Current Recommendations Research Articles

Nutzung von Machine Learning in der intelligenten Fabrik

Abstract The use of machine learning is associated with great hopes for the realization of a smart factory. This article aims to highlight the Potenzial and obstacles to the use of machine learning in real-life industrial manufacturing scenarios in the European economic area. Technical, organizational and current legal framework conditions are categorized. Finally, the article presents a tool that, based on the current technical regulations and recommendations for action, allows component and system manufacturers to carry out an initial risk assessment of AI applications in their products.

A slope method for the determination of electron energy for quality assurance.

Particle accelerators, manufactured for delivering patient radiation treatment, require numerous and frequent quality assurance measures. One of those is the periodic check for electron energy stability. The American Association of Physicists in Medicine has established requirements for this procedure. The current recommendation is to perform a ratio of two ionization points, one at Dmax and another at a point approximately to the 50% depth, compared to a baseline as a relative check. This ratio method is a sensitive measurement and sometimes produces results that are difficult to interpret or relate to acceptable tolerances. We sought to find a simple method that gives more stable results, which can be interpreted and related to energy changes. We propose a method that takes two measurements on the descending portion of the shifted percent depth ionization (PDI) curves to calculate the slope, tangent to the I50 point, the point at which the ionization falls to 50% of its maximum value. We then used the slope measurement, compared to an established baseline, to relate energy. After collecting data over a 3-year period, we saw that standard deviations for the slope method have much less variability than the traditional ratio method. We were also able to correlate the slope results to ionization scans performed in water and found they were in better agreement than the traditional ratio method. The slope method does not require precise positioning since the slope remains relatively constant over the descending portion of the curve. Our data show that this results in an easier interpretative test of electron energy stability and delivers reliable feedback for quality assurance.

Quantification of neurofilament light and glial fibrillary acidic protein in finger-prick blood

Abstract An accurate diagnosis of neurodegenerative disease and traumatic brain injury is important for prognostication and treatment. Neurofilament light and glial fibrillary acidic protein are leading biomarkers for neurodegeneration and glial activation that are detectable in blood. Yet, current recommendations require rapid centrifugation and ultra-low temperature storage post-venepuncture. Here, we investigated if these markers can be accurately measured in finger-prick blood using dried plasma spot cards. Fifty patients (46 with dementia; 4 with traumatic brain injury) and 19 healthy volunteers underwent finger-prick and venous sampling using dried plasma spot cards and aligned plasma sampling. Neurofilament light and glial fibrillary acidic protein were quantified using a Single molecule array assay and correlations between plasma and dried plasma spot cards assessed. Biomarker concentrations in plasma and finger-prick dried plasma spot samples were significantly positively correlated (neurofilament light ρ=0.57; glial fibrillary acidic protein ρ=0.58, P<0.001). Finger-prick neurofilament light and glial fibrillary acidic protein were significantly elevated after acute traumatic brain injury with non-significant group-level increases in dementia (91% having Alzheimer’s disease dementia). In conclusion, we present preliminary evidence that quantifying glial fibrillary acidic protein and neurofilament light using finger-prick blood collection is viable, with samples stored at room temperature using dried plasma spot cards. This has potential to expand and promote equitable testing access, including in settings where trained personnel are unavailable to perform venepuncture.

Total knee and hip replacement in rheumatoid arthritis: A current trend

Total joint replacement (TJR) is a surgical procedure widely used in severe destructive joint damage. TJR of the knee and hip joint (TKR and THR respectively) occupies an important place in the complex treatment of rheumatoid arthritis (RA) and osteoarthritis (OA), and can significantly reduce pain and improve function in patients with severe structural joint damage due to an ineffectiveness of conservative therapy. In recent years, due to the development of the modern concept of active treatment of RA (treat-to-target) and the introduction of new classes of anti-inflammatory drugs, such as biologic disease modifying antirheumatic drugs and JAK inhibitors, the need for TJR in RA has begun to decrease. At the same time, the aging of the population, the increase in the number of patients with OA and the lack of generally approved pathogenetic therapy determine the increase of TKR/THR incidence in this disease. This review presents the long-term dynamics of the incidence of TKR and THR according to the national registers of different countries. The issues of the complication risks in patients with RA and OA, current recommendations for anti-rheumatic therapy in RA in the perioperative period are also considered.

Impact Of Walking And The OTAGO Exercise Program On Improving Balance Parameters In The Elderly

There will likely be a rise in fall rates as the population ages. This will impact our society and put more strain on healthcare systems by increasing the number of unintentional injuries and injury-related deaths. According to Zijlstra et al. (2007), falls have a significant psychological impact on individuals, frequently leading to diminished confidence, decreased functional activity, deconditioning, and an elevated risk of falls. Estimated costs of fall-related damage to older adults owing to demographic changes in Australia (2003) predict that by 2051, fall-related injuries, which currently account for 5% of the country's overall health budget, would triple and cost the Australian health system about $1,375 million annually. Exercise and other modifications in lifestyle can potentially reduce the risk of many physical falls (Gregg et al., 2000; Sherrington et al., 2011). The current recommendations for physical exercise among older persons, which include elements of aerobic, resistance, and balance training, are not met by many of them. According to Chodzko-Zajko et al. (2009), the American College of Sports Medicine (ASCM) advises older persons to engage in aerobic, muscle-strengthening, and flexibility exercises. People who have mobility issues or are at risk of falling should also engage in certain activities designed to enhance their balance. We determined that the study's subjects would be third-age individuals (over 65) who reside in assisted living facilities located in Tirana's district and city due to the issues that this demographic faces. Keywords: falls prevention, ageing, nursing home support services, quality of life, older people, walking, OTAGO exercise program, balance, preventive care.

Consensus recommendations on management of selumetinib-associated adverse events in pediatric patients with neurofibromatosis type 1 and plexiform neurofibromas

Abstract Background Selumetinib is the first approved treatment for pediatric patients with neurofibromatosis type 1 (NF1) and symptomatic, inoperable plexiform neurofibromas (PN) in the EU and US, as well as in multiple other countries. Evidence for the management of selumetinib-associated adverse events (AEs) is mostly limited to clinical trials and expanded-access programs. We gathered a panel of European healthcare practitioners with clinical experience prescribing selumetinib and/or managing pediatric patients with NF1-PN to provide recommendations on the prevention and management of AEs. Methods A modified Delphi approach was used to develop the recommendations among the group of experts. Initial statements were developed from a literature review of current management recommendations and regulatory reports. The panel refined the statements and rated the extent to which they agreed with them in two sessions and a follow-up survey. The panel comprised two pediatric neuro-oncologists, one pediatric oncologist, one pediatrician, one neuropediatrician, one oncologist, one neurologist, two psychologists, and one dermatologist. Results The experts agreed on the relative frequency and impact of AEs potentially associated with selumetinib. Consensus-level agreement was reached for 36 statements regarding the prevention and management of AEs potentially associated with selumetinib. Experts recommended treatments for AEs based on their experience. Conclusion The development of a variety of consensus statements indicates expert agreement on best practices for the prevention and management of AEs potentially associated with selumetinib in pediatric patients with NF1-PN. These events are generally manageable and should be considered alongside treatment benefit. Information sharing is warranted as further experience is gained.

Trastuzumab-Induced Cardiotoxicity: When and How Much Should We Worry?

This review critically analyzes the incidence of trastuzumab-induced left ventricular systolic dysfunction and congestive heart failure (CHF), distinguishing between cases with and without prior anthracycline exposure. It highlights the fact that the elevated risk of trastuzumab-induced cardiotoxicity is closely associated with prior anthracycline exposure. In the absence of prior anthracycline exposure, the incidence rates of trastuzumab-induced cardiotoxicity, particularly CHF (ranging from 0% to 0.5%), are largely comparable with those reported in the general population, especially when reversibility is taken into account. Current cardiac surveillance recommendations during trastuzumab treatment have not yet adapted to the increasing adoption of nonanthracycline treatment strategies and the associated low risk of cardiotoxicity. We propose a refined monitoring protocol to reduce the frequency of cardiac evaluations for low-risk to moderate-risk patients, especially those receiving nonanthracycline treatments. By focusing on patients at high risk or those with prior anthracycline exposure, this strategy seeks to optimize the cost-effectiveness of cardiac care in oncology.

Malignant melanoma in the hand: current evidence and recommendations.

Malignant melanoma is the leading cause of death from skin cancer. In spite of significant advances in the management of melanoma with the advent of sentinel lymph node biopsy (SLNB) and adjuvant oncological therapies, the death rate continues to increase worldwide. Melanoma in the hand poses additional diagnostic and management challenges. Consequently, these tend to present at a later stage and are associated with a poorer prognosis. It is imperative that hand surgeons treat any pigmented hand lesion with suspicion to ensure rapid diagnosis and treatment. This article outlines the presentation of melanoma, and how to investigate suspicious pigmented lesions of the hand and digits. It guides hand surgeons in their approach to melanoma of the hand, outlining the multidisciplinary team approach as well as current standard surgical and reconstructive options to optimize outcomes.

User experience with ultrawide curved displays: A mixed methods analysis

Due to the trend of replacing dual displays with ultrawide (UW) curved displays, we used a mixed methods analysis to investigate the user experience with UW curved displays. We conducted an experimental laboratory study that quantified user self-selected positions for three displays – 24 in. flat panel, and 34 in. and 40 in. UW curved displays. Participants were first provided with a familiarization protocol, and they then positioned the display. The self-selected UW display viewing distances were within current recommendations; however, viewing distance increased with display size, potentially challenging small work surface depths and may have been in response to feeling “overwhelmed” by larger displays. Head twist range of motion increased with display width. While all displays were within recommendations, participants commented that less head twisting was a factor in choosing the 34 in. over the 40 in. display. Practitioners should assess potential workstation limitations and the potential impact on neck twist angles when installing ultrawide displays.

Iron supplementation in patients with chronic inflammatory bowel disease: recommendations for a practical approach

Iron deficiency is the predominant cause of anemia. Iron deficiency anemia plays a major role, especially in patients with inflammatory bowel disease (IBD), and is the most common extraintestinal manifestation and IBD-associated systemic complication. The presence of anemia leads to a reduction in quality of life in patients with IBD associated with limitations in physical, emotional, and cognitive function. In addition, it is associated with an increased hospitalization rate. For this reason, iron supplementation is of particular importance. Oral and intravenous iron supplements are used to treat iron deficiency. Due to the lack of absorption and gastrointestinal side effects of oral substitution, intravenous supplementation is becoming increasingly important. However, there are still certain concerns about intravenous administration.With the help of this review, we want to address the topic of iron substitution in patients with IBD, summarize current guideline recommendations, and provide a practical approach.

Contributions of Synthetic Chemicals to Autoimmune Disease Development and Occurrence.

Exposure to many synthetic chemicals has been linked to a variety of adverse human health effects, including autoimmune diseases. In this scoping review, we summarize recent evidence detailing the effects of synthetic environmental chemicals on autoimmune diseases and highlight current research gaps and recommendations for future studies. We identified 68 recent publications related to environmental chemical exposures and autoimmune diseases. Most studies evaluated exposure to persistent environmental chemicals and autoimmune conditions including rheumatoid arthritis (RA), systemic lupus (SLE), systemic sclerosis (SSc), and ulcerative colitis (UC) and Crohn's disease. Results of recent original research studies were mixed, and available data for some exposure-outcome associations were particularly limited. PFAS and autoimmune inflammatory bowel diseases (UC and CD) and pesticides and RA appeared to be the most frequently studied exposure-outcome associations among recent publications, despite a historical research focus on solvents. Recent studies have provided additional evidence for the associations of exposure to synthetic chemicals with certain autoimmune conditions. However, impacts on other autoimmune outcomes, particularly less prevalent conditions, remain unclear. Owing to the ubiquitous nature of many of these exposures and their potential impacts on autoimmune risk, additional studies are needed to better evaluate these relationships, particularly for understudied autoimmune conditions. Future research should include larger longitudinal studies and studies among more diverse populations to elucidate the temporal relationships between exposure-outcome pairs and to identify potential population subgroups that may be more adversely impacted by immune modulation caused by exposure to these chemicals.

Traumatic Ulnar Carpal Translocation, Distal Radioulnar Joint Subluxation with Occult Perilunate Injury

Abstract Background Perilunate injuries pose a significant treatment challenge, particularly when initially missed or underestimated. These injuries have a multitude of variations as propagation of the injury may be through ligaments and/or bone, with more recent appreciation given to nondislocated perilunate injuries. Case Description We present a new variant of perilunate injuries, not dislocated (PLIND). This occult ligamentous perilunate injury was associated with ulnar carpal translocation, radiocarpal subluxation, and distal radioulnar subluxation. The extent of injury was fully appreciated intraoperatively, with only subtle clues present on preoperative exam and imaging, emphasizing the high index of suspicion required to identify these injuries. Clinical outcome at 1-year follow-up was very satisfactory. Literature Review PLIND consist a distinct subset within the spectrum of perilunate injuries in which there is no observed disruption of the capitolunate relationship. Based on few cases reported in the literature (attributable to their rare occurrence and likely additional lack of awareness surrounding the injury pattern), current recommendations for surgical management include arthroscopic or open approach to appropriately address osseous and ligamentous injuries. Clinical Relevance Recognition of PLIND injuries is challenging given the lack of frank dislocation of the capitate head on the lunate, as observed in classic perilunate injuries. Heightened clinical suspicion in patients with consistent mechanism and presentation, followed by timely surgical management, may limit sequelae of persistent instability and arthritis. Our case contributed to relevant literature by presenting a previously undescribed PLIND variant combined with radiocarpal instability, ulnar carpal translocation, and distal radioulnar subluxation.

Emergency Department Management of Precipitated Opioid Withdrawal after Intravenous Buprenorphine/Naloxone Use: A Case Report

The opioid epidemic in the United States continues to grow at staggering rates. More than 760,000 people have died of drug overdose since 1999, with the annual death toll increasing exponentially. In response, the use of medication assisted treatment (MAT) for opioid use disorder has grown considerably. Abuse of MAT is common, with studies showing rates as high as 28% of patients on MAT abusing the medications. There are case reports detailing precipitated withdrawal following intravenous buprenorphine/naloxone (Suboxone) misuse, but little literature exists regarding management of these cases. The current recommendation per other case reports is to treat with additional doses of Suboxone. We present the case of a 44-year-old male presenting to the emergency department in precipitated withdrawal after injecting Suboxone intravenously. In this case, the patient had eloped from inpatient rehabilitation about 36 hours after his last dose of Fentanyl. He then injected Suboxone to combat symptoms of opioid withdrawal. He felt markedly worse following the injection, prompting him to seek treatment. On arrival he was visibly uncomfortable and irritable during the exam. He was treated with additional Suboxone at the suggestion of other case reports, but this significantly worsened his symptoms. He was additionally treated with diazepam, resulting in improvement. He was discharged with resources for opioid use disorder and was successfully contacted six months after his initial presentation, at which time he reported continued opioid use as well as suboxone misuse.

The Teaching of Introductory Statistics: Results of a National Survey

The Statistics Teaching Inventory (STI) was designed to assess the teaching practices of U.S.-based, college-level introductory statistics instructors in a variety of institutions and departments. This instrument has now been updated to reflect current trends and recommendations in statistics education. In this study, we used the STI to examine the current state of the curricular and instructional practices being used by U.S.-based, college-level introductory statistics instructors. We explore the extent to which instructors report that their introductory statistics courses are aligned with recommended practices as outlined by the 2016 GAISE College Report. Data were collected from a sample of college-level U.S.-based, college-level introductory statistics instructors. Results based on 228 usable responses indicated that instructors, by-and-large, tended to be following the GAISE recommendations, especially related to content. However, courses may not yet be aligned with newer content recommendations (e.g., provide students opportunities to work with multivariate data), and there is still a large percentage of instructors that are not embracing student-oriented pedagogies and assessment methods. Supplementary materials for this article are available online.

Modeling multi-behavior sequence via HyperGRU contrastive network for micro-video recommendation

Micro-video prediction with the multi-behavior sequence remains a challenging task for current recommendation systems. Existing approaches tend to model each individual behavior sequence separately to obtain multi-level user preferences. However, they neglected the semantic correlations among different types of behaviors, that is, the ordinal rankings of user satisfaction conveyed through multi-type actions. Additionally, they failed to capture the temporal dependencies among a user’s historical multi-behavioral sequence, especially the dependencies between positive and negative behaviors. To address this issue, we propose a novel HyperGRU contrastive network to model the multi-behavior sequence for micro-video recommendation. We first propose a concept of hypernode to capture semantic dependencies among multiple behaviors. Based on the hypernode, we then design a novel HyperGRU network to extract positive and negative interests from users’ temporal multi-behavior sequence. Beyond that, we train the HyperGRU under the guidance of a contrastive learning framework to make the positive and negative interests discriminating. Technically, we assign labels for the positive and negative interests by modeling the “skip” and “click” sub-sequences separately. Subsequently, contrastive tasks are conducted to encourage the interest representations to be closer to their associated labels than the opposite labels. Finally, the system makes predictions with the input of the disentangled preferences. The experiments conducted on three public real-world datasets demonstrate the effectiveness of our model.

Medical rehabilitation in dermatology : Goals, program content, and application process

Medical rehabilitation plays an important role in the management of patients with chronic dermatoses and dermato-oncological diseases. Which dermatological indications qualify for amedical rehabilitation? What forms need to be completed for asuccessful application? Which treatments are provided and what are goals to be accomplished during dermatological rehabilitation? Evaluation of current guidelines, directives, and recommendations as well as exemplary reviews. Dermato-oncological diseases and every chronic dermatological disease that is associated with alimitation of body functions and structures, activity and participation is eligible for medical rehabilitation. They include need, ability to absolve arehabilitation, and afavorable prognosis. Treatments range from therapy of the underlying dermatological condition to interdisciplinary treatment of comorbidities with the aim of restoring functional health. Medical rehabilitation follows aholistic approach and represents asignificant addition to outpatient and acute inpatient care, often leading to along-term improvement in clinical outcome, participation, and activity.

A review of the topical management of acne and its associated sequelae in the Asia-Pacific region with a spotlight on trifarotene.

Acne, a highly prevalent skin disease, can be particularly bothersome for patients of Asian background because of its impact on self-confidence and social interactions. In addition to active acne lesions, some patients may develop sequelae such as scarring, macular/postinflammatory hyperpigmentation, or erythema. The tendency of Asian skin to develop sequelae because of its increased susceptibility to irritation, cultural preferences for lighter skin phototypes, and differences in skincare regimens may all contribute to the increased burden of acne. Moreover, many Asia-Pacific countries do not have their own guidelines for acne management, and those that do often have no schedule in place for regular updates. In this article, we provide a critical review of the published guidance for the management of acne and its sequelae in the Asia-Pacific region, identifying gaps in current recommendations that could be addressed to enhance standards of acne care in Asia-Pacific countries. Along with highlighting the importance of a comprehensive skincare regimen to increase treatment efficacy and adherence, we discuss topical retinoids and retinoid combination options in the acne armamentarium that may be beneficial for sequelae prevention and management, such as adapalene 0.3% ± benzoyl peroxide 2.5%, tretinoin 0.05%, tazarotene 0.1%, and trifarotene 0.005%. In particular, trifarotene 0.005% has been observed to significantly reduce acne scar counts in a Phase 4 study. The recent data highlight the need to establish up-to-date guidance for acne and acne sequelae management in Asia-Pacific countries to provide optimal care to Asian patients.

Midwives as influencers in skin care for newborns at risk of atopic diseases : Survey of midwives' current recommendations

The prevalence of atopic diseases remains high. Initial studies suggest that primary prevention with regular basic care may influence the incidence of atopic dermatitis in infants; however, data are unclear. Midwives play an important role in the care of women in the peripartum period and therefore also in providing advice on topics such as skin care, breastfeeding and nutrition of the newborn and young infant. The aim of this study was to determine the care recommendations for newborns by midwives. We conducted across-sectional survey among German midwives using questionnaires on the topic of newborn skin care. A total of 128 questionnaires were analyzed. The most common recommendations were oil-based herbal topicals (34.9%) and plain water (34.0%). Approximately 70% of midwives reported recommending various options when there was aknown family history of atopic diathesis. It was remarkable that most of the midwives' recommendations were identical regardless of the presence of an atopic diathesis. Essential care products are only used "when necessary". Training programs for midwives on the topic of "care and strengthening of the skin barrier", taking into account the current guidelines for allergy prevention, should be implemented.

Current Status and Potential Recommendations of Childhood Obesity in China

Childhood obesity has become a thorny issue that has aroused mounting concern worldwide. Especially in China, the prevalence of overweight and obesity among Chinese children has risen rapidly in recent decades, which face serious challenges. Despite lacking the research focused on the economic burden of childhood obesity in China, it can be inferred that childhood obesity and possible health risks in adulthood will impose tremendous economic burden. In China, there were many effective interventions that can help address childhood obesity, including suitable preventions, drugs and surgeries. Besides, the government also provided support for the increasing childhood obesity problem by introducing related policies. However, theres still room for improvement about the childhood obesity in China. This article aims to clarify the current situation of childhood obesity in China and further provide some reference suggestions from the perspectives of the government, pharmaceutical companies and children. In order to reduce the disease burden of childhood obesity to some extent, this article aims to put forward suggestions that are suitable for Chinese children and adolescents according to the actual situations of China.

Study protocol - assessing parkrun for walking rehabilitation for people living with, and beyond, cancer: acceptability, adherence, social support and physical function

IntroductionDue to a variety of barriers, the majority of cancer survivors do not do enough physical activity to meet current recommendations. This study will assess the feasibility of participation in parkrun walk-run events as a novel mode of community rehabilitation exercise.MethodsThis protocol describes a single-arm intervention study with participants acting as their own controls. The study accepts adults diagnosed with any type of cancer, undergoing treatment or in remission. Participants must be able to walk and have medical clearance to exercise. A sample of 100 participants will be recruited across the Sunshine Coast over two years. Data will be collected over 9-months at 4 time points: Baseline (T1); after 4-weeks of usual daily activities and cancer management prior to parkrun participation(T2); after a 6-month parkrun intervention (T3); at 2-month follow-up (T4). The primary objectives are to assess the acceptability of, and adherence to, parkrun as rehabilitation exercise. Secondary outcomes include wellness, health-related quality of life, anxiety, depression, mood, physical function, parkrun metrics, dietary intake, and diet and exercise behaviour.ConclusionThis study will be the first to examine the long-term effects of parkrun as a cancer rehabilitation modality with regard to physical function, psychosocial outcomes and dietary intake.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12623000473662 registered 09/05/2023.Approved by UniSC Human Research Ethics Committee (A221828) and the UK parkrun Research Board. Original protocol. Authors SB, RB, HHW, MM, YK.