Search Results (36)

Background: Colon capsule endoscopy (CCE) or panenteric capsule endoscopy (PCE) offers a promising, non-invasive diagnostic approach for patients with iron deficiency anaemia (IDA). However, high rates of conversion to conventional colonoscopy (CCC) following capsule procedures reduce cost-effectiveness and patient satisfaction. Optimising the faecal immunochemical test (FIT) threshold may improve patient stratification and reduce unnecessary conversions in future applications within the IDA diagnostic pathway. Methods: The CLEAR IDA study was a multicentre, retrospective observational study conducted across four UK hospitals. Data were collected over a six-month study period and included patients referred via the two-week-wait (2WW) cancer pathway for iron deficiency, with or without anaemia, over a 12-month timeframe. Colonoscopy findings were analysed and extrapolated using NHS England’s CCE-to-colonoscopy referral criteria to assess the predictive value of FIT for colorectal cancer (CRC), polyp burden, and CCC using ROC curve analysis. The optimal FIT threshold was identified through three complementary approaches: threshold-based analysis, decision curve analysis, and cost–benefit modelling. Results: A total of 1531 patients were analysed; only 1.6% underwent small bowel capsule endoscopy. The diagnostic accuracy (AUC) of FIT for predicting CRC, polypoidal lesions, and CCC was 0.78, 0.58, and 0.69, respectively. Threshold-based analysis identified FIT = 15 µg/g as the lowest level at which CCC rates significantly increased (p = 0.02; OR = 1.87; 95% CI: 1.07–3.14). Decision curve analysis showed a maximum net benefit at FIT = 17.6 µg/g, while cost–benefit modelling identified 9 µg/g as the most cost-effective. Raising the threshold to 10 µg/g resulted in a net loss of GBP –294.4 per patient. An optimal cost-effective FIT threshold range was identified between 10 and 17.6 µg/g. The threshold selection should be tailored to local service capacity and resource availability. Conclusions: While FIT alone is an imperfect triage tool, optimising thresholds between 10 and 17 µg/g may enhance cost-effectiveness and guide appropriate PCE use in IDA. Full article

The global transportation sector is rapidly shifting towards electrification, aiming to create more sustainable environments. As a result, there is a significant focus on optimizing performance and increasing the lifespan of batteries in electric vehicles (EVs). To achieve this, the battery pack must operate with constant current charging and discharging modes of operation. Further, in an EV powertrain, maintaining a constant DC link voltage at the input stage of the inverter is crucial for driving the motor load. To satisfy these two conditions simultaneously during the energy transfer, a hybrid energy storage system (HESS) consisting of a lithium–ion battery and a supercapacitor (SC) connected to the semi-active topology of the bidirectional DC–DC converter (SAT-BDC) in this research work. However, generating the duty cycle for the switches to regulate the operation of SAT-BDC is complex due to the simultaneous interaction of the two mentioned constraints: regulating the DC link voltage by tracking the reference and maintaining the battery current at a constant value. Therefore, this research aims to efficiently resolve the issue by incorporating a highly flexible nonlinear model predictive control (NMPC) to control the switches of SAT-BDC. Furthermore, the converter system design is tested for operational performance using MATLAB 2022B with the battery current and the DC link voltage with different priorities. In the NMPC approach, these constraints are carefully evaluated with varying prioritizations, representing a crucial trade-off in optimizing EV powertrain operation. The results demonstrate that battery current prioritization yields better performance than DC link voltage prioritization, extending the lifespan and efficiency of batteries. Thus, this research work further aligns with the conceptual realization of the sustainability goals by minimizing the environmental impact associated with battery production and disposal. Full article

The tropical dry regions in the Neotropics are under intense anthropogenic pressures, resulting in changes for local communities related with their life patterns, wellbeing, and their relationship with ecosystems. The region has a history of human occupation that has shaped the traditional use of resources. We evaluated the richness, redundancy, and divergence of traditional uses of tree species present in vegetation patches of the tropical dry region of the Gulf of Mexico using functional diversity indices. The most used species are Acacia cochliacantha, Cedrela odorata, Enterolobium cyclocarpum, Gliricidia sepium, and Guazuma ulmifolia, and the uses with the broadest distributions across the region are firewood and pasture management, while reforestation is the least common use. While distance to the nearest patch of the closest human settlement is the most predictive variable associated with inhabitants’ different uses or recognitions of the value of different plant species, the most recognized and valued species are widely distributed in Mexico. Even when the forest cover is greatly reduced, the inhabitants recognize numerous uses that can be obtained from the vegetation patches. The approach used in this work provides important baseline information, as well as a methodology that facilitates the identification of priority areas for conservation. Full article

There is a lack of rapid dietary assessment tools to screen for compliance with guidelines for cancer prevention, such as those issued by the World Cancer Research Fund and the American Institute for Cancer Research. Our aim was to develop and validate a short screener (Nutri S-Can) to evaluate adherence to these recommendations, with the potential to be used in cancer prevention strategies. Four stages were defined: development, pilot study, refinement and validation study. The Nutri S-Can captures several domains of the WCRF/AICR recommendations: body composition, physical activity, diet, alcohol consumption, and breastfeeding. A first version was piloted in n = 100 PREDIMED-Plus study participants, for which comprehensive dietary, physical activity, and anthropometric measurements were available (+/− 6 months). Nutri S-Can was retested 6 months later in a subsample of 60 participants. Its validity was evaluated by comparing total and individual domain scores of the screener to those obtained from validated methods (breastfeeding not validated), and its reproducibility was measured comparing the first to the second administration (Pearson correlation). The first version of the Nutri S-Can included 15 questions distributed across five domains. Each question had three possible answers to determine whether participants meet (1 point), partially meet (0.5) or do not meet (0) the recommendations (score range: 0–7). Participant’s average age was 71.4 ± 5.03 y (41 women, 59 men), taking an average of 6.9 min to complete the screener. The total average score was 4.9 ± 0.9 vs. 3.5 ± 0.9 using data from validated questionnaires (high correlation; r = 0.51). Individual domains presented a high and significant correlation (r = 0.25–0.85) when comparing Nutri S-Can to validated assessments, except for processed foods (r = 0.15). A high correlation (r > 0.3) was observed when comparing Nutri S-Can before and after 6 months for individual dimensions and overall score. The refinement study aimed to increase preciseness and accuracy: two additional questions were included (total: 17 questions) to reduce the under-estimation of processed foods and improve self-classification of physical activity, and the nº of answers available was increased to six. This final version is being validated in two different populations (university students (n = 100) and PREDIMED-Plus participants (n = 117)) with the aim of having a validated screener that can be used in clinical settings at the individual level. Full article

(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal rehabilitation (MSR), as a treatment of various disorders that cause disability and chronic pain. (2) Aim: We discuss the role of VR in MSR, presenting its use and development on acute and chronic musculoskeletal disorders, based on the most recent literature. (3) Design and Methods: Literature searches were conducted in the databases Pubmed and Medline up to 30 September 2023. The PRISMA-Scr Checklist was followed. (4) Results: A total of 51 records were included. The analysed studies were conducted within a variety of populations, musculoskeletal disorders, settings, and VR technologies. Only a few studies could statistically affirm the efficacy of VR in MSR, as mentioned for the rehabilitation of the upper limb. Nevertheless, the observed trend is an improvement of the global perceived effect compared to traditional rehabilitation. (5) Conclusion: VR allows for the personalisation of treatment with an adaptable treatment platform, which may improve the participation of the patient and increase acceptability and adherence to long-term rehabilitation programs. We provide recommendations and suggestions for future research and use of VR in musculoskeletal rehabilitation. Full article

Satellite-derived Ecosystem Functional Types (EFTs) are increasingly used in ecology and conservation to characterize ecosystem heterogeneity. The diversity of EFTs, also known as Ecosystem Functional Diversity (EFD), has been suggested both as a potential metric of ecosystem-level biodiversity and as a predictor for ecosystem functioning, ecosystem services, and resilience. However, the impact of key methodological choices on patterns of EFTs and EFD have not been formally assessed. Using Costa Rica as a study system, we compared EFTs and EFD, derived from MODIS and Landsat data using different methodological assumptions, at both national and local extents. Our results showed that the regional spatial patterns of EFTs and EFD derived from 250 m MODIS and 30 m Landsat are notably different. The selection of sensors for deriving EFTs and EFD is dependent on the study area, data quality, and the research objective. Given its finer spatial resolution, Landsat has greater capacity to differentiate more EFTs than MODIS, though MODIS could be a better choice in frequently cloudy areas due to its shorter revisiting time. We also found that the selection of spatial extent used to derive EFD is critical, as smaller extents (e.g., at a local rather than a national scale) can show much higher diversity. However, diversity levels derived at smaller extents appear to be nested within the diversity levels derived at larger extents. As EFTs and EFD continue to develop as a tool for ecosystem ecology, we highlight the important methodological choices to ensure that these metrics best fit research objectives. Full article

Excessive alcohol consumption carries a significant health, social and economic burden. Screening, brief intervention and referral to treatment (SBIRT) is one approach to identifying patients with excessive alcohol consumption and providing interventions to help them reduce their drinking. However, healthcare workers in urgent and emergency care settings do not routinely integrate SBIRT into clinical practice and raise a lack of training as a barrier to SBIRT delivery. Therefore, “Alcohol Prevention in Urgent and Emergency Care” (APUEC) training was developed, delivered, and evaluated. APUEC is a brief, stand-alone, multimedia, interactive digital training package for healthcare workers. The aim of APUEC is to increase positive attitudes, knowledge, confidence and skills related to SBIRT through the provision of (a) education on the impact of alcohol and the role of urgent and emergency care in alcohol prevention, and (b) practical guidance on patient assessment, delivery of brief advice and making referral decisions. Development involved collaborative–participatory design approaches and a rigorous six-step ASPIRE methodology (involving n = 28 contributors). APUEC was delivered to healthcare workers who completed an online survey (n = 18) and then participated in individual qualitative interviews (n = 15). Analysis of data was aligned with Levels 1–3 of the Kirkpatrick Model of Training Evaluation. Survey data showed that all participants (100%) found the training useful and would recommend it to others. Insights from the qualitative data showed that APUEC digital training increases healthcare workers’ perceived knowledge, confidence and skills related to alcohol prevention in urgent and emergency care settings. Participants viewed APUEC to be engaging and relevant to urgent and emergency care workers. This digital training was perceived to be useful for workforce skills development and supporting the implementation of SBIRT in clinical practice. While the impact of APUEC on clinician behaviour and patient outcomes is yet to be tested, APUEC digital training could easily be embedded within education and continuing professional development programmes for healthcare workers and healthcare trainees of any discipline. Ultimately, this may facilitate the integration of SBIRT into routine care and contribute to population health improvement. Full article

Anemia causes hypo-oxygenation in the brain, which could lead to cognitive disorders. We examined dietary iron intake as well as anemia markers (i.e., hemoglobin, hematocrit, mean corpuscular volume) and diabetes coexistence in relation to neuropsychological function and quality of life. In this study, 6117 community-dwelling adults aged 55–75 years (men) and 60–75 years (women) with overweight/obesity and metabolic syndrome were involved. We performed the Mini-Mental State Examination (MMSE), the Trail Making Test parts A and B (TMT-A/B), Semantic Verbal Fluency of animals (VFT-a), Phonological Verbal Fluency of letter P (VFT-p), Digit Span Test (DST), the Clock Drawing Test (CDT), and the Short Form-36 Health Survey (SF36-HRQL test). Dietary iron intake did not influence neuropsychological function or quality of life. However, anemia and lower levels of anemia markers were associated with worse scores in all neurophysiological and SF36-HRQL tests overall, but were especially clear in the MMSE, TMT-B (cognitive flexibility), and the physical component of the SF36-HRQL test. The relationships between anemia and diminished performance in the TMT-A/B and VFT tasks were notably pronounced and statistically significant solely among participants with diabetes. In brief, anemia and reduced levels of anemia markers were linked to inferior cognitive function, worse scores in different domains of executive function, as well as a poorer physical, but not mental, component of quality of life. It was also suggested that the coexistence of diabetes in anemic patients may exacerbate this negative impact on cognition. Nevertheless, dietary iron intake showed no correlation with any of the outcomes. To make conclusive recommendations for clinical practice, our findings need to be thoroughly tested through methodologically rigorous studies that minimize the risk of reverse causality. Full article

Purpose: Wine is an alcoholic beverage considered to have health benefits when consumed in moderation. Studies have investigated the healthfulness of wine via various approaches; however, given that wine consumption behavior is evolving, fresh data are needed. There is a paucity of evidence on the perceived mental health benefits of wine; hence, this study examined consumers’ perceptions of wine healthfulness separately for each physical and mental health benefit and compared them with wine consumption behaviors. Design/methodology/approach: A quantitative data collection method was used. The questionnaires were given to participants in South Korea who had consumed wine in the six months before the survey. A total of 304 responses were collected for further analysis. A paired t-test, ANOVA, and descriptive analysis were used to analyze the data. Findings: This study found that respondents perceived higher mental health benefits than physical health benefits from wine consumption. Demographic characteristics showed significant differences in the mental or physical health benefits of wine. Consumers who believed in the physical health benefits of wine preferred white wine over red wine; however, consumers who believed in the mental health benefits of wine had no preferences. Originality: This study suggests that segmented marketing tools are needed due to the various characteristics of wine consumers. In addition, to encourage a healthy drinking environment, marketing should focus on moderation for both the wine industry and consumers. Furthermore, consumers’ consideration of the mental health benefits of wine consumption cannot be underestimated compared to the physical health benefits of wine consumption; however, wine is also regarded as an alcoholic beverage that needs to be consumed with consideration of health concerns in various restrictions. Full article

To assess the efficacy of different modalities and frequencies of physical exercise on glycaemic control in adults with prediabetes. A two-phase, parallel, randomised, controlled clinical trial will be carried out, in 210 participants. In phase 1, 120 participants will be randomized into four arms: (1) aerobic exercise, (2) aerobic exercise combined with resistance, (3) high-intensity intervallic exercise and (4) control group. In phase 2, 90 new participants will be randomized into three arms, using the exercise modality that showed the best glycaemic control in phase 1 in the following manner: (1) frequency of 5 days/week, (2) frequency of 3 days/week and (3) frequency of 2 days/week. The control group (n = 30) will be included in phase 1 to evaluate the effect of any type of intervention versus no intervention. Data collection will be performed at baseline and after 15 weeks of follow up. Sociodemographic data, medication, comorbidity, blood biochemical parameters, blood pressure, anthropometric measurements, body composition, physical activity, sedentary lifestyle, diet, smoking, alcohol consumption, quality of life and sleep questionnaires will be collected. Physical activity, sedentary behaviour and sleep will be further determined with an accelerometer, and continuous glycaemia will be determined with a glycaemic monitor, both during seven days, at two time points. The main dependent variable will be the reduction in the mean amplitude of glycaemic excursions. The impact of these interventions on health will also be evaluated through gene expression analysis in peripheral blood cells. The results of this study will contribute to a better understanding of the mechanisms behind the glucose response to physical exercise in a population with prediabetes as well as improve physical exercise prescriptions for diabetes prevention. Increasing glycaemic control in people with prediabetes through physical exercise offers an opportunity to prevent diabetes and reduce associated comorbidities and health costs. Full article

The increasing frequency of isolation of methicillin-resistant Staphylococcus aureus (MRSA) limits the chances for the effective antibacterial therapy of staphylococcal diseases and results in the development of persistent infection such as bacteremia and osteomyelitis. The aim of this study was to identify features of the MRSA_ST239 0943-1505-2016 (SA943) genome that contribute to the formation of both acute and chronic musculoskeletal infections. The analysis was performed using comparative genomics data of the dominant epidemic S. aureus lineages, namely ST1, ST8, ST30, ST36, and ST239. The SA943 genome encodes proteins that provide resistance to the host’s immune system, suppress immunological memory, and form biofilms. The molecular mechanisms of adaptation responsible for the development of persistent infection were as follows: amino acid substitution in PBP2 and PBP2a, providing resistance to ceftaroline; loss of a large part of prophage DNA and restoration of the nucleotide sequence of beta-hemolysin, that greatly facilitates the escape of phagocytosed bacteria from the phagosome and formation of biofilms; dysfunction of the AgrA system due to the presence of psm-mec and several amino acid substitutions in the AgrC; partial deletion of the nucleotide sequence in genomic island vSAβ resulting in the loss of two proteases of Spl—operon; and deletion of SD repeats in the SdrE amino acid sequence. Full article

A review on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorder (ASD) published just over 10 years ago found a limited evidence base for pharmacological intervention in this group. The aim of this paper was therefore to review the evidence in the subsequent 10 years, with a focus on polypharmacy use in adults who have both ID and ASD. A critical literature review of key papers published from 2009 to 2021 was undertaken on adults with both ID and ASD and related to psychopharmacology, polypharmacy, antipsychotics, antidepressants, mood stabilisers and anxiolytics interventions in improving symptoms. After excluding articles for lack of relevance, a review with a focus on the use of polypharmacy was carried out on the retrieved results. Four papers were identified as relevant to adults with both ID and ASD. Three main themes were identified in the review, including the application of pharmacogenetics, the influence of national policy on prescribing practices and safety concerns in a population with multiple health comorbidities. The past decade has produced a small increase in the evidence base on psychopharmacology use in adults with ID and ASD. However, more evidence on the effectiveness and impact of long-term polypharmacy use is required. Full article

Colorectal cancer (CRC) is a major health problem worldwide, with an estimated 1.9 million new cases and 915,880 deaths in 2020 alone. The etiology of CRC is complex and involves both genetic and lifestyle factors. Obesity is a major risk factor for CRC, and the mechanisms underlying this link are still unclear. However, the generalized inflammatory state of adipose tissue in obesity is thought to play a role in the association between CRC risk and development. Visceral adipose tissue (VAT) is a major source of proinflammatory cytokines and other factors that contribute to the characteristic systemic low-grade inflammation associated with obesity. VAT is also closely associated with the tumor microenvironment (TME), and recent evidence suggests that adipocytes within the TME undergo phenotypic changes that contribute to tumor progression. In this review, we aim to summarize the current evidence linking obesity and CRC, with a focus on the role of VAT in tumor etiology and progression. Full article

Background: The COVID-19 pandemic highlighted underlying disparities in health, healthcare access, and other social factors that have been documented for racial/ethnic minorities. The social-distancing mandate exacerbated the impact of social determinants of health, such as unemployment and food insecurity, particularly among underserved minority populations. We highlight intervention outcomes and lessons learned from the Florida International University (FIU) Herbert Wertheim College of Medicine (HWCOM) NeighborhoodHELP’s response to pandemic-related food insecurity among Miami Dade County’s underserved population. Methods: Following the stay-at-home mandate, a weekly needs assessment of program households was conducted by the NeighborhoodHELP team, during which food insecurity emerged as a pandemic-related urgent need, rising from three percent of program Households in March 2020 to 36.9 percent six months later. Consequently, the program staff collaborated with another FIU department, community partners, and a benefactor to develop a food donation and delivery project. Results: Fifteen hundred and forty-three culturally appropriate food boxes were delivered to 289 participating households, comprising 898 household members, over a 14-month period. Conclusion: This project underscores the importance of leveraging community assets to address their needs during a crisis and the significance of sustained community engagement for researchers and service providers who work in underserved communities. Full article

The health of Hawaiian coral reefs is threatened by sunscreen ingredients (e.g., oxybenzone). This study sought to determine factors leading to the pro-environmental behavior of using reef-safe sunscreen (RSS) and identify practices hoteliers could implement to influence patrons to engage in this behavior. The study applied a framework to model pro-environmental behavior in the hospitality industry. It proposed that attitudes, personal capabilities, and habits are causal variables that influence pro-environmental intention, the predictor of pro-environmental behavior. Contextual factors were proposed as moderating variables for the relationship between pro-environmental intention and pro-environmental behavior. Past Hawaiian hotel patrons (n = 400) were the subjects for this survey. Intention to use RSS and the factors that influenced intention were investigated. Responses were analyzed using multiple linear regression and ANOVA. Results suggested that hotel patrons’ intention to use RSS was primarily influenced by three determinants: attitudes, personal capabilities, and contextual factors. Targeting the development of personal capabilities and employing contextual factors that facilitate the behavior were shown as effective methods to influence RSS use. Findings supported educational campaigns and complimentary RSS programs as practices that Hawaii hotel operators could use to influence patrons’ intention to use RSS. Full article