Background There are no explicit guidelines or tools available to support clinicians in selecting exercise therapy modalities according to the characteristics of individual patients despite the apparent need. Objective This study develops a methodology based on a novel multiobjective optimization model and examines its feasibility as a decision support tool to support healthcare professionals in comparing different modalities and identifying the most preferred one based on a patient’s needs. Methods Thirty-one exercise therapy modalities were considered from 21 randomized controlled trials. A novel interactive multiobjective optimization model was designed to characterize the efficacy of an exercise therapy modality based on five objectives: minimizing cost, maximizing pain reduction, maximizing disability improvement, minimizing the number of supervised sessions, and minimizing the length of the treatment period. An interactive model incorporates clinicians’ preferences in finding the most preferred exercise therapy modality for each need. Multiobjective optimization methods are mathematical algorithms designed to identify the optimal balance between multiple conflicting objectives among available solutions/alternatives. They explicitly evaluate the conflicting objectives and support decision-makers in identifying the best balance. An experienced research-oriented physiotherapist was involved as a decision-maker in the interactive solution process testing the proposed decision support tool. Results The proposed methodology design and interactive process of the tool, including preference information, graphs, and exercise suggestions following the preferences, can help clinicians to find the most preferred exercise therapy modality based on a patient’s needs and health status; paving the way to individualize recommendations. Conclusions We examined the feasibility of our decision support tool using an interactive multiobjective optimization method designed to help clinicians balance between conflicting objectives to find the most preferred exercise therapy modality for patients with knee osteoarthritis. The proposed methodology is generic enough to be applied in any field of medical and healthcare settings, where several alternative treatment options exist. • KEY MESSAGES • We demonstrate the potential of applying Interactive multiobjective optimization methods in a decision support tool to help clinicians compare different exercise therapy modalities and identify the most preferred one based on a patient’s needs. • The usability of the proposed decision support tool is tested and demonstrated in prescribing exercise therapy modalities to treat knee osteoarthritis patients.
Alterations in the gut microbiota composition have been associated with a range of neurodevelopmental, neurodegenerative, and neuropsychiatric disorders. The gut microbes transform and metabolize dietary- and host-derived molecules generating a diverse group of metabolites with local and systemic effects. The bi-directional communication between brain and the microbes residing in the gut, the so-called gut-brain axis, consists of a network of immunological, neuronal, and endocrine signaling pathways. Although the full variety of mechanisms of the gut-brain crosstalk is yet to be established, the existing data demonstrates that a single metabolite or its derivatives are likely among the key inductors within the gut-brain axis communication. However, more research is needed to understand the molecular mechanisms underlying how gut microbiota associated metabolites alter brain functions, and to examine if different interventional approaches targeting the gut microbiota could be used in prevention and treatment of neurological disorders, as reviewed herein.Abbreviations:4-EPS 4-ethylphenylsulfate; 5-AVA(B) 5-aminovaleric acid (betaine); Aβ Amyloid beta protein; AhR Aryl hydrocarbon receptor; ASD Autism spectrum disorder; BBB Blood-brain barrier; BDNF Brain-derived neurotrophic factor; CNS Central nervous system; GABA ɣ-aminobutyric acid; GF Germ-free; MIA Maternal immune activation; SCFA Short-chain fatty acid; 3M-4-TMAB 3-methyl-4-(trimethylammonio)butanoate; 4-TMAP 4-(trimethylammonio)pentanoate; TMA(O) Trimethylamine(-N-oxide); TUDCA Tauroursodeoxycholic acid; ZO Zonula occludens proteins.
Purpose: Health-promoting behaviours (HPBs) are considered the key to determining health among older adults with hypertension. Increasing our understanding of older adults’ views on HPBs could facilitate the development of interventions aimed at improving their quality of life. This study aims to describe the perceptions of older adults with high blood pressure concerning their HPBs and associated factors. Methods: Semi-structured interviews with 40 individuals in Thailand were used to collect the data, which were analysed using thematic analysis. Results: The results were categorized into five main themes related to personal, social, and environmental factors. Older adults explained that their experiences with HPBs involve taking responsibility for controlling blood pressure by following a doctor’s prescription, modifying their lifestyles to be healthier, sustaining social relationships, and experiencing spiritual growth through religious practices for inner peace. Older adults also identified environmental factors that influenced their engagement in HPBs depending on their residential areas. Conclusions: The findings of this study highlight the importance of practices in which professionals support and encourage older adults to perform HPBs to maintain health and improve their well-being. © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Background Genome-wide association studies (GWAS) have identified multiple common breast cancer susceptibility variants. Many of these variants have differential associations by estrogen receptor (ER) status, but how these variants relate with other tumor features and intrinsic molecular subtypes is unclear. Methods Among 106,571 invasive breast cancer cases and 95,762 controls of European ancestry with data on 173 breast cancer variants identified in previous GWAS, we used novel two-stage polytomous logistic regression models to evaluate variants in relation to multiple tumor features (ER, progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and grade) adjusting for each other, and to intrinsic-like subtypes. Results Eighty-five of 173 variants were associated with at least one tumor feature (false discovery rate < 5%), most commonly ER and grade, followed by PR and HER2. Models for intrinsic-like subtypes found nearly all of these variants (83 of 85) associated at p < 0.05 with risk for at least one luminal-like subtype, and approximately half (41 of 85) of the variants were associated with risk of at least one non-luminal subtype, including 32 variants associated with triple-negative (TN) disease. Ten variants were associated with risk of all subtypes in different magnitude. Five variants were associated with risk of luminal A-like and TN subtypes in opposite directions. Conclusion This report demonstrates a high level of complexity in the etiology heterogeneity of breast cancer susceptibility variants and can inform investigations of subtype-specific risk prediction.
Background Migraine is a common brain disorder that predominantly affects women. Migraine pain seems mediated by the activation of mechanosensitive channels in meningeal afferents. Given the role of transient receptor potential melastatin 3 (TRPM3) channels in mechanical activation, as well as hormonal regulation, these channels may play a role in the sex difference in migraine. Therefore, we investigated whether nociceptive firing induced by TRPM3 channel agonists in meningeal afferents was different between male and female mice. In addition, we assessed the relative contribution of mechanosensitive TRPM3 channels and that of mechanosensitive Piezo1 channels and transient receptor potential vanilloid 1 (TRPV1) channels to nociceptive firing relevant to migraine in both sexes. Methods Ten- to 13-week-old male and female wildtype (WT) C57BL/6 J mice were used. Nociceptive spikes were recorded directly from nerve terminals in the meninges in the hemiskull preparations. Results Selective agonists of TRPM3 channels profoundly activated peripheral trigeminal nerve fibres in mouse meninges. A sex difference was observed for nociceptive firing induced by either PregS or CIM0216, both agonists of TRPM3 channels, with the induced firing being particularly prominent for female mice. Application of Yoda1, an agonist of Piezo1 channels, or capsaicin activating TRPV1 channels, although also leading to increased nociceptive firing of meningeal fibres, did not reveal a sex difference. Cluster analyses of spike activities indicated a massive and long-lasting activation of TRPM3 channels with preferential induction of large-amplitude spikes in female mice. Additional spectral analysis revealed a dominant contribution of spiking activity in the α- and β-ranges following TRPM3 agonists in female mice. Conclusions Together, we revealed a specific mechanosensitive profile of nociceptive firing in females and suggest TRPM3 channels as a potential novel candidate for the generation of migraine pain, with particular relevance to females.
Background Laser scanning and individual-tree detection are used increasingly in forest inventories. As a consequence, methods that optimize forest management at the level of individual trees will be gradually developed and adopted. Results The current study proposed a hierarchical two-level optimization method for tree-level planning where the cutting years are optimized at the higher level. The lower-level optimization allocates the trees to the cutting events in an optimal way. The higher-level optimization employed differential evolution whereas the lower-level problem was solved with the simulated annealing metaheuristic. The method was demonstrated with a 30 m × 30 m sample plot of planted Larix olgensis. The baseline case maximized the net present value as the only management objective. The solution suggested heavy thinning from above and a rotation length of 62 years. The baseline problem was enhanced to mixed stands where species diversity was used as another management objective. The method was also demonstrated in a problem that considered the complexity of stand structure, in addition to net present value. The objective variables that were used to measure complexity were the Shannon index (species diversity), Gini index (tree size diversity), and the index of Clark and Evans, which was used to describe the spatial distribution of trees. The article also presents a method to include natural advance regeneration in the optimization problem and optimize the parameters of simulated annealing simultaneously with the cutting years. Conclusions The study showed that optimization approaches developed for forest-level planning can be adapted to problems where treatment prescriptions are required for individual trees.
Background Mass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources. Methods The data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses. Results Our findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area. Conclusion The workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.
Background Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems. Methods This retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described. Results A total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories. Conclusions Medical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.
Background Treating hemorrhaging patients with prehospital blood product transfusions (PHBT) narrows transfusion delays and potentially benefits the patient. We describe our initial experiences of PHBT in a ground-based emergency medical service (EMS), where the transfusion protocol covers both traumatic and nontraumatic hemorrhaging patients. Methods A descriptive retrospective analysis was performed on the records of all the patients receiving red blood cells, freeze-dried plasma, or both during prehospital care from September 2016 to December 2020. The delays of PHBT and the effects on patients’ vital signs were analyzed and reported as the median and interquartile range (IQR) and analyzed using a Wilcoxon Signed rank test. Results 65 patients received prehospital blood product transfusions (PHBT), 29 (45%) were non-traumatic, and 36 (55%) traumatic. The main two reasons for PHBT were blunt trauma (n = 30, 46%) and gastrointestinal hemorrhage (n = 20, 31%). The median time from the emergency call to the start of PHBT was 54 min (IQR 38), and the transfusion began on a median of 61 min (IQR 42) before arrival at the hospital. The median systolic blood pressure improved from a median 76.5 mmHg (IQR 36.5) before transfusion to a median of 116.60 mmHg (IQR 26.5) (p < 0.001) on arrival to the hospital. No transfusion-related severe adverse events were noted. Conclusions Starting PHBT in ground-based EMS is a feasible and viable option. The PHBT began significantly earlier than it would have started on arrival to the hospital, and it seems to be safe and improve patients’ physiology. Study approval D/2603/07.01.04.05/2019.
Shopping convenience can be turned into a competitive advantage for online grocery retailers. Consequently, we study how personalized product recommendations (recommendation agents) and price promotions (algorithmic pricing) compensate for the negative impact that consumer's perceived cognitive effort causes on loyalty. By default, the relationship from perceived cognitive efforts to attitudinal and behavioral loyalty is negative, yet these results demonstrate that personalized price promotions lessen the negative impact, while personalized product recommendations do not have such an influence. The findings contribute to a better understanding of personalized marketing activities in today's data-driven online grocery retailing.
Mobile Live Streaming Shopping (MLSS) has become the most rapidly growing e-commerce business. However, there is a dearth of theoretical concern on the MLSS platform designing issue - the key factor affecting business success. Based on the axiomatic design theory, a systematic view of design features of MLSS platform is given, and a three-layer model including thirteen design features is built. The perceived differences of consumers across design features and individual characteristics, as well as the prioritization strategies of MLSS platform are derived with a mixed-method schema. The study provides fine-grained insights for enhancing the differentiated consumer experience by optimizing and improving the design of MLSS platforms.
The absorption spectra of the Fe– and Ce–doped 15Na2O–15CaO–70SiO2 glasses (mol%), melted in oxidising and reducing conditions, have been analysed. A repeatable set of the fitting parameters has been developed for the Ce³⁺ and Ce⁴⁺ ions, while previously published parameters were used for the Fe–ions. The Ce–ions significantly decrease the proportion of Fe²⁺ions in both electric– and gas–melted glasses, and the Ce³⁺ ions content increases due to the mutual redox between Fe and Ce, most effectively in reduced glasses. The Fe³⁺ ions in octahedral sites decrease and in tetrahedral sites increase. The photoluminescence (PL) emission spectra (excited at 355 nm laser) confirmed the changes between the Fe³⁺ and Ce³⁺ ions at low concentrations. The PL emission of the Fe³⁺ ions is very weak and may come from the tetrahedral sites. The Ce³⁺ emission peak was strong and consist of four components.
The objective of this study was to explore the effects of (1) the presence/absence of snow and snow depth, (2) solar noise, i.e., day/night and sun angle observations, and (3) strong/weak beam differences on ICESat-2 data in the context of data utility for forest AGB estimation. The framework of the study is multiphase modeling, where AGB field data and wall-to-wall airborne laser scanning (ALS) and Sentinel-2 data are used to produce proxy ALS plots on ICESat-2 track positions. Models between the predicted proxy AGB and the ICESat-2 photon data are then formulated and evaluated by subsets, such as only strong beam data captured in snowy conditions. Our results indicate that, if possible, strong beam night data from snowless conditions should be used in AGB estimation, because our models showed clearly smallest RMSE (26.9%) for this data subset. If more data are needed, we recommend using only strong beam data and constructing separate models for the different data subsets. In the order of increasing RMSE%, the next best options were snow/night/strong (30.4%), snow/day/strong (33.5%), and snowless/day/strong (34.1%). Weak beam data from snowy night conditions could also be used if necessary (31.0%).
Bioenergy can contribute to the development of a more sustainable environmental friendly alternative in rural areas in China. The perceptions, preferences and awareness concerning bioenergy among farmers are assessed in a systematic study of 594 Chinese farmers in 33 towns in the province of Shaanxi, using a generalized mixed model approach. In addition to the farmer's background and socio-economic variables, the spatial variation in the perceptions is addressed by mapping the residual between-county variation. The overall awareness of bioenergy as a viable alternative is still low (N = 80). Education and preferences on centralized heating systems play the most important role to explain the willingness to use biomass for domestic use or bioenergy from power plants. Users of large amounts of coal and electricity for heating increase the willingness to pay for bioenergy; users of firewood and raw residues are less prone to change their current energy uses. Nearly 75 % of farmers see bioenergy as a promising alternative to current consumption and production patterns of energy. The results show that not only the farmer's profile but the local context concerning energy mix, land uses and socio-economic factors are influencing their views, presenting defined spatial patterns and reflecting local geographies. Over one-third of respondents provide spontaneous recommendations to develop bioenergy markets. The results contribute to a better understanding of farmers' motivations, perceptions and views concerning energy uses, and can be used as an empirical basis for local energy planning towards a more sustainable energy transition in rural areas.
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