Individual Health Assessment Research Articles

Swa-Anguli Pramana of Shira (Head) in Asthi-Sara-Purusha (Person Having Enriched Bone Tissue)

Ayurveda is an ancient Indian holistic medicine system focusing on promoting health by maintaining body balance. It is gaining relevance in today's integrative medicine landscape for treating chronic diseases. Key Ayurvedic concepts like Shira Pradesha, Maha Shira, and Asthi-Sara-Purusha contribute to individual health assessment. Methods: This review examines the applicability of Ayurvedic anthropometric methods, particularly Swa-Anguli Pramana, in current clinical practice. It includes discussions on validation studies and comparative analyses with modern techniques. Results: Swa-Anguli Pramana shows consistent personalized diagnostic potential across different demographic groups. Challenges exist regarding discrepancies with modern measurements and the need for standardization. Discussion: Integrating Ayurvedic measurements with modern metrics is likely to be valid and acceptable in contemporary healthcare. There is growing interest in traditional measurement methods for providing personal health information aligned with the holistic approach of Ayurveda. Conclusion: Ayurvedic anthropometric methods, especially Swa-Anguli Pramana, have potential for individualized health assessment. Standardization and validation are vital, and future research should focus on establishing a standardized integrative framework.

Environmental exposure and respiratory health: Unraveling the impact of toxic release inventory facilities on COPD prevalence

This cross-sectional geospatial analysis explores the prevalence of Chronic Obstructive Pulmonary Disease (COPD) concerning the proximity to toxic release inventory (TRI) facilities in Jefferson County, Alabama. Employing the fuzzy analytical hierarchy process (FAHP), the study evaluates COPD prevalence, comorbidities, healthcare access, and individual health assessments. Given the mounting evidence linking environmental pollutants to COPD exacerbations, the research probes the influence of TRI sites on respiratory health, integrating Geographic Information Systems (GIS) to scrutinize the geospatial vulnerability of communities neighboring TRI sites. Socio-demographic disparities, economic conditions, and air pollution are emphasized in the analysis. The EPA's Toxic Release Inventory serves as the cornerstone for assessing the association between TRI proximity and COPD prevalence. The analysis uncovers a notable inverse correlation between distance from TRI sites and COPD prevalence, signaling potential health risks for populations residing closer to these facilities. Moreover, factors such as minority status, low income, and air pollution are associated with higher COPD prevalence, underscoring the imperative of comprehending the interplay between environmental exposure and respiratory health. This study bridges gaps in the literature by addressing the geographical nexus between COPD prevalence and pollution exposure. By leveraging FAHP, the research furnishes a holistic understanding of the multifaceted factors influencing vulnerability to COPD. The findings underscore the necessity for targeted public health interventions and policy measures to redress environmental disparities and alleviate the repercussions of TRI facilities on respiratory health.

Metabolic phenotyping with computed tomography deep learning for metabolic syndrome, osteoporosis and sarcopenia predicts mortality in adults.

Computed tomography (CT) body compositions reflect age-related metabolic derangements. We aimed to develop a multi-outcome deep learning model using CT multi-level body composition parameters to detect metabolic syndrome (MS), osteoporosis and sarcopenia by identifying metabolic clusters simultaneously. We also investigated the prognostic value of metabolic phenotyping by CT model for long-term mortality. The derivation set (n=516; 75% train set, 25% internal test set) was constructed using age- and sex-stratified random sampling from two community-based cohorts. Data from participants in the individual health assessment programme (n=380) were used as the external test set 1. Semi-automatic quantification of body compositions at multiple levels of abdominal CT scans was performed to train a multi-layer perceptron (MLP)-based multi-label classification model. External test set 2 to test the prognostic value of the model output for mortality was built using data from individuals who underwent abdominal CT in a tertiary-level institution (n=10141). The mean ages of the derivation and external sets were 62.8 and 59.7years, respectively, without difference in sex distribution (women 50%) or body mass index (BMI; 23.9kg/m2). Skeletal muscle density (SMD) and bone density (BD) showed a more linear decrement across age than skeletal muscle area. Alternatively, an increase in visceral fat area (VFA) was observed in both men and women. Hierarchical clustering based on multi-level CT body composition parameters revealed three distinctive phenotype clusters: normal, MS and osteosarcopenia clusters. The L3 CT-parameter-based model, with or without clinical variables (age, sex and BMI), outperformed clinical model predictions of all outcomes (area under the receiver operating characteristic curve: MS, 0.76 vs. 0.55; osteoporosis, 0.90 vs. 0.79; sarcopenia, 0.85 vs. 0.81 in external test set 1; P<0.05 for all). VFA contributed the most to the MS predictions, whereas SMD, BD and subcutaneous fat area were features of high importance for detecting osteoporosis and sarcopenia. In external test set 2 (mean age 63.5years, women 79%; median follow-up 4.9years), a total of 907 individuals (8.9%) died during follow-up. Among model-predicted metabolic phenotypes, sarcopenia alone (adjusted hazard ratio [aHR] 1.55), MS+sarcopenia (aHR 1.65), osteoporosis+sarcopenia (aHR 1.83) and all three combined (aHR 1.87) remained robust predictors of mortality after adjustment for age, sex and comorbidities. A CT body composition-based MLP model detected MS, osteoporosis and sarcopenia simultaneously in community-dwelling and hospitalized adults. Metabolic phenotypes predicted by the CT MLP model were associated with long-term mortality, independent of covariates.

A systematic review of approaches to assess fish health responses to anthropogenic threats in freshwater ecosystems.

Anthropogenic threats such as water infrastructure, land-use changes, overexploitation of fishes and other biological resources, invasive species and climate change present formidable challenges to freshwater biodiversity. Historically, management of fish and fishery species has largely been based on studies of population- and community-level dynamics; however, the emerging field of conservation physiology promotes the assessment of individual fish health as a key management tool. Fish health is highly sensitive to environmental disturbances and is also a fundamental driver of fitness, with implications for population dynamics such as recruitment and resilience. However, the mechanistic links between particular anthropogenic disturbances and changes in fish health, or impact pathways, are diverse and complex. The diversity of ways in which fish health can be measured also presents a challenge for researchers deciding on methods to employ in studies seeking to understand the impact of these threats. In this review, we aim to provide an understanding of the pathway through which anthropogenic threats in freshwater ecosystems impact fish health and the ways in which fish health components impacted by anthropogenic threats can be assessed. We employ a quantitative systematic approach to a corpus of papers related to fish health in freshwater and utilize a framework that summarizes the impact pathway of anthropogenic threats through environmental alterations and impact mechanisms that cause a response in fish health. We found that land-use changes were the most prolific anthropogenic threat, with a range of different health metrics being suitable for assessing the impact of this threat. Almost all anthropogenic threats impacted fish health through two or more impact pathways. A robust understanding of the impact pathways of anthropogenic threats and the fish health metrics that are sensitive to these threats is crucial for fisheries managers seeking to undertake targeted management of freshwater ecosystems.

Prevalence of oral complications in the course of severe SARS-CoV-2 infection under mechanical non-invasive ventilation

BackgroundThe management of oral health during severe symptoms of Covid-19 is still a challenge, especially in intensive care units under invasive/noninvasive ventilation in hospital. Understanding the cause-and-effect relationships may allow for individual adjustment of oral care recommendations during Covid-19 disease. The study’s objective was to assess Covid-19 patients’ oral health status under hospital treatment due to pulmonary adverse Covid-19 outcomes.Material and methodsCovid-19 patients (mean age 74.4 ± 15.4; n = 120, male n = 50/female n = 70) were admitted to hospital in the acute phase of Covid-19 between January and March 2022 who required oxygen therapy due to pneumonia, rapid respiratory failure, low saturation. Blood and radiological tests were taken according to National Health Fund guidelines. The condition of teeth (Decayed, Missing, Filled teeth as DMFT index), dental hygiene (Plaque Control Record as PCR index), periodontal status (probing depth PD, clinical attachment CAL, bleeding on probing BOP) and oral mucosa (BRUSHED and Beck scores) were examined.ResultsCharateristics of the teeth (dental caries 35.2%, DMFT Median 22), plaque retention (83.4%), advanced periodontitis (48.3%), xerostomia (74.2%), oral mucosa inflammation (80.8%), angular cheilitis (53.3%), hemorrhagic (21.7%) showed a high incidence of harmful oral conditions. BRUSHED model and Beck score indicated moderate oral dysfunction and need for oral care every 8 h. Spearman’s analysis revealed a significant positive correlation between pneumonia and neutrophile, interleukin-6 IL-6, C-reactive protein CRP (p = 0.01, p < 0.001, p < 0.001), negative to lymphocyte count (p < 0.001). Multiple and logistic regressions selected the following risk predictors for pneumonia as IL-6, CRP, obesity and for severe COVID-19 symptoms D-dimer level and a lack of targeted vaccination (p < 0.001). Among oral predictors, the PCR index and Beck score were significant for both outcomes (respectively p < 0.001, p < 0.012). Patients who received oxygen therapy with face masks had more often angular heilitis and debris (p = 0.025, p = 0.035).ConclusionsCOVID-19 hospitalised patients with severe symptoms crossing with poor oral health-related conditions. This may exacerbate a response for COVID infection, and play a role in cytokine storm. For Covid-19 management, to inhibit extraoral/intraoral complications, it is recommended to adjust oral hygiene procedures, including antibacterial, protective, moisturising agents after individual oral health assessment.

UAV-Based Computer Vision System for Orchard Apple Tree Detection and Health Assessment

Accurate and efficient orchard tree inventories are essential for acquiring up-to-date information, which is necessary for effective treatments and crop insurance purposes. Surveying orchard trees, including tasks such as counting, locating, and assessing health status, plays a vital role in predicting production volumes and facilitating orchard management. However, traditional manual inventories are known to be labor-intensive, expensive, and prone to errors. Motivated by recent advancements in UAV imagery and computer vision methods, we propose a UAV-based computer vision framework for individual tree detection and health assessment. Our proposed approach follows a two-stage process. Firstly, we propose a tree detection model by employing a hard negative mining strategy using RGB UAV images. Subsequently, we address the health classification problem by leveraging multi-band imagery-derived vegetation indices. The proposed framework achieves an F1-score of 86.24% for tree detection and an overall accuracy of 97.52% for tree health assessment. Our study demonstrates the robustness of the proposed framework in accurately assessing orchard tree health from UAV images. Moreover, the proposed approach holds potential for application in various other plantation settings, enabling plant detection and health assessment using UAV imagery.

Patient Self-Performed Point-of-Care Ultrasound: Using Communication Technologies to Empower Patient Self-Care.

Point-of-Care ultrasound (POCUS) is an invaluable tool permitting the understanding of critical physiologic and anatomic details wherever and whenever a patient has a medical need. Thus the application of POCUS has dramatically expanded beyond hospitals to become a portable user-friendly technology in a variety of prehospital settings. Traditional thinking holds that a trained user is required to obtain images, greatly handicapping the scale of potential improvements in individual health assessments. However, as the interpretation of ultrasound images can be accomplished remotely by experts, the paradigm wherein experts guide novices to obtain meaningful images that facilitate remote care is being embraced worldwide. The ultimate extension of this concept is for experts to guide patients to image themselves, enabling secondary disease prevention, home-focused care, and self-empowerment of the individual to manage their own health. This paradigm of remotely telementored self-performed ultrasound (RTMSPUS) was first described for supporting health care on the International Space Station. The TeleMentored Ultrasound Supported Medical Interventions (TMUSMI) Research Group has been investigating the utility of this paradigm for terrestrial use. The technique has particular attractiveness in enabling surveillance of lung health during pandemic scenarios. However, the paradigm has tremendous potential to empower and support nearly any medical question poised in a conscious individual with internet connectivity able to follow the directions of a remote expert. Further studies and development are recommended in all areas of acute and chronic health care.

Pre-pandemic social isolation as a predictor of the adverse impact of the pandemic on self-rated health: A longitudinal COVID-19 study in Japan

Many studies have found adverse effects of the coronavirus disease pandemic on health. Irrespective of being infected by the coronavirus, lockdowns and other measures to restrict mobility have worsened an individual's subjective health assessment. Unlike previous studies, this study examined how pre-pandemic social isolation (in the form of no interaction with others and having no social support) affected the impact of the pandemic on self-rated health in Japan. To this end, we estimated fixed-effects models using 4172 observations of 2086 individuals obtained from a three-wave Internet nationwide survey conducted in January/February 2019 and February 2020 (before the pandemic), in March 2021 (when the pandemic-related state of emergency was effective in four prefectures and just after it was lifted in six prefectures), and in October/November (a full month after the state of emergency was lifted in all prefectures). The state of emergency raised the probability of reporting poor health by 17.8 (95% confidence interval [CI]:1.9–33.8) percentage points among the participants who had not interacted with others before the pandemic, compared with only 0.7 (95% CI: −3.1–4.5) percentage points among other participants. Similar results were obtained in the absence of social support prior to the pandemic. In conclusion, pre-pandemic social isolation was detrimental to health, suggesting that policy measures are needed to avoid social isolation to increase the resilience of public health to external shocks.

Assessment of mental health and psychosocial support in Ukrainian refugee minors resettled in Norway

Abstract Background The recent invasion of Ukraine has forced millions of civilians, especially women and children, to leave their country. Although the European Union offers guidance on individual health assessment of refugees fleeing the war in Ukraine, assessment practice varies across host countries and even on national basis. Thus, the aim of this project was to identify and prioritize procedures for mental health assessment of Ukrainian refugee minors in Norway. Methods This project applied a modified three-round-Delphi method. In a first step, the leading public health nurse and community physician in 40 municipalities across Norway were contacted via e-mail and asked to state who is in charge of health assessment, what is current assessing practice and what are the problems and needs. Answers were analysed and condensed and will be presented for rating in a second and third round. Results Preliminary results from the first round suggest that most municipalities are currently in a planning phase with uncertainties surrounding who and how future assessments will be done. Public health nurses or general practitioners are often in charge of health assessments, but it is unclear if this includes age-adjusted mental health assessments. Conclusions Preliminary results show that current practice in assessing mental health and psychosocial support for Ukranian refugee minors in Norway is very diverse. There is a need to evaluate and prioritize current procedures to assure an equal and age-adjusted procedures for all refugee minors, regardless of where they have resettled. Key messages

Maternity care during a pandemic: Can a hybrid telehealth model comprising group interdisciplinary education support maternal psychological health?

BackgroundThe transition to parenthood is one of the most challenging across the life course, with profound changes that can impact psychological health. In response to the coronavirus disease 2019 (COVID-19), came the rapid implementation of remote antenatal care, i.e., telehealth, with fewer in-person consultations. A change in service delivery in addition to the cancellation of antenatal education represented a potential threat to a woman’s experience – with likely adverse effects on mental health and wellbeing. AimTo explore a hybrid model of pregnancy care, i.e., telehealth and fewer in-person health assessments, coupled with concurrent small group interdisciplinary education delivered via video conferencing, extending into the postnatal period. MethodsUsing a quasi-experimental design with an interrupted time series and a control group, this population-based study recruited low-risk women booking for maternity care at one community health site affiliated with a large public hospital in Victoria, Australia. FindingsWhilst there was no difference in stress and anxiety scores, a significant interactive effect of the hybrid model of care with time was seen in the DASS depression score (−1.17, 95% CI: −1.81, −0.53) and the EPDS (−0.83, 95% CI: −1.5, −0.15). DiscussionThe analyses provide important exploratory findings regarding the positive effects of a hybrid model of care with interdisciplinary education in supporting mental health of first-time mothers. ConclusionThis study demonstrates that small group online education scheduled in conjunction with individual pregnancy health assessments can be executed within a busy antenatal clinic with promising results and modest but dedicated staff support.

Establishing haematological and biochemical reference intervals for free-ranging Scottish golden eagle nestlings (Aquila chrysaetos)

Health assessment of individuals is an important aspect of monitoring endangered wildlife populations. Haematological and biochemical values are a common health assessment tool, and whilst reference values are well established for domestic species, they are often not available for wild animal species. This study established 31 haematological and biochemical reference intervals for golden eagle (Aquila chrysaetos) nestlings in Scotland, in order to improve the understanding of the species’ health and support conservation efforts. Reference intervals were created from 47 nestlings (ages 2–7.5 weeks old) across 37 nests, to date, the largest sample of wild individuals of this species and age cohort sampled for these purposes. Upper reference intervals for concentrations of lymphocytes, total protein, cholesterol, triglycerides, uric acid, and monocytes, calculated in this study, are higher than those found for adult raptors and the interval span is higher than that observed in adult raptors for concentrations of AST, albumin, eosinophil, LDH, and monocyte count. Statistically significant positive correlations were found with age and concentrations of haemoglobin, lymphocytes, serum pH, and creatine kinase, and significant negative correlations with age for concentrations of thrombocytes, heterophils, total protein, globulin, and lactate dehydrogenase. Packed cell volume was significantly higher for females than males, and concentration of calcium and eosinophils were higher for individuals in good body condition than those in moderate body condition. The reference intervals produced by this study will be of important use to the veterinary and conservation management communities and will aid the long-term monitoring of the Scottish golden eagle population health.

Patient-Wise Methodology to Assess Glycemic Health Status: Applications to Quantify the Efficacy and Physiological Targets of Polyphenols on Glycemic Control.

A growing body of evidence indicates that dietary polyphenols could be used as an early intervention to treat glucose-insulin (G-I) dysregulation. However, studies report heterogeneous information, and the targets of the intervention remain largely elusive. In this work, we provide a general methodology to quantify the effects of any given polyphenol-rich food or formulae over glycemic regulation in a patient-wise manner using an Oral Glucose Tolerance Test (OGTT). We use a mathematical model to represent individual OGTT curves as the coordinated action of subsystems, each one described by a parameter with physiological interpretation. Using the parameter values calculated for a cohort of 1198 individuals, we propose a statistical model to calculate the risk of dysglycemia and the coordination among subsystems for each subject, thus providing a continuous and individual health assessment. This method allows identifying individuals at high risk of dysglycemia—which would have been missed with traditional binary diagnostic methods—enabling early nutritional intervention with a polyphenol-supplemented diet where it is most effective and desirable. Besides, the proposed methodology assesses the effectiveness of interventions over time when applied to the OGTT curves of a treated individual. We illustrate the use of this method in a case study to assess the dose-dependent effects of Delphinol® on reducing dysglycemia risk and improving the coordination between subsystems. Finally, this strategy enables, on the one hand, the use of low-cost, non-invasive methods in population-scale nutritional studies. On the other hand, it will help practitioners assess the effectiveness of an intervention based on individual vulnerabilities and adapt the treatment to manage dysglycemia and avoid its progression into disease.

Case studies on longitudinal mercury content in humpback whale (Megaptera novaeangliae) baleen

Quantification of contaminant concentrations in baleen whales is important for individual and population level health assessments but is difficult due to large migrations and infrequent resighings. The use of baleen allows for a multiyear retrospective analysis of contaminant concentrations without having to collect repeated samples from the same individual. Here we provide case studies of mercury analysis using cold vapor atomic absorption spectroscopy in three individual humpback whales (Megaptera novaeangliae), a 44.5-year-old female and two males aged ≥35 and 66 years, over approximately three years of baleen growth. Mercury concentrations in the female's baleen were consistently 2–3 times higher than in either male. Age did not affect mercury concentrations in baleen; the younger male had comparable levels to the older male. In the female, mercury concentrations in the baleen did not change markedly during pregnancy but mercury did spike during the first half of lactation. Stable isotope profiles suggest that diet likely drove the female's high mercury concentrations. In conclusion, variations in baleen mercury content can be highly individualistic. Future studies should compare sexes as well as different populations and species to determine how the concentrations of mercury and other contaminants vary by life history parameters and geography.

FAKTOR-FAKTOR YANG MEMPENGARUHI PENGGUNAAN LAYANAN TELEMEDICINE PADA MASA PANDEMI COVID-19 DI PULAU JAWA

The spread of COVID-19 in Indonesia has prompted the government to urge health agencies to develop telemedicine and direct people to minimize activities outside the home, including visiting health services. In its implementation, the use of telemedicine has increased rapidly even though it is still in the development stage and there is no specific regulation. Java Island as a region with a high number of COVID-19 cases has the potential to utilize telemedicine. The purpose of this study was to analyze the factors that influence the use of telemedicine during the COVID-19 pandemic on the island of Java. This research is a quantitative study with a cross-sectional approach. Respondents of the study were 269 people using the incidental sampling method. The results of this study indicate factors related to the use of telemedicine services during the Covid-19 period in Java, namely knowledge (p = 0.000), attitude (p = 0.000), trust (p = 0.000), accessibility (p = 0.000), role environment (p = 0.000), individual health assessment (p = 0.000), and perceived benefits (p = 0.006). Meanwhile, the unrelated factor was the perception of obstacles (p = 0.090). It is recommended that the government formulate telemedicine regulations related to patient protection guarantees, medical record safety, information and communication technology standards, and quality assurance. The health office conducts telemedicine education to the public and supervises telemedicine providers to ensure that services remain integrated with the health facilities.

Development of clinical practice guidelines for allied health and nursing assessment and management of Duchenne muscular dystrophy

Purpose To provide evidence-based guidance specific to allied health and nursing practice for the assessment and management of individuals with Duchenne muscular dystrophy (DMD). Materials and methods Thirteen key focus areas were identified in consultation with health professionals and consumer advocacy groups. A series of systematic literature reviews were conducted to identify assessment and management strategies for each key focus area. A consensus process using modified Delphi methodology, including an Australia-New Zealand expert consensus meeting, was conducted. Recommendations underwent consultative review with key groups before being finalised and prepared for dissemination. Results This clinical practice guideline (CPG) generated 19 evidence-based recommendations, 117 consensus-based recommendations and five research recommendations across the 13 focus areas to inform allied health assessment and management of individuals with DMD. Conclusions The resulting recommendations can be used in conjunction with existing medical CPGs to improve, standardise and advocate for allied health and rehabilitation care in DMD. The process used here may be useful for the development of CPGs in other rare diseases. Implications for rehabilitation Implementation-ready evidence-based statements to guide clinical care of individuals with DMD are provided with the potential to improve participation, function in the community and quality of life. A model for developing best practice statements for other rare neurological diseases is described. Allied health and nursing health professionals should focus research efforts to generate quality evidence to support rehabilitation practice.

Ensuring that biomedical AI benefits diverse populations.

Artificial Intelligence (AI) can potentially impact many aspects of human health, from basic research discovery to individual health assessment. It is critical that these advances in technology broadly benefit diverse populations from around the world. This can be challenging because AI algorithms are often developed on non-representative samples and evaluated based on narrow metrics. Here we outline key challenges to biomedical AI in outcome design, data collection and technology evaluation, and use examples from precision health to illustrate how bias and health disparity may arise in each stage. We then suggest both short term approaches—more diverse data collection and AI monitoring—and longer term structural changes in funding, publications, and education to address these challenges.

CLINICAL PATHOLOGY OF CAPTIVE ENDANGERED MAHOGANY GLIDERS (PETAURUS GRACILIS) IN RESPONSE TO ENVIRONMENTAL CHANGE.

The impetus of this study was the imperative to establish blood biomarker values for clinically healthy mahogany gliders (Petaurus gracilis) in order to monitor the health status of eight captive individuals during their movement to a new facility. The study established ranges for 18 hematologic and 21 biochemical blood biomarkers for healthy individuals in a captive environment. The reported values are consistent with those published for other Australian glider and possum species. No statistically significant differences were found between the sexes, but significant age effects were observed. Specifically, subadult animals reported significantly higher total white cell counts, lymphocyte counts, alkaline phosphatase, creatine kinase, and glucose and chloride levels, compared to adult animals. Although there were no clinically significant changes in blood biomarkers associated with the relocation, many of the hematologic and biochemical biomarkers demonstrated the expected changes associated with the physiological stress of relocation. Specifically, triglycerides, glucose, globulins, creatinine kinase, aspartate transferase (AST), total protein, urea, phosphorous, potassium, sodium, chloride, neutrophils, and hematocrit showed changes with the large environmental change. The majority of the blood biomarkers returned to baseline levels 5 wk postrelocation, with all but one aged animal showing no signs of chronic health derangements following the relocation. The abnormal blood biomarker profiles of two geriatric individuals, one male diagnosed with pericloacal and adrenal gland tumors at the beginning of the study, and one female diagnosed with chronic urinary tract infections and suspected bone marrow disease following the relocation, are presented. The findings of this study inform the health monitoring of native gliders in captivity, rehabilitation, and clinical research scenarios. These findings also provide useful baseline data to aid in the health assessment of captive-bred individuals during their reintroduction into free-living populations.

Comparison of milk replacer composition and effects on growth and health of preruminant lambs, and health-associated costs of artificial rearing

This research evaluated the effects of 2 milk replacer (MR) formulations on lamb performance, morbidity, mortality, and antibiotic usage and health-associated costs of artificial lamb rearing. East-Friesian male lambs (n = 206; BW = 4.9 ± 0.24 kg; 2–5 d of age) were stratified by BW and age and randomly allocated to 1 of 8 pens per treatment (10–15 lambs/pen). Lambs were artificially reared on 1 of 2 commercially available MR formulations [MR1 (100% milk protein): 25.3% protein, 26.5% milk fat, 34.9% lactose; MR2 (milk protein + hydrolyzed wheat protein): 23% protein, 24.3% vegetable oil, 30.4% lactose]. The MR was offered ad libitum via automatic feeders, mixed on-demand at 230 g/L of MR at 37°C. Lambs had free access to grass hay throughout the study. Lamb BW was recorded on entry and weekly thereafter to determine ADG and the time taken to reach a minimum of 13.5 kg of BW. Individual animal health assessments were undertaken daily for the first 4 d and weekly thereafter, and any animal health issues were recorded. All animal health interventions including antibiotic use, mortality, and labor requirements for animal health and hygiene management were recorded. Lamb mortality was similar between MR1 and MR2 lambs (8 vs. 10%, P = 0.79). Overall, ADG was greater for MR1 than MR2 (mean ± SE: 296 ± 17.6 vs. 242 ± 17.7 g/d, P = 0.02). For lambs not treated with antibiotics, ADG was greater in MR1 versus MR2 lambs (331 ± 12.3 vs. 305 ± 13.5 g/d, P = 0.03) resulting in fewer days to reach a minimum of 13.5 kg of BW (target for weaning: 30 ± 1.3 vs. 33 ± 1.4 d, P = 0.03). Thus, the percentage of lambs that reached 13.5 kg without antibiotic treatment was greater in MR1 than in MR2 lambs (73 ± 4.4 vs. 48 ± 4.9%, P < 0.001). Overall, 4 times more lambs failed to reach 13.5 kg by the end of the study in MR2 than in MR1 (16 vs. 4%, P = 0.009) reflecting their 53 g/d lower ADG. A much lower incidence (range from 1.5 to 13 times) of animal health issues and associated antibiotic use was observed with MR1 compared with MR2 lambs. As a result, the costs associated with animal health interventions were greater for MR2 than for MR1 ($NZ17.2 vs. $NZ7.32 per head). Milk replacer formulation did not affect mortality rates; however, ADG was greater and morbidity, antibiotic use, and costs of animal health interventions were lower in lambs reared on a MR formulated from 100% milk proteins and fats compared with MR containing a combination of milk protein, hydrolyzed wheat protein, and vegetable oil.

QualFatigue study: which factors influence the use of specific interventions for breast cancer survivors with fatigue? A cross-sectional exploratory study.

International guidelines recommend specific interventions to reduce cancer-related fatigue (CRF). Evidence suggests underutilization of these interventions among breast cancer survivors. The QualFatigue study aimed to explore the potential factors influencing the use of specific interventions, for relief, in patients with CRF through qualitative analyses. Patients with stage I-III breast cancer, and CRF ≥4 on a 10-point numerical scale were recruited within 6-24 months at the end of their primary treatment. Semi-structured interviews were performed. Emergent themes were identified using a stepped content analysis (QDA Miner software). Data saturation was achieved with 15 interviews. Four main themes emerged as potential sources of influence in the participants' use of specific interventions: (1) expectations regarding the management of CRF, (2) representations of the benefits provided by the interventions, (3) individual physical and psychological conditions, and (4) social and environmental situations. Six key levers came out transversally to optimize the use of specific interventions to relieve CRF: (1) listening and recognition of the individual difficulties and needs; (2) individual and global health assessments; (3) information and advice on how to manage CRF; (4) discussion groups focused on the management of CRF; (5) group activities; and (6) professional and personalized guidance. This study calls for multi-level action to address many persistent barriers and exploit levers in the management of CRF.

Skin microbiome of beluga whales: spatial, temporal, and health-related dynamics

BackgroundHost-specific microbiomes play an important role in individual health and ecology; in marine mammals, epidermal microbiomes may be a protective barrier between the host and its aqueous environment. Understanding these epidermal-associated microbial communities, and their ecological- or health-driven variability, is the first step toward developing health indices for rapid assessment of individual or population health. In Cook Inlet, Alaska, an endangered population of beluga whales (Delphinapterus leucas) numbers fewer than 300 animals and continues to decline, despite more than a decade of conservation effort. Characterizing the epidermal microbiome of this species could provide insight into the ecology and health of this endangered population and allow the development of minimally invasive health indicators based on tissue samples.ResultsWe sequenced the hypervariable IV region of bacterial and archaeal SSU rRNA genes from epidermal tissue samples collected from endangered Cook Inlet beluga whales (n = 33) and the nearest neighboring population in Bristol Bay (n = 39) between 2012 and 2018. We examined the sequences using amplicon sequence variant (ASV)-based analyses, and no ASVs were associated with all individuals, indicating a greater degree of epidermal microbiome variability among beluga whales than in previously studied cetacean species and suggesting the absence of a species-specific core microbiome. Epidermal microbiome composition differed significantly between populations and across sampling years. Comparing the microbiomes of Bristol Bay individuals of known health status revealed 11 ASVs associated with potential pathogens that differed in abundance between healthy individuals and those with skin lesions or dermatitis. Molting and non-molting individuals also differed significantly in microbial diversity and the abundance of potential pathogen-associated ASVs, indicating the importance of molting in maintaining skin health.ConclusionsWe provide novel insights into the dynamics of Alaskan beluga whale epidermal microbial communities. A core epidermal microbiome was not identified across all animals. We characterize microbial dynamics related to population, sampling year and health state including level of skin molting. The results of this study provide a basis for future work to understand the role of the skin microbiome in beluga whale health and to develop health indices for management of the endangered Cook Inlet beluga whales, and cetaceans more broadly.