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Philosophical Transactions. Series A,... Jun 2017Scientific investigations in medicine and beyond increasingly require observations to be described by more features than can be simultaneously visualized. Simply...
Scientific investigations in medicine and beyond increasingly require observations to be described by more features than can be simultaneously visualized. Simply reducing the dimensionality by projections destroys essential relationships in the data. Similarly, traditional clustering algorithms introduce data bias that prevents detection of natural structures expected from generic nonlinear processes. We examine how these problems can best be addressed, where in particular we focus on two recent clustering approaches, Phenograph and Hebbian learning clustering, applied to synthetic and natural data examples. Our results reveal that already for very basic questions, minimizing clustering bias is essential, but that results can benefit further from biased post-processing.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.
Topics: Animals; Bias; Cluster Analysis; Computer Simulation; Epidemiologic Methods; Epidemiologic Studies; Humans; Models, Biological; Models, Statistical
PubMed: 28507238
DOI: 10.1098/rsta.2016.0293 -
Current Pharmaceutical Design 2013Stimulant use disorders are an unrelenting public health concern worldwide. Agonist replacement therapy is among the most effective strategies for managing substance use... (Review)
Review
Stimulant use disorders are an unrelenting public health concern worldwide. Agonist replacement therapy is among the most effective strategies for managing substance use disorders including nicotine and opioid dependence. The present paper reviewed clinical data from human laboratory self-administration studies and clinical trials to determine whether agonist replacement therapy is a viable strategy for managing cocaine and/or amphetamine use disorders. The extant literature suggests that agonist replacement therapy may be effective for managing stimulant use disorders, however, the clinical selection of an agonist replacement medication likely needs to be based on the pharmacological mechanism of the medication and the stimulant abused by patients. Specifically, dopamine releasers appear most effective for reducing cocaine use whereas dopamine reuptake inhibitors appear most effective for reducing amphetamine use.
Topics: Amphetamine-Related Disorders; Animals; Clinical Trials as Topic; Cocaine-Related Disorders; Dopamine; Dopamine Agents; Dopamine Uptake Inhibitors; Humans; Self Administration
PubMed: 23574440
DOI: 10.2174/138161281940131209142843 -
Netherlands Heart Journal : Monthly... Jun 2022Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in...
BACKGROUND
Healthcare expenditure in the Netherlands is increasing at such a rate that currently 1 in 7 employees are working in healthcare/curative care. Future increases in healthcare spending will be restricted, given that 10% of the country's gross domestic product is spent on healthcare and the fact that there is a workforce shortage. Dutch healthcare consists of a curative sector (mostly hospitals) and nursing care at home. The two entities have separate national budgets (€25 bn + €20 bn respectively) AIM: In a proof of concept, we explored a new hospital-at-home model combining hospital cure and nursing home care budgets. This study tests the feasibility of (1) providing hospital care at home, (2) combining financial budgets, (3) increasing workforces by combining teams and (4) improving perspectives and increasing patient and staff satisfaction.
RESULTS
We tested the feasibility of combining the budgets of a teaching hospital and home care group for cardiology. The budgets were sufficient to hire three nurse practitioners who were trained to work together with 12 home care cardiovascular nurses to provide care in a hospital-at-home setting, including intravenous treatment. Subsequently, the hospital-at-home programme for endocarditis and heart failure treatment was developed and a virtual ward was built within the e‑patient record.
CONCLUSION
The current model demonstrates a proof of concept for a hospital-at-home programme providing hospital-level curative care at home by merging hospital and home care nursing staff and budgets. From the clinical perspective, ambulatory intravenous antibiotic and diuretic treatment at home was effective in safely achieving a reduced length of stay of 847 days in endocarditis patients and 201 days in heart-failure-at-home patients. We call for further studies to facilitate combined home care and hospital cure budgets in cardiology to confirm this concept.
PubMed: 34524621
DOI: 10.1007/s12471-021-01614-2 -
BMJ Global Health Apr 2021Despite considerable improvements in vaccination coverage over the last decade, half of the world's unvaccinated and undervaccinated children are located in Africa. The...
INTRODUCTION
Despite considerable improvements in vaccination coverage over the last decade, half of the world's unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so far has only been quantified in a small number of high-income countries.
METHODS
We matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys at the subnational level. A total of 166 953 children from 41 surveys administered in 22 African countries covering 216 subnational regions were used. Based on a principal component analysis, we constructed an institutional mistrust index that combined the level of mistrust in the head of state, parliament, electoral system, courts and local government. Associations between institutional mistrust and child vaccination uptake were assessed with multivariable fixed effects logistic regressions that controlled for time-invariant subnational region characteristics and various child, caregiver, household and community characteristics.
RESULTS
A 1 SD increase in the institutional mistrust index was associated with a 10% (95% CI of ORs: 1.03 to 1.18) increase in the likelihood that a child had not received any of eight basic vaccines and with a 6% decrease in the likelihood a child had received all of the basic vaccines (95% CI: 0.92 to 0.97). Institutional mistrust was negatively associated with the likelihood that a child had received each of the eight basic vaccinations (p<0.05).
CONCLUSIONS
Child vaccination rates in Africa are considerably lower in areas in which the local population displays high levels of mistrust towards local authorities. Institutional mistrust is an important dimension of vaccine hesitancy, considered as one of the most important threats to global health. Empowering local authorities with resources and communication strategies to address institutional mistrust may be needed to close the remaining vaccination gaps in Africa.
Topics: Africa; Child; Humans; Trust; Vaccination; Vaccination Coverage; Vaccines
PubMed: 33926893
DOI: 10.1136/bmjgh-2020-004595 -
Frontiers in Network Physiology 2022Hearing is one of the human's foremost sensors; being able to hear again after suffering from a hearing loss is a great achievement, under all circumstances. However, in...
Hearing is one of the human's foremost sensors; being able to hear again after suffering from a hearing loss is a great achievement, under all circumstances. However, in the long run, users of present-day hearing aids and cochlear implants are generally only halfway satisfied with what the commercial side offers. We demonstrate here that this is due to the failure of a full integration of these devices into the human physiological circuitry. Important parts of the hearing network that remain unestablished are the efferent connections to the cochlea, which strongly affects the faculty of listening. The latter provides the base for coping with the so-called cocktail party problem, or for a full enjoyment of multi-instrumental musical plays. While nature clearly points at how this could be remedied, to achieve this technologically will require the use of advanced high-precision electrodes and high-precision surgery, as we outline here. Corresponding efforts must be pushed forward by coordinated efforts from the side of science, as the commercial players in the field of hearing aids cannot be expected to have a substantial interest in advancements into this direction.
PubMed: 36926095
DOI: 10.3389/fnetp.2022.868470 -
Progress in Brain Research 1996
Review
Topics: Animals; Brain; Brain-Derived Neurotrophic Factor; Cerebral Cortex; Ciliary Neurotrophic Factor; Long-Term Potentiation; Nerve Growth Factors; Nerve Tissue Proteins; Neuromuscular Junction; Rats; Synapses
PubMed: 9009723
DOI: 10.1016/s0079-6123(08)62118-4 -
International Journal of Environmental... Nov 2021Crawling is recommended for avoiding high heat and toxic fumes and for obtaining more breathable air during evacuations. Few studies have evaluated the effects of...
Crawling is recommended for avoiding high heat and toxic fumes and for obtaining more breathable air during evacuations. Few studies have evaluated the effects of crawling on physical joints and velocity, especially in children. Based on motion capture technology, this study proposes a novel method of using wearable sensors to collect exposure (e.g., mean duration, frequency) on children's joints to objectively quantify the impacts of different locomotion methods on physical characteristics. An on-site experiment was conducted in a kindergarten with 28 children (13 boys and 15 girls) of different ages (4-6 years old) who traveled up to 22 m in three different postures: upright walking (UW), stoop walking (SW), and knee and hand crawling (KHC). The results showed that: (1) The level of joint fatigue for KHC was heavier than bipedal walking ( < 0.05), which was evidenced by higher mean duration and frequency. There was no significant difference between UW and SW ( > 0.05). (2) The physical characteristics of the children in the different postures observed in this study were different ( < 0.05). The ankle was more fatigued than other joints during bipedal walking. Unlike infants, the wrists and hips of the children became fatigued while crawling. The key actions flexion/extension are more likely to induce joint fatigue vs. other actions. (3) Crawling velocity was significantly slower than the bipedal velocities, and UW was 10.6% faster than SW ( < 0.05). The bipedal walking velocity started to decrease after the children had travelled up to 13 m, while the KHC velocity started to decrease after traveling up to 11.6 m. (4) In a severe fire, the adoption of SW is suggested, as the evacuees can both evacuate quickly and avoid overworking their joints. (5) There were no significant differences in the age ( > 0.05) and gender ( > 0.05) of the children on the joints in any of the three postures. To conclude, KHC causes more damage to body joints compared to bipedal walking, as evidenced by higher exposure (mean duration, frequency), whereas UW and SW are similar in terms of the level of joint fatigue. The above findings are expected to provide a useful reference for future applications in the children's risk assessment and in the prevention design of buildings.
Topics: Biomechanical Phenomena; Child; Child, Preschool; Ergonomics; Female; Gait; Humans; Infant; Male; Posture; Walking
PubMed: 34831799
DOI: 10.3390/ijerph182212029 -
International Journal of Integrated Care Jun 2020
PubMed: 32607104
DOI: 10.5334/ijic.5492 -
Pharmacology, Biochemistry, and Behavior Mar 2023The FDA has not yet approved a pharmacotherapy for cocaine use disorder despite nearly four decades of research. This study determined the initial efficacy, safety, and... (Randomized Controlled Trial)
Randomized Controlled Trial
The FDA has not yet approved a pharmacotherapy for cocaine use disorder despite nearly four decades of research. This study determined the initial efficacy, safety, and tolerability of naltrexone-bupropion combinations as a putative pharmacotherapy for cocaine use disorder. Thirty-one (31) non-treatment seeking participants with cocaine use disorder completed a mixed-design human laboratory study. Participants were randomly assigned to the naltrexone conditions (i.e., 0, 50 mg/day; between-subject factor) and maintained on escalating doses of bupropion (i.e., 0, 100, 200, 400 mg/day; within-subject factor) for at least four days prior to the conduct of experimental sessions. Cocaine self-administration (IN, 0, 40, 80 mg) was then determined using a modified progressive ratio and relapse procedure. Subjective and cardiovascular effects were also measured. Cocaine produced prototypical dose-related increases in self-administration, subjective outcomes (e.g., "Like Drug"), and cardiovascular indices (e.g., heart rate, blood pressure) during placebo maintenance. Naltrexone and bupropion alone, or in combination, did not significantly decrease self-administration on either procedure. Low doses of bupropion (i.e., 100 mg) blunted the effects of the cocaine on subjective measures of "Like Drug" and "Stimulated". No unexpected adverse effects were observed with naltrexone and bupropion, alone and combined, in conjunction with cocaine. Together, these results do not support the use of these bupropion-naltrexone combinations for the treatment of cocaine use disorder. Future research should determine if novel drug combinations may decrease cocaine self-administration.
Topics: Humans; Blood Pressure; Bupropion; Cocaine; Drug Combinations; Naltrexone
PubMed: 36805862
DOI: 10.1016/j.pbb.2023.173526 -
Clinical Trials (London, England) Oct 2019A major goal of the National Institutes of Health's Clinical and Translational Science Award program is to facilitate clinical research and enhance the transition of...
BACKGROUND
A major goal of the National Institutes of Health's Clinical and Translational Science Award program is to facilitate clinical research and enhance the transition of basic to clinical research. As such, a number of Clinical and Translational Science Award centers have developed services to facilitate the conduct of clinical research, including support with fulfilling regulatory requirements.
METHODS
The University of Kentucky sought to establish an institutional semi-independent monitoring committee to provide oversight for clinical research studies per National Institutes of Health requirements and recommendations. Our semi-independent monitoring committee was initiated in 2010.
RESULTS
Since the inception of our semi-independent monitoring committee we have restructured its operations and protocols to improve efficiency. This article discusses our experiences with semi-independent monitoring committee creation and growth.
CONCLUSION
This article summarizes our experience in creating and maturing an institutional data monitoring committee.
Topics: Clinical Trials Data Monitoring Committees; Clinical Trials as Topic; Financing, Government; Humans; National Institutes of Health (U.S.); United States; Universities
PubMed: 31257918
DOI: 10.1177/1740774519859876