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Deutsches Arzteblatt International Nov 2018The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and...
BACKGROUND
The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and treatment of this disease.
METHODS
The scientific literature was systematically searched and the retrieved publications were assessed at the German Cochrane Center (Deutsches Cochrane Zentrum) in Freiburg in the 12 months beginning in March 2014. In addition to the main search terms "Lyme disease," "neuroborreliosis," "Borrelia," and "Bannwarth," 28 further terms relating to neurological manifestations of the disease were used for the search in the Medline and Embase databases and in the Cochrane Central Register of Controlled Trials.
RESULTS
In the treatment of early Lyme neuroborreliosis, orally administered doxycycline is well tolerated, and its efficacy is equivalent to that of intravenously administered beta-lactam antibiotics (penicillin G, ceftriaxone, and cefotaxime) (relative risk [RR]: 0.98, 95% confidence interval [CI]: [0.68; 1.42], P = 0.93). 14 days of treatment suffice for early Lyme neuroborreliosis, and 14-21 days of treatment usually suffice for late (chronic) Lyme neuroborreliosis.
CONCLUSION
Lyme neuroborreliosis has a favorable prognosis if treated early. The long-term administration of antibiotics over many weeks or even months for putative chronic Lyme neuroborreliosis with nonspecific symptoms yields no additional benefit and carries the risk of serious adverse effects.
Topics: Anti-Bacterial Agents; Borrelia; Doxycycline; Humans; Lyme Neuroborreliosis; Polyradiculopathy; Prognosis; Treatment Outcome
PubMed: 30573008
DOI: 10.3238/arztebl.2018.0751 -
The Cochrane Database of Systematic... Dec 2020Vitamin D deficiency is common worldwide, contributing to nutritional rickets and osteomalacia which have a major impact on health, growth, and development of infants,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vitamin D deficiency is common worldwide, contributing to nutritional rickets and osteomalacia which have a major impact on health, growth, and development of infants, children and adolescents. Vitamin D levels are low in breast milk and exclusively breastfed infants are at risk of vitamin D insufficiency or deficiency.
OBJECTIVES
To determine the effect of vitamin D supplementation given to infants, or lactating mothers, on vitamin D deficiency, bone density and growth in healthy term breastfed infants.
SEARCH METHODS
We used the standard search strategy of Cochrane Neonatal to 29 May 2020 supplemented by searches of clinical trials databases, conference proceedings, and citations.
SELECTION CRITERIA
Randomised controlled trials (RCTs) and quasi-RCTs in breastfeeding mother-infant pairs comparing vitamin D supplementation given to infants or lactating mothers compared to placebo or no intervention, or sunlight, or that compare vitamin D supplementation of infants to supplementation of mothers.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial eligibility and risk of bias and independently extracted data. We used the GRADE approach to assess the certainty of evidence.
MAIN RESULTS
We included 19 studies with 2837 mother-infant pairs assessing vitamin D given to infants (nine studies), to lactating mothers (eight studies), and to infants versus lactating mothers (six studies). No studies compared vitamin D given to infants versus periods of infant sun exposure. Vitamin D supplementation given to infants: vitamin D at 400 IU/day may increase 25-OH vitamin D levels (MD 22.63 nmol/L, 95% CI 17.05 to 28.21; participants = 334; studies = 6; low-certainty) and may reduce the incidence of vitamin D insufficiency (25-OH vitamin D < 50 nmol/L) (RR 0.57, 95% CI 0.41 to 0.80; participants = 274; studies = 4; low-certainty). However, there was insufficient evidence to determine if vitamin D given to the infant reduces the risk of vitamin D deficiency (25-OH vitamin D < 30 nmol/L) up till six months of age (RR 0.41, 95% CI 0.16 to 1.05; participants = 122; studies = 2), affects bone mineral content (BMC), or the incidence of biochemical or radiological rickets (all very-low certainty). We are uncertain about adverse effects including hypercalcaemia. There were no studies of higher doses of infant vitamin D (> 400 IU/day) compared to placebo. Vitamin D supplementation given to lactating mothers: vitamin D supplementation given to lactating mothers may increase infant 25-OH vitamin D levels (MD 24.60 nmol/L, 95% CI 21.59 to 27.60; participants = 597; studies = 7; low-certainty), may reduce the incidences of vitamin D insufficiency (RR 0.47, 95% CI 0.39 to 0.57; participants = 512; studies = 5; low-certainty), vitamin D deficiency (RR 0.15, 95% CI 0.09 to 0.24; participants = 512; studies = 5; low-certainty) and biochemical rickets (RR 0.06, 95% CI 0.01 to 0.44; participants = 229; studies = 2; low-certainty). The two studies that reported biochemical rickets used maternal dosages of oral D3 60,000 IU/day for 10 days and oral D3 60,000 IU postpartum and at 6, 10, and 14 weeks. However, infant BMC was not reported and there was insufficient evidence to determine if maternal supplementation has an effect on radiological rickets (RR 0.76, 95% CI 0.18 to 3.31; participants = 536; studies = 3; very low-certainty). All studies of maternal supplementation enrolled populations at high risk of vitamin D deficiency. We are uncertain of the effects of maternal supplementation on infant growth and adverse effects including hypercalcaemia. Vitamin D supplementation given to infants compared with supplementation given to lactating mothers: infant vitamin D supplementation compared to lactating mother supplementation may increase infant 25-OH vitamin D levels (MD 14.35 nmol/L, 95% CI 9.64 to 19.06; participants = 269; studies = 4; low-certainty). Infant vitamin D supplementation may reduce the incidence of vitamin D insufficiency (RR 0.61, 95% CI 0.40 to 0.94; participants = 334; studies = 4) and may reduce vitamin D deficiency (RR 0.35, 95% CI 0.17 to 0.72; participants = 334; studies = 4) but the evidence is very uncertain. Infant BMC and radiological rickets were not reported and there was insufficient evidence to determine if maternal supplementation has an effect on infant biochemical rickets. All studies enrolled patient populations at high risk of vitamin D deficiency. Studies compared an infant dose of vitamin D 400 IU/day with varying maternal vitamin D doses from 400 IU/day to > 4000 IU/day. We are uncertain about adverse effects including hypercalcaemia.
AUTHORS' CONCLUSIONS
For breastfed infants, vitamin D supplementation 400 IU/day for up to six months increases 25-OH vitamin D levels and reduces vitamin D insufficiency, but there was insufficient evidence to assess its effect on vitamin D deficiency and bone health. For higher-risk infants who are breastfeeding, maternal vitamin D supplementation reduces vitamin D insufficiency and vitamin D deficiency, but there was insufficient evidence to determine an effect on bone health. In populations at higher risk of vitamin D deficiency, vitamin D supplementation of infants led to greater increases in infant 25-OH vitamin D levels, reductions in vitamin D insufficiency and vitamin D deficiency compared to supplementation of lactating mothers. However, the evidence is very uncertain for markers of bone health. Maternal higher dose supplementation (≥ 4000 IU/day) produced similar infant 25-OH vitamin D levels as infant supplementation of 400 IU/day. The certainty of evidence was graded as low to very low for all outcomes.
Topics: 25-Hydroxyvitamin D 2; Bone Density; Bone and Bones; Breast Feeding; Female; Humans; Hypercalcemia; Infant; Lactation; Mothers; Randomized Controlled Trials as Topic; Rickets; Term Birth; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 33305822
DOI: 10.1002/14651858.CD013046.pub2 -
Soa--ch'ongsonyon Chongsin Uihak =... Apr 2023This study aimed to analyze research trends in autism spectrum disorder (ASD) and savant syndrome and their cognitive characteristics through a systematic literature...
OBJECTIVES
This study aimed to analyze research trends in autism spectrum disorder (ASD) and savant syndrome and their cognitive characteristics through a systematic literature review. The objectives of this study were to establish an overview of research trends in ASD and savant syndrome, analyze the overall characteristics of individuals with ASD and savant syndrome, and examine their cognitive characteristics.
METHODS
For the systematic literature review, three criteria were used to select review articles: 1) literature from peer-reviewed journals, published in the past 15 years, from 2008 to 2022; 2) subjects with ASD and savant syndrome; 3) study objectives focused on the basic phenomenon and cognitive characteristics of ASD and savant syndrome. Finally, based on the selection criteria, a total of 40 articles were included.
RESULTS
Five themes and nine subthemes were derived from the analysis of 40 studies. The five main themes were as follows: 1) What is savant syndrome? 2) Demographic characteristics of savant syndrome; 3) Spectra of savant syndrome; 4) Savant syndrome and ASD; and 5) Cognitive characteristics of ASD with savant syndrome. The subthemes of the cognitive characteristics were weak central coherence, detail-focused cognitive processing, enhanced perceptual functioning, and hyper-systemizing.
CONCLUSION
Several studies have been conducted to understand ASD and savant syndrome; however, no single theory can specify the cognitive characteristics of people with ASD and savant syndrome. Therefore, further systematic and multi-layered research on ASD and savant syndrome are required for more comprehensive results.
PubMed: 37035789
DOI: 10.5765/jkacap.230003 -
International Journal of Environmental... Oct 2022Nowadays, water pollution has become a global issue affecting most countries in the world. Water quality should be monitored to alert authorities on water pollution, so... (Review)
Review
Nowadays, water pollution has become a global issue affecting most countries in the world. Water quality should be monitored to alert authorities on water pollution, so that action can be taken quickly. The objective of the review is to study various conventional and modern methods of monitoring water quality to identify the strengths and weaknesses of the methods. The methods include the Internet of Things (IoT), virtual sensing, cyber-physical system (CPS), and optical techniques. In this review, water quality monitoring systems and process control in several countries, such as New Zealand, China, Serbia, Bangladesh, Malaysia, and India, are discussed. Conventional and modern methods are compared in terms of parameters, complexity, and reliability. Recent methods of water quality monitoring techniques are also reviewed to study any loopholes in modern methods. We found that CPS is suitable for monitoring water quality due to a good combination of physical and computational algorithms. Its embedded sensors, processors, and actuators can be designed to detect and interact with environments. We believe that conventional methods are costly and complex, whereas modern methods are also expensive but simpler with real-time detection. Traditional approaches are more time-consuming and expensive due to the high maintenance of laboratory facilities, involve chemical materials, and are inefficient for on-site monitoring applications. Apart from that, previous monitoring methods have issues in achieving a reliable measurement of water quality parameters in real time. There are still limitations in instruments for detecting pollutants and producing valuable information on water quality. Thus, the review is important in order to compare previous methods and to improve current water quality assessments in terms of reliability and cost-effectiveness.
Topics: Water Quality; Reproducibility of Results; Water Pollution; Internet of Things; Computers
PubMed: 36360992
DOI: 10.3390/ijerph192114080 -
Brain Sciences Nov 2022The functioning of the brain has been a complex and enigmatic phenomenon. From the first approaches made by Descartes about this organism as the vehicle of the mind to... (Review)
Review
The functioning of the brain has been a complex and enigmatic phenomenon. From the first approaches made by Descartes about this organism as the vehicle of the mind to contemporary studies that consider the brain as an organism with emergent activities of primary and higher order, this organism has been the object of continuous exploration. It has been possible to develop a more profound study of brain functions through imaging techniques, the implementation of digital platforms or simulators through different programming languages and the use of multiple processors to emulate the speed at which synaptic processes are executed in the brain. The use of various computational architectures raises innumerable questions about the possible scope of disciplines such as computational neurosciences in the study of the brain and the possibility of deep knowledge into different devices with the support that information technology (IT) brings. One of the main interests of cognitive science is the opportunity to develop human intelligence in a system or mechanism. This paper takes the principal articles of three databases oriented to computational sciences (EbscoHost Web, IEEE Xplore and Compendex Engineering Village) to understand the current objectives of neural networks in studying the brain. The possible use of this kind of technology is to develop artificial intelligence (AI) systems that can replicate more complex human brain tasks (such as those involving consciousness). The results show the principal findings in research and topics in developing studies about neural networks in computational neurosciences. One of the principal developments is the use of neural networks as the basis of much computational architecture using multiple techniques such as computational neuromorphic chips, MRI images and brain-computer interfaces (BCI) to enhance the capacity to simulate brain activities. This article aims to review and analyze those studies carried out on the development of different computational architectures that focus on affecting various brain activities through neural networks. The aim is to determine the orientation and the main lines of research on this topic and work in routes that allow interdisciplinary collaboration.
PubMed: 36421877
DOI: 10.3390/brainsci12111552 -
Pathogens (Basel, Switzerland) May 2021In this paper, we carried out a systematic literature review to document the emerging scientific knowledge about COVID-19 impact on livestock systems and food security... (Review)
Review
In this paper, we carried out a systematic literature review to document the emerging scientific knowledge about COVID-19 impact on livestock systems and food security in developing countries to identify gaps and possible avenues for future research undertakings. Specifically, we systematically reviewed 68 peer-reviewed articles extracted based on rigorous selection criteria from Scopus, PubMed and ISI Web of Science databases and published between December 2019 and February 2021. Our results reveal that livestock supply chains presented an important 'intermediary' pathway through which the pandemic affected various dimensions of food security in developing countries. Although the research response has been rapid in terms of both quantity and temporal succession, we find a highly suggestive disjunction in studies analyzing the interconnections between COVID-19 pandemic, livestock systems and food security in developing countries. With respect to the livestock supply chain, the bulk of the reviewed evidence focuses on production and consumption, whereas considerably less focus is given to the pandemic's impact on intermediaries within livestock chains, including traders, intermediaries and processors. The analysis of livestock supply chain resilience revolves predominantly around the 'absorbance' and 'recovery' phases of resilience, whereas only a small subset of the literature investigates actions taken by supply chain actors to 'plan' or to 'adapt' livestock systems in order to reduce their vulnerability and enhance their overall resilience. Furthermore, food security has often been narrowly defined, with the majority of articles focusing on 'availability' and 'accessibility' to food due to the pandemic, and other dimensions of food security, including utilization, stability and sustainability, have been widely neglected. Based on our findings, we recommend future research to examine the dynamics of propagation of COVID-19 impact through livestock supply chains in order to develop more targeted interventions that enhance the capacity of developing countries to cope with this and future disruptions and mitigate their food insecurity outcomes. To this end, more holistic, integrated and resilience-based approaches are much recommended to recognize the complex nature of livestock systems in developing countries and to address the multifaceted and widespread effects of COVID-19 on food security channeled through livestock chains.
PubMed: 34064749
DOI: 10.3390/pathogens10050586 -
BMC Medical Informatics and Decision... Jan 2023The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent...
BACKGROUND
The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent need to develop integration mechanisms among the various health information systems. The aim of this review was to investigate the interoperability requirements for heterogeneous health information systems and to summarize and present them.
METHODS
In accordance with the PRISMA guideline, a broad electronic search of all literature was conducted on the topic through six databases, including PubMed, Web of science, Scopus, MEDLINE, Cochrane Library and Embase to 25 July 2022. The inclusion criteria were to select English-written articles available in full text with the closest objectives. 36 articles were selected for further analysis.
RESULTS
Interoperability has been raised in the field of health information systems from 2003 and now it is one of the topics of interest to researchers. The projects done in this field are mostly in the national scope and to achieve the electronic health record. HL7 FHIR, CDA, HIPAA and SNOMED-CT, SOA, RIM, XML, API, JAVA and SQL are among the most important requirements for implementing interoperability. In order to guarantee the concept of data exchange, semantic interaction is the best choice because the systems can recognize and process semantically similar information homogeneously.
CONCLUSIONS
The health industry has become more complex and has new needs. Interoperability meets this needs by communicating between the output and input of processor systems and making easier to access the data in the required formats.
Topics: Humans; Health Information Systems; Electronic Health Records; Systematized Nomenclature of Medicine
PubMed: 36694161
DOI: 10.1186/s12911-023-02115-5 -
International Archives of... Jul 2022Bone conduction implants, responsible for transmitting sound from an external processor to the inner ear, can be divided into active and passive, depending on the...
Bone conduction implants, responsible for transmitting sound from an external processor to the inner ear, can be divided into active and passive, depending on the vibratory stimulus location. The use of transcutaneous device has increased, given its aesthetic appeal, the complications and limitations of percutaneous devices, and patient's treatment adherence, focusing mainly on efficacy. However, various complications are associated with the use of transcutaneous prosthesis, which can often be serious. To approach the literature on complications involving transcutaneous bone-anchored prostheses through a systematic review of articles published in the past 10 years (2011-2021). The MEDLINE, EMBASE, Scopus, and Cochrane Library databases were searched. All articles written in English reporting on currently available transcutaneous prosthesis implantation and its complications were selected. Studies on both children and adults were included. The data on complications were extracted, and complications were classified as minor or major and associated to each device used. Thirty-seven articles were included in the study, of which 14 were prospective cohort studies, 22 were retrospective case series, and 1 was a case report. Most studies (18) included both adults and children. Moreover, 901 implantations were performed, of which 552 implanted Baha Attract (Cochlear Ltd., Sydney, Australia), 244 implanted BoneBridge (MED-EL, Innsbruck, Austria), and 105 implanted Sophono (Sophono Inc., Boulder, CO, USA]). Furthermore, 192 adverse events were reported (total complication rate, 21.3%), with 161 minor complications (84.3%) and 31 major complications (16.1%). Transcutaneous prosthesis is an audiological alternative with fewer complications than percutaneous prosthesis. However, its indication should be judicious because complications are common, and although most complications are minor, serious infections requiring explantation may develop.
PubMed: 35846823
DOI: 10.1055/s-0042-1742352 -
Frontiers in Veterinary Science 2021Pig and poultry production systems have reached high-performance levels over the last few decades. However, there is still room for improvement when it comes to their...
Pig and poultry production systems have reached high-performance levels over the last few decades. However, there is still room for improvement when it comes to their environmental sustainability. This issue is even more relevant due to the growing demand for food demand since this surplus food production needs to be met at an affordable cost with minimum impact on the environment. This study presents a systematic review of peer-reviewed manuscripts that investigated the environmental impacts associated with pig and poultry production. For this purpose, independent reviews were performed and two databases were constructed, one for each production system. Previous studies published in peer-reviewed journals were considered for the databases if the method of life cycle assessment (LCA) was applied to pig (pork meat) or poultry (broiler meat or table eggs) production to estimate at least the potential effects of climate change, measured as CO-eq. Studies considering the cradle-to-farm gate were considered, as well as those evaluating processes up to the slaughterhouse or processor gate. The pig database comprised 55 studies, while 30 publications were selected for the poultry database. These studies confirmed feeding (which includes the crop cultivation phase, manufacturing processes, and transportation) as the main contributor to the environmental impact associated with pig and poultry production systems. Several studies evaluated feeding strategies, which were indicated as viable alternatives to mitigate the environmental footprint associated with both production chains. In this study, precision feeding techniques are highlighted given their applicability to modern pig and poultry farming. These novel feeding strategies are good examples of innovative strategies needed to break paradigms, improve resource-use efficiency, and effectively move the current productive scenario toward more sustainable livestock systems.
PubMed: 34778435
DOI: 10.3389/fvets.2021.750733 -
Health Technology Assessment... Jul 2011A bone-anchored hearing aid (BAHA) consists of a permanent titanium fixture, which is surgically implanted into the skull bone behind the ear, and a small detachable... (Review)
Review
BACKGROUND
A bone-anchored hearing aid (BAHA) consists of a permanent titanium fixture, which is surgically implanted into the skull bone behind the ear, and a small detachable sound processor that clips onto the fixture. BAHAs are suitable for people with conductive or mixed hearing loss who cannot benefit fully from conventional hearing aids.
OBJECTIVES
To assess the clinical effectiveness and cost-effectiveness of BAHAs for people who are bilaterally deaf.
DATA SOURCES
Nineteen electronic resources, including MEDLINE, EMBASE and The Cochrane Library (inception to November 2009). Additional studies were sought from reference lists and clinical experts.
REVIEW METHODS
Inclusion criteria were applied by two reviewers independently. Data extraction and quality assessment were undertaken by one reviewer and checked by a second. Prospective studies of adults or children with bilateral hearing loss were eligible. Comparisons were BAHAs versus conventional hearing aids [air conduction hearing aid (ACHA) or bone conduction hearing aid (BCHA)], unaided hearing and ear surgery; and unilateral versus bilateral BAHAs. Outcomes included hearing measures, validated measures of quality of life (QoL), adverse events and measures of cost-effectiveness. For the review of cost-effectiveness, full economic evaluations were eligible.
RESULTS
Twelve studies were included (seven cohort pre-post studies and five cross-sectional 'audiological comparison' studies). No prospective studies comparing BAHAs with ear surgery were identified. Overall quality was rated as weak for all included studies and meta-analysis was not possible due to differences in outcome measures and patient populations. There appeared to be some audiological benefits of BAHAs compared with BCHAs and improvements in speech understanding in noise compared with ACHAs; however, ACHAs may produce better audiological results for other outcomes. The limited evidence reduces certainty. Hearing is improved with BAHAs compared with unaided hearing. Improvements in QoL with BAHAs were identified by a hearing-specific instrument but not generic QoL measures. Studies comparing unilateral with bilateral BAHAs suggested benefits of bilateral BAHAs in many, but not all, situations. Prospective case series reported between 6.1% and 19.4% loss of implants. Most participants experienced no or minor skin reactions. A decision analytic model was developed. Costs and benefits of unilateral BAHAs were estimated over a 10-year time horizon, applying discount rates of 3.5%. The incremental cost per user receiving BAHA, compared with BCHA, was £ 16,409 for children and £ 13,449 for adults. In an exploratory analysis the incremental cost per quality-adjusted life-year (QALY) gained was between £ 55,642 and £ 119,367 for children and between £ 46,628 and £ 100,029 for adults for BAHAs compared with BCHA, depending on the assumed QoL gain and proportion of each modelled cohort using their hearing aid for ≥ 8 or more hours per day. Deterministic sensitivity analysis suggested that the results were highly sensitive to the assumed proportion of people using BCHA for ≥ 8 hours per day, with very high incremental cost-effectiveness ratio values (£ 500,000-1,200,000 per QALY gained) associated with a high proportion of people using BCHA. More acceptable values (£ 15,000-37,000 per QALY gained) were associated with a low proportion of people using BCHA for ≥ 8 hours per day (compared with BAHA).
LIMITATIONS
The economic evaluation presented in this report is severely limited by a lack of robust evidence on the outcome of hearing aid provision. This has lead to a more restricted analysis than was originally anticipated (limited to a comparison of BAHA and BCHA). In the absence of useable QoL data, the cost-effectiveness analysis is based on potential utility gains from hearing, that been inferred using a QoL instrument rather than measures reported by hearing aid users themselves. As a result the analysis is regarded as exploratory and the reported results should be interpreted with caution.
CONCLUSIONS
Exploratory cost-effectiveness analysis suggests that BAHAs are unlikely to be a cost-effective option where the benefits (in terms of hearing gain and probability of using of alternative aids) are similar for BAHAs and their comparators. The greater the benefit from aided hearing and the greater the difference in the proportion of people using the hearing aid for ≥ 8 hours per day, the more likely BAHAs are to be a cost-effective option. The inclusion of other dimensions of QoL may also increase the likelihood of BAHAs being a cost-effective option. A national audit of BAHAs is needed to provide clarity on the many areas of uncertainty surrounding BAHAs. Further research into the non-audiological benefits of BAHAs, including QoL, is required.
Topics: Age Factors; Audiometry; Bone Conduction; Cost-Benefit Analysis; Decision Making; Hearing Aids; Hearing Loss, Bilateral; Hearing Loss, Conductive; Humans; Models, Economic; Prevalence; Quality of Life; Quality-Adjusted Life Years; Suture Anchors; United Kingdom
PubMed: 21729632
DOI: 10.3310/hta15260