Multidisciplinary Research Articles

E-Health Interventions for Managing Spine Pain—Benefits for Pain, Quality of Life, Catastrophizing and Fear Avoidance Beliefs: An Overview of Systematic Reviews With Meta-Analysis

OBJECTIVE: To summarize the effectiveness of eHealth interventions for improving pain, physical disability, psychological factors, and the quality of life for people with spine pain. DESIGN: Overview of systematic reviews. LITERATURE SEARCH: CINAHL, Embase, PubMed, and SPORTDiscus e-databases were searched. STUDY SELECTION CRITERIA: Systematic reviews with meta-analysis of randomized clinical trials evaluating any type of eHealth were included. DATA SYNTHESIS: AMSTAR 2 was used to assess the methodological quality of included reviews. The degree of overlap between reviews was calculated. RESULTS: Sixteen systematic reviews were included. Of them, thirteen reviews were exclusively focused on back pain or low back pain. Exercise and psychological interventions were the primary contents of eHealth interventions. In general, eHealth interventions based on physical exercise may improve the quality of life of people with low back pain. eHealth interventions based on cognitive behavioral therapy may reduce pain catastrophizing and fear-avoidance beliefs for physical activity for people with low back pain. eHealth interventions based on multidisciplinary approaches including physical exercise may reduce low back pain. Few systematic reviews used the GRADE system to evaluate the certainty of evidence, and few specified the content of eHealth interventions. CONCLUSION: eHealth interventions may improve the quality of life, pain catastrophizing, fear-avoidance beliefs, for people with low back pain. It is unclear, based on available systematic reviews, how clinicians should deliver eHealth interventions for people with spine pain (e.g., neck pain or low back pain).

The long lost denture: a rare case of an acquired, non-malignant tracheo-oesophageal fistula

BackgroundIngested dental prosthesis are susceptible to impaction in the gastrointestinal tract due to their sharp edges, size and contour. Delays in presentation arise from the lack of clear history of ingestion and misdiagnosis occurs due to the radiolucency of denture material on plain radiography. An acquired, non-malignant tracheo-oesophageal fistula (TOF) may develop from a chronically impacted denture. Surgical management of a TOF secondary to denture is a challenging clinical problem that is rarely reported in the literature and no previous case reports have described the two-staged reconstruction approach that we present here.Case presentationWe report a case of a male in his early 60s who presented to an acute general hospital with symptoms ongoing for over one year of dysphagia, recurrent chest infections and weight loss. Barium swallow and computed tomography identified an ingested dental prosthesis (denture) that had caused a TOF. He was transferred to our specialist thoracic surgery unit where an attempt to remove the foreign body endoscopically was abandoned due to firm impaction and risk of further injury. The subsequent multi-disciplinary management of this complex case required a two-staged reconstruction approach. The first procedure involved extracting the foreign body, repairing the underlying defects with tracheal resection and anastomosis, and creating an oesophageal diversion with cervical oesophagostomy. The second procedure achieved continuity of the gastrointestinal tract with gastric pull-up and pharyngo-gastric anastomosis. Following rehabilitation, the patient was discharged on oral intake alongside percutaneous jejunostomy feeding.ConclusionsEarly recognition and removal of impacted dental prosthesis is essential to prevent morbidity and mortality. Delayed diagnosis can lead to acquired TOF with associated consequences such as recurrent pulmonary infection, mediastinitis and nutritional deficit. Challenges we encountered, such as failed attempts at endoscopic retrieval and the difficult dissection of fibrotic tissue, were directly due to the delayed identification of the denture. We highlight the importance of holding a high index of clinical suspicion of foreign body ingestion in dental prosthesis wearers who present with recurrent chest infections and ongoing dysphagia. We also promote the need for a collaborative multi-disciplinary approach in the surgical management of complex cases.

IMPACTO DAS ANOMALIAS CONGÊNITAS NA MORTALIDADE NEONATAL: UMA REVISÃO SOBRE FATORES DE RISCO E PREVENÇÃO

This integrative review aimed to analyze the incidence of congenital anomalies in neonates and identify associated risk factors, as well as explore the most effective preventive measures described in the scientific literature. Congenital anomalies are structural or functional defects that develop during intrauterine life and are a major cause of neonatal and infant mortality. An estimated 303,000 newborns die annually within the first month of life due to these conditions (WHO, 2016). This study was conducted through the analysis of scientific articles published in the PubMed, SciELO, and Google Scholar databases, using keywords such as "congenital anomalies," "neonates," and "risk factors." Studies published in the last ten years, in Portuguese and English, addressing the incidence and risk factors of congenital anomalies in neonates were included. The results showed that the most common congenital anomalies include neural tube defects, cardiac malformations, and chromosomal abnormalities, such as Down syndrome (PACHECO et al., 2009). The prevalence of these conditions varies according to geographic region and population (BRASIL, 2021). Several maternal risk factors were identified, including advanced maternal age, smoking, alcohol consumption, and exposure to teratogenic substances during pregnancy (ANDRADE et al., 2017). Additionally, adverse socioeconomic conditions and lack of access to quality prenatal care were highlighted as important determinants for the increased incidence of congenital anomalies (LANSKY et al., 2014). Preventive strategies suggested by the literature include folic acid supplementation before and during pregnancy, proper vaccination of pregnant women, and genetic counseling (BRASIL, 2013; ACGO, 2018). Early diagnosis through neonatal screening tests, such as the heel prick test, pulse oximetry, and hearing screening, is crucial for early identification of anomalies and enabling interventions that can improve health outcomes for neonates (MINISTÉRIO DA SAÚDE, 2021). The review also emphasized the importance of early interventions, such as corrective surgeries and supportive therapies, to improve the prognosis of neonates affected by congenital anomalies (CHRISTIANSON, 2006). These interventions can significantly reduce morbidity and mortality rates associated with these conditions, improving the quality of life of affected individuals. In conclusion, this integrative review identified significant risk factors for congenital anomalies and highlighted the importance of preventive interventions and early diagnosis to improve neonatal health outcomes. The effective prevention and management of congenital anomalies require a multidisciplinary approach, including awareness among healthcare professionals, effective public policies, and family involvement in implementing preventive strategies. Ongoing research is recommended to further understand the causes, risk factors, and effective interventions to reduce the incidence of congenital anomalies and improve neonatal health outcomes.

Investigation on the failure mechanism of slope deformations induced by water level fluctuation with InSAR and numerical simulation: a case study

The Alagou Reservoir was officially closed for water storage in November 2014. Since September 2016, gradual slope collapse and deformation have been observed at elevations ranging from 600 to1050 m upstream of the left bank of the Alagou Reservoir dam site. The increasing annual deformation raises significant concerns about a potential landslide, which could lead to surge waves, posing a threat to both the dam and the surrounding environment. Due to difficult access and worsening conditions, thorough exploration of the site was challenging. Consequently, After emptying the reservoir, we conducted on-site investigations using satellite D-InSAR analysis, numerical modeling, and post-event monitoring. This multidisciplinary approach aimed to investigate the relationship between deformation behavior, triggering conditions, and reservoir water level changes. Our study provides valuable insights into the complex geological processes involved in slope deformation and failure mechanisms induced by water level fluctuations. We elucidated the interplay between deformation behavior and triggering conditions, which is essential for designing effective reinforcement treatments for deformed slopes. While InSAR has proven to be a cost-effective tool for monitoring surface deformation, it offers limited insights alone. Therefore, we recommend a multi-technique approach incorporating geophysical, geotechnical, and remote sensing data for a comprehensive understanding of slope stability.

Adverse food reactions and alterations in nutritional status in children with autism spectrum disorders: results of the NAFRA project

BackgroundTo assess the adverse food reactions (AFR) prevalence in children with autism spectrum disorder (ASD) and in non-ASD healthy controls (NASD). Nutritional status alterations, food selectivity and adherence to Mediterranean Diet (MD) were also evaluated.MethodsThe NAFRA (Nutritional status and Adverse Food Reactions in children with Autism Spectrum Disorder) project was an observational, case-control, comparative study conducted at a tertriary center for pediatrics involving Caucasian patients of both sexes, aged 18 months-7 years, with a diagnosis of ASD, and matched NASD controls.ResultsFrom October 2017 to December 2023, 100 ASD patients [79 male, mean (± SD) age 49.9 months (± 15.4)] and 100 NASD controls [75 male, mean (± SD) age 49.8 months (± 17.7)] were enrolled at the Pediatric Section of the Department of Translational Medical Science of the University of Naples Federico II. A significantly higher prevalence of AFR was observed in ASD patients if compared with NASD (16% vs. 2%, p = 0.001), mainly due to a higher prevalence of food allergy (7% vs. 1%, p = 0.03). A significantly higher prevalence of food intolerance and celiac disease was also observed in ASD children. The rate of obesity was significantly higher in ASD patients compared to NASD. Food selectivity and low MD-adherence were more frequent in ASD children (26% vs. 2%, p < 0.0001 and 28% vs. 16%, p = 0.041, respectively).ConclusionsThe high rate of AFR, obesity and unhealthy dietary habits observed in ASD children strongly suggest the importance of a multidisciplinary approach, providing early diagnosis of AFR and appropriate nutritional management to improve core and associated ASD-related conditions.Trial registrationThe NAFRA Project was registered on https://clinicaltrials.gov/ with the identifier NCT04719923. Registered 18 January 2021. https://clinicaltrials.gov/study/NCT04719923.

Evaluation of the quality of physiotherapy service in university of Gondar comprehensive specialized hospital, northwest Ethiopia: A mixed method evaluation.

Currently, the number of people with physical disability and impairment is increasing significantly in Ethiopia, especially in the northern part. In that regard, the Ethiopian government has been providing physical rehabilitation services to recover patients. However, due to the widespread problem of healthcare service and the increase in patients seeking physiotherapy service, the quality of the service might be compromised, and the evidence is limited. Thus, this study aimed to evaluate the quality of physiotherapy services at the University of Gondar Comprehensive Specialized Hospital, northwest Ethiopia. A single case study with concurrent mixed method research design was conducted from June 02- August 10, 2022. The evaluation used patient-centeredness, timeliness, compliance and availability dimensions with 27 indicators. A total of 415 systematically selected patients who came for physiotherapy service for exit interviews, 9 service providers and managers for key-informant interviews, and 8 patients for in-depth interviews participated in the study. Approximately 176 patient medical charts were reviewed, and direct observation of 14 patient-provider interactions was performed. Binary logistic regression analysis was computed to identify factors associated with patient-centeredness. In the final model, variables with a p value < 0.05 and adjusted odds ratio (AOR) with 95% confidence interval (CI) were used to declare statistical significance. Thematic analysis for the qualitative data using OPEN CODE version 4.03 was performed. Finally, the dimensions and overall quality of physiotherapy service were judged using predetermined criteria. The overall quality of the physiotherapy service was found to be fair or intermediate (66.5%), computed from the availability of resources 63.4%, compliance of service providers 68.6%, timelines 64.2%, and patient centeredness 73.1%. Qualitative findings also revealed that insufficient staffing and heavy workload, lack of resources, inconvenient facilities, relocation of resources in the academic division of physiotherapy department, lack of training and continuous professional development opportunities, lack management attention and institutional support and nonexistence of multidisciplinary approaches leads to significant gaps in quality service delivery. Attending primary school (AOR = 3.22, 95% CI: 1.56, 6.61), secondary (AOR = 4.24, 1.91, 9.41), and higher education (AOR = 4.79, 1.94, 11.84) and being a private employee (AOR = 0.34, 95% CI: 0.16, 0.76) were significantly associated with patient centeredness. The overall quality of physiotherapy service was deemed intermediate and needs further improvement. The required resources, such as clinical assessment tools, therapeutic exercise equipment, electrotherapy modalities and infrastructure, were not adequate. Educational level and occupation were significantly associated with patient centeredness.

Association of ovarian teratoma with anti-N-methyl-D-aspartate receptor encephalitis: a case report and narrative review.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially life-threatening autoimmune disorder which is strongly associated with ovarian teratomas in young female patients. The primary aim is to highlight the importance of considering NMDAR encephalitis in the differential diagnosis of young female patients presenting with acute or subacute neuropsychiatric symptoms, especially when accompanied by ovarian teratomas. This case report and literature review detail the presentation, diagnosis, and treatment of a 35-year-old G4P3 Indigenous woman who initially presented with neuropsychiatric symptoms and fever, having a history of extensive drug and alcohol use. Misdiagnosed initially, the patient's lack of response to standard treatments led to further investigations, revealing paraneoplastic anti-NMDAR encephalitis secondary to a left ovarian teratoma. The report examines the treatment regimen followed, including prednisolone, intravenous immunoglobulin, rituximab injections, and laparoscopic bilateral salpingo-oophorectomy. This case underscores the critical need for increased clinical vigilance for anti-NMDAR encephalitis in patients, particularly young females, presenting with neuropsychiatric symptoms and potential ovarian teratomas. The literature review accompanying the case report provides valuable insights into the presentation, diagnosis, and management of this complex condition. Lastly, this study emphasised the diagnostic challenges inherent in paraneoplastic neuropsychiatric syndromes, advocating for a multidisciplinary approach in similar clinical scenarios.

Inflammatory Bowel Disease and Endometriosis: Diagnosis and Clinical Characteristics

Background/Objectives: Endometriosis and inflammatory bowel disease (IBD) share some epidemiological, clinical and pathogenetic features. A differential diagnosis between pelvic endometriosis and IBD may be challenging, even for expert clinicians. In the present review, we aimed to summarize the currently available data regarding the relationship between endometriosis and IBD and their possible association. Methods: The PubMed and Scopus database were considered, by searching the following terms: “Crohn’s Disease”, “Ulcerative Colitis”, “Endometriosis”, “Adenomyosis”, and “Inflammatory Bowel Disease”, individually or combined. Full-text papers published in English with no date restriction were considered. Results: Few studies have researched the possible association between endometriosis and IBD. Both conditions are characterized by chronic recurrent symptoms, which may be shared (abdominal pain, fatigue, infertility, menstrual irregularities, diarrhea, constipation). Deep infiltrating endometriosis (DIE) can cause bowel symptoms. In a large Danish study, a 50% increased risk of IBD was observed in women with endometriosis. A missed diagnosis of endometriosis and an increased risk of endometriosis has been reported in IBD. Current evidence does not support an association between endometriosis and IBD characteristics. However, IBD may be associated with DIE, characterized by pelvic symptoms (dyschezia, dyspareunia). Preliminary observations suggest an increased IBD risk in patients with endometriosis treated with hormonal therapy. Conclusions: Current findings suggest that a careful search is needed for concomitant endometriosis in subgroups of patients with IBD showing compatible symptoms and vice versa. A multidisciplinary approach including dedicated gastroenterologists and gynecologists is required for a proper search for IBD and endometriosis in subgroups of patients. This approach may avoid diagnostic delays or overtreatments for these conditions.

Enhancing intersection safety: Testing measures to reduce law violations in Loja (Ecuador)

This study evaluates the effectiveness of measures aimed at reducing traffic violations, specifically focusing on wrong-way driving, at intersections in Loja, Ecuador. The high incidence of accidents at these intersections, often resulting from wrong-way driving and non-compliance with traffic regulations, underscores the critical need for effective strategies to enhance road safety. To address this issue, we adopted a multidisciplinary approach to assess the impact of two specific interventions: the implementation of official warnings and the presence of traffic officers at a selected intersection. Data collection involved recording instances of traffic violations, administering road safety surveys, and monitoring the implementation of these interventions. The post-implementation analysis sought to determine the effect of these measures on driver behavior and overall traffic safety. Our findings indicate that while the interventions succeeded in increasing awareness about traffic violations, they did not produce a significant reduction in undesirable driving behaviors. This suggests that, although the presence of warnings and traffic officers is beneficial in raising awareness, these measures alone may not be sufficient to effect substantial behavioral changes. The research provides valuable insights for the development of more comprehensive road safety strategies and emphasizes the need for further studies to explore and address the underlying causes of traffic violations.

Design of EEG based thought identification system using EMD & deep neural network

Biological communication system for neurological disorder patients is similar to the Brain Computer Interface in a way that it facilitates the connection to the outside world in real time. The interdisciplinary field of Electroencephalogram based message depiction is gaining importance as it assists the paralysed person to communicate. In the proposed method a novel approach of feature extraction is done by Empirical Mode Decomposition on non- stationary & non-linear kind of EEG signal. EMD helps in the effective time frequency analysis by disintegrating the EEG signal in the form of six Intrinsic Mode Functions with help of the frequency components. In all nine features are extracted from the decomposed IMFs so as to predict the states or messages of the patient. The above computed features are then served to the Deep Neural Network to perform the classification. The performance of suggested method is studied through applying it to the acquired database generated by the designed hardware as well as also in real time message depiction. The maximum classification accuracy 97% for the acquired database & 85% in real time are obtained respectively by comparative analysis. The command messages generated from the proposed system helps the person suffering from neurological disorder to establish the communication link with the outside world in an efficient way. Thus, the proposed novel method shows better performance in real time message depiction purpose as related to other existing methods.

A person-centred primary care pharmacist-led osteoporosis review for optimising medicines (PHORM): a protocol for the development and co-design of a model consultation intervention.

Adherence to medicines in osteoporosis is poor, with estimated 1 year persistence rates between 16% and 60%. Poor adherence is complex, relating to combinations of fear of side effects, beliefs about medication being unnecessary, doubts about effectiveness and the burden of medication management. This is compounded by an absence of monitoring, as many patients are effectively discharged from ongoing care following the initial prescription. Clinical pharmacists in general practice are a relatively new workforce in the UK NHS; this is an unexplored professional group that could provide person-centred, adherence-focused interventions in an osteoporosis context.A model consultation intervention to be delivered by clinical pharmacists in general practice for patients already prescribed fracture prevention medications will be developed using existing evidence and theory and empirical qualitative work outlined in this protocol. We will investigate the current practice and barriers and facilitators to a clinical pharmacist-led osteoporosis intervention, including exploring training needs, through focus groups with people living with osteoporosis, pharmacists, general practitioners, osteoporosis specialists and service designers/commissioners. Framework analysis will identify and prioritise salient themes, followed by mapping codes to the theoretical domains framework and normalisation process theory to understand integration and implementation issues.We will further develop the content and model of care for the new consultation intervention through co-design workshops with stakeholder and patient and public involvement and engagement group members. The intervention in practice will be refined in a sequential process with workshops and in-practice testing with people prescribed fracture prevention medication, pharmacists and the multidisciplinary team. Ethical approval was obtained from NHS North West-Greater Manchester South Research Ethics Committee (Ref 23/NW/0199). Dissemination and knowledge mobilisation will be facilitated through a range of national bodies/stakeholders. Impact and implementation plans will accelerate this research towards a future clinical trial to determine cost and clinical effectiveness.

A IMPORTÂNCIA DA FISIOTERAPIA NAS VISITAS DOMICILIARES NA ATENÇÃO BÁSICA DE SAÚDE: REVISÃO BIBLIOGRÁFICA

This study addresses the relevance of including physiotherapists in Primary Health Care, highlighting their fundamental role in promoting comprehensive care for patients. The research emphasizes that the presence of physiotherapists is not limited to rehabilitation, but extends to disease prevention, health promotion and improving the population's quality of life. Through a multidisciplinary approach, physiotherapists contribute to the formation of more cohesive and efficient health teams, establishing meaningful bonds with users. The objective of this study was to analyze how physiotherapy fits into and develops in this context, seeking to understand the impact of this practice within the public health system. This study was conducted through a detailed systematic review, which included an extensive bibliographic search in several renowned databases, such as Scielo, Medline (Pubmed) and the Virtual Health Library (BVS). The study concludes that the effective inclusion of physiotherapists in Primary Care is essential for the construction of a more integrated and humanized health system, which better meets the needs of the population.

The Integration of Arts-Based Research Methods in Scientific Studies

Arts-based research (ABR) integrates creative and artistic practices into academic research, offering novel methodologies that enrich scientific inquiry. This interdisciplinary approach enables the exploration of complex human experiences, emotions, and phenomena through mediums like visual art, drama, poetry, and music. This paper examines the benefits and challenges of integrating arts-based research into scientific studies, highlighting its capacity to elicit deeper, embodied insights that complement traditional methods. While ABR fosters innovative data collection and engagement, it faces skepticism regarding rigor and validity in the scientific community. This study examines how the collaboration between scientists and artists can bridge these challenges, emphasizing best practices for effective integration. The paper concludes by offering examples of successful arts-based research in scientific contexts and suggests strategies for future implementation. Keywords: Arts-based research, Interdisciplinary research, Artistic methodologies, Scientific inquiry, Creative expression, Data collection.

A Frequency Reconfigurable Antireflection Metasurface for GPR

Abstract The antireflection metasurface (AM) is employed in ground penetrating radar (GPR) to mitigate the strong reflection of electromagnetic waves at the air-ground interface due to impedance mismatch. However, due to constraints imposed by the relative bandwidth (RBW) and manufacturing processes, these layers tend to exhibit excessive thickness and bulky shape, narrow RBW, and fixed functionality in a passive configuration. This paper presents a novel, dual-band, independent wideband tuning, frequency reconfigurable AM based on varactor diodes with center frequencies of 1.35 GHz and 2.60 GHz. This metasuface possesses positive characteristics such as a single layer, the ultrathin thickness (0.03 \&amp; 0.06$\lambda$), the wide RBW (43.3\% \&amp; 27.4\%) and remarkable antireflection. The aforementioned metasurface achieves the described mechanisms and features through the destructive interference theory and the combine element technique. Numerical simulation results of surface currents and electric field energy power demonstrate the antireflection property. The equivalent electromagnetic parameter retrieval results also provide equivalent impedance conditions for non-perfect antireflection. The proposed AM samples demonstrates notable stepwise frequency reconfigurable characteristics in free-space experiments. The imaging effect after loading this AM is significantly improved in real-world GPR ballast roadbed anomaly detection experiments. This approach provides significant research value and promising prospects across various disciplines, including the stepped-frequency GPR, microwave imaging, and interdisciplinary fields.

Distinct comorbidity phenotypes among post-9/11 Veterans with epilepsy are linked to diverging outcomes and mortality risks.

To investigate phenotypes of comorbidity before and after an epilepsy diagnosis in a national cohort of post-9/11 Service Members and Veterans and explore phenotypic associations with mortality. Among a longitudinal cohort of Service Members and Veterans receiving care in the Veterans Health Administration (VHA) from 2002 to 2018, annual diagnoses for 26 conditions associated with epilepsy were collected over 5 years, ranging from 2 years prior to 2 years after the year of first epilepsy diagnosis. Latent class analysis (LCA) was used to identify probabilistic comorbidity phenotypes with distinct health trajectories. Descriptive statistics were used to describe the characteristics of each phenotype. Fine and Gray cause-specific survival models were used to measure mortality outcomes for each phenotype up to 2021. Six distinct phenotypes were identified: (1) relatively healthy, (2) post-traumatic stress disorder, (3) anxiety and depression, (4) chronic disease, (5) bipolar/substance use disorder, and (6) polytrauma. Accidents were the most common cause of death overall, followed by suicide/mental health and cancer, respectively. Each phenotype exhibited unique associations with mortality and cause of death, highlighting the differential impact of comorbidity patterns on patient outcomes. By delineating clinically meaningful epilepsy comorbidity phenotypes, this study offers a framework for clinicians to tailor interventions. Moreover, these data support systems of care that facilitate treatment of epilepsy and comorbidities within an interdisciplinary health team that allows continuity of care. Targeting treatment toward patients with epilepsy who present with specific heightened risks could help mitigate adverse outcomes and enhance overall patient care.

Telemedicine ultrasound assessment for placenta accreta spectrum: Utility and interobserver reliability of asynchronous remote imaging review.

Management of patients with placenta accreta spectrum (PAS) by trained multidisciplinary teams is associated with improved outcomes. Ultrasound can predict intraoperative risks, but expert ultrasound imaging of PAS is often limited. Telemedicine is used increasingly in obstetrics, permitting expert consultation when essential resources are not available locally. Our objective was to evaluate the feasibility of teleconsultation using standardized ultrasound image acquisition and reporting, and to correlate prognosis with intraoperative findings in patients at risk for PAS. A total of 12 PAS imaging experts (teleconsultants) were selected to asynchronously review deidentified standardized grayscale and color Doppler ultrasound images for five patients who had completed treatment for PAS, resulting in 60 individual teleconsultations. All patients were managed at a center using standardized imaging acquisition and intraoperative topographic classification to individualize surgical management. Teleconsultants reported the predicted topographic classification and recommended a surgical approach based on the topographic classification algorithm. Prognoses were compared with that reported by the local sonologist and with intraoperative findings. In all five patients, local sonologist prognosis and antenatal topographic classification was confirmed during surgery and the final surgical approach matched that which was recommended preoperatively. Teleconsultant antenatal evaluation and management plans matched those of the local team in 71.7% of the cases. When reports differed, PAS severity was overestimated in nine reviews (16.9%) and was underestimated in six reviews (11.3%). Remote imaging teleconsultation provides accurate prenatal staging in most patients at risk for PAS. Teleconsultation is a feasible strategy to improve prenatal imaging, management planning, and guidance for local teams in settings with limited healthcare resources.

Evaluating Severe Therapy-Resistant Asthma in Children: Diagnostic and Therapeutic Strategies

Introduction: Worldwide, asthma is the most common non-communicable respiratory disease and causes considerable morbidity and mortality. Most people with asthma can be treated effectively with low-dose medications if these are taken correctly and regularly. Around 10% of people with asthma have an uncontrolled form of the disease or can only achieve control with high-dose medications, incurring disproportionately high health care costs. Areas Covered: PubMed and personal archives were searched for relevant articles on the definition, management and pharmacotherapy of severe asthma. The WHO classification of severe asthma and the treatment levels encompassed in the definition are discussed. Most children and young people referred for consideration of ‘beyond-guidelines therapy’ can in fact be managed on standard treatment after a multi-disciplinary team assessment focusing on ensuring correct basic management, and these steps are described in detail. Options for those with true therapy-resistant asthma are described. These include monoclonal antibodies, most of which target type 2 inflammation. Expert Opinion: Getting the basics right is still the most important aspect of asthma care. For those with severe, therapy-resistant asthma, an increasing number of life-transforming monoclonals have been developed, but there is still little understanding of, and a paucity of treatment options for, non-eosinophilic asthma.

Raising awareness of potential biases in medical machine learning: Experience from a Datathon.

To challenge clinicians and informaticians to learn about potential sources of bias in medical machine learning models through investigation of data and predictions from an open-source severity of illness score. Over a two-day period (total elapsed time approximately 28 hours), we conducted a datathon that challenged interdisciplinary teams to investigate potential sources of bias in the Global Open Source Severity of Illness Score. Teams were invited to develop hypotheses, to use tools of their choosing to identify potential sources of bias, and to provide a final report. Five teams participated, three of which included both informaticians and clinicians. Most (4/5) used Python for analyses, the remaining team used R. Common analysis themes included relationship of the GOSSIS-1 prediction score with demographics and care related variables; relationships between demographics and outcomes; calibration and factors related to the context of care; and the impact of missingness. Representativeness of the population, differences in calibration and model performance among groups, and differences in performance across hospital settings were identified as possible sources of bias. Datathons are a promising approach for challenging developers and users to explore questions relating to unrecognized biases in medical machine learning algorithms. Disadvantaged groups are at risk of being adversely impacted by biased medical machine learning models. To avoid these undesirable outcomes, developers and users must understand the challenges involved in identifying potential biases. We conducted a datathon aimed at challenging a diverse group of participants to explore an open-source patient severity model for potential biases. Five groups of clinicians and informaticians used tools of their choosing to evaluate possible sources of biases, applying a range of analytic techniques and exploring multiple features. By engaging diverse participants with hands-on data experience with meaningful data, datathons have the potential to raise awareness of potential biases and promote best practices in developing fair and equitable medical machine learning models.

Lumbosacral rotation flap: a simple method for covering sacral pressure injuries.

Pressure injuries (PIs) are among the most common skin and soft tissue wounds occurring in patients who are bedbound and/or immobile. PI management hinges on their prevention; however, reoccurrence poses a challenge to their management and requires a multidisciplinary approach. Here, the authors describe a lumbosacral rotation flap (LSRF) for the coverage of sacral PIs. A single-centre, retrospective analysis of prospectively collected data was carried out. All patients undergoing LSRF for sacral PIs were included. Patients with active systemic sepsis, immune compromise, hepatic or renal dysfunction were excluded. All patients underwent preoperative optimisation and wound cultures to direct antibiotic therapy after surgery. A total of nine patients underwent the procedure (seven male and two female). Mean age was 47.6 years with a mean ulcer size of 92.9 cm2. Bone biopsy indicated the presence of osteomyelitis in three patients. Of the LSRFs, two flaps showed minimal local complications in the form of marginal flap necrosis which was managed conservatively. All flaps healed well with no cases of flap loss or the need for secondary procedures. The results of this analysis showed that LSRF can be considered a first line of treatment of sacral PIs. They can be used to cover large defects. Due to their large base and flap size, readvancement in cases of recurrence is also possible.

Integrated Genetic and Statolith Shape Analysis Reveals the Population Structure of Loliolus (Nipponololigo) uyii (Cephalopoda: Loliginidae) in the Coastal Waters of China

Understanding population structure is a priority for evaluating population dynamics of commercially fished cephalopods under fishing pressure and environmental changes. This study employed a multidisciplinary approach to clarify the population structure of Loliolus (Nipponololigo) uyii, a common squid in inshore fisheries. Sampling was conducted multiple times to cover the distribution range across the East China Sea and South China Sea. High haplotype diversity was revealed by three gene markers (COI, 16S and ODH). Two geographical clades with significant genetic differentiation were divided through phylogenetic trees and haplotype networks. The boundary between the two clades is delineated by the Dongshan population in the southern East China Sea. Furthermore, the neutrality tests and mismatch analysis suggested that L. (N.) uyii populations may have undergone population expansion. Correspondingly, statolith differences in lateral dome and posterior indentation, along with high classification success, further supported the genetic division. The overall difference in statolith shape also efficiently identified seasonal groups in the Beibu Gulf lacking genetic differentiation. This result offers new insights into the influence of genetic and environmental factors on statolith shape. The integrated results provide a comprehensive understanding of the population structure of L. (N.) uyii, laying the foundation for resource development and the conservation of the species.