Large Burden Research Articles

How far has diabetes-related foot disease research progressed in Australia? A bibliometric review (1970-2023).

Diabetes-related foot disease (DFD) is a leading cause of the Australian and global disease burdens and requires proportionate volumes of research to address. Bibliometric analyses are rigorous methods for exploring total research publications in a field to help identify volume trends, gaps and emerging areas of need. This bibliometric review aimed to explore the volume, authors, institutions, journals, collaborating countries, research types and funding sources of Australian publications investigating DFD over 50years. A systematic search of the Scopus® database was conducted by two independent authors to identify all Australian DFD literature published between 1970 and 2023. Bibliometric meta-data were extracted from Scopus®, analyzed in Biblioshiny, an R Statistical Software interface, and publication volumes, authors, institutions, journals and collaborative countries were described. Publications were also categorised for research type and funding source. Overall, 332 eligible publications were included. Publication volume increased steadily over time, with largest volumes (78%) and a 7-fold increase over the last decade. Mean co-authors per publication was 5.6, mean journal impact factor was 2.9 and median citation was 9 (IQR2-24). Most frequent authors were Peter Lazzarini (14%), Vivienne Chuter (8%) and Jonathon Golledge (7%). Most frequent institutions affiliated were Queensland University Technology (33%), University Sydney (30%) and James Cook University (25%). Most frequent journals published in were Journal Foot and Ankle Research (17%), Diabetic Medicine (7%), Journal Diabetes and its Complications (4%) and International Wound Journal (4%). Most frequent collaborating countries were the United Kingdom (9%), the Netherlands (6%) and the United States (5%). Leading research types were etiology (38%), treatment evaluation (25%) and health services research (13%). Leading funding sources were no funding (60%), internal institution (16%) and industry/philanthropic/international (10%). Australian DFD research increased steadily until more dramatic increases were seen over the past decade. Most research received no funding and mainly investigated etiology, existing treatments or health services. Australian DFD researchers appear to be very productive, particularly in recent times, despite minimal funding indicating their resilience. However, if the field is to continue to rapidly grow and address the very large national DFD burden, much more research funding is needed in Australia, especially targeting prevention and clinical trials of new treatments in DFD.

Heart failure events prediction algorithm for patients implanted with multi-brand CIED

Abstract Background Heart failure (HF) hospitalizations are associated with poor patient outcomes and generate a large burden on healthcare systems. Mitigation is a priority. Among HF patients with CIEDs, existing HF algorithm-based management solutions are manufacturer and device-specific, which imposes limitations. The SignalHF universal algorithm was developed to democratize access to HF management solutions by enabling prediction of HF decompensation based on CIED sensors data agnostic to manufacturer. Objective FORESEE-HF study aims to validate the SignalHF machine learning score and alerting system by matching alerts generated by SignalHF from CIED-related stored data in a universal platform (Implicity™) with HF events available in the French national health database containing medico-administrative data on patients’ characteristics, hospitalizations and deaths across 10 years. Methods The study cohort consisted of 19,013 patients (pacemaker (PM) 7,711, ICD 6,022, CRT-D 4,367 and CRT-P 913; age 70.0 ± 13.3, male 70.7%). Co-primary endpoints were sensitivity of HF hospitalizations detection with HF as primary diagnosis, the unexplained alert rate per patient-year defined as alert states not followed within 30 days by a hospitalization with HF as primary or secondary diagnosis (UAR PPY), and the lower quartile on alerting time defined as the lower bound on the time-to-event of 75% of true alert states (see Table 1). Results SignalHF for ICD/CRT-Ds demonstrated a sensitivity of 60%, a UAR PPY of 0.66 and a lower quartile on alerting time of 35 days. For PM/CRT-Ps, SignalHF demonstrated a sensitivity of 46%, a UAR PPY of 0.47 and a lower quartile on alerting time of 37 days. Conclusion FORESEE-HF demonstrates that SignalHF is an improvement over existing HF monitors for ICD/CRT-Ds, while also providing the same capability for PM/CRT-Ps. Being an algorithm that can be easily activated through a universal CIED remote monitoring platform, SignalHF widens the pool of patients that can benefit from HF monitoring solutions.Table 1:Study coprimary endpointsTable 2:Study results per device type

#2739 Determinants of well-being of spousal caregivers of CKD patients: a directed qualitative content analysis

Abstract Background and Aims Informal caregivers are essential to patients with chronic kidney disease (CKD) in all stages of the disease. They provide, most often unpaid, practical and emotional support to someone with whom they have a personal relationship, mostly spouses, family members and friends. Support from caregivers helps CKD patients adjust to their disease and increase treatment adherence. However, CKD puts a large burden on both patients themselves and their caregivers. Overburdening is especially seen in spousal caregivers, as they are more often older, co-residents, perform longer hours of care, and suffer more from relational stress compared to other types of informal caregivers. Although previous studies show high levels of caregiver burden, a comprehensive understanding of caregiver role, caregiver burden, and factors that may relieve this burden is lacking. Therefore, our aim was to explore both the contributing and alleviating determinants of well-being of spousal caregivers of patients with CKD in a qualitative way. Method A qualitative interview study was performed among spousal caregivers of patients with CKD. Informal caregivers were recruited by the Dutch Kidney Patients Association to assist in the development of an informal caregiver module with interviews for the Kidney Guide (Nierwijzer.nl). Fifteen face-to-face interviews were held between December 2021 and April 2022 at participants’ homes. Interviews lasted approximately 1 to 1.5 hours. All participants were adults and able to speak and understand Dutch. A directed qualitative content analysis was performed, using the stress-appraisal model as a framework. The model proposes that the care demand (primary stressors) leads to the actual provision of care by the informal caregiver (primary appraisal). Consequently, the provision of care leads to consequences for the caregiver's own life (secondary stressors), leading to burden (secondary appraisal). Finally, the experienced burden leads to the outcome, namely caregivers’ well-being. Moderators change the effect of stressors (e.g., social support may alleviate burden by sharing care tasks). Results Of the fifteen participating spousal caregivers, nine were female. Caregivers’ age ranged from 34 to 82 years. Duration of informal caregiving ranged from approximately 4 to 37 years. Most patients were on a type of kidney replacement therapy (KRT). In this study, we extended the stress-appraisal model to the context of CKD, providing a disease-specific model for practice (Fig. 1). Through this model, we describe the impact of care provision on all aspects of spousal caregivers’ lives and the burden associated with it, and identify possible modifiable factors to prevent overburdening of spousal caregivers. CKD-specific determinants included, amongst others, the impact of kidney disease and KRT on patients themselves as well as the associated caregiver tasks, for example adjusting to dietary restrictions and attending dialysis appointments. KRT options and flexibility (e.g., the choice for home or in-center dialysis) were CKD-specific moderators that alleviated burden. The care for someone on dialysis led to additional tasks (e.g., transportation to the dialysis center or assisting with home dialysis), negative impact on caregivers’ personal and social lives, and additional burden, emphasizing a distinction with caring for a CKD patient not on dialysis. Conclusion To our knowledge, this is the first study that gives a comprehensive overview of the contributing and alleviating determinants of the well-being of spousal caregivers of CKD patients. A disease-specific version of the stress-appraisal model for use in practice was provided, with evidence for all paths in the model. Moreover, we underline the need for acknowledgement of spousal caregivers in four areas: (1) personal and relational, (2) social environment, (3) healthcare, and (4) work and legislation (Fig. 2). This acknowledgement is of great importance to support and facilitate informal care within nephrology.

Associations between PM2.5 Components and Mortality of Ischemic Stroke, Chronic Obstructive Pulmonary Disease and Diabetes in Beijing, China

Ischemic stroke (IS), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) account for a large burden of premature deaths. However, few studies have investigated the associations between fine particular matter (PM2.5) components and mortality of IS, COPD and DM. We aimed to examine these associations in Beijing, China. Data on daily mortality, air pollutants and meteorological factors from 2008 to 2011 in Beijing were collected. Daily concentrations of five PM2.5 components, namely, sulfate ion (SO42−), ammonium ion (NH4+), nitrate ion (NO3−), organic matter (OM) and black carbon (BC), were obtained from the Tracking Air Pollution (TAP) database in China. The association between PM2.5 components and daily deaths was explored using a quasi-Poisson regression with the distributed lag nonlinear model (DLNM). The average daily concentrations of SO42−, NH4+, NO3−, OM and BC were 11.24, 8.37, 12.00, 17.34 and 3.32 μg/m3, respectively. After adjusting for temperature, relative humidity, pressure, particulate matter less than 10 μm in aerodynamic diameter (PM10), nitrogen dioxide (NO2) and sulfur dioxide (SO2), an IQR increase in OM at lag day 2 and lag day 6 was associated with an increased DM mortality risk (RR 1.038; 95% CI: 1.005–1.071) and COPD mortality risk (RR 1.013; 95% CI: 1.001–1.026). An IQR increase in BC at lag day 0 and lag day 6 was associated with increased COPD mortality risk (RR 1.228; 95% CI: 1.017–1.48, RR 1.059; 95% CI: 1.001–1.121). Cumulative exposure to SO42− and NH4+ was associated with an increased mortality risk for IS, with the highest effect found for lag of 0–7 days (RR 1.085; 95% CI: 1.010–1.167, RR 1.083; 95% CI: 1.003–1.169). These effects varied by sex and age group. This study demonstrated associations of short-term exposure to PM2.5 components with increased risk of IS, COPD and DM mortality in the general population. Our study also highlighted susceptible subgroups.

Constructing and applying a neural-network-based architectural landscape evaluation model

With the continuous improvement of living standards, people go outdoors and spend more and more time in scenic spots. The landscape architecture design that serves people in urban scenic spots attracts more and more public attention, which puts forward higher requirements for landscape architecture design that serves people in scenic spots. How to integrate better the design of all kinds of landscape architecture into nature, to serve the public better, is an urgent problem to be solved at this stage. This paper selects the evaluation indexes of urban architectural landscapes, uses the analytic hierarchy process to determine the weight of each index and quantifies six evaluation indexes to build an evaluation model of architectural landscape design. In terms of the improvement of the you only look once version 4 (YOLOv4) model, MobileNetV3 was selected as the backbone feature extraction network, and the convolution in the feature enhancement extraction network was replaced by the depth-separable volume, and an architectural landscape recognition system based on the improved YOLOv4 model was constructed. In terms of algorithm performance verification, the improved algorithm was compared with the single-shot detector, MobileNetV3, ShuffleNetV2, YOLOv3, YOLOv4 and YOLOv5s algorithms under multiple evaluation indexes. The experimental results show that the size of the model is 51.4 MB, which does not cause a large burden. The mean average precision value of the improved YOLOv4 algorithm is 93.5%, and the frames per second (FPS) value is 30 FPS, which has higher recognition accuracy and detection speed and has obvious advantages.

Long-Time Coherent Integration for the Spatial-Based Bistatic Radar Based on Dual-Scale Decomposition and Conditioned CPF

This paper addresses the problem of weak maneuvering target detection in the space-based bistatic radar system through long-time coherent integration (LTCI). The space-based bistatic radar is vulnerable to the high-order range migration (RM) and Doppler frequency migration (DFM), since the target, the receiver and the transmitter all can play fast movement independently. To correct high- order RM and DFM, this usually involves joint high-dimensional parameter searching, incurring a large computational burden. In our previous work, a dual-scale (DS) decomposition of motion parameters was proposed, in which the optimal GRFT is conditionally decoupled into two cascade procedures called the modified generalized inverse Fourier transform (GIFT) and generalized Fourier transform (GFT), resulting in the DS-GRFT detector. However, even if the DS-GRFT detector preserves the superior performance and dramatically decreases the complexity, high-dimensional searching is still required. In this paper, by analyzing the structure of the DS-GRFT detector, we further designed a conditioned cubic phase function (CCPF) tailored to the range–slow-time signal after GIFT, breaking the joint high-dimensional searching into independent one-dimensional searching. Then, by connecting the proposed CCPF with the GIFT, we achieved a new LTCI detector called the DS-GIFT-CCPF detector, which obtained a significant computational cost reduction with acceptable performance loss, as demonstrated in numerical experiments.

Clinical and echocardiographic characterization of patients hospitalized for severe tricuspid valve regurgitation: a single tertiary-care center experience with two-year follow-up.

Tricuspid regurgitation (TR) is a common acquired valvular heart disease. Recently new transcatheter treatment options for severe TR have emerged that could change the management of this condition, which warrants better characterization of this specific patient group. The aim of the study was to describe the clinical and echocardiographic characteristics of patients with severe TR and to evaluate their short- and mid-term prognosis. This retrospective, observational single-center study enrolled consecutive patients with severe TR hospitalized between January 2016 and September 2021 in the 1st Chair and Department of Cardiology, Medical University of Warsaw, Poland. The severity of heart failure (HF) was evaluated using New York Heart Association (NYHA) classification. Echocardiographic assessment was performed by experienced sonographer. EuroSCORE II and TRI-SCORE were computed for each patient. 12- and 24-month clinical outcomes were reported. There were 172 patients [93 female (54.1%)] included. The mean age was 76.4 (± 10.5) years. The most common comorbidities included: atrial fibrillation (84.9%), hypertension (68.0%), chronic kidney disease (54.1%), coronary artery disease (45.3%), diabetes mellitus (30.9%). The median EuroSCORE II and TRI-SCORE values were 4.68% and 14.0%, respectively. The median follow-up was 24 months. The overall mortality was 29.7% at 1 year and 47.3% at 2 years. TR grade, TAPSE <17 mm, TAPSE/SPAP <0.26 and right atrial area were significant factors associated with mortality. Patients presenting with severe TR are characterized by a large comorbidity burden and poor prognosis, despite intensive heart failure management.

Proportion of inflammatory bowel diseases patients withsuboptimal disease control in daily clinical practice-Real-world evidence from the inflammatory bowel diseases-podcast study.

Crohn's disease and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) characterized by a progressive nature of the disease resulting in subsequent intestinal damage, limited efficacy of current treatments and suboptimal disease management and a significant burden for patients. The IBD-PODCAST study aims to estimate the proportion of Crohn's disease and UC patients with suboptimal disease control (SDC) in a real-world setting. A non-interventional and cross-sectional study was conducted across 103 sites in 10 countries (Austria, Belgium, Canada, Germany, Greece, Italy, Portugal, Spain, Turkey, and UK). Criteria for SDC were based on STRIDE-II criteria and adapted by an expert panel. 2185 patients (Crohn's disease: n=1,108, UC: n=1077) with a mean (SD) age of 44.0 (14.8) years and mean (SD) disease duration of 12.4 (9.2) years were included (52.2% male). Ileal involvement was present in 39.1% of Crohn's disease patients, 35.3% of UC patients had extensive colitis. 77.3% of Crohn's disease and 65.3% of UC patients were on targeted immunomodulators and, according to STRIDE-II-based treatment phases, 85.6% of Crohn's disease and 85.4% of UC patients were assigned to the long-term treatment phase. SDC was detected in 52.2% of Crohn's disease and 44.3% of UC patients predominantly due to impaired quality of life (QoL), clinically significant extraintestinal manifestations, steroid overuse, signs of active inflammation in UC and Crohn's disease, and active fistulas in Crohn's disease. More than one criterion was seen in 37% of patients with SDC. Opportunities for on-label treatment optimization were observed in 49% of Crohn's disease and 61% of UC patients on advanced therapy. The high percentage of SDC in this global, real-world cohort suggests a large disease burden and high unmet medical need in IBD patients. Future analysis should focus on monitoring and responding to SDC in this cohort and on patients' QoL.

Routine 2-Week Postoperative Radiographs After Geriatric Hip Fracture Fixation: Low Utility and High Cost

Background: Geriatric hip fractures are associated with a large financial burden on both patients and payors, yet minimal data exist regarding postoperative cost optimization and guidelines for delivering high-value care. We assessed the utility and cost of routine radiographs at the first postoperative visit (FPOV) after fixation of geriatric hip fractures. Methods: We retrospectively evaluated patients with isolated geriatric hip fractures treated with internal fixation between January 2018 and September 2020. Medical records were reviewed to assess whether radiographs at the FPOV changed management. Direct costs of radiographs at the FPOV were estimated using Medicare Fee Schedule data. Indirect costs were estimated by assessing transportation costs. National costs were estimated by extrapolating institutional and Medicare data to the estimated 300,000 to 500,000 annual hip fractures in the United States. Results: Two hundred forty-one patients were included. A majority had intertrochanteric fractures (80%), were injured because of a ground-level fall (94%), and received long intramedullary nails (73%). One patient (1/241, 0.41%) had their postoperative management changed by FPOV radiographs, and that patient had an acute reinjury before their FPOV. Patients discharged home (50/241, 21%) traveled mean 51.3 miles each way, and those discharged to another facility (191/241, 79%) traveled mean 24.1 miles each way. The national estimated direct cost of routine radiographs at the FPOV totaled $10.9 to $18.2 m annually. The national indirect costs are estimated to be $1.2 to $1.9 m annually for patients discharged home and $63.4 to $105.7 m annually for patients discharged to a facility. Conclusions: Routine radiographs at the FPOV after internal fixation of geriatric hip fractures may not change management and should only be obtained when specifically indicated. Elimination of routine radiographs and conduction of the FPOV virtually by telemedicine could result in national cost savings of estimated $75.5 to $125.8 m annually without compromising quality of care.

Lower Urinary Tract Symptoms in US Women: Contemporary Prevalence Estimates from the RISE FOR HEALTH Study.

To estimate the prevalence of a wide range of lower urinary tract symptoms (LUTS) in US women, and to explore associations with bother and discussion with healthcare providers, friends, and family. We analyzed baseline data collected from 5/2022-12/2023 in the RISE FOR HEALTH study-a large, regionally-representative cohort study of adult female community members. LUTS and related bother were measured by the 10-item Symptoms of Lower Urinary Tract Dysfunction Research Network Symptom Index and discussion was assessed by a study-specific item. Of the 3000 eligible participants, 73% (95% confidence interval [CI] = 71-74%) reported any storage symptoms, 52% (95% CI = 50-53) any voiding or emptying symptoms, and 11% (95% CI = 10-13%) any pain with bladder filling, for an overall LUTS prevalence of 79% (95% CI = 78-81%). This prevalence estimate included 43% (95% CI = 41-45%) of participants with mild-to-moderate symptoms and 37% (95% CI = 35-38%) with moderate-to-severe symptoms. Over one-third of participants reported LUTS-related bother (38%, 95% CI = 36-39%) and discussion (38%, 95% CI = 36-40%), whereas only 7.1% (95% CI = 6.2-8.1%) reported treatment. Urgency and incontinence (including urgency and stress incontinence) were associated with the greatest likelihood of bother and/or discussion (adjusted prevalence ratios = 1.3-2.3), even at mild-to-moderate levels. They were also the most commonly treated LUTS. LUTS, particularly storage LUTS such as urgency and incontinence, were common and bothersome in the RISE study population, yet often untreated. Given this large burden, both prevention and treatment-related interventions are warranted to reduce the high prevalence and bother of LUTS.

Long-term exposure to transportation noise and diabetes mellitus mortality: a national cohort study and updated meta-analysis

BackgroundLong-term exposure to transportation noise is related to cardio-metabolic diseases, with more recent evidence also showing associations with diabetes mellitus (DM) incidence. This study aimed to evaluate the association between transportation noise and DM mortality within the Swiss National Cohort.MethodsDuring 15 years of follow-up (2001–2015; 4.14 million adults), over 72,000 DM deaths were accrued. Source-specific noise was calculated at residential locations, considering moving history. Multi-exposure, time-varying Cox regression was used to derive hazard ratios (HR, and 95%-confidence intervals). Models included road traffic, railway and aircraft noise, air pollution, and individual and area-level covariates including socio-economic position. Analyses included exposure-response modelling, effect modification, and a subset analysis around airports. The main findings were integrated into meta-analyses with published studies on mortality and incidence (separately and combined).ResultsHRs were 1.06 (1.05, 1.07), 1.02 (1.01, 1.03) and 1.01 (0.99, 1.02) per 10 dB day evening-night level (Lden) road traffic, railway and aircraft noise, respectively (adjusted model, including NO2). Splines suggested a threshold for road traffic noise (~ 46 dB Lden, well below the 53 dB Lden WHO guideline level), but not railway noise. Substituting for PM2.5, or including deaths with type 1 DM hardly changed the associations. HRs were higher for males compared to females, and in younger compared to older adults. Focusing only on type 1 DM showed an independent association with road traffic noise. Meta-analysis was only possible for road traffic noise in relation to mortality (1.08 [0.99, 1.18] per 10 dB, n = 4), with the point estimate broadly similar to that for incidence (1.07 [1.05, 1.09] per 10 dB, n = 10). Combining incidence and mortality studies indicated positive associations for each source, strongest for road traffic noise (1.07 [1.05, 1.08], 1.02 [1.01, 1.03], and 1.02 [1.00, 1.03] per 10 dB road traffic [n = 14], railway [n = 5] and aircraft noise [n = 5], respectively).ConclusionsThis study provides new evidence that transportation noise is associated with diabetes mortality. With the growing evidence and large disease burden, DM should be viewed as an important outcome in the noise and health discussion.

A Novel Accelerated Multistage Learning Control Mechanism via Virtual Performance Reduction.

This study uses a multistage learning mechanism concept to investigate the accelerated learning control for stochastic systems. In this mechanism, the learning iterations are divided into successive stages, with each stage comprising several iterations. The learning gain is constant in each stage to accelerate the learning process and decreases it from one stage to another to eliminate the noise effect asymptotically. The critical issue is determining the switching iteration when a new stage starts. This study resolves this issue by calculating a virtual performance index of the mean-squared input error and its estimated upper bound. Specifically, the ideal, practical, and improved multistage learning control schemes are proposed to determine the switching iteration and generate the learning gain sequence. The ideal scheme achieves the best performance at the cost of a large computation burden, and the practical scheme saves computation cost, but the performance is not excellent. The improved scheme significantly approximates the best performance by introducing additional stretching parameters to the performance index. Illustrative simulations are provided to verify the theoretical results.

Transitioning from paediatric to adult care in epilepsy: a qualitative study of adolescent experiences.

ObjectiveTransition into adulthood and adult medical care is an important step in the life of young people with epilepsy. We aimed to gain a better insight into the lived experience of the transition to adulthood and adult medical care in epilepsy in Sweden, to improve future transitional care. MethodsA cross-sectional observational study with digital focus-group meetings and interviews with young people with epilepsy (16-22 years, n=37) prior to, or after the transfer to adult care, or their primary caregivers if they had intellectual disability. We used reflexive thematic analysis to analyse the experiences and expectations on the transition to adulthood and adult medical care. ResultsThe results of the thematic analysis included four key areas during transition to adulthood and adult care for young persons with epilepsy: (I) worries on coming changes and future, (II) transfers are not smooth and adult care is less integrated, (III) epilepsy is part of a bigger picture, and (IV) parental roles change. In those with intellectual disability, parents experienced a stressful process and had to increase their efforts to coordinate all care contacts in adult care. Here, epilepsy was often experienced as a minor part of a more complex disease picture, where neurodevelopmental issues were often the primary concern. SignificanceTransition in epilepsy is often complex due to the large burden of co-occurring disease, specifically intellectual disability and neuropsychiatric diagnoses. Transfer to adult care is experienced as unplanned and participants experience uncertainty, indicating a need for an improved transition process. As effective interventions are known in other chronic diseases, future studies should focus on the evaluation of how these approaches can be feasible and effective in young people with epilepsy.

Development of palliative care clinical practice guidelines and referral care pathways for primary care practitioners in Pakistan

BackgroundDespite a large burden of life-limitingillness, there exists a dearth of services of palliative care in Pakistan. International guidelines have questionable applicability in Pakistan due to the socioeconomic differences. We generated a protocol describing the process of developing comprehensive palliative care guidelines and palliative care referral pathways for primary care practitioners to adopt in Pakistan.MethodsA GRADE-ADOLOPMENT approach with modification has been employed to create guidelines for a Pakistani context. The “National Comprehensive Cancer Network Guidelines Insights: Palliative Care, Version 2.2021” was used as the source guideline. Recommendations from the source guideline were reviewed by two local palliative care specialists to either “Adopt,” “Adapt” or “Exclude”. The finalized recommendations were incorporated into the local palliative care guideline. Clinical diagnosis and referral pathways were made from the finalized guideline. Any gaps in management found in the pathways were filled by taking existing recommendations from other credible guidelines.ResultsTwenty-seven recommendations were adopted without modification. No recommendations were deemed to be adapted and 15 were excluded. The referral care pathways created were reflective of the local guideline and included elements of initial assessment, preliminary management, reassessment, and referral. 6 additional recommendations were made.ConclusionThe described clinical practice guidelines and primary care clinical referral pathways will aid to standardize palliative care provision in Pakistan. These can be used by other resource constrained settings to develop guidelines within their own local context.

Dengue fever coinfection in COVID-19 era: A public health concern.

Dengue and SARS-CoV-2 coinfection is commonly encountered and constantly reported in particularly the dengue-endemic regions thus posing a co-epidemic threat. Coinfection is also significantly associated with morbidity and mortality. Comorbidity risk during a coinfection is of a greater concern. Although the pathophysiologies of the two infections vary, their identical clinical symptoms during coinfection result in diagnostic and therapeutic complexities. A literature search for the current relevant reports was carried out. The searched databases were Scopus, PubMed, Google Scholar and the Web of Science, with health agencies like the WHO. Based on the selection criteria, the most recent and pertinent reports published in English language were included for the ease of understanding, deciphering and analysing the secondary data. A delay in proper diagnosis of coinfection could result in serious complications with poor patient outcome. Whether it is a standalone dengue or COVID-19 infection or a coinfection, specific biomarkers may be utilized for its foolproof diagnosis. This article highlights the various diagnostic techniques and immune responses from the perspective of prompt and appropriate public health management for patients suffering from COVID-19 and dengue viral coinfections, both being independently or collectively capable of damaging a human body. As coinfection poses significantly large burden on an already-fragile healthcare facility, constant monitoring of a coinfected patient is needed for prompt and suitable therapeutics. Also, to maintain high vigilance and invoke appropriate preventive measures particularly in dengue endemic regions, the government, healthcare authority and the general public need to collaborate and cooperate.

Podcast on the IWGDF 2023 Guidelines on the Prevention of Foot Ulcers in Persons with Diabetes.

In this podcast, we discuss the 2023 update of the International Working Group on the Diabetic Foot (IWGDF) Guidelines on the prevention of foot ulcers in people with diabetes. Prevention of foot ulcers is paramount, to reduce their large burden on patients and society. Nevertheless, many clinical guidelines do not cover prevention as a topic. The IWGDF Guidelines ensure that a full chapter is dedicated to ulcer prevention. In that chapter, the key cornerstones of prevention are outlined, as well as the importance of integrated preventative foot care. With this podcast, we aim to highlight the importance of ulcer prevention and the opportunities to incorporate recommendations into clinical practice. This hopefully stimulates clinicians and researchers to increase focus on ulcer prevention in diabetic foot disease.A podcast audio is available with this article.

Seroprevalence of sexually transmitted infections over 44 years - A cross-sectional study in Sweden.

Sexually transmitted infections (STIs) may cause substantial individual suffering and a large economic burden for society. This study examined the seroprevalence of Chlamydia trachomatis, Mycoplasma genitalium, herpes simplex virus (HSV) types 1 and 2, and several human papillomaviruses (HPV) in the Swedish population over time. The study population consisted of 30-year-old women attending maternity care, and 50year-old men and women attending health check-ups, from 1975 to 2018. Antibody status was determined by multiplex serology and quantified using median reporter fluorescence intensity (MFI). A total of 891 samples were analysed (519 from 30-year-old women, 186 from 50year-old women and 186 from 50year-old men). Of these, 41.5% showed seropositivity for Chlamydia trachomatis, 16.7% for Mycoplasma genitalium, 70.5% for HSV-1, 14.9% for HSV-2, 13.2% for high-risk HPV, and 8.3% for low-risk HPV. Seropositivity for Mycoplasma genitalium, HSV-1 and especially Chlamydia trachomatis decreased over time. There was a decrease over time in Chlamydia trachomatis seroprevalence, probably due to contact tracing, testing and early treatment; this might also have affected Mycoplasma genitalium seroprevalence. Despite the reduction, seroprevalences are still high, so continued and new efforts to reduce STI incidence are essential.

Optimization of short-term hydropower scheduling with dynamic reservoir capacity based on improved genetic algorithm and parallel computing

The optimal scheduling of hydropower plants is important for the efficient operation and management of hydropower energy systems. In the short-term optimization scheduling of river-type reservoirs, the dynamic reservoir capacity is a key factor. Currently, the short-term power generation scheduling model considering dynamic reservoir capacity was solved by the enumeration method, providing a more accurate simulation of the water flow process compared to the model considering static reservoir capacity. However, the solving process had the disadvantage of a large computational burden and excessive time consumption, which restricted application in the actual scheduling of reservoirs. Therefore, to solve the time-consuming problem of repeated calculation of hydrodynamics model in optimization scheduling, an improved genetic algorithm including adaptive and elitist-selection strategies combined with the parallel computing technique was proposed. The optimal scheduling plan generated by this model were compared with the optimization results of the enumeration method and the genetic algorithm scheduling model. The results showed that the optimal power generation selected by the three models were extremely similar and the optimization model could find the optimal value for the scheduling period. In terms of computing speed, the improved genetic algorithm parallel technique took approximately 0.8 h, around 246 times faster than the enumeration method and 20 times faster than the model without using parallel computing. It demonstrates that the present algorithm is practically usable, significantly enhancing the optimization efficiency of scheduling solutions. Furthermore, it satisfies the engineering application efficiency requirements and can provide technical support for the subsequent power generation scheduling of the Three Gorges Reservoir.

Shaking Up Our Approach: The Need for Characterization and Optimization of Pre-clinical Models of Infant Abusive Head Trauma.

Traumatic brain injuries (TBIs) are a large societal and individual burden. In the first year of life, the vast majority of these injuries are the result of inflicted abusive events by a trusted caregiver. Abusive head trauma (AHT) in infants, formerly known as shaken baby syndrome, is the leading cause of inflicted mortality and morbidity in this population. In this review we address clinical diagnosis, symptoms, prognosis, and neuropathology of AHT, emphasizing the burden of repetitive AHT. Next, we consider existing animal models of AHT, and we evaluate key features of an ideal model, highlighting important developmental milestones in children most vulnerable to AHT. We draw on insights from other injury models, such as repetitive, mild TBIs (RmTBIs), post-traumatic epilepsy (PTE), hypoxic-ischemic injuries, and maternal neglect, to speculate on key knowledge gaps and underline important new opportunities in pre-clinical AHT research. Finally, potential treatment options to facilitate healthy development in children following an AHT are considered. Together, this review aims to drive the field toward optimized, well-characterized animal models of AHT, which will allow for greater insight into the underlying neuropathological and neurobehavioral consequences of AHT.

Impact of electric vehicle charging demand on power distribution grid congestion

California, a pioneer in EV adoption, has enacted ambitious electric vehicle (EV) policies that will generate a large burden on the state's electric distribution system. We investigate the statewide impact of uncontrolled EV charging on the electric distribution networks at a large scale and high granularity, by employing an EV charging profile projection that combines travel demand model, EV adoption model, and real-world EV charging data. We find a substantial need for infrastructure upgrades in 50% of feeders by 2035, and 67% of feeders by 2045. The distribution system across California must upgrade its capacity by 25 GW by 2045, corresponding to a cost between $6 and $20 billion. While the additional infrastructure cost drives the electricity price up, it is offset by the downward pressure from the growth of total electricity consumption and leads to a reduction in electricity rate between $0.01 and $0.06/kWh by 2045. We also find that overloading conditions are highly diverse spatially, with feeders in residential areas requiring twice as much upgrade compared to commercial areas. Our study provides a framework for evaluating EVs' impact on the distribution grid and indicates the potential to reduce infrastructure upgrade costs by shifting home-charging demand. The imminent challenges confronting California serve as a microcosm of the forthcoming obstacles anticipated worldwide due to the prevailing global trend of EV adoption.