Category: Nevin Manimala

J Med Internet Res. 2023 Jan 19;25:e42672. doi: 10.2196/42672.

ABSTRACT

BACKGROUND: Anxiety and depression are the most common mental disorders worldwide. Owing to the lack of psychiatrists around the world, the incorporation of artificial intelligence (AI) into wearable devices (wearable AI) has been exploited to provide mental health services.

OBJECTIVE: This review aimed to explore the features of wearable AI used for anxiety and depression to identify application areas and open research issues.

METHODS: We searched 8 electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, IEEE Xplore, ACM Digital Library, Scopus, and Google Scholar) and included studies that met the inclusion criteria. Then, we checked the studies that cited the included studies and screened studies that were cited by the included studies. The study selection and data extraction were carried out by 2 reviewers independently. The extracted data were aggregated and summarized using narrative synthesis.

RESULTS: Of the 1203 studies identified, 69 (5.74%) were included in this review. Approximately, two-thirds of the studies used wearable AI for depression, whereas the remaining studies used it for anxiety. The most frequent application of wearable AI was in diagnosing anxiety and depression; however, none of the studies used it for treatment purposes. Most studies targeted individuals aged between 18 and 65 years. The most common wearable device used in the studies was Actiwatch AW4 (Cambridge Neurotechnology Ltd). Wrist-worn devices were the most common type of wearable device in the studies. The most commonly used category of data for model development was physical activity data, followed by sleep data and heart rate data. The most frequently used data set from open sources was Depresjon. The most commonly used algorithm was random forest, followed by support vector machine.

CONCLUSIONS: Wearable AI can offer great promise in providing mental health services related to anxiety and depression. Wearable AI can be used by individuals for the prescreening assessment of anxiety and depression. Further reviews are needed to statistically synthesize the studies’ results related to the performance and effectiveness of wearable AI. Given its potential, technology companies should invest more in wearable AI for the treatment of anxiety and depression.

PMID:36656625 | DOI:10.2196/42672

JMIR Mhealth Uhealth. 2023 Jan 19;11:e37716. doi: 10.2196/37716.

ABSTRACT

BACKGROUND: Overweight and obesity have been linked to several serious health problems and medical conditions. With more than a quarter of the young population having weight problems, the impacts of overweight and obesity on this age group are particularly critical. Mobile health (mHealth) apps that support and encourage positive health behaviors have the potential to achieve better health outcomes. These apps represent a unique opportunity for young people (age range 10-24 years), for whom mobile phones are an indispensable part of their everyday living. However, despite the potential of mHealth apps for improved engagement in health interventions, user adherence to these health interventions in the long term is low.

OBJECTIVE: The aims of this research were to (1) review and analyze mHealth apps targeting obesity and overweight and (2) propose guidelines for the inclusion of user interface design patterns (UIDPs) in the development of mHealth apps for obese young people that maximizes the impact and retention of behavior change techniques (BCTs).

METHODS: A search for apps was conducted in Google Play Store using the following search string: [“best weight loss app for obese teens 2020”] OR [“obesity applications for teens”] OR [“popular weight loss applications”]. The most popular apps available in both Google Play and Apple App Store that fulfilled the requirements within the inclusion criteria were selected for further analysis. The designs of 17 mHealth apps were analyzed for the inclusion of BCTs supported by various UIDPs. Based on the results of the analysis, BCT-UI design guidelines were developed. The usability of the guidelines was presented using a prototype app.

RESULTS: The results of our analysis showed that only half of the BCTs are implemented in the reviewed apps, with a subset of those BCTs being supported by UIDPs. Based on these findings, we propose design guidelines that associate the BCTs with UIDPs. The focus of our guidelines is the implementation of BCTs using design patterns that are impactful for the young people demographics. The UIDPs are classified into 6 categories, with each BCT having one or more design patterns appropriate for its implementation. The applicability of the proposed guidelines is presented by mock-ups of the mHealth app “Morphe,” intended for young people (age range 10-24 years). The presented use cases showcase the 5 main functionalities of Morphe: learn, challenge, statistics, social interaction, and settings.

CONCLUSIONS: The app analysis results showed that the implementation of BCTs using UIDPs is underutilized. The purposed guidelines will help developers in designing mHealth apps for young people that are easy to use and support behavior change. Future steps involve the development and deployment of the Morphe app and the validation of its usability and effectiveness.

PMID:36656624 | DOI:10.2196/37716

JAMA Netw Open. 2023 Jan 3;6(1):e2250423. doi: 10.1001/jamanetworkopen.2022.50423.

ABSTRACT

IMPORTANCE: An initial step to reducing emergency department (ED) visits among patients with cancer is to identify the characteristics of patients visiting the ED and examine which of those visits could be prevented.

OBJECTIVE: To explore nationwide trends and characteristics of ED visits and examine factors associated with potentially preventable ED visits and unplanned hospitalizations among patients with cancer in the US.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data on ED visits from the National Hospital Ambulatory Medical Care Survey from January 1, 2012, to December 31, 2019; US Cancer Statistics reports were used to estimate new cancer cases each year. Frequencies and trends among 35 510 014 ED visits by adult patients (aged ≥18 years) with cancer were calculated.

MAIN OUTCOMES AND MEASURES: The primary outcome was potentially preventable ED visits, and secondary outcomes were unplanned hospitalizations and the immediacy of the ED visits. Potentially preventable ED visits were identified using the Centers for Medicare & Medicaid Services definition. The Emergency Severity Index, a triage algorithm that ranks patients based on the urgency of their health care condition, was used to measure the immediacy of ED visits (immediate [most urgent], emergent, urgent, less urgent, and nonurgent), with the categories of immediate and emergent classified as high acuity. The Wilcoxon rank sum test was used to calculate trends in ED visits among patients with cancer over time. Multivariable logistic regression analyses were performed to examine the associations of patient, hospital, and temporal factors with potentially preventable ED use and ED use resulting in hospitalization.

RESULTS: Among 854 911 106 ED visits, 35 510 014 (4.2%) were made by patients with cancer (mean [SD] age, 66.2 [16.2] years); of those, 55.2% of visits were among women, 73.2% were among non-Hispanic White individuals, 89.8% were among patients living in a private residence, and 54.3% were among Medicare enrollees. A total of 18 316 373 ED visits (51.6%) were identified as potentially preventable, and 5 770 571 visits (21.3%) were classified as high acuity. From 2012 to 2019, potentially preventable ED visits increased from 1 851 692 to 3 214 276. Pain (36.9%) was the most common reason for potentially preventable ED visits. The number of patients who visited an ED because of pain increased from 1 192 197 in 2012 to 2 405 849 in 2019 (a 101.8% increase). Overall, 28.9% of ED visits resulted in unplanned hospitalizations, which did not change significantly over time (from 32.2% in 2012 to 26.6% in 2019; P = .78 for trend). Factors such as residence in a nursing home (odds ratio, 1.73; 95% CI, 1.25-2.41) were positively associated with having a potentially preventable ED visit, and factors such as the presence of more than 1 comorbidity (odds ratio, 1.82; 95% CI, 1.43-2.32) were positively associated with having an unplanned hospitalization.

CONCLUSIONS AND RELEVANCE: In this study, 51.6% of ED visits among patients with cancer were identified as potentially preventable, and the absolute number of potentially preventable ED visits increased substantially between 2012 and 2019. These findings highlight the need for cancer care programs to implement evidence-based interventions to better manage cancer treatment complications, such as uncontrolled pain, in outpatient and ambulatory settings.

PMID:36656584 | DOI:10.1001/jamanetworkopen.2022.50423

JAMA Netw Open. 2023 Jan 3;6(1):e2251496. doi: 10.1001/jamanetworkopen.2022.51496.

ABSTRACT

IMPORTANCE: Early integration of pediatric palliative care (PPC) for children with cancer is critical for the quality of life of both patient and family. To improve access to PPC in resource-limited settings, barriers to early integration must be understood.

OBJECTIVES: To evaluate the ideal vs actual timing of PPC integration for children with cancer and to uncover barriers to early integration identified by physicians in Latin America.

DESIGN, SETTING, AND PARTICIPANTS: The Assessing Doctors’ Attitudes on Palliative Treatment (ADAPT) survey was distributed electronically from August 1, 2020, to January 31, 2021, to physicians who treat children with cancer in 17 countries in Latin America.

MAIN OUTCOMES AND MEASURES: The ADAPT survey queried for understanding of ideal vs actual timing of PPC for children with cancer and for identification of barriers to PPC integration. Descriptive statistics were used to summarize the data. For secondary analyses, a comparison of the associations of previous palliative care training with physician specialty was performed using the Pearson χ2 test or the Fisher exact test. The McNemar test was used to assess responses regarding the actual vs ideal timing of PPC consultation. Analysis of variance was used to compare mean values for perceived barriers by country income level. Answers to open-ended questions were analyzed qualitatively.

RESULTS: A total of 831 physicians (578 women [69.6%]; 275 physicians [33.1%] aged <35 years and 556 physicians [66.9%] aged ≥35 years) from 17 countries participated, with an overall response rate of 37.9% (831 of 2193) and a median country response rate of 51.4% (range, 22.2%-88.9%). Most respondents (572 [68.8%]) said that PPC should be involved from diagnosis, but only 117 (14.1%) stated that this occurred at their institution (P < .001). The most significantly ranked barriers to PPC were lack of home-based services (713 [85.8%]), personnel (654 [78.7%]), and knowledge about PPC (693 [83.4%]), along with physician (676 [81.3%]) and family (603 [72.6%]) discomfort about PPC involvement. In addition, these barriers were rated as more important in lower-middle income countries compared with upper-middle income countries and high-income countries.

CONCLUSIONS AND RELEVANCE: This study highlights the discrepancy between ideal and actual timing of PPC for children with cancer and barriers to early PPC integration in Latin America. Interventions addressing access to PPC resources, didactic training, and clinical education (with a particular focus on equitable access to basic resources and support) are critical to improve the timing and quality of PPC in the region.

PMID:36656580 | DOI:10.1001/jamanetworkopen.2022.51496

JAMA Netw Open. 2023 Jan 3;6(1):e2251506. doi: 10.1001/jamanetworkopen.2022.51506.

ABSTRACT

IMPORTANCE: Several observational studies have reported that smoking cessation is associated with a lower risk of dementia. However, no studies have examined the association between change in smoking intensity and risk of dementia.

OBJECTIVE: To investigate the association between a change in smoking intensity, including smoking reduction and smoking cessation, and risk of all dementia.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from the National Health Insurance Service database of Korea. The cohort included participants 40 years or older who underwent biennial health examinations (2009 and 2011) and had current smoking status at the first health examination. The cohort was followed up until December 31, 2018, and statistical analysis was performed between July and December 2021.

EXPOSURES: Change in smoking intensity from baseline was defined operationally as follows: quitters (stopped smoking), reducers I (decreased number of cigarettes smoked per day by ≥50%), reducers II (decreased number of cigarettes smoked per day by 20%-50%), sustainers (maintained [decreased or increased] number of cigarettes smoked per day by less than 20%), or increasers (increased number of cigarettes smoked per day by ≥20%).

MAIN OUTCOMES AND MEASURES: The primary outcome was newly diagnosed dementia, which was identified by prescribed antidementia medications with concomitant International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnosis codes for dementia. Adjusted hazard ratios and 95% CIs were used to determine the association between change in smoking intensity and incidence of dementia, including Alzheimer disease (AD) and vascular dementia (VaD).

RESULTS: A total of 789 532 participants (756 469 males [95.8%]; mean [SD] age, 52.2 [8.5] years) were included. During a median (IQR) follow-up period of 6.3 (6.1-6.6) years, 11 912 dementia events, including 8800 AD and 1889 VaD events, were identified. Overall, participants in the quitter group had a significantly lower risk of all dementia (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.87-0.97) compared with those in the sustainer group. Those in the reducer I (aHR, 1.25; 95% CI, 1.18-1.33) and increaser (aHR, 1.12; 95% CI, 1.06-1.18) groups had a significantly higher risk of all dementia compared with those in the sustainer group.The patterns for AD and VaD remained consistent with patterns for all dementia.

CONCLUSIONS AND RELEVANCE: The results of this study showed that smoking cessation was associated with a lower risk of dementia compared with sustained smoking intensity, while smoking reduction was associated with a higher risk. Smoking cessation should be emphasized in efforts to reduce the disease burden of dementia.

PMID:36656579 | DOI:10.1001/jamanetworkopen.2022.51506

Eur J Haematol. 2023 Jan 19. doi: 10.1111/ejh.13929. Online ahead of print.

ABSTRACT

INTRODUCTION: Thrombopoietin receptor agonists (TPO-RAs) increase platelet counts (PC) in the majority of patients with chronic immune thrombocytopaenia (ITP). Platelet kinetics study (PKS) might contribute to the understanding of mechanisms that lead to durable response.

OBJECTIVES: To evaluate the effects of TPO-RAs on PKS parameters in chronic ITP patients.

METHODS: Fifteen chronic ITP patients, aged 59 years [range: 22-84], female/male: 10/5, splenectomised 7/15, were treated with TPO-RAs (eltrombopag/romiplostim: 11/4). Durable response was defined as PC ≥30×10⁹ /L at 6 months. Autologous ¹¹¹ Indium-oxinate PKS was performed before and five months after TPO-RAs initiation. Accordingly, platelet survival (PS), platelet turnover, production ratio and sequestration site were assessed.

RESULTS: Durable response was achieved in 13/15 of patients (eltrombopag/romiplostim: 10/3). Pre-treatment parameters were: PC 10×10⁹ /L [range: 1-110], PS 0.5 days [range: 0.1-1.7; normal values: 7-10)], platelet turnover 30857 Plt/μl/day [range: 944-103500] and platelet production ratio 0.64 [range: 0.01-3.2 (normal values: 1±0.2)]. Post-treatment assessment showed significantly higher: PC 92.5×10⁹ /L [range:28-260, P=0.001], PS 2.2 days [range: 0.1-3.6, P=0.008], platelet turnover 70213Plt/μl/day [range:2800-462236, P=0.02] and platelet production ratio 1.8 [range: 0.5-37.9, P=0.011] compared to the pre-treatment values. Platelet sequestration site altered in 3/15 treated with TPO-RAs.

CONCLUSIONS: TPO-RAs could increase PC by simultaneous increasing of platelet production and decreasing of platelet destruction. This article is protected by copyright. All rights reserved.

PMID:36656555 | DOI:10.1111/ejh.13929

Am J Respir Crit Care Med. 2023 Jan 19. doi: 10.1164/rccm.202210-1988LE. Online ahead of print.

NO ABSTRACT

PMID:36656551 | DOI:10.1164/rccm.202210-1988LE

J Ultrasound. 2023 Jan 19. doi: 10.1007/s40477-022-00766-0. Online ahead of print.

ABSTRACT

PURPOSE: In a poor resource country where screening for adverse pregnancy outcomes using maternal biomarkers seems unattainable, there is a need to search for credible alternatives. This study is, therefore, aimed at determining the sensitivity of uterine artery Doppler pulsatility index (UtAD-PI) in predicting pregnancy outcomes in the first and second trimesters and to establish any statistical difference in mean UtAD-PI in first and second trimesters screening of women with normal and abnormal pregnancy outcomes respectively.

METHODS: This clinical-based, longitudinal, and unpaired cohort study involved 500 pregnant women, who were screened for adverse outcomes using UtAD-PI and delivered in the hospital. These were divided into two groups, each having a training set and a test set. The training set was used to generate the receiver operator characteristic curve and cut-off point while the test set was used to test for sensitivity and specificity of the Ut-ADI in each trimester.

RESULTS: The sensitivity and specificity of UtAD-PI in first-trimester screening are 97% and 76.5% while second-trimester gave sensitivity and specificity of 57.5% and 63.3% respectively. The uterine artery Doppler pulsatility index shows statistically significant differences between normal pregnancy and pregnancy with adverse outcomes (p-value = 0.000).

CONCLUSION: The uterine artery Doppler pulsatility index is a good screening tool for adverse pregnancy outcomes. First-trimester screening of patients for adverse outcomes is more sensitive than the second-trimester screening using UtAD-PI. There is also a statistically significant difference between mean UtAD-PI between normal pregnancy and pregnancy with adverse pregnancy outcomes.

PMID:36656494 | DOI:10.1007/s40477-022-00766-0

Environ Sci Pollut Res Int. 2023 Jan 19. doi: 10.1007/s11356-023-25310-3. Online ahead of print.

ABSTRACT

Food product drying is a crucial stage in the preservation of crops and agricultural by-products that are used as raw materials for numerous end applications. The novelty of the study is the application of a phase change material in a solar dryer to improve the effectiveness of drying and reducing the overall drying period for drying while retaining/improving the quality parameters of the dried dhekia (Diplazium esculentum). The modified indirect thermal storage integrated solar dryer made up of a single-pass solar collector is attached with the drying chamber of 16.5 kg capacity. A thermal energy storage system prepared with paraffin wax embedded inside the drying cabinet was used. The proposed solar dryer has a thermal efficiency that is 11 ± 0.2% greater than the conventionally constructed solar dryer and reduces drying time by 40 ± 2.1%. Drying kinetic analysis of dhekia was performed, and two new drying kinetic models were proposed to predict moisture ratio. From statistical analysis, it was found that the chi square value and root mean square error value fits well for the proposed models. The anti-oxidant, total phenolic content, and total flavonoid content values of samples dried in solar dryer exhibit better results compared to fresh, tray dried, and open sun-dried samples. The developed dryer shows better results in saving drying time and quality of the product. Due to its affordability and long-term solution for drying fresh farm goods, this dryer can be very helpful to small-scale farmers.

PMID:36656481 | DOI:10.1007/s11356-023-25310-3

Genetica. 2023 Jan 19. doi: 10.1007/s10709-023-00179-9. Online ahead of print.

ABSTRACT

Extensive evidence from genome-wide association studies (GWAS) has shown that jointly analyzing multiple phenotypes can improve the power of the association test compared to the traditional single variant versus single trait approach. Here we propose an adaptive test based on principal components (ATPC) that is powerful and efficient for discovering the association between a single variant and multiple traits. Our method only needs GWAS summary statistics that are often available. We first estimate the trait correlation matrix by LD score regression. Then, based on the correlation matrix, we construct a series of test statistics that contain different numbers of principal components. The ultimate test statistic combines the P values of these principal component-based statistics by using the aggregated Cauchy association test. The analytical P-value of the test statistic can be computed quickly without the permutation process, which is the notable feature of our proposed method. The extensive simulation studies demonstrate that ATPC can control the type I error rates and have powerful and robust performance compared to several existing tests in a wide range of simulation settings. The analysis of the lipids GWAS summary data from the Global Lipids Genetics Consortium shows that ATPC identifies 230 new SNPs that are missed by the original single trait association analysis. By searching the GWAS Catalog, some SNPs and mapped genes identified by ATPC are reported to be associated with lipid traits. Through further analysis for GWAS results, we also find some Gene Ontology terms and biological pathways related to lipids.

PMID:36656460 | DOI:10.1007/s10709-023-00179-9