Monitoring Of Progression Research Articles

Role of joint interactions in upper limb joint movements: a disability simulation study using wearable inertial sensors for 3D motion capture

BackgroundRestriction of movement at a joint due to disease or dysfunction can alter the range of motion (ROM) at other joints due to joint interactions. In this paper, we quantify the extent to which joint restrictions impact upper limb joint movements by conducting a disability simulation study that used wearable inertial sensors for three-dimensional (3D) motion capture.MethodsWe employed the Wearable Inertial Sensors for Exergames (WISE) system for assessing the ROM at the shoulder (flexion–extension, abduction–adduction, and internal–external rotation), elbow (flexion–extension), and forearm (pronation-supination). We recruited 20 healthy individuals to first perform instructed shoulder, elbow, and forearm movements without any external restrictions, and then perform the same movements with restriction braces placed to limit movement at the shoulder, elbow, and forearm, separately, to simulate disability. To quantify the extent to which a restriction at a non-instructed joint affected movement at an instructed joint, we computed average percentage reduction in ROM in the restricted versus unrestricted conditions. Moreover, we performed analysis of variance and post hoc Tukey tests (q statistic) to determine the statistical significance (p < 0.05 denoted using *) of the differences in ROM of an instructed joint in the unrestricted versus restricted conditions.ResultsRestricting movement at the shoulder led to a large reduction in the average ROM for elbow flexion–extension (21.93%, q = 9.34*) and restricting elbow movement significantly reduced the average ROM for shoulder flexion–extension (17.77%, q = 8.05*), shoulder abduction–adduction (19.80%, q = 7.60*), and forearm pronation-supination (14.04%, q = 4.96*). Finally, restricting the forearm significantly reduced the average ROM for shoulder internal–external rotation (16.71%, q = 3.81*) and elbow flexion–extension (10.01%, q = 4.27*).ConclusionsJoint interactions across non-instructed joints can reduce the ROM of instructed movements. Assessment of ROM in the real-world using 3D motion capture, for example using the WISE system, can aid in understanding movement limitations, informing interventions, and monitoring progress with rehabilitation.

Ranking performances of Olympic-style weightlifters adjusted for body mass on the same scale for both sexes: A novel approach.

Males typically outperform females in Olympic-style weightlifting, as judged by total weight lifted, and similarly heavier athletes outperform lighter athletes. Current methods can standardise weightlifting performances across body mass to compare different body mass classes, but they do not address the sex gap. This study introduces a novel approach that puts male and female performances on a single unified scale, across the range of body mass, allowing mixed sex teams to be compared. The method uses standardised residuals or "z-scores" derived from models of performance regressed on sex and body mass fitted by GAMLSS (generalised additive models for location, scale and shape). Reference data come from the International Weightlifting Federation (IWF) world championships and Olympics 2017-2023. To ensure the validity of the model for ranking team performances in the future, results from 2000 to 2023 were compared and shown to be stable over time. A web application is available to aid athletes, coaches and health professionals to compare performances and monitor progress over time.

Parkinson disease therapy: current strategies and future research priorities.

Parkinson disease (PD) is the fastestgrowing neurological disorder globally and poses substantial management challenges owing to progressive disability, emergence of levodopa-resistant symptoms, and treatment-related complications. In this Review, we examine the current state of research into PD therapies and outline future priorities for advancing our understanding and treatment of the disease. We identify two main research priorities for the coming years: first, slowing the progression of the disease through the integration of sensitive biomarkers and targeted biological therapies, and second, enhancing existing symptomatic treatments, encompassing surgical and infusion therapies, with the goal of postponing complications and improving long-term patient management. The path towards disease modification is impeded by the multifaceted pathophysiology and diverse mechanisms underlying PD. Ongoing studies are directed at α-synuclein aggregation, complemented by efforts to address specific pathways associated with the less common genetic forms of the disease. The success of these efforts relies on establishing robust end points, incorporating technology, and identifying reliable biomarkers for early diagnosis and continuous monitoring of disease progression. In the context of symptomatic treatment, the focus should shift towards refining existing approaches and fostering the development of novel therapeutic strategies that target levodopa-resistant symptoms and clinical manifestations that substantially impair quality of life.

Deep-Learning-Based Automated Building Construction Progress Monitoring for Prefabricated Prefinished Volumetric Construction

Prefabricated prefinished volumetric construction (PPVC) is a relatively new technique that has recently gained popularity for its ability to improve flexibility in scheduling and resource management. Given the modular nature of PPVC assembly and the large amounts of visual data amassed throughout a construction project today, PPVC building construction progress monitoring can be conducted by quantifying assembled PPVC modules within images or videos. As manually processing high volumes of visual data can be extremely time consuming and tedious, building construction progress monitoring can be automated to be more efficient and reliable. However, the complex nature of construction sites and the presence of nearby infrastructure could occlude or distort visual data. Furthermore, imaging constraints can also result in incomplete visual data. Therefore, it is hard to apply existing purely data-driven object detectors to automate building progress monitoring at construction sites. In this paper, we propose a novel 2D window-based automated visual building construction progress monitoring (WAVBCPM) system to overcome these issues by mimicking human decision making during manual progress monitoring with a primary focus on PPVC building construction. WAVBCPM is segregated into three modules. A detection module first conducts detection of windows on the target building. This is achieved by detecting windows within the input image at two scales by using YOLOv5 as a backbone network for object detection before using a window detection filtering process to omit irrelevant detections from the surrounding areas. Next, a rectification module is developed to account for missing windows in the mid-section and near-ground regions of the constructed building that may be caused by occlusion and poor detection. Lastly, a progress estimation module checks the processed detections for missing or excess information before performing building construction progress estimation. The proposed method is tested on images from actual construction sites, and the experimental results demonstrate that WAVBCPM effectively addresses real-world challenges. By mimicking human inference, it overcomes imperfections in visual data, achieving higher accuracy in progress monitoring compared to purely data-driven object detectors.

Exploring Urbanization Strategies by Dissecting Aggregate Crowd Behaviors: A Case Study in China

Town development, a crucial stage of urbanization, has been increasingly prioritized in recent sustainable socio-economic growth strategies. Vitality, especially the one measured by aggregate crowd behaviors, is widely recognized as a crucial development element. Conducting comprehensive assessments of the drivers of town vitality, particularly crowd vitality, is thus essential for addressing challenges and monitoring progress. This study examines representative towns in China and employs multiple datasets along with XGBoost-SHAP to investigate the mechanisms of development environment factors on aggregate crowd vitality. Key findings highlight the study’s novelty and broader implications: (1) The degree of industrial agglomeration is the most significant factor impacting the dependent measures, providing new data-driven insights into the role of economic clustering in town development. (2) Other indicators, such as the minimum distance to the town center, the enclosure, and car and pedestrian friendliness, can effectively predict town vitality, offering practical considerations for town planning. (3) Industrial innovation and diversification, rational planning of living circles, and enhancement of town conditions emerge as three crucial strategies for promoting urbanization. This study enhances empirical insights with strategies for addressing urbanization challenges, emphasizing how crowd data can be used to inform urbanization policies and planning practices, aiding urban planners in building more sustainable systems.

Squamous Cell Carcinoma: From Diagnosis to Effective Treatment-A Comprehensive Guide

Squamous cell carcinoma (SCC) is the second most common malignant skin cancer, and its occurrence is on the rise globally. The main risk factors are cumulative sun exposure, immunosuppression, and inflammation. Early diagnosis and treatment are crucial to prevent metastasis and improve patient outcomes. Advanced diagnostic techniques, such as dermoscopy and reflectance confocal microscopy (RCM), have improved the accuracy of SCC diagnosis. Dermoscopy allows for better identification and targeted biopsy of suspicious areas, while RCM provides noninvasive and precise monitoring of treatment progress. The treatment of SCC has also advanced significantly in recent years. For patients with severe actinic damage and multiple in situ/low-risk SCC, cancer treatment has shown promising results. This approach involves the use of topical agents to target the tumor and the surrounding areas where cancer may develop. Additionally, novel therapies, such as epidermal growth factor receptor inhibitors and immune checkpoint inhibitors have been developed for locally advanced and metastatic SCC. In conclusion, the incidence of SCC has been increasing globally, and early diagnosis and treatment are crucial to prevent metastasis and improve patient outcomes. Advanced diagnostic techn

Noncontact 3D Bioprinting of Proteinaceous Microarrays for Highly Sensitive Immunofluorescence Detection within Clinical Samples.

Immunofluorescence assays are extensively used for the detection of disease-associated biomarkers within patient samples for direct diagnosis. Unfortunately, these 2D microarrays suffer from low repeatability and fail to attain the low limits of detection (LODs) required to accurately discern disease progression for clinical monitoring. While three-dimensional microarrays with increased biorecognition molecule density stand to circumvent these limitations, their viscous component materials are not compatible with current microarray fabrication protocols. Herein, we introduce a platform for 3D microarray bioprinting, wherein a two-step printing approach enables the high-throughput fabrication of immunosorbent hydrogels. The hydrogels are composed entirely of cross-linked proteins decorated with clinically relevant capture antibodies. Compared to two-dimensional microarrays, these proteinaceous microarrays offer 3-fold increases in signal intensity. When tested with clinically relevant biomarkers, ultrasensitive single-plex and multiplex detection of interleukin-6 (LOD 0.3 pg/mL) and tumor necrosis factor receptor 1 (LOD 1 pg/mL) is observed. When challenged with clinical samples, these hydrogel microarrays consistently discern elevated levels of interleukin-6 in blood plasma derived from patients with systemic blood infections. Given their easy-to-implement, high-throughput fabrication, and ultrasensitive detection, these three-dimensional microarrays will enable better clinical monitoring of disease progression, yielding improved patient outcomes.

A short version of the Everyday Cognition scale can predict clinical progression and cognitive decline.

The Everyday Cognition scale (ECog-39) scores are associated with future cognitive decline. We investigated whether the 12-item ECog (ECog-12), which is being collected in Alzheimer's Disease Neuroimaging Initiative (ADNI)4, can predict progression. Baseline self (PT)- and study partner (SP)-ECog-12 data were extracted from the 39-item version collected in the ADNI. Weibull analysis examined the relationship between baseline ECog-12 and future clinical progression (change in Clinical Dementia Rating Sum of Boxes [CDR-SB] scores and diagnostic conversion). Higher PT- and SP-ECog-12 scores were associated with faster CDR-SB worsening, with hazard ratios in cognitively unimpaired (CU) 3.34 and 9.61, mild cognitive impairment (MCI) 1.44 and 2.82, and dementia 0.93 and 1.82. They were associated with conversion from CU to MCI 3.01 and 6.24 and MCI to dementia 1.61 and 3.07. SP-ECog-12 provided a higher prognostic value for predicting clinical progression, so this can help identify and monitor patients at risk in research and health-care settings. The 12-item Everyday Cognition scale (ECog-12) data obtained from both raters increased diagnostic conversion risk from cognitively unimpaired to mild cognitive impairment (MCI) and from MCI to dementia. ECog-12, rated by study partners, was associated with an increased risk of Clinical Dementia Rating Sum of Boxes worsening in all diagnostic groups. Our results provide novel information about the specific scoring outputs and rater types (participant vs. study partner) of ECog-12 that can facilitate screening, prioritization, and longitudinal monitoring of the clinical progression of participants in Alzheimer's Disease Neuroimaging Initiative 4 and other Alzheimer's disease clinical studies, clinical trials, and in health-care settings.

T2 mapping as a marker of active myocardial injury in Anderson-Fabry disease patients

Abstract Background In Anderson-Fabry Disease (AFD) with cardiac involvement, left ventricular hypertrophy (LVH) is often associated with myocardial scarring by cardiovascular magnetic resonance (CMR) late gadolinium enhancement (LGE) imaging. Myocardial inflammation, detected as increased T2 weighted/T2 mapping (T2m) signal, has also been reported, although its role in disease progression is still unclear. Purpose To investigate the relationship between T2m and LGE/LVH progression in AFD patients. Methods 67 paired CMR scans (1.5T) from 30 AFD patients were included. Three groups were defined according to LGE: no LGE at either scan (LGE-/-); LGE at baseline, unchanged at follow-up (LGE+/-); LGE at follow-up, appeared or increased compared to baseline (LGE+/+). T2m was measured in the infero-lateral basal segment in all scans; in LGE+ scans only, LGE was also manually contoured (ROI_LGE), and the ROI_LGE copied and pasted on the matching T2m image (T2m_ROI_LGE). See Figure 1. Troponin I (TnI) was also dosed at each scan. A univariate repeated measures analysis of variance was used to compare the groups and Tukey-Kramer correction was applied. Results As expected, the presence of LGE was strongly associated with older age, higher global and regional T2m, left ventricular (LV) mass and TnI values. As a novelty, in the LGE+/+ scans (scar appearance/progression) T2m in the ROI_LGE was higher than in the LGE+/- scans (scar unchanged) (p value 0.02). None of the other parameters, such as LV mass, TnI and global T2m values, differ between the the LGE+/+ compared to the LGE +/- group. See Table 1. Conclusions In our AFD patients’ cohort, scar progression was associated with focal increase in T2m values, i.e. T2m may identify patients with active myocardial injury. The potential implication on management/disease progression monitoring needs to be tested in future research, with longer follow-up. The role of sex, with females known to have higher average T2m values, will also need to be explored in a wider patient’s cohort.

Monitoring the digital healthcare transition in the Netherlands: Challenges, achievements and future

Abstract Since 2013, the Netherlands Institute of Health Service Research, along with other Dutch research institutes, has monitored the digital healthcare transition in The Netherlands. Through annual surveys of both healthcare professionals (from primary and secondary care) and users (patients as well as the general population) from 2013 to 2023, trends in digital health utilization and experiences have been tracked. Overall, there has been a steady increase in digital care adoption since 2013, but in 2023, growth among professionals stabilized while slightly rising among users. Some tools saw significant increases, like automatic medicine dispensers and home monitoring, freeing up nurses’ time. Utilization patterns differ among patients according to their educational attainment and age, showing lower usage rates among older individuals and those with lower levels of education. Most professionals, especially nurses, view digital care positively, but they recognize its limitations in solving healthcare challenges entirely. Healthcare professionals believe it offers only a limited contribution to cost management, workload reduction, and job satisfaction and emphasize the need for seamless integration into routine care. User opinions are divided, with those with chronic conditions often expressing skepticism. Both professionals and patients agree that personal experience is crucial in determining its value. Additionally, ensuring user-friendliness and clarifying reimbursement for digital healthcare are essential. This workshop provides an overview of developments in the Netherlands and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care.

Characterizing the progression of subclinical cardiac amyloidosis through artificial intelligence applied to electrocardiographic images and echocardiograms

Abstract Background Transthyretin amyloid cardiomyopathy (ATTR-CM) follows an indolent course and may remain undiagnosed for many years before resulting in clinical disease. Purpose To assess the utility of scalable artificial intelligence (AI) methods applied to electrocardiographic (ECG) images and echocardiograms in detecting longitudinal changes that precede the clinical diagnosis of ATTR-CM. Methods Across 5 hospitals of a large U.S.-based hospital system, we identified a total of 234 patients (age 79 [IQR:70-85] years, n=56 (23.9%) women) with ATTR-CM, defined by the presence of a positive bone scintigraphy scan (or pharmacotherapy with an approved transthyretin stabilizer) between 2015 and 2023. Using 10:1 age- and sex-matched controls, we independently trained convolutional neural network algorithms to discriminate ATTR-CM from controls using i) ECG images (AUROC 0.915) or ii) echocardiographic studies by incorporating all available views (AUROC 0.93). In a leave-out testing set of n=82 individuals with serial ECGs and n=49 individuals with serial echocardiograms we characterized longitudinal patterns in the evolution of the AI ECG and echo-based scores, and estimated the percentage of individuals that would have screened positive across distinct time intervals. Results In the leave-out testing set 52.4% and 34.7% of all individuals who went on to receive a diagnosis of ATTR-CM would have screened positive by AI deployed to ECGs and echocardiograms, respectively, 1 to 3 years before their confirmatory testing, with the percentage increasing to 75.6% and 69.4% in the 12 months before their eventual diagnosis (A). Across both modalities, there was a longitudinal increase in AI predictions when comparing the median of all studies performed more than a year before diagnosis versus the median of any studies performed within 12 months of diagnosis (AI-Echo: 0.20 [IQR: 0.04-0.35] to 0.49 [0.24-0.59] &amp; AI-ECG: 0.07 [0.02-0.20] to 0.32 [0.11-0.49], p&amp;lt;0.001 for both) (B), consistent with evolution in the ECG and echocardiographic signature of ATTR-CM before its clinical diagnosis. Conclusions We demonstrate that AI applied directly to ECG images and echocardiography may enable scalable monitoring of subclinical ATTR-CM progression.

Monitoring the digital healthcare transition in Denmark: Challenges, achievements and future

Abstract Denmark is often mentioned as one of the countries that have introduced digital solutions early and extensively within the health care sector, including the launch of health portal sundhed.dk in 2003, the introduction of the e-record system ‘e-Journalen’ in 2007, and the establishment of a national infrastructure for telemedicine in 2012. Denmark is well advanced in digital health measurement, providing opportunities for researching the digital transition and its effects for healthcare organizations and Danish citizens. Most digital health data is collected through national population-based databases and registries. Additionally, annual surveys of health professionals and biennial surveys of citizens’ use of health IT are conducted. Recent data show that all general practitioners use electronic health records, mainly for receiving laboratory test results from hospitals, ordering prescriptions at pharmacies, exchanging records, and sending referrals to hospitals. This workshop provides an overview of developments in Denmark and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care. Issues about implementation and evaluation of digital infrastructure will be discussed with examples from Danish health care. A key question is whether digital solutions can fulfill their promise of supporting integrated and home based health care in an era of changing demographics.

A comparative analysis of national dementia plans: preventive strategies in five European countries

Abstract Background About 8.5% of people aged +65 live with dementia in Europe. Preventive measures can avert up to 40% of cases. The aim of the study is to analyse National Dementia Plans (NDP) in Europe, to elicit how much dementia prevention is considered a priority and whether policies are evidence-based. Methods A qualitative comparative analysis was performed between NDPs of countries with the best healthy life expectancy in the elderly in Europe. The NDPs of France, Ireland, Italy, Spain, and Sweden were included. The consensus on actions and elements of prevention policies was evaluated, according to the WHO recommendations and to Cheung’s framework designed for evaluating chronic diseases policies. Results All the NDPs prioritised early diagnosis, public awareness, and community engagement for dementia risk reduction. They fostered the development of information system for data collection and established committees for progress monitoring. However, not all NDPs defined timelines for policy implementation and most of them expired years ago. NDPs included prevention research agenda, but their preventive actions did not address alcohol consumption, traumatic brain injury, and air pollution, representing 3 well-known risk factors attributable for the 15% of preventable cases. Neither integration of dementia with other chronic disease preventive strategies was present and a clear allocation of funds for NDPs always missed. Conclusions NDPs partially address risk factors of preventable cases. All countries need to update their NDPs, integrating new scientific evidence and allocating clear financial funds. This can potentially prevent millions of new cases, decreasing the burden of disease and improving the sustainability of health systems. Key messages • NDPs do not target adequately dementia in Europe. • New evidence-based preventive policies, including most recent identified risk factors, would have a clear impact on burden of disease and health systems’ sustainability.

Self-assessed levels of preparedness, engagement willingness and teaching preferences on antibiotic use of medical and pharmacy students in Romanian universities: a cross-sectional study

BackgroundTo effectively support health professionals in optimizing antibiotic prescribing and dispensing, policymakers need to understand how these professionals are trained, feel prepared and want to be educated. The study aimed to assess the current situation and explore potential improvements in antibiotic use among future health professionals in Romania by: (i) evaluating their self-assessed preparedness on antibiotic-related topics, (ii) understanding their perceptions of their role in antibiotic stewardship, and (iii) gathering their recommendations for optimizing antibiotic use.MethodsA survey of students’ self-assessment of technical preparedness, engagement willingness, expectations, teaching preferences, training received and evolution of situation in Romania. Overall, 41 and 38 questions were asked to medical and pharmacy students respectively. Scores were calculated for preparedness, engagement willingness and teaching preferences to enable various comparisons. Exploratory factor analysis was used to explore the questionnaire construct.ResultsA total of 479 participants completed the survey- 233 medical students from 7 universities and 246 pharmacy students from 4 universities. Median overall preparedness score indicated that most students felt prepared in at least 14 questions (out of 22 for medical students, and 19 for pharmacy students). Engagement scores for medical and pharmacy students were similar (2 and 3 out of 4). Overall, more than half reported that ‘yes, very likely’ they received adequate training to ensure the appropriate use of antibiotics in their professional areas (n = 254, 53.5%). Medical and pharmacy students with low preparedness scores expressed a need for more education. Most of both medical and pharmacy students considered the antibiotic situation in Romania ‘will get worse’ (n = 159, 33.5%).ConclusionsThe study’s findings have important implications for the education and training of future Romanian health professionals and highlight the need for further research on optimal and standardized tools to allow for periodic monitoring and evaluation of progress into preparedness, engagement willingness and teaching preferences on antibiotic use.

Keratoconus.

Keratoconus is a progressive eye disorder primarily affecting individuals in adolescence and early adulthood. The ectatic changes in the cornea cause thinning and cone-like steepening leading to irregular astigmatism and reduced vision. Keratoconus is a complex disorder with a multifaceted aetiology and pathogenesis, including genetic, environmental, biomechanical and cellular factors. Environmental factors, such as eye rubbing, UV light exposure and contact lens wearing, are associated with disease progression. On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy. Clinically, keratoconus is diagnosed through clinical examination and corneal imaging. Advanced imaging platforms have improved the detection of keratoconus, facilitating early diagnosis and monitoring of disease progression. Treatment strategies for keratoconus are tailored to disease severity and progression. In early stages, vision correction with glasses or soft contact lenses may suffice. As the condition advances, rigid gas-permeable contact lenses or scleral lenses are prescribed. Corneal cross-linking has emerged as a pivotal treatment aimed at halting the progression of corneal ectasia. In patients with keratoconus with scarring or contact lens intolerance, surgical interventions are performed.

Longitudinal Micro-Computed Tomography Detects Onset and Progression of Pulmonary Fibrosis in Conditional Nedd4-2 Deficient Mice.

Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease which is usually diagnosed late in advanced stages. Little is known about the subclinical development of IPF. We previously generated a mouse model with conditional Nedd4-2 deficiency (Nedd4-2-/-) that develops IPF-like lung disease. The aim of this study was to characterize the onset and progression of IPF-like lung disease in conditional Nedd4-2-/- mice by longitudinal micro-computed tomography (CT). In vivo micro-CT was performed longitudinally in control and conditional Nedd4-2-/- mice at 1, 2, 3, 4 and 5 months after doxycycline induction. Further, terminal in vivo micro-CT followed by pulmonary function testing and post mortem micro-CT was performed in age-matched mice. Micro-CT images were evaluated for pulmonary fibrosis using an adapted fibrosis scoring system. Histological assessment of lung collagen content was conducted as well. Micro-CT is sensitive to detect onset and progression of pulmonary fibrosis in vivo and to quantify distinct radiological IPF-like features along disease development in conditional Nedd4-2-/- mice. Nonspecific interstitial alterations were detected from 3 months, whereas key features such as honeycombing-like lesions were detected from 4 months onwards. Pulmonary function correlated well with in vivo (r=-0.738) and post mortem (r=-0.633) micro-CT fibrosis scores and collagen content. Longitudinal micro-CT enables in vivo monitoring of onset and progression and detects radiologic key features of IPF-like lung disease in conditional Nedd4-2-/- mice. Our data support micro-CT as sensitive quantitative endpoint for preclinical evaluation of novel antifibrotic strategies.

Progression of Crohn's Disease in Newly Diagnosed Patients: Results from an Observational Study Using US Claims Data.

Patients with Crohn's disease (CD) experience disease progression over time, including strictures/stenoses, penetrating fistulae, and abscesses. This retrospective US population-based study aimed to characterize CD progression in newly diagnosed patients. Patient-level data from the Optum® Market Clarity database from January 1, 2016, to June 30, 2020, were used. The study comprised a 12-month baseline period (pre-diagnosis), an index date (diagnosis date), and a follow-up period. The risk of, and time to, CD progression since CD diagnosis, dispensed treatment changes following CD progression, and healthcare resource utilization before and after CD progression were assessed. Overall, 6804 newly diagnosed patients were included. Of these, 1714 (25.2%) experienced CD progression as follows: 19.3% (1183/6117) in the first 6months, 21.6% (1188/5503) by 1year, 24.6% (953/3875) by 2years, and 26.6% (444/1668) by 3years. Intestinal obstruction/stenosis was more common than fistula or abscess. Among patients with CD progression, the median (interquartile range) estimated time to progression was 2 (0-140) days; the shortest time to progression was seen with a first intestinal obstruction/stenosis (0 [0-137] days). The frequency of several dispensed treatments increased following CD progression. Among patients who experienced progression, CD-related inpatient hospital admissions/visits increased from 436 of 1714 patients (25.4%) in the month before progression to 965 (56.3%) in the month after progression. Over one quarter of patients with newly diagnosed CD experienced CD progression and complications within 3years of diagnosis, highlighting the importance of monitoring for progression and early intervention to limit progression.

A NIR light activated self‐reporting carbon dots assembly as phototheranostics for tumor photodynamic therapy

AbstractPhotodynamic therapy (PDT) has emerged as a promising protocol for cancer therapy. However, real‐time monitoring of PDT progress and accurate determination of the optimal treatment timing remain challenges. In this work, we selected carbon dots (CDs) and new indocyanine green (IR820) as building units to fabricate a smart nanotheranostics (CDs‐IR820 assembly) with the characteristics of controlled release and real‐time imaging to solve the time gap between diagnosis and treatment. The fabricated CDs‐IR820 assembly locked the photosensitivity of the CDs and could degrade under 750 nm laser irradiation to achieve controlled release of the CDs, thus used for cell imaging and producing single oxygen under the white light. Besides, the released CDs could migrate from the mitochondria to the nucleus during the PDT process, indicating the cell activity, which facilitated the regulation of treatment parameters to achieve the precise PDT for cancer.

Common Elements of Trauma-Informed Schools and Attention to Racial Equity: A Scoping Review

Abstract Introduction Notwithstanding the multiple descriptions and principles associated with trauma-informed schools (TIS), the field lacks a well-defined operational definition of TIS. This scoping review aimed to characterize TIS intervention components and implementation strategies described in published studies of TIS. This review also examined the extent to which published examples of TIS had an explicit focus on promoting racial equity. Method: Eligible studies described school- or district-wide trauma-informed approaches in Preschool-12 education, and included elements across at least two domains of TIS design: Organizational &amp; Policy Reforms; Workforce Professional Development/Training; and Educational &amp; Clinical Practices. A trained coding team reviewed eligible studies and applied 32 codes characterizing TIS intervention components and implementation strategies. Results: 30 eligible studies were identified. The most common implementation strategies included availability of trauma-informed training &amp; consultation, implementation progress monitoring, and developing community partnerships. The most common intervention components included multi-tiered interventions and specific knowledge areas for trauma-informed training content. Least common, were intervention components related to promoting racial equity (e.g., de-implementation of exclusionary discipline, de-implementation of carceral practices, and culturally inclusive curriculum). Conclusion: Findings suggest TIS components related to implementation strategies are most frequently employed, and that explicit attention to racial equity was infrequent in published descriptions of TIS design and implementation.

Implementing Visual Activity Schedules to Support Elementary Student Engagement

Visual activity schedules (VASs) are an effective, efficient intervention designed to promote positive language and behavioral development for elementary students with and at risk for emotional and behavioral disorders (EBD). However, VAS design and implementation varies widely in the extant research, prohibiting the ease of implementation in classrooms. The purpose of this article is to provide systematic guidance for educators to design, plan, implement, and progress monitor VAS effectiveness for students with or at risk for EBD.