Exploratory Analysis Research Articles

Comparing the technical quality and clinical outcomes of root canal treatment on immature permanent incisors in children: a retrospective evaluation of three bioceramic plug materials.

To assess the technical quality and clinical outcomes of non-surgical endodontic treatment of immature permanent incisor teeth with three different bioceramic plug materials and highlight variables which may influence treatment and quality outcomes. This cross-sectional analysis forms part of a retrospective service evaluation of the technical quality and clinical outcome of orthograde root canal treatment carried out in the Paediatric Dentistry Department of Charles Clifford Dental Hospital (United Kingdom). Twenty-five cases were identified chronologically, using the electronic patient record system, for three bioceramic plug materials: Mineral Trioxide Aggregate (MTA), Biodentine, and TotalFill Putty. All radiographs were analysed using standard conditions. Intra- and inter-examiner agreement was calculated using Kappa and weighted Kappa tests. Data were collected using a data collection tool, entered into Microsoft Excel, and analysed using descriptive statistics, exploratory analysis with Chi-squared tests, and multivariable analyses (logistic regression). At 12-month review, the success rate for each apexification material was MTA (84%), Biodentine (88%), and TotalFill Putty (92%). MTA had the highest frequency of post-operative coronal discolouration, with Biodentine most associated with apical extrusion. A number of variables and trends that affect the clinical outcome were identified, including the presence of pre-operative resorption, the number of operators involved in treatment, the number of appointments to complete treatment, as well as how non-use of local anaesthetic during apical plug placement had no adverse effect on technical quality or clinical outcome. MTA, Biodentine, and TotalFill Putty are highly effective apexification materials which produce excellent clinical outcomes. As such, logistical and situational factors, such as continuity of care from operators with increased levels of experience, skill and ability, rather than material choice, may be more prognostic regarding the technical quality and clinical outcome of immature endodontic treatment. Further high-quality evidence is required.

Decreased functional connectivity is associated with increased levels of Cerebral Spinal Fluid soluble-PDGFRβ, a marker of blood brain barrier breakdown, in older adults.

Resting-state functional connectivity (FC) is suggested to be cross-sectionally associated with both vascular burden and Alzheimer's disease (AD) pathology. For instance, studies in pre-clinical AD subjects have shown increases of cerebral spinal fluid soluble platelet-derived growth factor receptor-β (CSF sPDGFRβ, a marker of BBB breakdown) but have not demonstrated if this vascular impairment affects neuronal dysfunction. It's possible that increased levels of sPDGFRβ in the CSF may correlate with impaired FC in metabolically demanding brain regions (i.e. Default Mode Network, DMN). Our study aimed to investigate the relationship between these two markers in older individuals that were cognitively normal and had cognitive impairment. Eighty-nine older adults without dementia from the University of Southern California were selected from a larger cohort. Region of interest (ROI) to ROI analyses were conducted using DMN seed regions. Linear regression models measured significant associations between BOLD FC strength among seed-target regions and sPDGFRβ values, while covarying for age and sex. Comparison of a composite ROI created by averaging FC values between seed and all target regions among cognitively normal and impaired individuals was also examined. Using CSF sPDGFRβ as a biomarker of BBB breakdown, we report that increased breakdown correlated with decreased functional connectivity in DMN areas, specifically the PCC, and while the hippocampus exhibited an interaction effect using CDR score, this was an exploratory analysis that we feel can lead to further research. Ultimately, we found that BBB breakdown, as measured by CSF sPDGFRβ, is associated with neural networks, and decreased functional connections.

Trust and Fertility Intentions in High-Trust Sweden: An Exploratory Analysis

Trust and Fertility Intentions in High-Trust Sweden: An Exploratory Analysis

Real-World Outcomes of a Digital Behavioral Coaching Intervention to Improve Employee Health Status: Retrospective Observational Study.

Chronic noncommunicable diseases (NCDs) account for major disability and premature mortality worldwide, with low- and middle-income countries being disproportionately burdened. Given the negative impact of NCDs on employee performance and work productivity, there is a rising need for stakeholders to identify effective workplace solutions that can improve employee health outcomes. As the workplace becomes more dispersed post pandemic, digital behavioral coaching offers a scalable, personalized, and cost-effective method of managing chronic disease risk factors among employees. This study aimed to retrospectively evaluate the impact of a digital behavioral coaching program on year-to-year changes in employee health status in a cohort of Indonesian employees. This retrospective real-world exploratory analysis of secondary health data followed 774 employees of an Indonesian company who completed company-sponsored health screenings between 2021 and 2022 and were given access to Naluri (Naluri Hidup Sdn Bhd), a holistic digital therapeutics platform offering digital behavioral health coaching and self-help tools. Participants were retrospectively classified as those who received active coaching (n=177), passive coaching (n=108), and no coaching (n=489). Linear mixed-effects models were used to evaluate the year-to-year changes in health outcomes across the 3 employee groups, with post hoc analyses evaluating within-group differences between the 2 time points and between-group differences at follow-up. Significant time×group interaction effects were detected for body weight, BMI, hemoglobin A1c, low-density lipoprotein, total cholesterol, and systolic and diastolic blood pressure. Post hoc pairwise comparisons revealed significant improvements in hemoglobin A1c (mean difference [Mdiff]=-0.14, P=.008), high-density lipoprotein (Mdiff=+2.14, P<.001), and total cholesterol (Mdiff=-11.45, P<.001) for employees in the Active Coaching group between 2021 and 2022, with the other 2 groups reporting deteriorations in multiple health outcomes throughout the 2 time points. At follow-up, those who received active coaching between 2021 and 2022 reported significantly lower body weight (P<.001), BMI (P=.001), low-density lipoprotein (P=.045), and total cholesterol (P<.001) than the No Coaching group. This study demonstrates real-world outcomes and implications supporting the use of workplace digital behavioral coaching in improving employee health status. Given the rising burden of NCDs in the Southeast Asian region, our findings underscore the role that workplace digital health interventions can play in preventing and managing chronic disease risk factors.

Is Technology Uniquely Placed to Solve Our Problems? An Examination Into Technosolutionism, What It Entails and What It Predicts

Technology plays an important role in business and society. This has resulted in the belief that technology is in a unique position to solve organizational and societal problems. However, technology is not regarded as equally impactful by all. To explore these differences, we designed a technosolutionism scale to measure the extent to which individuals deem technological solutions to be better-suited to address organizational and societal problems. In Studies 1a and 1b, exploratory and confirmatory analyses indicated two reliable factors: (1) near-term and (2) long-term focused technosolutionism. Study 2 confirmed the scale’s convergent and discriminant validity. Next, we tested the predictive validity of the technosolutionism scale. We argue that a propensity to consider intelligent technologies as being able to provide solutions should also predict preferences in areas where technological solutions are being considered in response to organizational issues. Studies 3 and 4 demonstrate that the technosolutionism scale relates to preferences for a robot over a human in job replacement decisions and preferences for artificial intelligence managers over human managers in managerial decision-making tasks, respectively. This is an important finding as current research indicates that people are generally against being replaced or being managed by intelligent technologies, whereas our findings indicate that this preference flips when it comes to those with a higher propensity for technosolutionism. Our technosolutionism scale can be used to gauge the extent to which individuals believe that technology is uniquely placed to solve problems, such that they opt for intelligent technological solutions over and above other (human) solutions.

Whole Lung Irradiation in Rhabdomyosarcoma With Lung Metastases: A Report From the Soft Tissue Sarcoma Committee of the Children's Oncology Group.

Patients with rhabdomyosarcoma with metastatic disease have a poor prognosis despite therapy intensification. The aim of this study was to investigate the efficacy of whole lung irradiation (WLI) in patients with rhabdomyosarcoma and lung metastases. Patients with rhabdomyosarcoma with lung metastases enrolled on four Children's Oncology Group protocols (D9802, D9803, ARST08P1, ARST0431) were retrospectively reviewed. Event-free survival (EFS) and overall survival (OS) were compared between patients who received and did not receive WLI. In 143 patients with rhabdomyosarcoma with lung metastases, 65 patients (45.5%) received WLI and 78 patients (54.5%) did not receive WLI despite protocol requirements. The 5-year EFS was 38.3% (95% CI, 24.8 to 51.8) in patients who received WLI and 25.2% (95% CI, 13.8 to 36.6) in patients who did not receive WLI (P = .0496). The 5-year OS was 45.5% (95% CI, 31.8 to 59.3) in patients who received WLI and 32.4% (95% CI, 20.4 to 44.4) in patients who did not receive WLI (P = .08). In exploratory subgroup analyses, the benefit of WLI on EFS and OS was significant in patients 10 years and older. Other clinical factors associated with EFS on univariable analysis included age, histology FOXO1 fusion status, number of metastatic sites, location of metastatic sites, and Oberlin Score. WLI is associated with improved EFS in patients with rhabdomyosarcoma with lung metastases. These results highlight the potential importance of WLI and need for more stringent protocol compliance for administering WLI.

Description of the etiological factors behind acute moderate and severe malnutrition in children under 5 years hospitalized at two high-complexity referral centers: Case series.

Acute malnutrition in children <5 years of age has a direct relationship with medical complications and mortality. We aimed to describe the etiologic factors in children with moderate and severe non-illness-related acute malnutrition who required hospitalization for treatment of malnutrition in two high-complexity hospital centers in Bogotá, Colombia. This is a multicenter case series (December 2016 to December 2020) including patients aged 1-59 months with a weight/height indicator less than -2 SD. Electronic health records were reviewed, and demographic (sex, age, city of origin, and socioeconomic status) and clinical data (gestational age at birth, edema, and nutrition status) were collected. Descriptive analysis of information was performed. An exploratory bivariate analysis by diagnostic categories of moderate and severe acute malnutrition vs days of hospitalization was also performed. Forty-five patients were included, 62.2% of whom were male, with a median age of 14 months (Q1-Q3: 7-24). The main etiologic factors of malnutrition were related to problems with total food intake (33.3%), transition in consistency of feeding (31.1%), and breastfeeding technique (22.2%). Only 13.3% had problems related to food insecurity. There were no statistically significant differences between moderate (median: 7 days; Q1-Q3: 5-12) and severe (median: 8 days; Q1-Q3: 5-16) acute malnutrition when compared by days of hospitalization. The main etiologic factors of malnutrition in our study population were related to problems in the amount of food provided and transition in consistency of complementary feeding.

A network approach to emotion regulation and symptom activation in depression and anxiety

BackgroundEmotions can be regulated through several regulatory strategies that are involved in the development of psychopathological symptoms. Despite the well-established association between psychopathology and emotion dysregulation, little is known about the relationship between individual symptoms of depression and anxiety and emotion regulation strategies (ERS), as well as between ERS themselves.MethodWe conducted a cross-sectional study and examined the interactions between six ERS (reappraisal, engagement, rumination, suppression, arousal control, and distraction) and assessed their distinctive association with the activation of specific symptoms of depression and anxiety in a community sample of 376 adults (80.4% female; Mage = 32.70; SDage = 11.80). The Regulation Emotion Systems Survey (RESS) was used to measure ERS. The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) were used to assess psychological symptoms. An exploratory graph analysis was performed to examine the structural properties of the network of interactions between these behaviors. Additionally, to test the association of ERS with the activation of the depression symptoms network, an expected symptoms activity (ESA) was conducted.ResultsSix communities were found that correspond to the six ERS. Rumination and suppression have a significant association with symptom activation (particularly low self-esteem), whereas reappraisal reduces symptomatic activation. The effect of arousal control, engagement, and distraction appears to depend on the remaining ERS rather than having much influence on their own.ConclusionThis study provides insight into how ERS interact with each other and with individual symptoms of depression and anxiety. Understanding the effects of these interactions on symptom activation and comorbidity can improve our understanding of psychopathology.

Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic.

During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.

Exploring vaccine hesitancy among citizens of the Métis Nation of Ontario: a population-based data linkage study

Objective and ApproachUnderstanding vaccine hesitancy among distinct communities is crucial to ensuring equitable uptake of vaccination. The objective was to examine the influence of psychological antecedents of vaccine uptake, known as the “5Cs”, on COVID-19 vaccination among Métis Nation of Ontario (MNO) citizens. The Métis people are one of three Indigenous peoples in Canada. A population-based online survey was implemented by the MNO, including the short version of the “5C” (confidence, complacency, constraint, calculation, collective responsibility) psychological antecedents of vaccination scale. Census sampling achieved a 39% response rate and respondents were linked to the COVID-19 vaccine database (COVAX) in Ontario (n=4,012). Analyses included logistic regression models (adjusted for sociodemographics) and exploratory latent class analyses. ResultsIn logistic regression models, MNO citizens who were less confident that COVID-19 vaccines were safe (OR=0.04; 95% CI=0.03-0.06) and did not agree vaccination was a collective action to prevent the spread of disease (OR=0.11, 95% CI: 0.07-0.17) had lower odds of being vaccinated. MNO citizens who disagreed the risk of COVID-19 was small (OR=14.87, 95% CI: 9.99-22.13) had a higher odds of being vaccinated. Vaccine hesitancy profiles with (i) lower confidence in availability/safety of COVID-19 vaccines, (ii) lower perceptions about severity of COVID-19 and (iii) higher everyday life constraints/stressors were associated with lower vaccination rates (males, OR: 4.69; CI: 3.18–6.92; females, OR: 4.77, CI: 3.03–7.51) in latent class analyses. Conclusions and ImplicationsMétis-specific analyses enabled a community-driven response, resulting in low vaccine hesitancy and high uptake.

Distinct patterns of emotional processing in ADHD and anxiety. Evidence from an eye-movement Go/No-Go task

ABSTRACT Young people with Attention-Deficit/Hyperactivity Disorder (ADHD) demonstrate cognitive control difficulties, particularly when emotional processing is involved. In contrast, individuals with anxiety show disruptions primarily in threat-related contexts. ADHD and anxiety frequently co-occur and the impact of emotional stimuli on cognitive processes in these groups remains unclear. This study used an eye-tracking Go/No-Go task with emotional (happy, angry) and neutral stimuli to explore attentional processing in children/adolescents with ADHD, anxiety and typically developing (TD) controls. The results showed that children with ADHD had slower disengagement from angry compared to happy faces, while those with anxiety exhibited no such differences. Inhibitory control challenges were evident in the ADHD group for both emotional faces, whereas the anxiety group demonstrated improved control with angry faces. Exploratory analyses suggested that children with comorbid ADHD and anxiety might have distinct cognitive-affective profile, characterized by heightened difficulties in processing emotional stimuli.

Differential efficacy of remote ischaemic conditioning in anterior versus posterior circulation stroke: A prespecified secondary analysis of the RICAMIS trial.

The benefit of remote ischaemic conditioning (RIC) in acute moderate ischaemic stroke has been demonstrated by the Remote Ischaemic Conditioning for Acute Moderate Ischaemic Stroke (RICAMIS) study. This prespecified exploratory analysis aimed to determine whether there was a difference of RIC efficacy in anterior versus posterior circulation stroke based on RICAMIS data. In this analysis, eligible patients presenting within 48 h of stroke onset were divided into two groups: anterior circulation stroke (ACS) and posterior circulation stroke (PCS) groups. The primary endpoint was an excellent functional outcome, defined as a modified Rankin Scale (mRS) score 0-1 at 90 days. In all, 1013 patients were included in the final analysis, including 642 with ACS and 371 with PCS. Compared with the control group, RIC was significantly associated with an increased proportion of mRS scores 0-1 within 90 days in the PCS group (unadjusted odds ratio 1.6, 95% confidence interval 1.0-2.4, p = 0.04; adjusted odds ratio 2.0, 95% confidence interval 1.2-3.3, p = 0.005), but not in the ACS group (p = 0.29). Similar results were found regarding secondary outcomes including mRS score 0-2 at 90 days, mRS distribution at 90 days and change in National Institutes of Health Stroke Scale score at day 12 from baseline. However, there was no significant interaction effect between stroke location and intervention on the primary outcome (pinteraction = 0.21). Amongst patients with acute PCS who are not candidates for reperfusion treatment, RIC may be associated with a higher probability of improved functional outcomes. These findings need to be validated in prospective trials.

Reshaping water distribution topology from the carbon emission reduction perspective: An exploratory analysis of water distribution reliability

As urban economies continue to evolve, the water distribution networks (WDNs) are expanding in scale and becoming more interconnected, leading to increased carbon emissions from operations and maintenance. Consequently, enhancing the stability and safety of WDNs while saving energy has emerged as a primary research focus. This study abandoned the original use of high economic costs for post-maintenance of WDNs. Instead, it reshaped the traditional water distribution topology to form a dynamic, storable, energy-efficient "WDN self-help" model. Drawing inspiration from the "deep tunnel" project in drainage systems, the proposal was to leverage underground spaces to create a deep aqueduct (DA) complementing the traditional WDN, forming a three-dimensional (3D) WDN. Hydraulic and water quality analyses of varying scales of the 3D WDN model demonstrated its superior ability to equalize node pressures, reduce pipeline head losses, and maintain water quality for end-users. Reliability assessments of the 3D WDN revealed enhanced system robustness for medium-to large-scale distributions, while energy consumption analyses indicated a significant increase in water supply energy utilization and significant long-term reductions in carbon footprint. A practical case study was presented to validate the effectiveness of the 3D WDN concept, confirming its ability to reliably distribute water even in the event of a failure. Finally, an estimate of the retrofit cost and the static payback period of the 3D WDN was conducted. This study aims to provide a theoretical reference for the renovation of water supply projects or the optimal design of new WDNs in the context of carbon neutrality.

Incidence of university sustainability on university performance: An exploratory analysis from five private Latin American universities

Sustainability has become a generalized concern for society, specifically businesses, governments, and academia. In the specific case of universities, sustainability has been approached from different perspectives, some viewing it from environmental practices, management initiatives, operational criteria, green buildings, and even education for sustainable development. This research focuses on sustainability as a managerial practice and investigates how it affects the performance of five private universities in Medellin, Colombia. For this purpose, a literature review using a mixed sequential approach, including bibliometric and content analysis, was initially conducted. In the s second phase, more than 5000 responses from students, professors, and employees of the five mentioned private universities were collected. A previously validated instrument for both sustainability and performance was applied in the quantitative phase, and a novel dimensionality of the constructs was proposed by conducting an exploratory factor analysis using the SPSS software. Results were then processed through a structural equation analysis with the Smart PLS software. The impact of sustainability on university performance is verified, making some managerial recommendations.

Early sleep apnea treatment in stroke (eSATIS) - a multicentre, randomised controlled, rater-blinded, clinical trial: The association of post-stroke cognition with sleep-disordered breathing and its treatment.

Sleep-disordered breathing (SDB) is linked to cognitive dysfunction. Although SDB is common in stroke patients, the impact of SDB and its early treatment on cognitive functioning after stroke remains poorly investigated. Therefore, we explored the association between SDB and post-stroke cognitive functioning, including the impact of early SDB treatment with adaptive servo-ventilation (ASV) on cognitive recovery from acute event to 3 months post-stroke. We used data from two studies, which included ischaemic stroke patients (n = 131) and no-stroke controls (n = 37) without SDB (apnea-hypopnea index, AHI <5/h) and with SDB (AHI≥20/h). Cognitive functioning was assessed within 7 days and 3 months post-stroke in stroke patients, or at study inclusion in no-stroke control group, respectively. Stroke patients with SDB were randomized to ASV treatment (ASV+) or usual care (ASV-). Linear regression adjusted for main confounders assessed the impact of SDB and its treatment on cognitive recovery. The intention-to-treat analysis did not show significant associations of SDB ASV+ (n = 30) versus SDB ASV- (n = 29) with cognitive recovery. In an exploratory subanalysis, compliant SDB ASV+ (n = 14) versus SDB ASV- showed improvements with ASV in visual memory and cognitive flexibility. Combining the stroke and non-stroke datasets, SDB (n = 85) versus no-SDB (n = 83) was associated with deficits in visual memory and response inhibition independently of stroke. SDB ASV- versus no-SDB (n = 51) was associated with less improvement in visual memory. There was no substantial evidence for benefits of intention-to-treat ASV on cognitive recovery. Exploratory analysis indicated that compliant ASV treatment could benefit visual memory and cognitive flexibility, whereas untreated SDB could contribute to a poor recovery of visual memory.

Machine learning methods to discover hidden patterns in well-being and resilience for healthy aging.

A whole person approach to healthy aging can provide insight into social factors that may be critical. Digital technologies, such as mobile health (mHealth) applications, hold promise to provide novel insights for healthy aging and the ability to collect data between clinical care visits. Machine learning/artificial intelligence methods have the potential to uncover insights into healthy aging. Nurses and nurse informaticians have a unique lens to shape the future use of this technology. The purpose of this research was to apply machine learning methods to MyStrengths+MyHealth de-identified data (N = 988) for adults 45 years of age and older. An exploratory data analysis process guided this work. Overall (n = 988), the average Strength was 66.1% (SD = 5.1), average Challenges 66.5% (SD = 7.5), and average Needs 60.06% (SD = 3.1). There was a significant difference between Strengths and Needs (p < 0.001), between Challenges and Needs (p < 0.001), and no significant differences between average Strengths and Challenges. Four concept groups were identified from the data (Thinking, Moving, Emotions, and Sleeping). The Thinking group had the most statistically significant challenges (11) associated with having at least one Thinking Challenge and the highest average Strengths (66.5%) and Needs (83.6%) compared to the other groups. This retrospective analysis applied machine learning methods to de-identified whole person health resilience data from the MSMH application. Adults 45 and older had many Strengths despite numerous Challenges and Needs. The Thinking group had the highest Strengths, Challenges, and Needs, which aligns with the literature and highlights the co-occurring health challenges experienced by this group. Machine learning methods applied to consumer health data identify unique insights applicable to specific conditions (e.g., cognitive) and healthy aging. The next steps involve testing personalized interventions with nurses leading artificial intelligence integration into clinical care.

Effects of system-sanctioned framing on climate awareness and environmental action in the United States and beyond

Despite growing scientific alarm about anthropogenic climate change, the world is not on track to solve the crisis. Inaction may be partially explained by skepticism about climate change and resistance to proenvironmental policies from people who are motivated to maintain the status quo (i.e., conservative-rightists). Therefore, practical interventions are needed. In the present research program, we tested an experimental manipulation derived from system justification theory in which proenvironmental initiatives were framed as patriotic and necessary to maintain the American “way of life.” In a large, nationally representative U.S. sample, we found that the system-sanctioned change intervention successfully increased liberal-leftists’ as well as conservative-rightists’ belief in climate change; support for proenvironmental policies; and willingness to share climate information on social media. Similar messages were effective in an aggregated analysis involving 63 countries, although the overall effect sizes were small. More granular exploratory analyses at the country level revealed that while the intervention was moderately successful in some countries (e.g., Brazil, France, Israel), it backfired in others (Germany, Belgium, Russia). Across the three outcome variables, the effects of the intervention were consistent and pronounced in the United States, in support of the hypothesis that system justification motivation can be harnessed on behalf of social change. Potential explanations for divergent country-level effects are discussed. The system-sanctioned change intervention holds considerable promise for policymakers and communicators seeking to increase climate awareness and action.

Uncovering possible silent acquired long QT syndrome using exercise stress testing in long-term pediatric acute lymphoblastic leukemia survivors.

An example of chemotherapy-induced cardiotoxicity in cancer survivors is acquired long QT syndrome (aLQTS), which may cause serious yet preventable life-threatening consequences. Our objective was to identify and characterize childhood acute lymphoblastic leukemia (ALL) survivors with possible aLQTS using maximal exercise testing. In this cross-sectional study with exploratory analysis, a total of 250 childhood ALL survivors were evaluated for abnormal QT interval prolongation using the McMaster cycle exercise test. A total of 198 survivors (102 males; 96 females), having reached their peak (mean 32.1 ± 8.4 mL/kg/min; range 15.5-57.8 mL/kg/min), were included in our analyses. Two survivors were excluded for possible congenital LQTS. QT intervals were corrected for heart rate using the Bazett, Fridericia, and Rautaharju formulas at rest (supine, sitting, and standing positions), at the end of each stage of the CPET, and at 1, 3, and 5 minutes into the recovery period. The corrected QT (QTc) of borderline (n = 37) and long QT survivors (n = 20) was significantly longer than normal survivors (n = 141) at rest, exercise, and recovery. Out of 57 survivors presenting an abnormal QTc prolongation, 40 survivors (70%) showed no QT interval anomalies at rest but developed various anomalies during exercise. No significant differences were found between the groups for any of the measured clinical characteristics or cardiac parameters. The standardization of exercise testing in the regular follow-up of oncology patients is necessary for appropriate cardiac prevention and surveillance to enhance the health and quality of life of the ever-increasing number of cancer survivors.

Comparative clinical study of Mist Amen Fevermix and Edhec Malacure: two polyherbal products used for the treatment of uncomplicated malaria in Ghana against Artemether/Lumefantrine

The use of herbal products for the treatment of malaria, has increased globally. However, inadequate scientific studies about the safety and effectiveness of such herbal products have been raised. Also, the reduced sensitivity of the malaria parasites to artemisinin-based combination therapies is of concern. There is therefore the need for new antimalarial medications including those from alternative sources such as herbal medicinal products. In this study, a prospective, comparative parallel group randomized, clinical study was done to assess the safety and effectiveness of Mist Amen Fevermix and Mist Edhec Malacure with Artemether/Lumefantrine as control at the Tafo Government Hospital, Kumasi between July and November 2019, after Committee on Human Research, Publication and Ethics approval (CHRPE/AP/424/19). The study was conducted in accordance with Good Clinical and Laboratory Practice (GCLP) and registered with the Pan African Clinical Trials Registry with trial number PACTR202109664146698. Participant completed an informed consent form. Randomization was based on a single sequence to allocate participants to a group. SPSS version 19. One-way ANOVA test and exploratory statistics was used for data analysis. Total sample size was 150 participants with 50 on each arm of the group. Male and female patients aged 15–45 years and meet inclusion criteria with clinically established malaria were treated with Mist Amen Fevermix and Mist Edhec Malacure, at the specified doses of 45 mls (0.1063 g) and 30 mls (0.0521 g) three times daily after meals for three days. Artemether/Lumefantrine was administered at a dose of 80/480 mg/kg twice daily after meals for three days. Baseline data was taken on day 0. Patients were then followed up on Day 3, 7 and 28 to establish treatment outcomes and any side effect using a checklist for signs and symptoms and Karnofsky’s scale to assess the quality of life. Mist Amen Fevermix was effective with a cure rate of 95.89%. Mist Edhec Malacure was also effective with a cure rate of 91.87%. The cure rate of Artemether/Lumefantrine was 97.25%. Kidney and liver panels were within normal reference range at the end of the 28-day study. This study supports the use of Mist Amen Fevermix and Mist Edhec Malacure, two multi-component products as safe and effective for the treatment of uncomplicated malaria. Both products achieved a comparable clinical treatment outcome with Artemether/Lumefantrine.

Data Mining of Telematics Data: Unveiling the Hidden Patterns in Driving Behavior

With the advancements in technology, telematics data that capture vehicle movement information are becoming available to more insurers. Because these data capture the actual driving behavior, they are expected to improve our understanding of driving risk and facilitate more accurate auto insurance ratemaking. In this article, we analyze an auto insurance dataset with telematics data collected from a major European insurer. Through a detailed discussion of the telematics data structure and related data quality issues, we elaborate on practical challenges in processing and incorporating telematics information in loss modeling and ratemaking. Then, with an exploratory data analysis, we demonstrate the existence of heterogeneity in individual driving behavior, even within the groups of policyholders with and without claims, which supports the study of telematics data. Our regression analysis reiterates the importance of telematics data in claims modeling; in particular, we propose a speed transition matrix that describes discretely recorded speed time series and produces statistically significant predictors for claim counts. We conclude that large speed transitions, together with higher maximum speed attained, nighttime driving, and increased harsh braking, are associated with increased claim counts. Moreover, we empirically illustrate the learning effects in driving behavior: we show that both severe harsh events detected at a high threshold and expected claim counts are not directly proportional with driving time or distance but they increase at a decreasing rate.