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Nutritional intelligence in the food system: combining food, health, data and AI expertise
No full textTransformative change is needed across the food system to improve health and environmental outcomes. As food, nutrition, environmental and health data are generated beyond human scale, there is an opportunity for technological tools to support multifactorial, integrated, scalable approaches to address the complexities of dietary behaviour change. Responsible technology could act as a mechanistic conduit between research, policy, industry and society, enabling timely, informed decision making and action by all stakeholders across the food system. Domain expertise in food, nutrition and health should always be integrated into both the development and continuous deployment of AI-powered nutritional intelligence (NI) to ensure it is responsible, accurate, safe, useable and effective. Dietary behaviours are complex and improving diet-related health outcomes requires socio-cultural-demographic considerations within the design and deployment of NI tools. This article describes existing examples of NI within the food system and future opportunities. Human-in-the-loop approaches with food, health and nutrition experts involved at all stages including data acquisition, processing, output validation and ongoing quality assurance are essential to ensure evidence-based practice. The same ethical considerations should apply in this domain as in any other (e.g. privacy, inclusivity, robustness, transparency and accountability) and responsible practice must encompass rigorous standards and alignment with regulatory frameworks. Critical today and in the future is accessibility to appropriate high-quality food compositional data sets, which include up-to-date information on commercially available products that reflect the constantly evolving food landscape to realise the potential of responsible AI to help address the existing food system challenges.<br/
Efficacy of delivery of care with Tele-continuous EEG in critically ill patients: a multicenter randomized controlled trial (Tele-cRCT study) study
No full textBACKGROUND: Continuous electroencephalography (cEEG) has been recommended in critically ill patients although its efficacy for improving patients' functional status remains unclear. This study aimed to compare the efficacy of Tele-cEEG with Tele-routine EEG (Tele-rEEG), in terms of seizure detection rate, mortality and functional outcomes.METHODS: This study is a 3-year randomized, controlled, parallel, multicenter trial, conducted in eight regional hospitals across Thailand. Eligible participants were critically ill patients aged ≥ 15 years and at-risk for developing nonconvulsive seizure (NCS)/nonconvulsive status epilepticus (NCSE). Study interventions were 24-72 h Tele-cEEG versus 30-min Tele-rEEG. Study outcomes were seizure detection rate, mortality and functional outcomes (mRS), assessed at hospital discharge, ≤ 7 days, 3-, 6-, 9-months and 1 year.RESULTS: Two hundred and fifty-four patients were randomized, 128 and 126 patients received Tele-cEEG and Tele-rEEG, respectively. NCS/NCSE were detected more commonly in the Tele-cEEG (21.88%) than Tele-rEEG arm (14.29%) but this was not statistically significant (p = 0.116). Intention-to-treat, per-protocol and as-treated analysis showed non-significant differences in mortality at all assessment periods, with corresponding mortality rates of 10.03% (Tele-cEEG) versus 10.10% (Tele-rEEG) (p = 0.894), 9.67% versus 9.06% (p = 0.833) and 10.34% versus 9.06% (p = 0.600), respectively. Functional outcome was also not significantly different in all analyses.CONCLUSIONS: Both Tele-cEEG and Tele-rEEG are feasible, although Tele-EEG requires additional EEG specialists, budget, and computational resources. While Tele-cEEG may help detect NCS/NCSE, this study had limited power to detect its efficacy in reducing mortality or improving functional outcomes. In limited-resource settings, Tele-rEEG approximating 30 min or longer offers a feasible and potentially valuable initial screening tool for critically ill patients at-risk of seizures. However, where Tele-cEEG is readily available, it remains the recommended approach. Trial registration Thai Clinical Trials Registry (TTCTR20181022002); Registered 22 October 2018.</p
A scoping review of educational and training interventions on Parkinson's disease for staff in care home settings
No full textBackground/Objectives: Parkinson’s disease (PD) is a complex neurodegenerative disorder that presents significant challenges for care home residents and staff. This scoping review aimed to synthesize evidence on PD education and training available to care home staff, examine existing programs and their effectiveness, and identify gaps in current educational approaches. Methods: A scoping review (ScR) was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for ScR (PRISMA-ScR) checklist. A comprehensive search of six electronic databases was conducted in September 2024. Studies focusing on PD education and training for care home staff were included. Data extraction and quality appraisal were performed, followed by thematic analysis to identify key patterns and themes. Results: Seven studies met the inclusion criteria. The thematic analysis revealed four main themes: improvements in PD knowledge and confidence, improvements in care practices and outcomes, the need for increased specialist education, and the incorporation of communication training. Educational interventions led to significant improvements in staff knowledge, confidence, and care practices. However, these studies also highlighted a critical need for more specialized PD training among care home staff. Conclusions: This review provides evidence of promise regarding the potential impact of PD-specific education on care home staff knowledge and practices. Future research should focus on developing and evaluating comprehensive, tailored educational programs to enhance the quality of care for people with PD in care home settings.<br/
Alkaline phosphatase decline and pain response as predictors of overall survival benefit in patients treated with radium-223: a post hoc analysis of the REASSURE study
No full textBackgroundAlkaline phosphatase (ALP) declines and pain responses can occur during radium-223 (223Ra) treatment, but their association with treatment outcomes is unclear.MethodsFor patients with metastatic castration-resistant prostate cancer treated with 223Ra in the REASSURE study, we investigated whether ALP decline (Week 12) and/or pain response (during treatment) are associated with improved overall survival (OS). The Brief Pain Inventory-Short Form (BPI-SF) was used to assess pain at baseline and pain response (in patients with baseline BPI-SF score ≥2).ResultsOf 785 patients with baseline and Week 12 ALP measurements, 779 were eligible for the OS analyses. Overall, 80% of patients had an ALP decline. Median OS was longer in patients with than without an ALP decline (18.1 versus 14.2 months; HR 0.74; 95% CI 0.60–0.92). In patients with an ALP decline, there was no clear OS difference between those with versus without a pain response. For patients without ALP decline, median OS was longer in those with versus without a pain response (16.2 versus 10.9 months; HR 0.50; 95% CI 0.32–0.77).ConclusionsDecreases in ALP and/or pain during 223Ra treatment are associated with improved OS. This may help support clinical decisions.<br/
Deep learning-enhanced defects detection for printed circuit boards
No full textPrinted circuit boards (PCBs) are an important component of electronic devices. Therefore, ensuring the quality of such PCBs in the manufacturing process is crucial. Especially, cracks or scratches appearing on the PCB surface pose a significant hurdle, due to their minuscule size, making them the most challenging to address. In this work, we present a real-time automated algorithm for defects inspection of printed circuit boards (PCBs) in different lighting conditions. First, the Oriented FAST and Rotated BRIEF (ORB) algorithm extracts features from the input images, then the Brute-force matching method matches these features with the ORB features template. Next, the input images are calibrated to match the size and orientation of the template data by the RANSAC(Random Sample Consensus) algorithm. Finally, the defective areas on the PCB surface are segmented by using the U-NET (i.e., a type of convolutional neural network (CNN)) model. The proposed algorithm is tested in three different lighting conditions: low light, normal light, and high light conditions. Experimental studies are conducted on a representative PCB to evaluate the defect detection capacity of the proposed algorithm and the experimental results show that the proposed system works well in the three different lighting conditions with an accuracy of up to 97%, the detection speed is 12 frames per second (FPS)
No alternative but Europeanisation. Slow violence and critical imaginaries in/from/with South East Europe
No full textThis chapter centres the post-Yugoslav space as a productive vantage point for understanding the multifarious forms of violence through which Europeanisation proceeds around the world. It builds on rich intellectual dialogues from/about the region that, mobilising wider epistemological frames shaped by intersecting postcolonial, postsocialist and post-conflict legacies, posit the region as a site of knowledge production about global politics, rather than as an object of intervention, as predominantly understood in mainstream IR narratives. From this vantage point, the chapter illustrates how Europeanisation engenders a complex set of affective registers and material effects that ‘entrap’ the post-Yugoslav space in a never-ending transition towards the cruel promises of Europeanisation. Conceptualising this affective/material impasse as slow violence, the chapter unpacks the region’s ambivalent positioning as both the Balkan other in need of EU intervention and containment, and its accomplice in racialised logics of spectacular and everyday violence at the core of the European project and its b/ordering. At the same time, it proposes the post-Yugoslav space as a site of critical imaginaries and alternative solidarities emerging from creative cultural interventions and social movements that challenge the violence of Europeanisation. The chapter argues that attending to these complexities refracted through the region contributes to an interrogation of Europeanisation as violence from multiple positionings, spotlighting global entanglements in the politics of race and Empire, as well as activating resonances across seemingly unrelated histories and struggles
Efficacy of mineralocorticoid receptor antagonists on kidney and cardiovascular outcomes in patients with chronic kidney disease: an umbrella review
No full textRationale & Objective: To comprehensively summarize the efficacy of mineralocorticoid receptor antagonists (MRAs) to improve kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD). Study Design: Relevant studies were identified from Medline and Scopus databases from their inception up to August 2023.Setting & Study Populations: Patients with nondialysis or dialysis CKD. Selection Criteria for Studies: Systematic reviews and meta-analyses (SR-MAs) of randomized controlled trials (RCTs) that investigated the efficacy of MRAs on kidney and CV outcomes in patients with nondialysis or dialysis CKD were included in this study. Data Extraction: Characteristics of studies and participants, and treatment effects were extracted. Analytic Approach: Efficacy of MRAs was qualitatively summarized according to types of patients and MRAs. Results: Forty SR-MAs were included. When compared with placebo/usual care, steroidal MRAs (sMRAs) provided significant benefit in decreasing all-cause (pooled RRs of 0.38 [0.22-0.65] to 0.87 [0.77-0.98]) and CV mortality (pooled RRs of 0.34 [0.15-0.75] to 0.46 [0.28-0.76]) only in patients treated with dialysis, when compared with placebo. Nonsteroidal MRAs (nsMRAs) significantly lowered composite CV events in both nondialysis CKD (pooled RRs of 0.86 [0.79-0.94] to 0.92 [0.85-0.99]) and patients with diabetic kidney disease (DKD) (pooled RRs of 0.86 [0.78-0.95] to 0.88 [0.81-0.96]). In addition, nsMRAs showed significant benefit in reducing composite kidney outcomes in patients with either nondialysis CKD or DKD when compared with placebo. However, this efficacy was lower than sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with DKD. Moreover, both sMRAs and nsMRAs significantly increased the risk of hyperkalemia in patients with nondialysis CKD and DKD. Limitations: The comparison between nsMRAs and SGLT2i is based on network meta-analyses. Consequently, additional head-to-head RCTs are necessary to confirm the advantages of SGLT2i over nsMRAs. Conclusions: sMRAs offer benefits in reducing all-cause and cardiovascular mortality and composite CV events in patients treated with dialysis. nsMRAs improve kidney outcomes in patients with nondialysis CKD and DKD but increase hyperkalemia risk. Plain Language Summary: Chronic kidney disease (CKD) can increase the risk of severe kidney problems and heart disease. A key factor in kidney decline and heart disease risk is the overactivation of mineralocorticoid receptors (MR). Medications called MR antagonists (MRAs) may lower heart disease risk. We performed a thorough review of all existing studies on both steroidal MRAs (sMRAs) and nonsteroidal MR antagonists (nsMRAs) to see how they might help reduce kidney and heart problems in different types of CKD. Our review found that sMRAs significantly lower the risk of death from all causes and heart issues in patients treated with dialysis, whereas nsMRAs reduce the chances of heart and kidney problems in patients not requiring dialysis. Both types of MRAs, however, do increase the risk of high potassium in patients requiring nondialysis.</p
Systematic review of the application of the kidney failure risk equation and Oxford classification in estimating prognosis in IgA nephropathy
No full textBackgroundIgA nephropathy (IgAN) is the most common primary glomerulonephritis in the world and is an important cause of chronic kidney disease (CKD) and kidney failure. Outcomes are heterogeneous, and accurate risk stratification is important to identify the highest risk individuals for treatment and to help prevent disease progression. The Oxford classification (OC) is an internationally adopted standard for renal biopsy reporting in IgAN, which measures the degree of histological abnormalities and predicts prognosis. The kidney failure risk equation (KFRE) was developed to predict kidney failure in all causes of CKD and has been shown to be highly accurate across diverse etiologies. This review aimed to compare the KFRE with formulae incorporating the OC in accurately determining the risk of kidney failure in IgAN.MethodsA systematic review was conducted in accordance with the Cochrane library guidelines and PRISMA statement for reporting of systematic reviews. Studies comparing the accuracy of the KFRE with the OC in predicting disease progression and kidney failure in IgAN were evaluated. The search strategy and analysis were performed independently by two reviewers. Studies that were eligible for inclusion compared the KFRE with any tool incorporating the OC in a cohort of individuals with IgAN. Eligible outcomes were reduction of estimated glomerular filtration rate (eGFR) or end-stage renal disease (ESRD), and prognostic tools were required to assess the accuracy of these formulae by discrimination and/or calibration.ResultsAfter searching several databases, only one study was eligible for inclusion in the review. This study of 2300 Chinese individuals with IgAN had a median follow-up of 2.5 years. Two-hundred eighty-eight individuals had a composite outcome of 50% decline in eGFR or ESRD, and 214 individuals developed ESRD. Both the KFRE and the IgAN Risk Prediction (IRP) tool (incorporating the OC) were highly accurate at predicting ESRD with a C-statistic of 0.90 and 0.91, respectively. Subgroup analysis demonstrated improved performance of IRP over KFRE in discrimination for individuals with preserved eGFR (> 60 ml/min/1.73 m2) at baseline. The risk of bias was high due to insufficient follow-up and handling of missing data, so overall confidence in findings is very low.ConclusionThere is currently insufficient evidence to compare the accuracy of the KFRE and OC in determining outcomes in IgAN. Further research is required in this field.<br/