Representative Group Research Articles

Critical analysis of updated international recommendations on nutrition of patients with cystic fibrosis

The aim of the review is to analyse the Guidelines in the updated version of the ESPEN-ESPGHAN-ECFS 2024 Guidelines on infant, child and adult nutrition in cystic fibrosis (CF). The previous version of the Guideline was published in 2016. An expert working group of physicians, dietitians, and patient community representatives updated the nutritional recommendations, including methods for nutritional assessment and management at all ages. Chapters on pregnancy, liver disease, CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics have been expanded. There are new chapters on nutrition in the use of highly effective CFTR modulator (targeted) therapies and nutrition after organ transplantation. The main point is the change in the concept of nutrition in the era of targeted therapy from a hypercaloric high-fat diet for all patients to ‘healthy eating’ as the main recommendation. The ESPEN-ESPGHAN-ECFS 2024 Guidelines on nutrition in CF contain a number of important provisions that will be useful to paediatricians and general practitioners, pulmonologists, gastroenterologists and dietitians specialising in CF. Significant differences in the clinical and epidemiological situation in the Russian Federation should be taken into account when diagnosing disturbances of nutritional status and determining the tactics of nutritional support for patients with CF.

Setting Primary Health and Social Care Priorities Using a Deliberative Democratic Participatory Approach.

Publicly funded regional primary health care investments are usually informed by analysis of locally collected data, surveys, focus groups and consultations. We wanted a deeper understanding of baseline health and social care priorities in culturally diverse Western Sydney. If WentWest could understand the priorities, the operational agenda for commissioning services could be tailored around them. This research describes the organisation, conduct and recommendations of a citizens' jury in 2023. Thematic analysis of the transcribed facilitated discussions identified the well-informed priorities of a diverse and representative group of Western Sydney citizens. Listening to internal and external advisory groups delivered communication pathways, expert presenters, handbook preparation and practical support for the jury event. Consistent with the principle that research about the community should include the community, four consumer advisors were colleagues in the research team. The jury supported a focus on prevention, including early intervention to keep children thriving and connected at school, and better cross-sectoral bonds via coalitions to enable social care to be linked to health care. Team-based care in general practice for proactive data use and building a culture for relationship-based care, developing a patient-centred workforce through incentivising students and expediting registration of overseas trained health workers were recommended. Assets-based community development was seen as an essential approach in linking the community with these recommendations. The use of citizens' juries in primary health settings is rare. In this culturally diverse community, WentWest now has a foundational understanding of what investments will deliver and has committed to institutionalising this deliberative approach into a permanent citizens assembly. The design of the jury was guided by several advisory groups across the local region. The research team included four consumer advisors to provide overarching feedback and external insights. The jurors were selected to be representative of the regional community. They developed the recommendations reported in this article. This research does not involve clinical trials.

Molecular phylogeny and morphology reveal a new wood-inhabiting fungus, Hyphoderma cinereofuscum (Polyporales, Basidiomycota), from southwest China

Hyphoderma is one of the important representative groups of wood-inhabiting fungi. These fungi secrete various enzymes capable of degrading cellulose, hemicellulose, and lignin into simple inorganic substances. The taxa within the genus cause a white rot of wood, play a key role in the carbon cycle and are the most efficient wood decomposers in the forest ecosystem. This study proposes a new wood-inhabiting fungal taxon, Hyphoderma cinereofuscum, based on morphological features and molecular evidence. It is characterized by the white hymenial surface, a monomitic hyphal system, generative hyphae with simple-septa, colorless, thin-walled, the presence of the tubular and capitate cystidia, and cylindrical basidiospores 9–11.5 × 4.5–5 µm. The phylogenetic tree inferred from a combination of the internal transcribed spacer regions (ITS) and the large subunit nuclear ribosomal RNA gene (nLSU) revealed that Hyphoderma cinereofuscum nested in the Hyphoderma clade and is closely related to H. marginatum. A full description, illustrations and phylogenetic analysis results of the new species are provided.

A sustainable mixed diet for children without compromising nutritional needs: The vitamin B12 issue.

Global climate change requires a paradigm change in diets, especially in affluent countries, with a reduction of animal-based food, including children. This will have direct consequences for Vitamin B12 supply as animal-based foods are the only food source. We examined these potential consequences using the German food based dietary guidelines for infants, children, and adults in Germany as the basis for the model calculation. The guidelines for 4 representative age groups were examined, representing exclusive milk feeding (2 months), complementary feeding (8 months), and mixed family diet (children: 4-6 years, adolescents: 11-14 years). For each age group (except 2 months), the contribution of animal-based food groups (milk/dairy, meat, fish, eggs) to the total daily intake of vitamin B12 was calculated based on 7-day menus with recipes for all meals. This allowed us to assess the potential Vitamin B12 deficits due to food group exclusion. Even in the guidelines diets, including exclusive breastfeeding, the vitamin B12 intakes just reached the reference values in all age groups. In infants on complementary feeding and also later in children and adolescents, cow's milk was by far the most important source of vitamin B12. Among the other animal-based foods, meat (16.9%-23.0%) ranked first, followed by fish (11.0%-16.5%), and eggs (8.1%). In our analysis of the German food-based guidelines for infant, child, and adolescent diets, the increased planetary health due to reduction of milk intake turned out severely to compromise vitamin B12 intake. In children, a reduction in the consumption of animal foods to improve the health of the planet must be weighed against the risk of inadequate intake of individual nutrients.

Ethnic disloyalty or federal loyalty? A case of contesting Baloch representation in postcolonial Pakistan

This article captures the representation of the Baloch ethnic minority in Pakistan’s multinational federation. The research establishes a taxonomy of Baloch representatives and their contesting ideological positions by analysing a sample of news articles published in Pakistan’s national and international newspapers between 2006 and 2024. This approach provides fresh insights into the complex dynamics of minority representation for the Baloch. The study classifies the contesting groups of Baloch representatives into three clusters: (a) The federalists, (b) The nationalists, and (c) The secessionists. Not restricting its scope to periodisation, the research further investigates if there are linkages between the British colonial view of the Baloch, their treatment as a belligerent ethnic group and the submission of their ethnic loyalty in the postcolonial federation of Pakistan. Using the qualitative content analysis technique, the research attaches themes emerging from the analysed discourse of Baloch representatives from the news articles. Moreover, the article scrutinises each representative group’s understanding of how they perceive themselves and other representatives of the Baloch minority within the federation – in the context of the broader Baloch question. The research also aims to provoke thought within federalism theory: if representatives of an ethnic minority group show more allegiance to the federal centre than the minority they represent, is it a case of federal loyalty or ethnic disloyalty?

Development of an Evaluation Model for Industrial Internship Programs

Evaluation of industrial internship programs is crucial to assess their effectiveness and ensure alignment with the needs of the workforce. This study arises from several pressing issues, including the lack of competency alignment between vocational education and industry, significant gaps in the design and implementation of apprenticeship programs, and the reliance on conventional evaluation methods that lack technological integration. The research aims to address these challenges by developing a robust evaluation model tailored for industrial apprenticeship programs in Indonesia and Malaysia. Drawing upon established frameworks such as the CIPP model, Countenance Model, and Kirkpatrick evaluation model, this study incorporates innovative elements, including an adaptive, technology-driven evaluation system designed to enhance assessment accuracy and relevance. The novelty of this research lies in its focus on creating a link-and-match ecosystem between vocational education and industry, leveraging advanced evaluation tools to provide actionable insights for improving program quality and policy decisions. Using interviews, questionnaires, and field observations, data were collected from a diverse group of vocational university students, lecturers, and industry representatives. The findings not only validate the urgent need for an enhanced evaluation model but also demonstrate its potential to elevate the preparedness of graduates, equipping them with the skills and competencies required to succeed in the job market or as entrepreneurs. The final deliverables include a comprehensive evaluation framework, a technology-based assessment application, and a handbook to support stakeholders in adopting and implementing the model.

Brain, heart and lung weight in landrace pigs and their association with biochemical indicators

The genesis of internal organ systems is determined by a spectrum of various factors and characterizes the growth rate of animals, their constitution, resistance to diseases and the ability of animals to adapt to environmental conditions. An assessment of the absolute weight of the lungs, brain and heart of Landrace pigs of Irish selection was carried out. At the early stages of the technological cycle, a representative group of pigs was formed, taking into account their origin, sex, age, and live weight. The total number of animals was 12. The fattening of the animals took place in a large pig-breeding farm in the Altai Territory, where standard living conditions were provided according to the standards of meat fattening of animals. Vaccination of animals was carried out in accordance with the preventive plan, and systematic veterinary control was provided. At the end of the technological cycle, when the live weight reached 100 kg, slaughter was carried out on the basis of the current technological instructions. The absolute mass of organs without surrounding structures was determined by weighing on scales with a high accuracy class. The obtained data were evaluated using Microsoft Office Excel and the R programming language in the data analysis environment RStudio version 2022.07.2+576 (RStudio, PBC). Visual assessment showed the absence of pathoanatomic changes in organs. In all cases, based on the ShapiroWilk test, a normal distribution was established. In pigs, the median absolute lung weight was 447.8 g, brain – 81.6 g, for the heart – 33.8 g; 95% confidence interval for the lungs – 245,56 525,85 g, for the brain 45,33–98,42 g, for the heart – 190,21–404,49 g. The article provides indicators of variability of the trait in question. The interbreed differentiation of pigs by lung and heart weight has been established.

Prevalence of Hypertension in Outpatient Consultations in a Cardiology Department in West Africa in Dakar, Senegal According to "MY MEASURE MONTH"

Objectives: This study, conducted as part of the "My Measure Month" program in collaboration with the French Society of Hypertension, aimed to investigate the prevalence of hypertension, emphasize the importance of measuring blood pressure. Methodology: This was an observational and cross-sectional study conducted over one month in the outpatient department of a center specialized in hypertension management. The study included patients aged over 18 years. We examined hypertension data (duration, treatments, compliance) and cardiovascular risk factors. Blood pressure was measured. Three measurements were taken at one-minute intervals. In the bivariate analysis, a p-value ≤ 0.05 was considered statistically significant. Results: The prevalence of hypertension was 45.6%. Hypertension was more frequent in women (54.2%), and the most represented age group was 50 to 70 years, with a prevalence exceeding 70% in patients over 70 years old. In our sample, 13% of patients not previously known to be hypertensive had elevated blood pressure readings. Successive measurements showed variations in hypertension grades, with a progressive decrease in patients with grade II and III hypertension. Among hypertensive patients, 93% had no coverage for their medications. Most patients were on pharmacological treatment, but a significant proportion remained uncontrolled (36.2%), especially those on dual therapy. Bivariate analysis showed that age ≥ 65 years, smoking, dyslipidemia and heart failure were significantly associated with hypertension. Conclusion: An integrated strategy for prevention, screening, and treatment is crucial to reduce the burden of hypertension in this population, improve the quality of life for hypertensive patients.

P0203 Unique faecal & oral microbiota signatures in first degree relatives of inflammatory bowel disease patients

Abstract Background While the aetiology of IBD is unknown, a range of genetic and environmental risk factors have been described. First-degree relatives (FDRs; siblings, parents and children) of IBD patients share many of these factors. To better understand the interplay between environmental and genetic risk factors, we evaluated the gut microbial profiles of an FDR cohort, their IBD probands and healthy controls (HC). The aim was to identify whether FDRs of IBD patients have healthy or IBD-like microbial features. Methods All participants were recruited as part of the Australian IBD Microbiome (AIM) study. Participants were selected based on self-reported first-degree relative status (n=68) and, where possible, affected IBD relatives (n=24) were included for comparison. All participants were antibiotic free for 3-months prior to baseline sampling. Oral and faecal samples underwent 16S rRNA sequencing. The Microbiome Research Centre 16S analysis pipeline and R studio were used for statistical analysis and data visualisation. Results The FDR group was predominantly female (63%) with a mean age of 49.7 years and BMI of 25.5 kg/m2. The IBD cohort was significantly different in age to FDR (mean 36.7; p < 0.05) but not controls (mean 40.4 years) and BMI was comparable between groups. European Australians were the most represented ethnic group (47.6%) and 98.6% of participants were non-smokers. Oral microbiota profiles showed no significant difference in alpha diversity across FDR, IBD and HC groups. Differential abundance analysis of the oral microbiota revealed FDRs had increased abundance of Oribacterium, Granulicatella, Lachnoanaerobaculum and Rothia compared to HC, and increased levels of Capnocytophaga, Tannerella and Abiotrophia compared to the IBD group. In agreement with other studies, faecal microbial profiles in the IBD group had significantly reduced alpha diversity compared to both FDR and HC groups. All groups were compositionally different by Bray-Curtis beta dissimilarity analysis (p<0.018). FDRs had higher abundance of Akkermansia, Alistipes and Monoglobus compared to IBD and HC groups. FDRs and IBD shared similar abundance of Butyricicoccus which was lower than the HCs. Conclusion FDR oral microbiome signatures had greater variance from HC than IBD groups. Faecal microbial analysis showed distinct differences with enrichment of key beneficial genera in the FDR group. FDR profiles however still shared significant gut microbial features with the IBD group, remaining distinct from healthy controls. FDRs oral microbiome was higher in opportunistic pathogens and IBD-like whereas faecal composition was protective, rich in beneficial metabolite producing genera.

National Consensus on the Assessment of Visual Function for Driving in Switzerland.

To establish a national consensus on assessing visual function for fitness to drive in Switzerland. The minimum medical requirements for visual function for fitness to drive are regulated by Swiss Federal Law, namely, by the Traffic Licensing Ordinance (TLO). The medical examination techniques relevant in this context and their assessment are not further specified therein, which leads to legal inequality among drivers and uncertainty among examiners. We established a study group of representatives of the Traffic Medicine Section of the Swiss Society of Forensic Medicine and the Traffic Commission of the Swiss Society of Ophthalmology to develop a national consensus on assessing visual function for fitness to drive in Switzerland. In structured meetings, the authors discussed medical examination techniques and available international and local recommendations on this topic, with respect to Swiss legislation. In the event of a contrary opinion, the topic was discussed again in a follow-up session until we reached an agreement. We defined consensus as complete agreement on the subject under discussion. The study group held five in-person meetings between March 2019 and January 2023. The authors developed recommendations intended for all professional groups assessing driving fitness. We prepared an aid for daily practice on how to examine the minimum medical requirements for visual function listed in the TLO Annex 1, using standardized test procedures and considered how to interpret the findings obtained, accounting for aspects of traffic medicine and ophthalmology. A consensus on the assessment of visual function for fitness to drive in Switzerland is crucial to ensure legal equality for drivers and legal certainty for examiners. Regular review of the consensus is imperative if we are to consider future legal developments and new scientific evidence in assessing fitness to drive.

At-Home Immersive Virtual Reality Exergames to Reduce Cardiometabolic Risk Among Office Workers: Protocol for a Randomized Controlled Trial.

The worldwide rise in the prevalence of noncommunicable diseases has increased the recognition of the need to identify modifiable risk factors for preventing and managing these diseases. The office worker, as a representative group of physically inactive workers, is exposed to risk factors for metabolic syndrome, which is a primary driver of noncommunicable diseases. The use of virtual reality (VR) exergames may offer a potential solution to the problem of increasing noncommunicable disease prevalence, as it can help individuals increase their physical activity levels while providing a more immersive experience. This exploratory study aims to examine the interventional efficacy of at-home immersive VR exergames on metabolic syndrome biomarkers among office workers. Additionally, it seeks to investigate the impacts of at-home immersive VR exergames on the active and sedentary behaviors of office workers. A 3-arm, single-blinded pilot randomized controlled trial will be conducted to examine the therapeutic effects of at-home immersive VR exergames. A total of 120 Chinese office workers, engaging in less than 150 minutes per week of moderate to vigorous intensity physical activity, will be recruited via a convenience sampling method. The participants, who will be tested over a 12-week period, will be randomly assigned to one of three groups: (1) the VR exergame intervention group, (2) the regular physical activity control group, and (3) the nonexercise control group. Throughout the 12-week trial, three categories of variables will be collected across the three groups: clinical risk factors associated with metabolic syndrome, active and sedentary behaviors, and demographics. To analyze variance among the groups, a mixed linear model will be applied to assess the efficacy of each group. Differences in metabolic syndrome clinical risk factors among all groups will be used to evaluate the effects of at-home immersive VR exergames. Changes in active and sedentary behaviors will also be used to determine the impacts of VR exergames on metabolic syndrome. The ethics committee of Guangzhou University, China, approved this study on September 25, 2024. Participant recruitment will begin in early 2025 and continue for approximately 3 months. Data will be analyzed after the 12-week trial is completed, with full results expected to be presented in early 2026. This study explores an emerging topic by applying an at-home immersive VR exergame intervention, potentially contributing to understanding the effects of an exergame program on metabolic syndrome risk among office workers. ClinicalTrials.gov NCT06556784; https://clinicaltrials.gov/study/NCT06556784. PRR1-10.2196/64560.

Unmet Needs in the Management of Chronic Kidney Disease-Associated Pruritus and the Characteristics of the Ideal Treatment: A Spanish Cross-Sectional Survey from a Multidisciplinary Perspective.

Objectives: Chronic kidney disease-associated pruritus (CKD-aP) is underdiagnosed and not fully understood by healthcare professionals, which leads to poor patient management and impacts patients' quality of life (QoL). The aim of this study was to analyse unmet needs in CKD-aP management and explore the attributes/characteristics that the ideal CKD-aP treatment should have from the perspective of a group of nephrologists, hospital pharmacists, nurses, patient representatives, and regional health authorities in Spain. Methods: A descriptive, cross-sectional study was conducted using an e-survey including ad hoc questions (6-point Likert scale) related to unmet needs in CKD-aP and best-worst scaling (BWS) to prioritise the attributes/characteristics of the ideal CKD-aP treatment. The survey was developed from a literature review, a patient focus group, and a multidisciplinary expert committee. Results: A total of 21 people participated, and it was considered, among other aspects, that CKD-aP had a significant impact on patient QoL (4.29/5), but the diagnosis rate and knowledge level of agents involved, as well as current treatment efficacy and safety, were low (1.71/5, 2.19/5, 1.91/5, and 2.67/5, respectively). The attributes "improves overall QoL (physical and mental)", "reduces itch with statistical significance", and "treatment is supported by clinical development/high evidence and has AEMPS (Spanish Agency for Medicines and Medical Devices)-approved indication for pruritus" were selected as the most valued attributes. There was a positive balance between best-worst scores (86-5, 71-2, and 78-13 points, respectively). Conclusions: The results show the need to undertake actions to drive relevant changes in current clinical practice to improve CKD-aP diagnosis and management.

Revealing the removal behavior of polystyrene nanoplastics and natural organic matter by AlTi-based coagulant from the perspective of functional groups.

The interactions of nanoplastics (NPs) with natural organic matter (NOM) are influenced by their surface functional groups. In this study, the effects of representative functional groups on the interactions among polystyrene nanoplastics (PS-COOH and PS-NH2), hydrophilic low molecular weight (LMW) substances (salicylic acid (SA), phthalic acid (PA), and gluconic acid (GA)), and a novel AlTi-based coagulant were investigated. We found that PS-NH2 (83.02 % - 93.38 %) was easier to remove over a wider pH range than PS-COOH (6.94 % - 91.07 %). PS-COOH and PS-NH2 were both able to interact with SA (-OH, -COO-, and benzene ring) through hydrogen bonding, π-π conjugation, and n-π electron donor-acceptor interactions. However, the binding of PS-COOH/PS-NH2 with SA has no effect on the interaction strength between SA and PATC due to the preferential occupation of the coagulant binding sites by SA. The lower SA removal in the PS-COOH@SA system was attributed to its stronger electrostatic repulsion and hydrophilicity. PATC could form carboxylate outer and C-O inner complexes with SA and carboxylate inner complexes with PA. In this study, the analysis of the interaction mechanisms among metal-based coagulants, NPs, and LMW substances lays a theoretical foundation for further research and understanding of coagulation theory.

A case for broadening our view of mechanism in developmental biology.

Developmental biologists can perform studies that describe a phenomenon (descriptive work) and/or explain how the phenomenon works (mechanistic work). There is a prevalent perception that molecular/genetic explanations achieved via perturbations of gene function are the primary means of advancing mechanistic knowledge. We believe this to be a limited perspective, one that does not effectively represent the breadth of work in our field. We surveyed a representative and diverse group of colleagues to share their views on what it takes to infer mechanism. Here, we briefly examine the factors that have shaped the dominant view of mechanism, summarize responses to the survey, present our views, and suggest a path forward that embraces a broad outlook on the diversity of studies that advance knowledge in our field.

CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity.

Contrast media, including iodinated contrast media and gadolinium-based contrast agents, are commonly administered pharmaceuticals with excellent safety profiles. However, a minority of the population may experience a hypersensitivity reaction following intravenous administration. Hypersensitivity reactions can be immediate or delayed, and range from mild, such as urticaria, to severe, including anaphylaxis. There is emerging evidence that longstanding pretreatment protocols, such as diphenhydramine and corticosteroids, are ineffective and have the potential for side effects and other harms. Moreover, the evidence for efficacy on which this practice is based is weak and outdated. A joint collaborative working group of representatives from the Canadian Association of Radiologists and the Canadian Society of Allergy and Clinical Immunology was assembled to inform medical professionals and hospital policies regarding hypersensitivity reactions to contrast media. The objectives of the working group were to provide an overview of the epidemiology, physiology, risk factors, and types of hypersensitivity reactions; to synthesize the evidence for pretreatment strategies that minimize the risk of a breakthrough reaction for both iodinated contrast media and gadolinium-based contrast agents; to review the allergy investigations used to evaluate patients with a history of severe hypersensitivity reaction; and to provide an overview of existing guidelines. Following appraisal of the evidence, the working group established recommendations based on consensus in this practice guidance.

Gastroenterologists' Goals for Ergonomic Colonoscopes: Results of a National Survey.

Survey based studies show a high prevalence of endoscopy related injury (ERI). This survey aims to provide data regarding the type of design changes to the colonoscope that would be most beneficial for gastroenterologists and facilitate user-centered design changes. A 26-item anonymous, electronic, multiple-choice survey was answered by 455 gastroenterologists. Information obtained included demographic data (age, gender), workload parameters (current practice type, years practicing, time spent performing endoscopy), and questions related to colonoscope maneuvers and design (hand size, ease of use of tip angulation controls, impact of shaft parameters, use of right-hand torque, use of dial extenders, future desired design changes). Data analysis was performed using IBM SPSS 29.0. The survey respondents included a broad distribution of representative groups, with 55.3% in private practice, 31.4% women, and 51.5% having > 10 years in practice. 85.7% favored a pro-ergonomic colonoscope redesign, with customizability for hand size of the control knobs (85%) and decreased force required for "up/down" knob manipulation (78%) being the most desired features. Women were statistically more likely to desire a more ergonomic colonoscope and customizability for hand size (P < 0.001). This paper reports the results of the first national survey to assess gastroenterologist preferences for ergonomic colonoscope design changes. The colonoscope changes respondents prioritized were those pertaining to customizability for hand size and more easily manipulated control surfaces. Professional societies and industry should work together to design scopes more aligned with best ergonomic principles.

Pattern of Thyroid Disorders in a Tertiary Care Centre of a High-Altitude Region of Nepal: A hospital-based retrospective study

Background: Millions of people globally suffer from thyroid disorders, with over half of them are unaware of their conditions. Untreated, these disorders can lead to severe health complications such as heart problems, pregnancy complications, goiter, bone health issues, etc. Jumla, a high-altitude Himalayan region in Nepal, includes iodine-deficient areas, making it prone to thyroid disorders. This study aimed to identify the prevalence and pattern of thyroid disorders in this region. Methods: A retrospective hospital-based cross-sectional study was conducted using data from the Karnali Academy of Health Sciences, Jumla, spanning from 1st January–31st December 2023. Participants of all ages with complete thyroid function test results (fT3, fT4, and TSH assessed via chemiluminescence immunoassay) were included. Data were extracted from Bahmni EMR, cleaned in MS-Excel, and analyzed in R software, with a significance threshold of p &lt; 0.05. Results: Among 816 participants (mean age: 35.66 ± 14.60 years), 660 (80.8%) were female, and 156 (19.1%) were male. The most represented age group was 25–34 years. Subclinical hypothyroidism was the most prevalent disorder, affecting 33 males (21.15%) and 143 females (21.66%). Primary hyperthyroidism was the least common, found in 1 male (0.64%) and 7 females (1.06%). Other disorders included secondary hypothyroidism, secondary hyperthyroidism, primary hypothyroidism, and subclinical hyperthyroidism. Conclusion: Subclinical hypothyroidism was the most common thyroid disorder, with females disproportionately affected. Wider population screening for early detection and management is essential to mitigate health risks.

Dutch Nationwide Cohort Experience with a New PROMs Set in Metabolic and Bariatric Surgery: BODY-Q Obesity Module.

Patient-reported outcomes are important as obesity is a chronic disease with a substantial impact. A multidisciplinary task force selected six scales (48 questions) from the validated BODY-Q questionnaire. This subset was gradually introduced and evaluated in a mandatory nationwide registry. The focus was to assess the scale's module results and its feasibility in a quality registry. All Dutch patients undergoing bariatric surgery between 2019 and 2022 were selected. Completed questionnaires of RAND-36, EQ-5D-5L, and BODY-Q were reviewed with baseline and 1-year results. Uni- and multivariable regression analyses were performed to assess the relationship between baseline characteristics and quality of life scores over time. A total of 10,972 patients completed at least one BODY-Q scale. The lowest score was on the body image scale preoperatively (28.2, SD 20.9) and the highest on the social scale postoperatively (76.2, SD 18.8). A representative group of 510 patients with repeated measurements showed the most improvement on the body image scale (+ 32.2) followed by physical function (+ 26.3). Multivariable linear regression analysis showed a significant influence, primarily for gender, age, and BMI on BODY-Q scores. Score improvement for BODY-Q was mainly driven by weight loss, while EQ-5D-5L and RAND-36 showed no clear pattern. Comparing the three questionnaires showed significant correlations for physical and social function only. The BODY-Q obesity module demonstrates potential as a relevant PROM for inclusion in a quality registry. BODY-Q scores provide a foundation for future research, with notable improvements in quality of life observed, particularly in the body image and physical function scales.

Applications of Entropy in Data Analysis and Machine Learning: A Review.

Since its origin in the thermodynamics of the 19th century, the concept of entropy has also permeated other fields of physics and mathematics, such as Classical and Quantum Statistical Mechanics, Information Theory, Probability Theory, Ergodic Theory and the Theory of Dynamical Systems. Specifically, we are referring to the classical entropies: the Boltzmann-Gibbs, von Neumann, Shannon, Kolmogorov-Sinai and topological entropies. In addition to their common name, which is historically justified (as we briefly describe in this review), another commonality of the classical entropies is the important role that they have played and are still playing in the theory and applications of their respective fields and beyond. Therefore, it is not surprising that, in the course of time, many other instances of the overarching concept of entropy have been proposed, most of them tailored to specific purposes. Following the current usage, we will refer to all of them, whether classical or new, simply as entropies. In particular, the subject of this review is their applications in data analysis and machine learning. The reason for these particular applications is that entropies are very well suited to characterize probability mass distributions, typically generated by finite-state processes or symbolized signals. Therefore, we will focus on entropies defined as positive functionals on probability mass distributions and provide an axiomatic characterization that goes back to Shannon and Khinchin. Given the plethora of entropies in the literature, we have selected a representative group, including the classical ones. The applications summarized in this review nicely illustrate the power and versatility of entropy in data analysis and machine learning.

Setting the foundation for a national collaborative learning health system in acute TBI rehabilitation: CARE4TBI Year 1 experience

AbstractIntroductionA learning health system (LHS) approach is a collaborative model that continuously examines, evaluates, and re‐evaluates data eventually transforming it into knowledge. High quantity of high‐quality data are needed to establish this model. The purpose of this article is to describe the collaborative discovery process used to identify and standardize clinical data documented during daily multidisciplinary inpatient rehabilitation that would then allow access to these data to conduct comparative effectiveness research.MethodsCARE4TBI is a prospective observational research study designed to capture clinical data within the standard inpatient rehabilitation documentation workflow at 15 TBI Model Systems Centers in the US. Three groups of stakeholders guided project development: therapy representative work group (TRWG) consisting of frontline therapists from occupational, physical, speech‐language, and recreational therapies; rehabilitation leader representative group (RLRG); and informatics and information technology team (IIT). Over a 12‐month period, the three work groups and research leadership team identified the therapeutic components captured within daily documentation throughout the duration of inpatient TBI rehabilitation.ResultsData brainstorming among the groups created 98 distinct categories of data with each containing a range of data elements comprising a total of 850 discrete data elements. The free‐form data were sorted into three large categories and through review and discussion, reduced to two categories of prospective data collection—session‐level and therapy activity‐level data. Twelve session data elements were identified, and 54 therapy activities were identified, with each activity containing discrete sub‐categories for activity components, method of delivery, and equipment or supplies. A total of 561 distinct meaningful data elements were identified across the 54 activities.DiscussionThe CARE4TBI data discovery process demonstrated feasibility in identifying and capturing meaningful high quantity and high‐quality treatment data across multiple disciplines and rehabilitation sites, setting the foundation for a LHS coalition for acute traumatic brain injury rehabilitation.