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Abstract Background Coronavirus disease 2019 originated in China and swiftly spread worldwide, posing a significant threat to public health. Caused by SARS-CoV-2, it manifests as a flu-like illness that can escalate to Acute Respiratory Distress Syndrome, potentially resulting in fatalities. In countries where HIV/Leishmania infantum is endemic, the occurrence of concurrent SARS-CoV-2/HIV/Leishmania infantum infections is a reality, prompting inquiries into appropriate clinical management. Case presentation We present the case of a 48-year-old woman who was hospitalized for 36 days across three different hospitals in the state of Pernambuco, Brazil. She was diagnosed with SARS-CoV-2/HIV/L. infantum coinfection. The patient exhibited severe COVID-19 symptoms, including fever, productive cough, and dyspnea. Throughout her hospitalization, she experienced oxygen saturation levels of ≤ 93%, along with fluctuations in blood pressure, respiratory rate, and heart rate. Her blood tests revealed lymphopenia, leukopenia, and neutropenia, while laboratory results indicated abnormal levels of d-dimer, AST, ALT, lactate dehydrogenase, ferritin, and C-reactive protein. A computed tomography scan revealed 75% involvement of the lung parenchyma with patchy ground-glass opacities. Conclusion Against all odds, the patient was discharged. The leukopenia associated with HIV/L. infantum may have played a decisive role. Further studies are necessary to better understand diagnostic strategies and clinical management measures for HIV/L. infantum coinfected patients who are susceptible to SARS-CoV-2 infection.

BackgroundRace/ethnicity and gender concordance between patients and providers is a potential strategy to improve health care interventions. In digital health, where human interactions occur both synchronously and asynchronously, the effect of concordance between patients and providers is unknown. ObjectiveThis study aimed to evaluate the impact of race/ethnicity or gender concordance between patients and physical therapists (PTs) in engagement and the clinical outcomes following a digital care program (DCP) in patients with musculoskeletal (MSK) conditions. MethodsThis secondary analysis of 2 prospective longitudinal studies (originally focused on assessing the acceptance, engagement, and clinical outcomes after a remote DCP) examined the impact of both race/ethnicity concordance and gender concordance between patients and PTs on outcomes for a digital intervention for MSK conditions. Outcomes included engagement (measured by the completion rate and communication, assessed by text interactions), satisfaction, and clinical outcomes (response rate, ie, percentage of patients achieving at least a minimal clinically important change in pain, measured by the Numerical Pain Rating Scale [NPRS]; anxiety, measured by the Generalized Anxiety Disorder 7-item scale [GAD-7]; depression, measured by the Patient Health Questionnaire 9-item [PHQ-9]; and daily activity impairment, measured by the Work Productivity and Activity Impairment [WPAI] questionnaire). ResultsOf 71,201 patients, 63.9% (n=45,507) were matched with their PT in terms of race/ethnicity, while 61.2% (n=43,560) were matched for gender. Concordant dyads showed a higher completion rate among White (adjusted odds ratio [aOR] 1.11, 95% CI 1.05-1.19, P8.52, 95% CI 8.27-8.77) reported across all dyads. Response rates for pain, anxiety, and daily activity impairment were unaffected by race/ethnicity concordance. An exception was observed for depression, with White patients reporting a higher response rate when matched with PTs from other races/ethnicities (aOR 1.20, 95% CI 1.02-1.39, P=.02). In terms of gender, men had a slightly higher pain response rate in discordant dyads (aOR 1.08, 95% CI 1.01-1.15, P=.03) and a higher depression response rate in concordant dyads (aOR 1.23, 95% CI 1.05-1.47, P=.01). ConclusionsRace/ethnicity and gender concordance between patients and PTs does not translate into higher satisfaction or improvement for most clinical outcomes, aside from a positive effect on treatment completion. These results highlight the importance of other PT characteristics, in addition to race/ethnicity or gender concordance, suggesting the potential benefit of experience, languages spoken, and cultural safety training as ways to optimize care. Trial RegistrationClinicalTrials.gov NCT04092946, NCT05417685; https://clinicaltrials.gov/study/NCT05417685, https://clinicaltrials.gov/study/NCT04092946

Abstract Background Deficits in executive function (EF) are consistently reported in autism spectrum disorders (ASD). Tailored cognitive training tools, such as neurofeedback, focused on executive function enhancement might have a significant impact on the daily life functioning of individuals with ASD. We report the first real-time fMRI neurofeedback (rt-fMRI NF) study targeting the left dorsolateral prefrontal cortex (DLPFC) in ASD. Methods Thirteen individuals with autism without intellectual disability and seventeen neurotypical individuals completed a rt-fMRI working memory NF paradigm, consisting of subvocal backward recitation of self-generated numeric sequences. We performed a region-of-interest analysis of the DLPFC, whole-brain comparisons between groups and, DLPFC-based functional connectivity. Results The ASD and control groups were able to modulate DLPFC activity in 84% and 98% of the runs. Activity in the target region was persistently lower in the ASD group, particularly in runs without neurofeedback. Moreover, the ASD group showed lower activity in premotor/motor areas during pre-neurofeedback run than controls, but not in transfer runs, where it was seemingly balanced by higher connectivity between the DLPFC and the motor cortex. Group comparison in the transfer run also showed significant differences in DLPFC-based connectivity between groups, including higher connectivity with areas integrated into the multidemand network (MDN) and the visual cortex. Conclusions Neurofeedback seems to induce a higher between-group similarity of the whole-brain activity levels (including the target ROI) which might be promoted by changes in connectivity between the DLPFC and both high and low-level areas, including motor, visual and MDN regions.

Abstract Background An assessment of the factors that interfere with serum levels and the persistence of anti-SARs-CoV-2 IgG antibodies is essential in order to estimate the risk of reinfection and to plan vaccination. We analyzed the impact of the severity of coronavirus disease 2019 (COVID-19) and the clinical and biological factors regarding the persistence of SARs-CoV-2 anti-spike protein (IgG-S) antibodies at 12 months. Methods This was an observational, longitudinal study with individuals who had recovered from COVID-19 between August 2020 and June 2021. Peripheral blood samples were collected from volunteers who were hospitalized (SERIOUS COVID-19) and those who required no hospitalization (COVID-19 LIGHT). Samples were grouped according to days after symptom onset: up to 90, between 91 and 180, ≥ 180 days after symptom onset. A semiquantitative test for IgG anti-spike protein S1(IgG-S1) was used. Results We analyzed 238 individuals who had recovered from COVID-19, of whom 87 had been hospitalized and 151 had not. They provided 148 and 220 samples, respectively. Among those hospitalized, males (65.5%), volunteers aged over 60 years (41.1%), comorbidities such as arterial hypertension (67.8%) and diabetes mellitus (37.9%) were most frequent. We observed higher median serum IgG-S1 titers among those who had recovered from COVID-19 and had been hospitalized, at all collection time intervals (p

The profile of executive function (EF) in adults with Schizophrenia (SCZ) and autism spectrum disorder (ASD) remains unclear. This study aims to ascertain if distinct EF patterns can be identified between each clinical condition by comparing the neuropsychological profile of adults with SCZ and ASD, for whom the differential diagnosis is still highly challenging. Forty-five individuals (15 SCZ, 15 ASD, 15 controls) matched for age, sex, education level, and handedness underwent intelligence evaluation and neuropsychological testing for working memory, inhibition, planning and set-shifting, and verbal fluency subdomains. Principal component analysis (2D-PCA) using variables representing 4 domains was employed to identify patterns in neuropsychological profiles. The ASD group had lower scores on the Digits Forward subtest compared to the SCZ group (7.2 ± 2.1 vs. 9.3 ± 1.9, p = 0.003; Cohen’s d: 1.05). ASD also performed significantly worse on the Stroop Word Test compared to the control group (77.7± 17.9 vs. 98.0 ± 12.7, p = 0.009; Cohen’s d: 1.31). No significant differences were observed between ASD and SCZ on other EF measures. The larger contributors for the dimensions in 2D-PCA were the Digits Forward subtest and Stroop Word Test. Still, there was substantial overlap between the clinical groups. This study suggests a high degree of similarity of EF between SCZ and ASD. Through four EF measures, the discrimination of low and high-functioning EF groups spanning both diagnostic categories may help to identify the individuals who could better benefit from cognitive rehabilitation strategies.

Innate vulnerabilities in autism spectrum disorder (ASD) could increase the risk of comorbid psychiatric conditions and judicial problems. Persistent deficits in social communication, narrow, repetitive interests, or sensory impairments could lead to deviant behaviors. This case study refers to a 22-year-old male who exhibited behavioral particularities in agreement with the presence of frotteurism and kleptomania. The impulsive nature of these behaviors was consistent with repetitive and stereotyped patterns. Premorbid social impairments, mainly in the communication domain, were also prominent, leading to the suspicion of ASD. This case report introduces two rare comorbid conditions in ASD, with forensic implications that can severely impact patients’ lives. The importance of this association especially applies to high-functioning ASD, given the propensity to an unknown diagnosis. A high-level awareness of ASD, especially in forensic psychiatry, is of paramount pertinence regarding the opportunity for early interventions addressing sexual education and social skills training. Autism, high-level, frotteurism, kleptomania, sexual, impulse, forensic, psychiatry, social skills

Abstract Anterior dislocations represent about 96% of total shoulder dislocations, with recurrence/instability being more common in young patients. Injury of other shoulder structures is frequent, namely bony Bankart lesion. However, the association with coracoid apophysis fracture is very rare. The present article describes the clinical case of a 67-year-old man who presented to the emergency department with complaints of persistent omalgia, with acute episodes, beginning after a fall from his own height. The patient also presented history of shoulder trauma 3 months earlier, which was evaluated at another hospital. Shoulder anterior dislocation was observed radiographically, and the computed tomography (CT) confirmed bone erosion of the anteroinferior part of the glenoid (bone loss of about 50% of the anteroposterior diameter in the lower region of the glenoid), with almost complete resorption of the bony Bankart lesion (apparent in later analysis of the radiography of the initial traumatic episode). Connectedly, a transverse fracture of the coracoid apophysis (type II in the Ogawa classification) was diagnosed. The patient was submitted to surgical treatment, with anterior bone stop confection using the remnant of the fractured fragment of the coracoid supplemented by tricortical autologous iliac graft, fixed with cannulated screws (according to the Bristow-Latarjet and Eden-Hybinett techniques). In the postoperative follow-up, a good functional result was observed, with no new episodes of dislocation and no significant pain complaints. A rare association of shoulder lesions is described, and the challenge of their treatment is highlighted, given the late diagnosis, as in the case presented.

Abstract Digital interventions have emerged as a solution for time and geographical barriers, however, their potential to target other social determinants of health is largely unexplored. In this post-hoc analysis, we report the impact of social deprivation on engagement and clinical outcomes after a completely remote multimodal musculoskeletal (MSK) digital care program managed by a culturally-sensitive clinical team. Patients were stratified in five categories according to their social deprivation index, and cross-referenced with their race/ethnicity, rurality and distance to healthcare facilities. From a total of 12,062 patients from all U.S. states, 8569 completed the program. Higher social deprivation was associated with greater baseline disease burden. We observed that all categories reported pain improvements (ranging from −2.0 95%CI −2.1, −1.9 to −2.1 95%CI −2.3, −1.9, p

Abstract The ability of endothelial cells to respond to blood flow is fundamental for the correct formation and maintenance of a functional and hierarchically organized vascular network. Defective flow responses, in particular related to high flow conditions, have been associated with atherosclerosis, stroke, arteriovenous malformations, and neurodegenerative diseases. Yet, the molecular mechanisms involved in high flow response are still poorly understood. Here, we described the development and validation of a 96-wells fluidic system, with interchangeable cell culture and fluidics, to perform high-throughput screenings under laminar high-flow conditions. We demonstrated that endothelial cells in our newly developed 96-wells fluidic system respond to fluid flow-induced shear stress by aligning along the flow direction and increasing the levels of KLF2 and KLF4. We further demonstrate that our 96-wells fluidic system allows for efficient gene knock-down compatible with automated liquid handling for high-throughput screening platforms. Overall, we propose that this modular 96-well fluidic system is an excellent platform to perform genome-wide and/or drug screenings to identify the molecular mechanisms involved in the responses of endothelial cells to high wall shear stress.

Abstract In the last two decades, safety concerns about general anesthesia (GA) arose from studies documenting brain cell death in various pharmacological conditions and animal models. Nowadays, a thorough characterization of sevoflurane-induced apoptosis in the entire neonatal mouse brain would help identify and further focus on underlying mechanisms. We performed whole-brain mapping of sevoflurane-induced apoptosis in post-natal day (P) 7 mice using tissue clearing and immunohistochemistry. We found an anatomically heterogenous increase in cleaved-caspase-3 staining. The use of a novel P7 brain atlas showed that the neocortex was the most affected area, followed by the striatum and the metencephalon. Histological characterization in cortical slices determined that post-mitotic neurons were the most affected cell type and followed inter- and intracortical gradients with maximal apoptosis in the superficial layers of the posterodorsal cortex. The unbiased anatomical mapping used here allowed us to confirm sevoflurane-induced apoptosis in the perinatal period, neocortical involvement, and indicated striatal and metencephalic damage while suggesting moderate hippocampal one. The identification of neocortical gradients is consistent with a maturity-dependent mechanism. Further research could then focus on the interference of sevoflurane with neuronal migration and survival during development.

While musculoskeletal pain (MSP) stands as the most prevalent health condition among Veterans, timely and high-quality care is often hindered due to access barriers. Team Red, White & Blue (Team RWB), a nonprofit organization dedicated to promoting a healthier lifestyle among Veterans, aimed to assess innovative approaches to veteran care. This is a single-arm pilot study investigating the feasibility, clinical outcomes, engagement, and satisfaction of a remote multimodal digital care program among Veterans with MSP. The impact of deployment experience on outcomes was explored as a secondary aim. From 75 eligible Veterans, 61 started the program, reporting baseline pain frequently comorbid with mental distress. Program acceptance was suggested by the high completion rate (82%) and engagement levels, alongside high satisfaction (9.5/10, SD 1.0). Significant improvements were reported in all clinical outcomes: pain (1.98 points, 95%CI 0.13; 3.84, p = 0.036); mental distress, with those reporting at least moderate baseline depression ending the program with mild symptoms (8.50 points, 95%CI: 6.49; 10.51, p = 0.012); daily activity impairment (13.33 points, 95%CI 1.31; 25.34, p = 0.030). Deployed Veterans recovered similarly to their counterparts. Overall, the above results underscore the potential of a remote digital intervention to expand Veterans’ access to timely MSP care.

Abstract Low back pain (LBP) is the world’s leading cause of years lived with disability. Digital exercise-based interventions have shown great potential in the management of musculoskeletal conditions, promoting access and easing the economic burden. However, evidence of their effectiveness for chronic LBP (CLBP) management compared to in-person physiotherapy has yet to be unequivocally established. This randomized controlled trial (RCT) aims to compare the clinical outcomes of patients with CLBP following a digital intervention versus evidence-based in-person physiotherapy. Our results demonstrate that patient satisfaction and adherence were high and similar between groups, although a significantly lower dropout rate is observed in the digital group (11/70, 15.7% versus 24/70, 34.3% in the conventional group; P = 0.019). Both groups experience significant improvements in disability (primary outcome), with no differences between groups in change from baseline (median difference: −0.55, 95% CI: −2.42 to 5.81, P = 0.412) or program-end scores (−1.05, 95% CI: −4.14 to 6.37; P = 0.671). Likewise, no significant differences between groups are found for secondary outcomes (namely pain, anxiety, depression, and overall productivity impairment). This RCT demonstrates that a remote digital intervention for CLBP can promote the same levels of recovery as evidence-based in-person physiotherapy, being a potential avenue to ease the burden of CLBP.

Abstract With the growing demand for solutions to prevent and resolve faults in gas-insulated substations that affect the operation of the electrical system, a fault simulation laboratory for gas-insulated substations was developed to develop solutions for monitoring and locating these faults. The laboratory is composed of instruments for a fault location system based on traveling wave theory. The laboratory also has computational programs for fault simulation control and signal acquisition, in addition to having tools to analyze the data. The results were obtained through tests carried out that confirmed the laboratory's ability to simulate the operation of faults in gas-insulated substations, which allowed demonstrating the capacity of the fault location system using the theory of traveling waves.

This study aimed to evaluate the use of sewage treatment plant (STP) waste on the production of red ceramic. The raw materials used were clayey ceramic body and STP waste from Campos dos Goytacazes - RJ. The raw materials were characterized through techniques of X-ray fluorescence and X-ray diffraction; moreover. The thermal behavior of STP waste was evaluated by DSC/TG/DTG analysis. The formulations of the clayeys ceramics were prepared with use 0, 3, 5, 10 and 15 wt% STP waste. Through these formulations, specimens were prepared by extrusion with 30% moisture content and fired at 800 °C. The evaluated physical and mechanical properties of the fired ceramics were water absorption, linear shrinkage, flexion strength and relative density. The microstructure of fired pieces was investigated by scanning electron microscopy. The results showed the STP waste increased the resistance to flexion and water absorption. The use of the waste improved the mechanical strength of the ceramic mass and tended to increase the flexural strength with the increase in the waste content added to the specimen. This type of waste can be aproveited in red ceramic by up to 15% by mass.

A set of 2-aryl-9-H or methyl-6-morpholinopurine derivatives were synthesized and assayed through radioligand binding tests at human A1, A2A, A2B, and A3 adenosine receptor subtypes. Eleven purines showed potent antagonism at A1, A3, dual A1/A2A, A1/A2B, or A1/A3 adenosine receptors. Additionally, three compounds showed high affinity without selectivity for any specific adenosine receptor. The structure-activity relationships were made for this group of new compounds. The 9-methylpurine derivatives were generally less potent but more selective, and the 9H-purine derivatives were more potent but less selective. These compounds can be an important source of new biochemical tools and/or pharmacological drugs.

Introdução: A disfunção autonómica é uma condição frequente pós lesão encefálica (LE) e indica a capacidade de assegurar a autorregulação cerebral, que, quando presente, assegura o fluxo sanguíneo cerebral adequado às necessidades da pessoa. O treino de reabilitação em plano inclinado relaciona-se com a recuperação sensorial, autonómica e de equilíbrio. Pretende-se avaliar a adaptação cerebrovascular na pessoa em situação crítica (PSC) pós LE submetida ao treino de ortostatismo através de plano inclinado. Metodologia: Estudo multicaso retrospetivo, realizado numa Unidade de Neurocríticos. Amostra constituída por (n=7). Aplicou-se um programa de reabilitação utilizando o plano inclinado, com elevação da cabeceira até 60° em dois momentos. As variáveis recolhidas foram: Escala de Coma de Glasgow, pressão arterial, frequência cardíaca (FC) e oximetria cerebral (CO). Através de análise retrospetiva estudaram-se: variabilidade da frequência cardíaca (VFC) e sensibilidade do barorreflexo (SB). Resultados: Mediana ECG 11, SAPS II 31±23 e estadia média de 67±26 dias. Em posição supina, a VFC e a SB foram diminuídas. Identificaram-se diferenças estatisticamente significativas na FC durante a elevação da cabeceira até 60° na primeira sessão (p=0,03). Não foi identificada nenhuma diferença estatística nas variáveis calculadas (p>0,05). Discussão: Comparativamente com o primeiro treino, verificou-se melhoria na regulação do equilíbrio simpático-vagal observado no segundo treino, através dos valores de CO mais elevados. Conclusão: O treino de ortostatismo com recurso a plano inclinado demonstrou ser uma opção segura na reabilitação da PSC pós LE, pois verificou-se melhoria na adaptação cerebrovascular do primeiro para o segundo treino.

Abstract Shielded substations with SF6 gas insulation (GIS) play a critical role in supplying power to urban areas, and it is crucial to quickly identify and isolate faults to restore system operation and meet supply demands. However, locating faults in such substations can involve extensive and time-consuming procedures, such as opening and closing hermetically sealed compartments containing SF6. This paper presents the development of an acoustic test bench that accurately replicates the dynamic characteristics of SF6 shielded substations. By utilizing the traveling wave technique, partial discharges occurring in high-voltage insulation can be detected and precisely located. The method employs various techniques, including the analysis of the arrival time of traveling waves at different points within the substation and triangulation methods. The use of traveling waves in partial discharge detection offers several advantages, such as precise fault location and non-interference with normal substation operations. Additionally, acoustic methods are highly sensitive to other sources of partial discharges, such as moving particles and fluctuating potential discharges. The results demonstrate that the combination of the acoustic test bench and the disturbance localization technique presents an innovative approach to fault location studies in GIS. The acoustic test bench enables controlled simulation of failure conditions, providing accurate data on the acoustic behavior of substations. Through the disturbance location technique, these data can be analyzed and interpreted to pinpoint the exact fault location. This integrated approach enhances the efficiency of the troubleshooting process and reduces the time required to repair GIS.

Introdução: O setor farmacêutico está em constante evolução e é altamente regulado com normas para garantir eficácia, segurança e qualidade dos medicamentos. O Quality by Design (QbD) é uma abordagem sistemática para o desenvolvimento farmacêutico, fundamentada no conhecimento científico e no gerenciamento do risco associado ao processo de fabricação. Aplicado ao desenvolvimento de procedimentos analíticos, o QbD vem sendo denominado de Analytical Quality by Design (AQbD) e torna-se um processo de delineamento de procedimentos mais robustos, aplicáveis ao longo do ciclo de vida do produto com redução da incidência de resultados fora da tendência ou fora de especificação relacionados ao método. Objetivo: Esclarecer os conceitos de AQbD e o escopo de seus elementos-chave para alinhamento dentro da indústria farmacêutica. Método: Busca em bases de dados de artigos científicos, além de guias e diretrizes nacionais e internacionais acerca do tema. Resultados: Os elementos AQbD incluem: (1) perfil analítico alvo; (2) identificação dos atributos e parâmetros críticos do procedimento analítico; (3) desenvolvimento, otimização e compreensão do procedimento analítico; (4) robustez e definição da região de concepção operacional do método; (5) estratégia de controle que inclua especificações, bem como controles necessários. O AQbD valoriza o conhecimento prévio, aplica avaliação de risco e planejamento de experimentos durante o delineamento do procedimento analítico. Conclusões: À medida que a indústria farmacêutica avança em direção à implementação do AQbD, uma terminologia comum, compreensão de conceitos e expectativas são necessárias, o que facilitará uma melhor comunicação entre os envolvidos no desenvolvimento de medicamentos, incluindo as agências regulatórias.

Justin K Scheer,1 Fabíola Costa,2 Dora Janela,2 Maria Molinos,2 Anabela C Areias,2 Robert G Moulder,3 Jorge Lains,4,5 Virgílio Bento,2 Vijay Yanamadala,2,6,7 Fernando Dias Correia2,8 1Department of Neurological Surgery, University of California, San Francisco, CA, USA; 2Sword Health, Inc, Draper, UT, USA; 3Institute for Cognitive Science, University of Colorado Boulder, Boulder, CO, USA; 4Rovisco Pais Medical and Rehabilitation Centre, Tocha, Portugal; 5Faculty of Medicine, Coimbra University, Coimbra, Portugal; 6Department of Surgery, Quinnipiac University Frank H. Netter School of Medicine, Hamden, CT, USA; 7Department of Neurosurgery, Hartford Healthcare Medical Group, Westport, CT, USA; 8Neurology Department, Centro Hospitalar e Universitário do Porto, Porto, PortugalCorrespondence: Fernando Dias Correia, Sword Health Inc, 13937 Sprague Lane Ste 100, Draper, UT, 84020, USA, Tel +1 385-308-8034, Fax +1 801-206-3433, Email fcorreia@swordhealth.comBackground: Musculoskeletal (MSK) pain is highly prevalent worldwide, resulting in significant disability, and comorbid sleep disturbances. Digital therapy for MSK pain can provide significant improvements in care access, alongside pain and disability reductions. However, studies on the effect of such programs on sleep are lacking.Purpose: To evaluate the impact on pain-related sleep impairment after a 12-week remote multimodal digital care program (DCP) for MSK conditions.Patients and Methods: This is an ad-hoc analysis of a decentralized single-arm study into engagement and clinical outcomes after a DCP for MSK rehabilitation. Patients were stratified by baseline sleep disturbance, based on sleep questions in the questionnaires: Oswestry Disability Index, Neck Disability Index, and the Quick Disabilities of the Arm, Shoulder and Hand questionnaire. Additional outcomes were pain, Generalized Anxiety Disorder 7-item scale, Patient Health 9-item questionnaire, Work Productivity, and Activity Impairment, and program engagement.&#x00A0Results: At baseline, 5749 patients reported sleep disturbance (78.0% of eligible patients). These reported significantly worse clinical outcomes at baseline than patients without sleep disturbance (all p< 0.001). Patients with comorbid sleep disturbance showed improvements in sleep, with a significant proportion reporting full recovery at program completion: 56% of patients with upper limb conditions (including 10% of patients with severe sleep disturbance at baseline), and 24% with spine conditions. These patients also reported significant improvements in all clinical outcomes at program completion. Engagement and satisfaction were high, and also higher than in patients without sleep impairment.Conclusion: This is the first study of its kind investigating the effect of a completely remote DCP for MSK pain on sleep. Patients reporting comorbid sleep disturbance had significant improvement in sleep, alongside pain, mental health and work productivity at program completion. The results suggest that a DCP for MSK pain can improve sleep disturbances in patients with upper limb and spine conditions.Keywords: pain, physical therapy, eHealth, telerehabilitation, remote care

Abstract Background Depression is a common condition among cancer patients, across several points in the disease trajectory. Although presenting higher prevalence rates than the general population, it is often not reported or remains unnoticed. Moreover, somatic symptoms of depression are common in the oncological context and should not be dismissed as a general symptom of cancer. It becomes even more challenging to track psychological distress in the period after the treatment, where connection with the healthcare system typically becomes sporadic. The main goal of the FAITH project is to remotely identify and predict depressive symptoms in cancer survivors, based on a federated machine learning (ML) approach, towards optimization of privacy. Methods FAITH will remotely analyse depression markers, predicting their negative trends. These markers will be treated in distinct categories, namely nutrition, sleep, activity and voice, assessed in part through wearable technologies. The study will include 300 patients who have had a previous diagnosis of breast or lung cancer and will be recruited 1 to 5 years after the end of primary cancer. The study will be organized as a 12-month longitudinal prospective observational cohort study, with monthly assessments to evaluate depression symptoms and quality of life among cancer survivors. The primary endpoint is the severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (Ham-D) at months 3, 6, 9 and 12. Secondary outcomes include self-reported anxiety and depression symptoms (HADS scale), and perceived quality of life (EORTC questionnaires), at baseline and monthly. Based on the predictive models gathered during the study, FAITH will also aim at further developing a conceptual federated learning framework, enabling to build machine learning models for the prediction and monitoring of depression without direct access to user’s personal data. Discussion Improvements in the objectivity of psychiatric assessment are necessary. Wearable technologies can provide potential indicators of depression and anxiety and be used for biofeedback. If the FAITH application is effective, it will provide healthcare systems with a novel and innovative method to screen depressive symptoms in oncological settings. Trial registration Trial ID: ISRCTN10423782 . Date registered: 21/03/2022.

BackgroundAging is closely associated with an increased prevalence of musculoskeletal conditions. Digital musculoskeletal care interventions emerged to deliver timely and proper rehabilitation; however, older adults frequently face specific barriers and concerns with digital care programs (DCPs). ObjectiveThis study aims to investigate whether known barriers and concerns of older adults impacted their participation in or engagement with a DCP or the observed clinical outcomes in comparison with younger individuals. MethodsWe conducted a secondary analysis of a single-arm investigation assessing the recovery of patients with musculoskeletal conditions following a DCP for up to 12 weeks. Patients were categorized according to age: ≤44 years old (young adults), 45-64 years old (middle-aged adults), and ≥65 years old (older adults). DCP access and engagement were evaluated by assessing starting proportions, completion rates, ability to perform exercises autonomously, assistance requests, communication with their physical therapist, and program satisfaction. Clinical outcomes included change between baseline and program end for pain (including response rate to a minimal clinically important difference of 30%), analgesic usage, mental health, work productivity, and non–work-related activity impairment. ResultsOf 16,229 patients, 12,082 started the program: 38.3% (n=4629) were young adults, 55.7% (n=6726) were middle-aged adults, and 6% (n=727) were older adults. Older patients were more likely to start the intervention and to complete the program compared to young adults (odds ratio [OR] 1.72, 95% CI 1.45-2.06; P

BackgroundChronic shoulder pain (CSP) is a common condition with various etiologies, including rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. It is associated with substantial disability and psychological distress, resulting in poor productivity and quality of life. Physical therapy constitutes the mainstay treatment for CSP, but several barriers exist in accessing care. In recent years, telerehabilitation has gained momentum as a potential solution to overcome such barriers. It has shown numerous benefits, including improving access and convenience, promoting patient adherence, and reducing costs. However, to date, no previous randomized controlled trial has compared fully remote digital physical therapy to in-person rehabilitation for nonoperative CSP. ObjectiveThe aim of this study is to compare clinical outcomes between digital physical therapy and conventional in-person physical therapy in patients with CSP. MethodsWe conducted a single-center, parallel-group, randomized controlled trial involving 82 patients with CSP referred for outpatient physical therapy. Participants were randomized into digital or conventional physical therapy (8-week interventions). The digital intervention consisted of home exercise, education, and cognitive behavioral therapy (CBT), using a device with movement digitalization for biofeedback and asynchronous physical therapist monitoring through a cloud-based portal. The conventional group received in-person physical therapy, including exercises, manual therapy, education, and CBT. The primary outcome was the change (baseline to 8 weeks) in function and symptoms using the short-form of Disabilities of the Arm, Shoulder, and Hand questionnaire. Secondary outcome measures included self-reported pain, surgery intent, analgesic intake, mental health, engagement, and satisfaction. All questionnaires were delivered electronically. ResultsA total of 90 participants were randomized into digital or conventional physical therapy, with 82 receiving the allocated intervention. Both groups experienced significant improvements in function measured by the short-form of the Disabilities of the Arm, Shoulder, and Hand questionnaire, with no differences between groups (–1.8, 95% CI –13.5 to 9.8; P=.75). For secondary outcomes, no differences were observed in surgery intent, analgesic intake, and mental health or worst pain. Higher reductions were observed in average and least pain in the conventional group, which, given the small effect sizes (least pain 0.15 and average pain 0.16), are unlikely to be clinically meaningful. High adherence and satisfaction were observed in both groups, with no adverse events. ConclusionsThis study shows that fully remote digital programs can be viable care delivery models for CSP given their scalability and effectiveness, assessed through comparison with high-dosage in-person rehabilitation. Trial RegistrationClinicalTrials.gov (NCT04636528); https://clinicaltrials.gov/study/NCT04636528

Abstract Introduction: Obesity is thought to play a role in the disruption of cardiac rhythmicity in obese children, but this is mostly an unexplored field of investigation. We aimed to evaluate the impact of overweight and obesity on circadian and ultradian cardiovascular rhythmicity of prepubertal children, in comparison with normal weight counterparts. Methods: We performed a cross sectional study of 316 children, followed in the birth cohort Generation XXI (Portugal). Anthropometrics and 24-hour ambulatory blood pressure were measured and profiles were examined with Fourier analysis for circadian and ultradian blood pressure (BP) and heart rate (HR) rhythms. Results: Overweight/obese children presented more frequently a non-dipping BP pattern than normal weight counterparts (31.5% vs. 21.6%, p = 0.047). The prevalence of 24-hour mean arterial pressure (MAP) and 8-hour HR rhythmicity was significantly lower in obese children (79.3% vs. 88.0%, p = 0.038 and 33.3% vs. 45.2%, p = 0.031, respectively). The prevalence of the remaining MAP and HR rhythmicity was similar in both groups. No differences were found in the median values of amplitudes and acrophases of MAP and HR rhythms. Discussion: The alterations found in rhythmicity suggest that circadian and ultradian rhythmicity analysis might be sensitive in detecting early cardiovascular dysregulations, but future studies are needed to reinforce our findings and to better understand their long-term implications.

Abstract As high-voltage circuit breakers (HVCBs) are responsible for switching off the load in the event of anomalies, they suffer various wear and tear, both on their main contacts and on the other actuation mechanisms. Not only load maneuvers but also weather conditions can bring factors that contribute to deterioration and, consequently, contribute to failures of this component that is so important for energy supply. Both failures and maintenance shutdowns generate costs for substations, something that could be minimized if there was monitoring of the condition of the HVCBs. This paper shows a methodology to analyze the vibration signal of HVCB in order to identify and quantify contact failures. The proposed methodology is verified through an experimental setup. The results show that it is possible not only to identify the fault but also to assess its intensity using vibration analysis.

Background Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown. Objective To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions. Methods This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated. Results Fourteen trials were included: 10 using motion tracker technology ( N = 1284) and four with camera-based biofeedback ( N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19–1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11–0.13; very low evidence). No study found superior results in a control group. Conclusions Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.

The integration of renewable energy sources is crucial for achieving sustainability and environmental preservation. However, their intermittent nature poses challenges to electrical system stability, requiring robust integration strategies. Microgrids emerge as a flexible solution, but their successful deployment requires meticulous planning and intelligent operation to overcome these challenges. This paper presents the development of a reduced-scale laboratory dedicated to researching both hardware and software solutions for intelligent microgrid management. The laboratory was designed to incorporate key components that are becoming increasingly important in the present microgrid context, including renewable energy generation, storage systems, electrolyzers for hydrogen production, and combined heat and power sources. While some equipment consists of commercial models, the battery bank, converter, and supervisory systems were custom-designed to meet the specific requirements of the laboratory. The laboratory has proven itself as a robust tool for conducting studies on microgrids, effectively incorporating essential components, addressing pertinent system issues, and allowing for several tests on converting control algorithms.

Female urinary incontinence (UI) is highly prevalent in the US (>60%). Pelvic floor muscle training (PFMT) represents first-line care for UI; however, access and adherence challenges urge new care delivery models. This prospective cohort study investigates the feasibility and safety of a remote digital care program (DCP) combining education and PFMT with real-time biofeedback with an average duration of 10 weeks. The primary outcome was the change in the Urinary Impact Questionnaire—short form (UIQ-7) from baseline to program-end, calculated through latent growth curve analysis (LGCA). Secondary outcomes included the impact of pelvic conditions (PFIQ-7), depression (PHQ-9), anxiety (GAD-7), productivity impairment (WPAI), intention to seek additional healthcare, engagement, and satisfaction. Of the 326 participants who started the program, 264 (81.0%) completed the intervention. Significant improvement on UIQ-7 (8.8, 95%CI 4.7; 12.9, p < 0.001) was observed, corresponding to a response rate of 57.3%, together with improvements in all other outcomes and high satisfaction (8.9/10, SD 1.8). This study shows the feasibility and safety of a completely remote DCP with biofeedback managed asynchronously by a physical therapist to reduce UI-related symptoms in a real-world setting. Together, these findings may advocate for the exploration of this care delivery option to escalate access to proper and timely UI care.