Health Evaluation Research Articles

Occupational health and safety management systems – analysis of selected requirements for evaluation of occupational health and safety performance

The publication undertakes the problems of occupational health and safety in the aspect of requirements for occupational health and safety management systems. The aim of the work was analysis of selected aspects of evaluation of occupational health and safety performance according to the ISO 45001:2018 standard. Performance evaluation and improvement are one of the basic requirements, that determine the suitability, adequacy, effectiveness and efficiency of management systems. The essential element of the study was the development of assumptions for evaluation of occupational health and safety performance, which include the analysis of occupational health and safety state and the evaluation of occupational health and safety management systems.

Analisis Akibat Hukum Terhadap Kelalaian Pilot Dalam Menjaga Keselamatan Penerbangan (Kasus Pesawat Batik Air Tahun 2024)

Flight safety is a cornerstone of the aviation industry, heavily reliant on the professionalism and vigilance of pilots. This study examines the legal consequences of pilot negligence in maintaining flight safety, focusing on a case involving a fatigued Batik Air pilot. Employing a normative juridical approach, this research analyzes relevant legal frameworks, including Indonesia’s Law No. 1 of 2009 on Aviation, Civil Aviation Safety Regulations (CASR), International Civil Aviation Organization (ICAO) Annex 13, and related legal instruments. The findings reveal that negligence resulting from fatigue constitutes a severe violation of safety standards, breaching the duty of care expected in aviation operations. Such negligence may attract various legal repercussions, ranging from administrative sanctions, such as license revocation, to criminal charges as stipulated under Artt. 411 and 412 of Law No. 1 of 2009. Additionally, airlines may face civil liabilities for compensating passengers for damages incurred. The study also highlights the legal obligation of airlines to ensure the physical and mental fitness of pilots through stringent monitoring of work schedules and regular health evaluations. This paper concludes that strict law enforcement and the establishment of a robust safety culture within the aviation industry are essential to mitigating risks associated with human factors, particularly pilot negligence.

BLOOD FATTY ACID PROFILES IN CHILEAN (PHOENICOPTERUS CHILENSIS) AND CARIBBEAN (PHOENICOPTERUS RUBER) FLAMINGOS IN MANAGED CARE.

Flamingos in managed care are vulnerable to inflammatory states, including pododermatitis, trauma, and capture myopathy. Fatty acids are an important component of well-balanced nutrition and crucial to endogenous immune responses associated with these conditions, yet fatty acids have not been assessed in flamingos. This study reported complete whole blood circulating fatty acid profiles in two flamingo species in managed care receiving different diets. Whole blood from Chilean flamingos (Phoenicopterus chilensis) (n=16) and Caribbean flamingos (Phoenicopterus ruber) (n=17) was collected during routine exams and prepared on blood spot cards for complete fatty acid profile analysis in which 24 individual fatty acids, nine fatty acids groups, and four calculated parameters were quantifiable. Non-parametric statistical analysis compared profiles between species, and between sex of Chilean flamingos. The median ratio of omega-6/omega-3 fatty acids was 5.64. Chilean flamingos had significantly (P<0.05) higher percentages of 11 individual fatty acids, total polyunsaturated and highly unsaturated fatty acids, total omega-3 and omega-6 fatty acids, arachidonic acid (AA; 20:4w6)/eicosapentaenoic acid (EPA; 20:5w3) ratio, and total EPA + DHA, whereas Caribbean flamingos had significantly (P<0.05) higher percentages of eight individual fatty acids, and total saturated fatty acids. Male Chilean flamingos had significantly (P<0.05) higher percentages of AA, EPA, and total polyunsaturated fatty acids, whereas females had significantly (P<0.05) higher oleic acid (18:1w9), total monounsaturated fatty acids, and total omega-9 fatty acids. Differences reported are highly attributable to variability in diet, although differences in fatty acid synthesizing pathways and hormonal influences may also play a role. This novel fatty acid data set in healthy flamingos is a valuable reference for complete health evaluations in managed care settings. Further comparisons with controlled diets and inclusion of free-ranging animals may enhance clinical utility.

A stacked ensemble deep learning model for predicting the intensive care unit patient mortality

Accurate mortality prediction in intensive care units (ICUs) is essential for optimizing patient treatment, nursing care, and resource allocation. Traditional models, such as Acute Physiology and Chronic Health Evaluation and Simplified Acute Physiology Score, have been very important in clinical practice, but they frequently have issues with prediction accuracy and adaptability, especially when dealing with complex and evolving patient data. These issues can be resolved, and the accuracy of mortality prediction increased due to recent developments in machine learning, especially deep learning. The present study introduces a new deep learning ensemble model that achieves a significant improvement over existing methods. Using stacked ensemble learning, our approach combines the advantages of one Random Forests model and two CatBoost models. We achieved a notable performance in mortality prediction by carefully training and optimizing this ensemble using the electronic ICU Collaborative Research Database. Our model boasts an accuracy of 94.19%, precision of 94.097%, recall of 94.29%, and F1-score of 94.191%, demonstrating a substantial improvement over conventional approaches. The prediction of ICU mortality has been significantly improved using ensemble learning, which helps medical and nursing staff to better treat patients individually, allocate resources efficiently, and enhance patient outcomes. This approach gives healthcare experts the ability to make data-driven decisions, leading to more effective and efficient care within the ICU.

Systematic review and meta-analysis of colistin plus meropenem therapy for the treatment of nosocomial pneumonia

Background and Objectives: Nosocomial pneumonia caused by multidrug-resistant gram-negative bacteria presents a sig- nificant challenge for healthcare systems, as there are limited effective treatments available. This systematic review and meta-analysis aim to investigate the outcomes of colistin plus meropenem combination therapy on nosocomial pneumonia. Materials and Methods: An exhaustive search of PubMed, Scopus, Web of Science (WOS), and Embase databases was conducted, resulting in the extraction of 5 studies for qualitative assessment and meta-analysis. The study sample included 991 patients admitted with nosocomial pneumonia. The outcomes evaluated were clinical improvement, microbiological response, mortality, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, Charlson Comorbidity Index (CCI), Clinical Pulmonary Infection Score (CPIS), C-reactive protein (CRP) levels, procalcitonin (PCT) levels, and intensive care unit (ICU) duration. Results: The results demonstrated that colistin plus meropenem combination therapy significantly improved clinical out- comes (OR = 1.37, 95% CI = 1.04-1.81, p = 0.027), reduced SOFA scores (OR = -0.28, 95% CI = -0.44 to -0.11, p = 0.001), and increased CCI scores (OR = 0.16, 95% CI = 0.02-0.29, p = 0.021) compared to other medications. However, other eval- uated parameters did not show significant differences. Conclusion: This meta-analysis indicates that colistin-meropenem combination therapy is superior to other colistin-based treatments for nosocomial pneumonia in terms of clinical improvement, SOFA score reduction, and CCI score increase. Nevertheless, other variables assessed did not exhibit remarkable differences between the treatment regimens.

Using concept mapping methods to evaluate overdose data to action program efforts in Allegheny County, Pennsylvania.

The Pitt Public Health evaluation team used a mixed-methods, community-based participatory research method of concept mapping to evaluate factors affecting the Overdose Data to Action (OD2A) opioid overdose surveillance and prevention project outcomes for Allegheny County, Pennsylvania. In June 2021 we developed the focal prompt: "What factors work to help or limit OD2A program outcomes at the individual, community, and or/system level?"Community partners participated in three phases: Brainstorming, Sorting and Rating, and Interpretation. Using concept mapping software, we applied multidimensional scaling to visualize a point map displaying factors and their relative relationships, and hierarchical cluster analysis to generate concept maps displaying clusters of factors. During the brainstorming phase community partners (N = 18) generated 69 unique statements describing factors impacting OD2A work and community partners (N = 16) sorted and rated statements using concept mapping software. In the interpretation community partners (N = 26) selected the 10-cluster map as the most salient cluster solution. Using this cluster map and cluster ratings, we identified Stigma, Criminalization and Marginalization, and Racial Equity as factors of highest importance to overdose prevention success but lowest in success thus far. Using concept mapping to evaluate factors affecting OD2A outcomes was a successful method of engaging community partners in considering opportunities to strengthen OD2A and future overdose prevention efforts.

Diffuse Alveolar Hemorrhage in Patients with Systemic Lupus Erythematosus: A Single Center Retrospective Study in Malaysia

Background: The objective of this study was to evaluate demographic characteristics, clinical presentation, laboratory findings, treatments, and their impact on the outcome of systemic lupus erythematosus (SLE)-related diffuse alveolar hemorrhage (DAH) in our local setting. Methods: A total of seven patients were selected from our hospital’s local SLE database between 2013 and 2024 based on the inclusion criteria. Various variables were captured and analyzed using the Mann-Whitney [Formula: see text] test or Fisher’s exact test for comparison where appropriate. Results: All seven patients were female, with a median age of 26 years, and the median duration of SLE before DAH was 3 months. More than half were presented with all three symptoms: fever (57%), dyspnea (71.4%), and hemoptysis (85.7%). Kidney involvement was present in all cases. All patients received methylprednisolone as initial treatment with 71.4% subsequently received plasmapheresis, 57% received cyclophosphamide, 28.6% received intravenous immunoglobulin, and 14.3% received rituximab. Five out of the seven patients required invasive mechanical ventilation. The mortality rate was 57%. Two out of three survivors received a combination of multiple immunosuppressive agents. Non-survivors had significantly higher acute physiology and chronic health evaluation II (APACHE II) scores ([Formula: see text] = 0.034), while other variables were not statistically linked to mortality. In spite of that, all patients with nosocomial infection did not survive. Conclusion: Our observational study showed that a higher APACHE-II score was associated with a higher mortality rate. The efficacy of these treatment modalities cannot be conclusively determined due to the small sample size of this study. However, a combination of multiple immunosuppressive agents appeared to be associated with better outcomes in some patients.

A bibliometric analysis of inflammatory bowel disease research in the Arab world.

The prevalence of inflammatory bowel disease (IBD) continues to increase worldwide, including in the Arab world. This study investigates IBD research output in Arab countries from 2009 to 2023, alongside prevalence and incidence trends. We utilized bibliometric analysis with data from Clarivate Analytics, the Institute for Health Metrics and Evaluation, and the World Bank. We compared the research output, citation impact, and funding across 22 Arab countries with global averages. Spearman's correlation examined relationships between IBD publications and prevalence, incidence rates, gross domestic product (GDP), and population size. Between 2009 and 2023, Arab countries produced 1004 IBD-related publications (2.9% of global output), with Saudi Arabia (37.7%) and Egypt (27.5%) being the leading countries. The median IBD incidence rose from 2.42 to 3.06 per 100,000, with the prevalence increasing from 28.93 to 33.95 per 100,000 from 2009 to 2019. Arab IBD research had a citation impact of 14.49 compared to the global average of 23.98. Funded research constituted 18.7% of Arab publications, lower than the global rate of 32.4%. We found positive correlations between IBD publication counts and prevalence (r s = 0.753), incidence rates (r s = 0.734), and GDP (r s = 0.782), all with P < 0.001. Population size showed a nonsignificant correlation (r s = 0.371, P = 0.090) with IBD publication counts. Arab nations contribute 2.9% of global IBD research, with lower citation impact and funding than the global average. Enhanced local support is crucial to improving research impact and addressing the rising prevalence of IBD in the Arab world.

Viral concentration method biases in the detection of viral profiles in wastewater.

Viral detection methodologies used for wastewater-based epidemiology (WBE) studies have a broad range of efficacies. The complex matrix and low viral particle load in wastewater emphasize the importance of the concentration method. This study focused on comparing three commonly used virus concentration methods: polyethylene glycol precipitation (PEG), immuno-magnetic nanoparticles (IMNP), and electronegative membrane filtration (EMF). Influent and effluent wastewater samples were processed by the methods and analyzed by DNA/RNA quantification and sequencing for the detection of human viruses. SARS-COV-2, Astrovirus, and Hepatitis C virus were detected by all the methods in both sample types. PEG precipitation resulted in the detection of 20 types of viruses in influent and 16 types in effluent samples. The corresponding number of virus types detected was 21 and 11 for IMNP, and 16 and 8 for EMF. Certain viruses were unique to only one concentration method. For example, PEG detected three types of viruses in influent and six types in effluent compared to IMNP, which detected seven types in influent and one type in effluent samples. However, the EMF method appeared to be the least effective, detecting three types in influent and none in effluent samples. Rotavirus was detected in influent sample using IMNP method, whereas EMF and PEG methods failed to yield a similar outcome. Consequently, the potential false negative results pose a risk to the credibility of WBE applications. Therefore, implementation of a proper concentration technique is critical to minimize method biases and ensure accurate viral profiling in WBE studies.IMPORTANCEIn recent years, significant research efforts have been focused on the development of viral detection methodology for wastewater-based epidemiology studies, showing a range of variability in detection efficacies. A proper methodology is essential for an appropriate evaluation of disease prevalence and community health in such studies and necessitates designing a concentration method based on the target pathogenic virus. There remains a need for comparative performance evaluations of methods in the context of detection efficiencies. This study highlights the significant impact of sample matrix, viral structure, and nucleic acid composition on the efficacy of viral concentration methods. Assessing WBE techniques to ensure accurate detection and understanding of viral presence within wastewater samples is critical for revealing viral profiles in municipality wastewater samples.

Predictors of mortality for blunt trauma patients in intensive care: A retrospective cohort study

Background Major trauma places substantial demand on critical care services, is a leading cause of death in under 40-year-olds and causes significant morbidity and mortality across all age groups. Various factors influence patient outcome and predefining these could allow prognostication. The aim of this study was to identify predictors of mortality from major trauma in intensive care. Methods This was a retrospective study of adult trauma patients admitted to general intensive care between January 2018 and December 2019. We assessed the impact on mortality of patient demographics, patterns of injury, injury scores (Glasgow Coma Score (GCS), Charlson’s comorbidity index (CCI), Acute Physiology and Health Evaluation II (APACHE II), Injury Severity Score (ISS) and Probability of Survival Score (Ps19)), number of surgeries and mechanism of injury using logistic regression. Results A total of 414 patients were included with a median age of 54 years (IQR 34–72). Overall mortality was 18.6%. The most common mechanism of injury was traffic collision (46%). Non-survivors were older, had higher ISS scores with lower GCS on admission and lower probability of survival scores. Factors independently predictive of mortality were age 70-80 (OR 3.267, p = 0.029), age &gt;80 (OR 27.043, p &lt; 0.001) and GCS &lt; 15 (OR 8.728, p &lt; 0.001). Ps19 was the best predictor of mortality (p &lt;0.001 for each score category), with an AUROC of 0.90. Conclusions The significant mortality predictors were age, fall from &lt;2 metres, injury of head or limbs, GCS &lt;15 and Ps19. Contrary to previous studies, CCI and APACHE II did not significantly predict mortality. Although Ps19 was found to be the best current prognostic score, trauma prognostication would benefit from a single validated scoring system incorporating both physiological variables and injury patterns.

Impact of weight and health-behavior information on evaluations of girls' health.

The dominant public health narrative equates excess weight with poor health, and previous research has demonstrated that people judge adults with higher body weights as being in poor health, even when they engage in healthy lifestyles. The present study investigated whether the same pattern of beliefs holds for perceptions of children's health. Participants (n = 445) viewed the health profile of a female child that varied in terms of weight status (normal weight, obese), health behaviors (good, poor), and age (younger, older), and then rated the child's overall health and indicated their agreement with suggested behavior recommendations. For older children, targets with obesity were perceived as less healthy and were recommended to engage in more healthy and weight control behaviors than were the targets with normal weight. Health behaviors did influence perceptions of health and behavioral recommendations, but much less so for the target with obesity than for the target with normal weight. For younger children, participants placed a greater emphasis on health behaviors than on weight in their perceptions of the target's health and healthy behavior recommendations, but the target's weight did play a greater role in weight-control behavior recommendations. Overall, perceptions of older children reflect the mainstream weight-centric health beliefs that are perpetuated in public health messaging, whereas perceptions of younger children seem to be more aligned with the scientific evidence supporting the importance of health behaviors to overall health. Public health messaging, particularly messaging targeting parents, should be reframed to focus on the importance of engagement with health behaviors without reference to weight.

Navigating diversity: primer impact on arthropod recovery in molecular environmental monitoring in tropical Amazon

IntroductionThe urgent need for effective environmental monitoring amid the escalating biodiversity crisis has prompted the adoption of molecular techniques like DNA metabarcoding. Through sequencing of taxonomically informative mitochondrial markers in bulk arthropod samples, metabarcoding allows assessment of arthropod diversity, which is crucial for ecosystem health evaluations, especially in threatened regions like the Amazon. However, challenges such as primer biases and reference database limitations persist. MethodsHere, we assess the performance of four metabarcoding primer sets, two COI markers (ZBJ-ArtF1c/ZBJ-ArtR2c [Zeale]: 157bp, targeting arthropods, and mlCOIintF/jgHCO2198 [Leray]: 313bp, targeting metazoans) and two 16S markers (Ins16S_1shortF/Ins16S_1shortR [Ins16S]: 150bp, targeting insects, and Coleop_16Sc/Coleop_16Sd [EPP]: 105bp, targeting arthropods, mainly Coleoptera) in amplifying the taxonomic constituents of bulk arthropod samples, collected across different natural and anthropogenic habitats from the Brazilian Amazon biome. To evaluate primer performance, we used the indicators (i) amplification efficiency, (ii) primer specificity, i.e., the amount of non-target sequences, (iii) detected OTU richness, (iv) group coverage and (v) taxonomic resolution. Finally, we (vi) estimated the refinement in taxa recovery by additional amplifications. ResultsDespite lower specificity and contrasting results regarding OTU richness, the primer pairs returning larger fragments showed higher taxonomic resolution (Ins16S) and broader taxonomic coverage (Leray) than Zeale and EPP did. Furthermore, results demonstrated the complementarity of the Leray and the Ins16S primer sets from taxon-dependent studies. ConclusionsDespite limitations, combining these primers could enhance biodiversity monitoring in the region. Considering incomplete reference gene banks, primers maximizing OTU richness (EPP and Leray) may be the best choice for taxon-independent surveys. These findings underscore the importance of primer selection and highlight the ongoing efforts to refine DNA metabarcoding for robust environmental assessments.

Comparison of Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment intensive care unit scoring system as mortality predictors in intensive care unit patients with sepsis

Background: Sepsis is a life-threatening organ dysfunction caused by a deregulated host response to infection. It is one of the leading causes of in-hospital mortality and morbidity among patients. It also results in significant morbidity and financial burden. Aims and Objectives: (1) To study the etiological profile of patients admitting with sepsis to ICU. (2) To compare between APACHE II and SOFA ICU scoring system of patients with sepsis at admission and at 24 h in predicting the 5th-day mortality. Materials and Methods: This was a single center hospital based prospective, observational, study conducted in patients in ICUs of ESICMC PGIMSR and Model Hospital Rajajinagar, Bangalore. Patients over age 18 years admitted in ICU who have fulfilled the criteria for sepsis were included in our study. Their clinical profile, APACHE II and SOFA scores were evaluated and followed up to 5th day of admission and data were compared with respect to patients’ outcome in the form of survival. Results: In this study, out of 53 patients the maximum number of patients belong to the age groups of &gt;60 years (23 patients). Male-to-female distribution in this study noted was 30 and 23 patients, respectively. Aspiration Pneumonitis (17%) and Community-Acquired Pneumonia (17%) were the most common causes of septic. Out of 53 patients, 31 patients did not survive. In this study, it was observed that the SOFA scoring had the highest specificity (87.10%) and APACHE II had the highest sensitivity (96.77%) at admission. However at 24 h of admission, both the highest sensitivity and highest specificity was more for APACHE II score. The most area under the Receiver-operating characteristic curve was better for SOFA score (AUROC=58.0%) at admission than APACHE II score with AUROC of 53.7%, however AUROC of both SOFA and APACHE II score calculated at 24 h of admission were equally good in predicting 5th-day mortality. Conclusion: We found that the SOFA score outperformed APACHE II scores in predicting survival in septic shock patients at admission. SOFA and APACHE II calculated at 24 h of admission and both scores provided equal efficacy in predicting 5th-day mortality in patients with sepsis.

Case Report: A Comprehensive Early Childhood Mental Health Evaluation for Children in the Foster Care System.

Children in the foster care system often have a host of prenatal and postnatal risk factors that can compromise development including disruptions in important attachment relationships. We argue that to effectively address this complex history and inform specific recommendations for intervention, it is important for an Early Childhood Mental Health (ECMH) evaluation to include both an assessment of the caregiver-child relationship status and neurodevelopment. We describe an ECMH evaluation for a 21-month-old girl who was referred to a multidisciplinary birth to three specialty clinic for difficulties separating from her preadoptive mother, indiscriminate friendliness, and emotional and behavioral dysregulation. She had a history of prenatal substance exposure and several disruptions in important attachment relationships. We gained insight into the caregiver-child relationship through behavioral observations and used standardized testing to assess neurodevelopment. This combination of assessment techniques revealed inconsistencies in secure base attachment patterns between the parent and child. She also performed lower than what would be expected for her age across several domains of development. This case highlights a comprehensive approach to an ECMH evaluation. Recommendations for intervention prioritized the parent-child relationship given the importance of attunement between caregiver and child to first optimize stress regulation and thus set the foundation for higher-order cognitive processes to develop.

Elevated glucagon and postprandial hyperglycemia in fatty liver indicate early glucose intolerance in metabolic dysfunction associated steatotic liver disease

In Japan, fatty liver cases with elevated body mass index are increasing. Because of being non-malignant, these are often neglected unless accompanied by diabetes. This study investigated the risk of glucose intolerance in individuals with non-alcoholic fatty liver. We included 165 men (mean age 56.3 years; range 29–75 years) who underwent an overnight 2-day physical examination at our Health Evaluation Center. All patients underwent abdominal ultrasonography to examine fatty liver. Fasting blood glucose and 75-g glucose tolerance test (OGTT) were conducted. alanine aminotransferase (ALT) (p < 0.01) and triglyceride (p < 0.001) levels were significantly higher in the fatty liver group (FL) than in the non-fatty liver group. HbA1c, fasting blood glucose, and blood glucose level at OGTT (0 and 30 min) did not show significant differences. In the FL, OGTT was significantly elevated at 60 min(p < 0.01)and 120 min (p < 0.001), insulin level was significantly elevated at 0 and 30 min (p < 0.001), and glucagon level was significantly elevated at 0 min (p < 0.05) and 30 min (p < 0.01), with no significant differences between the groups at 60 and 120 min. This is the first study to demonstrate elevated glucagon levels after OGTT. Metabolic dysfunction-associated steatotic liver disease (MASLD) requires treatment for insulin resistance with glucagon dysregulation likely associated with its pathogenesis.

Resisting industry narratives: guidance to avoid tobacco and nicotine industry framing.

The tobacco and nicotine industry has a long history of endangering the health and wellbeing of individuals, populations and society, including Indigenous peoples, via dubious practices and tactics that continue today. These tactics include generating opposition, fracturing consensus, dehumanizing groups and minimizing the perception of harms from tobacco use. This article offers guidance for people working in health promotion and tobacco control to align with the World Health Organization's Framework Convention on Tobacco Control, which includes Articles on research, monitoring and information exchange regarding the tobacco and nicotine industry. Recommendations are given to resist the tobacco and nicotine industry's narrative in health promotion, research, evaluation and publications. Holding the industry to account provides a further step forward to eliminating tobacco disease and death.

Measuring the Well-Being of the Whole Person in Clinical Care, Health Research, and Population Health Evaluation: Findings and Recommendations From the XVIII Veterans Health Administration State of the Art Meeting.

In 2023, the U.S. Veterans Health Administration convened a State of the Art meeting to evaluate the existing evidence and make recommendations for measuring the well-being of the whole person in clinical care, health research, and population health evaluation. In this article, we describe findings and recommendations concerning each of these health care system functions, as well as key takeaways from the meeting as a whole. There has been a growing call for health care organizations to expand their focus beyond disease-based concepts to consider both positive aspects of health and indicators of well-being that extend beyond the health domain. Yet, knowledge remains limited regarding how best to integrate these types of measurements in clinical care, health research, and population health evaluation efforts. State of the Art activities were organized into 3 workstreams, each focused on a core health care system function (clinical care, health research, and population health evaluation). Drawing from existing literature on the measurement of the well-being of the whole person in the assigned health care function, workgroups evaluated the existing state of knowledge and made recommendations for future work on well-being measurement in the health care setting. Cross-cutting themes included: (1) difficulty evaluating the current state of knowledge due to varied use of terminology in this literature; (2) appreciation for the value of well-being measurement in each health care function; (3) need for additional research on the use and benefits of well-being measures, including their role as predictors and moderators of health and health care outcomes; (4) importance of ensuring that measures are applicable for diverse patient groups and adequately reflect the "patient voice;" and (5) need for additional leadership investment and resource allocation to support use of these measures in the health care setting. Knowledge from this meeting can be applied to enhance the use and application of measurement of well-being to improve patients' health and health care outcomes.

Tyrosine hydroxylase-positive neurons in the rostral ventrolateral medulla mediate sympathetic activation in sepsis

AimSepsis results in high mortality and is associated with organ dysfunction caused by infection. The present study aimed to elucidate whether early-stage sympathetic activation is associated with the prognosis of sepsis and its possible mechanisms. MethodsPatients with sepsis and healthy controls were included. Sepsis in rats was induced by lipopolysaccharide. Dexmedetomidine, a α2-adrenergic receptor agonist, was used in patients and rats with sepsis to evaluate the role of the sympathetic nervous system in sepsis. Holter monitoring was used to detect heart rate variability, while plasma samples were obtained to measure levels of norepinephrine and inflammatory markers. Mean arterial pressure, heart rate, and renal sympathetic nerve activity were recorded. Immunofluorescence was used to detect the activation of neurons in the rostral ventrolateral medulla (RVLM). ResultsIn patients with sepsis, plasma levels of norepinephrine and interleukin-1β were higher compared with those in controls and positively correlated with acute physiology and chronic health evaluation (APACHEII). SDNN and SDANN were significantly reduced as well as negatively correlated with APACHEII. Meanwhile, rats with sepsis showed increased of sympathetic outflow and plasma levels of norepinephrine, with increased c-fos levels in the RVLM. Treatment with dexmedetomidine could improve prognosis. Lesion of tyrosine hydroxylase-positive neurons in the RVLM attenuated sympathetic activation and target organs damage in septic rats as well as improved survival. ConclusionThe results suggest that tyrosine hydroxylase-positive neurons in the RVLM might contribute to the prognosis of sepsis via activation of the sympathetic nervous system, while dexmedetomidine could ameliorate sepsis via inhibiting sympathetic activation.

Acoustical features as knee health biomarkers: A critical analysis

Acoustical knee health assessment has long promised an alternative to clinically available medical imaging tools, but this modality has yet to be adopted in medical practice. The field is currently led by machine learning models processing acoustical features, which have presented promising diagnostic performances. However, these methods overlook the intricate multi-source nature of audio signals and the underlying mechanisms at play. By addressing this critical gap, the present paper introduces a novel causal framework for validating knee acoustical features. We argue that current machine learning methodologies for acoustical knee diagnosis lack the required assurances and thus cannot be used to classify acoustic features as biomarkers. Our framework establishes a set of essential theoretical guarantees necessary to validate this claim. We apply our methodology to three real-world experiments investigating the effect of researchers’ expectations, the experimental protocol, and the wearable employed sensor. We reveal latent issues such as underlying shortcut learning and performance inflation. This study is the first independent result reproduction study in acoustical knee health evaluation. We conclude by offering actionable insights that address key limitations, providing valuable guidance for future research in knee health acoustics.

Evaluation of Mental Health of Polytechnic Students through Correlation Analysis in SPSS

Evaluation of Mental Health of Polytechnic Students through Correlation Analysis in SPSS