Clinical Decision Support and Natural Language Processing in Medicine: Systematic Literature Review.

BACKGROUND: Ensuring access to accurate and verified information is essential for effective patient treatment and diagnosis. Although health workers rely on the internet for clinical data, there is a need for a more streamlined approach. OBJECTIVE: This systematic review aims to assess the current state of artificial intelligence (AI) and natural language processing (NLP) techniques in health care to identify their potential use in electronic health records and automated information searches. METHODS: A search was conducted in the PubMed, Embase, ScienceDirect, Scopus, and Web of Science online databases for articles published between January 2000 and April 2023. The only inclusion criteria were (1) original research articles and studies on the application of AI-based medical clinical decision support using NLP techniques and (2) publications in English. A Critical Appraisal Skills Programme tool was used to assess the quality of the studies. RESULTS: The search yielded 707 articles, from which 26 studies were included (24 original articles and 2 systematic reviews). Of the evaluated articles, 21 (81%) explained the use of NLP as a source of data collection, 18 (69%) used electronic health records as a data source, and a further 8 (31%) were based on clinical data. Only 5 (19%) of the articles showed the use of combined strategies for NLP to obtain clinical data. In total, 16 (62%) articles presented stand-alone data review algorithms. Other studies (n=9, 35%) showed that the clinical decision support system alternative was also a way of displaying the information obtained for immediate clinical use. CONCLUSIONS: The use of NLP engines can effectively improve clinical decision systems' accuracy, while biphasic tools combining AI algorithms and human criteria may optimize clinical diagnosis and treatment flows. TRIAL REGISTRATION: PROSPERO CRD42022373386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=373386.

The southwesternmost record of late Silurian (Pridolian) early land plants of Gondwana.

The Silurian-Devonian transition played a crucial role in the development of early terrestrial ecosystems due to the rapid diversification of early vascular plants. However, records of Pridolian plants in western Gondwana are scarce, limited to outcrops located in southern Bolivia. In this contribution, an association of fossil plants housed in the Rinconada Formation is presented. This association corresponds to primitive fossil flora with reproductive structures and sterile axes linked to basal tracheophytes. The fossil assemblage is composed of Aberlemnia caledonica, Caia langii Cooksonia cf. cambrensis, C. paranensis, C. cf. pertoni, Hostinella sp, Cf. Isidrophyton sp, Salopella marcensis, Steganoteca striata, two morphotypes of doubtful taxonomy, and graptolites colonies. The association between flora remains and graptolites, represents a parautochthonous assemblage in an inner marine platform, dominated by gravity flows. This record has paleophytogeographic importance indicating the extension of the northwest Gondwana-southern Laurusia unit to more southern areas of Gondwana. This expansion would have been favored by the post-glacial climatic improvement of the Late Silurian, together with a great radiation capacity and environmental flexibility of the flora. Furthermore, the biochron is extended of three taxa (A. caledonica, C. paranensis and Cf. Isidrophyton sp) first known from the Lochkovian, to the Pridoli.

Intraoperative Acetabular Fractures in Primary Total Hip Arthroplasty Management and Functional Outcomes.

PURPOSE: Intraoperative acetabular fracture (IAF) is a non-common complication of primary total hip arthroplasty (THA). Despite the prevalence of intraoperative periprosthetic fractures are increasing, little has been written about this type of fracture. The main objective is to analyze possible risk factors, treatment options and functional outcomes associated with IAF. METHODS: Between 2006 and 2020, 4 senior arthroplasty surgeons performed 5540 uncemented primary THA. We reviewed our Total Joint Registry and found 18 cases with an IAF. We analyzed demographic factors, medical history, preoperative diagnose, acetabular cups designs, anatomic location of the fracture, treatment, associated complications and functional outcomes. The minimum duration of follow-up was 12 months. RESULTS: The prevalence of an IAF was 0,3%. All the acetabular cups were hemispherical modular. The most frequent acetabular cup associated with an IAF was the CSF Plus (JRI). In two cases the acetabular components were judged to be stable and no additional treatment was done. In the other sixteen patients, various surgical procedures were carried out. Almost 30% of patients that sustained an IAF had some complication during their follow up. Moreover, poor functionality outcomes were obtained (12.1 ± 4.1). in the final follow up accordance to Postel Merle d'Aubingé score. CONCLUSION: Although IAF is a rare complication of THA, maintaining a high index of suspicion is important as they can be difficult to identify. Still with an adequate early treatment they have poor functionality and high risk of associated complications.

A physiological perspective of the relevance of sweat biomarkers and their detection by wearable microfluidic technology: A review.

The great majority of published microfluidic wearable platforms for sweat sensing focus on the development of the technology to fabricate the device, the integration of sensing materials and actuators and the fluidics of sweat within the device. However, very few papers have discussed the physiological relevance of the metabolites measured using these novel approaches. In fact, some of the analytes present in sweat, which serve as biomarkers in blood, do not show a correlation with blood levels. This discrepancy can be attributed to factors such as contamination during measurements, the metabolism of sweat glands, or challenges in obtaining significant samples. The objective of this review is to present a critical and meaningful insight into the real applicability and potential use of wearable technology for improving health and sport performance. It also discusses the current limitations and future challenges of microfluidics, aiming to provide accurate information about the actual needs in this field. This work is expected to contribute to the future development of more suitable wearable microfluidic technology for health and sports science monitoring, using sweat as the biofluid for analysis.

Mixed-integer disciplined convex programming approach applied to the optimal energy supply of near-zero energy buildings.

Energy needs in the buildings sector accounts for 40 % of global energy demand. Therefore, the implementation of several renewable energy sources is necessary to reduce this demand. The design stage of a decentralized generation project requires quantifying the power to be installed and the energy forecast for each source throughout the useful life of the building. This study develops a novel optimization algorithm for a long-term economic function based on mixed-integer disciplined convex programming (MIDCP) which guarantees the sustainability of the building and its energy systems. The robust algorithm integrates risk management of intermittent sources, technical and economic parameters of selected technologies, and life cycle analysis (LCA) of different energy systems, including storage. Furthermore, the penetration of green hydrogen into the distributed generation mix is evaluated as an important contribution. Meteorological and energy demand variables of two antagonistic scenarios were also used as inputs to the algorithm. As a result, the optimal energy supply sizing for tertiary buildings in the two defined locations was obtained. The results of the simulations have achieved an optimal convergence of 100 % in the proposed scenarios, with a resolution time of 14 s and using a memory of about 183 MB. The simulations suggest a higher penetration of green hydrogen in scenarios where supply and investment costs decrease to gray hydrogen supply levels, reaching up to 81 % coverage of the thermal demand of the building. Hybrid energy systems under favorable conditions show a penetration of about 92 % within the distributed generation mix. The developed tool could enable decision-makers to optimally plan distributed generation projects in buildings based on economic, policy, and geographic conditions.

Current Challenges in the Development of Platelet-Rich Plasma-Based Therapies.

Nowadays, biological therapies are booming and more of these formulations are coming to the market. Platelet-rich plasma, or PRP, is one of the most widely used biological therapies due to its ease of obtention and autologous character. Most of the techniques to obtain PRP are focusing on new processes and methods of optimization. However, not enough consideration is being given to modify the molecular components of PRP to generate more effective formulations with the aim of improving PRP treatments. Therefore, this review covers different novel PRP-obtaining methods that attempt to modify the molecular composition of the plasma.

Use of Non-Thermal Plasma as Postoperative Therapy in Anal Fistula: Clinical Experience and Results.

Anal fistula, characterized by abnormal tracts between the perianal skin and the anal canal, presents challenges in treatment because of its diversity and complexity. This study investigates the use of non-thermal plasma as a postsurgical therapy for anal fistula, aiming to promote healing and tissue regeneration. A specialized plasma reactor was designed to apply non-thermal plasma within the anorectal cavity practically. Non-thermal plasma treatment was administered to 20 patients including 10 undergoing fistulectomies and 10 undergoing fistulotomies. The average duration of non-thermal plasma application in the operating room was shorter for fistulotomies. The pain reported the day after surgery was similar in both groups. Improvements in the number of evacuations starting from the day after surgery, as well as the assessment of stool quality using the Bristol scale, indicated satisfactory intestinal recovery. Fistulotomy patients exhibited faster wound healing times. These findings underscore the efficacy of non-thermal plasma as a postoperative therapy for anal fistula, enhancing healing and recovery outcomes without increasing complication risks.

Age-, region-, and day/night-related variation of the chloride reversal potential in the rat suprachiasmatic nucleus.

The master control of mammalian circadian rhythms is the suprachiasmatic nucleus (SCN), which is formed by the ventral and dorsal regions. In SCN neurons, GABA has an important function and even excitatory actions in adulthood. However, the physiological role of this neurotransmitter in the developing SCN is unknown. Here, we recorded GABAergic postsynaptic currents (in the perforated-patch configuration using gramicidin) to determine the chloride reversal potential (ECl) and also assessed the immunological expression of the Na-K-Cl cotransporter 1 (NKCC1) at early ages of the rat (postnatal days (P) 3 to 25), during the day and night, in the two SCN regions. We detected that ECl greatly varied with age and depending on the SCN region and time of day. Broadly speaking, ECl was more hyperpolarized with age, except for the oldest age studied (P20-25) in both day and night in the ventral SCN, where it was less negative. Likewise, ECl was more hyperpolarized in the dorsal SCN both during the day and at night; while ECl was more negative at night both in the ventral and the dorsal SCN. Moreover, the total NKCC1 fluorescent expression was higher during the day than at night. These results imply that NKCC1 regulates the circadian and developmental fluctuations in the [Cl-]i to fine-tune ECl, which is crucial for either excitatory or inhibitory GABAergic actions to occur in the SCN.

Hospital referrals, exclusions from hospital care, and deaths among long-term care residents in the Community of Madrid during the March-April 2020 COVID-19 epidemic period: a multivariate time series analysis.

BACKGROUND: From March 7 to April 7, 2020, the Community of Madrid (CoM), Spain, issued interventions in response to the COVID-19 epidemic, including hospital referral triage protocols for long-term care facility (LTCF) residents (March 18-25). Those with moderate to severe physical disability and cognitive impairment were excluded from hospital referral. This research assesses changes in the association between daily hospital referrals and the deaths of LTCF residents attributable to the triage protocols. METHODS: Daily hospital referrals and all-cause mortality from January to June 2020 among LTCF residents and the CoM population aged 65 + were obtained. Significant changes in LTCF resident daily hospital referrals time series, and in-LTCF and in-hospital daily deaths, were examined with tests for breaks and regimes in time series. Multivariate time series analyses were conducted to test changes in the associations between LTCF resident hospital referrals with daily deaths in-hospital and in-LTCF, and in the CoM population aged 65 + when the triage protocols were implemented. RESULTS: Among LTCF residents, hospital referrals declined sharply from March 6 to March 23, 2020. Increases in LTCF residents' daily deaths occurred from March 7 to April 1, followed by a decrease reaching pre-epidemic levels after April 28. The daily ratio of in-hospital deaths to in-LTCF deaths reached its lowest values from March 9 to April 19, 2020. The four versions of the triage protocol, published from March 18 to March 25 had no impact on further changes in the association of hospital referrals with daily deaths of LTCF residents in-hospital or in-LTCF. CONCLUSIONS: While LTCF residents' deaths increased, hospital referrals of LTCF residents decreased with the introduction of the CoM governmental interventions on March 7. They were implemented before the enactment of the triage protocols, protecting hospitals from collapse while overlooking the need for standards of care within LTCFs. The CoM triage protocols sanctioned the existing restrictions on hospital referrals of LTCF residents.

Cobalt-Catalyzed (3 + 2) Cycloaddition of Cyclopropene-Tethered Alkynes: Versatile Access to Bicyclic Cyclopentadienyl Systems and Their CpM Complexes.

Low-valent cobalt complexes can promote intramolecular (3 + 2) cycloadditions of alkyne-tethered cyclopropenes to provide bicyclic systems containing highly substituted cyclopentadienyl moieties with electronically diverse functional groups. The adducts can be easily transformed into new types of CpRh(III) and CpIr(III) complexes, which show catalytic activity in several relevant transformations. Preliminary computational (DFT) and experimental studies provide relevant information on the mechanistic peculiarities of the cobalt-catalyzed process and allow us to rationalize its advantages over the homologous rhodium-promoted reaction.

Effects of Nozzle Temperature on Mechanical Properties of Polylactic Acid Specimens Fabricated by Fused Deposition Modeling.

This paper investigates the effect of nozzle temperature, from 180 to 260 °C, on properties of polylactic acid (PLA) samples manufactured by fused deposition modeling (FDM) technology. The main objective of this research is to determinate an optimum nozzle temperature relative to tensile, flexural and compressive properties of printed specimens. After manufacturing, the samples exhibit an amorphous structure, without crystallization effects, independently of the fabrication temperature. In order to determine the influence of printing temperature on mechanical properties, uniaxial tensile, three-point flexural and compression strength tests were carried out. The obtained results suggest that a relative low printing temperature could reduce the material flow and decrease the density of the final prototype, with a negative effect on both the quality and the mechanical properties of the pieces. If temperature increases up to 260 °C, an excess of material can be deposited, but with no significant negative effect on mechanical parameters. There is an optimum nozzle temperature interval, depending on the considered piece and test, for which mechanical values can be optimized. Taking into account all tests, a recommended extruder temperature interval may be identified as 220-240 °C. This range encompasses all mechanical parameters, avoiding the highest temperature where an excess of material was observed. For this printing temperature interval, no significant mechanical variations were appreciated, which corresponds to a stable behavior of the manufactured specimens.

A randomised trial of malaria vaccine R21/Matrix-M™ with and without antimalarial drugs in Thai adults.

In preparation for mass vaccinations with R21/Matrix-M™ combined with mass administrations of dihydroartemisinin, piperaquine, and a single low dose primaquine we assessed the tolerability, safety, and potential interactions of this combination affecting immunogenicity or pharmacokinetics. 120 healthy Thai volunteers were randomised to receive either antimalarials combined with vaccinations (n = 50), vaccinations alone (n = 50), or antimalarials only (n = 20). Three rounds of vaccines and antimalarials were administered one month apart. The vaccine was well tolerated alone and in combination with the antimalarials. None of the participants failed completion of the 3-dose vaccine course. There was no significant difference in the vaccine immunogenicity or in the pharmacokinetics of piperaquine given individually or in combination. This study supports proceeding to a large trial of mass vaccinations with R21/Matrix-M™ combined with mass antimalarial administration in Bangladesh.

Promoting walking as a self-care strategy in women with fibromyalgia: a cross­sectional study using accelerometers.

INTRODUCTION: Walking is a beneficial healthy lifestyle for fibromyalgia patients as it reduces the intensity of pain and fatigue experienced and improves quality of life. In this context, self-efficacy and commitment are potential predictors of walking for women with fibromyalgia. Present study aims at examining the moderation role of exercise commitment in the association between self-efficacy for walking and walking behavior in this population. METHOD: It is a cross­sectional study. A total of 132 women with fibromyalgia participated (mean age = 57.63, SD = 10.44) between January and December 2018. Self-efficacy about walking was assessed through Spanish version of self-efficacy scale for physical activity scale (SEPAS) and exercise commitment through ad-hoc questionnaire (two Likert-type items about the committed action of physical activity). Walking behavior was measured using accelerometers for seven consecutive days. Pain and fatigue prior to placement of the accelerometer were evaluated as possible covariates. Regarding medical history, time since onset of symptoms (i.e. pain, fatigue) and since diagnosis, and medication were also assessed as possible covariates. RESULTS: A moderation effect of exercise commitment was found in the relationship between self-efficacy on walking behavior (B = 10.48, p = .021, 95%, CI = 0.61 to 6.79). Post-hoc analyses showed a significant and positive relationship between self-efficacy and walking only with high commitment to physical activity (t = 10.08, p = .027, 95%, CI = 3.77 to 5.64). CONCLUSIONS: Self-efficacy for walking and commitment should be assessed and potentially targeted when focusing on increasing walking in women with fibromyalgia. Key Points • Associations between walking self-efficacy and exercise engagement provide indications of modifiable targets for promoting an active lifestyle in fibromyalgia. • When patients feel engaged in their physical exercise pattern (walking), patients feel more able to perform the behavior. • Rehabilitation interventions, focused on chronic pain, should contemplate the promotion of self-efficacy and engagement.

Integration of secreted signaling molecule sensing on cell monitoring platforms: a critical review.

Monitoring cell secretion in complex microenvironments is crucial for understanding cellular behavior and advancing physiological and pathological research. While traditional cell culture methods, including organoids and spheroids, provide valuable models, real-time monitoring of cell secretion of signaling molecules remains challenging. Integrating advanced monitoring technologies into these systems often disrupts the delicate balance of the microenvironment, making it difficult to achieve sensitivity and specificity. This review explored recent strategies for integrating the monitoring of cell secretion of signaling molecules, crucial for understanding and replicating cell microenvironments, within cell culture platforms, addressing challenges such as non-adherent cell models and the focus on single-cell methodologies. We highlight advancements in biosensors, microfluidics, and three-dimensional culture methods, and discuss their potential to enhance real-time, multiplexed cell monitoring. By examining the advantages, limitations, and future prospects of these technologies, we aim to contribute to the development of integrated systems that facilitate comprehensive cell monitoring, ultimately advancing biological research and pharmaceutical development.

Stereotactic Body Radiotherapy as a Curative Treatment for De Novo Mucosal Carcinoma of the Head and Neck: A Feasible Alternative Option for Fragile Patients with Small Lesion: A Systematic Review.

Stereotactic body radiotherapy (SBRT) is characterized by a high dose per fraction, well-defined small targets, superior dose conformity, and a steep off-target dose gradient. A literature search was conducted to examine the experience with SBRT as a curative treatment for newly diagnosed mucosal carcinoma of the head and neck (MCHN). Four retrospective case series and one prospective phase I clinical trial published between 2012 and 2020 described 124 patients. SBRT was mainly performed in older patients with different tumor sites. The median size of the planning target volumes ranged from 5.3 to 41 cm3. Different approaches were used to create margins. In two studies, limited elective nodal irradiation was performed. The equivalent doses used were 60-83.33 Gy delivered in five fractions. Considerable heterogeneity was observed in the radiation dose specification. The incidence of grade ≥3 late toxicity was 0-8.3%, with local and regional control ranging from 73% to 100%. Improved or stable quality of life after SBRT was reported in two studies. Curative-intent SBRT for de novo MCHN appears to be an effective and relatively safe treatment for small tumor targets, preferably without concomitant elective tissue irradiation. Standardization of SBRT practice and well-designed prospective clinical trials are needed to better define the role of SBRT in this setting.

Quantifying soil accumulation of atmospheric mercury using fallout radionuclide chronometry.

Soils are a principal global reservoir of mercury (Hg), a neurotoxic pollutant that is accumulating through anthropogenic emissions to the atmosphere and subsequent deposition to terrestrial ecosystems. The fate of Hg in global soils remains uncertain, however, particularly to what degree Hg is re-emitted back to the atmosphere as gaseous elemental mercury (GEM). Here we use fallout radionuclide (FRN) chronometry to directly measure Hg accumulation rates in soils. By comparing these rates with measured atmospheric fluxes in a mass balance approach, we show that representative Arctic, boreal, temperate, and tropical soils are quantitatively efficient at retaining anthropogenic Hg. Potential for significant GEM re-emission appears limited to a minority of coniferous soils, calling into question global models that assume strong re-emission of legacy Hg from soils. FRN chronometry poses a powerful tool to reconstruct terrestrial Hg accumulation across larger spatial scales than previously possible, while offering insights into the susceptibility of Hg mobilization from different soil environments.

Effects of the ActiveHip+ mHealth intervention on the recovery of older adults with hip fracture and their family caregivers: a multicentre open-label randomised controlled trial.

Background: Mobile health (mHealth) systems are a promising alternative for rehabilitation of hip fracture, addressing constrained healthcare resources. Half of older adults fails to recover their pre-fracture routines, which imposes a burden on caregivers. We aimed to test the effectiveness of the 3-month ActiveHip + mHealth intervention on physical and psychological outcomes of older adults with hip fracture and their family caregivers. Methods: In a multicentre open-label randomised controlled trial conducted across 3 hospitals in Andalusia (Spain), patients older than 65 with a hip fracture, who were previously independent and lacked cognitive impairment were recruited alongside with their caregivers. Participants were randomly allocated (1:1) to the intervention group (ActiveHip+) or control (usual care) group. The intervention group underwent a 12-week health education and tele-rehabilitation programme through the ActiveHip + mHealth intervention. The primary outcome, physical performance, was assessed using the Short Physical Performance Battery at three time points: at hospital discharge (baseline), 3-month after surgery (post intervention) and 1-year after surgery follow-up. Primary analyses of primary outcomes and safety data followed an intention-to-treat approach. This study is registered at ClinicalTrials.gov, NCT04859309. Findings: Between June 1st, 2021 and June 30th, 2022 data from 105 patients and their caregivers were analysed. Patients engaged in the ActiveHip + mHealth intervention (mean 7.11 points, SE 0.33) showed higher physical performance compared with patients allocated in the control group (mean 5.71 points, SE 0.32) at 3 months after surgery (mean difference in change from baseline 1.40 points, SE 0.36; puncorrected = 0.00011). These benefits were not maintained at 1-year after surgery follow-up (mean difference in change from baseline 0.19 points, SE 0.47; puncorrected = 0.68). No adverse events, including falls and refractures, were reported during the tele-rehabilitation sessions. At 3-months, the intervention group had 2 falls, compared to 4 in the control group, with no observed refractures. At the 1-year follow-up, the intervention group experienced 7 falls and 1 refracture, while the control group had 13 falls and 2 refractures. Interpretation: This study suggests that the ActiveHip + mHealth intervention may be effective for recovering physical performance in older adults with hip fracture. Importantly, the implementation of ActiveHip + into daily clinical practice may be feasible and has already been adopted in 18 hospitals, mostly in Spain but also in Belgium and Portugal. Thus, ActiveHip + could offer a promising solution when rehabilitation resources are limited. However, its dependence on caregiver support and the exclusion of participants with cognitive impairment makes it necessary to be cautious about its applicability. In addition, the non-maintenance of the effectiveness at 1-year follow-up highlights the need of refinement the ActiveHip + intervention to promote long-lasting behavioural changes. Funding: EIT Health and the Ramón y Cajal 2021 Excellence Research Grant action from the Spanish Ministry of Science and Innovation.

Gamification in eHealth for Chronic Disease Self-Management in Youth: A Systematic Review.

This systematic review primarily aims to provide a summary of the game mechanics implemented in eHealth tools supporting young people's self-management of their chronic diseases. This review secondarily investigates the rationale for implementing game mechanics and the effects of these tools. A systematic search was conducted in Embase, Medline, PsycINFO, and Web of Science, from inception until August 30, 2022. Studies were eligible if focus was on the utilization of gamification in eHealth self-management interventions for young people (age = 10-25 years) with chronic diseases. Primary quantitative, qualitative, and mixed-method studies written in English were included. We identified 34 eHealth tools, of which 20 (59%) were gamified tools and 14 (41%) were serious games. We found that 55 unique game mechanics were implemented. The most commonly used were rewards (50%), score (44%), creative control (41%), and social interaction (32%). In comparison with gamified tools, the number and diversity of game mechanics applied were higher in serious games. For most tools (85%), a general rationale was provided for utilizing gamification, which often was to promote engaging experiences. A rationale for using specific game mechanics was less commonly provided (only for 45% of the game mechanics). The limited availability of experimental research precludes to test the effectiveness of using gamification in eHealth to support self-management in young people with chronic diseases. In this study, we highlight the importance of reporting the rationale for utilizing specific game mechanics in eHealth tools to ensure a proper alignment with evidence-based practice and the need of conducting experimental research. PROSPERO: CRD42021293037.