NO2 levels before, during and after the tournament over Greater Doha. Analysis of annual NO2 levels from 2019 to 2023 showed an increase in 2022 compared to that of the previous three years and a clear decrease in 2023 post the completion of the world cup preparations and hosting. Results also showed an increase in NO2 levels during winter compared to that in summer, with wind speed being an important determining factor. Findings showed that Fridays and Saturdays (both constitute the local weekend in Qatar) were 44% and 13% lower than that of the averaged weekdays, respectively. The annual NO2 levels in the post-world cup year of 2023 were found to be 24% lower than that in 2022 and around 16% lower than that of the previous years. NO2 levels during the World Cup tournament (20 Nov to Dec 18, 2022) were found to be higher than that of the same corresponding periods in all other available years including an increase of 27% compared to that in 2023. Wind speed played an important role in determining the NO2 levels during the world cup period and accounted for >96% of their daily variability, indicating that meteorological factors substantially influenced the NO2 column during the event.

Experimental validation of a FLUKA Monte Carlo simulation for carbon-ion radiotherapy monitoring via secondary ion tracking.

BACKGROUND: In-vivo monitoring methods of carbon ion radiotherapy (CIRT) includes explorations of nuclear reaction products generated by carbon-ion beams interacting with patient tissues. Our research group focuses on in-vivo monitoring of CIRT using silicon pixel detectors. Currently, we are conducting a prospective clinical trial as part of the In-Vivo Monitoring project (InViMo) at the Heidelberg Ion Beam Therapy Center (HIT) in Germany. We are using an innovative, in-house developed, non-contact fragment tracking system with seven mini-trackers based on the Timepix3 technology developed at CERN. PURPOSE: This article focuses on the implementation of the mini-tracker in Monte Carlo (MC) based on FLUKA simulations to monitor secondary charged nuclear fragments in CIRT. The main objective is to systematically evaluate the simulation accuracy for the InViMo project. METHODS: The implementation involved integrating the mini-tracker geometry and the scoring mechanism into the FLUKA MC simulation, utilizing the finely tuned HIT beam line. The systematic investigation included varying mini-tracker angles (from 15 ∘ $15^\circ$ to 45 ∘ $45^\circ$ in 5 ∘ $5^\circ$ steps) during the irradiation of a head-sized phantom with therapeutic carbon-ion pencil beams. To evaluate our implemented FLUKA framework, a comparison was made between the experimental data and data obtained from MC simulations. To ensure the fidelity of our comparison, experiments were performed at the HIT using the parameters and setup established in the simulations. RESULTS: Our research demonstrates high accuracy in reproducing characteristic behaviors and dependencies of the monitoring method in terms of fragment distributions in the mini-tracker, track angles, emission profiles, and fragment numbers. Discrepancies in the number of detected fragments between the experimental data and the data obtained from MC simulations are less than 4% for the angles of interest in the InViMo detection system. CONCLUSIONS: Our study confirms the potential of our simulation framework to investigate the performance of monitoring inter-fractional anatomical changes in patients undergoing CIRT using secondary nuclear charged fragments escaping from the irradiated patient.