Associations between multiple long-term conditions and mortality in diverse ethnic groups

Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and Findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Cox regression models were used to estimate mortality by number of long-term conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional long-term condition at baseline was associated with increased mortality. This association differed across ethnic groups. Compared with 50-year-olds of white ethnicity with no conditions, the mortality rate was higher for white 50-year-olds with two conditions (HR 1.77) or four conditions (HR 3.13). Corresponding figures were higher for 50-year-olds of Black Caribbean ethnicity with two conditions (HR=2.22) or four conditions (HR 4.54). The direction of the interaction of number of conditions with ethnicity showed higher mortality associated with long-term conditions in nine out of ten minoritised ethnic groups, attaining statistical significance in four (Pakistani, Black African, Black Caribbean and Black other ethnic groups). Conclusions The raised mortality rate associated with having multiple conditions is greater in minoritised ethnic groups compared with white people. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.

TimesVector-Web: A Web Service for Analysing Time Course Transcriptome Data with Multiple Conditions

From time course gene expression data, we may identify genes that modulate in a certain pattern across time. Such patterns are advantageous to investigate the transcriptomic response to a certain condition. Especially, it is of interest to compare two or more conditions to detect gene expression patterns that significantly differ between them. Time course analysis can become difficult using traditional differentially expressed gene (DEG) analysis methods since they are based on pair-wise sample comparison instead of a series of time points. Most importantly, the related tools are mostly available as local Software, requiring technical expertise. Here, we present TimesVector-web, which is an easy to use web service for analysing time course gene expression data with multiple conditions. The web-service was developed to (1) alleviate the burden for analyzing multi-class time course data and (2) provide downstream analysis on the results for biological interpretation including TF, miRNA target, gene ontology and pathway analysis. TimesVector-web was validated using three case studies that use both microarray and RNA-seq time course data and showed that the results captured important biological findings from the original studies.

Passive Suicidal Ideation in Childhood

Background: A growing body of empirical research shows that suicidal behaviors are prevalent in childhood. Yet, few studies have examined risk factors related to suicidal ideation (SI) among children aged 12 and younger. Aims: The current study addresses this gap. Method: A questionnaire was filled out by 1,350 Flemish primary caregivers (94.7% mothers) of 9-year-old children (50.4% boys, Mage = 9.45). Their responses were analyzed using logistic regression and independent samples t tests. Results: The presence of passive SI was reported in 10.5% of the children. A psychiatric, developmental, or behavioral condition (or multiple conditions), a learning disorder, impulsivity, aggression, and experiencing multiple stressful family life events were discovered as potential risk factors of passive SI in childhood. Limitations: The cross-sectional nature of this study meant that causality could not be inferred. In addition, it was based on reports of primary caregivers, rather than on reports from the children themselves. Conclusion: These new empirical findings can be used for the development of prevention programs and be taken into account in risk assessments of SI in clinical practice. Confirmation of our findings in a longitudinal child-reported study is needed.

Cellular Memory of HipA-Induced Growth Arrest: The Length of Cell Growth Arrest Becomes Shorter for Each Successive Induction

Toxin–antitoxin (TA) systems are genetic modules found commonly in bacterial genomes. HipA is a toxin protein encoded from the hipBA TA system in the genome of Escherichia coli. Ectopic expression of hipA induces cell growth arrest. Unlike the cell growth arrest caused by other TA toxins, cells resume growth from the HipA-induced cell growth arrest phase after a defined period of time. In this article, we describe the change in the length of growth arrest while cells undergo repeated cycles of hipA induction, growth arrest and regrowth phases. In the multiple conditions tested, we observed that the length of growth arrest became successively shorter for each round of induction. We verified that this was not due to the appearance of HipA-resistant mutants. Additionally, we identified conditions, such as the growth phase of the starting culture and growth vessels, that alter the length of growth arrest. Our results showed that the length of HipA-induced growth arrest was dependent on environmental factors—in particular, the past growth environment of cells, such as a previous hipA induction. These effects lasted even after multiple rounds of cell divisions, indicating the presence of cellular “memory” that impacts cells’ response to HipA-induced toxicity.

The Connection between Carnot and CAPE Formulations of TC Potential Intensity

Tropical cyclone (TC) potential intensity (PI) theory has a well known form, consistent with a Carnot cycle interpretation of TC energetics, which relates PI to mean environmental conditions: the difference between surface and TC outflow temperatures and the air–sea enthalpy disequilibrium. PI has also been defined as a difference in convective available potential energy (CAPE) between two parcels, and quantitative assessments of future changes make use of a numerical algorithm based on this definition. Here, an analysis shows the conditions under which these Carnot and CAPE-based PI definitions are equivalent. There are multiple conditions, not previously enumerated, which in particular reveal a role for irreversible entropy production from surface evaporation. This mathematical analysis is verified by numerical calculations of PI’s sensitivity to large changes in surface-air relative humidity. To gain physical insight into the connection between the CAPE and Carnot formulations of PI, we use a recently developed analytic theory for CAPE to derive, starting from the CAPE-based definition, a new approximate formula for PI which nearly recovers the previous Carnot PI formula. The derivation shows that the difference in undilute buoyancies of saturated and environmental parcels which determines CAPE PI can in fact be expressed as a difference in the parcels’ surface moist static energy, providing a physical link between the Carnot and CAPE formulations of PI. This combination of analysis and physical interpretation builds confidence in previous numerical CAPE-based PI calculations that use climate model projections of the future tropical environment.

Medical Complexity, Mortality Among High-Cost Medicare Advantage Enrollees: Palliative, Hospice Implications

Older adults with high medical spend require tailored interventions and care delivery to meet their complex needs. Palliative is a high-value solution for high-cost patients because it provides relief from the symptoms, pain, and stress associated with multiple conditions. Likewise, other high-cost patients may be closer to end-of-life and therefore benefit from hospice care. For Accountable Care Organizations (ACOs) and hospitals to implement palliative care, these programs must identify and target the high-need patient populations. This study explored patterns of spending and mortality across 4 years (2016-2019) using claims from 1,701,647 patients continuously enrolled in UnitedHealth Group Medicare Advantage (mean age=73.7; S.E.=0.01). Patients with healthcare spend in the top decile were segmented into three subgroups based on health conditions and spend patterns. Analyses identified a subgroup of patients (mean age=76.6; S.E.=0.04), with the highest rate of mortality, and significantly more chronic conditions and frailty, indicating their cost and mortality was driven by medical complexity. Odds ratios from a multinomial logistic model tie blood formulation drugs (OR XX), medicative procedures (OR XX), and nonhospital-based care (OR XX) to members of this subgroup may be connected to short-term mortality. There is a critical need to identify patients who stand to benefit from palliative and end of life care, this is particularly true for high-cost high-need patients. Our study suggests that patterns of medical complexity and morality within high-cost patient subpopulations can be used to identify high-cost patients who would benefit from palliative or hospice care.

Performance evaluation of accelerometers ADXL345 and MPU6050 exposed to random vibrational input

The use of vibration monitors is a well-established practice in industrial maintenance, usually vibration sensors are positioned at specific points on the monitored machinery and data are continuously collected to feed a machine operating health control system. Nevertheless, the technology for obtaining the signal, its treatment and analysis is generally expensive, and the financial return is not evident, which justifies the development of low-cost alternatives technologies. In this work was performed an analysis of the responses of two Micro-Electro-Mechanical accelerometers, models ADXL345 and MPU6050, exposed to a low intensity random signal and standard operating frequency. The objective of the analysis was to verify the capacity of these devices to be used as mechanical vibration sensors for rotating machines. For this purpose, offset shift analyzes of the sensors due to the Earth's gravitational field were performed, as well as vibrational spectrum and rectification errors analysis under multiple conditions. The data pointed to a greater uniformity of the MPU6050 response, while several behavioral anomalies were seen in the ADXL345, when these sensors are exposed to the same mechanical signal. The qualitative and quantitative behavior of MPU6050 rectification error was consistent with reported in the literature. It was noted that the methodology used can profile the behavior of sensors, however, it is not sufficient to safely justify the inaccuracies, requiring that the tests be performed on a statistically representative number of sensors from different manufacturers and batches.

Checklist approach to vertigo: audit of current practice in a tertiary referral center

<p class="abstract"><strong>Background:</strong> Vertigo is a complex symptom which can be present in multiple conditions, some of which are life threatening. Diagnosing a patient with vertigo could sometimes be challenging and there is a need for a comprehensive, yet easily reproducible diagnostic model with emphasis on the red flag signs. A simple way to achieve this is a checklist. The aim of the study was to propose a diagnostic checklist for patients presenting with vertigo to an ENT clinic to aid diagnosis and prevent diagnostic errors.</p><p class="abstract"><strong>Methods:</strong> A diagnostic checklist was used in all patients who presented with the symptom of vertigo, necessary tests were conducted and referrals were done when required. </p><p class="abstract"><strong>Results:</strong> Out of eighty-five patients who presented with symptom of dizziness to ENT clinic, all patients received a definitive diagnosis treatment plan with the help of checklist.</p><p class="abstract"><strong>Conclusions:</strong> Checklist is an effective way to ensure elaborate assessment of the patient with emphasis on the red flag signs. It is a very important tool to arrive at diagnosis and formulate treatment plan.</p>

The Implementation of Action Observation Therapy in Virtual Worlds

<p>Upper limb rehabilitation after stroke is vital to the recovery of a patient’s range of motion, dexterity and strength (Jauch et al, 2010, p. 824). Rehabilitative practises are diverse and met with varying levels of success (Brewer et al, 2012, p. 11). This research is concerned with action observation therapy and its potential for neural reorganization through consistent repetition of prescribed physiotherapy exercises. Action observation utilizes mirror neurons to stimulate neural strengthening and recovery (Ertelt et al, 2007, p. 172). The observation of an expert completion of an action by either the patient, a representation of the patient or someone else fires the corresponding mirror neuron (Fogassi et al, 2005, p. 662). Mirror neurons’ ability to be fired under multiple conditions allow a patient who is unable to complete an action, in this case a physiotherapy exercise, to still receive the neural benefit just by observing the action (Ertelt et al, 2007, p. 165). In collaboration with sensory devices in a virtual medium, action observation will be used to create a dynamic and engaging simulation with the intent of providing a physiotherapy experience that progresses in difficulty. Incremental difficulty will ensure patients are being pushed to their limits in a controlled and monitored environment (IJsselsteijn, 2007, p. 27). Neural reorganization requires a large number of repetitions of exercises over extended periods of time creating rehabilitative experiences that have traditionally been tedious and mundane (Merians et al, 2002, p. 898; O’Dell, Lin & Harrison, 2009, p. 55). Gamification of traditional methods can engage the patient over an extended period of time By masking the repetitive nature of the exercises with a fun experience, patients can receive the full benefit of the treatment while performing enjoyable tasks (Muzzaffa et al, 2013, p. 69).</p>

The Implementation of Action Observation Therapy in Virtual Worlds

<p>Upper limb rehabilitation after stroke is vital to the recovery of a patient’s range of motion, dexterity and strength (Jauch et al, 2010, p. 824). Rehabilitative practises are diverse and met with varying levels of success (Brewer et al, 2012, p. 11). This research is concerned with action observation therapy and its potential for neural reorganization through consistent repetition of prescribed physiotherapy exercises. Action observation utilizes mirror neurons to stimulate neural strengthening and recovery (Ertelt et al, 2007, p. 172). The observation of an expert completion of an action by either the patient, a representation of the patient or someone else fires the corresponding mirror neuron (Fogassi et al, 2005, p. 662). Mirror neurons’ ability to be fired under multiple conditions allow a patient who is unable to complete an action, in this case a physiotherapy exercise, to still receive the neural benefit just by observing the action (Ertelt et al, 2007, p. 165). In collaboration with sensory devices in a virtual medium, action observation will be used to create a dynamic and engaging simulation with the intent of providing a physiotherapy experience that progresses in difficulty. Incremental difficulty will ensure patients are being pushed to their limits in a controlled and monitored environment (IJsselsteijn, 2007, p. 27). Neural reorganization requires a large number of repetitions of exercises over extended periods of time creating rehabilitative experiences that have traditionally been tedious and mundane (Merians et al, 2002, p. 898; O’Dell, Lin & Harrison, 2009, p. 55). Gamification of traditional methods can engage the patient over an extended period of time By masking the repetitive nature of the exercises with a fun experience, patients can receive the full benefit of the treatment while performing enjoyable tasks (Muzzaffa et al, 2013, p. 69).</p>