Short Episodes Research Articles

Management of Nausea and Vomiting in Palliative Care - Real Life Data From a Palliative Care Unit in Germany.

Nausea and vomiting significantly impact the quality of life in palliative care. Due to various underlying causes, treatment approaches vary. However, scientific evidence on pharmacotherapeutic management is limited, complicating treatment decisions. Objective is to assess the current antiemetic treatment approach in palliative care in Germany. A retrospective observational study (15months) was conducted, evaluating clinical records of adult patients admitted to palliative care in a German hospital. Symptom burden (Integrated Palliative care Outcome Scale (IPOS®)), suspected aetiology, antiemetics, treatment quality and drug-related problems (DRPs) were evaluated. We included 330 patients (median age 71years, 50.9% female), of which 172 (52%) experienced nausea/vomiting in 230 treatment episodes. Symptoms were more prevalent in cancer-patients (P = 0.002) and women (P = 0.002). Main aetiologies were intestinal obstruction (59/230, 25.7%), hypomotility (31/230, 16.1%), and raised intracranial pressure (23/230, 10.0%). Nearly 70% experienced a reduction of symptom burden within the first 3 days, with faster symptom relief and shorter episodes in cancer patients compared to non-cancer patients (median length 3d vs 2d). DRPs were documented in 213/230 episodes (92.6%), indicating high interaction potential of antiemetics (87.4%). Manifest DRPs affected patients due to ineffective treatment (29.0%) or side effects (6.5%). One-third experienced inadequate symptom control with the current treatment, underscoring the complexity of managing nausea/vomiting in palliative care and the need for a systematic approach. This study emphasizes the importance of evidence-based guidelines and further research into underutilized antiemetics, along with improved medical education in an interdisciplinary team to enhance treatment quality.

Music Drama as a Christian Parable: Mozart’s Idomeneo

This article discusses Wolfgang Amadeus Mozart’s opera Idomeneo: Re di Creta (1781, to a text by Giambattista Varesco) as a Christian parable in the historical context of its genesis. Mozart’s Idomeneo is based on a short episode in François Fénelon’s Télémaque, but also on Antoine Danchet’s adaptation of this episode for the theater in his tragédie lyrique Idoménée (1712; set to music by André Campra). In important aspects, Mozart’s Idomeneo changed the narrative with a marked independence of Fénelon as well as Danchet. In recent scholarship, important new information has come to light concerning Mozart’s composition of the Oracle scene, constituting the dénouement of the music drama. Based partly on these new insights, I attempt to provide a picture of a basic spiritual intention governing Mozart’s composition of the opera for the Carnival season of 1781 at the Munich court. Mozart’s Idomeneo is a Christian sacrifice drama modeled on the Aqedah (the sacrifice of Isaac; Gen 22: 1–14), which, in Christian traditions, is understood typologically as pointing to the Passion of Christ. Oppositely, Fénélon’s and Danchet’s versions rather correspond to the biblical story of Jephthah (Judges 11: 29–30). In a brief concluding section of this article, I also discuss the contemporary cultural importance of reading a classical opera such as Mozart’s Idomeneo as a conscious product of Enlightened Christianity. In modern times, ecclesiastical boundaries and religious doctrines often seem to matter little in the music and theater culture of the Western world; classical opera is often staged more in order to respond to contemporary political or social issues than to communicate the original intentions of its creators (the so-called Regieoper). I argue that Idomeneo, with its historical intention, potentially can have an impact in a cultural theology (or a theologically informed modern worldview), and further, in dialogue with a recent volume discussing the “music of theology”, that such a role for a piece of music must be developed in concrete musical (or music dramatic) contexts, not as a general philosophical contention. Mozart’s Idomeneo may work in a modern cultural context because it functions as a parable, easily understandable also in a modern political or social context, because of its deep human (psychological) insight and the empathy brought to bear on all the characters of the opera.

Associations Between Active Commuting and Sickness Absence in Finnish Public Sector Cohort of 28 485 Employees.

Active commuting can be beneficial for health. We examined whether active commuting by walking or cycling was associated with a lower risk of sickness absence in a Finnish public sector cohort of 28 485 employees. We used negative binomial regression to test associations of weekly active commuting in kilometers (no, low, moderate, and high dose) with all-cause sickness absence. Sickness absence data from employers registers comprised the number of (1) sickness absence days, (2) short (1-9 days) and (3) long (≥ 10 days) sickness absence episodes during 12- and 24-month follow-ups. The models were adjusted for sociodemographic factors, lifestyle risk factors, and previous sickness absence. To demonstrate absolute risk, we calculated sex- and age-adjusted incidence for sickness absence per 100 person years for each active commuting exposure group. The associations of cycling and walking were additionally studied in separate analyses. Compared to passive commuters (no active commuting), high dose of active commuting (mean of 61 km/week) was associated with an 8%-12% lower relative risk of sickness absence days and an 18% lower relative risk of long episodes. The absolute rate of sickness absence per 100 person-years was up to 452 days and 10 long episodes lower in the high-dose active commuters group. In the further analyses separating cyclists and walkers, similar reduced risks were observed only among high-dose cyclists. Our findings suggest that regular active commuting by bicycle has potential for reducing sickness absence by reducing the risk of long sickness absence episodes.

Sickness absence patterns during the COVID-19 pandemic among Finnish public sector employees

Abstract Background The patterns of sickness absence (SA), that is, the clustering of differing lengths of episodes and total number of days absent, have not been examined. We examined these SA patterns and factors associated with the patterns during the COVID-19 pandemic. Methods We used survey data from employees of four large Finnish cities in 2020 linked with SA data in 2021 retrieved from employer registers (n = 39 791). SA patterns were defined through cluster analysis (K-means) including number of SA days, short (1-9 days), and long (10-365 days) SA episodes within one year. The associations of employee and work characteristics in 2020 with SA clusters in 2021 were analysed with multinomial regression. Results Four SA patterns (=clusters) were identified: 1) Optimal SA pattern (n = 31 320, 79%), 2) Recurring short SA episodes (n = 5149, 13%), 3) Recurring long SA episodes (n = 2964, 7%), and 4) Very high levels of SA with long episodes (n = 358, 1%). Compared to optimal SA pattern, female gender, higher body mass index, former smoking, abstinence from alcohol, not being in high occupational socioeconomic position, on-site work during COVID-19, and COVID-19 infection were associated with all suboptimal SA patterns. Recurring short SA episodes were more likely in younger employees (odds ratio=0.98, 95% confidence interval 0.97-0.98), those with a temporary job (1.10, 1.00-1.20), current smokers (1.34, 1.21-1.48), those using passive commute modes (1.03, 1.01-1.05 [car]; 1.02, 1.00-1.04 [public transport]), and those who had experienced a team reorganization due to COVID-19 (1.27, 1.10-1.46). The two most adverse SA patterns were more likely among older employees, and less likely among those cycling to work (0.91, 0.84-0.98; 0.97, 0.95-0.99). Conclusions We identified three differential suboptimal SA patterns. Compared to the optimal SA pattern, several individual-level risk factors, but also some COVID-19 related factors were found to associate with suboptimal SA patterns. Key messages • We identified three suboptimal sickness absence patterns during COVID-19 pandemic. • Individual characteristics, but also COVID-19 related factors were associated with the observed sickness absence patterns.

Atrial fibrillation detection on implantable loop recorders in embolic stroke of undetermined source

Abstract Introduction Embolic stroke of undetermined source (ESUS) represents 17% of all ischaemic strokes, and has a 5% annual stroke recurrence risk. Recent large randomised control trials failed to demonstrate a benefit of empirical anticoagulation for all ESUS patients, with sub-analyses supporting the need for a tailored approach to those patients at greatest risk of atrial fibrillation (AF) development. Understanding how the increased incidence of ILR-detected AF in the ESUS cohort, compares with ILR-detected AF in other cohorts is an essential step in understanding the significance of this finding. Purpose To compare the incidence of ILR-detected AF following ESUS against patients undergoing ILR implantation for non-stroke indications for example syncope and palpitations. Methods We retrospectively studied all patients without known AF who were referred to our institution for ILR implantation following ESUS, syncope or palpitations from 2009 to 2019. The primary endpoint was any detection of AF or atrial flutter (AFL) by ILR. Kaplan-Meier and multivariable Cox-regression analyses were utilised to account for time-to-event. Results A total of 750 patients were included and followed up for a mean of 731 days (SD 443). An ILR was implanted following ESUS in 323 patients and for another reason in 427 patients (figure 1). The incidence of AF was significantly higher among patients with ESUS compared to the non-ESUS group; 48.6% versus 13.8% (for any duration of AF) and 32.2% versus 12.4% (for AF lasting > 30 seconds) both p <0.001. Kaplan-Meier analysis (figure 2), showed significantly higher incidence of AF for ESUS for any duration of AF. This was driven predominantly by AF duration <6 minutes and between 5.5 hours and 24 hours. Importantly, in a multivariable Cox regression analysis, ESUS independently conferred an almost 5-fold increase in the hazard for any duration of AF (Hazard Ratio 4.948, 95% confidence interval 3.587 – 6.825, p<0.001). Conclusion The incidence of AF is significantly higher amongst ESUS versus non-ESUS patients monitored constantly by an ILR. A high number of ESUS survivors have short duration AF episodes. Further work is needed to determine the optimal treatment strategy of these AF episodes in ESUS considering AF duration and overall burden.

Atypical Presentation of Multiple Myeloma: From Heart Failure to Multiple Myeloma

Multiple myeloma (MM) is a hematological malignancy commonly associated with bone pain, hypercalcemia, and renal failure. However, its presentation can occasionally mimic other medical conditions, which may delay diagnosis. This case report describes a patient who was initially diagnosed and treated for heart failure but was later found to have MM, highlighting the importance of considering MM in the differential diagnosis of heart failure. A 56-year-old lady presented with recurrent episodes of shortness of breath, orthopnea, paroxysmal nocturnal dypsnea and bilateral lower limb swelling which she had been treated for decompensated heart failure with optimal therapy. She denied any family history of cardiovascular disease personal history of underlying medical condition and was a nonsmoker. This patient was diagnosed with multiple myeloma and probability of concomitant cardiac amyloidosis and commenced on bortezomib, thalidomide and dexamethasone (VTD) regime and standard optimal therapy of heart failure but her condition deteriorated. After a few days of starting chemotherapy, patient demised despite all the resuscitative effort. Multiple myeloma is common hematological malignancy with its distinct clinical features of “CRAB”, however, more attention and alertness should also be exercised by clinicians as to be able to diagnose it early.

Calcareous nannoplankton fluctuation within the Albian-Cenomanian Boundary Event of the Tethyan Himalaya

A hemipelagic succession 29m thick, situated in South Tibet within the Tethyan Himalaya tectonic unit, has been investigated for its calcareous nannofossil content. A total of 17 samples were subject to qualitative and semi-quantitative analysis. The studied interval belongs to the upper Albian-lowermost Cenomanian and extends into the UC0 nannofossil zone; based on the last occurrence of Hayesites albiensis, the UC0a and UC0b-c subzones were recognized. The most abundant nannofossil of the Youxia section is Watznaueria barnesiae. Other common taxa are Eiffellithus turriseiffelii, Eprolithus floralis, Rhagodiscus spp., and Zeugrhabdotus spp. In the lowermost part of the studied section, below the beginning of the Albian-Cenomanian Boundary Event (ACBE), i.e., prior to the δ13C positive excursion related to OAE1d, the nannofossils confined to high paleolatitudes, namely Repagulum parvidentatum, Seribiscutum primitivum, and Sollasites horticus, are present with a low abundance. This occurrence is believed to be evidence of a short episode of cooler surface waters linked to a transgressive event. The nannofossil abundance and diversity, along with the fluctuation patterns of the nutrient and temperature indices throughout the section, reflects a primary signal of mesotrophic to eutrophic conditions from the base of the succession up to the two oldest δ13C peaks of ACBE, both late Albian in age and within the OAE1d. By contrast, the dominance of Watznaueria barnesiae, representing more than 80% of the total assemblages, along with the significant drop in abundance and diversity shown by nannofossils within late phases of ACBE, are interpreted as a diagenetic signal. Mesotrophic to eutrophic conditions returned towards the top of the studied succession, where Biscutum constans and Zeugrhabdotus erectus again show a higher abundance.

Cerebral haemodynamics and intracranial pressure during haemorrhagic shock and resuscitation with total endovascular balloon occlusion of the aorta in an animal model.

To assess changes of cerebral haemodynamic and intracranial pressure (ICP) in animals, with or without elevated ICP, during controlled haemorrhagic shock and resuscitation with Total REBOA (tREBOA). In 22 anaesthetized and normoventilated pigs, after placement of catheters for monitoring invasive proximal blood pressure (pMAP), ICP, and vital parameters, and 60min stabilisation phase, a controlled haemorrhagic shock (HS), was conducted. In 11 pigs (EICPG), an elevated ICP of 25-30 mmHg at the end HS was achieved by simulating an epidural mass. In 11 pigs (NICPG), the ICP was normal. tREBOA was then applied for 120min. The changes of pMAP and ICP were followed, and cerebral perfusion pressure (CPP) calculated. The integrity of the autoregulation was estimated using a calculated Modified-Long Pressure Reactivity Index (mL-PRx). After stabilisation, hemodynamics and physiological parameters were similar and normal in both groups. At the end of the HS, ICP was 16 mmHg in NICPG vs. 32 in EICPG (p = 0.0010). CPP was 30 mmHg in NICPG vs. 6 mmHg in EICPG (p = 0.0254). After aorta occlusion CPP increased immediately in both groups reaching after 15min up to104 mmHg in NICPG vs. 126 mmHg in EICPG. Cerebrovascular reactivity seems to be altered during bleeding and occlusion phases in both groups with positive mL-PRx. The alteration was more pronounced in EICPG, but reversible in both groups. tREBOA is lifesaving by restoration the cerebral circulation defined as CPP in animals with HS with normal or elevated ICP. Despite the observation of short episodes of cerebral autoregulation impairment during the occlusion, mainly in EICPG, tREBOA seems to be an effective tool for improving cerebral perfusion in HS that extends the crucial early window sometimes known as the "golden hour" for resuscitation even after a traumatic brain injury.

Biometrically measured sleep in medical students as a predictor of psychological health and academic experiences in the preclinical years

ABSTRACT Background Student wellness is of increasing concern in medical education. Increased rates of burnout, sleep disturbances, and psychological concerns in medical students are well documented. These concerns lead to impacts on current educational goals and may set students on a path for long-term health consequences. Methods Undergraduate medical students were recruited to participate in a novel longitudinal wellness tracking project. This project utilized validated wellness surveys to assess emotional health, sleep health, and burnout at multiple timepoints. Biometric information was collected from participant Fitbit devices that tracked longitudinal sleep patterns. Results Eighty-one students from three cohorts were assessed during the first semester of their M1 preclinical curriculum. Biometric data showed that nearly 30% of the students had frequent short sleep episodes (<6 hours of sleep for at least 30% of recorded days), and nearly 68% of students had at least one episode of three or more consecutive days of short sleep. Students that had consecutive short sleep episodes had higher rates of stress (8.3%) and depression (5.4%) symptoms and decreased academic efficiency (1.72%). Conclusions Biometric data were shown to significantly predict psychological health and academic experiences in medical students. Biometrically assessed sleep is poor in medical students, and consecutive days of short sleep duration are particularly impactful as it relates to other measures of wellness. Longitudinal, biometric data tracking is feasible and can provide students the ability to self-monitor health behaviors and allow for low-intensity health interventions.

Resilience of Juvenile Freshwater Pearl Mussels to ThermalStress.

Climate change poses a significant threat to freshwater ecosystems by causing increases of average water temperatures, and more frequent and extreme heating events. Freshwater mussels are declining globally, and the distribution of the freshwater pearl mussel (Margeritifera margeritifera) has decreased dramatically over the past century. Even though it is likely that climate change is contributing to the decline of the species, little is known about the specific mechanisms involved. Here, we test how short episodes of water temperatures above the known thermotolerance range affect the survival and growth of the early post parasitic juvenile phase of freshwater pearl mussels. We also test if previous experience with elevated water temperatures can modify survival and growth responses to subsequent high-temperatures exposure. Mortality was very low in all treatments (< 5%) and not affected by the temperature treatments, while growth rate was positively affected by temperature. Our results suggest that juvenile mussels can survive short periods of heat stress when other environmental conditions are favourable. Future studies should therefore address how heat stress affects survival in combination with other stressors, such as reduced availability of dissolved oxygen.

Study Protocol for Assessing Serum Superoxide Dismutase Response to a Novel Head Rotation Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo Treatment

Abstract Background: Benign paroxysmal positional vertigo (BPPV) is a condition with sudden onset which causes short episodes of severe vertigo on altering the position of the head. Superoxide dismutases (SODs) are antioxidant proteins that regulate oxidative stress response in the body. Through this study, we evaluate the role of SOD in causing BPPV and effect of a new alternating maneuver, head rotation maneuver, for the treatment of BPPV of the posterior canal in reducing oxidative stress levels. Methodology: For investigating the role of serum SOD in the occurrence of BPPV Posterior canal, 60 BPPV and 60 healthy controls will be recruited. Their serum samples will be collected and SOD levels will be evaluated through colorimetry. For evaluating the effectiveness of head rotation maneuver in reducing the oxidative stress, patients with posterior canal BPPV (PC-BPPV) will be enrolled and divided into two groups through random allocation. Both the groups will be treated with head rotation and Epley maneuvers, respectively, by two separate therapists. Post-therapy SOD level will also be assessed. Results: Two-way repeated measures analysis of variance will be used to compare the groups’ improvement; treatment measures will be referred to as intergroup variables. Binary logistic regression analysis will be used to determine how SOD levels affect BPPV and recurrent BPPV. Pre- and postmaneuver SOD level will also be compared. Conclusion: SOD can be established as a reliable and strong biomarker for the occurrence of BPPV. Moreover, head rotation maneuver which is easy to perform can be used for managing PC-BPPV if the results show promising outcomes.

Anticoagulation in Patients With Device-Detected Atrial Fibrillation With and Without a Prior Stroke or Transient Ischemic Attack: The NOAH-AFNET 6 Trial.

Short and rare episodes of atrial fibrillation (AF) are commonly detected using implanted devices (device-detected AF) in patients with prior stroke or transient ischemic attack (TIA). The effectiveness and safety of oral anticoagulation in patients with prior stroke or TIA and device-detected AF but with no ECG-documented AF is unclear. This prespecified analysis of the NOAH-AFNET 6 (Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial High Rate Episodes) trial with post hoc elements assessed the effect of oral anticoagulation in patients with device-detected AF with and without a prior stroke or TIA in the randomized, double-blind, double-dummy NOAH-AFNET 6 trial. Outcomes were stroke, systemic embolism, and cardiovascular death (primary outcome) and major bleeding and death (safety outcome). A prior stroke or TIA was found in 253 patients with device-detected AF randomized in the NOAH-AFNET 6 (mean age, 78 years; 36.4% women). There was no treatment interaction with prior stroke or TIA for any of the primary and secondary time-to-event outcomes. In patients with a prior stroke or TIA, 14 out of 122 patients experienced a primary outcome event with anticoagulation (5.7% per patient-year). Without anticoagulation, there were 16 out of 131 patients with an event (6.3% per patient-year). The rate of stroke was lower than expected (anticoagulation: 4 out of 122 [1.6% per patient-year]; no anticoagulation: 6 out of 131 [2.3% per patient-year]). Numerically, there were more major bleeding events with anticoagulation in patients with prior stroke or TIA (8 out of 122 patients) than without anticoagulation (2 out of 131 patients). Anticoagulation appears to have ambiguous effects in patients with device-detected AF and a prior stroke or TIA in this hypothesis-generating analysis of the NOAH-AFNET 6 in the absence of ECG-documented AF, partially due to a low rate of stroke without anticoagulation.

Cognitive effects of altitude exposure.

It is a common misconception that cognitive function is impaired in a linear fashion by declining oxygen availability (e.g. at altitude). While this may apply for prolonged exposures to high altitudes (&amp;gt;2500 m), moderate altitude (1500–2500 m) or short intermittent hypoxic episodes can even be beneficial for the brain.

Effect of physiotherapy intervention (chest physiotherapy) on chronic obstructive pulmonary disease (COPD) in a 72-year-old patient: a case report

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive obstruction of the airflow that is often fatal if not appropriately managed. COPD is prevalent among older adults worldwide, and diagnosis is often missed in comprehensive geriatric assessment. According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, the management approach includes pharmacological, non-pharmacological treatment, and surgery in severe cases. This case report determines the effect of physiotherapy intervention (a non-pharmacological approach) on geriatric patients with COPD.Case presentationThis is a case report of a 72-year-old male patient who presented as an outpatient with COPD grade D (GOLD guidelines) with a forced expiratory volume in 1 s (FEV1) value of 52%. The patient had 3 acute episodes of exacerbation but was stabilized. The first episode of shortness of breath was 2 years ago while taking a brisk walk at home. He was immediately rushed to the hospital where he was placed on hospital admission and managed for about 2 weeks and was discharged but to continue physiotherapy on an outpatient basis due to the proximity of his home from the hospital. On physical examination with chronic obstructive pulmonary assessment test (CAT), 6-min walk test (6MWT), and functional assessment with the Barthel Index, the patient was easily fatigued and had challenges in performing basic activities of daily living (BADL). The patient had 72 sessions of physiotherapy interventions for 6 months which consisted of education, purse-lip breathing, active cycle of breathing technique, incentive spirometry exercise, aerobic exercise, and home exercise aimed at improving activity tolerance, encouraging diaphragmatic breathing, enhancing sputum clearance, improving function, and overall quality of life.Improvement was initially gradual and then significant in about the third month of the intervention. Activity tolerance improved with a 6MWT of 2 laps. The patient developed more confidence in performing ADL and leaving his home despite his lung condition as seen in CAT scores.ConclusionsOverall, results from this study showed that COPD is a treatable condition that is amenable to physiotherapy interventions in a multidisciplinary approach.

Outcomes of newly diagnosed atrial fibrillation in patients with acute coronary syndromes.

Acute coronary syndrome (ACS) is frequently accompanied by newly diagnosed atrial fibrillation (AF). We aimed to compare the risk of major adverse cardiovascular events (MACE) in ACS patients presenting with known, newly diagnosed, or no AF. In our multicentre, prospective registry study, we included patients with confirmed ACS. Patients are classified as having known, newly diagnosed or no AF. Newly diagnosed AF is subdivided according to the duration of the episode, time of onset, post-coronary artery bypass graft (CABG) or spontaneous occurrence, and treatment with oral anticoagulants (OAC). The primary endpoint is MACE at 1 year. Key secondary endpoints include ischaemic stroke and bleeding complications. Amongst 4,433 patients with confirmed ACS, 3,598 (81.2%) had no AF, 438 (9.9%) had newly diagnosed AF, and 397 (9.0%) had known AF. The rates of OAC treatment at discharge were 53.4% in patients with newly diagnosed AF and 89.2% in patients with known AF. After adjusting for baseline imbalances, only new AF was independently associated with increased rates of MACE, whereas known AF was not (hazard ratio [HR] 1.52, 95% confidence interval [CI]: 1.19-1.90 and HR 0.93, 95% CI: 0.70-1.23). For ACS patients with newly diagnosed AF, episodes lasting >24 hours were associated with a higher risk of MACE compared to episodes <24 hours (HR 1.99, 95% CI: 1.36-2.93). Episodes of new AF occurring post-CABG had more favourable outcomes compared to spontaneously occurring new AF (HR for MACE 0.52, 95% CI: 0.31-0.86). OAC treatment rates were higher in the new AF subcategories with higher rates of MACE and ischaemic stroke. Newly diagnosed AF in ACS patients was associated with higher rates of MACE and ischaemic stroke compared to ACS patients without or with known AF. Among the ACS patients with new AF, an episode lasting >24 hours was associated with worse outcomes than shorter episodes, while post-CABG occurrence of AF showed relatively better outcomes compared to spontaneously occurring AF. Only 53% of new AF patients were discharged on OAC therapy versus 89% with known AF.

Innovative approaches to atrial fibrillation prediction: should polygenic scores and machine learning be implemented in clinical practice?

Atrial fibrillation (AF) prediction and screening are of important clinical interest because of the potential to prevent serious adverse events. Devices capable of detecting short episodes of arrhythmia are now widely available. Although it has recently been suggested that some high-risk patients with AF detected on implantable devices may benefit from anticoagulation, long-term management remains challenging in lower-risk patients and in those with AF detected on monitors or wearable devices as the development of clinically meaningful arrhythmia burden in this group remains unknown. Identification and prediction of clinically relevant AF is therefore of unprecedented importance to the cardiologic community. Family history and underlying genetic markers are important risk factors for AF. Recent studies suggest a good predictive ability of polygenic risk scores, with a possible additive value to clinical AF prediction scores. Artificial intelligence, enabled by the exponentially increasing computing power and digital data sets, has gained traction in the past decade and is of increasing interest in AF prediction using a single or multiple lead sinus rhythm electrocardiogram. Integrating these novel approaches could help predict AF substrate severity, thereby potentially improving the effectiveness of AF screening and personalizing the management of patients presenting with conditions such as embolic stroke of undetermined source or subclinical AF. This review presents current evidence surrounding deep learning and polygenic risk scores in the prediction of incident AF and provides a futuristic outlook on possible ways of implementing these modalities into clinical practice, while considering current limitations and required areas of improvement.

Incidence Rates and Predictors of Recurrent Long-Term Mental Sickness Absence Due to Common Mental Disorders.

Several predictors have been identified for mental sickness absence, but those for recurrences are not well-understood. This study assesses recurrence rates for long-term mental sickness absence (LTMSA) within subgroups of common mental disorders (CMDs) and identifies predictors of recurrent LTMSA. This historical prospective cohort study used routinely collected data from 16,310 employees obtained from a nationally operating Dutch occupational health service (ArboNed). Total follow-up duration was 23,334 person-years. Overall recurrence rates were assessed using Kaplan-Meier estimators. Recurrence rates within subgroups of CMDs were calculated using person-years. Univariable and multivariable Cox proportional hazards models were used to identify predictors. 15.6% of employees experienced a recurrent LTMSA episode within three years after fully returning to work after a previous LTMSA episode. Highest recurrence rates for LTMSA were observed after a previous LTMSA episode due to mood or anxiety disorders. Mood or anxiety disorders and shorter previous episode duration were predictors of recurrent LTMSA. No associations were found for age, gender, company size, full-time equivalent and job tenure. Employees should be monitored adequately after they fully returned to work after LTMSA. It is recommended to monitor high-risk employees (i.e. employees with mood or anxiety disorders and short LTMSA episode) more intensively, also beyond full return to work. Moreover, diagnosis of anxiety and depressive symptoms should be given a higher priority in occupational healthcare.

Assessing current and future available resources to supply urban water demands using a high-resolution SWAT model coupled with recurrent neural networks and validated through the SIMPA model in karstic Mediterranean environments

Hydrological simulation in karstic areas is a hard task due to the intrinsic intricacy of these environments and the common lack of data related to their geometry. Hydrological dynamics of karstic sites in Mediterranean semiarid regions are difficult to be modelled mathematically owing to the existence of short wet episodes and long dry periods. In this paper, the suitability of an open-source SWAT method was checked to estimate the comportment of a karstic catchment in a Mediterranean semiarid domain (southeast of Spain), which wet and dry periods were evaluated using box-whisker plots and self-developed wavelet test. A novel expression of the Nash–Sutcliffe index for arid areas (ANSE) was considered through the calibration and validation of SWAT. Both steps were completed with 20- and 10-year discharge records of stream (1996–2015 to calibrate the model as this period depicts minimum gaps and 1985–1995 to validate it). Further, SWAT assessments were made with records of groundwater discharge and relating SWAT outputs with the SIMPA method, the Spain’s national hydrological tool. These methods, along with recurrent neural network algorithms, were utilised to examine current and predicted water resources available to supply urban demands considering also groundwater abstractions from aquifers and the related exploitation index. According to the results, SWAT achieved a “very good” statistical performance (with ANSE of 0.96 and 0.78 in calibration and validation). Spatial distributions of the main hydrological processes, as surface runoff, evapotranspiration and aquifer recharge, were studied with SWAT and SIMPA obtaining similar results over the period with registers (1980–2016). During this period, the decreasing trend of rainfalls, characterised by short wet periods and long dry periods, has generated a progressive reduction of groundwater recharge. According to algorithms prediction (until 2050), this declining trend will continue reducing groundwater available to meet urban demands and increasing the exploitation index of aquifers. These results offer valuable information to authorities for assessing water accessibility and to provide water demands in karstic areas.

Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study.

Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior's variability. This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes' characteristics (eg, length, intensity, and consciousness) if applicable. The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=-0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=-0.41). These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh.

Radiation diagnosis of single lung hemangioendothelioma in combination with atypical carcinoid – literature review and clinical observation

A clinical case of epithelioid hemangioendothelioma (EHEL) in combination with atypical lung carcinoid (AC) is presented. According to computed tomography (CT), magnetic resonance imaging (MRI) in the lower lobe of the right, a solid-fluid formation was easily identified, associated with the lower lobe artery, slightly accumulating 18F-FDG. CT and PET monitoring for 6 years did not reveal any negative dynamics of the lesion. After suffering from Covid-19 associated pneumonia, the patient developed episodes of hemoptysis and shortness of breath. CT and PET scans revealed an increase in the size of a focal formation in C6 of the right lung, a significant increase in metabolic activity, and accumulation of radionuclide in the mediastinal lymph nodes and the spinous process of the ThII vertebral body. Lower bilobectomy revealed EHEL and a previously unrecognized atypical carcinoid with metastases to the bifurcation lymph nodes.