Personal Advice Research Articles

Perspectives of patients with metastatic breast cancer on physical exercise programs: results from a survey in five European countries

BackgroundTo successfully implement exercise programs for patients with metastatic breast cancer (MBC), services and patient education should consider patients’ knowledge, preferences, values, and goals. Hence, gaining insight into their perspectives on exercise and exercise programming is important.MethodIn this cross-sectional survey, we recruited patients with MBC from the Netherlands, Germany, Poland, Spain, and Sweden. We collected data on patients’ knowledge and skills about exercise and outcome expectations. We identified barriers to and facilitators of participation in exercise programs, and patients’ preferences for program content and modes of exercise delivery.ResultsA total of 420 patients participated in the survey. Respondents were, on average, 56.5 years old (SD 10.8) and 70% had bone metastases. Sixty-eight percent reported sufficient skills to engage in aerobic exercise, but only 35% did so for resistance exercise. Respondents expected exercise to have multiple physical benefits, but a few patients expected exercise to worsen their pain (5%). Not having access to an exercise program for cancer patients (27%), feeling too tired (23%), and/or weak (23%) were the most often reported barriers. Facilitators for exercising regularly were previous positive physical (72%) and emotional (68%) experiences with exercising, and receiving personalized advice from a physiotherapist or sport/fitness instructor (62%). Patients were most interested in walking and preferred exercising at a public gym, although there were differences by country. Fifty-seven percent did not know whether their insurance company reimburses exercise programs and only 9% would be willing to pay more than €50 per month to participate.ConclusionA large percentage of patients with MBC lack the skills to engage in regular exercise as recommended by exercise guidelines for people with cancer. Patients may benefit from personalized advice and appropriate training facilities to overcome barriers. When implementing exercise interventions, attention should be given to reimbursement and the relatively low willingness-to-pay.

Smart Fashion Recommendation System using FashionNet

An intelligent system known as a fashion suggestion system gives consumers personalised fashion advice based on their tastes, style, body shape, and other variables. The system analyses a user's data and predicts the best fashion products for them using data analytics, machine learning, and artificial intelligence approaches. Intelligent fashion suggestion is currently desperately needed due to the explosive expansion of fashion-focused trends. We create algorithms that automatically recommend users' attire based on their own fashion tastes. We investigate the use of deep networks to this difficult problem. Our technology, called FashionNet, is made up of two parts: a matching network for determining compatibility and a feature network for feature extraction. We create a two-stage training method that transfers a broad compatibility model to a model that embeds personal choice in order to achieve personalised recommendation.

Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study.

This study assesses whether out-of-hospital coaching of re-hospitalized, severe COPD patients by specialized respiratory nurses is feasible in terms of cost-effectiveness, implementation, and recipient acceptability. The coaching was aimed at improving patients' health management abilities, motivation for healthy behavior, strengthening the professional and informal care network, stimulating physiotherapy treatment and exercise training, improving knowledge on symptom recognition and medication use, and providing safety and support. Cost-effectiveness of 6 months of out-of-hospital coaching was assessed based on a before-after intervention design, with real-life data and one-year follow-up. A total of 170 patients were included. Primary (questionnaires, meeting reports) and secondary data (insurance reimbursement data) were collected in one province in the Netherlands. The implementing and recipient acceptability was assessed based on the number of successfully delivered coaching sessions, questionnaire response rate, Patient Reported Experience Measure, and interviews with coaches. Post-intervention, the COPD-related hospitalization rate was reduced by 24%, and patients improved in terms of health status, anxiety, and nutritional status. Patients with a high mental burden and a poor score for health impairment and wellbeing at the start of the intervention showed the greatest reduction in hospitalizations. The coaching service was successfully implemented and considered acceptable by recipients, based on patient and coach satisfaction and clinical use of patient-reported measures. The study demonstrates the value of coaching patients out-of-hospital, with a strong link to primary care, but with support of hospital expertise, thereby adding to previous studies on disease- or self-management support in either primary or secondary care settings. Patients benefit from personal attention, practical advice, exercise training, and motivational meetings, thereby improving health status and reducing the likelihood of re-hospitalization and its associated costs.

An Ideal-Type Analysis of People's Perspectives on Care Plans Received from the Emergency Department following a Self-Harm or Suicidal Crisis.

People presenting to Emergency Departments (EDs) in a self-harm/suicidal crisis in England receive a psychosocial assessment and care plan. We aimed to construct a typology of peoples' perspectives on crisis care plans to explore the range of experiences of care plans. Thirty-two semi-structured interviews with people who presented to EDs following a self-harm/suicidal crisis in England were analysed using an ideal-type analysis. Cases were systematically compared to form clusters of cases with similar experiences of care plans. People's perspectives on care plans fitted into three types: (1) personalised care plans (n = 13), consisting of advice or referrals perceived as helpful; (2) generic care plans (n = 13), consisting of generic advice that the person already knew about or had already tried; and (3) did not receive a care plan (n = 6) for those who reported not receiving a care plan, or who were only provided with emergency contacts. Care planning in the ED following a suicidal/self-harm crisis was perceived as supportive if it provided realistic and personalised advice, based on what had/had not worked previously. However, many people reported not receiving a helpful care plan, as it was ill-fitted to their needs or was not considered sufficient to keep them safe, which may mean that these patients are at increased risk of repeat self-harm.

Evaluating Variation in the Cardiac Management of Children with Hereditary Thoracic Aortic Disease in the United States.

Hereditary thoracic aortic diseases (HTAD) such as Marfan syndrome (MFS), Loeys-Dietz syndrome (LDS), and vascular Ehlers-Danlos syndrome (VEDS) frequently result in complex cardiovascular pathology that can lead to premature death. However, given limited research and lack of detailed pediatric management guidelines, practice in the U.S. is largely guided by personal experience and/or advice from other professionals. A REDCap survey was composed that covered topics including genetic testing, imaging, and medication choice (all in children), among others. After piloting, the survey was distributed via email and advertised on PediHeartNet. Email addresses of providers were obtained through an established aortic research collaborative and a clinic directory offered through The Marfan Foundation. There were 64 survey responses (pediatric cardiologists 66%; geneticists 13%, genetic counselors 6%; the remaining 15% was comprised of a combination of cardiothoracic surgeons, adult cardiologists, adult congenital specialists, combined cardiology and genetics specialist, nurse practitioners, physician assistants, and nurse coordinators). The most supported indication for genetic evaluation in a child with mild aortic root dilation was family history of thoracic aortic dissection (100%), in contrast to mild root dilation with no other HTAD features (39% supported, 45% did not, 15% saying it would depend on other factors). The majority would start medical therapy in MFS at an aortic root z-score of 2, however differences existed regarding medication preferences for initiation (47% angiotensin receptor blockers, 36% beta blockers, 17% would not or cannot prescribe medication/defer medication choice to another provider). Variation existed for cross-sectional imaging indications and modality and for exercise restrictions, although on average respondents were more lenient than the Bethesda guidelines. While there are areas of general agreement in the cardiac management of children with HTAD, there are also several areas of considerable variation. This highlights the need for additional study in these areas with the ultimate goal of creating consensus guidelines.

Work-focused healthcare from the perspective of employees living with cardiovascular disease: a patient experience journey mapping study

BackgroundPeople living with cardiovascular diseases (CVD) often experience work participation problems. Good work-focused healthcare, defined as the received advice, treatment, and guidance focusing on work participation, can support the patient and work place. However, experiences with work-focused healthcare are generally not always positive which is a barrier for work participation. Therefore, the objective of this study is to gain insight into the work-focused healthcare journey from the perspective of patients with work participation problems due to CVD, to understand their experiences and needs, and to derive opportunities for improving work-focused healthcare service at a system level.MethodsSemi-structured interviews, preceded by preparatory assignments, were conducted with 17 patients who experience(d) work participation problems due to CVD. The patient experience journey map (PEJM) approach was used to visualize the patients’ work-focused healthcare journey, including experiences and needs over time and place, from which opportunities to improve work-focused healthcare from the patient’s perspective were derived.ResultsAn aggregated PEJM consisting of six phases was composed and graphically mapped. The first phase, working, represents a period in which CVD health problems and subsequent functional limitations occur. The next two phases, short- and long-term sick leave, represent a period of full sick leave. The last three phases, start-, partial-, and full vocational reintegration, focus on the process of return to work that takes place ranging from a few months up to several years after sick-listing. For each phase the touchpoints, timespan, stakeholders, activities, experiences and needs from the perspective of the patients were identified. Finally, for better work-focused healthcare nine opportunities for improvement were derived from the PEJM, e.g. emphasize the need for work adjustment prior to the medical intervention, provide more personalized advice on handling work limitations, and putting more compelling pressure on the employer to create suitable work positions for their employees.Discussion/conclusionThis paper contributes insights to provide a more patient-centered work-focused healthcare trajectory for patients employed in paid jobs when living with CVD. The PEJM provides an understanding of the patients’ perspectives throughout their work-focused healthcare journey and highlights opportunities for improvement towards a better suited and seamless patient journey, Although this research was conducted within the Dutch healthcare system, it can be assumed that the findings on integrated work-focused healthcare are largly transferable to other healthcare systems.

A machine learning-based score for precise echocardiographic assessment of cardiac remodelling in hypertensive young adults.

Accurate staging of hypertension-related cardiac changes, before the development of significant left ventricular hypertrophy, could help guide early prevention advice. We evaluated whether a novel semi-supervised machine learning approach could generate a clinically meaningful summary score of cardiac remodelling in hypertension. A contrastive trajectories inference approach was applied to data collected from three UK studies of young adults. Low-dimensional variance was identified in 66 echocardiography variables from participants with hypertension (systolic ≥160 mmHg) relative to a normotensive group (systolic < 120 mmHg) using a contrasted principal component analysis. A minimum spanning tree was constructed to derive a normalized score for each individual reflecting extent of cardiac remodelling between zero (health) and one (disease). Model stability and clinical interpretability were evaluated as well as modifiability in response to a 16-week exercise intervention. A total of 411 young adults (29 ± 6 years) were included in the analysis, and, after contrastive dimensionality reduction, 21 variables characterized >80% of data variance. Repeated scores for an individual in cross-validation were stable (root mean squared deviation = 0.1 ± 0.002) with good differentiation of normotensive and hypertensive individuals (area under the receiver operating characteristics 0.98). The derived score followed expected hypertension-related patterns in individual cardiac parameters at baseline and reduced after exercise, proportional to intervention compliance (P = 0.04) and improvement in ventilatory threshold (P = 0.01). A quantitative score that summarizes hypertension-related cardiac remodelling in young adults can be generated from a computational model. This score might allow more personalized early prevention advice, but further evaluation of clinical applicability is required.

“Stay away from the Park”: A Case for Police-Issued Personal Safety Advice for Women

AbstractAre police officers morally justified in issuing unsolicited personal safety advice to women? Such advice often attracts accusations of ‘victim blaming’, although prevention advice remains a common tool used by police to address many crime and safety risks. While some examples of police advice are clearly outrageous, this article considers whether there is a place for ‘sound’ advice, i.e., advice that is proportionate, easy to follow, empirically justified, and objectively likely to reduce harm. To explore this, the article proposes a thought experiment that compares safety advice dealing with threats to women from human sources with safety advice issued in response to natural phenomena, such as flooding. It argues that, despite apparent differences, safety advice addressing risks from humans and natural phenomena are relevantly similar. Consequently, if advice dealing with natural phenomena is morally justified then advice to women about human threats is also morally justifiable. Nevertheless, the article also considers whether the purported prevalence of sexism in policing may make safety advice for women morally problematic. While levels of sexism in policing may vary across time and location, it is argued that safety advice would be morally justified even if sexism was widespread among police officers. Finally, the article considers whether crime prevention advice may backfire by effectively curtailing women’s freedoms. Rather than curtailing freedom, however, it is argued that sound advice may actually enable women to flourish by helping them overcome fear of crime and achieve non-instrumental goals that they have set for themselves.

More than a principal: Ubuntu at the heart of successful school leadership in the Western Cape

School leadership matters. After teachers and teaching, school leadership is the most important determinant of learner achievement in school. Despite this, there is still uncertainty regarding what successful school leadership is and what successful school leaders do in non-Western contexts. In this mixed methods study I explored successful high school leadership in South Africa. Specifically, a questionnaire was administered to 38 principals from academically high-achieving schools from a range of socioeconomic contexts throughout the Western Cape, and 14 principals were interviewed. An integrated analysis reveals the paradox of uniqueness and universality of successful school leadership in South Africa, outlining that while there is no single best approach, various similarities exist between successful school leaders and established international literature. I found that successful principals adapt to their context, amalgamate transformational, instructional and distributed leadership styles, set direction, develop people, constantly realign the school with teaching and learning, and, importantly, strive to make a difference in the lives of others. It is about leading with Ubuntu. By highlighting these characteristics and practices, I offer theoretical, practical and personal advice to current and aspiring school leaders, academics and policy makers.

Personalised decision making to predict absolute metastatic risk in cutaneous squamous cell carcinoma: development and validation of a clinico-pathological model

Cutaneous squamous cell carcinoma (cSCC) is a common skin cancer, affecting more than 2 million people worldwide yearly and metastasising in 2-5% of patients. However, current clinical staging systems do not provide estimates of absolute metastatic risk, hence missing the opportunity for more personalised treatment advice. We aimed to develop a clinico-pathological model that predicts the probability of metastasis in patients with cSCC. Nationwide cohorts from (1) all patients with a first primary cSCC in The Netherlands in 2007-2008 and (2) all patients with a cSCC in 2013-2015 in England were used to derive nested case-control cohorts. Pathology records of primary cSCCs that originated a loco-regional or distant metastasis were identified, and these cSCCs were matched to primary cSCCs of controls without metastasis (1:1 ratio). The model was developed on the Dutch cohort (n=390) using a weighted Cox regression model with backward selection and validated on the English cohort (n=696). Model performance was assessed using weighted versions of the C-index, calibration metrics, and decision curve analysis; and compared to the Brigham and Women's Hospital (BWH) and the American Joint Committee on Cancer (AJCC) staging systems. Members of the multidisciplinary Skin Cancer Outcomes (SCOUT) consortium were surveyed to interpret metastatic risk cutoffs in a clinical context. Eight out of eleven clinico-pathological variables were selected. The model showed good discriminative ability, with an optimism-corrected C-index of 0.80 (95% Confidence interval (CI) 0.75-0.85) in the development cohort and a C-index of 0.84 (95% CI 0.81-0.87) in the validation cohort. Model predictions were well-calibrated: the calibration slope was 0.96 (95% CI 0.76-1.16) in the validation cohort. Decision curve analysis showed improved net benefit compared to current staging systems, particularly for thresholds relevant for decisions on follow-up and adjuvant treatment. The model is available as an online web-based calculator (https://emc-dermatology.shinyapps.io/cscc-abs-met-risk/). This validated model assigns personalised metastatic risk predictions to patients with cSCC, using routinely reported histological and patient-specific risk factors. The model can empower clinicians and healthcare systems in identifying patients with high-risk cSCC and offering personalised care/treatment and follow-up. Use of the model for clinical decision-making in different patient populations must be further investigated. PPP Allowance made available by Health-Holland, Top Sector Life Sciences & Health, to stimulate public-private partnerships.

Academic services of psychological support of university education

Introduction. Modern university life is rich in events and problems: it has many difficulties, including such as adaptation to a new environment and the general stress of student / teaching life, etc. The university stress significantly reduces academic performance and negatively affects the psychological well-being of students, teachers and other members of the university community. Purpose setting. The psychological support service of the university is an important additional form of social and psychological protection of a person with support at the educational and / or workplace. It is designed to help the subjects of the educational process to overcome stresses and their consequences that affect educational relationships, the causes of which are both related and not directly related to these relationships. The purpose of the study is to analyze the problems and directions of work of modern academic psychological services. Methodology and methods of the study. The research method is a theoretical analysis of the psychological support of the educational process as a sphere of numerous types of psychological assistance from a person to a person in solving the tasks facing him of coping with crises of personal, interpersonal and educational and professional development. The research methodology is a systematic analysis of the problems and areas of work of the academic psychological service. Results. Academic services can be contacted by clients for getting confidential, personal and professional advice, etc. for their development, assistance in the following areas: immediate relief from stress, identifying strategies for coping with current problems or a crisis, exploring ways for longer-term solutions and larger changes, developing and thinking about next steps, correcting planned routes, etc., developing self-help competencies. Conclusion. Modern academic psychological support services are interdisciplinary, polymorphic, multifunctional and multitechnological structures that are actively developing in the direction of providing assistance and self-help support to people with disorders and requests that are very different in type, form, intensity and mode.

Nutrition Education Improves Intakes of Protein, Polyunsaturated Fatty Acids, and Vitamins C and E in Community-Dwelling Older Adults

This study investigated the effect of nutrition education program on protein and nutrient intake, physical performance, and health-related quality of life (HRQoL) in community-dwelling older adults (≥65 years). The participants were randomized in clusters to intervention (IG, n = 51) and control (CG, n = 45) groups. Those in IG took part in the Eating for Strong Aging education program consisting of nutrition education in peer groups, written materials, and personal advice. Nutrient intake was assessed with 3-day food diaries, physical performance with Short Physical Performance Battery (SPPB) and HRQoL with 15-D-QoL instrument. Total of 89 participants completed the study. The mean age was 76 years (IG) and 74 years (CG). At three months, the mean change in protein intake was 0.10 g/adjusted bodyweight (ABW) kg/d in the IG, and −0.07 g/ABW kg/d in the CG (p = 0.024). Intakes of polyunsaturated fatty acids and vitamins C and E increased in the IG compared to the CG (p < 0.05). Changes in SPPB or total HRQoL scores between the IG and the CG did not differ. HRQoL dimension mobility improved in the IG compared to the CG (p = 0.035). In conclusion, the Eating for Strong Aging educational program improved nutrition and may be beneficial for mobility-related QoL.

Leveraging ChatGPT to aid patient education on coronary angiogram.

Natural-language artificial intelligence (AI) is a promising technological advancement poised to revolutionise the delivery of healthcare. We aim to explore the quality of ChatGPT in providing medical information regarding a common cardiology procedure-the coronary angiogram-and evaluating the potential opportunities and challenges of patient education through this natural-language AI model in the broader context. In a conversational manner, we asked ChatGPT common questions about undergoing a coronary angiogram according to the areas of: description of procedure, indications, contraindications, complications, alternatives, and follow-up. The strengths of the answers given by ChatGPT were that they were generally presented in a comprehensive and systematic fashion, covering most of the major information fields that are required. However, there were certain deficiencies in its responses. These include occasional factual inaccuracies, significant omissions, inaccurate assumptions, and lack of flexibility in recommendations beyond the line of questioning, resulting in the answers being focused solely on the topic. We would expect an increasing number of patients who may choose to seek information about their health through these platforms given their accessibility and perceived reliability. Consequently, it is prudent for healthcare professionals to be cognisant of both the strengths and deficiencies of such models. While these models appear to be good adjuncts for patients to obtain information, they cannot replace the role of a healthcare provider in delivering personalised health advice and management.

Use of Off-Label Drugs in COVID-19: Clinicians' Perceptions Based on a Cross-Sectional Observational Study.

Introduction The absence of a common National Treatment Guideline during the second wave of the COVID-19 pandemic in India resulted in different treatment strategies, and the use of "off-label drugs" (OfLDs) was one of them. Aims This study aimed to assess the proportion of doctors who prescribed OfLDs, their perceived appropriateness, and the factors leading to their use. Settings and design This is an undergraduate student research project, in which a web-based cross-sectional survey was conducted on doctors who delivered care to COVID-19 patients during the second wave of the pandemic in Uttarakhand, India. Materials and methods The minimum sample size was 370 (for a 95% confidence level, an alpha error of 0.5, and a power of 80%). Data were collected electronically using a validated questionnaireafter institutional ethical clearance and the participants' consent. Statistical analysis This is a descriptive-analytical study. Results We received 419 completed responses; all specialties had seen COVID-19 patients, and 91.4% (383) of the doctors had provided care toCOVID-19 patients in some way or the other. About 90.7% (380) of the doctors used OfLDs; 62.5% (262) agreed that OfLDs were beneficial, and 78.9% (331) disagreed on universal steroid use. Only 34.1% (143) felt that using OfLDs was ethical. About 16.9% (71) of the doctors believed that alternative medicine was a useful treatment adjunct, and 20% (84) of doctors prescribed OfLDs under duress. About 21.2% (89) believed that Remdesivir was the main treatment for the disease, and 18.6% (78) believed that Tocilizumab was the main treatment for the disease. Personal experience, conviction, or advice from peers were among the various reasons that were put forward for using OfLDs. Conclusions The use of OfLDs during the COVID-19 pandemic in India was extensive. It was done sometimes under pressure and was largely based on confusion (multiplicity of guidelines, many times at variance with each other) as well as on a personal or low level of scientific evidence forwarded to support the use.

Collaborative Consumption Practices in Kyrgyzstan

This research article studies collaborative consumption practices in Kyrgyzstan in the context of the Theory of Planned Behaviour and Auckland Individualism and Collectivism dimensions. The research aims to answer the question: To what extent are the Theory of Planned Behaviour and Individualism and Collectivism dimensions relevant framework to explaining intention to engage in collaborative consumption and collaborative consumption behaviour. A quantitative online survey of 308 respondents was conducted. A linear regression analysis was performed using the R statistics engine. The study found that dimensions of the TPB such as attitude, subjective norm, perceived behavioural control, and personal norms; and the dimension of individualism – responsibility are among the statistically significant positive predictors of intentions to engage in collaborative consumption. Whereas personal norms, behavioural beliefs, advice, and closeness are positive; biospheric value orientations and harmony are negative factors impacting the collaborative consumption behaviour of respondents.

Evaluating the Impact of Early Career Academic Medicine Workshops on Medical Students' Interest.

Introduction Academic medicine is an important field that has had a notable decline in physician interest. The aim of this study was to introduce academic medicine to medical students early in their careers with a workshop in the medical school setting, beyond conferences, to promote even greater interest in the field. Methods This workshop consisted of (1) an informational didactic session using a Microsoft PowerPoint presentation, (2) small-group breakout discussion sessions to review case scenarios, and (3) a faculty panel to provide personal anecdotes and advice to students. The authors administered online pre- and post-workshop surveys to the students. One workshop was presented to first-year medical students and another to second-year medical students at California University of Science and Medicine. Data were analyzed using the IBM SPSS Statistics 27.0 for Windows. Pre- and post-workshop survey question means were compared using a paired t-test. Results There were 104 pre-clerkship student attendees, 83 of whom were in their first year and 21 in their second. Within each class year, there was a statistical significance in pre- and post-workshop survey responses for questions one through four (p < 0.001, p < 0.001, p < 0.001, p < 0.001), but question five responses were not statistically significant (p = 0.78). Conclusion Academic medicine workshops held early in medical students' careers are an effective way to foster interest in the field. Implementing academic medicine scholars' programs, in addition to these workshops, can help provide guidance and resources for students who want to pursue a career in academic medicine.

Experience attributes and service quality dimensions of peer-to-peer accommodation in Malaysia

This paper reports the empirical findings of experience attributes and service quality dimensions of peer-to-peer accommodation (P2P) in Malaysia. Data collection was conducted using in-depth interviews, which involved 10 P2P accommodation hosts and 15 P2P accommodation guests. Thematic analysis of the data guided by the concepts of service experience and service quality, revealed that P2P accommodation has four experience dimensions (property/accommodation, hosts, local people/culture, and location) and seven service quality dimensions (home facilities, personal advice, helpfulness, feeling welcome, responsiveness, reliability, and caring). These dimensions differentiate P2P accommodation from other types of accommodation, such as hotels, and are different from those of the SERVQUAL model. Subsequently, a new model, P2PSERVQUAL, is proposed for peer-to-peer accommodation. The findings add to the tourism and hospitality literature on experience attributes and service quality, with implications for the marketing and management of P2P accommodation.

Development of Yorkshire Terrier Dentition.

The development of dentition in dogs has been associated with several problems including tooth over-crowding, missing permanent dentition, and persistent deciduous teeth (PDT). Information on dentition development in different breeds is lacking. This study of 61 Yorkshire terriers aimed to determine the (i) average age at deciduous tooth exfoliation, (ii) average age at permanent tooth eruption, (iii) PDT incidence, and influencing factors such as body weight. The ages of exfoliation of deciduous teeth and eruption of permanent dentition were influenced by body weight and tooth type. These dentition changes tended to occur later in dogs ≤ 3 kg versus dogs > 5 kg. Generally, incisors were exfoliated first, followed by premolars and then canines. At a body weight of 4.5 kg, the middle of the data range, the estimated age at loss of deciduous teeth (with 95% confidence intervals) was 21.9 (21.1, 22.9) weeks for incisors, 26.1 (24.9, 27.4) weeks for canines, and 23.9 (22.9, 24.9) weeks for premolar. The estimated age at eruption of permanent dentition was 22.3 (21.6, 23.0) weeks for incisors, 23.8 (23.0, 24.6) weeks for canines, 24.7 (24.0, 25.5) weeks for premolars, and 26.4 (25.5, 27.3) for molar teeth. However, this sequence was disrupted in dogs ≤ 3 kg. Yorkshire terriers had a high incidence of PDT. At a body weight of 4.5 kg, the estimated proportion of PDT was: incisors 0.86% (0.32, 2.31), canines 15.62% (7.62, 29.37) and premolars 3.57% (1.62, 7.66). Canines constituted the most frequently retained tooth type, with 89.1% retained in dogs ≤ 3 kg compared to 12.0% in dogs > 5 kg. This information will enable veterinarians to provide personalised advice regarding the oral care requirements for Yorkshire terriers and highlights the need to regularly monitor this breed between the ages of two and seven months, during the active phases of tooth development.

Analysis of the applicability of the mHealth ALIBIRD platform and its impact on the follow-up of patients with lung cancer.

e24050 Background: Lung cancer is associated with a wide symptom burden. Often, patient's symptoms are inadequately captured during routine visits. For this reason, there is an increasing interest in developing effective approaches for patient-reported symptom management at home. Emerging evidence suggests that this strategy should lead to reducing toxicity and emergency room visits and improving quality of life. In the context of the ALIBIRD2020-CM project, we developed the mHealth ALIBIRD platform (mHAP) to remotely monitoring cancer patients. Methods: The mHAP implemented consists of a mobile application for patients and a web tool for the clinical team. Through the mobile application, patients record symptoms, toxicities, and lifestyle variables such as diet, physical activity and sleep through Fitbit wearables. Based on patient-reported outcomes (PRO), patient-reported outcome measures (PROM), patient gut microbiome and nutrigenomics data, this platform provides personalised recommendations and advice. Clinicians can visualise patient data, resolve symptom alerts, and make clinical-therapeutic decisions. A single-branch interventional pilot study was carried out at Hospital Infanta Sofía and approved by the Ethics Committee (HULP PI-4735). The primary outcome was to assess the mHAP, usability. The secondary outcome was to assess the clinical impact of the tool. Results: Twenty patients with stage IV thoracic neoplasms under active treatment participated for 6 months with 10 face-to-face visits for oncological and nutritional control. Anthropometric parameters were measured at each nutritional control, and muscle ultrasound was performed on visits 1, 5, and 10. Our results demonstrate a high level of user satisfaction with mHAP. A total of 679 symptoms were captured by mHAP, 96 alerts were detected and resolved (only 3 patients were referred to ER) and an early detection of a progression was done. The two main categories of severe toxicities recorded through the PROCTCAE questionnaire were the sensation of pain (25%) and asthenia and quality of rest (23%). There was an increase in the trend of moderate physical activity and adherence to the Mediterranean diet (21.4%) from baseline. Nutrigenetic analyses have led to the detection of 5 lactose intolerant patients and 4 patients with intermediate tolerance to gluten. Preliminary results from gut microbiome analysis indicate that 75% of the patients have dysbiosis. At the last visit, the HADS questionnaire showed 7% of cases with anxiety problems and 14% with depression. Conclusions: The findings obtained so far relate the mHAP to a favourable clinical impact, high usability and satisfaction. mHAP promotes healthy lifestyle and patient´empowerment, and supports clinicians for personalized recommendations, therapeutic adjustments in medication and nutritional supplementation as well as referrals to other specialists.

Combining data and mathematical models for the design of personalised light interventions to improve sleep timing in aging

AbstractBackgroundMore than 70% of people living with dementia (PLWD) experience sleep disturbances (e.g., early bedtime, long time in bed) even in the early stages of cognitive decline. Light interventions have been proposed as a promising non‐pharmacological approach to improve sleep timing, but current implementations are burdensome and not personalised. Quantitative tools for designing pragmatic light interventions for the home‐setting could benefit PLWD and their carers.Here, we report on a quantitative computational tool which combines readily collectable data with a new mathematical model to provide personalised advice on light interventions. Our focus is on designing low‐burden interventions requiring minimal changes to lifestyle or sleep‐wake routines.MethodEighteen older adults (65‐80 y) monitored their light exposure and sleep for a period of 7‐10 days at home using a wristworn monitor (Actiwatch Spectrum) and a sleep diary from which we calculated daily sleep timing and duration.We constructed a new mechanistic mathematical model for sleep timing that incorporates sleep homeostasis, circadian rhythmicity and light data (HCL). For each participant, we fitted the model to their sleep timing and duration data. We then used simulations to predict the effect of different light interventions on sleep timing and used optimisation to determine light exposure patterns that promote a target sleep onset time.ResultIndividuals varied in their sleep duration (07:18 ± 0:56 hh:mm; mean ± SD) and mid‐sleep timing (03:22 ± 01:00 hh:mm). We successfully retrieved ‘personal’ model parameters that accurately captured sleep duration and timing for 17 of the 18 participants. Our simulations indicated that the effect of a given light exposure pattern on sleep timing depends on the personalised model parameters, suggesting that an intervention that works for one person may not work for someone else. We were able to propose light exposure patterns requiring minimal behavioural change, facilitating adherence.ConclusionIt is possible to extract individual physiological parameters for sleep‐wake regulation from data collected in the field. These individual parameters can be used to design personalised light interventions. Our fully‐documented code could be combined with passive sleep monitors and environmental light sensors to unobtrusively recommend personalised light exposure patterns in close‐to real time.