Search Results (66)

Background/Objectives: Parkinson’s disease (PD) is a major neurodegenerative condition, mainly treated using dopamine-based therapies. However, the side effects and limitations of these therapies hinder their use. This study aimed to analyze the utilization of Korean medicine (KM) by patients with PD in Korea. Methods: Data of the Health Insurance Review and Assessment Service–National Patient Sample were used to investigate the status and trend of KM utilization by patients with PD in Korea from January 2010 to December 2019. Data of 18,562 patients were included, and analyses were performed on the status of KM and Western medicine (WM) utilization, cost of care, prescribed medications, comorbidities, and characteristics of patients with PD. Results: The number of patients who utilized KM services for PD gradually increased over the 10-year period, with 10.6% of all patients with PD using KM services in 2019. In addition, the number of KM users with PD, number of claims, and expenses all showed an increase. The rate of increase in KM service utilization was greater than that of WM. Among KM services, acupuncture had the highest expense (50.6%). Regarding comorbidities in patients with PD, musculoskeletal diseases were the most common (58.6%). Among WM medications prescribed for the KM users, dopa and dopa derivatives (15.5%) and anti-dementia drugs (11.7%) were the most common. Conclusions: This study provides useful information on KM utilization status and trends among patients with PD and the characteristics of these patients. Follow-up research is warranted on the utilization status of more diverse KM services. Full article

Background/Objectives: Recent evidence supporting the medicinal use of cannabis has brought significant regulatory changes regarding its legal status, cultivation, and use. Several countries have adopted regulatory strategies enabling access to cannabis-based medicinal products; however, the regulation and availability of high-quality cannabis products differs globally. This work aimed to explore the regulatory pathways available for cannabis-based medicinal products, particularly those regulated as medicines, and establish the current landscape of those approved. Methods: The public repositories of the European Medicines Agency, U.S. Food and Drug Administration, and Therapeutic Goods Administration were searched. A consumer website, Amazon, was searched to provide illustrative examples of cannabis products readily available to consumers. Finally, clinical trial data were collected to evaluate trends in medicinal cannabis research. Results: Only Epidyolex™ has been approved by these three agencies. Whilst topical cannabinoid consumer products are popular, no topical cannabis-based medicines have been approved by regulators, despite being the focus of several clinical trials. There are few regulator-approved cannabis-based medicines available and, evidence supporting the therapeutic use of consumer products is very limited. A complex regulatory and legislative scenario hinders research on and development of cannabis-based medicines, leaving a market gap filled with unregulated products that are potentially misleading regarding their therapeutic claims. Full article

Personalized medicine, including targeted and immunotherapy, has substantially changed the landscape of non-small cell lung cancer (NSCLC). About 30% of NSCLC tumors have targetable mutations, like EGFR, and 28% of tumors will have a PD-L1 score or tumor mutation burden high enough to warrant immunotherapy; a molecular test prior to therapy assesses eligibility. However, the congruence between testing and treatment, and the effect of treatment without testing on outcomes, is understudied. We extracted a cohort of NSCLC patients from the Surveillance, Epidemiology and End Results (SEER)-Medicare-linked data. The primary outcome was survival. Demographic and clinical characteristics of those receiving vs. not receiving a molecular test were compared, and a Kaplan–Meier curve along with a multivariable Cox proportional hazards regression assessed the association of survival with the receipt of molecular diagnostic testing, adjusting for sex, race, age, income tract, metro/urban/rural region, histology, and stage. There were 911 NSCLC patients treated with personalized therapy, of which 513 (56.3%) had received prior molecular testing. Black patients were less likely than White patients to receive testing (36.4% vs. 59.9%; p < 0.001). Testing was significantly more frequent in patients with fewer comorbidities (p < 0.001), adenocarcinoma (p = 0.004), tumors in the lower lobe (p = 0.037), or diagnosed at a later stage (p = 0.026). Only 39.9% of patients receiving EGFR inhibitors were initially tested for an EGFR mutation. Among NSCLC patients treated with personalized therapy, untested patients were at increased mortality risk compared to tested patients (median survival 8.22 vs. 12.79 months, p = 0.024). After adjustment, treated patients not tested beforehand had a significantly higher mortality risk (HRadj: 1.20; 95% CI: 1.04–1.40). Substantial incongruence between receipt of molecular testing and personalized therapies exists according to nationwide claims data, with only about half of treated patients having had an appropriate molecular diagnostic workup. This could explain, in part, the higher mortality among treated patients who did not undergo testing. Before expanding personalized therapies, further addressing these issues through standardized, reflexive testing protocols and improved clinician education is critical to optimizing the integration of molecular diagnostics into treatment planning. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted global healthcare. This study explores the effects of perioperative COVID-19 infection on postoperative outcomes, aiming to refine risk assessment and enhance personalized perioperative care using a comprehensive dataset from the Korean National Health Insurance Service. This analysis extends previous research by providing a large-scale validation of risk factors associated with COVID-19 in a perioperative setting. Methods: In this retrospective cohort study, we analyzed data from 2,903,858 patients who underwent surgery under general anesthesia between January 2020 and December 2021. Patients were categorized into COVID-19 (+) and COVID-19 (−) groups within 30 d before or after surgery. Logistic regression models were used to identify independent risk factors for mortality and pulmonary complications. Results: After propensity score matching, the final cohort comprised 19,235 patients (COVID-19 (+): 3847; COVID-19 (−): 15,388). The COVID-19 (+) group had significantly higher overall mortality than the COVID-19 (−) group. No significant difference was observed between the groups concerning 30 d mortality. Pulmonary complications, including pneumonia and acute respiratory distress syndrome, were significantly more frequent in the COVID-19 (+) group. The independent predictors of 30 d mortality included advanced age, emergency surgery, and the American Society of Anesthesiologists physical status classification. Conclusions: Our study confirms that perioperative COVID-19 infection significantly elevates overall mortality and pulmonary complications, emphasizing the necessity of tailored perioperative management. Incorporating individual risk factors into care protocols not only reduces risks for surgical patients but also enhances treatment approaches. These findings advocate for the implementation of personalized medicine principles in surgical settings to improve patient outcomes during and after the COVID-19 pandemic. This research uses a comprehensive national medical claims dataset to set new standards for studying pandemic health impacts and improving clinical strategies. Full article

Theranostic nanoparticles integrate diagnostic and therapeutic potential, representing a promising approach in precision medicine. Accordingly, numerous inventions have been patented to protect novel formulations and methods. This review examines the evolution of patented theranostic nanoparticles, focusing on organic nanosystems, particularly polymeric and lipid nanoparticles, to assess their development, technological advances, and patentability. A scoping review approach was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines in the World Intellectual Property Organization (WIPO) and European Patent Office (EPO) database. The search included patents filed within the last ten years (2014–2024) that specifically claimed organic and/or hybrid theranostic nanoparticles. Data extraction focused on nanoparticle composition, synthesis methods, functionalization strategies, and theranostic applications. The search identified 130 patents, of which 13 met the inclusion criteria. These patents were primarily filed by inventors from the United States, Canada, Great Britain, Italy, and China. Polymeric nanoparticles were frequently engineered for targeted drug delivery and imaging, utilizing hyperbranched polyesters, sulfated polymers, or chitosan-based formulations. Lipid nanoparticles were often hybridized with inorganic nanomaterials or magnetic nanostructures to enhance their theranostic potential. While most patents detailed synthesis methods and physicochemical characterizations, only a few provided comprehensive preclinical validation, limiting their demonstrated efficacy. The analysis of recent patents highlights significant advances in the design and application of theranostic nanoparticles. However, a notable gap remains in validating these nanosystems for clinical translation. Future efforts should emphasize robust preclinical data, including in vitro and in vivo assessments, to enhance patent quality and applicability to substantiate the claimed theranostic capabilities. Full article

Background: Major depression places psychological strain on the individual that may increase the risk of developing rheumatoid arthritis (RA). Though the use of Chinese herbal medicines (CHMs) is widespread in clinical practice, its effect on the prevention of RA incidents is still unknown. This study aimed to evaluate the association between CHMs use by patients with depression and their subsequent risk of being diagnosed with RA. Methods: This nested case–control study used claims data from a nationwide insurance database. We identified patients aged 20–70 years with newly diagnosed depression and without pre-existing RA between 2002 and 2010. We enrolled those with RA onset occurring after depression by the end of 2013 (n = 973). Randomly matched controls were selected from the remaining patients with depression but without RA (n = 1946). Conditional logistic regression analysis was executed to assess the association between CHMs use and RA onset. Data are presented as p-values with the significance set at 0.05 and as odds ratios (ORs) with 95% confidence intervals (CIs). Results: In this study, we found that adding CHMs treatment to conventional antidepressants greatly decreased the subsequent risk of RA among patients with depression, with an ORs of 0.64 (95% CIs: 0.57–0.76). Those using CHMs for more than three years had the most striking benefit, with a 61% lower risk of RA. Notably, initiating CHMs within the first 2 years after depression onset resulted in the greatest decrease in the RA risk. Conclusion: Using CHMs with conventional antidepressant therapy reduced the RA risk among patients with depression. Further well-designed randomized controlled trials are needed to determine the molecular mechanism underlying the action of these herbal agents. Full article

Background: Cannabidiol (CBD) is a cannabinoid present in the hemp plant (Cannabis sativa L.). Non-medicinal CBD oils with typically 5–40% CBD are advertised for various alleged positive health effects. While such foodstuffs containing cannabinoids are covered by the Novel Food Regulation in the European Union (EU), none of these products have yet been authorized. Nevertheless, they continue to be available on the European market. Methods: The Permanent Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) reviewed the currently available data on adverse and potential beneficial effects of CBD in the dose range relevant for foods. Results: Increased liver enzyme activities were observed in healthy volunteers following administration of 4.3 mg CBD/kg bw/day and higher for 3–4 weeks. As lower doses were not tested, a no observed adverse effect level (NOAEL) could not be derived, and the dose of 4.3 mg/kg bw/day was identified as the lowest observed adverse effect level (LOAEL). Based on the CBD content and dose recommendations of CBD products on the market, the SKLM considered several exposure scenarios and concluded that the LOAEL for liver toxicity may be easily reached, e.g., via consumption of 30 drops of an oil containing 20% CBD, or even exceeded. A critical evaluation of the available data on potential beneficial health effects of CBD in the dose range at or below the LOAEL of 4.3 mg/kg bw/day revealed no scientific evidence that would substantiate health claims, e.g., in relation to physical performance, the cardiovascular, immune, and nervous system, anxiety, relaxation, stress, sleep, pain, or menstrual health. Conclusions: The SKLM concluded that consumption of CBD-containing foods/food supplements may not provide substantiated health benefits and may even pose a health risk to consumers. Full article

The positive effects of whole-body vibration exercise in rehabilitation, sport, fitness and preventive medicine have led to a proliferation of vibrating platforms. However, discrepancies have been claimed between the manufacturers’ vibration parameters and the vibration applied by the platforms. In addition, the dimensions, materials and motors used in their manufacture mean that each platform behaves differently. These factors can influence their transmission to the human body and, consequently, their effects. Thus, measured vibration parameters were recommended to report the vibration parameters as accurately as possible. Therefore, the present study aimed to determine the feasibility of a large vibration platform. Measurements of vibration parameters and their transmission were added. These parameters were measured using six accelerometers (platform, ankle, knee, hip, third lumbar vertebra, and head) throughout five postures (toe-standing, erect, high squat, deep squat, and lunge) and three vibration frequencies (20 Hz, 25 Hz, and 30 Hz). On the platform, peak accelerations of 1 ± 0.2 g, displacements of 1 ± 0.1 mm at 20 Hz and 25 Hz and 0.6 mm at 30 Hz, and a frequency from the setting of +0.5 Hz were obtained. In the human body, peak accelerations can exceed 2 g, and these transmissibility amplifications were found at the ankles and knees. However, at the hip, accelerations plummet and transmissibility attenuation occurs all the way to the head. The signal purity was highly satisfactory, although at the hip and third lumbar vertebra when adopting the toe-standing and lunge, some less satisfactory results were found—especially at 20 Hz and 30 Hz. Present data indicate that the long vibration platform can be used for exercise and health in a safe way, although its specific behaviours have to be taken into account in order to optimise its applicability. Full article

Vaccine hesitancy, a pressing global challenge in vaccination programs, was significantly amplified during the COVID-19 pandemic. The proliferation of misinformation, including false claims and rumours, and the influence of anti-vaccine movements fuelled hesitancy. This study aims to explore the socio-economic determinants that influenced vaccine hesitancy and the impact of public health information sharing in Sri Lanka during the pandemic. The study employed a comprehensive mixed-method approach for data collection, administrating a household survey (n = 3330) and 206 semi-structured interviews. The survey results indicated that 37.8% (n = 3113) of respondents delayed or rejected vaccines for various reasons, the leading cause being the fear of side effects of the vaccine. Although fear of side effects was the prime reason for rejection (n = 1176, 46.29%), respondents demonstrated an extremely poor understanding of the potential side effects of vaccines, which was 55.39% (n = 3113). Notably, 84.60% (n = 3113) were unaware of the vaccine development process. Multivariate logistic regression analysis showed that middle-income people (AOR—0.42) and females (0.65) were less likely not to make decisions based on scientific information compared to underprivileged people and males. The survey also revealed that strong belief in the use of traditional medicines and remedies and religious beliefs (n = 1176, 3.95%) were among the main reasons for hesitancy. The findings illustrate that misinformation, lack of health knowledge, and lack of understanding to seek scientific information have fuelled vaccine hesitancy in Sri Lanka. Full article

Time series forecasting is undoubtedly a key area in machine learning due to the numerous fields where it is crucial to estimate future data points of sequences based on a set of previously observed values. Deep learning has been successfully applied to this area. On the other hand, growing concerns about the steady increase in the amount of resources required by deep learning-based tools have made Green AI gain traction as a move towards making machine learning more sustainable. In this paper, we present a deep learning-based time series forecasting methodology called GreeNNTSF, which aims to reduce the size of the resulting model, thereby diminishing the associated computational and energetic costs without giving up adequate forecasting performance. The methodology, based on the ODF2NNA algorithm, produces models that outperform state-of-the-art techniques not only in terms of prediction accuracy but also in terms of computational costs and memory footprint. To prove this claim, after presenting the main state-of-the-art methods that utilize deep learning for time series forecasting and introducing our methodology we test GreeNNTSF on a selection of real-world forecasting problems that are commonly used as benchmarks, such as SARS-CoV-2 and PhysioNet (medicine), Brazilian Weather (climate), WTI and Electricity (economics), and Traffic (smart cities). The results of each experiment conducted objectively demonstrate, rigorously following the experimentation presented in the original papers that addressed these problems, that our method is more competitive than other state-of-the-art approaches, producing more accurate and efficient models. Full article

Reduced-order models (ROMs) have achieved a lot of success in reducing the computational cost of traditional numerical methods across many disciplines. In fluid dynamics, ROMs have been successful in providing efficient and relatively accurate solutions for the numerical simulation of laminar flows. For convection-dominated (e.g., turbulent) flows, however, standard ROMs generally yield inaccurate results, usually affected by spurious oscillations. Thus, ROMs are usually equipped with numerical stabilization or closure models in order to account for the effect of the discarded modes. The literature on ROM closures and stabilizations is large and growing fast. In this paper, instead of reviewing all the ROM closures and stabilizations, we took a more modest step and focused on one particular type of ROM closure and stabilization that is inspired by large eddy simulation (LES), a classical strategy in computational fluid dynamics (CFD). These ROMs, which we call LES-ROMs, are extremely easy to implement, very efficient, and accurate. Indeed, LES-ROMs are modular and generally require minimal modifications to standard (“legacy”) ROM formulations. Furthermore, the computational overhead of these modifications is minimal. Finally, carefully tuned LES-ROMs can accurately capture the average physical quantities of interest in challenging convection-dominated flows in science and engineering applications. LES-ROMs are constructed by leveraging spatial filtering, which is the same principle used to build classical LES models. This ensures a modeling consistency between LES-ROMs and the approaches that generated the data used to train them. It also “bridges” two distinct research fields (LES and ROMs) that have been disconnected until now. This paper is a review of LES-ROMs, with a particular focus on the LES concepts and models that enable the construction of LES-inspired ROMs and the bridging of LES and reduced-order modeling. This paper starts with a description of a versatile LES strategy called evolve–filter–relax (EFR) that has been successfully used as a full-order method for both incompressible and compressible convection-dominated flows. We present evidence of this success. We then show how the EFR strategy, and spatial filtering in general, can be leveraged to construct LES-ROMs (e.g., EFR-ROM). Several applications of LES-ROMs to the numerical simulation of incompressible and compressible convection-dominated flows are presented. Finally, we draw conclusions and outline several research directions and open questions in LES-ROM development. While we do not claim this review to be comprehensive, we certainly hope it serves as a brief and friendly introduction to this exciting research area, which we believe has a lot of potential in the practical numerical simulation of convection-dominated flows in science, engineering, and medicine. Full article

Sickle cell disease (SCD) and transfusion-dependent β-thalassemia (TDT) are hereditary haemoglobinopathies characterized by a reduction in functional β-globin chains. Both conditions cause tiredness and increase susceptibility to infection, which can lead organ failure, significantly reducing life expectancy and typically requiring those affected to undergo regular erythrocyte transfusion. Recently, a novel therapeutic treatment for SCD and TDT was approved by the UK regulatory body (Medicines and Healthcare products Regulatory Agency; MHRA). Exagamglogene autotemcel (Casgevy) is the first licensed therapy globally to utilize CRIPSR/Cas9 technology and induces an increase in expression of γ-globin chains to compensate for the reduction in functional β-globin. Casgevy represents a first-in-class therapeutic, and numerous considerations were made by the MHRA throughout its assessment of the medicine. These include, but are not limited to, the risk of tumorigenicity and off-target editing, a limited cohort size, the validity of proposed dosing and the conduction of only single-arm studies. The MHRA’s analyses of the data to support the proposed indications are presented and discussed throughout this manuscript. Overall, the sponsors claims were considered well supported by their data, and Casgevy was licensed for the treatment of TDT or SCD in patients 12 years of age and older for whom hematopoietic stem cell (HSC) transplantation is appropriate, but a human leukocyte antigen-matched related HSC donor is not available. Full article

Inappropriate antimicrobial use is a global problem, especially because the use of antimicrobials in excess of appropriate doses is associated with increased antimicrobial resistance. Duplicate prescriptions are an issue contributing to inappropriate antimicrobial use. This study aimed to analyse antibiotic prescriptions during a specific month to examine the frequency of outpatients receiving duplicate antibiotic prescriptions and the associated determinants. Utilizing the Japan Medical Data Centre health insurance claim database, we retrospectively identified 527,110 insured individuals with at least one medicine prescription in October 2014. Data regarding age, gender, antibiotic drug usage, and health insurance status were extracted. Duplicate prescriptions entailed a patient receiving two or more prescriptions of systemic antibiotics from multiple facilities within one month. The risk factors for duplicate antibiotic prescriptions were evaluated using logistic regression analysis. Of the total sample, 131,709 individuals (25.0%) received antibiotics, and 24,529 of these individuals (18.6%) had duplicate prescriptions. Third-generation cephalosporins accounted for the largest proportion of prescriptions (37.4%). Duplicate prescriptions were significantly associated with sex, age, medical facilities, and health insurance status. These findings could help to identify patients at risk of duplicate antibiotic prescriptions, highlighting the need to promote proper antimicrobial use in both patients and medical professionals. Full article

The World Health Organization (WHO) recommends the use of annual mass drug administration (MDA) as the strategy for controlling and eliminating the five preventive chemotherapy neglected tropical diseases (PC-NTDs). The success of MDAs hinges on community acceptance, active participation, and compliance. This study aimed to explore the experiences and perceptions of community members, to obtain a more thorough understanding of their openness and willingness to participate in MDA and other NTD elimination activities. A mixed-methods approach was employed, utilizing qualitative and quantitative methods for comprehensive data collection. Eighteen key informant interviews (KIIs) and sixteen focus group discussions (FGDs) were conducted to explore community engagement, participation, medication utilization, and programme perception. Triangulation of findings from interviews and discussions with household survey results was performed to gain a deeper understanding of emerging themes. The household survey involved interviewing 1220 individuals (Abaji: 687; Bwari: 533). Audio tapes recorded KIIs and FGDs, with interview transcripts coded using Nvivo 12.0 software based on predefined themes. Descriptive analysis using SPSS version 21 was applied to quantitative data. Results indicated high awareness of mass drug administration (MDA) campaigns in both area councils (Abaji: 84.9%; Bwari: 82.9%), with a small percentage claiming ignorance (15.1%), attributed to lack of information or absence during health campaigns. Respondents primarily participated by taking medication (82.5%), with minimal involvement in other MDA campaigns. Perception of medicines was generally positive, with a significant association between participation level and performance rating (p < 0.05). The study recommends leveraging high awareness and community responsiveness to enhance engagement in various MDA activities, ensuring sustainability and ownership of the programme. Full article

Due to the COVID-19 pandemic, many children missed their routine vaccinations globally. There is insufficient evidence on the trends in vaccination coverage in the private healthcare sector in South Africa. This study explored the changes in childhood vaccination patterns (non-COVID vaccines) in the private healthcare sector in South Africa using medicine claim data. Using the information on medication claims from a South African pharmaceutical benefit management (PBM) company, we performed a quantitative cross-sectional analysis comparing the period before (2018–2019) and during the COVID-19 pandemic (2020–2021). All patients who made claims within the study period were included. This study included 67,830 children aged two years and younger. In particular, from 2018 to 2021, boys (52%) outnumbered girls (48%). Pharmacists consistently held the predominant prescriber role before and during the COVID-19 pandemic. The proportion of children receiving non-COVID-19 vaccines was higher before the pandemic (60%) than during the pandemic (55%). Furthermore, there was a notable decline of 5% in measles vaccination rates during the children’s first year of life, while a notable increase was observed for measles (5%), hepatitis A (7.7%), and the pentavalent vaccine (5%) during the second year of life. Governments and private healthcare providers must take action to enhance vaccination coverage rates for children in their first year of life to prevent a resurgence of vaccine-preventable diseases. The results obtained in this study underscore the significance of implementing vaccine catch-up campaigns to address missed vaccination opportunities arising from the impact of the COVID-19 pandemic. Moreover, pharmacists emerged as the predominant healthcare providers responsible for administering vaccinations within the private healthcare sector in South Africa, both prior and during the COVID-19 pandemic. Their pivotal role in the vaccination process warrants due recognition and should not be underestimated. Full article