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In this retrospective cohort study, the authors investigate the risk of hospitalisation and death for all adults in England who tested positive for COVID-19 from October 2020–April 2021. They find that the risk of hospitalisation and death varied substantially over time after taking into account individual risk factors.

Abstract Background Within the United Kingdom’s National Health System (NHS), patients suffering from obesity may be provided with bariatric surgery. After receiving surgery many of these patients require further support to continue to lose more weight or to maintain a healthy weight. Remotely monitoring such patients’ physical activity and other health-related variables could provide healthworkers with a more ‘ecologically valid’ picture of these patients’ behaviours to then provide more personalised support. The current study assesses the feasibility of two smartphone apps to do so. In addition, the study looks at the barriers and facilitators patients experience to using these apps effectively. Methods Participants with a BMI > 35 kg/m2 being considered for and who had previously undergone bariatric surgery were recruited. Participants were asked to install two mobile phone apps. The ‘Moves’ app automatically tracked participants’ physical activity and the ‘WLCompanion’ app prompted participants to set goals and input other health-related information. Then, to learn about participants’ facilitators and barriers to using the apps, some participants were asked to complete a survey informed by the Theoretical Domains Framework. The data were analysed using regressions and descriptive statistics. Results Of the 494 participants originally enrolled, 274 participants data were included in the analyses about their activity pre- and/or post-bariatric surgery (ages 18–65, M = 44.02, SD ± 11.29). Further analyses were performed on those 36 participants whose activity was tracked both pre- and post-surgery. Participants’ activity levels pre- and post-surgery did not differ. In addition, 54 participants’ survey responses suggested that the main facilitator to their continued use of the Moves app was its automatic nature, and the main barrier was its battery drain. Conclusions The current study tracked physical activity in patients considered for and who had previously undergone bariatric surgery. The results should be interpreted with caution because of the small number of participants whose data meet the inclusion criteria and the barriers participants encountered to using the apps. Future studies should take note of the barriers to develop more user-friendly apps. Trial registration ClinicalTrials.gov- NCT01365416 on the 3rd of June 2011.

Water is a vital source for both human and biological living. Today, water management and conservation, not only both in developing countries but also in and the developed countries ones, has is of great importance. In the traditional economy, water is not considered as a productive factor in the national accounts; however, but in reality, water is the primary factor in many direct and indirect goods and services. To evaluate the effect of growth in the added value of agriculture, industry and electricity sectors on the added value of water sector in the Mazandaran province, coefficients of ARDL model were estimated using the Micro fit software. The extended Dickey-Fuller unit root test was used for the statistical test of variables. The static test of variables showed that all variables were significant at the 95% confidence level and were also consistent with the theory. A 1% increase (decrease) in the added value of industry and electricity resulted in the increase of 0.54 % and 0.39 %, respectively, increase (decrease) in the added value of the water sector, respectively. Also, 1% increase (decrease) in the added value of the agricultural sector caused in a 0.54% increase (decrease) in the added value of the water sector. Industry and electricity sectors affected the added value of water sector more than agriculture. In the long-term, the growth of the added value of the industry sector had the greatest impact on the growth of the added value of water sector. Based on the results, controlling water use in agriculture, industry and electricity sectors increases increased the effects of the added value of these sectors on the added value of the water sector.

ABSTRACT We investigated the individual and combined effects of diet and physical exercise on metabolism and the gut microbiome to establish how these lifestyle factors influence host-microbiome cometabolism. Urinary and fecal samples were collected from athletes and less active controls. Individuals were further classified according to an objective dietary assessment score of adherence to healthy dietary habits according to WHO guidelines, calculated from their proton nuclear magnetic resonance (1H-NMR) urinary profiles. Subsequent models were generated comparing extremes of dietary habits, exercise, and the combined effect of both. Differences in metabolic phenotypes and gut microbiome profiles between the two groups were assessed. Each of the models pertaining to diet healthiness, physical exercise, or a combination of both displayed a metabolic and functional microbial signature, with a significant proportion of the metabolites identified as discriminating between the various pairwise comparisons resulting from gut microbe-host cometabolism. Microbial diversity was associated with a combination of high adherence to healthy dietary habits and exercise and was correlated with a distinct array of microbially derived metabolites, including markers of proteolytic activity. Improved control of dietary confounders, through the use of an objective dietary assessment score, has uncovered further insights into the complex, multifactorial relationship between diet, exercise, the gut microbiome, and metabolism. Furthermore, the observation of higher proteolytic activity associated with higher microbial diversity indicates that increased microbial diversity may confer deleterious as well as beneficial effects on the host. IMPORTANCE Improved control of dietary confounders, through the use of an objective dietary assessment score, has uncovered further insights into the complex, multifactorial relationship between diet, exercise, the gut microbiome, and metabolism. Each of the models pertaining to diet healthiness, physical exercise, or a combination of both, displayed a distinct metabolic and functional microbial signature. A significant proportion of the metabolites identified as discriminating between the various pairwise comparisons result from gut microbe-host cometabolism, and the identified interactions have expanded current knowledge in this area. Furthermore, although increased microbial diversity has previously been linked with health, our observation of higher microbial diversity being associated with increased proteolytic activity indicates that it may confer deleterious as well as beneficial effects on the host.

Over the past few decades, composite joints have been regarded as one of the most promising approaches. After reviewing the research articles dealing with composite beam-column joints, it can be withdrawn that few researchers studied and developed different types of composite beam-column joints. The objectives of this paper to study the effect and behavior of different connection types on the composite beam – column joint under repeated loading as well as to investigate new forms of slab connection with column flange in composite connection joints, aiming to enhance the behaviors of the joints and make the slab endure a part of the load in a more efficient way. Five specimens with various connection types were tested to failure; the composite model number two (CM2) was considered the control specimen. Regarding the ultimate moment, the result found that CM5 has moment 50.47% more than control specimen, the lowest rotation value was in CM5. The general behaviours of the FEM were in good accordance with the experiment results. According to the parametric a higher yield strength is more rigid stiffer, the effect of web thickness on the load is too small and increase in load resistance with an increase in beam flange thickness.

The study aims to determine the influence of behavioural biases on financial risk propensity. It also attempts to examine the influence of financial risk propensity on investment decisions and the mediational role of financial risk propensity on the relationship between behavioural biases and investment decisions. A survey by questionnaire method is adopted to collect data from 203 respondents using the purposive sampling technique among the investors. The study has found that prospect, herding, and heuristics dimensions of behavioural bias have a significant impact on financial risk propensity, and in turn, financial risk propensity has a significant impact on investment decisions. The results of the study can help to develop more realistic investment valuation models in light of the revised risk-return expectations of investors who act contrary to the traditional concept of rational utility maximisers.

Abstract In this paper, we have explored the existence and uniqueness of solutions for a pair of nonlinear fractional integro-differential equations comprising of the Ψ-Caputo fractional derivative and the Ψ-Riemann–Liouville fractional integral. These equations are subject to nonlocal boundary conditions and a variable coefficient. Our findings are drawn upon the Mittage–Leffler function, Babenko’s attitude, and topological degree theory for condensing maps and the Banach contraction principle. To further elucidate our principal outcomes, we have presented two illustrative examples.

Abstract Background Ensuring the integrity of sperm DNA is of paramount importance for the production of healthy offspring. The process of sperm formation involves intricate molecular adjustments that condense and safeguard its genetic material. However, the risk posed by sperm DNA fragmentation (SDF) can impede natural and assisted fertility and may arise from various testicular and post-testicular factors. While there are recommendations against routine SDF testing, recent research has sparked debate by demonstrating the positive impact of such testing on fertility outcomes. Objective To identify the factors associated with SDF among infertile individuals. Methods and materials The medical records of infertile men referred to our hospital were comprehensively reviewed and included in the study as they met the inclusion criteria. Patients dissatisfied with participation in the study or those with incomplete medical records were excluded. The association of SDF, sperm analysis, and demographic characteristics were evaluated for further investigation. Results The average age of participants was 36.1 ± 8.1 years. The average semen volume was 2.5 ± 0.3 cc with a semen pH of 7.4 ± 0.2. The average sperm count was 10.9 ± 0.7 million, sperm motility was 36.9 ± 2.4%, and normal sperm morphology was 41.7 ± 2.7%. SDF levels below 15% were seen in 27.9%, between 15 and 30% in 32.4%, and above 30% in 39.7% of patients. Significant associations were found between the SDF and various factors in sperm analysis, including sperm count (P

Abstract Background The Cost of Living Crisis (CoLC), a real term reduction in basic income, risks individuals being unable to afford essentials such as heat, food and clothing. The impact of the CoLC is disproportionate – with different population sub-groups more likely to be negatively affected. The objective of this survey was to evaluate the perceived impact of the CoLC on the life and health of participants across four European countries. Methods A survey housing two questions to investigate the relationship between the CoLC and its perceived impact on life and health was developed. Four European countries (U.K., Sweden, Italy and Germany) took part via the YouGov platform. Logistic regression models were created for each country and question to evaluate which population characteristics were associated with a negative reported impact of the CoLC. Results A total of 8,152 unique individuals responded between 17th March and 30th March 2023. Each country was equally represented. Those aged 36–64 were more likely to report a negative impact of the CoLC on their life and health than younger participants (p

Background: The clinical pathogenesis of COVID-19 necessitates a comprehensive and homogeneous study to understand the disease mechanisms. Identifying clinical symptoms and laboratory parameters as key predictors can guide prognosis and inform effective treatment strategies. This study analyzed comorbidities and laboratory metrics to predict COVID-19 mortality using a homogeneous model. Method: A retrospective cohort study was conducted on 7500 COVID-19 patients admitted to Rasoul Akram Hospital between 2022 and 2022. Clinical and laboratory data, along with comorbidity information, were collected and analyzed using advanced coding, data alignment, and regression analyses. Machine learning algorithms were employed to identify relevant features and calculate predictive probability scores. Results: The frequency and mortality rates of COVID-19 among males (19.3 %) were higher than those among females (17 %) (p = 0.01, OR = 0.85, 95 % CI = 0.76–0.96). Cancer (p 55 was the most predictive parameter for mortality (p 0.05). WBC, Cr, CRP, ALP, and VBG-HCO3 were the most significant critical data associated with death prediction across all comorbidities (p

Adapting sowing date (SD) based on environmental sustainability and increasing productivity is crucial for creating flexibility in agriculture and maintaining food security. This study aimed to optimize SD and nitrogen (N) management using environmental indices in an arid climate. Yield, N use efficiency (NUE), water productivity (WP), and total environmental impact (EI) were assessed for five SDs for barley and triticale crops, along with three levels of N fertilizer application. The AquaCrop model was used for crop yield prediction, and EI was evaluated using Life Cycle Assessment (LCA). Delayed SD led to a shorter growing period (10.6–12.8 %), decreased WP (76.4–87.5 %), and decreased yield (58.3–87.6 %) for both crops compared to conventional SD. In contrast, earlier SD resulted in an extended growing period (1.7–3.6 %), increased WP (14.8–20.4 %), and increased yield (8.3–10.2 %). NUE showed an inverse relationship with increasing fertilizer levels. The most significant EIs were due to N consumption (33.4 %), followed by diesel (28.5 %) and potassium fertilizer (13.7 %) for both crops. Early SD could reduce EI by an average of 12.5 %. Combining early SD with moderate N levels was the most sustainable approach to maximize yield, minimize water use, and reduce EI, thereby informing sustainable practices for cereal cultivation in similar climates.

Improving global food security hinges on achieving sustainable agricultural production within independent irrigation and drainage units, considering the availability of sustainable water resources. This study investigated the potential for enhancing the sustainability of agricultural production in a modern irrigation and drainage network (TIDN) area and evaluated the network's performance under various strategies. These strategies included mulching, transitioning from traditional to drip irrigation, combining mulching with drip irrigation (IDM), and reducing the crop yield gap. Utilizing 2009–2018 data and the AquaCrop model, which was both calibrated and validated, the green and blue water footprints (GWF and BWF) of dominant crops in the region's cropping pattern were assessed. The crop cultivation was prioritized based on the total and unit unsustainable BWF. The performance of TIDN was evaluated using indicators of reliability, vulnerability, system deficiency, flexibility, and sustainability. The drip irrigation had the most significant impact on reducing BWF, while mulching was more effective in decreasing GWF. The adoption of IDM led to a total annual water savings of 382.4 m3 ha−1. The 10-year average reductions in BWF from May to August ranged from 1.7 to 3.1 MCM, with approximately 88–93 % of these savings attributed to decreased water consumption in rice fields. Mulch, drip, and IDM decreased the BWF by 3.3 %, 9.4 %, and 10.2 %, respectively, compared to current conditions. The study revealed that the expansion of rice cultivation under conventional flooding irrigation was incompatible with the sustainable blue water resources available, and replacing rice with wheat could reduce the unsustainable BWF by 95–100 %. Compared to current conditions, IDM improved network sustainability by 1.2 %, while closing the yield gap improved the indicator by 24 %. The findings suggest that combining infrastructural solutions, such as updating irrigation systems, with farm management solutions, such as reducing crop yield gaps and implementing mulching, can significantly enhance the sustainability of production in intensively agricultural areas.

BackgroundFalls are the leading cause of injury morbidity and mortality in older adults. This study aimed to: (1) Explore gender differences in falls injury incidence and outcomes in Victoria, Australia; and (2) Test if these differences are explained by patient demographics and clinical complexity.MethodFall-related injury admissions records from 1-JULY-2018 to 30-JUNE-2023 were extracted from the Victorian Admitted Episodes Dataset. Admissions for injury (S00-T98) caused by a fall (W00-W19), in males and females aged 60+ years, were selected using ICD-10-AM codes. Incidence was calculated as annual falls admissions per 100,000 population. Gender differences in terms of demographics, falls details, injury types, complexity and admission outcomes were tested using logistic regression models.ResultsThere were 187,878 fall-related injury admissions: 67,635 (36.0%) by males and 120,243 (64.0%) by females. The incidence rate ratio peaked at 1.52 (female: male) at 70–79 years. Compared to males, female fall injuries were more likely due to same-level falls and to occur at home. Female sex was associated with fractures and male sex was associated with head injuries. Although female sex was associated with surgery and longer hospital stay, death-in-hospital was associated with male sex, with and without adjustment for patient demographics, fall details, injury type and clinical complexity.ConclusionThis contemporary gender-stratified study provides important evidence relevant to falls prevention and management. The findings suggest that same-level falls prevention is of particular relevance to females while in males, improved hospital outcomes and fall-related injury survivability, and any underlying frailty, should be prioritized.

Objectives To evaluate whether commercially available ‘off-the-shelf’ wearable technology can improve patient rehabilitation outcomes, and to categorise all wearables currently being used to augment rehabilitation, including the disciplines and conditions under investigation.Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 statement checklist, and using the Grading of Recommendations, Assessment, Development and Evaluation approach.Data sources Embase, MEDLINE, Web of Science and the Cochrane Library were searched up to and including July 2023.Eligibility criteria We included trials and observational studies evaluating the use of consumer-grade wearables, in real patient cohorts, to aid physical therapy or rehabilitation. Only studies investigating rehabilitation of acute events with defined recovery affecting adult patients were included.Data extraction and synthesis Two independent reviewers used a standardised protocol to search, screen and extract data from the included studies. Risk of bias was assessed using the Cochrane Methods Risk of Bias in Randomised Trials V.2 and Risk of Bias in Non-Randomised Studies of Interventions tools for randomised controlled trials (RCTs) and observational studies, respectively.Results Eighteen studies encompassing 1754 patients met eligibility criteria, including six RCTs, six quasi-experimental studies and six observational studies. Eight studies used wearables in Orthopaedics, seven in Stroke Medicine, two in Oncology and one in General Surgery. All six RCTs demonstrated that wearable-driven feedback increases physical activity. Step count was the most common measure of physical activity. Two RCTs in orthopaedics demonstrated non-inferiority of wearable self-directed rehabilitation compared with traditional physiotherapy, highlighting the potential of wearables as alternatives to traditional physiotherapy. All 12 non-randomised studies demonstrated the feasibility and acceptability of wearable-driven self-directed rehabilitation.Conclusion This review demonstrates that consumer-grade wearables can be used as adjuncts to traditional physiotherapy, and potentially as alternatives for self-directed rehabilitation of non-chronic conditions. Better designed studies, and larger RCTs, with a focus on economic evaluations are needed before a case can be made for their widespread adoption in healthcare settings.PROSPERO registration ID CRD42023459567

BackgroundLarge language models (LLMs) have dominated public interest due to their apparent capability to accurately replicate learned knowledge in narrative text. However, there is a lack of clarity about the accuracy and capability standards of LLMs in health care examinations. ObjectiveWe conducted a systematic review of LLM accuracy, as tested under health care examination conditions, as compared to known human performance standards. MethodsWe quantified the accuracy of LLMs in responding to health care examination questions and evaluated the consistency and quality of study reporting. The search included all papers up until September 10, 2023, with all LLMs published in English journals that report clear LLM accuracy standards. The exclusion criteria were as follows: the assessment was not a health care exam, there was no LLM, there was no evaluation of comparable success accuracy, and the literature was not original research.The literature search included the following Medical Subject Headings (MeSH) terms used in all possible combinations: “artificial intelligence,” “ChatGPT,” “GPT,” “LLM,” “large language model,” “machine learning,” “neural network,” “Generative Pre-trained Transformer,” “Generative Transformer,” “Generative Language Model,” “Generative Model,” “medical exam,” “healthcare exam,” and “clinical exam.” Sensitivity, accuracy, and precision data were extracted, including relevant CIs. ResultsThe search identified 1673 relevant citations. After removing duplicate results, 1268 (75.8%) papers were screened for titles and abstracts, and 32 (2.5%) studies were included for full-text review. Our meta-analysis suggested that LLMs are able to perform with an overall medical examination accuracy of 0.61 (CI 0.58-0.64) and a United States Medical Licensing Examination (USMLE) accuracy of 0.51 (CI 0.46-0.56), while Chat Generative Pretrained Transformer (ChatGPT) can perform with an overall medical examination accuracy of 0.64 (CI 0.6-0.67). ConclusionsLLMs offer promise to remediate health care demand and staffing challenges by providing accurate and efficient context-specific information to critical decision makers. For policy and deployment decisions about LLMs to advance health care, we proposed a new framework called RUBRICC (Regulatory, Usability, Bias, Reliability [Evidence and Safety], Interoperability, Cost, and Codesign–Patient and Public Involvement and Engagement [PPIE]). This presents a valuable opportunity to direct the clinical commissioning of new LLM capabilities into health services, while respecting patient safety considerations. Trial RegistrationOSF Registries osf.io/xqzkw; https://osf.io/xqzkw

Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.

IntroductionInadequate exposure to real-life operating can impede timely acquisition of technical competence among surgical residents, and is a major challenge faced in the current training climate. Mental rehearsal (MR)—the cognitive rehearsal of a motor task without overt physical movement—has been shown to accelerate surgical skills learning. However, the neuroplastic effect of MR of a complex bimanual surgical task is unknown. The aim of this study is to use functional near-infrared spectroscopy (fNIRS) to assess the impact of MR on prefrontal and motor cortical activation during a laparoscopic knot tying task.MethodsTwelve surgical residents performed a laparoscopic knot tying task before and after either mental rehearsal (MR, intervention group) or textbook reading (TR, control group). In both groups, fNIRS was used to measure changes in oxygenated hemoglobin concentration (HbO2) in the prefrontal (24 channels) and motor cortices (22 channels). Technical performance was measured using leak volume, objective performance score and task progression score.ResultsMR led to a decrease in HbO2 (reduced activation) in the bilateral prefrontal cortex (PFC), and an increase in HbO2 (increased activation) in the left middle frontal gyrus, left precentral gyrus, and left postcentral gyrus. No discernible changes in activation were observed after TR in either the PFC or motor cortex. Moreover, smaller ΔHbO2 responses in the right PFC and greater ΔHbO2 responses in the left motor cortex were observed in the MR group compared with the TR group. Leak volume was significantly less following MR (p = 0.019), but not after TR (p = 0.347). Mean objective performance score was significantly higher following MR compared with TR (p = 0.043).ConclusionMental rehearsal may enhance surgical skill acquisition and technical proficiency by reducing utilization of attentional resources in the prefrontal cortex and improving neural efficiency in motor areas during a laparoscopic surgical task.