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Long-term exposure to air pollution can lead to cardiovascular disease, metabolic syndrome, and chronic respiratory disease. However, from a lifetime perspective, the critical period of air pollution exposure in terms of health risk is unknown. This study aimed to evaluate the impact of air pollution exposure at different life stages. The study participants were recruited from community centers in Northern Taiwan between October 2018 and April 2021. Their annual averages for fine particulate matter (PM2.5) exposure were derived from a national visibility database. Lifetime PM2.5 exposures were determined using residential address information and were separated into three stages (40 years). We employed exponentially weighted moving averages, applying different weights to the aforementioned life stages to simulate various weighting distribution patterns. Regression models were implemented to examine associations between weighting distributions and disease risk. We applied a random forest model to compare the relative importance of the three exposure life stages. We also compared model performance by evaluating the accuracy and F1 scores (the harmonic mean of precision and recall) of late-stage (>40 years) and lifetime exposure models. Models with 89% weighting on late-stage exposure showed significant associations between PM2.5 exposure and metabolic syndrome, hypertension, diabetes, and cardiovascular disease, but not gout or osteoarthritis. Lifetime exposure models showed higher precision, accuracy, and F1 scores for metabolic syndrome, hypertension, diabetes, and cardiovascular disease, whereas late-stage models showed lower performance metrics for these outcomes. We conclude that exposure to high-level PM2.5 after 40 years of age may increase the risk of metabolic syndrome, hypertension, diabetes, and cardiovascular disease. However, models considering lifetime exposure showed higher precision, accuracy, and F1 scores and lower equal error rates than models incorporating only late-stage exposures. Future studies regarding long-term air pollution modelling are required considering lifelong exposure pattern.

IntroductionMedical devices, including high-risk medical devices, have greatly contributed to recent improvements in the management of diabetes. However, the clinical evidence that is submitted for regulatory approval is not transparent, and thus a comprehensive summary of the evidence for high-risk devices approved for managing diabetes in Europe is lacking. In the framework of the Coordinating Research and Evidence for Medical Devices group, we will, therefore, perform a systematic review and meta-analysis, which will evaluate the efficacy, safety and usability of high-risk medical devices for the management of diabetes.Method and analysisThis study has been reported according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. We will search Embase (Elsevier), Medline All (Ovid), Cochrane Library (Wiley), Science Citation Index Expanded and Emerging Sources Citation Index (Web of Science) to identify interventional and observational studies that evaluate the efficacy and/or safety and/or usability of high-risk medical devices for the management of diabetes. No language or publication dates’ limits will be applied. Animal studies will be excluded. In accordance with the Medical Device Regulation in European Union, high-risk medical devices are those in classes IIb and III. The following medical devices for diabetes management are considered as having a high risk: implantable continuous glucose monitoring systems, implantable pumps and automated insulin delivery devices. Selection of studies, data extraction and quality of evidence assessment will be performed independently by two researchers. Sensitivity analysis will be performed to identify and explain potential heterogeneity.Ethics and disseminationNo ethical approval is needed for this systematic review, as it is based in already published data. Our findings will be published in a peer-reviewed journal.PROSPERO registration numberCRD42022366871.

Spontaneous rupture of hepatic artery pseudoaneurysms (HAP) is a rare cause of intra-abdominal hemorrhage. Herein, we present a case of a spontaneous rupture of a nontraumatic HAP. A 61-year-old female, not on any anticoagulant or antiplatelet medications, presented with abdominal pain and hemorrhagic shock. Cross-sectional imaging revealed a left HAP with evidence of active bleeding. Emergent diagnostic angiography was performed, and angioembolization of an actively bleeding pseudoaneurysm was performed. Given the risk of rupture and high mortality rate associated with rupture, aggressive treatment of HAP should be pursued.

BACKGROUND Hypoglycemia is a serious complication in diabetes, it impairs cognitive and psychomotor function, and is linked to driving mishaps. In-vehicle voice assistants (VAs) have been designed to proactively deliver a warning of hypoglycemia while driving. However, proactive VAs can cause driving impairments through startling. Hence, we complement the voice warning from the VA with ambient light-emitting diodes (LED) and investigate the effect of this addition on emotional reaction. OBJECTIVE Designing an in-vehicle voice warning for hypoglycemia and assessing its effect on the emotional reaction and technology acceptance. METHODS We present two studies investigating the emotional reactions of drivers with diabetes to different hypoglycemia warning modalities. The same procedure was replicated in two settings: simulated and real driving. A quasi-experimental design, with two independent variables (blood glucose phase and warning modality) and one main dependent variable (emotional reaction), was implemented. The material and apparatus included intravenous catheters to manipulate blood glucose and a tablet with an app to simulate hypoglycemia warnings. The warnings had three possible modalities: Standard, Voice, and Voice + LED. Objective emotional reaction (arousal) was measured physiologically via skin conductance response (SCR). Subjective emotional reaction was measured with the Affective Slider (valence and arousal). Both emotional reaction measures were tested with a mixed-effect linear model. Secondary outcomes included self-reported measures of technology acceptance. RESULTS Our results showed that in the simulated-driving setting, the Voice + LED warning modality was preferred over other modalities. However, this advantage decreased in real-world driving because the LED was less visible outdoors. The Voice modality was more effective than the Standard warning modality in both simulated and real-world driving studies. The mixed model on self-reported emotional reaction yielded significant results. Self-reported arousal was higher during Decreasing blood glucose and Hypoglycemia for Voice and Voice + LED in the real-world driving study. In contrast, self-reported valence was influenced by blood glucose manipulation rather than the warning modality. The mixed model on SCR did not yield significant results. Participants consistently ranked the Voice and Voice + LED warning modalities superior to the Standard modality. CONCLUSIONS This paper proposes using the in-vehicle VA and ambient lighting system installed in a car to deliver a warning of hypoglycemia. It investigated how the warning modality affects emotional response and acceptance in virtual and real-world environments. The study provides insight into the potential of implementing VA-based health warnings in cars and contributes to a better understanding of the challenges and opportunities of in-vehicle VA-based health interventions.

Background Micro- and macrovascular complications are a major burden for individuals with diabetes and can already arise in a prediabetic state. To allocate effective treatments and to possibly prevent these complications, identification of those at risk is essential. Objective This study aimed to build machine learning (ML) models that predict the risk of developing a micro- or macrovascular complication in individuals with prediabetes or diabetes. Methods In this study, we used electronic health records from Israel that contain information about demographics, biomarkers, medications, and disease codes; span from 2003 to 2013; and were queried to identify individuals with prediabetes or diabetes in 2008. Subsequently, we aimed to predict which of these individuals developed a micro- or macrovascular complication within the next 5 years. We included 3 microvascular complications: retinopathy, nephropathy, and neuropathy. In addition, we considered 3 macrovascular complications: peripheral vascular disease (PVD), cerebrovascular disease (CeVD), and cardiovascular disease (CVD). Complications were identified via disease codes, and, for nephropathy, the estimated glomerular filtration rate and albuminuria were considered additionally. Inclusion criteria were complete information on age and sex and on disease codes (or measurements of estimated glomerular filtration rate and albuminuria for nephropathy) until 2013 to account for patient dropout. Exclusion criteria for predicting a complication were diagnosis of this specific complication before or in 2008. In total, 105 predictors from demographics, biomarkers, medications, and disease codes were used to build the ML models. We compared 2 ML models: logistic regression and gradient-boosted decision trees (GBDTs). To explain the predictions of the GBDTs, we calculated Shapley additive explanations values. Results Overall, 13,904 and 4259 individuals with prediabetes and diabetes, respectively, were identified in our underlying data set. For individuals with prediabetes, the areas under the receiver operating characteristic curve for logistic regression and GBDTs were, respectively, 0.657 and 0.681 (retinopathy), 0.807 and 0.815 (nephropathy), 0.727 and 0.706 (neuropathy), 0.730 and 0.727 (PVD), 0.687 and 0.693 (CeVD), and 0.707 and 0.705 (CVD); for individuals with diabetes, the areas under the receiver operating characteristic curve were, respectively, 0.673 and 0.726 (retinopathy), 0.763 and 0.775 (nephropathy), 0.745 and 0.771 (neuropathy), 0.698 and 0.715 (PVD), 0.651 and 0.646 (CeVD), and 0.686 and 0.680 (CVD). Overall, the prediction performance is comparable for logistic regression and GBDTs. The Shapley additive explanations values showed that increased levels of blood glucose, glycated hemoglobin, and serum creatinine are risk factors for microvascular complications. Age and hypertension were associated with an elevated risk for macrovascular complications. Conclusions Our ML models allow for an identification of individuals with prediabetes or diabetes who are at increased risk of developing micro- or macrovascular complications. The prediction performance varied across complications and target populations but was in an acceptable range for most prediction tasks.

O terror, enquanto gênero, explora a tese psicanalítica de que a fantasia organiza a relação individual com a realidade. Os filmes de terror com zumbis, por sua vez, podem explorar e explicitar teses psicanalíticas fundadas por Sigmund Freud, como nos casos dos conceitos infamiliar e pulsões. Dentre os conteúdos ficcionais de zumbis, certamente uma das séries mais populares e a mais duradoura (2010 - atualmente) é The Walking Dead, baseada na obra de Robert Kirkman. Assim, este artigo propõe como objetivo geral a percepção de como algumas teorias de Freud se relacionam com o audiovisual de zumbis a partir de títulos específicos, isto é, escolhemos a figura do zumbi para estudar tais conceitos da teoria psicanalítica. O infamiliar trata daquilo que é aterrorizante, que promove “angústia e horror” e que remete ao antigo conhecido e íntimo. O infamiliar é tudo aquilo que deveria permanecer afastado dos olhos e do conhecimento, em segredo, ocultado e que se revelou. Para Freud, um conceito imprescindível, fundamental e convencional da Psicanálise é o de pulsão, que atua como uma força constante, atacando do interior do corpo e da qual a fuga é ineficaz. Freud sugere, inicialmente, a diferenciação entre dois grupos de pulsões primordiais: as pulsões do Eu e as pulsões sexuais. Freud caracteriza a pulsão sexual como um conceito fronteiriço entre o somático e o psíquico. Também esclarece que uma pulsão de morte é “uma pressão inerente ao orgânico animado para restabelecer um estado anterior”, abandonada pela influência de forças externas. Dois episódios da série televisiva The Walking Dead serão analisados de acordo com os conceitos freudianos estudados: o primeiro episódio da primeira temporada, intitulado Days Gone Bye, e o último episódio também da primeira temporada, intitulado TS-19, ambos televisionados no ano de 2010.

Aim To develop a non-invasive hypoglycemia detection approach using smartwatch data. Research Design and Methods We prospectively collected data from two wrist-worn wearables (Garmin vivoactive 4S; Empatica E4) and continuous glucose monitoring values in adults with diabetes mellitus on insulin treatment. Using this data, we developed a machine learning (ML) approach to detect hypoglycemia ( Results Twenty-two individuals were included in the final analysis (age 54.5±15.2y, HbA1c 6.9±0.6%, 16 male). Hypoglycemia was detected with an area under the receiver operating characteristic curve of 0.76±0.07 solely based on wearable data. Feature analysis revealed that the ML model associated increased heart rate, decreased heart rate variability, and increased tonic electrodermal activity with hypoglycemia. Conclusions Our approach may allow for non-invasive hypoglycemia detection using wearables in people with diabetes and thus complement existing methods for hypoglycemia detection and warning.

This briefing paper discusses the current knowledge on the effects of tyre wear particles on our health and environment, highlights the need for an ambitious research agenda to build further understanding of the impacts on people and nature and develop solutions, and includes recommendations for policymakers.

The carbon efficiency of storage lipid biosynthesis from imported sucrose in green Brassicaceae seeds is proposed to be enhanced by the PRK/Rubisco shunt, in which ribulose 1,5-bisphosphate carboxylase/oxygenase (Rubisco) acts outside the context of the Calvin–Benson–Bassham cycle to recycle CO2 molecules released during fatty acid synthesis. This pathway utilizes metabolites generated by the nonoxidative steps of the pentose phosphate pathway. Photosynthesis provides energy for reactions such as the phosphorylation of ribulose 5-phosphate by phosphoribulokinase (PRK). Here, we show that loss of PRK in Arabidopsis thaliana (Arabidopsis) blocks photoautotrophic growth and is seedling-lethal. However, seeds containing prk embryos develop normally, allowing us to use genetics to assess the importance of the PRK/Rubisco shunt. Compared with nonmutant siblings, prk embryos produce one-third less lipids—a greater reduction than expected from simply blocking the proposed PRK/Rubisco shunt. However, developing prk seeds are also chlorotic and have elevated starch contents compared with their siblings, indicative of secondary effects. Overexpressing PRK did not increase embryo lipid content, but metabolite profiling suggested that Rubisco activity becomes limiting. Overall, our findings show that the PRK/Rubisco shunt is tightly integrated into the carbon metabolism of green Arabidopsis seeds, and that its manipulation affects seed glycolysis, starch metabolism, and photosynthesis., The Plant Cell, 35 (2), ISSN:1040-4651, ISSN:1531-298X, ISSN:1532-298X