Individual Cases Research Articles

Body integrity dysphoria and moral responsibility: an interpretation of the scepticism regarding on-demand amputations

A patient who requests an amputation deemed medically unnecessary by professionals is disqualified per se from being regarded as having medical decision-making capacity. This decision is based on the assumption...

Assessment of Neurologic Safety Profile of Immune Checkpoint Inhibitors: Evaluation of Adverse Drug Reaction Reports.

Immune checkpoint inhibitors (ICIs) used in immunotherapy have revolutionized cancer management. However, ICI therapy can come with serious neurologic risks. The objective of our study is to analyze the occurrence of neurologic events with ICIs. We referred to EudraVigilance (EV) and VigiAccess to evaluate the frequency of individual case safety reports (ICSRs), including neurologic events with ICIs. Data was gathered for a period from the date of ICI's marketing authorization till 30 January 2023. The computational assessment was conducted with the help of reporting odds ratio (ROR) and its 95% confidence interval (CI). Overall, 8181 ICSRs in EV and 15905 ICSRs from VigiAccess were retrieved for neurologic events, with at least one ICI as the suspected drug. The majority of the ICSRs were reported for nivolumab, pembrolizumab, and ipilimumab, whereas frequently reported events were neuropathy peripheral, myasthenia gravis, seizure, Guillain-Barre syndrome, paraesthesia, syncope, encephalopathy, somnolence. Under EV, 92% of ICSRs were reported as serious, 10% included fatal outcomes, and nearly 61% cited patient recovery. Atezolizumab (ROR 1.64, 95% CI 1.75- 1.52), cemiplimab (ROR 1.61, 95% CI 1.98-1.3), and nivolumab (ROR 1.38, 95% CI 1.44-1.31) had a considerable increase in the frequency of ICSR reporting. Cerebrovascular accident, posterior reversible encephalopathy syndrome, tremor, and somnolence were identified as potential signals. ICIs were significantly associated with neurologic risks, which cannot be generalized. A considerable increase in ICSR reporting frequency was observed with atezolizumab, cemiplimab, and nivolumab, while avelumab, pembrolizumab, durvalumab, and cemiplimab were linked with four potential signals. These findings suggest the consideration of a revision of the neurologic safety profile of ICIs. Furthermore, the necessity for additional ad-hoc research is emphasized.

Strong effect of demographic changes on Tuberculosis susceptibility in South Africa.

South Africa is among the world's top eight tuberculosis (TB) burden countries, and despite a focus on HIV-TB co-infection, most of the population living with TB are not HIV co-infected. The disease is endemic across the country, with 80-90% exposure by adulthood. We investigated epidemiological risk factors for (TB) in the Northern Cape Province, South Africa: an understudied TB endemic region with extreme TB incidence (926/100,000). We leveraged the population's high TB incidence and community transmission to design a case-control study with similar mechanisms of exposure between the groups. We recruited 1,126 participants with suspected TB from 12 community health clinics and generated a cohort of 774 individuals (cases = 374, controls = 400) after implementing our enrollment criteria. All participants were GeneXpert Ultra tested for active TB by a local clinic. We assessed important risk factors for active TB using logistic regression and random forest modeling. We find that factors commonly identified in other global populations tend to replicate in our study, e.g. male gender and residence in a town had significant effects on TB risk (OR: 3.02 [95% CI: 2.30-4.71]; OR: 3.20 [95% CI: 2.26-4.55]). We also tested for demographic factors that may uniquely reflect historical changes in health conditions in South Africa. We find that socioeconomic status (SES) significantly interacts with an individual's age (p = 0.0005) indicating that protective effect of higher SES changed across age cohorts. We further find that being born in a rural area and moving to a town strongly increases TB risk, while town birthplace and current rural residence is protective. These interaction effects reflect rapid demographic changes, specifically SES over recent generations and mobility, in South Africa. Our models show that such risk factors combined explain 19-21% of the variance (r2) in TB case/control status.

Characterization of urinary metabolites associated with malaria infection using infra-red spectroscopy and liquid chromatography–mass spectrometry in South Western Uganda

Early malaria diagnosis improves outcomes during malaria treatment; routine diagnostic techniques rely on blood samples obtained invasively. Therefore, this study used infra-red (IR) spectroscopy coupled with Principle Component Analysis (PCA) to study the urinary profile of malaria patients and that of controls aimed at understanding metabolite perturbation during malaria infection so as to contribute towards development of non-invasive malaria diagnosis methods. Freeze dried human urine samples form malaria infected individuals (cases) and controls were screened in the IR region of 4000 cm−1 to 600 cm−1 and overall spectral differences were observed at wave numbers 1618 cm−1, 1679 cm−1 (amino acids). Peaks at 3030 cm−1 (NH4+) and 940 cm−1 (O–H of carboxylic acids) showed high absorbance in patients compared to controls. Liquid-chromatography–mass spectrometry (LC–MS/MS) was used to quantify amino acids in the urine samples and the results indicated a significant increase of amino acid cystine (P = 0.012). Lysine and tyrosine also increased in patients compared to controls. The use of IR-PCA differentiated clusters of urine samples from patients with malaria from control and the demonstrated amino acid perturbation is consistent with malaria infection. This data provides baseline information for application in development of a non-invasive diagnostic tests for malaria.

Polygenic risk score adds to a clinical risk score in the prediction of cardiovascular disease in a clinical setting.

A cardiovascular disease polygenic risk score (CVD-PRS) can stratify individuals into different categories of cardiovascular risk, but whether the addition of a CVD-PRS to clinical risk scores improves the identification of individuals at increased risk in a real-world clinical setting is unknown. The Genetics and the Vascular Health Check Study (GENVASC) was embedded within the UK National Health Service Health Check (NHSHC) programme which invites individuals between 40-74 years of age without known CVD to attend an assessment in a UK general practice where CVD risk factors are measured and a CVD risk score (QRISK2) is calculated. Between 2012-2020, 44,141 individuals (55.7% females, 15.8% non-white) who attended an NHSHC in 147 participating practices across two counties in England were recruited and followed. When 195 individuals (cases) had suffered a major CVD event (CVD death, myocardial infarction or acute coronary syndrome, coronary revascularisation, stroke), 396 propensity-matched controls with a similar risk profile were identified, and a nested case-control genetic study undertaken to see if the addition of a CVD-PRS to QRISK2 in the form of an integrated risk tool (IRT) combined with QRISK2 would have identified more individuals at the time of their NHSHC as at high risk (QRISK2 10-year CVD risk of ≥10%), compared with QRISK2 alone. The distribution of the standardised CVD-PRS was significantly different in cases compared with controls (cases mean score .32; controls, -.18, P = 8.28×10-9). QRISK2 identified 61.5% (95% confidence interval [CI]: 54.3%-68.4%) of individuals who subsequently developed a major CVD event as being at high risk at their NHSHC, while the combination of QRISK2 and IRT identified 68.7% (95% CI: 61.7%-75.2%), a relative increase of 11.7% (P = 1×10-4). The odds ratio (OR) of being up-classified was 2.41 (95% CI: 1.03-5.64, P = .031) for cases compared with controls. In individuals aged 40-54 years, QRISK2 identified 26.0% (95% CI: 16.5%-37.6%) of those who developed a major CVD event, while the combination of QRISK2 and IRT identified 38.4% (95% CI: 27.2%-50.5%), indicating a stronger relative increase of 47.7% in the younger age group (P = .001). The combination of QRISK2 and IRT increased the proportion of additional cases identified similarly in women as in men, and in non-white ethnicities compared with white ethnicity. The findings were similar when the CVD-PRS was added to the atherosclerotic cardiovascular disease pooled cohort equations (ASCVD-PCE) or SCORE2 clinical scores. In a clinical setting, the addition of genetic information to clinical risk assessment significantly improved the identification of individuals who went on to have a major CVD event as being at high risk, especially among younger individuals. The findings provide important real-world evidence of the potential value of implementing a CVD-PRS into health systems.

Assessment of Adolescents' Overweight and Obesity Risk Factors Among Alabnaa Schools in Tabuk City, Saudi Arabia.

The prevalence of overweight and obesity among adolescents in Saudi Arabia has been progressively increasing. Obesity is associated with an increased risk of various morbidities and mortality. Identifying the factors that contribute to obesity in this age group is crucial for implementing targeted prevention measures. The aim of this study was to identify risk factors for overweight and obesity among adolescents aged nine to 17 years residing in Tabuk City, Saudi Arabia. A case-control study was conducted during the 2021-2022 academic year at Alabnaa Schools in Tabuk City, Saudi Arabia. The study included overweight/obese individuals (cases, n = 125) and normal-weight individuals (controls, n = 201) who were selected based on their body mass index and classified according to the World Health Organization's reference for defining overweight and obesity in individuals aged five to 19 years. Data were collected from both groups using a self-administered questionnaire. The study analyzed 125 overweight/obese students and 201 normal-weight students who were matched for sex and age (p > 0.05). Logistic regression analysis identified several risk factors for overweight or obesity among adolescents. A family history of obesity was found to be associated with a 5.735 times increased likelihood of obesity (95% CI: 3.318-9.912, p < 0.001). Another significant contributing risk factor for obesity was frequent consumption of four or more meals per day (adjusted odds ratio: 3.091, 95% CI: 1.094-8.736, p = 0.033). Students who used electronic devices for more than five hours were 2.422 times more likely to exhibit obesity (p = 0.006). Certain factors may increase the risk of overweight or obesity in adolescents aged nine to 17 years. These factors include frequent eating, prolonged use of electronic devices, family history of obesity, and the misconception that obesity is not an illness. Tailored school health programs are needed to improve students' healthy lifestyles and eating behaviors, minimize sedentary entertainment and use of electronic devices, and engage children in physical activity.

Multilevel meta-analysis of single-case experimental designs using robust variance estimation.

Single-case experimental designs (SCEDs) are used to study the effects of interventions on the behavior of individual cases, by making comparisons between repeated measurements of an outcome under different conditions. In research areas where SCEDs are prevalent, there is a need for methods to synthesize results across multiple studies. One approach to synthesis uses a multilevel meta-analysis (MLMA) model to describe the distribution of effect sizes across studies and across cases within studies. However, MLMA relies on having accurate sampling variances of effect size estimates for each case, which may not be possible due to auto-correlation in the raw data series. One possible solution is to combine MLMA with robust variance estimation (RVE), which provides valid assessments of uncertainty even if the sampling variances of effect size estimates are inaccurate. Another possible solution is to forgo MLMA and use simpler, ordinary least squares (OLS) methods with RVE. This study evaluates the performance of effect size estimators and methods of synthesizing SCEDs in the presence of auto-correlation, for several different effect size metrics, via a Monte Carlo simulation designed to emulate the features of real data series. Results demonstrate that the MLMA model with RVE performs properly in terms of bias, accuracy, and confidence interval coverage for estimating overall average log response ratios. The OLS estimator corrected with RVE performs the best in estimating overall average Tau effect sizes. None of the available methods perform adequately for meta-analysis of within-case standardized mean differences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

질적 메타분석을 통해 살펴본 교사-부모 관계에 관한 영유아교사의 경험

Objectives This study aims to identify factors that influence the formation of teacher-parent relationships as early childhood educators experience interactions with parents, and to explore how these variables affect changes in early childhood educators. Methods To achieve this, a qualitative meta-analysis was conducted on qualitative research materials regarding early childhood teacher-parent relationship experiences. The analysis included 18 qualitative research papers published in domestic journals (KCI listed) from 2000 to 2023. Through processes of data coding between in-dividual studies, case categorization and classification across studies, comparative analysis between studies, and deriving and interpreting results, the changes in teachers during the early childhood teacher-parent relationship process were identified. Results First, the factors of negative experience in the teacher-parent relationship were parental disposition, ex-cessive demands of parents, imbalance in the relationship, teachers' own factors, problems in the teacher training process, and emotional dissonance. Second, the teacher-parent relationship was shown to be a change stage in three stages: teacher-parent relationship experience, coping, and growth into a professional early childhood teacher. Conclusions This study attempted to clarify in depth by comprehensively comparing and interpreting individual qualitative studies on the experience of teacher-parent relationships. We identified relevant factors linked to the teacher-parent relationship and derived comprehensive results.

Pneumococcal vaccination effectiveness (PCV13 and PPSV23) in individuals with and without reduced kidney function: a test-negative design study.

Streptococcus pneumoniae vaccination effectiveness (VE) in individuals with reduced kidney function is unknown. We estimated pneumococcal conjugate vaccine (PCV13), pneumococcal polysaccharide vaccine (PPSV23), and combined PCV13 and PPSV23 effectiveness against pneumococcal disease in individuals with and without reduced estimated glomerular filtration rate (eGFR). All eligible individuals (case and controls) were adults (aged ≥18 years) hospitalized within the Geisinger Health System and required to have S. pneumoniae urinary antigen testing (i.e. test-negative design). Vaccination records were obtained from the electronic health record and statewide vaccination registry. After controlling for the probability of receiving a pneumococcal vaccine, we used multivariable logistic regression models to estimate the odds ratios (ORs) of vaccination between those who did and did not meet the S. pneumoniae case definition. VE was calculated as (1-OR)×100%. There were 180 cases and 3889 controls (mean age 69 years, female 48%, white 97%, mean eGFR 71mL/min/1.73m2). The adjusted population PCV13 VE was 39% (95% CI 13%-58%), and combination PCV13 and PPSV23 was 39% (95% CI 12%-58%). PPSV23 VE was -3.7% (95% CI -57% to 32%). Stratified by eGFR, adjusted PCV13 VE was consistent in eGFR ≥60 [VE 38% (95% CI 2.9%-61%)] and 30-59 [VE 61% (95% CI 24%-80%)] without significant interaction. VE was not calculable for eGFR <30 due to small sample size. PCV13 vaccination was associated with reduced risk of S. pneumoniae hospitalization in individuals with a reduced eGFR (30-59mL/min/1.73m2).

Enhancing the Efficiency of the Individual Case Safety Report (ICSR) Quality and Compliance through Automation.

Over the past few years, major inspection findings have been identified in the "management of adverse reactions" that may be due to increasing workload in pharmaceutical organizations impacting the correctness of information in individual case safety reports (ICSRs). Although retrospective quality check (Retro-QC) and late submission analyses are important steps in ensuring ICSR quality, their manual application poses several challenges that can be overcome through automation. To improve the efficiency of the Retro-QC analysis and late submission analysis using a computer-operated tool called Compliance and Metrics Management (CMM) tool, and to measure the tool's effectiveness in terms of productivity, time, and cost savings by comparing against the manual process. Time savings were calculated by measuring the difference in time taken during the manual process versus the automated process. Cost savings were measured in terms of hourly remuneration for the time saved. Productivity was calculated as the difference between the number of cases handled in the manual versus automated process. Thus, the overall efficiency was measured in terms of time and cost savings along with increased productivity. Automation resulted in time savings of 49% and cost savings of 43% for Retro-QC analysis, and the productivity level increased by 67%. For late submission analysis, the CMM tool resulted in time savings of 88% and cost savings of 87%. CMM tool enhanced the efficiency of both Retro-QC and late submission analyses by increasing productivity along with time and cost savings. It also reduced the number of errors, thereby enhancing the accuracy of the process and overall compliance.

Effect of Enteric Fever on Hematological Cells Parameters

Background: Salmonella typhoid and paratyphoid are the agents that cause Enteric fever (Typhoid fever). It is primarily a disease of developing countries because of poor sanitation standards. Fever is a prominent and well-known feature of the illness that increases steadily to a maximum degree. The hematological criteria of an affected individual are changed by this infectious disease. To ascertain the different hematological cells parameters in our sample population, we conducted the investigation. Patients and Methodology: The study, which involved 100 Afghans, was carried out at the Nangarhar University Teaching Hospital between June and November of 2022. A case-control study design was used. Fifty individuals (Cases) who had a confirmed diagnosis of Enteric fever (Typhoid fever) based on typhoid (IgG and IgM) were included in the study. As a control group, fifty healthy individuals with negative typhoid (IgG and IgM) results and no other complaints were included in the study. For both the case and control groups, a complete blood count was performed. Hemoglobin (Hb), White Blood Cell Count (WBC), and Platelet Count (PLT) are regarded as hematological markers. Every patient was also interviewed, and a questionnaire was employed. Numerous demographic factors were questioned, including sex, age, economic status, level of education, and clinical symptoms. SPSS version 16 was then used to analyze the collected data. Results. In the current research, over all 100 patients were enrolled (50 were case, and 50 were control group). The mean age± SD of the patients under the study were 38.74±15.22 years. The most common hematological changes observed were; anemia (32%), thrombocytopenia (24%), leukocytosis (8%) &amp; leucopenia (22%). Fever was the most common presenting symptom (78%) and abdominal symptoms were about 38%. Most of the people were of lower socioeconomic state and were uneducated. Conclusion: This study shows that Enteric fever is bacterial infection and are acquired by enteral route. This disease commonly affects people of low socioeconomical states and those that are uneducated. Fever was the most commonly presenting symptom in these patients. Enteric fever causes changes in the hematological cells parameters which is probably due to bone marrow suppression, which is transient and shows response to therapy.

Ethics Consult: Using Hospice as "Treatment" for Behavioral Problems of Dementia

Patients with Behavioral and Psychological Symptoms of Dementia (BPSD) are among the most challenging patients to treat; these behaviors are estimated to occur in up to 90% of patients with dementia (Aigbogun 2019); of these, one in 5 patients displays aggression (Eastley 1997). The usual treatments have only modest efficacy at best and at times are ineffective in some individuals. Some behaviors such as physical aggression make it difficult, if not impossible, to find placement for these patients. Placement in nursing homes on a hospice status have traditionally required evidence of a 6 month life expectancy; placement in an inpatient hospice setting is usually reserved for patients with even shorter life expectancies such as 2 weeks. Prognosticating life expectancy in patients with dementia is challenging and often inaccurate (Jayes 2004). Furthermore the use of terminal palliative sedation is supposed to be confined to the last 2 weeks of life and/or extreme physical suffering (Schuman-Oliver 2008, AMA Opinion 2013).This session will present 2 cases of individuals with advanced dementia who did not meet the traditional Medicare criteria for hospice, as both were ambulatory and did not have significant co-morbid medical issues. Both had significant aggressive behaviors that responded poorly to extensive trials of various medications during extended stays on a geriatric psychiatry inpatient unit. Both were referred to a local inpatient hospice where the staff use “suffering" as a hospice criteria and were “treated” with the usual hospice medications and expired in less than 3 weeks.This session will use the two clinical cases to address the following: review the issue of prognostication of advanced dementia and the challenges of defining the end of life; review efforts to define “suffering” in advanced dementia in both the medical and ethics literature; review issues concerning palliative sedation; define how this differs from medical aid in dying and euthanasia. The experience of Dutch geriatricians addressing these issues will be presented (Veldwijck-Rouenhorst 2021). A geriatric psychiatrist will present the 2 cases and set up the questions and ethical issues that these cases pose. An ethics professor-scholar from Emory University will review the ethics literature and teachings that address these issues and help lead a discussion with the audience. The overall goal is to provide a framework of steps the audience members can take if confronted with similar cases.

Sensitivity to basic emotional expressions and the emotion perception space in the absence of facial mimicry: The case of individuals with congenital facial palsy.

According to sensorimotor simulation models, recognition of another person's emotion is achieved by recreating the motor production of the perceived facial expression in oneself. Therefore, congenital difficulties in the production of facial expressions may affect emotion processing. The present study assessed a sample (N = 11) of Moebius syndrome (MBS) patients and a matched control group (N = 33), using a highly sensitive emotion recognition task. Leveraging the uniqueness of MBS, which is characterized by congenital facial paralysis, the role of facial mimicry and sensorimotor simulation in creating precise embodied concepts of emotion categories was investigated. Particularly, the research focused on how MBS patients (both as a group and individually, compared to controls) perceived the intensity of primary emotions and how well they discriminated between these and secondary (i.e., blended) emotions. The results showed that MBS patients registered significantly lower intensities for sadness, fear, anger, and disgust. Furthermore, these emotions appeared closely clustered-and therefore confused with anger and surprise-in the multidimensional scaling map, which was used to qualitatively analyze the emotion perception space. Further analysis of each MBS participant showed a stronger tendency in most patients to perceive primary emotions as less intense, relative to controls. Thus, the findings provide evidence for a residual deficit in emotion processing in adults with MBS. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Compositional data analysis tutorial.

This article presents techniques for dealing with a form of dependency in data arising when numerical data sum to a constant for individual cases, that is, "compositional" or "ipsative" data. Examples are percentages that sum to 100, and hours in a day that sum to 24. Ipsative scales fell out of fashion in psychology during the 1960s and 1970s due to a lack of methods for analyzing them. However, ipsative scales have merits, and compositional data commonly occur in psychological research. Moreover, as we demonstrate, sometimes converting data to a compositional form yields insights not otherwise accessible. Fortunately, there are sound methods for analyzing compositional data. We seek to enable researchers to analyze compositional data by presenting appropriate techniques and illustrating their application to real data. First, we elaborate the technical details of compositional data and discuss both established and new approaches to their analysis. We then present applications of these methods to real social science data-sets (data and code using R are available in a supplementary document). We conclude with a discussion of the state of the art in compositional data analysis and remaining unsolved problems. A brief guide to available software resources is provided in the first section of the supplementary document. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bitcoin Use Cases: A Scoping Review

This scoping review examines individual and societal use cases of Bitcoin in the peer-reviewed literature. Arksey and O’Malley’s scoping review methodology was used, and a comprehensive search strategy was employed using Web of Science and Engineering village databases. Articles were screened at the title and abstract and full-text levels by the authors. One author conducted data extraction to summarize the data. In total, 17 relevant articles were included in this review. Investment and savings were the most widely reported use cases at an individual level, with payments and international transfers less frequently reported in the studies. Only two studies reported on societal use cases of legal tender; however, only one country, El Salvador, executed its intention. Our study suggests that Bitcoin is being used by individuals around the world with little report of societal (e.g., country adoption) uses cases. For example, there is evidence on the internet and on a grass-roots level that Bitcoin is being used in circular economies; however, the peer-reviewed literature may not yet capture the extent and full benefits and challenges. As such, we provide ideas for future research to more comprehensively explore Bitcoin uses and its impacts on individuals and society.

Human rights in international law, state responsibilities and accountability mechanisms: a case study of Iran

ABSTRACT This research presents a critical theoretical and practical re-examination of the link between human rights' issues and politics at national and international levels. The study of human rights is an inherently multidisciplinary enterprise. The paper provides an insight into the relations between diplomacy and human rights and discusses how the latter are exploited for political and commercial aims. This study focuses on the case and constitution of the Islamic Republic of Iran (IRI), and the problem of hostage taking. An internationally-oriented study and based on theoretical arguments and an empirical research approach-notably by using several real cases of ordinary individuals of foreign and dual nationalities who became hostages and the subject of political games and financial conflicts between Iran and the Western countries-the paper highlights the issue of hostage taking of individuals by a state as a political policy and prisoner swaps involving financial and commercial deals. The paper provides evidence of the substantial suffering of the hostages and their families. The paper makes an academic contribution to the literature-the unlawful act of hostage taking involving a state has rarely been discussed -and addresses the legal vacuum in international law and human rights conventions regarding the topic.

Assessing the efficacy of acupuncture as the sole analgesic for canine chronic pain

PICO Question In dogs with chronic pain, is acupuncture alone, compared to a placebo, more efficacious in alleviating pain and pain-related dysfunction? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Four randomised, placebo-controlled clinical trials were critically appraised. Strength of evidence Weak. Outcomes reported A single study evaluating the efficacy of gold bead implantation, a form of permanent acupuncture, on pain associated with canine hip dysplasia (CHD) endorsed acupuncture’s superior pain alleviation and locomotion improvement through owner and veterinarian subjective outcome evaluation. Three studies concluded that, overall, acupuncture was not efficacious regarding pain reduction or dysfunction improvement compared with placebo treatment. Conclusion Based on the limited current evidence, acupuncture could have analgesic effects as perceived by owners, but acupuncture, as a sole analgesic, is unlikely to be effective in alleviating pain and pain-related dysfunction in canine chronic pain associated with musculoskeletal causes. Evidence is lacking on chronic pain due to neurological and oncological causes. Further studies need to focus on researching various acupuncture modalities’ effects on chronic pain with musculoskeletal, neuropathic and oncological causes when utilised as a component of multimodal therapy. Currently, for canine patients with chronic pain, there is insufficient evidence for a veterinarian to recommend that a client utilise acupuncture as the sole method for pain management. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

User Impressions and Gait Analysis of Exoskeleton Device Usage in Generalized Tank Farm Activities

Tank farm workers involved in nuclear cleanup activities perform physically demanding tasks, typically while wearing heavy personal protective equipment (PPE). Exoskeleton devices have the potential to bring considerable benefit to this industry but have not been thoroughly studied in the context of nuclear cleanup. In this paper, we examine the performance of exoskeletons during a series of tasks emulating jobs performed on tank farms while participants wore PPE commonly deployed by tank farm workers. The goal of this study was to evaluate the effects of commercially available lower-body exoskeletons on a user’s gait kinematics and user perceptions. Three participants each tested three lower-body exoskeletons in a 70-min protocol consisting of level treadmill walking, incline treadmill walking, weighted treadmill walking, a weight lifting session, and a hand tool dexterity task. Results were compared to a no exoskeleton baseline condition and evaluated as individual case studies. The three participants showed a wide spectrum of user preferences and adaptations toward the devices. Individual case studies revealed that some users quickly adapted to select devices for certain tasks while others remained hesitant to use the devices. Temporal effects on gait change and perception were also observed for select participants in device usage over the course of the device session. Device benefit varied between tasks, but no conclusive aggregate trends were observed across devices for all tasks. Evidence suggests that device benefits observed for specific tasks may have been overshadowed by the wide array of tasks used in the protocol.

Bi-level configuration and operation collaborative optimization of shared hydrogen energy storage system for a wind farm cluster

Energy storage is indispensable to achieve dispatchable and reliable power generation through renewable sources. As a kind of long-duration energy storage, hydrogen energy storage systems are expected to play a key role in supporting the net zero energy transition. However, the high cost has become an obstacle to hydrogen energy storage systems. The shared hydrogen energy storage (SHES) for multiple renewable energy power plants is an emerging mode to mitigate costs. This study presents a bi-level configuration and operation collaborative optimization model of a SHES, which applies to a wind farm cluster. Different operation modes, including the ‘electricity‑hydrogen-electricity (E-H-E)’ mode and the ‘electricity‑hydrogen (E-H)’ mode, are considered. Results show that SHES system offers substantial advantages over individual hydrogen energy storage solutions. It achieves a notable reduction in annual operation and maintenance (O&M) costs by 9.5 % and a significant increase in annual profit by 10.49 %. Moreover, the SHES system demonstrates a lower wind curtailment rate of 0.24 %, in contrast to the 0.37 % observed in individual cases. SHES will play a more significant role in larger wind farm clusters. The aforementioned advantages of SHES systems become even more pronounced in larger wind farm clusters, where their impact on cost reduction and efficiency is significantly amplified.

Social determinants of health, the microbiome, and surgical injury.

Postinjury infection continues to plague trauma and emergency surgery patients fortunate enough to survive the initial injury. Rapid response systems, massive transfusion protocols, and the development of level 1 trauma centers, among others, have improved the outcome for millions of patients worldwide. Nonetheless, despite this excellent initial care, patients still remain vulnerable to postinjury infections that can result in organ failure, prolonged critical illness, and even death. While risk factors have been identified (degree of injury, blood loss, time to definitive care, immunocompromise, etc.), they remain probabilistic, not deterministic, and do not explain outcome variability at the individual case level. Here, we assert that analysis of the social determinants of health, as reflected in the patient's microbiome composition (i.e., community structure, membership) and function (metabolomic output), may offer a "window" with which to define individual variability following traumatic injury. Given emerging knowledge in the field, a more comprehensive evaluation of biomarkers within the patient's microbiome, from stool-based microbial metabolites to those in plasma and those present in exhaled breath, when coupled with clinical metadata and machine learning, could lead to a more deterministic assessment of an individual's risk for a poor outcome and those factors that are modifiable. The aim of this piece is to examine how measurable elements of the social determinants of health and the life history of the patient may be buried within the ecologic memory of the gut microbiome. Here we posit that interrogation of the gut microbiome in this manner may be used to inform novel approaches to drive recovery following a surgical injury.